APEX Shoulder Mastering Surgical Techniques for Clinical Success-When is a Bankart Not Enough? Factors to Consider

Video Transcription

Video Summary

In this video, Dr. Michael O'Brien from Tulane University discusses the topic of when the soft tissue Bankart procedure is not enough in terms of factors to consider. He mentions that significant glenoid bone loss is the most common cause of failure for arthroscopic Bankart repairs. He identifies several factors that indicate when the soft tissue repair may not be sufficient, including glenoid bone loss over 40%, bipolar defects with an engaging Hill-Sachs defect, revision surgery, ELPS lesions, Haggle lesions, collagen tissue disorders, and ligamentous laxity. He focuses on glenoid bone loss between 10% and 20%, which he refers to as subcritical bone loss. He explains that for glenoid bone loss less than 10%, an arthroscopic Bankart repair is usually successful, while bone augmentation procedures like Latter-Jay are more appropriate for 20% to 30% bone loss. For more extensive bone loss, a distal tibia allograft or iliac crest allograft may be considered. Dr. O'Brien also discusses the importance of history, physical examination, and imaging in determining the appropriate treatment. He highlights the use of modalities like rump lesion, latter-Jay, and arthroscopic anatomic glenoid reconstruction, and provides insights from various studies comparing these procedures in terms of recurrence rates, patient-reported outcomes, complication rates, and other factors. He concludes by emphasizing the need for early intervention and prevention of recurrent instability.

Asset Caption

Michael O’Brien, MD

Keywords

glenoid bone loss

arthroscopic Bankart repair

soft tissue Bankart procedure

bone augmentation procedures

recurrent instability