Case Study: 24M Recurrent Shoulder Instability
A computed tomography image of a 24-year-old banker who has recurrent shoulder instability demonstrates 6% bone loss of his glenoid. His first dislocation occurred as a teenager while snowboarding. This first dislocation required a relocation in the emergency department. He has now sustained his fourth dislocation, with each subsequent dislocation relocated himself. What is the most appropriate definitive treatment?
A. Immobilization in external rotation for 6 weeks
B. Arthroscopic bony Bankart repair
C. Arthroscopic Bankart repair
D. Arthroscopic Remplissage procedure
E. Glenoid augmentation using coracoid transfer
What is this type of shoulder instability?
What is the most appropriate definitive treatment?
Could something have been done differently?
Answer: B. Arthroscopic bony Bankart repair
This patient has recurrent shoulder instability with a small bony defect of the anterior glenoid. He has had no previous surgery. The best answer for this patient is an arthroscopic bony Bankart repair.
Patients older than >20 years old, recreational athletes with minor glenoid bone loss (<20% of the glenoid surface area) may be treated with soft tissue stabilization with suture anchors to repair the torn ligament and labrum to the glenoid. Younger, contact sports athletes with large glenoid defects (>20%) may require bony augmentation type of procedures, such as a Latarjet procedure.