scholarly journals Comparison of clinical and patient-reported outcomes of three procedures for recurrent anterior shoulder instability: arthroscopic Bankart repair, capsular shift, and open Latarjet

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Yingjie Xu ◽  
Kailun Wu ◽  
Qianli Ma ◽  
Lei Zhang ◽  
Yong Zhang ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Subjective Perception ◽  
Capsular Shift ◽  
Shift Group ◽  
Arthroscopic Bankart Repair ◽  
Significant Difference ◽  
Patient Reported ◽  
Recurrent Anterior Shoulder Instability

Abstract Background Best surgical of recurrent anterior shoulder instability remained controversial. We knew little about the superiority and choice between traditional open and modern arthroscopic techniques. We hypothesized that outcomes of all patients will be similar regardless of surgical technique. Methods A retrospective case-cohort analysis of 168 patients who had recurrent anterior shoulder instability was conducted from September 2010 to December 2013. All cases (mean age 30.8 [range 18–50] years) were performed with arthroscopic Bankart repair (33 males/20 females), open Latarjet (34 males/18 females), and capsular shift (31 males/14 females). The average follow-up was 67.6 months (range 60–72). The shoulder instability index score (ISIS) was more than 3 with an average of 6.4. Results All treatments proved to be effective in improving shoulder functional status and reducing symptoms, while Latarjet had an advantage over subjective perception. The Rowe scores in arthroscopic Bankart, open Latarjet, and capsular shift group were 92.3 ± 1.5, 96.2 ± 2.1, and 93.2 ± 2.3, respectively, with significant difference. There was no significant difference in other functional outcomes. However, the Latarjet group in subjective results (subjective shoulder value (SSV) and subjective shoulder value for sport practice (SSV Sport)) was superior to the others (P < 0.05). There were two relapsed cases in arthroscopic Bankart and capsular shift group, respectively, and no recurrence in open Latarjet group. Conclusion Arthroscopic Bankart repair has the advantage of mini-invasion and rapid recovery. Capsular shift offers stabilizing of inferior or multidirectional type, especially for little bone defect. Latarjet was more effective in reducing recurrence with higher stability. Level of evidence Therapeutic level III

scholarly journals Functional outcome of arthroscopic Bankart repair for anterior shoulder instability based on suture anchor configuration

2020 ◽  
Vol 6 (2) ◽  
pp. 301
Author(s):  
Madan Ballal ◽  
Tarun Jayakumar
Keyword(s):  
Functional Outcome ◽  
Shoulder Instability ◽  
Bankart Repair ◽  
Functional Improvement ◽  
Anterior Shoulder Instability ◽  
Suture Anchors ◽  
Arthroscopic Bankart Repair ◽  
Significant Difference ◽  
Functional Scores

<p class="abstract"><strong>Background:</strong> The objective of the study was to evaluate the functional outcome of arthroscopic Bankart repair for anterior shoulder instability to assess whether the number and position of suture anchors plays a role in determining the functional outcome.</p><p class="abstract"><strong>Methods:</strong> This was a prospective study on 32 patients operated with arthroscopic Bankart repair between December 2017 to April 2019. Pre-op and regular follow-up scores were measured at 1 month, 3 months and 6 months post-op using Rowe score and American Shoulder and Elbow Surgeons score to assess functional outcome.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean age of the study group was 24.5±6.9 years. Functional outcome as determined by Rowe score and ASES score at 6 months follow-up were found to be 90.5±7.2 and 85.9±14.1 respectively when compared to the pre-op scores of 23.2±8.2 and 47.9±5.7 respectively; all of which showed highly significant functional improvement with highly significant reduction in visual analog scale (VAS) pain score. Patients had no recurrent dislocations with mean external rotation limitation of 5<sup>o</sup>. 25 (78.1%) patients had two suture anchors inserted and 7 (21.9%) patients had multiple (&gt;2) anchors; and when analysis was done, there was no statistically significant difference between number of suture anchors used with respect to the functional scores.</p><p class="abstract"><strong>Conclusions:</strong> We conclude that arthroscopic Bankart repair is a useful and successful procedure. Patient identification and selection remains the key in determining the success of repair. Meticulous surgical technique and correct positioning of suture anchors may help in reducing the number of anchors without compromising on the final functional outcome, thereby reducing the economic burden on patients.</p>

