Mid-term results of arthroscopic Bankart repair and remplissage for recurrent anterior shoulder instability in patients with a history of seizures

Abstract Background Seizure predisposes patients to shoulder dislocation. However, there is no consensus regarding the best management approach for recurrent shoulder dislocation in patients who have a history of seizures. In this study, we report the outcome of arthroscopic Bankart repair augmented by Remplissage for the recurrent anterior shoulder dislocation in a series of patients with a history of seizures. Methods In this retrospective study, 27 patients with 29 recurrent anterior shoulder dislocations who were treated with the arthroscopic Bankart repair were included. All cases had deep Hill-Sachs lesions according to Hardy classification that was managed with a Remplissage technique. Patients with a glenoid defect of more than 20% in the CT scan were excluded. Twenty-two patients had an epileptic seizure, while the remaining five patients had convulsions due to other causes. The mean age of the patients was 28.3 ± 6.2 years. The mean follow-up of the patients was 3.1 ± 1.2 years. Outcome measures included the shoulder range of motion that was compared with the non-injured side in the unilateral subjects and the shoulder function that was evaluated by the Rowe score and the Walch-Duplay score. Results The mean forward flexion, abduction, external rotation, and internal rotation were not significantly different between injured and non-injured shoulder (p = 0.34, p = 0.41, p = 0.11, p = 0.23). The mean Rowe score was 49.1 ± 7.8 before the surgery and 92.1 ± 6.4 at the last visit (p < 0.001). According to the Walch-Duplay score, the shoulders were categorized as excellent, good, and fair in 17 (58.7%), 11 (37.9%), and 1 (3.4%) shoulder, respectively. The overall rate of instability recurrence was 17.2% (n = 5). Conclusion In patients with a history of seizures, arthroscopic Bankart repair augmented by Remplissage could be regarded as a safe and efficient method for the treatment of recurrent anterior shoulder dislocation with glenoid defect < 20%.

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The results of Bankart repair without capsular plication in patients with recurrent traumatic anterior shoulder dislocation

Journal of Orthopaedic Surgery ◽

10.1177/2309499016684753 ◽

2017 ◽

Vol 25 (1) ◽

pp. 230949901668475 ◽

Cited By ~ 1

Author(s):

İsmail Kalkar ◽

Cem Zeki Esenyel ◽

Mehmet Selçuk Saygılı ◽

Ayşın Esenyel ◽

Hakan Gürbüz

Keyword(s):

Range Of Motion ◽

Shoulder Instability ◽

Shoulder Dislocation ◽

Full Range ◽

Bankart Repair ◽

Anterior Shoulder Instability ◽

Anterior Shoulder Dislocation ◽

Shoulder Range Of Motion ◽

Shoulder Range ◽

Shoulder Score

Purpose: The aim of this study was to evaluate the results of patients with recurrent anterior shoulder dislocation, who had been treated with repair of the Bankart lesion without capsuler plication. Material and method: The study included 22 shoulders of 22 patients (16 males and 6 females) with a mean age of 28 years, who underwent Bankart repair between 2011 and 2014. Patients with bilateral shoulder instability, multiple instability, >25% glenoid bone loss, and those with a history of shoulder surgery were not included in the study. The average follow-up time was 21.2 months. Evaluation was made of the preoperative number of dislocations, postoperative recurrence, functional status, and daily activity performance of the patients. Shoulder range of motion was measured. The results were evaluated using the Rowe shoulder score and the Oxford shoulder instability score. Results: Recurrence was observed in only one patient who had a shoulder dislocation after trauma, thus giving a recurrence rate of 4.5%. Shoulder range of motion was full in all except that one patient. The mean Rowe shoulder score was 95.5 (excellent) and Oxford shoulder stability score was 44.6 (excellent). Conclusion: No recurrent shoulder dislocation was observed in patients who underwent Bankart repair surgery. Plication was not performed with the Bankart repair. Close to full range of motion was obtained in all patients. In conclusion, Bankart repair alone can be considered to be sufficient for the treatment of traumatic recurrent anterior shoulder instability.

