Abstract
Objectives:
Advances in surgical techniques have improved the ability to addressrecurrent glenohumeral instability via arthroscopic capsulolabral repair and bonerestoring procedures such as Latarjet. Given the paucity of studies analyzing temporaltrends in surgical management of glenohumeral instability, the purpose of this studywas to assess trends in treatment of anterior, posterior, and multidirectional instabilityover a 10-year period and model projections to 2030.
Methods:
Using IBM Watson Marketscan national database, all patients thatunderwent glenohumeral instability procedures from 2009 to 2018 were identified.Procedures were identified using common procedural terminology (CPT) codes foropen Bankart Repair, Latarjet, anterior bone block, posterior bone block,multidirectional capsular shift, and arthroscopic Bankart procedures. Sample weightsprovided by the database were utilized to calculate national estimates. The UnitedStates (U.S.) Census Bureau annual population data were utilized for calculatingincidence. Future projections to 2030 were modeled using Poisson and linearregression.
Results:
There were an estimated 446,072 glenohumeral instability cases from 2009-2018. Per capita (per 100,000) incidence remained constant, from 14.8 in 2009 to 14.5in 2018. Arthroscopic Bankart comprised the highest number of procedures throughoutthe study period, accounting for 89% of all procedures in 2009 and 93% in 2018. OpenBankart procedures decreased by 65% from 2009 to 2018, while there was a 250%increase in Latarjet procedures over the same period. Patient demographics did notchange over the study period, and males aged 18-25 comprised the largestdemographic group undergoing anterior instability procedures. Multidirectionalinstability procedures exhibited the least pronounced gender differences. Futuremodeling from 2018-2030 projected continued steady rise in arthroscopic Bankart(40,000-49,000 case/yr), rapid growth in Latarjet (1370-4300 cases/yr), and continueddecline in open Bankart (1000-250 cases/yr) procedures.
Conclusions:
Arthroscopic Bankart continues to be the most common glenohumeralinstability procedure in the U.S. From 2009 to 2018, incidence of open Bankartprocedures declined while Latarjet procedures markedly increased. Future projectionsto 2030 mirrored these findings. These data may provide an enhanced understandingof the evolution of surgical treatment of glenohumeral instability within the U.S. layingthe foundation for continued prospective studies into the appropriate indications andadvancements in surgical techniques.
