Factors Influencing Recurrence Rate in Bankart Arthroscopic Surgery

Authors: Lionel Neyton, MD Lyon France

References: Presented AAOS 2005

Glenoid or humeral bone defect and deficient capsular tissue increase the risk of recurrence of instability and are contra-indication for arthroscopic stabilization

GOAL OF STUDY: Analyze factors leading to failure of arthroscopic anterior shoulder stabilization.

MATERIAL AND METHODS: 91 consecutive patients were operated with an arthroscopic Bankart surgery for anterior shoulder instability and reviewed with a mean follow up of 33 months (24-49). There was 22 dislocations, 27 subluxations and 12 painful unstable shoulders. 71 were males (20 females) and mean age was 21.5 (12-49) at first event and 26.4 (17-72) at surgery. Definition of failure was recurrence of an anterior instability (dislocation or subluxation) and was correlated to different anatomic and epidemiologic factors.

RESULTS : Fourteen patients (15%) failed (6 dislocations and 8 subluxations) and 13 were male. Mean delay before recurrence was 17.6 months (7-32), five recurred after first year and 4 after two years. Three anatomic factors were linked to failure: 1) Glenoid compression-fracture (6 cases, p=0.012); 2) Large Hill-Sach lesion (5 cases, p<0.05); 3) Deficient anterior capsule (tear or severe elongation of IGHL, 8 cases). Some epidemiologic factors are also linked to failure: non-traumatic first event (5/6), number of events (>20), inferior laxity (10 cases) which is defined as an asymmetric hyperabduction test (>20°) or apprehension, and return to high risk sports (rugby, hand-ball, judo, water skiing). Capsular status revealed two recurrence pattern: Adequate capsule in which recurrence delay is long and caused by new a traumatic event; and Deficient capsule in which recurrence delay are short with no significant traumatic event.

CONCLUSION : Glenoid or humeral bone defect and deficient capsular tissue lead to an increased risk of recurrence of instability. The presence of one of those factors is a contra-indication for arthroscopic stabilization and in favor of a Latarjet-type open surgery. It is even truer if patient is a young, hyper lax male with more than 20 events after a non-traumatic first event and wants to return to high risk sports

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