Biomechanical Comparison of Arthroscopic Single- and Double-Row Repair Techniques for Acute Bony Bankart Lesions

Authors:

Ulrich J Spiegl, Sean D Smith, Jocelyn N Todd, Garrett A Coatney, Coen A Wijdicks, Peter J Millett

Abstract:

Bony Bankart lesions are commonly associated with anterior or anterior-inferior glenohumeral dislocations, often caused by a traumatic event. The prevalence of osseous Bankart lesions reportedly ranges from 7.9% to 50.0% in shoulders that exhibit traumatic glenohumeral instability. Acute osseous Bankart lesions must be differentiated from chronic cases and are defined by acute glenohumeral dislocations with a glenoid rim fracture within 3 to 6 months of the initial injury. In contrast, chronic lesions, particularly in cases of recurrent anterior instability, often present as bony erosion of the anterior glenoid rim caused by osseous lysis.

Although it has been shown that acute Bankart lesions can be successfully treated nonoperatively if the fracture is concentrically reduced, Nakagawa reported a high percentage of fragment absorption within 1 year after an acute injury. Recent advancements in arthroscopic technologies have made arthroscopic bony reconstruction possible. Additionally, recent case series have shown favorable outcomes after arthroscopic bony repair with suture anchors for patients with bone defects ranging in size from 11.4% to 49.0% of the inferior glenoid width.

Two techniques for arthroscopic bony repair of acute bony Bankart lesions have been described in the literature. The method described by Porcellini involved implementation of 1 anchor in the fracture, corresponding to a single-row repair. In contrast, the ‘‘bony Bankart bridge’’ technique described by Millett and Braun used a double-row technique that deployed anchors at the medial and lateral borders of the fracture site. Favorable clinical outcomes have been reported for both techniques.

Giles compared both of the described fixation techniques in a cadaveric biomechanical model with a simulated osseous defect size of 15% without creating a labral avulsion. The authors reported significant differences in fragment displacement at various loading conditions; however, they reported that these small, but statistically significant, differences were likely clinically insignificant. In conjunction with the reported nonsignificant differences in failure strength and load transfer between the 2 techniques, the authors concluded that the 2 techniques were biomechanically equivalent. However, several studies have shown that significantly increased anterior glenohumeral instability associated with glenoid rim lesions only occurs for defects exceeding 20% of the glenoid surface area. Thus, controversy exists regarding the need for surgical repair in glenoid rim defects of less than 20%. There exists no biomechanical data to date comparing arthroscopic bony repair techniques for osseous Bankart lesions with defect sizes exceeding 20% of the glenoid surface area.

Therefore, the purpose of this study was to compare the time zero reduction of distance across the fracture and bio- mechanical stability associated with the single-row technique described by Porcellini and the double-row technique described by Millett and Braun of bony Bankart lesions with a 25% defect. The double-row technique was hypothesized to provide improved fracture reduction and superior stability compared with the single-row technique.

For the complete study: Biomechanical Comparison of Arthroscopic Single- and Double-Row Repair Techniques for Acute Bony Bankart Lesions

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Biomechanical Comparison of Arthroscopic Single- and Double-Row Repair Techniques for Acute Bony Bankart Lesions

Authors:

Abstract:

About the Author: Peter Millett, MD