Risk Factors for Recurrence of Anterior Shoulder Instability after Arthroscopic Surgery with Suture Anchors Choi, Chang-Hyuk; Kim, Seok-Jun; Chae, Seung-Bum; Lee, Jae-Keun; Kim, Dong-Young;
Background: We investigated the risk factors for the recurrence of anterior shoulder instability after arthroscopic surgery with suture anchors and the clinical outcomes after reoperation. Methods: A total of 281 patients (February 2001 to December 2012) were enrolled into our study, and postoperative subluxation and dislocation were considered as recurrence of the condition. We analyzed radiologic results and functional outcome including the American Shoulder and Elbow Surgeons Evaluation Form, the Korean Shoulder Society Score, and the Rowe scores. Results: Of the 281 patients, instability recurred in 51 patients (18.1%). Sixteen out of 51 patients (31.4%) received a reoperation. In terms of the functional outcome, we found that the intact group, comprising patients without recurrence, had a significantly better functional outcome than those in the recurrent group. The size of glenoid defect at the time of initial surgery significantly differed between intact and recurrent group (p<0.05). We found that the number of dislocations, the time from the initial presentation of symptoms to surgery, and the number of anchor points significantly differed between initial operation and revision group (p<0.05). The functional outcome after revision surgery was comparable to intact group after initial operation. Conclusions: Eighteen percent of recurrence occurred after arthroscopic instability surgery, and 5.6% received reoperation surgery. Risk factors for recurrence was the initial size of glenoid defect. In cases of revision surgery, good clinical outcomes could be achieved using additional suture anchor.
Abrams JS, Savoie FH 3rd, Tauro JC, Bradley JP. Recent advances in the evaluation and treatment of shoulder instability: anterior, posterior, and multidirectional. Arthroscopy. 2002; 18(9 Suppl 2):1-13.
Flinkkila T, Hyvonen P, Ohtonen P, Leppilahti J. Arthroscopic bankart repair: results and risk factors of recurrence of instability. Knee Surg Sports Traumatol Arthrosc. 2010;18(12):1752-8.
Boileau P, Villalba M, Hery JY, Balg F, Ahrens P, Neyton L. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am. 2006;88(8):1755-63.
Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. 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(1):35-46.
Mologne TS, Provencher MT, Menzel KA, Vachon TA, Dewing CB. Arthroscopic stabilization in patients with an inverted pear glenoid: results in patients with bone loss of the anterior glenoid. Am J Sports Med. 2007;35(8):1276-83.
Sugaya H, Moriishi J, Kanisawa I, Tsuchiya A. Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability. Surgical technique. J Bone Joint Surg Am. 2006;88(Suppl 1 Pt 2):159-69.
Ahmed I, Ashton F, Robinson CM. 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(14):1308-15.
Shibata H, Gotoh M, Mitsui Y, et al. Risk factors for shoulder re-dislocation after arthroscopic Bankart repair. J Orthop Surg Res. 2014;9:53.
Creighton RA, Romeo AA, Brown FM Jr, Hayden JK, Verma NN. Revision arthroscopic shoulder instability repair. Arthroscopy. 2007;23(7):703-9.
Boileau P, Richou J, Lisai A, Chuinard C, Bicknell RT. The role of arthroscopy in revision of failed open anterior stabilization of the shoulder. Arthroscopy. 2009;25(10):1075-84.
Rhee KJ, Kim KC, Shin HD, Kim YM. Revision using modified transglenoid reconstruction in recurred glenohumeral instability combined with anchor-induced arthropathy. Knee Surg Sports Traumatol Arthrosc. 2007;15(12):1494-8.
Millett PJ, Braun S. The "bony Bankart bridge" procedure: a new arthroscopic technique for reduction and internal fixation of a bony Bankart lesion. Arthroscopy. 2009;25(1):102-5.
Zhang J, Jiang C. A new "double-pulley" dual-row technique for arthroscopic fixation of bony Bankart lesion. Knee Surg Sports Traumatol Arthrosc. 2011;19(9):1558-62.
Yoneda M. New concept of arthroscopic bankart repair: double anchor footprint fixation (DAFF) technique. J Bone Joint Surg Am. 2005;24(11):1305-16.