Increased Failure Rates After Arthroscopic Bankart Repair After Second Dislocation Compared to Primary Dislocation With Comparable Clinical Outcomes

Published:December 07, 2022DOI:


      The purpose of this study was to compare rates of recurrent dislocation and postsurgical outcomes in patients undergoing arthroscopic Bankart repair for anterior shoulder instability immediately after a first-time traumatic anterior dislocation versus patients who sustained a second dislocation event after initial nonoperative management.


      A retrospective chart review was performed of patients undergoing primary arthroscopic stabilization for anterior shoulder instability without concomitant procedures and minimum 2-year clinical follow-up. Primary outcome was documentation of a recurrent shoulder dislocation. Secondary clinical outcomes included range of motion, Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons Shoulder Score (ASES), and Shoulder Activity Scale (SAS).


      Seventy-seven patients (mean age 21.3 years ± 7.3 years) met inclusion criteria. Sixty-three shoulders underwent surgical stabilization after a single shoulder dislocation, and 14 underwent surgery after 2 dislocations. Average follow-up was 35.9 months. The rate of recurrent dislocation was significantly higher in the 2-dislocation group compared to single dislocations (42.8% vs 14.2%, P = .03). No significant difference was present in range of motion, VAS, ASES, and SAS scores. The minimal clinically important difference (MCID) was 1.4 for VAS and 1.8 for SAS scores. The MCID was met or exceeded in the primary dislocation group in 31/38 (81.6%) patients for VAS, 23/31 (74.1%) for ASES, and 24/31 for SES (77.4%) scores. For the second dislocation cohort, MCID was met or exceeded in 7/9 (77.8%) for VAS, 4/7 (57.1%) for ASES, and 5/7 for SES (71.4%) scores.


      Immediate arthroscopic surgical stabilization after a first-time anterior shoulder dislocation significantly decreases the risk of recurrent dislocation in comparison to those who undergo surgery after 2 dislocation events, with comparable clinical outcome scores. These findings suggest that patients who return to activities after a primary anterior shoulder dislocation and sustain just 1 additional dislocation event are at increased risk of a failing arthroscopic repair.

