Arthroscopic Stabilization Research Articles

Outcome of the influence of remplissage repair on shoulder range of motion after arthroscopic bankart repair

Recurrent shoulder dislocation can predispose to Hill-Sach’s lesion. Failure to address humeral osseous defects during arthroscopic stabilization surgery leads to an increased rate of recurrence. This procedure is not much studied in terms of Range of Motion. To further study it we have done a prospective study of 2 patient populations (arthroscopic Bankart repair alone vs Bankart and remplissage). Main clinical outcome was the range of motion within Minimum follow-up was 2 years while Total Patients in each Group taken was 50. In arthroscopic remplissage, the posterior capsule and infraspinatus are sutured into the humeral head. The rate of recurrence was identical in both groups (6.25%) while the range of movement were significantly more in patients where remplissage repair was done along with bankart repair. When compared with Walch-Duplay score we got excellent result in 45 patients where remplissage repair was done out of 50 patients whereas with remplissage excellent range of movement was only 42 patients out of 50 patients. Our study to have some limitation like Sample size was small. All procedures were performed by the same surgeon. Study included postoperative care and follow-up assessments; therefore, the results of this study may not reflect general surgical outcomes of the procedure. The same operative indications and consistent surgical technique were applied in all patients. The conclusion of the study was its always better to do remlissage along with bankart repair for better result in term of range of movement.

Minimal Clinically Important Differences and Correlating Factors for the Rowe Score and the American Shoulder and Elbow Surgeons Score After Arthroscopic Stabilization Surgery for Anterior Shoulder Instability

To determine the minimal clinically important differences (MCIDs) for the Rowe score and the American Shoulder and Elbow Surgeons (ASES) score after arthroscopic stabilization surgery for anterior shoulder instability and to evaluate the effect of various patient- and treatment-related factors on MCIDs. The study enrolled 216 patients who underwent arthroscopic stabilization surgery for anterior shoulder instability. The patients were categorized into "no-change" and "minimal-change" groups by a 15-item questionnaire at the 1-year postoperative visit. The Rowe and ASES scores were assessed preoperatively and at the 1-year postoperative follow-up visit. MCIDs were calculated using an anchor-based method. Correlations between MCIDs and several factors were evaluated using Spearman correlation analysis and univariate regression analysis. On the basis of the questionnaires administered at the 1-year postoperative follow-up visit, 10 patients were assigned to the no-change group and 33 patients were placed in the minimal-change group. MCIDs for the Rowe and ASES scores were 9.7 and 8.5, respectively. Body mass index was negatively correlated with the MCID for the Rowe score (P= .01). Number of dislocations, symptom duration, and presence of Hill-Sachs lesions were positively correlated with the MCID for the ASES score (P= .02, P= .04, and P= .02, respectively). Other variables such as age, sex, and arm dominance were not related to the MCIDs for either the Rowe or ASES score. In patients who underwent arthroscopic stabilization surgery, differences of at least 9.7 in the Rowe score and 8.5 in the ASES score were clinically relevant. Patients with a greater body mass index required a smaller change in the Rowe score and patients with a greater number of dislocations, a longer symptom duration, or a Hill-Sachs lesion required a larger change in the ASES score to feel clinically relevant changes. Level IV, case series.

