Physiotherapy following surgical repair of Bankart lesions of the shoulder
Date First Published:
January 13, 2006
Last Updated:
January 17, 2006
Report by:
Michael Callaghan, Physiotherapy, Research Fellow (Centre for Rehabilitation Science, MRI)
Search checked by:
Ioannis Paneris, Centre for Rehabilitation Science, MRI
Three-Part Question:
In [adults following surgical repair of Bankart lesions] does [an accelerated compared to a conservative physiotherapy programme] improve [Long term shoulder function & recurrence rate of dislocation]
Clinical Scenario:
A fine Irish male professional rugby union player is spear tackled by 2 nasty New Zealand players and sustains a totally undeserved dislocated shoulder. He undergoes operation to reduce the dislocation and repair the associated detached glenoid labrum. The surgeon wants to play safe in the post-operative phase whilst the physios are keen to get him back to playing as soon as possible but are worried about re-dislocation rate and permanent loss of function. Debate ensues about whether an accelerated rehabilitation programme or a more conservative approach should be adopted for him.
Search Strategy:
MEDLINE 1966-01/05, CINAHL 1982 –01/05, AMED 1985-01/05, SPORTDiscus 1830-01/05, via the OVID interface, EMBASE 1996-01/05, and the Cochrane database. In addition the PEDro database was searched.
Search Details:
[{(bankart lesion.mp OR labral tear OR glenoid adj5 lesion) AND (exp shoulder OR exp shoulder joint) AND (exp exercise therapy OR exp physical therapy techniques OR physiotherapy.mp OR exp rehabilitation})] PEDro: [ bankart lesion OR labral tear]. LIMIT to human AND English language.
Outcome:
Only 1 paper was retrieved that was relevant to the 3 part question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Accelerated rehabilitation after arthroscopic Bankart repair for selected cases: A prospective randomized clinical study. Kim, SH, Ha KI, Jung MW, Lim MS, Kim YM, Park JH. 2003 S. Korea | N = 62 post arthroscopic Bankart repair. Group 1:- n=28 immobilisation & conventional rehab. Group 2:- n=34 Accelerated rehab for 3 months inclusion criteria:1.Traumatic unilateral & unidirectional anterior instability 2. Recurrent dislocation 3, not active in sports.# 4. classic Bankart & healthy labrum 5. Bankart lesion ¡Ü 1Cm above midglenoid notch |
PRCT | 1. Recurrent dislocation rate | 1. NSS between Gp2 & Gp1(5.9% v 7.1%) | Results cannot be extrapolated to all instability patients and more serious Bankart lesions. Ill defined long term FU time period. Very specific inclusion criteria: almost best case scenario (see column 2) |
| 2. Functional shoulder scores | 2. NSS between groups | ||||
| 3. Pain scores | 3. Gp2 better than Gp 1 @ 6weeks (VAS 0.9 v 1.5) (P=0.013) butNSS @ final FU | ||||
| 4. ROM | 4. NSS deficit between groups | ||||
| 5. Mean time to 90% final ERot | 5.Gp 2 better than Gp1 (6.9 v 8.9 wks, p<0.001) | ||||
| 6. Mean % activity return | 6. NSS between groups | ||||
| 7. Mean time to 90% activity return | 7. Gp2 better than Gp1 (P <0 .001) | ||||
| 8. Patient satisfaction with early motion @ final FU | 8. Gp 2 better than Gp1 (P <0.001)(satisfactory 68% v 7%. Unsatisfactory 9% v 64%) |
Author Commentary:
There seem to be some short term benefits from the accelerated rehab programme, notably the pain score at 6 weeks post op, the mean time taken to achieve 90% of gleno-humeral external rotation and 90% of return to activity. 64% of the immobilisation group thought the initial rehab phase was unsatisfactory compared to 9% of the accelerated group.
Bottom Line:
Accelerated rehabilitation in selected patients after Bankarts repair does NOT increase the rate of recurrent dislocation and has the same long term shoulder functional improvement as a prolonged sling immobilisation programme.
References:
- Kim, SH, Ha KI, Jung MW, Lim MS, Kim YM, Park JH.. Accelerated rehabilitation after arthroscopic Bankart repair for selected cases: A prospective randomized clinical study.