Arthroscopic Bankart Repair With a 6 o'Clock Anchor Reduces Recurrence and Improves Clinical Outcomes in Recurrent Anterior Instability.
TL;DR
Placement of the most inferior suture anchor at the 6 o'clock position during an arthroscopic Bankart repair was associated with significantly lower recurrence rates and better clinical outcomes than in the non-6 o'clock anchor group.
Abstract
Purpose
To evaluate the clinical effectiveness of placing the most inferior suture anchor at the 6 o'clock position during arthroscopic Bankart repair compared with non-6 o'clock anchor repair for recurrent anterior shoulder instability.
Methods
From January 2012 to December 2022, this retrospective study included patients with recurrent anterior shoulder instability and anteroinferior labral tears, without significant glenoid bone loss, who underwent arthroscopic Bankart repair and had at least 2 years of follow-up. Patients were categorized into 2 groups based on the placement of a 6 o'clock anchor. Clinical outcomes-including the Korean Shoulder Score for Instability; Rowe score; and University of California, Los Angeles score-pain, range of motion, and recurrence rates were assessed at the final follow-up (>2 years). Recurrence was defined as a positive apprehension sign, subluxation, or redislocation. Multivariate logistic regression was used to identify independent risk factors for recurrence. For each clinical score, the minimum clinically important difference was calculated using a cohort-specific distribution-based method, defined as 0.5 standard deviation of the change in score.
Results
Overall, 136 patients were included (6 o'clock, n = 79; non-6 o'clock, n = 57). The recurrence rate was significantly lower in the 6 o'clock anchor group (10.1%) than in the non-6 o'clock group (26.3%; P = .024). The multivariate analysis revealed the presence of a 6 o'clock anchor as an independent factor associated with reduced recurrence (odds ratio: 2.89; 95% confidence interval: 1.13-7.37; P = .027). The 6 o'clock anchor group showed significantly higher Korean Shoulder Score for Instability (92.4 ± 9.5 vs 87.5 ± 13.2; P = .040), Rowe (93.4 ± 10.3 vs 86.3 ± 16.8; P = .012), and University of California, Los Angeles (32.5 ± 3.0 vs 30.2 ± 4.1; P = .003) scores. There were no significant between-group differences in minimum clinically important difference achievement rates between the 6 o'clock and non-6 o'clock anchor groups for the Korean Shoulder Score for Instability (91.1% vs 84.2%; P = .282), Rowe score (89.9% vs 80.7%; P = .141), or University of California, Los Angeles score (88.6% vs 77.2%; P = .099). No significant between-group differences were observed in the postoperative range of motion.
Conclusions
Minimum clinically important difference achievement rates were high in both groups, with no significant differences. However, placement of the most inferior suture anchor at the 6 o'clock position during an arthroscopic Bankart repair was associated with significantly lower recurrence rates and better clinical outcomes than in the non-6 o'clock anchor group. LEVEL OF EVIDENCE Level III, retrospective cohort study.