title: Outcomes After Arthroscopic Bankart Repair: Patients With First-Time Versus Recurrent Dislocations.
abstract: BACKGROUND
  The young athletic population makes up the largest portion of shoulder instability and, when treated nonoperatively, has a recurrent dislocation rate as high as 71%. It is unknown how the outcomes of those who have a recurrent dislocation are affected versus those who have a stabilization procedure after a first-time dislocation.
  
  
  OBJECTIVE
  To report the postoperative outcomes of patients with first-time dislocations versus patients with recurrent dislocations before surgery.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  Current Procedural Terminology codes were used to identify patients who had arthroscopic Bankart repair between 2003 and 2013. A total of 173 eligible patients were identified across 8 fellowship-trained surgical practices. The first phase of the study was a retrospective chart review. Patients were identified as having a first-time dislocation or as having recurrent dislocations when they had >1 dislocation before surgical intervention. The second phase consisted of a survey to record a Simple Shoulder Test score and return to sport and to report postoperative instability and whether patients had further surgery on the shoulder.
  
  
  RESULTS
  A total of 121 patients participated, providing 70% follow-up at an average of 51 months. There were 53 patients in the recurrent dislocation group and 68 in the first-time dislocation group. The postoperative instability rate was 29% in the first-time dislocation group and 62% in the recurrent dislocation group; this difference was significant ( P < .001). The odds of postoperative instability were 4 times higher in the recurrent dislocation group (odds ratio = 4.14). The first-time dislocation group reported a 7% rate of repeat operation to address instability, whereas the recurrent dislocation group reported a rate of 32%; this difference was significant ( P < .001). The odds of needing additional surgery on the index shoulder was 6 times higher in the recurrent dislocation group (odds ratio = 6.01).
  
  
  CONCLUSIONS
  Patients with first-time dislocations had lower postoperative instability rates and reoperation rates when compared with patients with recurrent dislocations before surgery. Young patients with shoulder instability should be offered early surgical intervention to lower the risk of postoperative instability and reoperation.
authors.affiliation: Alabama Ortho Spine and Sports, Birmingham, Alabama, USA.
authors.forename: Tyler
authors.initials: T
authors.lastname: Marshall
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Vega
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Siqueira
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Cagle
authors.affiliation: Highline Orthopaedics, New York, New York, USA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Gelber
authors.affiliation: Cleveland Clinic Sports Health, Ohio, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Saluan
mesh_terms: D000293:Adolescent; D000328:Adult; D056352:Athletes; D000070896:Bankart Lesions / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bankart; instability; labrum; shoulder