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Patient-reported outcomes decline over time following arthroscopic Bankart repair for anterior shoulder instability
Sahil Dadoo1, Ryan Gilbert2, Ryan T Lin2
1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Background:
To evaluate how patient-reported outcomes (PROs) trend over time following arthroscopic Bankart repair (ABR) for anterior shoulder instability with on-track Hill-Sachs lesions (HSLs).
Methods:
A retrospective review was performed of patients undergoing ABR with or without remplissage between 2007 and 2023. Exclusion criteria included age <14 years, glenoid bone loss >20%, off-track HSLs, and prior shoulder surgery. PROs and clinical outcomes, including Western Ontario Shoulder Index (WOSI), pain visual analog scale (pVAS), Subjective Shoulder Value (SSV), and recurrent instability, were collected at final follow-up. Spearman rank correlation assessed relationships between PROs and time from surgery. Rates of achieving Patient Acceptable Symptom State for WOSI and pVAS were compared across follow-up intervals (<5 years, 5-9 years, ≥10 years) and between patients with and without recurrent instability. Significance was set at P < .05.
Results:
A total of 121 patients (age: 23 ± 8 years, 27% females) were included at mean follow-up of 7.1 years (range: 1.6-17.2). Longer follow-up duration was associated with worsening WOSI (r = 0.239; P = .008), pVAS (r = 0.180; P = .049), and SSV (r = -0.186; P = .041) scores. Patients undergoing isolated ABR demonstrated significant deterioration in PROs over time (WOSI: r = 0.331, P = .002; pVAS: r = 0.261, P = .015; SSV: r = -0.216, P = .045), whereas those undergoing remplissage showed no change in PROs over time (all P > .05). Patients with recurrent instability had lower rates of achieving WOSI Patient Acceptable Symptom State at <5 years (56% vs. 88%; P = .029), 5-9 years (22% vs. 87%; P < .001), and ≥10 years (20% vs. 86%; P < .001) compared to patients without recurrent instability. On linear regression analysis, longer follow-up length remained an independent predictor of worse WOSI scores after controlling for recurrent instability.
Conclusion:
PROs may decline over time following ABR for anterior shoulder instability for patients who experience recurrent anterior shoulder instability and undergo isolated ABR compared to ABR with remplissage. These findings may be relevant for pre-operative counseling regarding long-term subjective outcomes.
