Arthroscopic Reduction and Suspensory Button Fixation of Bony Bankart Lesion

Bony Bankart lesions (anteroinferior glenoid avulsion fractures) often occur after anterior shoulder dislocations, with an incidence up to 33% in first-time dislocaters. Detachment of the labrum and underlying glenoid bone piece can lead to recurrent instability, especially with increasing glenoid bone loss. Treatment is generally arthroscopic bony Bankart repair in acute injuries with viable bone fragments and minimal glenoid bone loss (<13.5%). However, there is no gold standard for arthroscopic fixation.

Given the acuity of the lesion with a sizeable bony Bankart fracture, a reducible fragment, and the patient's high activity level, arthroscopic reduction and fixation were indicated.

A high posterolateral viewing portal was created, with the remainder of the portals created under direct visualization. The fracture hematoma was debrided with a shaver. The anterior glenoid fracture was identified with the labrum still attached, and a radial tear of the superior labrum was noted. A combination of instruments was used to release and mobilize the fracture fragment. Two traction stitches were placed into the superior and inferior ends of the fragment to control it during reduction. A hooked guide was used to reduce the fracture back to its origin. A cannulated drill was used to drill through the posterior glenoid through the fracture fragment. The suture and the button were passed anterior to posterior to secure the fragment, tensioned to 100 N, and the fragment was stable in an anatomic position. A luggage tag suture was placed into the capsular-labral complex at the superior aspect of the bony Bankart lesion, and this was impacted just superior to the end of the fracture fragment to secure the labrum back in place.

The patient was immobilized in a sling for weeks 0 to 4, progressed in range of motion from weeks 5 to 12, and began strengthening at 12 weeks. At the final follow-up, the patient was back to his usual activities without complaints of pain or apprehension.

Arthroscopic reduction and suspensory button fixation of bony Bankart lesions is a viable option for reducing and fixing these injuries to prevent future development of recurrent instability.

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