Beach Chair Versus Lateral Decubitus Positioning for Primary Arthroscopic Anterior Shoulder Stabilization: A consecutive series of 641 shoulders

Objectives: There are no studies that directly compare beach chair (BC) versus lateral decubitus (LD) position for anterior instability. In the only systematic review evaluating BC vs LD, bone loss is not accounted for in the recurrence rate. The purpose of this is to identify predictors of shoulder instability recurrence and revision after anterior shoulder stabilization surgery in a young, high demand population and evaluate surgical position and glenoid bone loss as independent predictors of the outcomes of interest, recurrence and revision. Methods: A consecutive series of 641 arthroscopic Bankart stabilizations were performed by sports-medicine certified and fellowship trained orthopaedic surgeons from 2009-2016 in either the BC or LD position. Patients were included if they underwent an isolated primary arthroscopic anterior capsulolabral repair. Patients were excluded if concomitant labral repair and/or Remplissage procedures were performed at the time of surgery. Shoulders were additionally excluded if magnetic resonance imaging (MRI) was not available at the time of preoperative evaluation or the patient was lost to follow-up. All shoulders were evaluated for glenohumeral bone loss using the perfect circle technique on the sagittal en-face MRI as well as for bipolar lesions according to the on/off-track method of Diagacomo et al. Glenoid bone loss was grouped into three categories: <5%, 5-13.5%, and >13.5%. The primary outcomes of interest were recurrent instability and revision stabilization. Recurrent instability was defined as the presence of a recurrent subluxation and or dislocation event and/or the presence of a positive apprehension. Multivariable logistic regression models were used to assess the relationships of outcomes with age, position, glenoid bone loss group, and, track. Results: 641 shoulders with a mean age of 22.3 years (SD 4.46) underwent isolated arthroscopic Bankart repair and were followed for a mean 6 years. The overall recurrent instability and revision rates were 15.7% (101/641) and 11.5% (74/641). Recurrent instability was observed in 15.6% (24/154) and 15.9% (77/487) of LD and BC shoulders, respectively. After adjusting for confounders, multivariable logistic regression found no association between surgical position and recurrent instability (p=0.85). Age was an independent predictor for recurrence. The odds of recurrence were 1.58 times higher per 4.5 years (1 standard deviation) decrease in age (P<0.01, 95% CI 1.02 to 1.72). In a separate multivariable logistic regression model of revision surgery as the dependent variable, revision surgery was not associated with age, surgical position, glenoid bone loss group, or recurrence. Conclusions: Among fellowship-trained orthopaedic surgeons the overall failure of primary arthroscopic anterior shoulder stabilization was 15.7% in a high-demand population and equivalent outcomes may be anticipated with arthroscopic Bankart repair performed in the BC or LD position. In multivariable analysis, younger age, but not surgical position, was an independent risk factor for recurrence.

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Clinical Outcomes of Shoulder Stabilization in Females With Glenoid Bone Loss

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211007525 ◽

2021 ◽

Vol 9 (5) ◽

pp. 232596712110075

Author(s):

Rachel M. Frank ◽

Hytham S. Salem ◽

Catherine Richardson ◽

Michael O’Brien ◽

Jon M. Newgren ◽

...

Keyword(s):

