Risk Factors for Recurrent Instability After Arthroscopic Bankart Repair in Pediatric and Adolescent Patients: A Systematic Review

Abstract

Background: While risk factors for recurrent instability (RI) after arthroscopic Bankart repair (ABR) for anterior glenohumeral instability (aGHI) have been well established in adult populations, there is much less evidence in pediatric and adolescent patients, despite being the most affected epidemiologic subpopulation.

Purpose: To identify the clinical, demographic, radiologic, and operative risk factors for RI after ABR for aGHI in pediatric and adolescent patients.

Study design: Systematic review; Level of evidence, 4.

Methods: This systematic review was performed according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Three databases (PubMed, Embase, and Ovid [MEDLINE]) were searched from data inception to July 5, 2023, using the terms "pediatric,""shoulder instability," and "Bankart repair," allowing data on patients with age up to 19 years. The Methodological Index for Non-randomized Studies tool was used to assess the quality of included studies.

Results: Eleven studies met the criteria, with 767 patients (770 shoulders) with a mean age of 16.4 years (range, 12-19; 18% female). The pooled RI rate was 28%, and the revision aGHI surgery rate was 20%. The following risk factors were identified for RI after ABR, in descending order of frequency of identification, in terms of number of studies: younger age and greater glenoid bone loss, as well as the presence and/or greater size of a Hill-Sachs lesion (HSL) (2 studies each), followed by off-track HSL, >1 dislocation before index surgery, overhead and/or contact sports participation, larger anterior labral tear size, loss of glenoid retroversion, greater number of anchors used, lower postoperative patient-reported outcome scores (PROs), nonunion after bony Bankart repair, and absence of concomitant remplissage (1 study each).

Conclusion: In pediatric and adolescent patients with aGHI, the most common risk factors identified for RI after ABR were younger age, greater glenoid bone loss, and the presence and greater size of an HSL. Other risk factors included >1 dislocation before index surgery, participation in overhead and/or contact sports, larger anterior labral tear size, loss of glenoid retroversion, greater number of anchors used, lower postoperative PROs, nonunion after bony Bankart repair, and absence of concomitant remplissage.

Keywords: Bankart; adolescent; glenohumeral instability; pediatric; risk factors; shoulder.