ARTHROSCOPIC ANATOMIC GLENOID RECONSTRUCTION VERSUS BANKART AND REMPLISSAGE: A RANDOMIZED CONTROLLED TRIAL COMPARING SAFETY PROFILES

Bankart repair, Arthroscopic Anatomic Glenoid Reconstruction (AAGR) and Latarjet are three surgical options for treating recurrent anterior shoulder instability. Latarjet stands out for its superior effectiveness in preventing recurrence, making it a preferred choice when this is the primary concern. On the other hand, Bankart is widely recognized for its safety profile. Existing literature shows AAGR is comparable to Latarjet in terms of recurrence rates, but no previous high-level studies have directly compared Bankart repair with AAGR. In this single center, double blinded, randomized controlled trial, we aimed to compare the safety profile of arthroscopic Bankart repair with that of Arthroscopic Bankart repair plus AAGR. We hypothesized that AAGR is as safe as Bankart repair. Patients who experienced recurrent anterior shoulder dislocation with two or more incidents and aged between 16 and 60, with confirmed presence of subcritical glenoid bone loss on imaging including X-ray, and CT would be eligible for enrollment. Consented patients were randomized into two groups with a minimum of 12-month follow up. Safety profiles were evaluated based on 1) intra-operative complications (e.g., bleeding, nerve injury, screw issues), 2) perioperative complications (e.g., nerve and graft position), and 3) postoperative complications within the year (e.g., revision surgery, stiffness, subluxation, infection, chondrolysis). This study included 80 participants who underwent arthroscopic Bankart repair and 73 participants who underwent arthroscopic AAGR with a minimum of 12-month follow-up. Both groups had comparable demographics, including age (32.6±9.8 years for Bankart, and 31.8±9.6 years for AAGR), BMI (25.2±3.8 for Bankart, and 25.2±4.2 for AAGR) and clinical follow-up time (3.4±2.1 years for Bankart, and 3.2±2.0 for AAGR). The majority of patients in both groups were male, with 76% for Bankart and 81% for AAGR. Neither group reported intra-operative or perioperative complications. Among the participants, 15% of participants who received a Bankart repair experienced re-dislocation event compared to 1.4% of participants who received an AAGR repair (p=0.003). Subluxations were reported in the Bankart group, but they were not observed in the AAGR group. Neither group experienced any other complications, such as infection, chondrolysis, neurovascular deficits or stiffness. In the AAGR group, all grafts were consistently positioned in the ideal 3-5 o'clock location in the sagittal plane. Also, in the mediolateral plane, most patients showed the graft positioned flush with glenoid with 100% healing. This study demonstrates that AAGR appears to be as safe as Bankart repair with proper graft positions and the absence of nerve complications, bleeding, or other complications at a minimum 12-month follow-up. Long-term follow-up of clinical and radiographic outcomes is required to make a more comprehensive comparison between the two procedures.