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Association Between Excessive Joint Laxity and a Wider Hill-Sachs Lesion in Anterior Shoulder Instability

 Joon-Ryul Lim  ;  Hyung-Min Lee  ;  Tae-Hwan Yoon  ;  Hwan-Mo Lee  ;  Yong-Min Chun 
 AMERICAN JOURNAL OF SPORTS MEDICINE, Vol.49(14) : 3981-3987, 2021-12 
Journal Title
Issue Date
Arthroscopy ; Bankart Lesions* ; Cohort Studies ; Humans ; Joint Instability* / surgery ; Recurrence ; Shoulder ; Shoulder Dislocation* / diagnostic imaging ; Shoulder Dislocation* / surgery ; Shoulder Joint* / diagnostic imaging ; Shoulder Joint* / surgery
Bankart repair ; anterior shoulder instability ; excessive joint laxity
Background: Excessive general joint laxity, a negative prognostic factor in joint instability, has not been studied to determine its relationship with bipolar bone loss in anterior shoulder instability.

Purpose/hypothesis: This study aimed to investigate the characteristics of bipolar bone defects in the presence of excessive joint laxity and the clinical outcomes based on the on-track/off-track theory. We hypothesized that (1) patients with excessive joint laxity might have less significant bipolar bone defects compared with those without excessive joint laxity and (2) no significant difference would be found in the clinical outcomes, including recurrence rate.

Study design: Cohort study; Level of evidence, 3.

Methods: This study included 81 patients who had undergone arthroscopic Bankart repair, with (group L; n = 33) or without (group N; n = 48) excessive joint laxity. The presence of excessive joint laxity was defined as a score of ≥4 using Beighton and Horan criteria preoperatively. Bipolar bone lesions were assessed using preoperative 3-dimensional computed tomography. Additional remplissage was performed for cases with off-track or positive engagement test in borderline on-track lesions. The functional outcomes at the 2-year follow-up were assessed using the recurrence rate, Subjective Shoulder Value, Rowe score, University of California Los Angeles shoulder score, active range of motion, and the sports/recreation activity level.

Results: No significant difference was found in the glenoid bone defect between groups (14.1%, group L; 14.4%, group N). Off-track lesions were identified in 39.4% (13/33) of group L and 14.6% (7/48) of group N (P = .011). The mean Hill-Sachs interval to glenoid track ratio was 83.1% in group L and 75.2% in group N (P = .021). Additional remplissage procedures were more frequently performed in group L (48.5%; 16/33) than in group N (16.7%; 8/48) (P = .002). However, no significant difference was observed in the shoulder functional scores and recurrence rates between the groups.

Conclusion: Patients with anterior shoulder instability and excessive joint laxity had significantly wider Hill-Sachs lesions and more off-track lesions than did those with normal joint laxity despite the lack of a significant difference in the glenoid bone defect. However, these differences in the Hill-Sachs lesion were not related to differences in the functional outcomes between the groups.
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1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Yoon, Tae Hwan(윤태환) ORCID logo https://orcid.org/0000-0002-2859-5240
Lee, Hwan Mo(이환모) ORCID logo https://orcid.org/0000-0002-5405-3832
Lim, Joon Ryul(임준열) ORCID logo https://orcid.org/0000-0002-0123-7136
Chun, Yong Min(천용민) ORCID logo https://orcid.org/0000-0002-8147-6136
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