Journal article
Factors Influencing Surgeon's Choice of Procedure for Anterior Shoulder Instability: A Multicenter Prospective Cohort Study
Arthroscopy, Vol.35(7), pp.2014-2025
07/01/2019
DOI: 10.1016/j.arthro.2019.02.035
PMID: 31208919
Abstract
Purpose: To investigate preoperative factors associated with selection of surgical treatment for anterior shoulder instability. Methods: Patient demographics, initial physical examinations, and patient-oriented outcome questionnaires were collected prospectively from 26 shoulder surgeons at 10 sites. Symptom duration, number of dislocations, sport, history of prior stabilization procedure, Hill-Sachs/glenoid bone loss, pain level, and failure of conservative treatment were recorded. Statistical analysis was performed with Fisher's exact test and logistic regression analysis. Results: A total of 564 patients who underwent surgical treatment for anterior shoulder instability from November 2012 to June 2017 were enrolled. Of these, 426 shoulders underwent arthroscopic stabilization alone, 38 underwent arthroscopic stabilization with remplissage, 28 underwent open Bankart repair, and 72 underwent a Latarjet procedure. Predictors for undergoing Latarjet (P <.003) were symptom duration (75% had symptoms for > 1 year), number of dislocations (47% had > 5 dislocations), revision surgery (69%), Hill-Sachs lesion size (45% had a lesion between 11% and 20% of the humeral head), and glenoid bone loss (75% of Latarjet patients had 11% to 30% loss). Predictors for undergoing open Bankart repair (P <.001) were number of dislocations (32% had > 5 dislocations), revision surgeries (54%), and glenoid bone loss (11% of open Bankart patients had 11% to 20% loss). History of prior shoulder surgery was the only significant predictor of open versus arthroscopic Bankart procedure. Prediction models showed athletes involved in high-risk sports were 2.61 times more likely to have a Latarjet (P <.01). Conclusions: Indications for the Latarjet were: humeral and glenoid bone loss, duration of symptoms, number of dislocations, and revision stabilizations. Athletes involved in high-risk sports were more likely to undergo the Latarjet procedure, even if other predictive factors were not present. The open Bankart procedure was the least common procedure performed, with a history of prior shoulder surgery being the only predictor for use when treating recurrent instability.
Details
- Title: Subtitle
- Factors Influencing Surgeon's Choice of Procedure for Anterior Shoulder Instability: A Multicenter Prospective Cohort Study
- Creators
- Julie Y. Bishop - The Ohio State University Wexner Medical CenterKrystin A. Hidden - The Ohio State University Wexner Medical CenterGrant L. Jones - The Ohio State University Wexner Medical CenterCarolyn M. Hettrich - University of KentuckyBrian R. Wolf - University of IowaKeith M. Baumgarten - Orthoped Inst, Sioux Falls, SD USAMatthew Bollier - Univ Iowa, Iowa City, IA USAJonathan Bravman - Univ Colorado, Boulder, CO 80309 USAEric C. McCarty - Univ Colorado, Boulder, CO 80309 USARobert H. Brophy - Washington Univ, St Louis, MO 63110 USAMatthew V. Smith - Washington Univ, St Louis, MO 63110 USARick W. Wright - Washington Univ, St Louis, MO 63110 USACharlie Cox - Vanderbilt UniversityJohn Kuhn - Vanderbilt UniversityBrian Feely - Univ Calif San Francisco, San Francisco, CA 94143 USAC. Benjamin Ma - Univ Calif San Francisco, San Francisco, CA 94143 USAAlan Zhang - Univ Calif San Francisco, San Francisco, CA 94143 USAJohn Grant - Univ Michigan, Ann Arbor, MI 48109 USABruce Miller - Univ Michigan, Ann Arbor, MI 48109 USARobert G. Marx - Hosp Special Surg, 535 E 70th St, New York, NY 10021 USAMOON Shoulder Group
- Resource Type
- Journal article
- Publication Details
- Arthroscopy, Vol.35(7), pp.2014-2025
- DOI
- 10.1016/j.arthro.2019.02.035
- PMID
- 31208919
- NLM abbreviation
- Arthroscopy
- ISSN
- 0749-8063
- eISSN
- 1526-3231
- Publisher
- Elsevier
- Number of pages
- 12
- Grant note
- DOI: 10.13039/100004319, name: Pfizer; DOI: 10.13039/100009026, name: Smith & Nephew; name: DePuy; DOI: 10.13039/100000002, name: National Institutes of Health; DOI: 10.13039/100006093, name: PCORI; DOI: 10.13039/100006338, name: Zimmer; DOI: 10.13039/100008187, name: Histogenics; name: Samumed; name: Anika; DOI: 10.13039/100000980, name: Arthritis Foundation; DOI: 10.13039/100006093, name: PCORI; DOI: 10.13039/100000002, name: National Institutes of Health
- Language
- English
- Date published
- 07/01/2019
- Academic Unit
- Orthopedics and Rehabilitation; Physical Therapy and Rehabilitation Science
- Record Identifier
- 9984294957802771
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