Patients With Critical Humeral Bone Loss Have Similar Patient‐Reported Outcomes to Patients Without Critical Humeral Bone Loss After Arthroscopic Shoulder Stabilization at a Mean Follow‐Up of 7 Years
Ryan Gilbert, Ryan T. Lin, Sahil Dadoo, Andrew Liu, Ting Cong, Adam Popchak, Bryson P. Lesniak, Mark Rodosky, Jonathan D. Hughes, Albert LinPurpose
To compare long‐term patient‐reported outcomes (PROs) between patients with and without critical humeral bone loss (CHBL) and to compare long‐term PROs among patients with CHBL who underwent arthroscopic Bankart repair (ABR) alone versus those who received a remplissage augmentation (ABR + R).
Methods
A retrospective review included patients aged 13 to 50 years who underwent ABR or ABR + R for anterior shoulder instability from 2007 to 2023. Exclusion criteria included <1‐year follow‐up, >20% glenoid bone loss, off‐track Hill‐Sachs lesion, concomitant pathology, or revision surgery. CHBL was defined as humeral head defect extension below the 90° equator. Western Ontario Shoulder Index, pain Visual Analog Scale, and Subjective Shoulder Value were collected at the final follow‐up. PROs and recurrence rates were compared between cohorts and within the CHBL subgroup.
Results
Three hundred eighty‐four patients were included (mean age 23 ± 9 years (range: 13‐49), 78% men), of which 99 (26%) were successfully contacted for PROs: 129 (34%) with CHBL and 255 (66%) without CHBL. The CHBL cohort was older (25 vs 22 years, P < .01) and had smaller distance to dislocation (9 vs 13 mm, P < .01). Recurrent instability rates were comparable overall (22% vs 15%, P = .08), but, within the CHBL cohort, recurrence was significantly lower after ABR + R than ABR alone (9% vs 32%, P < .01). Ninety‐nine patients (26%) (41 CHBL, 58 non‐CHBL) completed PROs at a mean follow‐up of 7.3 years (range: 1.9‐14.4), with no significant differences in Western Ontario Shoulder Index, pain Visual Analog Scale, Subjective Shoulder Value, or recurrent instability between groups (all P > .05). In a multivariable linear regression, only recurrent instability was an independent predictor of inferior PROs; the presence of CHBL was not an independent predictor. Among CHBL patients, PROs were similar between ABR and ABR + R.
Conclusions
Patients with CHBL had similar long‐term PROs to those without CHBL after ABR or ABR + R at a minimum follow‐up of 1 year. Furthermore, the addition of remplissage was found to be associated with a reduced rate of recurrent anterior shoulder instability in patients with CHBL.
Level of Evidence
Level III, retrospective cohort study.