AJSM Webinar Series: Management of Anterior Shoulder Instability: A Highlight of the Top 4 Articles in AJSM (2024 to 2025)-Barth - Long-term Recurrence Rates After Isolated Arthroscopic Bankart Repair

Barth - Long-term Recurrence Rates After Isolated Arthroscopic Bankart Repair

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This matched-pair cohort study compared long-term outcomes of isolated arthroscopic Bankart repair (IAB) versus the open Latarjet procedure (OLP) for recurrent anterior shoulder instability in patients without preoperative bone loss. Analyzing 685 shoulders with a mean follow-up of 9 years and 3 months, 45 IAB cases were matched 1:1 with 45 OLP cases based on demographics and clinical factors. Patients selected for IAB had no significant glenoid or humeral bone loss verified by imaging.<br /><br />Results demonstrated a significantly lower recurrence rate after OLP (2%) compared to IAB (20%) (P=0.04), with an odds ratio of 11 for instability recurrence after IAB. Kaplan-Meier analysis showed that IAB had an increasing failure rate over time, plateauing around five years but with recurrences occurring up to 14 years postoperatively, whereas OLP had no recurrences after four years. Despite the recurrence differences, both groups exhibited similar functional outcomes, including range of external rotation, pain scores, Walch and Duplay functional scores, and return-to-sport rates, though patient satisfaction was higher after OLP.<br /><br />The study highlighted that recurrence rates after IAB exceed the acceptable threshold of 5% even in patients without bone loss and suggest that the Instability Severity Index Score alone may not reliably predict failures long term. While the IAB group had less severe instability scores, their recurrence was still notably higher, indicating that OLP remains superior for durable stabilization. The study was limited by its retrospective design, single-surgeon series, and regional practice patterns favoring Latarjet, which may influence generalizability.<br /><br />In conclusion, for young active patients without bone loss, OLP provides significantly better long-term stability than IAB, with an 11-fold lower risk of recurrent instability. These findings question the role of isolated arthroscopic Bankart repair in preventing recurrent anterior shoulder instability over the long term, supporting OLP as the preferred surgical option despite similar short-term functional results.

Keywords

arthroscopic Bankart repair

open Latarjet procedure

recurrent anterior shoulder instability

long-term outcomes

isolated Bankart repair

shoulder instability recurrence

Instability Severity Index Score

functional outcomes

shoulder surgery comparison

young active patients