Each and every day, patients and surgeons face some difficult problems and treatment choices. In this article, surgeons from the Steadman Philippon Research Institute in Colorado explore the use of an all-arthroscopic Bony Bankart Bridge (BBB) surgical technique for chronic shoulder instability.
Here are a few details to help us understand the significance of this treatment procedure. First, chronic shoulder instability means the shoulder continues to dislocate over and over. Pain, fear of movement that might cause another dislocation, and loss of function for daily activities plague these patients. With each dislocation can come further damage to the soft tissues and especially the bony rim around the shoulder socket.
The result can be bony instability of the anterior glenohumeral joint — in other words a shoulder that dislocates forward. Some people report up to 10 or more repeat dislocations. These microtraumas cause the bony rim around the shoulder socket to break away taking with it the attached soft tissues.
Studies have shown that a loss of 20 per cent (or more) of the bony rim significantly increases contact pressure (bone on bone). This type of bone loss also reduces resistance to dislocation. And with this type of bone deficiency, there is a high rate of failure after surgical repair of the soft tissues.
The Bony Bankart Bridge (BBB) addresses the bone loss by reattaching the bone fragment back into its “donor bed” (original place). A special bridging technique using push-lock knotless suture anchors reconstructs the shoulder and restores stability. There is no hardware where the two bony edges meet (where healing takes place). The surgeon also repairs any soft tissue damage to the capsule, labrum, and glenohumeral ligament. Care is taken to avoid tilting the bony piece, which could lead to over- or under-correcting the problem.
The greatest significance of this technique is that it was done completely by arthroscopic techniques. In other words, no open or large incisions were made to give the surgeon access to the area. All-arthroscopic procedures are becoming more common now even for difficult-to-treat problems like this one. The goal of this treatment is to restore the surface area of the shoulder socket and prevent any more dislocations.
How well does it work? And what are the success/failure rates with the all-arthroscopic Bony Bankart Bridge for chronic anterior shoulder instability? This was a small study (only 15 patients) so the total answer to those questions is not available yet. But the results were still important and significant in helping patients with this diagnosis.
Of the 15 patients included, there was only one failed surgery and that was because the person fell and injured the repaired tissue resulting in a shoulder dislocation. For the rest of the patient group, there were improvements in physical function and better mental health because of reduced pain and increased health-related quality of life. Patient satisfaction was 100 per cent. They could sleep better and return to recreational activities. And best of all, there were no reported complications from the surgery.
The authors concluded that this new all-arthroscopic repair for a mild-to-moderate Bankart lesion can restore shoulder stability. Patients experience significant pain relief and return to normal (or near normal) function. The Bony Bankart Bridge technique may help avoid the high failure rates normally associated with this type of bony reconstruction procedure when they are done with an open incision.