Functional outcome and the structural integrity of arthroscopic Bankart repair: a prospective trial

Abstract

Background: Recurrent anterior shoulder dislocations are common in young patients with Bankart lesions. Arthroscopic repair is an established treatment; however, recurrent instability occurs in up to 35% of patients. It is unclear whether recurrence is the result of a failure of the surgical repair to heal or a repeat injury. The aim of the present pilot study was to assess radiographic healing of Bankart lesions 6 months post surgical repair and identify any correlations between radiographic findings and subsequent recurrent dislocations. Methods: Eighteen patients underwent arthroscopic Bankart repair for recurrent instability. Magnetic resonance (MR) arthrograms were obtained both pre-operatively and 6 months postoperatively. Standard T1 and T2 views were obtained along with an abduction and external rotation (ABER) view. Patients were followed for a minimum of 4 years for the risk of recurrence, and functional outcomes were obtained, including the American Shoulder and Elbow Surgeons Subjective Shoulder Scale, Ontario Shoulder Instability Index, Oxford Shoulder Instability Score and 12-Item Short Form Health Survey. Scores were correlated with pre-operative and postoperative MR findings. Results: Six of 18 patients developed recurrent instability. We could not identify correlations between reconstructed labrum (labral bumper) position, failure at suture sites and ABER findings with recurrent instability or functional outcome. Paradoxically, there was a nonstatistically significant trend for patients with no clefts between the labrum and the glenoid at any points along the repair to have worse outcomes than patients with partial or complete clefts. Conclusions: In our pilot study, MR arthrogram was used to evaluate the labrum in detail 6 months postoperatively. Despite its proven ability to detect labral lesions, we were unable to demonstrate any features on postoperative MR arthrogram that predicted either functional outcome or recurrent instability. At 6 months post operation, functional recovery and the risk of recurrence may not depend on the anatomical appearance of the labrum alone.

Return to Play Following Shoulder Stabilization: A Systematic Review and Meta-analysis

“…Arthroscopic Bankart repair has demonstrated an excellent rate of return to sport to the preinjury athletic level. 14 , 31 – 33 Blonna and colleagues, 5 for example, demonstrated a 90% return to preinjury level among their 30 patients who underwent arthroscopic Bankart repair. A 94% rate of return to play at all levels was reported by Gerometta et al 12 following arthroscopic stabilization in 46 athletes.…”

“…Arthroscopic Bankart repair has demonstrated an excellent rate of return to sport to the preinjury athletic level. 14,[31][32][33] Blonna and colleagues, 5 for example,…”

“… 27 The arthroscopic Bankart repair improves stability by directly tightening the anterior capsule as well as repairing the anterior labrum into a so-called anteroinferior bumper. 33 …”

“…27 The arthroscopic Bankart repair improves stability by directly tightening the anterior capsule as well as repairing the anterior labrum into a socalled anteroinferior bumper. 33 In the literature to date, there are data suggesting that arthroscopic and open techniques, including open capsular repair and reconstruction and the Latarjet procedure for addressing anterior shoulder instability, are safe and effective, with few complications and low rates of recurrent instability regardless of the technique. 5,23 The focus of the current literature comparing these techniques, however, has largely been to investigate any difference in rates of redislocation or need for revision surgery.…”

Inconsistencies in Controlling for Risk Factors for Recurrent Shoulder Instability After Primary Arthroscopic Bankart Repair: A Systematic Review

“…23 However, the procedure is still associated with relatively high rates of failure, with recurrent instability rates ranging from 4% to 33%. 32,66 Other management options, such as the Latarjet and other bone block procedures and the remplissage procedure, may have a lower recurrent instability rate but may also lead to complications such as reduced range of motion, altered anatomy complicating revision, nerve injury, and premature osteoarthritis. 18,22,24,36,40,62 This management dilemma has prompted extensive research with the goal of optimizing surgical techniques and refining indications to improve outcomes by matching the appropriate surgical procedure to the appropriate patient.…”