Abstract
Purpose: To investigate preoperative factors associated with selection of surgical treatment for anterior shoulder instability. Methods: Patient demographics, initial physical examinations, and patient-oriented outcome questionnaires were collected prospectively from 26 shoulder surgeons at 10 sites. Symptom duration, number of dislocations, sport, history of prior stabilization procedure, Hill-Sachs/glenoid bone loss, pain level, and failure of conservative treatment were recorded. Statistical analysis was performed with Fisher's exact test and logistic regression analysis. Results: A total of 564 patients who underwent surgical treatment for anterior shoulder instability from November 2012 to June 2017 were enrolled. Of these, 426 shoulders underwent arthroscopic stabilization alone, 38 underwent arthroscopic stabilization with remplissage, 28 underwent open Bankart repair, and 72 underwent a Latarjet procedure. Predictors for undergoing Latarjet (P < .003) were symptom duration (75% had symptoms for >1 year), number of dislocations (47% had >5 dislocations), revision surgery (69%), Hill-Sachs lesion size (45% had a lesion between 11% and 20% of the humeral head), and glenoid bone loss (75% of Latarjet patients had 11% to 30% loss). Predictors for undergoing open Bankart repair (P < .001) were number of dislocations (32% had >5 dislocations), revision surgeries (54%), and glenoid bone loss (11% of open Bankart patients had 11% to 20% loss). History of prior shoulder surgery was the only significant predictor of open versus arthroscopic Bankart procedure. Prediction models showed athletes involved in high-risk sports were 2.61 times more likely to have a Latarjet (P < .01). Conclusions: Indications for the Latarjet were: humeral and glenoid bone loss, duration of symptoms, number of dislocations, and revision stabilizations. Athletes involved in high-risk sports were more likely to undergo the Latarjet procedure, even if other predictive factors were not present. The open Bankart procedure was the least common procedure performed, with a history of prior shoulder surgery being the only predictor for use when treating recurrent instability. Level of Evidence: Level II, prospective prognostic cohort investigation.
| Original language | English |
|---|---|
| Pages (from-to) | 2014-2025 |
| Number of pages | 12 |
| Journal | Arthroscopy - Journal of Arthroscopic and Related Surgery |
| Volume | 35 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 2019 |
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In: Arthroscopy - Journal of Arthroscopic and Related Surgery, Vol. 35, No. 7, 07.2019, p. 2014-2025.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Factors Influencing Surgeon's Choice of Procedure for Anterior Shoulder Instability
T2 - A Multicenter Prospective Cohort Study
AU - MOON Shoulder Group
AU - Bishop, Julie Y.
AU - Hidden, Krystin A.
AU - Jones, Grant L.
AU - Hettrich, Carolyn M.
AU - Wolf, Brian R.
AU - Baumgarten, Keith M.
AU - Bollier, Matthew
AU - Bravman, Jonathan
AU - McCarty, Eric C.
AU - Brophy, Robert H.
AU - Smith, Matthew V.
AU - Wright, Rick W.
AU - Cox, Charlie
AU - Kuhn, John
AU - Feely, Brian
AU - Ma, C. Benjamin
AU - Zhang, Alan
AU - Grant, John
AU - Miller, Bruce
AU - Marx, Robert G.
