Review Question - QID 78

The lesion shown in Figure A is a Bankart lesion, or avulsion of the anteroinferior fibrocartilaginous labrum adjacent to the IGHL, along with a glenolabral articular disruption. Hill-Sachs lesion are the most common associated intra-articular findings.

Bankart lesions frequently occur following a traumatic anterior shoulder dislocations and may result in recurrent instability, especially in younger patients. Because of the violent mechanism of injury, compression fractures of the posterolateral humeral head (Hill-Sachs lesions) may also result as the soft humeral head impacts against the relatively hard anterior glenoid. It is important to note that the presence of a Hill-Sachs lesion may destabilize the GH joint and predispose to subsequent dislocation if it engages the glenoid.

Hintermann et al conducted a prospective study to evaluate the arthroscopic findings of the unstable shoulder to provide insights in the causes and mechanisms of shoulder instability. In 212 patients who had at least 1 documented shoulder dislocation; 87% had anterior glenoid labral tears (Bankart lesion), 79% had ventral capsule insufficiency, 68% had Hill-Sachs compression fractures, 55% had glenohumeral ligament insuffiency, 14% had complete rotator cuff tears, 12% had posterior glenoid labral tears, and 7% had SLAP tears. Thus, of the choices, Hill-Sachs lesions are the most common finding.

Kralinger et al found that the only factor associated with instability recurrence following an initial dislocation was age between 21 and 30 years (immobilization and physical therapy were not associated with recurrence).

Illustration A shows a Bankart lesion with glenolabral articular disruption; (A) labrum, (B) glenolabral articular disruption, (C) glenoid. Illustration B shows the 2cm loose body removal from the glenolabral articular disruption. Illustration C shows suture anchor placement within the glenolabral articular disruption on the anterior glenoid; (A) labrum, (B) glenolabral articular disruption, (C) glenoid. Illustration D shows the completed bankart repair; (A) labrum, (B) filled glenolabral articular defect, (C) glenoid. Illustration E is a video of the intra-articular structures during routine shoulder arthroscopy.

Incorrect Answers:
Answer 1: Rotator cuff tears are more common in elderly patients who sustain a shoulder dislocation and would be less common in this younger patient
Answer 2: A SLAP tear would be less common than a Hill-Sachs lesion following an anterior shoulder dislocation
Answer 3: A posterior labral tear would be uncommon with an anterior shoulder dislocation
Answer 5: A Buford complex may be mistaken for a labral injury, but this is a normal variant and should not be repaired due to post-operative external rotation limitations