Arthroscopic Excision of a Bennett Lesion: A Labrum-Sparing Approach
Thomas Boissinot, Yvan Leblanc-Barbedienne, Nicolas BonnevialleBackground:
Bennett lesions are posterior glenoid exostoses commonly encountered in overhead throwing athletes and may become symptomatic despite extensive nonoperative management. Associated posterior capsular and labral pathology varies considerably among patients, requiring individualized surgical treatment.
Indication:
A 19-year-old international baseball pitcher presented with persistent throwing-related shoulder pain for >3 years despite physical therapy, computed tomography-guided corticosteroid injection, and pitching mechanics modification. Serial imaging demonstrated progression of a Bennett lesion from a stable Freehill type 2A lesion to an unstable type 2B lesion associated with posterior labral wear, posterosuperior chondral wear, a pseudo–Hill-Sachs lesion, and a deep-layer posterior rotator cuff lesion. Surgical treatment was indicated because of persistent symptoms and radiologic progression.
Technique Description:
Arthroscopic excision was performed in the beach-chair position under general anesthesia and an interscalene block. Following diagnostic glenohumeral arthroscopy, a posterior sublabral capsulotomy was performed to expose the ossified fragment. The Bennett lesion was carefully dissected and resected using electrocautery and a bur until a flat posterior glenoid surface was restored. As the posterior labrum remained firmly attached to the glenoid rim, it was preserved. The posterior capsule was subsequently repaired using 2 suture anchors placed along the posterior glenoid rim, restoring posterior capsulolabral anatomy while avoiding unnecessary labral disruption. Optional closure of the posterior portal may be performed to minimize residual capsular distension.
Results:
Complete arthroscopic excision of the Bennett lesion was achieved while preserving the intact posterior labrum. At 4-month follow-up, the patient reported only mild residual anterior shoulder pain, demonstrated satisfactory recovery of shoulder motion, and had resumed hitting activities.
Discussion/Conclusion:
This labrum-sparing technique allows complete arthroscopic excision of symptomatic Bennett lesions through temporary posterior capsular takedown and repair while preserving an intact posterior labrum. The technique provides excellent exposure of the ossification, restores posterior capsular anatomy, and avoids unnecessary labral disruption.
Patient Consent Disclosure Statement:
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.