Summary

Patients can expect excellent outcomes with low failure rates after Bankart repair, even in the setting of revision cases, concomitant SLAP repair or =3 prior dislocations, but repairs with GLAD lesions were less favorable.

Abstract

Background

and Purpose: Arthroscopic Bankart repair is the gold standard for patients with failed non-operative treatment for anteroinferior instability (AI) of the shoulder. Bony glenoid deficiency of 20% or more, engaging Hill-Sachs (HS) lesions and the use of fewer than 3 suture anchors have previously been identified as predictors of failure and inferior outcomes. The effect of previously failed stabilization surgeries, the number of dislocations prior to stabilization, GLAD lesions and SLAP lesions on failure rates and outcomes remain unclear. The purpose of this study was to investigate the effect that (1) three or more dislocations prior to surgery, (2) previous arthroscopic stabilization surgeries, (3) GLAD lesions and (4) additional SLAP repairs have on failure rates and functional outcomes.

Methods

Only patients who were at least 2 years out from arthroscopic Bankart repair for AI were included. Exclusion criteria were prior open stabilization surgery, multidirectional shoulder instability, or patients who underwent concurrent rotator cuff repair, distal clavicle excision, or acromioclavicular reconstruction at the time of Bankart repair. Pre- and postoperatively the SF-12 PCS, SANE, QuickDASH, ASES scores, and satisfaction (10-point scale) were collected. An a priori decision was made to evaluate the effects of the following factors on outcomes and failure rates of Bankart repair: (1) previous arthroscopic stabilization surgeries, (2) three or more dislocations prior to stabilization, (3) GLAD lesions, and (4) concurrent SLAP repair.

Results

72 patients (10 female, 62 male) with median age 23 (range 14-49) years were included. 9 patients (12.5%) required subsequent revision instability surgery; additionally, 1 patient (1.4%) experienced recurrent dislocation but did not undergo revision surgery. Outcomes data was available for 52 of the remaining 62 patients (84%) at a median follow-up of 3 years (range 2-9). All outcome scores significantly improved pre- to post-operatively (P < 0.05); median satisfaction was 10 (range 1-10). Among patients who did not fail, all risk factors were not associated with lower outcome scores (P > 0.05). However, GLAD lesions were significantly associated with failure (P = 0.007). Previous stabilization surgeries, number of dislocations prior to index surgery, and concurrent SLAP repair had no significant effect on outcome scores or failure rates (P > 0.05).

Conclusions

Patients with arthroscopic Bankart repair for traumatic AI experienced excellent outcomes and low failure rates, even in the context of previous arthroscopic stabilization surgery, three or more dislocations prior to surgery, or concurrent SLAP repair. However, GLAD lesions were associated with a higher rate of failure.