Recurrence Rate, Complications and Revisions in Long-term Follow-up of Arthroscopic Posterior Bankart Repair Compared to Posterior Bone Block

Background: The literature suggests that both arthroscopic posterior Bankart repair (APB) and posterior bone block (PBB) are effective procedures in the short to medium term, although recurrence and revision rates do not appear to be negligible. However, fewer studies, especially comparative ones, are available regarding the long-term outcomes of these procedures. Purpose/Hypothesis: The purpose was to compare the long-term outcomes of APB and PBB procedures. It was hypothesized that at long-term follow-up, APB would have the same recurrence rate as PBB but lower complication and revision rates, with both techniques providing good or excellent functional outcomes and high satisfaction and return-to-sport (RTS) rates. Study Design: Cohort study; Level of evidence, 3. Methods: From January 2007 to December 2024, 86 patients underwent surgery for posterior shoulder instability. Exclusion criteria included a single episode of posterior instability (Moroder types A1 and A2), nontraumatic instability, static instability (Moroder type C1s and C2), functional or voluntary and reproducible instability (Moroder type B1), multidirectional instability, posterior unstable painful shoulder, posterior Bankart lesion with paraglenoid cysts, and patients with <2 years of follow-up. Of the initial 52 patients who met the inclusion criteria, 46 were available for follow-up and were divided into 2 groups: 28 underwent APB, and 18 underwent PBB. Results: At a mean follow-up of 8 years, APB and PBB showed no difference in recurrence rates (3.6% and 5.9%, respectively; P > .999). However, APB had lower revision rates (3.6% vs 33.3%; P < .01) and lower complication rates (3.6% vs 50%; P < .001) compared with PBB. Both groups achieved good or excellent clinical and functional outcomes, along with high satisfaction and RTS rates. There were no statistically significant differences in scores, except for the Western Ontario Shoulder Instability Index score, which favored PBB (122.1 vs 282.4 for APB; P = .026). Time to return to work was longer for the APB group, with 70.4% taking >2 months, compared with 29.4% of the PBB group ( P = .009). Conclusion: At a mean follow-up of 5 years for APB and 12 years for PBB, the APB group had a similar recurrence rate but fewer complications and revisions compared with the PBB group. Both techniques resulted in good to excellent clinical and functional outcomes, as well as high satisfaction and RTS rates.