APEX Shoulder Mastering Surgical Techniques for Clinical Success-When is a Bankart Not Enough

Video Transcription

Video Summary

Michael O'Brien from Tulane University discusses when an arthroscopic Bankart repair alone is insufficient for anterior shoulder instability. Key reasons include significant glenoid bone loss (over 20-25%), bipolar defects with engaging Hill-Sachs lesions, and revision surgeries. Bone loss under 10% generally allows successful Bankart repair; 10-20% ("subcritical") is challenging and depends on Hill-Sachs engagement. Remplissage, a capsulotenodesis procedure, added to Bankart reduces recurrence, especially for engaging lesions. For bone loss over 20%, bony augmentation like Latarjet is preferred, though it has higher complication rates. Large defects (30-40% loss) may require distal tibia or iliac crest allografts. Open Bankart helps in failed arthroscopic repairs with minimal bone loss. Newer arthroscopic anatomic glenoid reconstructions using distal clavicle or distal tibia grafts with metal button fixation show promise. O'Brien emphasizes careful preoperative imaging and early surgery after initial dislocations to optimize outcomes and prevent failure, tailoring treatment by bone loss and lesion engagement.

Asset Caption

Michael O’Brien, MD

Keywords

arthroscopic Bankart repair

anterior shoulder instability

glenoid bone loss

Hill-Sachs lesion

Latarjet procedure