Arthroscopic Bankart Repair Versus Immobilization for First Episode of Anterior Shoulder Dislocation Before the Age of 25: A Randomized Controlled Trial

2021 ◽  
pp. 036354652199638
Author(s):  
Cécile Pougès ◽  
Alexandre Hardy ◽  
Thomas Vervoort ◽  
Thomas Amouyel ◽  
Pauline Duriez ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Group ◽  
Shoulder Dislocation ◽  
Nonoperative Treatment ◽  
Bankart Repair ◽  
First Episode ◽  
Anterior Shoulder Dislocation ◽  
Arthroscopic Bankart Repair ◽  
Nonoperative Group

Background: The risk of recurrence after the first episode of anterior shoulder dislocation is high with nonoperative treatment in younger patients. Purpose/Hypothesis: The aim of this study was to compare the results of arthroscopic Bankart repair and nonoperative treatment for shoulder dislocation in patients younger than 25 years, with a minimum of 2 years of follow-up. The hypothesis was that surgery would decrease the risk of recurrence. Study design: Randomized controlled trial; Level of evidence, 1. Methods: We included patients aged between 18 and 25 years after a first episode of anterior shoulder dislocation and divided them into 2 groups. The first group was treated surgically with an arthroscopic Bankart repair within 2 weeks after the dislocation; the second group was treated nonoperatively. Both groups were immobilized for 3 weeks in internal rotation and followed the same physical therapy protocol. Standard radiography and computed tomography were performed immediately after reduction of the dislocation, and follow-up was performed at 3, 6, 12, and 24 months. The primary outcome measure was instability recurrence, defined as another anterior shoulder dislocation requiring closed reduction by another person (the patient was unable to reduce the dislocated joint themselves), a subluxation, or a positive apprehension test. Secondary outcome measures included range of motion, return to sport, and functional scores such as the short version of the Disabilities of the Arm, Shoulder and Hand score the Walch-Duplay score, and the Western Ontario Shoulder Instability Index (WOSI). Results: A total of 20 patients were included in each group. The mean ± SD age was 21 ± 1.8 years, and there were 33 men (82.5%) and 7 women (17.5%) in the total sample. Recurrence of instability was significantly decreased in the surgical treatment group compared with the nonoperative group (2 [10%] vs 14 [70%], respectively; P = .0001). Fewer patients in the surgical treatment group versus the nonoperative group had another episode of dislocation (0 vs 6 [30%], respectively), subluxation (2 [10%] vs 13 [65%], respectively; P = .003), or a positive apprehension test (1 [5%] vs 11 [58%], respectively; P = .0005). The Walch-Duplay score (88.4 vs 70.3 points; P = .046) and WOSI (11.5 vs 17.7 points; P = .035) were significantly better in the surgical group versus the nonoperative group after a 2-year follow-up. Level of sport was the same or better in 89% of the surgical treatment group vs 53% of the nonoperative treatment group ( P = .012). No surgical complication was recorded. We did not find any significant difference in range of motion. Conclusion: In patients with first-time shoulder dislocations, arthroscopic labral repair (Bankart procedure) reduced the risk of secondary shoulder dislocation and improved functional outcome versus nonoperative treatment after a 2-year follow-up. Surgical treatment after a first episode of shoulder dislocation could be offered as a primary treatment option in a younger population if these results are confirmed by larger studies with a longer follow-up. Registration: NCT03315819 (ClinicalTrials.gov identifier)

scholarly journals Latarjet procedure for failed arthroscopic Bankart repair: a case report

2020 ◽  
Vol 8 (5) ◽  
pp. 1921
Author(s):  
I. G. N. Wien Aryana ◽  
Rizki Zainuraditya
Keyword(s):  
Shoulder Dislocation ◽  
Coracoid Process ◽  
Bankart Repair ◽  
Anterior Shoulder Dislocation ◽  
Latarjet Procedure ◽  
Recurrence Rates ◽  
Arthroscopic Bankart Repair ◽  
Long Term Follow Up

