Trends in utilization and patient demographics for shoulder instability procedures from 2010 to 2019

Haskoor, John; Wang, Kevin Y.; Agarwal, Amil R.; Mikula, Jacob D.; Sharma, Sribava; Nayar, Suresh K.; Srikumaran, Uma

doi:10.1016/j.jse.2021.12.020

Cited by 8 publications

(6 citation statements)

References 26 publications

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“…Over time, there has been a noticeable shift in the approach to managing patients with failed soft-tissue Bankart repairs. 1 Surgeons are increasingly favoring anatomical reconstruction of the anterior glenoid surface using bone-block techniques instead of revisiting soft-tissue repairs. Among these techniques, variations of the open Latarjet procedure have gained prominence.…”

Section: Introductionmentioning

confidence: 99%

Surgical management of recurrent instability following Latarjet procedure – A systematic review of salvage procedures

Baur,

Satalich,

O’Connell

et al. 2024

Shoulder & Elbow

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Background Failed Latarjet procedures pose a surgical challenge due to complex anatomical issues. This systematic review investigates salvage techniques for recurrent instability following a Latarjet procedure. Methods A search was conducted on MEDLINE and PubMed Central following the methodology registered to International Prospective Register of Systematic Reviews. Inclusion criteria focused on identifying revision procedures following a Latarjet procedure. Exclusion criteria filtered out irrelevant studies, such as those focused on Bankart procedures. After a multistage selection process, 10 eligible studies were included for data extraction. Results The most frequently utilized technique for salvage was variations of the Eden–Hybinette procedure. Complications associated with these salvage procedures include graft-related problems and donor site morbidity. Patients reported significant improvements in multiple patient-reported outcome scores, and multiple studies indicated high rates of return to sports activities. However, it is noteworthy that there remains an average recurrence rate of 7%. Discussion The review emphasizes the limited therapeutic options available largely due to shoulder anatomy alterations. Despite promising trends in patient-reported outcomes, recurrence remains possible post-salvage surgeries. Conclusion Addressing recurrent instability after a Latarjet procedure continues to be a unique surgical challenge. However, this systematic review highlights encouraging indications, with positive trends evident in patient-reported outcomes.

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Section: Introductionmentioning

confidence: 99%

Surgical management of recurrent instability following Latarjet procedure – A systematic review of salvage procedures

Baur,

Satalich,

O’Connell

et al. 2024

Shoulder & Elbow

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“…In many studies, an arthroscopic Bankart repair has been found to elicit favorable outcomes with low complication rates, unless a glenoid defect is large enough to require reconstructive procedures [2, 6, 11, 23]. Thus, recurrent shoulder dislocations are commonly addressed arthroscopically [8].…”

Section: Introductionmentioning

confidence: 99%

High failure rate after conservative treatment for recurrent shoulder dislocation without subjective apprehension on physical examination

Kim

Lim

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to investigate the outcomes of conservative treatment for recurrent shoulder dislocation without subjective apprehension, despite the presence of a Bankart lesion or glenoid defect. Methods A retrospective analysis was performed for 92 patients with recurrent shoulder dislocation treated with conservative treatment due to negative apprehension between 2009 and 2018. The failure of the conservative treatment was deined as a dislocation or subluxation episode or subjective feeling of instability based on a positive apprehension. The Kaplan-Meier method was used to estimate failure rates over time, and a receiver operating characteristic (ROC) curve was constructed to determine a cut-of value for a glenoid defect. The clinical outcomes were compared between patients who completed conservative treatment without recurrence of instability (Group A) and those who failed and subsequently underwent surgical treatment (Group B) using shoulder functional scores and sports/recreation activity level. Results This retrospective study included 61 of 92 eligible patients with recurrent shoulder dislocation. Among the 61 patients, conservative treatment failed in 46 (75.4%) over the 2-year study period. The cut-of value for a glenoid defect was 14.4%. The association between glenoid defect size (≥ 14.4% or as a continuous variable) and survival was statistically signiicant (p = 0.039 and p < 0.001, respectively). The mean glenoid defect size in Group B increased from 14.6 ± 3.0% to 17.3 ± 3.1% (p < 0.001), and clinical outcomes for Group A were inferior to those for Group B at the 24-month follow-up. Conclusions Conservative treatment for recurrent shoulder dislocation in patients without subjective apprehension showed a high failure rate during the study period, especially if the glenoid defect was ≥ 14.4% in size. Despite clinical improvement in patients who completed conservative treatment without recurrence, functional outcome scores and sport/recreation activity levels were better in the patients who underwent arthroscopic Bankart repair. Therefore, for recurrent anterior shoulder instability, even without subjective apprehension, surgical treatment is warranted over conservative treatment. Level of evidence: Level IV.

