scholarly journals Editorial Commentary: Should We Worry About Progressive Glenoid Bone Loss After Arthroscopic Bankart Repair?

2020 ◽  
Vol 36 (1) ◽  
pp. 54-55
Author(s):  
Daniel J. Solomon
Keyword(s):  
Bone Loss ◽  
Glenoid Bone Loss ◽  
Bankart Repair ◽  
Editorial Commentary ◽  
Arthroscopic Bankart Repair

Recurrence and Revision Rates With Arthroscopic Bankart Repair Compared With the Latarjet Procedure in Competitive Rugby Players With Glenohumeral Instability and a Glenoid Bone Loss <20%

2021 ◽  
Vol 49 (4) ◽  
pp. 866-872
Author(s):  
Luciano A. Rossi ◽  
Ignacio Tanoira ◽  
Tomás Gorodischer ◽  
Ignacio Pasqualini ◽  
Maximiliano Ranalletta
Keyword(s):  
Bone Loss ◽  
Functional Outcomes ◽  
Return To Sport ◽  
Glenoid Bone Loss ◽  
Bankart Repair ◽  
Latarjet Procedure ◽  
Glenohumeral Instability ◽  
Arthroscopic Bankart Repair ◽  
Significant Difference ◽  
Rugby Players

Background: There is a lack of evidence in the literature comparing outcomes between the arthroscopic Bankart repair and the Latarjet procedure in competitive rugby players with glenohumeral instability and a glenoid bone loss <20%. Purpose: To compare return to sport, functional outcomes, and complications between the arthroscopic Bankart repair and the Latarjet procedure in competitive rugby players with glenohumeral instability and a glenoid bone loss <20%. Study Design: Cohort study; Level of evidence, 3. Methods: Between June 2010 and February 2018, 130 competitive rugby players with anterior shoulder instability were operated on in our institution. The first 80 patients were operated on with the arthroscopic Bankart procedure and the other 50 with the open Latarjet procedure. Return to sport, range of motion (ROM), the Rowe score, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences, reoperations, and complications were also evaluated. Results: In the total population, the mean follow-up was 40 months (range, 24-90 months) and the mean age was 24.2 years (range, 16-33 years). Ninety-two percent of patients were able to return to rugby, 88% at their preinjury level of play. Eighty-nine percent of patients in the Bankart group and 87% in the Latarjet group returned to compete at the same level ( P = .788). No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe and ASOSS scores showed statistical improvement after operation ( P < .01). No significant difference in functional scores was found between the groups The Rowe score in the Bankart group increased from a preoperative mean (± SD) of 41 ± 13 points to 89.7 points postoperatively, and in the Latarjet group, from a preoperative mean of 42.5 ± 14 points to 88.4 points postoperatively ( P = .95). The ASOSS score in the Bankart group increased from a preoperative mean of 53.3 ± 3 points to 93.3 ± 6 points postoperatively, and in the Latarjet group, from a preoperative mean of 53.1 ± 3 points to 93.7 ± 4 points postoperatively ( P = .95). There were 18 recurrences (14%). The rate of recurrence was 20% in the Bankart group and 4% in the Latarjet group ( P = .01). There were 15 reoperations (12%). The rate of reoperation was 16% in the Bankart group and 4% in the Latarjet group ( P = .03). There were 6 complications (5%). The rate of complications was 4% in the Bankart group and 6% in the Latarjet group ( P = .55). The proportion of postoperative osteoarthritis was 10% in the Bankart group (8/80 patients) and 12% (6/50 patients) in the Latarjet group ( P = .55). Conclusion: In competitive rugby players with glenohumeral instability and a glenoid bone loss <20%, both the arthroscopic Bankart repair and the Latarjet procedure produced excellent functional outcomes, with most athletes returning to sport at the same level they had before the injury. However, the Bankart procedure was associated with a significantly higher rate of recurrence (20% vs 4%) and reoperation (16% vs 4%) than the Latarjet procedure.

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.

scholarly journals “Subcritical” Glenoid Bone Loss Increases Redislocation Rates in Primary Arthroscopic Bankart Repair

2014 ◽  
Vol 2 (7_suppl2) ◽  
pp. 2325967114S0002 ◽  
Author(s):  
James S. Shaha ◽  
Jay B. Cook ◽  
Daniel J. Song ◽  
Douglas J. Rowles ◽  
Craig R. Bottoni ◽  
...  
Keyword(s):  
Bone Loss ◽  
Glenoid Bone Loss ◽  
Bankart Repair ◽  
Arthroscopic Bankart Repair

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.

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.

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.

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