Clinical and radiological outcomes of arthroscopic bony Bankart repair using the 'door-locking' technique: excellent bone healing with a low complication rate.

Background: Arthroscopic repair is recommended for patients with bony Bankart lesions to restore anterior shoulder stability and avoid recurrent glenohumeral instability. The aim of this study was to investigate the clinical and radiological outcomes of patients following arthroscopic bony Bankart repair using a single suture anchor fixation technique named the "door-locking" technique.

Methods: From January 2017 to February 2024, a consecutive series of 22 patients with acute bony Bankart lesions underwent shoulder arthroscopy. The size of the fragment was measured using computed tomography (CT). The range of motion (ROM) and functional scores including the American Shoulder and Elbow Surgeons (ASES) score, the University of California, Los Angeles (UCLA) score, and Rowe score were assessed preoperatively, immediately after the surgery, and at the final follow-up. The adequacy of reduction and union of the bony fragment were evaluated by CT postoperatively. Intra- and postoperative complications and patient satisfaction were evaluated.

Results: Four women and 18 men were included in the study, with an average age of 39.4 years (range, 21-68 years). The mean time from the initial injury to surgery was 16.5 days (range, 3-45 days). The average glenoid bone defect was 21.1% (range, 9%-45%). The operation time ranged from 45-150 minutes, with an average of 80.4 minutes. The mean duration of follow-up was 28.0 months (range, 4-54 months). The mean ASES score, UCLA score, and Rowe score improved from 42.1, 11.6, and 56.0 preoperatively to 91.8, 31.1, and 93.2 at the last follow-up, respectively (all P < 0.05). At the final follow-up, the ROM in terms of forward elevation, external rotation, and internal rotation was significantly improved compared with that before surgery. There was no recurrence of instability. No serious complications (e.g., infection, thrombosis, and re-dislocation) occurred. The postoperative CT scan showed adequate reduction and complete union of the bony fragment in 20 cases. However, the bony fragments were not anatomically reduced in two patients due to a large fragment size. All patients were satisfied or very satisfied with the outcome.

Conclusion: The arthroscopic "door-locking" technique is a valid method for treating acute bony Bankart lesions with an intact capsular-labrum-ligament complex. This method has a low complication rate and is associated with high levels of patient satisfaction.