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Hurley ET, O'Grady J, Davey MS, Levin JM, Mojica ES, Gaafar M, Dickens JF, Delaney RA, Mullett H. Glenohumeral morphological predictors of recurrent shoulder instability following arthroscopic Bankart repair. Knee Surg Sports Traumatol Arthrosc 2024; 32:1571-1578. [PMID: 38572679 DOI: 10.1002/ksa.12169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/28/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE The purpose of this study was to evaluate glenohumeral morphological features on a magnetic resonance arthrogram (MRA) to determine risk factors for recurrence of anterior shoulder instability following arthroscopic Bankart repair (ABR). METHODS A retrospective review of patients who underwent ABR between 2012 and 2017 was performed to identify patients who had recurrence of instability following stabilisation (Group 1). These were pair-matched in a 2:1 ratio for age, gender and sport with a control (Group 2) who underwent ABR without recurrence. Preoperative MRAs were evaluated for risk factors for recurrence, with glenoid bone loss and Hill-Sachs lesions also measured. Multilinear and multilogistic regression models were used to evaluate factors affecting recurrence. RESULTS Overall, 72 patients were included in this study, including 48 patients without recurrence and 24 patients with recurrent instability. There was a significant difference between the two groups in mean glenoid bone loss (Group 1: 7.3% vs. Group 2: 5.7%, p < 0.0001) and the rate of off-track Hill-Sachs lesions (Group 1: 20.8% vs. Group 2: 0%, p = 0.0003). Of the variables analysed in logistic regression, increased glenoid anteversion (p = 0.02), acromioclavicular (AC) degeneration (p = 0.03) and increased Hill-Sachs width were associated with increased risk of failure. Increased chondral version (p = 0.01) and humeral head diameter in the anteriorposterior view were found to be protective and associated with a greater likelihood of success. CONCLUSION Glenoid anteversion was a risk factor for recurrent instability, whereas increased chondral version and humeral head diameter were associated with higher rates of success following ABR. Glenoid bone loss, presence of an off-track Hill-Sachs lesion, increased Hill-Sachs width and AC degeneration were also associated with failure. These findings should be used by surgeons to stratify risk for recurrence following ABR. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Eoghan T Hurley
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Jack O'Grady
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Martin S Davey
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Jay M Levin
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Edward S Mojica
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Mohammed Gaafar
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Jonathan F Dickens
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Ruth A Delaney
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Hannan Mullett
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
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Cong T, Charles S, Reddy RP, Fatora G, Fox MA, Barrow AE, Lesniak BP, Rodosky MW, Hughes JD, Popchak AJ, Lin A. Defining Critical Humeral Bone Loss: Inferior Craniocaudal Hill-Sachs Extension as Predictor of Recurrent Instability After Primary Arthroscopic Bankart Repair. Am J Sports Med 2024; 52:181-189. [PMID: 38164666 DOI: 10.1177/03635465231209443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND The glenoid track concept for shoulder instability primarily describes the medial-lateral relationship between a Hill-Sachs lesion and the glenoid. However, the Hill-Sachs position in the craniocaudal dimension has not been thoroughly studied. HYPOTHESIS Hill-Sachs lesions with greater inferior extension are associated with increased risk of recurrent instability after primary arthroscopic Bankart repair. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS The authors performed a retrospective analysis of patients with on-track Hill-Sachs lesions who underwent primary arthroscopic Bankart repair (without remplissage) between 2007 and 2019 and had a minimum 2-year follow-up. Recurrent instability was defined as recurrent dislocation or subluxation after the index procedure. The craniocaudal position of the Hill-Sachs lesion was measured against the midhumeral axis on sagittal magnetic resonance imaging (MRI) using either a Hill-Sachs bisecting line through the humeral head center (sagittal midpoint angle [SMA], a measure of Hill-Sachs craniocaudal position) or a line tangent to the inferior Hill-Sachs edge (lower-edge angle [LEA], a measure of Hill-Sachs caudal