Purpose: Bony Bankart injuries are avulsion fractures of the glenoid rim that usually result from a traumatic glenohumeral dislocation. The resulting osseous defect may cause recurrent glenohumeral instability, leading to erosion of the glenoid rim and progressive instability. Patients may experience pain, stiffness, weakness, and impaired function of the shoulder. Orthopaedic surgeons must understand the multifactorial preoperative considerations that guide surgical management and be comfortable using various fixation techniques in the management of these clinically challenging cases. This video discusses osseous glenoid defects that cause shoulder instability and describes the physical examination and diagnostic findings of, identifies the appropriate treatment strategy for, and illustrates the appropriate surgical technique for the management of bony Bankart lesions.

Methods: The video presents the case studies of three patients with a traumatic bony Bankart lesion resulting in glenohumeral instability in whom surgical repair and bony stabilization is indicated. Patient history, physical examination findings, radiographs, and advanced imaging studies are discussed. The video reviews the important preoperative considerations for each patient, describes the appropriate portal sites for each surgical procedure, illustrates arthroscopic technique, discusses suture options, discusses anchor placement, and describes the postoperative outcomes for each bony Bankart defect repair.

Results: Postoperative follow-up at various time points is reviewed, and postoperative imaging studies are presented. The patients in this series were progressing well, with 5/5 strength in forward elevation, external rotation, and internal rotation. More than 120° of active forward elevation was achieved in all patients, and instability was resolved. Return to rigorous physical activity without symptoms of pain or instability was achieved in all patients.

Conclusion: Bony Bankart lesions are challenging clinical injuries that require various fixation techniques, depending on the injury and physical examination findings. These case studies demonstrate effective methods to restore glenohumeral stability via various arthroscopic techniques, which provides surgeons with reproducible methods to manage bony Bankart lesions efficiently while minimizing errors and improving patient outcomes.