scholarly journals Arthroscopic Bankart Repairs With and Without Remplissage in Recurrent Adolescent Anterior Shoulder Instability With Hill-Sachs Deformity

2018 ◽  
Vol 6 (12) ◽  
pp. 232596711881398 ◽  
Author(s):  
Jessica L. Hughes ◽  
Tracey Bastrom ◽  
Andrew T. Pennock ◽  
Eric W. Edmonds
Keyword(s):  
Shoulder Instability ◽  
Adult Population ◽  
Patient Reported Outcome ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Anterior Glenoid ◽  
The Hill ◽  
Recurrent Anterior Shoulder Instability

Background: Recurrent shoulder dislocation after surgical intervention in adolescents with anterior instability is now understood to occur with a relatively high frequency. The remplissage procedure is successfully used in the adult population to mitigate the ability of a Hill-Sachs lesion to engage the anterior glenoid and can be used during an arthroscopic Bankart repair for anterior shoulder instability. Purpose: To compare the clinical outcomes in adolescent patients who underwent a Bankart repair with or without remplissage for treatment of recurrent anterior shoulder instability and associated Hill-Sachs defects. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was conducted on adolescents who underwent a remplissage procedure for recurrent anterior shoulder instability from 2009 to 2017 at a single institution. Controls were identified in a cohort of patients who underwent a Bankart repair only and were matched based on age, sex, and size of Hill-Sachs lesion. All patients were then contacted to determine instability recurrence as well as to complete the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) and the Pediatric Adolescent Shoulder Score (PASS) outcome surveys. Results: Twenty-one adolescents underwent a remplissage procedure, and 20 matched controls underwent only a Bankart procedure. A significantly higher rate of recurrence was noted in the Bankart-only patients (8/17) compared with remplissage patients (2/15) ( P = .04). No statistical difference was found in patient-reported outcome scores between treatment groups or in range of motion measurements ( P > .05). In a subset of patients in the remplissage group with pre- and postoperative surveys available, mean ± SD scores for PASS (77 ± 11) and QuickDASH (19 ± 12) improved when compared with preoperative scores (PASS, 54 ± 16; QuickDASH, 35 ± 28), but only the PASS score was statistically improved (PASS, P = .003; QuickDASH, P = .23). Conclusion: The addition of the remplissage procedure to a Bankart repair is a reasonable surgical option to treat a Hill-Sachs deformity in adolescents with anterior shoulder instability. The success of this additional procedure may be due to filling the Hill-Sachs defect, or perhaps it augments stability through a mechanism of posterior capsulorrhaphy. Either way, this young athletic population appears to have a lower rate of recurrence and improved patient-reported outcomes with a remplissage procedure to address the Hill-Sachs deformity.

A lower Instability Severity Index score threshold may better predict recurrent anterior shoulder instability after arthroscopic Bankart repair: a systematic review

2021 ◽  
pp. jisakos-2020-000584
Author(s):  
Samuel I Rosenberg ◽  
Simon J Padanilam ◽  
Brandon Alec Pagni ◽  
Vehniah K Tjong ◽  
Ujash Sheth
Keyword(s):  
Shoulder Instability ◽  
Severity Index ◽  
Postoperative Recurrence ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Recurrence Rates ◽  
Recurrent Instability ◽  
Arthroscopic Bankart Repair ◽  
Score Threshold ◽  
Recurrent Anterior Shoulder Instability

