AOSSM/AANA Specialty Day 2020-Revision Arthroscopic Bankart Repair in the Military

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This study by Jonathan F. Dickens et al. examines the outcomes of revision arthroscopic Bankart repair for failed primary arthroscopic Bankart stabilization in a high-demand military population. Primary arthroscopic Bankart repairs have a 5-15% recurrence rate, and revision has traditionally been performed with open procedures, which have higher stiffness and pain and still reported up to 22% recurrent instability. The viability of revision arthroscopic stabilization remains unclear, with prior studies limited by small sample sizes and short follow-up.<br /><br />The study prospectively analyzed 41 cases of revision arthroscopic Bankart repair out of 1030 shoulder stabilization surgeries between 2005-2016, focusing on patients without significant glenoid bone loss (>20%). The mean patient age was 22.9 years, with a mean follow-up of 7.8 years. The primary outcome was the ability to return to military duty without recurrent instability.<br /><br />Results showed a 44% failure rate of the revision surgery, with 56% success in returning to duty without recurrence. There were no significant differences between successful and failed groups regarding age, mechanism of injury, time to reinjury, bone loss (mean glenoid bone loss ~6%), or concomitant pathologies like Hill-Sachs lesions. Failures tended to occur later, with some occurring more than three years post-revision. The study noted a trend toward shorter time to reinjury after the index surgery in those who failed revision.<br /><br />Discussion highlighted that the failure rate of arthroscopic revision is higher than primary arthroscopic or open revision procedures, which may be better suited for managing capsular laxity and volume critical in this young, active population. The authors suggest durable soft tissue repair is essential, not just addressing bone loss, and emphasize the importance of long-term follow-up.<br /><br />In conclusion, revision arthroscopic Bankart repair has a substantial failure rate (44%) in high-demand young military patients, warranting consideration of alternative surgical strategies and careful patient selection.

Asset Caption

Sean E. Slaven, M.D., Michael A. Donohue, M.D., Robert A. Tardif, M.D., Kevin A. Foley, M.D., Kenneth L. Cameron, Ph.D., M.P.H., A.T.C., Jeffrey R. Giuliani, M.D., Matthew A. Posner, M.D., Jonathan F. Dickens, M.D.

Keywords

revision arthroscopic Bankart repair

failed primary Bankart stabilization

high-demand military population

shoulder stabilization surgery

recurrence rate

glenoid bone loss

return to military duty

failure rate

capsular laxity

long-term follow-up