This retrospective cohort followed patients who had classic Bankart reconstructions for recurrent anterior shoulder instability between 1970 and 1983. The question: how often does late degenerative glenohumeral arthrosis develop after this motion-preserving repair? Thirty-one patients (33 shoulders) returned at an average 15-year followup for questionnaire, exam, and bilateral radiographs.
The core teaching point: late glenohumeral arthrosis after instability surgery tracks with how much external rotation you take away, not with the repair itself.
At 15 years, 87% of these classic Bankart shoulders were essentially arthrosis-free, which stands in sharp contrast to non-anatomic procedures. The Eden-Hybbinette bone block showed 72% moderate-to-severe arthrosis, and Putti-Platt repairs were implicated in overtightening-driven degeneration.
The mental model to carry into the OR: an excessively tight anterior capsulorrhaphy generates compression and shear at the articular surface that worsen with attempted external rotation. Address the specific lesion (the detached labrum/capsule) and avoid over-imbricating the anterior soft tissues.
Read this paper critically, though. Only 60% of patients returned, there were no preoperative radiographs, and just 4 shoulders had moderate or severe changes. As the discussant noted, meniscectomy takes 15 to 20 years to show joint changes, so even 15 years may be too early to declare the Bankart truly protective.
This retrospective cohort followed patients who had classic Bankart reconstructions for recurrent anterior shoulder instability between 1970 and 1983. The question: how often does late degenerative glenohumeral arthrosis develop after this motion-preserving repair? Thirty-one patients (33 shoulders) returned at an average 15-year followup for questionnaire, exam, and bilateral radiographs.
The core teaching point: late glenohumeral arthrosis after instability surgery tracks with how much external rotation you take away, not with the repair itself.
At 15 years, 87% of these classic Bankart shoulders were essentially arthrosis-free, which stands in sharp contrast to non-anatomic procedures. The Eden-Hybbinette bone block showed 72% moderate-to-severe arthrosis, and Putti-Platt repairs were implicated in overtightening-driven degeneration.
The mental model to carry into the OR: an excessively tight anterior capsulorrhaphy generates compression and shear at the articular surface that worsen with attempted external rotation. Address the specific lesion (the detached labrum/capsule) and avoid over-imbricating the anterior soft tissues.
Read this paper critically, though. Only 60% of patients returned, there were no preoperative radiographs, and just 4 shoulders had moderate or severe changes. As the discussant noted, meniscectomy takes 15 to 20 years to show joint changes, so even 15 years may be too early to declare the Bankart truly protective.