ImportanceThe Instability Severity Index (ISI) score was developed to evaluate a patient’s risk of recurrent shoulder instability following arthroscopic Bankart repair. While patients with an ISI score of >6 were originally recommended to undergo an open procedure (ie, Latarjet) to minimise the risk of recurrence, recent literature has called into question the utility of the ISI score.ObjectiveThe purpose of this systematic review was to evaluate the efficacy of the ISI score as a tool to predict postoperative recurrence among patients undergoing arthroscopic Bankart procedures.Evidence reviewArticles were included if study participants underwent arthroscopic Bankart repair for anterior shoulder instability and reported postoperative recurrence by ISI score at a minimum of 2 years of follow-up. Methodological study quality was assessed using the Methodological Index for Non-Randomized Studies criteria. Pearson’s χ2 test was used to compare recurrence rates among patients above and below an ISI score of 4. Sensitivity, specificity, mean ISI scores and predictive value of individual factors of the ISI score were qualitatively reviewed.FindingsFour studies concluded the ISI score was effective in predicting postoperative recurrence following arthroscopic Bankart repair; however, these studies found threshold values lower than the previously proposed score of >6 may be more predictive of recurrent instability. A pooled analysis of these studies found patients with an ISI score <4 to experience significantly lower recurrence rates when compared with patients with a score ≥4 (6.3% vs 26.0%, p<0.0001). The mean ISI score among patients who experienced recurrent instability was also significantly higher than those who did not.Conclusions and relevanceThe ISI score as constructed by Balg and Boileau may have clinical utility to help predict recurrent anterior shoulder instability following arthroscopic Bankart repair. However, this review found the threshold values published in their seminal article to be insufficient predictors of recurrent instability. Instead, a lower score threshold may provide as a better predictor of failure. The paucity of level I and II investigations limits the strength of these conclusions, suggesting a need for further large, prospective studies evaluating the predictive ability of the ISI score.Level of evidenceIV.

Long-term Results of the Arthroscopic Bankart Repair for Recurrent Anterior Shoulder Instability in Patients Older Than 40 Years: A Comparison With the Open Latarjet Procedure

2020 ◽  
Vol 48 (9) ◽  
pp. 2090-2096
Author(s):  
Lukas Ernstbrunner ◽  
Bianca De Nard ◽  
Maurits Olthof ◽  
Silvan Beeler ◽  
Samy Bouaicha ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Constant Score ◽  
Bankart Repair ◽  
Long Term Results ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Level Of Evidence ◽  
Arthroscopic Bankart Repair ◽  
Recurrent Anterior Shoulder Instability

Background: Long-term results of the arthroscopic Bankart repair in patients older than 40 years are unknown and may be favorable in terms of postoperative glenohumeral arthritis as opposed to the long-term results of the open Latarjet procedure in patients older than 40 years. Purpose: To analyze our long-term results of the arthroscopic Bankart repair for recurrent anterior shoulder instability in patients older than 40 years of age and to compare these results with previously published long-term results of the Latarjet procedure in a cohort of similar age. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 35 consecutive patients (36 shoulders) with a mean age of 47 years (range, 40-69) at time of the arthroscopic Bankart repair were studied at a mean 13.2 years (range, 8-18) after surgery. Clinical and radiographic results were then compared with those of our previous study of 39 consecutive patients (40 shoulders) of a same age group who had been treated for the same pathology with an open Latarjet procedure. Results: Six shoulders (17%) sustained a recurrent shoulder dislocation after a mean 5.3 years; subluxation occurred in 3 shoulders (8%); and apprehension persisted in 3 shoulders (8%). Revision surgery was performed in 8 patients (22%): 2 Bankart and 6 open Latarjet. The relative preoperative Constant score and Subjective Shoulder Value were significantly improved ( P < .001) at final follow-up. Arthropathy of stabilization was advanced in the shoulders of 16 patients (47%) and had progressed by at least 2 grades in 21 patients (62%). There were significantly higher rates of redislocation and subluxation when compared with the open Latarjet procedure (9 vs 3; P = .037), and the mean final Subjective Shoulder Value was significantly lower in the Bankart group (86% vs 91%; P = .011). There were no significant differences in final advanced arthropathy (16 vs 14; P = .334) and revision rates (8 vs 7; P = .409) when compared with the Latarjet procedure. Conclusion: Arthroscopic Bankart repair for recurrent anterior shoulder instability in patients older than 40 years was associated with reliable pain relief and patient satisfaction similar to that after the open Latarjet procedure. Restoration of stability was significantly less successful and development of arthropathy no better than the open Latarjet procedure in patients older than 40 years.

