On-the-Edge Anchor Placement May Be Protective Against Glenoid Rim Erosion After Arthroscopic Bankart Repair Compared to On-the-Face Anchor Placement

Anterior glenoid rim resorption after arthroscopic Bankart repair by the footprint fixation technique and its correlation with the healing of the repaired capsulolabral complex: a computed tomography and magnetic resonance arthrography imaging study

Background

Studies have revealed that anterior glenoid rim bone resorption occurs in the early stage after arthroscopic Bankart repair (ABR) if bony Bankart lesions are absent or fail to heal. However, this structural change has never been studied after repair by footprint fixation (FF). Additionally, the relationship between the extent of rim resorption and healing of the repaired capsulolabral complex (CLC) remains unclear. Therefore, this study aimed to investigate anterior glenoid rim changes after ABR by FF and to elucidate the correlation between rim resorption and the healing of the repaired CLC.

Methods

This was a retrospective study on shoulders that underwent ABR by a combination of knotless twin anchor FF and single row techniques for anterior shoulder instability from January 2022 to June 2023. From 44 shoulders, we included 23 after excluding 14 with preoperative bony Bankart lesions and 7 with missing postoperative imaging. We used 3-dimensional computed tomography scans to calculate the change in glenoid width (Δ%) due to anterior glenoid rim change from baseline to 3 months postoperatively and images from magnetic resonance arthrography, which was performed at around 5 months postoperatively, to evaluate CLC healing according to a 3-point grading scale (good, 3 points; fair, 2 points; poor, 1 point) on 6 oblique axial slices perpendicular to the glenoid long axis. Finally, we calculated the correlation coefficient between Δ% and the healing index, that is, the mean CLC healing grade of the 6 slices.

Results

Glenoid width decreased by 7.2% (range, 2.0%-12.8%; P < .001). The mean CLC healing index was 2.59 points (range, 1.8-3.0). The Δ% showed a moderate positive correlation with the healing index (correlation coefficient, 0.55; P = .006).

Conclusion

Anterior glenoid rim resorption also occurs after ABR by the combination of FF and single row technique at 3 months postoperatively. Although this is a preliminary result, the extent of rim resorption is greater with better healing of the repaired CLC.

Modified double-pulley fixation provides better reduction of bone fragments and union compared to single-point fixation in bony Bankart lesions

PURPOSE

The purpose of this study was to compare clinical scores and imaging outcomes of bony Bankart lesions that underwent single-point and modified double-pulley fixation after at least 2 years of follow-up.

METHODS

Patients who underwent surgery to treat bony Bankart injuries were included and divided into groups A and B. A total of 69 patients were included (32 in group A and 37 in group B). Patients in group A underwent arthroscopic modified double-pulley fixation and patients in group B underwent arthroscopic single-point fixation. Three-dimensional computed tomography (3D-CT) was used to assess glenoid reduction one day after surgery. Postoperative bony union was assessed using 3D-CT and multiplanar reconstruction images 6 months after surgery. Constant-Murley, Rowe rating system, visual analogue scale and University of California at Los Angeles and American Shoulder and Elbow Surgeons scores were recorded before and after surgery.

RESULTS

In terms of imaging measurements, there was no significant group difference in the preoperative size of the glenoid defect, the size of the bony fragment or the expected postoperative size of the glenoid defect. The sizes of the actual postoperative glenoid defects differed significantly between the groups (p = 0.027), as did the absolute difference between the expected and actual glenoid defect sizes (p < 0.001). At 6 months postoperatively, 50.0% of group A patients and 24.3% of group B patients exhibited complete bony union (p = 0.027); the rates of partial union were 37.5% and 56.8%, respectively. At the final follow-up, all clinical scores were significantly better than the preoperative scores (all p < 0.05), with no significant group differences (not significant).

CONCLUSIONS

The use of the modified double-pulley technique with two anchors to treat bony Bankart injuries provides a better reduction of bone fragments than single-point fixation with two anchors and was associated with a higher rate of early bone union.

LEVEL OF EVIDENCE

Level III.

Arthroscopic Bankart repair with peeling osteotomy of the anterior glenoid rim preserves glenoid morphology

BACKGROUND

A decrease in the glenoid size after arthroscopic Bankart repair (ABR) was common in shoulders without osseous fragments compared with those with osseous fragments. For cases of chronic recurrent traumatic anterior glenohumeral instability without osseous fragments, we have performed ABR with peeling osteotomy of the anterior glenoid rim (ABRPO) to make an intentional osseous Bankart lesion. The aim of this study was to compare the glenoid morphology after ABRPO with it after simple ABR.

METHODS

The medical records of patients who underwent arthroscopic stabilization for chronic recurrent traumatic anterior glenohumeral instability were retrospectively reviewed. Patients with an osseous fragment, with revision surgery and without complete data were excluded. Patients were assigned to 1 of 2 groups: Group A, ABR without peeling osteotomy procedure or Group B, with ABRPO procedure. Computed tomography was performed preoperatively and 1 year after surgery. The size of the glenoid bone loss was investigated by the assumed circle method. The following formula was used to calculate the decreased size of the glenoid: (Δ) = (postoperative size of the glenoid bone loss) - (preoperative size of the glenoid bone loss). The size of the glenoid 1 year after surgery was assessed to determine if it had decreased (Δ > 0%) or not decreased (Δ ≤ 0%) relative to the preoperative size.

