Influence of Glenoid Defect Size and Bone Fragment Size on the Clinical Outcome After Arthroscopic Bankart Repair in Male Collision/Contact Athletes

Nakagawa, Shigeto; Mae, Tatsuo; Yoneda, Kenji; Kinugasa, K.; Nakamura, Hiroyuki

doi:10.1177/0363546517700864

Cited by 41 publications

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“…This suggests that the type of sport also has a significant effect on recurrence, independent of bone loss. Nakagawa et al 9 , 10 reported that the recurrence rate was higher among rugby players compared with other athletes and that rugby players had a high recurrence rate despite a small glenoid defect. Therefore, the indications for stabilization surgery should be decided by considering both the extent of bipolar bone loss and the sporting category.…”

Section: Discussionmentioning

confidence: 99%

“…To quantify the glenoid defect, the inferior portion of the glenoid rim was approximated to a true circle on en face 3D-CT scans that had been reconstructed with elimination of the humeral head. 10 – 13 The extent of the glenoid defect was calculated as a percentage of the glenoid rim length by the equation B / A × 100%, where A is the diameter of the fitted circle and B is the width of the defect ( Figure 1A ). A Hill-Sachs lesion was diagnosed if an abnormal groove was detected on the posterolateral aspect of the head of the humerus.…”

Section: Methodsmentioning

confidence: 99%

“… 7 For the treatment of bony Bankart lesions, arthroscopic bony Bankart repair was performed without resection of the fragment. 10 , 12 Bony Bankart lesions were identified during surgery and were repaired in 38 shoulders among 55 shoulders with a glenoid defect. Even in shoulders with a large glenoid defect, no bone grafting or rotator interval closure was performed during the study period.…”

Section: Methodsmentioning

confidence: 99%

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Bipolar Bone Loss in Male Athletes With Traumatic Anterior Shoulder Instability: An Evaluation Using a New Scoring System

Nakagawa

Hanai

Mae

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:The combination of a glenoid defect and a Hill-Sachs lesion in a shoulder with anterior instability has recently been termed “bipolar bone loss,” but the prevalence and influence of this condition on postoperative recurrence after arthroscopic Bankart repair are still unclear.Purpose:To investigate bipolar bone loss in male athletes using a new scoring system and to evaluate its efficacy by comparing it with the glenoid track concept.Study Design:Case-control study; Level of evidence, 3.Methods:The sizes of both lesions were evaluated retrospectively in 80 male athletes (85 shoulders) using computed tomography. The glenoid defects and the length, width, and depth of the Hill-Sachs lesions were classified into 5 size categories and were allocated scores from “0” for no defect to “4” for the largest defect. Patients were then classified into 5 classes according to the total score for both lesions: class 1, 0-1 point; class 2, 2 points; class 3, 3 points; class 4, 4 points; and class 5, ≥5 points. The prevalence of bipolar bone loss and postoperative recurrence rates for patients with at least 2 years of follow-up were compared among the classes. The recurrence rate for each class was also compared between shoulders with an off-track lesion and shoulders with an on-track lesion as well as among 3 sporting categories: rugby, American football, and other sports.Results:Based on the combination of glenoid defect size and Hill-Sachs lesion length, the postoperative recurrence rate was 0% for shoulders in class 1, 12.5% for class 2, 33.3% for class 3, 28.6% for class 4, and 31.3% for class 5, while the recurrence rates were 0%, 16.7%, 28.6%, 27.3%, and 31.6%, respectively, for the combination of glenoid defect size and Hill-Sachs lesion width and 0%, 8.3%, 26.7%, 28.6%, and 35.3%, respectively, for the combination of glenoid defect size and Hill-Sachs lesion depth. Postoperative recurrence was frequently recognized regardless of the presence of off-track Hill-Sachs lesions. No recurrence was recognized in class 1 shoulders among rugby players, in classes 1 and 2 among American football players, and in classes 1 through 3 among other athletes based on the combination of glenoid defect size and Hill-Sachs lesion size.Conclusion:Our scoring system for bipolar bone loss was useful to evaluate the influence on postoperative recurrence in male athletes. The postoperative recurrence rate was influenced by the extent of bipolar bone loss and the sporting category regardless of the presence of off-track lesions.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Bipolar Bone Loss in Male Athletes With Traumatic Anterior Shoulder Instability: An Evaluation Using a New Scoring System

Nakagawa

Hanai

Mae

et al. 2018

Orthopaedic Journal of Sports Medicine

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“…There is an increased redislocation rate in collision athletes with glenohumeral instability operated with the Bankart procedure. 1 , 2 , 3 Nonetheless, there is no universally accepted definition of “contact” sports in the literature. The most widely used classification is the one proposed by the American Academy of Pediatrics Committee on Sports Medicine.…”

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confidence: 99%

High Variability in Functional Outcomes and Recurrences Between Contact Sports After Arthroscopic Bankart Repair: A Comparative Study of 351 Patients With a Minimum 3-Year Follow-Up