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

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]

Borderline Glenoid Bone Defect in Anterior Shoulder Instability: Latarjet Procedure Versus Bankart Repair

2018 ◽  
Vol 46 (9) ◽  
pp. 2170-2176 ◽  
Author(s):  
Yoon Sang Jeon ◽  
Ho Yeon Jeong ◽  
Dong Ki Lee ◽  
Yong Girl Rhee
Keyword(s):  
Bone Defect ◽  
Shoulder Instability ◽  
External Rotation ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Spinal Segment ◽  
Arthroscopic Bankart Repair ◽  
Recurrent Anterior Shoulder Instability

Background: The optimal procedure for anterior shoulder instability with a borderline (15%-20%) bone defect on the anterior rim of the glenoid is still controversial. Purpose: To compare the clinical outcome and recurrence rate between the arthroscopic Bankart repair and Latarjet procedure among patients with recurrent anterior shoulder instability and a borderline glenoid bone defect. Study Design: Cohort study; Level of evidence, 3. Methods: The authors retrospectively reviewed cases of arthroscopic Bankart repair and the Latarjet procedure for recurrent anterior shoulder instability with a borderline (15%-20%) glenoid bone defect. Enrollment comprised 149 patients (Bankart group, n = 118; Latarjet group, n = 31). The mean follow-up and age at operation were 28.9 ± 7.3 months (range, 24-73 months) and 26 ± 5 years (range, 16-46 years), respectively. Results: Rowe and UCLA (University of California, Los Angeles) shoulder scores significantly improved from 42.0 ± 14.3 and 22.9 ± 3.2 preoperatively to 90.9 ± 15.4 and 32.5 ± 3.3 postoperatively in the Bankart group ( P < .001) and from 41.0 ± 17.9 and 22.3 ± 3.4 to 91.1 ± 16.1 and 32.3 ± 3.4 in the Latarjet group ( P < .001), respectively. There were no significant between-group differences in Rowe ( P = .920) or UCLA ( P = .715) scores at the final follow-up. Mean postoperative loss of motion during forward flexion, external rotation in abduction, and internal rotation to the posterior was 3.0° ± 6.2°, 11.6° ± 10.2°, and 0.6 spinal segment in the Bankart group and 3.7° ± 9.8°, 10.3° ± 12.8°, and 0.9 spinal segment in the Latarjet group, respectively. These differences were not significant. However, the loss of external rotation at the side was significantly greater in the Bankart group (13.3° ± 12.9°) than in the Latarjet group (7.3° ± 18.1°, P = .034). The overall recurrence rate was significantly higher in the Bankart group (22.9%) than in the Latarjet group (6.5%), ( P = .040). Conclusion: The Latarjet procedure and arthroscopic Bankart repair both provided satisfactory clinical outcome scores and pain relief for anterior shoulder instability with a borderline glenoid bone defect. However, the Latarjet procedure resulted in significantly lower recurrences and less external rotation limitation than the arthroscopic Bankart repair. Therefore, the Latarjet procedure could be a more reliable surgical option in anterior recurrent instability with a borderline glenoid bone defect.

Sign in / Sign up

Export Citation Format

Share Document