Bone Loss ◽

Clinical Outcomes ◽

Shoulder Instability ◽

Glenoid Bone Loss ◽

Anterior Shoulder Instability ◽

Latarjet Procedure ◽

Shoulder Stabilization ◽

Simple Shoulder Test ◽

Female Patients

Background: Nearly all studies describing shoulder stabilization focus on male patients. Little is known regarding the clinical outcomes of female patients undergoing shoulder stabilization, and even less is understood about females with glenoid bone loss. Purpose: To assess the clinical outcomes of female patients with recurrent anterior shoulder instability treated with the Latarjet procedure. Study Design: Case series; Level of evidence, 4. Methods: All cases of female patients who had recurrent anterior shoulder instability with ≥15% anterior glenoid bone loss and underwent the Latarjet procedure were analyzed. Patients were evaluated after a minimum 2-year postoperative period with scores of the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale. Results: Of the 22 patients who met our criteria, 5 (22.7%) were lost to follow-up, leaving 17 (77.2%) available for follow-up with a mean ± SD age of 31.7 ± 12.9 years. Among these patients, 16 (94.1%) underwent 1.6 ± 0.73 ipsilateral shoulder operations (range, 1-3) before undergoing the Latarjet procedure. Preoperative indications for surgery included recurrent instability with bone loss in all cases. After a mean follow-up of 40.2 ± 22.9 months, patients experienced significant score improvements in the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale ( P < .05 for all). There were 2 reoperations (11.8%). There were no cases of neurovascular injuries or other complications. Conclusion: Female patients with recurrent shoulder instability with glenoid bone loss can be successfully treated with the Latarjet procedure, with outcomes similar to those of male patients in the previously published literature. This information can be used to counsel female patients with recurrent instability with significant anterior glenoid bone loss.

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Prospective Evaluation of Glenoid Bone Loss After First-time and Recurrent Anterior Glenohumeral Instability Events

The American Journal of Sports Medicine ◽

10.1177/0363546519831286 ◽

2019 ◽

Vol 47 (5) ◽

pp. 1082-1089 ◽

Cited By ~ 24

Author(s):

Jonathan F. Dickens ◽

Sean E. Slaven ◽

Kenneth L. Cameron ◽

Adam M. Pickett ◽

Matthew Posner ◽

...

Keyword(s):

Cohort Study ◽

Bone Loss ◽

Shoulder Instability ◽

Glenoid Bone Loss ◽

Anterior Instability ◽

Glenohumeral Instability ◽

Recurrent Instability ◽

History Of ◽

Anterior Glenohumeral Instability ◽

First Time

Background: Determining the amount of glenoid bone loss in patients after anterior glenohumeral instability events is critical to guiding appropriate treatment. One of the challenges in treating the shoulder instability of young athletes is the absence of clear data showing the effect of each event. Purpose: To prospectively determine the amount of bone loss associated with a single instability event in the setting of first-time and recurrent instability. Study Design: Cohort study; Level of evidence, 2. Methods: The authors conducted a prospective cohort study of 714 athletes surveilled for 4 years. Baseline assessment included a subjective history of shoulder instability. Bilateral noncontrast shoulder magnetic resonance imaging (MRI) was obtained for all participants with and without a history of previous shoulder instability. The cohort was prospectively followed during the study period, and those who sustained an anterior glenohumeral instability event were identified. Postinjury MRI with contrast was obtained and compared with the screening MRI. Glenoid width was measured for each patient’s pre- and postinjury MRI. The projected total glenoid bone loss was calculated and compared for patients with a history of shoulder instability. Results: Of the 714 athletes (1428 shoulders) who were prospectively followed during the 4-year period, 22 athletes (23 shoulders) sustained a first-time anterior instability event (5 dislocations, 18 subluxations), and 6 athletes (6 shoulders) with a history of instability sustained a recurrent anterior instability event (1 dislocation, 5 subluxations). On average, there was statistically significant glenoid bone loss (1.84 ± 1.47 mm) after a single instability event ( P < .001), equivalent to 6.8% (95% CI, 4.46%-9.04%; range, 0.71%-17.6%) of the glenoid width. After a first-time instability event, 12 shoulders (52%) demonstrated glenoid bone loss ≥5% and 4 shoulders, ≥13.5%; no shoulders had ≥20% glenoid bone loss. Preexisting glenoid bone loss among patients with a history of instability was 10.2% (95% CI, 1.96%-18.35%; range, 0.6%-21.0%). This bone loss increased to 22.8% (95% CI, 20.53%-25.15%; range, 21.2%-26.0%) after additional instability ( P = .0117). All 6 shoulders with recurrent instability had ≥20% glenoid bone loss. Conclusion: Glenoid bone loss of 6.8% was observed after a first-time anterior instability event. In the setting of recurrent instability, the total calculated glenoid bone loss was 22.8%, with a high prevalence of bony Bankart lesions (5 of 6). The findings of this study support early stabilization of young active patients after a first-time anterior glenohumeral instability event.