Patella instability in children: surgical treatment results

Introduction. Despite the fact that instability of the patella is a common pathology within the structure of knee joint diseases and injuries in children, currently there is no complete information on the basis of which one could judge the effectiveness and preference of a particular method of treating instability of the patella in children. Purpose of study: to evaluate the efficacy of surgical treatment techniques in children with post-traumatic instability of the patella. Patients and methods. The study was performed on the basis of examination and treatment data on 127 patients aged from 8 to 17 years with post-traumatic instability of the patella. Arthroscopic stabilization by Yamamoto technique, modified at our department, was performed in 49 patients, patella stabilization with transposition of the tibial tuberosity - in 67 patients, with the medial patellofemoral ligament autoplasty - 9, corrective osteotomy - in 2. Treatment efficacy was assessed using AKPS and 2000 IKDC knee joint assessment scores. The questionnaires were carried out at admission, in 1, 2-4 and 4-7 years after surgery. Results. At early terms after operation (up to 2 years) in the group of children after stabilization of the patella by modified Yamamoto technique good and excellent results were observed in 77.8% of cases, after transposition of the tibial tuberosity - in 73.3%, after stabilization of the patella with medial patellofemoral ligament autoplasty - in 88.9%. Long-term follow up (5-7 years) showed 90.9 and 86.5% of cases from the 1st and 2nd groups, respectively. Conclusion. The proposed algorithm for examination and treatment provides the most effective treatment and enables to obtain good and excellent results in the majority children with post-traumatic instability of the patella.

Arthroscopic Management of Acute Traumatic Primary Anterior Shoulder Dislocation

AbstractBackground: Glenohumeral joint is the most mobile and most commonly dislocated joint in the human body. The patient's age at the time of injury is inversely related to the incidence of dislocation recurrence rate. Recurrence rate in athletes younger than 20, may be as high as 90%. Arthroscopic stabilization is usually successful in preventing the recurrence of shoulder dislocations leads to reduced recurrence, improved functional outcome.Aim of Study: The aim of this study is to asses the benefits of Bankart repair using suture anchors in treating patient with first time anterior traumatic shoulder instability.Patients and Methods: This prospective study was per-formed on 30 patients having anterior primary shoulder dislocation. All cases were managed by arthroscopic repair of the anterior labral lesion using suture knotted anchors.Results: Patients were assessed pre and post operatively by modified Rowe scale and ASES (American shoulder and Elbow disability system).Conclusion: Primary arthroscopic repair for first-time traumatic anterior shoulder dislocation provided satisfactory functional outcomes and improved quality of life. Primary arthroscopic stabilization can be considered best treatment option in patients younger than 30 years with first time shoulder dislocation.

Risk Factors for Recurrent Shoulder Instability after Arthroscopic Revision Anterior Stabilization

Risk Factors for Recurrent Shoulder Instability after Arthroscopic Revision Anterior Stabilization

Posterior Glenoid Bone Deficiency: Incidence and Impact on Failure Following Arthroscopic Posterior Shoulder Stabilization

The purpose of this study was to determine the incidence, characteristics, and clinical impact of posterior glenohumeral bone deficiency on shoulders undergoing isolated posterior shoulder stabilization, our hypothesis was that posterior glenoid bone deficiency would not impact reoperation rate.

Ankle Stabilization With Arthroscopic Versus Open With Suture Tape Augmentation Techniques

Ankle instability is a common problem that often leads to surgery to stabilize the ankle if conservative methods are unsuccessful in returning the patient to full activity. Surgical ankle stabilization, including arthroscopic and open methods, has been performed with overall excellent results reported. Although initial ligament strength after repair is weaker than the native ligament, new methods of augmentation with suture tape have yielded initial strength comparable to native ligament. The present study compares arthroscopic ankle stabilization and open stabilization with suture tape augmentation. A retrospective comparative trial was undertaken with a follow-up satisfaction survey. A total of 55 patients were ultimately included, consisting of 43 arthroscopic patients and 12 open with suture tape augmentation patients. Ancillary procedures are reported. The mean follow-up duration was 24.2 months in the arthroscopic group and 21 months in the open group. There was a statistically significantly faster return to activity/sports in the arthroscopic group (127.2 days vs 170 days; p = .008). Although not statistically significant, there was a trend toward favoring the open group in terms of revision surgery and patient satisfaction. Our data indicate that both methods of stabilization are reasonable for ankle instability repair.

