Open Bankart repair plus inferior capsular shift may be indicated for collision athletes
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Key takeaways:
- Open Bankart repair plus inferior capsular shift may be preferred vs. arthroscopic Bankart repair in collision athletes.
- Open Bankart was associated with decreased rates of recurrent instability.
Published results showed open Bankart repair plus inferior capsular shift had similar functional outcomes and decreased rates of recurrent instability vs. arthroscopic Bankart repair and may be preferred for collision athletes.
Researchers performed a prospective cohort comparison study of 86 collision athletes who underwent open Bankart repair plus inferior capsular shift (n = 43) vs. arthroscopic Bankart repair (n = 43) for recurrent anterior shoulder instability. Researchers assessed American Shoulder and Elbow Surgeons scores, Western Ontario Shoulder Instability Index (WOSI) scores, range of motion (ROM) and recurrence rates at baseline, 6 months, 1 year and a minimum 5 years after surgery.
Researchers found no significant differences in ASES scores, WOSI scores or ROM between the cohorts at final follow-up. Mean WOSI score improved from 40.1 to 84.2 for the open Bankart cohort and from 42.5 to 83.9 for the arthroscopic Bankart cohort. Mean ASES score improved from 64.8 to 91.5 for the open Bankart cohort and from 65.6 to 90.7 for the arthroscopic Bankart cohort.
However, researchers found a significant difference in recurrence rates between the cohorts at final follow-up that favored the open Bankart cohort (P = .012). Patients in the open Bankart cohort had three dislocations (6.9%), while patients in the arthroscopic Bankart cohort had 10 dislocations (23.2%).
“We recommend performing open Bankart repair plus inferior capsular shift as a treatment alternative in collision athletes with recurrent anterior shoulder instability,” the researchers wrote in the study.
Perspective
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Asheesh Bedi, MD
This matched cohort study by Iván José Bitar, PhD, and colleagues provides important insights on the outcomes of arthroscopic Bankart repair compared with an open Bankart repair with an associated capsular shift in the higher-risk population of collisions with subcritical glenoid bone loss. Despite equivalent functional outcomes and range of motion postoperatively, the study reports a significantly higher recurrence rate of instability in the arthroscopic (23%) compared with open (7%) approach at a minimum of 5 years follow-up. This is reasonable and aligned with the historical literature on this topic, although what is not known is the impact of the potential addition of remplissage for these on-track lesions (which was not performed in this study).
Remplissage is being increasingly recommended and performed by surgeons based on new studies in the literature, suggesting a reduced risk of recurrence, even for on-track lesions with minimal additional morbidity, and this may be even more relevant in the higher-risk population of collision athletes.
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