Long-Term Clinical Outcomes of Arthroscopic Suture Anchor Fixation of Bony Bankart Lesions at a Mean 18-Year Follow-Up.

Purpose

To evaluate shoulder stability and function at long-term follow-up after arthroscopic single-row suture anchor fixation of bony Bankart lesions.

Methods

This was a retrospective, single-center study. Patients with anterior glenoid rim fractures after traumatic shoulder instability who underwent arthroscopic single-row suture anchor fixation for bony Bankart lesions between 1999 and 2010 were included. Only patients with a minimum follow-up of 14 years were eligible for the present long-term analysis. Patients completed a standardized questionnaire including clinical data regarding shoulder stability, reoperation, patient satisfaction, and sports activity as well as patient-reported outcome measures, including the Constant Score, Subjective Shoulder Value (SSV), American Shoulder and Elbow Surgeons Score, Oxford Instability Score, and Western Ontario Shoulder Instability Index. Changes in patient-reported outcome measures were evaluated using cohort-specific minimal clinically important difference thresholds, and patient satisfaction was assessed against a predefined threshold (≥8/10). Paired t-tests or Wilcoxon signed-rank tests were used as appropriate, with P < .05 considered significant.

Results

Fifty patients were initially identified, of whom 45 were included in a previously published midterm follow-up study. Of these, 13 patients were unavailable for long-term follow-up (7 lost to follow-up and 6 deceased), resulting in a final cohort of 32 patients with a mean follow-up of 18.3 years (range, 14.4-25.1 years). Of patients, 90.6% reported no subjective instability. The redislocation rate was 3.1% (1 patient), and the recurrent subjective instability rate was 9.4% (3 patients). Two patients required revision surgery (1 open reosteosynthesis after traumatic glenoid fracture 9 years postoperatively and 1 reverse shoulder arthroplasty because of cuff arthropathy 21.9 years postoperatively). High satisfaction was reported by 29 of 32 patients (90.6%) based on the predefined threshold, and 96.9% of patients indicated that they would undergo the procedure again. Most patients (92.9%) returned to sports at the same level or higher than compared with their preinjury level. The mean Constant Score was 80.7 points, SSV 87.2%, American Shoulder and Elbow Surgeons 92.4 points, Oxford Instability Score 44.6 points, and Western Ontario Shoulder Instability Index 90.4 points. Although a statistically significant decline in SSV was observed over time (P < .05), cohort-specific minimal clinically important difference thresholds were met or exceeded by 12 of 32 patients for SSV (37.5%), 12 of 32 for Western Ontario Shoulder Instability Index (37.5%), and 9 of 32 for Oxford Instability Score (28.1%).

Conclusions

Arthroscopic single-row suture anchor repair of bony Bankart lesions provides excellent long-term stability with low rates of recurrence and reoperation, high patient satisfaction, and favorable functional outcomes, even after nearly 2 decades. LEVEL OF EVIDENCE Level IV, retrospective case series.