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Evaluation of arthroscopic Bankart repair in recurrent shoulder dislocation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20192683 ◽

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

Background: 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.Methods: 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.Results: 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%).Conclusions: 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.

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Latarjet procedure for failed arthroscopic Bankart repair: a case report

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20201952 ◽

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.

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Anterior Shoulder Instability in the Professional Athlete: Return to Competition, Time to Return, and Career Length

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120959728 ◽

2020 ◽

Vol 8 (11) ◽

pp. 232596712095972

Author(s):

Travis J. Dekker ◽

Brandon Goldenberg ◽

Lucca Lacheta ◽

Marilee P. Horan ◽

Peter J. Millett

Keyword(s):

Surgical Treatment ◽

Shoulder Instability ◽

Bankart Repair ◽

Professional Athletes ◽

Successful Outcome ◽

Anterior Shoulder Instability ◽

Shoulder Stabilization ◽

Arthroscopic Bankart Repair ◽

The Mean ◽

Return To Competition

Background: Anterior shoulder instability is a common condition in professional athletes, yet little is known about the success of surgery. Return to competition (RTC) is a metric indicative of a successful outcome for professional athletes who undergo anterior shoulder stabilization surgery. Purpose: To determine the rate of RTC, time to RTC, recurrence rate, and length of career after surgery in professional athletes who had undergone surgical treatment for anterior shoulder instability. Study Design: Case series; Level of evidence, 4. Methods: We evaluated professional athletes who underwent surgical treatment for anterior shoulder instability by a single surgeon between 2007 and 2018. Data from patients’ medical records, a patient data registry, basic search engines, sports websites, and individual team websites were used to determine length of professional play before injury, duration of career after surgery, and RTC level. Results: Overall, 23 professional athletes (25 shoulders from 12 contact and 13 noncontact athletes) were identified. The mean age at the time of surgery was 24.3 ± 4.9 years (range, 16-35 years). Primary procedures included arthroscopic Bankart repair (76%; 19/25), open Latarjet (20%; 5/25), and bony Bankart repair (4%; 1/25). Of the 23 athletes, 22 returned to their previous level of competition (96%; 95% CI, 78%-100%). The mean time between surgery and RTC was 4.5 months (range, 3-8 months). There was no difference in time to RTC between contact and noncontact athletes (4.1 vs 4.4 months). There was no difference in RTC rates and time to return for players who received a Bankart repair versus a Latarjet procedure (4.6 vs 4.2 months). A total of 12 participants were still actively engaged in their respective sport at an average of 4.3 years since surgery, while 11 athletes went on to retire at an average of 4.8 years. Duration of play after surgery was 3.8 years for contact athletes and 5.8 years for noncontact athletes ( P > .05). Conclusion: In this series, professional athletes who underwent surgical shoulder stabilization for the treatment of anterior glenohumeral instability returned to their presurgical levels of competition at a high rate. No differences in RTC rate or time to RTC were observed for contact versus noncontact athletes or for those who received arthroscopic Bankart repair versus open Latarjet. However, contact athletes had shorter careers after surgery than did noncontact athletes.

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Outcomes of the Latarjet procedure for the treatment of chronic anterior shoulder instability: patients with prior arthroscopic Bankart repair versus primary cases

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00204 ◽

2019 ◽

Vol 7 (5_suppl3) ◽

pp. 2325967119S0020

Author(s):

Jean-David Werthel ◽

Vincent Sabatier ◽

Lior Amsallem ◽

Marie Vigan ◽

Alexandre Hardy

Keyword(s):

Shoulder Instability ◽

Bankart Repair ◽

Anterior Shoulder Instability ◽

Latarjet Procedure ◽

Sports Activity ◽

Simple Shoulder Test ◽

Arthroscopic Bankart Repair ◽

Functional Scores ◽

The Mean

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.