extension). Univariate and multivariate regression were used to determine the predictive value of both SMA and LEA for recurrent instability. RESULTS In total, 176 patients were included with a mean age of 20.6 years, mean follow-up of 5.9 years, and contact sport participation of 69.3%. Of these patients, 42 (23.9%) experienced recurrent instability (30 dislocations, 12 subluxations) at a mean time of 1.7 years after surgery. Recurrent instability was found to be significantly associated with LEA >90° (ie, Hill-Sachs lesions extending below the humeral head equator), with an OR of 3.29 (P = .022). SMA predicted recurrent instability to a lesser degree (OR, 2.22; P = .052). Post hoc evaluation demonstrated that LEA >90° predicted recurrent dislocations (subset of recurrent instability) with an OR of 4.80 (P = .003). LEA and SMA were found to be collinear with Hill-Sachs interval and distance to dislocation, suggesting that greater LEA and SMA proportionally reflect lesion severity in both the craniocaudal and medial-lateral dimensions. CONCLUSION Inferior extension of an otherwise on-track Hill-Sachs lesion is a highly predictive risk factor for recurrent instability after primary arthroscopic Bankart repair. Evaluation of Hill-Sachs extension below the humeral equator (inferior equatorial extension) on sagittal MRI is a clinically facile screening tool for higher-risk lesions with subcritical glenoid bone loss. This threshold for critical humeral bone loss may inform surgical stratification for procedures such as remplissage or other approaches for at-risk on-track lesions.
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Affiliation(s)
- Ting Cong
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shaquille Charles
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rajiv P Reddy
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gabrielle Fatora
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael A Fox
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Aaron E Barrow
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bryson P Lesniak
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mark W Rodosky
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jonathan D Hughes
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Adam J Popchak
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Albert Lin
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Nakagawa S, Hirose T, Ohori T, Yokoi H, Uchida R, Sahara W, Mae T. The process of bone union after arthroscopic bony Bankart repair in younger athletes with a subcritical glenoid defect: An advantage of remained large bone fragment. J Orthop Sci 2024; 29:115-121. [PMID: 36372678 DOI: 10.1016/j.jos.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/13/2022] [Accepted: 10/21/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND The purpose of the present study was to investigate the bone union process after arthroscopic bony Bankart repair (ABBR) in shoulders with a subcritical glenoid defect of 13.5% or larger. METHODS Bone union process after ABBR performed from 2011 to 2018 were retrospectively investigated in 47 athletes younger than 30 years with a subcritical glenoid defect, who underwent CT at least twice postoperatively. The change of bone union between first CT within 6 months and final CT later than 6 months was investigated, especially noticing bone fragment size (≥7.5% versus <7.5%). RESULTS The mean period at first CT and at final CT was 4.1 ± 0.6 months (3-6 months) and 16.8 ± 11.6 months (7-71 months), respectively. From the first to final CT, among 15 shoulders with a small bone fragment (<7.5%), complete union increased from 4 shoulders (26.7%) to 8 shoulders (53.3%), while among 32 shoulders with a large bone fragment (≥7.5%), complete union increased from 15 shoulders (46.9%) to 25 shoulders (78.1%). On the other hand, while non-union or disappeared bone fragment was recognized in 8 shoulders (53.3%) with a small fragment and in 2 shoulders (6.3%) with a large fragment at first CT, it was solely recognized in 4 shoulders (26.7%) with a small fragment and in no shoulders with a large fragment at final CT. While postoperative glenoid fracture at the site of bone union was recognized in 7 shoulders, complete union was finally obtained after conservative treatment in 5 shoulders. So, final complete union was obtained in 9 (60%) of 15 shoulders with a small fragment and in 29 (90.6%) of 32 shoulders with a large fragment (p = 0.021). CONCLUSIONS In shoulders with a subcritical glenoid defect, when a large bone fragment (≥7.5%) was repaired, complete union rate was higher and complete union could be obtained earlier.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan.
