Arthroscopic Suture Anchor Fixation of Bony Bankart Lesions: Clinical Outcome, Magnetic Resonance Imaging Results, and Return to Sports.
OBJECTIVE
The purpose of this study was to evaluate the outcome, return to sporting activity, and postoperative articular cartilage and bony morphology of shoulders that underwent arthroscopic suture anchor repair of bony Bankart lesions.


METHODS
The inclusion criteria for this retrospective study were anterior glenoid rim fractures after traumatic shoulder instability that were treated with arthroscopic suture anchor repair. Patients were surveyed by a questionnaire including sport-specific outcome, Rowe score, Western Ontario Shoulder Instability Index, and Oxford Instability Score. Three-tesla magnetic resonance imaging could be performed in 30 patients to assess osseous integration, glenoid reconstruction, and signs of osteoarthritis.


RESULTS
From November 1999 to April 2010, 81 patients underwent an anterior bony Bankart repair in our department (50 arthroscopic suture anchor repairs, 5 arthroscopic screw fixations, and 26 open repairs). The 55 arthroscopic repairs comprised a consecutive cohort of patients treated by a single surgeon. Of the 50 patients in the suture anchor group, 45 (90%) were available for evaluation. At 82 ± 31 months postoperatively, the mean Rowe score was 85.9 ± 20.5 points, the mean Western Ontario Shoulder Instability Index score was 89.4% ± 14.7%, and the mean Oxford Instability Score was 13.6 ± 5.4 points. Compared with the contralateral shoulder, all scores showed a significantly reduced outcome (P < .001, P < .001, and P < .001, respectively). A redislocation occurred in 3 patients (6.6%). Regarding satisfaction, 35 patients (78%) were very satisfied, 9 (20%) were satisfied, and 1 was partly satisfied. Overall, 95% of patients returned to any sporting activity after surgery. The number of sports disciplines (P < .001), duration (P = .005), level (P = .02), and risk category (P = .013) showed a significant reduction compared with the pretrauma condition. However, only 19% of patients reported that shoulder complaints were the reason for the reduction in activity. Nonunion occurred in 16.6%, with a higher frequency in patients with chronic lesions (P = .031). Anatomic reduction was achieved in 72%, the medial step-off in patients with nonanatomic reduction averaged 1.8 ± 0.9 mm, and the remaining glenoid defect size averaged 6.8% ± 7.3%. Full-thickness cartilage defects of the anterior glenoid were detected in 70% of patients.


CONCLUSIONS
Arthroscopic suture anchor repair may enable an anatomic reduction of bony Bankart lesions with no or only minimal articular steps and provides successful midterm outcomes concerning clinical scores, recurrence, and patient satisfaction. The return to activity is limited for various, mostly non-shoulder-related causes. Chronic lesions may have an inferior healing potential; therefore early surgical stabilization of acute Bankart fragments is suggested to avoid possible nonunion.


METHODS
Level IV, therapeutic case series.
Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany; Department of Trauma Surgery, Klinikum Augsburg, Augsburg, Germany. Electronic address: johannes.plath@gmail.com.
Johannes E
JE
Plath
Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany; Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Freiburg, Germany.
Matthias J
MJ
Feucht
Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
Robert
R
Bangoj
Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
Frank
F
Martetschläger
Department of Radiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
Klaus
K
Wörtler
Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
Gernot
G
Seppel
Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany; Department of Orthopedic Surgery and Traumatology, Mansoura University, Mansoura, Egypt.
Mohamed
M
Aboalata
Department of Orthopedics, Rostock University Hospital, Rostock, Germany.
Thomas
T
Tischer
Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
Andreas B
AB
Imhoff
Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany; Department of Sports Orthopedics, Hessing Klinik, Augsburg, Germany.
Stephan
S
Vogt
D000293:Adolescent; D000328:Adult; D000368:Aged; D001178:Arthroplasty / Q000379:methods*; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000601:surgery*; D061165:Glenoid Cavity / Q000293:injuries / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000068958:Return to Sport; D012783:Shoulder Dislocation / Q000150:complications; D011795:Surveys and Questionnaires; D053441:Suture Anchors; D016896:Treatment Outcome; D055815:Young Adult