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Abstract
Although arthroscopic Bankart repair has become an accepted surgical stabilization
technique for anterior shoulder instability, the failure rate remains unacceptably
high. Little information is available concerning healing of the Bankart repair. The
purpose of this article is to clarify this issue by analyzing a cohort of 15 patients
who underwent a “second-look” artroscopy to evaluate and treat pain or recurrent instability
following arthroscopic Bankart repair with the Suretac device (Acufex Microsurgical,
Mansfield, MA). “Second-look” arthroscopy was performed at an average of 9 months
following the index surgical procedure. The reasons for this second surgery were recurrent
instability in 7, pain in 6, and pain and stiffness in 2. In the 7 patients with recurrent
instability, the Bankart repair was found to be completely healed in 3 (43%), partially
healed in 1 (14%), and had recurred in 3 (43%); however, 6 of 7 were observed to have
lax capsular tissue. In 4 of these cases, retrospective review of the index surgical
procedure showed that a technical error had been made during the repair. Two cases
had biopsy of the repair site on “second-look” at 6 to 8 months, and this showed residual
polyglyconate polymer debris surrounded by a histiocytic infiltrate. In the remaining
8 cases with stable shoulders, the Bankart repair had completely healed in 5 cases
(62.5%) and partially healed in 3 cases (37.5%). The higher failure rate with this
approach compared with open approaches appears to result from improper patient selection
and errors in surgical technique. There is some question concerning healing strength
of the Bankart repair, although complete healing of the Bankart does not seem to be
a prerequisite for shoulder stability. Success of the procedure might be expected
to improve by selecting only patients with unidirectional, post-traumatic, anterior
instabilit who are found to have a discrete Bankart lesion and well-developed ligamentous
tissue.
Keywords
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© 1995 Published by Elsevier Inc.
