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ASES scores confirm that arthroscopic Bankart repair is as effective as open
Recurrent instability is no longer an appropriate outcome measure for Bankart repair.
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HOLLYWOOD, Fla. – New and improved techniques in arthroscopic Bankart repair have led to a decrease in recurrent instability following the procedure. Now, surgeons are turning to patient assessment tools to determine the effectiveness of arthroscopic over open Bankart repair.
A recent study at the University of Pennsylvania School of Medicine in Philadelphia found no statistical differences in the modified American Shoulder and Elbow Surgeons (ASES) scores among 93 patients who underwent either arthroscopic or open Bankart repair for recurrent anterior-inferior glenohumeral instability.
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Source: Tjoumakaris FP |
The researchers’ findings reinforced the fact that recurrent dislocation is no longer an appropriate outcome measure, said Fotios Paul Tjoumakaris, MD, of the University of Pennsylvania.
Important to note, however: “Arthroscopic repair was not associated with greater patient satisfaction as you might perceive,” Tjoumakaris said at the Arthroscopy Association of North America 25th Annual Meeting.
Initially researchers retrospectively reviewed 106 patients surgically treated for recurrent anterior glenohumeral instability at a tertiary care referral center from 1998 to 2001. After excluding 13 patients based on strict criteria, the researchers were left with 93 patients, including 72 men and 21 women with an average age of 29.9 years, Tjoumakaris said.
“Any patient with a bony defect, any patient with prior surgery, any evidence of multidirectional instability, cuff tears or associated injuries and any patient with workers’ compensation or litigation pending was excluded from our study,” Tjoumakaris said.
Two fellowship-trained shoulder surgeons performed arthroscopic Bankart repair on 69 patients and open Bankart repair on the remaining 24 patients. All patients previously failed conservative management. The surgeons used identical fixation methods with suture anchors, Tjoumakaris said.
“The operative methods were based on the surgical preference at the time the procedure was performed,” Tjoumakaris said. “Those performed between 1998 and 2000 were mostly open and beyond 2000, [they were] almost all arthroscopic.”
At an average 42-month follow-up (range 24 months to 77 months), researchers measured patient outcomes using a modified ASES questionnaire, known as the Penn Shoulder Score, which adds satisfaction as a measurement with pain and function. They compared the groups’ scores using the Student’s t-test (P<.05).
The researchers found overall results were similar between the two groups with a Penn score of 89.5 in the open repair group and 90 in the arthroscopic repair group.
For pain, they found a score of 26.6 in the open group, compared to 26.3 in the arthroscopic groups. Patients ranked function at an average 54.2 in the open group and 55.1 in the arthroscopic group. Satisfaction was slightly higher in the open repair group at 8.8, compared to 8.5 in the arthroscopic group.
In all areas, researchers found no significant difference when they excluded patients treated with both Bankart and SLAP repair, Tjoumakaris said.
Researchers found one incidence of recurrent instability in each group. The open group patient underwent nonoperative management, while the arthroscopic patient underwent revision arthroscopic repair.
They found no residual subluxation, apprehension, infections or subscapularis failures.
Study limitations included its retrospective nature, surgeon and investigator bias, applicability to surgeons less skilled in arthroscopy, strict inclusion and exclusion criteria and the fact that patients may have been treated for other pathologies, Tjoumakaris said.
For more information:
- Tjoumakaris FP, Abboud J, Michener T, et al. Equivalent patient-assessed outcomes between arthroscopic and open Bankart repair. #SS-04. Presented at the Arthroscopy Association of North America 25th Annual Meeting. May 18-21, 2006. Hollywood, Fla.