| | - Takehito Hirose
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Hiroyuki Yokoi
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Wataru Sahara
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
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Moore TK, Kilkenny CJ, Hurley ET, Magee BM, Levin JM, Khan SU, Dickens JF, Mullett H. Posterior Shoulder Instability but Not Anterior Shoulder Instability Is Related to Glenoid Version. Arthrosc Sports Med Rehabil 2023; 5:100794. [PMID: 37711163 PMCID: PMC10497783 DOI: 10.1016/j.asmr.2023.100794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 08/08/2023] [Indexed: 09/16/2023] Open
Abstract
Purpose To assess and compare glenoid version in patients with anterior shoulder instability (ASI), posterior shoulder instability (PSI), and a control group. Methods The operative notes of all patients that had undergone arthroscopic shoulder instability repair between January 2017 and May 2022 were retrospectively reviewed. Magnetic resonance imaging scans were then analyzed, and glenoid version was measured by a single blinded observer. A P value <.05 was considered statistically significant. Results There were 100 patients included in the ASI group, 65 in PSI group, and 100 in the control group. The mean glenoid versions for the ASI group were -16°, -9.1°, and -9.2° for the vault version, simplified vault version, and chondrolabral version, respectively. The mean glenoid versions for the PSI group were -21°, -13.4°, and -16.6° for the vault version, simplified vault version, and chondrolabral version, respectively. The mean versions for the control group were -17.8°, -9.5°, and -9.8° for the vault version, simplified vault version and chondrolabral version, respectively. ANOVA testing and post hoc comparisons revealed the PSI group to be significantly more retroverted than both other groups P < .001. The ASI group's degree of glenoid version was not significantly different to that of the control P = .009. Conclusion Patients with PSI have a higher degree of retroversion in comparison to those with ASI and control. There is no significant difference in glenoid version among patients with ASI when compared with control. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Thomas K. Moore
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Conor J. Kilkenny
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan T. Hurley
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Duke University, Durham, North Carolina, U.S.A
| | | | | | | | | | - Hannan Mullett
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Nakagawa S, Take Y, Mizuno N, Ozaki R, Hanai H, Iuchi R, Kinugasa K. The prevalence of shoulders with a large glenoid defect and small bone fragment increases after several instability events during conservative treatment for traumatic anterior instability. JSES Int 2023; 7:538-543. [PMID: 37426910 PMCID: PMC10328779 DOI: 10.1016/j.jseint.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Background Unstable shoulders with a large glenoid defect and small bone fragment are at higher risk for postoperative recurrence after arthroscopic Bankart repair. The purpose of the present study was to clarify the changes in the prevalence of such shoulders during conservative treatment for traumatic anterior instability. Methods We retrospectively investigated 114 shoulders that underwent conservative treatment and computed tomography (CT) examination at least twice after an instability event in the period from July 2004 to December 2021. We investigated the changes in glenoid rim morphology, glenoid defect size, and bone fragment size from the first to the final CT. Results At first CT, 51 shoulders showed no glenoid bone defect, 12 showed glenoid erosion, and 51 showed a glenoid bone fragment [33 small bone fragment (<7.5%) and 18 large bone fragment (≥7.5%); mean size: 4.9 ± 4.2% (0-17.9%)]. Among patients with glenoid defect (fragment and erosion), the mean glenoid defect was 5.4 ± 6.6% (0-26.6%); 49 were considered a small glenoid defect (<13.5%) and 14 were a large glenoid defect (≥13.5%). While all 14 shoulders with large glenoid defect had a bone fragment, small fragment was solely seen in 4 shoulders. At final CT, 23 of the 51 shoulders persisted without glenoid defect. The number of shoulders presenting glenoid erosion increased from 12 to 24, and the number of shoulders with bone fragment increased from 51 to 67 [36 small bone fragment and 31 large bone fragment; mean size: 5.1 ± 4.9% (0-21.1%)]. The prevalence of shoulders with no or a small bone fragment did not increase from first CT (71.4%) to final CT (65.9%; P = .488), and the bone fragment size did not decrease (P = .753). The number of shoulders with glenoid defect increased from 63 to 91 and the mean glenoid defect significantly increased to 9.9 ± 6.6% (0-28.4%) (P < .001). The number of shoulders with large glenoid defect increased from 14 to 42 (P < .001). Of these 42 shoulders, 19 had no or a small bone fragment. Accordingly, among a total of 114 shoulders, the increase from first to final CT in the prevalence of a large glenoid defect accompanied by no or a small bone fragment was significant [4 shoulders (3.5%) vs. 19 shoulders (16.7%); P = .002]. Conclusions The prevalence of shoulders with a large glenoid defect and small bone fragment increases significantly after several instability events.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Osaka, Japan
