Greater Glenoid Chondral Lesion Extent and Lack of Labral Coverage Are Associated With the Development of Radiographic Osteoarthritis After Arthroscopic Bankart Repair

PURPOSE: To classify glenoid chondral lesions based on their spatial relation to the glenoid bare area and to investigate the association between lesion extent, postoperative coverage status, and radiographic glenohumeral osteoarthritis after arthroscopic Bankart repair. METHODS: Patients who underwent arthroscopic Bankart repair between 2015 and 2022 were included retrospectively. Patients were eligible if they had symptomatic recurrent anterior shoulder instability and completed at least a 2-year follow-up. All patients had no radiographic osteoarthritis preoperatively. Glenoid chondral lesions were classified by anterior extension relative to the bare area arthroscopically. A reference line was defined connecting the bare area to the 3-o'clock position of the glenoid, and a perpendicular line at the midpoint of this distance was used to demarcate the anterior half; lesions confined within this boundary were classified as group 1, lesions extending beyond this boundary but remaining anterior to the bare area were classified as group 2, and lesions extending beyond the bare area were classified as group 3. Postoperative labral coverage status was assessed. Radiographic osteoarthritis was defined as Samilson-Prieto grade ≥1. RESULTS: Glenoid chondral lesions were present in 165 of 293 shoulders (56.3%). Compared with those without lesions, patients were older (P = .001), had more dislocations (P = .001), and had higher rates of bony Bankart lesions (P = .001). After repair, all group 1 lesions (n = 144) were covered by the repaired labrum, whereas 73.3% of group 2 (n = 15) and all group 3 (n = 6) remained uncovered (P = .001). At a mean follow-up of 27.1 ± 7.6 months (range, 24-47 months), radiographic osteoarthritis developed in 6.9% of group 1, 40.0% of group 2, and 66.7% of group 3 (P = .001). Multivariate analysis showed that older age (P = .005), greater lesion extent (P < .001), and uncovered lesions (P < .001) were independent predictors of radiographic osteoarthritis. CONCLUSIONS: The extent of glenoid chondral lesions and lack of postoperative labral coverage were associated with the development of radiographic osteoarthritis after arthroscopic Bankart repair at a minimum of 2-year follow-up. LEVEL OF EVIDENCE: Level III, retrospective cohort study.