Open Bankart repair plus inferior capsular shift versus isolated arthroscopic Bankart repair in collision athletes with recurrent anterior shoulder instability: a prospective study.

Abstract

Background: Open Bankart repair plus inferior capsular shift and isolated arthroscopic Bankart repair have never been prospectively compared under the concept of glenoid track in collision athletes with recurrent anterior shoulder instability. The aim of this study was to compare the functional outcomes, range of motion, and recurrence rate between these 2 surgical techniques. We hypothesized that open Bankart repair plus inferior capsular shift would provide similar functional outcomes to isolated arthroscopic Bankart repair but with a lower recurrence rate.

Methods: A prospective cohort study was conducted with 86 collision athletes divided into 2 groups of 43 patients each. All patients had a subcritical glenoid bone loss ≤13.5% and an on-track Hill Sachs lesion. The average follow-up was 66 (60-93) months for the open group and 68 (60-97) months for the arthroscopic group. The primary functional outcomes of each group were evaluated at baseline, 6 months, 1 year and for a minimum of 5 years after surgery. The functional outcomes were also compared between the 2 groups. The assessment tools included the Western Ontario Shoulder Instability Index (WOSI) score and American Shoulder and Elbow Surgeons scale (ASES) score. In addition, recurrent instability and range of motion were also evaluated.

Results: In each group, there were significant differences in Western Ontario Shoulder Instability Index score and American Shoulder and Elbow Surgeons scale score between the pre and postoperative periods. There were no differences between the groups at the end of follow-up (P = .47 and .22). Three dislocations (6.9%) in the open group and 10 dislocations (23.2%) in the arthroscopic group were reported showing significant differences (P = .012). In addition, there were no differences in range of motion between pre and postoperative periods for each group as well as between them.

Conclusion: We found no differences in functional outcomes and range of motion between the 2 groups. The recurrence rate was significantly higher in the arthroscopic group. We recommend performing open Bankart repair plus inferior capsular shift as a treatment alternative in collision athletes with recurrent anterior shoulder instability.