Clinical outcomes and return to sport after arthroscopic Bankart repair with subscapularis augmentation in high-body-mass combat athletes: a retrospective case series

Combat athletes are exposed to repetitive high-energy contact and extreme shoulder positions. This study aimed to describe the clinical outcomes, instability events, range of motion, and return to sport after arthroscopic Bankart repair with arthroscopic subscapularis augmentation (ASA) in combat athletes weighing ≥ 90 kg, a cutoff used only to define the study population. Fifteen combat athletes weighing ≥ 90 kg with recurrent traumatic anterior shoulder instability and glenoid bone loss < 20% who underwent arthroscopic Bankart repair with ASA were retrospectively analyzed; athletes with glenoid bone loss ≥ 20% underwent a bone-block or Latarjet procedure and were excluded. Bankart repair was performed using 4 all-suture anchors, the most superior of which was shared for ASA, with final fixation at 45° of external rotation. Clinical scores, range of motion, instability events (classified using published definitions), and return to sport were assessed at each visit by an independent examiner not involved in the surgery. Mean follow-up was 30.1 ± 6.8 months. The mean body weight was 106.4 ± 10.7 kg, and 4 patients (26.7%) had off-track lesions. The VAS score decreased from 5.6 to 0.7, and the ASES, Rowe, and SANE scores improved from 47.8 to 94.2, 38.0 to 93.3, and 45.7 to 92.6, respectively (all p < 0.001). ER1 and ER2 decreased by a mean of 7° (95% CI 2.0–12.0°) and 5° (95% CI 0.6–9.4°), respectively, without reported functional limitation. No redislocation occurred (0/15; 95% CI 0.0–20.4%). One patient with an on-track lesion had a subluxation at 9 months postoperatively (overall recurrent instability 6.7%; 95% CI 1.2–29.8%); no revision surgery was required. All athletes returned to competition, 14 (93.3%) at their preinjury level; the mean time to return to competition was 9.3 ± 1.2 months. In this small retrospective case series, arthroscopic Bankart repair with ASA in combat athletes weighing ≥ 90 kg was followed by favorable short-term outcomes. However, the 95% CI for redislocation extended to 20.4%, there was no comparison group, and subscapularis tendon integrity was not assessed. These findings do not establish the efficacy, safety, or indications of ASA, and comparative studies are needed. Not applicable. This study is a retrospective case series rather than a clinical trial. Not applicable.