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Orthop J Sports Med. 2017 Dec 20;5(12):2325967117745511. doi: 10.1177/2325967117745511. eCollection 2017 Dec.

Trends in Shoulder Stabilization Techniques Used in the United States Based on a Large Private-Payer Database.

Author information

1
IU Health Orthopedics & Sports Medicine, Indianapolis, Indiana, USA.
2
University of Colorado, Denver, Colorado, USA.
3
Rush University Medical Center, Chicago, Illinois, USA.
4
Shriners Hospital for Children, Sacramento, California, USA.

Abstract

Background:

Arthroscopic stabilization is the most broadly used surgical procedure in the United States for management of recurrent shoulder instability. Latarjet coracoid transfer has been considered a salvage surgical procedure for failed arthroscopic repairs or cases of significant glenoid bone loss; however, with recent literature suggesting reduced risk of recurrent instability with Latarjet, several surgeons have advocated its broader utilization as a primary operation for treatment of shoulder instability.

Purpose:

To determine trends in shoulder stabilization techniques used in the United States.

Study Design:

Cross-sectional study.

Methods:

A retrospective analysis of a publicly available national insurance database was performed to identify shoulder stabilization procedures performed over 9 years (2007-2015). The following Current Procedural Terminology codes were searched: 29806 (arthroscopic stabilization), 23455 (open capsulolabral repair), 23466 (open capsular shift), 23462 (Latarjet coracoid transfer), and 23460 (open anterior capsulorrhaphy with other bone block augmentation). Outcomes of interest included (1) trends in the use of each technique throughout the study interval, (2) age and sex distributions of patients undergoing each technique, and (3) regional predilections for the use of each technique.

Results:

Arthroscopic stabilization was the most broadly used shoulder stabilization procedure in the database (87%), followed by open Bankart (7%), Latarjet (3.2%), open capsular shift (2.6%), and alternative bone block procedure (0.8%). Throughout the study period, the incidence of arthroscopic stabilization and Latarjet increased (8% and 15% per year, respectively); the incidence of open capsular shift remained relatively constant; and the incidence of open Bankart decreased (9% per year). Arthroscopic stabilization, open Bankart, and Latarjet each had similar sex-based distributions (roughly 70% male), while open capsular shift and alternative bone block were relatively more common in females (54% and 50% male, respectively). The incidence of arthroscopic stabilization and Latarjet were greatest in the South and lowest in the Northeast.

Conclusion:

Arthroscopic stabilization remains the most commonly utilized stabilization technique in the United States. The use of the Latarjet procedure is steadily increasing and now rivals open Bankart stabilization among the most commonly used open stabilization techniques.

KEYWORDS:

Latarjet; dislocation; shoulder; shoulder instability; shoulder stabilization

Conflict of interest statement

One or more of the authors declared the following potential conflicts of interest or source of funding: B.R.B. receives research support from Arthrex, ConMed Linvatec, DJ Orthopaedics, Ossur, Smith & Nephew, and Tornier and receives publishing royalties from SLACK Inc. N.N.V. receives research support from Arthrex, Arthrosurface, DJ Orthopaedics, Ossur, Smith & Nephew, Athletico, ConMed Linvatec, Miomed, and Mitek; receives publishing royalties from Arthroscopy and Vindico Medical-Orthopedics Hyperguide; has stock/stock options in Cymedica, Minivasive, and Omeros; is a paid consultant for Minivasive, Orthospace, and Smith & Nephew; and receives royalties from Smith & Nephew. A.A.R. receives royalties from Arthrex; is a paid consultant for Arthrex; is a paid speaker for Arthrex; receives research support from Arthrex, DJO Surgical, Ossur, and Smith & Nephew; and receives publishing royalties from Saunders/Mosby-Elsevier and SLACK Inc.

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