Editorial Commentary: Open Bankart Procedure for Anterior Shoulder Instability Is Recommended for Contact Athletes With Bony Bankart Fractures or Approximately 10% Glenoid Bone Loss.

Recurrent anterior shoulder instability with subcritical bone loss is a challenging clinical scenario. Many treatment options have been described, including arthroscopic Bankart repair, arthroscopic Bankart repair plus remplissage, open Bankart repair, and the Latarjet procedure. Arthroscopic Bankart repair alone has higher rates of failure in high-risk patient populations, especially at long-term follow-up. These high-risk populations include patients with significant glenoid bone loss (>20%), bipolar bone loss (including subcritical bone loss and off-track or "near-track" [8-10 mm] Hill-Sachs lesions), and demographic risk factors including young age, hyperlaxity, contact sports participation, and number of prior dislocations. Treatment algorithms favor arthroscopic Bankart repair plus remplissage or the Latarjet procedure for high-risk patients, but they go from "A" (arthroscopy) to "C" (coracoid transfer) and forget about "B" (open Bankart repair). Open Bankart repair has decreased in use by 65% across the United States since 2008, whereas the popularity of the Latarjet procedure has risen by 250% over the same time frame. With its reported success at long-term follow-up (1.6%-17.5% failure rates at 17-21 years), open Bankart repair must be reconsidered for properly indicated patients. Ongoing large-scale multicenter trials such as the Open Versus Arthroscopic Surgery for Shoulder Instability (OASIS) trial are looking at arthroscopic Bankart repair with or without remplissage versus open Bankart repair versus the Latarjet procedure in the setting of 10% to 20% anterior glenoid bone loss. We highly recommend open Bankart repair in contact athletes with an acute bony Bankart fracture and thoughtfully consider open Bankart repair in contact athletes with approximately 10% glenoid bone loss.