Long-term outcomes of arthroscopic Bankart repair with additional posteroinferior capsular plication in patients with anterior shoulder instability and hyperlaxity: Minimum 10-year follow-up.

Abstract

Purpose: To evaluate the long-term outcomes of arthroscopic Bankart repair with additional posteroinferior capsular plication in patients with anterior shoulder instability and hyperlaxity, and to compare the outcomes of posteroinferior capsular plication using suture-only fixation versus suture anchor fixation.

Methods: In this retrospective study, patients were included who underwent arthroscopic Bankart repair and additional posteroinferior capsular plication for anterior shoulder instability and hyperlaxity (type B3) between 2006 and 2014 at our institution. Primary outcome was recurrent instability. Secondary outcomes were Subjective Shoulder Value (SSV), visual analog scale (VAS), Constant score (CS), Western Ontario Shoulder Instability Index (WOSI) and Rowe score, as well as return to sport.

Results: Of 54 included shoulders, 33 shoulders in 32 patients (61.1%) were evaluated after a mean follow-up of 13.2 ± 2.3 years. The overall recurrence rate was 18.2% (6/33). The total revision rate was 9.1%, with two revisions due to recurrent instability and one due to posteroinferior knot impingement. The number of preoperative dislocations correlated negatively with the CS (ρ = -0.425, p = 0.019) and the WOSI (ρ = -0.471, p = 0.009). A total of 97% of all patients returned to sports, with 57.6% returning to 90%-100% of their preoperative sports activity. Posteroinferior capsular plication using suture-only fixation was associated with a higher recurrence rate (3/6, 50%), compared to the use of suture anchor fixation (3/27, 11.1%; p = 0.025).

Conclusion: Arthroscopic Bankart repair combined with posteroinferior capsular plication provided durable long-term shoulder function and reliable return to sport in patients with anterior instability and hyperlaxity. Performing the posteroinferior plication with suture anchor fixation might be associated with lower recurrence rates compared to suture-only plication. Clinical outcomes declined with an increasing number of preoperative dislocations.

Level of evidence: Level III, cohort study.