N1 - Funding Information: The authors report the following potential conflicts of interest or sources of funding: B.W. receives royalties from ConMed and Linvatec and serves on the board of United Healthcare, outside the submitted work. K.B. receives personal speaking fees from Arthrex, is a consultant for Wright Medical, receives grant support from Pfizer , and receives royalties from Lippincott, Williams & Wilkins, outside the submitted work. J.B. is a consultant for and receives personal fees from Smith & Nephew and DJO Global and receives royalties from Shukla Medical, outside the submitted work. E.M. receives personal fees as a consultant for Zimmer Biomet and personal fees from royalties from Elsevier; he also receives fellowship program support from Smith & Nephew and DePuy , outside the submitted work. R.B. receives speaking fees from Arthrex and Smith & Nephew and royalties from Magellan, outside the submitted work. M.S. receives personal fees as a consultant for Arthrex and Flexion Therapeutics, outside the submitted work. R.W.'s research is funded by the National Institutes of Health and he receives book royalties from Wolters Kluwer Lippincott, Williams & Wilkins, outside the submitted work. J.K.’s research is funded by PCORI , and he has received honoraria as a visiting professor from multiple universities and organizations; he also receives compensation as an editor for the Journal of Shoulder and Elbow Surgery. B. Ma receives grants and personal fees for research funding from and is a consultant from Zimmer , Histogenics , and Samumed ; receives grants for research support from Anika , the Arthritis Foundation , PCORI , and the National Institutes of Health ; and receives personal fees as a consultant for Medacta and Tornier, outside the submitted work. A.Z. receives personal fees as a consultant for Stryker, outside the submitted work. J.G. is a consultant for Ossur and JRF Ortho, outside the submitted work. B. Miller receives personal fees as a consultant for FH Orthopedics, outside the submitted work. R.M. receives royalties from Springer and Demos Health, outside the submitted work. The other authors report no conflicts of interest. Full ICMJE author disclosure forms are available for this article online, as supplementary material . Funding Information: The authors report the following potential conflicts of interest or sources of funding: B.W. receives royalties from ConMed and Linvatec and serves on the board of United Healthcare, outside the submitted work. K.B. receives personal speaking fees from Arthrex, is a consultant for Wright Medical, receives grant support from Pfizer, and receives royalties from Lippincott, Williams & Wilkins, outside the submitted work. J.B. is a consultant for and receives personal fees from Smith & Nephew and DJO Global and receives royalties from Shukla Medical, outside the submitted work. E.M. receives personal fees as a consultant for Zimmer Biomet and personal fees from royalties from Elsevier; he also receives fellowship program support from Smith & Nephew and DePuy, outside the submitted work. R.B. receives speaking fees from Arthrex and Smith & Nephew and royalties from Magellan, outside the submitted work. M.S. receives personal fees as a consultant for Arthrex and Flexion Therapeutics, outside the submitted work. R.W.'s research is funded by the National Institutes of Health and he receives book royalties from Wolters Kluwer Lippincott, Williams & Wilkins, outside the submitted work. J.K.?s research is funded by PCORI, and he has received honoraria as a visiting professor from multiple universities and organizations; he also receives compensation as an editor for the Journal of Shoulder and Elbow Surgery. B. Ma receives grants and personal fees for research funding from and is a consultant from Zimmer, Histogenics, and Samumed; receives grants for research support from Anika, the Arthritis Foundation, PCORI, and the National Institutes of Health; and receives personal fees as a consultant for Medacta and Tornier, outside the submitted work. A.Z. receives personal fees as a consultant for Stryker, outside the submitted work. J.G. is a consultant for Ossur and JRF Ortho, outside the submitted work. B. Miller receives personal fees as a consultant for FH Orthopedics, outside the submitted work. R.M. receives royalties from Springer and Demos Health, outside the submitted work. The other authors report no conflicts of interest. Full