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Not all Rowe scores are the same! Which Rowe score do you use?
J Shoulder Elbow Surg (2009) 18, 511-514
www.elsevier.com/locate/ymse
Not all Rowe scores are the same! Which Rowe score do you use? Kai-Uwe Jensen, MDa,*, Genio Bongaerts, MDb, Raphael Bruhnb, Silke Schneider, MDa a b
Arthro Clinic Institute, Hamburg, Germany Arthro Clinic, Hamburg, Germany Background: The Rowe score is an internationally recognized scoring system for the postoperative assessment of Bankart repairs; however, there are 4 different Rowe score versions. All 4 versions are used in parallel and results are sometimes published without any information about the Rowe score version used. Therefore, the aim of the present study was to assess the correlation and agreement of the various Rowe score versions. Method: Sixty-two patients were scheduled for follow-up examination after arthroscopic Bankart repair. All 4 Rowe score versions were used. The results of all Rowe scores were compared and correlation and agreement evaluated. Result: The evaluation revealed significant differences. The highest mean score was observed in the 1988 Rowe score (Ø 88.7 points) and the lowest mean score in the 1981 Rowe score (Ø 73.6 points). Conclusion: Not all Rowe scores are the same! Therefore, the used Rowe score should always be indicated. It would be desirable to establish one single Rowe score. Level of evidence: Level 3; Diagnostic study. Ó 2009 Journal of Shoulder and Elbow Surgery Board of Trustees.
The Rowe score is an internationally recognized scoring system for the postoperative assessment of Bankart repairs. However, research at www.PubMed.gov and www.MedPilot. de revealed that 4 different versions of the Rowe score exist. The first version of the Rowe score was published in 1978 in ‘‘The Journal of Bone & Joint Surgery’’ by Rowe, Patel and Southmayd.6 In 1981 and 1982, Rowe and Zarins7,8 published updated versions of the score in the same journal. The fourth and last Rowe score version was published by Carter R. Rowe in his book ‘‘The Shoulder’’.9 Literature research revealed that all different Rowe score versions are used in parallel,1e5,10 and results are sometimes published without any information about the Rowe score *Reprint requests: Kai-Uwe Jensen, MD, Arthro Clinic Institute, Rahlstedter Bahnhofstr. 7a, 22143 Hamburg, Germany. E-mail address: [email protected] (K.-U. Jensen).
version used. Consequently, various score results are compared internationally. We did not find any paper about the correlation and consistency of the various Rowe scores. Therefore, the aim of the present study was to assess the correlation and agreement of the various Rowe Score versions.
Materials and methods Study population and study design Sixty-two patients were followed up after Bankart repair within the scope of a follow-up study. All 4 Rowe score versions were used. All patients were examined between 2007 and 2008 after arthroscopic Bankart repair using knotless suture anchors (Knotless/Bioknotless by DePuy Mitek) between 2002 and 2006. Only patients with anterior shoulder instability were included in the
1058-2746/2009/$36.00 - see front matter Ó 2009 Journal of Shoulder and Elbow Surgery Board of Trustees. doi:10.1016/j.jse.2009.02.003
512 Table I
K.-U. Jensen et al. Various classifications of the 4 Rowe scores
1978 score 1981 score 1982 score 1988 score
Excellent
Good
Fair
Poor
90-100 points 90-100 points 90-100 points 85-100 points
75-89 points 70-89 points 70-89 points 70-84 points
51-74 points 40-69 points 50-69 points 50-69 points
50 points 39 points < 50 points 49 points
study. Patients with posterior or multidirectional shoulder instability were not included in the study. Forty-three male (69.4%) and 19 female (30.6%) patients were examined. The mean follow-upperiod from surgery was 38.9 months (minimum 20 months, maximum 68 months, standard deviation 13.4).
The scores All 4 Rowe score versions range from 0 to 100 points, and the points represent a certain evaluation. All 4 Rowe score versions include possible ratings of excellent, good, fair, and poor. However, all scores have different assessment classifications; eg, patients with 85 points were rated ‘‘excellent’’ in the 1988 Rowe score, whereas in all other scores only results with at least 90 points are classified as ‘‘excellent’’. Table I shows a comparison of the different classifications. The Rowe scores also differ in terms of quantity and content of the individual items (see Table II). Three of the 4 Rowe scores do not record exactly whether there was a re-dislocation.
