Bone Fragment Union and Remodeling After Arthroscopic Bony Bankart Repair for Traumatic Anterior Shoulder Instability With a Glenoid Defect

Nakagawa, Shigeto; Ozaki, Ritsuro; Take, Yasuhiro; Mae, Tatsuo; Hayashida, Kenji

doi:10.1177/0363546515571555

Cited by 56 publications

(98 citation statements)

References 20 publications

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“…The glenoid defect size, bone fragment size, and extent of bone fragment absorption were quantified with the methods shown in Figure 1 . 16 Although Hill-Sachs lesion size and associated capsular tear, including humeral avulsion of the glenohumeral ligament (HAGL) lesions, could be preoperatively diagnosed on pain radiograph, CT, or MRI, intraoperative arthroscopic findings were adopted as a gold standard for diagnosis. Hill-Sachs lesions were assessed according to the arthroscopic criteria reported by Calandra et al 4 : Negative (no bony lesion): grade 0 (no lesion) and grade 1 (defect of the articular surface not involving the subchondral bone) Small bony lesion: grade 2 (small defect involving the subchondral bone, ≤1 cm) Large bony lesion: grade 3 (large defect involving the subchondral bone, >1 cm) …”

Section: Methodsmentioning

confidence: 99%

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Risk Factors for the Postoperative Recurrence of Instability After Arthroscopic Bankart Repair in Athletes

Nakagawa

Mae

Sato

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Several risk factors for the postoperative recurrence of instability after arthroscopic Bankart repair have been reported, but there have been few detailed investigations of the specific risk factors in relation to the type of sport.Purpose:This study investigated the postoperative recurrence of instability after arthroscopic Bankart repair without additional reinforcement procedures in competitive athletes, including athletes with a large glenoid defect. The purpose of this study was to investigate risk factors related to the postoperative recurrence of instability in athletes.Study Design:Case-control study; Level of evidence, 3.Methods:A total of 115 athletes (123 shoulders) were classified into 5 groups according to type of sport: rugby (41 shoulders), American football (32 shoulders), other collision sports (18 shoulders), contact sports (15 shoulders), and overhead sports (17 shoulders). First, the recurrence rate in each sporting category was investigated, with 113 shoulders followed up for a minimum of 2 years. Then, factors related to postoperative recurrence were investigated in relation to the type of sport.Results:Postoperative recurrence of instability was noted in 23 of 113 shoulders (20.4%). The recurrence rate was 33.3% in rugby, 17.2% in American football, 11.1% in other collision sports, 14.3% in contact sports, and 12.5% in overhead sports. The most frequent cause of recurrence was tackling, and recurrence occurred with tackling in 12 of 16 athletes playing rugby or American football. Reoperation was completed in 11 shoulders. By univariate analysis, significant risk factors for postoperative recurrence of instability included playing rugby, age between 10 and 19 years at surgery, preoperative glenoid defect, small bone fragment of bony Bankart lesion, and capsular tear. However, by multivariate analysis, the most significant factor was not the type of sport but younger age at operation and a preoperative glenoid defect with small or no bone fragment. Compared with the other sports, there was a significantly greater recurrence rate among rugby players without the aforementioned significant risk factors (small glenoid defect, ≤10%; medium or large bone fragment, >5%; and no capsular tear).Conclusion:Younger age at operation and preoperative glenoid defect with small or no bone fragment significantly influenced recurrent instability among competitive athletes.

