Risk factors for postage stamp fracture following arthroscopic Bankart repair: a systematic review

Postage stamp fractures are a rare but considerable complication after arthroscopic Bankart repair. Previous literature has implicated various patient- and technique-specific factors, but analyses often lacked comparison to the broader operative sample. The purpose of this study is to systematically review the literature on postage stamp fracture after arthroscopic Bankart repair, evaluate patient- and anchor-specific risk factors, and contextualize findings within the full operative sample.

A systematic review was conducted to identify studies reporting postage stamp fractures following arthroscopic Bankart repair using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Patient demographics, anchor characteristics, and surgical outcomes were extracted. Risk factor associations were evaluated descriptively, with emphasis on whether reported associations held true across the full sample of surgical cases in each study.

A systematic search yielded 2,349 articles; after duplicate removal and screening, 7 studies met inclusion criteria (2 comparative, 5 noncomparative). Studies included a total of 1,264 patients aged 10-61, with fracture incidence in larger cohorts ranging from 1.58% to 5%. Most patients with fractures participated in sports, particularly contact or high-risk activities. Although male patients made up the majority of fracture cases, this reflected the underlying demographic of operative patients. Patients with fractures were often the same age or older than the overall sample. Anchor number, diameter, type, and material were variably reported. Average anchor count was not consistently higher in patients with fractures, and no study found a significant association between anchor quantity and fracture risk. Absorbable anchors were implicated in a higher proportion of fracture cases. Osteolysis was common among patients with fractures. Insertion angle and suture type (knotted vs. knotless) were inconsistently reported and not clearly linked to fracture incidence.

Male sex and younger age, previously identified as risk factors, were not associated with postage stamp fractures when contextualized within the full operative sample. Presence of osteolysis and athletic participation was consistently associated with postage stamp fracture and may represent meaningful risk factors. Contrary to earlier reports, higher anchor quantity was not associated with increased postage stamp fracture risk; instead, lower anchor counts may be linked to instability, which itself may predispose to postage stamp fracture. Use of absorbable anchors emerged as a potential contributor to fracture risk that warrants further research.