J Shoulder Elbow Surg (2012) 21, 350-355

www.elsevier.com/locate/ymse

Arthrosis of glenohumeral joint after arthroscopic

Bankart repair: a long-term follow-up of 13 years
Lauri Kavaja, MBa,*, Jarkko Pajarinen, MD, PhDb, Ilkka Sinisaari, MD, PhDb,
Vesa Savolainen, MD, PhDb, Jan-Magnus Bjo €rkenheim, MD, PhDb,
Ville Haapam€aki, MD, PhDc, Mika Paavola, MD, PhDb,d

a
Medical Faculty, University of Helsinki, Helsinki, Finland
b
Department of Orthopedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
c
Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
d
Centre for Health and Social Economics, Institute of Health and Welfare, Helsinki, Finland

Hypothesis: The purpose of the study was to establish radiologic and clinical occurrence of glenohumeral
arthrosis after arthroscopic Bankart repair.
Materials and methods: Between January 1994 and December 1998, an arthroscopic Bankart repair was
performed in 187 patients at our institution. We were able to assess clinical and radiologic glenohumeral
arthrosis in 72 of the 101 patients who met the inclusion criteria (74 shoulders) (71%) after a 13-year
follow-up. An additional 9 patients were interviewed by telephone. Radiologic arthrosis was evaluated
with the Samilson-Prieto classification and clinical arthrosis with an arthrosis-specific quality-of-life ques-
tionnaire (Western Ontario Osteoarthritis of the Shoulder test). In addition, functional impairment was
assessed with the Constant score and subjective satisfaction with a questionnaire.
Results: Radiologic arthrosis was diagnosed in 50 of 74 shoulders (68%), with 40 (80%) of them classified
as mild. The mean score on the Western Ontario Osteoarthritis of the Shoulder questionnaire was 280
points (85% of the best possible score), which is considered relatively good. The mean Constant score
was 78 points, and 75% of the patients were extremely satisfied or satisfied with the final results of oper-
ative treatment.
Discussion: The radiologic evaluation and self-assessment of the patients imply that the incidence of gle-
nohumeral arthrosis after arthroscopic Bankart repair is quite common but the symptoms are generally mild
and comparable to nonoperative treatment.
Conclusion: Arthrosis rarely causes more than minor subjective symptoms or a minor objectively
perceived disadvantage during 13 years’ follow-up.
Level of evidence: Level IV, Case Series, Treatment Study.
Ó 2012 Journal of Shoulder and Elbow Surgery Board of Trustees.
Keywords: Shoulder; arthroscopy; Bankart repair; arthrosis; Samilson-Prieto classification; WOOS

This study was approved by the Ethical Committee of Helsinki University
Central Hospital (No. 114/13/03/02/09).
*Reprint requests: Lauri Kavaja, MB, HUCH T€o€ol€o Hospital, Tope-
liuksenkatu 5, FIN-00029 HUS, Finland.
E-mail address: lauri.kavaja@helsinki.fi (L. Kavaja).
The shoulder joint has the widest range of motion of all
human joints. The stability of the joint is based mostly on the
coordination of the joint capsule and the supporting muscles,
whereas the joint is relatively unstable because of its bony

1058-2746/$ - see front matter Ó 2012 Journal of Shoulder and Elbow Surgery Board of Trustees.
doi:10.1016/j.jse.2011.04.023
Shoulder arthrosis after arthroscopic Bankart repair
and cartilaginous structures. The glenoid labrum, a crucial
stabilizer of the joint, is frequently torn from the anterior
glenoid in traumatic glenohumeral dislocation. This injury,
called the Bankart lesion,2 is considered the most common
cause of recurrent glenohumeral instability.3,5,27,29,31,34,44
In case of primary shoulder dislocation, operative
treatment is seldom needed. However, if shoulder insta-
bility with recurrent dislocations or subluxations persists
during or after appropriately executed conservative treat-
ment, surgery is often considered as the treatment of
choice.24 The most common surgical method nowadays is
an arthroscopic Bankart repair, in which the torn labrum
undergoes refixation to the anterior glenoid rim.1,14,27,34
The incidence of glenohumeral arthrosis after conserva-
tive treatment of traumatic anterior shoulder dislocation in
a long-term follow-up of 25 years has been reported to be as
high as 60% (97 of 161 shoulders).15 Although the results
after long-term follow-up of arthroscopic Bankart repair
have been reported widely,5,6,12,19,20,23,24,26,27,33 the focus in
these studies has been on the functional outcome and joint
stability whereas the occurrence of glenohumeral arthrosis
after surgery has not been studied in detail. The aim of our
study is to establish the radiologic and clinical occurrence of
glenohumeral arthrosis after arthroscopic Bankart repair.
