Bankart lesion

I think one of the things that's great about this group is that it's a bunch of high-volume academic research-involved people.

What I learned from some of my mentors through fellowship was, as you enter practice, template your op note or at least set up your op notes in such a way just expecting that in 5, 10, 15 years from now, someone's going to go back and look at it and remember what it was like when you were a resident or a fellow and went back and looked at charts and How nice would it be if you had all this data kind of ready to go and less requirement for subjective interpretation? Kind of for all the clinical conditions that I treat, meniscus ACL, patellofemoral, OCD, Bankart, things like that, I've kind of created for myself variables that I think are most important.

And I almost like template them right into the top of my note.

For OCDs, for instance, I'll have ICRS grade, rock arthroscopic classification.

So that's neither here nor there.

What do we do? We don't have an X-ray, but we see this, and we have our gestalt, our, our gut says, "Oh yeah, this is dislocated." So traumatic anterior shoulder dislocations or instability, th- we also call, like, TUBBS, uh, traumatic unilateral dislocations with Bankart lesions, they require dis- uh, reduction.

Basically, the anterior force, whatever they did, the mechanism of injury, pushes it anteriorly in front of the glenoid, and it dislocates.

A posterior dislocation does happen, but it's, it's more rare than an anterior dislocation.

Okay? So you either don't think it's dislocated, uh, and then, or five to ten percent of the reductions are not done correctly.

You think it's in, and you get that X-ray, and you're like, "It's still out of the glenoid." So you always get this X-ray before and afterwards.

So, so the complications are missed dislocation or, or you didn't actually reduce it, fracturing the glenoid, it's called a Bankart lesion, and/or folks that have repeated dislocations or subluxations that the humeral head comes out and slams on the glenoid, slams on the glenoid, slams on again.

So you get this Bankart lesion on the glenoid, and you get a ding on the humeral head, which is called a Hill-Sachs lesion.

Yeah, I do.

I think, you know, most of our patients who dislocate for the first time do not have any bony problems, i.e. Bankart or Hill-Sachs lesions.

And I do want their shoulder to be supple.

I want them to have appropriate perception around the shoulder joint and movement.

We're going to master the quantification of glenoid bone loss.

We'll navigate the incredibly complex decision tree between the Bankart repair, the Letarjet procedure, and free bone block alternatives.

Which is a minefield if you don't know the parameters.

It really is.

Exactly.

So 2D scans still hold value.

They are excellent for identifying the sheer presence of a bony Bankart fragment that a vulsed piece of bone floating anteriorly.

They're also necessary for assessing glenoid version and the status of the rotator cuff muscles.

But subscapularis tears was, uh, was one of the best examples of, of, of my quote, which is, "Everything I know, I learned from patients," you know? We had a-- I had a-- My physical therapist, uh, in the, in the shoulder clinic at the time was a, was a Dutch guy, uh, very, very good, and he had a bilateral recurrent anterior shoulder dislocation.

So I did an anterior Bankart on one side, which worked extremely well.

He did very well, was very happy.

But then the other side sort of continued to pop out, and he asked me to do the other side.

So that, that ac- I mean, the approach was completely different.

And, you know, I, I...

When you think about that, everybody who listens probably knows what a Bankart repair is.

Mm-hmm.