Resident Physician University of Pittsburgh Medical Center, Department of Orthopaedic Surgery
Disclosure(s): No financial relationships to disclose
Disclosure(s):
Sahil Dadoo, MD: No financial relationships to disclose
Objectives: Recent literature has identified high recurrence rates following isolated arthroscopic Bankart repair (ABR) for anterior shoulder instability with on-track Hill-Sachs lesions (HSLs) at mid and long-term follow-up. However, there is limited data evaluating patient-reported outcomes (PROs) at long-term follow-up after ABR for anterior shoulder instability with on-track HSLs. Methods: A retrospective review was conducted on patients undergoing isolated ABR for anterior shoulder instability between 2007-2018. Exclusion criteria included age <14 or >40 years, glenoid bone loss >25%, off-track HSL, concomitant rotator cuff tears, and revision procedures. All patients were contacted to obtain minimum 7-year PROs, including Western Ontario Shoulder Index (WOSI), pain Visual Analog Scale (pVAS), Subjective Shoulder Value (SSV) scores, recurrent anterior shoulder instability events, and subsequent shoulder surgery. Variables were compared between 'recurrent instability' and 'no recurrent instability' groups. Significance was set to p<0.05. Results: Long-term outcomes were obtained from 56 patients (mean age: 22 years, range: 14-40 years) at mean follow-up of 10.7 years (range: 7.0-17.2 years). Fourteen (25%) patients sustained at least one recurrent anterior shoulder instability event, and 11 (19.6%) patients underwent subsequent surgery over the follow-up period. Younger age was significantly associated with recurrent anterior shoulder instability (17 vs 24 years old; p=0.002). Nearly 70% of patients achieved the Patient Acceptable Symptom State (PASS) for WOSI and 53.6% of patients achieved the PASS for pVAS. Recurrent anterior shoulder instability was associated with decreased likelihood of achieving the PASS for both WOSI (35.7% vs 81.0%; p=0.001) and pVAS (28.6% vs 61.9%; p=0.030). Conclusions: Recurrent anterior shoulder instability rates were high following isolated ABR for on-track HSLs and were associated with inferior PROs at mean 10-year follow-up. There remains a clinical need for improved stratification of on-track HSLs to identify patients who may benefit from additional procedures to improve recurrence rates in addition to subjective outcomes.
