Purpose
The purpose of this study was to demonstrate that arthroscopic Bankart repair with
associated arthroscopic subscapularis augmentation (ASA) could be a valid surgical
option in the treatment of anterior shoulder instability, in collision and contact
sports athletes, affected by shoulder hyperlaxity.
Methods
In total, 591 arthroscopic Bankart repairs plus ASA were performed in 6 shoulder centers
from 2009 to 2017. Inclusion criteria were the following: collision and contact sports
activities, recurrent anterior instability associated with hyperlaxity and glenoid
bone loss (GBL) < 15%. Exclusion criteria were GBL > 15%, voluntary instability, multidirectional
instability, pre-existing osteoarthritis and throwing athletes. The minimum follow-up
was 24 months. Hyperlaxity was clinically evaluated according to Neer and Coudane-Walch
tests. Before surgery, all patients underwent magnetic resonance imaging and computed
tomography scanning. Pico area method was used to assess the percentage of GBL. Patients
were operated on by 6 surgeons, and their functional outcomes were evaluated by 2
independent observers. The Western Ontario Shoulder Instability Index (WOSI), Rowe,
American Shoulder and Elbow Surgeons (ASES) scores were used to assess results.
Results
Overall, 397 patients with evidence of shoulder hyperlaxity (positive sulcus sign
in ER1 position and Coudane-Walch test > 85°) met all inclusion criteria. The mean
WOSI score was 321; the mean Rowe score rose from 68.5 to 92.5 (P = .037), and the ASES score rose from 71.5 to 97.4 (P = .041). Seven patients (1.6%) had atraumatic redislocation, and 9 patients (2.2%)
had post-traumatic redislocation. At final follow-up the mean functional deficit of
external rotation was 15° with the arm in adduction (ER1 position) and 10° in abduction
(ER2 position).
Conclusions
The Bankart repair plus ASA has been demonstrated to be safe and effective for restoring
joint stability in patients practicing collision and contact sports or affected by
chronic anterior shoulder instability associated with GBL (<15%) and hyperlaxity,
without compromising external rotation.
Level of Evidence
Level IV, case series.
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Article info
Publication history
Published online: February 10, 2021
Accepted:
January 27,
2021
Received:
June 20,
2020
Footnotes
The authors report the following potential conflicts of interest or sources of funding: M.M is a Consultant for Arthrex. R.R is a Consultant for Arthrex. C.R. is a Consultant for Arthrex and Smith and Nephew. S.F.H. is an unpaid consultant for Biomet, CONMED, Exatech, Depuy, Mitek, Rotation Medical and Smith and Nephew. Full ICMJE author disclosure forms are available for this article online, as supplementary material
See commentary on page 2063
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