Glenoid Pathology, Skeletal Immaturity, and Multiple Pre-Operative Instability Events are Risk Factors for Recurrent Anterior Shoulder Instability after Arthroscopic Stabilization in Adolescent Athletes

2020 ◽  
Author(s):  
Timothy T. Cheng ◽  
Eric W. Edmonds ◽  
Tracey P. Bastrom ◽  
Andrew T. Pennock
Keyword(s):  
Risk Factors ◽  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Arthroscopic Stabilization ◽  
Adolescent Athletes ◽  
Recurrent Anterior Shoulder Instability ◽  
Skeletal Immaturity

scholarly journals Risk Factors for Recurrent Anterior Shoulder Instability after Arthroscopic Stabilization in Adolescent Athletes

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0034
Author(s):  
Timothy Cheng ◽  
Eric W. Edmonds ◽  
Tracey P. Bastrom ◽  
Andrew T. Pennock
Keyword(s):  
Risk Factors ◽  
Bone Loss ◽  
Matched Cohort ◽  
Arthroscopic Stabilization ◽  
Anterior Instability ◽  
Adolescent Athletes ◽  
Recurrent Instability ◽  
Age And Gender ◽  
And Gender ◽  
Skeletal Immaturity

Objectives: Arthroscopic stabilization has become the preferred surgery for adolescent athletes with anterior instability without significant bone loss. Although successful for most patients, 10-40% will experience recurrent instability. The purpose of the current study was to compare a consecutive series of patients who had failed an arthroscopic stabilization to an age and gender matched cohort of patients who had no evidence of recurrent instability with a goal of identifying risk factors for future instability. Methods: A retrospective review was undertaken of all patients undergoing an arthroscopic shoulder stabilization for anterior instability between 2009 and 2016. Patients over the age of 18 years and those with underlying syndromes affecting the musculoskeletal system were excluded. Two patient cohorts were identified: (1) Patients with recurrent instability (frank dislocations or subluxations) after their arthroscopic stabilization; (2) An age and gender matched cohort of patients with no recurrent instability at a minimum of 2 years follow-up from surgery. Patient demographic, injury, radiographic, and surgical variables were recorded. In particular, bone loss measurements were performed on both the glenoid and humerus, and Hill-Sachs lesions were classified as “on-track” or ”off-track”. Variables at p<0.10 on univariate analysis were entered into a binary logistic multivariate regression analysis. Results: 35 patients were identified that failed an arthroscopic stabilization at a mean of 1.2 ± 1.0 years after their index surgery. A separate age and gender matched cohort of 35 patients was also identified with no symptoms of recurrent instability. Univariate analysis identified the following 4 risk factors for recurrent instability (glenoid bone loss > 10%, glenoid retroversion < 5◦, skeletal immaturity, and patients with more than one pre-surgical instability event). Collision sport participation, the presence and size of a Hill-Sachs deformity, and the glenoid track were not predictive of failure. Multivariate regression analysis revealed that loss of glenoid retroversion, skeletal immaturity, and a greater number of prior instability events best predicted future recurrence with two risk factors having a 3x increased risk and patients with all three risk factors having a 4x increased risk of recurrent instability after arthroscopic stabilization. Conclusion: Anterior glenoid bone loss, glenoid version, skeletal immaturity, and multiple pre-operative instability events are risk factors for failed arthroscopic stabilization in adolescent athletes with anterior instability. In the setting of multiple risk factors, patients and families should be counselled of the increased odds of surgical failure and other forms of surgical stabilization may need to be considered.

Arthroscopic Versus Open Anterior Shoulder Stabilization: A Prospective Randomized Clinical Trial With 15-Year Follow-up With an Assessment of the Glenoid Being “On-Track” and “Off-Track” as a Predictor of Failure

2021 ◽  
pp. 036354652110182
Author(s):  
Craig R. Bottoni ◽  
John D. Johnson ◽  
Liang Zhou ◽  
Sarah G. Raybin ◽  
James S. Shaha ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Shoulder Stabilization ◽  
Mri Studies ◽  
Open Stabilization ◽  
The Mean ◽  
Recurrent Anterior Shoulder Instability

