Boileau and colleagues reviewed the results of arthroscopic suture‑anchor Bankart repair for recurrent traumatic anterior shoulder instability and looked for factors that predicted recurrence.
Retrospective case series (Level IV) of 91 of 100 consecutive patients operated on in 1999 to 2001 at the University of Nice, followed a mean of 36 months (minimum 24) and examined by independent observers.
Methods
Design
Retrospective case series of consecutive patients (Level IV)
Patients followed prospectively
9 of 100 lost before 2 years
Data source
Hôpital de L’Archet, University of Nice, France
Patients
91 patients with recurrent traumatic anterior instability
Mean age 26.4 years
71 male
79 in sports, 40 of them in high‑risk sports
Exposure
Arthroscopic capsulolabral reattachment with capsular retensioning
Absorbable suture anchors, mean 4.3 (range 2 to 7)
Follow-up
Mean 36 months (range 24 to 56)
Final examination by independent observers
Outcomes
Failure: any dislocation or any reported subluxation
Rowe and Walch‑Duplay scores
Key Findings
Instability recurred in 14 of 91 patients (15.3%) over a mean 36 months of follow‑up, with 6 dislocations and 8 subluxations, after a mean of 17.6 months.
Patients with both glenoid bone loss and a stretched inferior glenohumeral ligament had a 75% recurrence rate on multivariate analysis (p < 0.001), although the paper does not report the size of this subgroup.
The authors recommend at least four anchor points, whatever the extent of the Bankart lesion.
Age at first episode, sex, contact sport, dislocation vs subluxation, number of episodes and bilateral instability did not affect recurrence with the numbers studied.
Nine of the 14 recurrences occurred more than a year after surgery.
All 9 failures revised with a Latarjet procedure were stable afterward.
Board pearl
The authors consider glenoid bone loss combined with hyperlaxity (external rotation above 90° at the side and/or abnormal hyperabduction) a formal contraindication to arthroscopic Bankart repair.
Authors' conclusion
In the treatment of traumatic recurrent anterior shoulder instability, patients with bone loss or with shoulder hyperlaxity are at risk for recurrent instability after arthroscopic Bankart repair. At least four anchor points should be used to obtain secure shoulder stabilization.
Boileau and colleagues reviewed the results of arthroscopic suture‑anchor Bankart repair for recurrent traumatic anterior shoulder instability and looked for factors that predicted recurrence.
Retrospective case series (Level IV) of 91 of 100 consecutive patients operated on in 1999 to 2001 at the University of Nice, followed a mean of 36 months (minimum 24) and examined by independent observers.
Methods
Design
Retrospective case series of consecutive patients (Level IV)
Patients followed prospectively
9 of 100 lost before 2 years
Data source
Hôpital de L’Archet, University of Nice, France
Patients
91 patients with recurrent traumatic anterior instability
Mean age 26.4 years
71 male
79 in sports, 40 of them in high‑risk sports
Exposure
Arthroscopic capsulolabral reattachment with capsular retensioning
Absorbable suture anchors, mean 4.3 (range 2 to 7)
Follow-up
Mean 36 months (range 24 to 56)
Final examination by independent observers
Outcomes
Failure: any dislocation or any reported subluxation
Rowe and Walch‑Duplay scores
Key Findings
Instability recurred in 14 of 91 patients (15.3%) over a mean 36 months of follow‑up, with 6 dislocations and 8 subluxations, after a mean of 17.6 months.
Patients with both glenoid bone loss and a stretched inferior glenohumeral ligament had a 75% recurrence rate on multivariate analysis (p < 0.001), although the paper does not report the size of this subgroup.
The authors recommend at least four anchor points, whatever the extent of the Bankart lesion.
Age at first episode, sex, contact sport, dislocation vs subluxation, number of episodes and bilateral instability did not affect recurrence with the numbers studied.
Nine of the 14 recurrences occurred more than a year after surgery.
All 9 failures revised with a Latarjet procedure were stable afterward.
Board pearl
The authors consider glenoid bone loss combined with hyperlaxity (external rotation above 90° at the side and/or abnormal hyperabduction) a formal contraindication to arthroscopic Bankart repair.
Authors' conclusion
In the treatment of traumatic recurrent anterior shoulder instability, patients with bone loss or with shoulder hyperlaxity are at risk for recurrent instability after arthroscopic Bankart repair. At least four anchor points should be used to obtain secure shoulder stabilization.