ARTHROSCOPIC BANKART SUTURE REPAIR FOR TRAUMATIC ANTERIOR SHOULDER INSTABILITY - ANALYSIS OF THE CAUSES OF A RECURRENCE

Eighty-two patients with traumatic anterior shoulder instability were treated with an arthroscopic transglenoid multiple suture technique (C aspari's method) and followed-up for more than 2 years. A retrospectiv e analysis of the clinical outcome was performed to determine the fact ors related to poor results. The mean age at operation was 21 years (r ange, 13 to 50 years) and the mean follow-up period was 40 months (ran ge, 24 to 70 months). According to the status of the ligament-labrum c omplex and the glenoid bone defect, the Bankart lesions were classifie d into five types arthroscopically. There were 21 shoulders of type 1, 33 shoulders of type 2, 22 shoulders of type 3, and 6 shoulders of ty pe 5. Twenty-four of the patients played contact sports before the ope ration. The clinical outcome was assessed by Rowe's criteria (1978). T o analyze the factors related to a poor outcome, a multivariate analys is was done to assess the influence of 12 clinical factors (age at ope ration, age at first dislocation, sex, dominant side, disease duration , number of dislocations, sporting activity before operation, inferior joint laxity, thickness of the ligament-labrum complex, type of Banka rt lesion, number of sutures, and method of suture fixation). Fifty-fi ve of 82 patients had an excellent outcome, 14 had a good result, and 13 had a poor result. According to postoperative instability, redisloc ation was seen in 13 patients (16%), resubluxation in 2 patients (2%), with a recurrence rate of 18%. The mean limitation of external rotati on at 90 degrees abduction was 6.0 degrees (range, 0 degrees to 30 deg rees), and there was a 10 degrees loss of external rotation in 10 pati ents. The factors significantly related to recurrence were a type 3 Ba nkart lesion, playing contact sports preoperatively, a thin ligament-l abrum complex, and repair with less than four sutures. In conclusion, a 18% rate of recurrence is not acceptable. To obtain a better clinica l outcome, very careful selection of patients for this technique is ne cessary. Our analysis of the factors related to a poor outcome may hel p to decide what the proper indications are for this technique.