Original Article| Volume 30, ISSUE 2, P172-177, February 2014

Outcomes After Bankart Repair in a Military Population: Predictors for Surgical Revision and Long-Term Disability


      To quantify the rate of surgical failure after anterior shoulder stabilization procedures, as well as to identify demographic and surgical risk factors associated with poor outcomes.


      All Army patients undergoing arthroscopic or open Bankart repair for shoulder instability were isolated from the Military Health System Management Analysis and Reporting Tool between 2003 and 2010. Demographic variables (age, gender) and surgical variables (treatment facility volume, admission status, surgical technique) were extracted. Rates of surgical failure, defined as subsequent revision surgery or medical discharge with persistent shoulder complaints, were recorded from the electronic medical record and US Army Physical Disability Agency database. Risk factor analysis was performed with univariate t tests, χ2 tests, and a multivariable logistic regression model with failure as the outcome.


      A total of 3,854 patients underwent Bankart repair during the study period, with most procedures having been performed arthroscopically (n = 3,230, 84%) and on an outpatient basis (n = 3,255, 84%). Patients were predominately men (n = 3,531, 92%), and the mean age was 28.0 years (SD, 7.5 years). A total of 193 patients (5.0%) underwent revision stabilization whereas 339 patients (8.8%) were medically discharged with complaints of shoulder instability, for a total combined failure rate of 13.8% (n = 532). Univariate analyses showed no significant effect for gender; however, younger age, higher facility volume, open repair, and inpatient status were significant factors associated with subsequent surgical failure. Multivariable analyses confirmed that young age (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.91 to 0.96; P < .001), open repair (OR, 0.52; 95% CI, 0.36 to 0.75; P = .001), and inpatient status (OR, 0.58; 95% CI, 0.40 to 0.84; P = .004) were independently associated with failure by revision surgery.


      Young age remains a significant risk factor for surgical failure after Bankart repair. Patients who underwent arthroscopic Bankart repair had a significantly lower surgical failure rate (4.5%) than patients who underwent open anterior stabilization (7.7%). Despite advances in surgical technique, 1 in 20 military service members required revision surgery after failed primary stabilization in this study.

