• Philipp Moroder, Marco Odorizzi, Severino Pizzinini, Ernst Demetz, Herbert Resch, and Peter Moroder.
• Department of Traumatology and Sports Injuries, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria.
• J Bone Joint Surg Am. 2015 Sep 2;97(17):1398-405.

BackgroundNeglected osseous glenoid defects are thought to be one of the reasons for the reported high rates of recurrent instability at long-term follow-up after Bankart repair. We hypothesized that open Bankart repair for the treatment of anterior glenohumeral instability in the absence of a substantial osseous glenoid defect would result in a lower long-term recurrence rate than has been reported in previous long-term studies.MethodsForty-seven patients were treated with a primary modified open Bankart repair for recurrent anterior shoulder instability between 1989 and 1994. Double-contrast computed tomography scanning was used to exclude patients with a substantial osseous glenoid defect. Forty patients (85.1%) were available for subjective and objective follow-up at a minimum of twenty years (maximum, twenty-five years). Twenty-six patients (65%) underwent clinical examination as well as bilateral shoulder radiography, and fourteen (35%) completed a self-assessment questionnaire and were interviewed by telephone.ResultsSeven patients (17.5%) had a recurrence of instability, and six of them had the instability occur after more than eight years without symptoms. The mean Western Ontario Shoulder Instability Index score (and standard deviation) was 256.7 ± 284.8 points; the mean Rowe score, 88.7 ± 12.0 points; and the mean Subjective Shoulder Value, 90.1% ± 10.5%.The mean range of motion of the affected shoulder was decreased by 4° of abduction (p = 0.009), two levels of internal rotation (p = 0.003), 5° of internal rotation in 90° of abduction (p = 0.005), 7° of external rotation in neutral position (p < 0.001), and 7° of external rotation in 90° of abduction (p = 0.004) compared with the contralateral side. The collective instability arthropathy (CIA) index was 0.92 for the affected side and 0.35 for the contralateral side.ConclusionsOpen Bankart repair provides good results twenty years after surgery in terms of subjective and objective outcome measurements. However, the long-term failure rate remains high despite the exclusion of substantial osseous glenoid defects. Recurrence of instability seems to be associated with an increased shoulder-specific activity level.Level Of EvidenceTherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

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