Labral Morphology and Number of Preoperative Dislocations Are Associated With Recurrent Instability After Arthroscopic Bankart Repair

Vaswani, Ravi; Gasbarro, Gregory; Como, Christopher; Golan, Elan; Fourman, Mitchell S.; Wilmot, Andrew; Borrero, Camilo; Vyas, Dharmesh; Lin, Albert

doi:10.1016/j.arthro.2019.11.111

Cited by 21 publications

(13 citation statements)

References 26 publications

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“…Therefore, the inclusion of risk factors is susceptible to confounding by publication date. While this review discussed 12 risk factors, other factors have been presented in literature that did not meet the threshold or inclusion criteria for this analysis, such as the number of preoperative dislocations, 37,60 patient positioning, 21 anchor placement, 48 time to surgery, 37,51 and overhead sports participation. 64 Last, we excluded studies of first-time dislocations in our analysis.…”

Section: Discussionmentioning

confidence: 99%

Inconsistencies in Controlling for Risk Factors for Recurrent Shoulder Instability After Primary Arthroscopic Bankart Repair: A Systematic Review

et al. 2021

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Background: Failure rates after arthroscopic shoulder stabilization are highly variable in the current orthopaedic literature. Predictive factors for risk of failure have been studied to improve patient selection, refine surgical techniques, and define the role of bony procedures. However, significant heterogeneity in the analysis and controlling of risk factors makes evidence-based management decisions challenging. Purpose: The goals of this systematic review were (1) to critically assess the consistency of reported risk factors for recurrent instability after arthroscopic Bankart repair, (2) to identify the existing studies with the most comprehensive inclusion of confounding factors in their analyses, and (3) to give recommendations for which factors should be reported consistently in future clinical studies. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed in accordance with the PRISMA guidelines. An initial search yielded 1754 titles, from which 56 full-text articles were screened for inclusion. A total of 29 full-text articles met the following inclusion criteria: (1) clinical studies regarding recurrent anterior shoulder instability; (2) surgical procedures performed including arthroscopic anterior labral repair; (3) reported clinical outcome data including failure rate; and (4) assessment of risk factors for surgical failure. Further subanalyses were performed for 15 studies that included a multivariate analysis, 17 studies that included glenoid bone loss, and 8 studies that analyzed the Instability Severity Index Score. Results: After full-text review, 12 of the most commonly studied risk factors were identified and included in this review. The risk factors that were most consistently significant in multivariate analyses were off-track lesions (100%), glenoid bone loss (78%), Instability Severity Index Score (75%), level of sports participation (67%), number of anchors (67%), and younger age (63%). In studies of bone loss, statistical significance was more likely to be found using advanced imaging, with critical bone loss thresholds of 10% to 15%. Several studies found predictive thresholds of 2 to 4 for Instability Severity Index Score by receiver operating characteristic or multivariate analysis. Conclusion: Studies reporting risk factors for failure of arthroscopic Bankart repair often fail to control for known confounding variables. The factors with the most common statistical significance among 15 multivariate analyses are off-track lesions, glenoid bone loss, Instability Severity Index Score, level of sports participation, number of anchors, and younger age. Studies found significance more commonly with advanced imaging measurements or arthroscopic assessment of glenoid bone loss and with lower thresholds for the Instability Severity Index Score (2-4). Future studies should attempt to control for all relevant factors, use advanced imaging for glenoid bone loss measurements, and consider a lower predictive threshold for the Instability Severity Index Score.

