Outcomes of Arthroscopic Versus Open Bankart Repair in Collision Athletes Following a First Episode of Anterior Shoulder Dislocation: A 5-Year Prospective Cohort Study.

Abstract

Isolated arthroscopic Bankart repair (IABR) and open Bankart repair with inferior capsular shift (OBICS) have not been previously compared in the context of a first episode of anterior shoulder dislocation (FEAD). This study aimed to compare the recurrence rate, functional outcomes, range of motion (ROM), and return to preinjury sport level (RTS) between IABR and OBICS in collision athletes with FEAD. We hypothesized that OBICS would yield clinical outcomes comparable to those of IABR. A prospective cohort study involving 80 collision athletes, divided into two groups of 40 patients each, was conducted. The inclusion criteria were age ≤30 years, with or without a glenoid bone defect ≤13%, and on-track Hill-Sachs lesions, all of which presented with first-time anterior shoulder dislocation. The mean follow-up was 68.9 months (range, 60-85) for the OBICS group and 70.5 months (range, 60-87) for the IABR group. The recurrence rate was considered the primary outcome, whereas the Western Ontario Shoulder Instability Index (WOSI), American Shoulder and Elbow Surgeons (ASES) score, ROM, and RTS were secondary outcomes. All assessments were conducted at baseline, 6 months, 12 months, and a minimum of 60 months postoperatively. All outcomes were compared between the two groups. The OBICS group demonstrated a significantly lower recurrence rate (2.5%) than did the IABR group (17.5%) (P = 0.031). Both groups showed significant improvements in WOSI and ASES scores from baseline to the final follow-up (P = 0.001); however, no significant differences were found between the groups at the five-year follow-up (WOSI: P = 0.38; ASES: P = 0.72). There were no significant differences in ROM within or between groups. The degree of external rotation was similar in both groups (rotation at the side: OBICS P = 0.82, IABR P = 0.91; at 90° abduction: OBICS P = 0.68, IABR P = 0.43). RTS rates were also comparable, with 80% of OBICS patients and 82.5% of IABR patients returning to their preinjury level (P = 0.69) and 17.5% (OBICS) and 15% (IABR) returning to a lower level (P = 0.47). Compared with IABR, OBICS resulted in a significantly lower recurrence rate. The functional scores and the ROM and RTS outcomes were comparable between the groups. We highly recommend OBICS for collision athletes with FEADs.