Arthroscopic Acromioclavicular Fixation With Suture Tape Augmentation After Coracoclavicular Fixation With Dog Bone Button: Surgical Technique

An arthroscopic technique for the surgical treatment of acute acromioclavicular (AC) joint injuries is presented in this study. This procedure aims to achieve both vertical and horizontal stability through the healing of both coracoclavicular (CC) and AC ligaments. As a routine maneuver, arthroscopic CC stabilization was applied using the dog bone button to obtain only vertical stability. Additional arthroscopic AC joint fixation with suture tape augmentation is simple and easy and provides a safe technique to achieve horizontal stability of the joint and to increase the vertical stability to minimize the complications of standard CC reconstruction techniques.

Early mobilisation versus sling immobilisation following Arthroscopic shoulder stabilisation: A prospective randomised controlled trial

Early mobilisation versus sling immobilisation following Arthroscopic shoulder stabilisation: A prospective randomised controlled trial

Arthroscopic assisted stabilization of acute acromioclavicular dislocations by cortical fixation buttons for acute acromioclavicular dislocation

Purpose: To evaluate the results of 15 patients following arthroscopically assisted AC joint fixation using cortical fixation buttons (AC tightrope or dog bone fiber tape construct) for acute AC joint separations.Patients and Methods: Patients with acute AC joint injuries (Rockwood grades III–V) of less than 3 weeks duration were included in the study. We had 15 cases of AC joint injuries, which fulfilled the inclusion criteria. All patients were diagnosed based on history, examination and plain radiographs. Patients with grades III–V were selected for arthroscopic assisted fixation using cortical fixation buttons (AC tightrope or dog bone fiber tape construct or double endobutton, Zip Tight). Functional outcome of patients was assessed using constant shoulder score, Quick DASH score preoperatively and postoperatively.Results: VAS for pain in 80% of patients there was a minimal pain VAS score of (0-2). Mean post-operative constant score at one year was 92.33. The Quick DASH subjective functional disability score was ≤ 10 in 75% of patients. The difference in Coracoclavicular distance between the injured and uninjured sides showed a significant improvement in mean values between the preoperative and 1-year evaluations (9.3 mm and 2 mm, respectively; p < 10–6). All patients had satisfactory outcome. We reported only one case of coracoid fracture, which was the 2nd case operated due to improper exposure of coracoid base & was fixed with hook plate. Conclusion: Arthroscopic fixation using the cortical fixation buttons (AC Tightrope or dog bone fiber tape construct) for acute AC joint dislocation achieves satisfactory outcome.

Arthroscopic Meniscopexy for the Treatment of Nontraumatic Osteochondritis Dissecans in the Knee Joint of Adult Patients

The etiology of osteochondritis dissecans (OCD) is still uncertain. Recently, it has been hypothesized that instability of the anterior horn of the meniscus is an important cause for the development of a nontraumatic OCD in adolescents with good results after surgical stabilization. This case series aims to evaluate the treatment results after meniscus stabilization in adults with nontraumatic OCD. Ten patients with magnetic resonance imaging (MRI)-confirmed OCD of the knee joint, meniscal instability, and closed epiphyseal plates were enrolled in this study. The instable meniscus was stabilized by direct suturing of the anterior horn of the meniscus. MRI examinations were performed preoperative and 6 and 12 months postoperative. The OCD was classified arthroscopically according to Guhl and according to Hughes in the MRI. The overall knee function was evaluated by the Lysholm score before treatment and 12 months postoperative. Four women and 6 men with a mean age of 20.6 ± 1.9 years were included in this study. Preoperatively 60% of the patients showed a grade II or III lesion arthroscopically and 70% a grade III or IVa lesion in the MRI examination. After arthroscopic meniscus stabilization the Lysholm score increased in average from 48.1 ± 14.12 before treatment to 97.5 ± 3.1 postoperative. At final follow-up after 12 months, an improvement of the OCD in the MRI could be demonstrated in all patients (100%). In 80% of the patients a complete healing of the OCD could be noted. The clinical concept of an instable anterior horn of the meniscus as a cause for the development of a nontraumatic OCD seems to be transferable to adults and arthroscopic stabilization can lead to a sufficient healing of this knee pathology.

