Risk for recurrent instability and reoperation following arthroscopic and open shoulder stabilization in a large cross-sectional population

Alexander R. Markes, MD; Nicolas Cevallos, BS; Drew A. Lansdown, MD; C. Benjamin Ma, MD; Brian T. Feeley, MD; Alan L. Zhang, MD

JSES International (Sep 2022)

Risk for recurrent instability and reoperation following arthroscopic and open shoulder stabilization in a large cross-sectional population

Alexander R. Markes, MD,
Nicolas Cevallos, BS,
Drew A. Lansdown, MD,
C. Benjamin Ma, MD,
Brian T. Feeley, MD,
Alan L. Zhang, MD

Affiliations

Alexander R. Markes, MD: Corresponding author: Alexander R. Markes, MD, 1500 Owens Street, San Francisco, CA 94158, USA.; Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA
Nicolas Cevallos, BS: Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA
Drew A. Lansdown, MD: Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA
C. Benjamin Ma, MD: Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA
Brian T. Feeley, MD: Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA
Alan L. Zhang, MD: Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA, USA

Journal volume & issue: Vol. 6, no. 5
pp. 730 – 735

Abstract

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Background: Recurrent shoulder instability is an orthopedic problem with potentially long-term functional ramifications. Although arthroscopic stabilization has become increasingly utilized over open stabilization, optimal surgical intervention to minimize recurrent instability remains controversial. Methods: The PearlDiver Mariner database was queried for all cases of open and arthroscopic shoulder stabilization from 2010 to 2019. Utilization trends were aggregated after identifying cohorts of 107,210 and 13,217 patients who respectively underwent arthroscopic or open stabilization using Current Procedural Terminology codes. Subsets from those cohorts with laterality-specific International Classification of Diseases, Tenth Revision codes for shoulder instability were used to evaluate 2-year rates of recurrent instability (presence of shoulder dislocation or revision open or arthroscopic stabilization). Linear regression and chi-squared analysis were used to analyze utilization trends and to compare recurrent instability. Results: Arthroscopic stabilization comprised 90% of all stabilization procedures with annual utilization continuing to increase into 2019. Latarjet utilization increased from 15% to 42% of all open stabilization procedures while open Bankart repair utilization decreased from 56% to 35%. The rate of recurrent instability was 10.2% after arthroscopic stabilization and 12.3% after open stabilization (P = .01). Rates of redislocation (4.0% vs. 2.6%, P < .01), conversion to shoulder arthroplasty (1.2% vs. 0.4%, P < .01), and revision open stabilization (6.8% vs. 2.3%, P < .01) after index open stabilization were significantly higher than after index arthroscopic stabilization. There was no difference in revision stabilization or dislocation rates between open procedures. Conclusion: Despite increasing utilization of coracoid transfer, arthroscopic stabilization is still the dominant modality used for surgical treatment of shoulder instability and in our analysis, showed lower 2-year rates of dislocation, revision open stabilization, and conversion to shoulder arthroplasty.

Published in JSES International

ISSN: 2666-6383 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery; Medicine: Internal medicine: Specialties of internal medicine: Diseases of the musculoskeletal system
Website: https://www.journals.elsevier.com/jses-international

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