Purpose
The purpose of this study was to establish and analyze a simplified scoring system
based on anatomic imaging measurements to predict recurrent instability after primary
arthroscopic shoulder capsulolabral repair.
Methods
All patients undergoing primary arthroscopic anterior capsulolabral repair of the
shoulder were reviewed. Patients were contacted and charts were reviewed for endpoint
of recurrent instability and return to prior level of activity. Predictive variables
for recurrent instability studied included age, sex, amount of glenoid bone loss,
intact anterior articular arc (IAAA), glenohumeral tracking (off-track), contact sports
and overhead sports participation.
Results
540 patients met inclusion criteria and follow-up data with magnetic resonance imaging
data were available for 337 shoulders. Average follow-up was 6.2 years(range 3.4-9.3
years). Symptomatic recurrent instability occurred in 102 patients (30.3%) and 68%
of contacted patients returned to pre-injury activities. In univariate analysis, age
under 21 years, off-track lesions, IAAA <150°, and glenoid bone loss (GBL) of 10%
or greater displayed an increased risk of recurrent instability. Multivariable analysis
showed these factors remained significant: age <21 (odds ratio [ratio] 2.37), off-track
glenoid (OR 2.86), IAAA <150 (OR 3.90), and GBL ≥10% (OR 7.47). A scoring system assigning
1 point each for age and off-track lesions, 2 points for IAAA <150, and 4 points for
GBL >10% yielded 79% sensitivity, 75% specificity, 58% positive predictive value,
and 89% negative predictive value using a probability value of 20 percent for recurrent
instability.
Conclusion
At mid-term follow-up, recurrent shoulder instability following primary arthroscopic
anterior capsulolabral repair was 30% in this series. Younger age, glenoid bone loss
of 10% or more, IAAA <150° and off-track glenoid lesion conferred the greatest risk
for postoperative instability. We propose a scoring system assigning 1 point for age,
1 point for off-track lesions, 2 points for IAAA <150, and 4 points for GBL >10%.
This schema demonstrated moderate accuracy for predicting recurrent instability when
using a cutoff threshold score above 2 points for failure.
Level of Evidence
Level III, Retrospective Cohort Study.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study.J Bone Joint Surg Am. 2000; 82: 35-46
- What is the critical value of glenoid bone loss at which soft tissue bankart repair does not restore glenohumeral translation, restricts range of motion, and leads to abnormal humeral head position?.Am J Sports Med. 2016; 44: 2784-2791
- Critical value of anterior glenoid bone loss that leads to recurrent glenohumeral instability after arthroscopic bankart repair.Am J Sports Med. 2017; 45: 1975-1981
- The effect of subcritical bone loss and exposure on recurrent instability after arthroscopic bankart repair in intercollegiate American football.Am J Sports Med. 2017; 45: 1769-1775
- Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: a new concept of glenoid track.J Shoulder Elbow Surg. 2007; 16: 649-656
- Hill-Sachs off-track lesions as risk factor for recurrence of instability after arthroscopic Bankart repair.Arthroscopy. 2016; 32: 1993-1999
- Clinical validation of the glenoid track concept in anterior glenohumeral instability.J Bone Joint Surg Am. 2016; 98: 1918-1923
- Diagnosis of engaging bipolar bone defects in the shoulder using 2-dimensional computed tomography: a cadaveric study.Am J Sports Med. 2016; 44: 2771-2777
- Diagnostic accuracy of MRI in the measurement of glenoid bone loss.AJR Am J Roentgenol. 2012; 199: 873-878
- Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from “engaging/non-engaging” lesion to “on-track/off-track” lesion.Arthroscopy. 2014; 30: 90-98
- Evaluation of the Instability Severity Index Score and the Western Ontario Shoulder Instability Index as predictors of failure following arthroscopic Bankart repair.Bone Joint J. 2014; 96-b: 1688-1692
- Arthroscopic versus open shoulder stabilization: current practice patterns in the United States.Arthroscopy. 2014; 30: 436-443
- Long-term restoration of anterior shoulder stability: a retrospective analysis of arthroscopic Bankart repair versus open Latarjet procedure.J Bone Joint Surg Am. 2016; 98: 1954-1961
- Long-term results of arthroscopic Bankart repair: minimum 10 years of follow-up.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 94-99
- Arthroscopic stabilization in anterior shoulder instability: collision athletes versus noncollision athletes.Arthroscopy. 2006; 22: 947-953
- Clinical and radiographic outcomes of open Latarjet procedure in patients aged 40 years or older.J Shoulder Elbow Surg. 2019; 28: e304-e312
- Arthroscopic versus open reconstruction of the shoulder with isolated Bankart lesions.Am J Sports Med. 1996; 24: 144-148
- The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation.J Bone Joint Surg Br. 2007; 89: 1470-1477
- Results of 45 arthroscopic Bankart procedures: Does the ISIS remain a reliable prognostic assessment after 5 years?.Eur J Orthop Surg Traumatol. 2015; 25: 709-716
- Is the Instability Severity Index Score a valid tool for predicting failure after primary arthroscopic stabilization for anterior glenohumeral instability?.Arthroscopy. 2019; 35: 361-366
- Evaluation of the Instability Severity Index score in predicting failure following arthroscopic Bankart surgery in an active military population.J Shoulder Elbow Surg. 2019; 28: e156-e163
- Arthroscopic Bankart repair and capsular shift for recurrent anterior shoulder instability: functional outcomes and identification of risk factors for recurrence.J Bone Joint Surg Am. 2012; 94: 1308-1315
- Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder.Am J Sports Med. 1998; 26: 41-45
- The inverted pear glenoid: an indicator of significant glenoid bone loss.Arthroscopy. 2004; 20: 169-174
- Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion.Arthroscopy. 2000; 16: 677-694
- The effect of a combined glenoid and Hill-Sachs defect on glenohumeral stability: a biomechanical cadaveric study using 3-dimensional modeling of 142 patients.Am J Sports Med. 2015; 43: 1422-1429
- Risk factors for recurrent instability or revision surgery following arthroscopic Bankart repair.Bone Joint J. 2018; 100: 325-330
- Risk factors for failure of arthroscopic revision anterior shoulder stabilization.J Bone Joint Surg Am. 2018; 100: 1319-1325
- Outcomes after Bankart repair in a military population: predictors for surgical revision and long-term disability.Arthroscopy. 2014; 30: 172-177
- High rate of return to sport in adolescent athletes following anterior shoulder stabilization: a systematic review.J ISAKOS. 2019; 4: 33-40
- Patients in whom arthroscopic Bankart repair is not enough: evaluation and management of complex anterior glenohumeral instability.Instr Course Lect. 2017; 66: 79-89
- Arthroscopic anterior stabilization of the shoulder: two to six-year follow-up.J Bone Joint Surg Am. 2003; 85: 1511-1518
- Prospective evaluation of arthroscopic bankart repairs for anterior instability.Am J Sports Med. 2010; 38: 302-307
Article Info
Publication History
Published online: January 08, 2020
Accepted:
November 16,
2019
Received:
July 3,
2019
Footnotes
The authors report the following potential conflicts of interest or sources of funding: The authors acknowledge research funding from the Kaiser Permanente Regional Research Committee (RRC) #20150401. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2020 by the Arthroscopy Association of North America