ICMJE author disclosure forms are available for this article online, as supplementary material. The authors report the following potential conflicts of interest or sources of funding: B.W. receives royalties from ConMed and Linvatec and serves on the board of United Healthcare, outside the submitted work. K.B. receives personal speaking fees from Arthrex, is a consultant for Wright Medical, receives grant support from Pfizer, and receives royalties from Lippincott, Williams & Wilkins, outside the submitted work. J.B. is a consultant for and receives personal fees from Smith & Nephew and DJO Global and receives royalties from Shukla Medical, outside the submitted work. E.M. receives personal fees as a consultant for Zimmer Biomet and personal fees from royalties from Elsevier; he also receives fellowship program support from Smith & Nephew and DePuy, outside the submitted work. R.B. receives speaking fees from Arthrex and Smith & Nephew and royalties from Magellan, outside the submitted work. M.S. receives personal fees as a consultant for Arthrex and Flexion Therapeutics, outside the submitted work. R.W.'s research is funded by the National Institutes of Health and he receives book royalties from Wolters Kluwer Lippincott, Williams & Wilkins, outside the submitted work. J.K.?s research is funded by PCORI, and he has received honoraria as a visiting professor from multiple universities and organizations; he also receives compensation as an editor for the Journal of Shoulder and Elbow Surgery. B. Ma receives grants and personal fees for research funding from and is a consultant from Zimmer, Histogenics, and Samumed; receives grants for research support from Anika, the Arthritis Foundation, PCORI, and the National Institutes of Health; and receives personal fees as a consultant for Medacta and Tornier, outside the submitted work. A.Z. receives personal fees as a consultant for Stryker, outside the submitted work. J.G. is a consultant for Ossur and JRF Ortho, outside the submitted work. B. Miller receives personal fees as a consultant for FH Orthopedics, outside the submitted work. R.M. receives royalties from Springer and Demos Health, outside the submitted work. The other authors report no conflicts of interest. Full ICMJE author disclosure forms are available for this article online, as supplementary material. MOON Shoulder Group collaborators were: Keith M. Baumgarten, M.D., Orthopedic Institute, Sioux Falls, South Dakota; Matthew Bollier, M.D., University of Iowa, Iowa City, Iowa; Jonathan Bravman, M.D., and Eric C. McCarty, M.D., University of Colorado, Boulder, Colorado; Robert H. Brophy, M.D., Matthew V. Smith, M.D., and Rick W. Wright, M.D., Washington University, St. Louis, Missouri; Charlie Cox, M.D., and John Kuhn, M.D., Vanderbilt University Medical Center; Brian Feely, M.D., C. Benjamin Ma, M.D., and Alan Zhang, M.D., University of California-San Francisco, San Francisco, California; John Grant, M.D., and Bruce Miller, M.D., University of Michigan, Ann Arbor, Michigan; and Robert G. Marx, M.D., Hospital for Special Surgery, New York, New York. Funding Information: The authors report the following potential conflicts of interest or sources of funding: B.W. receives royalties from ConMed and Linvatec and serves on the board of United Healthcare, outside the submitted work. K.B. receives personal speaking fees from Arthrex, is a consultant for Wright Medical, receives grant support from Pfizer, and receives royalties from Lippincott, Williams & Wilkins, outside the submitted work. J.B. is a consultant for and receives personal fees from Smith & Nephew and DJO Global and receives royalties from Shukla Medical, outside the submitted work. E.M. receives personal fees as a consultant for Zimmer Biomet and personal fees from royalties from Elsevier; he also receives fellowship program support from Smith & Nephew and DePuy, outside the submitted work. R.B. receives speaking fees from Arthrex and Smith & Nephew and royalties from Magellan, outside the submitted work. M.S. receives personal fees as a consultant for Arthrex and Flexion Therapeutics, outside the submitted work. R.W.'s research is funded by the National Institutes of Health and he receives book royalties from Wolters Kluwer Lippincott, Williams & Wilkins, outside the submitted work. J.K.’s research is funded by PCORI, and he has received honoraria as a visiting professor from multiple universities and organizations; he