Arthroscopic Bankart Repair Versus Immobilization for First Episode of Anterior Shoulder Dislocation Before the Age of 25: A Randomized Controlled Trial

Abstract

Background: The risk of recurrence after the first episode of anterior shoulder dislocation is high with nonoperative treatment in younger patients. Purpose/Hypothesis: The aim of this study was to compare the results of arthroscopic Bankart repair and nonoperative treatment for shoulder dislocation in patients younger than 25 years, with a minimum of 2 years of follow-up. The hypothesis was that surgery would decrease the risk of recurrence. Study design: Randomized controlled trial; Level of evidence, 1. Methods: We included patients aged between 18 and 25 years after a first episode of anterior shoulder dislocation and divided them into 2 groups. The first group was treated surgically with an arthroscopic Bankart repair within 2 weeks after the dislocation; the second group was treated nonoperatively. Both groups were immobilized for 3 weeks in internal rotation and followed the same physical therapy protocol. Standard radiography and computed tomography were performed immediately after reduction of the dislocation, and follow-up was performed at 3, 6, 12, and 24 months. The primary outcome measure was instability recurrence, defined as another anterior shoulder dislocation requiring closed reduction by another person (the patient was unable to reduce the dislocated joint themselves), a subluxation, or a positive apprehension test. Secondary outcome measures included range of motion, return to sport, and functional scores such as the short version of the Disabilities of the Arm, Shoulder and Hand score the Walch-Duplay score, and the Western Ontario Shoulder Instability Index (WOSI). Results: A total of 20 patients were included in each group. The mean ± SD age was 21 ± 1.8 years, and there were 33 men (82.5%) and 7 women (17.5%) in the total sample. Recurrence of instability was significantly decreased in the surgical treatment group compared with the nonoperative group (2 [10%] vs 14 [70%], respectively; P = .0001). Fewer patients in the surgical treatment group versus the nonoperative group had another episode of dislocation (0 vs 6 [30%], respectively), subluxation (2 [10%] vs 13 [65%], respectively; P = .003), or a positive apprehension test (1 [5%] vs 11 [58%], respectively; P = .0005). The Walch-Duplay score (88.4 vs 70.3 points; P = .046) and WOSI (11.5 vs 17.7 points; P = .035) were significantly better in the surgical group versus the nonoperative group after a 2-year follow-up. Level of sport was the same or better in 89% of the surgical treatment group vs 53% of the nonoperative treatment group ( P = .012). No surgical complication was recorded. We did not find any significant difference in range of motion. Conclusion: In patients with first-time shoulder dislocations, arthroscopic labral repair (Bankart procedure) reduced the risk of secondary shoulder dislocation and improved functional outcome versus nonoperative treatment after a 2-year follow-up. Surgical treatment after a first episode of shoulder dislocation could be offered as a primary treatment option in a younger population if these results are confirmed by larger studies with a longer follow-up. Registration: NCT03315819 (ClinicalTrials.gov identifier)

Outcomes of Arthroscopic Anterior Labroligamentous Periosteal Sleeve Avulsion Lesions: A Minimum 2-Year Follow-up

“…13,17 Clearer data continue to be published showing the increased bony and soft tissue injuries that occur with recurrent dislocations as well as the improved outcomes with surgical treatment in patients with first-time dislocations. 14,19 The current study adds to that growing body of literature. We therefore recommend serious consideration of surgical treatment in those at risk for recurrent shoulder dislocations with the hope of avoiding ALPSA lesions, which continue to portend a higher probability of postoperative redislocations.…”

A 2-Year Follow-up May Not be Enough to Accurately Evaluate Recurrences After Arthroscopic Bankart Repair: A Long-term Assessment of 272 Patients With a Mean Follow-up of 10.5 Years

“…17,18,23,31 Recently, 2 randomized controlled trials published in 2021 reported 2% and 10% recurrence rates after arthroscopic Bankart repair at 24 months of follow-up. 17,23 Moreover, a recent systematic review reported a 6.5% recurrence rate after 3 years of follow-up with arthroscopic Bankart repair. 2 However, other authors have reported very high percentages of recurrences with a longer follow-up that vary between 18% and 37%.…”

“…10,11 Although the risk factors for a recurrence after Bankart repair have been intensively investigated in recent years, there is very little information on the evolution of this complication over time. There is a great discrepancy between the rates of recurrences reported in different studies in relation to the follow-up time, which varies between 2% and 10% 17,23 in short-term studies and from 18% to 41% in studies with a long-term followup. 1,5,12,20,31 This may be a determining factor when choosing the most appropriate treatment, as the majority of patients who undergo surgery for recurrent glenohumeral instability are healthy young athletes who are looking for not only an effective solution for their shoulder but also a long-lasting one.…”

Arthroscopic Repair Versus Conservative Treatment for First-time Anterior Shoulder Dislocation

“…A total of 1,784 literature articles were left for further evaluation after the removal of duplicates. 1,759 literatures were screened out through title and abstract evaluation, and 7 studies were finally included according to the inclusion criteria [11][12][13][14][15][16][17] (▶ Fig. 1).…”