Risk Factors for Recurrence of Anterior-Inferior Instability of the Shoulder After Arthroscopic Bankart Repair in Patients Younger Than 30 Years

Lee, Sung Hyun; Lim, Kyeong Hoon; Kim, Jeong Woo

doi:10.1016/j.arthro.2018.03.032

Cited by 68 publications

(55 citation statements)

References 36 publications

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“…Recent studies have reported recurrence rates of 4 to 19% after arthroscopic Bankart repair. [26,27] In similar studies that have compared isolated Bankart and accompanying SLAP lesions, recurrence rates of 4.2% and 8.7% have been reported. [19,20] In our study, this rate was 7.3%.…”

Section: Discussionmentioning

confidence: 91%

Comparison of the clinical results of isolated Bankart and SLAP 5 lesions after arthroscopic repair

et al. 2020

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The glenohumeral joint is the most mobile joint in the human body. Shoulder stability is provided by static and dynamic stabilizers and load resistance is ensured by these stabilizers. [1] Damage to these structures leads to dislocation and recurrent instability. Traumatic anterior instability or dislocation of the shoulder joint usually results in avulsion of the anterior inferior labrum. Bankart defined this lesion as the "essential lesion" of shoulder instability. [2] In addition to Bankart lesions, lesions in different areas of the labrum can occur, such as superior labrum anterior to posterior (SLAP) lesions. Superior labral tears were first defined by Andrews et al. in 1985. [2] Then in 1990, Snyder [3] coined the term SLAP lesions. With SLAP lesions, the superior labrum detaches along with the biceps tendon and the labral tear extends anteriorly from the posterior superior labrum. Snyder further classified SLAP lesions into four categories and over time different types of SLAP lesions were added to Snyder's classification. [3-5] The etiology of SLAP lesions remains uncertain. There Objectives: This study aims to compare the clinical results of patients with traumatic isolated Bankart lesions and type V superior labrum anterior to posterior (SLAP) lesions after arthroscopic repair. Patients and methods: Patients who underwent arthroscopic repair for traumatic anterior glenohumeral instability were evaluated retrospectively between December 2014 and January 2019. Fifty-one patients (49 males, 2 females; mean age 25 years; range, 18 to 36 years) without bone defects affecting >20% of the glenoid fossa, off-track engaging Hills-Sachs lesions, multidirectional instability, or ligamentous laxity were included in the study. Group 1 had 31 patients with isolated Bankart lesions and group 2 had 20 patients with type V SLAP lesions. There were only two female patients in group 1 and all patients were male in group 2. The mean age was 25 years (range, 18 to 36 years) in group 1 and 25 years (range, 19 to 35 years) in group 2. Rowe, Constant, and Western Ontario Shoulder Instability (WOSI) scoring systems were used to evaluate the clinical outcomes of the patients preoperatively and at the last follow-up. Results: The mean follow-up time was 32 months (range, 12 to 48 months) in group 1 and 28.5 months (range, 12 to 42 months) in group 2. There were no statistically significant differences between the two groups in terms of the number of shoulder dislocations before the surgery, mean age at the time of surgery, and the mean time from the first dislocation to surgical treatment. When the Rowe, Constant, and WOSI scores were evaluated preoperatively and at the last follow-up, there were statistically significant changes within, but not between, the two groups. Conclusion: In type V SLAP lesions, the affected and repaired labrum surface area is larger than isolated Bankart lesions. However, as a result of appropriate surgical treatment, the affected surface area does not have a negative effect on clinical outcomes, and s...

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Section: Discussionmentioning

confidence: 91%

Comparison of the clinical results of isolated Bankart and SLAP 5 lesions after arthroscopic repair

et al. 2020

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“…This article does a great job to clarify those risk factors, including total length of instability symptoms, bone loss issues, especially off-track lesions, and the number of preoperative dislocations. Based on the work of Lee et al, 7 as well as others, the emerging evidence is becoming clearer: Recurrent instability is a negative prognostic factor. It may finally be time to take a stand with regard to those patients who have recurrent instability or a prolonged (>6 months) history of instability.…”

Section: Primary Latarjetmentioning

confidence: 97%

“…Lee et al 7 use retrospective case-control methods to evaluate a total of 170 patients with shoulder instability. Overall, the authors report a recurrence rate of 18.8%.…”

