Outcomes After Arthroscopic Bankart Repair With and Without Biceps Tenodesis in a Military Population

Active duty U.S. Military service members experience rates of anterior shoulder instability up to twenty times greater than the general population. Arthroscopic Bankart repair is the primary treatment for anterior shoulder instability without bone loss, though coexistent pathology involving the long head of the biceps tendon (LHBT) or biceps labral complex (BLC) may necessitate additional intervention. Biceps tenodesis (BT) is frequently employed in such cases. Although BT has been studied extensively in the context of superior labrum anterior to posterior (SLAP) tears and rotator cuff disease, few studies have investigated its outcomes when performed alongside Bankart repair, particularly within an active duty military population.

A retrospective cohort study was conducted using data from the Medical Assessment and Readiness System or "MARS" database at Womack Army Medical Center (WAMC) identifying active duty service members who underwent arthroscopic Bankart repair alone or in combination with open or arthroscopic BT between January 2017 and March 2020. Subjects were followed for up to 24 months. The primary outcome was defined as undergoing revision surgery related to instability or LHBT/BLC pathology. Secondary outcomes included need for advanced postoperative imaging (magnetic resonance imaging [MRI] or computed tomography [CT]), change in military occupational specialty (MOS), and separation from military service. Multivariable logistic regression models were constructed to adjust for sex, military branch, pay grade, and years of service, with adjusted odds ratios (aORs) and 95% CIs reported.

A total of 4,737 service members met inclusion criteria. The most common primary intervention was arthroscopic Bankart repair alone (3,640, 76.84%), followed by arthroscopic Bankart repair with open BT (862, 18.20%) and arthroscopic Bankart repair with arthroscopic BT (235, 4.96%). The mean follow-up time was 1.57 ± 0.59 years. Revision surgery occurred in 3.25% (n = 154) of cases, with revision arthroscopic Bankart repair being the most common procedure. Subjects undergoing arthroscopic BT in conjunction with arthroscopic Bankart repair had a significantly increased risk of requiring revision surgery compared to those who underwent arthroscopic Bankart repair alone (aOR 1.91, 95% CI 1.04-3.48, P = .04). In contrast, those who underwent open BT with arthroscopic Bankart repair did not show a statistically significant difference in revision rates (aOR 0.80, 95% CI 0.49-1.30, P = .37). Neither type of BT was associated with significantly increased odds of postoperative imaging, MOS change, or separation from service.

Arthroscopic BT performed with arthroscopic Bankart repair was associated with higher odds of revision surgery, whereas arthroscopic Bankart repair with open BT conferred no such increase. These findings suggest that, in a military population, open BT may be a more favorable adjunct to Bankart repair than arthroscopic BT. Further prospective research is needed to clarify optimal surgical strategies and their functional implications.