Park In, Kim Dong-Hyeon, Shin Sang-Jin
Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
Clin Orthop Surg. 2025 Jun;17(3):470-477. doi: 10.4055/cios24347. Epub 2025 Apr 15.
This study aimed to evaluate the degree of glenoid concavity restoration and its effect on surgical failure after arthroscopic bony Bankart repair for recurrent anterior shoulder instability with a bony Bankart lesion.
Forty-one patients who underwent arthroscopic bony Bankart repair for recurrent anterior shoulder instability with a bony Bankart lesion were retrospectively evaluated. All patients underwent 3-dimensional computed tomography (3D-CT) preoperatively to evaluate the glenoid concavity using the bony shoulder stability ratio (BSSR). Bony fragments were incorporated to the anterior glenoid during arthroscopic stabilization procedure. All patients were reevaluated by 3D-CT at postoperative 1 year to assess the changes in the BSSR and the final glenoid bone defect size after bony Bankart repair. Clinical outcomes including surgical failure were evaluated at least 2 years after surgery.
The BSSR significantly increased after surgery (26.0% ± 14.0% preoperatively and 35.5% ± 13.2% postoperatively, < 0.001). Preoperative glenoid bone defect size was 16.2% ± 8.1%, and bony Bankart fragment size was 11.3% ± 7.2%. Four patients (9.8%) had recurrent instability requiring revision surgery. In patients with surgical failure, the BSSR was not improved after surgery (18.2% ± 13.3% preoperatively and 23.1% ± 17.3% postoperatively, = 0.24). In contrast, patients without surgical failure showed significantly improved BSSR after surgery (26.9% ± 14.0% preoperatively and 36.9% ± 12.2% postoperatively, < 0.001). No significant differences were found in the final glenoid bone defect size (6.6% ± 5.9% in patients with surgical failure vs. 6.2% ± 5.7% in patients without surgical failure, = 0.92) and bony Bankart fragment nonunion rate (0% in patients with surgical failure vs. 5.4% in patients without surgical failure, = 0.99) between patients with and without surgical failure.
Glenoid concavity, as represented by the BSSR, improved after arthroscopic bony Bankart repair, and satisfactory restoration of the glenoid concavity led to successful clinical outcomes without surgical failure. The BSSR could be considered an important factor for predicting clinical outcomes after arthroscopic bony Bankart repair. However, further research including more contributing factors is needed to better analyze the impact of the BSSR on clinical outcomes.
本研究旨在评估关节镜下骨性Bankart损伤修复治疗复发性肩关节前脱位时，肩胛盂凹陷的恢复程度及其对手术失败的影响。
回顾性分析41例行关节镜下骨性Bankart损伤修复治疗复发性肩关节前脱位的患者。所有患者术前均行三维计算机断层扫描（3D-CT），采用骨性肩关节稳定率（BSSR）评估肩胛盂凹陷情况。关节镜下稳定手术过程中将骨块固定于肩胛盂前部。所有患者术后1年行3D-CT复查，评估BSSR变化及骨性Bankart损伤修复术后最终肩胛盂骨缺损大小。术后至少2年评估包括手术失败在内的临床结局。
术后BSSR显著增加（术前26.0%±14.0%，术后35.5%±13.2%，<0.001）。术前肩胛盂骨缺损大小为16.2%±8.1%，骨性Bankart损伤骨块大小为11.3%±7.2%。4例患者（9.8%）出现复发性脱位，需要翻修手术。手术失败患者术后BSSR未改善（术前18.2%±13.3%，术后23.1%±17.3%，=0.24）。相比之下，未发生手术失败的患者术后BSSR显著改善（术前26.9%±14.0%，术后36.9%±12.2%，<0.001）。手术失败组与未失败组患者最终肩胛盂骨缺损大小（手术失败组6.6%±5.9%，未失败组6.2%±5.7%，=0.92）及骨性Bankart损伤骨块不愈合率（手术失败组0%，未失败组5.4%，=0.99）差异均无统计学意义。
关节镜下骨性Bankart损伤修复术后，以BSSR表示的肩胛盂凹陷得到改善，肩胛盂凹陷的满意恢复可带来成功的临床结局，避免手术失败。BSSR可被视为预测关节镜下骨性Bankart损伤修复术后临床结局的重要因素。然而，需要进一步研究包括更多影响因素，以更好地分析BSSR对临床结局的影响。