Arthroscopic Bankart Repair (ABR) provides acceptable results for recurrent anterior shoulder dislocation. However, recent studies have shown recurrent rates of 4-19% or even up to 35-40% in patients aged <25 years, and the results tend to get worse after long-term follow-up. The Latarjet procedure can improve anterior stability by multiple mechanisms, not only can the Bankart lesion be repaired and provide stability, but the transfer of the coracoid process extends the bony articular arc of the glenoid, and the addition of the conjoint tendon may provide dynamic stability as well. The Latarjet procedure for correcting recurrent anterior shoulder dislocation led to good and excellent results in 82.7% of the cases. The Latarjet procedure had the lowest re-dislocation rate, which was significantly lower than the arthroscopic Bankart repair. Latarjet procedure is effective in terms of restoring anteroinferior glenohumeral stability and good option for failed arthroscopic Bankart repair. Recurrence rates of instability are acceptable and re-operation rates were low.

scholarly journals Arthroscopic Bankart Repair Versus Open Latarjet for First-Time Dislocators in Athletes

2021 ◽  
Vol 9 (8) ◽  
pp. 232596712110238
Author(s):  
Eoghan T. Hurley ◽  
Martin S. Davey ◽  
Connor Montgomery ◽  
Ross O’Doherty ◽  
Mohamed Gaafar ◽  
...  
Keyword(s):  
Shoulder Dislocation ◽  
Return To Play ◽  
Bankart Repair ◽  
Recurrence Rates ◽  
Level Of Evidence ◽  
Arthroscopic Bankart Repair ◽  
Significant Difference ◽  
Patient Reported ◽  
First Time

Background: In athletes with a first-time shoulder dislocation, arthroscopic Bankart repair (ABR) and the open Latarjet procedure (OL) are the most commonly utilized surgical procedures to restore stability and allow them to return to play (RTP). Purpose: To compare the outcomes of ABR and OL in athletes with a first-time shoulder dislocation. Study Design: Cohort study; Level of evidence, 3. Methods: We performed a retrospective review of patients with first-time shoulder dislocation who underwent primary ABR and OL and had a minimum 24-month follow-up. Indications for OL over ABR in this population were those considered at high risk for recurrence, including patients with glenohumeral bone loss. Patients who underwent ABR were pair-matched in a 2:1 ratio with patients who underwent OL by age, sex, sport, and level of preoperative play. The rate, level, and timing of RTP, as well as the Shoulder Instability–Return to Sport after Injury (SIRSI) score were evaluated. Additionally, we compared recurrence, visual analog scale pain score, Subjective Shoulder Value, Rowe score, satisfaction, and whether patients would undergo the surgery again. Results: Overall, 80 athletes who underwent ABR and 40 who underwent OL were included, with a mean follow-up of 50.3 months. There was no significant difference between ABR and OL in rate of RTP, return to preinjury level, time to return, or recurrent dislocation rate. There were also no differences between ABR and OL in patient-reported outcome scores or patient satisfaction. When collision athletes were compared between ABR and OL, there were no differences in RTP, SIRSI score, or redislocation rate. Conclusion: ABR and OL resulted in excellent clinical outcomes, with high rates of RTP and low recurrence rates. Additionally, there were no differences between the procedures in athletes participating in collision sports.

scholarly journals Evaluation of arthroscopic Bankart repair in recurrent shoulder dislocation

2019 ◽  
Vol 5 (4) ◽  
pp. 675
Author(s):  
R. G. Asutosh Mohapatra ◽  
Jitendra Kumar
Keyword(s):  
Shoulder Dislocation ◽  
External Rotation ◽  
Recurrent Dislocation ◽  
Bankart Repair ◽  
X Rays ◽  
Suture Anchors ◽  
Anterior Shoulder Dislocation ◽  
Range Of Movement ◽  
Arthroscopic Bankart Repair ◽  
The Mean

<p class="abstract"><strong>Background:</strong> Our aim was to study the surgical and functional outcome and postoperative shoulder motion following, arthroscopic repair of the Bankart lesion of the shoulder with suture anchors.</p><p class="abstract"><strong>Methods:</strong> This was a study of arthroscopic Bankart repair in recurrent anterior shoulder dislocation with suture anchors in 20 patients. Most of patients had symptoms for a period ranging from 1 to 2 years and 1- 4 recurrent dislocation episodes preoperatively. Necessary radiological and haematological investigations were done. The post-operative x-rays were evaluated and the post-operative rehabilitation evaluation done at 3 weeks, 6 weeks, 12 weeks, 6 months and 1 year, for any recurrence of symptoms.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study of 20 patients, with the mean follow up period of 12 months, the mean Rowe score post-operatively improved to 94 from a pre-operative mean score of 56.25. Out of 20 patients none had episodes of recurrent dislocation. In 15 patients 3 suture anchors were used and in 5 patients 2 suture anchors used intra operatively. The range of movement – external rotation in 90º of abduction improved in 17 patients (85%).</p><p><strong>Conclusions:</strong> We concluded that arthroscopic Bankart repair in recurrent anterior shoulder dislocation with suture anchors is effective in providing better shoulder function with range of movement and lower rate of recurrence.</p>

