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The "bony Bankart bridge" technique for restoration of anterior shoulder stability
Peter J Millett1, Marilee P Horan, Frank Martetschläger
1Steadman Philippon Research Institute, Vail, CO 81657, USA. drmillett@thesteadmanclinic.com
Background:
Bony deficiency of the anteroinferior glenoid rim can cause recurrent glenohumeral instability. To address this problem, bony reconstruction is recommended in patients with glenoid bone loss more than 20% to 25%. Recent advances in shoulder surgery techniques allow for the arthroscopic reconstruction of glenoid bone defects to restore stability.
Hypothesis:
The all-arthroscopic "bony Bankart bridge" (BBB) technique for bony anterior glenohumeral instability can restore shoulder stability and provide good shoulder function as well as improve patient satisfaction for these difficult-to-treat cases.
Study Design:
Case series; Level of evidence, 4.
Methods:
A consecutive series of 15 patients with bony anterior shoulder instability were treated using the arthroscopic BBB technique. All patients were assessed with the Disabilities of the Arm, Shoulder and Hand-short version (QuickDASH), American Shoulder and Elbow Surgeons (ASES) score, and Short Form-12 (SF-12) preoperatively and at final evaluation. In addition, a specific questionnaire evaluated patient satisfaction and possible complications.
Results:
Two women and 13 men were included in the study, with an average age of 44 years (range, 24-70 years). The average glenoid bone loss was 29% (range, 17%-49%). The mean duration of follow-up was 2.7 years (range, 2.0-4.4 years). At that time, the mean ASES score had improved from 81 (range, 50-98) to 98 (range, 88-100) (P = .133). Although this change was not statistically significant because of low patient numbers, the amount of improvement was almost 3 times the minimal clinically important difference of 6.4 points as reported in previous studies. The mean SF-12 (physical component) improved from 46.8 to 56.2 at final follow-up (P = .015). The mean QuickDASH score at final follow-up was 2.8 (range, 0-15.9), and the mean Single Assessment Numeric Evaluation score was 99 (range, 95-100). There were 14 (93%) stable shoulders and 1 (7%) failure with redislocation from a fall. Median patient satisfaction at final follow-up was 10 (range, 7-10) out of 10.
Conclusion:
The arthroscopic BBB technique for anterior instability with glenoid rim fracture successfully restores shoulder stability with a high median patient satisfaction (10/10) and a very low complication rate.
