Variability of Reporting Recurrence After Arthroscopic Bankart Repair: A Call for a Standardized Study Design

Background: High recurrence rates have been reported after anterior shoulder dislocations, regardless of the treatment utilized. However, the definition of recurrent instability has been inconsistent, making a comparison between studies difficult. Purpose: To report on the nature with which the rate of recurrent instability is reported after arthroscopic Bankart repair, across all levels of evidence, and to analyze factors that may affect the reported rate of recurrence. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed by searching PubMed, the Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov for studies published within the dates of January 2008 and September 2018. Studies in English that reported on the recurrence of instability after arthroscopic Bankart repair for anterior shoulder instability were considered for inclusion in this review. A meta-regression was performed to test for a linear association between the reported recurrence rate and several continuous covariates, including mean age at surgery, mean length of follow-up, attrition rate (loss to follow-up percentage), and percentage of male patients. Results: A trim-and-fill meta-analysis yielded an estimated overall recurrence rate of 17.4% (95% CI, 14.3%-20.9%). There was a significant difference in the recurrence rate depending on the level of evidence (Q(3) = 10.98; P = .012). Significant associations were found with the recurrence rate through the meta-regression, including a negative association with mean age ( P = .009), a positive association with mean follow-up time ( P = .002), and a positive association with attrition rate ( P = .035). Conclusion: A call for standardization is necessary for reporting outcomes of anterior instability after arthroscopic Bankart repair, especially with regard to the reporting of recurrence/failure rates, with careful consideration of the effects that may occur from patient demographics and study design. With no current recommendations for deeming failure, we suggest that all forms of instability be accounted for when determining a failed treatment procedure, with future studies placing an emphasis on greater control of the study design.

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

The American Journal of Sports Medicine ◽

10.1177/03635465020300041801 ◽

2002 ◽

Vol 30 (4) ◽

pp. 576-580 ◽

Cited By ~ 277

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.

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Arthroscopic Bankart Repair Versus Open Latarjet for Recurrent Shoulder Instability in Athletes

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211023801 ◽

2021 ◽

Vol 9 (9) ◽

pp. 232596712110238

Author(s):

Eoghan T. Hurley ◽

Martin S. Davey ◽

Connor Montgomery ◽

Ross O’Doherty ◽

Mohamed Gaafar ◽

...

Keyword(s):

Recurrence Rate ◽

Shoulder Instability ◽

Return To Play ◽

Bankart Repair ◽

Level Of Evidence ◽

Lower Recurrence Rate ◽

Recurrent Shoulder Instability ◽

Arthroscopic Bankart Repair ◽

Significant Difference

Background: In athletes with recurrent shoulder instability, arthroscopic Bankart repair (ABR) and the open Latarjet procedure (OL) are commonly indicated to restore stability and allow them to return to play (RTP). Purpose: To compare the outcomes of ABR and OL in athletes with recurrent shoulder instability. Study Design: Cohort study; Level of evidence, 3. Methods: We performed a retrospective review of patients with recurrent shoulder instability who underwent 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. The patients were pair-matched in a 1:1 ratio (OL and ABR) by age, sex, sport, and level of preoperative play. We evaluated the rate, level, and timing of RTP, and the Shoulder Instability–Return to Sport after Injury (SIRSI) score between procedures. Additionally we compared the recurrence rate, visual analog scale (VAS) pain score, Subjective Shoulder Value (SSV), Rowe score, satisfaction, and whether patients would undergo the same surgery again. Results: Participants included 62 athletes who underwent ABR and 62 who underwent OL, with a mean follow-up of 47.7 months. There was no significant difference between ABR and OL in rate of RTP, return to preinjury level, time to return, SIRSI score, VAS score, SSV, or patient satisfaction. OL resulted in a significantly lower recurrence rate (1.6% vs 16.1% for ABR; P = .009) and a significantly higher Rowe score (mean ± SD, 90.5 ± 12.2 vs 82.2 ± 20.8 for ABR; P = .008). In collision athletes, there was no significant difference between ABR and OL regarding RTP rate (89.1% vs 94.5%; P = .489) or SIRSI score (70.4 ± 24.8 vs 73.8 ± 19.6; P = .426), but OL resulted in a lower recurrence rate (14.5% vs 1.8%; P = .031). Conclusion: ABR and OL resulted in excellent clinical outcomes, with high rates of RTP in athletes. However, lower recurrence rates were seen with OL.

