Skip to main content
SpringerLink
Log in

Risk factors for recurrence after Bankart repair a systematic review

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Arthroscopic Bankart repair of anterior shoulder instability is a common practice in orthopedics. The aim of this study was to evaluate pre-operative risks factors associated with recurrent instability and to delineate possible indications for revision surgery.

Methods

A systematic review was performed including the following keywords: arthroscopy, Bankart repair, anterior shoulder instability, recurrence of instability, suture anchors and treatment outcome. Studies eligible for inclusion in the review were clinical trials published in the last 10 years investigating patients with anterior shoulder instability managed by an arthroscopic repair technique with suture anchors. The studies had to report data about recurrence of instability and investigational parameters (risk factors) that influenced the results referred to the rate of recurrence. Twenty-four articles were identified that met the inclusion criteria and underwent further review. Data from these studies were collected, and the risk of treatment failure was statistically recalculated. An estimate of the overall recurrence rate was obtained by pooling data about failure from the trials.

Results

The rate of recurrent instability at 10 years of follow-up ranged from 3.4 to 35 %. Epidemiological parameters significantly associated with the recurrence of instability were age below 22 years old, male gender, the number of preoperative dislocations and participation in competitive sports. Surgical parameters significantly associated with recurrence of instability were repair with fewer than three anchors and the use of knotless anchors. The patho-anatomical factors significantly associated with recurrences were substantial associated glenoid or humeral head bone loss and the presence of anterior labroligamentous periosteal sleeve avulsion.

Conclusions

Knowledge of risk factors for post-operative outcomes allows surgeons to provide appropriate preoperative counselling to patients and support more realistic expectations. An accurate analysis of causes of failure should enable the correct revision strategy to be adopted.

Level of evidence

II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Balg F, Boileau P (2007) The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 89(11):1470–1477

    Article  PubMed  CAS  Google Scholar 

  2. Burkhart SS, De Beer JF (2000) Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 16(7):677–694

    Article  PubMed  CAS  Google Scholar 

  3. Carreira DS, Mazzocca AD, Oryhon J, Brown FM, Hayden JK, Romeo AA (2006) A prospective outcome evaluation of arthroscopic Bankart repairs: minimum 2-year follow-up. Am J Sports Med 34(5):771–777

    Article  PubMed  Google Scholar 

  4. Castagna A, Markopoulos N, Conti M, Rose GD, Papadakou E, Garofalo R (2010) Arthroscopic bankart suture-anchor repair: radiological and clinical outcome at minimum 10 years of follow-up. Am J Sports Med 38(10):2012–2016

    Article  PubMed  Google Scholar 

  5. Chapovsky F, Kelly JD 4th (2005) Osteochondral allograft transplantation for treatment of glenohumeral instability. Arthroscopy 21(8):1007

    PubMed  Google Scholar 

  6. Cho NS, Lubis AM, Ha JH, Rhee YG (2006) Clinical results of arthroscopic bankart repair with knot-tying and knotless suture anchors. Arthroscopy 22(12):1276–1282

    Article  PubMed  Google Scholar 

  7. Ee GW, Mohamed S, Tan AH (2011) Long term results of arthroscopic Bankart repair for traumatic anterior shoulder instability. J Orthop Surg Res 6:28

    Article  PubMed  Google Scholar 

  8. Flinkkila T, Hyvonen P, Ohtonen P, Leppilahti J (2010) Arthroscopic Bankart repair: results and risk factors of recurrence of instability. Knee Surg Sports Traumatol Arthrosc 18(12):1752–1758

    Article  PubMed  Google Scholar 

  9. Hantes ME, Venouziou AI, Liantsis AK, Dailiana ZH, Malizos KN (2009) Arthroscopic repair for chronic anterior shoulder instability: a comparative study between patients with Bankart lesions and patients with combined Bankart and superior labral anterior posterior lesions. Am J Sports Med 37(6):1093–1098

    Article  PubMed  Google Scholar 

  10. Helfet AJ (1958) Coracoid transplantation for recurring dislocation of the shoulder. J Bone Joint Surg Br 40-B(2):198–202

    PubMed  CAS  Google Scholar 

  11. Hobby J, Griffin D, Dunbar M, Boileau P (2007) Is arthroscopic surgery for stabilisation of chronic shoulder instability as effective as open surgery? A systematic review and meta-analysis of 62 studies including 3,044 arthroscopic operations. J Bone Joint Surg Br 89(9):1188–1196

