Background: Several arthroscopic methods have been developed to
treat posttraumatic recurrent anterior shoulder instability in an attempt to
match the results that can be achieved with open repair. The aim of this study
was to perform an independent long-term clinical and radiographic evaluation
after extra-articular arthroscopic Bankart repair with use of absorbable tacks
Methods: Eighty-one consecutive patients with posttraumatic
recurrent anterior shoulder instability underwent an extra-articular
arthroscopic Bankart procedure. Seventy-one (88%) of the patients were
reexamined physically after a median duration of follow-up of 107 months by
two independent examiners and constituted the study group. Their clinical and
radiographic outcomes were documented.
Results: At the time of follow-up, twenty-seven (38%) of the
seventy-one patients had experienced some kind of shoulder instability,
although fifteen of them had had a new, clinically relevant shoulder injury.
Eleven patients had had subluxation only, and sixteen had had redislocation.
Fourteen of the twenty-seven patients had had a single episode of instability.
Seven patients had undergone additional surgery to treat shoulder instability.
The instability episodes occurred less than two years postoperatively in nine
patients, between two and five years postoperatively in twelve, and more than
five years postoperatively in six. At the time of final follow-up the median
external rotation in abduction was 90° (range, 0° to 120°)
compared with 95° (range, 70° to 125°) for the contralateral,
uninjured shoulders (p < 0.001). Before the injury, fifty-two patients
(73%) participated in overhead or contact sports, whereas thirty-four patients
(45%) participated in such activities at the time of follow-up. At the time of
follow-up, the drill holes used to implant the absorbable tacks were invisible
or hardly visible in fifty-eight (91%) of sixty-four patients for whom
radiographs had been made. A marked increase in degenerative changes was noted
when follow-up radiographs were compared with the preoperative
Conclusions: This long-term follow-up study of arthroscopic
extra-articular Bankart repairs revealed an unexpectedly high number of
patients with new episodes of instability. This finding led to a slight
modification of the technique. Since most instability episodes occurred after
two years, it is important to follow patients for a longer period of time
after surgical treatment of recurrent anterior shoulder instability to
identify the true recurrence rate.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.