Chondral Damage After Arthroscopic Repair Techniques for Acute Bony Bankart Lesions: A Biomechanical Study

Abstract

Background: Bony Bankart lesions can be encountered during treatment of shoulder instability. Current arthroscopic bony Bankart repair techniques involve intra-articular suture placement, but the effect of these repair techniques on the integrity of the humeral head articular surface warrants further investigation. Purpose: To quantify the degree of humeral head articular cartilage damage secondary to current arthroscopic bony Bankart repair techniques in a cadaveric model. Study Design: Controlled laboratory study. Methods: Testing was performed in 13 matched pairs of cadaveric glenoids with simulated bony Bankart fractures, with a defect width of 25% of the glenoid diameter. Half of the fractures were repaired with a double-row technique, while the contralateral glenoids were repaired with a single-row technique. Samples were subjected to 20,000 cycles of internal-external rotation across a 90° arc at 2 Hz after a compressive load of 750 N, or 90% body weight (whichever was less) was applied to simulate wear. Cartilage defects on the humeral head were quantified through a custom MATLAB script. Mean cartilage cutout differences were analyzed by the Wilcoxon rank-sum test. Results: Both single- and double-row repairs showed macroscopic damage. The histomorphometric analysis demonstrated that the double-row technique resulted in a significantly ( P = .036) more chondral damage (mean, 57,489.1 µm2; SD, 61,262.2 µm2) than the single-row repair (mean, 28,763.5 µm2; SD, 24,4990.2 µm2). Conclusion: Both single-row and double-row arthroscopic bony Bankart fixation techniques resulted in damage to the humeral head articular cartilage in the concavity-compression model utilized in this study. The double-row fixation technique resulted in a significantly increased cutout to the humeral head cartilage after simulated wear in this cadaveric model. Clinical Relevance: This study provides data demonstrating that placement of intra-articular suture during arthroscopic bony Bankart repair techniques may harm the humeral head cartilage. While the double-row repair of bony Bankart lesions is more stable, it results in increased cartilage damage. These findings suggest that alternative, cartilage-sparing arthroscopic techniques for bony Bankart repair should be investigated.

Arthroscopic Stabilization of Osteochondral Fracture of the Anterior-Inferior Glenoid Using Double-Row Suture Bridge Technique

“…If left untreated, this lesion can cause recurrent instability 1 , 6 , 7 and may lead to early degenerative changes in the glenohumeral joint. 3 , 8 , 9 , 10 Osteochondral fracture can be treated with various treatment options, including debridement, structural repair, screws fixation, microfracture, bone grafting, and arthroplasty.…”

A novel arthroscopic transosseous suture-button fixation technique for anterior glenoid fractures

“…Also, Nakawaga et al found that placing multiple soft suture anchors in a linear arrangement for Bankart repairs might be associated with postoperative recurrence of instability due to new glenoid fractures along the suture anchor insertion sites [16]. In addition, Greenstein et al demonstrated in a cadaveric model that placement of intraarticular sutures during arthroscopic bony Bankart repair techniques may harm the humeral head cartilage and suggested further investigation of alternative, cartilage-sparing arthroscopic techniques for anterior glenoid fractures [9]. All these arthroscopic methods have in common that the implants are drilled and placed from anteriorly.…”

“…Also, the linear placement of anchors has been reported to be associated with secondary fractures of the glenoid or irritation Fig. 2 8 With the anterior edge of the anterior fragment under the hook, the two bullets are placed on the scapula neck over the glenoid guide through an additional posteromedial skin incision of the joint due to non-absorbable sutures [9,16].…”

Glenoidfraktur

“…Zu beachten bei dieser Art der Fixierung ist jedoch die hiermit verbundene intraartikuläre Lage des Fadenmaterials. Da dieses in aller Regel sehr stabil und nicht resorbierbar ist, ist nicht verwunderlich, dass dies in der biomechanischen Untersuchung von Greenstein et al zu Knorpelschäden im Bereich des Humeruskopfes führt[24]. Eine tatsächlich deutlich höhere Rate an posttraumatischer Arthrose ist aufgrund der fehlenden Daten für diese Techniken im Vergleich zu anderen Techniken noch nicht bekannt.Bei schweren nicht rekonstruierbaren Frakturen muss grundsätzlich ein struktureller Glenoidaufbau mit Becken-kammspan, Korakoidtransfer oder allogenem Knochen erwogen werden.…”