also receives compensation as an editor for the Journal of Shoulder and Elbow Surgery. B. Ma receives grants and personal fees for research funding from and is a consultant from Zimmer, Histogenics, and Samumed; receives grants for research support from Anika, the Arthritis Foundation, PCORI, and the National Institutes of Health; and receives personal fees as a consultant for Medacta and Tornier, outside the submitted work. A.Z. receives personal fees as a consultant for Stryker, outside the submitted work. J.G. is a consultant for Ossur and JRF Ortho, outside the submitted work. B. Miller receives personal fees as a consultant for FH Orthopedics, outside the submitted work. R.M. receives royalties from Springer and Demos Health, outside the submitted work. The other authors report no conflicts of interest. Full ICMJE author disclosure forms are available for this article online, as supplementary material. The authors report the following potential conflicts of interest or sources of funding: B.W. receives royalties from ConMed and Linvatec and serves on the board of United Healthcare, outside the submitted work. K.B. receives personal speaking fees from Arthrex, is a consultant for Wright Medical, receives grant support from Pfizer, and receives royalties from Lippincott, Williams & Wilkins, outside the submitted work. J.B. is a consultant for and receives personal fees from Smith & Nephew and DJO Global and receives royalties from Shukla Medical, outside the submitted work. E.M. receives personal fees as a consultant for Zimmer Biomet and personal fees from royalties from Elsevier; he also receives fellowship program support from Smith & Nephew and DePuy, outside the submitted work. R.B. receives speaking fees from Arthrex and Smith & Nephew and royalties from Magellan, outside the submitted work. M.S. receives personal fees as a consultant for Arthrex and Flexion Therapeutics, outside the submitted work. R.W.'s research is funded by the National Institutes of Health and he receives book royalties from Wolters Kluwer Lippincott, Williams & Wilkins, outside the submitted work. J.K.’s research is funded by PCORI, and he has received honoraria as a visiting professor from multiple universities and organizations; he also receives compensation as an editor for the Journal of Shoulder and Elbow Surgery. B. Ma receives grants and personal fees for research funding from and is a consultant from Zimmer, Histogenics, and Samumed; receives grants for research support from Anika, the Arthritis Foundation, PCORI, and the National Institutes of Health; and receives personal fees as a consultant for Medacta and Tornier, outside the submitted work. A.Z. receives personal fees as a consultant for Stryker, outside the submitted work. J.G. is a consultant for Ossur and JRF Ortho, outside the submitted work. B. Miller receives personal fees as a consultant for FH Orthopedics, outside the submitted work. R.M. receives royalties from Springer and Demos Health, outside the submitted work. The other authors report no conflicts of interest. Full ICMJE author disclosure forms are available for this article online, as supplementary material. MOON Shoulder Group collaborators were: Keith M. Baumgarten, M.D., Orthopedic Institute, Sioux Falls, South Dakota; Matthew Bollier, M.D., University of Iowa, Iowa City, Iowa; Jonathan Bravman, M.D., and Eric C. McCarty, M.D., University of Colorado, Boulder, Colorado; Robert H. Brophy, M.D., Matthew V. Smith, M.D., and Rick W. Wright, M.D., Washington University, St. Louis, Missouri; Charlie Cox, M.D., and John Kuhn, M.D., Vanderbilt University Medical Center; Brian Feely, M.D., C. Benjamin Ma, M.D., and Alan Zhang, M.D., University of California-San Francisco, San Francisco, California; John Grant, M.D., and Bruce Miller, M.D., University of Michigan, Ann Arbor, Michigan; and Robert G. Marx, M.D., Hospital for Special Surgery, New York, New York. Publisher Copyright: © 2019 Arthroscopy Association of North America
PY - 2019/7
Y1 - 2019/7
