Review Question - QID 3442

The clinical presentation and imaging is consistent with a bony Bankart lesion following a shoulder dislocation. The most appropriate treatment for this injury is open or arthroscopic bony Bankart stabilization. Approximately 48% of patients with an anterior dislocation will have EMG changes in the axillary nerve and this is treated with observation. Surgery (i.e.neuroloysis, grafting, or transfer) is typically only reserved in cases where there is no signs of recovery after 3 to 6 months.

Itoi et al present a cadaveric study of 10 specimens under 11 different testing conditions to determine effect of such glenoid defects on the stability and motion of the shoulder after Bankart repair. They found that a glenoid defect width that is at least 21% of the glenoid length may prompt instability and limit shoulder ROM after Bankart repair. Bony deficiencies involving >21% of the anteroinferior glenoid mandate interventions such as ORIF of acute fractures, structural bone grafting, and coracoid transfer procedures (Bristow-Latarjet).

Burkhart et al present level 4 evidence reviewing 194 consecutive arthroscopic Bankart repairs. They found that 66% of the 21 recurrent dislocations had a significant glenoid bone defect. In those patients without glenoid bony defect, there was only a 4% dislocation recurrence.

Illustration A displays an arthroscopic view of a bony bankart lesion from a posterior viewing portal in a right shoulder in the lateral decubitus position.