[Surgical therapy of traumatic shoulder dislocation. Are there evidence-based indications for arthroscopic Bankart operation?].

INTRODUCTION: For young athletic patients with a primary traumatic shoulder dislocation a surgical treatment is recommended. The operation of choice is the Bankart-Repair.

QUESTION: Are there evidence-based indications for an arthroscopic Bankart repair.

METHODS: Based on the criteria of the "Cochrane Collaboration" a systematic literature search was performed using medline (1966 to 9/2000). 172 publications were found with the key words "shoulder dislocation" and "Bankart". All relevant articles were ranked and analysed by the criteria of "evidence-based medicine".

RESULTS: There are 12 prospective studies (evidence grade Ib/IIa) and another 28 retrospective studies (evidence grade III). For open Bankart-Repair a recurrence rate of 0 to 8% is reported (prospective/retrospective studies). For arthroscopic Bankart-Repair, 19 of 40 studies and 8 of 12 prospective studies, show a recurrence rate of < 10%; however in other studies (prospective/retrospective) an atraumatic recurrence rate of up to 38% is reported. The reasons for these differences in the recurrence rate are not obvious from the given data. In particular, there seems to be no correlation between the type of arthroscopic fixation technique and the recurrence rate. Concerning the postoperative range of shoulder motion, the reported data suggest that external rotation is less limited after arthroscopic than after open Bankart-Repair (arthroscopic: 5-12 degrees, open: 5-25 degrees). However, there is no evidence that patients are more likely to return to their previous level of sporting activities when operated on in an arthroscopic technique than in an open technique (arthroscopic: 42-100%, open: 72-94%).

CONCLUSION: In the surgical treatment of a traumatic shoulder dislocation, the open Bankart-Repair remains the "gold standard". In reviewing the literature, arthroscopic Bankart-Repair has not been shown to be equal or superior to the open technique.