Glenoid Bone Loss in Traumatic Glenohumeral Instability in the Adolescent Population

Ellis, Henry B.; Seiter, Max; Wise, Kelsey; Wilson, Philip D.

doi:10.1097/bpo.0000000000000586

Cited by 16 publications

(12 citation statements)

References 27 publications

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“…3 Glenohumeral bone loss occurs in nearly half of first-time shoulder dislocations and has been noted to be as high as 90% in those with recurrent dislocations. 13,14,16,29 For adolescents undergoing surgery to treat shoulder instability, the critical threshold for recommending bony or soft tissue augmentation is still not known. Furthermore, the effect and understanding of bipolar bone loss on shoulder stability, particularly in the high-risk adolescent population, continues to evolve.…”

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confidence: 99%

Arthroscopic Bankart Repair for Adolescent Anterior Shoulder Instability: Clinical and Imaging Predictors of Revision Surgery and Recurrent Subjective Instability

et al. 2023

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Background: Multiple clinical and radiologic risk factors for recurrent instability after arthroscopic Bankart repair have been described. Humeral bone loss has gained more recent attention, particularly with respect to “off-track” lesions and increased rates of recurrent instability and revision surgery. Purpose: To evaluate clinical and radiologic predictors of failure after arthroscopic Bankart repair in adolescents. Study Design: Case series; Level of evidence, 4. Methods: A single-institution retrospective study was performed in patients <19 years of age treated with arthroscopic Bankart repair from 2011 to 2017. Magnetic resonance imaging measurements of glenoid and humeral bone loss, the glenoid track, and the presence of off-track Hill-Sachs (HS) lesions were assessed. All patients had a minimum follow-up of 24 months and completed patient-reported outcome scores. Failure was defined as revision surgery or postoperative subjective instability. Results: A total of 59 patients (46 male, 13 female) with a median age of 16 years (range, 12-18 years) were included. Ten patients (17%) had revision surgery and 8 patients (14%) had subjective instability without revision surgery. No clinical or radiologic factors were significantly different between the failure cohort and the nonfailure cohort. Four patients (7%) measured off-track, and 2 of these patients experienced failure. A total of 38 patients (64%) were identified to have an HS defect. Subgroup analysis of these patients identified a greater HS interval (HSI) in patients who underwent revision surgery as compared with those patients who did not have revision surgery. Among patients with GT ratio ≥15 mm, there was a 50% rate of revision surgery. The Pediatric/Adolescent Shoulder Survey (PASS) and Single Assessment Numeric Evaluation (SANE) scores at the final follow-up were not significantly different among patients with or without revision surgery. However, those with subjective instability who had not undergone revision surgery had significantly lower PASS and SANE scores as compared with the remainder of the cohort. Conclusion: Of the adolescents in this cohort, 31% either had revision surgery (17%) or reported subjective feelings of instability (14%) after arthroscopic Bankart repair. Off-track instability was identified in 7% of the cohort but was not predictive of failure. Among the subgroup of patients with an HS defect, those who underwent revision surgery had a significantly larger HSI.

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confidence: 99%

Arthroscopic Bankart Repair for Adolescent Anterior Shoulder Instability: Clinical and Imaging Predictors of Revision Surgery and Recurrent Subjective Instability

et al. 2023

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“…This may explain the minimal recurrence rate after subluxations in our study, which are less traumatic injuries by definition. 11 A unique finding in our study was the matched-cohort analysis of career length and related performance variables. Although injured athletes played significantly fewer games per season, there were no significant differences in PER changes on return compared with controls.…”

Section: Discussionmentioning

confidence: 92%

Return to play and performance after shoulder instability in National Basketball Association athletes

Okoroha

Patel

et al. 2020

Journal of Shoulder and Elbow Surgery

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“…Like age < 20 years old, the presence of a glenoid deficit > 20% also represents a risk factor for recurrences after Bankart repair. 27 Therefore, the population included in our study (competitive athletes younger than 20 years with a glenoid bone loss < 20%) represent a very high-risk group for recurrences. Today, most authors agree that adult athletes with a significant glenoid bone loss should be treated with some type of glenoid reconstruction.…”

Section: Discussionmentioning

confidence: 99%

The Latarjet procedure in competitive athletes younger than 20 years old with a significant glenoid bone loss

et al. 2020

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Purpose To analyze return to sports, functional outcomes, and complications following the Latarjet procedure in competitive athletes younger than 20 years old with a significant glenoid bone loss. Methods Between 2010 and 2017, 60 competitive athletes younger than 20 years old with a significant glenoid bone loss were operated with the Latarjet procedure. Return to sports, range of motion, and the Rowe and the Athletic Shoulder Outcome Scoring System score were used to assess functional outcomes. Complications and bone consolidation were also evaluated. Results The mean follow-up was 58 months and the mean age was 16.3 years. Overall, 93% were able to return to sports and 84% returned at the same level. The Rowe and Athletic Shoulder Outcome Scoring System scores showed statistical improvement after operation ( P < .001). The total complication rate was 22% and the revision rate was 1.6%. The recurrence rate was 3.3%. The bone block healed in 93% of the cases. Conclusions In competitive athletes younger than 20 years old with a significant glenoid bone loss, the Latarjet procedure resulted in excellent functional outcomes, with most of the patients returning to sports and at the same level they had before injury with a low rate of recurrences. However, this procedure is associated with a significant rate of complications and should preferably be performed by experienced surgeons.

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Glenoid Bone Loss in Traumatic Glenohumeral Instability in the Adolescent Population

Abstract: This study establishes patients who may be at high risk for glenoid bone loss based on mechanism of injury and physical examination findings. This prognostic study is a level II retrospective study.

Cited by 16 publications

References 27 publications

Arthroscopic Bankart Repair for Adolescent Anterior Shoulder Instability: Clinical and Imaging Predictors of Revision Surgery and Recurrent Subjective Instability

Arthroscopic Bankart Repair for Adolescent Anterior Shoulder Instability: Clinical and Imaging Predictors of Revision Surgery and Recurrent Subjective Instability

Return to play and performance after shoulder instability in National Basketball Association athletes

The Latarjet procedure in competitive athletes younger than 20 years old with a significant glenoid bone loss

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