Rossi

Tanoira

Gorodischer

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To compare return to sports, functional outcomes, and complications of a consecutive series of contact athletes with anterior glenohumeral instability treated with isolated arthroscopic Bankart repair for isolated anterior instability. Methods Between January 2008 and December 2016, 351 competitive athletes who participated in contact or collision sports underwent isolated arthroscopic Bankart repair at our institution (rugby n = 105, soccer n = 90, martial arts n = 36 boxing n = 28, field hockey n = 30, handball n = 31, and basketball n = 31). Return to sports, the Rowe score, and the Athletic Shoulder Outcome Scoring System (ASOSS) score were used to assess functional outcomes. Complications also were evaluated. Results The mean follow-up period was 66.7 months (range, 36-148 months) and the mean age of the 351 patients was 21.3 years (range, 17-30 years).Overall, 309 patients (88%) were able to return to sports, and 284 (81%) returned at the same level as before the injury. The mean time to return to sports was 5.3 months. The rate of return to sports, the level achieved by the patients, and time to return to sports varied significantly between sports. The Rowe and ASOSS scores showed statistical improvement after operation ( P < .001). The ASOSS score varied significantly between sports ( P < .001). There were 40 recurrences (11.3%), 7 complications (2%) and 21 patients (6%) underwent revision surgery. There was a significant difference in the rate of recurrences and revisions between the different contact sports. Conclusions In athletes with glenohumeral instability who undergo isolated arthroscopic Bankart repair for isolated anterior instability, there is great variability in the rate of return to sport at the same level, in shoulder performance after returning to competition, and in the postoperative recurrence rates. Due to the high variability found in our study, results after arthroscopic Bankart repair in contact athletes should not be reported globally by including the different sports under the “collision or contact sports” label. Level of Evidence Retrospective Case Series; Level of evidence, 4.

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“…Although they performed arthroscopic bony Bankart repair (ABBR), postoperative union of the bone fragment was not investigated, and neither was the relationship between recurrent instability and the postoperative glenoid defect size. Because Nakagawa et al 10,11 showed that postoperative bone union had a significant influence on recurrence of instability after ABBR, the postoperative status of bony lesions could have influenced their finding that recurrent instability was unrelated to the preoperative glenoid defect size. Accordingly, further investigation is needed to determine the influence of the postoperative size of bipolar bone defects, including the size of the residual postoperative glenoid defect after bone union, on recurrent instability.…”

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confidence: 99%

Changes of Bipolar Bone Defect Size After Arthroscopic Bankart Repair for Traumatic Anterior Shoulder Instability: Evaluation Using a Scoring System and Influence on Postoperative Recurrence

Nakagawa

Uchida

Yokoi

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background:The combination of a glenoid defect and a Hill-Sachs lesion in shoulders with traumatic anterior instability has been termed bipolar bone loss, and the preoperative size of these lesions has been reported to influence postoperative recurrence of instability after arthroscopic Bankart repair.Purpose:To investigate the influence of postoperative bipolar bone defect size on postoperative recurrence of instability.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 64 male collision/contact athletes (69 shoulders) were evaluated for a minimum of 2 years after surgery, and the pre- and postoperative sizes of both lesions (glenoid defect and Hill-Sachs) were evaluated retrospectively with 3-dimensional computed tomography. The sports played by the athletes included rugby (n = 28 shoulders), American football (n = 24 shoulders), and other collision/contact sports (n = 17 shoulders). Glenoid defects and Hill-Sachs lesions were classified into 5 size categories and assigned scores from 0 (no defect) to 4 (very large defect). Patients were then classified according to the total score (sum of the scores for both lesions). The influence of pre- and postoperative bipolar bone defect sizes on recurrence of instability was investigated by using the total scores for bipolar bone defects. The influence of postoperative glenoid morphology (normal preoperative glenoid, preoperative glenoid erosion, bone union after arthroscopic bony Bankart repair [ABBR], or nonunion after ABBR) was also investigated, as well as changes in shoulders with a preoperative off-track Hill-Sachs lesion.Results:Of 69 shoulders, 15 (21.7%) developed recurrent instability after surgery. The postoperative recurrence rate was 0% in shoulders with a total score ≤1, while the recurrence rate was consistently higher in shoulders with a total score ≥2 at both pre- and postoperative evaluation (mean, 28.8% and 32.6%, respectively). Postoperative recurrence was uncommon when there was a normal preoperative glenoid or bone union after ABBR, while it was frequent in shoulders with preoperative glenoid erosion or shoulders with nonunion after ABBR and a total score ≥2. An off-track lesion was recognized in 9 shoulders preoperatively. It was transformed to on-track lesions in 4 of the 5 shoulders showing bone union after ABBR, and there was no recurrence in the 5 shoulders with bone union. In contrast, postoperative recurrence of instability occurred in 3 of the 4 shoulders without bone union.Conclusion:Postoperative recurrence was influenced by the pre- and postoperative size of bipolar bone defects. Recurrence was uncommon if bone union was achieved after ABBR, even if there had been an off-track lesion preoperatively.

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Influence of Glenoid Defect Size and Bone Fragment Size on the Clinical Outcome After Arthroscopic Bankart Repair in Male Collision/Contact Athletes

Cited by 41 publications

References 16 publications

Bipolar Bone Loss in Male Athletes With Traumatic Anterior Shoulder Instability: An Evaluation Using a New Scoring System

Bipolar Bone Loss in Male Athletes With Traumatic Anterior Shoulder Instability: An Evaluation Using a New Scoring System

High Variability in Functional Outcomes and Recurrences Between Contact Sports After Arthroscopic Bankart Repair: A Comparative Study of 351 Patients With a Minimum 3-Year Follow-Up

Changes of Bipolar Bone Defect Size After Arthroscopic Bankart Repair for Traumatic Anterior Shoulder Instability: Evaluation Using a Scoring System and Influence on Postoperative Recurrence

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