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Sex differences in outcomes after arthroscopic bankart repair

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2020-000965 ◽

2020 ◽

Vol 6 (1) ◽

pp. e000965

Author(s):

Natalie A Lowenstein ◽

Peter J Ostergaard ◽

Daniel B Haber ◽

Kirsten D Garvey ◽

Elizabeth G Matzkin

Keyword(s):

Mental Health ◽

Sex Differences ◽

Patient Reported Outcomes ◽

Strength Function ◽

Bankart Repair ◽

Level Of Evidence ◽

Arthroscopic Bankart Repair ◽

Patient Reported ◽

Males And Females

ObjectivesRisk factors for anterior shoulder dislocation include young age, contact activities and male sex. The influence of sex on patient-reported outcomes of arthroscopic Bankart repair (ABR) is unclear, with few studies reporting potential differences. This study’s purpose was to compare patient-reported outcomes of males and females following ABR.MethodsProspectively collected data was analysed for 281 patients (males: 206, females: 75) after ABR with preoperative, 1-year and 2-year follow-up responses. The Wilcoxon signed-rank and χ2 tests, preoperative, 1 year and 2 year follow-up results were examined to determine differences of scores in males versus females.ResultsNo statistically significant sex differences were observed in Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), Visual Analogue Scale (VAS) or Single Assessment Numerical Evaluation (SANE) Scores at 1-year or 2-year follow-up. Females had lower Veterans RAND 12-item health survey (VR-12) mental health subscores at 2-year follow-up (females: 52.3±9.0, males: 55.8±7.6, p=0.0016). Females were more likely to report that treatment had ‘exceeded expectations’ at 2-year follow-up regarding motion, strength, function and normal sports activities.ConclusionResults of study demonstrate that ABR has similar outcomes for both males and females. There were no statistically significant sex-related differences in SST, ASES, VAS or SANE scores following ABR. VR-12 mental health subscores showed a minimal difference at 2-year follow-up, with lower scores in females.Level of evidenceRetrospective cohort study; level II.

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Clinical Outcome of Arthroscopic Bankart Repair Combined With Simultaneous Capsular Repair

The American Journal of Sports Medicine ◽

10.1177/0363546516687752 ◽

2017 ◽

Vol 45 (6) ◽

pp. 1289-1296 ◽

Cited By ~ 10

Author(s):

Shigeto Nakagawa ◽

Ryo Iuchi ◽

Tatsuo Mae ◽

Naoko Mizuno ◽

Yasuhiro Take

Keyword(s):

