Patients without re-dislocation in the short term after arthroscopic knotless Bankart repair for anterior shoulder instability may show residual apprehension and recurrence in the long term after 5 years
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Arthroscopic Bankart Repair: Long-Term Clinical Outcomes and Stability Analysis
This study evaluates the long-term results, residual instability, and recurrence rates of patients who underwent arthroscopic Bankart repair and did not experience a re-dislocation event within the first five years post-surgery. The primary objective is to understand the durability of the procedure beyond the initial recovery phase and identify potential late-stage failures.
Methodology and Patient Selection Criteria
A retrospective analysis was conducted at a single center, involving surgeries performed by a single surgeon with a minimum follow-up period of 5 years. The study specifically included patients who remained stable during the first five years following their procedure.
To ensure data integrity, certain exclusion criteria were applied:
- Patients who underwent open repair or revision surgery.
- Individuals with critical glenoid bone loss.
The final cohort consisted of 68 shoulders in 66 patients (51 male, 15 female). Failure was categorized into two domains: re-dislocation and residual instability (defined as the combination of apprehension and re-dislocation). Clinical success was measured using the American Shoulder and Elbow Surgeons (ASES) score, the Western Ontario Shoulder Instability (WOSI) index, and shoulder range of motion.
Long-Term Clinical Results and Statistical Data
The study group had a mean age of 31.16 years, with a mean follow-up duration of 8.42 ± 2.1 years. Prior to surgery, the median number of dislocations was 3, and the median time from the first injury to surgical intervention was 16 months.
| Parameter | Value / Result |
|---|---|
| Re-dislocation Rate (After 5 Years) | 7.4% (5 patients) |
| Mean Time to Re-dislocation | 6.54 ± 2.5 years |
| Mean Shoulder Elevation | 161.3° ± 12.4° |
| Mean External Rotation | 39.2° ± 11° |
| Mean ASES Score | 91 ± 11.9 |
| Mean WOSI Score | 88 ± 12.1 |
| Mean VAS (Pain) Score | 0.5 ± 1.4 |
Analysis of Instability and Patient Satisfaction
While the majority of patients achieved stability, residual apprehension was reported by seven patients without re-dislocations and two patients with re-dislocations. Statistical analysis revealed that the WOSI score was significantly lower in patients experiencing re-dislocation (P = .030) and residual instability (P = .049). Interestingly, age did not show a significant difference between patients with stable shoulders and those with recurrence.
Conclusion: The Importance of Long-Term Monitoring
Arthroscopic Bankart repair remains a successful surgical option for treating anterior shoulder instability. However, the 7.4% re-dislocation rate occurring after the five-year mark suggests a potential deterioration of the capsulolabral repair over time in specific cases.
These findings highlight that long-term failure patterns may be underestimated in short- to mid-term clinical projections. Continuous monitoring is essential to fully grasp the late-stage efficacy of arthroscopic interventions in shoulder stability.