    Article  PubMed  CAS  Google Scholar 

  12. Hoffmann F, Reif G (1995) Arthroscopic shoulder stabilization using Mitek anchors. Knee Surg Sports Traumatol Arthrosc 3(1):50–54

    Article  PubMed  CAS  Google Scholar 

  13. Ide J, Maeda S, Takagi K (2004) Arthroscopic Bankart repair using suture anchors in athletes: patient selection and postoperative sports activity. Am J Sports Med 32(8):1899–1905

    Article  PubMed  Google Scholar 

  14. Imhoff AB, Ansah P, Tischer T, Reiter C, Bartl C, Hench M, Spang JT, Vogt S (2010) Arthroscopic repair of anterior-inferior glenohumeral instability using a portal at the 5:30-o’clock position: analysis of the effects of age, fixation method, and concomitant shoulder injury on surgical outcomes. Am J Sports Med 38(9):1795–1803

    Article  PubMed  Google Scholar 

  15. Kandziora F, Jager A, Bischof F, Herresthal J, Starker M, Mittlmeier T (2000) Arthroscopic labrum refixation for post-traumatic anterior shoulder instability: suture anchor versus transglenoid fixation technique. Arthroscopy 16(4):359–366

    Article  PubMed  CAS  Google Scholar 

  16. Kim SH, Ha KI, Cho YB, Ryu BD, Oh I (2003) Arthroscopic anterior stabilization of the shoulder: 2- to 6-year follow-up. J Bone Joint Surg Am 85-A(8):1511–1518

    PubMed  Google Scholar 

  17. Kim SH, Ha KI, Kim YM (2002) Arthroscopic revision Bankart repair: a prospective outcome study. Arthroscopy 18(5):469–482

    Article  PubMed  Google Scholar 

  18. Kocaoglu B, Guven O, Nalbantoglu U, Aydin N, Haklar U (2009) No difference between knotless sutures and suture anchors in arthroscopic repair of Bankart lesions in collision athletes. Knee Surg Sports Traumatol Arthrosc 17(7):844–849

    Article  PubMed  Google Scholar 

  19. Kropf EJ, Sekiya JK (2007) Osteoarticular allograft transplantation for large humeral head defects in glenohumeral instability. Arthroscopy 23(3):322.e321–322.e325

    Google Scholar 

  20. Latarjet M (1954) Treatment of recurrent dislocation of the shoulder. Lyon Chir 49(8):994–997

    PubMed  CAS  Google Scholar 

  21. Law BK, Yung PS, Ho EP, Chang JJ, Chan KM (2008) The surgical outcome of immediate arthroscopic Bankart repair for first time anterior shoulder dislocation in young active patients. Knee Surg Sports Traumatol Arthrosc 16(2):188–193

    Article  PubMed  Google Scholar 

  22. Milano G, Grasso A, Santagada DA, Saccomanno MF, Deriu L, Fabbriciani C (2010) Comparison between metal and biodegradable suture anchors in the arthroscopic treatment of traumatic anterior shoulder instability: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 18(12):1785–1791

    Article  PubMed  Google Scholar 

  23. Mologne TS, Provencher MT, Menzel KA, Vachon TA, Dewing CB (2007) Arthroscopic stabilization in patients with an inverted pear glenoid: results in patients with bone loss of the anterior glenoid. Am J Sports Med 35(8):1276–1283

    Article  PubMed  Google Scholar 

  24. Monteiro GC, Ejnisman B, Andreoli CV, Pochini AC, Cohen M (2008) Absorbable versus nonabsorbable sutures for the arthroscopic treatment of anterior shoulder instability in athletes: a prospective randomized study. Arthroscopy 24(6):697–703

    Article  PubMed  Google Scholar 

  25. Ozbaydar M, Elhassan B, Diller D, Massimini D, Higgins LD, Warner JJ (2008) Results of arthroscopic capsulolabral repair: Bankart lesion versus anterior labroligamentous periosteal sleeve avulsion lesion. Arthroscopy 24(11):1277–1283

    Article  PubMed  Google Scholar 

  26. Petrera M, Patella V, Patella S, Theodoropoulos J (2010) A meta-analysis of open versus arthroscopic Bankart repair using suture anchors. Knee Surg Sports Traumatol Arthrosc 18(12):1742–1747

