Benefits of bone graft augmentation to arthroscopic Bankart repair for recurrent anterior shoulder instability with glenoid bone loss

Abstract

Purpose Glenoid bone loss contributes to recurrent instability after arthroscopic Bankart repair alone. With significant glenoid bone loss, better results have been reported after arthroscopic Bankart repair with glenoid arc reconstruction. However, no reports compare augmentation using bone graft with non‐augmentation for glenoid bone loss. The purpose of this study was to assess clinical results of an arthroscopic Bankart repair with or without arthroscopic bone graft augmentation. It was hypothesized that such bone graft augmentation would restore shoulder stability, and lead to excellent outcomes. Methods Of 552 patients treated for anterior glenohumeral instability with arthroscopic Bankart repair, 68 met this study's inclusion criteria of glenoid bone loss over 20% and follow‐up of at least 2 years. Patients were divided into 2 groups based on whether with bone graft augmentation for glenoid bone loss [Group A: n = 35, median age; 21 years (range 13–72 years)], or not (Group B: n = 33, median age; 21 years (range 13–50 years)]. For grafting, either autologous iliac bone or artificial bone made of hydroxyapatite was used. Rowe score, recurrence rate, and return to sport were used to assess the results. Results Mean Rowe score was 95.0 (SD 10.6) in Group A and 69.7 (SD 27.2) in Group B (p < 0.05). The recurrence rate was 2.9% (1/36) in Group A and 48.5% (16/33) in Group B (p < 0.05). Regarding contact/collision athletes, 24 were contained in Group A and 22 in Group B. Of the patients with recurrence in Group B, 13 (59.1%) were contact/collision athletes. Finally, 50% of the contact/collision sports athletes for both groups returned to their sports at the same as pre‐injury level. Of the 11 patients who returned to the same level of contact/collision sports in Group B, seven returned with residual instability. Nine athletes in Group A and 3 in Group B quit their sports for personal or social reasons. Conclusions Bone graft augmentation was beneficial when used with Arthroscopic Bankart repair for recurrent anterior shoulder instability with glenoid bone loss. Especially, for recurrent anterior shoulder instability with glenoid bone loss in contact/collision sports athletes, bone graft augmentation should be strongly considered as beneficial. Level of evidence Level IV.

High Variability of the Definition of Recurrent Glenohumeral Instability: An Analysis of the Current Literature by a Systematic Review

“…On the Coleman methodology score, one scored poor, 11 43 studies scored fair, 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 37 scored good, 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 ...…”

“… 22 140 24 + + Retrospective + + 1,2,3 1 1 61 Iizawa et al. 66 68 31 + + Retrospective + + 1,2,3 1, 3,4 1,2 72 Lavoué et al. 23 41 72 +/− + Retrospective + + 1,2,3 1,3,4 1 67 Pandey et al.…”

“… 22 140 DS 25 (18) Iizawa et al. 66 68 DS 17 (25) † 17 (25) † Lavoué et al. 23 41 DS 1 (2) 4 (10) 11 (27) 5 (1) Pandey et al.…”

“…Ono et al 65 51 DS 9 (18) 7 ( 14) (31) Nakagawa et al 22 140 DS (18) Iizawa et al 66 68 DS 17 (25) y 17 (25) y Lavoué et al 23 41 DS 1 (2) 4 ( 10) 11 (27) (1) Pandey et al 25 136 DS 15 (11.0) (11) Brzóska et al 67 100 DSA (…”

Bone Fragment Resorption and Clinical Outcomes of Traumatic Bony Bankart Lesion Treated With Arthroscopic Repair Versus Open Latarjet

“…Nakagawa et al 20 reported a complete bone union rate in 50% of patients with small bone fragments (<5% of the glenoid diameter) after arthroscopic bony Bankart repair, while shoulders with medium (5%-10%) and large (>10%) fragments had union rates of 56.3% and 86.7%, respectively. Alternatively, Iizawa et al 12 found that patients treated for bony Bankart lesions (with >20% glenoid bone loss [GBL]) using an iliac crest bone graft or artificial graft had bone union rates of 100% (7/7 patients) and 75% (21/28 patients), respectively. Discrepancies in the current literature therefore necessitate further investigation of bone fragment resorption patterns and optimal surgical intervention for the treatment of bony Bankart lesions.…”