Sex differences in outcomes after arthroscopic bankart repair

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Abstract

Objectives

Risk factors for anterior shoulder dislocation include young age, contact activities and male sex. The influence of sex on patient-reported outcomes of arthroscopic Bankart repair (ABR) is unclear, with few studies reporting potential differences. This study’s purpose was to compare patient-reported outcomes of males and females following ABR.

Methods

Prospectively collected data was analysed for 281 patients (males: 206, females: 75) after ABR with preoperative, 1-year and 2-year follow-up responses. The Wilcoxon signed-rank and χ ² tests, preoperative, 1 year and 2 year follow-up results were examined to determine differences of scores in males versus females.

Results

No statistically significant sex differences were observed in Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), Visual Analogue Scale (VAS) or Single Assessment Numerical Evaluation (SANE) Scores at 1-year or 2-year follow-up. Females had lower Veterans RAND 12-item health survey (VR-12) mental health subscores at 2-year follow-up (females: 52.3±9.0, males: 55.8±7.6, p=0.0016). Females were more likely to report that treatment had ‘exceeded expectations’ at 2-year follow-up regarding motion, strength, function and normal sports activities.

Conclusion

Results of study demonstrate that ABR has similar outcomes for both males and females. There were no statistically significant sex-related differences in SST, ASES, VAS or SANE scores following ABR. VR-12 mental health subscores showed a minimal difference at 2-year follow-up, with lower scores in females.

Level of evidence

Retrospective cohort study; level II.

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Most cited references 20

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Epidemiology of shoulder dislocations presenting to emergency departments in the United States.

Michael A Zacchilli, Jesse B Owens (2010)

The epidemiology of traumatic shoulder dislocations is poorly understood. The aim of the current study was to determine the incidence of shoulder dislocations presenting to hospital emergency departments in the United States and define demographic risk factors for these injuries. The National Electronic Injury Surveillance System, a probability sample of all injuries presenting to emergency departments in the United States, was queried for shoulder dislocations from 2002 through 2006. Patient and injury characteristics were analyzed. United States Census data were utilized to calculate incidence rates for the United States population and subgroups. Incidence rate ratios were then calculated with respect to age, sex, and race. A total of 8940 shoulder dislocations were identified, resulting in an overall incidence rate in the United States of 23.9 (95% confidence interval, 20.8 to 27.0) per 100,000 person-years. The male incidence rate was 34.90 (95% confidence interval, 30.08 to 39.73) per 100,000 person-years, with an incidence rate ratio of 2.64 (95% confidence interval, 2.39 to 2.88) relative to the female incidence rate. It was found that 71.8% of the dislocations were in males. Stratified by decade, the maximum incidence rate (47.8 [95% confidence interval, 41.0 to 54.5]) occurred in those between the ages of twenty and twenty-nine years; 46.8% of all dislocations were in patients between fifteen and twenty-nine years of age. There were no significant differences based on race. Dislocations most frequently resulted from a fall (58.8%) and occurred at home (47.7%) or at sites of sports or recreation (34.5%). Overall, 48.3% of injuries occurred during sports or recreation. The estimated incidence rate of shoulder dislocations in the United States is 23.9 per 100,000 person-years, which is approximately twice the previously reported value. A young age and male sex are risk factors for shoulder dislocation in the United States population.

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Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients.

C Michael Robinson, Jonathan Howes, Helen Murdoch … (2006)

The prevalence and risk factors for recurrent instability and functional impairment following a primary glenohumeral dislocation remain poorly defined in younger patients. We performed a prospective cohort study to evaluate these outcomes. We also aimed to produce guidelines for the design of future clinical trials, assessing the efficacy of interventions designed to improve the outcome after a primary dislocation. We performed a prospective cohort study of 252 patients ranging from fifteen to thirty-five years old who sustained an anterior glenohumeral dislocation and were treated with sling immobilization, followed by a physical therapy program. Patients received regular clinical follow-up to assess whether recurrent instability had developed. Functional assessments were made and were compared for two subgroups: those who had not had instability develop and those who had received operative stabilization to treat recurrent instability. On survival analysis, instability developed in 55.7% of the shoulders within the first two years after the primary dislocation and increased to 66.8% by the fifth year. The younger male patients were most at risk of instability, and 86.7% of all of the patients known to have recurrent instability had this complication develop within the first two years. A small but measurable degree of functional impairment was present at two years after the initial dislocation in most patients. Sample-size calculations revealed that a relatively small number of patients with a primary dislocation would be required in future clinical trials examining the effects of interventions designed to reduce the prevalence of recurrent instability and improve the functional outcome. Recurrent instability and deficits of shoulder function are common after primary nonoperative treatment of an anterior shoulder dislocation. There is substantial variation in the risk of instability, with younger males having the highest risk and females having a much lower risk. Future clinical trials to evaluate primary interventions should evaluate the prevalence of recurrent instability and functional deficits, with use of an assessment tool specifically for shoulder instability, during the first two years after the initial dislocation.

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Epidemiology of primary anterior shoulder dislocation requiring closed reduction in Ontario, Canada.

Timothy Leroux, David Wasserstein, Christian Veillette … (2014)

There is a lack of high-quality population-based literature describing the epidemiology of primary anterior shoulder dislocation.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open Sport Exerc Med

Journal ID (iso-abbrev): BMJ Open Sport Exerc Med

Journal ID (hwp): bmjosem

Journal ID (publisher-id): bmjosem

Title: BMJ Open Sport — Exercise Medicine

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2055-7647

Publication date Collection: 2020

Publication date (Electronic): 30 December 2020

Volume: 6

Issue: 1

Electronic Location Identifier: e000965

Affiliations

[1]departmentDepartment of Orthopaedic Surgery , Brigham and Women's Hospital , Boston, Massachusetts, USA

Author notes

[Correspondence to ] Dr Elizabeth G Matzkin; ematzkin@ 123456bwh.harvard.edu

Author information

Natalie A Lowenstein http://orcid.org/0000-0003-0083-9167

Elizabeth G Matzkin http://orcid.org/0000-0001-8592-7187

Article

Publisher ID: bmjsem-2020-000965

DOI: 10.1136/bmjsem-2020-000965

PMC ID: 7780536

SO-VID: 5e1b14ca-931d-46c0-9801-c7c37b29f9ff

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date accepted : 17 December 2020

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Keywords: arthroscopy,orthopaedics,shoulder,sports medicine,sporting injuries

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Keywords: arthroscopy, orthopaedics, shoulder, sports medicine, sporting injuries

Sex differences in outcomes after arthroscopic bankart repair

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Abstract

Objectives

Methods

Results

Conclusion

Level of evidence

Related collections

SICOT-J (Orthopedic surgery and traumatology)

Most cited references 20

Epidemiology of shoulder dislocations presenting to emergency departments in the United States.

Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients.

Epidemiology of primary anterior shoulder dislocation requiring closed reduction in Ontario, Canada.

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