Purpose of the study: There are few reports onlong-term outcome after Bankart procedure. The purpose of this study was to determine the rate of recurrent dislocation, the clinical results and the incidence of glenohumeral osteoarthritis after a minimum 10-year follow-up.

Material and methods: Ninety-seven Bankart procedures were performed in 97 patients between 1972 and 1986 for treatment of anterior shoulder instability with recurrent dislocations. We retrospectively reviewed 74 patients and obtained 64 complete radioclinical evaluations for an average follow-up of 16 years. Clinical evaluation was based on the G. Walch and the Duplay group score but for easier comparisons, we also calculated the Rowe et al. score. Radiographical evaluation was established on the Samilson and Prieto classification but real glenohumeral osteoarthritis with joint narrowing was noted independently as grade four. We also studied the contralateral shoulder.

Results: At last follow-up, 7 shoulders (9.5%) had recurrent dislocation, but two of them occurred subsequent to severe trauma over 18 months. Most patients (95%) were satisfied or very satisfied. Six patients (8.1%) had persistent apprehension but in some it was not due to anterior apprehension. According to the Duplay score (or the Rowe score), 25 shoulders (44.6%) had an excellent result (35/61.4%) 16 (28.6%) a good result (7/12.3%), 11 (19.7%) a fair result (11.19.3) and 4 (5.4%) a poor result (4/7%). Operated shoulders were pain free for 75% and painful for forced movements only for 25%. External rotation at 90° of abduction was reduced by 8.7 ± 15.7°. There was no limitation of internal rotation. Patients returned to preoperative sports activities at the same level for 70.9% and at a lower level for 12.7%. According to the Samilson classification, 7 (13%) of the shoulders had grade 2 and 2 (3.7%) had grade 3 glenohumeral osteoarthritis. We found 4 cases (7.4%) of real glenohumeral osteoarthritis (grade four) and 2 of these patients had contralateral osteoarthritis of a non unstable shoulder. There was no perioperative complication.

Discussion: In our hands the Bankart procedure is appeared as a safe procedure with a low rate of glenohumeral osteoarthritis and a high rate of patient satisfaction.

Purpose: The aims of this work were to assess very long-term outcome and to assess functional course of talocrural arthrodesis as well as to determine the clinical and radiological impact on adjacent joints.

Material and method: Fifty-two talocrural arthrodeses performed in 52 patients between 1963 and 1981 served as the reference population for this study. Clinical and radiological assessment of this series of patients was conducted in 1983, then again in 1999. Twenty-five talocrural arthrodeses in 25 patients were reviewed at a mean 23 years (19 to 36 years) (six patients were lost to follow-up, 20 had died, one had had leg amputation. The arthrodesis had been performed for advanced degenerative joint disease or to correct for post-traumatic deformity, or in two cases, for neurological varus equinus. Functional outcome was evaluated on the Duquennoy and Stahl score (100 points) that was also used for the intermediary assessment. Radiographic assessment included the position of the arthrodesis, the status of the adjacent joints (subtalar and mediotarsal), and residual motion of the forefoot.

Results: At 23 years follow-up, 13 patients (52%) had good (five patients) or very good (eight patients) function and 12 (48%) had fair function, according to the 100 point scale. There were no patients with poor function. Patients without intercurrent conditions (neurological or heart disease, obesity) had good or very good function in 80% of the cases. Patients were very satisfied in 48% of the cases, having “forgotten” their ankle. At the seven-year follow-up analysis, 15 patients (60%) had a very good (ten patients) or good (five patients) result, seven had a fair result, and three had a poor result. Comparing the 7-year and 23-year assessments did not disclose any significant degradation of the result (p = 0.07). Intercurrent conditions explained the two functional degradations, but there were also three functional improvements over the same period. Talocrural arthrodesis induced stiffness in the subtalar joint in all cases, associated with severe osteoarthritis with little clinical expression. There was a slow degradation of the mediotarsal joint but hypermobility useful for good function was maintained in 45% of the cases (mean 24°). Fair results were related to development of subtalar osteoarthritis, malposition of the arthrodesis in the frontal plane (rear foot varus) and presence of intercurrent conditions (cardiovascular, neurological disease).

Conclusion: Talocrural arthrodesis is a safe and reliable procedure for the treatment of destroyed joints. This palliative surgery can restore satisfactory function which persists in the long term.