Background: The most common surgical technique in traumatic anterior shoulder instability is the arthroscopic Bankart repair, which has excellent short-term results. The longterm results of the arthroscopic Bankart repair are less frequently studied with a high recurrence rate of 23 to 35%. The aim of this study was to evaluate the medium to long-term results of arthroscopic Bankart repair using suture anchors and to identify specific risk factors for recurrent instability. Methods: 147 patients after traumatic anterior shoulder dislocation who underwent an arthroscopic Bankart repair were included. The primary outcome was recurrent instability, defined as dislocation or subluxation as perceived by the patients. The secondary outcome was subjective shoulder stability and function, and quality of life, evaluated using the Western Ontario Shoulder Instability Index (WOSI), the Simple Shoulder Test (SST) and the Short Form-12 (SF-12). Prognostic factors for recurrent instability were analysed. Results: 22% of the patients experienced recurrent instability with a mean follow-up of 6.3 years. 5-years and 10-years survival without recurrent instability was 79% and 78%, respectively (95% CI: 72-85% and 71-85%, respectively). The WOSI-score, the SST-score and the SF-12 physical scale improved significantly in the non-recurrence group (p<0.001, p=0.004 and p=0.002, respectively). Younger age and use of less than three anchors were associated with a higher risk of recurrent dislocation (p=0.008 and p=0.039, respectively). Conclusion: We found an overall recurrent instability rate of 22% (dislocation or subluxation). Good long-term results were observed after arthroscopic Bankart repair in patients above age of 20 years with 3 or more suture anchors used.

Background Several surgical reconstructive options are available to treat massive rotator cuff tears (MRCTs). The rotator cable has an important function and we evaluated the clinical result after arthroscopic reconstruction of the rotator cable with an autograft tendon. Methods A prospective pilot study was performed with inclusion of four patients, average age of 64 years, with an irreparable MRCT. The patients underwent an arthroscopic reconstruction of the rotator cable with the use of the long head of biceps tendon autograft, except for one which was reconstructed with a hamstring tendon. Pre- and postsurgically, the Constant-Murley Score (CMS), Western Ontario Rotator Cuff Index (WORC), Simple Shoulder Test (SST), visual analog scale (VAS) scores, and an MRI was performed. Clinical results of the study group were compared with clinical results of comparable cohort of patients with a MRCT, treated non-operatively with physiotherapy. Results The CMS score increased after surgery in three of the four patients. The improvement of CMS score was comparable to the improvement of the CMS score encountered in a comparable cohort. The MRI at 12 months follow-up showed that the reconstructed rotator cable was disintegrated in all patients and the rotator cuff was detached and retracted. Conclusions In our pilot study, arthroscopic reconstruction of the rotator cable using a tendon autograft failed over time and showed no clinical benefit in comparison to the non-operative treatment with physiotherapy. Trial registration The regional Medical Ethical Committee (Zwolle) gave approval at 14th of October 2016 and assigned no. 16.06100.

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