Arthroscopy - 2026-09-14 - Journal Article
Arthroscopic Bankart Repair With a 6 o'Clock Anchor Reduces Recurrence and Improves Clinical Outcomes in Recurrent Anterior Instability.
Lee JH, Hwang K, Song CM, Jeong WK
Topics
Key Takeaway
Placing the most inferior Bankart anchor at the 6 o'clock position reduces recurrence from 26.3% to 10.1% (OR 2.89) compared to non-6 o'clock anchor placement.
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Summary
This retrospective study compared arthroscopic Bankart repair with versus without a 6 o'clock inferior anchor in 136 patients with recurrent anterior instability and no significant glenoid bone loss. The 6 o'clock group had a significantly lower recurrence rate (10.1% vs 26.3%, P=.024), with the anchor placement identified as an independent protective factor on multivariate regression (OR 2.89, 95% CI 1.13–7.37). All three functional scores (Korean Shoulder Score for Instability, Rowe, UCLA) were significantly higher in the 6 o'clock group, though MCID achievement rates did not differ significantly between groups.
Key Limitation
Retrospective design with no standardization of anchor placement criteria means the non-6 o'clock group may represent more complex anatomy or surgeon-perceived technical barriers that independently elevate recurrence risk.
Original Abstract
PURPOSE
To evaluate the clinical effectiveness of placing the most inferior suture anchor at the 6 o'clock position during arthroscopic Bankart repair compared with non-6 o'clock anchor repair for recurrent anterior shoulder instability.
METHODS
From January 2012 to December 2022, this retrospective study included patients with recurrent anterior shoulder instability and anteroinferior labral tears, without significant glenoid bone loss, who underwent arthroscopic Bankart repair and had at least 2 years of follow-up. Patients were categorized into 2 groups based on the placement of a 6 o'clock anchor. Clinical outcomes-including the Korean Shoulder Score for Instability; Rowe score; and University of California, Los Angeles score-pain, range of motion, and recurrence rates were assessed at the final follow-up (>2 years). Recurrence was defined as a positive apprehension sign, subluxation, or redislocation. Multivariate logistic regression was used to identify independent risk factors for recurrence. For each clinical score, the minimum clinically important difference was calculated using a cohort-specific distribution-based method, defined as 0.5 standard deviation of the change in score.
RESULTS
Overall, 136 patients were included (6 o'clock, n = 79; non-6 o'clock, n = 57). The recurrence rate was significantly lower in the 6 o'clock anchor group (10.1%) than in the non-6 o'clock group (26.3%; P = .024). The multivariate analysis revealed the presence of a 6 o'clock anchor as an independent factor associated with reduced recurrence (odds ratio: 2.89; 95% confidence interval: 1.13-7.37; P = .027). The 6 o'clock anchor group showed significantly higher Korean Shoulder Score for Instability (92.4 ± 9.5 vs 87.5 ± 13.2; P = .040), Rowe (93.4 ± 10.3 vs 86.3 ± 16.8; P = .012), and University of California, Los Angeles (32.5 ± 3.0 vs 30.2 ± 4.1; P = .003) scores. There were no significant between-group differences in minimum clinically important difference achievement rates between the 6 o'clock and non-6 o'clock anchor groups for the Korean Shoulder Score for Instability (91.1% vs 84.2%; P = .282), Rowe score (89.9% vs 80.7%; P = .141), or University of California, Los Angeles score (88.6% vs 77.2%; P = .099). No significant between-group differences were observed in the postoperative range of motion.
CONCLUSIONS
Minimum clinically important difference achievement rates were high in both groups, with no significant differences. However, placement of the most inferior suture anchor at the 6 o'clock position during an arthroscopic Bankart repair was associated with significantly lower recurrence rates and better clinical outcomes than in the non-6 o'clock anchor group.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.