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Section: Discussionmentioning

confidence: 99%

Inconsistencies in Controlling for Risk Factors for Recurrent Shoulder Instability After Primary Arthroscopic Bankart Repair: A Systematic Review

et al. 2021

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“…There are more likelihood of ALAPSA lesions (which have 4 times more risk of failures than Bankart lesion) more capsular and cartilage lesions, large and deeper Hillsach lesion, increased glenoid bone loss, and increased glenohumeral arthrosis [21]. In a level 3 casecontrol study it is concluded that an increased number of recurrent dislocations before primary repair was associated with increased odds of recurrent instability after surgery [22]. In a well-executed study, Duethman et al [23] studied the success rate of nonoperative treatment of 379 patients with average age of 23.9 years, followed up for 10.2 years, and factors associated to conversion to surgery and concluded t h a t 3 5 % o f p a t i e n t s t r e a t e d conservatively after the first dislocation experienced dislocation after 6 months and 20% underwent surgical treatment.…”

Section: Treatmentmentioning

confidence: 98%

A Clinical Overview of Management of First time Anterior Shoulder Dislocation

Narvekar¹,

Iyer²,

Shetty³

et al. 2022

Jcorth

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Background: Instability following a traumatic shoulder dislocation is known to cause significant morbidity especially as ost-traumatic dislocations occur in young active patients. The management of this injury is still controversial. There is always a debate between those that recommend surgical stabilization following a 1st time dislocation (FTD) and those that prefer treating them conservatively. The aim of treatment following a dislocation is to manage the episode such that there is no threat of recurrence, there is a full functional recovery with no apprehension, and an ability to get back to the same level of sporting activity. Purpose: The purpose of the study is to review the current literature and provide recommendations regarding management following FTD. Design: Clinical overview, Perspective. Methods: Review of literature using PUBMED, MEDLINE. Results: The present thought process is towards Arthroscopic primary stabilization following 1st time post-traumatic dislocation in young active individuals with projected significant overhead activities. Conclusion: Management of a patient following a FTD/subluxation has been the subject of debate for a long time. A number of factors have been studied and published such as age, sports participation, sex, pathological findings after the dislocation to enable the surgeon to decide on the management of this condition. Recurrence comes at a cost of increasing the instability with every episode of dislocation. More the instability before the surgical stabilization, more are the chances of either failure or the requirement of a salvage procedure like a Latarjet with its inherent high complication rate. But not every patient with FTD should warrant a surgical stabilization. A personalized approach is recommended and not a one size fits all approach.

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“…The more you dislocate, the more the weakness increases. 19 Is the time between the surgery and its repair also a factor, as it is for other ligaments like at the thumb or the knee? 20 In our view, this is the most challenging opportunity of research in shoulder instability for the next few years.…”

Section: Paris Francementioning

confidence: 99%

Editorial Commentary: A Functional Capsule, Not the Type of Bone Graft, Determines Outcome After Shoulder Stabilization in Cases of Anterior Glenoid Bone Deficiency

Nourissat¹,

Housset²,

Lehanneur³

et al. 2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Many clinical results of surgical treatment of recurrent anterior shoulder instability confirm the importance of anterior bone grafting of the glenoid defect. Some studies even propose to perform a graft, even when there is no bony defect. Short-and middle-term studies report comparable results between bone grafting and Latarjet procedure. But one of the main questions that still remains is the quality and efficiency of the capsule. If Latarjet is the gold standard in anterior shoulder stabilization with very good results at very long follow-up, it is probably because the capsule is replaced by the conjoint tendon. Because Latarjet is a difficult surgery and has some complexes and/or challenging complications and because it is a nonanatomic procedure, there is a true place for anterior bone grafting. This anterior grafting under arthroscopy provides excellent results, but it is mandatory to be sure that the shoulder capsule is working. Clinical, functional, and imaging studies of this capsule need to be performed for a better understanding of the unstable shoulder function and treatment.

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Labral Morphology and Number of Preoperative Dislocations Are Associated With Recurrent Instability After Arthroscopic Bankart Repair

Cited by 21 publications

References 26 publications

Inconsistencies in Controlling for Risk Factors for Recurrent Shoulder Instability After Primary Arthroscopic Bankart Repair: A Systematic Review

Inconsistencies in Controlling for Risk Factors for Recurrent Shoulder Instability After Primary Arthroscopic Bankart Repair: A Systematic Review

A Clinical Overview of Management of First time Anterior Shoulder Dislocation

Editorial Commentary: A Functional Capsule, Not the Type of Bone Graft, Determines Outcome After Shoulder Stabilization in Cases of Anterior Glenoid Bone Deficiency

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