Risk Factors for the Postoperative Recurrence of Instability After Arthroscopic Bankart Repair in Athletes

Abstract

Background:Several risk factors for the postoperative recurrence of instability after arthroscopic Bankart repair have been reported, but there have been few detailed investigations of the specific risk factors in relation to the type of sport.Purpose:This study investigated the postoperative recurrence of instability after arthroscopic Bankart repair without additional reinforcement procedures in competitive athletes, including athletes with a large glenoid defect. The purpose of this study was to investigate risk factors related to the postoperative recurrence of instability in athletes.Study Design:Case-control study; Level of evidence, 3.Methods:A total of 115 athletes (123 shoulders) were classified into 5 groups according to type of sport: rugby (41 shoulders), American football (32 shoulders), other collision sports (18 shoulders), contact sports (15 shoulders), and overhead sports (17 shoulders). First, the recurrence rate in each sporting category was investigated, with 113 shoulders followed up for a minimum of 2 years. Then, factors related to postoperative recurrence were investigated in relation to the type of sport.Results:Postoperative recurrence of instability was noted in 23 of 113 shoulders (20.4%). The recurrence rate was 33.3% in rugby, 17.2% in American football, 11.1% in other collision sports, 14.3% in contact sports, and 12.5% in overhead sports. The most frequent cause of recurrence was tackling, and recurrence occurred with tackling in 12 of 16 athletes playing rugby or American football. Reoperation was completed in 11 shoulders. By univariate analysis, significant risk factors for postoperative recurrence of instability included playing rugby, age between 10 and 19 years at surgery, preoperative glenoid defect, small bone fragment of bony Bankart lesion, and capsular tear. However, by multivariate analysis, the most significant factor was not the type of sport but younger age at operation and a preoperative glenoid defect with small or no bone fragment. Compared with the other sports, there was a significantly greater recurrence rate among rugby players without the aforementioned significant risk factors (small glenoid defect, ≤10%; medium or large bone fragment, >5%; and no capsular tear).Conclusion:Younger age at operation and preoperative glenoid defect with small or no bone fragment significantly influenced recurrent instability among competitive athletes.

Bipolar Bone Loss in Male Athletes With Traumatic Anterior Shoulder Instability: An Evaluation Using a New Scoring System

“…This suggests that the type of sport also has a significant effect on recurrence, independent of bone loss. Nakagawa et al 9 , 10 reported that the recurrence rate was higher among rugby players compared with other athletes and that rugby players had a high recurrence rate despite a small glenoid defect. Therefore, the indications for stabilization surgery should be decided by considering both the extent of bipolar bone loss and the sporting category.…”

High Variability in Functional Outcomes and Recurrences Between Contact Sports After Arthroscopic Bankart Repair: A Comparative Study of 351 Patients With a Minimum 3-Year Follow-Up

“…There is an increased redislocation rate in collision athletes with glenohumeral instability operated with the Bankart procedure. 1 , 2 , 3 Nonetheless, there is no universally accepted definition of “contact” sports in the literature. The most widely used classification is the one proposed by the American Academy of Pediatrics Committee on Sports Medicine.…”

Editorial Commentary: Is Arthroscopic Bankart Repair Using Suture Anchors on the Glenoid Appropriate Treatment for Traumatic Anterior Shoulder Instability?

“…According to the review by Woolnough et al, 5 postage-stamp fractures were frequent in male patients, patients aged 25 years or younger, patients involved in sporting activities, patients who received initial stabilization with 3 or more anchors or conventional knot-tying anchors, and patients with osteolysis around the anchor sites. It is well known that young male patients and persons involved in sports have an increased risk of recurrent instability after arthroscopic repair, 13 and this review clearly showed that postagestamp fractures are not like the osteoporotic fractures frequently seen in elderly patients and instead appear to be characteristic of young active athletes. It has been reported that a small number of anchors is a risk factor for postoperative recurrence of instability, and use of at least 3 anchors during stabilization surgery is recommended.…”