Title : Short-term outcomes of arthroscopic treatment for concomitant bony bankart lesions and massive rotator cuff tears in middle-aged and elderly patients
Abstract:
Objective: To investigate the surgical technique and postoperative outcomes of simultaneous repair of bony Bankart lesions combined with rotator cuff tears using suture anchor technology under shoulder arthroscopy.
Methods: From June 2021 to January 2023, a total of 10 middle-aged and elderly patients with combined bony Bankart lesions and rotator cuff tears were treated. The cohort included 6 females and 4 males, with an average age of 59.5 years (range, 56-72 years). All patients had a history of anterior shoulder dislocation caused by traffic accidents or accidental falls. Eight patients were directly admitted to the hospital following emergency CT examination that revealed bony Bankart lesions, while 2 patients were admitted after experiencing redislocation following emergency reduction at home. All 10 patients were definitively diagnosed with concurrent bony Bankart lesions and full-thickness massive rotator cuff tears (involving the subscapularis, supraspinatus, and infraspinatus) through X-ray, three-dimensional CT, and MRI. All patients underwent primary simultaneous repair of both injuries under arthroscopy. During the procedure, suture anchors were first used to fix the bony Bankart lesion, followed by anchors for total or partial repair of the torn rotator cuff.
Results: The average follow-up period for the 10 patients was 17.5 months (range, 12-30 months). At the final follow-up, all patients achieved bony Bankart healing, although 2 cases showed slight displacement; no patient experienced recurrent shoulder dislocation. Abduction and elevation functions returned to near-normal in 7 patients, with MRI follow-up showing good rotator cuff healing. Three patients had mild limitation in postoperative shoulder abduction and elevation; MRI at 3 months post-surgery indicated partial rotator cuff non-healing or re-tear. The Visual Analogue Scale (VAS) pain score significantly improved postoperatively compared to preoperatively (1.6±1.2 vs 7.2±1.7). According to the University of California at Los Angeles (UCLA) shoulder rating scale, the mean score improved from 18.6±4.5 preoperatively to 33.4±4.3 postoperatively, with a statistically significant difference (P<0.05).
Conclusion: In middle-aged and elderly patients with shoulder dislocation, X-ray, three-dimensional CT, and MRI examinations are recommended. When bony Bankart lesions and rotator cuff tears coexist, arthroscopic repair of both injuries yields positive short-term outcomes.
