Bone Fragment Resorption and Clinical Outcomes | Shoulder - Matthew Provencher, MD | Orthopedic Knee & Shoulder Surgeon

Title:

Bone Fragment Resorption and Clinical Outcomes of Traumatic Bony Bankart Lesion Treated With Arthroscopic Repair Versus Open Latarjet

Authors:

Giovanni Di Giacomo, MD, Mattia Pugliese, MD, MSc, Annalise M. Peebles, BA, Capt. Matthew T. Provencher, MD, MBA, MC, USNR (Ret.)

Abstract:

Background:

Bony Bankart lesions can perpetuate chronic anterior glenohumeral instability. When surgical treatment is pursued, several factors need to be considered to obtain optimal outcomes.

Purpose:

To (1) quantitatively describe patterns of bone fragment resorption and associated risk factors for developing glenoid bone loss (GBL) and (2) to compare clinical and radiological results of attritional bone loss treated with either the arthroscopic Bankart or the open Latarjet procedure.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A retrospective analysis of prospectively collected data was conducted for patients who underwent arthroscopic stabilization (group A1, 10%-20% GBL; group A2, >20% GBL) or open Latarjet (group B, >10% GBL) for recurrent shoulder instability with bony Bankart lesion. Patient characteristics, number of dislocations, and Western Ontario Shoulder Instability Index (WOSI) scores were obtained. Pre- and postoperative computed tomography imaging was used to quantitatively describe patterns of bone fragment resorption.

Results:

A total of 120 consecutive patients (group A1, 40; group A2, 23; group B, 57) were included in the study, with a mean age of 25.6 years (range, 19-35 years). The average follow-up was 5.0 years for all groups (range, 4.83-5.16 years in group A1, 4.58-5.41 years in group A2, and 4.33-5.67 years in group B). The mean times between dislocation event and surgery were 12.8 months (range, 6-32 months) and 13.6 months (range, 6-38 months) for groups A and B, respectively. Redislocation rates were 7.5% in group A1 versus 13.0% in group A2, and only occurred in patients with ≥13.5% GBL. There were no redislocations for group B (0%). Patients had better WOSI scores in group B (234.1 ± 126.9) than in group A (576.1 ± 224.6) (P < .0001). In group A, smaller preoperative bone fragment size displayed a higher percentage of resorption after surgery (r = −0.64; P < .05).

Conclusion:

A significant inverse relationship exists between preoperative bone fragment size and percentage of postoperative resorption. Patients treated with arthroscopic bony Bankart repair who had final GBL ≥13.5% had worse outcomes. When planned GBL approaches 13.5% in high-demand patients, a smaller fragment size can result in worse clinical outcomes because of resorption. In these cases, choosing the open Latarjet procedure leads to better clinical results.

You may request a copy of the full study: Bone Fragment Resorption and Clinical Outcomes of Traumatic Bony Bankart Lesion Treated With Arthroscopic Repair Versus Open Latarjet

Dr. Provencher’s study is also sited in this news publication: Orthopedics This Week

Matthew Provencher, MD | Orthopedic Knee & Shoulder Surgeon | Vail Aspen Denver Colorado Springs, CO

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Matthew Provencher, MD

64 reviews

Gene reiling

Jul 21, 2023

by Gene reiling on Matthew Provencher, MD

Success

If you are planning to see Dr Provencher ,do not hesitate ,do it. In 2018 Dr Provencher replaced my LCL. I had no complications and very little pain. I did my physical therapy as prescribed. I was able to ski 30 plus days the winter of 2019-2020. Before seeing dr Provencher I had spent a years time trying to solve my problem locally. I saw a pain specialist, orthopedic urgent care and a orthopedic surgeon. All had access to an mri done locally. It was also read by local radiologist. Pain dr gave injections as did orthopedic urgent care. No relief from pain. Orthopedic surgeon told me about arthritis, meniscus needing cleaning up and general deterioration from age. Told me to take ibuprofen for pain. At that time I reached out to Steadman Clinic. By luck of the draw I was assigned Dr Provencher. I took with me the mri that had been done locally and viewed by 3 local Drs and 1 PA. It took Dr Provencher less than a minute to tell me my problem was my LCL after viewing my mri. He told me my options . I selected surgery as I wanted to continue an active life style. It was a complete success!!

THEODORE Wirecki

by THEODORE Wirecki on Matthew Provencher, MD

My reverse shoulder replacement

I had my reverse shoulder replacement with Dr.Provencher four months ago. Took an hour, home an hour later. No pain with the meds cocktail, ice machine, and lidocaine pump. My recovery was incredible quick and effortless, no pain and good range of motion. Dr.Provencher is really the best surgeon, and a genuine and kind human being. If you are able to have Dr. Provencher do your shoulder you would be a fool to go anywhere else. The Steadman Clinic is state of the art, extremely efficient, using tranexamic acid intravenously right before surgery to minimize bleeding and many other sophisticated strategies not available in community hospitals. The process and the outcome way exceeded my expectations. If you would like more detail about the experience email me or call on my cell, 3036182303.
Ted Wirecki MD

Alvin Hrubes

Feb 1, 2023

by Alvin Hrubes on Matthew Provencher, MD

My shoulder was ruined in a car accident. I am 82 years old and Dr. Provencher did more than I had ever hoped for. He did a reverse shoulder and at 2 weeks the range of motion exceeded what I had before replacement. He is my hero! Thank you, Dr. Provencher!!

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