This Level III cohort study examined how glenoid bone loss affects outcomes after isolated arthroscopic Bankart repair in 73 military shoulders. It asks whether "subcritical" bone loss, below the traditional 20%-25% range, hurts function and raises failure rates. Patients were grouped into quartiles by percentage of bone loss and tracked with WOSI and SANE scores.
The clinical rule from this paper: in a high-demand patient, glenoid bone loss above roughly 13.5% should make you reconsider an isolated arthroscopic Bankart and weigh a bony augmentation procedure.
The traditional teaching pegged "critical" loss at 20%-25%, the point where redislocation risk climbs and the inverted-pear glenoid appears. This study confirmed that failure rate does spike above 20% (27.8% vs 7.3%).
The added insight is that function deteriorates well before that. Patients above 13.5% loss had unacceptable WOSI scores even when their shoulder never dislocated again. A "successful" stabilization by the old definition can still be a clinical disappointment.
Weigh the caveats. This is a Level III retrospective series of 73 shoulders in active-duty military patients with mandatory high activity and no preoperative scores, so the exact 13.5% number may not transfer to lower-demand civilians. For boards, know the perfect circle method on MRI, the 20%-25% classic threshold, and that this paper pushed the conversation toward a lower, function-based cutoff.
This Level III cohort study examined how glenoid bone loss affects outcomes after isolated arthroscopic Bankart repair in 73 military shoulders. It asks whether "subcritical" bone loss, below the traditional 20%-25% range, hurts function and raises failure rates. Patients were grouped into quartiles by percentage of bone loss and tracked with WOSI and SANE scores.
The clinical rule from this paper: in a high-demand patient, glenoid bone loss above roughly 13.5% should make you reconsider an isolated arthroscopic Bankart and weigh a bony augmentation procedure.
The traditional teaching pegged "critical" loss at 20%-25%, the point where redislocation risk climbs and the inverted-pear glenoid appears. This study confirmed that failure rate does spike above 20% (27.8% vs 7.3%).
The added insight is that function deteriorates well before that. Patients above 13.5% loss had unacceptable WOSI scores even when their shoulder never dislocated again. A "successful" stabilization by the old definition can still be a clinical disappointment.
Weigh the caveats. This is a Level III retrospective series of 73 shoulders in active-duty military patients with mandatory high activity and no preoperative scores, so the exact 13.5% number may not transfer to lower-demand civilians. For boards, know the perfect circle method on MRI, the 20%-25% classic threshold, and that this paper pushed the conversation toward a lower, function-based cutoff.