Postoperative Recurrence ◽

Bankart Repair ◽

Level Of Evidence ◽

Old Patients ◽

Glenohumeral Ligament ◽

Capsular Repair ◽

Arthroscopic Bankart Repair ◽

Significant Difference ◽

Competitive Athletes

Background: A capsular tear and humeral avulsion of the glenohumeral ligament lesion are not uncommon findings in association with a Bankart lesion. However, there have been few reports regarding the prevalence of such capsular lesions and the postoperative recurrence after capsular repair. Purpose/Hypothesis: This study investigated the prevalence of capsular lesions and clarified their influence on the postoperative recurrence of instability. In addition, factors were identified that were associated with the occurrence of capsular lesions and the postoperative recurrence of instability. We hypothesized that clinical outcomes would be improved by combining arthroscopic Bankart repair with simultaneous capsular repair. Study Design: Cohort study; Level of evidence, 3. Methods: Capsular lesions were retrospectively examined through operative records, still pictures, and videos in 172 shoulders with traumatic anterior instability. First, the prevalence of capsular lesions and their severity were investigated. Then, postoperative recurrence was determined in shoulders observed for a minimum of 2 years. Finally, factors were assessed that were associated with the occurrence of capsular lesions and the postoperative recurrence of instability. Results: A capsular lesion was recognized in 37 shoulders (21.5%), being severe and mild in 20 and 17, respectively. All were repaired simultaneously with the arthroscopic Bankart procedure. After follow-up for at least 2 years, recurrence of instability was detected in 10 of 34 shoulders (29.4%), including 6 (31.6%) with severe capsular lesions and 4 (26.7%) with mild lesions. The recurrence rate was significantly higher in shoulders with a capsular lesion than in shoulders without a capsular lesion (18 of 120, 15%; P = .013), but there was no significant difference between severe and mild lesions. Regardless of the sport played, capsular lesions were significantly more frequent in patients ≥30 years old, patients with complete dislocation, and patients with a coexisting Hill-Sachs lesion. Postoperative recurrence of instability was significantly more frequent in patients <30 years and competitive athletes. Conclusion: In shoulders undergoing arthroscopic Bankart repair, capsular lesions were often present and were associated with higher postoperative recurrence of instability. While these lesions were more frequent in older patients, postoperative recurrence of instability was more likely in young competitive athletes.

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High recurrence rate after isolated arthroscopic Bankart repair with a 9 to 12-year follow-up

Asia-Pacific Journal of Sports Medicine Arthroscopy Rehabilitation and Technology ◽

10.1016/j.asmart.2017.05.039 ◽

2017 ◽

Vol 9 ◽

pp. 27-28

Author(s):

Yohei Ono ◽

Diego Alejandro Dávalos Herrera ◽

Jarret M. Woodmass ◽

Devin B. Lemmex ◽

Michael Carroll ◽

...

Keyword(s):

Recurrence Rate ◽

Bankart Repair ◽

High Recurrence Rate ◽

Arthroscopic Bankart Repair

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A Multicenter Retrospective Study With a Minimum 5-Year Follow-up Comparing Arthroscopic Bankart Repair and the Latarjet Procedure

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120941366 ◽

2020 ◽

Vol 8 (8) ◽

pp. 232596712094136

Author(s):

Eran Maman ◽

Oleg Dolkart ◽

Rafael Krespi ◽

Assaf Kadar ◽

Gabriel Mozes ◽

...

Keyword(s):

Shoulder Instability ◽

Bankart Repair ◽

Anterior Shoulder Instability ◽

Published Data ◽

Return To Sports ◽

Latarjet Procedure ◽

Recurrent Instability ◽

Arthroscopic Bankart Repair ◽

Functional Scores

Background: Arthroscopic Bankart repair (ABR) and the Latarjet procedure are surgical techniques commonly used to treat anterior shoulder instability. There is no consensus among shoulder surgeons regarding the indications for choosing one over the other. Purpose: To compare the results of the Latarjet procedure with those of ABR for the treatment of anterior shoulder instability. Study Design: Cohort study; Level of evidence, 3. Methods: Data on all patients who were treated surgically for recurrent anterior shoulder instability between 2006 and 2011 were retrospectively collected at 4 medical centers. The minimum follow-up was 5 years. Data were retrieved from medical charts, and patients were interviewed to assess their level of satisfaction (range, 0-100), functional outcomes (using the American Shoulder and Elbow Surgeons shoulder score; the Subjective Shoulder Value; and the Disabilities of the Arm, Shoulder and Hand score), and quality of life (using the 12-Item Short Form Health Survey [SF-12]). Information on return to sports activities and postoperative level of activity compared with that of the preinjury state, complications, reoperations, and recurrent instability were recorded and evaluated. Results: A total of 242 patients were included. The Latarjet procedure was performed in 27 shoulders, and ABR was performed in 215 shoulders. Patients in the ABR group had significantly higher rates of redislocation (18.5%; P = .05) and subluxation (21.4%; P = .43) but a lower rate of self-reported apprehension (43.0%; P = .05) compared with patients in the Latarjet group (3.7%, 14.8%, and 63.0%, respectively). There were 5 patients in the ABR group who underwent reoperation with the Latarjet procedure because of recurrent instability. The functional scores in the Latarjet group were better than those in the ABR group. The SF-12 physical score was significantly better in the Latarjet group than in the ABR group (98.1 vs 93.9, respectively; P = .01). Patient satisfaction and subjective scores were similar in both groups. Conclusion: These results support recently published data on the Latarjet procedure that showed its superiority over ABR in midterm stability (dislocations or subluxations). The contribution of self-reported apprehension to the broad definition of stability is not clear, and apprehension rates were not correlated with satisfaction scores or the recurrence of dislocation or subluxation.

