Glenoid bone loss and patient history influence surgical decision-making for bony Bankart lesion: A mid-term follow-up retrospective study.

Background: To analyze how patient history, glenoid bone loss (GBL), and the size of the residual glenoid bone fragment (GBF) influence the choice between arthroscopic Bankart repair and open Latarjet procedure in patients with anteroinferior glenohumeral instability and bony Bankart lesions.

Methods: Review of 290 patients with bony Bankart lesions treated for anterior glenohumeral instability was conducted and patients were categorized into three groups based on GBL and GBF: Group A (GBL < 10% and GBF <10%), Group B (GBL ≥ 10% and GBF <10%), and Group C (GBL ≥10%, GBF ≥10%). Number of preoperative dislocations, time from the first instability, Western Ontario Shoulder Index (WOSI) scores, Hill-Sachs lesion (HSL) location (central or peripheral), HSL track status, and Glenoid Track Instability Management Score (GTIMS) were analyzed.

Results: The study included 231 males and 59 females, with an age range of 17-46 years (mean 26.7). Arthroscopic Bankart repair was primarily performed in patients with GBL <10%. In cases with GBL >10%, an arthroscopic procedure was favored when GBF was >10%. The Latarjet procedure was chosen for patients with GBF <10% and GBL >10%. This group also exhibited the longest time elapsed since dislocation and a higher number of preoperative dislocations. Notably, patients with peripherally located HSLs treated with arthroscopic Bankart repair had significantly worse WOSI scores (p=0.001).

Conclusion: Surgical intervention choices, between Latarjet and ABBR, were primarily influenced by preoperative GBL and GBF size (threshold 10%), time since dislocation, and number of preoperative dislocations. These findings highlight the importance of a personalized approach to surgical planning, considering individual patient characteristics and injury specifics.