RESULTS

This study evaluated 39 shoulders divided into 2 groups: 27 shoulders in Group A and 12 shoulders in Group B. In Group A, postoperative glenoid bone loss was significantly greater than preoperative glenoid bone loss (7.8 ± 6.2 vs. 5.5 ± 5.3, respectively, P = .02). In Group B, postoperative glenoid bone loss was significantly lower than preoperative glenoid bone loss (5.6 ± 5.4 vs. 8.7 ± 4.0, respectively, P = .02). The P value for the interaction of group (A or B) × time (preoperative or postoperative) was 0.001. The decreased size of the glenoid was significantly larger in Group A than in Group B (2.1 ± 4.2 vs. -3.1 ± 4.5, respectively, P = .001). The rate of shoulders in which the size of the glenoid decreased 1 year after surgery relative to the preoperative size was significantly higher in Group A than in Group B (63% [17/27] vs. 25% [3/2], respectively, P = .04).

CONCLUSIONS

The study showed that ABRPO preserved the glenoid size better than simple ABR without a peeling osteotomy procedure.

New bone formation after arthroscopic Bankart repair for unstable shoulders with an erosion-type glenoid defect

BACKGROUND

The purpose of the present study was to retrospectively evaluate new bone formation after arthroscopic Bankart repair (ABR) and the influence of new bone formation on recurrence in shoulders with an erosion-type glenoid defect.

METHODS

We analyzed data on shoulders with an erosion-type glenoid defect. Participants were patients who underwent computed tomography to evaluate new bone formation after ABR performed from 2004 to 2021 and were followed for a minimum of 2 years. We investigated the factors influencing new bone formation, in particular the presence of an intraoperative bone fragment, and the influence of new bone formation and its size on postoperative recurrence.

RESULTS

A total of 100 shoulders were included. The mean glenoid defect size was 10.1% ± 6.3% (range, 1.2%-31.5%). New bone formed postoperatively in 15 shoulders (15.0%) and was seen in significantly more shoulders with an intraoperative bone fragment (11 of 18, 61.1%) than in those without a fragment (4 of 82, 4.9%; P < .001). Recurrence occurred in 22 shoulders (22.0%), and the rate of recurrence was not different between shoulders with new bone formation (3 of 15, 20.0%) and without new bone formation (19 of 85, 22.4%; P = .999). Among the 15 shoulders with new bone formation, the size of the new bone fragments relative to glenoid width was <5% in 2 shoulders, 5%-<7.5% in 8 shoulders, 7.5%-<10% in 3 shoulders, and ≥10% in 2 shoulders; in all 3 shoulders with postoperative recurrence, the relative size was <7.5%.

CONCLUSIONS

Even in shoulders with an erosion-type glenoid defect, new bone may form after ABR, especially in shoulders with an intraoperative bone fragment. However, new bone formation does not decrease the rate of postoperative recurrence.

Arthroscopic Stabilization of Posterior Shoulder Instability Without Glenoid Bone Loss

Background

Contact athletes who experience posterior shoulder instability have a high likelihood of recurrence necessitating surgery.

Indications

Patients with posterior shoulder instability without glenoid or humeral head bone loss who have failed activity modification, bracing, and physical therapy may benefit from arthroscopic stabilization surgery.

Technique Description

We describe a technique for arthroscopic labral repair with capsular plication through 4 portals in the lateral decubitus position.

Results

Arthroscopic capsulolabral reconstruction is an effective and reliable treatment for posterior shoulder instability with good patient-reported outcomes, low recurrence rates, and high rate of return-to-play.

Discussion/Conclusion

Arthroscopic capsulolabral reconstruction in the lateral decubitus position with appropriately placed portals allows for safe and effective repair of the labrum and capsular plication to address posterior shoulder instability.The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Editorial Commentary: Anchor Position Affects Glenoid Resorption Rates After Arthroscopic Bankart Repair: Shoulder Stabilization Surgery Is a Game of Millimeters

The technical nuances of arthroscopic Bankart repair cannot be overstated. Previous literature has identified a number of risk factors for failure of arthroscopic stabilization procedures, and the implications of glenoid bone loss is widely recognized as a critical driver of postoperative outcomes. However, other technical considerations (inadequate number of suture anchors, improper position of suture anchors) have been acknowledged as risk factors for the failure of arthroscopic stabilization procedures. More recently, concerns have been raised regarding the observed rates of glenoid bone resorption following arthroscopic Bankart repair, which theoretically may predispose higher rates of clinical failure. Furthermore, certain techniques for placing anchors on the glenoid during arthroscopic Bankart repair may accelerate these resorptive changes. Precise measures of poststabilization surgery glenoid resorption coupled with comprehensive assessments of clinical outcomes are required to determine the optimal technique for anchor insertion during arthroscopic Bankart repair.