Burkhart and De Beer analyzed 194 consecutive arthroscopic Bankart repairs to determine why some fail. They asked whether traumatic bone defects — rather than soft tissue repair quality — explain recurrent instability. This is the paper that introduced the inverted-pear glenoid and engaging Hill-Sachs lesion as the field's standard framework for surgical decision-making.
When you evaluate a patient with recurrent anterior shoulder instability, your first question before choosing repair technique must be: is there a bone defect?
If the glenoid has lost enough anterior-inferior bone that the inferior diameter is narrower than the superior (inverted-pear), or if the Hill-Sachs lesion engages the anterior glenoid rim at 90° abduction with external rotation (long axis parallel to the glenoid), arthroscopic Bankart repair will fail at unacceptable rates — 61% and 100%, respectively.
These patients need bone reconstruction. The Latarjet procedure (not Bristow) is preferred for glenoid-side defects because its 2–3 cm coracoid graft meaningfully extends the glenoid arc length; the Bristow graft is too small to restore a bony buttress.
For contact athletes specifically: do not default to open repair simply because of sport. Athletes without bone defects fail at only 6.5% arthroscopically. Reserve open surgery for those with documented bone loss.
This paper is the direct predecessor of the off-track/on-track Hill-Sachs concept and the quantitative glenoid bone loss thresholds (approximately 25% of glenoid width) that now guide preoperative CT planning.
Burkhart and De Beer analyzed 194 consecutive arthroscopic Bankart repairs to determine why some fail. They asked whether traumatic bone defects — rather than soft tissue repair quality — explain recurrent instability. This is the paper that introduced the inverted-pear glenoid and engaging Hill-Sachs lesion as the field's standard framework for surgical decision-making.
When you evaluate a patient with recurrent anterior shoulder instability, your first question before choosing repair technique must be: is there a bone defect?
If the glenoid has lost enough anterior-inferior bone that the inferior diameter is narrower than the superior (inverted-pear), or if the Hill-Sachs lesion engages the anterior glenoid rim at 90° abduction with external rotation (long axis parallel to the glenoid), arthroscopic Bankart repair will fail at unacceptable rates — 61% and 100%, respectively.
These patients need bone reconstruction. The Latarjet procedure (not Bristow) is preferred for glenoid-side defects because its 2–3 cm coracoid graft meaningfully extends the glenoid arc length; the Bristow graft is too small to restore a bony buttress.
For contact athletes specifically: do not default to open repair simply because of sport. Athletes without bone defects fail at only 6.5% arthroscopically. Reserve open surgery for those with documented bone loss.
This paper is the direct predecessor of the off-track/on-track Hill-Sachs concept and the quantitative glenoid bone loss thresholds (approximately 25% of glenoid width) that now guide preoperative CT planning.