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When to Abandon the Arthroscopic Bankart Repair: A Systematic Review

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738120940676 ◽

2020 ◽

Vol 12 (5) ◽

pp. 425-430

Author(s):

Benjamin J. Levy ◽

Nathan L. Grimm ◽

Robert A. Arciero

Keyword(s):

Systematic Review ◽

Bone Loss ◽

Study Design ◽

Humeral Head ◽

Measurement Techniques ◽

Glenoid Bone Loss ◽

Bankart Repair ◽

Glenohumeral Instability ◽

Level Of Evidence ◽

Arthroscopic Bankart Repair

Context: Bone loss is a major factor in determining surgical choice in patients with anterior glenohumeral instability. Although bone loss has been described, there is no consensus on glenoid, humeral head, and bipolar bone loss limits for which arthroscopic-only management with Bankart repair can be performed. Objective: To provide guidelines for selecting a more complex repair or reconstruction (in lieu of arthroscopic-only Bankart repair) in the setting of glenohumeral instability based on available literature. Data Sources: An electronic search of the literature for the period from 2000 to 2019 was performed using PubMed (MEDLINE). Study Selection: Studies were included if they quantified bone loss (humeral head or glenoid) in the setting of anterior instability treated with arthroscopic Bankart repair. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Study design, level of evidence, patient demographics, follow-up, recurrence rates, and measures of bone loss (glenoid, humeral head, bipolar). Results: A total of 14 studies met the inclusion criteria. Of these, 10 measured glenoid bone loss, 5 measured humeral head bone loss, and 2 measured “tracking” without explicit measurement of humeral head bone loss. Measurement techniques for glenoid and humeral head bone loss varied widely. Recommendations for maximum glenoid bone loss for arthroscopic repair were largely <15% of glenoid width in recent studies. Recommendations regarding humeral head loss were more variable (many authors providing only qualitative descriptions) with increasing attention on glenohumeral tracking. Conclusion: It is essential that a standardized method of glenoid and humeral head bone loss measurements be performed preoperatively to assess which patients will have successful stabilization after arthroscopic Bankart repair. Glenoid bone loss should be <15%, and humeral head lesions should be “on track” if an arthroscopic-only Bankart is planned. If there is greater bone loss, adjunct or open procedures should be performed.

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Revision Arthroscopic Bankart Repair for Anterior Shoulder Instability After a Failed Arthroscopic Soft-Tissue Repair Yields Comparable Failure Rates to Primary Bankart Repair: A Systematic Review

HSS Journal ® ◽

10.1177/15563316211030606 ◽

2021 ◽

pp. 155633162110306

Author(s):

Ajaykumar Shanmugaraj ◽

Seaher Sakha ◽

Tushar Tejpal ◽

Timothy Leroux ◽

Jacob M Kirsch ◽

...

Keyword(s):