Materials and methods
A retrospective medical record review was performed to identify
arthroscopic Bankart repair performed in patients at our institution
between January 1994 and December 1998. Of the 187 patients
found, 101 met the inclusion criteria of the study: the primary
dislocation was of traumatic origin (sports injury in 46 shoulders
[55%]), there was anterior-inferior instability with a Bankart lesion,
the patient was operated on by an arthroscopic Bankart procedure
(refixation of anterior labral lesion), and the patient had not had
previous surgeries to the shoulder region. Patients who had shown
posterior or multidirectional instability during the preoperative
clinical evaluation or during anesthesia and those with congenital
instability of the shoulder were excluded from the study. Our patient
material is described in Table I. All patients gave informed consent.
Initial shoulder surgery was performed by the senior author
(J.-M.B.). The patient was lying in the beach-chair position under
general anesthesia. A standard posterior portal and an anterior
portal above the subscapularis tendon were established. After
general evaluation of the glenohumeral joint, the anterior labral
lesion was evaluated. A rasp was used to free up the anterior
capsulolabral structures from the neck of the glenoid. A bur was
then used to create a raw bleeding bony surface throughout the
length of the anterior labral lesion. A Suretac fixation tack
(Acufex Microsurgical, Mansfield, MA, USA) was then intro-
duced over the guidewire and was seated with use of a cannulated
driver. The procedure was repeated with a second tack. If the
second Suretac fixation tack did not secure the whole lesion,
a repair was performed with use of 1 or 2 more intra-articularly
positioned tacks. After surgery, the patients were immobilized for
a period of 3 weeks and followed a rehabilitation protocol
including active-assisted range-of-motion exercises, isometric
351
Table I Patient characteristics in 81 patients (83 shoulders)
with 13-year follow-up after arthroscopic Bankart repair
Data
No. of patients 81
No. of female patients 21
No. of male patients 60
No. of shoulders operated on 83
Age at time of surgery 29  9 (range, 15-59)
(mean  SD) (y)
Dislocations before initial surgery
[No. of shoulders (%)]
1 28 (34%)
2-5 20 (24%)
5-10 10 (12%)
>10 25 (30%)
Delay from primary dislocation 5  8 (range, 0-38)
to surgery (mean  SD) (y)
No. of patients with reoperations 12 (mean, 1.5 surgeries)
due to recurrent instability
We assessed 72 patients (74 shoulders) clinically, 2 patients had
a bilateral complaint, and an additional 9 patients were interviewed.
and concentric strengthening, and a limited return to sports at
3 months. Routine postoperative assessments were conducted at 2
weeks, 3 months, and 6 months by the surgeon.
Of the initial 101 patients, 72 (74 shoulders) (71%) were
assessed clinically and radiologically after a mean follow-up of
13 years (range, 11-15 years). Nine patients were unable to attend
the final follow-up visit and were interviewed by telephone.
Regarding the missing 20 patients, a mailing address was
unavailable for 6, 8 were not reached regardless of numerous
attempts, 3 lived abroad, and 3 did not want to take part in the
study.
At the final follow-up, radiographs were taken from both
shoulders with anteroposterior and axillary projections. Joint
arthrosis was evaluated by the Samilson-Prieto classification,39
which defines arthrosis by the size and presence of osteophytes,
narrowed joint gap, and subchondral sclerosis (0, normal gleno-
humeral joint; 1, mild arthrosis [inferior humeral or glenoid
osteophytes <3 mm] (Fig. 1, A); 2, moderate arthrosis [inferior
humeral or glenoid osteophytes measuring 3-7 mm] (Fig. 1, B); or
3, severe arthrosis [osteophytes >7 mm with or without articular
incongruence] (Fig. 1, C)). Radiologic evaluation was performed
by an independent radiologist.
