Arthroscopic Bankart repair.

Recurrent instability in athletes may lead to decreased athletic performance and interference with activities of daily living. When a Bankart lesion is created, the probability that instability will recur is high. Open Bankart repairs have been shown to produce greater than 95% good to excellent results but do require extensive dissection and may result in significant loss of external rotation of the shoulder. This loss of external rotation may interfere or prevent the resumption of athletic activities. Arthroscopic Bankart repair offers the hope of re-creating shoulder stability surgically with minimal damage to the surrounding tissues, resulting in little, if any, loss of external rotation. Arthroscopic Bankart repair is demanding and is associated with an increased risk of failure compared with open techniques. If the surgeon remains cognizant of the precise technical details of arthroscopic Bankart repair, greater than 90% good to excellent results should be achieved with arthroscopic shoulder stabilization. In discussing arthroscopic versus open repair with an athlete, however, the surgeon should talk about his or her own results with the procedure to allow an athlete to make an informed decision. The author believes that arthroscopic Bankart repair is appropriate for all overhead athletes requiring as much external rotation of the shoulder as possible, noncontact athletes, athletes who have dislocated three or fewer times, and those who do not have a significant degree of generalized ligamentous laxity. It also may be appropriate for the low-demand patient who dislocates a shoulder in an accident (e.g., a fall) and, after stabilization, is not expected to place significant demands on the shoulder. The author also believes that arthroscopic Bankart repair is not appropriate in patients with generalized ligamentous laxity, in patients with more than three dislocations (unless they are an overhead athlete), in patients who are found to have poor quality tissue at the time of arthroscopy, or in athletes who are perceived to be noncompliant. Open procedures are probably more appropriate in each of these groups of patients.