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Benefits of bone graft augmentation to arthroscopic Bankart repair for recurrent anterior shoulder instability with glenoid bone loss

  • SHOULDER
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Glenoid bone loss contributes to recurrent instability after arthroscopic Bankart repair alone. With significant glenoid bone loss, better results have been reported after arthroscopic Bankart repair with glenoid arc reconstruction. However, no reports compare augmentation using bone graft with non-augmentation for glenoid bone loss. The purpose of this study was to assess clinical results of an arthroscopic Bankart repair with or without arthroscopic bone graft augmentation. It was hypothesized that such bone graft augmentation would restore shoulder stability, and lead to excellent outcomes.

Methods

Of 552 patients treated for anterior glenohumeral instability with arthroscopic Bankart repair, 68 met this study’s inclusion criteria of glenoid bone loss over 20% and follow-up of at least 2 years. Patients were divided into 2 groups based on whether with bone graft augmentation for glenoid bone loss [Group A: n = 35, median age; 21 years (range 13–72 years)], or not (Group B: n = 33, median age; 21 years (range 13–50 years)]. For grafting, either autologous iliac bone or artificial bone made of hydroxyapatite was used. Rowe score, recurrence rate, and return to sport were used to assess the results.

Results

Mean Rowe score was 95.0 (SD 10.6) in Group A and 69.7 (SD 27.2) in Group B (p < 0.05). The recurrence rate was 2.9% (1/36) in Group A and 48.5% (16/33) in Group B (p < 0.05). Regarding contact/collision athletes, 24 were contained in Group A and 22 in Group B. Of the patients with recurrence in Group B, 13 (59.1%) were contact/collision athletes. Finally, 50% of the contact/collision sports athletes for both groups returned to their sports at the same as pre-injury level. Of the 11 patients who returned to the same level of contact/collision sports in Group B, seven returned with residual instability. Nine athletes in Group A and 3 in Group B quit their sports for personal or social reasons.

Conclusions

Bone graft augmentation was beneficial when used with Arthroscopic Bankart repair for recurrent anterior shoulder instability with glenoid bone loss. Especially, for recurrent anterior shoulder instability with glenoid bone loss in contact/collision sports athletes, bone graft augmentation should be strongly considered as beneficial.

Level of evidence

Level IV.

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Abbreviations

SLAP:

Superior labrum anterior–posterior

3D-CT:

Three-dimensional reconstructed computed tomography

CT:

Computed tomography

ABR:

Arthroscopic Bankart repair

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan

    Norishige Iizawa, Minoru Yoneda, Satoshi Iwashita, Hiroshi Hashiguchi & Shinro Takai

  2. Department of Orthopaedic Surgery, Hoshigaoka Medical Center of Japan Community Health Care Organization (JCHO), 4-8-1, Hoshigaoka, Hirakata, Osaka, Japan

    Shinichi Yamada

  3. Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibahara, Toyonaka, Osaka, Japan

    Naoko Mizuno

  4. Department of Orthopaedic Surgery, Osaka Hospital of Japan Community Health Care Organization (JCHO), 4-2-78, Fukushima, Fukushima-ku, Osaka, Japan

    Kazuki Goto

  5. Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadagaoka, Suita, Osaka, Japan

    Tatsuo Mae

Authors
  1. Norishige Iizawa
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  2. Minoru Yoneda
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  3. Shinichi Yamada
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  4. Naoko Mizuno
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  6. Satoshi Iwashita
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  7. Tatsuo Mae
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  8. Hiroshi Hashiguchi
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Correspondence to Minoru Yoneda.

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This study was approved by the institutional review board of Osaka Hospital of Japan Community Health Care Organization (No. 201855).

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Written informed consent was obtained from all patients.

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Iizawa, N., Yoneda, M., Yamada, S. et al. Benefits of bone graft augmentation to arthroscopic Bankart repair for recurrent anterior shoulder instability with glenoid bone loss. Knee Surg Sports Traumatol Arthrosc 28, 2325–2333 (2020). https://doi.org/10.1007/s00167-019-05746-2

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  • DOI: https://doi.org/10.1007/s00167-019-05746-2

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