Recurrence After Arthroscopic Labral Repair for Traumatic Anterior Instability in Adolescent Rugby and Contact Athletes

Background: Traumatic glenohumeral dislocation of the shoulder is one of the most common shoulder injuries, especially among adolescent athletes. The treatment of instability for young athletes continues to be controversial owing to high recurrence rates. Purpose: To investigate the recurrence rate of shoulder instability after arthroscopic capsulolabral repair for adolescent contact and collision athletes. Study Design: Case series; Level of evidence, 4. Methods: Sixty-seven patients aged <18 years underwent an arthroscopic labral repair over a 5-year period. The mean ± SD age of the cohort was 16.3 ± 0.9 years (range, 14-17 years) and consisted of 1 female and 66 males. All patients were contact athletes, with 62 of 67 playing rugby. Demographic, clinical, and intraoperative data for all patients with shoulder instability were recorded in our database. Recurrence rates were recorded and relative risks calculated. Results: At a follow-up of 33 ± 20 months, 34 of 67 patients had recurrent instability for an overall recurrence rate of 51% among adolescent contact athletes after arthroscopic labral repair surgery. The mean time to recurrence was 68.1 ± 45.3 weeks. All recurrences occurred as a result of a further sporting injury. Relative risk analysis demonstrated that athletes aged <16 years had 2.2 (95% CI, 1.2-2.1) times the risk of developing a further instability episode as compared with athletes aged ≥16 years at the time of index surgery (P = .0002). The recurrence rate among adolescent athletes after bony Bankart repairs was 57.9% versus 47.9% for soft tissue labral repairs (P = .4698). The incidence of Hill-Sachs lesions (P = .0002) and bony Bankart lesions (P = .009) among adolescent athletes was significantly higher than among adult controls (P = .002). The presence of bone loss did not lead to a significant increase in recurrence rate over and above the effect of age. Conclusion: Adolescent contact athletes undergoing arthroscopic labral repair have an overall recurrence rate of 51%. Rugby players who undergo primary arthroscopic shoulder stabilization aged <16 years have 2.2 times the risk of developing a further instability episode when compared with athletes aged ≥16 years at the time of index surgery, with a recurrence rate of 93%.

Arthroscopic Management of Locked Posterior Shoulder Dislocations

Locked posterior shoulder dislocations occur relatively uncommonly but pose aunique array of challenges for the treating surgeon. Posterior labral detachments and capsular damage along with reverse Hill-Sachs lesions are commonly present in these patients and must often be addressed at the time of surgical intervention. Multiple open and arthroscopic procedures that address these pathologic lesions have been described. Arthroscopic shoulder stabilization for patients with locked posterior shoulder dislocations for whom significant posterior instability and subluxation persist following closed reduction is described. A specific patient who underwent both arthroscopic posterior stabilization and supplemental advancement of the subscapularis into the reverse Hill-Sachs defect serves as a case example of this technique.

Ninety-day complications following the Latarjet procedure

The purpose of this study was to describe the rate and type of complications occurring within 90 days following the Latarjet procedure for anterior glenohumeral instability. Consecutive patients undergoing the Latarjet procedure by fellowship-trained surgeons from a single institution between 2007 and 2016 were included for analysis. Indications for the Latarjet procedure included primary or recurrent anterior instability with clinically significant anterior glenoid bone loss and/or failed prior arthroscopic stabilization. Patients undergoing the Latarjet procedure after prior glenoid bone grafting were excluded. All complications that occurred within 90 days of surgery were analyzed and correlated with demographic factors. A total of 146 consecutive patients (146 shoulders) were included. Of these patients, 11 were lost to follow-up and 2 were excluded for having undergone prior open bone grafting. Among the remaining 133 patients (average age, 28.5 ± 11.8 years; 75% male patients), 10 total complications occurred within 90 days of surgery, for an overall short-term complication rate of 7.5%. Of these 10 complications, 6 required subsequent surgery, with recurrent instability in 2 cases (overall rate, 1.50%), infection in 2 (overall rate, 1.50%), musculocutaneous nerve palsy in 1 (overall rate, 0.75%), and postoperative pain in 1 (overall rate, 0.75%). The remaining 4 complications were transient, resolving with nonoperative treatment. No cases of hardware failure or graft osteolysis were reported. The overall 90-day complication rate following the Latarjet procedure for anterior shoulder stabilization was 7.5%. In 6 of the 10 cases, complications led to subsequent surgery, including recurrent instability in 2, while in the remaining 4 cases, the complications were transient and resolved with nonoperative treatment.

