Trends and projections in surgical stabilization of glenohumeral instability in the United States from 2009 to 2030: rise of the Latarjet procedure and fall of open Bankart repair.

Abstract

Advances in surgical techniques have improved the ability to address recurrent glenohumeral instability via arthroscopic capsulolabral repair and bone-restoring procedures such as the Latarjet procedure. Given the paucity of studies analyzing temporal trends in the surgical management of glenohumeral instability, the purpose of this study was to assess trends in the treatment of anterior, posterior, and multidirectional instability over a 10-year period and model projections to 2030. Using the IBM Watson MarketScan national database, we identified all patients who underwent glenohumeral instability procedures from 2009 to 2018. Procedures were identified using Current Procedural Terminology codes for open Bankart, Latarjet, anterior bone block, posterior bone block, multidirectional capsular shift, and arthroscopic Bankart procedures. Sample weights provided by the database were used to calculate national estimates. US Census Bureau annual population data were used to calculate incidence. Future projections to 2030 were modeled using Poisson and linear regression. There were an estimated 446,072 glenohumeral instability cases from 2009 to 2018. The per capita incidence (per 100,000) remained constant, from 14.8 in 2009 to 14.5 in 2018. Arthroscopic Bankart procedures comprised the highest number of procedures throughout the study period, accounting for 89% of all procedures in 2009 and 93% in 2018. The number of open Bankart procedures decreased by 65% from 2009 to 2018, whereas the number of Latarjet procedures showed a 250% increase over the same period. Patient demographics did not change over the study period, and male patients aged 18-25 years comprised the largest demographic group undergoing anterior instability procedures. Multidirectional instability procedures exhibited the least pronounced sex differences. Future modeling from 2018 to 2030 projected a continued steady rise in arthroscopic Bankart procedures (from 40,000 to 49,000 cases/yr), rapid growth in Latarjet procedures (from 1370 to 4300 cases/yr), and continued decline in open Bankart procedures (from 1000 to 250 cases/yr). Arthroscopic Bankart repair continues to be the most common glenohumeral instability procedure in the United States. From 2009 to 2018, the incidence of open Bankart procedures declined whereas the incidence of Latarjet procedures markedly increased. Future projections to 2030 mirrored these findings. These data may provide an enhanced understanding of the evolution of surgical treatment of glenohumeral instability within the United States, laying the foundation for continued prospective studies into the appropriate indications and advancements in surgical techniques.