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Surgical treatment for recurrent shoulder instability: factors influencing surgeon decision making.

Publication ,  Journal Article
Lau, BC; Hutyra, CA; Gonzalez, JM; Mather, RC; Owens, BD; Levine, WN; Garrigues, GE; Kelly, JD; Kovacevic, D; Abrams, JS; Cuomo, F; Kaar, S ...
Published in: J Shoulder Elbow Surg
March 2021

BACKGROUND: The optimal surgical approach for recurrent anterior shoulder instability remains controversial, particularly in the face of glenoid and/or humeral bone loss. The purpose of this study was to use a contingent-behavior questionnaire (CBQ) to determine which factors drive surgeons to perform bony procedures over soft tissue procedures to address recurrent anterior shoulder instability. METHODS: A CBQ survey presented each respondent with 32 clinical vignettes of recurrent shoulder instability that contained 8 patient factors. The factors included (1) age, (2) sex, (3) hand dominance, (4) number of previous dislocations, (5) activity level, (6) generalized laxity, (7) glenoid bone loss, and (8) glenoid track. The survey was distributed to fellowship-trained surgeons in shoulder/elbow or sports medicine. Respondents were asked to recommend either a soft tissue or bone-based procedure, then specifically recommend a type of procedure. Responses were analyzed using a multinomial-logit regression model that quantified the relative importance of the patient characteristics in choosing bony procedures. RESULTS: Seventy orthopedic surgeons completed the survey, 33 were shoulder/elbow fellowship trained and 37 were sports medicine fellowship trained; 52% were in clinical practice ≥10 years and 48% <10 years; and 95% reported that the shoulder surgery made up at least 25% of their practice. There were 53% from private practice, 33% from academic medicine, and 14% in government settings. Amount of glenoid bone loss was the single most important factor driving surgeons to perform bony procedures over soft tissue procedures, followed by the patient age (19-25 years) and the patient activity level. The number of prior dislocations and glenoid track status did not have a strong influence on respondents' decision making. Twenty-one percent glenoid bone loss was the threshold of bone loss that influenced decision toward a bony procedure. If surgeons performed 10 or more open procedures per year, they were more likely to perform a bony procedure. CONCLUSION: The factors that drove surgeons to choose bony procedures were the amount of glenoid bone loss with the threshold at 21%, patient age, and their activity demands. Surprisingly, glenoid track status and the number of previous dislocations did not strongly influence surgical treatment decisions. Ten open shoulder procedures a year seems to provide a level of comfort to recommend bony treatment for shoulder instability.

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Published In

J Shoulder Elbow Surg

DOI

EISSN

1532-6500

Publication Date

March 2021

Volume

30

Issue

3

Start / End Page

e85 / e102

Location

United States

Related Subject Headings

  • Young Adult
  • Surgeons
  • Shoulder Joint
  • Shoulder Dislocation
  • Shoulder
  • Orthopedics
  • Joint Instability
  • Humans
  • Decision Making
  • Adult
 

Citation

APA
Chicago
ICMJE
MLA
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Lau, B. C., Hutyra, C. A., Gonzalez, J. M., Mather, R. C., Owens, B. D., Levine, W. N., … Riboh, J. C. (2021). Surgical treatment for recurrent shoulder instability: factors influencing surgeon decision making. J Shoulder Elbow Surg, 30(3), e85–e102. https://doi.org/10.1016/j.jse.2020.07.003
Lau, Brian C., Carolyn A. Hutyra, Juan Marcos Gonzalez, Richard C. Mather, Brett D. Owens, William N. Levine, Grant E. Garrigues, et al. “Surgical treatment for recurrent shoulder instability: factors influencing surgeon decision making.J Shoulder Elbow Surg 30, no. 3 (March 2021): e85–102. https://doi.org/10.1016/j.jse.2020.07.003.
Lau BC, Hutyra CA, Gonzalez JM, Mather RC, Owens BD, Levine WN, et al. Surgical treatment for recurrent shoulder instability: factors influencing surgeon decision making. J Shoulder Elbow Surg. 2021 Mar;30(3):e85–102.
Lau, Brian C., et al. “Surgical treatment for recurrent shoulder instability: factors influencing surgeon decision making.J Shoulder Elbow Surg, vol. 30, no. 3, Mar. 2021, pp. e85–102. Pubmed, doi:10.1016/j.jse.2020.07.003.
Lau BC, Hutyra CA, Gonzalez JM, Mather RC, Owens BD, Levine WN, Garrigues GE, Kelly JD, Kovacevic D, Abrams JS, Cuomo F, McMahon PJ, Kaar S, Dines JS, Miniaci A, Nagda S, Braman JP, Harrison AK, MacDonald P, Riboh JC. Surgical treatment for recurrent shoulder instability: factors influencing surgeon decision making. J Shoulder Elbow Surg. 2021 Mar;30(3):e85–e102.
Journal cover image

Published In

J Shoulder Elbow Surg

DOI

EISSN

1532-6500

Publication Date

March 2021

Volume

30

Issue

3

Start / End Page

e85 / e102

Location

United States

Related Subject Headings

  • Young Adult
  • Surgeons
  • Shoulder Joint
  • Shoulder Dislocation
  • Shoulder
  • Orthopedics
  • Joint Instability
  • Humans
  • Decision Making
  • Adult