Open Bankart Repair: Where do We Stand Now?
Authors: Kholinne Erica , Jeon In-Ho 
Published: November 2019

The operative treatment for recurrent traumatic anterior shoulder dislocation is classified as an anatomical or non-anatomical technique. The anatomical technique was first described for more than 80 years ago by Dr. Arthur. S. B. Bankart.

[Table: see text] Up to date, Bankart repair still is the most common procedure performed to treat recurrent anterior dislocation of the shoulder joint with Bankart lesion, the anterior-inferior labral disruption, namely as the most common pathology observed in 85% of those patients.2 At the earlier year, many orthopedic surgeons favored the open Bankart procedure for its reliable long term follow up result. Hence, open Bankart has been historically considered the gold standard in the treatment of shoulder instability. Open Bankart repair was previously a standard care, resulting in recurrence rates below 10%.3 Advocates of open Bankart surgery argue that a more anatomic and secure repair is reliably accomplished. However, arthroscopic shoulder stabilization methods have also evolved significantly during the past 25 years. Initially, there was an early disappointment for the high failure rates for arthroscopic Bankart repair as great as 49% for its trans-glenoid suturing and 23% for its bio-absorbable tack fixation.4 However, suture anchor came or should I say “save the day” and reduce the failure rates to 8 – 11% combined with capsular plication.5 United States’s data showed that arthroscopic Bankart repairs are increasingly used, from 71.2% of all cases in 2004 to 89% in 2009.6 Given the ceiling effect of a surgical learning curve in the last decade, the recurrence and failures rate should have been substantially decreased. These numbers have led to the suggestion that, could it be that arthroscopic Bankart repair with suture anchors is our ”blue ribbon” in this “competition”? Should we say ”abandon ship” now to open Bankart repair? A recent meta-analysis of open versus arthroscopic shoulder stabilization comparing 2 recent decades (the past 20 years) demonstrated there was no significant difference in improvements achieved for clinical outcomes and external rotation deficits.7 The recurrence rate for open Bankart surgery remained resolutely consistent at 10.7% (at the past 20 years) and 10.6% (at the past 10 years). The glory of arthroscopic surgery that has been taught for generations in orthopedic surgery is the ability to recon the additional intra-articular pathology with lower surgical morbidity, improved cosmesis and decreased pain. However, the earlier one can be mostly encountered by the advanced imaging system used these days. Hence, I would like to say, open Bankart surgery is considered not a history lesson and may be worthy to revisit.

References

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