Editorial Commentary: Is It Time to Take a Stand? When Arthroscopic Bankart Repair Is No Longer a Viable Option for Anterior Shoulder Instability

Provencher, Matthew T.

doi:10.1016/j.arthro.2018.06.021

Cited by 15 publications

(6 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Early surgical treatment was later supported by Provencher. 24 He stated that an isolated Bankart repair should not be considered in patients with a prolonged history of instability or multiple dislocation episodes. He goes on to say that early surgery may be considered after a first dislocation event so that the development of more severe lesions, culminating in overall poorer outcomes, is avoided.…”

Section: Discussionmentioning

confidence: 99%

Association of Instability History and Off-Track Hill-Sachs Lesions in Anterior Shoulder Instability

Delgado,

Luengo-Alonso,

Valencia

et al. 2023

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: The glenoid track concept is now widely accepted, and its evaluation is considered essential for making decisions about surgery. Purpose: To define preoperative descriptive data and clinical and functional features in patients with anterior glenohumeral instability according to glenoid track status and to analyze the influence of off-track Hill-Sachs (HS) lesions on preoperative shoulder function. Study Design: Case-control study; Level of evidence, 3. Methods: Preoperative magnetic resonance imaging or computed tomography scans were used to measure the glenoid track. Descriptive data and preoperative objective and subjective clinical and functional features were compared between patients with on-track HS lesions versus off-track HS lesions. Multivariate regression analysis was conducted to identify potential risk factors for off-track HS lesion development. Results: A total of 235 patients (201 men, 34 women; mean age, 29.6 ± 8.6 years) were included— 134 shoulders (57%) with on-track HS lesions and 101 shoulders (43%) with off-track HS lesions. Age <20 years at first dislocation, number of dislocations, and ≥2 years between first dislocation and surgery were significantly different between the study groups ( P = .005, P = .0001, and P = .01, respectively). Regarding these characteristics, the odds ratios for the risk of developing an off-track lesion were 2.67 (95% CI, 1.2-5.99)—1.2 times higher for each additional instability episode (95% CI, 1.025-1.14) and 2.42 times higher (95% CI, 1.176-4.608) for patients whose first dislocation was ≥2 years before surgery, respectively. Patients with off-track HS lesions had a significantly greater degree of instability ( P = .04), worse Rowe scores (48.8 ± 15.3 vs 54.8 ± 28.3 for on-track HS lesions; P = .04), and lower Western Ontario Shoulder Instability scores (975 ± 454 vs 1179 ± 428 for on-track HS lesions; P = .01). Conclusion: Characteristics related to a history of instability (age <20 years at first instability episode, larger number of dislocations, ≥2 years between first dislocation and surgery) were found to be risk factors for the development of an off-track HS lesion in this study. Off-track lesions led to a higher degree of instability and worse objective and subjective preoperative shoulder function versus on-track HS lesions.

show abstract

Section: Discussionmentioning

confidence: 99%

Association of Instability History and Off-Track Hill-Sachs Lesions in Anterior Shoulder Instability

Delgado,

Luengo-Alonso,

Valencia

et al. 2023

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

show abstract

“…15,52 This sentiment has been echoed by others, suggesting arthroscopic Bankart should be abandoned in patients with a history of multiple dislocations, significant glenoid bone loss, and humeral head bone loss. 48 In recent years, increased glenoid bone loss has shifted many surgeons away from performing arthroscopic-only Bankart procedures. 6 Contrary to the above evidence, others have shown some success with arthroscopic-only management in patients with glenoid bone deficiency >20%, if the patients have low to moderate shoulder demand.…”

