Age, participation in competitive sports, bony lesions, ALPSA lesions, &gt; 1 preoperative dislocations, surgical delay and ISIS score &gt; 3 are risk factors for recurrence following arthroscopic Bankart repair: a systematic review and meta-analysis of 4584 shoulders

Verweij, Lukas P.E.; Spanning, Sanne H. van; Grillo, Adriano; Kerkhoffs, Gino M. M. J.; Priester-Vink, Simone; Deurzen, Derek F.P. van; Bekerom, Michel P.J. van den

doi:10.1007/s00167-021-06704-7

Cited by 58 publications

(53 citation statements)

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“… 31 Risk factors associated with failure of an arthroscopic Bankart repair include young age (≤30 years), participation in competitive sports, multiple preoperative dislocations, >6 months surgical delay from first-time dislocation to surgery, ISIS >3 and associated lesions (Hill-Sachs, glenoid bone loss and anterior labrum periosteal sleeve avulsion (ALPSA) lesions. 19 It is impossible to take all these risk factors into account and make an objective decision on what treatment is most suitable. Several prediction tools have been developed to help counselling patients; however, these tools only provide an indicative overall score and are not patient specific.…”

Section: Discussionmentioning

confidence: 99%

“… 18 To identify relevant studies, a systematic approach was used searching PubMed, Embase/Ovid, Cochrane Database of Systematic Reviews/Wiley, Cochrane Central Register of Controlled Trials/Wiley, CINAHL/Ebsco and Web of Science/Clarivate according to the search terms used in Verweij et al (see online supplemental appendix 1 for the search strategy) from inception up to July 2021. 19 The systematic review by Verweij et al is completed and submitted for publication separately. All studies reporting on risk factors for recurrence following Bankart repairs were included.…”

Section: Methods and Analysismentioning

confidence: 99%

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Development and training of a machine learning algorithm to identify patients at risk for recurrence following an arthroscopic Bankart repair (CLEARER): protocol for a retrospective, multicentre, cohort study

et al. 2022

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IntroductionShoulder instability is a common injury, with a reported incidence of 23.9 per 100 000 person-years. There is still an ongoing debate on the most effective treatment strategy. Non-operative treatment has recurrence rates of up to 60%, whereas operative treatments such as the Bankart repair and bone block procedures show lower recurrence rates (16% and 2%, respectively) but higher complication rates (<2% and up to 30%, respectively). Methods to determine risk of recurrence have been developed; however, patient-specific decision-making tools are still lacking. Artificial intelligence and machine learning algorithms use self-learning complex models that can be used to make patient-specific decision-making tools. The aim of the current study is to develop and train a machine learning algorithm to create a prediction model to be used in clinical practice—as an online prediction tool—to estimate recurrence rates following a Bankart repair.Methods and analysisThis is a multicentre retrospective cohort study. Patients with traumatic anterior shoulder dislocations that were treated with an arthroscopic Bankart repair without remplissage will be included. This study includes two parts. Part 1, collecting all potential factors influencing the recurrence rate following an arthroscopic Bankart repair in patients using multicentre data, aiming to include data from >1000 patients worldwide. Part 2, the multicentre data will be re-evaluated (and where applicable complemented) using machine learning algorithms to predict outcomes. Recurrence will be the primary outcome measure.Ethics and disseminationFor safe multicentre data exchange and analysis, our Machine Learning Consortium adhered to the WHO regulation ‘Policy on Use and Sharing of Data Collected by WHO in Member States Outside the Context of Public Health Emergencies’. The study results will be disseminated through publication in a peer-reviewed journal. No Institutional Review Board is required for this study.

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Section: Discussionmentioning

confidence: 99%

Section: Methods and Analysismentioning

confidence: 99%

Development and training of a machine learning algorithm to identify patients at risk for recurrence following an arthroscopic Bankart repair (CLEARER): protocol for a retrospective, multicentre, cohort study

et al. 2022

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confidence: 99%

“…13 Arthroscopic shoulder stabilization has been shown to effectively treat anterior shoulder instability, decreasing recurrence rates to between 10% and 17%. 5,16 However, significant risk factors such as younger patient age, participation in competitive sports, off-track Hill-Sachs lesions, and glenoid bone loss increase the chances of recurrent instability after surgery. 16 Surgical positioning can affect perioperative and/or postoperative complication rates for many reasons, including proximity to nerves, issues with positioning, and surgical access.…”

mentioning

confidence: 99%

“…5,16 However, significant risk factors such as younger patient age, participation in competitive sports, off-track Hill-Sachs lesions, and glenoid bone loss increase the chances of recurrent instability after surgery. 16 Surgical positioning can affect perioperative and/or postoperative complication rates for many reasons, including proximity to nerves, issues with positioning, and surgical access. 11,14 The beach-chair and lateral decubitus positions are the 2 most common positions for shoulder arthroscopy, and each offers its own unique advantages and disadvantages for surgeons.…”

