Arciero and colleagues compared arthroscopic Bankart suture repair with nonoperative care after a first traumatic anterior shoulder dislocation in young athletes, asking whether early repair lowers recurrence.
Prospective, nonrandomized study of 36 cadet athletes (average age 20) at the US Military Academy from 1988 to 1991, in which each athlete chose his or her treatment.
Methods
Design
Prospective, nonrandomized comparison
Athletes chose their own treatment
Enrolled September 1988 to October 1991
Data source
Orthopaedic Service, US Military Academy, West Point
Patients
36 athletes, average age 20
First traumatic anterior dislocation, seen acutely
Dislocation needed manual reduction
No prior impingement or occult subluxation
No associated neurologic injury
Exposure
Group I (15): immobilization for 1 month, then rehabilitation
Group II (21): arthroscopic transglenoid suture Bankart repair, then the same protocol
Full activity allowed at 4 months
Follow-up
Repair group: mean 32 months (range 15 to 45)
Nonoperative group: mean 23 months (range 15 to 39)
Outcomes
Recurrent instability
Later open Bankart repair
Return to preinjury participation
Rowe score
Key Findings
Recurrent instability developed in 12 of 15 nonoperative patients (80%) vs 3 of 21 after arthroscopic repair (p = 0.001).
Later open Bankart repair was needed in 7 of 15 nonoperative patients (47%) vs 1 of 21 after arthroscopic repair (5%) (p = 0.005).
In varsity or club athletes, recurrence followed 8 of 10 nonoperative cases (80%) vs 1 of 8 arthroscopic repairs (13%) (p = 0.008).
All 3 recurrences after arthroscopic repair occurred in athletes playing collision sports.
The repair group included significantly more limited‑contact athletes than the nonoperative group (p = 0.003), which may bias the comparison toward repair.
Repair caused 3 complications: one posterior suture‑knot abscess and two cases of transient median nerve hypesthesia that resolved within 3 weeks.
Board pearl
At arthroscopy after a first traumatic anterior dislocation, all 21 young athletes had a Grade III Bankart lesion, meaning the capsule, labrum and inferior glenohumeral ligament complex were avulsed from the scapular neck.
Authors' conclusion
In this study, arthroscopic Bankart repair significantly reduced the recurrence rate in young athletes who sustained an acute, initial anterior dislocation of the shoulder.
Arciero and colleagues compared arthroscopic Bankart suture repair with nonoperative care after a first traumatic anterior shoulder dislocation in young athletes, asking whether early repair lowers recurrence.
Prospective, nonrandomized study of 36 cadet athletes (average age 20) at the US Military Academy from 1988 to 1991, in which each athlete chose his or her treatment.
Methods
Design
Prospective, nonrandomized comparison
Athletes chose their own treatment
Enrolled September 1988 to October 1991
Data source
Orthopaedic Service, US Military Academy, West Point
Patients
36 athletes, average age 20
First traumatic anterior dislocation, seen acutely
Dislocation needed manual reduction
No prior impingement or occult subluxation
No associated neurologic injury
Exposure
Group I (15): immobilization for 1 month, then rehabilitation
Group II (21): arthroscopic transglenoid suture Bankart repair, then the same protocol
Full activity allowed at 4 months
Follow-up
Repair group: mean 32 months (range 15 to 45)
Nonoperative group: mean 23 months (range 15 to 39)
Outcomes
Recurrent instability
Later open Bankart repair
Return to preinjury participation
Rowe score
Key Findings
Recurrent instability developed in 12 of 15 nonoperative patients (80%) vs 3 of 21 after arthroscopic repair (p = 0.001).
Later open Bankart repair was needed in 7 of 15 nonoperative patients (47%) vs 1 of 21 after arthroscopic repair (5%) (p = 0.005).
In varsity or club athletes, recurrence followed 8 of 10 nonoperative cases (80%) vs 1 of 8 arthroscopic repairs (13%) (p = 0.008).
All 3 recurrences after arthroscopic repair occurred in athletes playing collision sports.
The repair group included significantly more limited‑contact athletes than the nonoperative group (p = 0.003), which may bias the comparison toward repair.
Repair caused 3 complications: one posterior suture‑knot abscess and two cases of transient median nerve hypesthesia that resolved within 3 weeks.
Board pearl
At arthroscopy after a first traumatic anterior dislocation, all 21 young athletes had a Grade III Bankart lesion, meaning the capsule, labrum and inferior glenohumeral ligament complex were avulsed from the scapular neck.
Authors' conclusion
In this study, arthroscopic Bankart repair significantly reduced the recurrence rate in young athletes who sustained an acute, initial anterior dislocation of the shoulder.