Cortical Button Fixation for Large Bony Bankart Lesions

Large bony Bankart lesions remain a complex problem in the management of anterior shoulder instability. Traditional fixation with screws or suture anchors can be limited by fragment size, thin cortical bone, or medial extension of the fragment, where anchor placement may be technically challenging or unreliable. We describe an arthroscopic surgical technique using cortical button fixation for large bony Bankart lesions, particularly when medial extension makes conventional anchor placement difficult. With the patient in the beach chair position, diagnostic arthroscopy is performed using a 30° arthroscope. Following mobilization of the bony fragment and preparation of the glenoid neck, a transosseous tunnel is drilled from the posterior glenoid cortex to the fragment base. High-strength sutures are passed and secured using a cortical button construct, allowing controlled reduction and stable compression of the fragment. Capsulolabral repair is performed as required. Arthroscopic cortical button fixation provides a low-profile, fragment-preserving solution for large bony Bankart lesions, particularly when medial extension limits conventional anchor-based fixation.