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

Abstract

Recurrent anterior shoulder instability with subcritical bone loss is a challenging clinical scenario. Many described treatment options include arthroscopic Bankart repair, arthroscopic Bankart repair plus remplissage, open Bankart, and Latarjet. 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 those with significant glenoid bone loss (>20%), bipolar bone loss (including subcritical bone loss and off-track or "near-track" [8-10mm] Hill-Sachs lesions), and demographic risk factors including young age, hyperlaxity, contact sport participation, and a number of prior dislocations. Treatment algorithms favor arthroscopic Bankart repair plus remplissage or Latarjet for high-risk patients, but go from "A" (arthroscopy) to "C" (coracoid transfer) and forget about the "B" (open Bankart). Open Bankart repair has decreased in use 65% across the U.S. since 2008, while Latarjet popularity has risen 250% over the same timeframe. 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 OASIS trial look at arthroscopic Bankart with or without remplissage versus open Bankart versus Latarjet in the setting of 10%-20% anterior glenoid bone loss. We highly recommend open Bankart in contact athletes with an acute bony Bankart fracture and thoughtfully consider open Bankart in contact athletes with approximately 10% of glenoid bone loss.