scholarly journals Outcomes After Arthroscopic Bankart Repair in Adolescent Athletes Participating in Collision and Contact Sports

2017 ◽  
Vol 5 (3) ◽  
pp. 232596711769795 ◽  
Author(s):  
Michael G. Saper ◽  
Charles Milchteim ◽  
Robert L. Zondervan ◽  
James R. Andrews ◽  
Roger V. Ostrander

Background: Literature on arthroscopic stabilization in adolescent patients participating in collision and contact sports is limited, as most studies include adolescents within a larger sample group comprised primarily of adults. Purpose: To review the outcomes of arthroscopic Bankart repair for anterior shoulder instability in an adolescent population participating in collision and contact sports. Study Design: Case series; Level of evidence, 4. Methods: This retrospective review included 39 shoulders in 37 adolescent (≤19 years) athletes who underwent primary arthroscopic Bankart repair using suture anchors with at least 2-year follow-up. All patients had a history of trauma to their shoulder resulting in an anterior dislocation. Outcome measures included patient satisfaction, the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score. Recurrence of dislocation and return to sporting activity were also assessed. Results: The mean age at the time of surgery was 16.9 years (range, 15-19 years), and the mean follow-up was 6.3 years (range, 4.3-10.0 years); 58.6% of patients participated in collision sports. Time to surgery after the initial dislocation episode was 9.2 months (range, 0.5-36.2 months). Four shoulders (10.3%) had dislocation events postoperatively. The majority (78.1%) of patients returned to sports at the same level of competition. Mean VAS was 0.49 ± 1.0, and the mean ASES and Rowe scores were 92.8 ± 12.6 and 85.0 ± 24.2, respectively. Univariate analyses demonstrated that subjective functional outcomes were negatively correlated with recurrence (ASES, P = .005; Rowe, P = .001) and failure to return to sport (ASES, P = .016; Rowe, P = .004). Independent variables shown to have no significant relationship to functional outcomes included age, follow-up, number of preoperative dislocations, time to surgery, sport classification, competition level, tear extent, number of anchors, concurrent Hill-Sachs lesion, and repair of a superior labral anterior-posterior (SLAP) lesion. Conclusion: Arthroscopic Bankart repair is an effective surgical option for traumatic shoulder instability in adolescents participating in collision and contact sports. At a minimum 4-year follow-up, arthroscopic Bankart repair effectively restored stability in 90% of cases; 80% returned to their preinjury level of sport.

2019 ◽  
Vol 7 (5_suppl3) ◽  
pp. 2325967119S0020
Author(s):  
Jean-David Werthel ◽  
Vincent Sabatier ◽  
Lior Amsallem ◽  
Marie Vigan ◽  
Alexandre Hardy

Objectives The two most common surgical interventions for recurrent anterior shoulder instability include arthroscopic Bankart repair and the Latarjet procedure. However, indications for each procedure remain debated between surgeons with 90% of surgeons (except French surgeons) preferring soft tissue Bankart repair initially. It remains unclear whether the results of a Latarjet procedure performed after a failed arthroscopic Bankart repair differ from those performed for primary cases. The purpose of our study was to compare the postoperative outcomes of patients who had undergone a Latarjet as a primary surgery versus those who had had a Latarjet as revision surgery for a failed arthroscopic Bankart repair Methods Patients who had undergone open or arthroscopic Latarjet procedure between 2003 and 2015 in 5 fellowship-trained surgical practices were included. Charts were retrospectively reviewed to identify patients who had undergone a primary Latarjet or those who had had a Bankart repair prior to the Latarjet. Age, ISIS score, BMI, sports activity, hyperlaxity and delay before surgery were retrospectively collected. Outcome measures were prospectively collected, including range of motion, SSV, Walch-Duplay, scores, recurrence of instability, apprehension or new surgery. Results A total of 311 patients were included. 28% of the patients were lost to follow-up and the mean follow-up was 3.4 years +/-0.8. There were 21 patients who had had a Bankart repair prior to the Latarjet procedure. Both populations were comparable regarding preoperative data. The postoperative instability rate was 3% in the overall population; 4.8% in the “primary Latarjet” group and 2.3% in the ”Latarjet for failed Bankart” group. This difference was not significant (p=0.50). However, the mean Walch-Duplay score was significantly lower and the pain scores significantly higher in patients who had had a prior Bankart repair: 51.9 +/- 25 versus 72.1 +/- 25.2 and 2.5/10 versus 1.2/10 respectively. The Simple Shoulder Test was comparable in both groups. Conclusion The study confirms that the Latarjet is an effective procedure to treat primary chronic anterior instability and also to stabilize a shoulder after a failed Bankart repair. However, the thought that a Bankart repair does not “burn any bridges” appears to be incorrect relative to postoperative pain and functional scores in the setting of future Latarjet procedure.


