J Shoulder Elbow Surg. 2021 Oct 20:S1058-2746(21)00752-7. doi: 10.1016/j.jse.2021.10.002. Online ahead of print.
ABSTRACT
BACKGROUND: The purpose of this study was to compare the preoperative magnetic resonance arthrography (MRA) findings in patients who underwent glenohumeral stabilization with a history of primary instability, recurrent instability or failed prior stabilization.
METHODS: All patients who presented with glenohumeral instability and underwent stabilization under a single surgeon in our institution between 2008 and 2020 were considered for inclusion in this study. The MRA findings of all were recorded. Imaging findings were compared between those with primary instability, recurrent instability, and those with failed prior stabilization. A p-value of p < 0.05 was considered statistically significant.
RESULTS: Overall, 871 patients were included; 814 of whom were male (93.5%) with a mean age of 23.1 years (range 13-55). There were 200 patients with primary instability, 571 patients with recurrent instability, and 100 patients who required revision stabilization surgery, with no significant differences in demographics between the groups. There was a significantly higher amount of glenoid bone loss in those with recurrent instability (43.4%) and failed prior stabilization (56%) than those with primary instability (26.5%), p < 0.0001. Additionally, there was a significantly higher number of Hill-Sachs lesions in those with recurrent instability (70.1%) and failed prior stabilization (89%) than those with primary instability (67.5%), p < 0.0001. There were no significant differences between the groups for articular cartilage damage, GLAD lesions, ALPSA lesions, HAGL lesions or SLAP tears (P>0.05).
CONCLUSION: Patients presenting for stabilization with recurrent instability or following a failed prior stabilization possess higher rates of glenohumeral bone loss when compared to those with primary instability. Therefore, stabilization of primary instability, particularly in high functioning athletes with a view to preventing recurrence may reduce overall progression of glenohumeral bone loss and potential subsequent inferior clinical outcomes.
PMID:34687918 | DOI:10.1016/j.jse.2021.10.002
