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.
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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
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© 2020 by the Arthroscopy Association of North America
