Clinical and Functional Outcomes After Arthroscopic Bankart Repair After a Median Follow-up of 23 Years

Previous studies have shown that arthroscopic Bankart repair (ABR) for the treatment of anterior shoulder instability (ASI) may lead to high rates of instability recurrence and revision surgery at 10-year follow-up, but data on 20-year postoperative outcomes are scarce.

The purpose was to evaluate the clinical and functional outcomes after ABR for the treatment of ASI at long-term follow-up. It was hypothesized that ABR would be associated with high rates of revision surgery, reinstability, and redislocation, but good to excellent shoulder function.

Case series; Level of evidence, 4.

Patients who underwent ABR for the treatment of ASI at least 20 years ago and had initially been followed up after a minimum 10 years postoperatively were eligible to participate. Rates of revision surgery, subjective reinstability, and redislocations were evaluated, as were patient-reported outcome measures, including the American Shoulder and Elbow Surgeons score and Constant-Murley score.

In total, 82 patients were followed up at a median 23.0 years (IQR, 23.0-25.0) postoperatively. Twenty-eight patients (34.1%) had any kind of instability recurrence: 13 (15.9%) had reinstability at follow-up, 9 (11.0%) reported redislocations postoperatively, and 6 patients (7.3%) had both. Of those patients, 12 (42.9%) did not report instability at the previous minimum 10-year follow-up. Six patients who experienced redislocations underwent further surgery. Ten more patients underwent revision surgery for reasons other than redislocation. All patients who underwent revision surgery (n = 16; 19.5%) were excluded from further analysis. In patients who did not undergo revision surgery, shoulder function was good to excellent (median [IQR]; American Shoulder and Elbow Surgeons score, 95.0 [88.5-100]; Constant-Murley score, 87.5 [76.8-95.0]). Inferior glenohumeral laxity was associated with subjective reinstability (odds ratio, 7.214 [95% CI, 1.266-41.096]; P = .026). The use of fewer suture anchors for ABR was associated with redislocations (median [IQR]; no redislocation, 3.0 [3.0-4.0]; redislocation, 3.0 [2.0-3.0]; P = .016).

About 1 in 3 patients reported instability recurrence or redislocations, and 1 in 5 underwent further surgery. In patients who did not undergo further surgery, good to excellent shoulder function as well as low pain and instability levels were observed at a minimum 20 years after ABR. The presence of inferior glenohumeral laxity was associated with a higher risk for subjective reinstability, and the use of fewer anchors was associated with redislocations.