Single or Double-Row Bankart Repair: Which Is Least Best?

While bony Bankart lesions can be treated successfully arthroscopically, a new cadaveric simulation study finds that the double-row technique significantly increases humeral head cartilage damage.

“Bony Bankart lesions can be encountered during treatment of shoulder instability. Current arthroscopic bony Bankart repair techniques involve intra-articular suture placement,” the researchers of “Chondral Damage After Arthroscopic Repair Techniques for Acute Bony Bankart Lesions: A Biomechanical Study,” wrote.

The study was published online on July 8, 2021, in The American Journal of Sports Medicine. In it the researchers sought to measure the degree of humeral head articular cartilage damage secondary to current arthroscopic bony Bankart repair techniques in a cadaver model.

Thirteen matched pairs of cadaveric glenoids with simulated bony Bankart fractures were used for the study. Each one had a defect width of 25% of the glenoid diameter. Half of the glenoids were repaired with a double-row technique. The researchers used a single-row technique for the contralateral glenoids.

Wear and tear on the cadaveric glenoids were then simulated by subjecting them to 20,000 cycles of internal-external rotation across a 90˚arc at 2 Hz after a compressive load of 750N, or 90% body weight.

The testing showed that both techniques cause macroscopic damage, however, the damage was significantly worse with the double-row repair (mean, 57,489.1 µm²; SD, 61,262.2 µm²) vs. mean, 28,763.5 µm²; SD, 24,4990.2 µm²; p = .036).

“Both single-row and double-row arthroscopic bony Bankart fixation techniques resulted in damage to the humeral head articular cartilage in the concavity-compression model utilized in this study. The double-row fixation technique resulted in a significantly increased cutout to the humeral head cartilage after simulated wear in this cadaveric model,” the researchers wrote.

“While the double-row repair of bony Bankart lesions is more stable, it results in increased cartilage damage. These findings suggest that alternative, cartilage-sparing arthroscopic techniques for bony Bankart repair should be investigated.”