The Bankart repair versus the Putti-Platt procedure

Figures & data

Table 1. Preoperative data and perioperative findingsfor the 2 groups, median (range)

	Putti-Platt (n = 33)	Bankart (n = 33)	p-value
Median age	29 (17–52)	26 (16–63)	0.8
Female / Male	11 / 22	6 / 27	0.2
Duration of instability, months	32 (4–300)	42 (7–144)	0.03
Dominant arm	14 patients	19 patients	0.2
Number dislocations	10 (1–100)	7 (1–50)	0.08
Number subluxations	8 (0–100)	7 (0–100)	0.2
Mean Rowe score preop.	57 units	58 units	0.5
(95% CI)	53–60	55–62
Glenoid defect / wear	7 / 15	7 / 14	0.6
Bankart lesion, length in mm	20 (0–35)	15 (0–35)	0.3
External rotation after
wound closure	–7°	18°	< 0.001
(95% CI)	–1° to –13°	12° to 23°

Figure 1. The Bankart repair with Figure 2. The modified Putti-suture anchors and capsular Platt procedure (Symenoides imbrication (Rockwood Jr 1990). 1991). Right shoulder seen from Right shoulder seen from above. above.

Figure 2. The modified Putti-Platt procedure (Symenoides 1991). Right shoulder seen from above.

Table 2. Mean differences in outcome at the 2-year follow-up

	Putti-Platt (n = 33)	Bankart (n = 33)	p-value
Decrease in external rotation ^a	–10°	–3°	0.03
(95% CI)	–15° to –6°	–7° to 1°
Active external rotation
postoperatively	59°	68°	0.03
(95% CI)	54°–65°	62°–73°
Painful movements	10 patients	1 patient	0.003
Anterior apprehension	15 shoulders	10 shoulders	0.2
Rowe score postoperatively	90 units	90 units	0.9
(95% CI)	86–95	85–94
Improvement in Rowe score	33 units	31 units	0.8
(95% CI)	27–38	27–38
Rowe score > 70 points	30 patients	28 patients	0.7
(good and excellent)
Strength, abduction (kg)	9.6	10.7	0.3
(95% CI)	8.3–11.0	9.3–12.0
Strength, internal rotation (kg)	11.5	12.1	0.6
(95% CI)	9.8–13.2	10.4–13.8

^a Mean decrease at 2 years compared to preoperative value.

Table 3. Breakdown of patients in terms of time to failure

Time to failure:	0–2 years (n = 14)	2–5 years (n = 10)	5–10 years (n = 11)
Bankart	8	8	3
Putti-Platt	6	2	8
Redislocations	9	4	6
Subluxations only	5	6	5

Table 4. Mean WOSI score (%) and (95% confidence intervals) for the stable shoulders compared with separate groups of unstable shoulders at the 10-year follow-up (n = 62)

	Stable (n = 28)	All unstable (n = 34)	p-value vs. stable	Occasional ^a (n = 14)	p-value vs. stable	Recurrent ^b (n = 13)	p-value vs. stable	Reoperated ^c (n = 7)	p-value vs. stable
Physical	88 (84–92)	81 (78–85)		83 (77–89)		78 (72–85)	0.01	84 (76–93)
Sport	89 (83–96)	73 (67–79)	< 0.001	80 (70–89)	0.05	72 (62–82)	0.001	62 (49–76)	< 0.001
Lifestyle	88 (81–94)	79 (73–85)		83 (73–93)		74 (63–84)	0.03	81 (67–95)
Emotion	80 (70–89)	65 (56–74)	0.03	80 (67–92)		46 (33–59)	< 0.001	71 (53–88)
WOSI Total	87 (82–92)	77 (72–82)	0.005	82 (75–89)		72 (64–79)	0.001	78 (68–88)

^a Occasional: recurrent on one or more occasions that were associated with subjective instability, but the patients considered their shoulders to be stable and had no further problems for several years.

^b Recurrent on several occasions: the patients considered their shoulder to be unstable.

^c Reoperated: 8 patients, but 1 patient died before the 10-year follow-up.

Table 5. The WOSI score (%) (with individual domains) at the 10- year follow-up. Values are mean (95% confidence intervals). There were no statistically significant differences

	Putti-Platt (n = 30)	Bankart (n = 32)
Physical	83 (78–87)	86 (82–90)
Sport	78 (71–85)	83 (76–90)
Lifestyle	83 (76–89)	83 (77–90)
Emotion	69 (59–78)	74 (65–83)
WOSI Total	80 (75–86)	83 (78–88)

Rockwood CA, Jr. Anterior glenohumeral instability. The shoulder, CA Rockwood, Jr, FA Matsen, III. W. B. Saunders, Philadelphia 1990; 592–8

 Google Scholar

Symenoides PP. The Putti-Platt procedure. Surgical disorders of the shoulder, MS Watson. Churchill Livingstone, New York 1991; 379–85

 Google Scholar