Increased Failure Rates After Arthroscopic Bankart Repair After Second Dislocation Compared to Primary Dislocation With Comparable Clinical Outcomes

Fox, Michael A.; Drain, Nicholas; Rai, Ajinkya; Zheng, Aaron; Carlos, Noel Bien T.; Riera, Rafael Serrano; Sabzevari, Soheil; Hughes, Jonathan D.; Popchak, Adam; Rodosky, Mark W.; Lesniak, Bryson P.; Lin, Albert

doi:10.1016/j.arthro.2022.10.012

Cited by 8 publications

(2 citation statements)

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“…Preoperative instability has also been well established as a risk factor for failure after arthroscopic Bankart repair alone. 10,12,18,25 In concordance with the results of numerous previous studies that have shown a higher risk of failure in patients with an increasing number of preoperative instability events, our study also found that .1 preoperative instability episode was a significant predictor of failure after arthroscopic Bankart repair alone. In these cases, other surgical approaches including remplissage augmentation, open approaches, or bony augmentation can be considered.…”

Section: Discussionsupporting

confidence: 91%

Recurrent Instability After Arthroscopic Bankart Repair in Patients With Hyperlaxity and Near-Track Lesions

Boden,

Charles,

Hughes

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Recurrent anterior shoulder instability after arthroscopic Bankart repair presents a challenging clinical problem, with the primary stabilization procedure often portending the best chance for clinical success. Purpose: To determine if capsuloligamentous laxity affects failure (recurrent dislocation, subluxation, and/or perceived instability symptoms) after arthroscopic Bankart repair in patients with near-track lesions (ie, those with smaller distance to dislocation [DTD]). Study Design: Case-control study; Level of evidence, 3. Methods: The authors retrospectively reviewed consecutive patients who underwent primary arthroscopic Bankart repair for recurrent anterior glenohumeral instability at a single institution between 2007 and 2019 and who had at least 2 years of follow-up data. Patients with glenoid bone loss >20%, off-track lesions, concomitant remplissage, or rotator cuff tear were excluded. Capsuloligamentous laxity, or hyperlaxity, was defined as external rotation >85° with the arm at the side and/or grade ≥2 in at least 2 planes with the shoulder at 90° of abduction. Near-track lesions were defined as those with a DTD <10 mm. Results: Included were 173 patients (mean age, 20.5 years; mean DTD, 16.2 mm), of whom 16.8% sustained a recurrent dislocation and 6.4% had recurrent subluxations (defined as any subjective complaint of recurrent instability without frank dislocation), for an overall recurrent instability rate of 23.1%. The rate of revision stabilization was 15.6%. The mean time to follow-up was 7.4 years. Independent predictors of recurrent instability were younger age ( P = .001), smaller DTD ( P = .021), >1 preoperative instability episode ( P < .001), and the presence of hyperlaxity during examination under anesthesia ( P = .013). Among patients with near-track lesions, those with hyperlaxity had a recurrent instability rate almost double that of patients without hyperlaxity (odds ratio, 34.1; P = .04). The increased rate of failure and recurrent dislocation in the near-track hyperlaxity cohort remained elevated, even in patients with no bone loss. Conclusion: Capsuloligamentous shoulder laxity was a significant independent risk factor for failure after primary arthroscopic Bankart repair without remplissage and was more predictive of failure in patients with versus without near-track lesions.

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Section: Discussionsupporting

confidence: 91%

Recurrent Instability After Arthroscopic Bankart Repair in Patients With Hyperlaxity and Near-Track Lesions

Boden,

Charles,

Hughes

et al. 2023

Orthopaedic Journal of Sports Medicine

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“…If there was more than 19% glenoid bone loss at the time of surgical intervention significant shoulder instability was found to persist after fixation ( 13 ). Additionally, the rate of recurrent dislocations after Bankart repair of primary or secondary dislocations was found to be 14.2% and 42.8% respectively ( 14 ). Given the high prevalence of recurrence, other arthroscopic procedures as mentioned above, mainly an all-arthroscopic double-row suture bridge, have emerged as newer methods of fixation for bony Bankart lesions between 10% and 50%.…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic suture bridge fixation for acute bony Bankart with anterior glenohumeral instability: a case report and narrative review

