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Trends in Surgical Stabilization of Glenohumeral Instability in the United States from 2009 to 2018: Rise of the Latarjet and Fall of the Open Bankart
Adil Shahzad Ahmed, M.D.1, Alex Dawes, BS2, John T Hurt, BS3, Roy Toston, BS4, Michael Gottschalk, MD5 and Eric R. Wagner, MD3, (1)University of South Florida, Tampa, FL, (2)Emory University School of Medicine, Atlanta, GA, (3)Emory University, Atlanta, GA, (4)Emory University School Medicine, Atlanta, GA, (5)Orthopedic Surgery, Emory School of Medicine, Atlanta, GA

INTRODUCTION: As the most commonly dislocated joint in the body, shoulder instability is a common pathology treated by orthopaedic surgeons. Recent innovations have improved the ability to treat recurrent shoulder instability via arthroscopic Bankart procedures or open bone block procedures, such as the Latarjet. Given the paucity of studies analyzing temporal trends in surgical management of shoulder instability, this study aimed to assess trends in treatment of anterior, posterior, and multidirectional shoulder instability over a 10-year period.
METHODS: Using the Truven Marketscan database, all patients who underwent shoulder instability surgery from 2009 to 2018 were identified via common procedural terminology codes for open Bankart, anterior bone block, Latarjet, posterior bone block, multidirectional capsular shift, and arthroscopic Bankart procedures. Database sample weights were utilized to calculate national estimates. The United States Census Bureau population data were utilized for calculating incidence.
RESULTS: There were an estimated 446,072 shoulder instability cases from 2009 to 2018. Procedure incidence (per 100,000) remained constant, from 14.8 in 2009 to 14.5 in 2018. Arthroscopic Bankart had the highest incidence throughout the study period, accounting for 89% of all procedures in 2009 and 93% in 2018. There was a decrease in utilization of open Bankart by 65% from 2009 to 2018, while the Latarjet procedure increased by 250%. Patient demographics did not change over the study period, while males aged 18 to 25 were the dominant demographic to undergo an anterior instability procedure. There were no regional differences observed in the study period.
CONCLUSION: Arthroscopic Bankart was the most common shoulder instability procedure in the US. From 2009 to 2018; utilization of open Bankart procedures declined while open Latarjet procedures increased. These estimates will hopefully provide enhanced understanding of the evolution of surgical treatment of shoulder instability within the US and foster studies into the appropriate indications and advancements in surgical techniques.


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