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Stratification of arthroscopic shoulder stabilization outcomes equates young age with poorer results
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SAN DIEGO — In a presentation here at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons, Scottish investigators encouraged counseling younger patients with recurrent shoulder dislocations about the possible risk of failure following an arthroscopic repair for shoulder instability.
Their single-center prospective study, led by Issaq Ahmed, MRCS, followed 302 patients who underwent arthroscopic Bankart repairs. The patients had a mean age of 26.4 years. The study showed higher recurrence rates in some patients and also revealed that younger age at the time of surgery, glenoid bone loss and engaging Hill-Sachs lesions were predictive of a poor outcome.
The patients had preoperative clinical and radiological assessments, and blinded assessors reviewed the results of the patients’ preoperative diagnostic arthroscopies. In-office follow-ups using the Western Ontario Shoulder Instability Index and DASH scores occurred at 2 years postoperatively and annually thereafter.
Recurrence rate
“The true recurrence rate in our population of 302 patients was 13.2%,” Ahmed, of the Department of Trauma and Orthopedics at the Royal Infirmary of Edinburgh, Scotland, said during his presentation, noting that 55% of those recurrences were within 1 year.
Seven patients who had a recurrence underwent open stabilization. Another seven patients were treated with a Latarjet procedure, and one had another arthroscopic repair as a secondary treatment.
Predictive model
Of considerable interest to meeting attendees was the predictive model that Ahmed and colleagues developed from their research. Among its findings were an 8% dislocation risk in the non-engaging Hill-Sachs lesions group and 25% risk in the glenoid bone loss group.
Those rates can be even higher when engaging Hill-Sach lesions are present, according to Ahmed.
“We are currently evaluating the role of 3D CT to assess these bony defects,” he said.
Reference:
- Ahmed I, et al. Arthroscopic stabilization for recurrent shoulder dislocation: Long term outcome & risk stratification. Paper #612. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19, 2011. San Diego.
Disclosure: Ahmed has no relevant disclosures.
I’d like to applaud the work by Drs. Ahmed and Robinson on several factors. The last few years, we have been honed in on this bone loss issue. We talk about glenoid defect. We talk about engaging Hill-Sachs. But, in point of fact, most of these patients have combined lesions so we cannot really dutifully predict with any method right now because in any given patient, usually when they come to this issue, there are two bony issues.
I think [this] predictive … data is very, very compelling.
– Robert A. Arciero, MD
University of Connecticut Health Center
Farmington, Conn.
Disclosure: Arciero is on the speaker’s bureau for and receives institutional support from Arthrex.
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