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Study: Subcritical bone loss worsens outcomes after Bankart repair

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HOLLYWOOD, Fla. —Patients who have subcritical glenoid bone loss after an isolated Bankart repair had increased failure rates and worse clinical outcomes, according to a presenter at the Arthroscopy Association of North America Annual Meeting, here.

John M. Tokish, MD, and colleagues conducted a consecutive retrospective review of 73 shoulders in 72 patients with a mean age of 26 years who underwent an isolated Bankart repair. Data was obtained from an ongoing quality improvement program at a single Army medical center. Exclusion criteria were concomitant procedures or extension of labral pathology. Subjective evaluations, such as the Western Ontario Shoulder Instability Index (WOSI) and instances of recurrent instability, were gathered from all patients as well as demographics, number of anchors and glenoid bone loss at the mean follow-up of 4 years. Glenoid bone loss was evaluated using a “perfect circle” technique by four independent reviewers. Cases were divided into quartiles and stratified by bone loss.

Tokish said the average glenoid bone loss observed among all patients was 13.4%. Bone loss by quartile went from 2.8% in quartile one to 24.5% in quartile four. Instability recurrence rates increased in line with increasing bone loss with a recurrence rate of 6% in the lowest quartile to 28% in the highest quartile. Bone loss was two times higher and WOSI scores were two times as poor for patients who had recurrence of instability compared to patients without recurrence.

“Interestingly, when we excluded all patients with the recurrence, bone loss still predicted outcomes,” he said. “If you were above 13.5% [of glenoid bone loss], your WOSI scores were significantly worse.” – by Christian Ingram

Reference:

Tokish JM. Paper #SS-07. Presented at: Arthroscopy Association of North America Annual Meeting; May 1-3, 2014; Hollywood, Fla.

Disclosure: Tokish is a member of the editorial board of Orthopedics Today and is an associate editor of the Journal of Shoulder and Elbow Surgery.