Clinical Outcome of Arthroscopic Bankart Repair Combined With Simultaneous Capsular Repair

Abstract

Background: A capsular tear and humeral avulsion of the glenohumeral ligament lesion are not uncommon findings in association with a Bankart lesion. However, there have been few reports regarding the prevalence of such capsular lesions and the postoperative recurrence after capsular repair. Purpose/Hypothesis: This study investigated the prevalence of capsular lesions and clarified their influence on the postoperative recurrence of instability. In addition, factors were identified that were associated with the occurrence of capsular lesions and the postoperative recurrence of instability. We hypothesized that clinical outcomes would be improved by combining arthroscopic Bankart repair with simultaneous capsular repair. Study Design: Cohort study; Level of evidence, 3. Methods: Capsular lesions were retrospectively examined through operative records, still pictures, and videos in 172 shoulders with traumatic anterior instability. First, the prevalence of capsular lesions and their severity were investigated. Then, postoperative recurrence was determined in shoulders observed for a minimum of 2 years. Finally, factors were assessed that were associated with the occurrence of capsular lesions and the postoperative recurrence of instability. Results: A capsular lesion was recognized in 37 shoulders (21.5%), being severe and mild in 20 and 17, respectively. All were repaired simultaneously with the arthroscopic Bankart procedure. After follow-up for at least 2 years, recurrence of instability was detected in 10 of 34 shoulders (29.4%), including 6 (31.6%) with severe capsular lesions and 4 (26.7%) with mild lesions. The recurrence rate was significantly higher in shoulders with a capsular lesion than in shoulders without a capsular lesion (18 of 120, 15%; P = .013), but there was no significant difference between severe and mild lesions. Regardless of the sport played, capsular lesions were significantly more frequent in patients ≥30 years old, patients with complete dislocation, and patients with a coexisting Hill-Sachs lesion. Postoperative recurrence of instability was significantly more frequent in patients <30 years and competitive athletes. Conclusion: In shoulders undergoing arthroscopic Bankart repair, capsular lesions were often present and were associated with higher postoperative recurrence of instability. While these lesions were more frequent in older patients, postoperative recurrence of instability was more likely in young competitive athletes.