Arthroscopic Bony Bankart Fixation Using Single-Row Technique with Knotless Suture Anchors

Bony Bankart lesions involve detachment of the anteroinferior labrum with an associated glenoid rim fracture after traumatic anterior shoulder instability. Compared with isolated soft-tissue Bankart lesions, osseous involvement increases the risk of recurrent instability and progressive glenoid bone loss. Arthroscopic fixation techniques have evolved as minimally invasive alternatives to open repair and bone augmentation in appropriately selected cases.

Arthroscopic single-row fixation is indicated for reducible bony Bankart lesions involving small to moderate fragments, typically <25% of the glenoid surface, with adequate fragment viability and an intact capsulolabral sleeve. Larger defects or irreducible fragments may require open fixation or bone augmentation procedures.

The patient is positioned in the beach-chair position, and standard posterior, anterior, and anterosuperior portals are established. A systematic diagnostic arthroscopy is performed. The capsulolabral complex and attached osseous fragment are thoroughly mobilized using an elevator to achieve anatomic reducibility. The native anterior glenoid rim is lightly decorticated to create a bleeding bone bed while preserving fragment integrity. Fixation proceeds from inferior to superior. A knotless suture anchor is placed at the 5:30 position, and the suture is passed through the anteroinferior labrum at the base of the fragment, restoring inferior glenohumeral ligament tension. A second anchor is placed at the 3:00 position to secure the superior portion of the fragment. Knotless fixation permits incremental tensioning and retensioning to optimize reduction while minimizing fragment malrotation. Final probing confirms stable anatomic reduction.

Stable fixation with restoration of the anterior-inferior labral bumper and glenoid contour was achieved arthroscopically. Early follow-up demonstrated maintained stability, minimal pain, and progressive return of range of motion.

Arthroscopic single-row fixation using knotless anchors provides a reproducible, minimally invasive technique for selected bony Bankart lesions. Key technical principles include complete mobilization, preparation of the native glenoid bed, inferior-to-superior fixation, and controlled tensioning. When applied appropriately, this technique restores stability while preserving bone stock and avoiding the morbidity of open procedures.

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