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

The American Journal of Sports Medicine ◽

10.1177/0363546521996381 ◽

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)

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Functional outcome of arthroscopic Bankart repair in post-traumatic recurrent shoulder dislocation in a private tertiary care teaching hospital in eastern India

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20204590 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1233

Author(s):

Ayon Das ◽

Subhrojyoti Bhowmick ◽

Nikhilesh Das ◽

Swarnendu Samanta ◽

Somanth De ◽

...

Keyword(s):

Range Of Motion ◽

Shoulder Dislocation ◽

Full Range ◽

Tertiary Care ◽

Young Patients ◽

Bankart Repair ◽

Care Hospital ◽

Shoulder Range Of Motion ◽

Arthroscopic Bankart Repair ◽

Post Traumatic

Background: Recurrent anterior shoulder dislocations are quite common in young patients with Bankart lesions. The open Bankart repair was the gold standard for years, however arthroscopic Bankart repair has gained popularity. The aim of the study was to evaluate the functional results of arthroscopic Bankart repair in patients with post-traumatic recurrent anterior glenohumeral instability.Methods: Patients who underwent arthroscopic Bankart repair for post-traumatic recurrent anterior shoulder dislocation were included in the study. This was a prospective study conducted at a tertiary care Hospital in Kolkata, India between August 2017 to May 2019. All patients were followed up at an interval of 2 weeks, 6 weeks, 12 weeks, 6 months, 9 months and 1 year. Rowe score was used to assess the functional outcomes of the patients.Results: 34 (91.9%) patients reported good to excellent results, whereas only 2 (5.4%) patients had fair outcome and 1 (2.7%) patient demonstrated poor surgical result. The total rowe score improved from 46.62 pre-operatively to 94.20 post-operatively after 1 year (p<0.01). By the end of 1-year follow-up, 35 (94.6%) patients had full range of motion in all the planes. Majority of (89.2%) patients did not have any complications. Only 1 patient out of 37 had a recurrence (2.7%).Conclusion: Arthroscopic Bankart repair is an effective, cosmetic and safe surgical procedure with good clinical outcomes and excellent post-operative shoulder range of motion. This surgical intervention also has low recurrence rate and minimum surgical complications.

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Clinical Outcomes and Prognostic Factors of Arthroscopic Bankart Repair for Recurrent Shoulder Instability in Soldiers: A Retrospective Single-Center Analysis

10.21203/rs.3.rs-34799/v1 ◽

2020 ◽

Author(s):

Ji Li ◽

Wei Qi ◽

Qiang Zhang ◽

Ketao Wang ◽

Wei Li ◽

...

Keyword(s):

Risk Factors ◽

Statistical Analysis ◽

Shoulder Instability ◽

Bankart Repair ◽

Anterior Shoulder Instability ◽

Time Interval ◽

Single Center ◽

Recurrent Shoulder Instability ◽

Arthroscopic Bankart Repair ◽

The Mean

Abstract Background: The optimal surgical treatment of recurrent traumatic anterior shoulder instability remains a debated topic. The soldier is a special population with high-intensity military training of shoulder. The purpose of this study was to evaluate the clinical outcomes of arthroscopic Bankart repair for recurrent shoulder instability in soldiers and identify the related risk factors. Methods: A retrospective single-center analysis was performed for soldiers with recurrent shoulder instability who underwent arthroscopic Bankart repair between 2009 and 2014. The primary outcome measure was recurrence of instability (redislocation or subluxation). Statistical analysis by binary logistic regression analysis was performed for the significance of various risk factors including sex, gender, number of preoperative dislocations (single/recurrent), the time interval between the first dislocation and the surgery (less or more than 6 months), SLAP repair and number of anchors. The functional outcomes were assessed with the visual analog scale (VAS), the American Shoulder and Elbow Surgery Score (ASES) and Rowe stability score preoperatively and at the last follow-up. Results: A total of 95 shoulders were followed for 53.81±9.37 months (range, 38 to 92 months). The overall postoperative recurrent instability rate was 16.84% (16 in 95). The statistical analysis showed significant differences in age (P=0.045, OR=0.818), and the time interval between the first dislocation and surgery (P=0.035, OR=5.289). There was a significant improvement in the mean VAS, ASES, and Rowe scores postoperatively (P<0.05), but the mean VAS and Rowe scores were lower in the patients of recurrence (P=0.022 and 0.034, respectively). Conclusions: This study suggested that surgery within 6 months of the first dislocation may be required for the young soldiers, although several repair techniques exist for anterior shoulder instability, arthroscopic Bankart repair remains a viable option.