The patients answered questionnaires evaluating arthrosis-
specific quality of life (Western Ontario Osteoarthritis of the
Shoulder [WOOS] test)25 and instability-specific quality of life
(Western Ontario Shoulder Instability Index [WOSI]).22
Functional status of the shoulder was assessed by the Constant
score.11 Subjective satisfaction of the patients was evaluated by
questions measuring symptoms and inconvenience. Clinically, the
shoulder stability was measured by the sulcus sign, apprehension
test, relocation test, and anterior and posterior load-and-shift tests.
Range of motion was tested in elevation, abduction, external
rotation, and internal rotation (humerus in 90
of abduction).
Descriptive statistics were summarized for subject demo-
graphic data. Microsoft Excel 2007 software (Microsoft, Seattle,
WA, USA) was used for statistical analysis.
352
Figure 1 In the Samilson-Prieto classification, arthrosis is defined by the size and presence of osteophytes, narrowed joint gap, and sub-
chondral sclerosis. (A) In mild arthrosis, glenoid osteophytes are less than 3 mm in size; (B) in moderate arthrosis, inferior humeral or glenoid
osteophytes are 3 to 7 mm in size; and (C) in severe arthrosis, osteophytes are more than 7 mm with or without articular incongruence.
Results
Glenohumeral arthrosis was found on the radiographs in 50
of 74 shoulders (68%). In most of the cases (40 of 50 [80%]),
arthrosis was classified as mild with the Samilson-Prieto
classification. Arthrosis in the contralateral shoulder was less
frequent. There were no lytic changes of the glenoid seen
radiologically. The mean score on the arthrosis-specific
WOOS questionnaire was 280 (range, 14-1447; SD, 307),
which equates to 85% of the best possible score. The mean
score of interviewed patients was 144 (range, 26-399; SD,
129), which equates to 92% of the best possible score.
Radiologic arthrosis and clinical arthrosis are described in
Table II.
The mean score on the instability-specific WOSI
questionnaire was 456 (range, 13-1920; SD, 429), which
equates to 78% of the best possible score. The mean
score of interviewed patients was 278 (range, 95-824;
SD, 230), which equates to 87% of the best possible
score. Subjective symptom questionnaires are described
in Table III.
The mean Constant score was 78 points (range, 20-94;
SD, 15). Forward elevation was on average 160
; abduc-
tion, 150
; external rotation, 55
; and internal rotation,
50
. On clinical stability testing, 47 of 74 shoulders tested
(64%) were classified as stable whereas 36% of patients
had mild anterior instability, which was mostly manifested
by pain on the apprehension test and laxity on the anterior
load-and-shift test. Of the 81 operated patients, 24 (30%)
reported disturbances in daily routines; disturbances in
sports/recreation/work were reported in 28 of 81 (35%). Of
the 81 patients, 30 (37%) reported no disturbance at all
during the last year. The disturbance was mostly dependent
on recurrent instability. Of the 19 patients who had redis-
locations in our material, 4 had had reoperations and
positive apprehension tests.
L. Kavaja et al.
Discussion
Radiologic arthrosis was found in 50 of 74 shoulders (68%)
after Bankart repair at 13 years’ follow-up. However, the
arthrosis was mild in most cases, and according to the clinical
tests and specific questionnaires, the patients with mild
radiologic arthrosis did as well as patients with no radiologic
arthrosis. In the contralateral shoulder, radiologic arthrosis
was less frequent and usually associated with injuries and/or
other operations. Results of the WOOS (280 points [85%]) and
the WOSI questionnaires (456 points [78%]) were relatively
good in our study when the age and sex distribution of our
patients was taken into account. Clarke et al.9 have reported
the normal value on the WOSI questionnaire in symptomless
shoulders in a young and active population of male patients to
be 82.7 points, which is 96.1% of the best possible score. This
difference between patients assessed and interviewed may
reflect that the patients with fewer complaints might be less
adherent to long-term follow-up assessment.
