Results of Open Bankart Surgery for Recurrent Anterior Shoulder Dislocation with Glenoid Bone Defect and Concomitant Hill-Sachs Lesion

Document Type: RESEARCH PAPER

Authors

Bone and Joint Reconstruction Research Center, Department of Orthopedic Surgery, Shafa Orthopedic Hospital, Iran university of medical Sciences, Tehran, Iran

Abstract

 
Background: Open Bankart surgery is the main treatment procedure in patients with recurrent anterior shoulder dislocation, especially in cases with glenoid bone defect. The goal of this study was to determine the outcomes after open Bankart surgery in cases of recurrent anterior shoulder dislocation with glenoid bone defects and concomitant Hill-Sachs lesions.
Methods: Between 2006 and 2010, 89 patients with recurrent anterior shoulder dislocation and concomitant glenoid bone defects (10-30%) and Hill-Sachs lesions undergoing open Bankart surgery were reviewed. The mean follow-up after surgery was 7 years (5.5-9.5 years). The recurrence rate as well as the degree of shoulder pain and daily activity level was determined subjectively based on the visual analogue scale (VAS) and activity daily living scale (ADLs). Shoulder range of motion (ROM) in abduction and external rotation was compared with contralateral side; and finally, the American shoulder and elbow score (ASES) and constant-Murley score (CMS) were calculated.
Results: Over 7 years of follow-up, a total of 15 patients (16.8%) undergoing surgery were found to have instability (3 patients (3.3%) with dislocation and 12 patients with (13.4%) subluxation). Patients with postsurgical instability had significantly larger glenoid bone defects (P=0.0001) and Hill-Sachs lesions (P=0.019) compared to those without instability. The mean loss of forward flexion compared with the normal contralateral side was 4º while the mean loss of external rotation between both sides was 5º. At the final visit, the average VAS was 0.4 (out of 10); ADL was 28.97 (range: 25-30); ASES was 96.1(range: 78.3-100); and the mean CMS value was 93.9(range: 82-100).
Conclusion: Open Bankart surgery with anteroinferior capsular shift for recurrent anterior shoulder dislocation with up to 30% glenoid bone defect and Hill-Sachs lesion provided desirable results in terms of shoulder function and recurrence rate. Bankart surgery is a successful and practical option in these patients and can be considered as an alternative to other procedures.
Level of evidence: IV

Keywords

Main Subjects


1. Rowe CR, Patel D, Southmayd WW. The Bankart
procedure: a long-term end-result study. J Bone Joint
Surg Am. 1978; 60(1):1-16.
2. Lenters TR, Franta AK, Wolf FM, Leopold SS, Matsen
FA 3nd. Arthroscopic compared with open repairs for
recurrent anterior shoulder instability. A systematic
review and meta-analysis of the literature. J Bone
Joint Surg Am. 2007; 89(2):244-54.
3. Neer CS 2nd, Foster CR. Inferior capsular shift for
involuntary inferior and multidirectional instability
of the shoulder: a preliminary report. J Bone Joint
Surg Am. 1980; 62(6):897-908.
4. Kim SH, Ha KI, Cho YB, Ryu BD, Oh I. Arthroscopic
anterior stabilization of the shoulder: two to sixyear
follow-up. J Bone Joint Surg Am. 2003; 85-
A(8):1511-8.
5. Aslani H, Zafarani Z, Ebrahimpour A, Salehi S, Moradi
A, Sabzevari S. Early clinical results of arthroscopic
remplissage in patients with anterior shoulder
instability with engaging hill-sachs lesion in Iran.
Arch Bone Joint Surg. 2014; 2(1):43-6.
6. Boileau P, Villalba M, Hery JY, Balg F, Ahrens P, Neyton
L. Risk factors for recurrence of shoulder instability
after arthroscopic Bankart repair. J Bone Joint Surg
Am. 2006; 88(8):1755-63.
7. Freedman KB, Smith AP, Romeo AA, Cole BJ, Bach BR
Jr. Open Bankart repair versus arthroscopic repair
with transglenoid sutures or bioabsorbable tacks for
recurrent anterior instability of the shoulder: a metaanalysis.
Am J Sports Med. 2004; 32(6):1520-7.
8. Bigliani LU, Newton PM, Steinmann SP, Connor PM,
Mcllveen SJ. Glenoid rim lesions associated with
recurrent anterior dislocation of the shoulder. Am J
Sports Med. 1998; 26(1):41-5.
9. Burkhart SS, De Beer JF. Traumatic glenohumeral
bone defects and their relationship to failure of
arthroscopic Bankart repairs: significance of the
inverted-pear glenoid and the humeral engaging Hill-
Sachs lesion. Arthroscopy. 2000; 16(7):677-94.
10. Hovelius L, Sandström B, Sundgren K, Saebö M.
One hundred eighteen Bristow-Latarjet repairs
for recurrent anterior dislocation of the shoulder
prospectively followed for fifteen years: study
I-clinical results. J Shoulder Elbow Surg. 2004;
13(5):509-16.
11. Burkhart SS, De Beer JF, Barth JR, Cresswell T,
Roberts C, Richards DP. Results of modified Latarjet
reconstruction in patients with anteroinferior
instability and significant bone loss. Arthroscopy.
2007; 23(10):1033-41.

