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Neer Modification of Open Bankart Procedure: What Are the Rates of Recurrent Instability, Functional Outcome, and Arthritis?

·Clin Orthop Relat Res·2012·35 citations·Shoulder & Elbow
DOI·PubMed
SummaryAbstract on PubMed →

This is a retrospective case series of the Neer modification of the open Bankart procedure, which adds a superoinferior capsular shift to labral reattachment. It asks whether this technique reduces recurrent instability, preserves external rotation, and limits arthritis in traumatic anteroinferior instability. 64 patients were followed for a median of 40 months.

Study Snapshot

Design
Retrospective case series
Blinding: Open-label
Setting: Single center, University of Nice
Funding: None
Objective
Whether the Neer superoinferior capsular shift lowers recurrence and arthritis without limiting external rotation
Outcome(s)
Recurrent instability rate at minimum 2-year followup
Subjects
64 patients
  • 39Dislocations
  • 25Subluxations
Inclusion
  • Recurrent anteroinferior instability
  • Bankart lesion present at surgery
Exclusion
  • First-time dislocation
  • No Bankart lesion at surgery
  • Atraumatic or voluntary instability
Follow-up
Minimum 24 months (median 40)
Statistics
Descriptive statistics

Key Findings

  • Recurrent instability occurred in 11% (7 of 64) at a mean of 25 months, and most recurrences were trauma-related. This rate matched contemporary arthroscopic Bankart results, which is precisely why the authors abandoned the open procedure.
  • An additional 13% (8 patients) had persistent apprehension or discomfort without frank recurrence. Counting these together with true recurrences, roughly a quarter of shoulders had a suboptimal stability result.
  • Five of the seven recurrences were revised with a Latarjet procedure and all became stable. This reinforces Latarjet as the go-to salvage after a failed soft-tissue repair.
  • Functional scores were high (mean Rowe 83, Walch-Duplay 84), yet only 56% returned to sport at their prior level. High scores can mask a meaningful drop in athletic performance.
  • External rotation loss was modest at 13 degrees at the side and 17 degrees in abduction. The superoinferior shift avoids the mediolateral shortening that historically limited rotation with Bankart and Putti-Platt.
  • Glenohumeral osteoarthritis rose from 4% to 17%, but with no Stage IV joint-space narrowing at this short followup. Arthropathy is known to climb to 40-61% at 18-29 years, so this is reassuring only in the near term.
  • Reflex sympathetic dystrophy was the most common complication at 13%, all resolving by one year after prolonged rehabilitation.
Board PearlThe Neer-modified open Bankart yields an 11% recurrence rate matching arthroscopic repair, which is why the authors abandoned the open procedure.

Clinical Relevance

The clinical takeaway is a decision rule about technique choice: when open and arthroscopic Bankart give equivalent recurrence rates, the added morbidity of open surgery is hard to justify.

The Neer modification was designed to fix a real biomechanical problem. Anteroinferior instability stretches the capsule vertically, so a superoinferior shift restores tension without the mediolateral shortening that limited external rotation in older repairs.

That design worked mechanically: external rotation loss was only 13 degrees and no shoulder reached end-stage arthropathy at short followup. But the 11% recurrence and 56% return-to-sport rates matched arthroscopy, so the open approach lost its advantage.

For boards, know the Samilson and Prieto staging (osteophyte size thresholds of 3 mm and 8 mm, with Stage 4 being joint-space loss) and remember Latarjet is the salvage for failed soft-tissue repair or significant glenoid bone loss.

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Neer Modification of Open Bankart Procedure: What Are the Rates of Recurrent Instability, Functional Outcome, and Arthritis?

·Clin Orthop Relat Res·2012·35 citations·Shoulder & Elbow
DOI·PubMed
SummaryAbstract on PubMed →

This is a retrospective case series of the Neer modification of the open Bankart procedure, which adds a superoinferior capsular shift to labral reattachment. It asks whether this technique reduces recurrent instability, preserves external rotation, and limits arthritis in traumatic anteroinferior instability. 64 patients were followed for a median of 40 months.

Study Snapshot

Design
Retrospective case series
Blinding: Open-label
Setting: Single center, University of Nice
Funding: None
Objective
Whether the Neer superoinferior capsular shift lowers recurrence and arthritis without limiting external rotation
Outcome(s)
Recurrent instability rate at minimum 2-year followup
Subjects
64 patients
  • 39Dislocations
  • 25Subluxations
Inclusion
  • Recurrent anteroinferior instability
  • Bankart lesion present at surgery
Exclusion
  • First-time dislocation
  • No Bankart lesion at surgery
  • Atraumatic or voluntary instability
Follow-up
Minimum 24 months (median 40)
Statistics
Descriptive statistics

Key Findings

  • Recurrent instability occurred in 11% (7 of 64) at a mean of 25 months, and most recurrences were trauma-related. This rate matched contemporary arthroscopic Bankart results, which is precisely why the authors abandoned the open procedure.
  • An additional 13% (8 patients) had persistent apprehension or discomfort without frank recurrence. Counting these together with true recurrences, roughly a quarter of shoulders had a suboptimal stability result.
  • Five of the seven recurrences were revised with a Latarjet procedure and all became stable. This reinforces Latarjet as the go-to salvage after a failed soft-tissue repair.
  • Functional scores were high (mean Rowe 83, Walch-Duplay 84), yet only 56% returned to sport at their prior level. High scores can mask a meaningful drop in athletic performance.
  • External rotation loss was modest at 13 degrees at the side and 17 degrees in abduction. The superoinferior shift avoids the mediolateral shortening that historically limited rotation with Bankart and Putti-Platt.
  • Glenohumeral osteoarthritis rose from 4% to 17%, but with no Stage IV joint-space narrowing at this short followup. Arthropathy is known to climb to 40-61% at 18-29 years, so this is reassuring only in the near term.
  • Reflex sympathetic dystrophy was the most common complication at 13%, all resolving by one year after prolonged rehabilitation.
Board PearlThe Neer-modified open Bankart yields an 11% recurrence rate matching arthroscopic repair, which is why the authors abandoned the open procedure.

Clinical Relevance

The clinical takeaway is a decision rule about technique choice: when open and arthroscopic Bankart give equivalent recurrence rates, the added morbidity of open surgery is hard to justify.

The Neer modification was designed to fix a real biomechanical problem. Anteroinferior instability stretches the capsule vertically, so a superoinferior shift restores tension without the mediolateral shortening that limited external rotation in older repairs.

That design worked mechanically: external rotation loss was only 13 degrees and no shoulder reached end-stage arthropathy at short followup. But the 11% recurrence and 56% return-to-sport rates matched arthroscopy, so the open approach lost its advantage.

For boards, know the Samilson and Prieto staging (osteophyte size thresholds of 3 mm and 8 mm, with Stage 4 being joint-space loss) and remember Latarjet is the salvage for failed soft-tissue repair or significant glenoid bone loss.

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