A recent meta-analysis of current evidence in literature compared arthroscopic Bankart repair versus non-operative management for first-time dislocators. Management of first shoulder dislocation following reduction remains controversial and decision making involves consideration of factors such as natural history and effect of surgical intervention on the natural history. This new study has concluded that first-time shoulder dislocations may benefit from Bankart repair.
Here, we’ll look at what the latest study found and what Bankart repair technique actually is.
What the study revealed
There was a total of 10 prospective studies included in the latest research, including a total of 569 patients. The aim of the review was to compare the Bankart repair method against conservative management for first-time shoulder dislocations.
A meta-analysis of current evidence was performed, with recurrence, return to play and further treatment compared. The results showed that the Bankart repair technique produced a lower rate of recurrent instability. It also resulted in an increased number of patients who could return to play. Compared to 80.8% of patients who were treated with conservative management techniques, 92.8% of Bankart repair patients could return to play.
The conclusion of the study was that Arthroscopic Bankart repair had a 7-fold decreased recurrence rate. This indicates that patients with a first-time shoulder dislocation who play sports may benefit more from the Bankart repair treatment method.
The Bankart repair technique
The Bankart repair technique is a commonly used technique to treat shoulder instability. It was first described by American orthopaedic surgeon Lanny Johnson in 1980 and it is aimed at treating Bankart lesions. In a shoulder dislocation, the labrum can pull away from the front of the socket, resulting in a Bankart lesion.
The Bankart repair technique reattaches the labrum to the socket. It is usually carried out through arthroscopy which is a minimally invasive technique. Small incisions are made before a camera is inserted to help the surgeon see what they are doing. They can repair any tears within the tendon, cartilage or muscle before stitching and closing the incisions.
Patients will usually need to keep their arm in a sling for the first month after surgery. The exact physical therapy regime depends on the extent of the repair and varies between surgeon to surgeon.
Surgical approach vs non-surgical treatment
In a review published in the Archives of Bone and Joint Surgery in 2016, London Shoulder Specialist Mr Ali Narvani and his fellow authors focused on surgery vs non-operative treatment for traumatic first-time shoulder dislocation. In particular, highlighting some of the issues that influence the decision-making process between the surgeon and the patient.
In order to determine which treatment method would be better for the patient, a number of factors need to be considered. Age, lifestyle and the severity of the dislocation will all impact which treatment method should be used. The study found that individuals younger than 25 are likely to re-dislocate without surgery which also reduces the risk of recurrent instability that appears to raise the risk of developing arthritis in the future.
If you are suffering from a first-time dislocation, it is important to undergo a consultation with a shoulder specialist. The surgeon will be able to determine the best approach based upon your individual circumstances.