Prospective evaluation of arthroscopic bankart repairs for anterior instability.
BACKGROUND
Arthroscopic treatment has evolved to become the primary surgical option in the management of anterior shoulder instability as studies show comparable outcomes between open and arthroscopic techniques.


OBJECTIVE
To evaluate prospectively the results of our institutional database for arthroscopic Bankart repairs at a minimum 2-year follow-up for patients with anterior instability treated with suture anchors.


METHODS
Case series; Level of evidence, 4.


METHODS
Eighty-three consecutive patients underwent arthroscopic Bankart repair with suture anchors. The mean age at the time of surgery was 33 years (range, 15-55 years). At an average follow-up of 33 months (range, 24-49 months), 73 patients (61 males, 12 females) were assessed with outcomes scores including the American Shoulder and Elbow Surgeons, L'Insalata, and visual analog scores. The rate of recurrent instability, range of motion, and risk factors for postoperative recurrence were evaluated.


RESULTS
Thirteen patients (18%) suffered a recurrence after surgery. Seven patients (10%) had a subsequent dislocation and 6 (8%) a subluxation event or apprehension. Six of the 13 had a traumatic event that resulted in recurrent episodes of instability. Revision surgery was needed for 2 patients (3%) for instability and 2 for postoperative shoulder stiffness. On average there was no significant loss of external rotation postoperatively (average, 71 degrees pre- and postoperatively). The American Shoulder and Elbow Surgeons and L'Insalata scores improved from 75.4 to 94.9 and 66.5 to 90.9, respectively (P <.0001). The visual analog score improved from 2.4 to 0.4 (P <.001). Patient age under 25, ligamentous laxity, and the presence of a large (>250 mm(3)) Hill-Sachs lesion were associated with recurrence (P <.05). Patients under age 20 had a 37.5% recurrence rate.


CONCLUSIONS
In the arthroscopic treatment of anterior instability, identification of risk factors for recurrence allows for appropriate patient counseling and consideration of open stabilization. In our series, patients under age 25, with ligamentous laxity, and with a large (>250 mm(3)) Hill-Sachs lesion were at the greatest risk of recurrence.
Voos
James E
JE
Hospital for Special Surgery Sports Medicine and Shoulder Service, New York, New York 10021, USA.
Livermore
Ryan W
RW
Feeley
Brian T
BT
Altchek
David W
DW
Williams
Riley J
RJ
Warren
Russell F
RF
Cordasco
Frank A
FA
Allen
Answorth A
AA
D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009519:New York City; D011446:Prospective Studies; D012783:Shoulder Dislocation / Q000601:surgery*; D053441:Suture Anchors; D055815:Young Adult