Statistical methods Numerical results: The distributions of the numerical results (0-100 possible points) of the different Rowe score versions were described by mean and standard deviation, median, minimum, and maximum and graphically illustrated by the use of box plots and scatter plots. The correlations between each 2 Rowe score numerical results were examined by means of the Spearman’s rank correlation coefficient. The Friedman test was used to evaluate the agreement between the Rowe score numerical results. Post-hoc comparisons were performed with the Wilcoxon matched pairs test, whereas adjustment for multiple testing was made according to Bonferroni. Evaluation results: Evaluation results (excellent, good, fair, and poor) of the different Rowe score versions are expressed using percentage frequency and represented in bar charts. Pairwise comparisons of the evaluation results were performed using contingency tables. The agreement between each 2 Rowe score evaluation results was evaluated using Bowker’s test for symmetry and Cohen’s kappa.
Table II
Number and content of the Rowe score items
1978 Rowe Score Score contains 3 items (stability, motion, function). Score distinguishes between re-dislocation, subluxation, and apprehension. 1981 Rowe Score Score contains 4 items (function, pain, stability, motion). Score does not distinguish between re-dislocation, subluxation, or apprehension. 1982 Rowe Score Score contains 3 items (pain, motion, function). Stability is assessed within the scope of the item ‘‘function’’. Score does not distinguish between re-dislocation, subluxation, or significant functional restrictions. 1988 Rowe Score Score contains eight items with 5 topics (pain, stability, function, motion, strength). Score does not distinguish precisely between re-dislocation, subluxation, and apprehension in every single case.
proven (Spearman’s rank correlation coefficient 0.81 to 0.87). This roughly means that patients who achieve aboveaverage points in one Rowe score tend to also achieve aboveaverage points in the other Rowe scores, and vice-versa; however, distinct deviations of the actual points were observed. Significant differences of the totals in the various Rowe scores were proven with the Friedman test (P < .001). Subsequent pair-wise comparisons using the Wilcoxon matched pairs test also revealed significant differences in 4 of 6 comparisons even after adjustment. Only between the 1978 and 1982 Rowe scores were there no significant differences observed (P > .05). The differences between the 1978 and 1988 scores were no longer significant after adjustment (P < .05, Padj > .05). Highly significant differences (P < .001, Padj < .001) were observed in all other pair-wise comparisons (1978 vs 1981, 1981 vs 1982, 1981 vs 1988, and 1982 vs 1988). The highest mean numerical results were observed in the 1988 Rowe score (Ø 88.7 points) and the lowest mean numerical results in the 1981 Rowe score (Ø 73.6 points). Thus the difference between these 2 scores is 15.1 points. Table III shows a comparison of the totals in the various Rowe score versions. The graphical presentation as box plot also shows the different distribution patterns of the numerical results in the various Rowe scores (see Figure 1). Scatter plots showed a moderate agreement of the numerical results in the various Rowe score versions.
Results
Evaluation results
Numerical results
The differences of the various Rowe score versions became even more obvious upon examination of the evaluation results. These are influenced by the various classifications of the Rowe scores (see Table I).
All Rowe scores range from 0 to 100 points. A close correlation of the numerical results in the various scores was
Rowe score
513
Table III Various numerical results of the 4 Rowe scores with n ¼ 62 patients
1978 score 1981 score 1982 score 1988 score
Mean value
Median Standard deviation
Minimum Maximum
84.6
95.0
19.45
20
100
73.6
75.0
22.05
10
100
85.7
90.0
12.40
40
100
88.7
91.0
10.73
45
100
Table IV Various evaluation results of the 4 Rowe scores with n ¼ 62 patients 1978 1981 1982 1988
Score Score Score Score
Excellent
Good
Fair
Poor
67.7% 29.0% 51.6% 74.2%
12.9% 27.4% 43.5% 19.4%
12.9% 35.5% 3.2% 4.8%
6.5% 8.1% 1.6% 1.6%
Statistical comparison of the evaluation results between the individual Rowe score versions revealed significant differences (P .05 to .001, Bowker’s test for symmetry). Only between the 1978 and 1988 score no significant differences (P > .05) were observed with low agreement (Cohen’s kappa coefficient .272).
Discussion
Figure 1 Box plot of numerical results of the 4 Rowe scores with n ¼ 62 patients.
