Mini-invasive open surgery Bankart repair for recurrent traumatic shoulder instability: a single surgeon/single institution's experience

Abstract

Background: Primary traumatic anterior dislocations of the shoulder are common injuries which are complicated by persistent instability in a high proportion of patients. Surgery is successful and has been well described in the literature. Current scientific debate centres on the role of open and arthroscopic techniques. We describe the outcomes of a mini-invasive open surgery modified Bankart technique which was developed within our institution.

Methods: Twenty-six patients with traumatic shoulder instability (one bilateral) were prospectively entered into a database between June 1998 and March 2008. The mean age was 28 years, and the mean follow-up period was 58 months. Twenty-seven shoulders underwent shoulder arthroscopy and mini-invasive open surgery using a delto-pectoral approach with subscapularis muscle split and three bio-absorbable anchor-fixations of the avulsed Bankart–labrum–capsule complex.

Results: Patients reported no re-dislocation in 24 shoulders (89%). Three shoulders re-dislocated with additional trauma. Satisfaction was very good in 16 and good in nine shoulders (93%). Nineteen patients had minimal or no pain. Seven patients experienced moderate shoulder pain, and none complained of severe pain. VAS and QuickDASH (Disability Arm Shoulder Hand) scores were encouraging.

Conclusions: Our technique combines the ability to appreciate all shoulder pathology arthroscopically with the visualisation and operative tissue handling gained in open Bankart surgery. This technique facilitates to judge the need for anterior capsular shift and perform it in an open procedure without detachment of subscapularis muscle. Functionally, patients do well. The low re-dislocation rate, only reported after significant additional trauma, is encouraging. We feel that long-term outcomes are needed using larger cohorts of patients to identify if this technique will fulfil its promise.