Arthroscopic Bankart repair: A matched cohort comparison of the modified Mason Allen method and the simple stitch method

摘要

IntroductionArthroscopic Bankart repair (ABR) has become a standard treatment for recurrent anterior shoulder dislocation in cases with minimal bone loss. Using the standard Bankart repair technique, the failure rate has been reported to be approximately between 4 and 35%. In addition to the original injury, multiple pathologies can occur after a dislocation including a Bankart lesion, capsular redundancy and bone defects. In cases with no significant bone loss, soft tissue plays a major role in stabilizing the shoulder joint. We hypothesized that effective repair of soft tissue with good inferior capsular shifting and proper capsulolabral restoration can create a proper level of soft tissue tension so the horizontal mattress suture method should improve outcomes.Materials and methodsA retrospective cohort study was conducted by reviewing the records of patients with recurrent anterior instability who underwent ABR at a single institution between January 2009 and December 2017. Demographic information, preoperative radiographic data including glenoid bone loss, Hill-Sachs width, glenoid track and other surgical details were retrieved from the medical records. The patients identified were divided into 2 groups. Group 1 had one modified Mason Allen stitch plus simple stitches, while Group 2 had only simple stitches. Data obtained from the patient included failure rate, patient satisfaction, the ROWE score and Walch-Duplay score at a minimum of 2 years after surgery. Risk factors for failure were also identified.ResultsGroup 1 included 50 patients (mean age 27.2?±?9.4 years) who underwent modified Mason Allen stitch ABR (median follow-up, 59.2 months; range, 26.2–128.6 months). Group 2 included 30 patients (mean age 26.9?±?8.5 years) who underwent simple stitch repair ABR (median follow-up, 68.0 months; range, 24.0–127.9 months). All patients met the inclusion criteria. Evaluation at the final follow-up compared Group 1 and Group 2: ROWE score (86.8 vs 76.3, P?=?0.001), Walch-Duplay score (87.2 vs 82.0, P?=?0.035), respectively. Failure rates were 6% in group 1 compared to 10% in group 2 (P?=?0.511).ConclusionsThe modified Mason Allen stitch technique and the simple stitches technique ABR both result in excellent patient satisfaction at a minimum 2-year follow-up. Both techniques successfully restore shoulder stability, but the modified Mason Allen stitch technique results in better functional outcomes.Study designCohort study; level of evidence, 3.