In the 1988 Rowe score, most ‘‘excellent’’ ratings were received (74.2% excellent). Most ‘‘good’’ or ‘‘excellent’’ scores were achieved in the 1982 Rowe score (95.2% good or excellent). Fewest of all ‘‘excellent’’ scores were achieved in the 1981 Rowe score (29% excellent); in this score, the fewest ‘‘good’’ or ‘‘excellent’’ ratings were received (56.5% good or excellent). Table IV shows a comparison of the evaluation results in the various Rowe scores. The graphic representation of the percentage frequency of evaluation results (see Figure 2) clearly shows the different distribution patterns. Agreement of the evaluation results of the Rowe score versions were compared pairwise in contingency tables. The lowest contingency of evaluation results was observed between the 1981 and 1988 scores. Only 22 out of 62 patients achieved the same values in both scores. Forty patients achieved a better evaluation in the 1988 score; none of the patients achieved better values in the 1981 Rowe score.
With the present study significant differences were proven between the various Rowe score versions. All Rowe scores show a close correlation of numerical results; however, significant deviations of the actual points were observed. The difference of evaluation results (excellent, good, fair, and poor) with different classification was particularly noticeable. The different Rowe scores were issued in various years and each score is an updated version of the previous Rowe score. However, all versions are used in parallel and results are sometimes published without any information about the Rowe score version used. Consequently, results of different scoring systems are compared internationally. Depending on the Rowe score used, significantly different results can be published of the same patient population. In our case, this means: Good to excellent results in 94% of the patients after arthroscopic Bankart repair! (1988 Rowe score), or Only 57% of the patients achieve good or excellent results after arthroscopic Bankart repair! (1981 Rowe score) But which score should be used? As each Rowe score version is an updated version of the previous version, the latest Rowe score version (1988) should consequently be used; however, according to our knowledge, the 1988 Rowe score was never published in a scientific journal. This would be an argument in favor of the 1982 Rowe score. An argument for the 1978 Rowe score, however, is that it is the only score which clearly documents re-dislocation. Some authors also refer to this score as the ‘‘original’’ Rowe score. Regardless of the Rowe score used, we recommend to always indicate the Rowe score version used. If the 1981,
514
K.-U. Jensen et al. 80 70
1978 Rowe score Excellent 67,7%
80 70
60
60
50
50
40
40
30
30 Good 12,9%
20
Fair 12,9%
10
Good 43,5%
Fair 3,2%
10
Poor 1,6%
0
1981 Rowe score
1988 Rowe score
80
80
70
70
60
60
50
30
Excellent 51,6%
20 Poor 6,5%
0
40
1982 Rowe score
Excellent 74,2%
50 Excellent Good 29% 27,4%
20 10
Fair 35,5%
40 30 Poor 8,1%
10
Good 19,4% Fair 4,8%
Poor 1,6%
0
0
Figure 2
20
Various evaluation results of the 4 Rowe scores with n ¼ 62 patients.
1982, and 1988 Rowe scores are used, it should be documented if the patient experienced re-dislocation. All in all, it would be desirable to establish one single Rowe score.
References 1. Balg F, Boileau P. The instability severity index score. A simple preoperative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 2007;89B:1470-7. 2. Boileau P, Villalba M, He´ry JY, Balg F, Ahrens P, Neyton L. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am 2006;88:1755-63. 3. Cho NS, Lubis AM, Ha JH, Rhee YG. Clinical results of arthroscopic bankart repair with knot-tying and knotless suture anchors. Arthroscopy 2006;22:1276-82.
4. Goga I. Chronic shoulder dislocations. J Shoulder Elbow Surg 2003; 12:446-50. 5. Kartus C, Kartus J, Matis N, Forstner R, Resch H. Long-term independent evaluation after arthroscopic extra-articular Bankart repair with absorbable tacks. A clinical and radiographic study with a seven to ten-year follow-up. J Bone Joint Surg Am 2007;89:1442-8. 6. Rowe CR, Patel D, Southmayd WW. The Bankart procedure: a longterm end-result study. J Bone Joint Surg Am 1978;60:1-16. 7. Rowe CR, Zarins B. Recurrent transient subluxation of the shoulder. J Bone Joint Surg Am 1981;63:863-72. 8. Rowe CR, Zarins B. Chronic unreduced dislocations of the shoulder. J Bone Joint Surg Am 1982;64:494-505. 9. Rowe CR. Evaluation of the shoulder. In: Rowe CR, editor. The Shoulder. New York: Churchill Livingstone; 1988. p. 631-7. 10. Sugaya H, Moriishi J, Kanisawa I, Tsuchiya A. Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability. Surgical technique. J Bone Joint Surg Am 2006;88:159-69.
