Comparison of Time to Recurrence of Instability After Open and Arthroscopic Bankart Repair Techniques

Abstract

Background:The results of open and arthroscopic instability repairs have been shown to be equivalent in recent literature.Purpose:To compare the time to recurrence (TTR) of instability and disease-specific outcome measures in patients undergoing open and arthroscopic Bankart repair.Study Design:Cohort study; Level of evidence, 3.Methods:Patients with recurrent traumatic anterior shoulder instability and a Bankart lesion on diagnostic arthroscopy underwent either open Bankart repair (OB) or arthroscopic Bankart and suture capsulorrhaphy (ABSC) using suture anchors. There was a minimum follow-up of 24 months. The primary outcome measures included Western Ontario Shoulder Instability Index (WOSI) score and time to recurrence of instability (dislocation or subluxation). Rowe score, Simple Shoulder Test, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Short Form–12 (SF-12) score were also compared.Results:A total of 82 shoulders in 80 patients (ABSC, n = 58; OB, n = 24) were evaluated at a mean of 39 months postoperatively. There were 4 clinical failures in the OB group (4 dislocations) and 7 clinical failures in the ABSC group (2 dislocations and 5 subluxations; P = .72 vs OB). The mean time to recurrence of postoperative instability was significantly shorter in the ABSC group (12.6 ± 2.7 months) compared with the OB group (34.2 ± 12 months; P = .04). The WOSI score in the OB group (265 ± 48.1) was better but not statistically significantly compared with the ABSC group (449.8 ± 63.8; P = .06).Conclusion:The time to recurrence of instability after open Bankart repair is significantly longer compared with arthroscopic Bankart repair.Clinical Relevance:Delayed time to recurrence after open Bankart repair suggests that the open technique may be more suited to withstand the high stress and demands of a heavy-duty profession (contact athletes and heavy manual labor).

Arthroscopic Bankart Repair for the Management of Anterior Shoulder Instability: Indications and Outcomes

“…Surgical intervention should be completed as quickly as practical once decided upon as the proper course of treatment. Benefits of using an arthroscopic Bankart repair technique include a lower complication rate, smaller incisions, less blood loss, shorter operative times, greater range of shoulder motion postoperatively, less postoperative pain, better cosmesis, less postoperative shoulder stiffness, and fewer wound infections [4,29].…”

“…The reported recurrence rate after arthroscopic Bankart repair ranges from 4 to 19% [65]; in newer literature, the risk is increased by participation in contact sports [66]. Additionally, the average amount of time prior to another instability event is less with arthroscopic than open Bankart repair (12.6 versus 34.2 months, respectively) [9]. Patients who desire to return to contact sports should be counseled on the higher recurrent instability rate after arthroscopic repair and weigh this risk against the benefits of this technique, including a faster return to activity, as well as a greater likelihood that they will be able to do so [5].…”

“…From 2003 to 2005, 71.2% of repairs were performed arthroscopically, compared with 87.7% from 2006 to 2008 [2]. With an increase in literature revealing similar clinical outcomes between patients undergoing open versus arthroscopic repair [3][4][5][6][7][8][9][10], there has been a recent shift towards arthroscopic stabilization as the first-line in surgical management of shoulder instability.…”

Trends in Shoulder Stabilization Techniques Used in the United States Based on a Large Private-Payer Database

“… 10 Nevertheless, some surgeons continue to favor open Bankart for contact athletes and manual laborers owing to a longer interval to recurrence and a reduced recurrence rate among collision athletes. 7 , 11 , 14 , 18 For patients with a history of failed arthroscopic or open capsulolabral repair or those with clinically significant anterior glenoid bone loss, the Latarjet procedure is considered an excellent option. Notably, recent comparative trials have found that primary Latarjet coracoid transfer may result in a reduced rate of recurrent instability when compared with arthroscopic stabilization.…”

Avaliação pós-operatória de pacientes submetidos a reparo artroscópico de instabilidade anterior do ombro

“…Outras vantagens da artroscopia são a menor perda sanguínea, menor duração da cirurgia e a maior satisfação estética. 12 As taxas de recidivas de luxação após a cirurgia artroscópica vêm diminuindo devido aos avanços tecnológicos e o Quanto à perda de rotação lateral, Bottoni et al 16 demonstraram uma diminuição de 2°a 3°no grupo artroscópico, enquanto, no grupo de cirurgias abertas, houve uma perda de aproximadamente 6,5°da amplitude de movimento. Em nosso estudo, a perda de rotação lateral foi mais observada nos pacientes que apresentavam instabilidade traumática, dado semelhante aos resultados de Ferreira Neto et al, 17 que também encontraram maior limitação da rotação lateral em pacientes com essa característica.…”