Do Reduction and Healing of the Bony Fragment Really Matter in Arthroscopic Bony Bankart Reconstruction? A Prospective Study With Clinical and Computed Tomography Evaluations

作者：Jiang, Chun-Yan; Zhu, Yi-Ming^*; Liu, Xin; Li, Feng-Long; Lu, Yi; Wu, Guan

来源：The American Journal of Sports Medicine, 2013, 41(11): 2617-2623.

DOI：10.1177/0363546513499304

• shoulder instability
• fracture
• Bankart lesion
• arthroscopic surgery
• suture anchor

Background: Bony Bankart lesions can be treated with arthroscopic repair. However, few studies have evaluated the importance of bony fragment reduction and healing to stability of the glenohumeral joint after arthroscopic bony Bankart repair. @@@ Purpose: To evaluate functional results after surgery and determine the correlation between reduction and healing of the fracture and postoperative stability of the glenohumeral joint. @@@ Study Design: Case series; Level of evidence, 4. @@@ Methods: A total of 50 patients (47 men, 3 women; average age, 27.6 years; range, 16.5-50.1 years) with bony Bankart lesions and recurrent anterior shoulder dislocations were treated with arthroscopic reduction and internal fixation with suture anchors. The average follow-up period was 32.5 months (range, 24.3-61.2 months). Preoperative and postoperative range of motion and American Shoulder and Elbow Surgeons (ASES), Constant-Murley, and Rowe scores were compared to evaluate the results of the surgeries. Sequential 3-dimensional computed tomography (CT) scans were available for 37 patients and were analyzed to investigate the effect of the bony defect of the glenoid and the correlation between the success of the surgery and reduction and healing of the bony fragment. @@@ Results: After surgery, active forward elevation was significantly improved (P < .05). No significant differences were found regarding external and internal rotations after surgery. The ASES, Constant-Murley, and Rowe scores improved significantly after surgery. Redislocations occurred in 3 patients, and a positive anterior apprehension sign was detected in 1 patient during follow-up. The overall failure rate was 8.0% (4/50). The CT scans during the follow-up period showed a nonunion of the bony fragment in 13.5% of cases (5/37). The reconstructed size of the glenoid was <80% in 3 of the 4 failure cases but >80% in all of the successful cases. @@@ Conclusion: Arthroscopic reduction and fixation of a bony Bankart lesion can achieve good results in selected cases. The size of the reconstructed glenoid is crucial to the success of the surgery.

• 出版日期2013-11
• 单位北京积水潭医院; 北京大学