Speaker details predictors of revision arthroscopic Bankart repair in adolescents
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NASHVILLE, Tenn. — Traumatic, unidirectional, anterior shoulder instability treated with arthroscopic Bankart repair in adolescents has a high rate of revision and inferior patient-reported outcome measures, according to a presenter.
“Adolescents, as we all know, are at high risk for recurrent instability following arthroscopic Bankart repair, with numerous authors citing failure rates of 10% to 47%,” Crystal A. Perkins, MD, a pediatric orthopedic surgeon at Children’s Healthcare of Atlanta, said during her presentation at the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America Combined Meeting.
“Glenoid bone loss is a well-established risk factor for recurrent instability,” Perkins added. “However, humeral bone loss secondary to a Hill-Sachs defect has gained increasing attention as a potential contributor to recurrent instability.”
Perkins and colleagues analyzed 58 patients (median age of 16 years) who underwent arthroscopic Bankart repair to assess clinical and radiographic predictors of failure, specifically whether the presence of an “off-track” lesion would predict failure in this population.
According to the study, radiographic assessment consisted of glenoid track, Hill-Sachs depth, Hill-Sachs interval and intact anterior articular angle.
Overall, 17% of patients underwent revision surgery, and 14% had recurrent instability. Perkins and colleagues found “off-track” lesions were present in 8.5% of patients; however, these were not an independent risk factor for recurrent instability. Subgroup analysis of the 64% of patients (n = 38) with a Hill-Sachs defect revealed an association between greater Hill-Sachs interval, Hill-Sachs depth and revision surgery.
“We feel that the results of this study suggest there should be a shift in the treatment of adolescent, unidirectional, anterior shoulder instability,” Perkins concluded. “While ‘off-track’ lesions are certainly a clear indication for the addition of remplissage with or without glenoid augmentation, perhaps the ‘on-track’ lesion with an increased Hill-Sachs interval and depth may also warrant the additional procedures among our adolescent patients who are already at a higher risk of failure.”
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Perkins CA, et al. Bankart repair in adolescents: Clinical and radiographic predictors of revision surgery. Presented at: American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America Combined Meeting; July 7-11, 2021; Nashville, Tennessee.
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