EFFECT OF ACCELERATED REHABILITATION AFTER ARTHROSCOPIC BANKART REPAIR ON EARLY POSTOPERATIVE RANGE OF MOTION TRANSITION AND THE RECURRENCE OF INSTABILITY

K. Kumashiro¹, K. Takayama², S. Yamada², Y. Kobori², K. Kitamoto¹, A. Shiraishi¹, K. Yamada¹

Background: The injury of the anteroinferior capsulolabral complex (Bankart lesion) resulting from traumatic anterior dislocation of the shoulder joint can contribute to anterior instability. Arthroscopic Bankart repair has been shown to reduce the tensile strength of the repaired capsulolabral complex in the first 12 weeks postoperatively; thus, it is important to limit range of motion (ROM) in the early postoperative period to protect the repaired tissues from excessive stress. To promote the healing of surgically repaired tissues, the conventional postoperative immobilization period has been 3 to 6 weeks. However, in recent years, there have been scattered reports recommending shorter immobilization periods and accelerated rehabilitation in terms of early functional recovery and return to functional activities, and there is still no consistent view of rehabilitation protocols after Bankart repair.

Purpose: The purpose of this study is to determine whether accelerated rehabilitation after arthroscopic Bankart repair affects the transition of ROM and recurrence of instability. We hypothesized that accelerated rehabilitation after arthroscopic Bankart repair would result in early functional recovery without compromising the stability.

Methods: Thirty-two patients (mean age 33.8±11.6 years, 24 males and 8 females) who underwent arthroscopic Bankart repair between 2012 and 2019 were included in the study. ROM and the recurrence of instability were evaluated. The recurrence of instability was defined when re-dislocation or subluxation occurred. The mean physiotherapy duration was 179.1±58.0 days, and the mean follow-up duration was 321.2±163.8 days. The ROMs (passive flexion, abduction, external rotation at 90° shoulder abduction, and active flexion) was measured using a goniometer at postoperative 4, 8, 12, and 16 weeks and at the final follow-up of physiotherapy. The patients wore a sling for immobilization, and received physiotherapy under the surveillance of physiotherapists. The characteristics of our rehabilitation protocol was to start passive ROM exercise, except for external rotation, at 1 week postoperatively. The sling was removed at 4 weeks postoperatively and active exercise in all direction was started with the patients in the supine and sitting positions.

Results: No recurrence of instability was observed in all patients during the follow-up period.
ROMs were: passive flexion 131.6±16.0°, 147.0±15.9°, 154.8±15.0°, 159.4±14.4°, and 164.7±11.4°; abduction 112.6±24.1°, 144.2±27.4°, 153.6±25.7°, 159.8±22.8°, and 170.5±13.8°; external rotation 48.3±21.4°, 59.7±21.4°, 64.8±17.8°, 74.2±16.6°, and 82.3±11.4°; and active flexion 115.0±30.2°, 142.3±21.1°, 150.6±19.3°, 156.4±17.3°, and163.3±13.9° at 4, 8, 12, and 16 weeks postoperatively and at the final follow-up of physiotherapy, respectively.

Conclusion(s): After arthroscopic Bankart repair, an early recovery of shoulder function was achieved without compromising the stability, even when ROM exercises were performed early postoperatively.

Implications: No recurrence of instability was observed in all patients, suggesting that the early postoperative initiation of ROM exercises may not interfere with the promotion of the healing of the repaired tissue.

Funding, acknowledgements: No specially-occurring costs were incurred through the implementation of the study.

Keywords: Arthroscopic Bankart repair, Accelerated rehabilitation, Instability

Topic: Orthopaedics

Did this work require ethics approval? Yes

Institution: Kurashiki Central Hospital

Committee: Clinical Research Review Committee

Ethics number: Clinical research application No. 3444