AJSM - 2026-04-07 - Journal Article
Preoperative Instability Episodes as a Predictor of Recurrence After Arthroscopic Bankart Repair.
Lin RT, Gilbert R, Dadoo S, Karimi A, Feder N, Balsan A, Nazzal EM, Charles S, Hughes JD, Pittsburgh Shoulder Institute, Popchak A, Lesniak BP, Rodosky M, Dvorsky JL, Mirvish A, McMahon S, Lin A
Topics
Key Takeaway
A threshold of ≥2 preoperative instability episodes predicts recurrent anterior shoulder instability after arthroscopic Bankart repair with an AUC of 0.72 and OR of 9.70 (95% CI, 2.63–35.70).
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Summary
This study sought to define a discrete threshold of preoperative instability episodes predicting recurrence after arthroscopic Bankart repair in patients aged 14–40 with on-track Hill-Sachs lesions and <20% glenoid bone loss. ROC analysis of 151 consecutive patients identified ≥2 preoperative episodes as the optimal threshold (AUC=0.72, OR 9.70). Recurrence occurred in 28 patients (19%), and stratifying beyond 1 vs. ≥2 episodes provided no additional predictive gain.
Key Limitation
Recall bias in self-reported preoperative instability episode counts undermines the precision of the primary predictor, especially in patients with high-episode burdens.
Original Abstract
BACKGROUND
Previous literature has demonstrated that an increased number of preoperative anterior shoulder instability episodes is associated with recurrent anterior shoulder instability after arthroscopic Bankart repair (ABR). However, a threshold for the number of preoperative instability episodes that increases the risk of recurrent anterior shoulder instability is not well established.
PURPOSE
To establish a threshold value for the number of preoperative instability episodes that predicts recurrent anterior shoulder instability after ABR and to compare glenoid bone loss, the Hill-Sachs interval, and the distance to dislocation between patients who have surpassed the threshold and those who have not.
STUDY DESIGN
Retrospective cohort study; Level of evidence, 3.
METHODS
This retrospective review included consecutive patients with "on-track" Hill-Sachs lesions who underwent primary ABR for anterior shoulder instability at a single institution between 2007 and 2019. Patients with an unknown number of preoperative instability episodes, >20% glenoid bone loss, <2 years' follow-up, or age >40 or <14 years were excluded. Logistic regression assessed associations between preoperative anterior shoulder instability episodes and recurrent anterior shoulder instability after ABR, defined as a recurrent subluxation or dislocation. Receiver operating characteristic analysis determined the optimal threshold of preoperative anterior shoulder instability episodes to predict recurrent anterior shoulder instability. Significance was set as P < .050.
RESULTS
A total of 151 patients (mean age, 20 ± 5 years; mean follow-up, 6.0 ± 3.1 years) were included, of whom 28 (19%) experienced recurrent anterior shoulder instability. Multiple thresholds showed increased odds of recurrent anterior shoulder instability: ≥2 preoperative anterior shoulder instability events (odds ratio [OR], 9.70 [95% CI, 2.63-35.70]; P = .001), ≥3 events (OR, 3.47 [95% CI, 1.37-8.80]; P = .009), and ≥4 events (OR, 3.08 [95% CI, 1.17-8.08]; P = .023). Receiver operating characteristic analysis revealed that ≥2 preoperative anterior shoulder instability events was the strongest predictor of recurrent anterior shoulder instability (area under the curve = 0.72).
CONCLUSION
A threshold of ≥2 preoperative anterior shoulder instability episodes best predicted recurrent anterior shoulder instability after ABR. Stratification beyond 1 versus ≥2 preoperative anterior shoulder instability episodes did not increase predictive ability. This finding may help surgeons to counsel patients and consider earlier surgical stabilization in those who have sustained anterior shoulder instability episodes.