Variability in Outcome Reporting for Operatively Managed Anterior Glenohumeral Instability: A Systematic Review

Lukenchuk, Jayd; Sims, Laura A.; Shin, Jason J.

doi:10.1016/j.arthro.2016.07.027

Cited by 17 publications

(22 citation statements)

References 20 publications

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“…Moreover, and in line with our study, the authors found that the results shown by the scores typically used such as, Rowe, Constant, or Walch–Duplay, did not correlate with the scores which specifically evaluated shoulder performance in the sport (ASOSS and SSAS). 10 Therefore, although there is no agreement in the literature as to which score should be used to evaluate patients who underwent glenohumeral instability surgery, 17 we think it is important to evaluate athletes according to a score that reflects shoulder performance during the sports practice since general scores might not accurately reflect shoulder sport performance, thus overestimating the results.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Our results highlight an issue within outcomes research in the current literature, raising concerns for a comparison of results across differing modalities and the resultant effect of pooling data for systematic reviews and meta-analyses. 23,24,29,39,42,63 Lukenchuk et al 39 reported on the extensive variability in preferred outcome measures, in which 28 different tools are currently being used for tracking the postoperative phase of anterior shoulder instability. Kasik and Saper 33 likewise reported an inconsistency in outcome measurements in the adolescent population after arthroscopic Bankart repair.…”

Section: Discussionmentioning

confidence: 99%

Variability of Reporting Recurrence After Arthroscopic Bankart Repair: A Call for a Standardized Study Design

Kennedy

Murphy

Dornan

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: High recurrence rates have been reported after anterior shoulder dislocations, regardless of the treatment utilized. However, the definition of recurrent instability has been inconsistent, making a comparison between studies difficult. Purpose: To report on the nature with which the rate of recurrent instability is reported after arthroscopic Bankart repair, across all levels of evidence, and to analyze factors that may affect the reported rate of recurrence. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed by searching PubMed, the Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov for studies published within the dates of January 2008 and September 2018. Studies in English that reported on the recurrence of instability after arthroscopic Bankart repair for anterior shoulder instability were considered for inclusion in this review. A meta-regression was performed to test for a linear association between the reported recurrence rate and several continuous covariates, including mean age at surgery, mean length of follow-up, attrition rate (loss to follow-up percentage), and percentage of male patients. Results: A trim-and-fill meta-analysis yielded an estimated overall recurrence rate of 17.4% (95% CI, 14.3%-20.9%). There was a significant difference in the recurrence rate depending on the level of evidence (Q(3) = 10.98; P = .012). Significant associations were found with the recurrence rate through the meta-regression, including a negative association with mean age ( P = .009), a positive association with mean follow-up time ( P = .002), and a positive association with attrition rate ( P = .035). Conclusion: A call for standardization is necessary for reporting outcomes of anterior instability after arthroscopic Bankart repair, especially with regard to the reporting of recurrence/failure rates, with careful consideration of the effects that may occur from patient demographics and study design. With no current recommendations for deeming failure, we suggest that all forms of instability be accounted for when determining a failed treatment procedure, with future studies placing an emphasis on greater control of the study design.

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“… 13 Unfortunately, there is considerable variability in the reporting of patient demographics, surgical indications, surgical techniques, and patient outcomes in the available studies. 13 , 14 Furthermore, no previous investigation has directly analyzed the results of arthroscopic stabilization in the high-risk subgroup of MA athletes. Although a few studies involved patients who practiced MA, the small number of patients evaluated and the fact that they were analyzed together with the rest of the collision athletes make it difficult to obtain specific conclusions about this subgroup.…”

Section: Discussionmentioning

confidence: 99%

Return to Sports and Recurrences After Arthroscopic Anterior Shoulder Stabilization in Martial Arts Athletes

Ranalletta

Rossi

Sirio

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:The high demands to the glenohumeral joint and the violent shoulder blows experienced during martial arts (MA) could compromise return to sports and increase the recurrence rate after arthroscopic stabilization for anterior shoulder instability in these athletes.Purpose:To report the functional outcomes, return to sports, and recurrences in a series of MA athletes with anterior shoulder instability treated with arthroscopic stabilization with suture anchors.Study Design:Case series; Level of evidence, 4.Methods:A total of 20 consecutive MA athletes were treated for anterior shoulder instability at a single institution between January 2008 and December 2013. Range of motion (ROM), the Rowe score, a visual analog scale (VAS), and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Return-to-sport and recurrence rates were also evaluated.Results:The mean age at the time of surgery was 25.4 years (range, 18-35 years), and the mean follow-up was 71 months (range, 36-96 months). No significant difference in preoperative and postoperative shoulder ROM was found. The Rowe, VAS, and ASOSS scores showed statistical improvement after surgery (P < .001). In all, 19 athletes (95%) returned to sports. However, only 60% achieved ≥90% recovery after surgery. The recurrence rate was 20%.Conclusion:In this retrospective study of a consecutive cohort of MA athletes, arthroscopic anterior shoulder stabilization significantly improved functional scores. However, only 60% of the athletes achieved the same level of competition, and there was a 20% recurrence rate.

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Variability in Outcome Reporting for Operatively Managed Anterior Glenohumeral Instability: A Systematic Review

Cited by 17 publications

References 20 publications

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

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

Variability of Reporting Recurrence After Arthroscopic Bankart Repair: A Call for a Standardized Study Design

Return to Sports and Recurrences After Arthroscopic Anterior Shoulder Stabilization in Martial Arts Athletes

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