About “Arthroscopic Bankart Repair …”

After reading the recently published article by Marquardt et al.,1Marquardt B. Witt K.A. Liem D. Steinbeck J. Potzl W. Arthroscopic Bankart repair in traumatic anterior shoulder instability using a suture anchor technique.Arthroscopy. 2006; 22: 931-936Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar I have some questions concerning the inclusion and the outcome measures that were used. The Constant score is used as an outcome measure by the authors. Kirkley et al.2Kirkley A. Griffin S. McLintock H. Ng L. The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability—The Western Ontario Shoulder Instability Index (WOSI).Am J Sports Med. 1998; 26: 764-772Crossref PubMed Scopus (0) Google Scholar, 3Kirkley A. Alvarez C. Griffin S. The development and evaluation of a disease-specific quality-of-life questionnaire for disorders of the rotator cuff: The Western Ontario Rotator Cuff Index.Clin J Sport Med. 2003; 13: 84-92Crossref PubMed Scopus (325) Google Scholar stated that this instrument may be useful for discriminating between patients with significant rotator cuff disease or osteoarthritis but it is not useful for patients with instability. In fact, in one study all of the patients with instability of the shoulder scored nearly perfectly (95 to 100) despite having problems of sufficient magnitude to request surgical intervention.4Conboy V.B. Morris R.W. Kiss J. Carr A.J. An evaluation of the Constant-Morley shoulder assessment.J Bone Joint Surg Br. 1996; 78: 229-232PubMed Google Scholar Reading this, I cannot understand by which criteria a group of athletic young men, with a mean age of 25 years, have an average Constant score at inclusion of 55.3 points! In a patient with recurrent anterior traumatic instability, the score will be normal (as previously mentioned), unless the shoulder is permanently dislocated. A Constant score of 55 is associated with important strength loss, continuous pain, and severely restricted range of motion, which is not the case in recurrent anterior shoulder dislocation. I would like the authors to explain their rationale for using the score and to explain how they calculated the score. Arthroscopic Bankart Repair in Traumatic Anterior Shoulder Instability Using a Suture Anchor TechniqueArthroscopyVol. 22Issue 9PreviewPurpose: The purpose of this study was to prospectively evaluate the surgical outcome of arthroscopic Bankart repair via suture anchors in patients with recurrent traumatic anterior shoulder instability with a minimum follow-up of 2 years. Methods: We included 54 consecutive patients without an osseous Bankart lesion of greater than 25% of the glenoid circumference with a mean age of 25.3 years (range, 16 to 58 years) undergoing arthroscopic Bankart repair via suture anchors for traumatic anterior shoulder instability. Full-Text PDF Author’s ReplyArthroscopyVol. 23Issue 6PreviewWe thank Dr. Diercks for his valuable comments regarding our article.1 He may certainly be correct in his concerns about the use of the Constant score as a measurement tool for patients with shoulder instability in our study. The Western Ontario Shoulder Instability Index indeed appears to be a sensitive measurement tool in these patients, because it focuses on the patient’s own perception of changes in health status.2 However, its use in the current literature is not very widespread. The Constant score assesses pain, function, range of motion, and strength and thus combines subjective and objective parameters. Full-Text PDF

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