St. Jeor,

Mason,

Glover

et al. 2024

Ann Joint

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Background and Objective Anterior shoulder dislocations can result in acute glenoid rim fractures that compromise the bony stability of the glenohumeral joint. Adequate fixation of these fractures is required to restore stability, decrease shoulder pain, and facilitate return to activity. The double-row suture bridge is a relatively novel fixation technique, first described in 2009, that accomplishes internal fixation with sufficient stability using an all-arthroscopic technique to restore the glenoid footprint. A 40-year-old female with recurrent anterior shoulder instability in the setting of seizure disorder was found to have a bony Bankart lesion of 25% to 30% with a concomitant superior labral tear. The patient was treated with a double-row bony Bankart bridge and labral repair. At six months follow-up, she has progressed to a full recovery with no recurrence. Methods A search was conducted in May 2023 in PubMed, EMBASE, and CINAHL with the search terms bony Bankart, bone Bankart, osseous Bankart, acute, bridge, suture bridge, double row. Key Content and Findings Double-row suture bridge repairs result in improvement in shoulder function as determined by ASES (93.5), QuickDASH (4.5), SANE (95.9), and SF-12 (55.6). The overall recurrence rate of anterior instability after a bony Bankart bridge repair is 8%. When examining the return to prior level of function, 81.4% of patients were able to do so with only 7.9% of patients reporting significant modifications to their activity level. In mid-term results, double row suture bridge demonstrates similar outcomes to other all-arthroscopic fixation methods of bony Bankart injuries. Importantly, bony Bankart bridge remains a viable option for critical glenoid lesions over the 20% cutoff used in other all arthroscopic techniques. Biomechanically, the double-row suture bridge offers distinct benefits over its single-row counterpart including increased compression, reduced displacement, and reduced step-off. Conclusions Although there is limited data, the studies discussed and the demonstrative case show the potential benefit of all-arthroscopic double-row suture bridge fixation including increased compression, decreased displacement, and a lower complication rate in patients with large bony Bankart lesions traditionally requiring bony augmentation. However, more robust studies are necessary to determine the long-term success of the double-row suture bridge.

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High long‐term failure rates after arthroscopic Bankart repair in younger patients with recurrent shoulder dislocations: A plea for early treatment

Delgado,

Calvo,

Martínez‐Catalán

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo determine arthroscopic Bankart repair outcomes and recurrence risk factors at a minimum 5‐year follow‐up.MethodsRetrospective assessment of prospectively collected data, single‐cohort study of patients who underwent arthroscopic Bankart repair with a minimum 5‐year follow‐up. Demographical and preoperative instability features were collected. Primary outcome was recurrent instability set as dislocation or subluxation. Secondary outcomes were revision surgery, postoperative instability degree according to Manta criteria, objective and subjective clinical and functional status, assessed by the Rowe, Western Ontario Shoulder Index (WOSI) and Subjective Shoulder Value (SSV) scores. Return to sport and postoperative sports activity at the final follow‐up were also recorded.ResultsOne‐hundred and seventy‐two patients, 82% men, average age at surgery 29.5 ± 9.2 years, were included. At a mean follow‐up of 8.3 ± 2.6 years, recurrent instability occurred in 53 of 172 patients (30.8%). Revision surgery was required in 23/53 (43.4%) of shoulder with recurrent instability. Recurrence occurred within the first 2 years postoperative in 49% of the shoulders, whereas 51% of recurrences occurred after this period. Recurrence took place after a traumatic event in 25% and 56%, respectively. Recurrence rates were higher in patients who underwent surgery after two or more dislocations (p = 0.029). Patients younger at the time of first dislocation, younger at surgery and those with a higher preoperative degree of instability also showed significantly higher rates of recurrence (p = 0.04, p = 0.02, p = 0.03). Postoperative ROWE, WOSI and SSV scores were significantly worse in patients with recurrent instability (p < 0.001). Return‐to‐sports rate was also lower in patients with postoperative recurrence (p < 0.001).ConclusionThe arthroscopic Bankart repair was associated with a high long‐term recurrence rate, and its effectiveness decreased over time. The lowest recurrence rates in arthroscopic Bankart repair were achieved in older patients with only one prior instability episode and a lower instability degree.Level of EvidenceLevel IV.

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Increased Failure Rates After Arthroscopic Bankart Repair After Second Dislocation Compared to Primary Dislocation With Comparable Clinical Outcomes

Cited by 8 publications

References 35 publications

Recurrent Instability After Arthroscopic Bankart Repair in Patients With Hyperlaxity and Near-Track Lesions

Recurrent Instability After Arthroscopic Bankart Repair in Patients With Hyperlaxity and Near-Track Lesions

Arthroscopic suture bridge fixation for acute bony Bankart with anterior glenohumeral instability: a case report and narrative review

High long‐term failure rates after arthroscopic Bankart repair in younger patients with recurrent shoulder dislocations: A plea for early treatment

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