2018 ◽  
Vol 46 (10) ◽  
pp. 2466-2471 ◽  
Author(s):  
Jin-Young Park ◽  
Jae-Hyung Lee ◽  
Seok Won Chung ◽  
Kyung-Soo Oh ◽  
Young Min Noh ◽  
...  

Background: In arthroscopic Bankart repair, anchor positions can affect glenoid labral height and functional outcomes. Purpose: To evaluate anchor placement on the glenoid during Bankart lesion repair and determine which placement would lead to better functional outcomes. Study Design: Cohort study; Level of evidence, 3. Method: This study included 90 patients (74 males, 16 females; average age, 23.7 years; range, 18-47 years) who underwent surgery for Bankart lesions between December 2009 and March 2014. The mean follow-up duration was 32.7 months (range, 26-48 months). We divided anchor positions into 2 groups: on the glenoid face and at the glenoid edge. The anchor position on the glenoid and the labral height were examined with computed tomography (CT) arthrography at 4.5-month follow-up, and Rowe scores were calculated at 2-year follow-up. Results: The group with the anchor placed on the glenoid face contained 63 patients, and the group with the anchor placed at the glenoid edge or rim contained 27 patients. Mean labral heights at 4.5 months postoperatively in the 2 groups were 5.4 ± 0.22 mm and 3.2 ± 0.16 mm, respectively ( P < .01), and mean Rowe scores at 2 years were 94.7 and 79.5, respectively ( P < .01). Rowe scores calculated at 2-year follow-up were significantly related to anchor position ( P < .01). Conclusion: Anchors positioned on the glenoid face resulted in the greatest restored labral height and better functional outcome (Rowe score). Thus, anchor placement on the glenoid face should be considered, as it may yield better functional outcome in arthroscopic Bankart repair.


2019 ◽  
Vol 7 (11) ◽  
pp. 232596711988164 ◽  
Author(s):  
George A. Komnos ◽  
Konstantinos Banios ◽  
Athanasios Liantsis ◽  
Konstantinos Alexiou ◽  
Sokratis Varitimidis ◽  
...  

Background: Arthroscopic Bankart repair is the most common procedure for anterior shoulder instability management. However, the long-term efficacy of the procedure is questionable, and the results are different among different populations. Few studies have focused on specific populations, such as recreational athletes and laborers. Hypothesis: Good to excellent long-term results, with a low recurrence rate, can be achieved using arthroscopic Bankart repair in recreational athletes and laborers suffering from anterior shoulder instability. Study Design: Case series; Level of evidence, 4. Methods: A specific group of laborers and recreational athletes were included in this study. A total of 52 patients (52 shoulders) with anterior-inferior traumatic shoulder instability underwent arthroscopic Bankart repair and met our strict criteria for study inclusion. The recurrence rate was recorded. Patients were evaluated at a minimum follow-up of 5 years using the American Shoulder and Elbow Surgeons (ASES) score, the Rowe score, the Constant score, and a visual analog scale (VAS) for pain. A radiological evaluation for arthritis was also performed according to the Samilson-Prieto classification. Results: The mean follow-up was 105.4 months (range, 65-164 months). Our overall recurrence rate was 11.5% (6/52 patients). All patients were able to return to their previous job status with minimum limitations, and 76.7% of our study population reported returning to their preinjury sporting activities. Postoperatively, all scores were improved, with statistically significant increases from preoperative values ( P < .001). At the last radiographic follow-up, 9 patients (18.8%) had mild arthritis, while 2 patients (4.2%) had moderate arthritis. Conclusion: Arthroscopic soft tissue Bankart repair may provide good to excellent long-term clinical results with an acceptable recurrence rate in medium-demand patients (recreational athletes and laborers).


2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0020
Author(s):  
Agustín Guala ◽  
Pedro Rial ◽  
Luciano Mendoza ◽  
Walter RIal ◽  
Lucas Perezlindo ◽  
...  

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.


