AJSM - 2026-09-22 - Journal Article
Indications for Isolated Arthroscopic Bankart Repair in the Adolescent Shoulder May Be Limited: Bipolar Bone Loss and Low Distance to Dislocation Found Commonly in an Adolescent Population With Glenohumeral Instability.
Arvesen JE, Ellis HB, Do DH, Todesco C, Dinulescu AL, Van Pelt RL, Wyatt CW, Wilson PL
Topics
Key Takeaway
74.6% of adolescents presenting with anterior shoulder instability had bone loss on MRI, with 34.3% demonstrating bipolar bone loss and 7.2% off-track lesions, suggesting isolated Bankart repair is insufficient for a substantial proportion of this population.
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Summary
This retrospective single-center study evaluated the prevalence and predictors of bipolar bone loss in 181 adolescents (ages 10–19) with anterior shoulder instability using MRI-based measurement of glenoid bone loss, Hill-Sachs interval, on-track/off-track status, and distance to dislocation (DTD). Among first-time dislocators, 69.2% already had bone loss and 37.4% had DTD <10 mm. On multivariate logistic regression, male sex (OR 14.20, p=0.011) and ≥5 prior dislocations (OR 3.22, p=0.026) were independent predictors of bipolar bone loss.
Key Limitation
Single tertiary referral center cohort without surgical outcomes data means the clinical consequence of the observed bone loss patterns—specifically whether off-track status and DTD <10 mm actually predict failure after Bankart repair in this age group—remains unestablished.
Original Abstract
BACKGROUND
Bone loss is an established risk factor for recurrent anterior shoulder instability and failure of isolated arthroscopic Bankart repair; however, its prevalence and clinical significance at initial presentation in adolescents remains poorly characterized.
PURPOSE/HYPOTHESIS
The purpose of this study was to evaluate the prevalence of bone loss and the factors that correlate with bipolar bone loss in adolescent patients evaluated with anterior shoulder instability. It was hypothesized that male sex, older age, higher number of dislocations, and contact sports participation would be associated with bipolar bone loss at initial presentation.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
A retrospective institutional review board-approved study of 181 patients aged 10 to 19 years diagnosed with anterior shoulder instability from January 2022 to March 2024 was performed at a single tertiary referral center. Glenoid bone loss, Hill-Sachs interval, on-track versus off-track status, and distance to dislocation (DTD) were measured on magnetic resonance imaging. The association between bipolar bone loss and patient characteristics, sports participation, and prior dislocation history was evaluated using chi-square and Mann-Whitney U tests with univariate and multivariate logistic regression.
RESULTS
Overall, 74.6% of patients exhibited bone loss; 34.3% had bipolar bone loss, 7.2% were off-track, and 41.4% had a DTD <10 mm. Among those with first-time dislocation, 69.2% presented with bone loss and 37.4% had a DTD <10 mm. Bipolar bone loss was significantly associated with older age (16.29 vs 15.61 years; P = .012), male sex (96.8% vs 69.7%; P < .001), high-impact/collision sports participation (94.6% vs 73.6%; P = .001), and ≥5 prior dislocations (28.8% vs 9.9%; P = .003). On multivariate analysis, male sex (OR, 14.20; P = .011) and ≥5 prior dislocations (OR, 3.22; P = .026) were independent predictors of bipolar bone loss.
CONCLUSION
One-third of adolescents in our series presenting with anterior shoulder instability had bipolar bone loss at the initial evaluation, with male sex and ≥5 prior dislocations as independent predictors. The high prevalence of off-track lesions and DTD <10 mm suggests that isolated Bankart repair may be insufficient for many adolescent patients.