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Recurrent Instability After Arthroscopic Bankart Reconstruction: A Systematic Review of Surgical Technical Factors

      Purpose

      Recurrent instability remains of concern after arthroscopic Bankart reconstruction. We evaluated various technical factors including anchor design, anchor material, number of anchors used, and interval closure on risk of recurrent instability after arthroscopic Bankart reconstruction.

      Methods

      A systematic review of MEDLINE and Cochrane databases was conducted, following PRISMA guidelines. Extracted data were recorded on a standardized form. Methodological index for non-randomized studies (MINORS) and Newcastle-Ottawa Scale (NOS) were used to assess study quality and risk bias. Because of study heterogeneity and low levels of evidence, meta-analysis was not possible. Pooled weighted means were calculated and individual study evaluation and comparisons (qualitative analysis) were performed for systematic review.

      Results

      Of 2097 studies identified, 26 met criteria for systematic review. Pooled weighted means revealed 11.4% versus 15% recurrent instability with 3 or more suture anchors versus fewer than 3 anchors, 10.1% versus 7.8% with absorbable versus nonabsorbable suture anchors, respectively, and 8.0% versus 9.4% with knotless versus standard anchors, respectively. Interval closure did not qualitatively decrease recurrent instability or decrease range of motion.

      Conclusions

      Our systematic review reveals that despite individual study, and previous systematic reviews pointing to the contrary, the composite contemporary published literature would support no difference in the risk of recurrent instability after arthroscopic Bankart reconstruction with rotator interval closure, differing numbers of anchors used for the repair, use of knotless versus standard anchors, or use of bioabsorbable versus nonabsorbable anchors. We recommend surgeons focus on factors that have been shown to modify the risk factors after arthroscopic Bankart reconstruction, such as patient selection.

      Level of Evidence

      Level IV, systematic review of Level III and IV studies.
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      References

