Long-term Results of the Arthroscopic Bankart Repair for Recurrent Anterior Shoulder Instability in Patients Older Than 40 Years: A Comparison With the Open Latarjet Procedure

Abstract

Background: Long-term results of the arthroscopic Bankart repair in patients older than 40 years are unknown and may be favorable in terms of postoperative glenohumeral arthritis as opposed to the long-term results of the open Latarjet procedure in patients older than 40 years. Purpose: To analyze our long-term results of the arthroscopic Bankart repair for recurrent anterior shoulder instability in patients older than 40 years of age and to compare these results with previously published long-term results of the Latarjet procedure in a cohort of similar age. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 35 consecutive patients (36 shoulders) with a mean age of 47 years (range, 40-69) at time of the arthroscopic Bankart repair were studied at a mean 13.2 years (range, 8-18) after surgery. Clinical and radiographic results were then compared with those of our previous study of 39 consecutive patients (40 shoulders) of a same age group who had been treated for the same pathology with an open Latarjet procedure. Results: Six shoulders (17%) sustained a recurrent shoulder dislocation after a mean 5.3 years; subluxation occurred in 3 shoulders (8%); and apprehension persisted in 3 shoulders (8%). Revision surgery was performed in 8 patients (22%): 2 Bankart and 6 open Latarjet. The relative preoperative Constant score and Subjective Shoulder Value were significantly improved ( P < .001) at final follow-up. Arthropathy of stabilization was advanced in the shoulders of 16 patients (47%) and had progressed by at least 2 grades in 21 patients (62%). There were significantly higher rates of redislocation and subluxation when compared with the open Latarjet procedure (9 vs 3; P = .037), and the mean final Subjective Shoulder Value was significantly lower in the Bankart group (86% vs 91%; P = .011). There were no significant differences in final advanced arthropathy (16 vs 14; P = .334) and revision rates (8 vs 7; P = .409) when compared with the Latarjet procedure. Conclusion: Arthroscopic Bankart repair for recurrent anterior shoulder instability in patients older than 40 years was associated with reliable pain relief and patient satisfaction similar to that after the open Latarjet procedure. Restoration of stability was significantly less successful and development of arthropathy no better than the open Latarjet procedure in patients older than 40 years.

High Variability of the Definition of Recurrent Glenohumeral Instability: An Analysis of the Current Literature by a Systematic Review

“…On the Coleman methodology score, one scored poor, 11 43 studies scored fair, 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 37 scored good, 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 ...…”

“… 67 100 83 + + Retrospective + + 1,2,3 1,2,3,4 1 77 Ernstbrunner et al. 26 36 158 +/− + Retrospective + + 1,2,3 1,2,3,4 1 68 Gül et al. 27 62 29 + + Retrospective + + 1,2,3 1,3,4 1 67 Loppini et al.…”

“… 67 100 DSA 14 (14) Ernstbrunner et al. 26 36 Any redislocation requiring reduction by a third party or medical professional 6 (17) 3 (8) 3 (8) 6 (17) Gül et al. 27 62 Dislocation 5 (8) 8 (13) 5 (8) Loppini et al.…”

“…Definition of dislocation Dislocation needing reduction (by medical professional or third party) 12,16,19,26,31,33,34,37,57,58,68,70,[72][73][74]87,91,102 Objective documentation of a dislocation either radiologically or clinically 24,32,59,62,71,75,92 Increased translation of the humerus relative to the glenoid to the point of complete separation of articular surfaces 96 More than 1 episode of instability which needed manual reduction by other people 97…”

“…Instability without the need of reduction 12,13,16,26,31,33,34,45,57,58,68,70,72,87,91,97,102 Subjective sense of subluxation/instability 24,37,44,60,69,71,99 Sense of dislocation with a positive anterior apprehension test 59 Transient instability event that did not require reduction but demonstrated a positive apprehension and relocation sign with radiographic or magnetic resonance imaging evidence of a Bankart or Hill-Sachs 19 Symptomatic self-reported subluxation 62 "Dead-arm" phenomenon or instability which spontaneously reduced 73,75 Symptomatic translation of the humeral head relative to the glenoid articular surface without a dislocation 96 Subluxation at the time of the clinical assessment or through a history of at least 1 episode of dead arm syndrome 84 with signs of a sustained dislocation in further radiographs, such as Hill-Sachs or bony Bankart lesion in comparison with the preoperative situation, could be categorized as a confirmed dislocation. For subluxations, we advise using the definition of the feeling of a dislocation that can be (spontaneously) reduced without the need for a radiographically confirmed dislocation.…”