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Review
. 2024 Apr 10:9:16.
doi: 10.21037/aoj-23-46. eCollection 2024.

Arthroscopic suture bridge fixation for acute bony Bankart with anterior glenohumeral instability: a case report and narrative review

Jeffery D St Jeor  1 , Thomas W Mason  2 , Mark A Glover  2 , Nicholas A Trasolini  1 , Brian R Waterman  1
Affiliations
Review

Arthroscopic suture bridge fixation for acute bony Bankart with anterior glenohumeral instability: a case report and narrative review

Jeffery D St Jeor et al. Ann Jt. .

Abstract

Background and objective: Anterior shoulder dislocations can result in acute glenoid rim fractures that compromise the bony stability of the glenohumeral joint. Adequate fixation of these fractures is required to restore stability, decrease shoulder pain, and facilitate return to activity. The double-row suture bridge is a relatively novel fixation technique, first described in 2009, that accomplishes internal fixation with sufficient stability using an all-arthroscopic technique to restore the glenoid footprint. A 40-year-old female with recurrent anterior shoulder instability in the setting of seizure disorder was found to have a bony Bankart lesion of 25% to 30% with a concomitant superior labral tear. The patient was treated with a double-row bony Bankart bridge and labral repair. At six months follow-up, she has progressed to a full recovery with no recurrence.

Methods: A search was conducted in May 2023 in PubMed, EMBASE, and CINAHL with the search terms bony Bankart, bone Bankart, osseous Bankart, acute, bridge, suture bridge, double row.

Key content and findings: Double-row suture bridge repairs result in improvement in shoulder function as determined by ASES (93.5), QuickDASH (4.5), SANE (95.9), and SF-12 (55.6). The overall recurrence rate of anterior instability after a bony Bankart bridge repair is 8%. When examining the return to prior level of function, 81.4% of patients were able to do so with only 7.9% of patients reporting significant modifications to their activity level. In mid-term results, double row suture bridge demonstrates similar outcomes to other all-arthroscopic fixation methods of bony Bankart injuries. Importantly, bony Bankart bridge remains a viable option for critical glenoid lesions over the 20% cutoff used in other all arthroscopic techniques. Biomechanically, the double-row suture bridge offers distinct benefits over its single-row counterpart including increased compression, reduced displacement, and reduced step-off.

Conclusions: Although there is limited data, the studies discussed and the demonstrative case show the potential benefit of all-arthroscopic double-row suture bridge fixation including increased compression, decreased displacement, and a lower complication rate in patients with large bony Bankart lesions traditionally requiring bony augmentation. However, more robust studies are necessary to determine the long-term success of the double-row suture bridge.

Keywords: Glenoid bone loss; bony Bankart; double-row; shoulder arthroscopy; suture bridge.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://aoj.amegroups.com/article/view/10.21037/aoj-23-46/coif). The series “Bone Loss in Shoulder Instability and Shoulder Arthroplasty” was commissioned by the editorial office without any funding or sponsorship. N.A.T. declares that he is a paid presenter or speaker of DJ Orthopaedics. B.R.W. declares that he receives publishing royalties from Arthroscopy and Elsevier, works as a paid consultant for DePuy and FH Ortho, works as a paid presenter for Arthrex and Vericel, serves on the board member of American Academy of Orthopaedic Surgeons, Arthroscopy, American Orthopaedic Society for Sports Medicine, American Association of Nurse Anesthesiology and American Shoulder and Elbow Society, and serves on the editorial or governing board of The Video Journal of Sports Medicine. He also holds stock or stock options of Kaliber AI, Sparta and Vivorte, and has other financial or material support from Musculosckelatal transplant foundation and Smith and Nephew. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
An anterior-posterior X-ray view of the left shoulder shows no appreciable malalignment and no evidence of fractures.
Figure 2
Figure 2
A scapula Y view X-ray of the left shoulder shows no appreciable malalignment and no evidence of fractures.
Figure 3
Figure 3
Axial oblique proton dense fat-suppressed MRI of chronic Hill-Sachs (yellow arrow) and Bony Bankart lesion (yellow triangle). MRI, magnetic resonance imaging.
Figure 4
Figure 4
Coronal oblique T2 fat-suppressed MRI with a labral flap noted at the 5 o’clock position (yellow arrow) and a subadjacent glenoid cyst (yellow triangle). MRI, magnetic resonance imaging.
Figure 5
Figure 5
Axial oblique T2 fat-suppressed MRI showing anteroinferior labral flap with adjacent bony Bankart lesion (yellow arrow). MRI, magnetic resonance imaging.
Figure 6
Figure 6
Coronal oblique T2 fat-suppressed superior labral tear extending anterior and posterior to the biceps anchor, and posteriorly to the 10 o’clock position (yellow arrow).
Figure 7
Figure 7
Patient positioning in the right lateral decubitus positioning with an axillary roll.
Figure 8
Figure 8
Diagnostic arthroscopy from a low anterior portal looking superiorly showing grade IV chondromalacia of the mid-anterior glenoid (A) and bony Bankart lesion (B).
Figure 9
Figure 9
Mobilization of the labrum viewing anteriorly from the posterior portal.
Figure 10
Figure 10
Viewing from the 7 o’clock portal anteriorly to drill 2.4 mm into the glenoid with a double-loaded anchor at the 6 o’clock position.
Figure 11
Figure 11
Viewing from the posterior portal, sutures were passed around the bone fragment and docked into a PushLock for fixation on the bare subchondral bone of the inferior surface bony Bankart lesion at the 4 o’clock position for the inferior anchor placement (A,B).
Figure 12
Figure 12
Viewing from the posterior portal, placement of the medial (A) and superior (B) anchors.
Figure 13
Figure 13
From the posterior portal, all three anchors (A) are shown with anchor placement of the second row of articular fixation (B).
Figure 14
Figure 14
Final construct of bony Bankart bridge via double-row articular fixation viewed from the posterior portal.
See this image and copyright information in PMC

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