Open Bankart Repair for the Treatment of Anterior Shoulder Instability without Substantial Osseous Glenoid Defects: Results After a Minimum Follow-up of Twenty Years

Abstract

Background: Neglected osseous glenoid defects are thought to be one of the reasons for the reported high rates of recurrent instability at long-term follow-up after Bankart repair. We hypothesized that open Bankart repair for the treatment of anterior glenohumeral instability in the absence of a substantial osseous glenoid defect would result in a lower long-term recurrence rate than has been reported in previous long-term studies.

Methods: Forty-seven patients were treated with a primary modified open Bankart repair for recurrent anterior shoulder instability between 1989 and 1994. Double-contrast computed tomography scanning was used to exclude patients with a substantial osseous glenoid defect. Forty patients (85.1%) were available for subjective and objective follow-up at a minimum of twenty years (maximum, twenty-five years). Twenty-six patients (65%) underwent clinical examination as well as bilateral shoulder radiography, and fourteen (35%) completed a self-assessment questionnaire and were interviewed by telephone.

Results: Seven patients (17.5%) had a recurrence of instability, and six of them had the instability occur after more than eight years without symptoms. The mean Western Ontario Shoulder Instability Index score (and standard deviation) was 256.7 ± 284.8 points; the mean Rowe score, 88.7 ± 12.0 points; and the mean Subjective Shoulder Value, 90.1% ± 10.5%.The mean range of motion of the affected shoulder was decreased by 4° of abduction (p = 0.009), two levels of internal rotation (p = 0.003), 5° of internal rotation in 90° of abduction (p = 0.005), 7° of external rotation in neutral position (p < 0.001), and 7° of external rotation in 90° of abduction (p = 0.004) compared with the contralateral side. The collective instability arthropathy (CIA) index was 0.92 for the affected side and 0.35 for the contralateral side.

Conclusions: Open Bankart repair provides good results twenty years after surgery in terms of subjective and objective outcome measurements. However, the long-term failure rate remains high despite the exclusion of substantial osseous glenoid defects. Recurrence of instability seems to be associated with an increased shoulder-specific activity level.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Fig. 1

An example of a preoperative sequence of double-contrast CT scans of one of the patients.

Fig. 2

Schematic drawings of the modified open Bankart repair technique. Fig. 2-A After a vertical incision of the anterior capsule (C), a small notch (N) is created at the anterior glenoid rim (G) at the cartilage-bone junction using a chisel, and four drill-holes are made from lateral to medial starting from the notch. Figs. 2-B, 2-C, and 2-D Sutures are passed through each drill-hole, and the most inferior suture is passed through the lateral part of the incised capsule in the form of a mattress stitch and is returned through the second inferior hole. Fig. 2-E The knot is tied medially. Another mattress stitch is completed using the two superior holes. Afterward, the medial part of the incised capsule is sutured over the lateral capsule, which was previously attached to the glenoid rim.