Systematic Review ◽

Soft Tissue ◽

Shoulder Instability ◽

Bankart Repair ◽

Quality Data ◽

Anterior Shoulder Instability ◽

Failure Rates ◽

Recurrent Instability ◽

Arthroscopic Bankart Repair

Background: The management of recurrent instability after arthroscopic Bankart repair remains challenging. Of the various treatment options, arthroscopic revision repairs are of increasing interest due to improved visualization of pathology and advancements in arthroscopic techniques and instrumentation. Purpose: We sought to assess the indications, techniques, outcomes, and complications for patients undergoing revision arthroscopic Bankart repair after a failed index arthroscopic soft-tissue stabilization for anterior shoulder instability. Methods: We performed a systematic review of studies identified by a search of Medline, Embase, and PubMed. Our search range was from data inception to April 29, 2020. Outcomes include clinical outcomes and rates of complication and revision. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. Data are presented descriptively. Results: Twelve studies were identified, comprising 279 patients (281 shoulders) with a mean age of 26.1 ± 3.8 years and a mean follow-up of 55.7 ± 24.3 months. Patients had improvements in postoperative outcomes (eg, pain and function). The overall complication rate was 29.5%, the most common being recurrent instability (19.9%). Conclusion: With significant improvements postoperatively and comparable recurrent instability rates, there exists a potential role in the use of revision arthroscopic Bankart repair where the glenoid bone loss is less than 20%. Clinicians should consider patient history and imaging findings to determine whether a more rigorous stabilization procedure is warranted. Large prospective cohorts with long-term follow-up and improved documentation are required to determine more accurate failure rates.

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Postoperative Recurrence of Instability After Arthroscopic Bankart Repair for Shoulders With Primary Instability Compared With Recurrent Instability: Influence of Bipolar Bone Defect Size

The American Journal of Sports Medicine ◽

10.1177/0363546519880496 ◽

2019 ◽

Vol 48 (1) ◽

pp. 48-55

Author(s):

Shigeto Nakagawa ◽

Takehito Hirose ◽

Ryohei Uchida ◽

Makoto Tanaka ◽

Tatsuo Mae

Keyword(s):

Recurrence Rate ◽

Bone Defect ◽

Bone Defects ◽

Postoperative Recurrence ◽

Defect Size ◽

Bankart Repair ◽

Recurrent Instability ◽

Important Indicator ◽

Arthroscopic Bankart Repair ◽

Primary Instability

Background: In shoulders with traumatic anterior instability, a bipolar bone defect has recently been recognized as an important indicator of the prognosis. Purpose: To investigate the influence of bipolar bone defects on postoperative recurrence after arthroscopic Bankart repair performed at primary instability. Study Design: Cohort study; Level of evidence, 3. Methods: The study group consisted of 45 patients (45 shoulders) who underwent arthroscopic Bankart repair at primary instability before recurrence and were followed for at least 2 years. The control group consisted of 95 patients (95 shoulders) with recurrent instability who underwent Bankart repair and were followed for at least 2 years. Glenoid defects and Hill-Sachs lesions were classified into 5 size categories on 3-dimensional computed tomography and were allocated scores ranging from 0 for no defect to 4 for the largest defect. The shoulders were classified according to the total score for both lesions (0-8 points). The postoperative recurrence rate was investigated for each score of bipolar bone defects and was compared between patients with primary instability and patients with recurrent instability. The same analysis was performed for the age at operation (<20 years, 20-29 years, or ≥30 years) and for the presence of an off-track Hill-Sachs lesion. Results: Bipolar bone defects were smaller in shoulders with primary instability (mean ± SD defect score, 1.4 ± 1.5 points) than in those with recurrent instability (3.6 ± 1.9 points) and were larger in older patients than in younger patients at the time of primary instability. The postoperative recurrence rate was low (6.7%) in shoulders with primary instability regardless of the size of the bipolar bone defect and the patient’s age, whereas the postoperative recurrence rate was high (23.2%) in shoulders with recurrent instability, especially among patients younger than 20 years with bipolar bone defects of 2 points or greater. An off-track Hill-Sachs lesion was found in only 1 patient in the oldest age group (2.2%) at primary instability, but it was found in 19 patients (20%) at recurrent instability, including 14 patients younger than 30 years. Among patients with an off-track lesion, the postoperative recurrence rate was significantly higher in patients younger than 20 years with recurrent instability (recurrence rates: <20 years, 71.4%; 20-29 years, 14.3%; ≥30 years, 0%). Conclusion: The recurrence rate was consistently low in patients with primary instability and was significantly influenced by bipolar bone defect size and patient age in patients with recurrent instability.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211023803 ◽

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.

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