Summary

This study compared the safety and outcomes of arthroscopic anatomic glenoid reconstruction (AAGR) and Bankart repair for patients with recurrent shoulder instability, finding that AAGR has a similar safety profile and lower recurrence rates, making it a viable option for those with subcritical bone loss.

Abstract

Purpose

Arthroscopic anatomic glenoid reconstruction (AAGR) is an increasingly popular treatment approach for shoulder instability. Promising retrospective results demonstrate AAGR has a similar safety profile to a Bankart repair, while demonstrating low recurrence rates similar to a Latarjet. Although Bankart repair is the traditional treatment for subcritical bone loss, there are ongoing debates in the literature surrounding the best procedure to achieve optimal patient outcomes. In this single center, double blinded, randomized controlled trial, we aimed to compare the safety profile of arthroscopic Bankart repair vs. AAGR as well as explore graft remodeling in the AAGR population.

Method

Patients aged between 16 to 60 who experienced recurrent anterior shoulder instability with subcritical bone loss were considered for enrollment. Patients were included if they experienced 2 or more anterior shoulder dislocations with subcritical glenoid bone loss <20%. Glenoid bone loss was determined from preoperative CT scan. Patients were randomized into two groups, Bankart or AAGR, preoperatively and were analyzed if they had a minimum of 12-month follow up. Safety profiles were evaluated for intraoperative, perioperative and postoperative complications. CT imaging was conducted after 6 months postoperatively for individuals randomized to AAGR to assess graft healing and remodeling. Graft resorption was assessed using the modified Zhu classification.

Results

This study included 80 participants who underwent arthroscopic Bankart repair and 73 participants who underwent arthroscopic AAGR. Similar demographics were demonstrated with no differences in age, BMI, clinical follow-up time, and preoperative glenoid bone loss between groups. Neither group reported intra-operative or perioperative complications. Fifteen percent of participants who received a Bankart repair experienced a re-dislocation whereas no AAGR participants experienced re-dislocation (p>0.01). One individual (1.4%) in the AAGR group required reoperation for hardware complications (p>0.05). In the AAGR group, 100% of patients demonstrated graft healing with 97% of grafts appropriately positioned in the ideal 3-5 o’clock location in the sagittal plane. Eighty-eight percent of participants experienced less than 50% resorption with allograft resorption occurring equally from the superior to inferior portion of the graft.

Conclusion

AAGR demonstrates an excellent safety profile comparable to Bankart repair with no associated incidence of recurrent dislocation. AAGR graft remodelling appears to reform the native glenoid architecture. In conclusion AAGR should be considered as a surgical option for patients with subcritical bone loss to reduce instances of recurrent instability.