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The Instability Severity Index Score Revisited: Evaluation of 217 Consecutive Cases of Recurrent Anterior Shoulder Instability

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00269 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0026

Author(s):

Matthew T. Provencher ◽

George Sanchez ◽

Andrew S. Bernhardson ◽

Liam A. Peebles ◽

Daniel B. Haber ◽

...

Keyword(s):

Bone Loss ◽

Severity Index ◽

Index Score ◽

Glenoid Bone Loss ◽

Anterior Shoulder Instability ◽

Arthroscopic Stabilization ◽

Recurrent Instability ◽

Severity Index Score ◽

Recurrent Anterior Shoulder Instability

Objectives: The instability severity index score (ISIS) was designed to predict the risk of recurrence after arthroscopic instability shoulder surgery and to better predict those who would benefit from an open or bone transfer operation. Although this score has been widely disseminated to predict recurrence, there are certain areas in which preoperative assessment is limited, especially in radiographic workup. The objective of this study was to examine the validity of ISIS based on its existing variables, as well as to evaluate additional imaging and patient history variables pertinent to the potential redevelopment of a new score to assess risk of recurrent anterior instability following an arthroscopic Bankart repair. Methods: All consecutive patients were prospectively enrolled with recurrent anterior shoulder instability who subsequently underwent an arthroscopic stabilization with minimum 24 months follow-up. Exclusion criteria included, prior surgery on the shoulder, posterior or multidirectional instability, or a rotator cuff tear. All instability severity index score variables were recorded (age <20, degree and sport type, hyperlaxity, Hill Sachs on AP xray, glenoid loss of contour on AP xray), as well as additional variables: 1. Position of arm at dislocation; 2. Number of instability events; 3. Total time of instability; 4. Glenoid bone loss percent; 5. Amount of attritional glenoid bone loss; 6. Hill Sachs measures (H/W/D and volume), and outcomes (recurrent instability) and scores (WOSI, ASES and SANE). Regression analysis was utilized to determine preoperative variables that predicted outcomes and failures. Results: There were 217 consecutive patients (209 male-96.5%, 8 female-3.5%) who met criteria and were all treated with a primary arthroscopic shoulder stabilization during a 3.5-year period (2007-2011), with mean follow-up of 42 (range, 26-58 mos). The mean age at first instability event was 23.9 (range, 16-48), with 55% right shoulder affected, 60% dominant shoulder. Outcomes were improved from mean scores preoperative (WOSI=1050/2100, ASES=61.0, SANE=52.5) to postoperative (WOSI=305/2100, ASES=93.5, SANE=95.5), and 11.5% (25/217) had evidence or recurrent instability or subluxation. A total of 51/217 were 20 years or under, hyperlaxity in 5, Hill Sachs on internal rotation XR in 77, glenoid contour on AP XR in 41, with an overall mean ISIS score of 3.6. Factors associated with failure were glenoid bone loss greater than 14.5%(p<0.001), total time of instability symptoms >11.5 months(p<0.03), Hill Sachs volume > 1.3 cm3 with H>1.5 cm, W>1.0 cm and D>5 mm(p<0.01), contact sport (p<0.01) and age 20 or under (p<0.01). There was no correlation in outcomes with Hill Sachs on IR or glenoid contour on XR (p>0.45), sports participation, and Instability Severity Score (mean=3.4 success, vs 3.9 failure, p>0.44). Conclusion: At nearly four years of follow-up, there was an 11.5% failure rate of scope stabilization surgery. However, there was no correlation between treatment outcome and the ISIS measure given a mean score of 3.4 with little difference identified in those that failed. However, several important parameters previously unidentified were detected including, glenoid bone loss >14.5%, Hill Sachs volume >1.3 cm3, and time length of instability symptoms. Therefore, the ISIS measure may need to be redesigned in order to incorporate variables that more accurately portray the actual risk of failure following arthroscopic stabilization.