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confidence: 99%

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Beach Chair Versus Lateral Decubitus Surgical Positioning for Arthroscopic Anterior Shoulder Stabilization: A Retrospective Comparison of Clinical and Patient-Reported Outcomes

Paul

Streicher

Osman

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Surgical positioning can affect both perioperative and postoperative complication rates. It is unclear whether beach-chair versus lateral decubitus positioning affects outcomes in patients undergoing arthroscopic anterior shoulder stabilization surgery. Purpose: The purpose of this study was to compare recurrent instability, complications, and patient-reported outcomes between patients who underwent arthroscopic anterior shoulder stabilization in the beach-chair versus the lateral decubitus positions. It was hypothesized that recurrent instability, complications, and patient-reported outcomes would not be affected by surgical positioning. Study Design: Cohort study; Level of evidence, 3. Methods: The authors reviewed the medical records of patients who underwent shoulder stabilization ( Current Procedural Terminology codes 29806 and 29807) from 2015 to 2019. Patients were included only if anterior instability was confirmed, arthroscopic surgery was performed in response to shoulder instability, and a minimum of 2 years of follow-up data were available. Data collected for eligible patients included perioperative and postoperative complications, recurrent instability, reoperation, and revision. Patients also completed surveys for the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, Oxford Shoulder Instability (OSI) score, and a return to any level of sport (RTS) questionnaire. Results: Overall, 294 patients (162 lateral decubitus and 132 beach-chair positions) were included, with an average follow-up of 2.4 ± 1.6 years. There were no significant differences in demographics between groups, nor were there differences in the rates of postoperative dislocations, subjective instability, reoperations, revisions, or complications. There was a trend toward a higher revision rate in the beach-chair group (beach-chair, 6.1% vs lateral decubitus, 1.9%; P = .069). There was no significant difference between groups regarding RTS rates or postoperative ASES, SANE, and OSI scores at 3.3 ± 1.1 years postoperatively. Conclusion: Surgical positioning for arthroscopic anterior shoulder stabilization did not significantly affect recurrent instability, complications, and patient-reported outcomes. Both beach-chair and lateral decubitus positioning provided good outcomes for anterior shoulder stabilization, with an overall recurrent dislocation rate of 7.8% at a mean of 3.3 years after surgery.

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Minimal but potentially clinically relevant anteroinferior position of the humeral head following traumatic anterior shoulder dislocations: A 3D‐CT analysis

Verweij,

Dobbe,

Kerkhoffs

et al. 2024

Journal Orthopaedic Research

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In unstable shoulders, excessive anteroinferior position of the humeral head relative to the glenoid can lead to a dislocation. Measuring humeral head position could therefore be valuable in quantifying shoulder laxity. The aim of this study was to measure (1) position of the humeral head relative to the glenoid and (2) joint space thickness during passive motion in unstable shoulders caused by traumatic anterior dislocations and in contralateral uninjured shoulders. A prospective cross‐sectional CT‐study was performed in patients with unilateral anterior shoulder instability. Patients underwent CT scanning of both injured and uninjured side in supine position (0° abduction and 0° external rotation) and in 60°, 90°, and 120° of abduction with 90° of external rotation without an external load. Subsequently, 3D virtual models were created of the humerus and the scapula to create a glenoid coordinate system to identify poster‐anterior, inferior‐superior, and lateral‐medial position of the humeral head relative to the glenoid. Joint space thickness was defined as the average distance between the subchondral bone surfaces of the humeral head and glenoid. Fifteen consecutive patients were included. In supine position, the humeral head was positioned more anteriorly (p = 0.004), inferiorly (p = 0.019), and laterally (p = 0.021) in the injured compared to the uninjured shoulder. No differences were observed in any of the other positions. A joint‐space thickness map, showing the bone‐to‐bone distances, identified the Hill−Sachs lesion footprint on the glenoid surface in external rotation and abduction, but no differences on average joint space thickness were observed in any position.

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Age, participation in competitive sports, bony lesions, ALPSA lesions, > 1 preoperative dislocations, surgical delay and ISIS score > 3 are risk factors for recurrence following arthroscopic Bankart repair: a systematic review and meta-analysis of 4584 shoulders

Cited by 58 publications

References 60 publications

Development and training of a machine learning algorithm to identify patients at risk for recurrence following an arthroscopic Bankart repair (CLEARER): protocol for a retrospective, multicentre, cohort study

Development and training of a machine learning algorithm to identify patients at risk for recurrence following an arthroscopic Bankart repair (CLEARER): protocol for a retrospective, multicentre, cohort study

Beach Chair Versus Lateral Decubitus Surgical Positioning for Arthroscopic Anterior Shoulder Stabilization: A Retrospective Comparison of Clinical and Patient-Reported Outcomes

Minimal but potentially clinically relevant anteroinferior position of the humeral head following traumatic anterior shoulder dislocations: A 3D‐CT analysis

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