www.elsevier.com/locate/ymse
Not all Rowe scores are the same! Which Rowe score do you use? Kai-Uwe Jensen, MDa,*, Genio Bongaerts, MDb, Raphael Bruhnb, Silke Schneider, MDa a b
Arthro Clinic Institute, Hamburg, Germany Arthro Clinic, Hamburg, Germany Background: The Rowe score is an internationally recognized scoring system for the postoperative assessment of Bankart repairs; however, there are 4 different Rowe score versions. All 4 versions are used in parallel and results are sometimes published without any information about the Rowe score version used. Therefore, the aim of the present study was to assess the correlation and agreement of the various Rowe score versions. Method: Sixty-two patients were scheduled for follow-up examination after arthroscopic Bankart repair. All 4 Rowe score versions were used. The results of all Rowe scores were compared and correlation and agreement evaluated. Result: The evaluation revealed significant differences. The highest mean score was observed in the 1988 Rowe score (Ø 88.7 points) and the lowest mean score in the 1981 Rowe score (Ø 73.6 points). Conclusion: Not all Rowe scores are the same! Therefore, the used Rowe score should always be indicated. It would be desirable to establish one single Rowe score. Level of evidence: Level 3; Diagnostic study. Ó 2009 Journal of Shoulder and Elbow Surgery Board of Trustees.
The Rowe score is an internationally recognized scoring system for the postoperative assessment of Bankart repairs. However, research at www.PubMed.gov and www.MedPilot. de revealed that 4 different versions of the Rowe score exist. The first version of the Rowe score was published in 1978 in ‘‘The Journal of Bone & Joint Surgery’’ by Rowe, Patel and Southmayd.6 In 1981 and 1982, Rowe and Zarins7,8 published updated versions of the score in the same journal. The fourth and last Rowe score version was published by Carter R. Rowe in his book ‘‘The Shoulder’’.9 Literature research revealed that all different Rowe score versions are used in parallel,1e5,10 and results are sometimes published without any information about the Rowe score *Reprint requests: Kai-Uwe Jensen, MD, Arthro Clinic Institute, Rahlstedter Bahnhofstr. 7a, 22143 Hamburg, Germany. E-mail address: [email protected] (K.-U. Jensen).
version used. Consequently, various score results are compared internationally. We did not find any paper about the correlation and consistency of the various Rowe scores. Therefore, the aim of the present study was to assess the correlation and agreement of the various Rowe Score versions.
Materials and methods Study population and study design Sixty-two patients were followed up after Bankart repair within the scope of a follow-up study. All 4 Rowe score versions were used. All patients were examined between 2007 and 2008 after arthroscopic Bankart repair using knotless suture anchors (Knotless/Bioknotless by DePuy Mitek) between 2002 and 2006. Only patients with anterior shoulder instability were included in the
1058-2746/2009/$36.00 - see front matter Ó 2009 Journal of Shoulder and Elbow Surgery Board of Trustees. doi:10.1016/j.jse.2009.02.003
512 Table I
K.-U. Jensen et al. Various classifications of the 4 Rowe scores
1978 score 1981 score 1982 score 1988 score
Excellent
Good
Fair
Poor
90-100 points 90-100 points 90-100 points 85-100 points
75-89 points 70-89 points 70-89 points 70-84 points
51-74 points 40-69 points 50-69 points 50-69 points
50 points 39 points < 50 points 49 points
study. Patients with posterior or multidirectional shoulder instability were not included in the study. Forty-three male (69.4%) and 19 female (30.6%) patients were examined. The mean follow-upperiod from surgery was 38.9 months (minimum 20 months, maximum 68 months, standard deviation 13.4).
The scores All 4 Rowe score versions range from 0 to 100 points, and the points represent a certain evaluation. All 4 Rowe score versions include possible ratings of excellent, good, fair, and poor. However, all scores have different assessment classifications; eg, patients with 85 points were rated ‘‘excellent’’ in the 1988 Rowe score, whereas in all other scores only results with at least 90 points are classified as ‘‘excellent’’. Table I shows a comparison of the different classifications. The Rowe scores also differ in terms of quantity and content of the individual items (see Table II). Three of the 4 Rowe scores do not record exactly whether there was a re-dislocation.
