Distance to Dislocation and Recurrent Shoulder Dislocation After Arthroscopic Bankart Repair: Rethinking the Glenoid Track Concept. Issue 14 (December 2022)

• Record Type: Journal Article
• Authors: Barrow, Aaron E.; Charles, Shaquille J.-C.; Issa, Mohamad; Rai, Ajinkya A.; Hughes, Jonathan D.; Lesniak, Bryson P.; Rodosky, Mark W.; Popchak, Adam; Lin, Albert
• Is Part Of: American journal of sports medicine. Volume 50:Issue 14(2022)
• Page Start: 3875
• Page End: 3880
• Publication Date: 2022-12
• Subjects: football -- glenoid track -- ice hockey -- rugby -- shoulder instability; Sports medicine -- Periodicals; Sports injuries -- Periodicals; Orthopedic surgery -- Periodicals; 617.102705
• DOI: 10.1177/03635465221128913
• Languages: English
• ISSNs: 0363-5465

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. 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. Study Design: Case-control study; Level of evidence, 3. 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. 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. 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.