The best possible score that a patient can receive on the
WOSI questionnaire is 0 points, which equates to 100%. It
can also be stated that the fewer points patients have, the
fewer symptoms they have. The WOSI score, on average
78%, applies only to instability symptoms. It can be consid-
ered that although 36% of patients show instability on clinical
tests, the patients are asymptomatic or have been habituated
to avoid activity that cause instability or subluxation.
The satisfaction rate of 75% refers to satisfaction
regarding the condition as a whole. The main reasons why
patients have not been satisfied are some limitation in range
of motion and habituation to avoid activities that promoted
instability before the primary operation. Only 2 patients
reported pain to be the main complaint, which would refer
to a limitation caused by arthrosis.
There are certain limitations in our study, and they
require some attention. First, our study is retrospective, and
Shoulder arthrosis after arthroscopic Bankart repair 353

Table II Data regarding arthrosis of glenohumeral joint in 74 shoulders (72 patients) with 13-year follow-up after arthroscopic
Bankart repair
Data
Radiologic arthrosis according to Samilson-Prieto classification)
Operated shoulder
No arthrosis (0) 24 (32.4%)
Mild arthrosis (1) 40 (54.0%)
Moderate arthrosis (2) 9 (12.2%)
Severe arthrosis (3) 1 (1.4%)
Contralateral shouldery
No arthrosis (0) 54 (77.1%)
Mild arthrosis (1) 15 (21.4%)
Moderate arthrosis (2) 1 (1.4%)
WOOS (mean  SD)z
Total (1900 points) 280  307 (range, 14-1447) (85%)
Physical symptoms (600 points) 95  96 (range, 0-445) (84%)
Sports/recreation/work (500 points) 86  105 (range, 1-460) (83%)
Lifestyle (500 points) 60  85 (range, 0-421) (88%)
Emotions (300 points) 40  49 (range, 0-200) (87%)
Radiologic arthrosis was evaluated with standard radiographic projections. Clinical arthrosis was evaluated with the WOOS questionnaire in an additional
9 patients without radiography.
) Samilson-Prieto classification: 0, normal glenohumeral joint; 1, mild arthrosis (osteophytes in humerus <3 mm); 2, moderate arthrosis (osteophytes

in humerus or on glenoid measuring 3-7 mm); or 3, severe arthrosis (osteophytes >7 mm with or without articular incongruence).
y
There were 70 shoulders; in 2 of the 72 patients in total, both shoulders had been operated on.
z
The best raw score is 0 points, and this can be converted into a clinically more favorable form: [(1900eRaw points)/1900]  100%. In a symptomless
shoulder, the score is 100%, and in the worst case, 0%.

it introduces an element of uncertainty as to the original

Table III Subjective results in 81 patients (83 shoulders)
circumstances and energy of the primary dislocation, as
with 13-year follow-up after arthroscopic Bankart repair
well as the number of subsequent dislocations. Second, in
our patients, the Bankart repair has been performed by use Data
of biodegradable tacks that are no longer widely in use. On WOSI (mean  SD))
the other hand, the basic principles in the arthroscopic Total (2100 points) 457  429 (range, 13-1920)
refixation of the labrum have remained principally constant (78%)
during the last 15 to 20 years. The follow-up time of our Physical symptoms 207  198 (range, 3-894)
(1000 points) (79%)
study is long: we believe this is the first long-term follow-
Sports/recreation/work 105  104 (range, 0-354)
up evaluating the incidence of arthrosis after arthroscopic
(400 points) (74%)
Bankart repair. In addition, patients in our study are Lifestyle (400 points) 75  84 (range, 0-374) (81%)
somewhat older than patients in previous reports,5 and this Emotions (300 points) 68  75 (range, 0-298) (77%)
may have a minor effect on the incidence of arthrosis. Satisfaction with operative results
The prevalence rate for traumatic anterior shoulder dislo- Extremely satisfied 38 (46%)
cations has been estimated at 1% to 2% over a lifetime in the Satisfied 24 (29%)
general population,22,24,40 and the most significant indepen- Neutral 15 (18%)
dent risk factors for the injury are male sex, white race, and age Unsatisfied 5 (6%)
less than 30 years.30,32,38 On the contrary, primary arthrosis of Extremely unsatisfied 0 (0%)
the glenohumeral joint is considered relatively rare.7 Subjective results were evaluated with the WOSI questionnaire,
According to Marx et al.,28 the risk of severe arthrosis may measuring symptoms and inconvenience.
