Purpose
The purpose of this study was to investigate current trends in arthroscopic and open
shoulder stabilization in the United States.
Methods
Patients who underwent arthroscopic shoulder stabilization (Current Procedural Terminology
code 29806) or open stabilization (Current Procedural Terminology codes 23455 [open
Bankart repair], 23460 [anterior bone block], and 23462 [coracoid transfer]) were
identified using a national database of insurance billing records during the years
2004 through 2009. Demographic data were recorded for each patient.
Results
From 2004 through 2009, there were 23,096 cases of shoulder stabilization, of which
84% (19,337) were arthroscopic and 16% (3,759) were open procedures. There were 17,241
male patients (75%) and 5,855 female patients (25%). The incidence of arthroscopic
shoulder stabilization nearly doubled during the period studied, increasing from 11.8
cases for every 10,000 patients in 2004 to 22.9 cases for every 10,000 patients in
2009. The percentage of arthroscopic stabilizations increased from 71% of stabilization
procedures in 2004 to 89% in 2009, whereas the percentage of open stabilizations decreased
from 29% in 2004 to 11% in 2009 (P < .0001). Among open procedures, a significant decline in the incidence of open Bankart
repair was observed, from 4.5 cases for every 10,000 patients in 2004 to 2.2 cases
for every 10,000 patients in 2009 (P < .0001), whereas the performance of open coracoid transfer increased from 0.17 cases
per 10,000 patients in 2004 to 0.40 cases per 10,000 patients in 2009 (P < .0001). For both arthroscopic and open stabilization, the group aged 10 to 19 years
had the highest rate of surgery (29%), followed by the group aged 20 to 29 years (25%).
Conclusions
The current data indicate that arthroscopic stabilization is performed in nearly 90%
of shoulder stabilization surgeries and nearly doubled in incidence from 2004 to 2009
in the United States. Additional research is needed to further investigate the long-term
clinical outcomes of this practice pattern.
Level of Evidence
Level IV, retrospective database review.
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References
- Prognosis of primary dislocation of the shoulder.Acta Orthop Scand. 1969; 40: 216-224
- The epidemiology of shoulder dislocations.Arch Orthop Trauma Surg. 1989; 108: 288-290
- Anterior dislocation of the shoulder: Prognosis and treatment.Surg Clin North Am. 1963; 43: 1609-1614
- The treatment of traumatic anterior instability of the shoulder: Nonoperative and surgical treatment.Arthroscopy. 2009; 25: 298-304
- Glenohumeral instability in adults.in: DeLee J.C. Drez Jr., D. Miller M.D. DeLee and Drez’s orthopaedic sports medicine. Ed 3. WB Saunders, Philadelphia2009
- The Bankart procedure: A long-term end-result study.J Bone Joint Surg Am. 1978; 60: 1-16
- Innovations in arthroscopic surgery of the shoulder: Advances in arthroscopic shoulder stabilization.Arthroscopy. 2003; 19: 106-108
- Open operative treatment for anterior shoulder instability: When and why?.J Bone Joint Surg Am. 2005; 87: 419-432
- Arthroscopic versus open Bankart repair: Analysis of patient subjective outcome and cost.Arthroscopy. 2005; 21: 1219-1222
- Arthroscopic versus open Bankart procedures: A comparison of early morbidity and complications.Arthroscopy. 1993; 9: 371-374
- Arthroscopic versus open treatment of Bankart lesion of the shoulder: A prospective randomized study.Arthroscopy. 2004; 20: 456-462
- Arthroscopic compared with open repairs for recurrent anterior shoulder instability: A systemic review and meta-analysis of the literature.J Bone Joint Surg Am. 2007; 89: 244-254
- Surgical treatment of traumatic anterior shoulder instability in American football players.J Bone Joint Surg Am. 2002; 84: 711-715
- Outcomes of arthroscopic Bankart repair in collision versus noncollision athletes.Orthopedics. 2013; 36: e621-e626
- Open capsular shift: There still is a role!.Orthop Clin North Am. 2010; 41: 427-436
- Surgical trends in Bankart repair: An analysis of data from the American Board of Orthopaedic Surgery certification examination.Am J Sports Med. 2011; 39: 1865-1869
- Demographic trends in arthroscopic SLAP repair in the United States.Am J Sports Med. 2012; 40: 1144-1147
- Analysis of rotator cuff repair trends in a large private insurance population.Arthroscopy. 2013; 29: 623-629
- Management of traumatic anterior shoulder dislocation in the 17- to 25-year age group: A dramatic evolution of practice.J Shoulder Elbow Surg. 2012; 21: 545-553
- Long-term outcomes after Bankart shoulder stabilization.Arthroscopy. 2013; 29: 920-933
- Treatment of Bankart lesions in traumatic anterior instability of the shoulder: A randomized controlled trial comparing arthroscopy and open techniques.Arthroscopy. 2012; 28: 900-908
- Comparison of arthroscopic and open anterior shoulder stabilization. A two to six-year follow-up study.J Bone Joint Surg Am. 2000; 82: 1108-1114
- Arthroscopic Bankart repair of anterior detachments of the glenoid labrum. A prospective study.J Bone Joint Surg Am. 1999; 81: 1357-1366
- An arthroscopic technique for anterior stabilization of the shoulder with a bioabsorbable tack.J Bone Joint Surg Am. 1996; 78: 1801-1807
- Arthroscopic shoulder stabilization using transglenoid sutures. A four-year minimum followup.Am J Sports Med. 1996; 24: 459-467
- Do the traditional and modified Latarjet techniques produce equivalent reconstruction stability and strength?.Am J Sports Med. 2012; 40: 2801-2807
- Surgical treatment of anterior instability in rugby union players: Clinical and radiographic results of the Latarjet-Patte procedure with minimum 5-year follow-up.J Shoulder Elbow Surg. 2012; 21: 1721-1727
- The Latarjet procedure for the treatment of recurrence of anterior instability of the shoulder after operative repair: A retrospective case series of forty-nine consecutive patients.J Bone Joint Surg Am. 2012; 94: e75
- Incidence of shoulder dislocation in the United States Military: Demographic considerations from a high-risk population.J Bone Joint Surg Am. 2009; 91: 791-796
Article info
Publication history
Published online: February 24, 2014
Accepted:
December 18,
2013
Received:
July 9,
2013
Footnotes
The authors report the following potential conflict of interest or source of funding: J.C.W. receives support from stock options in PearlDiver. Stock ownership is less than 1% of company's stock.
Identification
Copyright
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