N2 - Purpose: To investigate preoperative factors associated with selection of surgical treatment for anterior shoulder instability. Methods: Patient demographics, initial physical examinations, and patient-oriented outcome questionnaires were collected prospectively from 26 shoulder surgeons at 10 sites. Symptom duration, number of dislocations, sport, history of prior stabilization procedure, Hill-Sachs/glenoid bone loss, pain level, and failure of conservative treatment were recorded. Statistical analysis was performed with Fisher's exact test and logistic regression analysis. Results: A total of 564 patients who underwent surgical treatment for anterior shoulder instability from November 2012 to June 2017 were enrolled. Of these, 426 shoulders underwent arthroscopic stabilization alone, 38 underwent arthroscopic stabilization with remplissage, 28 underwent open Bankart repair, and 72 underwent a Latarjet procedure. Predictors for undergoing Latarjet (P < .003) were symptom duration (75% had symptoms for >1 year), number of dislocations (47% had >5 dislocations), revision surgery (69%), Hill-Sachs lesion size (45% had a lesion between 11% and 20% of the humeral head), and glenoid bone loss (75% of Latarjet patients had 11% to 30% loss). Predictors for undergoing open Bankart repair (P < .001) were number of dislocations (32% had >5 dislocations), revision surgeries (54%), and glenoid bone loss (11% of open Bankart patients had 11% to 20% loss). History of prior shoulder surgery was the only significant predictor of open versus arthroscopic Bankart procedure. Prediction models showed athletes involved in high-risk sports were 2.61 times more likely to have a Latarjet (P < .01). Conclusions: Indications for the Latarjet were: humeral and glenoid bone loss, duration of symptoms, number of dislocations, and revision stabilizations. Athletes involved in high-risk sports were more likely to undergo the Latarjet procedure, even if other predictive factors were not present. The open Bankart procedure was the least common procedure performed, with a history of prior shoulder surgery being the only predictor for use when treating recurrent instability. Level of Evidence: Level II, prospective prognostic cohort investigation.
AB - Purpose: To investigate preoperative factors associated with selection of surgical treatment for anterior shoulder instability. Methods: Patient demographics, initial physical examinations, and patient-oriented outcome questionnaires were collected prospectively from 26 shoulder surgeons at 10 sites. Symptom duration, number of dislocations, sport, history of prior stabilization procedure, Hill-Sachs/glenoid bone loss, pain level, and failure of conservative treatment were recorded. Statistical analysis was performed with Fisher's exact test and logistic regression analysis. Results: A total of 564 patients who underwent surgical treatment for anterior shoulder instability from November 2012 to June 2017 were enrolled. Of these, 426 shoulders underwent arthroscopic stabilization alone, 38 underwent arthroscopic stabilization with remplissage, 28 underwent open Bankart repair, and 72 underwent a Latarjet procedure. Predictors for undergoing Latarjet (P < .003) were symptom duration (75% had symptoms for >1 year), number of dislocations (47% had >5 dislocations), revision surgery (69%), Hill-Sachs lesion size (45% had a lesion between 11% and 20% of the humeral head), and glenoid bone loss (75% of Latarjet patients had 11% to 30% loss). Predictors for undergoing open Bankart repair (P < .001) were number of dislocations (32% had >5 dislocations), revision surgeries (54%), and glenoid bone loss (11% of open Bankart patients had 11% to 20% loss). History of prior shoulder surgery was the only significant predictor of open versus arthroscopic Bankart procedure. Prediction models showed athletes involved in high-risk sports were 2.61 times more likely to have a Latarjet (P < .01). Conclusions: Indications for the Latarjet were: humeral and glenoid bone loss, duration of symptoms, number of dislocations, and revision stabilizations. Athletes involved in high-risk sports were more likely to undergo the Latarjet procedure, even if other predictive factors were not present. The open Bankart procedure was the least common procedure performed, with a history of prior shoulder surgery being the only predictor for use when treating recurrent instability. Level of Evidence: Level II, prospective prognostic cohort investigation.
UR - http://www.scopus.com/inward/record.url?scp=85067174950&partnerID=8YFLogxK
U2 - 10.1016/j.arthro.2019.02.035
DO - 10.1016/j.arthro.2019.02.035
M3 - Article
C2 - 31208919
AN - SCOPUS:85067174950
SN - 0749-8063
VL - 35
SP - 2014
EP - 2025
JO - Arthroscopy - Journal of Arthroscopic and Related Surgery
JF - Arthroscopy - Journal of Arthroscopic and Related Surgery
IS - 7
ER -