The "bony Bankart bridge" technique for restoration of anterior shoulder stability.
BACKGROUND
Bony deficiency of the anteroinferior glenoid rim can cause recurrent glenohumeral instability. To address this problem, bony reconstruction is recommended in patients with glenoid bone loss more than 20% to 25%. Recent advances in shoulder surgery techniques allow for the arthroscopic reconstruction of glenoid bone defects to restore stability.


OBJECTIVE
The all-arthroscopic "bony Bankart bridge" (BBB) technique for bony anterior glenohumeral instability can restore shoulder stability and provide good shoulder function as well as improve patient satisfaction for these difficult-to-treat cases.


METHODS
Case series; Level of evidence, 4.


METHODS
A consecutive series of 15 patients with bony anterior shoulder instability were treated using the arthroscopic BBB technique. All patients were assessed with the Disabilities of the Arm, Shoulder and Hand-short version (QuickDASH), American Shoulder and Elbow Surgeons (ASES) score, and Short Form-12 (SF-12) preoperatively and at final evaluation. In addition, a specific questionnaire evaluated patient satisfaction and possible complications.


RESULTS
Two women and 13 men were included in the study, with an average age of 44 years (range, 24-70 years). The average glenoid bone loss was 29% (range, 17%-49%). The mean duration of follow-up was 2.7 years (range, 2.0-4.4 years). At that time, the mean ASES score had improved from 81 (range, 50-98) to 98 (range, 88-100) (P = .133). Although this change was not statistically significant because of low patient numbers, the amount of improvement was almost 3 times the minimal clinically important difference of 6.4 points as reported in previous studies. The mean SF-12 (physical component) improved from 46.8 to 56.2 at final follow-up (P = .015). The mean QuickDASH score at final follow-up was 2.8 (range, 0-15.9), and the mean Single Assessment Numeric Evaluation score was 99 (range, 95-100). There were 14 (93%) stable shoulders and 1 (7%) failure with redislocation from a fall. Median patient satisfaction at final follow-up was 10 (range, 7-10) out of 10.


CONCLUSIONS
The arthroscopic BBB technique for anterior instability with glenoid rim fracture successfully restores shoulder stability with a high median patient satisfaction (10/10) and a very low complication rate.
Steadman Philippon Research Institute, Vail, CO 81657, USA. drmillett@thesteadmanclinic.com
Peter J
PJ
Millett
Marilee P
MP
Horan
Frank
F
Martetschläger
D000328:Adult; D000367:Age Factors; D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D001862:Bone Resorption; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012008:Recurrence; D012042:Registries; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D053441:Suture Anchors; D013536:Suture Techniques; D055815:Young Adult