Arthroscopic Approach to Acute Bony Bankart Lesion Giuseppe Porcellini, M.D., Fabrizio Campi, M.D., and Paolo Paladini, M.D. Purpose: To report on an arthroscopic approach to a bony Bankart lesion that uses a modified Bankart technique to fix the avulsed bone fragment to the healthy glenoid. Type of Study: Case series study. Methods: Of 250 patients who received surgical treatment for shoulder dislocation at our unit, 25 sport-practicing patients with acute traumatic dislocation of the shoulder and anterior glenoid rim fracture were included in this study. Inclusion criteria were bony Bankart lesions less than 3 months old and involving less than 25% of the glenoid, absence of associated lesions, and follow-up longer than 2 years. Arthroscopic procedures were performed using a modified Bankart technique to fix the avulsed bone fragment to the healthy glenoid rim using suture anchors. A modified Rowe score was devised for evaluating range of motion outcomes. Results: Shoulder function and stability were restored in 23 patients (92%) by 2 years after surgery. There was no recurrence of instability. Range of motion was minimally reduced. All patients resumed sports activities: 23 (92%) at the same level of performance as before surgery and 2 (8%) at a lower level because of 20° loss of external rotation. Conclusions: This arthroscopic technique seems to offer an optimal method for evaluating and treating isolated acute bony Bankart lesions involving less than 25% of the glenoid. Key Words: Shoulder instability—Arthroscopy—Bony Bankart lesion— Glenoid fracture. B ony Bankart lesion is an avulsion of the gleno- humeral labral complex associated with an ante- rior glenoid rim fracture (Fig 1). It may occur as a consequence of a traumatic glenohumeral dislocation with forces applied to the glenoid fossa through the humeral head, 1 or when dislocation occurs with the arm adducted. 2 The incidence of anterior glenoid rim fractures associated with anterior dislocation ranges from 5.4% to 44%. 3-7 Rowe and Zarins 8 were the first to mention bony Bankart lesions associated with clas- sic Bankart lesion; subsequently, Bigliani et al. 1 stud- ied glenoid rim fracture and capsular quality. They classified bony Bankart lesions as type I, a displaced avulsion fracture with attached capsule; type II, a medially displaced fragment malunited to the glenoid rim; and type III, erosion of the glenoid rim with less than 25% (type IIIA) or greater than 25% (type IIIB) deficiency. In the same work, Bigliani et al. suggested treatment guidelines with the goal of reducing the risk of dislocation recurrences. Different approaches have been recommended to treat these anterior glenoid frac- tures: Arciero et al. 9 observed recurrence of disloca- tion in 80% of patients with classic or bony Bankart lesion treated with nonsurgical methods. De Palma 7 recommended that anterior glenoid fractures displaced by at least 10 mm and involving 25% of the glenoid surface be treated surgically, with open reduction and internal fixation. Gazielly and Godeneche 10 proposed a coracoid process transfer in cases in which definite radiographic evidence of a bone lesion of the glenoid is found. Moreover, according to Ideberg, 11 these frac- tures are always associated with recurrent subluxation or dislocation, and Cameron 12 reported that, even if the fragment does not exceed 25% of the entire gle- noid area, it is consistently associated with persistent instability. An open surgical procedure is currently the treatment of choice for these lesions, 1 although the open anterior approach to the shoulder joint entails some morbidity. 12 Heggland and Parker 13 first at- From the Unit of Shoulder and Elbow Surgery, Centro di Chiru- rgia della Spalla, Villa Serena, Forli, Italy. Address correspondence and reprint requests to Giuseppe Por- cellini, M.D., Centro di Chirurgia della Spalla, Villa Serena, Via del Camaldolino 8, 47100 Forli, Italy. E-mail: gporcellini@tin.it © 2002 by the Arthroscopy Association of North America 0749-8063/02/1807-3101$35.00/0 doi:10.1053/jars.2002.35266 764 Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 7 (September), 2002: pp 764 –769