Background: Recent studies have demonstrated equivalent short-term results when comparing arthroscopic versus open anterior shoulder stabilization. However, none have evaluated the long-term clinical outcomes of patients after arthroscopic or open anterior shoulder stabilization, with inclusion of an assessment of preoperative glenoid tracking. Purpose: To compare long-term clinical outcomes of patients with recurrent anterior shoulder instability randomized to open and arthroscopic stabilization groups. Additionally, preoperative magnetic resonance imaging (MRI) studies were used to assess whether the shoulders were “on-track” or “off-track” to ascertain a prediction of increased failure risk. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A consecutive series of 64 patients with recurrent anterior shoulder instability were randomized to receive either arthroscopic or open stabilization by a single surgeon. Follow-up assessments were performed at minimum 15-year follow-up using established postoperative evaluations. Clinical failure was defined as any recurrent dislocation postoperatively or subjective instability. Preoperative MRI scans were obtained to calculate the glenoid track and designate shoulders as on-track or off-track. These results were then correlated with the patients’ clinical results at their latest follow-up. Results: Of 64 patients, 60 (28 arthroscopic and 32 open) were contacted or examined for follow-up (range, 15-17 years). The mean age at the time of surgery was 25 years (range, 19-42 years), while the mean age at the time of this assessment was 40 years (range, 34-57 years). The rates of arthroscopic and open long-term failure were 14.3% (4/28) and 12.5% (4/32), respectively. There were no differences in subjective shoulder outcome scores between the treatment groups. Of the 56 shoulders, with available MRI studies, 8 (14.3%) were determined to be off-track. Of these 8 shoulders, there were 2 surgical failures (25.0%; 1 treated arthroscopically, 1 treated open). In the on-track group, 6 of 48 had failed surgery (12.5%; 3 open, 3 arthroscopic [ P = .280]). Conclusion: Long-term clinical outcomes were comparable at 15 years postoperatively between the arthroscopic and open stabilization groups. The presence of an off-track lesion may be associated with a higher rate of recurrent instability in both cohorts at long-term follow-up; however, this study was underpowered to verify this situation.

Recurrent Anterior Shoulder Instability

2013 ◽  
pp. 181-199
Author(s):  
Mary K. Mulcahey ◽  
John W. McNeil ◽  
Matthew T. Provencher
Keyword(s):  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Recurrent Anterior Shoulder Instability

scholarly journals Treatment of anterior shoulder instability: a bibliometric analysis

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Mingtao Zhang ◽  
Zhitao Yang ◽  
Borong Zhang ◽  
Tao Liu ◽  
Xiangdong Yun
Keyword(s):  
United States ◽  
Risk Factors ◽  
Shoulder Instability ◽  
Sports Medicine ◽  
The United States ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Arthroscopic Bankart Repair ◽  
Number Of Citations ◽  
Research Frontiers

Abstract Purpose The treatment of anterior shoulder instability is a focus in the field of sports medicine. While much research has been conducted, few bibliometric studies have been performed in this field. This study analyzed the main characteristics and identified emerging research trends and hotspots related to the treatment of anterior shoulder instability over the past four decades. Methods We searched for (anterior shoulder instability OR anterior shoulder dislocation) AND (treatment OR reconstruction) in ARTICLE (Mesh) in the Web of Science database from 1980 to 2020. We analyzed the keywords, author, institution, country, number of citations, average number of citations, publication year, and partnership of the identified articles. Information about annual publications was analyzed using Microsoft Excel 2019; the remaining data were analyzed using VOSviewer version 1.6.11 (Leiden University, Leiden, Netherlands) and CiteSpace version 5.7.R2 (Drexel University, Philadelphia, PA, USA). Results A total of 1964 articles were published between 1980 and 2020. The American Journal of Sports Medicine, the United States, the United States Department of Defense, and Arcieio were journals, countries, institutions, and authors with the highest numbers of publications. The topic hotspots were instability, shoulder, and dislocation, while the research frontiers were arthroscopic, Bankart repair, Latarjet procedure, risk factors, recurrence, and complications. Conclusion The treatment of anterior shoulder instability has shown an increasing number of publications each year and achieved great progress. The United States made the most outstanding contributions to this important field. Arthroscopic, Bankart repair, and Latarjet procedures were research hotspots and risk factors, recurrence, and complications were likely to research frontiers.

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