Background: The higher failure rates reported with arthroscopic
stabilization of traumatic, recurrent anterior shoulder instability compared
with open stabilization remain a concern. The purpose of this study was to
evaluate the outcomes of arthroscopic Bankart repairs with the use of suture
anchors and to identify risk factors related to postoperative recurrence of
shoulder instability.
Methods: Ninety-one consecutive patients underwent arthroscopic
stabilization for recurrent anterior traumatic shoulder instability. The mean
age (and standard deviation) at the time of surgery was 26.4 ± 5.4
years. Seventy-one patients were male. Seventy-nine patients were involved in
sports (forty, in high-risk sports). Capsulolabral reattachment and capsule
retensioning was performed with use of absorbable suture anchors (mean, 4.3
anchors; range, two to seven anchors). All patients were prospectively
followed, and, at the time of the last review, the patients were examined and
assessed functionally by independent observers.
Results: At a mean follow-up of thirty-six months, fourteen patients
(15.3%) experienced recurrent instability: six sustained a frank dislocation
and eight reported a subluxation. The mean delay to recurrence was 17.6
months. The risk of postoperative recurrence was significantly related to the
presence of a bone defect, either on the glenoid side (a glenoid
compression-fracture; p = 0.01) or on the humeral side (a large Hill-Sachs
lesion; p = 0.05). By contrast, a glenoid separation-fracture was not
associated with postoperative recurrent dislocation or subluxation. Recurrence
of instability was significantly higher in patients with inferior shoulder
hyperlaxity (p = 0.03) and/or anterior shoulder hyperlaxity (p = 0.01). On
multivariate analysis, the presence of glenoid bone loss and inferior
hyperlaxity led to a 75% recurrence rate (p < 0.001). Lastly, the number of
suture-anchors was critical: patients who had three anchors or fewer were at
higher risk for recurrent instability (p = 0.03).
Conclusions: In the treatment of traumatic recurrent anterior
shoulder instability, patients with bone loss or with shoulder hyperlaxity are
at risk for recurrent instability after arthroscopic Bankart repair. At least
four anchor points should be used to obtain secure shoulder stabilization.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.