The Bankart-Delitala procedure in the treatment of the recurrent glenohumeral dislocation

Background. The Bankart-Delitala repair addresses the pathologic components for recurrent shoulder dislocation restoring the premorbid anatomy. The purpose of the present study is to analyse the results of the Bankart-Delitala procedure in the treatment of athletically active patients who had recurrent unidirectional gleno-humeral dislocation. The open capsulorraphy of the isolated anterior-inferior detachment was evaluated prospectively by the use of subjective, functional and radiological criteria. Methods. Forty eight consecutive patients (fifty two shoulders) who had recurrent unidirectional dislocation were treated with open repair of the anterior-inferior capsulolabral lesion and 32 were observed during a mean follow-up of 6±0.8 years (range 4 to 13 years). Proper instruments as retractors for the medial capsular flap and the humeral-head retractors allowed good exposure avoiding the osteotomy of the coracoid process. To reattach the labrum were used different techniques: transglenoid sutures (8 cases), 'shaped' Delitala nails (4 cases), Shoulder staples (10 cases), Statak suture anchors (3 cases) and Mitek anchors (7 cases). The 32 patients available for follow-up were involved either in elite amateur (21 cases) or recreational (11 cases) sports. A questionnaire was completed about the current functional ability at home, at work and during sports. In addition the patients were asked to say if they would have again the same open procedure for the same problem. Clinical assessment at control was based on the Rowe scale score. Finally anteroposterior and axial x-ray views were obtained in order to evaluate hardware positioning as well as the articular state. Results. According to the Rowe rating system, 81% had excellent or good results while 19% had fair or poor results. The average loss of external rotation was 10°with the arm at side and 25°in 90°abduction. Twenty six elite athletes resumed sports at the same preinjury level and 1 at a lower level. Five recreational athletes did not return to sport and gave different reasons such as lack of time or fear of redislocation. Recurrence of dislocation (2 cases) was related to major trauma respectively 35 and 43 months after capsulorraphy. Subluxation (3 cases) was significantly related to a surgical finding of glenoid insufficiency. The greatest rate of poor results was observed in patients who had a high number of dislocations, in those who showed at surgery a bony Bankart lesion and in presence of loose bodies. We found no difference between the use of different devices (transglenoid sutures, Delitala nails, Shoulder staples, Statak or Mitek anchors) concerning the rate of redislocation or subluxation. Hardware migration was the main complication related to the use of 'T shaped' Delitala nails (75%). Twenty seven patients would have again the same open treatment for the same problem. Conclusions. The Bankart-Delitala capsulorraphy restored full stability, wide range of motion of the shoulder, high rate of satisfaction and full return to sport in the 82% of the 32 athletes. Our favourable outcomes confirm this open technique as a widely considered treatment of choice for the recurrent unidirectional shoulder dislocation in patients involved in elite amateur or recreational sports.