Does Suture Anchor Number Influence Outcomes after Arthroscopic Bankart Repair? A 2-year Prospective Study

Abstract Introduction: Anterior shoulder instability is common among young, active individuals, with Bankart lesions present in the majority of cases. While arthroscopic Bankart repair is the current standard of care, the optimal number of suture anchors remains debated. This prospective study evaluated whether anchor number influences functional outcomes and recurrence rates over 2 years. Methods: A total of 100 consecutive patients undergoing arthroscopic Bankart repair for magnetic resonance imaging-confirmed Bankart lesions between December 2019 and December 2022 were included. Exclusion criteria were significant bone loss, multidirectional instability, rotator cuff tears, and connective tissue disorders. Repairs were performed by a single surgeon using two or more anchors, with remplissage added for engaging Hill–Sachs lesions. Functional scores (American Shoulder and Elbow Surgeons [ASES], Quick Disabilities of the Arm, Shoulder, and Hand [DASH], and ROWE), range of motion, and pain (visual analog scale [VAS]) were recorded preoperatively and at 1, 3, 6, 12, and 24 months. Outcomes were compared between patients receiving two anchors versus ≥3 anchors. Results: Mean age was 25.2 ± 7.1 years; 91% were male. Two anchors were used in 77% of cases. Remplissage was performed in 26%. At 2 years, mean VAS decreased from 5.0 to 0.8, ASES improved from 48.2 to 88.1, Quick DASH from 42.0 to 9.6, and ROWE from 50.9 to 92.4 ( P < 0.001). Range of motion improved significantly without clinically relevant external rotation loss. No recurrences or anchor-related complications occurred. Functional outcomes were equivalent between anchor groups and remplissage status. Conclusion: Our findings suggest that, in carefully selected patients without major bone loss, arthroscopic Bankart repair provides excellent early to midterm functional outcomes and stability, and that outcomes are not significantly influenced by the absolute number of suture anchors used.