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Risk factors for recurrent instability or revision surgery following arthroscopic Bankart repair.

Abstract Aims The factors that predispose to recurrent instability and revision stabilization procedures after arthroscopic Bankart repair for anterior glenohumeral instability remain unclear. We sought to determine the rate and risk factors associated with ongoing instability in patients undergoing arthroscopic Bankart repair for instability of the shoulder. Materials and Methods We used the Statewide Planning and Research Cooperative System (SPARCS) database to identify patients with a diagnosis of anterior instability of the shoulder undergoing arthroscopic Bankart repair between 2003 and 2011. Patients were followed for a minimum of three years. Baseline demographics and subsequent further surgery to the ipsilateral shoulder were analyzed. Multivariate analysis was used to identify independent risk factors for recurrent instability. Results A total of 5719 patients were analyzed. Their mean age was 24.9 years (sd 9.3); 4013 (70.2%) were male. A total of 461 (8.1%) underwent a further procedure involving the ipsilateral shoulder at a mean of 31.5 months (sd 23.8) postoperatively; 117 (2.1%) had a closed reduction and 344 (6.0%) had further surgery. Revision arthroscopic Bankart repair was the most common subsequent surgical procedure (223; 65.4%). Independent risk factors for recurrent instability were: age < 19 years (odds ratio 1.86), Caucasian ethnicity (hazard ratio 1.42), bilateral instability of the shoulder (hazard ratio 2.17), and a history of closed reduction(s) prior to the initial repair (hazard ratio 2.45). Revision arthroscopic Bankart repair was associated with significantly higher rates of ongoing persistent instability than revision open stabilization (12.4% vs 5.1%, p = 0.041). Conclusion The incidence of a further procedure being required in patients undergoing arthroscopic Bankart repair for anterior glenohumeral instability was 8.1%. Younger age, Caucasian race, bilateral instability, and closed reduction prior to the initial repair were independent risk factors for recurrent instability, while subsequent revision arthroscopic Bankart repair had significantly higher rates of persistent instability than subsequent open revision procedures. Cite this article: Bone Joint J 2018;100-B:324-30.
PMID
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Authors

Mayor MeshTerms
Keywords

Anterior glenohumeral instability

Arthroscopic capsulorrhaphy

Bankart repair

Population analysis

Revision surgery

Shoulder arthroscopy

Shoulder dislocation

Survival analysis

Journal Title the bone & joint journal
Publication Year Start




PMID- 29589497
OWN - NLM
STAT- MEDLINE
DCOM- 20180402
LR  - 20180402
IS  - 2049-4408 (Electronic)
IS  - 2049-4394 (Linking)
VI  - 100-B
IP  - 3
DP  - 2018 Mar 1
TI  - Risk factors for recurrent instability or revision surgery following arthroscopic
      Bankart repair.
PG  - 324-330
LID - 10.1302/0301-620X.100B3.BJJ-2017-0557.R1 [doi]
AB  - Aims The factors that predispose to recurrent instability and revision
      stabilization procedures after arthroscopic Bankart repair for anterior
      glenohumeral instability remain unclear. We sought to determine the rate and risk
      factors associated with ongoing instability in patients undergoing arthroscopic
      Bankart repair for instability of the shoulder. Materials and Methods We used the
      Statewide Planning and Research Cooperative System (SPARCS) database to identify 
      patients with a diagnosis of anterior instability of the shoulder undergoing
      arthroscopic Bankart repair between 2003 and 2011. Patients were followed for a
      minimum of three years. Baseline demographics and subsequent further surgery to
      the ipsilateral shoulder were analyzed. Multivariate analysis was used to
      identify independent risk factors for recurrent instability. Results A total of
      5719 patients were analyzed. Their mean age was 24.9 years (sd 9.3); 4013 (70.2%)
      were male. A total of 461 (8.1%) underwent a further procedure involving the
      ipsilateral shoulder at a mean of 31.5 months (sd 23.8) postoperatively; 117
      (2.1%) had a closed reduction and 344 (6.0%) had further surgery. Revision
      arthroscopic Bankart repair was the most common subsequent surgical procedure
      (223; 65.4%). Independent risk factors for recurrent instability were: age &lt; 19
      years (odds ratio 1.86), Caucasian ethnicity (hazard ratio 1.42), bilateral
      instability of the shoulder (hazard ratio 2.17), and a history of closed
      reduction(s) prior to the initial repair (hazard ratio 2.45). Revision
      arthroscopic Bankart repair was associated with significantly higher rates of
      ongoing persistent instability than revision open stabilization (12.4% vs 5.1%, p
      = 0.041). Conclusion The incidence of a further procedure being required in
      patients undergoing arthroscopic Bankart repair for anterior glenohumeral
      instability was 8.1%. Younger age, Caucasian race, bilateral instability, and
      closed reduction prior to the initial repair were independent risk factors for
      recurrent instability, while subsequent revision arthroscopic Bankart repair had 
      significantly higher rates of persistent instability than subsequent open
      revision procedures. Cite this article: Bone Joint J 2018;100-B:324-30.
FAU - Mahure, S A
AU  - Mahure SA
AD  - NYU Langone Medical Center, Hospital for Joint Diseases, 333 East 38th Street,
      New York, NY 10016, USA.
FAU - Mollon, B
AU  - Mollon B
FAU - Capogna, B M
AU  - Capogna BM
AD  - NYU Langone Medical Center, Hospital for Joint Diseases, 333 East 38th Street,
      New York, NY 10016, USA.
FAU - Zuckerman, J D
AU  - Zuckerman JD
AD  - NYU Langone Medical Center, Hospital for Joint Diseases, 333 East 38th Street,
      New York, NY 10016, USA.
FAU - Kwon, Y W
AU  - Kwon YW
AD  - NYU Langone Medical Center, Hospital for Joint Diseases, 333 East 38th Street,
      New York, NY 10016, USA.
FAU - Rokito, A S
AU  - Rokito AS
AD  - NYU Langone Medical Center, Hospital for Joint Diseases, 333 East 38th Street,
      New York, NY 10016, USA.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Bone Joint J
JT  - The bone &amp; joint journal
JID - 101599229
SB  - AIM
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Arthroscopy/*methods
MH  - Child
MH  - Female
MH  - Humans
MH  - Joint Instability/*surgery
MH  - Male
MH  - Middle Aged
MH  - Recurrence
MH  - Reoperation/*statistics &amp; numerical data
MH  - Risk Factors
MH  - Shoulder Injuries/*surgery
MH  - Shoulder Joint/*injuries
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Anterior glenohumeral instability
OT  - Arthroscopic capsulorrhaphy
OT  - Bankart repair
OT  - Population analysis
OT  - Revision surgery
OT  - Shoulder arthroscopy
OT  - Shoulder dislocation
OT  - Survival analysis
EDAT- 2018/03/29 06:00
MHDA- 2018/04/03 06:00
CRDT- 2018/03/29 06:00
PHST- 2018/03/29 06:00 [entrez]
PHST- 2018/03/29 06:00 [pubmed]
PHST- 2018/04/03 06:00 [medline]
AID - 10.1302/0301-620X.100B3.BJJ-2017-0557.R1 [doi]
PST - ppublish
SO  - Bone Joint J. 2018 Mar 1;100-B(3):324-330. doi:
      10.1302/0301-620X.100B3.BJJ-2017-0557.R1.