EVALUATION OF RESULTS OF ARTHROSCOPIC BANKART REPAIR IN TRAUMATIC RECURRENT ANTERIOR SHOULDER INSTABILITY IN ADULT PATIENTS: A 10 YEAR FOLLOW-UP STUDY
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Keywords
Shoulder Arthroscopy, Bankart Lesion, Arthroscopic Bankart Repair, Long Term Outcome.
Abstract
Background: Arthroscopic Bankart repair has become the standard of care in the surgical treatment of Bankart’s lesion of shoulder. Though long term follow-up studies on Arthroscopic Bankart repair are coming up at various parts of the world, there is still shortage of such studies in the Indian sub-continent.
Method: A total of 59 patients with post-traumatic recurrent anterior dislocation of shoulder was operated arthroscopically with suture anchors at a well reputed teaching hospital in eastern India. Of the initial cohort 30 patients could be followed up for 10 years (mean 133 months) and included in the study. The were evaluated by Rowe score, Constant-Murley shoulder outcome score and UCLA shoulder score at 6 months, 1 year, 3 years, 5 years and at the end of the follow up period.
Results: Incidence of recurrence of instability was 3%. The mean pre-operative Rowe score increased post-operatively at 6 months to 71.83 (median 75, SD=18.17) and to 80.17 (median 75, SD=11.78) at the end of follow up period (p<0.001). The final results according to Rowe score were fair in 6 (20%) patients, good in 10 (33.3%) patients and excellent in the remaining 14 (46.6%). The mean Constant-Murley score increased post-operatively at 6 months to 68.2 (median 72, SD=11.9) and to 75.83 (median 79, SD=12.12) at the end of follow-up period (p<0.001). The final results according to Constant-Murley score were poor in 7 patients (23.3%), fair in 8 patients (26.6%), good in 12 (40%) patients and excellent in the remaining 3 (10%). The mean University of California and Los Angeles score increased post-operatively at 6 months to 29.3 (median 30, SD=3.87) and to 30.27 (median 31, SD=3.67) at the end of follow-up period (p<0.001). The final results according to UCLA rating were fair/poor in 4 patients (13.3%) and good/excellent in 26 (86.6%). Patient satisfaction, quantified by the visual analogue scale, which pre-operatively had a median value of 6 increased to 8 post-operatively
Conclusion: Arthroscopic Bankart repair is a successful surgery to address recurrent anterior instability of shoulder in well indicated cases, with encouraging long term results. There is scope for more such long-term follow up studies to understand the incidence of late complications like rotator cuff degeneration and arthritis.
References
[2] Flower WH. On pathologic changes produced in the shoulder joint by traumatic dislocation. Trans Path Soc London 1861;12:179-200.
[3] Eve FS: A case of subcoracoid dislocation of the humerus with the formation of an indentation on the posterior surface of the head. Medico-Chirurg Trans Soc London 1880;63:317-21.
[4] Hill HA, Sachs MD: The grooved defect of the humeral head. A frequently unrecognized complication of dislocations of the shoulder joint. Radiology 1940;35:690-700.
[5] Bankart ASB: Recurrent or habitual dislocation of the shoulder joint. Br Med J 1923;2:1132-1133.
[6] Rao JP, Francis AM, Hurley J, et al: Treatment of recurrent anterior dislocation of the shoulder by duToit staple capsulorrhaphy. Results of long-term follow-up study. Clin Orthop Relat Res 1986;(204):169-76.
[7] Karadimas J, Rentis G, Varouchas G: Repair of recurrent anterior dislocation of the shoulder using transfer of the subscapularis tendon. J Bone Joint Surg Am 1980;62:1147-9.
[8] Magnuson PB: Treatment of recurrent dislocation of the shoulder. Surg Clin North Am 1945;25:14-20.
[9] Magnuson PB, Stack JK: Bilateral habitual dislocation of the shoulder in twins, a familial tendency. JAMA 1940;144:2103.
[10] Magnuson PB, Stack JK: Recurrent dislocation of the shoulder. JAMA 1943;123:889-92.
[11] Miller LS, Donahue JR, Good RP, Staerk AJ: The Magnuson–Stack procedure for treatment of recurrent glenohumeral dislocation. Am J Sports Med 1984;12:133-7.
[12] Quigley TB, Freedman PA. Recurrent dislocation of the shoulder. Am J Surg 1974;128:595-9.
[13] DuToit GT, Roux D. Recurrent dislocation of the shoulder. A 24 year study of the Johannesburg stapling operation. J Bone Joint Surg Am 1956;38:1-12.
[14] Sisk TD, Boyd HB: Management of recurrent anterior dislocation of the shoulder. DuToit-type or staple capsulorrhaphy. Clin Orthop Relat Res 1974;(103):150-6.
[15] Helfet AJ: Coracoid transplantation for recurring dislocation of the shoulder. J Bone Joint Surg Br 1958;40:198-202.
[16] Baker CL, Uribe JW, Whitman C. Arthroscopic evaluation of acute initial anterior shoulder dislocations. Am J Sports Med 1990;18(1):25-8.
[17] Liu SH, Henry MH. Anterior shoulder instability. Current review. Clin Orthop Relat Res 1996;(323):327-37.
[18] Rowe CR, Zarins B. Recurrent transient subluxation of the shoulder. J Bone Joint Surg Am 1981;63(6):863-72.