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Arthroscopic Shoulder Stabilization in the High-Risk Young Athlete: Return to Sport and Second Surgery Rates

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00117 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0011

Author(s):

Frank A. Cordasco ◽

Brian Lin ◽

Daphne Ling ◽

Jacob G. Calcei

Keyword(s):

High Risk ◽

Revision Surgery ◽

Shoulder Instability ◽

Return To Sport ◽

Young Athlete ◽

High Rate ◽

Shoulder Stabilization ◽

Recurrent Instability ◽

Arthroscopic Shoulder Stabilization ◽

Second Surgery

Objectives: Shoulder instability in the young athlete has become an increasingly significant clinical problem in recent years. This high-risk population of athletes less than 25 years of age is a difficult cohort to manage because they have high failure rates with non-operative treatment and they reportedly have the lowest return to sport (RTS) rates and highest second surgery rates following arthroscopic shoulder stabilization compared to older patients. The purpose of this retrospective study is to evaluate the two-year clinical outcomes of a cohort of high-risk athletes less than or equal to 22 years of age following arthroscopic shoulder stabilization with a focus on RTS and incidence of second surgery. Methods: The primary outcomes evaluated were RTS and revision surgery following arthroscopic shoulder stabilization performed by the senior author at minimum follow-up of 24 months. Athletes were excluded if they had > 5 pre-operative episodes of instability, significant bone loss or had primary posterior instability. Demographic data was recorded including age, sex, BMI, last recorded range of motion, # episodes of recurrent instability, and revision surgery. A brief survey was completed regarding their shoulder instability history, sports prior to surgery, sports returned to following surgery, satisfaction with and level of RTS, time at which return to sports was achieved, recurrent instability, revision operations, and single assessment numeric evaluation (SANE) score. Results: A total of 67 athletes met inclusion criteria, with a mean age of 17.4 years (range, 13-22 years). There were 19 females (28%) and 48 males (72%). The mean number of instability events was 2 (range 0-5), 57% in the dominant arm and 43% in the non-dominant arm. Evaluation of RTS, demonstrated that 59 (88%) were able to RTS with 56 (84%) of those returning to the same level or higher, while 8 (12%) patients did not RTS for reasons other than recurrent instability or apprehension. Among the 59 patients who RTS, the average time to return was 7.3 months (range: 5-12 months) and baseball and football were the most common sports. There was a gender specific difference with respect to RTS and revision surgery. The male RTS rate was 94% compared to the female rate of 74%. Four of 67 (6%) patients underwent revision stabilization 11 to 36 months for recurrent instability, however all were male athletes 4/48 (8%). There were no female athletes who required revision surgery. Patient reported mean SANE score was 88 (SD, ±15). Conclusion: Shoulder instability in the young high-risk athlete is a complex problem with a relatively high rate of recurrence and revision surgery in the literature. In our case series, we found a relatively low reoperation rate (6%) with a high rate of RTS (88%), at an average time of 7.3 months. There was a gender specific difference with respect to RTS and revision surgery. The male RTS rate was 94% and revision surgery rate was 8% (4/48) while the female RTS rate was 74% and revision surgery rate was 0%. The athletes reported a return to near full function with an average SANE score of 88. We believe the improved outcomes in this cohort of high risk young athletes are related to the pre-operative selection criteria excluding those athletes with a greater number of pre-operative episodes of instability and those with significant bone loss and bipolar lesions as open stabilization and bone augmentation (Latarjet) are more predictable operations in athletes with these risk factors.

