Long-term outcomes following isolated arthroscopic Bankart repair: a 9- to 12-year follow-up

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Abstract

Background

The long-term outcomes following arthroscopic Bankart repair have been rarely reported. Because of its relative novelty, little is known about recurrent instability, postoperative arthritis, and patient satisfaction, particularly for well-established modern procedures. The purpose of the study was to evaluate the long-term outcomes following arthroscopic Bankart repair.

Methods

Patients who underwent isolated arthroscopic Bankart repair from 2003 to 2006 were retrospectively reviewed. Recurrent instability, radiographic, and clinical scores (American Shoulder and Elbow Surgeons [ASES], Simple Shoulder Test [SST], and Rowe scores) were evaluated. Patient factors (ie, age, gender, side, number of instability episodes, contact sports, and bone loss) were analyzed to determine the correlation with outcome measures.

Results

Among the 98 patients (102 shoulders), we were able to contact 50 patients (51 shoulders, mean age 27.0 years, mean follow-up 121.2 months). Significant bone loss in glenoid and humerus was arthroscopically observed in 16 (31.4%) and 28 (54.9%) shoulders, respectively. Sixteen shoulders (31.4%) experienced recurrent instability. Recent radiographs were obtained for 38 shoulders, 14 (36.8%) of which showed moderate to severe arthritis. Clinical outcomes at follow-up were 89.3, 10.8, and 76.0 for ASES, SST, and Rowe scores, respectively. Neither recurrent instability nor arthritis was correlated with any patient factors.

Conclusion

When isolated arthroscopic Bankart repair was used in all patients with shoulder instability regardless of bony defect, postoperative recurrent instability and arthritis rates were unacceptably high. Additional procedures should be chosen after careful consideration of multiple patient factors.

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Most cited references 31

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The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation.

F Balg, P. Boileau (2007)

There is no simple method available to identify patients who will develop recurrent instability after an arthroscopic Bankart procedure and who would be better served by an open operation. We carried out a prospective case-control study of 131 consecutive unselected patients with recurrent anterior shoulder instability who underwent this procedure using suture anchors. At follow-up after a mean of 31.2 months (24 to 52) 19 (14.5%) had recurrent instability. The following risk factors were identified: patient age under 20 years at the time of surgery; involvement in competitive or contact sports or those involving forced overhead activity; shoulder hyperlaxity; a Hill-Sachs lesion present on an anteroposterior radiograph of the shoulder in external rotation and/or loss of the sclerotic inferior glenoid contour. These factors were integrated in a 10-point pre-operative instability severity index score and tested retrospectively on the same population. Patients with a score over 6 points had an unacceptable recurrence risk of 70% (p < 0.001). On this basis we believe that an arthroscopic Bankart repair is contraindicated in these patients, to whom we now suggest a Bristow-Latarjet procedure instead.

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Dislocation arthropathy of the shoulder.

R L Samilson, V Prieto (1983)

Seventy-four shoulders in seventy patients with a history of single or multiple dislocations of the shoulder demonstrated radiographic evidence of glenohumeral arthropathy. In every patient radiographs of the contralateral shoulder failed to reveal any abnormality (except, of course, in patients with bilateral dislocation). There were sixty-two anterior and eleven posterior dislocations, and one multidirectional dislocation. Shoulders with a posterior dislocation had a much higher incidence of moderate and severe arthrosis than those that had an anterior dislocation. This seemed to be related to delay in diagnosis. The number of recurrent dislocations or the presence of defects of either the glenoid rim or the humeral head, or both, was not related to the severity of the arthrosis. Operations in which internal fixation devices intruded on joint cartilage frequently resulted in moderate to severe arthrosis. Ten of the fifteen shoulders with severe arthrosis and six of the fourteen with moderate arthrosis had had no operation for the dislocation. Six of these sixteen shoulders had had a posterior dislocation for which reduction had been delayed.

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Neer Award 2008: Arthropathy after primary anterior shoulder dislocation--223 shoulders prospectively followed up for twenty-five years.

Lennart Hovelius, Modolv Saeboe (2009)

Shoulder dislocation may cause arthropathy, but the natural history of this evolution is not well described. We therefore conducted a radiographic follow-up 25 years after the primary shoulder dislocation. A prospective Swedish multicenter study (1978-1979) included 257 shoulders in 255 patients (age, 12-40 years) with a first-time anterior shoulder dislocation. After 25 years, 227 patients (229 shoulders) were alive and had follow-up. Radiographic imaging was performed in 223 shoulders (97%). Shoulders were normal in 44%. Arthropathy was mild in 29%, moderate in 9%, and severe in 17%. Of the shoulders without a recurrence, 18% had moderate/severe arthropathy. The corresponding figures were 39% for shoulders that recurred once or more (without surgery) and 26% (16 of 62) for surgically stabilized shoulders. Seven of 221 patients (7 of 223 shoulders) were considered alcoholic at 25 years and all had severe arthropathy (P < .001). Other factors that correlated with moderate/severe arthropathy were age older than 25 years at primary dislocation (P = .01) and primary dislocation caused by high-energy sports activity (P = .009). Shoulders that had not recurred had less arthropathy than shoulders classified as recurrent (P = .047) or stabilized over time (P = .007). Sixty-two surgically stabilized shoulders had less arthropathy than those that became stable over time (P = .047). Mild arthropathy at 10 years was associated with moderate/severe arthropathy at 25 years in 19 of 30 shoulders (63%) compared with 13 of 146 (9%) classified as normal at 10 years (P < .001). Joint incongruence at 10 years was associated with moderate/severe arthropathy at 25 years (P = .001). Age at primary dislocation, recurrence, high-energy sports, and alcohol abuse were factors associated with the development of arthropathy. Also shoulders without a recurrence were associated with arthropathy.

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Author and article information

Contributors

Ian K. Lo

Journal

Journal ID (nlm-ta): JSES Open Access

Journal ID (iso-abbrev): JSES Open Access

Title: JSES Open Access

Publisher: Elsevier

ISSN (Electronic): 2468-6026

Publication date PMC-release: 09 August 2019

Publication date Collection: October 2019

Publication date (Electronic): 09 August 2019

Volume: 3

Issue: 3

Pages: 189-193

Affiliations

[a ]Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada

[b ]Department of Orthopedic Surgery, East Hokkaido Hospital, Kushiro, Japan

[c ]Department of Orthopedic Surgery, Colombia Universidad Nacional de Colombia Graduate School of Medicine, Bogota, Colombia

[d ]Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

Author notes

[∗ ]Corresponding author: Ian K. Lo, MD, FRCSC, Department of Surgery, University of Calgary , Group23 Sports Medicine, 147 Canada Olympic Drive, SW, Calgary, AB, T3B 6B7. ikylo@ 123456ucalgary.ca

Article

Publisher ID: S2468-6026(19)30017-8

DOI: 10.1016/j.jses.2019.05.002

PMC ID: 6835116

PubMed ID: 31720496

SO-VID: 53238843-68e8-4101-a466-a30ea24c4d09

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Long-term outcomes following isolated arthroscopic Bankart repair: a 9- to 12-year follow-up

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Abstract

Background

Methods

Results

Conclusion

Related collections

UN Sustainable Development Goals on ScienceOpen

Most cited references 31

The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation.

Dislocation arthropathy of the shoulder.

Neer Award 2008: Arthropathy after primary anterior shoulder dislocation--223 shoulders prospectively followed up for twenty-five years.

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