) The best raw score is 0 points, and this can be converted into a clin-
be as high as 10- to 20-fold among patients who have dis-
ically more favorable form: [(2100 e Raw points)/2100]  100%. In
located their shoulders compared with those who have not. The a symptomless shoulder, the score is 100%, and in the worst case, 0%.
risk of arthrosis has also been connected with the arthroscopic
operative technique, which is suggested to result from poorly
attached or misplaced suture anchors.43 However, according to
Rhee et al.,36 direct correlation between misplaced sutures and open and arthroscopic labral fixation have been
arthrosis has not been confirmed. equal.5,10,13,18,21,37,41 Advancements in surgery favoring
In comparative randomized studies and systematic arthroscopic procedures have led to the current situation,
reviews of the literature, the early clinical results between where patients with a tendency toward recurrent shoulder
354 L. Kavaja et al.

Table IV Results of 74 shoulders (72 patients) according to class of arthrosis at 13 years’ follow-up after arthroscopic Bankart repair
Class of arthrosis Age at time Age at Delay from No. of preoperative No. of postoperative
(N ¼ 74 shoulders) of initial time of primary trauma dislocations dislocations
dislocation (y) surgery (y) to surgery (y)
Moderate and severe arthrosis 32 32 3.5 1, n ¼ 3 0, n ¼ 6
(classes 2 and 3) (n ¼ 10) 2-5, n ¼ 1 1, n ¼ 1
5-10, n ¼ 3 2-5, n ¼ 1
>10, n ¼ 3 >10, n ¼ 2
Mild arthrosis (class 1) 23 30 7 1, n ¼ 11 0, n ¼ 32
(n ¼ 40) 2-5, n ¼ 10 2-5, n ¼ 3
5-10, n ¼ 6 5-10, n ¼ 2
>10, n ¼ 13 >10, n ¼ 3
No arthrosis (class 0) 23 27 4 1, n ¼ 9 0, n ¼ 17
(n ¼ 24) 2-5, n ¼ 9 1, n ¼ 1
5-10, n ¼ 1 2-5, n ¼ 6
>10, n ¼ 5

dislocation of traumatic origin are treated almost solely by

means of arthroscopic labrum reattachment.
Particularly in nonanatomic fixation methods, the risk of
arthrosis is estimated to be considerable. In the literature, the
risk of arthrosis varies between 12% and 89% depending on
the operative technique, follow-up time, and heterogeneity of
the patient material.4,8,16,17,35,42 In addition, in a 25-year
follow-up study by Hovelius and Saeboe,15 the risk of
arthrosis after conservative treatment of anterior shoulder
instability with traumatic origin was 60%. Arthroscopic
Bankart repair seems not to expose patients to an increased
risk of arthrosis nor to protect patients against arthrosis
because we observed practically similar incidence and
severity of arthrosis in our study. In addition, mild radiologic
findings did not seem to be associated with typical clinical
symptoms of shoulder arthrosis.
In our study, the patient’s age at the time of surgery and at
the time of initial instability episode seemed to correlate with
the severity of the arthrosis (Table IV). This is in concordance
with previous findings where the age at the time of initial
instability episode correlated to the severity of the
arthrosis.8,15,39 However, we did not observe this correlation,
with patients mostly having mild arthrosis or no arthrosis at
all. Hovelius and Saeboe15 reported that the cases of primary
dislocations occurring in patients aged younger than 25 years
had less arthropathy; we had a similar result. However, we
did not observe this correlation with the patient having the
most severe arthrosis, because this patient was aged 25 years
at the time of the primary dislocation.
