Comparable Subscapularis Tendon Outcomes After Open Versus Arthroscopic Bankart Repair With Remplissage in Collision/Contact Athletes With Anterior Shoulder Instability: A 5-Year Prospective Cohort Study

To compare clinical function and structural integrity of the subscapularis tendon in athletes with recurrent anterior shoulder instability treated with open Bankart repair with inferior capsular shift (OBICS) versus arthroscopic Bankart repair with remplissage (ABR + R). In this prospective nonrandomized comparative study, 90 collision/contact athletes with recurrent anterior shoulder instability were followed for ≥5 years (45 OBICS, 45 ABR + R). Clinical evaluation included the Western Ontario Shoulder Instability Index and the American Shoulder and Elbow Surgeons score, subscapularis tests (lift-off, belly-press, internal rotation lag), range of motion, and isometric strength. Magnetic resonance imaging (MRI) assessed subscapularis integrity, fatty infiltration, and tendon signal changes. Outcomes were compared between groups and against the contralateral shoulder. At final follow-up, both OBICS and ABR + R showed excellent outcomes, with no differences in the Western Ontario Shoulder Instability Index (88.3 ± 9.5 vs 86.7 ± 10.1; P = .41) or the American Shoulder and Elbow Surgeons score (91.0 ± 8.2 vs 89.4 ± 7.9; P = .38). Minimal clinically important difference was exceeded by 82% to 84% of patients and patient acceptable symptom state reached by 78% to 80%, with no between-group differences. Range of motion, subscapularis tests, and strength were comparable (internal rotation: 9.1 ± 1.4 vs 9.3 ± 1.5 kg; external rotation: 7.8 ± 1.3 vs 8.0 ± 1.4 kg). No within-group deficits were observed. Recurrence occurred in 2 OBICS (4.4%) and 4 ABR + R (8.8%), without significant difference. Some nonsignificant secondary findings may reflect limited power to detect small differences. MRI revealed no full-thickness tears, although OBICS showed more tendon signal changes (56.8% vs 15.0%; P = .02) and grade 1 fatty infiltration (22.7% vs 0%; P = .01). Both OBICS and ABR + R provide excellent clinical outcomes with comparable subscapularis strength and function, although OBICS is associated with more frequent, clinically silent MRI changes. Level II, prospective nonrandomized comparative study.