Summary

With proper patient selection, the outcomes of revision arthroscopic Bankart repair are similar to those obtained with primary stabilization.

Abstract

Background

Primary arthroscopic Bankart repair is considered by many to be the procedure of choice for anterior shoulder instability without bone loss. However, for cases of recurrent anterior instability, the clinical outcomes of arthroscopic revision Bankart repair compared to primary arthroscopic Bankart repair are not well known.

Hypothesis

Arthroscopic revision Bankart surgery for failed anterior shoulder stabilizations can provide clinical outcomes comparable to primary arthroscopic repairs.

Study Design: Case Series

Patients/Methods: A retrospective cohort study was performed to identify subjects 18 years and older who underwent arthroscopic revision stabilization for recurrent anterior shoulder instability. This group was compared to an age-matched control group of arthroscopic primary Bankart repairs by a single fellowship trained shoulder surgeon from 2003-2009. Subjects with significant glenoid bone loss were excluded from the study. Outcome measures included the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Score, and Short Form Health Survey (SF-12) Mental and Physical scores.

Results

16 patients met the criteria for inclusion in the revision arthroscopic Bankart repair group, and 37 patients were enrolled in the age-matched control group of arthroscopic primary Bankart repairs. Average follow-up was 5 years (range 1-7 years). In the revision group average ASES score was 91±9, average Simple Shoulder Score was 11±3, SF-12 mental was 43 and physical 45. In the primary group average ASES score 92 ±13, average Simple Shoulder Score 11±1, SF-12 Mental score 43 and physical score 45. There was no significant difference in ASES scores (p=0.54) or Simple Shoulder Score (p=0.69) between groups. In the isolated group the preoperative mean range of motion was 167 degrees in FF and 67 degrees in ER compared to post-operative ROM which was 168 degrees FF and 60 degrees ER. In the revision group there was a mean ROM of 154 degrees in FF and 66 degrees ER compared to a post-operative ROM of 162 degrees in FF and 64 degrees ER. At final follow-up, 14/16 (88%) subjects who had revision Bankart repair and 32/37 (86%) who had primary stabilization stated they would have the surgery again. There were 2 failures in each group that required revision surgery.

Conclusion

Arthroscopic revision Bankart repair has similar clinical outcomes to arthroscopic primary Bankart repair and is an effective option for recurrent anterior instability in the absence of significant bone loss.