Including Osseous Fragment in Bankart Repair Yields Good Results
When treating shoulders with a Bankart lesion that includes an osseous fragment, many orthopaedic surgeons excise the fragment while repairing the capsulolabral complex, and then deploy one of various bone-augmentation procedures to address glenoid bone loss. But in the November 18, 2015 issue of JBJS, Kitayama et al. report on positive medium- to long-term results with a procedure that incorporates the osseous fragment into the Bankart repair and thus avoids invasive bone-grafting procedures.
Thirty-eight patients with a chronic osseous Bankart lesion and >15% bone loss of the inferior glenoid who underwent the procedure described by Kitayama et al. were available for follow-up after a mean of 6.2 years. One patient had a redislocation resulting from a traffic accident five months after surgery. But among the remaining patients, the mean Rowe score improved from 30.7 points preoperatively to 95.4 points postoperatively, and the mean WOSI index improved from 26.5% preoperatively to 81.5% postoperatively. Mean glenoid bone loss, measured two different ways using 3-D CT images, improved from 20.4% preoperatively to ‒1.1% postoperatively.
While the authors concede that “the exact time required for osseous union is not known,” they speculate that “if the repair survives without failure at least one year after surgery, a histological osseous union can be expected in the long postoperative period regardless of the amount of glenoid bone loss.” They attribute the normalization of the glenoid anatomy and low recurrence rate found in this study to “excellent fragment reduction and retensioning of the entire inferior glenohumeral ligament.”