Clinical Outcomes of Arthroscopic Bankart Repair with Soft-Tissue Augmentation in Patients with Significant Glenoid Bone Loss: Is Non-Bony Reconstruction Sufficient?

Background. To evaluate the clinical and functional outcomes of arthroscopic Bankart repair (ABR) sup­ple­mented with soft-tissue augmentation in patients stratified by varying severities of glenoid bone loss (GBL). Material and methods. A retrospective cohort study was conducted on 37 patients undergoing ABR for recurrent traumatic anterior shoulder instability. GBL was quantified via preoperative CT using the best-fit circle method. Patients were stratified into three groups: Mild (<13.5%, n=15), Subcritical (13.5%–20%, n=8), and Critical (>20%, n=14). All “off-track” lesions received a concomitant remplissage procedure. Primary out­comes included the Western Ontario Shoulder Instability (WOSI) Index, Rowe scores, and recurrence of in­stability at a minimum 6-month follow-up. Results. Baseline demographics and instability chronicity were comparable across all groups. Critical GBL (>20%) was significantly associated with off-track lesions and the performance of a remplissage procedure (p = 0.025). Despite the higher magnitude of osseous deficiency, there were no significant differences in recur­rence rates (p = 0.875) or postoperative functional outcomes (WOSI, p = 0.700; Rowe, p = 0.856) among the three cohorts. High rates of “Good-to-Excellent” outcomes were maintained across the spectrum, with 64.2% of the critical bone loss group achieving excellent postoperative WOSI scores. Conclusions. 1. Arthroscopic Bankart repair supplemented with selective remplissage for off-track lesions was associated with satisfactory short- to mid-term stability and functional outcomes in this small cohort, in­cluding selected patients with >20% glenoid bone loss. 2. However, given the limited sample size in the critical bone-loss group and the small number of remplissage cases, these findings should be interpreted cautiously and should not be taken to conclude that bony augmentation procedures are unnecessary. 3. Larger comparative stu­dies with longer follow-up are required.