Neer Modification of Open Bankart Procedure: What are the Rates of Recurrent Instability, Functional Outcome, and Arthritis?

Abstract

Background Neer modified the Bankart procedure by combining a superoinferior capsular shift with the labral reattachment. The theoretical advantages of the modification were that such a procedure would restore the patient's anatomy and also treat the repeated capsular stretching encountered in anteroinferior instability without limiting external rotation and, thereby reducing the risk of arthritis. Questions/purposes We therefore determined: (1) the rate of recurrent instability after this modification, (2) patient function, and (3) the incidence and stage of glenohumeral osteoarthritis at greater than 2 years followup in patients with traumatic anteroinferior instability. Methods We retrospectively reviewed all 64 patients (average age, 27 years) who had the modified Bankart procedure for recurrent dislocations (n = 39) or subluxation (n = 25) from 1991 to 1997. The labrum was reattached with suture anchors and a superoinferior capsular shift was added. We determined the rate of recurrent instability, Rowe and Walch-Duplay scores and shoulder ROM, and the presence of glenohumeral osteoarthritis (modified Samilson and Prieto classification). The minimum followup was 24 months (median, 40 months; range, 24-120 months). Results Recurrent instability occurred in seven of the 64 patients (11%) at an average of 25 months postoperatively (range, 7 days to 6 years); in six patients the recurrence was associated with trauma; five of the six patients underwent reoperation with a Latarjet procedure. Eight additional patients (13%) presented with persistent shoulder apprehension or discomfort. The average Rowe score was 83% (range, 20-100%) and average Walch-Duplay score 83% (range, 15-100%). However, only 36 of 64 (56%) patients could return to the same sport at the same level. The loss of external rotation was 13°compared with the contralateral side. Glenohumeral osteoarthritis incidence increased from 4% preoperatively to 17% postoperatively. Conclusions The open Bankart procedure modified by Neer provided high function scores but a relatively low rate of return to sport and high rate of recurrent instability. Our rate of recurrent instability, similar to that obtained with arthroscopic Bankart procedures, has prompted us to abandon the open procedure.

Blood supply and vascularity of the glenoid labrum: Its clinical implications

“…The current study has shown that the glenoid labrum has a rich blood supply, which supports the excellent outcomes of glenoid labrum healing and joint re-instability observed, regardless of the types of the glenoid labrum lesions or their management. [33][34][35][36][37]10 It is suggested that the blood supply to the glenoid labrum is thus sufficient to enable its reattachment. On the other hand, it could be questioned how and why incomplete or non-healing of labrum injuries occurs, leading to recurrent shoulder instability and poor blood supply to the glenoid labrum, such as in diabetic patients, which could impair healing of the glenoid labrum.…”

Long-Term Outcome of Rockwood Capsular Shift for Recurrent Shoulder Dislocation

“…This reconstruction is a modification of the Putti-Platt, Bankart, and Neer capsular shift procedures. 1,9 One drawback of any capsular shift is the loss of ROM, particularly external rotation. 20 The mean loss of external rotation has been reported to be 13.8º (range, 0º-24º) 8 and 7º, 9 whereas in our patients, no significant loss of ROM was detected after 13 years.…”

“…Anatomic reconstruction of the subscapularis tendon, as with the Neer and Rockwood techniques, is more favourable for ROM recovery than techniques that rely on mediolateral soft tissue tightening (Putti-Platt) or subscapularis retensioning (Magnuson-Stack). 1,3 The rate of recurrent dislocation has been reported to be 0% to 57%. Predictors for recurrence include voluntary instability, previous surgical procedures, age at the time of surgery, the presence of labral tears and bone lesions (e.g.…”

“…24,32 The rate of shoulder osteoarthritis ranges from 39% to 60% in the long term after conservative treatment and from 9.7% to 100% (mean, 60%) after different surgical techniques. 1,3,7,8,11,33 The rate was 17% at 4 years after Neer capsuloplasty, 1 whereas it was 68% at 13 years after arthroscopic Bankart repair; nonetheless their clinical outcome was comparable with patients with no signs of osteoarthritis. 33 A large percentage of mild and moderate dislocation arthropathy cannot be detected when only clinical assessment is used in the absence of radiography.…”

“…The Rowe, Constant, WOSI and WOOS scores in our patients were comparable with those repaired by other techniques. 1,3 Severe rotator cuff injury occurs more frequently in elderly patients and results in poorer clinical outcome. 24,32 The rate of shoulder osteoarthritis ranges from 39% to 60% in the long term after conservative treatment and from 9.7% to 100% (mean, 60%) after different surgical techniques.…”