Speaker: Small bony Bankart lesions are consequential

WAIKOLOA, Hawaii — Arthroscopic fixation can be a treatment option for patients with bony Bankart lesions, according to presenter here at Orthopedics Today Hawaii 2016.

“Biologically you have to understand these patients well. Not all bone lesions are created equal, and the glenoid track is an important concept and, in my mind, Remplissage here to stay” John D. Kelly IV, MD, said. “Your goal is to restore native anatomy. Do not go to non-anatomic things right away.”

He said there is a powerful negative synergy between glenoid bone loss and humeral loss, and even small bony Bankart lesions are consequential.

“The take-home point more than anything else is that if you see a bony Bankart, then you have to fix it,” Kelly said.

John D. Kelly IV

He said the treatment algorithm presented by DiGiacomo, Itoi and Burkhart in Arthroscopy last year was a “real game changer.” According to the algorithm, Kelly said that if the patient has less than 25% glenoid bone loss and the Hill-Sachs lesion is on track, then the surgeon can safely scope a Bankart lesion.

“If your glenoid bone loss is less than 25% and you have an off-track lesion, then you can scope a Bankart, but you better address that Hill-Sachs through Remplissage. If you have more than 25% with an on-track lesion, then you better do Latarjet. If have more than 25% with an off-track lesion, use Latarjet. Then you check engagement and non-engaging. If use there is no engagement, then you can add a Remplissage to that. That is sort of optional,” he said. – by Kristine Houck, MA, ELS

Reference:

Kelly KD. Bipolar bone deficiency: Guiding treatment algorithm. Presented at: Orthopedics Today Hawaii 2016; Jan. 10-14, 2016; Waikoloa, Hawaii.

Disclosure: Kelly reports no relevant financial disclosures.