Clinical and Radiologic Outcomes of the Bankart Repair Using Mason-Allen (BRUMA) Technique for Small Bony Bankart Lesions: An Objective, Performance Criteria-Referenced, Single-Surgeon Case Series

Background: The optimal management of small bony Bankart lesions remains controversial. The Bankart repair using Mason-Allen (BRUMA) technique uses indirect fragment reduction through capsulolabral retensioning without direct fixation of the bony fragment. Purpose: To evaluate the clinical and radiologic outcomes of the BRUMA technique using literature-derived objective performance criteria (OPC) as external benchmarks. Study Design: Case series; Level of evidence, 4. Methods: The study included 32 consecutive patients with recurrent anterior shoulder instability and anterior glenoid bone loss <25% who underwent BRUMA repair. Clinical outcomes (American Shoulder and Elbow Surgeons [ASES] and Rowe scores) and radiologic outcomes (glenoid defect size on 3-dimensional computed tomography [3D-CT], bony union, and recurrence) were assessed at a mean follow-up of 21.5 ± 8.5 months. All patients underwent postoperative 3D-CT. OPC benchmarks were derived from previously published studies reporting outcomes of arthroscopic Bankart-type techniques for small bony Bankart lesions, excluding bone-block procedures. Results: The mean Rowe score improved by 70.5 ± 12.3 points, significantly exceeding the OPC benchmark of 54.1 ( P < .001). Glenoid defect decreased by 8.9 ± 6.0 percentage points, which was noninferior to the OPC (–10.3%; P = .212). ASES score improved by 19.9 ± 18.2 points, with 68% of patients exceeding the minimal clinically important difference. Bony union rate was 93.8% and recurrence rate was 6.3%. Although the primary confidence interval analysis did not meet all binary OPC thresholds due to small sample size, Wilson score sensitivity analysis confirmed that the union criterion was met. Conclusion: The BRUMA technique demonstrated superior Rowe score improvement and comparable glenoid remodeling relative to OPC benchmarks. A high bony union rate (93.8%) and a low recurrence rate (6.3%), comparable to those reported for other Bankart-type techniques, were observed. These findings suggest that indirect reduction without direct fragment fixation is an effective surgical option for small bony Bankart lesions.