This 20-year-old, right hand dominant professional player presented with recurring episodes of pain in his right shoulder. He described more than six episodes where he had landed awkwardly on his outstretched arm and had experienced a ‘dead feeling’ in his arm, followed by pain and restricted movement of his shoulder. The most recent episode occurred after a fall onto his chest with his arm abducted and forward flexed. On examination, the primary findings were a positive anterior apprehension/relocation test, normal axillary nerve function and no evidence of significant glenohumeral joint laxity.
An AP x-ray image shows a fracture involving the inferior glenoid. An MRI arthrogram was conducted with images confirming a large osteo-cartilaginous Bankart lesion. This fracture extends from the 3 o’clock position anteriorly to the 7 o’clock position inferiorly (see image three). There is a small amount of contrast in the defect between the separated anterior labrum and glenoid.
The player was treated with an open stabilisation procedure of his shoulder (Bankart repair). This was due to both the recurring episodes of instability and the associated glenoid fracture. The player opted for an open, rather than arthroscopic, procedure as it was felt that this may result in a lower risk of recurrence. He had an uneventful recovery and was able to return to football approximately five months after his surgery.
A Bankart lesion is an injury to the labrum and associated glenohumeral capsule and ligaments. An osseous or ‘bony’ Bankart occurs when there is also an associated fracture of the adjacent anteroinferior glenoid. Bankart lesions are commonly seen in patients who have sustained an anterior shoulder dislocation. They occur as a direct result of anterior shoulder instability when the posterior humerus strikes the anterior glenoid and labrum. The same mechanism of injury can result in a compression fracture to the posterior humeral head (Hill-Sachs lesion).
Following shoulder instability, imaging studies are crucial not only for detecting glenoid bone defects but also for measuring the amount of ‘bone loss’. These are both important considerations when making decisions about surgical treatment. It is widely thought that patients with an osseous loss involving between 20-25% of the glenoid have a high rate of re-dislocation after arthroscopic Bankart repair and an open procedure should be considered. Recent studies however suggest that good outcomes can still occur after arthroscopic stabilisation in patients with a significant bone loss.
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