Editorial Commentary: Improving Arthroscopic Bankart Repair Outcomes in Patients With Subcritical Bone Loss: Does Giving Up a Little (Cartilage), Give Us a Lot (of Stability)?

Abstract

Over the past 3 decades, arthroscopic Bankart repair has become the gold standard for anterior shoulder instability in the absence of significant bone loss. Glenoid curettage may seem unusual in the setting of Bankart repair, but the advantage of a bleeding bony surface in reconstructive procedures is nearly universal in sports medicine, from cartilage restoration in the knee to rotator cuff repair. Intuitively, maximizing the surface of bleeding bone should improve healing, but is it really necessary to remove undamaged cartilage to create a healing response? Perhaps not in general, but in high-risk patients with subcritical bone loss curettage it could make sense. It has been well established that as the amount of bone loss drifts above 10%, recurrent instability after standard Bankart repair begins to rise. For many surgeons, the amount of glenoid and humeral bone loss in this patient population would encourage additional stabilizing measures in the form of Latarjet or Bankart repair with the addition of remplissage. Anterior glenoid cartilage curettage could be an additional tool when treating patients in subcritical bone loss. Removing 5 mm of glenoid cartilage may allow for anchor placement further posterior on the glenoid face, thus further closing off of the anterior glenohumeral joint space while providing potential added biologic benefit of increased bone to capsulolabral apposition. The addition of remplissage could further enhance stability and help hold the humeral head posteriorly and perhaps obviate the need for a bone block procedure.