Arthroscopic revision Bankart repair: a preliminary evaluation

Arthroscopic stabilization of primary, recurrent anterior shoulder instability has become the procedure of choice with infrequent exceptions. Failures of stabilization can and do occur. This is a Level IV retrospective analysis of arthroscopic revision Bankart surgery performed on 15 non-consecutive patients over a 4-year period with an average 22-month follow-up. The average patient age was 27.5 with 12 men and 3 women. Four of the 15 failures were from the senior author's (R.K.N.R.) practice with the remaining 11 referred for treatment. Four of the 15 failures resulted from open surgery while the remaining 11 failed an arthroscopic stabilization procedure. Four contact/collision athletes were included, and significant bone loss was recorded in 5 patients. Operative findings included 10 recurrent Bankart lesions while 9 patients were felt to demonstrate capsular attenuation. Fourteen of the 15 had a Hill-Sachs lesion while chondromalacic change involving the anterior glenoid was noted in 13 of the 15 patients. A suture anchor technique was used with an average of 2.5 double-loaded suture anchors. In this series, 4 failures occurred after revision arthroscopic stabilization (27%) with an average SANE score of 86 (range, 65-100). One of the 5 patients with significant bone loss sustained a recurrence while 1 of 4 contact athletes failed the revision arthroscopic stabilization. Two of the 4 failures in this study subsequently underwent an open bone block procedure. Arthroscopic revision Bankart repair can be an effective alternative, but should only be considered in the properly selected patient.