Introduction Anterior glenohumeral instability associated with an anterior-inferior fracture of the glenoid (osseous Bankart lesion) can be treated successfully with arthroscopic, rather than open, surgical repair, or fixation of the osseous fragment.
Indications & Contraindications
Step 1: Patient Positioning Place the patient in the beach-chair position and examine both shoulders for laxity after induction of general anesthesia with an interscalene block.
Step 2: Portal Placement Create a standard posterior viewing portal and anterior and anterosuperior working portals.
Step 3: Mobilization Separate the displaced osseous fragment associated with the labroligamentous complex from the glenoid neck and mobilize the labroligamentous complex together with the fragment up to the 7 o’clock or 7:30 position (in a right shoulder).
Step 4: Inferior Labrum Repair Perform an inferior labrum repair by inserting 2 suture anchors at the anteroinferior part of the glenoid face.
Step 5: Osseous Fragment Fixation Fix the osseous fragment by passing the sutures either through or around the fragment with use of a bone penetrator, or Bone Stitcher, while stabilizing the labrum and fragment with a large grasper.
Step 6: Augmentation Procedures Rotator interval closure, done with the arm in >60° of external rotation, is the most frequently performed augmentation procedure.
Results A consecutive series of 46 patients with an osseous Bankart lesion who demonstrated >15% glenoid bone loss underwent osseous Bankart repair, which was performed regardless of the fragment size, between January 2005 and December 20061.
Pitfalls & Challenges
Anterior glenohumeral instability associated with an anterior-inferior fracture of the glenoid (osseous Bankart lesion) can be treated successfully with arthroscopic, rather than open, surgical repair, or fixation of the osseous fragment. Arthroscopic repair can achieve osseous union and normalization of glenoid anatomy with a low prevalence of recurrent instability1 even in shoulders with a chronic, large glenoid defect as …
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