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From the Department of Orthopedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, Illinois, and Rush Medical College, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois
* Address correspondence to Kevin B. Freedman, MD, MSCE, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153.
Background: In published comparative studies, it remains unknown if arthroscopic techniques for performing Bankart repair for anterior shoulder instability equal the success of open repair.
Hypothesis: The current literature supports a lower rate of recurrent instability after open Bankart repair compared to arthroscopic repair with bioabsorbable tacks or transglenoid sutures.
Study Design: Meta-analysis.
Methods: A Medline search identified all randomized controlled trials or cohort studies that directly compared open repair to arthroscopic techniques of Bankart repair for traumatic, unilateral, recurrent anterior instability. Data collected from each study included patient demographics, surgical technique, rehabilitation, outcome, and complications.
Results: Six studies met all inclusion criteria. There were 172 patients in the arthroscopic group (90 patients with transglenoid sutures, 77 patients with arthroscopic tacks, and 5 patients with suture anchors) and 156 patients in the open group. The groups were similar in demographic characteristics. When comparing the arthroscopic to the open group, there was a significantly higher rate of recurrent dislocation (12.6% vs 3.4%; P = .01) and total recurrence (recurrent dislocation or subluxation) (20.3% vs 10.3%; P = .01). In addition, there was a higher proportion of patients with an excellent or good postoperative Rowe score in the open group (88%) than in the arthroscopic group (71%) (P = .01).
Conclusions: Arthroscopic Bankart repair using transglenoid sutures or bioabsorbable tacks results in a higher rate of recurrence of instability compared to open techniques. Studies comparing open repair to newer arthroscopic techniques using suture anchor fixation and capsular plication are necessary.
Key Words: Bankart • instability • shoulder • arthroscopic • repair
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