Conclusions
The incidence of mild glenohumeral arthrosis after
arthroscopic Bankart repair is quite common and com-
parable to nonoperative treatment. However, it causes
only minor subjective symptoms or a minor objectively
perceived disadvantage. Because arthroscopic Bankart
repair is usually performed in relatively young patients
and the development of glenohumeral arthrosis is a slow
process, even longer-term follow-up studies are required
in the future.
Disclaimer
The authors, their immediate families, and any research
foundations with which they are affiliated have not
received any financial payments or other benefits from
any commercial entity related to the subject of this
article.
References
1. Bankart AS. The pathology and treatment of recurrent dislocation of the
shoulder joint. Br J Surg 1938;26:23-9. doi:10.1002/bjs.18002610104
2. Bankart AS, Cantab MC. Recurrent or habitual dislocation of the
shoulder-joint. 1923. Clin Orthop Relat Res 1993:3-6.
3. Barber FA, Snyder SJ, Abrams JS, Fanelli GC, Savoie FH III. Arthro-
scopic Bankart reconstruction with a bioabsorbable anchor. J Shoulder
Elbow Surg 2003;12:535-8. doi:10.1016/S1058-2746(03)00175-7
4. Berendes TD, Wolterbeek R, Pilot P, Verburg H, te Slaa RL. The open
modified Bankart procedure: outcome at follow-up of 10 to 15 years.
J Bone Joint Surg Br 2007;89:1064-8. doi:10.1302/0301-620X.89B8.
19280
5. Bottoni CR, Smith EL, Berkowitz MJ, Towle RB, Moore JH.
Arthroscopic versus open shoulder stabilization for recurrent anterior
instability: a prospective randomized clinical trial. Am J Sports Med
2006;34:1730-7. doi:10.1177/0363546506288239
6. Bottoni CR, Wilckens JH, DeBerardino TM, D’Alleyrand JC,
Rooney RC, Harpstrite JK, et al. A prospective, randomized evaluation
of arthroscopic stabilization versus nonoperative treatment in patients
with acute, traumatic, first-time shoulder dislocations. Am J Sports
Med 2002;30:576-80.
7. Brox JI, Lereim P, Merckoll E, Finnanger AM. Radiographic classi-
fication of glenohumeral arthrosis. Acta Orthop Scand 2003;74:186-9.
doi:10.1080/00016470310013932
Shoulder arthrosis after arthroscopic Bankart repair
8. Buscayret F, Edwards TB, Szabo I, Adeleine P, Coudane H, Walch G.
Glenohumeral arthrosis in anterior instability before and after surgical
treatment: incidence and contributing factors. Am J Sports Med 2004;
32:1165-72. doi:10.1177/0363546503262686
9. Clarke MG, Dewing CB, Schroder DT, Solomon DJ, Provencher MT.
Normal shoulder outcome score values in the young, active adult.
J Shoulder Elbow Surg 2009;18:424-8. doi:10.1016/j.jse.2008.10.009
10. Cole BJ, Romeo AA. Arthroscopic shoulder stabilization with suture
anchors: technique, technology, and pitfalls. Clin Orthop Relat Res
2001:17-30.
11. Constant CR, Murley AH. A clinical method of functional assessment
of the shoulder. Clin Orthop Relat Res 1987:160-4.
12. Edmonds G, Kirkley A, Birmingham TB, Fowler PJ. The effect of
early arthroscopic stabilization compared to nonsurgical treatment on
proprioception after primary traumatic anterior dislocation of the
shoulder. Knee Surg Sports Traumatol Arthrosc 2003;11:116-21. doi:
10.1007/s00167-003-0346-y
13. Fabbriciani C, Milano G, Demontis A, Fadda S, Ziranu F, Mulas PD.
Arthroscopic versus open treatment of Bankart lesion of the shoulder:
a prospective randomized study. Arthroscopy 2004;20:456-62. doi:10.
