Outcomes after isolated arthroscopic Bankart repair (ABR) depend on patient selection in athletes.
Methods
Retrospective cohort of athletes <30 years undergoing isolated ABR (2017–2020) with minimum 4-year follow-up. Exclusions: >10% glenoid bone loss, off-track Hill–Sachs, humeral avulsion of the glenohumeral ligament, superior labrum from anterior to posterior/posterior labral tears, prior surgery, hyperlaxity, multidirectional instability, acute bony Bankart, and collision sports. Outcomes: return to sport (RTS), Rowe, Subjective Shoulder Value (SSV), and Athletic Shoulder Outcome Scoring System (ASOSS). Recurrence was dislocation or clinically verified subluxation. Kaplan–Meier recurrence-free survival (RFS) and crude Cox regression by sport type were used.
Results
215 athletes met eligibility criteria and underwent isolated ABR; 205 completed follow-up; median age 20 years. Mean follow-up was 5.87 years (range: 4.0–7.75). RTS was 93.2%, and 86.8% returned to preinjury level at 5.09 ± 1.03 months. Rowe improved 45→95, SSV 50→90, and ASOSS 53→93 (all p < .001). Rowe minimal clinically important difference was achieved by 94.6% and ASOSS PASS by 100%. RFS was 95.5% at 4 years and 93.1% at 6 years; contact–overhead athletes showed lower RFS (HR 2.5; p = .03).
Conclusion
Isolated ABR in selected athletes younger than 30 years was associated with a high rate of RTS, excellent functional outcomes, and a low recurrence rate at mid-term follow-up.
ProvencherMTBhatiaSGhodadraNS, et al.Recurrent shoulder instability: current concepts for evaluation and management of glenoid bone loss. J Bone Joint Surg Am2010; 92: 133–151.
2.
HurleyETJamalMSAliZS, et al.Long-term outcomes of the Latarjet procedure for anterior shoulder instability: a systematic review of studies at 10-year follow-up. J Shoulder Elbow Surg2019; 28: e33–e39.
3.
RossiLATanoiraIGorodischerT, et al.Recurrence and revision rates with arthroscopic Bankart repair compared with the Latarjet procedure in competitive rugby players with glenohumeral instability and a glenoid bone loss <20. Am J Sports Med2021; 49: 866–872.
4.
WassersteinDDwyerTVeilletteC, et al.Predictors of dislocation and revision after shoulder stabilization in Ontario, Canada, from 2003 to 2008. Am J Sports Med2013; 41: 2034–2040.
5.
CordascoFALinBHellerM, et al.Arthroscopic shoulder stabilization in the young athlete: return to sport and revision stabilization rates. J Shoulder Elbow Surg2020; 29: 946–953.
6.
Di GiacomoGPeeblesLAPuglieseM, et al.Glenoid track instability management score: radiographic modification of the instability severity index score. Arthroscopy2020; 36: 56–67.
7.
Bracamontes-MartínezCNJuárez-JiménezHGRojas-LariosF, et al.Glenoid track “off-track” as a risk factor for recurrence of anterior glenohumeral instability in postoperative patients. Acta Ortop Mex2020; 34: 365–370.
8.
LynchJRClintonJMDewingCB, et al.Treatment of osseous defects associated with anterior shoulder instability. J Shoulder Elbow Surg2009; 18: 317–328.
9.
ThomazeauHLanglaisTHardyA, et al.Long-term, prospective, multicenter study of isolated Bankart repair for a patient selection method based on the instability severity index score. Am J Sports Med2019; 47: 1057–1061.
10.
BessièreCTrojaniCCarlesM, et al.The open Latarjet procedure is more reliable in terms of shoulder stability than arthroscopic Bankart repair. Clin Orthop Relat Res2014; 472: 2345–2351.
11.
DelgrandeDLonjonGHardyP, et al.Long-term results of arthroscopic Bankart repairs for anterior instability of the shoulder in patients aged thirty years or older. Int Orthop2021; 45: 1583–1589.
12.
MonroeEJBrandJC. Editorial Commentary: dynamic anterior stabilization via biceps tenodesis to the glenoid is an option for anterior shoulder instability with subcritical glenoid bone loss. Arthroscopy2022; 38: 1772–1773.
13.
KeelingLEWagalaNRyanPM, et al.Bone loss in shoulder instability: putting it all together. Ann Jt2023; 8: 27.
14.
ItoiE. On-track’ and ‘off-track’ shoulder lesions. EFORT Open Rev2017; 2: 343–351.
15.
CalvoELuengoGMorcilloD, et al.Revision arthroscopic Bankart repair versus arthroscopic Latarjet for failed primary arthroscopic stabilization with subcritical bone loss. Orthop J Sports Med2021; 9: 23259671211001809.
16.
HurleyETMatacheBAWongI, et al.Anterior shoulder instability Part I-diagnosis, nonoperative management, and Bankart repair-an international consensus statement. Arthroscopy2022; 38: 214–223.e7.
17.
OldsMEllisRDonaldsonK, et al.Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis. Br J Sports Med2015; 49: 913–922.
18.
BauerSCollinPZumsteinMA, et al.Current concepts in chronic traumatic anterior shoulder instability. EFORT Open Rev2023; 8: 468–481.
19.
LocherJWilkenFBeitzelK, et al.Hill-Sachs Off-track lesions as risk factor for recurrence of instability after arthroscopic Bankart repair. Arthroscopy2016; 32: 1993–1999.
20.
Di GiacomoGItoiEBurkhartSS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from ‘engaging/non-engaging’ lesion to ‘on-track/off-track’ lesion. Arthroscopy2014; 30: 90–98.
21.