2021 ◽  
Vol 9 (7) ◽  
pp. 232596712110133
Author(s):  
Luciano Andrés Rossi ◽  
Ignacio Tanoira ◽  
Rodrigo Brandariz ◽  
Ignacio Pasqualini ◽  
Maximiliano Ranalletta

Background: There is a lack of information regarding the reasons why patients do not return to sports after an arthroscopic Bankart repair and whether there is a relationship between return to sports and functional outcomes. Purpose: To evaluate the reasons why competitive athletes who underwent arthroscopic Bankart repair did not return to sports and whether there was a relationship between returning to sports and postoperative outcome scores and complications. Study Design: Cohort study; Level of evidence, 3. Methods: Of 217 competitive athletes who underwent arthroscopic Bankart repair for isolated anterior glenohumeral instability between June 2014 and December 2017, a total of 208 athletes (96%) were evaluated at minimum 2-year follow-up. Return to sports, the level of sports achieved, and the time between surgery and return to competition were assessed, and patients who did not return to sports were asked to provide the reasons for cessation. The Rowe score and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences, reoperations, and complications were also evaluated. Results: The mean patient age was 24 years (range, 18-30 years), and the mean follow-up was 44 months (range, 24-90 months). Of the 208 athletes, 73% were able to return to sports (65% returned to their preinjury level), and 27% did not return to sports. Of those who did not return, the most frequent reasons were fear of reinjury (44%), lack of confidence in their shoulder (12%), and concern about a new rehabilitation process in case of recurrence (10%). The Rowe and ASOSS scores showed significant postoperative improvement in all patients ( P < .001), with no significant differences between the 2 study groups at the final follow-up. There were 21 recurrences (10%) and 5 complications (2.4%), and 11 patients (5.3%) underwent revision surgery, with no significant differences in these rates between the groups. Conclusion: Of patients who did not return to sports, 74% left for a reason independent of shoulder function, with the most frequent causes being fear of reinjury and a concern about new rehabilitation process. Neither outcome scores nor complications varied significantly between patients who returned and those who did not return to sports.


2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110082
Author(s):  
Atsushi Tasaki ◽  
Wataru Morita ◽  
Taiki Nozaki ◽  
Yuki Yonekura ◽  
Masayoshi Saito ◽  
...  

Background: Traumatic anterior shoulder instability in collision sports athletes often involves osseous glenoid lesions, which make surgical treatment challenging. High redislocation rates have been seen in collision sports athletes treated using arthroscopic Bankart repair. Purpose: To investigate the effectiveness of a combined arthroscopic Bankart repair and open Bristow procedure for the treatment of traumatic anterior shoulder instability in collision sports athletes, with a focus on osseous glenoid lesions. Study Design: Case series; Level of evidence, 4. Methods: We reviewed 149 shoulders in 141 competitive collision sports athletes (mean ± standard deviation age, 20.1 ± 4.1 years; 8 bilateral cases) who underwent a combined arthroscopic Bankart repair and open Bristow procedure with minimum 2 years of follow-up. Osseous Bankart lesions were arthroscopically reduced and fixed using a coracoid graft. Results: Clinical outcomes as indicated by mean Rowe score improved significantly from 50.0 preoperatively to 98.9 postoperatively ( P < .001) at a median follow-up of 3.4 years (range, 2.5-7 years). There were 2 recurrent dislocations (1.3%), both of which had nonunion of the transferred coracoid. Osseous Bankart lesions were observed in 85 shoulders, and osseous glenoid lesions ≥10% of the diameter of the nonoperative side were found in 58 shoulders, including 24 off-track cases. Clinical outcomes were not significantly different between patients with a glenoid defect ≥10% and <10%. Nonunion of the transferred coracoid was observed in 16 shoulders (10.7%), which had inferior Rowe scores; however, we could not define any risk factors for nonunion, including patient characteristics or bone morphology. Postoperative computed tomography performed in 29 patients >1 year after surgery showed successful repair of the osseous glenoid lesions, with a restored glenoid articular surface in all cases. Significant pre- to postoperative increases were seen in glenoid diameter (mean, 13.1% [95% CI, 9.9%-16.3%]; P < .001) and area (mean, 10.6% [95% CI, 8.5%-12.7%]; P < .001). Conclusion: A combined arthroscopic Bankart repair and open Bristow procedure improved bone morphology and was a reliable surgical method for treating collision sports athletes with traumatic anterior shoulder instability involving osseous glenoid lesions.


2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.


2021 ◽  
pp. 175857322199308
Author(s):  
Ignacio Pasqualini ◽  
Luciano Andrés Rossi ◽  
Franco Luis De Cicco ◽  
Ignacio Tanoira ◽  
Ignacio Alonso Hidalgo ◽  
...  

