Congenital anteroinferior instability treated by Bankart repair

A subset of patients with symptomatic anteroinferior instability of the shoulder has been recognized. All patients had a history of minimal trauma that was not related to their symptoms. There were 29 men and four women, averaging 29 years of age. Forty-five percent of the patients had failed treatment for associated impingement syndrome. Eleven patients had 17 operations on the shoulder that failed to relieve pain. Preoperative duration of symptoms ranged from four to 130 months (average, 28 months). No Hill-Sachs lesions were present. After a Bankart stabilization, wherein 11 of 33 shoulders had labral tears, pain relief was achieved in 27 of 33 patients. Three additional patients had pain relief after a second-stage acromioplasty. Thus, three of 15 patients with associated impingement syndrome required a second-stage acromioplasty (20%). In summary, 30 of 33 patients had pain relief. There were three failures. Two of the three patients had multidirectional instability. One of these was lost to follow-up evaluation. Another, repaired by a capsular shift, has no further dislocations. One patient required a revision Bankart repair after he sustained a traumatic tear of the capsule ten days after his initial operation; there was no recurrence. The Bankart operation is a worthwhile procedure for congenital unidirectional anteroinferior instability with or without impingement syndrome. It should be done first rather than initially treating the associated impingement.