title: Increasing preoperative dislocations and total time of dislocation affect surgical management of anterior shoulder instability.
abstract: OBJECTIVE
  Our purpose was to determine the relationship between number of preoperative shoulder dislocations and total dislocation time and the need to perform bone deficiency procedures at the time of primary anterior instability surgery. Our hypothesis was that need for bone deficiency procedures would increase with the total number and hours of dislocation.
  
  
  METHODS
  A retrospective review was performed of primary instability surgeries performed by a single surgeon. Patients with <25% glenoid bone loss were treated with an isolated arthroscopic Bankart repair. Those who also had an engaging Hill-Sachs lesion underwent arthroscopic Bankart repair with remplissage. Patients with >25% glenoid bone loss were treated with Latarjet reconstruction. Number of dislocations and total dislocation time were examined for their relationship with the treatment method.
  
  
  RESULTS
  Ten arthroscopic Bankart repairs, 13 arthroscopic Bankart plus remplissage procedures, and 9 Latarjet reconstructions were available for review. Total dislocations (P = 0.012) and total hours of dislocation (P = 0.019) increased from the Bankart, to the remplissage, to the Latarjet groups. Patients with a total dislocation time of 5 h or more were more likely to require a Latarjet reconstruction (P = 0.039). Patients with only 1 preoperative dislocation were treated with an isolated Bankart repair in 64% (7 of 11) of cases, whereas those with 2 or more dislocations required a bone loss procedure in 86% (18 of 21) of cases (P = 0.013).
  
  
  CONCLUSIONS
  Increasing number of dislocations and total dislocation time are associated with the development of glenoid and humeral head bony lesions that alter surgical management of anterior shoulder instability. The necessity for the addition of a remplissage to an arthroscopic Bankart repair or the use of a Latarjet reconstruction increases with only 1 recurrent dislocation.
  
  
  METHODS
  Level III, retrospective comparative study.
authors.affiliation: Southern Oregon Orthopedics, Medford, Portland, Oregon, USA ; Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Denard
authors.affiliation: The San Antonio Orthopedic Group, San Antonio, Texas, USA.
authors.forename: Xuesong
authors.initials: X
authors.lastname: Dai
authors.affiliation: The San Antonio Orthopedic Group, San Antonio, Texas, USA.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Burkhart
keywords: Bankart; Latarjet; remplissage; shoulder dislocation