scholarly journals Age, participation in competitive sports, bony lesions, ALPSA lesions, > 1 preoperative dislocations, surgical delay and ISIS score > 3 are risk factors for recurrence following arthroscopic Bankart repair: a systematic review and meta-analysis of 4584 shoulders

2021 ◽  
Author(s):  
Lukas P. E. Verweij ◽  
Sanne H. van Spanning ◽  
Adriano Grillo ◽  
Gino M. M. J. Kerkhoffs ◽  
Simone Priester-Vink ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Bone Loss ◽  
Bankart Repair ◽  
Competitive Sports ◽  
Recurrent Instability ◽  
Surgical Delay ◽  
Arthroscopic Bankart Repair ◽  
Risk Factors For Recurrence ◽  
Meta Analyses

Abstract Purpose Determining the risk of recurrent instability following an arthroscopic Bankart repair can be challenging, as numerous risk factors have been identified that might predispose recurrent instability. However, an overview with quantitative analysis of all available risk factors is lacking. Therefore, the aim of this systematic review is to identify risk factors that are associated with recurrence following an arthroscopic Bankart repair. Methods Relevant studies were identified by searching PubMed, Embase/Ovid, Cochrane Database of Systematic Reviews/Wiley, Cochrane Central Register of Controlled Trials/Wiley, CINAHL/Ebsco, and Web of Science/Clarivate Analytics from inception up to November 12th 2020. Studies evaluating risk factors for recurrence following an arthroscopic Bankart repair with a minimal follow-up of 2 years were included. Results Twenty-nine studies met the inclusion criteria and comprised a total of 4582 shoulders (4578 patients). Meta-analyses were feasible for 22 risk factors and demonstrated that age ≤ 20 years (RR = 2.02; P < 0.00001), age ≤ 30 years (RR = 2.62; P = 0.005), participation in competitive sports (RR = 2.40; P = 0.02), Hill-Sachs lesion (RR = 1.77; P = 0.0005), off-track Hill-Sachs lesion (RR = 3.24; P = 0.002), glenoid bone loss (RR = 2.38; P = 0.0001), ALPSA lesion (RR = 1.90; P = 0.03), > 1 preoperative dislocations (RR = 2.02; P = 0.03), > 6 months surgical delay (RR = 2.86; P < 0.0001), ISIS > 3 (RR = 3.28; P = 0.0007) and ISIS > 6 (RR = 4.88; P < 0.00001) were risk factors for recurrence. Male gender, an affected dominant arm, hyperlaxity, participation in contact and/or overhead sports, glenoid fracture, SLAP lesion with/without repair, rotator cuff tear, > 5 preoperative dislocations and using ≤ 2 anchors could not be confirmed as risk factors. In addition, no difference was observed between the age groups ≤ 20 and 21–30 years. Conclusion Meta-analyses demonstrated that age ≤ 20 years, age ≤ 30 years, participation in competitive sports, Hill-Sachs lesion, off-track Hill-Sachs lesion, glenoid bone loss, ALPSA lesion, > 1 preoperative dislocations, > 6 months surgical delay from first-time dislocation to surgery, ISIS > 3 and ISIS > 6 were risk factors for recurrence following an arthroscopic Bankart repair. These factors can assist clinicians in giving a proper advice regarding treatment. Level of evidence Level IV.

Risk Factors for Recurrence After Arthroscopic Instability Repair—The Importance of Glenoid Bone Loss >15%, Patient Age, and Duration of Symptoms: A Matched Cohort Analysis

2020 ◽  
Vol 48 (12) ◽  
pp. 3036-3041
Author(s):  
Travis J. Dekker ◽  
Liam A. Peebles ◽  
Andrew S. Bernhardson ◽  
Samuel I. Rosenberg ◽  
Colin P. Murphy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Loss ◽  
Cohort Analysis ◽  
Glenoid Bone Loss ◽  
Bankart Repair ◽  
Recurrence Rates ◽  
Recurrent Instability ◽  
Duration Of Symptoms ◽  
Arthroscopic Bankart Repair ◽  
The Mean

