Biomechanical Comparison of Arthroscopic Single- and Double-Row Repair Techniques for Acute Bony Bankart Lesions

Abstract

Background: Single- and double-row arthroscopic reconstruction techniques for acute bony Bankart lesions have been described in the literature.

Hypothesis: The double-row fixation technique would provide superior reduction and stability of a simulated bony Bankart lesion at time zero in a cadaveric model compared with the single-row technique.

Study design: Controlled laboratory study.

Methods: Testing was performed on 14 matched pairs of glenoids with simulated bony Bankart fractures with a defect width of 25% of the glenoid diameter. Half of the fractures were repaired with a double-row technique, while the contralateral glenoids were repaired with a single-row technique. The quality of fracture reduction was measured with a coordinate measuring machine. To determine the biomechanical stability of the repairs, specimens were preconditioned with 10 sinusoidal cycles between 5 and 25 N at 0.1 Hz and then pulled to failure in the anteromedial direction at a rate of 5 mm/min. Loads at 1 mm and 2 mm of fracture displacement were determined.

Results: The double-row technique required significantly higher forces to achieve fracture displacements of 1 mm (mean, 60.6 N; range, 39.0-93.3 N; P = .001) and 2 mm (mean, 94.4 N; range, 43.4-151.2 N; P = .004) than the single-row technique (1 mm: mean, 30.2 N; range, 14.0-54.1 N and 2 mm: mean, 63.7 N; range, 26.6-118.8 N). Significantly reduced fracture displacement was seen after double-row repair for both the unloaded condition (mean, 1.1 mm; range, 0.3-2.4 mm; P = .005) and in response to a 10-N anterior force applied to the defect (mean, 1.6 mm; range, 0.5-2.7 mm; P = .001) compared with single-row repair (unloaded: mean, 2.1 mm; range, 1.3-3.4 mm and loaded: mean, 3.4 mm; range, 1.9-4.7 mm).

Conclusion: The double-row fixation technique resulted in improved fracture reduction and superior stability at time zero in this cadaveric model.

Clinical relevance: This information may influence the surgical technique used to treat large osseous Bankart fractures and the postoperative rehabilitation protocols implemented when such repair techniques are used.

Keywords: arthroscopic repair; bony Bankart lesion; double-row repair; glenoid rim fracture; single-row repair.