[19] Rhee YG, Cho NS, Cho SH. Traumatic anterior dislocation of the shoulder: factors affecting the progress of the traumatic anterior dislocation. Clin Orthop Surg 2009;1(4):188-93.
[20] Ömer Faruk Erkoçak, Mustafa Yel: The Functional Results of Arthroscopic Bankart Repair with Knotless Anchors for Anterior Glenohumeral Instability. Eur J Gen Med 2010;7(2):179-86.
[21] Cole BJ, L'Insalata J, Irrgang J, Warner JJ. Comparison of arthroscopic and open anterior shoulder stabilization. A two to six-year follow-up study. J Bone Joint Surg Am. 2000;82(8):1108-14.
[22] Gartsman GM, Roddey TS, Hammerman SM. Arthroscopic treatment of anterior-inferior glenohumeral instability. Two to five-year follow-up. J Bone Joint Surg Am 2000;82-A(7):991-1003.
[23] Mishra DK, Fanton GS. Two-years outcome of arthroscopic Bankart repair and electrothermal-assisted capsulorrha¬phy for recurrent traumatic anterior shoulder instability. Arthroscopy 2001;17:844-9.
[24] Ide J, Maeda S, Takagi K. Arthroscopic Bankart repair us¬ing suture anchors in athletes: patient selection and post¬operative sports activity. Am J Sports Med 2004;32:1899-905.
[25] Westerheide KJ, Dopirak RM, Snyder SJ. Arthroscopic anterior stabilization and posterior capsular plication for anterior glenohumeral instability: A report of 71 cases. Arthroscopy 2006;22:539-547.
[26] Sedeek S M, Tey I K, tan A H C. Arthroscopic bankart re¬pair for traumatic anterior shoulder instability with the use of suture anchors. Singapore Med J 2008;49(9):676-81.
[27] Lützner J, Krummenauer F, Lübke J, Kirschner S, Günther KP, Bottesi M. Functional outcome after open and ar¬throscopic bankart repair for traumatic shoulder instability. Eur J Med Res 2009;14(1):18-24.
[28] Dominic S. Carreira, Augustus D. Mazzocca, Jeremy Oryhon, Frederick M. Brown, Jennifer K. Hayden and Anthony A. Romeo: A Prospective Outcome Evaluation of Arthroscopic Bankart Repairs: Minimum 2-Year Follow-up, Am. J. Sports Med 2006;34:771.
[29] Voos JE, Livermore RW, Feeley BT, Altchek DW, Williams RJ, Warren RF, et al Prospective evaluation of arthroscopic bankart repairs for anterior instability, Am J Sports Med 2010 Feb;38(2):302-7.
[30] Seung-Ho Kim, Kwon-Ick Ha, Sang-Hyun Kim: Bankart repair in traumatic anterior shoulder instability, open versus arthroscopic technique. J Arthroscopy 2002;18(7):755-63.
[31] Kim SH, Ha KI, Cho YB, Ryu BD, Oh I. Arthroscopic Anterior Stabilization of the Shoulder, two to Six-Year Follow-up. J Bone Joint Surg Am 2003;85(8):1511-8.
[32] Fabbriciani C, Milano G, Demontis A, Fadda S, Ziranu F, Mulas PD. Arthroscopic Versus Open Treatment of Bankart Lesion of the Shoulder: A Prospective Randomized Study. Arthroscopy: The Journal of Arthroscopic and Related Surgery 2004;(5):456-62.
[33] Mishra A, Sharma P, Chaudhary D. Analysis of the functional results of arthroscopic Bankart repair in posttraumatic recurrent anterior dislocations of shoulder. Indian J Orthopaedics 2012;46(6):668-74.
[34] Karlsson J, PhD, Magnusson L, Ejerhed L, et al. Comparison of Open and Arthroscopic Stabilization for Recurrent Shoulder Dislocation in Patients with a Bankart Lesion. Am J Sports Med 2001;29(5):538
[35] Arciero RA, Toylor DC, Synder RJ. Arthroscopic bioabsorbable tack stabilization of initial anterior shoulder dislo¬cations: a preliminary report. Arthroscopy 1995;2:410-17
[36] Gartsman GM, Roddey TS, Hammerman SM. Arthroscopic treatment of anterior-inferior glenohumeral instability. Two to five-year follow-up. J Bone Joint Surg Am 2000;82A(7):991-1003.
[37] Snyder SJ, Banas MP, Belzer JP. Arthroscopic treatment of anterior shoulder instability using threaded suture anchors and nonabsorbable suture. Instr Course Lect 1996;45:71-81.
[38] Ee GW, Mohamed S, Tan AH. Long term results of arthroscopic Bankart repair for traumatic anterior shoulder instability. J Orthop Surg Res 2011;6:28.
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Dr. Sutanu Goswami
Assistant Professor, Department of Orthopaedics, SRIMS and Sanaka Hospital, Durgapur, West Bengal, India.
Dr. Shekhareswar De
Associate Professor, Department of Orthopaedics, SRIMS and Sanaka Hospital, Durgapur, West Bengal, India.
Dr. Shouvik Chowdhury
Assistant Professor, Department of Orthopaedics, SRIMS and Sanaka Hospital, Durgapur, West Bengal, India.
Dr. Tania Mukherjee
Assistant Professor, Department of ENT, Santiniketan Medical College and Hospital, Bolpur, West Bengal, India.