NEER MODIFIED BANKART PROCEDURE: RESULTS AFTER MORE THAN TWO YEARS

Abstract

Purpose: Neer modified the Bankart operation, adding a reinforcement crossing the capsule anteriorly on the humeral side. The purpose of this study was to report results after more than two years.

Material and methods: Between 1991 and 1998, 77 patients underwent surgery for traumatic anteroinferior instability. Clinical and radiological outcome was reviewed in 64 of this patients by an observer different from the operator at a mean follow-up of 45 months (24–120 months). Patients with a unique anterior reinforcement were excluded from the analysis. The patients were generally young (mean 27 years) with sports activities (89%). Recurrent dislocation was observed in 39 patients, subdislocation in seven and painful and unstable shoulders in seven. Ten patients had an associated hyperlaxity, defined by elbow-to-body external rotation greater than 85%, according to the SOFCOT criteria. Three patients had had a prior procedure for a coracoid bone block.

Results: According to the Duplay score: outcome was excellent in 27 cases, good in 22, fair in nine and poor in six. Mean delay to return to former occupational activity was four months; it was seven months for sports activity. The deficit in external rotation was 3.4° on the average. Ten patients had persistent apprehension. Recurrence was observed in seven patients (11%) a mean 25 months after the operation (seven days to six years) as dislocation in two and subdislocation in five and due to trauma in five cases. Young age, hyperlaxity, high-risk sports, an important humeral notch, major capsular distension, and a high number of dislocations or subdislocations were the factors associated with recurrence. According to the Samilson criteria, pre-osteoarthritic lesions of the gleno-humeral joint were present in two cases preoperatively (one grade I and one grade II) and in eight cases postoperatively (four grade I, three grade II, and one grade III).

Discussion, conclusion: The Bankart operation as modified by Neer does not produce a stiff joint as is thought by many, probably due to the upper-lower capsular retention rather than lateral-medial retention. Nevertheless, the stability results are less satisfactory than generally reported for coracoid stop procedures.