RISK FACTORS PREVENTING RETURN TO BASELINE ACTIVITY LEVEL AFTER BANKART REPAIR. Issue 3 (31st March 2019)

• Record Type: Journal Article
• Authors: Aoyama, Julien T.; Simmons, Shawn; Young-Hamilton, Tyrell; Horn, Molly; Ramesh, Siddhi; Wells, Lawrence
• Is Part Of: Orthopaedic journal of sports medicine. Volume 7:Issue 3(2019:Mar.)Supplement
• Publication Date: 2019-03-31
• Subjects: Sports medicine -- Periodicals; Orthopedics -- Periodicals; Arthroscopy -- Periodicals; Arthroplasty -- Periodicals; Knee -- Surgery -- Periodicals; 616.7
• DOI: 10.1177/2325967119S00054
• Languages: English
• ISSNs: 2325-9671

Abstract

Background: As sports specialization continues to grow amongst youth, the prevalence of shoulder instability continues to increase. Bankart repair exists as a primary method to combat these issues, yet a third or more of patients experience recurrent instability following surgery. Currently most studies examining Bankart repair look at surgical technique (open vs arthroscopic) and the original treatment employed; however, there has been a lack of research examining whether demographic, injury history, and perioperative risk factors exist as well. The purpose of this prognostic study was to examine Bankart repair in the pediatric population and identify a wider range of risk factors associated with poor functional outcomes. Methods: We conducted a retrospective review of all patients who received Bankart repair between 01/01/2010 and 12/31/2015 at the Children's Hospital of Philadelphia. A range of demographic, injury history, clinical exam, operative, and perioperative variables were abstracted to identify risk factors associated with limited functional outcome as defined by inability to return to baseline sport or activity. Chi square analyses were used to find significant associations between dichotomous variables, and point-biserial analyses were used to find strength of correlations for continuous variables. Results: 118 patients were included with an average age of 15.92 ±2.11 at the time of surgery. The mean OR time was 206.98 ±55.88 minutes. Point-biserial correlations for total OR time, BMI, and age with inability to return to baseline sport or activity were 0.32, .09, and .04 respectively. Chi square analyses found no significant associations for prior non-operative treatment, sulcus sign, and insurance type. For individuals who presented with prior instability, 92/119 (77.3%) with and 27/119 (22.7%) without, this was significantly associated with inability to return to baseline sport or activity (p = 0.04). For presence of a Hill Sachs Lesion 70/145 (48.2%) had a lesion, 75/145 (51.8%) did not, and this was significantly associated as well (p = 0.02). For injury type, 71/98 (72.4%) were contact, 27/98 (27.6%) were noncontact, and this was significantly associated as well (p = 0.01). Conclusion: Many clinicians have informally found in practice that certain patient characteristics seem to be associated with poor outcomes after Bankart repair. Here we find that a history of prior instability, Hill Sachs lesion presence, and a contact injury mechanism are significantly associated with inability to return to baseline sport or activity post-operatively. The risk factors identified here can be categorized into injury history risk factors and perioperative risk factors. Clinicians can use these identified risk factors to better inform patients receiving Bankart repair of their likelihood of returning to baseline sport or activity.