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From the Southern California Permanente Medical Group, San Diego, California
* Address correspondence to Raymond A. Sachs, MD, Southern California Permanente Medical Group, Department of Orthopedic Surgery, 250 Travelodge Drive, El Cajon, CA 92020 (e-mail: raymond.a.sachs{at}kp.org).
Background: The potential weakness of the open Bankart procedure is the takedown and repair of the subscapularis tendon. It is not known to what extent this part of the procedure affects the final result.
Hypothesis: The function of the subscapularis muscle after surgery will be related to the patient’s perception of surgical success.
Study Design: Cohort study; Level of evidence, 2.
Methods: A total of 30 patients with traumatic anterior instability had an open Bankart repair by a single surgeon. These patients were observed for a mean of 4 years. At final follow-up, the patients filled out 3 self-assessment forms: the American Shoulder and Elbow Surgeons scale, the Western Ontario Shoulder Instability Index, and the Constant and Murley scale. An independent physician performed a complete physical examination. Strength testing of all muscle groups was performed and compared with the opposite normal side.
Results: Multiple factors were related to the patient’s perception of the result. Only subscapularis function was found to have a statistically significant correlation. Of the patients, 23% had an incompetent subscapularis with a mean of 27% strength as compared with the opposite side. These patients had a positive lift-off test result and reported 57% good and excellent results; only 57% would have the surgery again. Of the patients, 77% had a normal functioning subscapularis with at least 80% strength as compared with the opposite side. These patients had a negative lift-off test result and had 91% good and excellent results; 100% would have the surgery again. The Western Ontario Shoulder Instability Index was the only scale that differentiated between a patient with subscapularis function and a patient without subscapularis function.
Conclusion: Postoperative subscapularis function was the most critical factor in determining the patient’s perception of surgical success.
Clinical Relevance: It is likely that handling of the subscapularis tendon during surgery and protection of the subscapularis in the first weeks after surgery are critical to the success of the open Bankart repair.
Key Words: subscapularis • Bankart • shoulder • instability
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