Aims

The aim of this study was to identify risk factors for recurrent instability of the shoulder and assess the ability to return to sport in patients with engaging Hill-Sachs lesions treated with arthroscopic Bankart repair and Hill-Sachs remplissage (ABR-HSR).

Introduction The standard surgical practice for athletes with recurrent anterior shoulder instability who play contact or collision sports is to perform either the Bankart repair or Bristow procedure. The purpose of this study was to investigate the outcome of a combined Bankart and Bristow procedure for recurrent anterior shoulder instability in high contact and collision athletes. Methods Ninety-one patients underwent 100 combined Bankart and Bristow procedures for anterior shoulder instability (nine bilateral cases). Combined procedures were indicated in athletes participating in contact and collision sports. We were able to follow-up 71% of cases (71 shoulders in 65 patients) at an average of 6.5 years after surgery (range 2.1 to 12.3 years). The average age at the time of surgery was 23 years (range 15 to 47 years). There were 63 males and only two females. All patients were participating in competitive level sport at the time of injury of which 76.1% was rugby. A Rowe rating was calculated for each patient. Results Forty-four percent were graded excellent, 18% good, 27% fair and 11% poor. Overall 66% of athletes returned to their pre-injury level of sport or better, whilst 25% return to a lower level of their sport. Nine percent did not return to sport after surgery. This cohort included 37 professional or semi-professional players of whom 73% were able to return to their pre-morbid or a higher level of sport. Only six percent have experienced further dislocations since surgery. A further 12% have experienced shoulder subluxation and another 19% report feelings of insecurity. Four percent have required an additional procedure. Eighty-nine reported no or only mild limitation of function or discomfort and 87% were either very satisfied or satisfied with their outcome. Conclusions The combined open Bankart repair and Bristow procedures gives good results in athletes who participate in contact and collision sports. It has proved to be a robust procedure in the long term, allowing almost 75% of professional and semi-professional athletes to return to the same level or higher of sporting participation

Arthroscopic stabilisation of the shoulder is a technically-demanding and developing technique, and the reported results have yet to match those for open surgery. We present a consecutive initial series of 55 patients with post-traumatic recurrent anteroinferior instability managed since September 1999 using a titanium knotless suture anchor. Patients were reviewed from 12–33 months postoperatively and assessed using the Rowe, Walch-Duplay and Constant scores. Following mobilisation of the capsulolabral complex, labral reconstruction was achieved using a two-portal technique and an average of three anchors placed on the glenoid articular rim. In 13 cases, additional electrothermal shrinkage was required to reduce capsular redundancy in the anterior and inferior recesses following labral repair, although 11 of these were in the first 18 months. Incorporation of a south-to-north capsular shift has reduced the need for supplementary shrinkage. Complications have included one instance of anchor migration requiring open retrieval and two documented episodes of recurrent instability, although these occurred in patients having surgery within the first six months after the introduction of this technique. Based on our initial experience, we believe that arthroscopic labral repair is a viable alternative to open Bankart repair and have now expanded the indications to include patients with primary dislocation, those participating in gymnastic and contact/collision sports, and revision cases with failed open repairs

A systematic search of the literature published between January 1985 and February 2006 identified 62 studies which reported the results of arthroscopic procedures for chronic anterior shoulder instability or comparisons between arthroscopic and open surgery. These studies were classified by surgical technique and research methodology, and when appropriate, were included in a meta-analysis.

The failure rate of arthroscopic shoulder stabilisation using staples or transglenoid suture techniques appeared to be significantly higher than that of either open surgery or arthroscopic stabilisation using suture anchors or bio-absorbable tacks. Arthroscopic anterior stabilisation using the most effective techniques has a similar rate of failure to open stabilisation after two years.