Evaluating Return to Sport Outcomes: Arthroscopic Anatomic Glenoid Reconstruction vs. Bankart Repair

Anterior shoulder instability with glenoid bone loss (GBL) poses a clinical challenge, especially for athletes aiming to return to sports (RTS). While arthroscopic Bankart repair (ABR) has demonstrated varying strengths, arthroscopic anatomic glenoid reconstruction (AAGR) has emerged as a promising alternative to address GBL.

The purpose of this study was to compare the rate and time of RTS between AAGR and ABR in patients with anterior shoulder instability. A subobjective was to compare recurrent instability rates between the groups. It was hypothesized that AAGR would result in higher RTS rates and lower redislocation rates compared to ABR.

Cohort study; Level of evidence, 3.

Patients with anterior shoulder instability and GBL treated with either AAGR or ABR between 2016 and 2021 were retrospectively analyzed. The inclusion criteria required preoperative participation in recreational or competitive sports. Patient characteristics, sports participation levels, RTS outcomes (based on patient survey), reasons for not returning to sports, and postoperative recurrence and complications were collected. Statistical analyses involved chi-square tests for categorical variables and t tests or Mann-Whitney U tests for continuous variables, with significance set at P < .05.

A total of 84 patients were included in the analysis (AAGR, n = 44; ABR, n = 40). The AAGR group had 21% GBL while the ABR group had 10% GBL (P < .001). Despite this difference, RTS rates were significantly higher in the AAGR group (75%) compared with the ABR group (50%) (P = .038). The redislocation rate was significantly lower in the AAGR group (2.3%) compared with the ABR group (17.5%) (P = .025).

In patients with anterior shoulder instability, our study showed that anterior AAGR demonstrates superior patient-reported RTS rates and lower redislocation rates than ABR, with comparable recovery timelines despite the AAGR group having higher GBL. These findings suggest that bone block procedures may achieve higher RTS rates than ABR alone. This study provides valuable guidance for clinicians advising athletes on surgical options by establishing appropriate RTS expectations and demonstrating that AAGR provides suitable RTS in the presence of GBL.