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Skeletal Lesions

The limited constraint provided by the glenoid is further decreased by bony lesions of the anterior or posterior glenoid rim. These lesions may result from an osseous (anterior or posterior) Bankart lesion, a displaced glenoid fracture, or wear and erosion of the glenoid rim as a result of multiple recurrent dislocations. Burkhart and De Beer reported on 194 consecutive arthroscopic Bankart repairs using a suture anchor technique with an average of 27 months follow-up.

The 173 patients without significant bone defects sustained 4% recurrence rate, whereas 21 patients with significant bone defects (either glenoid rim fractures resulting in inverted-pear shaped glenoids or humeral engaging Hill-Sachs lesions) sustained a 67% recurrence rate. The authors concluded that restoring bony anatomy is imperative for preventing recurrence and that arthroscopic Bankart repairs should not be performed in patients with the aforementioned significant bone defects.

Gerber et al.They have reported their clinical experience, which suggests that if a defect involves more than 25% of the glenoid surface, it should be repaired with intra-articular bone grafting. Gerber and Nyffeler demonstrated a method for quantifying the degree of glenoid bone loss with computed tomography (CT) scan by measuring the glenoid surface on either an oblique sagittal image or a three-dimensional reconstruction.

Through biomechanical testing, they determined that the force required for anterior dislocation is reduced by 70%, compared with that required when the glenoid is intact, if the length of the glenoid defect exceeds the radius. The goal of surgery is to increase the glenoid constraint and provide support for the joint capsule; however, in cases of excessive glenoid bone loss, standard Bankart repairs (arthroscopic or open) are likely to fail, and osseous augmentation is recommended.

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