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Bipolar Bone Loss And Glenoid Bone Loss Alone are Both Associated with Failure After Arthroscopic Anterior Shoulder Stabilization

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00316 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0031

Author(s):

Ryan T. Li ◽

Elan J. Golan ◽

Kevin William Wilson ◽

Bryson P. Lesniak ◽

Albert Lin

Keyword(s):

Bone Loss ◽

Threshold Value ◽

Lesion Size ◽

Glenoid Bone Loss ◽

Receiver Operating Curve ◽

Continuous Variables ◽

Shoulder Stabilization ◽

Loss Model ◽

Glenoid Track ◽

Failed Surgery

Objectives: Glenoid and humeral bone loss are both known risk factors for failure after anterior shoulder stabilization. Several models have previously been proposed to characterize bone loss and its association with recurrent instability. The purpose of this study was to determine the association of failure after arthroscopic anterior stabilization with three different models of shoulder instability. Methods: 128 individuals who underwent primary anterior shoulder stabilization between 2007-2015 were included in this study. Subjects were excluded on the basis of prior shoulder surgery, multidirectional instability, presence of connective tissue disorder, and concomitant rotator cuff pathology. Glenoid bone loss and Hill-Sachs lesion size were measured using previously reported methods. Cases were defined as individuals who sustained either a subluxation or dislocation event after the index procedure, while controls were defined as individuals who did not. The association between failure and three different models of instability were investigated. In the first model, a receiver-operating curve was constructed to determine the amount of glenoid bone loss alone that would best predict failure. In the second model, lesions were classified as on-track or off-track based on the glenoid track concept. In the third model, a distance-to-dislocation was determined based on the glenoid track concept. Combinations of glenoid bone loss and distance-to-dislocation were varied to determine the combination that was most closely associated with failure. T-test, chi-square, and Fisher exact testing was conducted to determine associations between categorical and continuous variables with failure. Results: There were 44 cases and 80 controls. There was no difference in age (p =.72) and sex (p= .69) between the two cohorts. Receiver-operator analysis of glenoid bone loss alone demonstrated that a threshold value of approximately 12% could best predict failure (AOC = 0.72). 21/25 (84%) of individuals with at least 12% bone loss failed surgery compared to 23/103 (22.3%) who had less than 12% bone loss (p < .001). Using the glenoid track model, 4/4 (100%) of individuals with off-track lesions failed surgery compared to 40/124 (32%) with on-track lesions (p < .001). Using a bipolar bone loss model, the combination thresholds of 9% glenoid bone loss and 11 mm distance-to-dislocation was associated with failure in 18/20 (90%) of subjects while 26/108 (24.1%) of subjects who did not meet this threshold failed surgery (p < .001). Intra-rater reliability for glenoid bone loss (ICC = 0.79) and Hill-Sachs lesion size (ICC = 0.75) were excellent. Conclusion: In our study, a threshold value of 12% glenoid bone loss predicted failure following an arthroscopic Bankart repair and all off-track Hill-Sachs lesions failed as well. Further, when both glenoid bone loss and glenoid track were subcritical, the combined use of a bipolar bone loss model accurately predicted failure. This model may be particularly useful for lesions felt to be on the cusp but not beyond threshold values for critical glenoid bone loss and off-track Hill-Sachs defects.

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Mild behavioral impairment is related to frailty in non-dementia older adults: a cross-sectional study

BMC Geriatrics ◽

10.1186/s12877-020-01903-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Shaoyi Fan ◽

Ximin Liang ◽

Tianchan Yun ◽

Zhong Pei ◽

Bin Hu ◽

...