| | - Yasuhiro Take
- Department of Orthopaedic Surgery, Daini Police Hospital, Osaka, Osaka, Japan
| | - Naoko Mizuno
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | | | - Hiroto Hanai
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Ryo Iuchi
- Department of Orthopaedic Surgery, Seihu Hospital, Sakai, Osaka, Japan
| | - Kazutaka Kinugasa
- Department of Orthopaedic Sports Medicine, Osaka Rosai Hospital, Sakai, Osaka, Japan
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Huang J, Huang D, Wang J, Ye Z, Liu H. Arthroscopic Subscapularis Augmentation Using the Long Head of the Biceps Tendon for Anterior Shoulder Instability. Arthrosc Tech 2022; 11:e805-e811. [PMID: 35646585 PMCID: PMC9134250 DOI: 10.1016/j.eats.2021.12.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/22/2022] [Indexed: 02/03/2023] Open
Abstract
The limitations of transferring the coracoid process along with the conjoined tendon are coracoacromial arch damage, technical difficulty, and nerve injury. The long head of the biceps tendon (LHBT) proximal transposition technique has a weaker sling effect and a risk of nerve injury. The arthroscopic subscapularis augmentation technique may have risks of shoulder external rotation restriction and subscapularis transection. Herein, we introduce an arthroscopic technique for the transfer of the LHBT for subscapularis augmentation to address these risks. Indications of this technique were patients younger than 45 years of age who engage in competitive sports, require forceful external rotation and abduction, have a related capsule-ligament insufficiency, and have a glenoid bone loss <25%. The steps include detaching the LHBT at the upper edge of the pectoralis major, transecting and braiding the LHBT, establishing a scapular tunnel, placing a guide suture through the upper third of the subscapular and scapular tunnel, passing the LHBT through the established tunnels, and fixating the LHBT. This technique achieves stability of the anterior shoulder by transecting and transferring the distal end of the LHBT to press on the upper third of the subscapularis muscle.
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Affiliation(s)
- Jianming Huang
- Address correspondence to Jianming Huang, M.D., and Haoyuan Liu, M.M., Department of Othopedics, the 73th Group Military Hospital of PLA, NO.94, Wenyuan Rd., Siming District, Xiamen City 361003, Fujian, China.
| | | | | | | | - Haoyuan Liu
- Address correspondence to Jianming Huang, M.D., and Haoyuan Liu, M.M., Department of Othopedics, the 73th Group Military Hospital of PLA, NO.94, Wenyuan Rd., Siming District, Xiamen City 361003, Fujian, China.
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Nakagawa S, Hirose T, Uchida R, Yokoi H, Ohori T, Sahara W, Mae T. A Glenoid Defect of 13.5% or Larger Is Not Always Critical in Male Competitive Rugby and American Football Players Undergoing Arthroscopic Bony Bankart Repair: Contribution of Resultant Large Bone Fragment. Arthroscopy 2022; 38:673-681. [PMID: 34389413 DOI: 10.1016/j.arthro.2021.07.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate bone union and postoperative recurrence after arthroscopic bony Bankart repair (ABBR) in male competitive rugby and American football players with a subcritical glenoid defect of ≥13.5% and to compare findings with those in players with a glenoid defect of <13.5%. METHODS Participants were male competitive rugby or American football players with a glenoid defect and bone fragment who underwent ABBR from July 2011 to December 2018 and were followed for a minimum of 2 years. We investigated the influence of glenoid defect and bone fragment size on bone union and postoperative recurrence after ABBR. RESULTS We included 45 rugby players and 35 American football players. A total of 38 shoulders were assigned to the small defect group (<13.5%) and 42 to the large defect group (≥13.5%). The complete bone union rate was 47.4% in the small defect group and 71.4% in the large defect group (P = .040), and postoperative recurrence was seen in 13 (34.2%) and 5 shoulders (11.9%), respectively (P = .030). In the small defect group, the bone fragment size was <7.5% in 30 shoulders and ≥7.5% in 8 shoulders; in comparison, the respective numbers were 12 and 30 shoulders in the large defect group, and large fragments (>7.5%) were significantly more common in this group (P < .001). The complete union rate was significantly higher in shoulders with a large fragment (≥7.5%) than in those with a small fragment (<7.5%; 78.9% versus 42.9%, respectively; P = .001). The recurrence rate was 33.3% in shoulders with a small fragment (<7.5%) and 10.5% in shoulders with a large fragment (≥7.5%; P = .017) and was significantly lower in shoulders with a complete union than in those without a complete union (6.3% versus 46.9%, respectively; P < .001). CONCLUSION The postoperative recurrence rate after ABBR was lower in male competitive rugby and American football players with a large glenoid defect (≥13.5%) than in those with a small glenoid defect (<13.5%) and might be associated with a higher rate of complete bone union of the resultant large bone fragment (≥7.5%). LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan.
