Anterior shoulder instability in patients older than 40 years treated with arthroscopic Bankart repair.
Background: Anterior shoulder instability in adults aged ≥40 years is frequently managed nonoperatively. There is limited published evidence for the surgical management of these patients. This study aims to assess the risk of recurrence and functional outcomes in older adults after arthroscopic Bankart repair (ARB).
Methods: A retrospective review of patients who underwent ARB by a single surgeon with a minimum of 2-year follow-up was performed. Recurrence, visual analog scale (VAS) score for pain, satisfaction, Subjective Shoulder Value (SSV), Rowe and Constant scores, along with rate, level, and timing of return to work and sport were evaluated.
Results: Overall, 51 patients who underwent ABR were included; there were 35 males (69%). The mean age was 46.9 ± 6.4 years, with mean follow-up of 77.9 ± 32.6 months (range 25-138 months). At final follow-up, 88% (45 of 51) were either satisfied or very satisfied. The mean SSV was 87.4 ± 14, the mean Constant score was 80.4 ± 19.6, and the mean Rowe score was 80.4 ± 19.6, whereas the mean VAS score was 2.2 ± 2.6. Overall, 45 of 47 patients (95.7%) returned to work at a mean of 5.7 ± 4.6 weeks (range 0-16). Of the 43 patients playing sport preoperatively, 81.4% returned to play at a mean of 6.5 ± 3.8 months, and 53.5% returned at the same level. However, only 27.3% of collision and 42.9% of overhead athletes returned at the same level. There were 4 patients (7.8%) who had a postoperative dislocation, all of which were traumatic. There were two revision (3.9%) arthroscopic stabilizations, whereas a total 8 patients (15%) had further procedures.
Conclusions: Arthroscopic stabilization in patients older than 40 years results in a high rate of satisfaction, good functional outcomes, and low pain scores at medium- to long-term follow-up. There was a high rate of return to play and work, although most returned to play at a lower level. There was a low rate of recurrent instability and a moderate rate of reoperation, with contact sports being the primary cause of recurrence.