scholarly journals The Comparison of Results of Early and Late Rehabilitation Following Arthroscopic Bankart Repair with Knotless Anchor in Recurrent Traumatic Anterior Shoulder Dislocation

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0012
Author(s):  
Harun Kütahya ◽  
Mustafa Yel ◽  
Onur Bilge ◽  
Ali Güleç ◽  
Burkay Kutluhan Kaçıra ◽  
...  
Keyword(s):  
Shoulder Dislocation ◽  
External Rotation ◽  
Bankart Repair ◽  
Knotless Anchor ◽  
Arthroscopic Bankart Repair ◽  
Significant Difference ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Objectives: The aim of this study was to compare the clinical and functional results of early and late rehabilitation of patients who had undergone arthroscopic Bankart repair with knotless anchor for recurrent shoulder dislocation and to define the most appropriate rehabilitation time and the effect of this on recurrence. Methods: 34 patients (32 male and 2 female) were included in this study. The patients were diagnosed with recurrent anterior shoulder dislocation with Bankart lesion in our institution. The exclusion criteria in this study were multi-directional shoulder instability, wide osseous Bankart lesion, wide Hill-Sachs lesion or rotator cuff tear. All patients underwent arthroscopic Bankart repair. Knotless anchor was used in all patients. The patients were grouped into 2 groups postoperatively according to the immobilization period and rehabilitation regimen. Both groups equally consisted of 17 patients. (Group 1; early rehabilitation group, Group 2; late rehabilitation group) All patients were examined retrospectively. Gender, age, dislocated side, dominant hand, recurrence, presence of additional pathologies, time of first and last dislocations preoperatively and numbers of dislocations were the demographic data recorded. At the final follow-up; the restriction in external rotation was measured by comparative goniometry and clinical evaluation was made using the Constant and Rowe scores. One-sample T-test, Mann-Whitney U Test, Crosstabs Chi Square Test and Shapiro-Wilk Tests used for statistical analysis. Results: The mean age of the patients in Group 1 was found to be 25.1 ± 6.5 ( 17-43) years and in Group 2, 30.8 ± 6.8 (21-46) years. After a mean follow-up period of 14.7 months, no patients in Group 1 experienced a recurrence, whereas in Group 2 over the mean follow-up period of 38.5 months, there was dislocation, following episodes of subluxation, in only 1 patient (5.8%). When the parameters of first dislocation, last dislocation and number of dislocations were evaluated separately in two groups, no statistical difference was observed between the groups in the relevant parameters (n.s.). A statistically significant difference was determined between the groups in respect to the restriction in external rotation (p<0.05). There was no statistically significant difference between the groups in respect to the Constant and Rowe scores (n.s.). Conclusion: The most important result of this study was that the early beginning of rehabilitation yielded less external rotation restriction than late beginning of rehabilitation. The absence of recurrence in the group of early beginning of rehabilitation reminds the question “does early rehabilitation reduce recurrence rates?” The findings in this study should be confirmed with further prospective, randomized and longer follow-up studies.

scholarly journals ASSESSMENT OF THE RESULTS FROM ARTHROSCOPIC SURGICAL TREATMENT FOR TRAUMATIC ANTERIOR SHOULDER DISLOCATION: FIRST EPISODE

2012 ◽  
Vol 47 (2) ◽  
pp. 222-227
Author(s):  
Alberto Naoki Miyazaki ◽  
Marcelo Fregoneze ◽  
Pedro Doneux Santos ◽  
Luciana Andrade da Silva ◽  
Guilherme do Val Sella ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Shoulder Dislocation ◽  
First Episode ◽  
Anterior Shoulder Dislocation ◽  
Traumatic Anterior Shoulder Dislocation

