Arthroscopic Bankart Repair for Primary Versus Recurrent Anterior Instability in Athletes Results in Excellent Clinical Outcomes, High Rates of Return to Play, and Low Recurrence Rates

Martin S Davey,Eoghan T Hurley,Mohamed Gaafar,Hannan Mullett,Leo Pauzenberger

doi:10.1016/j.asmr.2021.07.011

Abstract

PurposeTo compare the outcomes of athletes who have been treated for either primary or recurrent anterior shoulder instability with arthroscopic Bankart repair (ABR).MethodsA retrospective review of patients who underwent ABR for anterior shoulder instability, with a minimum of 24 months’ follow-up, was performed. Those who underwent ABR for primary instability were matched in a 1:1 ratio for age, sex, sport, and level of preoperative play to those who underwent ABR for recurrent instability. The rate, level, and timing of return to play (RTP), as well as the Shoulder Instability–Return to Sport After Injury score, were evaluated. Additionally, the recurrence rate, visual analog scale score, Subjective Shoulder Value, Rowe score, satisfaction, and whether patients would undergo the same operation again were compared.ResultsAfter analysis of 467 patients, 100 athletes who underwent ABR for primary instability were identified and subsequently pair matched to 100 patients who underwent ABR for recurrent instability, with a mean age of 27.2 years, 87% male patients, 68% collision athletes, and a mean follow-up period of 61.9 months. There was no significant difference between the groups in the rate of RTP (80% vs 79%, P = .86) or RTP at the preinjury level (65% vs 65%, P >. 999); however, there was a significant difference in time to RTP (6.9 ± 2.9 months vs 5.9 ± 2.5 months, P = .02). There were no significant differences in visual analog scale score, Shoulder Instability–Return to Sport After Injury score, Subjective Shoulder Value, Rowe score, patient satisfaction, and whether patients would undergo the operation again (P > .05 for all). There was no difference in the rate of recurrent instability after ABR (10% vs 16%, P = .29).ConclusionsABR results in excellent clinical outcomes, high rates of RTP, and low recurrence rates for both athletes with primary instability and those with recurrent instability.Level of EvidenceLevel III, retrospective comparative cohort study.

Highlights

There was no significant difference between the groups in the rate of return to play (RTP) (80% vs 79%, P 1⁄4 .86) or RTP at the preinjury level (65% vs 65%, P >. 999); there was a significant difference in time to RTP (6.9 Æ 2.9 months vs 5.9 Æ 2.5 months, P 1⁄4 .02)
There were no significant differences in visual analog scale score, Shoulder InstabilityeReturn to Sport After Injury score, Subjective Shoulder Value, Rowe score, patient satisfaction, and whether patients would undergo the operation again (P > .05 for all)
100 athletes treated with Arthroscopic Bankart repair (ABR) for primary instability were matched with 100 athletes treated with ABR for recurrent instability, with a mean follow-up period of 61.9 Æ 20.6 months

Summary

Introduction

There were no significant differences in visual analog scale score, Shoulder InstabilityeReturn to Sport After Injury score, Subjective Shoulder Value, Rowe score, patient satisfaction, and whether patients would undergo the operation again (P > .05 for all). Conclusions: ABR results in excellent clinical outcomes, high rates of RTP, and low recurrence rates for both athletes with primary instability and those with recurrent instability. Previous literature has shown that primary instability may be managed nonoperatively, a lower rate of RTP and a 7-fold higher rate of recurrent instability limit this treatment option in athletes.[5]. Those with primary instability often elect for operative management initially over nonoperative management with the hope of a successful RTP. ABR has been shown to result in high rates of RTP and satisfactory

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