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 ◽  
...  

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.

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110018
Author(s):  
Emilio Calvo ◽  
Gonzalo Luengo ◽  
Diana Morcillo ◽  
Antonio M. Foruria ◽  
María Valencia

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.


Author(s):  
Yingjie Xu ◽  
Kailun Wu ◽  
Qianli Ma ◽  
Lei Zhang ◽  
Yong Zhang ◽  
...  

Abstract Background Best surgical of recurrent anterior shoulder instability remained controversial. We knew little about the superiority and choice between traditional open and modern arthroscopic techniques. We hypothesized that outcomes of all patients will be similar regardless of surgical technique. Methods A retrospective case-cohort analysis of 168 patients who had recurrent anterior shoulder instability was conducted from September 2010 to December 2013. All cases (mean age 30.8 [range 18–50] years) were performed with arthroscopic Bankart repair (33 males/20 females), open Latarjet (34 males/18 females), and capsular shift (31 males/14 females). The average follow-up was 67.6 months (range 60–72). The shoulder instability index score (ISIS) was more than 3 with an average of 6.4. Results All treatments proved to be effective in improving shoulder functional status and reducing symptoms, while Latarjet had an advantage over subjective perception. The Rowe scores in arthroscopic Bankart, open Latarjet, and capsular shift group were 92.3 ± 1.5, 96.2 ± 2.1, and 93.2 ± 2.3, respectively, with significant difference. There was no significant difference in other functional outcomes. However, the Latarjet group in subjective results (subjective shoulder value (SSV) and subjective shoulder value for sport practice (SSV Sport)) was superior to the others (P < 0.05). There were two relapsed cases in arthroscopic Bankart and capsular shift group, respectively, and no recurrence in open Latarjet group. Conclusion Arthroscopic Bankart repair has the advantage of mini-invasion and rapid recovery. Capsular shift offers stabilizing of inferior or multidirectional type, especially for little bone defect. Latarjet was more effective in reducing recurrence with higher stability. Level of evidence Therapeutic level III


2020 ◽  
Author(s):  
Ji Li ◽  
Wei Qi ◽  
Qiang Zhang ◽  
Ketao Wang ◽  
Wei Li ◽  
...  

Abstract Background: The optimal surgical treatment of recurrent traumatic anterior shoulder instability remains a debated topic. The soldier is a special population with high-intensity military training of shoulder. The purpose of this study was to evaluate the clinical outcomes of arthroscopic Bankart repair for recurrent shoulder instability in soldiers and identify the related risk factors. Methods: A retrospective single-center analysis was performed for soldiers with recurrent shoulder instability who underwent arthroscopic Bankart repair between 2009 and 2014. The primary outcome measure was recurrence of instability (redislocation or subluxation). Statistical analysis by binary logistic regression analysis was performed for the significance of various risk factors including sex, gender, number of preoperative dislocations (single/recurrent), the time interval between the first dislocation and the surgery (less or more than 6 months), SLAP repair and number of anchors. The functional outcomes were assessed with the visual analog scale (VAS), the American Shoulder and Elbow Surgery Score (ASES) and Rowe stability score preoperatively and at the last follow-up. Results: A total of 95 shoulders were followed for 53.81±9.37 months (range, 38 to 92 months). The overall postoperative recurrent instability rate was 16.84% (16 in 95). The statistical analysis showed significant differences in age (P=0.045, OR=0.818), and the time interval between the first dislocation and surgery (P=0.035, OR=5.289). There was a significant improvement in the mean VAS, ASES, and Rowe scores postoperatively (P<0.05), but the mean VAS and Rowe scores were lower in the patients of recurrence (P=0.022 and 0.034, respectively). Conclusions: This study suggested that surgery within 6 months of the first dislocation may be required for the young soldiers, although several repair techniques exist for anterior shoulder instability, arthroscopic Bankart repair remains a viable option.


2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0009
Author(s):  
Peter B. MacDonald ◽  
Jason Old ◽  
Randhir Mascarenhas ◽  
Sheila McRae ◽  
Jon Marsh ◽  
...  

Objectives: The purpose of this prospective randomized, double blinded controlled trial was to compare patient-reported outcomes and clinical results between arthroscopic Bankart repair with and without arthroscopic infraspinatus remplissage in patients with anterior shoulder instability with a Hill-Sachs lesion. Failure to recognize and address large Hill Sach’s defects during arthroscopic stabilization surgery for glenohumeral instability is known to lead to high rates of recurrence. Arthroscopic remplissage has evolved in recent years as a reproducible technique with a proposed benefit of decreased dislocations. However, there are no high level clinical studies to conclusively support its efficacy in reducing redislocations. Methods: One hundred and four patients, aged 14 years and older, with a confirmed Hill Sach’s lesion on ultrasound, CT or MRI, were randomized intraoperatively after confirming an engaging Hill Sach’s lesion to either undergo arthroscopic infraspinatus remplissage (REMP) or no remplissage during arthroscopic Bankart repair (NO REMP). Exclusion criteria included a glenoid defect >15% of the AP glenoid diameter, significant shoulder arthropathy, infection, or medical comorbidities. The primary outcome measure was the Western Ontario Shoulder Instability score (WOSI). Secondary outcomes included the Simple Shoulder Test (SST), the American Shoulder and Elbow Society standardized assessment of shoulder function (ASES), active range of motion, stability tests, and incidence of revision surgery. Study time points were pre-, 3-, 6-, 12-, and 24-months post-operative. Significance level was 0.05. Results: A summary of demographics and outcomes are presented in Table 1. There were 53 patients (45 men, 8 women) randomized to REMP and 52 (46 men, 6 women) patients to NO REMP. The groups were comparable with regard to age, body mass index (BMI), and gender distribution). Both groups demonstrated a similar improvement in all subjective scores over time to 12-months post-operative with no difference between the groups (collection of data to 24-months post-operative is ongoing until 2019). The WOSI significantly improved from pre- to 12-months post-operative in both study groups. There were no differences between groups at any time point. ASES scores and SST scores followed a similar pattern. Additionally, there were no differences in range of motion between groups at any time point. There were 2/53 re-dislocations in REMP postoperatively compared to 6/52 in NO REMP; this difference was not significant (p=0.161). There were no differences between groups in reports of limitations in participation in sport attributed to the operated shoulder up to 12-months post-operative. Conclusion: Based on this study, there is no difference in subjective outcome scores and redislocations rates between remplissage and no remplissage for an engaging Hill Sach’s lesion while performing arthroscopic Bankart stabilization. As data continues to be gathered to 24-months post-operative including MRI, longer term benefits or drawbacks may become evident. [Table: see text]


Sign in / Sign up

Export Citation Format

Share Document