Arthroscopic repair of acute bony Bankart lesions: An analysis of risk factors for instability recurrence

Abstract

Purpose. To determine clinical and radiological outcomes of patients with acute bony Bankart lesions treated via the arthroscopic approach and evaluate the hypothesis that instability recurrence is associated with fragment reduction quality and/or glenoid defect. Material and Methods. Between 2008 to 2013, 27 patients (mean age 24.3 years) were examined before, and (on average) 29 months after, arthroscopic repair. Inclusion criteria were acute bony Bankart lesions, glenoid osseous defects of less than 20%, and postoperative follow-up period of at least 24 months. Functional recovery was assessed using the Rowe, Western Ontario Shoulder Instability Index (WOSI), and UCLA shoulder rating scales. Computed tomography scans were used to evaluate reduction and healing of bony fragments. Cases of instability recurrence were documented. Results. Postoperative mean Rowe score was 90.4 points (range, 35 to 100 points), the mean WOSI was 282.0 (range, 25-1100 points), and the mean UCLA was 28.5 points (range, 15 to 35 points). The recurrence rate of shoulder instability was 7.4% (2/27), which only occurred in cases of fragment malposition. The average loss of external rotation was 5º at 0º of abduction, and 7º at 90º of abduction. Twenty three patients (85.19%) returned to preinjury sport level. Radiological assessment revealed complete union of the bony fragment in all cases. Conclusion. Arthroscopic reduction and suture anchor fixation of acute bony Bankart lesions yield excellent outcomes providing a low recurrence instability and high bone union rates. In addition, non-anatomical reduction of the bony fragment is a reliable risk factor for instability recurrence in acute cases.