1016/j.arthro.2004.03.001
14. Freedman KB, Smith AP, Romeo AA, Cole BJ, Bach BR Jr. Open
Bankart repair versus arthroscopic repair with transglenoid sutures or
bioabsorbable tacks for recurrent anterior instability of the shoulder:
a meta-analysis. Am J Sports Med 2004;32:1520-7. doi:10.1177/
0363546504265188
15. Hovelius L, Saeboe M. Neer award 2008: arthropathy after primary
anterior shoulder dislocationd223 shoulders prospectively followed
up for twenty-five years. J Shoulder Elbow Surg 2009;18:339-47. doi:
10.1016/j.jse.2008.11.004
16. Hovelius L, Sandstrom B, Saebo M. One hundred eighteen Bristow-
Latarjet repairs for recurrent anterior dislocation of the shoulder
prospectively followed for fifteen years: study IIdthe evolution of
dislocation arthropathy. J Shoulder Elbow Surg 2006;15:279-89. doi:
10.1016/j.jse.2005.09.014
17. Hovelius LK, Sandstrom BC, Rosmark DL, Saebo M, Sundgren KH,
Malmqvist BG. Long-term results with the Bankart and Bristow-
Latarjet procedures: recurrent shoulder instability and arthropathy.
J Shoulder Elbow Surg 2001;10:445-52. doi:10.1067/mse.2001.117128
18. Karlsson J, Magnusson L, Ejerhed L, Hultenheim I, Lundin O,
Kartus J. Comparison of open and arthroscopic stabilization for
recurrent shoulder dislocation in patients with a Bankart lesion. Am J
Sports Med 2001;29:538-42.
19. Kartus C, Kartus J, Matis N, Forstner R, Resch H. Long-term inde-
pendent evaluation after arthroscopic extra-articular Bankart repair
with absorbable tacks. surgical technique. J Bone Joint Surg Am 2008;
90(Suppl 2, Pt 2):262-74. doi:10.2106/JBJS.H.00132
20. Kartus C, Kartus J, Matis N, Forstner R, Resch H. Long-term inde-
pendent evaluation after arthroscopic extra-articular Bankart repair
with absorbable tacks. A clinical and radiographic study with a seven
to ten-year follow-up. J Bone Joint Surg Am 2007;89:1442-8. doi:10.
2106/JBJS.F.00363
21. Kartus J, Ejerhed L, Funck E, Kohler K, Sernert N, Karlsson J.
Arthroscopic and open shoulder stabilization using absorbable implants.
A clinical and radiographic comparison of two methods. Knee Surg
Sports Traumatol Arthrosc 1998;6:181-8. doi:10.1007/s001670050096
22. Kirkley A, Griffin S, McLintock H, Ng L. The development and
evaluation of a disease-specific quality of life measurement tool for
shoulder instability. The Western Ontario Shoulder Instability Index
(WOSI). Am J Sports Med 1998;26:764-72.
23. Kirkley A, Griffin S, Richards C, Miniaci A, Mohtadi N. Prospective
randomized clinical trial comparing the effectiveness of immediate
arthroscopic stabilization versus immobilization and rehabilitation in
first traumatic anterior dislocations of the shoulder. Arthroscopy 1999;
15:507-14. doi:10.1053/ar.1999.v15.015050
24. Kirkley A, Werstine R, Ratjek A, Griffin S. Prospective randomized
clinical trial comparing the effectiveness of immediate arthroscopic
355
stabilization versus immobilization and rehabilitation in first traumatic
anterior dislocations of the shoulder: long-term evaluation. Arthros-
copy 2005;21:55-63. doi:10.1016/j.arthro.2004.09.018
25. Lo IK, Griffin S, Kirkley A. The development of a disease-specific
quality of life measurement tool for osteoarthritis of the shoulder:
the Western Ontario Osteoarthritis of the Shoulder (WOOS) index.
Osteoarthritis Cartilage 2001;9:771-8. doi:10.1053/joca.2001.0474
26. Marquardt B, Witt KA, Gotze C, Liem D, Steinbeck J, Potzl W. Long-
term results of arthroscopic Bankart repair with a bioabsorbable tack.
Am J Sports Med 2006;34:1906-10. doi:10.1177/0363546506290404
27. Marquardt B, Witt KA, Liem D, Steinbeck J, Potzl W. Arthroscopic
Bankart repair in traumatic anterior shoulder instability using a suture
anchor technique. Arthroscopy 2006;22:931-6. doi:10.1016/j.arthro.