12. Griesser MJ, Harris JD, McCoy BW, Hussain WM, Jones
MH, Bishop JY, et al. Complications and re-operations
after Bristow-Latarjet shoulder stabilization: a
systematic review. J Shoulder Elbow Surg. 2013;
22(2):286-92.
13. Barchilon VS, Kotz E, Barchilon Ben-Av M. A simple
method for quantitative evaluation of the missing
area of the anterior glenoid in anterior instability
of the glenohumeral joint. Skeletal Radiol. 2008;
37(8):731-6.
14. Keats TE, Sistrom C. Atlas of radiologic measurement.
7th ed. London: Mosby Incorporated; 2001. P. 181-2.
15. Richards RR, An KN, Bigliani LU, Friedman RJ,
Gartsman GM, Gristina AG, et al. A standardized
method for the assessment of shoulder function. J
Shoulder Elbow Surg. 1994; 3(6):347-52.
16. Constant CR, Murley AH. A clinical method of
functional assessment of the shoulder. Clin Orthop
Relat Res. 1987; 214(1):160-4.
17. Pelet S, Jolles BM, Farron A. Bankart repair for
recurrent anterior glenohumeral instability: results
at twenty-nine years’ follow-up. J Shoulder Elbow
Surg. 2006; 15(2):203-7.
18. Moroder P, Odorizzi M, Pizzinini S, Demetz E, Resch
H, Moroder P. Open Bankart repair for the treatment
of anterior shoulder instability without substantial
osseous Glenoid defects: results after a minimum
follow-up of twenty years. J Bone Joint Surg Am. 2015;
97(17):1398-405.
19. Strahovnik A, Fokter SK. Long-term results after open
Bankart operation for anterior shoulder instability.
Wien Klin Wochenschr. 2006; 118(Suppl 2):58-61.
20. Uhorchak JM, Arciero RA, Huggard D, Taylor
DC. Recurrent shoulder instability after open
reconstruction in athletes involved in collision and
contact sports. Am J Sports Med. 2000; 28(6):794-9.
21. Berendes TD, Wolterbeek R, Pilot P, Verburg H, te Slaa
RL. The open modified Bankart procedure: outcome
at follow-up of 10 to 15 years. J Bone Joint Surg Br.
2007; 89(8):1064-8.
22. Magnusson L, Ejerhed L, Rostgard L, Sernert N,
Kartus J. Absorbable implants for open shoulder
stabilization. A 7-8-year clinical and radiographic
follow-up. Knee Surg Sports Traumatol Arthrosc.
2006; 14(2):182-8.
23. Virk MS, Manzo RL, Cote M, Ware JK, Mazzocca AD,
Nissen CW, et al. Comparison of time to recurrence of
instability after open and arthroscopic Bankart repair
techniques. Orthop J Sports Med. 2016; 4(6):2325967.
24. Zimmermann SM, Scheyerer MJ, Farshad M,
Catanzaro S, Rahm S, Gerber C, et al. Long-term
restoration of anterior shoulder stability: a
retrospective analysis of arthroscopic Bankart
repair versus open Latarjet procedure. J Bone Joint
Surg Am. 2016; 98(23):1954-61.
25. Ebrahimzadeh MH, Moradi A, Zarei AR. Minimally
invasive modified latarjet procedure in patients with
traumatic anterior shoulder instability. Asian J Sports
Med. 2015; 6(1):e26838.
26. Ebrahimzadeh MH, Birjandinejad A, Golhasani F,
Moradi A, Vahedi E, Kachooei AR. Cross-cultural
adaptation, validation, and reliability testing of the
Shoulder Pain and Disability Index in the Persian
population with shoulder problems. Int J Rehabil Res.
2015; 38(1):84-7.
27. Mizuno N, Denard PJ, Raiss P, Melis B, Walch G. Longterm
results of the Latarjet procedure for anterior
instability of the shoulder. J Should Elbow Surg Am.
2014; 23(11):1691-9.
28. Hovelius L, Vikerfors O, Olofsson A, Svensson O, Rahme
H. Bristow-Latarjet and Bankart: a comparative study
of shoulder stabilization in 185 shoulders during a
seventeen-year follow-up. J Shoulder Elbow Surg.
2011; 20(7):1095-101.