Background: Glenoid bone loss (GBL) has been implicated as a risk factor for failure of arthroscopic anterior glenohumeral instability repair. Although certain amounts of GBL are associated with higher recurrence rates, there are limited studies on successes versus failures in these cohorts. Purpose: To compare the outcomes of arthroscopic Bankart repair in patients with and without GBL to determine a threshold percentage of GBL that predicts success. Study Design: Cohort study; Level of evidence, 2. Methods: All consecutive patients who underwent arthroscopic Bankart repair for anterior shoulder instability between 2004 and 2013 were prospectively enrolled. Patients with ≤25% GBL were included. Patients with no GBL were grouped and compared with those having 5% to 25% GBL. Outcomes included Single Assessment Numerical Evaluation, Western Ontario Shoulder Index, and American Shoulder and Elbow Surgeons scores, with evidence of recurrent instability. Patients with and without GBL were statistically compared with respect to outcomes and recurrence rates. Results: Of 434 eligible patients, the cases of 405 (45 female, 360 male; mean age, 27.5 years [range, 18-47 years]) were followed for a mean 61 months (range, 48-96 months). There were 189 (46.6%) with no GBL and 216 (53.3%) with GBL; the mean GBL of the latter cohort was 15% (range, 5%-25%). The mean duration of instability symptoms was 7.9 months (range, 1-21 months) and was significantly longer in the GBL group ( P < .05). The mean recurrence rate was 14.8%, which was significantly greater in patients presenting with GBL versus those with none (48/216 [22.2%] vs 12/189 [6.3%]; P < .01). Within the GBL group, GBL ≥15%, duration of symptoms >5 months, and younger age (<20 years) were independent risk factors for failure ( P < .01). Patients with any GBL had >4-times greater odds of recurrence after arthroscopic stabilization (odds ratio, 4.21; 95% CI, 2.16-8.21). Moreover, patients presenting for arthroscopic Bankart repair with GBL ≥15% had nearly 3-times greater odds of recurrent instability. Conclusion: GBL ≥15% in an active patient population portends to increased odds of recurrent instability events and inferior clinical outcomes after arthroscopic Bankart repair. Furthermore, nonmodifiable risk factors, such as age (<20 years) and duration of symptoms before presentation (>5 months), significantly affect risk of recurrence and should be key factors when counseling patients on risk of failure and determining the ideal procedure for the individual patient.

scholarly journals When to Abandon the Arthroscopic Bankart Repair: A Systematic Review

2020 ◽  
Vol 12 (5) ◽  
pp. 425-430
Author(s):  
Benjamin J. Levy ◽  
Nathan L. Grimm ◽  
Robert A. Arciero
Keyword(s):  
Systematic Review ◽  
Bone Loss ◽  
Study Design ◽  
Humeral Head ◽  
Measurement Techniques ◽  
Glenoid Bone Loss ◽  
Bankart Repair ◽  
Glenohumeral Instability ◽  
Level Of Evidence ◽  
Arthroscopic Bankart Repair

Context: Bone loss is a major factor in determining surgical choice in patients with anterior glenohumeral instability. Although bone loss has been described, there is no consensus on glenoid, humeral head, and bipolar bone loss limits for which arthroscopic-only management with Bankart repair can be performed. Objective: To provide guidelines for selecting a more complex repair or reconstruction (in lieu of arthroscopic-only Bankart repair) in the setting of glenohumeral instability based on available literature. Data Sources: An electronic search of the literature for the period from 2000 to 2019 was performed using PubMed (MEDLINE). Study Selection: Studies were included if they quantified bone loss (humeral head or glenoid) in the setting of anterior instability treated with arthroscopic Bankart repair. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Study design, level of evidence, patient demographics, follow-up, recurrence rates, and measures of bone loss (glenoid, humeral head, bipolar). Results: A total of 14 studies met the inclusion criteria. Of these, 10 measured glenoid bone loss, 5 measured humeral head bone loss, and 2 measured “tracking” without explicit measurement of humeral head bone loss. Measurement techniques for glenoid and humeral head bone loss varied widely. Recommendations for maximum glenoid bone loss for arthroscopic repair were largely <15% of glenoid width in recent studies. Recommendations regarding humeral head loss were more variable (many authors providing only qualitative descriptions) with increasing attention on glenohumeral tracking. Conclusion: It is essential that a standardized method of glenoid and humeral head bone loss measurements be performed preoperatively to assess which patients will have successful stabilization after arthroscopic Bankart repair. Glenoid bone loss should be <15%, and humeral head lesions should be “on track” if an arthroscopic-only Bankart is planned. If there is greater bone loss, adjunct or open procedures should be performed.