      Study Design

      Retrospective comparative study; Level of evidence, 3.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Galvin J.W.
        • Ernat J.J.
        • Waterman B.R.
        • Stadecker M.J.
        • Parada S.A.
        The epidemiology and natural history of anterior shoulder instability.
        Curr Rev Musculoskelet Med. 2017; 10: 411-424
        • Zacchilli M.A.
        • Owens B.D.
        Epidemiology of shoulder dislocations presenting to emergency departments in the United States.
        J Bone Joint Surg Am. 2010; 92: 542-549
        • Hughes J.D.
        • Vaswani R.
        • Paras T.M.
        • Lin A.
        Treatment algorithm for recurrent anterior shoulder instability: Putting it all together.
        Oper Tech Orthop. 2021; 31100862
        • Su F.
        • Kowalczuk M.
        • Ikpe S.
        • Lee H.
        • Sabzevari S.
        • Lin A.
        Risk factors for failure of arthroscopic revision anterior shoulder stabilization.
        J Bone Joint Surg Am. 2018; 100: 1319-1325
        • Wasserstein D.N.
        • Sheth U.
        • Colbenson K.
        • et al.
        The true recurrence rate and factors predicting recurrent instability after nonsurgical management of traumatic primary anterior shoulder dislocation: A systematic review.
        Arthroscopy. 2016; 32: 2616-2625
        • Waterman B.R.
        • Burns T.C.
        • McCriskin B.
        • Kilcoyne K.
        • Cameron K.L.
        • Owens B.D.
        Outcomes after bankart repair in a military population: predictors for surgical revision and long-term disability.
        Arthroscopy. 2014; 30: 172-177
        • Hovelius L.
        • Olofsson A.
        • Sandström B.
        • et al.
        Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. a prospective twenty-five-year follow-up.
        J Bone Joint Surg Am. 2008; 90: 945-952
        • Rugg C.M.
        • Hettrich C.M.
        • Ortiz S.
        • Wolf B.R.
        • Zhang A.L.
        • MOON Shoulder Instability Group
        Surgical stabilization for first-time shoulder dislocators: a multicenter analysis.
        J Shoulder Elbow Surg. 2018; 27: 674-685
        • McNeil J.W.
        • Beaulieu-Jones B.R.
        • Bernhardson A.S.
        • et al.
        Classification and analysis of attritional glenoid bone loss in recurrent anterior shoulder instability.
        Am J Sports Med. 2017; 45: 767-774
        • Nakagawa S.
        • Iuchi R.
        • Hanai H.
        • Hirose T.
        • Mae T.
        The development process of bipolar bone defects from primary to recurrent instability in shoulders with traumatic anterior instability.
        Am J Sports Med. 2019; 47: 695-703
        • Urayama M.
        • Itoi E.
        • Sashi R.
        • Minagawa H.
        • Sato K.
        Capsular elongation in shoulders with recurrent anterior dislocation: Quantitative assessment with magnetic resonance arthrography.
        Am J Sports Med. 2003; 31: 64-67
        • Rashid M.S.
        • Arner J.W.
        • Millett P.J.
        • Sugaya H.
        • Emery R.
        The Bankart repair: past, present, and future.
        J Shoulder Elbow Surg. 2020; 29: e491-e498
        • Dickens J.F.
        • Rue J.P.
        • Cameron K.L.
        • et al.
        Successful return to sport after arthroscopic shoulder stabilization versus nonoperative management in contact athletes with anterior shoulder instability: A prospective multicenter study.
        Am J Sports Med. 2017; 45: 2540-2546
        • Hurley E.T.
        • Matache B.A.
        • Wong I.
        • et al.
        Anterior shoulder instability Part I—Diagnosis, nonoperative management, and Bankart repair—An international consensus statement.
        Arthroscopy. 2022; 38: 214-223
        • Flinkkilä T.
        • Knape R.
        • Sirniö K.
        • Ohtonen P.
        • Leppilahti J.
        Long-term results of arthroscopic Bankart repair: Minimum 10 years of follow-up.
        Knee Surg Sports Traumatol Arthrosc. 2018; 26: 94-99
        • Hurley E.T.
        • Manjunath A.K.
        • Bloom D.A.
        • et al.
        Arthroscopic bankart repair versus conservative management for first-time traumatic anterior shoulder instability: A systematic review and meta-analysis.
        Arthroscopy. 2020; 36: 2526-2532
        • Marshall T.
        • Vega J.
        • Siqueira M.
        • Cagle R.
        • Gelber J.D.
        • Saluan P.
        Outcomes after arthroscopic bankart repair: Patients with first-time versus recurrent dislocations.
        Am J Sports Med. 2017; 45: 1776-1782
        • Vaswani R.
        • Gasbarro G.
        • Como C.
        • et al.
        Labral morphology and number of preoperative dislocations are associated with recurrent instability after arthroscopic Bankart repair.
        Arthroscopy. 2020; 36: 993-999
        • Grumet R.C.
        • Bach B.R.
        • Provencher M.T.
        Arthroscopic stabilization for first-time versus recurrent shoulder instability.
        Arthroscopy. 2010; 26: 239-248
        • Bernard C.D.
        • Leland D.P.
        • Keyt L.K.
        • et al.
        Although surgical techniques differ, similar outcomes can be obtained when operating after single versus multiple anterior shoulder dislocations.
        Arthrosc Sport Med Rehabil. 2021; 3: e163-e170
        • Barlow J.D.
        • Grosel T.
        • Higgins J.
        • Everhart J.S.
        • Magnussen R.A.
        Surgical treatment outcomes after primary vs recurrent anterior shoulder instability.
        J Clin Orthop Trauma. 2019; 10: 222-230
        • Lee R.K.L.
        • Griffith J.F.
        • Tong M.M.P.
        • Sharma N.
        • Yung P.
        Glenoid bone loss: Assessment with MR imaging.
        Radiology. 2013; 267: 496-502
        • Li R.T.
        • Kane G.
        • Drummond M.
        • et al.
        On-track lesions with a small distance to dislocation are associated with failure after arthroscopic anterior shoulder stabilization.
        J Bone Joint Surg Am. 2021; 103: 961-967
      1. Belk JW, Wharton BR, Houck DA, et al. Shoulder stabilization versus immobilization for first-time anterior shoulder dislocation: A systematic review and meta-analysis of level 1 randomized controlled trials [published online February 11, 2022]. Am J Sports Med. doi:10.1177/03635465211065403

