A Modified Bankart Repair Technique for the Throwing Shoulder to Prevent External Rotation Loss and Facilitate Return to Play in Baseball Players.

Abstract

Background: Arthroscopic Bankart repair (ABR) is the standard surgical treatment for traumatic anterior shoulder instability. In overhead athletes, however, postoperative limitations in external rotation (ER) can impair throwing mechanics and limit return to play (RTP).

Purpose: The dynamic anterior glenohumeral capsular ligament tensioning (DAGHT) technique aims to preserve ER by assessing capsular tension in abduction and external rotation (ABER) before suture passage, avoiding excessive tightening. This study evaluated clinical outcomes of ABR with DAGHT in competitive baseball players with traumatic instability of the throwing shoulder.

Study design: Case series; Level of evidence, 4.

Methods: A total of 24 competitive baseball players (mean age, 18.2 ± 3.8 years) underwent ABR with DAGHT between January 2017 and April 2024 and were retrospectively reviewed. Competitive baseball players were defined as those competing at the high school, collegiate, semiprofessional, or professional level. The inclusion criteria were traumatic dislocation of the throwing shoulder, a Bankart lesion confirmed by imaging and arthroscopy, failed conservative management, and active competition. The exclusion criteria were multidirectional instability, glenoid bone loss >20%, rotator cuff tears, or glenohumeral osteoarthritis. The sample comprised consecutive eligible patients. Clinical outcomes were evaluated at a mean follow-up of 27.7 ± 12.9 months (range, 12-54 months), with a minimum follow-up of 12 months. Assessments included the ABER range of motion; Jobe score; Kerlan-Jobe Orthopedic Clinic score; Disabilities of the Arm, Shoulder, and Hand sports module; Western Ontario Shoulder Instability Index; Rowe score; and RTP rate.

Results: All 24 participants returned to play; 83.3% (20/24) resumed the same or a higher level of competition. The mean time to RTP was 8.2 ± 3.7 months. Postoperative ABER on the throwing side averaged 95.2°± 8°, exceeding that of the contralateral shoulder (92.2°± 7.4°; P = .02), suggesting no reduction in ER relative to the contralateral shoulder. All clinical scores improved significantly compared with preoperative values (P < .001). One participant sustained a single subluxation after RTP.

Conclusion: ABR with DAGHT yielded favorable outcomes in competitive baseball players. The technique may preserve ER and address the thrower's paradox while maintaining stability and offering a useful option for overhead athletes requiring both stability and motion.