Rowe's 1978 landmark case series documents surgical findings and long-term outcomes in 161 patients (162 shoulders) undergoing open Bankart repair over a 30-year period (1946-1976). It asks: what pathoanatomy drives recurrent anterior instability, and how durable is meticulous capsulolabral repair across decades of follow-up? Mean follow-up was 6 years; 33% were followed 5-30 years.
Before this paper, competing procedures (Putti-Platt, Magnuson-Stack, Bristow, Eden-Hybbinette) each targeted a different anatomic culprit, and surgeons routinely overtightened the repair under the assumption that restricting external rotation would prevent redislocation.
Rowe proved the opposite: when you see a patient with ≤50% external rotation after stabilization surgery, that overtightening is itself a recurrence risk factor, not a safety margin. The takeaway for clinic is to incise the capsule with the shoulder in full external rotation to ensure the repair is not too tight.
This paper is also why we do not reflexively bone-graft every glenoid rim fracture. Fractures involving up to one-third of the glenoid surface had a 2% recurrence with capsular repair alone — lower than the overall series rate. Meaning soft tissue reconstruction is the primary driver of stability, not bony reconstruction at this threshold.
The Rowe Instability Rating Scale introduced here became the dominant outcomes instrument in shoulder surgery for decades, appearing in 33 of 298 shoulder outcome papers through 2005. It is the reason modern studies still report stability, motion, and function as the three pillars of shoulder instability outcome assessment.
Rowe's 1978 landmark case series documents surgical findings and long-term outcomes in 161 patients (162 shoulders) undergoing open Bankart repair over a 30-year period (1946-1976). It asks: what pathoanatomy drives recurrent anterior instability, and how durable is meticulous capsulolabral repair across decades of follow-up? Mean follow-up was 6 years; 33% were followed 5-30 years.
Before this paper, competing procedures (Putti-Platt, Magnuson-Stack, Bristow, Eden-Hybbinette) each targeted a different anatomic culprit, and surgeons routinely overtightened the repair under the assumption that restricting external rotation would prevent redislocation.
Rowe proved the opposite: when you see a patient with ≤50% external rotation after stabilization surgery, that overtightening is itself a recurrence risk factor, not a safety margin. The takeaway for clinic is to incise the capsule with the shoulder in full external rotation to ensure the repair is not too tight.
This paper is also why we do not reflexively bone-graft every glenoid rim fracture. Fractures involving up to one-third of the glenoid surface had a 2% recurrence with capsular repair alone — lower than the overall series rate. Meaning soft tissue reconstruction is the primary driver of stability, not bony reconstruction at this threshold.
The Rowe Instability Rating Scale introduced here became the dominant outcomes instrument in shoulder surgery for decades, appearing in 33 of 298 shoulder outcome papers through 2005. It is the reason modern studies still report stability, motion, and function as the three pillars of shoulder instability outcome assessment.