The Role of Rotator Interval Closure in Arthroscopic Shoulder Instability Repair: A Prospective Randomized Study

Oleg Dolkart Eran Maman Efi Kazum Noam Rosen Gavriel Mozes Ofir Chechik
Division of Orthopaedic Surgery, Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Purpose: Arthroscopic Bankart repair (ABR) provides satisfactory results for recurrent anterior shoulder instability, but the high recurrence rates post-ABR remain a concern. One of the adjunct procedures proposed to improve SBR results is arthroscopic rotator interval closure (ARIC). This study prospectively evaluated the outcomes of ABRs alone compared to combined ABR+ARIC and identified risk factors related to failure of each procedure.

Methods: Thirty-nine consecutive patients (mean age 23.1 (18.3-37.5) years; 37 males) underwent arthroscopic stabilization for recurrent anterior traumatic shoulder instability. Twenty patients underwent ABR alone and 19 underwent ABR+ARIC. Remplissage was added when glenoid engagement was observed during surgery. All patients were prospectively followed, and their postoperative courses were reviewed and functionally assessed at the last visit.

Results: The re-dislocation rate was higher in the ABR+ARIC group compared to the ABR only group at a mean follow-up of 4.2 (2-5.6) years (3 Vs. 0, P = .06). More subluxations were found in the ABR only group (2 Vs. 1, respectively; P = .58). The final limitation of range of motion (ROM) compared with the preoperative ROM was similar in both groups. Remplissage procedures were performed more often in the ABR only group [12 (60%) Vs. 4 (21%), P = .013].

Conclusions: ARIC performed as an adjunct to ABR showed no superiority in attaining value-added stability compared to ABR alone. Adding a remplissage procedure may achieve better stability.