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. 2023 Sep 28;11(9):23259671231200231.
doi: 10.1177/23259671231200231. eCollection 2023 Sep.

Recurrent Instability After Arthroscopic Bankart Repair in Patients With Hyperlaxity and Near-Track Lesions

Stephanie A Boden  1 , Shaquille Charles  2 , Jonathan D Hughes  1 , Liane Miller  1 , Mark Rodosky  1 , Adam Popchak  3 , Volker Musahl  1 , Bryson P Lesniak  1 , Albert Lin  1
Affiliations

Recurrent Instability After Arthroscopic Bankart Repair in Patients With Hyperlaxity and Near-Track Lesions

Stephanie A Boden et al. Orthop J Sports Med. .

Abstract

Background: Recurrent anterior shoulder instability after arthroscopic Bankart repair presents a challenging clinical problem, with the primary stabilization procedure often portending the best chance for clinical success.

Purpose: To determine if capsuloligamentous laxity affects failure (recurrent dislocation, subluxation, and/or perceived instability symptoms) after arthroscopic Bankart repair in patients with near-track lesions (ie, those with smaller distance to dislocation [DTD]).

Study design: Case-control study; Level of evidence, 3.

Methods: The authors retrospectively reviewed consecutive patients who underwent primary arthroscopic Bankart repair for recurrent anterior glenohumeral instability at a single institution between 2007 and 2019 and who had at least 2 years of follow-up data. Patients with glenoid bone loss >20%, off-track lesions, concomitant remplissage, or rotator cuff tear were excluded. Capsuloligamentous laxity, or hyperlaxity, was defined as external rotation >85° with the arm at the side and/or grade ≥2 in at least 2 planes with the shoulder at 90° of abduction. Near-track lesions were defined as those with a DTD <10 mm.

Results: Included were 173 patients (mean age, 20.5 years; mean DTD, 16.2 mm), of whom 16.8% sustained a recurrent dislocation and 6.4% had recurrent subluxations (defined as any subjective complaint of recurrent instability without frank dislocation), for an overall recurrent instability rate of 23.1%. The rate of revision stabilization was 15.6%. The mean time to follow-up was 7.4 years. Independent predictors of recurrent instability were younger age (P = .001), smaller DTD (P = .021), >1 preoperative instability episode (P < .001), and the presence of hyperlaxity during examination under anesthesia (P = .013). Among patients with near-track lesions, those with hyperlaxity had a recurrent instability rate almost double that of patients without hyperlaxity (odds ratio, 34.1; P = .04). The increased rate of failure and recurrent dislocation in the near-track hyperlaxity cohort remained elevated, even in patients with no bone loss.

Conclusion: Capsuloligamentous shoulder laxity was a significant independent risk factor for failure after primary arthroscopic Bankart repair without remplissage and was more predictive of failure in patients with versus without near-track lesions.

Keywords: anterior instability; distance to dislocation; glenoid track; laxity.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: S.A.B. has received education payments from Mid-Atlantic Surgical Systems. J.D.H. has received education payments from Medical Device Business Services, Mid-Atlantic Surgical Systems, and Smith & Nephew; grant support from Arthrex; and hospitality payments from SI-BONE. L.M. has received hospitality payments from Stryker. M.R. has received education payments from Mid-Atlantic Surgical Systems. V.M. has received consulting fees from Smith & Nephew. B.P.L. has received education payments from Mid-Atlantic Surgical Systems. A.L. has received nonconsulting fees from Arthrex; consulting fees from Arthrex, Stryker, and Wright Medical Technology; education payments from Arthrex; hospitality payments from Stryker; and honoraria from Wright Medical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from the University of Pittsburgh (IRB No. STUDY20030061).

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