        • 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
        • Mohtadi N.G.
        • Chan D.S.
        • Hollinshead R.M.
        • et al.
        A randomized clinical trial comparing open and arthroscopic stabilization for recurrent traumatic anterior shoulder instability: Two-year follow-up with disease-specific quality-of-life outcomes.
        J Bone Joint Surg Am. 2014; 96: 353-360
        • Van Tongel A.
        • Rosa F.
        • Heffernan G.
        • Levy O.
        • Sforza G.
        Long-term result after traumatic anterior shoulder dislocation: What works best?.
        Musculoskelet Surg. 2011; 95: S65-S70
        • Petrera M.
        • Patella V.
        • Patella S.
        • Theodoropoulos J.
        A meta-analysis of open versus arthroscopic Bankart repair using suture anchors.
        Knee Surg Sports Traumatol Arthrosc. 2010; 18: 1742-1747
        • Randelli P.
        • Ragone V.
        • Carminati S.
        • Cabitza P.
        Risk factors for recurrence after Bankart repair: A systematic review.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 2129-2138
        • Pope E.J.
        • Ward J.P.
        • Rokito A.S.
        Anterior shoulder instability—A history of arthroscopic treatment.
        Bull NYU Hosp Jt Dis. 2011; 69: 44-49
        • Bottoni L.C.R.
        • Smith M.E.L.
        • Berkowitz M.M.J.
        • Towle C.R.B.
        • Moore C.J.H.
        Arthroscopic versus open shoulder stabilization for recurrent anterior instability: A prospective randomized clinical trial.
        Am J Sports Med. 2006; 34: 1730-1737
        • Godin J.
        • Sekiya J.K.
        Systematic review of arthroscopic versus open repair for recurrent anterior shoulder dislocations.
        Sports Health. 2011; 3: 396-404
        • Harris J.D.
        • Gupta A.K.
        • Mall N.A.
        • et al.
        Long-term outcomes after Bankart shoulder stabilization.
        Arthrosc J Arthrosc Relat Surg. 2013; 29: 920-933
        • Hobby J.
        • Griffin D.
        • Dunbar M.
        • Boileau P.
        Is arthroscopic surgery for stabilisation of chronic shoulder instability as effective as open surgery? A systematic review and meta-analysis of 62 studies including 3044 arthroscopic operations.
        J Bone Joint Surg Br. 2007; 89: 1188-1196
        • Chalmers P.N.
        • Mascarenhas R.
        • Leroux T.
        • et al.
        Do arthroscopic and open stabilization techniques restore equivalent stability to the shoulder in the setting of anterior glenohumeral instability? A systematic review of overlapping meta-analyses.
        Arthrosc J Arthrosc Relat Surg. 2015; 31: 355-363
        • Balg F.
        • Boileau P.
        The Instability Severity Index score: A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation.
        J Bone Joint Surg Br. 2007; 89: 1470-1477
        • Flinkkilä T.
        • Hyvönen P.
        • Ohtonen P.
        • Leppilahti J.
        Arthroscopic Bankart repair: Results and risk factors of recurrence of instability.
        Knee Surg Sports Traumatol Arthrosc. 2010; 18: 1752-1758
        • Mauro C.S.
        • Voos J.E.
        • Hammoud S.
        • Altchek D.W.
        Failed anterior shoulder stabilization.
        J Shoulder Elbow Surg. 2011; 20: 1340-1350
        • Shibata H.
        • Gotoh M.
        • Mitsui Y.
        • et al.
        Risk factors for shoulder re-dislocation after arthroscopic Bankart repair.
        J Orthop Surg Res. 2014; 9: 53
        • van der Linde J.A.
        • van Kampen D.A.
        • Terwee C.B.
        • Dijksman L.M.
        • KleinJan G.
        • Willems W.J.
        Long-term results after arthroscopic shoulder stabilization using suture anchors.
        Am J Sports Med. 2011; 39: 2396-2403
        • Witney-Lagen C.
        • Perera N.
        • Rubin S.
        • Venkateswaran B.
        Fewer anchors achieves successful arthroscopic shoulder stabilization surgery: 114 patients with 4 years of follow-up.
        J Shoulder Elbow Surg. 2014; 23: 382-387
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • PRISMA Group
        Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.
        J Clin Epidemiol. 2009; 62: 1006-1012
        • Harris J.D.
        • Quatman C.E.
        • Manring M.M.
        • Siston R.A.
        • Flanigan D.C.
        How to write a systematic review.
        Am J Sports Med. 2014; 42: 2761-2768
        • Wright J.G.
        • Swiontkowski M.F.
        • Heckman J.D.
        Introducing levels of evidence to the journal.
        J Bone Joint Surg Am. 2003; 85: 1-3
        • Slim K.
        • Nini E.
        • Forestier D.
        • Kwiatkowski F.
        • Panis Y.
        • Chipponi J.
