Critical Bone Loss in Shoulder Instability Reconsidered: Subcritical Bone Loss Correlates to Worse Outcome in Arthroscopic Bankart Repair

2014 ◽  
Vol 30 (6) ◽  
pp. e4
Author(s):  
John Tokish ◽  
James Shaha ◽  
Jay Cook ◽  
Daniel Song ◽  
Douglas Rowles ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Bankart Repair ◽  
Arthroscopic Bankart Repair

scholarly journals Revision Arthroscopic Bankart Repair Versus Arthroscopic Latarjet for Failed Primary Arthroscopic Stabilization With Subcritical Bone Loss

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110018
Author(s):  
Emilio Calvo ◽  
Gonzalo Luengo ◽  
Diana Morcillo ◽  
Antonio M. Foruria ◽  
María Valencia
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
Revision Surgery ◽  
Shoulder Instability ◽  
Activity Level ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Arthroscopic Bankart Repair ◽  
Functional Scores ◽  
Arthroscopic Latarjet

Background: Limited evidence is available regarding the recommended technique of revision surgery for recurrent shoulder instability. Only 1 previous study has compared the results of soft tissue repair and the Latarjet technique in patients with persistent shoulder instability after primary surgical stabilization. Purpose/Hypothesis: To evaluate the results of revision surgery in patients with previous surgical stabilization failure and subcritical glenoid bone defects, comparing repeated Bankart repair versus arthroscopic Latarjet technique. The hypothesis was that Latarjet would be superior to soft tissue procedures in terms of objective and subjective functional scores, recurrence rates, and range of movement. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 45 patients (mean age, 29.1 ± 8.9 years) with subcritical bone loss (<15% of articular surface) who had undergone revision anterior shoulder instability repair after failed Bankart repair. Of these, 17 patients had arthroscopic Bankart repair and 28 had arthroscopic Latarjet surgery. Patients were evaluated at a minimum of 2 years postoperatively with the Rowe score, Western Ontario Shoulder Instability Index, and Subjective Shoulder Value. Subluxation or dislocation episodes were considered failures. Results: No statistically significant differences were found between groups in age, sex, sporting activity, preoperative Rowe score, or the presence of hyperlaxity or bony lesions. At revision arthroscopy, 20 shoulders showed a persistent Bankart lesion, 13 a medially healed labrum, and 6 a bony Bankart. In 6 patients, no abnormalities were present that could explain postoperative recurrence. In the Bankart repair group, 7 patients underwent isolated Bankart procedures; in the remaining 10 cases, a capsular shift was added. No significant differences were found between the Bankart and Latarjet groups in outcome scores, recurrence rate (11.8% vs 17.9%, respectively), or postoperative athletic activity level. The mean loss of passive external rotation at 0° and 90° of abduction was similar between groups. Conclusion: Arthroscopic Latarjet did not lead to superior results compared with repeated Bankart repair in patients with subcritical glenoid bone loss and recurrent anterior shoulder instability after Bankart repair.

scholarly journals State of the art for treatment of bony defects around anterior shoulder instability—the American perspective

2021 ◽  
Author(s):  
Rafael Kakazu ◽  
Matthew R. LeVasseur ◽  
Robert A. Arciero ◽  
Augustus D. Mazzocca
Keyword(s):  
Patient Outcome ◽  
Bone Loss ◽  
Shoulder Instability ◽  
Distal Tibia ◽  
Glenoid Bone Loss ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Index Procedure ◽  
American Perspective ◽  
Arthroscopic Bankart Repair

AbstractWhile arthroscopic Bankart repair yields high success rates, bone loss on the glenoid or humeral head can portend a poor outcome. The authors recommend a thorough evaluation including computed tomography (CT) scanning to best evaluate the amount of bone loss. Multiple studies have shown that the outcomes of revision stabilization procedures are inferior to the respective primary procedure; thus, it is of paramount importance to select the correct index procedure to optimize patient outcome. The authors present the American perspective on treating shoulder instability. For patients with a small on-track Hill Sachs lesion and less than 10 % glenoid bone loss, an isolated arthroscopic Bankart repair is appropriate. This procedure is also recommended for bony Bankart lesions, as well as in overhead throwing athletes. With an engaging Hill Sachs lesion and less than 15 % glenoid bone loss, the authors recommend the addition of a remplissage to the arthroscopic Bankart repair. For patients with up to 15 % bone loss or following a failed previous arthroscopic repair, the authors advocate for open Bankart repair. They recommend Latarjet in patients with a non-engaging Hill Sachs lesion greater than 15 % bone loss. Patients with bone loss over 30 % would benefit from bone grafting with iliac crest autograft or distal tibia allograft for stabilization. In summary, the authors believe that the index procedure provides an opportunity to optimize patient outcome and careful consideration of the treatment options is warranted.

scholarly journals Determining the Minimal Clinically Important Difference on the Oxford Shoulder Instability Score in Patients Undergoing Arthroscopic Bankart Repair for Shoulder Instability

2022 ◽  
Vol 10 (1) ◽  
pp. 232596712110600
Author(s):  
Wei Sheng Foong ◽  
Gerald Joseph Zeng ◽  
Graham S. Goh ◽  
Ying Hao ◽  
Denny Tjiauw Tjoen Lie ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
High Reliability ◽  
Linear Regression Analysis ◽  
Bankart Repair ◽  
Study Cohort ◽  
Recurrent Shoulder Instability ◽  
Arthroscopic Bankart Repair ◽  
Study Results ◽  
Patient Reported

Background: The literature on minimal clinically important differences (MCIDs) for patient-reported outcome measures assessing shoulder instability is limited, with none addressing the Oxford Shoulder Instability Score (OSIS). The OSIS was developed to provide a standardized method for assessing shoulder function after surgery for shoulder instability, and previous studies have demonstrated its high reliability, low interrater variability, and ease of administration. Purpose: To identify the MCID for the OSIS after arthroscopic Bankart repair for recurrent shoulder instability. Study Design: Case series; Level of evidence, 4. Methods: A longitudinally maintained institutional registry was queried for patients who underwent arthroscopic Bankart repair from 2010 to 2016 for recurrent shoulder instability secondary to a Bankart lesion without significant glenoid bone loss. The OSIS was completed preoperatively and at 1 year postoperatively. Patients were categorized into “expectations met” and “expectations unmet” groups using a questionnaire evaluating expectation fulfilment. The MCID of the OSIS at 1 year was calculated using 3 anchor-based approaches and a distribution-based approach. The 3 anchor-based approaches comprised (1) simple linear regression analysis, (2) receiver operating characteristic curve analysis, and (3) calculation of mean differences in change for the OSIS between the “expectations met” and “expectations unmet” groups. Results: The study cohort comprised 68 men and 11 women aged 29.9 ± 12.7 years (mean ± SD). Duration of follow-up for all patients exceeded 1 year. The MCIDs for the OSIS based on the 4 calculation approaches yielded a narrow range of values, ranging from 7.7 to 8.5 for the anchor-based methods and 8.6 for the distribution-based method. Conclusion: Study results indicated that patients with recurrent shoulder instability without significant bone loss who undergo primary arthroscopic Bankart repair and have at least 8.6 points of improvement on their OSIS experience a clinically significant change at 1 year postoperatively.

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