Bankart-Plus zur Behandlung von Patienten mit anteriorer Schulterinstabilität und kleinen bis moderaten Glenoiddefekten

Abstract

Introduction: A large number of patients with shoulder instability also have small or moderate glenoid defects which are below the threshold size requiring bony glenoid reconstruction but are still large enough to compromise the clinical results after conventional soft-tissue stabilization.

Materials and methods: In a prospective cohort study, 30 patients with anterior shoulder instability and small glenoid bone loss (max. 15% surface area) underwent the so-called Bankart plus procedure which includes capsulolabral repair using knotless anchors and interposition of a demineralized cancellous bone matrix (DCBM) between glenoid neck and labrum. Patients underwent preoperative and postoperative (6, 12, and 24 months) clinical assessment including the Western Ontario Shoulder Instability Index (WOSI), Rowe Score (RS), and Subjective Shoulder Value (SSV). Preoperative imaging included a CT scan with 3D reconstruction and measuring of the glenoid defect (Pico method). At 12 months, a follow-up MRI of the operated shoulder was performed to evaluate the integration of the labrum and graft.

Results: A total of 30 patients (average age 28 years [range 18-40], n = 4 female, n = 26 male) fulfilling the inclusion and exclusion criteria were enrolled and underwent surgery with the aforementioned technique between September 2018 and October 2020. In 13 cases (43%), an additional Remplissage was conducted. Preoperative clinical assessment showed the following clinical parameter (mean value): WOSI 45 +/- 17%, RS 56 +/- 10 points, and SSV 57 +/- 19%. Preoperative CT scans showed a mean glenoid defect of 7 +/- 3%. So far 25 patients completed radiological and clinical examinations after 12 months and significant improvement has been observed compared to the preoperative values (p < 0.05). The clinical outcome parameters after 1 year are as follows (mean value): WOSI 81 +/- 15%, RS 91 +/- 8 points, and SSV 87 +/- 10%. No recurrent dislocation, no complications or adverse events have been recorded. MRI revealed good integration of the labrum and graft forming a large bump at the anterior glenoid rim.

Conclusion: The Bankart plus procedure shows promising clinical and radiological results in the short-term follow-up and is a viable treatment option for patients with anterior shoulder instability and small to moderate glenoid defects.