        Methodological index for non-randomized studies (MINORS): Development and validation of a new instrument.
        ANZ J Surg. 2003; 73: 712-716
        • Wells G.
        • Shea B.
        • O'Connell D.
        • et al.
        The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.
        • Chechik O.
        • Maman E.
        • Dolkart O.
        • Khashan M.
        • Shabtai L.
        • Mozes G.
        Arthroscopic rotator interval closure in shoulder instability repair: A retrospective study.
        J Shoulder Elbow Surg. 2010; 19: 1056-1062
        • Chiang E.R.
        • Wang J.P.
        • Wang S.T.
        • et al.
        Arthroscopic posteroinferior capsular plication and rotator interval closure after Bankart repair in patients with traumatic anterior glenohumeral instability—A minimum follow-up of 5 years.
        Injury. 2010; 41: 1075-1078
        • Barber F.A.
        • Snyder S.J.
        • Abrams J.S.
        • Fanelli G.C.
        • Savoie F.H.
        Arthroscopic Bankart reconstruction with a bioabsorbable anchor.
        J Shoulder Elbow Surg. 2003; 12: 535-538
        • Castagna A.
        • Borroni M.
        • Delle Rose G.
        • et al.
        Effects of posterior-inferior capsular plications in range of motion in arthroscopic anterior Bankart repair: A prospective randomized clinical study.
        Knee Surg Sports Traumatol Arthrosc. 2009; 17: 188-194
        • Cho N.S.
        • Lubis A.M.T.
        • Ha J.H.
        • Rhee Y.G.
        Clinical results of arthroscopic Bankart repair with knot-tying and knotless suture anchors.
        Arthroscopy. 2006; 22: 1276-1282
        • Ee G.W.
        • Mohamed S.
        • Tan A.H.
        Long term results of arthroscopic Bankart repair for traumatic anterior shoulder instability.
        J Orthop Surg Res. 2011; 6: 28
        • Hayashida K.
        • Yoneda M.
        • Mizuno N.
        • Fukushima S.
        • Nakagawa S.
        Arthroscopic Bankart repair with knotless suture anchor for traumatic anterior shoulder instability: Results of short-term follow-up.
        Arthroscopy. 2006; 22: 620-626
        • Kim K.C.
        • Shin H.D.
        • Cha S.M.
        • Kim J.H.
        Arthroscopic double-loaded single-row repair in chronic traumatic anterior shoulder dislocation.
        Arch Orthop Trauma Surg. 2012; 132: 1515-1520
        • Kocaoglu B.
        • Guven O.
        • Nalbantoglu U.
        • Aydin N.
        • Haklar U.
        No difference between knotless sutures and suture anchors in arthroscopic repair of Bankart lesions in collision athletes.
        Knee Surg Sports Traumatol Arthrosc. 2009; 17: 844-849
        • Sedeek S.M.
        • Tey I.K.
        • Tan A.H.C.
        Arthroscopic Bankart repair for traumatic anterior shoulder instability with the use of suture anchors.
        Singapore Med J. 2008; 49: 676-681
        • Tan C.K.
        • Guisasola I.
        • Machani B.
        • et al.
        Arthroscopic stabilization of the shoulder: A prospective randomized study of absorbable versus nonabsorbable suture anchors.
        Arthroscopy. 2006; 22: 716-720
        • Carreira D.S.
        • Mazzocca A.D.
        • Oryhon J.
        • Brown F.M.
        • Hayden J.K.
        • Romeo A.A.
        A Prospective outcome evaluation of arthroscopic Bankart repairs: Minimum 2-year follow-up.
        J Sports Med. 2006; 35: 771-777
        • Cooke S.J.
        • Starks I.
        • Kathuria V.
        The results of arthroscopic anterior stabilisation of the shoulder using the BioKnotless anchor system.
        J Sports Med Arthrosc Rehabil Ther Technol. 2009; 1: 1-7
        • Kandziora F.
        • Jäger A.
        • Bischof F.
        • et al.
        Arthroscopic labrum refixation for post-traumatic anterior shoulder instability: Suture anchor versus transglenoid fixation technique.
        Arthroscopy. 2000; 16: 359-366
        • Kim S.-H.
        • Ha K.-I.
        • Cho Y.-B.
        • Ryu B.-D.
        • Oh I.
        Arthroscopic anterior stabilization of the shoulder: Two to six-year follow-up.
        J Bone Joint Surg Am. 2003; 85: 1511-1518
        • Milano G.
        • Grasso A.
        • Santagada D.A.
        • Saccomanno M.F.
        • Deriu L.
        • Fabbriciani C.
        Comparison between metal and biodegradable suture anchors in the arthroscopic treatment of traumatic anterior shoulder instability: A prospective randomized study.
        Knee Surg Sports Traumatol Arthrosc. 2010; 18: 1785-1791
        • Monteiro G.C.
        • Ejnisman B.
        • Andreoli C.V.
        • Pochini A.C.
        • Cohen M.
        Absorbable versus nonabsorbable sutures for the arthroscopic treatment of anterior shoulder instability in athletes: A prospective randomized study.
        Arthroscopy. 2008; 24: 697-703
