Summary

Despite arthroscopic Bankart repair being the technique of choice for recurrent anterior shoulder instability, our minimum 10-year follow-up results on 150 patients suggest higher than optimal recurrence and revision rates, especially in patients younger than 23 years old.

Abstract

Introduction

Arthroscopic Bankart repair has become the technique of choice for recurrent anterior shoulder instability. Despite enthusiasm for this method of stabilization, there is a paucity of long-term follow-up studies. Some longer-term follow-up studies have suggested higher recurrence rates than initially reported. The purpose of this study is to describe baseline characteristics of patients with recurrent instability and determine long-term clinical outcomes associated with arthroscopic Bankart repair.

Methods

Records from a single surgeon were reviewed from 2001-2011 (minimum 10-year follow-up) for arthroscopic Bankart repair to treat recurrent anterior shoulder instability. No patient with glenoid bone loss greater than 20% was included. Detailed chart review was performed for 150 patients using inpatient records, outpatient records, operative reports, and surgeon’s personal operative records in order to obtain demographic data, determine operative technique, and calculate recurrence and revision rates. Patient reported outcome measures (PROMs) were obtained prospectively, including OSS, WOSI, and SANE scores. Surgical technique included lateral decubitus, minimum 3 anchors, double-loaded high strength suture, posteroinferior plication, and often interval closure. Recurrence was defined as any dislocation or subluxation event that necessitated clinical evaluation.

Results

150 patients were included in our cohort. Average follow-up was 15.1 years, range 10.1-20.7. Average age was 24.0, range 13.5-58.0. Recurrent instability occurred in 35/150 (23.3%). Revision surgery performed in 21/150 (14.0%). Thirty out of 35 (85.7%) recurrences and 19 out of 21 (90.5%) revisions occurred in patients who were under 23 years old at time of index surgery. Average time to recurrence was 44.7 months. Seventeen of the 35 recurrences occurred beyond the 24-month follow-up mark. Fifty-six (37%) patients completed prospective PROMs. Average SANE score 86.8, range 25-100. Average WOSI 378.5, range 0-1700. Average OSS 41.6, range 13-48.

Discussion And Conclusion

Despite enthusiasm for arthroscopic Bankart repair, our long-term results, especially in patients younger than 23 years old, suggest higher than optimal recurrence and revision rates despite using modern day suture anchor and capsular tightening techniques.