Inconsistencies in Controlling for Risk Factors for Recurrent Shoulder Instability After Primary Arthroscopic Bankart Repair: A Systematic Review

2021 ◽  
pp. 036354652110387
Author(s):  
Nicholas A. Trasolini ◽  
Navya Dandu ◽  
Eric N. Azua ◽  
Grant E. Garrigues ◽  
Nikhil N. Verma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Bone Loss ◽  
Full Text ◽  
Severity Index ◽  
Index Score ◽  
Glenoid Bone Loss ◽  
Bankart Repair ◽  
Advanced Imaging ◽  
Severity Index Score

Background: Failure rates after arthroscopic shoulder stabilization are highly variable in the current orthopaedic literature. Predictive factors for risk of failure have been studied to improve patient selection, refine surgical techniques, and define the role of bony procedures. However, significant heterogeneity in the analysis and controlling of risk factors makes evidence-based management decisions challenging. Purpose: The goals of this systematic review were (1) to critically assess the consistency of reported risk factors for recurrent instability after arthroscopic Bankart repair, (2) to identify the existing studies with the most comprehensive inclusion of confounding factors in their analyses, and (3) to give recommendations for which factors should be reported consistently in future clinical studies. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed in accordance with the PRISMA guidelines. An initial search yielded 1754 titles, from which 56 full-text articles were screened for inclusion. A total of 29 full-text articles met the following inclusion criteria: (1) clinical studies regarding recurrent anterior shoulder instability; (2) surgical procedures performed including arthroscopic anterior labral repair; (3) reported clinical outcome data including failure rate; and (4) assessment of risk factors for surgical failure. Further subanalyses were performed for 15 studies that included a multivariate analysis, 17 studies that included glenoid bone loss, and 8 studies that analyzed the Instability Severity Index Score. Results: After full-text review, 12 of the most commonly studied risk factors were identified and included in this review. The risk factors that were most consistently significant in multivariate analyses were off-track lesions (100%), glenoid bone loss (78%), Instability Severity Index Score (75%), level of sports participation (67%), number of anchors (67%), and younger age (63%). In studies of bone loss, statistical significance was more likely to be found using advanced imaging, with critical bone loss thresholds of 10% to 15%. Several studies found predictive thresholds of 2 to 4 for Instability Severity Index Score by receiver operating characteristic or multivariate analysis. Conclusion: Studies reporting risk factors for failure of arthroscopic Bankart repair often fail to control for known confounding variables. The factors with the most common statistical significance among 15 multivariate analyses are off-track lesions, glenoid bone loss, Instability Severity Index Score, level of sports participation, number of anchors, and younger age. Studies found significance more commonly with advanced imaging measurements or arthroscopic assessment of glenoid bone loss and with lower thresholds for the Instability Severity Index Score (2-4). Future studies should attempt to control for all relevant factors, use advanced imaging for glenoid bone loss measurements, and consider a lower predictive threshold for the Instability Severity Index Score.

The Effect of Subcritical Bone Loss and Exposure on Recurrent Instability After Arthroscopic Bankart Repair in Intercollegiate American Football

2017 ◽  
Vol 45 (8) ◽  
pp. 1769-1775 ◽  
Author(s):  
Jonathan F. Dickens ◽  
Brett D. Owens ◽  
Kenneth L. Cameron ◽  
Thomas M. DeBerardino ◽  
Brendan D. Masini ◽  
...  
Keyword(s):  
Bone Loss ◽  
American Football ◽  
Bankart Repair ◽  
Recurrent Instability ◽  
Arthroscopic Bankart Repair

scholarly journals Revision Arthroscopic Bankart Repair for Anterior Shoulder Instability After a Failed Arthroscopic Soft-Tissue Repair Yields Comparable Failure Rates to Primary Bankart Repair: A Systematic Review

2021 ◽  
pp. 155633162110306
Author(s):  
Ajaykumar Shanmugaraj ◽  
Seaher Sakha ◽  
Tushar Tejpal ◽  
Timothy Leroux ◽  
Jacob M Kirsch ◽  
...  
Keyword(s):  
Systematic Review ◽  
Soft Tissue ◽  
Shoulder Instability ◽  
Bankart Repair ◽  
Quality Data ◽  
Anterior Shoulder Instability ◽  
Failure Rates ◽  
Recurrent Instability ◽  
Arthroscopic Bankart Repair