Risk Factors for Failure of Arthroscopic Revision Anterior Shoulder Stabilization

Recurrent anterior instability following a failed Bankart repair in the shoulder represents a challenging clinical scenario. Few studies have examined the role of arthroscopic revision anterior stabilization as a treatment option in these cases. The purpose of this study was to evaluate the outcomes of arthroscopic revision anterior stabilization for patients with recurrent instability after a failed index procedure. Ninety-two patients underwent arthroscopic revision anterior stabilization after a failed index (open or arthroscopic) stabilization procedure. Sixty-five patients with a minimum of 2 years of follow-up were included in this study. The mean age at the time of revision surgery was 26 years (range, 15 to 57 years). The rate of recurrent instability and risk factors for failure were evaluated; the mean duration of follow-up was 4.7 years (range, 2 to 10.8 years). Glenoid and humeral bone loss were quantitatively assessed using preoperative T1-weighted magnetic resonance arthrograms to determine if the lesions were on-track or off-track. Twenty-seven (42%) of the patients experienced recurrent instability at a mean of 2.3 years after arthroscopic revision anterior stabilization. On multivariate analysis, the presence of an off-track lesion, an age of <22 years, and ligamentous laxity were independent predictors of recurrence (p = 0.022, 0.028, and 0.031, respectively). Among a cohort with these risk factors excluded, the failure rate was 19%. Arthroscopic revision anterior stabilization is associated with a high rate of recurrent instability, and patient selection is of critical importance in order to minimize recurrence. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Arthroscopic knotless anterior labral stabilization using labral tape and wide awake anaesthesia-short term results

BackgroundThe shoulder is the least constrained of all joints of the body and is more susceptible to injury including dislocation. The rate of recurrent instability following primary stabilization procedure at 10 years of follow-up ranged from 3.4 to 20%. There is a lack of evidence in the literature regarding use of labral tape and anchors for anterior stabilization despite the growing market for this product. We describe the outcomes of 67 patients who underwent knotless arthroscopic anterior stabilisation under awake anaesthesia using 1.5 mm LabralTape with 2.9 mm Pushlock anchors for primary anterior instability by a single surgeon.MethodsThis was a retrospective analysis of prospectively collected outcome data for adult patients undergoing anterior stabilisation for primary traumatic anterior shoulder instability between 2013 and 2016 at two centres. Patients with > 25% glenoid bone loss, engaging Hill Sach’s, and multidirectional instability were excluded. All cases underwent surgery using awake anaesthetic technique. The surgical technique and post-operative physiotherapy was standardized. Outcomes were measured at 6 months and 12 months.ResultsOf the 74 patients in our study, 7 were lost to follow up. Outcomes were measured using the Oxford Instability Shoulder Score (OISS) and clinical assessment including the range of motion. The OISS showed statistically significant improvement from a mean score and standard deviation (SD) of 24.72 ± 2.8 pre-surgery to 43.09 ± 3.5 after the procedure at 12 months with good to excellent outcomes in 66 cases (98.5%). The mean abduction was 134.2 ± 6.32 and external rotation was 72.55 ± 5.42 at 60–90 position at 12 months. We report no failures due to knot slippage or anchor pull-out.ConclusionOur case series using the above technique has distinct advantages of combining a small non-absorbable implant with flat, braided, and high-strength polyethylene tape. This technique demonstrates superior medium term results to conventional suture knot techniques for labral stabilization thereby validating its use.

