Long-term outcomes of arthroscopic Bankart repair: risk of recurrence and osteoarthritis at 11-20 years of follow-up.

Abstract

Arthroscopic Bankart repair (ABR) is a commonly performed treatment for anterior shoulder instability. Risk factors for recurrence of dislocation after this procedure have been investigated previously at short- and mid-term follow-up. Recurrence of dislocation in the long term, as well as the incidence and risk factors for the development of osteoarthritis (OA) after this procedure require further investigation. In this single-institution retrospective study, patients who had received ABR for structural anterior instability of the shoulder with a history of at least 1 documented dislocation, were contacted for a clinical and radiographic reassessment at long-term follow-up. Functional outcomes were assessed by the Oxford Shoulder Instability Score, Rowe score, and subjective shoulder value. Recurrence was defined as redislocation. Postoperative range of motion and strength were systematically assessed. Standard radiographs of the operated shoulder were screened for degenerative changes and scored according to the Samilson-Prieto classification for OA. Out of 59 consecutive shoulders eligible for inclusion, 49 shoulders were reassessed at a mean follow-up of 15 (standard deviation [SD] ± 2.4, range 11-20) years after the index procedure. The mean age of our cohort was 27.7 (SD ± 9.5) years. Nine shoulders (18.4%) sustained recurrence of dislocation. At the end of follow-up, the mean subjective shoulder value was 87% (SD ± 18, range 40-100), the mean Oxford Shoulder Instability score was 44.5 (SD ± 4.6, range 30-48) and the mean Rowe score 81.1 (SD ± 19.1, range 30-100). At final follow-up, 57% of shoulders had developed mild, 16% moderate and 11% severe degenerative changes. Age at index surgery (relative risk 2.96 [1.76-17.31] at ≥30 years) and the number of preoperative dislocations (relative risk 1.30 [1.07-1.59] if ≥5 preoperative dislocations) were significant risk factors for the development of OA. Recurrence of dislocation (P = .40) and duration of follow-up (P = .31) showed no significant association with OA. In the long term, the risk of recurrence of dislocation after ABR is low in comparison with reports on conservative treatment of anterior shoulder instability, but the incidence of OA after this procedure remains equally high. Preoperative factors significantly affect the risk of OA, rather than postoperative factors. Despite the high incidence of postoperative degenerative changes in the long term, functional outcomes remain satisfactory.