Single- and Double-Row Arthroscopic Bony Bankart Repair

Bony injury to the anterior glenoid occurs in the setting of anterior instability, in addition to injury of the capsulolabral complex. If left untreated, this fracture-referred to as a bony Bankart-compromises the glenoid track, increasing the risk of recurrent instability. The aim of this video technique is to describe the indications and technique for arthroscopic single- and double-row repair of a bony Bankart lesion in patients with anterior shoulder instability.

Arthroscopic management of bony Bankart lesions should be pursued aggressively in acute cases (<3-6 months postinjury), when the fragment remains viable and more easily reducible. Lesion size plays a crucial role in determining the surgical approach: smaller lesions (<10% of the glenoid rim) may be effectively managed with a single-row repair, while medium-size (10% to 20%-25% of the glenoid rim) or larger-size (>20%-25% of the glenoid rim) lesions may benefit from a double-row technique in order to confer enhanced compressive and rotational stability.

Patients are placed in a lateral decubitus position. The capsulolabral complex and bony fragment are mobilized, and the glenoid margin is lightly decorticated to encourage healing. Suture anchors are first placed at the inferior and superior margins of the bony lesion, and the capsulolabral complex is restored. Depending on the bony Bankart lesion size, fixation of the lesion can be achieved using either a single-row or a double-row technique.

In the present cases, both techniques successfully achieved adequate fracture reduction, ensuring stability and proper alignment. Both patients achieved good functional outcomes, with return to all activities postoperatively.

Arthroscopic single- and double-row repair of bony Bankart lesions has demonstrated success in the treatment of anterior shoulder. While single-row repair may provide adequate fixation for smaller bony fragments, a double-row repair may offer superior biomechanical stability and be more appropriate for the treatment of medium- to large-sized bony fragments.

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