        • Thal R.
        • Nofziger M.
        • Bridges M.
        • Kim J.J.
        Arthroscopic Bankart repair using knotless or bioknotless suture anchors: 2- to 7-year results.
        Arthroscopy. 2007; 23: 367-375
        • Szyluk K.C.
        • Jasiński A.C.
        • Widuchowski W.C.
        • Mielnik M.C.
        • Koczy B.
        • Szyluk K.J.
        Results of arthroscopic Bankart lesion repair in patients with post-traumatic anterior instability of the shoulder and a non-engaging Hill-Sachs lesion with a suture anchor after a minimum of 6-year follow-up.
        J Med Sci Monit. 2015; 21: 2331-2338
        • Ng D.Z.
        • Kumar V.P.
        Arthroscopic Bankart repair using knot-tying versus knotless suture anchors: Is there a difference?.
        Arthroscopy. 2014; 30: 422-427
        • Alentorn-Geli E.
        • Álvarez-Díaz P.
        • Doblas J.
        • et al.
        Return to sports after arthroscopic capsulolabral repair using knotless suture anchors for anterior shoulder instability in soccer players: Minimum 5-year follow-up study.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 440-446
        • Cooke S.J.
        • Starks I.
        • Kathuria V.
        The results of arthroscopic anterior stabilisation of the shoulder using the BioKnotless anchor system.
        BMC Sports Sci Med Rehabil. 2009; 1: 2
        • Field L.D.
        • Warren R.F.
        • O'Brien S.J.
        • Altchek D.W.
        • Wickiewicz T.L.
        Isolated closure of rotator interval defects for shoulder instability.
        Am J Sports Med. 1995; 23: 557-563
        • Karas S.G.
        Arthroscopic rotator interval repair and anterior portal closure: An alternative technique.
        Arthroscopy. 2002; 18: 436-439
        • Sodl J.F.
        • McGarry M.H.
        • Campbell S.T.
        • Tibone J.E.
        • Lee T.Q.
        Biomechanical effects of anterior capsular plication and rotator interval closure in simulated anterior shoulder instability.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 365-373
        • Bigliani L.U.
        • Pollock R.G.
        • Soslowsky L.J.
        • Flatow E.L.
        • Pawluk R.J.
        • Mow V.C.
        Tensile properties of the inferior glenohumeral ligament.
        J Orthop Res. 1992; 10: 187-197
        • Lee H.J.
        • Kim N.R.
        • Moon S.G.
        • Ko S.M.
        • Park J.-Y.
        Multidirectional instability of the shoulder: Rotator interval dimension and capsular laxity evaluation using MR arthrography.
        Skeletal Radiol. 2013; 42: 231-238
        • Goble E.M.
        • Somers W.K.
        • Clark R.
        • Olsen R.E.
        The development of suture anchors for use in soft tissue fixation to bone.
        Am J Sports Med. 1994; 22: 236-239
        • Stein T.
        • Mehling A.P.
        • Reck C.
        • et al.
        MRI assessment of the structural labrum integrity after Bankart repair using knotless bio-anchors.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1771-1779
        • Athwal G.S.
        • Shridharani S.M.
        • O'Driscoll S.W.
        Osteolysis and arthropathy of the shoulder after use of bioabsorbable knotless suture anchors: A report of four cases.
        J Bone Joint Surg Am. 2006; 88: 1840-1845
        • Elmlund A.O.
        • Kartus J.
        • Rostgård-Christensen L.
        • Sernert N.
        • Magnusson L.
        • Ejerhed L.
        A 7-year prospective, randomized, clinical, and radiographic study after arthroscopic Bankart reconstruction using 2 different types of absorbable tack.
        Am J Sports Med. 2009; 37: 1930-1937
        • Freedman K.B.
        • Smith A.P.
        • Romeo A.A.
        • Cole B.J.
        • Bach B.R.
        Open Bankart repair versus arthroscopic repair with transglenoid sutures or bioabsorbable tacks for recurrent anterior instability of the shoulder: A meta-analysis.
        Am J Sports Med. 2004; 32: 1520-1527
        • Barber F.A.
        • Coons D.A.
        • Ruiz-Suarez M.
        Cyclic load testing and ultimate failure strength of biodegradable glenoid anchors.
        Arthroscopy. 2008; 24: 224-228
        • Freehill M.Q.
        • Harms D.J.
        • Huber S.M.
        • Atlihan D.
        • Buss D.D.
        Poly-l-lactic acid tack synovitis after arthroscopic stabilization of the shoulder.
        Am J Sports Med. 2003; 31: 643-647
        • Antonogiannakis E.
        • Yiannakopoulos C.K.
        • Karliaftis K.
        • Karabalis C.
        Late disengagement of a knotless anchor.
        Arthroscopy. 2002; 18: E40
        • Zumstein M.
        • Jacob H.A.C.
        • Schneeberger A.G.
        In vitro comparison of standard and knotless metal suture anchors.
        Arthroscopy. 2004; 20: 517-520