Rotator cuff muscular integrity after arthroscopic revision of a Bankart repair.

Abstract

Recurrent shoulder instability after arthroscopic Bankart repair is still a common complication. For primary Bankart repair studies have shown that the rotator cuff can recover completely. The ability of muscles to regenerate after arthroscopic revision Bankart repair (ARBR) has not been studied. Does the ARBR using a three-portal method allows complete muscle integrity compared with an uninjured imaging control group (ICG)? Twenty-two (1 female, 21 males) physically active patients (mean age at follow-up 28.5±7.1years; mean follow-up 27.5months±8.5) were assessed. ARBR with a three-portal method was carried out in all patients according to previous primary arthroscopic stabilization of the shoulder (revision Bankart group). Muscle atrophy of the subscapularis muscle (SSC), supraspinatus muscle (SSP) and infraspinatus muscle (ISP) was assessed by making lateral and vertical measurements by magnetic resonance imaging (MRI). Fatty infiltration was detected by standardized assessment from variations in intensity. Detailed clinical examination of the rotator cuff was carried out. MRI assessment was compared with that of a control group of 22 healthy volunteers of same age and activity level (ICG). For the SSC, no muscle impairment was noted compared with the ICG [superior atrophy index (sAISSC), p=0.439; inferior atrophy index (iAISSC), p=0.555; superior fatty infiltration index (sFDISSC), p=0.294; inferior fatty infiltration index (iFDISSC), p=0.62]. In investigation of the SSP and ISP, fatty infiltration was not shown (FDISSP, p=0.454; sFDIISP, p=0.504), though persistent muscle atrophy was found even>2years after surgery compared with the ICG (AISSP, p=0.0025; sAIISP, p=0.0009; iAIISP, p=0.0004). ARBR using a three-portal method allowed good muscular integrity compared with the ICG, but with persistent slight muscular atrophy of the SSP and ISP.