    Article  PubMed  CAS  Google Scholar 

  27. Pope EJ, Ward JP, Rokito AS (2011) Anterior shoulder instability—a history of arthroscopic treatment. Bull NYU Hosp Jt Dis 69(1):44–49

    PubMed  Google Scholar 

  28. Porcellini G, Campi F, Pegreffi F, Castagna A, Paladini P (2009) Predisposing factors for recurrent shoulder dislocation after arthroscopic treatment. J Bone Joint Surg Am 91(11):2537–2542

    Article  PubMed  Google Scholar 

  29. Provencher MT, Ghodadra N, LeClere L, Solomon DJ, Romeo AA (2009) Anatomic osteochondral glenoid reconstruction for recurrent glenohumeral instability with glenoid deficiency using a distal tibia allograft. Arthroscopy 25(4):446–452

    Article  PubMed  Google Scholar 

  30. Purchase RJ, Wolf EM, Hobgood ER, Pollock ME, Smalley CC (2008) Hill-sachs “remplissage”: an arthroscopic solution for the engaging hill-sachs lesion. Arthroscopy 24(6):723–726

    Article  PubMed  Google Scholar 

  31. Rahme H, Wikblad L, Nowak J, Larsson S (2003) Long-term clinical and radiologic results after Eden-Hybbinette operation for anterior instability of the shoulder. J Shoulder Elbow Surg 12(1):15–19

    Article  PubMed  Google Scholar 

  32. Re P, Gallo RA, Richmond JC (2006) Transhumeral head plasty for large Hill-Sachs lesions. Arthroscopy 22(7):798.e791–798.e794

    Google Scholar 

  33. Sekiya JK (2005) Arthroscopic labral repair and capsular shift of the glenohumeral joint: technical pearls for a multiple pleated plication through a single working portal. Arthroscopy 21(6):766

    PubMed  Google Scholar 

  34. Sekiya JK, Wickwire AC, Stehle JH, Debski RE (2009) Hill-Sachs defects and repair using osteoarticular allograft transplantation: biomechanical analysis using a joint compression model. Am J Sports Med 37(12):2459–2466

    Article  PubMed  Google Scholar 

  35. Shah AS, Karadsheh MS, Sekiya JK (2011) Failure of operative treatment for glenohumeral instability: etiology and management. Arthroscopy 27(5):681–694

    Article  PubMed  Google Scholar 

  36. Tan CK, Guisasola I, Machani B, Kemp G, Sinopidis C, Brownson P, Frostick S (2006) Arthroscopic stabilization of the shoulder: a prospective randomized study of absorbable versus nonabsorbable suture anchors. Arthroscopy 22(7):716–720

    Article  PubMed  Google Scholar 

  37. Thal R, Nofziger M, Bridges M, Kim JJ (2007) Arthroscopic Bankart repair using Knotless or BioKnotless suture anchors: 2- to 7-year results. Arthroscopy 23(4):367–375

    Article  PubMed  Google Scholar 

  38. Tjoumakaris FP, Sekiya JK (2008) Combined glenoid and humeral head allograft reconstruction for recurrent anterior glenohumeral instability. Orthopedics 31(5):497

    Article  PubMed  Google Scholar 

  39. van der Linde JA, van Kampen DA, Terwee CB, Dijksman LM, Kleinjan G, Willems WJ (2011) Long-term results after arthroscopic shoulder stabilization using suture anchors: an 8- to 10-year follow-up. Am J Sports Med 39(11):2396–2403

    Article  PubMed  Google Scholar 

  40. Voos JE, Livermore RW, Feeley BT, Altchek DW, Williams RJ, Warren RF, Cordasco FA, Allen AA (2010) Prospective evaluation of arthroscopic bankart repairs for anterior instability. Am J Sports Med 38(2):302–307

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dipartimento di Scienze Medico-Chirurgiche, Università Degli Studi Di Milano, IRCCS, Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy

    P. Randelli, V. Ragone, S. Carminati & P. Cabitza

Authors
  1. P. Randelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Ragone
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Carminati
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Cabitza
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Randelli.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Randelli, P., Ragone, V., Carminati, S. et al. Risk factors for recurrence after Bankart repair a systematic review. Knee Surg Sports Traumatol Arthrosc 20, 2129–2138 (2012). https://doi.org/10.1007/s00167-012-2140-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-012-2140-1

Keywords

Search

Navigation