Suture Anchor Fixation of Bony Bankart Fractures

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BACKGROUND: As an alternative to the standard single-point suture-anchor technique, a suture-bridge technique has been described for the treatment of bony Bankart fractures. There is, however, little evidence supporting one technique over the other. Purpose/ HYPOTHESIS: To compare the failure strength, fixation stability, and loading mechanics of the 2 techniques for the fixation of bony Bankart fractures. We hypothesized that use of the double-point suture-bridge technique would result in superior strength and fixation stability because of the increased compression and contact area between the bony fragment and glenoid fracture site. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 16 shoulders (8 pairs) were tested with an intact glenoid, after creation of a 15% bony Bankart fracture, and after fragment fixation using a single-point or suture-bridge technique. Paired specimens were randomly assigned to each technique. Cyclic progressive loading was applied via a materials testing machine to the glenoid concentrically and eccentrically according to a staircase protocol. Failure strength, fragment displacement, glenoid strain load transfer, and contact area were quantified. RESULTS: No significant differences in failure strength were found between the single-point and suture-bridge techniques (mean strength, 74 ± 28 N vs 77 ± 56 N, respectively; P = .91). Additionally, no significant differences were found for glenoid load transfer (P ≥ .318) and glenohumeral joint contact (P = .357) between the 2 techniques. Centralized loading, however, produced significant differences in fragment displacement at 5, 150, and 200 N (P ≤ .045), with the single-point technique permitting greater fragment displacement in all cases (0.06-0.28 mm). Similarly, eccentric loading caused significantly greater fragment displacement with the single-point technique at ≥25 N compared with the suture-bridge technique (mean range, 0.38-0.63 mm vs 0.14-0.19 mm, respectively; .009 ≤ P ≤ .048). CONCLUSION: Single-point and suture-bridge techniques for the fixation of bony Bankart fragments have equivalent failure strengths and load transfers. The suture-bridge technique does provide statistically greater initial fracture fragment stability; however, the clinical implications of this are presently unknown. CLINICAL RELEVANCE: This study will aid in the selection of the optimal repair technique for bony Bankart fractures by providing important insights into the quality of initial fixation and ultimate strength.

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