Damien Delgrande1, Guillaume Lonjon2, Philippe Hardy3, Bradley Schoch4, Jean-David Werthel5,6. 1. Institut de chirurgie orthopédique de Provence - Clinique Axium, 42 Avenue Maréchal de Lattre de Tassigny, Aix-en-Provence, France. 2. Centre chirurgical Orthosud Grasset, 15 Avenue du Professeur Grasset, Montpellier, France. 3. Orthopedic Department, Hopital Ambroise Pare, Boulogne-Billancourt, France. 4. Orthopedic Department, Mayo Clinic, Jacksonville, FL, 32224, USA. 5. Orthopedic Department, Hopital Ambroise Pare, Boulogne-Billancourt, France. jdwerthel@gmail.com. 6. Ramsay Générale de Santé, Clinique la Montagne, Courbevoie, France. jdwerthel@gmail.com.
Abstract
INTRODUCTION: Bankart repair is a popular treatment for anterior shoulder instability. However, long-term failure rates of arthroscopic Bankart repair remain higher than Latarjet procedures. The purpose of this study was to report long-term results of arthroscopic Bankart repair in patients greater than 30 years old and analyze risk factors of failure following arthroscopic Bankart repair that are independent of younger age. MATERIALS AND METHODS: Between January 1999 and December 2003, 41 patients aged 30 years or older treated with arthroscopic Bankart repair for anterior shoulder instability were evaluated. Outcome measures included pain (VAS), range of motion, post-operative Walch-Duplay, WOSII scores, complications, failure rate, and risk factors of failure. Failure was defined as recurrent dislocation or subluxation. RESULTS: At a mean 12-year follow-up (range; 10-15 years), the failure rate of arthroscopic Bankart repair in patients aged 30 years and older was 37%. The mean post-operative Walch-Duplay score was significantly higher in patients who had no recurrence compared to those who had had recurrence of instability (100 versus 90, p=0.02). An ISIS score≥3 (p=0.02), a glenoid bone lesion (p=0.06), and a Hill-Sachs lesion>15% defect (p=0.001) were risk factors for recurrent instability. When considering a modified ISIS score that accounted for bony defects on the glenoid and humeral side, patients with an ISIS score <3 + no glenoid lesion + Hill-Sachs ≤ 15% had a recurrence rate of 0%. CONCLUSION: The failure rate of arthroscopic Bankart repairs in patients over 30 was higher than previously reported. Specifically, patients with an ISIS >3 and bony glenoid defects and/or Hill-Sachs lesions > 15% may be at higher risk for recurrent instability following an isolated arthroscopic Bankart repair. Alternative stabilization techniques may need to be considered for this subset of patients.
INTRODUCTION: Bankart repair is a popular treatment for anterior shoulder instability. However, long-term failure rates of arthroscopic Bankart repair remain higher than Latarjet procedures. The purpose of this study was to report long-term results of arthroscopic Bankart repair in patients greater than 30 years old and analyze risk factors of failure following arthroscopic Bankart repair that are independent of younger age. MATERIALS AND METHODS: Between January 1999 and December 2003, 41 patients aged 30 years or older treated with arthroscopic Bankart repair for anterior shoulder instability were evaluated. Outcome measures included pain (VAS), range of motion, post-operative Walch-Duplay, WOSII scores, complications, failure rate, and risk factors of failure. Failure was defined as recurrent dislocation or subluxation. RESULTS: At a mean 12-year follow-up (range; 10-15 years), the failure rate of arthroscopic Bankart repair in patients aged 30 years and older was 37%. The mean post-operative Walch-Duplay score was significantly higher in patients who had no recurrence compared to those who had had recurrence of instability (100 versus 90, p=0.02). An ISIS score≥3 (p=0.02), a glenoid bone lesion (p=0.06), and a Hill-Sachs lesion>15% defect (p=0.001) were risk factors for recurrent instability. When considering a modified ISIS score that accounted for bony defects on the glenoid and humeral side, patients with an ISIS score <3 + no glenoid lesion + Hill-Sachs ≤ 15% had a recurrence rate of 0%. CONCLUSION: The failure rate of arthroscopic Bankart repairs in patients over 30 was higher than previously reported. Specifically, patients with an ISIS >3 and bony glenoid defects and/or Hill-Sachs lesions > 15% may be at higher risk for recurrent instability following an isolated arthroscopic Bankart repair. Alternative stabilization techniques may need to be considered for this subset of patients.
Authors: H Thomazeau; O Courage; J Barth; C Pélégri; C Charousset; F Lespagnol; G Nourissat; S Audebert; S Guillo; B Toussaint; L Lafosse; J Bradel; D Veillard; P Boileau Journal: Orthop Traumatol Surg Res Date: 2010-10-28 Impact factor: 2.256
Authors: Stefan M Zimmermann; Max J Scheyerer; Mazda Farshad; Sabrina Catanzaro; Stefan Rahm; Christian Gerber Journal: J Bone Joint Surg Am Date: 2016-12-07 Impact factor: 5.284