Arthroscopic stabilization procedures based on superoinferior fragment size improved shoulder function in patients with glenoid bone defect with bony fragment

Bony Bankart lesions are a common cause of recurrent anterior shoulder instability, and restoring the bony fragment is critical for glenohumeral joint stability. Although various arthroscopic fixation techniques have been described, there is currently no consensus on the optimal surgical approach based on fragment size. This study aimed to evaluate the clinical and radiologic outcomes after arthroscopic stabilization procedures for glenoid bone defect with bony fragment classified and managed according to the superoinferior (SI) extent of the fragment. Sixty-two patients with symptomatic anterior shoulder dislocation who underwent arthroscopic stabilization procedures with bony fragment were retrospectively reviewed. Patients were classified into three groups according to the SI length of the bony fragment relative to the anterior glenoid border: small (< 1/3), medium (1/3–2/3), and large (> 2/3). Fragment fixation techniques included conventional Bankart repair (group I, n = 20) for small, modified Mason–Allen repair (group II, n = 20) for medium, and double-row bridge fixation (group III, n = 22) for large fragment. Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) and Rowe scores, and three-dimensional computed tomography (3D-CT) was performed at 1 year postoperatively to assess radiologic parameters. All groups demonstrated significant postoperative improvement in ASES and Rowe scores ( p < 0.001). The mean fragment resorption rate decreased as fragment size increased (45.5%, 23.1%, and 13.2% for Groups I, II, and III; p < 0.001). No significant differences were found in nonunion rates ( p = 0.118), partial union rates ( p = 0.157), and shoulder functional recovery (ASES, p = 0.595 and Rowe score, p = 0.485) among the groups. The overall recurrence rate was 6.4% (group I, 10%; group II, 5%; and group III, 4.5%, p = 0.734). Postoperative osteoarthritis was observed in 4 of 22 patients (18.1%) in group III ( p = 0.105). SI extent-based arthroscopic stabilization procedures achieved adequate bone healing and functional improvement with a low recurrence rate in patients with glenoid bone defect and a bony fragment. The SI extent-based classification provided a simple and reproducible assessment of the bony fragment, which assisted in surgical planning and contributed to favorable postoperative outcomes. Level III Retrospective cohort study.