...with the rate of progression or death for each interval calculated, a product–limit estimator generates a progression or mortality risk (a hazard rate). ...censoring must be non-informative, ...infrequent, and balanced between treatment groups. ...discussion of results must acknowledge the limitations of data heavily burdened by censoring that is possibly or likely to be informative.
Objectives:
More recently, the glenoid track has been described as a continuum rather than a binary “on-track/off-track” concept. “Distance to dislocation” (DTD), which defines how far an on-track ...lesion is from being off-track, has proven to be a strong predictor for recurrent dislocation following arthroscopic Bankart repair. Risk of recurrent instability following a Latarjet as it relates to DTD, however, is unknown. The purpose of this study was to determine if DTD is a predictor of recurrent dislocation and return-to-sport/work (RTS). We hypothesized higher DTD values would correlate with lower failure rates and higher rates of RTS.
Methods:
We retrospectively identified 106 consecutive patients who underwent a Latarjet between 2012 and 2022. Glenoid bone loss, Hills-Sachs Interval (HSI), glenoid track (GT), and DTD (DTD = GT – HSI) were determined from preoperative MRIs. On-track shoulders corresponded with positive DTD values, while off-track shoulders revealed negative DTD values. Relatedly, the more positive or negative the DTD value, the more on-track or off-track the shoulder. Univariate and multivariate cox regression analyses were utilized to evaluate the association between recurrent dislocation, patient demographics, and DTD. Using parametric survival analysis, we evaluated the association between RTS, demographics, and DTD.
Results:
Seventeen patients (16%) experienced recurrent dislocations. Our cohort was 70% male with an average follow-up of 1.5 years. Patient age (p=0.035), revision status (p=0.033), and DTD (p=0.005) were significant predictors of reoperation on univariate analysis. After adjusting for confounders, only DTD (p=0.043) remained a significant predictor of recurrent instability, Figure 1. Regarding RTS, patient age (p=0.14), sex (p=0.029), and DTD (p<0.0005) were predictive of RTS on univariate analysis. After adjusting for covariates, we observed an interaction between patient age and DTD (p=0.036). More specifically, older patients have a more prolonged RTS at lower DTD values compared to younger patients, Figure 2.
Conclusions:
Regardless of on-track vs off-track status, DTD is a useful variable in the work-up of patients undergoing Latarjet reconstruction. Lower DTD values are predictive of higher rates of recurrent instability and lower rates of RTS, especially in older patients.
Objectives:
Anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions occur in patients with recurrent shoulder instability and are associated with higher rates of failure after ...capsulolabral repair surgery compared to typical Bankart lesions. Despite recognition that these lesions can portend poor outcomes, there is relatively limited data to understand the associated injuries and postoperative course in a young, active population. The purpose of this study is to evaluate ALPSA lesions for associated pathology and outcomes.
Methods:
Methods: We reviewed the records of 312 patients who underwent arthroscopic shoulder stabilization by one of two fellowship trained sports surgeons at a single facility between 1 January 2010 and 31 December 2015. Inclusion criteria were a minimum follow-up of five years after index surgical repair and presence of an ALPSA lesion as identified on arthroscopic exam, leaving 46 patients available for review. Our primary outcome measures were failure and operative revision surgery. We considered failure as any recurrent shoulder instability events including subjective subluxation and dislocation, recurrence of pain consistent with instability, or functionally limiting apprehension. We performed survival analysis and a multivariate logistic regression analysis to identify factors associated with failure.
Results:
Results: In total, 46 patients with average age 21.2 years met inclusion and underwent surgery a median of 7.1 months after initial recalled injury event. 11/46 had concomitant posterior pathology in addition to anterior labral lesion. Six patients were found to have SLAP lesions. All patients experienced subjective instability, and 44/46 endorsed pain prior to surgery. 38/46 reported having experienced complete dislocation. The median number of dislocations before surgery was 3. Repairs were performed with average 3.7 anchors. Eight patients failed surgery at median 15.1 months post-index procedure, with 75% of failures occurring before two years with the remaining 25% occurring later in follow-up. Three of these failed revision repair.
Conclusions:
Conclusions: ALPSA lesions frequently occur in the presence of other intra-articular shoulder lesions and portend a high rate of recurrent shoulder instability despite repair. Notably, while failure occurs at a high rate, most repair failure for these lesions tends to occur early.
Objectives:
To comprehensively define the time required to achieve outcomes (CSOs) after arthroscopic meniscal repair (AMR). The primary outcome was to identify an evidence-based timepoint for ...functional recovery, including the time needed to attain minimally clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for isolated AMR.
Methods:
Patients who underwent isolated AMR between 2015 and 2021 were collected. Those with completed preoperative and at least 1 post-operative (6-month, 1 year, and 2 years) Patient-Reported Outcome Measures (PROMs), including International Knee Documentation Committee (IKDC), Patient- Reported Outcomes Measurement Information System Physical Function (PROMIS PF), or Knee Injury and Osteoarthritis Outcome Score (KOOS) were included. Exclusion criteria included patients with significant concomitant ligament procedures, concomitant meniscectomies, or prior ipsilateral knee surgery. MCID and PASS for each PROM were identified from prior literature and utilized as a threshold needed to attain functional recovery. The time needed to achieve CSO was then calculated and plotted using Kaplan-Meier survival analysis.
Results:
Of the 71 included patients (33.8% female, age: 30±14.9 years), 69 patients had completed IKDC forms, and 41 had completed PROMIS PF forms. Patients attained IDKC achievement rates of 84% for MCID and 68% for PASS, and PROMIS PF achievement rates of 80.5% for MCID and 78% for PASS. Median achievement time across all surveys (IKDC, PROMIS PF, and KOOS) ranged between 5.27 - 5.31 months for MCID, and between 5.21–5.40 months for PASS. Averages for achievement time for MCID ranged from 6.28–8.20 months, and for PASS from 6.42 – 9.51 months, in respective PRO surveys.
Conclusions:
The majority of patients (72%) undergoing AMR achieved benefit within 6 months of surgery (overall median: 5.3 months), with diminishing proportions at later timepoints. The timeline for achieving improvement that was established by this study may aid in setting patient expectations and designing future outcome studies involving AMR.
