Outcomes of Bankart Repairs Using Modern Arthroscopic Technique in an Athletic Population

OBJECTIVES: The ideal technique for management of traumatic anterior shoulder instability is yet to be determined. Although open Bankart repairs have remained the gold standard, arthroscopic indications and techniques for Bankart repairs have significantly evolved over the last decade. The purpose of this study was to report a large number of highly active patients who underwent arthroscopic Bankart repair at our institution over the last decade. METHODS: A retrospective analysis of all patients with a history of trauma to their shoulder resulting in an anterior shoulder dislocation was performed. Both primary and revision arthroscopic Bankart repairs using bioabsorbable anchors with at least two-year follow-up were included. Exclusion criteria included: atraumatic or multidirectional instability; an associated rotator cuff tear; a humeral avulsion of the glenohumeral ligament; significant glenoid bone loss; isolated posterior instability. Outcome measures included recurrence of dislocation, ASES (American Shoulder and Elbow Scores), Rowe, VAS (Visual Analog Scale), Return to sports and satisfaction scores. Final shoulder ROM (range of motion) and any complications were also reported. RESULTS: A total of 94 shoulders met inclusion criteria and had sufficient follow-up data to be included in the study. Of these, 24% were professional athletes (19% NFL, 3% MLB, 1% NBA, 1% NHL), 31% were college athletes, 33% were high school athletes and the remaining played recreationally. Of these, 61% were classified as “collision” and 29% as “limited contact” sports. 22% were overhead athletes. A total of 78 primary repairs and 16 revision repairs were performed using the same arthroscopic technique with an average of 5.6 anchors. The recurrence rate was 6/94 (6.4%) at a mean follow-up of 4.3 years (range 2.3 - 8.3). The mean postoperative scores were as follows: ASES=91.5/100; Rowe=84.3/100; VAS=0.8/10; satisfaction=8.8/10. Return to sports at the previous level for at least one season was possible in 88% of patients. Statistical analyses revealed a significant increase in risk of recurrence amongst high school and recreational athletes. No recurrences were observed amongst professional or college level athletes. No significant difference in recurrence rates were observed in regards to age, time to surgery, type of athlete (collision vs limited contact), repair of SLAP lesion, number of anchors, overhead athlete or revision surgery. CONCLUSION: Although several repair techniques exist for traumatic anterior shoulder instability, arthroscopic repair remains a viable option even in a highly active patient population. To our knowledge, this is the second largest series of arthroscopic Bankart repairs in a population consisting primarily of patients involved in collision and limited contact sports. This study uniquely identified high school and recreational athletes at higher risk for recurrence. This is perhaps due to inferior shoulder development and technique as well as limited access to postoperative physical therapy. Nonetheless, the recurrence rate reported in this study approaches that of other recently reported studies. In conclusion, arthroscopic Bankart repairs can yield excellent results in highly active patients. Particular attention should be paid to the younger, underdeveloped athletes as they may be at higher risk for recurrence.