HurleyETToaleJPDaveyMS, et al.Remplissage for anterior shoulder instability with Hill-Sachs lesions: a systematic review and meta-analysis. J Shoulder Elbow Surg2020; 29: 2487–2494.
22.
DavisWHDiPasqualeJAPatelRK, et al.Arthroscopic remplissage combined with Bankart repair results in a higher rate of return to sport in athletes compared with Bankart repair alone or the Latarjet procedure: a systematic review and meta-analysis. Am J Sports Med2023; 51: 3304–3312.
23.
Villarreal-EspinosaJBKayJRamappaAJ. Arthroscopic Bankart with remplissage results in lower rates of recurrent instability with similar range of motion compared to isolated arthroscopic Bankart for anterior glenohumeral instability: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc2024; 32: 243–256.
24.
MirzayanRItoiEKarpyshynJ, et al.Controversies in surgical management of anterior shoulder instability: state of the art. J ISAKOS2024; 9: 168–183.
25.
MacDonaldPMcRaeSOldJ, et al.Arthroscopic Bankart repair with and without arthroscopic infraspinatus remplissage in anterior shoulder instability with a Hill-Sachs defect: a randomized controlled trial. J Shoulder Elbow Surg2021; 30: 1288–1298.
26.
FrantzTLEverhartJSCvetanovichGL, et al.What are the effects of remplissage on 6-month strength and range of motion after arthroscopic Bankart repair? A multicenter cohort study. Orthop J Sports Med2020; 8: 2325967120903283.
27.
RandelliPSCompagnoniRRadaelliS, et al.Arthroscopic remplissage is safe and effective: clinical and magnetic resonance results at a minimum 3 years of follow-up. J Orthop Traumatol2022; 23: 5.
28.
PasqualiniIRossiLAFrancoJVA, et al.Results after arthroscopic Bankart repair in contact athletes should not be reported globally because of the high variability in recurrences among the different contact or collision sports: a systematic review. Arthroscopy2024; 40: 523–539.e2.
29.
LabouteEHoffmannRBealuA, et al.Recurrence and return to sport after surgery for shoulder instability: arthroscopic Bankart versus Latarjet procedure. JSES Int2021; 5: 609–615.
30.
WoodmassJMMcRaeSLapnerP, et al.Arthroscopic Bankart repair with remplissage in anterior shoulder instability results in fewer redislocations than Bankart repair alone at medium-term follow-up of a randomized controlled trial. Am J Sports Med2024; 52: 2055–2062.
31.
BurkhartSSDe BeerJF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy2000; 16: 677–694.
32.
RiceSG. American Academy of Pediatrics Council on Sports Medicine and Fitness: Medical conditions affecting sports participation. Pediatrics2008; 121: 841–848.
33.
American Academy of Pediatrics Committee on Sports Medicine. Recommendations for participation in competitive sports. Pediatrics1988; 81: 737–739.
34.
GageyOJGageyN. The hyperabduction test. J Bone Joint Surg Br2001; 83: 69–74.
35.
GyftopoulosSBeltranLSBookmanJ, et al.MRI Evaluation of bipolar bone loss using the on-track off-track method: a feasibility study. AJR Am J Roentgenol2015; 205: 848–852.
36.
GilbartMKGerberC. Comparison of the subjective shoulder value and the constant score. J Shoulder Elbow Surg2007; 16: 717–721.
37.
RoweCRPatelDSouthmaydWW. The Bankart procedure: a long-term end-result study. J Bone Joint Surg Am1978; 60: 1–16.
38.
SteinTLinkeRDBuckupJ, et al.Shoulder sport-specific impairments after arthroscopic Bankart repair: a prospective longitudinal assessment. Am J Sports Med2011; 39: 2404–2414.
39.
PasqualiniITanoiraIHurleyET, et al.Effect of patient characteristics on the minimal clinically important difference and patient acceptable symptom state thresholds after arthroscopic Bankart repair. Am J Sports Med2024; 52: 174–180.
40.
AraújoCGSScharhagJ. Athlete: a working definition for medical and health sciences research. Scand J Med Sci Sports2016; 26: 4–7.
41.
ShinS-JKimRGJeonYS, et al.Critical value of anterior glenoid bone loss that leads to recurrent glenohumeral instability after arthroscopic Bankart repair. Am J Sports Med2017; 45: 1975–1981.
42.
BodenSACharlesSHughesJD, et al.Recurrent instability after arthroscopic Bankart repair in patients with hyperlaxity and near-track lesions. Orthop J Sports Med2023; 11: 23259671231200231.
43.
Hossein ZadehRDaliriMSadeghiM, et al.Arthroscopic Bankart repair vs. Latarjet procedure for recurrent shoulder instability: a meta-analysis of clinical outcomes and complication rates in general and athletic populations. J Shoulder Elbow Surg2024; 33: e652–e674.
44.
HurleyETSchwartzLBMojicaES, et al.Short-term complications of the Latarjet procedure: a systematic review. J Shoulder Elbow Surg2021; 30: 1693–1699.
45.
FengSChenMChenJ, et al.Patient outcomes and fear of returning to sports after arthroscopic Bankart repair with remplissage. Orthop J Sports Med2021; 9: 23259671211001775.
46.
GarciaGHWuH-HLiuJN, et al.Outcomes of the remplissage procedure and its effects on return to sports: average 5-year follow-up. Am J Sports Med2016; 44: 1124–1130.
47.
Owusu-AnsahGEAnuduEERossPP, et al.Psychological readiness to return to sport after shoulder instability. JBJS Rev2023; 11. doi: 10.2106/JBJS.RVW.23.00022
48.
TjongVKDevittBMMurnaghanML, et al.A qualitative investigation of return to sport after arthroscopic Bankart repair: beyond stability. Am J Sports Med2015; 43: 2005–2011.
