Five-Year Outcomes and Return to Sport After Arthroscopic Bankart Repair in Young Patients With Minimal (<10%) or No Glenoid Bone Loss

Abstract

Background: Arthroscopic Bankart repair is commonly used to address anterior instability in adolescents and young adults with no or minimal bone loss. However, failure rates remain high, particularly in high-risk populations. Purpose/Hypothesis: The purpose of this study was to evaluate clinical outcomes, return-to-sport (RTS) rates, and predictors of failure after arthroscopic Bankart repair in patients ≤24 years of age with minimal glenoid bone loss. It was hypothesized that patients would demonstrate favorable outcomes, low recurrence rates, and high RTS rates, and smaller distance-to-dislocation (DTD) measurements, and contact sports participation would be associated with failure. Study Design: Case series; Level of evidence, 4. Methods: The data of patients with anterior shoulder instability and minimal bone loss (<10%) who underwent primary arthroscopic Bankart repair between 2006 and 2020 were retrospectively analyzed. Remplissage was not performed. Data collected included preoperative instability events, patient-reported outcome measures, satisfaction, radiographic measurements (glenoid bone loss, glenoid track, and DTD), and RTS outcomes. Failure was defined as re-dislocation or recurrent instability requiring surgery. Results: A total of 130 patients were evaluated; 18 were excluded, leaving 112. Of these, 96 patients (85.7%) were available for the final follow-up (mean age, 19.9 ± 3.1 years; mean follow-up, 68.4 ± 42.7 months). All clinical outcomes improved significantly (P < .05) except for the 12-Item Short Form Health Survey Mental Component Summary score. The median satisfaction score was 9 (IQR, 8-10). Participation in contact sports was associated with failure, while other risk factors were not. RTS was achieved by 96.1% of patients; however, only 57.1% returned to their preinjury level. Fewer preoperative dislocation events were associated with successful return to full activity (P = .04). The recurrence rate was 33.3%, and revision surgery was required in 19 patients (19.8%). Conclusion: Arthroscopic Bankart repair was associated with high rates of recurrence and revision surgery in a series of patients ≤24 years of age without glenoid bone loss. In those who did not require revision surgery, clinical outcomes and RTS rates were high. Contact sports participation was associated with failure. A greater number of preoperative instability events negatively influence RTS outcomes. Arthroscopic Bankart repair in this population is safe and has a low complication rate, but the failure rate remains considerable.