Risk Factors for Recurrence After Arthroscopic Instability Repair-The Importance of Glenoid Bone Loss >15%, Patient Age, and Duration of Symptoms: A Matched Cohort Analysis - Matthew Provencher, MD | Orthopedic Knee & Shoulder Surgeon

Authors:

Travis J Dekker, Liam A Peebles, Andrew S Bernhardson, Samuel I Rosenberg, Colin P Murphy, Petar Golijanin, Matthew T Provencher

Abstract:

Background: Glenoid bone loss (GBL) has been implicated as a risk factor for failure of arthroscopic anterior glenohumeral instability repair. Although certain amounts of GBL are associated with higher recurrence rates, there are limited studies on successes versus failures in these cohorts.

Purpose: To compare the outcomes of arthroscopic Bankart repair in patients with and without GBL to determine a threshold percentage of GBL that predicts success.

Study design: Cohort study; Level of evidence, 2.

Methods: All consecutive patients who underwent arthroscopic Bankart repair for anterior shoulder instability between 2004 and 2013 were prospectively enrolled. Patients with ≤25% GBL were included. Patients with no GBL were grouped and compared with those having 5% to 25% GBL. Outcomes included Single Assessment Numerical Evaluation, Western Ontario Shoulder Index, and American Shoulder and Elbow Surgeons scores, with evidence of recurrent instability. Patients with and without GBL were statistically compared with respect to outcomes and recurrence rates.

Results: Of 434 eligible patients, the cases of 405 (45 female, 360 male; mean age, 27.5 years [range, 18-47 years]) were followed for a mean 61 months (range, 48-96 months). There were 189 (46.6%) with no GBL and 216 (53.3%) with GBL; the mean GBL of the latter cohort was 15% (range, 5%-25%). The mean duration of instability symptoms was 7.9 months (range, 1-21 months) and was significantly longer in the GBL group (P < .05). The mean recurrence rate was 14.8%, which was significantly greater in patients presenting with GBL versus those with none (48/216 [22.2%] vs 12/189 [6.3%]; P < .01). Within the GBL group, GBL ≥15%, duration of symptoms >5 months, and younger age (<20 years) were independent risk factors for failure (P < .01). Patients with any GBL had >4-times greater odds of recurrence after arthroscopic stabilization (odds ratio, 4.21; 95% CI, 2.16-8.21). Moreover, patients presenting for arthroscopic Bankart repair with GBL ≥15% had nearly 3-times greater odds of recurrent instability.

Conclusion: GBL ≥15% in an active patient population portends to increased odds of recurrent instability events and inferior clinical outcomes after arthroscopic Bankart repair. Furthermore, nonmodifiable risk factors, such as age (<20 years) and duration of symptoms before presentation (>5 months), significantly affect risk of recurrence and should be key factors when counseling patients on risk of failure and determining the ideal procedure for the individual patient.

For the complete study: Risk Factors for Recurrence After Arthroscopic Instability Repair-The Importance of Glenoid Bone Loss >15%, Patient Age, and Duration of Symptoms: A Matched Cohort Analysis

Matthew Provencher, MD

Average rating:

64 reviews

Gene reiling

Jul 21, 2023

by Gene reiling on Matthew Provencher, MD

Success

If you are planning to see Dr Provencher ,do not hesitate ,do it. In 2018 Dr Provencher replaced my LCL. I had no complications and very little pain. I did my physical therapy as prescribed. I was able to ski 30 plus days the winter of 2019-2020. Before seeing dr Provencher I had spent a years time trying to solve my problem locally. I saw a pain specialist, orthopedic urgent care and a orthopedic surgeon. All had access to an mri done locally. It was also read by local radiologist. Pain dr gave injections as did orthopedic urgent care. No relief from pain. Orthopedic surgeon told me about arthritis, meniscus needing cleaning up and general deterioration from age. Told me to take ibuprofen for pain. At that time I reached out to Steadman Clinic. By luck of the draw I was assigned Dr Provencher. I took with me the mri that had been done locally and viewed by 3 local Drs and 1 PA. It took Dr Provencher less than a minute to tell me my problem was my LCL after viewing my mri. He told me my options . I selected surgery as I wanted to continue an active life style. It was a complete success!!

THEODORE Wirecki

by THEODORE Wirecki on Matthew Provencher, MD

My reverse shoulder replacement

I had my reverse shoulder replacement with Dr.Provencher four months ago. Took an hour, home an hour later. No pain with the meds cocktail, ice machine, and lidocaine pump. My recovery was incredible quick and effortless, no pain and good range of motion. Dr.Provencher is really the best surgeon, and a genuine and kind human being. If you are able to have Dr. Provencher do your shoulder you would be a fool to go anywhere else. The Steadman Clinic is state of the art, extremely efficient, using tranexamic acid intravenously right before surgery to minimize bleeding and many other sophisticated strategies not available in community hospitals. The process and the outcome way exceeded my expectations. If you would like more detail about the experience email me or call on my cell, 3036182303.
Ted Wirecki MD

Alvin Hrubes

Feb 1, 2023

by Alvin Hrubes on Matthew Provencher, MD

My shoulder was ruined in a car accident. I am 82 years old and Dr. Provencher did more than I had ever hoped for. He did a reverse shoulder and at 2 weeks the range of motion exceeded what I had before replacement. He is my hero! Thank you, Dr. Provencher!!

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