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Distance to Dislocation and Recurrent Shoulder Dislocation After Arthroscopic Bankart Repair: Rethinking the Glenoid Track Concept.
- Source :
-
The American journal of sports medicine [Am J Sports Med] 2022 Dec; Vol. 50 (14), pp. 3875-3880. - Publication Year :
- 2022
-
Abstract
- Background: The "distance to dislocation" (DTD) calculation has been proposed as 1 method to predict the risk of recurrent dislocation after arthroscopic Bankart repair for an "on-track" shoulder. Rates of recurrent dislocation at specific DTD values are unknown.<br />Hypothesis: Among patients with "on-track" shoulder lesions who underwent primary arthroscopic Bankart repair, the rate of recurrent dislocation would increase as DTD values decrease.<br />Study Design: Case-control study; Level of evidence, 3.<br />Methods: We performed a retrospective analysis of 188 patients with "on-track" shoulder lesions who underwent primary arthroscopic anterior labral repair between 2007 and 2019, with a minimum 2-year follow-up. Glenoid bone loss, Hill-Sachs interval, glenoid track, and DTD were determined from preoperative magnetic resonance imaging scans. The rate of recurrent dislocation was determined at 2-mm DTD intervals. Univariate and multivariate regression analyses were used to evaluate the relationship between recurrent dislocation, patient characteristics, and bone loss variables. A multivariate regression model was created to predict the probability of failure at continuous DTD values. A subgroup analysis of failure rate based on collision sports participation was also performed.<br />Results: A total of 29 patients (15.4%) sustained recurrent dislocations. Patient age ( P = .046), multiple dislocations ( P = .03), glenoid bone loss ( P < .001), Hill-Sachs interval length ( P < .001), and DTD ( P < .001) were all independent predictors of failure. As the DTD decreased, the rate of recurrent dislocation increased. Below a DTD threshold of 10 mm, the recurrent dislocation rate increased exponentially. Up to a threshold of 24 mm, the failure rate for collision athletes remained >12.3%, independent of the DTD. Conversely, the failure rate among noncollision athletes decreased steadily as the DTD increased.<br />Conclusion: For "on-track" shoulder lesions, as the DTD approached 0 mm ("off-track" threshold), the risk of recurrent dislocation after arthroscopic Bankart repair increased significantly. Below a DTD threshold of 10 mm, the risk of failure increased exponentially. The risk of recurrent dislocation for collision sports athletes remained elevated at higher DTD values than for noncollision athletes.
- Subjects :
- Humans
Case-Control Studies
Retrospective Studies
Shoulder Dislocation surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1552-3365
- Volume :
- 50
- Issue :
- 14
- Database :
- MEDLINE
- Journal :
- The American journal of sports medicine
- Publication Type :
- Academic Journal
- Accession number :
- 36472485
- Full Text :
- https://doi.org/10.1177/03635465221128913