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Long-Term Outcomes following Instability After Isolated Arthroscopic Bankart Repair for On-Track Hill-Sachs Lesions
Sahil Dadoo1, Tyler C Williams2, Ryan T Lin2
1University of Pittsburgh Medical Center Department of Orthopaedic Surgery, Pittsburgh, Pennsylvania, USA.
Background:
Recurrent anterior shoulder instability rates are high after isolated arthroscopic Bankart repair (ABR), especially among patients with off-track Hill-Sachs lesions (HSLs) and significant glenoid bone loss. However, there are limited data on long-term recurrent anterior shoulder instability rates and patient-reported outcomes (PROs) following isolated ABR among patients with on-track HSLs and <20% glenoid bone loss.
Purpose:
To evaluate long-term clinical outcomes and PROs after isolated ABR for on-track HSLs with <20% glenoid bone loss, a population where isolated ABR remains indicated.
Study Design:
Case-control study; Level of evidence, 3.
Methods:
A retrospective review was conducted on patients undergoing isolated ABR for anterior shoulder instability between 2007 and 2018. Exclusion criteria included age <14 or >40 years, glenoid bone loss >20%, off-track HSL, concomitant remplissage, and revision procedures. All patients were contacted to obtain minimum 7-year clinical outcomes, including recurrent anterior shoulder instability and revision stabilization surgery, as well as PRO measures including Western Ontario Shoulder Index (WOSI), pain visual analog scale (pVAS), and Subjective Shoulder Value scores. Variables were compared between recurrent anterior shoulder instability and revision stabilization surgery groups. Significance was set to P < .05.
Results:
Long-term outcomes were obtained from 55 patients (mean age, 22 years; 32% of all eligible patients) at a mean follow-up of 10.4 years. Seventeen (31%) patients sustained ≥1 recurrent anterior shoulder instability event, and 8 (15%) patients underwent revision stabilization surgery. Younger age (P = .002) and collision athletics (P = .02) were associated with sustaining recurrent anterior shoulder instability, whereas distance to dislocation was not associated with recurrent anterior shoulder instability (P = .59). However, near-track HSLs (P = .02) and increased glenoid bone loss (P = .007) were associated with undergoing revision stabilization surgery. For every 1% increase in glenoid bone loss, there were 19% higher odds of undergoing revision stabilization surgery (P = .02). With regard to PROs, 67% of patients achieved the Patient Acceptable Symptom State (PASS) for WOSI and 55% of patients achieved the PASS for pVAS. Patients with recurrent anterior shoulder instability were less likely than those without recurrent instability to achieve the PASS for both WOSI (24% vs 87%; P < .001) and pVAS (29% vs 66%; P = .01).
Conclusion:
Rates of recurrent anterior shoulder instability were high following isolated ABR for on-track HSLs with <20% glenoid bone loss and were associated with inferior PROs at mean 10-year follow-up. Younger age and collision athletics were associated with sustaining recurrent anterior shoulder instability, while increased glenoid bone loss was an independent predictor of undergoing revision stabilization surgery. There remains a clinical need for improved stratification of on-track HSLs to identify patients who may benefit from additional procedures to improve recurrent anterior shoulder instability rates and subjective outcomes at long-term follow-up.
