Boileau (2006) — Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair.

Risk Factors for Recurrence of Shoulder Instability after Arthroscopic Bankart Repair.

·J Bone Joint Surg Am·2006·945 citations·Shoulder & Elbow

Prospective cohort of 91 patients undergoing arthroscopic Bankart repair with suture anchors for traumatic recurrent anterior shoulder instability. Designed to identify preoperative and intraoperative risk factors for postoperative recurrence at minimum two-year follow-up. Results defined which patients should not have arthroscopic repair at all.

Study Snapshot

Design

Retrospective cohort

Setting: Single center, Nice, France

Funding: None

Objective

Determine whether bone loss or hyperlaxity predicts recurrence after arthroscopic Bankart repair

Outcome(s)

Recurrence of instability (dislocation or subluxation) postoperatively

Subjects

91 patients with recurrent traumatic anterior shoulder instability

Arthroscopic Bankart repair with absorbable suture anchors, mean 4.3 anchors

Inclusion

Traumatic recurrent anteroinferior instability
Suture anchor arthroscopic stabilization
Minimum 2-year follow-up

Exclusion

Acute first dislocation
Prior failed instability repair (n=9 lost to follow-up)
Voluntary, posterior, or multidirectional instability

Follow-up

24–56 months (mean 36 months)

Statistics

Chi-square testYates-corrected chi-squareStudent t-testFisher variance analysis

Key Findings

The overall recurrence rate was 15.3% at mean 36 months (6 dislocations, 8 subluxations), with failures occurring late — mean time to recurrence was 17.6 months — suggesting mechanical creep rather than acute technical failure.
Glenoid bone loss type determines failure risk, not just its presence — the fracture pattern dictates whether the capsuloligamentous structures are intact:
–Compression fracture (>25% loss, no detached fragment) — significantly predicted failure (p = 0.01)
–Separation fracture with a detached fragment — did NOT predict failure (p = 0.59)
–Large Hill-Sachs lesion — also predicted failure (p = 0.05)
Two hyperlaxity patterns each independently predicted recurrence, and both are detectable on physical exam before any incision is made:
–Inferior laxity via Gagey test (>20° asymmetric hyperabduction) — p = 0.03
–Anterior hyperlaxity (external rotation >90°) — p = 0.01
Combined glenoid compression bone loss plus inferior hyperlaxity produced a 75% recurrence rate (p < 0.001) — the authors designate this combination a formal contraindication to arthroscopic repair; all nine patients revised to open Latarjet achieved stability.
Using three or fewer suture anchors significantly increased failure risk (p = 0.03); a minimum of four anchors is recommended regardless of how small the Bankart lesion appears.

Board PearlGlenoid bone loss plus inferior hyperlaxity yields 75% recurrence after arthroscopic Bankart — this combination mandates open Latarjet instead.

Clinical Relevance

Screening your instability patient before offering arthroscopic Bankart repair is not optional — it changes the operation.

Check three things in every pre-op evaluation: Glenoid bone loss type on CT (compression vs. Separation fracture) Gagey test (hyperabduction asymmetry >20° = stretched inferior glenohumeral ligament) External rotation at the side (>90° = anterior hyperlaxity)

If you find glenoid compression-type bone loss combined with either hyperlaxity marker, this paper gives you the number to quote: 75% recurrence with arthroscopic repair alone. That patient needs a Latarjet, not a Bankart. When you do proceed arthroscopically, place at least four anchors. Three anchors is not enough regardless of how small the Bankart lesion looks.

Core

Risk Factors for Recurrence of Shoulder Instability after Arthroscopic Bankart Repair.

Boileau, Neyton, et al.·J Bone Joint Surg Am·2006·945 citations·Shoulder & Elbow

Risk Factors for Recurrence of Shoulder Instability after Arthroscopic Bankart Repair.

Study Snapshot

Key Findings

Clinical Relevance

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Risk Factors for Recurrence of Shoulder Instability after Arthroscopic Bankart Repair.

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Risk Factors for Recurrence of Shoulder Instability after Arthroscopic Bankart Repair.

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Risk Factors for Recurrence of Shoulder Instability after Arthroscopic Bankart Repair.

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Key Findings

Clinical Relevance

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