Keyword(s):

Older Adults ◽

Logistic Regression ◽

Cross Sectional Study ◽

Consecutive Series ◽

Sectional Study ◽

Behavioral Impairment ◽

Cross Sectional ◽

Multivariable Logistic Regression ◽

Increased Risk ◽

The Relationship

Abstract Background Frailty and cognitive decline are highly prevalent among older adults. However, the relationship between frailty and mild behavioral impairment (MBI), a dementia risk syndrome characterized by later-life emergence of persistent neuropsychiatric symptoms, has yet to be elucidated. We aimed to evaluate the associations between MBI and frailty in older adults without dementia. Methods In this cross-sectional study, a consecutive series of 137 older adults without dementia in the Anti-Aging Study, recruited from primary care clinics, were enrolled. Frailty was estimated using the Fried phenotype. MBI was evaluated by the Mild Behavioral Impairment Checklist (MBI-C) at a cut-off point of > 8. Cognition was assessed with the Chinese versions of the Montreal Cognitive Assessment (MoCA-BC) and Mini-mental State Examination (MMSE). Multivariable logistic regression was performed to estimate the relationship between MBI and objective cognition with frailty status. Results At baseline, 30.7% of the older adults had frailty and 18.2% had MBI (MBI+ status). Multivariable logistic regression analysis demonstrated that compared to those without MBI (MBI- status), MBI+ was more likely to have frailty (odds ratio [OR] = 7.44, 95% CI = 1.49–37.21, p = 0.02). Frailty and MBI were both significantly associated with both MMSE and MoCA-BC score (p < 0.05). Conclusions Both frailty and MBI status were associated with higher odds of cognitive impairment. MBI was significantly associated with an increased risk of having frailty in the absence of dementia. This association merits further study to identify potential strategies for the early detection, prevention and therapeutic intervention of frailty.

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Prospective Evaluation of Glenoid Bone Loss After First-Time and Recurrent Anterior Glenohumeral Instability Events

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00096 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0009 ◽

Cited By ~ 1

Author(s):

Jonathan F. Dickens ◽

Sean E. Slaven ◽

Kenneth L. Cameron ◽

Adam M. Pickett ◽

Matthew A. Posner ◽

...

Keyword(s):

Bone Loss ◽

Shoulder Instability ◽

Glenoid Bone Loss ◽

Anterior Instability ◽

Glenohumeral Instability ◽

Post Injury ◽

Recurrent Instability ◽

History Of ◽

Anterior Glenohumeral Instability ◽

First Time

Objectives: Determining the amount of glenoid bone loss in patients following anterior glenohumeral instability events is critical to guiding appropriate treatment. One of the challenges in managing shoulder instability in young athletes is the absence of clear data showing the impact of each event. The purpose of this study was to prospectively determine the amount of bone loss associated with a single instability event, in the setting of both first-time and recurrent instability. Methods: We conducted a prospective cohort study of 714 athletes followed for four years. Baseline assessment included a subjective history of shoulder instability. Bilateral shoulder MRIs were obtained in all participants with and without a history of previous shoulder instability. The cohort was prospectively followed during the study period and those who sustained an anterior glenohumeral instability event were identified. A post-injury MRI was obtained and compared to the screening MRI. Glenoid width was measured for each patient’s pre- and post-injury MRI. The projected total glenoid bone loss was calculated and compared for patients with a prior history of shoulder instability. Results: Of the 714 athletes that were prospectively followed during the four-year period, 23 shoulders in 22 subjects sustained a first-time anterior instability event (5 dislocations, 18 subluxations), and six subjects with a previous history of instability sustained a recurrent anterior instability event (1 dislocation, 5 subluxations). On average, there was statistically significant glenoid bone loss (1.84 ± 1.47 mm) following a single instability event (p<0.001), equivalent to 6.8% (95% CI: 4.46%, 9.04%, range 0.71%-17.6%) of the glenoid width. Twelve shoulders (52%) demonstrated glenoid bone loss ≥ 5%, 4 shoulders demonstrated glenoid bone loss ≥13.5% and no shoulders had ≥20% glenoid bone loss after a first-time instability event. Pre-existing glenoid bone loss in subjects with a history of instability was 10.2% (95% CI: 1.96%, 18.35%, range 0.6% - 21.0%). This bone loss increased to 22.8% (95% CI: 20.53%, 25.15%, range 21.2% to 26.0%) following an additional instability event (P=0.0117). All six shoulders with recurrent instability had >20% glenoid bone loss. Conclusion: Glenoid bone loss of 6.8% was observed after a first-time anterior instability event. In the setting of recurrent instability, the total calculated glenoid bone loss was 22.8% with a high prevalence of bony Bankart lesions (5/6). The findings of this study support early stabilization of young, active subjects following a first-time anterior glenohumeral instability event. [Figure: see text][Table: see text]

