AANA/ISAKOS Knee and Shoulder Arthroscopy Course-Online Didactics (April 2024)-When is Bankart Enough

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Video Summary

Dr. Michael O'Brien from Tulane University discusses when a soft tissue Bankart repair is insufficient for shoulder instability, emphasizing the pivotal role of glenoid bone loss. Soft tissue repair alone often fails when glenoid bone loss exceeds 20%, especially with engaging Hill-Sachs lesions or in revision surgeries. Less than 10% bone loss typically responds well to arthroscopic Bankart; 10-20% (subcritical) is challenging, often requiring Bankart plus a remplissage or bone augmentation; above 20%, procedures like Latarjet or distal tibia allograft are preferred. Proper evaluation includes history, physical exam, and imaging with 3D CT scans to quantify bone loss and assess lesion "on-track" or "off-track" status. Remplissage lowers recurrence in primary repairs but is less effective in revisions. Open Bankart remains valuable, especially after failed arthroscopic attempts. Emerging arthroscopic anatomic glenoid reconstruction offers promising results with less invasiveness. Early surgical intervention after initial dislocations improves outcomes, and careful preoperative planning is essential to optimize treatment choice and minimize failure risk.

Keywords

soft tissue Bankart repair

glenoid bone loss

shoulder instability

arthroscopic Bankart

Latarjet procedure