Results of Open Bankart Repair After Failed Arthroscopic RepairIn this study thirty patients with a torn shoulder labrum had an arthroscopic Bankart repair that failed. The results of their second surgery to repair the first are reported. An open Bankart procedure was used to repair the failed arthroscopic repair.
The labrum is a dense fibrocartilage ring that is firmly attached to the bone around the shoulder socket. It provides depth and stability to the joint. When it's torn, the shoulder can dislocate repeatedly. A Bankart tear means the labrum in the front of the shoulder is damaged.
Surgery to repair this type of injury is usually with an open incision. The results are reliable and hold up long-term. Sometimes stiffness is a problem after an open Bankart procedure. Arthroscopic repair is less invasive and there's less stiffness afterwards. Some studies report that there are more shoulder instabilities (dislocations) after arthroscopic Bankart repairs.
The patients in this study all had a traumatic event that caused a dislocation after the first operation. The surgeon who performed the repairs on these 30 patients reported some suspected risk factors for their failed surgeries. They did not follow instructions and started to move the shoulder too soon. Immobilization is advised for at least four weeks followed by physical therapy to restore motion.
When the shoulder was opened during the second surgery, the surgeon could see that there weren't enough tacks or anchors to hold the labrum in place during healing. Improper anchor placement was also noted. These factors may be the reason the repair failed. It's possible that other patients with these same risk factors have a successful result. More study is needed to find out.
Results were rated as being at least good in 80 per cent of the patients. Loss of motion and limitation in overhead throwing or serving were present in the patients with only fair results. There were no poor results and 100 per cent of the patients said they were satisfied with the outcomes. Most were able to return to their former level of sports activity.
The authors conclude that proper anchor position is important in this surgery. Stiffness after open surgery is not acceptable for athletes. Surgeons will continue to look for ways to improve the arthroscopic technique.
Domenick J. Sisto, MD. Revision of Failed Arthroscopic Bankart Repairs. In The American Journal of Sports Medicine. April 2007. Vol. 35. No. 4. Pp. 537-541.
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