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Mild behavioral impairment is related to frailty in non-dementia older adults: a cross-sectional study

10.21203/rs.3.rs-34750/v4 ◽

2020 ◽

Author(s):

Shaoyi Fan ◽

Ximin Liang ◽

Tianchan Yun ◽

Zhong Pei ◽

Bin Hu ◽

...

Keyword(s):

Older Adults ◽

Logistic Regression ◽

Cross Sectional Study ◽

Consecutive Series ◽

Sectional Study ◽

Behavioral Impairment ◽

Cross Sectional ◽

Multivariable Logistic Regression ◽

Increased Risk ◽

The Relationship

Abstract Background: Frailty and cognitive decline are highly prevalent among older adults. However, the relationship between frailty and mild behavioral impairment (MBI), a dementia risk syndrome characterized by later-life emergence of persistent neuropsychiatric symptoms, has yet to be elucidated. We aimed to evaluate the associations between MBI and frailty in older adults without dementia.Methods: In this cross-sectional study, a consecutive series of 137 older adults without dementia in the Anti-Aging Study, recruited from primary care clinics, were enrolled. Frailty was estimated using the Fried phenotype. MBI was evaluated by the Mild Behavioral Impairment Checklist (MBI-C) at a cut-off point of >8. Cognition was assessed with the Chinese versions of the Montreal Cognitive Assessment (MoCA-BC) and Mini-mental State Examination (MMSE). Multivariable logistic regression was performed to estimate the relationship between MBI and objective cognition with frailty status.Results: At baseline, 30.7% of the older adults had frailty and 18.2% had MBI (MBI+ status). Multivariable logistic regression analysis demonstrated that compared to those without MBI (MBI- status), MBI+ was more likely to have frailty (odds ratio [OR] = 7.44, 95% CI = 1.49-37.21, p = 0.02). Frailty and MBI were both significantly associated with both MMSE and MoCA-BC score (p<0.05).Conclusions: Both frailty and MBI status were associated with higher odds of cognitive impairment. MBI was significantly associated with an increased risk of having frailty in the absence of dementia. This association merits further study to identify potential strategies for the early detection, prevention and therapeutic intervention of frailty.

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Clinical Outcomes of Primary versus Revision Surgery using Arthroscopic Anatomic Glenoid Reconstruction for Anterior Shoulder Instability. (244)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00352 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0035

Author(s):

Ivan Wong ◽

Ryland Murphy ◽

Sara Sparavalo ◽

Jie Ma

Keyword(s):