Section: Discussionmentioning

confidence: 99%

When to Abandon the Arthroscopic Bankart Repair: A Systematic Review

Levy

Grimm

Arciero

2020

Sports Health: A Multidisciplinary Approach

View full text Add to dashboard Cite

Context: Bone loss is a major factor in determining surgical choice in patients with anterior glenohumeral instability. Although bone loss has been described, there is no consensus on glenoid, humeral head, and bipolar bone loss limits for which arthroscopic-only management with Bankart repair can be performed. Objective: To provide guidelines for selecting a more complex repair or reconstruction (in lieu of arthroscopic-only Bankart repair) in the setting of glenohumeral instability based on available literature. Data Sources: An electronic search of the literature for the period from 2000 to 2019 was performed using PubMed (MEDLINE). Study Selection: Studies were included if they quantified bone loss (humeral head or glenoid) in the setting of anterior instability treated with arthroscopic Bankart repair. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Study design, level of evidence, patient demographics, follow-up, recurrence rates, and measures of bone loss (glenoid, humeral head, bipolar). Results: A total of 14 studies met the inclusion criteria. Of these, 10 measured glenoid bone loss, 5 measured humeral head bone loss, and 2 measured “tracking” without explicit measurement of humeral head bone loss. Measurement techniques for glenoid and humeral head bone loss varied widely. Recommendations for maximum glenoid bone loss for arthroscopic repair were largely <15% of glenoid width in recent studies. Recommendations regarding humeral head loss were more variable (many authors providing only qualitative descriptions) with increasing attention on glenohumeral tracking. Conclusion: It is essential that a standardized method of glenoid and humeral head bone loss measurements be performed preoperatively to assess which patients will have successful stabilization after arthroscopic Bankart repair. Glenoid bone loss should be <15%, and humeral head lesions should be “on track” if an arthroscopic-only Bankart is planned. If there is greater bone loss, adjunct or open procedures should be performed.

show abstract

“…Both recurrent dislocation (documented) and subluxation (undocumented) are considered the same. Provencher 17 recently pointed out that the exact definition of instability has a profound effect on the overall recurrence rate in shoulders and that failure rates are much higher in patients with recurrent instability or with instability symptoms persisting beyond 6 months. As with all predictive tools, clinical cases falling in the mid range may become victims of overgeneralization to an "all or none" decision (Latarjet procedure or arthroscopy).…”

Section: Limitationsmentioning

confidence: 99%

Editorial Commentary: Glenoid Track Instability Management Score or Instability Severity Index Score—Will This Decrease Latarjet Abuse?

Barber

Howard

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

View full text Add to dashboard Cite

Open treatment of anterior shoulder instability using a coracoid transfer, such as the Latarjet procedure, is associated with low recurrence rates but with significant complications such as nerve injury, arthrosis, and graft osteolysis. However, an arthroscopic Bankart procedure, although less invasive and with a low complication rate, has the possibility of a higher recurrent instability rate. Scoring systems such as the Instability Severity Index Score, created to select patients for an arthroscopic Bankart procedure or coracoid transfer, have varying levels of success. Often, the scoring system selects a relatively high percentage of patients for the coracoid transfer, possibly undermining its widespread adoption. The relation between glenoid and humeral bone loss has produced the concept of "on-track" and "off-track," which impacts recurrent instability rates. Merging the on-track and off-track concept with the new Glenoid Track Instability Management Score may produce an algorithm that more accurately assesses the need for the Latarjet procedure or arthroscopic stabilization.

show abstract

Editorial Commentary: Is It Time to Take a Stand? When Arthroscopic Bankart Repair Is No Longer a Viable Option for Anterior Shoulder Instability

Cited by 15 publications

References 45 publications

Association of Instability History and Off-Track Hill-Sachs Lesions in Anterior Shoulder Instability

Association of Instability History and Off-Track Hill-Sachs Lesions in Anterior Shoulder Instability

When to Abandon the Arthroscopic Bankart Repair: A Systematic Review

Editorial Commentary: Glenoid Track Instability Management Score or Instability Severity Index Score—Will This Decrease Latarjet Abuse?

Contact Info

Product

Resources

About