Arthroscopic Bankart repair may reduce secondary shoulder dislocation in young patients
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Published results showed treatment of anterior shoulder dislocation with arthroscopic Bankart repair may reduce the risk of secondary shoulder dislocation and improve functional outcomes compared with nonoperative treatment.
Cécile Pougès, MD, and colleagues categorized 40 patients (age 18-25 years) with anterior shoulder dislocation into groups to be treated either surgically with arthroscopic Bankart repair within 2 weeks after dislocation (n=20) or nonoperatively (n=20). Researchers immobilized both groups for 3 weeks in internal rotation, and both groups also followed the same physical therapy protocol. Researchers performed standard radiography and CT immediately after reduction of the dislocation and performed follow-up at 3, 6, 12 and 24 months.
Instability recurrence, defined as another anterior shoulder dislocation requiring closed reduction, a subluxation or a positive apprehension test, was considered the primary outcome measure. Researchers considered range of motion, return to sport and functional scores, including the short version of the DASH score, the Walch-Deplay score and the Western Ontario Shoulder Instability Index, as secondary outcome measures.
Results showed a significant decrease in recurrence of instability in the surgical treatment group vs. the nonoperative group. Researchers noted fewer episodes of dislocation, subluxation and positive apprehension tests among patients in the surgical group, as well as significantly better Walch-Duplay score and Western Ontario Shoulder Instability Index in the surgical group. According to results, 89% of patients in the surgical treatment group reported returning to the same or better level of sport compared with 53% of patients in the nonoperative treatment group. Researchers did not record any surgical complications and no significant differences in range of motion between the two groups.
“This study confirms the superiority of emergency arthroscopic treatment compared to orthopedic treatment in patients [younger than] 25 years with first anterior glenohumeral dislocation at 2 years follow-up. The operated patients had less recurrence of instability and returned to sport at a better level,” Pougès told Healio Orthopedics. “The recurrence rate after anterior glenohumeral dislocation is high in young patients, but despite the interesting results of several studies, emergency arthroscopic stabilization is not yet a current practice. Considering this study, it could be offered as a primary treatment option in a younger population.”
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There is continued debate on selecting the best management of a first-time anterior shoulder dislocation. Cécile Pougés, MD, and colleagues from Lille, France, have presented a comparison study of 40 active individuals, 18 to 25 years of age, split between two groups: early arthroscopic Bankart repair or immobilization in a simple sling. When considering dislocation, subluxation and continued apprehension, surgery reduced the risk to 10% compared with 70%. Interestingly, the return to a high level of activity was more quickly achieved following surgery.
Noteworthy is the concern with longer follow-up and the impact on increasing numbers of recurrence. The durability of this type of surgery has suggested that augmenting techniques to repair to the avulsed Bankart segment would improve midterm and long-term results. Athletes have a "window of opportunity," and this requires treatment to reduce recovery and provide lower risk of complications and recurrences. Patient-reported outcomes improve with reduced risk of recurrence, fewer complications adding confidence to the athlete's shoulder.
Recurrence creates additional articular injury to cartilage, bone, labrum and capsule. The authors included off-track lesions, glenoid rim fractures and SLAP tears in their study. Additional injury with recurrence may jeopardize the success of soft tissue surgery, adding to the complexities of surgical options. The arthroscopic Bankart repair should be considered a treatment option on high-risk athletes following the first dislocation. Additional injuries including extended labral tears, SLAP lesions, glenoid rim fractures and Hill-Sachs-engaging lesions add to discussions on best management for the active individuals.
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