Arthroscopic Bony Bankart Repair and Glenoid Reconstruction is a technique developed by Dr. Chudik to address shoulder instability complicated by glenoid bone loss. The procedure repairs or rebuilds the bony rim of the socket through small arthroscopic incisions, restoring shoulder stability without the larger open surgery that conventional treatment requires. Dr. Chudik designed both the procedure and the specialized instruments used to perform it.
What Is Arthroscopic Bony Bankart Repair and Glenoid Reconstruction?
A traumatic shoulder dislocation can fracture a piece of bone off the glenoid rim, producing a bony Bankart lesion. The humeral head is normally stabilized in the glenoid by a combination of muscles, the labrum, and ligaments. When the humerus is forced out of place during a dislocation, soft tissues stretch or tear, and bone can fracture off the glenoid rim.
Dislocations that produce bony Bankart lesions leave the shoulder unstable and prone to recurrent dislocation. With each subsequent dislocation, additional glenoid bone can erode, decreasing the surface on which the humeral head sits. Repair of the supportive soft tissues alone is inadequate when significant bone loss is present, because the glenoid must also be rebuilt to restore the bony foundation that the labrum and capsule attach to.
Dr. Chudik’s procedure addresses both elements through arthroscopic surgery: it repairs or replaces the missing glenoid bone using a bone graft, repairs the torn soft tissues, and restores stability. CT scans are used preoperatively to quantify the percentage of glenoid bone loss and plan the reconstruction.
Development Rationale
Conventional treatment of shoulder instability with glenoid bone loss has historically required open surgery (the Latarjet or iliac crest bone block procedures), which involves a larger incision, more soft-tissue disruption, and greater complication risk than arthroscopic Bankart repair. For surgeons not equipped to perform bony reconstruction arthroscopically, the alternative was either an open procedure or accepting a high recurrent-dislocation rate after soft-tissue-only repair in patients with bone loss.
Dr. Chudik developed an arthroscopic technique and instruments that allow the bony component of Bankart instability to be addressed through the same small portals used for routine arthroscopic Bankart repair. The technique:
- Avoids the open exposure and additional soft-tissue disruption of conventional bone-block procedures
- Permits placement of the bone graft under direct arthroscopic visualization
- Uses a specialized repair guide of Dr. Chudik’s design to position and fix the bone graft accurately
- Allows simultaneous repair of the torn labrum and capsule
The procedure addresses the clinical reality that soft-tissue Bankart repair alone has unacceptably high recurrence rates when glenoid bone loss exceeds approximately 13 to 15 percent.
Who Is a Candidate?
Candidates typically have:
- Pain and instability following a shoulder dislocation with a bony Bankart injury
- Recurrent shoulder dislocations with documented glenoid bone loss
- Active patients who require stable shoulder mechanics for sport, work, or daily activity
- Imaging (CT or MRI) confirming significant glenoid bone deficiency
Candidates without significant bone loss are typically treated with standard arthroscopic Bankart repair instead.
How the Procedure Is Performed
The procedure is performed arthroscopically through small portals around the shoulder. The arthroscopic camera visualizes the shoulder joint and the bone-deficient glenoid. The torn labrum and capsule are mobilized and prepared.
A bone graft (typically iliac crest autograft or distal tibia allograft, depending on case planning) is introduced through a portal and positioned along the deficient anterior glenoid using Dr. Chudik’s specialized arthroscopic repair guide. The guide allows precise placement and orientation of the graft. The graft is fixed to the native glenoid with screws.
The torn labrum and capsule are then repaired to the reconstructed glenoid rim with suture anchors, restoring both the bony foundation and the soft-tissue stabilizers in a single arthroscopic procedure.
The procedure is performed as outpatient surgery under general anesthesia with an interscalene block.
Recovery and Rehabilitation
Recovery follows the same protected protocol as standard arthroscopic Bankart repair, with attention to bone graft healing:
- Sling at all times for six weeks except for bathing, dressing, and exercises, especially while sleeping
- Sleeping upright on a couch or recliner is often more comfortable
- Wound care: clean and dry for three days; light showering after three days; no submersion under water for three weeks
- Driving typically resumes at six weeks once out of the sling
- Return to school or sedentary work in less than one week while in the sling
- Physical therapy begins two to three days after surgery and continues for four to six months
Return to sport or strenuous labor requires at least four to six months and full restoration of shoulder motion and strength.
Risks and Outcomes
Specific surgical risks include:
- Infection
- Rare nerve injury of the shoulder, arm, or hand
- Stretching of the Bankart repair and ligaments over time or with repeat injury
- Breakage of internal fixation devices
- Further fracture of the glenoid with a subsequent dislocation mechanism
- Uncommon shoulder stiffness
- Persistent pain with activities
- Need for revision surgery or hardware removal
- Arthritis
Outcomes for the developed arthroscopic technique compare favorably with conventional open bone-block procedures while avoiding the larger incision and additional soft-tissue disruption.
Why Dr. Chudik for Arthroscopic Bony Bankart Repair and Glenoid Reconstruction
Dr. Chudik designed both the procedure and the instruments used to perform it. The technique allows shoulder instability with glenoid bone loss to be addressed arthroscopically, where conventional treatment requires open surgery. For patients who would otherwise face a larger open bone-block procedure, the arthroscopic approach offers comparable structural restoration with the recovery profile of arthroscopic surgery.