A Prospective, Randomized Evaluation of Arthroscopic Stabilization versus Nonoperative Treatment in Patients with Acute, Traumatic, First-Time Shoulder Dislocations

2002 ◽  
Vol 30 (4) ◽  
pp. 576-580 ◽  
Author(s):  
Craig R. Bottoni ◽  
John H. Wilckens ◽  
Thomas M. DeBerardino ◽  
Jean-Claude G. D'Alleyrand ◽  
Richard C. Rooney ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Nonoperative Treatment ◽  
High Rate ◽  
Bankart Repair ◽  
Arthroscopic Stabilization ◽  
Young Athletes ◽  
Recurrent Instability ◽  
Arthroscopic Bankart Repair ◽  
First Time

Background Nonoperative treatment of traumatic shoulder dislocations leads to a high rate of recurrent dislocations. Hypothesis Early arthroscopic treatment for shoulder dislocation will result in a lower recurrence rate than nonoperative treatment. Study Design Prospective, randomized clinical trial. Methods Two groups of patients were studied to compare nonoperative treatment with arthroscopic Bankart repair for acute, traumatic shoulder dislocations in young athletes. Fourteen nonoperatively treated patients underwent 4 weeks of immobilization followed by a supervised rehabilitation program. Ten operatively treated patients underwent arthroscopic Bankart repair with a bioabsorbable tack followed by the same rehabilitation protocol as the nonoperatively treated patients. The average follow-up was 36 months. Results Three patients were lost to follow-up. Twelve nonoperatively treated patients remained for follow-up. Nine of these (75%) developed recurrent instability. Six of the nine have required subsequent open Bankart repair for recurrent instability. Of the nine operatively treated patients available for follow-up, only one (11.1%) developed recurrent instability. Conclusions Arthroscopic stabilization of traumatic, first-time anterior shoulder dislocations is an effective and safe treatment that significantly reduces the recurrence rate of shoulder dislocations in young athletes when compared with conventional, nonoperative treatment.

scholarly journals Arthroscopic Bankart Repair after Anterior Traumatic Shoulder Dislocation in Workers

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0020
Author(s):  
Agustín Guala ◽  
Pedro Rial ◽  
Luciano Mendoza ◽  
Walter RIal ◽  
Lucas Perezlindo ◽  
...  
Keyword(s):  
Return To Work ◽  
Shoulder Dislocation ◽  
High Rate ◽  
Bankart Repair ◽  
Anterior Dislocation ◽  
Arthroscopic Bankart Repair ◽  
Previous Level ◽  
The Mean ◽  
Shoulder Score

Objectives: The objective of this study was to evaluate clinical results in workers after Arthroscopic Bankart repair for traumatic unidirectional shoulder dislocation. Methods: A total of 45 patients (42 male- 3 female) meet the inclusion criteria: traumatic anterior dislocation, workers´ compensation patient, minimum of 2 years follow-up and exclusion criteria: bony Bankart >25%, engaging Hill Sachs, previous surgery, rotator cuff injury. Number of dislocations were 1 in 35 patients, 2 in 7 patients and 3 in 3 patients. Artroscopic Bankart repair was performed by a single surgeon. UCLA shoulder Score and ROWE score for shoulder instability were scored for clinical assessment. The mean follow up was 64 (SD+- 21.6) month with a mean age of 30 (SD+-10) years. Type of work and workload was recorded according to Canadian classification and dictionary of occupations. Time to return to work was also recorded. Statistical analysis was performed at the center for biostatistics at Facultad de Ciencias Medicas, Universidad Nacional del Litoral using SPSS 23.0-IBM. Results: The mean UCLA Shoulder Score was 33 (SD+-2) and ROWE Score 95 (SD +-7), none of the patients presented recurrent dislocation at the time of follow up. Time to return to work was mean 123 days (+-60 SD) of whom 52% were heavy workers, 39% medium and 9% light workers. All patients except one could return to his previous level of work. Pearsons bi variate correlation coefficient between days to return to work between heavy and medium/light workers was not significative (p>0,05) but in heavy workers return to work take more days than in medium/light workers. Age and return to work with 35 years as a cut point was not significative either. Conclusion: Workers treated with Arthroscopic Bankart repair after traumatic unilateral dislocation, presents good results and high rate of return to work at the previous level.

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