Statistical methods Numerical results: The distributions of the numerical results (0-100 possible points) of the different Rowe score versions were described by mean and standard deviation, median, minimum, and maximum and graphically illustrated by the use of box plots and scatter plots. The correlations between each 2 Rowe score numerical results were examined by means of the Spearman’s rank correlation coefficient. The Friedman test was used to evaluate the agreement between the Rowe score numerical results. Post-hoc comparisons were performed with the Wilcoxon matched pairs test, whereas adjustment for multiple testing was made according to Bonferroni. Evaluation results: Evaluation results (excellent, good, fair, and poor) of the different Rowe score versions are expressed using percentage frequency and represented in bar charts. Pairwise comparisons of the evaluation results were performed using contingency tables. The agreement between each 2 Rowe score evaluation results was evaluated using Bowker’s test for symmetry and Cohen’s kappa.
Table II
Number and content of the Rowe score items
1978 Rowe Score Score contains 3 items (stability, motion, function). Score distinguishes between re-dislocation, subluxation, and apprehension. 1981 Rowe Score Score contains 4 items (function, pain, stability, motion). Score does not distinguish between re-dislocation, subluxation, or apprehension. 1982 Rowe Score Score contains 3 items (pain, motion, function). Stability is assessed within the scope of the item ‘‘function’’. Score does not distinguish between re-dislocation, subluxation, or significant functional restrictions. 1988 Rowe Score Score contains eight items with 5 topics (pain, stability, function, motion, strength). Score does not distinguish precisely between re-dislocation, subluxation, and apprehension in every single case.
proven (Spearman’s rank correlation coefficient 0.81 to 0.87). This roughly means that patients who achieve aboveaverage points in one Rowe score tend to also achieve aboveaverage points in the other Rowe scores, and vice-versa; however, distinct deviations of the actual points were observed. Significant differences of the totals in the various Rowe scores were proven with the Friedman test (P < .001). Subsequent pair-wise comparisons using the Wilcoxon matched pairs test also revealed significant differences in 4 of 6 comparisons even after adjustment. Only between the 1978 and 1982 Rowe scores were there no significant differences observed (P > .05). The differences between the 1978 and 1988 scores were no longer significant after adjustment (P < .05, Padj > .05). Highly significant differences (P < .001, Padj < .001) were observed in all other pair-wise comparisons (1978 vs 1981, 1981 vs 1982, 1981 vs 1988, and 1982 vs 1988). The highest mean numerical results were observed in the 1988 Rowe score (Ø 88.7 points) and the lowest mean numerical results in the 1981 Rowe score (Ø 73.6 points). Thus the difference between these 2 scores is 15.1 points. Table III shows a comparison of the totals in the various Rowe score versions. The graphical presentation as box plot also shows the different distribution patterns of the numerical results in the various Rowe scores (see Figure 1). Scatter plots showed a moderate agreement of the numerical results in the various Rowe score versions.
Results
Evaluation results
Numerical results
The differences of the various Rowe score versions became even more obvious upon examination of the evaluation results. These are influenced by the various classifications of the Rowe scores (see Table I).
All Rowe scores range from 0 to 100 points. A close correlation of the numerical results in the various scores was
Rowe score
513
Table III Various numerical results of the 4 Rowe scores with n ¼ 62 patients
1978 score 1981 score 1982 score 1988 score
Mean value
Median Standard deviation
Minimum Maximum
84.6
95.0
19.45
20
100
73.6
75.0
22.05
10
100
85.7
90.0
12.40
40
100
88.7
91.0
10.73
45
100
Table IV Various evaluation results of the 4 Rowe scores with n ¼ 62 patients 1978 1981 1982 1988
Score Score Score Score
Excellent
Good
Fair
Poor
67.7% 29.0% 51.6% 74.2%
12.9% 27.4% 43.5% 19.4%
12.9% 35.5% 3.2% 4.8%
6.5% 8.1% 1.6% 1.6%
Statistical comparison of the evaluation results between the individual Rowe score versions revealed significant differences (P .05 to .001, Bowker’s test for symmetry). Only between the 1978 and 1988 score no significant differences (P > .05) were observed with low agreement (Cohen’s kappa coefficient .272).
Discussion
Figure 1 Box plot of numerical results of the 4 Rowe scores with n ¼ 62 patients.