Glenoid Bone Reaction to All-Soft Suture Anchors Used for Shoulder Labral Repairs.

All-soft suture anchors (ASSAs) are commonly used for shoulder labral repair and capsulorrhaphy in patients with shoulder instability. While these anchors may have some specific advantages over other types of suture anchors, little is known about the prevalence and time-dependence of bone cyst formation and tunnel expansion after implantation of ASSAs. The aim of this study was to quantify the proportions of cyst formation and tunnel expansion around ASSAs and to characterize and test for differences in abnormalities observed at different postoperative time points. Thirty patients who were treated with arthroscopic shoulder stabilization surgery with ASSAs (1.4 mm; JuggerKnot, Biomet) underwent a computed tomography (CT) scan of the operatively treated shoulder at 1 month (10 patients), 6 months (10 patients), or 12 months (10 patients) postoperatively. Demographic and operative data were collected, and CT scans were evaluated for cyst formation, tunnel expansion, and tunnel volume measured in cubic millimeters. Statistical analyses were performed to detect differences in these outcomes among the follow-up groups. All shoulders were stable at all time points of the study, and there were no incidents of recurrent instability during the study period. Ninety-one suture anchors were evaluated in 30 patients. Tunnel expansion was identified in the large majority of patients in the 6-month and 12-month follow-up groups, with a significant increase in these proportions compared with the 1-month follow-up group (p = 0.002). Mean tunnel volumes also significantly increased over the study period (p < 0.001). The presence of cyst formation was negligible in all 3 follow-up cohorts. This study demonstrated low rates of cyst formation but a significantly increased tunnel volume 6 and 12 months after shoulder labral surgery with ASSAs. There was no association with the initial tunnel location. Additional well-controlled studies with longer follow-up are needed to identify potential associations among tunnel expansion, intraoperative technique, and clinical outcomes. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Midterm outcomes after arthroscopic surgery for hypermobile lateral meniscus in adults: Restriction of paradoxical motion

BackgroundHypermobile lateral meniscus (HLM) is one of the causes of knee pain and a locking sensation. It is thought that disruption of the popliteomeniscle fascicles lead to hypermobility of the lateral meniscus in adults. In cases of HLM, the posterior portion of the lateral meniscus shows forward abnormal translation with knee flexion and backward translation with knee extension. We refer to this phenomenon as paradoxical motion. The purpose of this study was to report an arthroscopic HLM stabilization and evaluate the midterm clinical outcomes. MethodsTwenty consecutive HLM patients (21 knees) who underwent arthroscopic surgery were included. The mean age at the time of surgery was 37.7 (19–63) years. Mean duration from surgery to final follow-up was 37 (24–68) months. Meniscus movement according to the knee flexion and extension was observed by diagnostic arthroscopy. We performed arthroscopic inside-out vertical stacked suturing of disrupted popliteomeniscle fascicles. The number of suturing and details of meniscal movement were assessed. The Tegner activity level score and Lysholm knee scores were determined preoperatively and at 2 years postoperatively. Clinical outcomes included locking sensation, recurrences and complications reported at the final follow-up. ResultsParadoxical motion of the lateral meniscus was observed in all patients. We performed an average of 5.0 (2–8) vertical stacked sutures of the disrupted popliteomeniscal fascicles. Physiological motion of the lateral meniscus was observed after meniscus repairs. The mean Tegner activity level scales before and after surgery were 4.6 (2–8) and 4.7 (2–8), respectively. The mean Lysholm knee scores significantly improved from 72.0 (48–85) preoperatively to 97.8 (78–100) at 2 years postoperatively. There were no complications or recurrences of locking symptoms at the final follow-up. ConclusionsUse of arthroscopic inside-out vertical sutures for disrupted popliteomeniscle fascicles improved the clinical outcomes for HLM patients without complications.

