Clinical and Functional Outcomes After Arthroscopic Bankart Repair After a Median Follow-up of 23 Years

Background: Previous studies have shown that arthroscopic Bankart repair (ABR) for the treatment of anterior shoulder instability (ASI) may lead to high rates of instability recurrence and revision surgery at 10-year follow-up, but data on 20-year postoperative outcomes are scarce. Purpose/Hypothesis: The purpose was to evaluate the clinical and functional outcomes after ABR for the treatment of ASI at long-term follow-up. It was hypothesized that ABR would be associated with high rates of revision surgery, reinstability, and redislocation, but good to excellent shoulder function. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent ABR for the treatment of ASI at least 20 years ago and had initially been followed up after a minimum 10 years postoperatively were eligible to participate. Rates of revision surgery, subjective reinstability, and redislocations were evaluated, as were patient-reported outcome measures, including the American Shoulder and Elbow Surgeons score and Constant-Murley score. Results: In total, 82 patients were followed up at a median 23.0 years (IQR, 23.0-25.0) postoperatively. Twenty-eight patients (34.1%) had any kind of instability recurrence: 13 (15.9%) had reinstability at follow-up, 9 (11.0%) reported redislocations postoperatively, and 6 patients (7.3%) had both. Of those patients, 12 (42.9%) did not report instability at the previous minimum 10-year follow-up. Six patients who experienced redislocations underwent further surgery. Ten more patients underwent revision surgery for reasons other than redislocation. All patients who underwent revision surgery (n = 16; 19.5%) were excluded from further analysis. In patients who did not undergo revision surgery, shoulder function was good to excellent (median [IQR]; American Shoulder and Elbow Surgeons score, 95.0 [88.5-100]; Constant-Murley score, 87.5 [76.8-95.0]). Inferior glenohumeral laxity was associated with subjective reinstability (odds ratio, 7.214 [95% CI, 1.266-41.096]; P = .026). The use of fewer suture anchors for ABR was associated with redislocations (median [IQR]; no redislocation, 3.0 [3.0-4.0]; redislocation, 3.0 [2.0-3.0]; P = .016). Conclusion: About 1 in 3 patients reported instability recurrence or redislocations, and 1 in 5 underwent further surgery. In patients who did not undergo further surgery, good to excellent shoulder function as well as low pain and instability levels were observed at a minimum 20 years after ABR. The presence of inferior glenohumeral laxity was associated with a higher risk for subjective reinstability, and the use of fewer anchors was associated with redislocations.