In the 1988 Rowe score, most ‘‘excellent’’ ratings were received (74.2% excellent). Most ‘‘good’’ or ‘‘excellent’’ scores were achieved in the 1982 Rowe score (95.2% good or excellent). Fewest of all ‘‘excellent’’ scores were achieved in the 1981 Rowe score (29% excellent); in this score, the fewest ‘‘good’’ or ‘‘excellent’’ ratings were received (56.5% good or excellent). Table IV shows a comparison of the evaluation results in the various Rowe scores. The graphic representation of the percentage frequency of evaluation results (see Figure 2) clearly shows the different distribution patterns. Agreement of the evaluation results of the Rowe score versions were compared pairwise in contingency tables. The lowest contingency of evaluation results was observed between the 1981 and 1988 scores. Only 22 out of 62 patients achieved the same values in both scores. Forty patients achieved a better evaluation in the 1988 score; none of the patients achieved better values in the 1981 Rowe score.
With the present study significant differences were proven between the various Rowe score versions. All Rowe scores show a close correlation of numerical results; however, significant deviations of the actual points were observed. The difference of evaluation results (excellent, good, fair, and poor) with different classification was particularly noticeable. The different Rowe scores were issued in various years and each score is an updated version of the previous Rowe score. However, all versions are used in parallel and results are sometimes published without any information about the Rowe score version used. Consequently, results of different scoring systems are compared internationally. Depending on the Rowe score used, significantly different results can be published of the same patient population. In our case, this means: Good to excellent results in 94% of the patients after arthroscopic Bankart repair! (1988 Rowe score), or Only 57% of the patients achieve good or excellent results after arthroscopic Bankart repair! (1981 Rowe score) But which score should be used? As each Rowe score version is an updated version of the previous version, the latest Rowe score version (1988) should consequently be used; however, according to our knowledge, the 1988 Rowe score was never published in a scientific journal. This would be an argument in favor of the 1982 Rowe score. An argument for the 1978 Rowe score, however, is that it is the only score which clearly documents re-dislocation. Some authors also refer to this score as the ‘‘original’’ Rowe score. Regardless of the Rowe score used, we recommend to always indicate the Rowe score version used. If the 1981,
514
K.-U. Jensen et al. 80 70
1978 Rowe score Excellent 67,7%
80 70
60
60
50
50
40
40
30
30 Good 12,9%
20
Fair 12,9%
10
Good 43,5%
Fair 3,2%
10
Poor 1,6%
0
1981 Rowe score
1988 Rowe score
80
80
70
70
60
60
50
30
Excellent 51,6%
20 Poor 6,5%
0
40
1982 Rowe score
Excellent 74,2%
50 Excellent Good 29% 27,4%
20 10
Fair 35,5%
40 30 Poor 8,1%
10
Good 19,4% Fair 4,8%
Poor 1,6%
0
0
Figure 2
20
Various evaluation results of the 4 Rowe scores with n ¼ 62 patients.
1982, and 1988 Rowe scores are used, it should be documented if the patient experienced re-dislocation. All in all, it would be desirable to establish one single Rowe score.
References 1. Balg F, Boileau P. The instability severity index score. A simple preoperative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 2007;89B:1470-7. 2. Boileau P, Villalba M, He´ry JY, Balg F, Ahrens P, Neyton L. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am 2006;88:1755-63. 3. Cho NS, Lubis AM, Ha JH, Rhee YG. Clinical results of arthroscopic bankart repair with knot-tying and knotless suture anchors. Arthroscopy 2006;22:1276-82.
4. Goga I. Chronic shoulder dislocations. J Shoulder Elbow Surg 2003; 12:446-50. 5. Kartus C, Kartus J, Matis N, Forstner R, Resch H. Long-term independent evaluation after arthroscopic extra-articular Bankart repair with absorbable tacks. A clinical and radiographic study with a seven to ten-year follow-up. J Bone Joint Surg Am 2007;89:1442-8. 6. Rowe CR, Patel D, Southmayd WW. The Bankart procedure: a longterm end-result study. J Bone Joint Surg Am 1978;60:1-16. 7. Rowe CR, Zarins B. Recurrent transient subluxation of the shoulder. J Bone Joint Surg Am 1981;63:863-72. 8. Rowe CR, Zarins B. Chronic unreduced dislocations of the shoulder. J Bone Joint Surg Am 1982;64:494-505. 9. Rowe CR. Evaluation of the shoulder. In: Rowe CR, editor. The Shoulder. New York: Churchill Livingstone; 1988. p. 631-7. 10. Sugaya H, Moriishi J, Kanisawa I, Tsuchiya A. Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability. Surgical technique. J Bone Joint Surg Am 2006;88:159-69.