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Section: Methodsmentioning

confidence: 99%

“…For the treatment of bony Bankart lesions, arthroscopic bony Bankart repair was performed without resection of the fragment. 16 Even in shoulders with a large glenoid defect, bone grafting or rotator interval closure was not performed during the study period. There were no patients with isolated capsular tears or isolated HAGL.…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for the Postoperative Recurrence of Instability After Arthroscopic Bankart Repair in Athletes

Nakagawa

Mae

Sato

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…This is observed in 22% to 50% of the cases with recurrent anterior instability. 19 , 24 , 43 , 44 The treatment strategy for a bony Bankart lesion is still controversial. Some reported that it was sufficient to fix a fragment back to the glenoid even though the fragment size was much smaller than the size of the glenoid defect.…”

Section: Bony Bankart Lesionmentioning

confidence: 99%

“… 46 On the other hand, others reported that the smaller the fragment, the worse the union between the fragment and the glenoid, which in turn made the outcome worse. 44 At present, we recommend that the fragment be fixed to the glenoid if the reconstructed glenoid (native glenoid + bone fragment) is wide enough to cover the HSL (on-track lesion). We still do not know how much size discrepancy between a glenoid defect and a fragment would be acceptable.…”

Section: Bony Bankart Lesionmentioning

confidence: 99%

‘On-track’ and ‘off-track’ shoulder lesions

Itoi

2017

EFORT Open Reviews

107

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Shoulder stability depends on the position of the arm as well as activities of the muscles around the shoulder. The capsulo-ligamentous structures are the main stabilisers with the arm at the end-range of movement, whereas negative intra-articular pressure and concavity-compression effect are the main stabilisers with the arm in the mid-range of movement.There are two types of glenoid bone loss: fragment type and erosion type. A bone loss of the humeral head, known as a Hill-Sachs lesion (HSL), is a compression fracture of the humeral head caused by the anterior rim of the glenoid when the humeral head is dislocated anteriorly in front of the glenoid. Four out of five patients with anterior instability have both Hill-Sachs and glenoid bone lesions, which is called a ‘bipolar lesion’.With the arm moving along the posterior end-range of movement, or with the arm in various degrees of abduction, maximum external rotation and maximum horizontal extension, the glenoid moves along the posterior articular margin of the humeral head. This contact zone of the glenoid with the humeral head is called the ‘glenoid track’.A HSL, which stays on the glenoid track (on-track lesion), cannot engage with the glenoid and cannot cause dislocation. On the other hand, a HSL, which is out of the glenoid track (off-track lesion), has a risk of engagement and dislocation. Clinical validation studies show that the ‘on-track/off-track’ concept is able to predict reliably the risk of a HSL being engaged with the glenoid. For off-track lesions, either remplissage or Latarjet procedure is indicated, depending upon the glenoid defect size and the risk of recurrence.Cite this article: EFORT Open Rev 2017;2:343-351.

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“…8,24 Arthroscopy techniques offer less invasive and, theoretically, more precise solutions than standard open surgery through the anterior deltopectoral approach for treating these intra-articular fractures. 3,[10][11][12]14,16,[20][21][22][23][24][25] Arthroscopy also provides an opportunity to assess and treat any associated rotator cuff tendon injuries or greater tuberosity fracture. 17,24 There is currently no evidence that one surgical technique is superior for treating Ideberg IA fractures.…”

mentioning

confidence: 99%

Contribution of arthroscopy in the treatment of anterior glenoid rim fractures: a comparison with open surgery

Bonnevialle

Clavert

Arboucalot

et al. 2019

Journal of Shoulder and Elbow Surgery

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Bone Fragment Union and Remodeling After Arthroscopic Bony Bankart Repair for Traumatic Anterior Shoulder Instability With a Glenoid Defect

Abstract: Bone union was not always achieved after arthroscopic bony Bankart repair, and union was often delayed. Recurrence of instability was significantly more frequent when bone union failed. The size of the glenoid defect decreased significantly in shoulders with bone union.

Cited by 56 publications

References 20 publications

Risk Factors for the Postoperative Recurrence of Instability After Arthroscopic Bankart Repair in Athletes

Risk Factors for the Postoperative Recurrence of Instability After Arthroscopic Bankart Repair in Athletes

‘On-track’ and ‘off-track’ shoulder lesions

Contribution of arthroscopy in the treatment of anterior glenoid rim fractures: a comparison with open surgery

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