Risk Factors for Recurrent Shoulder Instability after Arthroscopic Revision Anterior Stabilization

Objectives:Individuals that fail arthroscopic anterior stabilization of the shoulder represent a unique and challenging patient population. To date, there have been few large studies that have investigated failure rates following arthroscopic revision anterior stabilization (ARAS) for failed primary arthroscopic stabilization. This study aims to determine the risk factors for recurrence of shoulder instability following ARAS. We hypothesized that male gender, younger age, participation in contact sports, significant glenoid and/or humeral bone loss, ligamentous laxity, and worker’s compensation would increase the risk of revision failure.Methods:Patients who underwent ARAS after a failed arthroscopic primary Bankart repair and had a minimum of 2-year follow-up were included in this study. Glenoid and humeral bone loss were quantitatively assessed using pre-operative T1-weighted magnetic resonance arthrograms to determine if the lesions were on- or off-track. Failure was defined as a recurrent dislocation or subluxation. Chi-square test and t-test were used to compare demographical and surgical parameters between failure and non-failure groups. The significance level was set to 0.05.Results:Sixty-five patients [age at revision = 26 years (range, 15 - 57), 44 (68%) male] met the inclusion criteria. The mean follow-up time was 4.7 years (range, 2 - 10.8). Twenty-seven patients (42%) had a failed revision at a mean time of 2.3 years (range, 0.2 - 6.1). Age less than 22 years old, ligamentous laxity, the presence of an off-track lesion, and a concomitant superior labral anterior to posterior were significantly associated with revision failure (p < 0.05) (Table 1). No difference was observed in the size of glenoid defect between failure and non-failure groups (14.1% ± 4.4% vs. 13.7% ± 3.9%, p = 0.762). The width and depth of the Hill-Sachs lesions were not significantly different between groups (width: 15.3 ± 5.1 mm vs. 14.2 ± 4.8 mm, p = 0.432; depth: 4.2 ± 2.3 mm vs. 3.5 ± 1.8 mm, p = 0.244). On multivariate analysis, only the presence of an off-track lesion, age less than 22 years, and ligamentous laxity were independent predictors for recurrent instability (OR = 8.9, p = 0.022; OR = 5.4, p = 0.028; OR = 7.8, p = 0.031, respectively).Conclusion:The failure rate of arthroscopic revision anterior stabilization was 42% with off-track lesions, age less than 22 years, and ligamentous laxity independent risk factors for recurrent instability. While ARAS may be a viable treatment option in the appropriate setting, our study suggests that considerable thought should be exercised before utilizing this approach given the significant number of patients who suffered recurrent instability at greater than 2-years follow-up. For young patients with off-track lesions and/or evidence of ligamentous laxity on physical exam, strong consideration should be given to either an open Bankart repair, a bony augmentation procedure such as a Bristow-Latarjet procedure, or an arthroscopic revision approach with additional augmentation such as a remplissage.Table 1.Parameters Tested Against Arthroscopic Revision Anterior Stabilization FailureaParameterRevision FailureNo Revision FailureORp-value Age at revision <22y 16/27 (59%)13/38 (34%)2.80 0.045 Ligamentous Laxity 10/27 (37%)5/38(13%)3.88 0.024 Off-Track Lesion 10/22 (45%)4/36(11%)6.67 0.003 SLAP Tear 11/27 (41%)6/38 (16%)3.67 0.024 Male Gender17/27 (63%)27/38 (71%)0.690.492BMI> 30 kg/m2 3/24 (13%)3/27 (11%)1.141.000Dominant Side Instability20/27 (74%)23/38 (61%)1.860.255Bilateral Anterior Instability3/27(11%)7/38 (18%)0.550.503Workers’ Compensation3/27 (11%)9/38 (24%)0.400.331Athletes12/27 (44%)17/38 (45%)0.990.981Contact sports9/12 (75%)12/17(71%)1.251.000Competitive Level3/12 (25%)3/17 (18%)1.560.699Open Primary Bankart Repair2/23 (9%)4/35(11%)0.741.000Traumatic Repair Failure7/18 (39%)16/35(46%)0.760.635Time from Failure to Revision < 1 y21/27 (78%)31/38(82%)0.790.706Total Number of Anchors ≤ 36/20 (30%)10/30(33%)0.860.804Number of Anteroinfaior Anchors ≤ 314/20(70%)19/30(63%)1.350.626Label Tear > 120°13/20(65%)20/30(67%)0.930.903 aData expressed as count/number of available cases (%). Competitive level is defined as collegiate or higher. Bold denotes significance. SLAP, superior labrum anterior and posterior; BMI, body mass index; OR, odds ratio.

