Purpose
To quantify the rate of surgical failure after anterior shoulder stabilization procedures,
as well as to identify demographic and surgical risk factors associated with poor
outcomes.
Methods
All Army patients undergoing arthroscopic or open Bankart repair for shoulder instability
were isolated from the Military Health System Management Analysis and Reporting Tool
between 2003 and 2010. Demographic variables (age, gender) and surgical variables
(treatment facility volume, admission status, surgical technique) were extracted.
Rates of surgical failure, defined as subsequent revision surgery or medical discharge
with persistent shoulder complaints, were recorded from the electronic medical record
and US Army Physical Disability Agency database. Risk factor analysis was performed
with univariate t tests, χ2 tests, and a multivariable logistic regression model with failure as the outcome.
Results
A total of 3,854 patients underwent Bankart repair during the study period, with most
procedures having been performed arthroscopically (n = 3,230, 84%) and on an outpatient
basis (n = 3,255, 84%). Patients were predominately men (n = 3,531, 92%), and the
mean age was 28.0 years (SD, 7.5 years). A total of 193 patients (5.0%) underwent
revision stabilization whereas 339 patients (8.8%) were medically discharged with
complaints of shoulder instability, for a total combined failure rate of 13.8% (n =
532). Univariate analyses showed no significant effect for gender; however, younger
age, higher facility volume, open repair, and inpatient status were significant factors
associated with subsequent surgical failure. Multivariable analyses confirmed that
young age (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.91 to 0.96; P < .001), open repair (OR, 0.52; 95% CI, 0.36 to 0.75; P = .001), and inpatient status (OR, 0.58; 95% CI, 0.40 to 0.84; P = .004) were independently associated with failure by revision surgery.
Conclusions
Young age remains a significant risk factor for surgical failure after Bankart repair.
Patients who underwent arthroscopic Bankart repair had a significantly lower surgical
failure rate (4.5%) than patients who underwent open anterior stabilization (7.7%).
Despite advances in surgical technique, 1 in 20 military service members required
revision surgery after failed primary stabilization in this study.
Level of Evidence
Level IV, therapeutic case series.
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Article info
Publication history
Accepted:
November 4,
2013
Received:
April 3,
2013
Footnotes
The authors report the following potential conflict of interest or source of funding: K.L.C. and B.D.O. receive support from Musculoskeletal Transplant Foundation.
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of Defense or the US government. The authors are employees of the US government.
Identification
Copyright
Published by Elsevier Inc.
