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Lau LCM, Chau WW, Ng R, Ng JP, Chui ECS, Ong MTY, Griffith JF, Yung PSH. Reconsidering "Critical" Bone Loss in Shoulder Instability: 17-Year Follow-Up Study following Arthroscopic Bankart Repair. Adv Orthop 2024; 2024:5598107. [PMID: 38328468 PMCID: PMC10849799 DOI: 10.1155/2024/5598107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/30/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
Background Glenoid bone loss is a risk factor leading to the failure of arthroscopic Bankart repair. While 20-25% glenoid bone loss has long been considered the level to necessitate bony augmentation, recent studies indicate that 13.5% has a "subcritical" glenoid bone loss level, which is associated with decreased short- and medium-term functional scores. Few researchers worked on the long-term effect of "subcritical" or even less severe degrees of glenoid bone loss on redislocation rates and functional outcomes after arthroscopic Bankart repair. This study aimed to evaluate the effect of subcritical or less severe glenoid bone loss on redislocation rates and function after arthroscopic Bankart repair. Methods A patient cohort who had undergone computed tomography (CT) of glenoid bone loss and arthroscopic Bankart repair over 15 years ago was reviewed. Western Ontario Shoulder Instability (WOSI) score, Single Assessment Numeric Evaluation (SANE) score, redislocation after operation, mechanism of recurrence, and revision details were reviewed. Results Seventy-five patients were reassessed 17.6 ± 1.9 years following initial surgery. The age at enrolment was 26.8 ± 8.3 years. Twenty-two (29%) patients of the 75 patients had a redislocation on long-term follow-up, though this was not related to glenoid bone loss severity. The impaired functional score was found in patients with initial glenoid bone loss of 7% or more on long-term follow-up: WOSI (physical symptoms): 0.98 ± 2.00 vs 2.25 ± 4.01, p=0.04 and WOSI (total): 0.79 ± 1.43 vs 1.88 ± 3.56, p=0.04. Conclusions At a mean of 17.5 years following arthroscopic Bankart repair, redislocation occurs in over a quarter of 75 patients, and they are not related to initial glenoid bone loss severity. Impaired functional outcome is apparent in patients with initial glenoid bone loss of >7%, though this impairment does not seem sufficiently severe to warrant an alternative treatment approach.
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Affiliation(s)
- Lawrence Chun-Man Lau
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wai-Wang Chau
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Randy Ng
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jonathan Patrick Ng
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Elvis Chun-Sing Chui
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Michael Tim-Yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - James Francis Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Lubowitz JH, Brand JC, Rossi MJ. Early Treatment of Shoulder Pathology Is Necessary but Not Enough Is Being Performed. Arthroscopy 2022; 38:2943-2953. [PMID: 36344053 DOI: 10.1016/j.arthro.2022.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
Delayed treatment of shoulder instability results in bone loss requiring more-complicated surgery, in turn resulting in less-optimal outcomes. Similarly, delayed treatment of repairable rotator cuff tears results in irreparable tears requiring more-complicated surgery and resulting in less-optimal outcomes. Delayed treatment of shoulder pathology is a problem. Solutions include education and research investigation.
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