Connecting Bone Fragment Resorption to Clinical Outcomes

There is an inverse relationship that exists between preoperative bone fragment size and percentage of postoperative resorption when using Latarjet to repair traumatic bony Bankart lesions, according to a new study.

In the study, “Bone Fragment Resorption and Clinical Outcomes of Traumatic Bony Bankart Lesion Treated With Arthroscopic Repair Versus Open Latarjet,” published in The American Journal of Sports Medicine online on March 4, 2022, researchers compared bone fragment resorption and clinical outcomes between arthroscopic repair versus open Latarjet.

“Bony Bankart lesions can perpetuate chronic anterior glenohumeral instability. When surgical treatment is pursued, several factors need to be considered to obtain optimal outcomes,” the researchers wrote.

For the study, they sought to describe patterns of bone fragment resorption and associated risk factors for developing glenoid bone loss. They also wanted to compare clinical and radiological results of attritional bone loss treated with either the arthroscopic Bankart or the open Latarjet procedure.

Patients were categorized by whether they underwent arthroscopic stabilization or open Latarjet and by the percentage of glenoid bone loss—arthroscopic stabilization (group A1, 10%-20% glenoid bone loss; group A2, >20% glenoid bone loss) or open Latarjet (group B, >10% glenoid bone loss).

The researchers analyzed patient characteristics, number of dislocations, and Western Ontario Shoulder Instability Index scores for each group and subgroup.

One hundred and twenty patients with a mean age of 25.6 years (range, 19-35 years) were included in the study. The average follow-up was 5.0 years for all groups (range, 4.83-5.16 years in group A1, 4.58-5.41 years in group A2, and 4.33-5.67 years in group B).

The mean times between dislocation event and surgery were 12.8 months (range, 6-32 months) and 13.6 months (range, 6-38 months) for groups A and B, respectively. Re-dislocation rates were 7.5% in group A1 versus 13.0% in group A2, and only occurred in patients ≥13.55 glenoid bone loss.

The researchers reported no re-dislocations for group B. Patients had better Western Ontario Shoulder Instability Index scores in group B (234.1 ±126.90) than in group A (576.1 ± 224.6) (p < .0001). In group A, smaller preoperative bone fragment size displayed a higher percentage of resorption after surgery (r = −0.64; p < .05).

“A significant inverse relationship exists between preoperative bone fragment size and percentage of postoperative resorption. Patients treated with arthroscopic bony Bankart repair who had final glenoid bone loss ≥13.55 had worse outcomes. When planned glenoid bone loss approaches 13.5% in high-demand patients, a smaller fragment size can result in worse clinical outcomes because of resorption. In these cases, choosing the open Latarjet procedure leads to better clinical results,” they wrote.

The study authors included Giovanni Di Giacomo, M.D., of Concordia Hospital, Rome, Italy Mattia Pugliese, M.D., of Ospedale Maggiore, Milano, Italy and Annalise M. Peebles and Capt. Matthew T. Provencher, M.D., MC, USNR (Ret.), both of Steadman Philippon Research Institute, Vail, Colorado.