Can we improve the indication for Bankart arthroscopic repair? A preliminary clinical study using the ISIS score

Abstract

The objectives of this study on arthroscopic treatment of chronic anterior shoulder instability were the collection of the current practices for this indication, their development as reported in the literature, and the analysis of preliminary results on a multicenter prospective series of Bankart arthroscopic procedures undertaken using a common technique on patients selected based on the Instability Severity Index Score (ISIS). This procedure predominates in the English-speaking world, whereas the Latarjet protocol is preferred in France. The choice between the two seems to be cultural since neither technique could be demonstrated to be superior in an analysis of 171 responses to an Internet questionnaire in this study. The literature reports disappointing results in the Bankart arthroscopic procedure and recent articles have researched the predictive factors for its failure. Eleven centers prospectively included 125 patients from 1 December 2007 to 30 November 2008. The inclusion criteria were recurrence of anterior instability and an ISIS less than or equal to four points out of 10. All the selected patients underwent capsuloligamentous reinsertion with a common minimal technique of at least three anchors and four sutures with the same postoperative protocol. At a mean follow-up of 18 months, four patients (3.2%) had experienced recurrence. For the 84 patients reexamined at 1 year, the Walch-Duplay and Rowe scores were, respectively, 88.4 and 87.8 points out of 100. Subjectively, 88.1% of the patients declared they were satisfied and would undergo the intervention again. This study confirmed the use of the ISIS as a consultation tool. Only continuation of the study with a minimum follow-up of 3 years will allow us to validate the lower limit of the ISIS below which this technique could be proposed provided that it respects the technical prerequisite of at least four capsuloligamentous sutures.

The Open Latarjet Procedure Is More Reliable in Terms of Shoulder Stability Than Arthroscopic Bankart Repair

“…Latarjet bone block procedures for treating traumatic recurrent anterior shoulder instability whereas in a large international survey 90% of shoulder surgeons in other countries preferred arthroscopic Bankart repair [31]. Rates of recurrence after these two techniques vary widely in the literature, ranging from 0% to 30% for arthroscopic Bankart repair [13,22], with a mean of 9% [18], and from 2% to 14% for the open Latarjet bone block procedure (with two screws and the block in lying down position), with a mean of 7% [1,10,12,15,17,24,32].…”

Técnica de Bristow-Latarjet en la inestabilidad glenohumeral anterior. [Bristow-Latarjet Technique in the Treatment of Anterior Shoulder Instability.]

“…[17][18][19][20][21][22][23][24][25][26] En 1993, Banas y cols. 17 publicaron su estudio con 79 pacientes intervenidos mediante la técnica modificada de Bristow, con una tasa de recidiva del 4%.…”

Diagnosis and treatment of anteroinferior capsular redundancy associated with anterior shoulder instability using an open Latarjet procedure and capsulorrhaphy

“…In this score, among four other items, shoulder hyperlaxity is considered a risk of recurrence after arthroscopic stabilization of the shoulder [44]. Using the ISIS, Thomazeau et al [47] in a multicentric study studied 125 patients with an ISIS of four or less who underwent an arthroscopic repair with follow-up of 18 months. They reported a 3.2 % rate of recurrence.…”