The clinical and functional outcome of arthroscopic bankart repair in recurrent shoulder dislocation

Abstract

Background: Study aimed to assess the functional and clinical outcome of arthroscopic bankart's repair in recurrent shoulder dislocation using UCLA & SST scoring system. Methods: It is a prospective cohort study conducted on the 28 patients undergoing arthroscopic bankart's repair for recurrent shoulder dislocation in the department of orthopaedics at vydehi institute of medical sciences and research centre, bengaluru from September 2017 to October 2019. Patients aged between 18-50 years of both genders undergoing arthroscopic bankart repair with anterior instability of glenohumeral joint with at least ≥2 episode of dislocation/subluxation, a positive clinical apprehension test and radiological evidence of glenohumeral instability and glenoid bone loss < 25% were included in the study and patients with glenoid bone loss >25%, contact sports athletes, previously failed arthroscopy or open surgery, seizure disorder, multidirectional instability/habitual dislocation were exclueded. Each case was followed post operatively for atleast 1 year. Results: This series consisted of 28 patients, with the mean follow up period of 12 months, the mean pre-operative UCLA score of 18 improved to 31.75 post operatively, the mean pre-operative SST score of 4.89 improved to 10.96 post operatively. Out of 28 patients none had episodes of recurrent dislocation and anterior translation or apprehension. External rotation in 90º of abduction improved in 25 patients (89%). Conclusion: we conclude that arthroscopic bankart's repair in recurrent shoulder dislocation with suture anchors is a reliable procedure with respect to shoulder function, recurrence rate and range of movement. Introduction Glenohumeral dislocation is a common entity and represents more than 50% of all joint dislocations with anterior dislocation being most common with overall incidence of 2% [1]. The shoulder is unstable joint due to its shallow glenoid that only articulates with a small part of the humeral head [2-6]. Recurrent dislocation of the shoulder is the leading complication of anterior glenohumeral dislocation and it accounts for an average of 70-90% recurrence rate in patients aged 20 to 40 years [7]. Forced abduction and external rotation of the shoulder can cause anterior dislocation resulting in instability [8]. Dislocation of shoulder involves a tear of the inferior capsuloligamentous complex and labrum from the anterior inferior glenoid most of the times (97%) [9]. Avulsion of this anterior inferior labrum from the glenoid rim was first described by Perthes [10] and Bankart [11] in the early 20th century. Bankart lesion is found in over 80% of shoulders with recurrent shoulder instability [12-13]. The frequency of dislocation keeps increasing with time and overhead activity, and it is termed as recurrent when dislocation occurs more than once [14]. The standard procedure for operative treatment of anterior glenohumeral instability is an open Bankart type procedure [15-16] , which closely restores normal anatomy. Recurrent instability rates with this type of procedure averaged as low as 7%. Despite these excellent results, there has been growing interest in the arthroscopic management of anterior glenohumeral instability because of the advantages like less morbidity, shorter time of surgery, improved range of motion, improved cosmesis, and less post-operative pain [17] The purpose of present study is to verify functional outcome of the patients with recurrent dislocation of shoulder with Bankart lesion, treated with arthroscopic stabilization with suture anchors.