Background: The management of recurrent instability after arthroscopic Bankart repair remains challenging. Of the various treatment options, arthroscopic revision repairs are of increasing interest due to improved visualization of pathology and advancements in arthroscopic techniques and instrumentation. Purpose: We sought to assess the indications, techniques, outcomes, and complications for patients undergoing revision arthroscopic Bankart repair after a failed index arthroscopic soft-tissue stabilization for anterior shoulder instability. Methods: We performed a systematic review of studies identified by a search of Medline, Embase, and PubMed. Our search range was from data inception to April 29, 2020. Outcomes include clinical outcomes and rates of complication and revision. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. Data are presented descriptively. Results: Twelve studies were identified, comprising 279 patients (281 shoulders) with a mean age of 26.1 ± 3.8 years and a mean follow-up of 55.7 ± 24.3 months. Patients had improvements in postoperative outcomes (eg, pain and function). The overall complication rate was 29.5%, the most common being recurrent instability (19.9%). Conclusion: With significant improvements postoperatively and comparable recurrent instability rates, there exists a potential role in the use of revision arthroscopic Bankart repair where the glenoid bone loss is less than 20%. Clinicians should consider patient history and imaging findings to determine whether a more rigorous stabilization procedure is warranted. Large prospective cohorts with long-term follow-up and improved documentation are required to determine more accurate failure rates.

scholarly journals Revision Arthroscopic Bankart Repair in the Military

2020 ◽  
Vol 8 (3_suppl2) ◽  
pp. 2325967120S0011
Author(s):  
Sean E. Slaven ◽  
Robert Tardif ◽  
Kevin Foley ◽  
Kenneth L. Cameron ◽  
Matthew A. Posner ◽  
...  
Keyword(s):  
Bone Loss ◽  
Active Duty ◽  
Glenoid Bone Loss ◽  
Bankart Repair ◽  
Arthroscopic Stabilization ◽  
Recurrent Instability ◽  
Active Duty Military ◽  
Arthroscopic Bankart Repair ◽  
Successful Group ◽  
Return To Duty

Objectives: There is no consensus on the optimal method of stabilization (arthroscopic or open) for revision anterior shoulder stabilization. The purpose of this study was to determine the success of revision arthroscopic stabilization at preventing further recurrence in active duty military patients. Methods: 53 revision arthroscopic stabilizations were performed at our institution between 2005-2016 for recurrent anterior shoulder instability after an arthroscopic Bankart index procedure. Shoulders with glenoid bone loss >20% were excluded from the study. The primary outcome of interest was the ability to return to activity/duty without subsequent instability. Patients were followed for time to a subsequent instability event and repeat revision arthroscopic stabilization following return to duty/activity. Results: Patient age at revision surgery averaged 22.9 ± 4.3 years. Mean follow up was 6.1 years (range 0.4-12.9). 34 out of 53 patients (64%) returned to duty without recurrent instability following revision arthroscopic anterior stabilization. 19 patients (36%) experienced recurrent instability following return to duty after revision arthroscopic stabilization. Glenoid bone loss averaged 7.8% ± 8.0% in the successful group and 6.5 % ± 6.5% in the failure group (p=0.573). Durability of the index surgery was significantly longer in the successful group (38.1 ± 31.3 months vs. 20.5 ± 17.8 months, p=.029). There was no difference between groups in patient age or number of anchors used in the index or revision stabilization procedures. Conclusion: Revision arthroscopic stabilization of failed primary arthroscopic Bankart repair has a failure rate of 36% in a young active duty military population, which is substantially higher than primary arthroscopic Bankart repair in this population and higher than revision arthroscopic Bankart repair in other patient populations. The similar amounts of bone loss between groups indicates that bone loss is not the primary determinant of failure in revision arthroscopic stabilization.

Risk Factors for Recurrence of Shoulder Instability After Arthroscopic Bankart Repair

2006 ◽  
Vol 88 (8) ◽  
pp. 1755-1763 ◽  
Author(s):  
Pascal Boileau ◽  
Matias Villalba ◽  
Jean-Yves Héry ◽  
Frédéric Balg ◽  
Philip Ahrens ◽  
...  
Keyword(s):  
Risk Factors ◽  
Shoulder Instability ◽  
Bankart Repair ◽  
Arthroscopic Bankart Repair ◽  
Risk Factors For Recurrence
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