Year: 2013
Type: letter
Abstract: With great interest, we read the systematic review by Harris et al.1Harris J.D. Gupta A.K. Mall N.A. et al.Long-term outcomes after Bankart shoulder stabilization.Arthroscopy. 2013; 29: 920-933Abstract Full Text Full Text PDF PubMed Scopus (201) Google Scholar entitled “Long-Term Outcomes After Bankart Shoulder Stabilization,” and we compliment the authors on their extensive and well-designed overview. They describe the long-term outcome, including recurrent instability, return to sport, postoperative osteoarthritis, and Rowe and Constant scores, after the most frequently used Bankart repair techniques, both open and arthroscopic. To keep their pooled data homogeneous, Harris et al.1Harris J.D. Gupta A.K. Mall N.A. et al.Long-term outcomes after Bankart shoulder stabilization.Arthroscopy. 2013; 29: 920-933Abstract Full Text Full Text PDF PubMed Scopus (201) Google Scholar understandably included only those articles in which failures were defined as fully redislocated shoulders. This unfortunately excludes patient-reported subluxations, which would lead to a much higher failure rate. This raises a very important question: How should we define a failure after surgical treatment for anterior shoulder instability? In our opinion, subluxations should be counted as failures too, based on 2 arguments. First, considering the fact that stable shoulder function is the purpose of our treatment, failure is a very important primary outcome after stabilization. The subjective experience of a shoulder subluxation is very inconvenient and an adverse surgical outcome for patients. Although only patients can tell their doctors what they experience during daily activities, we postulate that their own patients' experience or opinion should be central. Moreover, this is in line with the international trend of the increasing use of patient-reported outcome measurements to monitor results. Second, recurrent traumatic subluxation itself can be a reason for surgical treatment initially. Excluding subluxations postoperatively as failures would be applying a double standard. Although we agree with Harris et al.1Harris J.D. Gupta A.K. Mall N.A. et al.Long-term outcomes after Bankart shoulder stabilization.Arthroscopy. 2013; 29: 920-933Abstract Full Text Full Text PDF PubMed Scopus (201) Google Scholar that, ideally, both real dislocations and subluxations or positive apprehensions should be noted separately, we argue that defining only fully dislocated shoulders as failures is an underestimation of the effect of our surgical treatment. We emphasize that keeping patients' opinion central and being unambiguous in indication and outcome, it is justified to include both redislocations and subluxations as failures in future studies. Long-Term Outcomes After Bankart Shoulder StabilizationArthroscopyVol. 29Issue 5PreviewThe purposes of this study were (1) to analyze long-term outcomes in patients who have undergone open or arthroscopic Bankart repair and (2) to evaluate study methodologic quality through validated tools. Full-Text PDF Authors' ReplyArthroscopyVol. 29Issue 10PreviewWe thank Drs. van der Linde, van Kampen, and Willems for their interest and kind words regarding our article and appreciate their comments. They recognize a challenging postoperative evaluation of shoulder stability and recommend consideration of subluxations as failures based on sound argument. Both pre- and postoperatively, the assessment of shoulder stability exhibits a wide spectrum from positional apprehension to frank dislocation requiring manual reduction. In between, there is significant variation in the patient's reporting of “instability.” Since the primary purpose of surgery for instability is to gain stability, the subjective feeling of one's “shoulder popping out” after surgery is largely a “failure.” In fact, even without dislocation, this may lead a patient to undergo revision stabilization. Full-Text PDF
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2102986376