Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: Significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion

Purpose: Our goal was to analyze the results of 194 consecutive arthroscopi c Bankart repairs (performed by 2 surgeons with an identical suture anchor technique) in order to identify specific factors related to recurrence of i nstability. Type of Study: Case series. Materials and Methods: We analyzed 194 consecutive arthroscopic Bankart repairs by suture anchor technique per formed for traumatic anterior-inferior instability. The average follow-up w as 27 months (range, 14 to 79 months). There were 101 contact athletes (96 South African rugby players and 5 American football players). We identified significant bone defects on either the humerus or the glenoid as (1) "inve rted-pear" glenoid, in which the normally pear-shaped glenoid had lost enou gh anterior-inferior bone to assume the shape of an inverted pear; or (2) " engaging" Hill-Sachs lesion of the humerus, in which the orientation of the Hill-Sachs lesion was such that it engaged the anterior glenoid with the s houlder in abduction and external rotation. Results: There were 21 recurren t dislocations and subluxations (14 dislocations, 7 subluxations). Of those 21 shoulders with recurrent instability, 14 had significant bone defects ( 3 engaging Hill-Sachs and 11 inverted-pear Bankart lesions). For the group of patients without significant bone defects (173 shoulders), there were 7 recurrences (4% recurrence rate). For the group with significant bone defec ts (21 patients), there were 14 recurrences(67% recurrence rate). For conta ct athletes without significant bone defects, there was a 6.5% recurrence r ate, whereas for contact athletes with significant bone defects, there was an 89% recurrence rate. Conclusions: (1) Arthroscopic Bankart repairs give results equal to open Bankart repairs if there are no significant structura l bone deficits (engaging Hill-Sachs or inverted-pear Bankart lesions). (2) Patients with significant bone deficits as defined in this study are not c andidates for arthroscopic Bankart repair. (3) Contact athletes without str uctural bone deficits may be treated by arthroscopic Bankart repair. Howeve r, contact athletes with bone deficiency require open surgery aimed at thei r specific anatomic deficiencies. (4) For patients with significant glenoid bone loss, the surgeon should consider reconstruction by means of the Lata rjet procedure, using a large coracoid bone graft.