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“…Recurrent traumatic anterior shoulder instability remains a common problem encountered by shoulder surgeons. 4 Surgical stabilization is often needed to prevent further episodes of instability. While the most common procedure performed for shoulder instability in many countries is an arthroscopic Bankart repair, 4 the need for an adjunctive procedure continues to be refined.…”

mentioning

confidence: 99%

“… 4 Surgical stabilization is often needed to prevent further episodes of instability. While the most common procedure performed for shoulder instability in many countries is an arthroscopic Bankart repair, 4 the need for an adjunctive procedure continues to be refined. Hill-Sachs lesions are commonly found in recurrent traumatic anterior instability.…”

mentioning

confidence: 99%

Validating the Glenoid Track Concept Using Dynamic Arthroscopic Assessment

Rashid,

Tsuchiya,

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: Failure after isolated Bankart repair has led surgeons to consider when to address the Hill-Sachs lesion, which is thought to be a contributor to recurrent instability. One approach utilizes the glenoid track concept to determine whether a Hill-Sachs lesion is classified as “off-track,” suggesting that the addition of a remplissage procedure may aid stability. However, the accuracy and reliability of using this approach require validation using an appropriate reference. Purpose: To determine the accuracy and reliability of using the glenoid track concept against dynamic arthroscopic assessment of Hill-Sachs lesion engagement. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 49 patients undergoing arthroscopic Bankart repair surgery for recurrent traumatic anterior shoulder instability were enrolled in this diagnostic validation study. Shoulders were classified as on-track or off-track using 3-dimensional computed tomography (3DCT) and static arthroscopic measurements. These classifications were compared with dynamic arthroscopic assessment (engagement of the Hill-Sachs lesion on the anterior glenoid rim in the ‘athletic position’) to determine their accuracy and reliability. Results: The 3DCT-based measurements to determine glenoid track status had a higher positive predictive value (66% vs 42%), higher specificity (47% vs 42%), and higher accuracy (65% vs 59%) compared with static arthroscopic measurements. Static arthroscopic measurements to determine glenoid track status had a higher negative predictive value (96% vs 64%) and higher sensitivity (96% vs 81%) compared with 3DCT-based measurements. Interrater reliability (Krippendorff α) was ‘fair’ for determining the glenoid track status using 3DCT (0.368; 95% CI, 0.217-0.519) and ‘moderate’ for static arthroscopic measurements (0.523; 95% CI, 0.364-0.666). Intrarater reliability (intraclass correlation coefficient [ICC] 3, k) was ‘moderate’ for 3DCT measurements (0.660; 95% CI, 0.444-0.798) and ‘good’ for static arthroscopic measurements (0.769; 95% CI, 0.629-0.862). Conclusion: Determining glenoid track status using either 3DCT or static arthroscopic measurements yielded moderate accuracy and reliability. Surgeons using the glenoid track concept to aid surgical decision-making in traumatic recurrent anterior shoulder instability should utilize 3DCT or static arthroscopic measurements with caution.

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Trends in utilization and patient demographics for shoulder instability procedures from 2010 to 2019

Cited by 8 publications

References 26 publications

Surgical management of recurrent instability following Latarjet procedure – A systematic review of salvage procedures

Surgical management of recurrent instability following Latarjet procedure – A systematic review of salvage procedures

High failure rate after conservative treatment for recurrent shoulder dislocation without subjective apprehension on physical examination

Validating the Glenoid Track Concept Using Dynamic Arthroscopic Assessment

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