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Objectives and questions: Arthroscopic Bankart repair remains the standard treatment for anterior shoulder instability (ASI). However, the influence of glenoid bone loss (GBL), Hill-Sachs lesions (HSL) and hyperlaxity on outcomes has raised concerns and broadened indications for additional or bony augmentation procedures. This study evaluated the outcomes of isolated capsulolabral repair in patients with GBL <15% and developed a predictive model for its role in ASI management.

Material and methods: Patients undergoing arthroscopic capsulolabral repair for the treatment of ASI by a single surgeon between 12/2006–08/2021 were eligible. Those with GBL ≥15%, multidirectional instability, prior surgery, concomitant remplissage or unavailable preoperative magnetic resonance imaging (MRI) were excluded. Preoperative MRI was reviewed to evaluate GBL and HSL morphology (on-, near- or off-track; distance to dislocation [DTD]). Pre- and minimum 2 years postoperatively, patient-reported outcomes measures (PROM; American Shoulder and Elbow Surgeons [ASES] Score and Single Assessment Numeric Evaluation [SANE]), instability recurrence (defined as apprehension, subluxation and/or dislocation) and subsequent surgery rates were collected. Nonparametric tests and proportional odds logistic regression with multiple imputation for missing data were performed.

Results: In total, 178 patients (age: 27±10 years, sex: 76% male) were included at a median follow-up of 3.0 years (range, 2–13 years; 74% follow-up). The median number of preoperative dislocations was 1. Hyperlaxity was present in 34% of patients. Mean GBL was 8±4%. The majority of HSL were on- (35%) or near-track (35%). Shoulder function improved significantly from preoperatively until follow-up (ASES Score: 70 [53–80] to 98 [95–100], p<0.001; SANE: 64 [31–75] to 94 [84–99], p<0.001). The rates of instability recurrence and revision surgery were 14% and 7%, respectively. Multivariable regression showed that male sex (ASES Score: OR=3.4, p=0.024; SANE: OR=2.68, p=0.013) and higher patient age (SANE score: OR=1.04, p=0.027) were associated with better postoperative shoulder function. Univariable models identified younger age as a risk factors both for instability recurrence (HR=0.993 for each year of age, p=0.011) and for revision surgery (HR=0.996 for each year of age, p=0.047). More preoperative dislocations increased the risk for instability recurrence (HR=1.018 per additional dislocation, p=0.007). Hyperlaxity, GBL and DTD were not associated with any outcome.

Discussion and conclusions: In patients with ASI and GBL <15%, isolated capsulolabral repair achieved excellent shoulder function at short-term follow-up. Male sex and higher patient age were associated with better postoperative shoulder function. Younger age was associated with an increased risk for instability recurrence and revision surgery. A greater number of preoperative dislocations was associated with an increased risk for instability recurrence. Hyperlaxity, GBL (when <15%) and DTD did not influence outcomes.