Predisposing Factors for Recurrent Shoulder Dislocation After Arthroscopic Treatment

Porcellini, Giuseppe; Campi, Fabrizio; Pegreffi, Francesco; Castagna, Alessandro; Paladini, Paolo

doi:10.2106/jbjs.h.01126

Cited by 211 publications

(168 citation statements)

References 27 publications

Supporting

Mentioning

137

Contrasting

Unclassified

Order By: Relevance

“…Various risk factors for recurrence have been mentioned in the literature for both techniques [8,12,16,26]. There is particular emphasis laid on glenoid and humeral bone lesions, history of instability, age, sex, hyperlaxity, and type or level of sports [2].…”

Section: Introductionmentioning

confidence: 99%

The Open Latarjet Procedure Is More Reliable in Terms of Shoulder Stability Than Arthroscopic Bankart Repair

Bessière

Trojani

Carlès

et al. 2014

Clinical Orthopaedics &Amp; Related Research

238

188

View full text Add to dashboard Cite

Background Arthroscopic Bankart repair and open Latarjet bone block procedure are widely considered mainstays for surgical treatment of recurrent anterior shoulder instability. The choice between these procedures depends mainly on surgeon preference or training rather than published evidence. Questions/purposes We compared patients with recurrent posttraumatic anterior shoulder instability treated with arthroscopic Bankart or open Latarjet procedure in terms of (1) frequency and timing of recurrent instability, (2) risk factors for recurrent instability, and (3) patient-reported outcomes. Methods In this retrospective comparative study, we paired 93 patients undergoing open Latarjet procedures with 93 patients undergoing arthroscopic Bankart repairs over the same period for posttraumatic anterior shoulder instability by one of four surgeons at the same center. Both groups were comparable except that patients in the Latarjet group had more glenoid lesions and more instability episodes preoperatively. Minimum followup was 4 years (mean, 6 years; range, 4-10 years). Patients were assessed with a questionnaire, including stability, Rowe score, and return to sports. Recurrent instability was defined as at least one episode of recurrent dislocation or subluxation. Return to sports was evaluated using a 0% to 100% scale that patients completed after recovery from surgery. Various risk factors for recurrent instability were also analyzed. Results At latest followup, 10% (nine of 93) in the Latarjet group and 22% (20 of 93) in the Bankart group demonstrated recurrent instability (p = 0.026; odds ratio, 0.39; 95% CI, 0.17-0.91). Ten recurrences in the Bankart group (50%) occurred after 2 years, compared to only one (11%) in the Latarjet group. Reoperation rate was 6% and 7% in the Bankart and Latarjet groups, respectively. In both groups, patients younger than 20 years had higher recurrence risk (p = 0.019). In the Bankart group, independent factors predictive for recurrence were practice of competitive sports and shoulder hyperlaxity (ie, passive external rotation [ 85°in the contralateral uninjured shoulder). Although return to sports was not different between groups, the mean Rowe score was higher in the Latarjet group (78 versus 68, p = 0.018). Conclusions Patients who had the open Latarjet procedure had less recurrent instability and better Rowe scores over a mean 6-year followup. We now perform isolated arthroscopic Bankart repair for carefully selected patients, including patients with an Instability Severity Index Score of 3 or less. Level of Evidence Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

show abstract

Section: Introductionmentioning

confidence: 99%

The Open Latarjet Procedure Is More Reliable in Terms of Shoulder Stability Than Arthroscopic Bankart Repair

Bessière

Trojani

Carlès

et al. 2014

Clinical Orthopaedics &Amp; Related Research

238

188

View full text Add to dashboard Cite

show abstract

“…11 The reported risk factors for recurrent anterior stability include glenoid bone loss, large Hill-Sachs lesions and the use of less than three anchors. 5,[10][11][12][13][14][15][16][17][18] Such risk factors were identified on pre-operative, and not postoperative, MR arthrograms, and it is unclear whether postoperative structural integrity of the anteroinferior labrum as demonstrated on MR arthrogram post repair can predict clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Functional outcome and the structural integrity of arthroscopic Bankart repair: a prospective trial

et al. 2014

View full text Add to dashboard Cite

Background: Recurrent anterior shoulder dislocations are common in young patients with Bankart lesions. Arthroscopic repair is an established treatment; however, recurrent instability occurs in up to 35% of patients. It is unclear whether recurrence is the result of a failure of the surgical repair to heal or a repeat injury. The aim of the present pilot study was to assess radiographic healing of Bankart lesions 6 months post surgical repair and identify any correlations between radiographic findings and subsequent recurrent dislocations. Methods: Eighteen patients underwent arthroscopic Bankart repair for recurrent instability. Magnetic resonance (MR) arthrograms were obtained both pre-operatively and 6 months postoperatively. Standard T1 and T2 views were obtained along with an abduction and external rotation (ABER) view. Patients were followed for a minimum of 4 years for the risk of recurrence, and functional outcomes were obtained, including the American Shoulder and Elbow Surgeons Subjective Shoulder Scale, Ontario Shoulder Instability Index, Oxford Shoulder Instability Score and 12-Item Short Form Health Survey. Scores were correlated with pre-operative and postoperative MR findings. Results: Six of 18 patients developed recurrent instability. We could not identify correlations between reconstructed labrum (labral bumper) position, failure at suture sites and ABER findings with recurrent instability or functional outcome. Paradoxically, there was a nonstatistically significant trend for patients with no clefts between the labrum and the glenoid at any points along the repair to have worse outcomes than patients with partial or complete clefts. Conclusions: In our pilot study, MR arthrogram was used to evaluate the labrum in detail 6 months postoperatively. Despite its proven ability to detect labral lesions, we were unable to demonstrate any features on postoperative MR arthrogram that predicted either functional outcome or recurrent instability. At 6 months post operation, functional recovery and the risk of recurrence may not depend on the anatomical appearance of the labrum alone.

show abstract

“…In this study, arthroscopic Bankart repair was not used in patients with large Hill Sachs lesion or in patients with glenoid defect greater than 25%. These patients were treated with open surgical methods such as Laterjet Method [3,4].…”

Section: J Nov Physiothermentioning

confidence: 99%

“…The studies showed that increased number of pre-operative dislocations, period between injury and surgery and increased rate of anterior translation did not adversely affect post-operative outcomes. Mobilizing the anterior capsuloligamentous complex precisely from the glenoid neck, then shifting upward and towards the lateral, and fixation with an appropriate number of anchors provided successful arthroscopic outcomes [3,7].…”

Section: J Nov Physiothermentioning

confidence: 99%

See 1 more Smart Citation

Original Article Comparing Effect of Sports Activity on Arthroscopic Treatment of Shoulder Instability

Akan¹

2012

J Nov Physiother

View full text Add to dashboard Cite

Predisposing Factors for Recurrent Shoulder Dislocation After Arthroscopic Treatment

Abstract: Patients who are more likely to have a redislocation following arthroscopic repair of an anterior shoulder dislocation can be identified preoperatively on the basis of sex, age, and the time from the first dislocation to surgery.

Cited by 211 publications

References 27 publications

The Open Latarjet Procedure Is More Reliable in Terms of Shoulder Stability Than Arthroscopic Bankart Repair

The Open Latarjet Procedure Is More Reliable in Terms of Shoulder Stability Than Arthroscopic Bankart Repair

Functional outcome and the structural integrity of arthroscopic Bankart repair: a prospective trial

Original Article Comparing Effect of Sports Activity on Arthroscopic Treatment of Shoulder Instability

Contact Info

Product

Resources

About