Glenoid track measurement using magnetic resonance imaging arthrography is predictive of recurrent instability following arthroscopic shoulder stabilisation

Purpose The primary aim of this study was to investigate medium-term survivorship following arthroscopic Bankart repair (ABR) for anterior glenohumeral instability. The secondary aim was to determine whether the pre-operative magnetic resonance (MR) arthrography glenoid track measurement predicted r...

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Published in:	European journal of orthopaedic surgery & traumatology Vol. 32; no. 7; pp. 1313 - 1317
Main Authors:	Stirling, P. H. C., Crighton, E. A., Butterworth, G., Elias-Jones, C., Brooksbank, A. J., Jenkins, P. J.
Format:	Journal Article
Language:	English
Published:	Paris Springer Paris 01-10-2022 Springer Nature B.V
Subjects:	Age Magnetic resonance imaging Medicine Medicine & Public Health Original Article Orthopedics Patients Surgery Surgical Orthopedics Traumatic Surgery Bankart lesion Glenoid track Glenohumeral instability Bankart repair Arthroscopic stabilisation
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Summary:	Purpose The primary aim of this study was to investigate medium-term survivorship following arthroscopic Bankart repair (ABR) for anterior glenohumeral instability. The secondary aim was to determine whether the pre-operative magnetic resonance (MR) arthrography glenoid track measurement predicted recurrent instability following ABR. Methods Over a 9-year period (2008–2017), 215 patients underwent ABR. Median age was 26 years (IQR 22–32.5; range 14–77). There were 173 males (81%). 175 patients (81%) had available pre-operative MR arthrography, which was used to determine the presence of “off-track” bone loss. Retrospective analysis was undertaken to determine recurrence of instability at a median follow-up of 76 months (range 21–125 months). Survivorship analysis was undertaken using Kaplan–Meier methodology: the endpoints examined were repeat dislocation, revision stabilisation, and symptomatic instability. Results 56 patients (26%) presented with further instability, including 29 patients with recurrent dislocation and 15 patients required revision stabilisation. Cumulative incidence of instability was 10% at 1 year, 27% at 5 years and 28% at 7 years. No significant difference in instability was seen between men and women 7 years after stabilisation (19% vs 17%; p = 0.87). Age at time of surgery did not predict recurrence. “Off-track” lesions were identified in 29 patients (16.1%). The incidence of redislocation was significantly higher in these patients (24% vs 3%; p = 0.01; relative risk 7.2; 95% CI 2.45–20.5; p = 0.001). Recurrent instability without frank redislocation was also significantly higher in this group (60% vs 18%; RR 3.33, 95% CI 2.02–5.20; p < 0.0001). Conclusions This study has reported a significant rate of recurrent instability in longer-term follow-up after ABR. It has also identified pre-operative MR arthrography as an important predictor of recurrent instability, which may be used to risk stratify patients with anterior instability in a typical UK population. Level of evidence III (cohort study).
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1432-1068 1633-8065 1432-1068
DOI:	10.1007/s00590-021-03100-2