Arthroscopic vs Open Bankart Repair for Anterior Shoulder Instability: A Systematic Review and Meta-analysis

Background: Bankart repair is commonly performed for traumatic anterior shoulder instability. Modern arthroscopic techniques have advanced considerably, raising the question of whether their clinical performance now matches that of traditional open repair. Purpose: To compare contemporary arthroscopic and open Bankart repair across instability-related, functional, perioperative, and complication outcomes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of the PubMed, Scopus, Cochrane Library, and Google Scholar databases was conducted through December 2025. A total of 32 comparative studies met inclusion criteria. Extracted outcomes included postoperative dislocation, subluxation, overall instability, apprehension, patient-reported outcome measures (Rowe, American Shoulder and Elbow Surgeons [ASES], University of California Los Angeles [UCLA], Western Ontario Shoulder Instability Index [WOSI], and visual analog scale [VAS] scores), postoperative range of motion (ROM), loss of motion relative to baseline, operative time, infection, and reoperation rates. A subgroup analysis stratified studies by publication period (before 2010 vs 2010 onward) to explore the influence of evolving surgical techniques over time. Results: No differences were found between arthroscopic and open Bankart repair in postoperative dislocation ( P = .05), subluxation ( P = .40), overall instability ( P = .06), or apprehension ( P = .40). Patient-reported outcomes, including Rowe ( P = .19), ASES ( P = .28), UCLA ( P = .41), WOSI ( P = .40), and VAS pain ( P = .05) scores, were comparable between groups. Postoperative ROM showed no differences across most parameters; however, loss of external rotation in abduction relative to baseline favored arthroscopic repair (mean difference, −1.67; P = .04). Operative time did not differ between groups ( P = .11). Arthroscopic repair was associated with a shorter hospital stay ( P = .0001). Reoperation rates were higher after arthroscopic repair (RR, 2.15; P = .0004). Infection rates were similar ( P = .13). In subgroup analysis, studies published before 2010 showed higher postoperative dislocation (RR, 2.13; P = .01) and overall instability (RR, 1.67; P = .02) after arthroscopic repair, as well as greater external rotation in abduction with arthroscopy. In contrast, studies published from 2010 onward demonstrated no differences between arthroscopic and open repair across instability, functional, or ROM outcomes. Conclusion: Arthroscopic and open Bankart repair provide largely comparable postoperative stability, functional recovery, and ROM, with modest differences reflecting the intrinsic nature of each technique. Publication period subgroup analysis suggests that historical instability differences were driven primarily by earlier studies, whereas contemporary studies show comparable instability and functional outcomes between approaches. Given its minimally invasive profile, arthroscopy offers practical advantages, including slightly better preservation of external rotation in abduction, while maintaining stability outcomes comparable to open repair.