Apparently so. A new study looking at the postoperative recurrence rate after arthroscopic bony Bankart repair found that it was lower in male competitive rugby and American football players with a large glenoid defect, in fact 3x lower, than in those with a small glenoid defect.
In Terms of Glenoid Defects, Does Size Matter?
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Secondary#arthroscopy#boneunionrate#glenoiddefect
The study, “A glenoid defect of 13.5% or larger is not always critical in male competitive rugby and American football players undergoing arthroscopic bony Bankart repair: Contribution of resultant large bone fragment,” was published online in the journal Arthroscopy on August 10, 2021.
All the athletes in the study were treated with arthroscopic bony Bankart repair between July 2011 and December 2018 and were followed for an additional, minimum of two years.
The study collected data from 45 rugby players and 35 American football players. Thirty-eight of the shoulders had a small defect of less than 13.5% while 42 had a large defect of 13.5% or greater.
The complete bone union rate was 47.4% in the small defect group and 71.4% in the large defect group (p = 0.040). Postoperative recurrence occurred in 13 (34.2%) and 5 shoulders (11.9%), respectively (p = 0.30).
Bone fragment size in the small defect group was less than 7.5% in 30 shoulders and greater or equal to 7.5% in 8 shoulders. In the large defect group, however, large fragments of 7.5% or larger were more common (p < 0.001).
The complete union rate was significantly higher in shoulders with a large fragment than those with a smaller one (78.9% vs 42.9%, respectively; p = 0.001). The recurrence rate was 33.3% in shoulders with a small fragment and 10.5% in shoulders with a large fragment and was significantly lower in shoulders with a complete union than in those without a complete union (6.3% vs 46.9%, respectively; p < 0.001).
The authors wrote, “The postoperative recurrence rate after arthroscopic bony Bankart Repair was lower in male competitive rugby and American football players with a large glenoid defect (≥13.5%) than in those with a small glenoid defect (< 13.5%) and might be associated with a higher rate of complete bone union of the resultant large bone fragment (≥7.5%).”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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