Arthroscopic Shoulder Stabilization in the High-Risk Young Athlete: Return to Sport and Second Surgery Rates

Objectives:Shoulder instability in the young athlete has become an increasingly significant clinical problem in recent years. This high-risk population of athletes less than 25 years of age is a difficult cohort to manage because they have high failure rates with non-operative treatment and they reportedly have the lowest return to sport (RTS) rates and highest second surgery rates following arthroscopic shoulder stabilization compared to older patients. The purpose of this retrospective study is to evaluate the two-year clinical outcomes of a cohort of high-risk athletes less than or equal to 22 years of age following arthroscopic shoulder stabilization with a focus on RTS and incidence of second surgery.Methods:The primary outcomes evaluated were RTS and revision surgery following arthroscopic shoulder stabilization performed by the senior author at minimum follow-up of 24 months. Athletes were excluded if they had > 5 pre-operative episodes of instability, significant bone loss or had primary posterior instability. Demographic data was recorded including age, sex, BMI, last recorded range of motion, # episodes of recurrent instability, and revision surgery. A brief survey was completed regarding their shoulder instability history, sports prior to surgery, sports returned to following surgery, satisfaction with and level of RTS, time at which return to sports was achieved, recurrent instability, revision operations, and single assessment numeric evaluation (SANE) score.Results:A total of 67 athletes met inclusion criteria, with a mean age of 17.4 years (range, 13-22 years). There were 19 females (28%) and 48 males (72%). The mean number of instability events was 2 (range 0-5), 57% in the dominant arm and 43% in the non-dominant arm. Evaluation of RTS, demonstrated that 59 (88%) were able to RTS with 56 (84%) of those returning to the same level or higher, while 8 (12%) patients did not RTS for reasons other than recurrent instability or apprehension. Among the 59 patients who RTS, the average time to return was 7.3 months (range: 5-12 months) and baseball and football were the most common sports. There was a gender specific difference with respect to RTS and revision surgery. The male RTS rate was 94% compared to the female rate of 74%. Four of 67 (6%) patients underwent revision stabilization 11 to 36 months for recurrent instability, however all were male athletes 4/48 (8%). There were no female athletes who required revision surgery. Patient reported mean SANE score was 88 (SD, ±15).Conclusion:Shoulder instability in the young high-risk athlete is a complex problem with a relatively high rate of recurrence and revision surgery in the literature. In our case series, we found a relatively low reoperation rate (6%) with a high rate of RTS (88%), at an average time of 7.3 months. There was a gender specific difference with respect to RTS and revision surgery. The male RTS rate was 94% and revision surgery rate was 8% (4/48) while the female RTS rate was 74% and revision surgery rate was 0%. The athletes reported a return to near full function with an average SANE score of 88. We believe the improved outcomes in this cohort of high risk young athletes are related to the pre-operative selection criteria excluding those athletes with a greater number of pre-operative episodes of instability and those with significant bone loss and bipolar lesions as open stabilization and bone augmentation (Latarjet) are more predictable operations in athletes with these risk factors.