The ‘‘Bony Bankart Bridge’’ Technique for Restoration of Anterior Shoulder Stability

Authors:

Peter J Millett, Marilee P Horan, Frank Martetschläger

Abstract:

Bony deficiency of the anteroinferior glenoid can contribute to recurrent glenohumeral instability. Glenoid bone loss occurs during acute shoulder dislocation or because of erosion and attrition in more chronic cases of anterior instability. The incidence of bony Bankart lesions after shoulder dislocations ranges from 4% to 70% in the literature, with a higher prevalence in men. These injuries have been previously classified by Bigliani into 3 types, with type I representing an avulsion fracture with attached capsule, type II a medially displaced fragment malunited to the glenoid rim, and type III an erosion of the glenoid diameter with less (IIIA) or more (IIIB) than 25% deficiency. Burkhart and De Beer also demonstrated that glenoid bone loss is associated with a higher risk of surgical failure after arthroscopic soft tissue repair. A number of biomechanical studies have been performed to determine the critical amount of bone loss that results in recurrent instability.

Cadaveric studies have helped us understand the consequences of glenoid bone loss. Itoi reported that anosseous defect of at least 21% of the glenoid length will significantly decrease stability. Similarly, Yamamoto created a model with an osseous defect at 3-o’clock (right shoulder) and concluded that when the defect was equal to or greater than 20% of the glenoid length, there was significantly decreased anterior stability. According to Gerber and Nyffeler, when the length of the glenoid defect was greater than the glenoid radius, resistance to dislocation was reduced by 30%. Furthermore, glenoid bone loss of 20% of the diameter doubles the mean contact pressure in the anteroinferior quadrant and increases peak pressures from 50% to 100%. Therefore, based on the current data, a bony reconstruction procedure is recommended in patients with glenoid bone loss of greater than 20% to 25% to restore the surface area and to avoid high failure rates.

Bony procedures have historically been performed open. However, recent advances in arthroscopic technique have allowed for the reconstruction of glenoid bone defects to restore stability.9,16,18,20 In 2009, the senior author (P.J.M.) described an all-arthroscopic technique developed for this specific condition named the ‘‘bony Bankart bridge’’ (BBB). The purpose of this study was to investigate the clinical outcomes and complications after arthroscopic fixation of anterior glenoid rim fractures using this technique. We hypothesized that the BBB technique would provide good restoration of stability with a high patient satisfaction and a low complication rate.

For the complete study: The ‘‘Bony Bankart Bridge’’ Technique for Restoration of Anterior Shoulder Stability

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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