        • Park I.
        • Oh M.J.
        • Shin S.J.
        Minimal clinically important differences and correlating factors for the Rowe Score and the American Shoulder and Elbow Surgeons Score after arthroscopic stabilization surgery for anterior shoulder instability.
        Arthroscopy. 2019; 35: 54-59
        • Harris J.D.
        • Brand J.C.
        • Cote M.P.
        • Faucett S.C.
        • Dhawan A.
        Research pearls: The significance of statistics and perils of pooling. Part 1: Clinical versus statistical significance.
        Arthroscopy. 2017; 33: 1102-1112
        • Yapp L.Z.
        • Nicholson J.A.
        • Robinson C.M.
        Primary arthroscopic stabilization for a first-time anterior dislocation of the shoulder: Long-term follow-up of a randomized, double-blinded trial.
        J Bone Joint Surg Am. 2020; 102: 460-467
        • Robinson C.M.
        • Jenkins P.J.
        • White T.O.
        • Ker A.
        • Will E.
        Primary arthroscopic stabilization for a first-time anterior dislocation of the shoulder. A randomized, double-blind trial.
        J Bone Joint Surg Am. 2008; 90: 708-721
        • Jakobsen B.W.
        • Johannsen H.V.
        • Suder P.
        • Søjbjerg J.O.
        Primary repair versus conservative treatment of first-time traumatic anterior dislocation of the shoulder: A randomized study with 10-year follow-up.
        Arthroscopy. 2007; 23: 118-123
        • Buss D.D.
        • Lynch G.P.
        • Meyer C.P.
        • Huber S.M.
        • Freehill M.Q.
        Nonoperative management for in-season athletes with anterior shoulder instability.
        Am J Sports Med. 2004; 32: 1430-1433
        • Dickens J.F.
        • Slaven S.E.
        • Cameron K.L.
        • et al.
        Prospective evaluation of glenoid bone loss after first-time and recurrent anterior glenohumeral instability events.
        Am J Sports Med. 2019; 47: 1082-1089
        • Yoshida M.
        • Takenaga T.
        • Chan C.K.
        • Musahl V.
        • Lin A.
        • Debski R.E.
        Altered shoulder kinematics using a new model for multiple dislocations-induced Bankart lesions.
        Clin Biomech. 2019; 70: 131-136
        • Yoshida M.
        • Takenaga T.
        • Chan C.K.
        • Musahl V.
        • Debski R.E.
        • Lin A.
        Location and magnitude of capsular injuries varies following multiple anterior dislocations of the shoulder: Implications for surgical repair.
        J Orthop Res. 2021; 39: 648-656
        • Lemme N.J.
        • Kuczmarski A.S.
        • Goodman A.D.
        • Ready L.V.
        • Dickens J.F.
        • Owens B.D.
        Management and outcomes of in-season anterior shoulder instability in athletes.
        JBJS Rev. 2019; 7: e2
        • Duchman K.R.
        • Hettrich C.M.
        • Glass N.A.
        • et al.
        The incidence of glenohumeral bone and cartilage lesions at the time of anterior shoulder stabilization surgery: A comparison of patients undergoing primary and revision surgery.
        Am J Sports Med. 2018; 46: 2449-2456
        • Tokish J.M.
        • Kuhn J.E.
        • Ayers G.D.
        • et al.
        Decision making in treatment after a first-time anterior glenohumeral dislocation: A Delphi approach by the Neer Circle of the American Shoulder and Elbow Surgeons.
        J Shoulder Elbow Surg. 2020; 29: 2429-2445