Bone Loss ◽

Clinical Outcomes ◽

Revision Surgery ◽

Shoulder Instability ◽

Anterior Shoulder Instability ◽

Primary Group ◽

Recurrent Instability ◽

Exclusion Criteria ◽

Glenoid Reconstruction

Objectives: Revision surgeries after prior shoulder stabilization are known to have worse outcomes as compared to their primary counterparts. To date, no studies have looked at the utility of arthroscopic anatomic glenoid reconstruction (AAGR) as a revision surgery. The purpose of this study was to assess the clinical outcomes of primary versus revision AAGR for anterior shoulder instability with bone loss. Methods: We performed a retrospective review on consecutive patients with prospectively collected data who underwent AAGR from 2012 to 2018. Patients who received AAGR for anterior shoulder instability with bone loss and had a minimum follow-up of two years were included. Exclusion criteria included patients with rotator cuff pathology, multidirectional instability and glenoid fractures. There were 68 patients (48 primary and 20 revision) who met inclusion/exclusion criteria. Our primary outcome was measured using the Western Ontario Shoulder Instability Index (WOSI) and Disabilities of Arm, Shoulder, Hand (DASH) scores. Secondary outcomes included post-operative complications and post-operative recurrent instability. Results: The primary group showed a significant improvement in most-recent post-operative WOSI from 62.7 to 20.7 (P<0.001, α=0.05) and in DASH from 26.89 to 6.7 (p<0.001, α=0.05). The revision group also showed a significant improvement in WOSI from 71.5 to 34.6 (p<0.001, α=0.05) and in DASH from 39.5 to 17.0 (p<0.05, α=0.05). When comparing between groups, the revision group had worse WOSI scores (34.6) at most recent follow-up compared to the primary group (20.7); p<0.05. The most-recent DASH scores also showed the revision group (17.0) having worse outcomes than the primary group (6.7); p<0.05. Important to note that the minimal clinically important difference (MCID) was met for WOSI (MCID=10.4) but not DASH (MCID=10.83). There were no post-operative reports of instability in either group. For complications, one hardware failure (suture anchor) was seen in the primary group, and two hardware removals were seen in the revision group. Conclusions: While patient reported scores indicated worse outcomes in the revision group, the significant clinical improvement in DASH and WOSI, along with the lack of recurrent instability provides evidence that AAGR is a suitable option for revision patients.

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Glenoid erosion is a risk factor for recurrent instability after Hill-Sachs remplissage

The Bone & Joint Journal ◽

10.1302/0301-620x.103b4.bjj-2019-0736.r2 ◽

2021 ◽

Vol 103-B (4) ◽

pp. 718-724

Author(s):

Maxime Cavalier ◽

Tyler Robert Johnston ◽

Laurie Tran ◽

Marc-Olivier Gauci ◽

Pascal Boileau

Keyword(s):

High Risk ◽

Bone Loss ◽

Return To Sport ◽

Glenoid Bone Loss ◽

Secondary Outcome ◽

Recurrent Instability ◽

Group A ◽

Group B ◽

Glenoid Erosion

Aims The aim of this study was to identify risk factors for recurrent instability of the shoulder and assess the ability to return to sport in patients with engaging Hill-Sachs lesions treated with arthroscopic Bankart repair and Hill-Sachs remplissage (ABR-HSR). Methods This retrospective study included 133 consecutive patients with a mean age of 30 years (14 to 69) who underwent ABR-HSR; 103 (77%) practiced sports before the instability of the shoulder. All had large/deep, engaging Hill-Sachs lesions (Calandra III). Patients were divided into two groups: A (n = 102) with minimal or no (< 10%) glenoid bone loss, and B (n = 31) with subcritical (10% to 20%) glenoid loss. A total of 19 patients (14%) had undergone a previous stabilization, which failed. The primary endpoint was recurrent instability, with a secondary outcome of the ability to return to sport. Results At a mean follow-up of four years (1.0 to 8.25), ten patients (7.5%) had recurrent instability. Patients in group B had a significantly higher recurrence rate than those in group A (p = 0.001). Using a multivariate logistic regression, the presence of glenoid erosion of > 10% (odds ratio (OR) = 35.13 (95% confidence interval (CI) 8 to 149); p = 0.001) and age < 23 years (OR = 0.89 (0.79 to 0.99); p = 0.038) were associated with a higher risk of recurrent instability. A total of 80 patients (78%) could return to sport, but only 11 athletes (65%) who practiced high-risk (collision or contact-overhead) sports. All seven shoulders which were revised using a Latarjet procedure were stable at a mean final follow-up of 36 months (11 to 57) and returned to sports at the same level. Conclusion Patients with subcritical glenoid bone loss (> 10%) and younger age (≤ 23 years) are at risk of failure and reoperation after ABR-HSR. Furthermore, following this procedure, one-third of athletes practicing high-risk sports are unable to return at their pre-instability level, despite having a stable shoulder. Cite this article: Bone Joint J 2021;103-B(4):718–724.

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