      Level of Evidence

      Level IV, therapeutic case series.
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        • Owens B.D.
        • Dawson L.
        • Burks R.
        • Cameron K.L.
        Incidence of shoulder dislocation in the United States military: Demographic considerations from a high-risk population.
        J Bone Joint Surg Am. 2009; 91: 791-796
        • Owens B.D.
        • Duffey M.L.
        • Nelson B.J.
        • DeBerardino T.M.
        • Taylor D.C.
        • Mountcastle S.B.
        The incidence and characteristics of shoulder instability at the United States Military Academy.
        Am J Sports Med. 2007; 35: 1168-1173
        • Waterman B.R.
        • Laughlin M.
        • Kilcoyne K.
        • Cameron K.L.
        • Owens B.D.
        Surgical treatment of chronic exertional compartment syndrome of the leg: Failure rates and postoperative disability in an active patient population.
        J Bone Joint Surg Am. 2013; 95: 592-596
        • Silliman J.F.
        • Hawkins R.J.
        Classification and physical diagnosis of instability of the shoulder.
        Clin Orthop Relat Res. 1993; : 7-19
        • Kim S.H.
        • Park J.S.
        • Jeong W.K.
        • Shin S.K.
        The Kim test: A novel test for posteroinferior labral lesion of the shoulder—A comparison to the jerk test.
        Am J Sports Med. 2005; 33: 1188-1192
        • Blasier R.B.
        • Soslowsky L.J.
        • Malicky D.M.
        • Palmer M.L.
        Posterior glenohumeral subluxation: Active and passive stabilization in a biomechanical model.
        J Bone Joint Surg Am. 1997; 79: 433-440
        • Neer II, C.S.
        Involuntary inferior and multidirectional instability of the shoulder: Etiology, recognition, and treatment.
        Instr Course Lect. 1985; 34: 232-238
        • Gagey O.J.
        • Gagey N.
        The hyperabduction test.
        J Bone Joint Surg Br. 2001; 83: 69-74
        • Beighton P.
        • Horan F.
        Orthopaedic aspects of the Ehlers-Danlos syndrome.
        J Bone Joint Surg Br. 1969; 41: 444-453
        • Walch G.
        • Boileau P.
        • Levigne C.
        • Mandrino A.
        • Neyret P.
        • Donell S.
        Arthroscopic stabilization for recurrent anterior shoulder dislocation: Results of 59 cases.
        Arthroscopy. 1995; 11: 173-179
        • Owens B.D.
        • Harrast J.J.
        • Hurwitz S.R.
        • Thompson T.L.
        • Wolf J.M.
        Surgical trends in Bankart repair: An analysis of data from the American Board of Orthopaedic Surgery certification examination.
        Am J Sports Med. 2011; 39: 1865-1869
        • Cole B.J.
        • L'Insalata J.
        • Irrgang J.
        • Warner J.J.
        Comparison of arthroscopic and open anterior shoulder stabilization: A two- to six-year follow-up study.
        J Bone Joint Surg Am. 2000; 92: 1108-1114
        • Kim S.H.
        • Ha K.I.
        • Kim S.H.
        Bankart repair in traumatic anterior shoulder instability: Open versus arthroscopic technique.
        Arthroscopy. 2002; 18: 755-763
        • Fabbriciani C.
        • Milano G.
        • Demontis A.
        • Fadda S.
        • Ziranu F.
        • Mulas P.D.
        Arthroscopic versus open treatment of Bankart lesion of the shoulder: A prospective randomized study.
        Arthroscopy. 2004; 20: 456-462
        • Bottoni C.R.
        • Smith E.L.
        • Berkowitz M.J.
        • Towle R.B.
        • Moore J.H.
        Arthroscopic versus open shoulder stabilization for recurrent anterior instability.
        Am J Sports Med. 2006; 34: 1731-1737
        • Barber F.A.
        • Snyder S.J.
        • Abrams J.S.
        • Fanelli G.C.
        • Savoie III, F.H.
        Arthroscopic Bankart reconstruction with a bioabsorbable anchor.
        J Shoulder Elbow Surg. 2003; 12: 535-538
        • Abrams J.S.
        • Savoie III, F.H.
        • Tauro J.C.
        • Bradley J.P.
        Recent advances in the evaluation and treatment of shoulder instability: Anterior, posterior, and multidirectional.
        Arthroscopy. 2002; 18: 1-13
        • Zaffagnini S.
        • Muccioli M.M.
        • Giordano G.
        • et al.
        Long-term outcomes after repair of recurrent post-traumatic anterior shoulder instability: Comparison of arthroscopic transglenoid suture and open Bankart reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 816-821
        • Harris J.D.
        • Gupta A.K.
        • Mall N.A.
        • et al.
        Long-term outcomes after Bankart shoulder stabilization.
        Arthroscopy. 2013; 29: 920-933
        • Karlsson J.
        • Magnusson L.
        • Ejerhed L.
        • Hultenheim I.
        • Lundin O.
        • Kartus J.
        Comparison of open and arthroscopic stabilization for recurrent shoulder dislocation in patients with a Bankart lesion.
        Am J Sports Med. 2001; 29: 538-542
        • Lazarus M.D.
        • Harryman II, D.T.
        Complications of open anterior stabilization of the shoulder.
        J Am Acad Orthop Surg. 2000; 8: 122-132
        • Postacchini F.
        • Gumina S.
        • Cinotti G.
        Anterior shoulder dislocation in adolescents.
        J Shoulder Elbow Surg. 2000; 9: 470-474
        • Porcellini G.
        • Campi F.
        • Pegreffi F.
        • Castagna A.
        • Paladini P.
        Predisposing factors for recurrent shoulder dislocation after arthroscopic treatment.
        J Bone Joint Surg Am. 2009; 91: 2537-2542
        • Boileau P.
        • Villalba M.
        • Héry J.Y.
        • Balg F.
        • Ahrens P.
        • Neyton L.
        Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair.
        J Bone Joint Surg Am. 2006; 88: 1755-1763
        • Katz J.N.
        • Barrett J.
        • Mahomed N.N.
        • Baron J.A.
        • Wright R.J.
        • Losina E.
        Association between hospital and surgeon procedure volume and the outcomes of total knee replacement.
        J Bone Joint Surg Am. 2004; 86: 1909-1916
        • Forte M.L.
        • Virnig B.A.
        • Swiontkowski M.F.
        • et al.
        Ninety-day mortality after intertrochanteric hip fracture: Does provider volume matter?.
        J Bone Joint Surg Am. 2010; 92: 799-806
        • Jain N.
        • Pietrobon R.
        • Hocker S.
        • Guller U.
        • Shankar A.
        • Higgins L.D.
        The relationship between surgeon and hospital volume and outcomes for shoulder arthroplasty.
        J Bone Joint Surg Am. 2004; 86: 496-505
        • Hammond J.W.
        • Queale W.S.
        • Kim T.K.
        • McFarland E.G.
        Surgeon experience and clinical and economic outcomes for shoulder arthroplasty.
        J Bone Joint Surg Am. 2003; 85: 2318-2324