| | - Takehito Hirose
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, Hyogo, Japan
| | - Hiroyuki Yokoi
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Wataru Sahara
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Tatsuo Mae
- Department of Sports Medicine Biomechanics, Osaka University, Graduate School of Medicine, Osaka, Japan
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Nakagawa S, Hirose T, Uchida R, Ohori T, Mae T. Remaining Large Bone Fragment of a Bony Bankart Lesion in Shoulders With a Subcritical Glenoid Defect: Association With Recurrent Anterior Instability. Am J Sports Med 2022; 50:189-194. [PMID: 34855520 DOI: 10.1177/03635465211055707] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A preoperative glenoid defect of 13.5% or larger is recognized as a subcritical glenoid defect at arthroscopic Bankart repair (ABR) for collision/contact athletes or military personnel. PURPOSE To clarify the prevalence and size of remaining bone fragments in shoulders with a subcritical glenoid defect at recurrent anterior instability and to investigate the influence on postoperative recurrence after ABR for younger competitive athletes. STUDY DESIGN Cohort study; Level of evidence, 4. METHODS The study included 96 shoulders with recurrent instability that underwent ABR between July 2011 and March 2018 for shoulders with a subcritical glenoid defect. The patients were divided into 2 groups according to the glenoid defect size (13.5%-<20%, medium; ≥20%, large). The bone fragment size in each defect group was retrospectively investigated and classified into 4 groups (no, 0%; small, >0%-<5%; medium, 5%-<10%; large, ≥10%). The postoperative recurrence rate for each combination of glenoid defect size and bone fragment size was investigated for competitive athletes aged <30 years. The fragments, when present, were repaired to the glenoid. RESULTS The glenoid defect size was 13.5%-<20% in 60 shoulders (medium defect group) and ≥20% in 36 shoulders (large defect group). The mean bone fragment size was 6.7% ± 5.1% and 8.9% ± 4.9%, respectively (P = .042). In the medium defect group, there were 15 shoulders (25%) without a bone fragment, 6 shoulders (10%) with a small fragment, 23 shoulders (38.3%) with a medium fragment, and 16 shoulders (26.7%) with a large fragment. In the large defect group, the respective numbers were 2 shoulders (5.6%), 6 shoulders (16.7%), 14 shoulders (38.9%), and 14 shoulders (38.9%). A medium or large bone fragment was more common in the large defect group (P = .252). Among 64 younger competitive athletes who underwent ABR with a minimum of 2 years of follow-up, postoperative recurrence was recognized in 7 of 38 (18.4%) athletes in the medium defect group, but it was not recognized in any of the 26 athletes in the large defect group (P = .036). Postoperative recurrence was recognized in 4 of 12 (33.3%) athletes with a small fragment or no fragment and in 3 of 52 (5.8%) athletes with a medium or large fragment (P = .019). CONCLUSION A larger bone fragment frequently remained in shoulders with a subcritical glenoid defect at recurrent instability. The postoperative recurrence rate after ABR for younger competitive athletes was low when a remaining larger bone fragment was repaired.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Takehito Hirose
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Kansai-Rosai Hospital, Amagasaki, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan
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