Section: See Related Article On Page 2530mentioning

confidence: 99%

“…Lee et al 7 used a patient population that was wellstratified and included anterior and inferior shoulder instability, Bankart lesion, or anterior labral periosteal sleeve avulsions that were all fixed in a similar manner with arthroscopic capsulolabral repair with 3 or more anchors. In addition, the authors only included those patients under the age of 30 with a minimum 2 years of follow-up.…”

Section: Primary Latarjetmentioning

confidence: 99%

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

Provencher¹

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Recurrent anterior instability remains a challenging pathology to treat effectively. Arthroscopic Bankart repair, with its low invasiveness and complication rates, is readily the first, as well as most commonly, used procedure. However, some outcomes studies have reported an unacceptably high failure rate. As such, the ideal candidate for an arthroscopic repair has yet to be fully defined, mainly because of the multiple risk factors for failure after arthroscopic instability repair. Among those factors, recurrence of an instability event is clearly a risk factor for worse outcomes after arthroscopic instability repair. This may be due to an association between recurrent instability and an increase in glenoid bone loss, humeral bone loss, and more extensive labral tears, as well as more capsular, ligamentous, and rotator cuff injuries. Patients who present with 2 preoperative dislocations and a duration of instability symptoms of more than 6 months, as well as off-track Hill-Sachs lesions, may not be ideal candidates for arthroscopic instability repair. There is a "cost" to waiting on surgery after a first dislocation.

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“…[1][2][3] It is also becoming clear that such high failure rates are not related to technical insufficiencies or mistakes: Performing additional soft-tissue procedures (such as SLAP repair, interval closure, and capsular plication), when necessary, has no influence on the rate of recurrence. 4 Therefore, selecting the ideal patient for an arthroscopic Bankart procedure remains crucial. However, this task is difficult because of the multitude of potential risk factors for failure.…”

Section: See Related Article On Page 361mentioning

confidence: 99%

Editorial Commentary: Which Patients Are Likely to Undergo Redislocation After an Arthroscopic Bankart Repair? Preoperative Instability Severity Index Scoring Over 3 Points—The Game Is Over!

Boileau¹,

Lemmex²

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Risk factors for recurrent instability are present and identifiable preoperatively and can be incorporated into a severity scoring system to help with patient selection. The Instability Severity Index (ISI) Score is a tool used to preoperatively identify patients at risk of failure after an arthroscopic Bankart procedure for recurrent anterior shoulder instability. This 10-point score is also designed to help guide the treating surgeon's decision on whether a soft-tissue stabilization or bone block augmentation procedure is indicated. The ISI scoring system has been criticized for its lack of generalizability outside of the French health care system. However, evidence has emerged establishing the ISI Score as a valuable tool with excellent external validity. The ISI scoring system, based on factors derived from a preoperative questionnaire, physical examination, and imaging studies, is helpful to distinguish between patients who will benefit from an arthroscopic Bankart procedure and those who will not. The higher the score, the higher the risk of recurrence of instability. Patients with an ISI Score of 3 points or less may attain very good results with an arthroscopic Bankart procedure compared with patients with an ISI Score of more than 3 points. Performing this procedure in patients with an ISI Score of more than 6 points leads to an increased risk of recurrence (50%) within 5 years and is totally inacceptable. We believe that the information gained from this scoring system will help surgeons in their daily practice to not only decide the right procedure for the right patient but also inform their patients preoperatively of the risks and benefits of an arthroscopic Bankart procedure. As such, the ISI Score is an important strategic tool for shoulder surgeons.

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Risk Factors for Recurrence of Anterior-Inferior Instability of the Shoulder After Arthroscopic Bankart Repair in Patients Younger Than 30 Years

Cited by 68 publications

References 36 publications

Comparison of the clinical results of isolated Bankart and SLAP 5 lesions after arthroscopic repair

Comparison of the clinical results of isolated Bankart and SLAP 5 lesions after arthroscopic repair

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

Editorial Commentary: Which Patients Are Likely to Undergo Redislocation After an Arthroscopic Bankart Repair? Preoperative Instability Severity Index Scoring Over 3 Points—The Game Is Over!

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