Department of Orthopedics and Physical Rehabilitation
Musculoskeletal Diseases | Orthopedics | Surgery
Background: Recurrent anterior shoulder dislocation in patients aged > /= 40 years is not as rare as once thought. The mechanism of instability in this patient population is different-more likely to be attributed to rotator cuff pathology-compared with that in younger individuals. With an increasingly aging active population, surgical management has a rising role in preventing morbidity associated with recurrent instability. Our purpose was to evaluate outcomes of anterior shoulder instability repair (ie, Bankart or bony Bankart repair) with and without rotator cuff repair (RCR) in patients aged > /= 40 years.
Methods: We conducted a retrospective chart review of all patients aged > /= 40 years who underwent surgical repair for anterior shoulder instability from 2008-2016. Patients were categorized into 4 cohorts: Bankart repair only, bony Bankart repair only, Bankart repair with concomitant RCR, and bony Bankart repair with concomitant RCR. Demographic and history-of-instability data were collected. Clinical and functional outcomes assessed included the Single Assessment Numeric Evaluation score, American Shoulder and Elbow Surgeons score, Penn Shoulder Score, visual analog scale score for pain, Western Ontario Shoulder Instability Index score, and patient satisfaction score.
Results: A total of 146 patients were included in this study, with 103 patients (71%) having > /=2-year outcome scores. Outcome scores were not significantly different among groups. For patients who underwent Bankart repair only, bony Bankart repair only, Bankart repair with RCR, and bony Bankart repair with RCR, the Single Assessment Numeric Evaluation scores were 80.8 +/- 19.7, 90.0 +/- 10.7, 79.3 +/- 29.4, and 87.2 +/- 10.6, respectively (P = .284); American Shoulder and Elbow Surgeons scores, 83.8 +/- 19.7, 92.4 +/- 17.4, 82.5 +/- 25.6, and 85.6 +/- 12.7, respectively (P = .114); Penn Shoulder Scores for function, 84.5 +/- 17.9, 90.9 +/- 15.3, 83.6 +/- 25.1, and 95.7 +/- 13.0, respectively (P = .286); and Western Ontario Shoulder Instability Index scores, 481.0 +/- 519.5, 292.1 +/- 414.3, 548.9 +/- 690.5, and 320.6 +/- 258.7, respectively (P = .713). Age at the time of surgery significantly differed between cohorts (P < .001). No patients had recurrence of instability during the study period.
Conclusion: Similar functional outcomes can be achieved in the surgical management of anterior instability in patients aged > /= 40 years. Rotator cuff tears should be suspected and repaired in patients with anterior instability, especially those aged > /= 50 years.
Bankart repair, Shoulder instability, arthroscopy, bony Bankart repair, middle aged, rotator cuff repair, shoulder dislocation
Rights and Permissions
© 2020 The Author(s). Published by Elsevier Inc. on behalf of American Shoulder and Elbow Surgeons. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
DOI of Published Version
Chan WW, Brolin TJ, Thakar O, Patel MS, Sholder DS, Abboud JA, Getz CL. Concomitant rotator cuff repair and instability surgery provide good patient-reported functional outcomes in patients aged 40 years or older with shoulder dislocation. JSES Int. 2020 Sep 17;4(4):792-796. doi: 10.1016/j.jseint.2020.08.006. PMID: 33345217; PMCID: PMC7738596. Link to article on publisher's site
Chan WW, Brolin TJ, Thakar O, Patel MS, Sholder DS, Abboud JA, Getz CL. (2020). Concomitant rotator cuff repair and instability surgery provide good patient-reported functional outcomes in patients aged 40 years or older with shoulder dislocation. University of Massachusetts Medical School Faculty Publications. https://doi.org/10.1016/j.jseint.2020.08.006. Retrieved from https://escholarship.umassmed.edu/faculty_pubs/1899
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.