2006.04.105
28. Marx RG, McCarty EC, Montemurno TD, Altchek DW, Craig EV,
Warren RF. Development of arthrosis following dislocation of the
shoulder: a case-control study. J Shoulder Elbow Surg 2002;11:1-5.
doi:10.1067/mse.2002.119388
29. Okamura K, Takiuchi T, Aoki M, Ishii S. Labral shape after arthro-
scopic Bankart repair: comparisons between the anchor and Caspari
methods. Arthroscopy 2005;21:194-9. doi:10.1016/j.arthro.2004.10.020
30. Owens BD, DeBerardino TM, Nelson BJ, Thurman J, Cameron KL,
Taylor DC, et al. Long-term follow-up of acute arthroscopic Bankart
repair for initial anterior shoulder dislocations in young athletes. Am J
Sports Med 2009;37:669-73. doi:10.1177/0363546508328416
31. Paxinos A, Walton J, Tzannes A, Callanan M, Hayes K, Murrell GA.
Advances in the management of traumatic anterior and atraumatic
multidirectional shoulder instability. Sports Med 2001;31:819-28.
32. Porcellini G, Campi F, Pegreffi F, Castagna A, Paladini P. Predisposing
factors for recurrent shoulder dislocation after arthroscopic treatment.
J Bone Joint Surg Am 2009;91:2537-42. doi:10.2106/JBJS.H.01126
33. Porcellini G, Paladini P, Campi F, Paganelli M. Long-term outcome of
acute versus chronic bony Bankart lesions managed arthroscopically.
Am J Sports Med 2007;35:2067-72. doi:10.1177/0363546507305011
34. Pulavarti RS, Symes TH, Rangan A. Surgical interventions for anterior
shoulder instability in adults. Cochrane Database Syst Rev 2009:
005077. doi:10.1002/14651858.CD005077.pub2.
35. Rachbauer F, Ogon M, Wimmer C, Sterzinger W, Huter B. Gleno-
humeral osteoarthrosis after the Eden-Hybbinette procedure. Clin
Orthop Relat Res 2000:135-40.
36. Rhee YG, Lee DH, Chun IH, Bae SC. Glenohumeral arthropathy
after arthroscopic anterior shoulder stabilization. Arthroscopy 2004;
20:402-6. doi:10.1016/j.arthro.2004.01.027
37. Rhee YG, Lim CT, Cho NS. Muscle strength after anterior shoulder
stabilization: arthroscopic versus open Bankart repair. Am J Sports
Med 2007;35:1859-64. doi:10.1177/0363546507304329
38. Robinson CM, Dobson RJ. Anterior instability of the shoulder after
trauma. J Bone Joint Surg Br 2004;86:469-79. doi:10.1302/0301-
620X.86B4.15014.
39. Samilson RL, Prieto V. Dislocation arthropathy of the shoulder. J Bone
Joint Surg Am 1983;65:456-60.
40. Soderlund T, Mattila VM, Visuri TI, Pihlajamaki HK. Long-term
outcome of a transglenoid suture technique for anterior shoulder
instability in young adults. J Bone Joint Surg Br 2008;90:189-93. doi:
10.1302/0301-620X.90B2.20040
41. Stokes DA, Savoie FH III, Field LD, Ramsey JR. Arthroscopic repair of
anterior glenohumeral instability and rotator interval lesions. Orthop
Clin North Am 2003;34:529-38. doi:10.1016/S0030-5898(03)00091-9
42. van der Zwaag HM, Brand R, Obermann WR, Rozing PM. Gleno-
humeral osteoarthrosis after Putti-Platt repair. J Shoulder Elbow Surg
1999;8:252-8. doi:10.1016/S1058-2746(99)90138-6
43. Weber SC, Abrams JS, Nottage WM. Complications associated with
arthroscopic shoulder surgery. Arthroscopy 2002;18(Suppl 1):88-95.
doi:10.1016/S0749-8063(02)80008-1
44. Zarins B, McMahon MS, Rowe CR. Diagnosis and treatment of
traumatic anterior instability of the shoulder. Clin Orthop Relat Res
1993:75-84.