Background The purpose of our study was to investigate the influence of the different rugby playing positions on return to sports, functional outcomes, and recurrences after an arthroscopic Bankart repair. Methods A total of 88 rugby players were treated for anterior shoulder instability in our institution between 2010 and 2018. Functional outcomes, return to sports, recurrences, complications, and revisions rates were evaluated according to the playing position. Results Overall, 73.8% of the patients returned to rugby and 60% returned at the same level as before the injury. The tight forwards and outside backs experienced a significant decrease in their competitive level after surgery, and showed the lowest functional outcomes. The tight forwards and outside backs showed a statistically significant increase in recurrence and revision rates, and an OR for recurrence of 12.8 and 9.6, respectively. Discussion The playing position significantly influenced return to sports and recurrences after an arthroscopic Bankart repair in competitive rugby players. Specifically, the tight forwards and outside backs have returned to a lower level than they had before surgery, showed the lowest functional outcomes, and a significant increase in recurrences and revisions rates than the other groups.


2019 ◽  
Vol 7 (3_suppl2) ◽  
pp. 2325967119S0019
Author(s):  
Hoshika Shota ◽  
Hiroyuki Sugaya ◽  
Norimasa Takahashi ◽  
Keisuke Matsuki ◽  
Morihito Tokai ◽  
...  

Objectives: Surgical options for shoulder instability in collision athletes remain controversial. Although arthroscopic soft tissue stabilization is widely accepted treatment for traumatic anterior shoulder instability, many surgeons prefer coracoid transfer such as Latarjet procedure for collision athletes with or without glenoid defect due to potential high recurrence rate after arthroscopic soft tissue Bankart repair (ABR). In the meantime, Hill-Sachs remplissage (HSR) has been gaining popularity as an effective arthroscopic augmentation procedure. Since 2002, we performed rotator interval closure (RIC) as an augmentation in addition to ABR or arthroscopic bony Bankart repair (ABBR) for collision athletes and obtained satisfactory outcome. However, teen players demonstrated higher recurrence rate compared to twenties and thirties. Therefore, from 2012, we performed HSR as an additional augmentation for teen players besides ABR/ABBR and RIC. The purpose of this study was to assess the outcomes after arthroscopic stabilization in collision athletes who underwent shoulder stabilization under our treatment strategy. Methods: Between 2012 through 2015, 95 consecutive collision athletes underwent shoulder stabilization. Among those, only 2 patients (2%) underwent arthroscopic bony procedure for poor capsular integrity. Among the remaining 93 patients who underwent soft tissue stabilization, 65 were available for minimum 2-year follow-up (70%). Therefore, subjects consisted of 65 players including 54 rugby and 11 American football players (Table 1). There were 13 national top league, 24 collegiate, 21 junior or senior high school, and 7 recreational players. The mean age at surgery was 20 years (range, 16-36). The mean follow-up was 37 months (range, 24-64). We retrospectively reviewed intraoperative findings and surgical procedures using patient records including surgical reports and videos. We also investigated functional outcome and recurrence rate. Pre- and postoperative Rowe scores were compared using paired t test. Results: Preoperative 3DCT of the glenoid demonstrated bony Bankart (fragment type) in 43 players (66%), attritional type in 16 (25%), and normal glenoid in 6 (9%). Mean glenoid bone loss was 15% (range, 0-25) and all of the glenoid with more than 10% bone loss retained bony fragment. All 65 players demonstrated Bankart lesion and 15 had concomitant SLAP lesion (23%) which required to be repaired. In addition, 5 players demonstrated capsule tear (8%), which were also repaired. Twenty-four players (36%) underwent ABR or ABBR with RIC and forty one players (64%) underwent ABR or ABBR combined with HSR (Table 1). The mean Rowe score significantly improved after surgery from 65 (range, 55-75) to 92 (range, 65-100) (P < .001). Recurrence appeared in 2 cases (3%), both of which were junior or senior high school players who underwent ABR with HSR. Ten national top league players who underwent ABR with RIC had no recurrence. Conclusion: Soft tissue stabilization combined with selective augmentation procedures for traumatic shoulder instability in collision athletes demonstrated satisfactory outcomes with extremely low recurrence rate. Since the incidence of having bony Bankart lesion in collision athletes was very high, arthroscopic bony Bankart repair worked in many patients even with significant glenoid bone loss. Further, Hill-Sachs remplissage seemed to be effective additional augmentation especially in young collision athletes. [Table: see text]


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