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Arthroscopic Bankart Repair with and without Arthroscopic Infraspinatus Remplissage in Anterior Shoulder Instability with Hill-Sachs Defect: Randomized Controlled Trial

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00095 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0009

Author(s):

Peter B. MacDonald ◽

Jason Old ◽

Randhir Mascarenhas ◽

Sheila McRae ◽

Jon Marsh ◽

...

Keyword(s):

Range Of Motion ◽

Shoulder Instability ◽

Controlled Trial ◽

Bankart Repair ◽

Anterior Shoulder Instability ◽

Glenohumeral Instability ◽

Glenoid Defect ◽

Arthroscopic Bankart Repair ◽

Patient Reported ◽

Time Point

Objectives: The purpose of this prospective randomized, double blinded controlled trial was to compare patient-reported outcomes and clinical results between arthroscopic Bankart repair with and without arthroscopic infraspinatus remplissage in patients with anterior shoulder instability with a Hill-Sachs lesion. Failure to recognize and address large Hill Sach’s defects during arthroscopic stabilization surgery for glenohumeral instability is known to lead to high rates of recurrence. Arthroscopic remplissage has evolved in recent years as a reproducible technique with a proposed benefit of decreased dislocations. However, there are no high level clinical studies to conclusively support its efficacy in reducing redislocations. Methods: One hundred and four patients, aged 14 years and older, with a confirmed Hill Sach’s lesion on ultrasound, CT or MRI, were randomized intraoperatively after confirming an engaging Hill Sach’s lesion to either undergo arthroscopic infraspinatus remplissage (REMP) or no remplissage during arthroscopic Bankart repair (NO REMP). Exclusion criteria included a glenoid defect >15% of the AP glenoid diameter, significant shoulder arthropathy, infection, or medical comorbidities. The primary outcome measure was the Western Ontario Shoulder Instability score (WOSI). Secondary outcomes included the Simple Shoulder Test (SST), the American Shoulder and Elbow Society standardized assessment of shoulder function (ASES), active range of motion, stability tests, and incidence of revision surgery. Study time points were pre-, 3-, 6-, 12-, and 24-months post-operative. Significance level was 0.05. Results: A summary of demographics and outcomes are presented in Table 1. There were 53 patients (45 men, 8 women) randomized to REMP and 52 (46 men, 6 women) patients to NO REMP. The groups were comparable with regard to age, body mass index (BMI), and gender distribution). Both groups demonstrated a similar improvement in all subjective scores over time to 12-months post-operative with no difference between the groups (collection of data to 24-months post-operative is ongoing until 2019). The WOSI significantly improved from pre- to 12-months post-operative in both study groups. There were no differences between groups at any time point. ASES scores and SST scores followed a similar pattern. Additionally, there were no differences in range of motion between groups at any time point. There were 2/53 re-dislocations in REMP postoperatively compared to 6/52 in NO REMP; this difference was not significant (p=0.161). There were no differences between groups in reports of limitations in participation in sport attributed to the operated shoulder up to 12-months post-operative. Conclusion: Based on this study, there is no difference in subjective outcome scores and redislocations rates between remplissage and no remplissage for an engaging Hill Sach’s lesion while performing arthroscopic Bankart stabilization. As data continues to be gathered to 24-months post-operative including MRI, longer term benefits or drawbacks may become evident. [Table: see text]

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00125 ◽

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.

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