The Arthroscopic Bankart-Plus Procedure for Treatment of Anterior Shoulder Instability With Small to Intermediate Glenoid Defects

Abstract

To date, specific surgical procedures are available for the treatment of anterior shoulder instability with substantial bony glenoid defects, as well as for patients without osseous lesions. However, specific treatment options are lacking for the frequently observed small to intermediate glenoid defects, which may not necessitate glenoid reconstruction surgery according to current guidelines but can still jeopardize the outcome after mere soft-tissue stabilization procedures. This article describes the so-called arthroscopic Bankart-Plus procedure for the treatment of anterior shoulder instability with small to intermediate bony glenoid defects. In addition to the conventional capsulolabral repair, an allogeneic demineralized spongy bone matrix is inserted between the glenoid neck and the labrum with the aim of compensating for the glenoid bone loss by increasing the volume of the labrum and thus its stabilizing effect.

Fig 1

Arthroscopic visualization of the right anterior glenoid rim (AGR) from the anterosuperior portal with the patient placed in the lateral decubitus position. (A, B) Release of the capsulolabral complex (CLC) from the AGR with an arthroscopic periosteal elevator or an electrothermal instrument. (C) Preparation of the AGR using a motorized burr. (D) Subsequent insertion of an all-suture anchor into the middle of the glenoid defect (GD) approximately 4 mm medial to the articular surface.

Fig 2

Flexible allogeneic demineralized spongy bone matrix (A) and passage of suture strands through the graft (B) for intra-articular insertion through the cannula of the anteroinferior portal.

Fig 3

Arthroscopic visualization of the right anterior glenoid rim from the anterosuperior portal with the patient placed in the lateral decubitus position. Anatomic positioning of the graft (G) in the pouch between the anterior glenoid rim (AGR) and the capsulolabral complex (CLC) before (A) and after (B) the suture strands of the all-suture anchor are tied.

Fig 4

Arthroscopic visualization of the right anterior glenoid rim from the anterosuperior portal (A-D) and the posterior portal (E, F) with the patient placed in the lateral decubitus position. Refixation of the capsulolabral complex (CLC) to the anteroinferior glenoid using an inferior cinch stitch (ICS) (A), a middle simple stitch (MSS) passing the graft (G) (B), and 1 or 2 superior cinch stitches all inserted at the anterior glenoid rim (AGR) using knotless suture anchors (KSA) (C). Visualization of the anatomically reconstructed and augmented CLC from the posterior (D) and anterosuperior (E) portals. (F) The increased volume of the bump is created as a result of the graft (G) augmentation, which is situated extra-articularly right underneath the CLC.

Fig 5

(A-D) Axial magnetic resonance imaging views at 2 weeks postoperatively showing graft placement (arrows) underneath the capsulolabral complex with the resulting large soft-tissue bump at the anterior glenoid rim. (E, F) Sagittal magnetic resonance imaging views showing the positioning of the graft (arrows) leading to an increase in the anteroposterior glenoid extension.