TY - JOUR
T1 - The Glenoid Track Paradigm Does Not Reliably Affect Military Surgeons’ Approach to Managing Shoulder Instability
AU - Cognetti, Daniel J.
AU - Tenan, Matthew S.
AU - Dickens, Jonathan F.
AU - Patzkowski, Jeanne C.
AU - Cote, Mark P.
AU - Sansone, Mikael
AU - Sheean, Andrew J.
N1 - Funding Information:
The authors report the following potential conflicts of interest or sources of funding: The MOTION (Military Orthopaedics Tracking Injuries and Outcomes Network) research study was funded through the Congressionally Directed Medical Research Program (award No. W81XWH-14-DMRCP-CRI-IRA-MTI; principal investigator [PI]: J.F.D.), the Defense Health Program Work Unit (No. 604110HP.3740.001.A1269 (PI: J.F.D.), and the Uniformed Services University of the Health Sciences (grant No. HU0001-15-2-0028; PI: Matthew Bradley). D.J.C. is an editorial board member of Arthroscopy and American Academy of Orthopaedic Surgeons Resident Assembly. J.F.D. receives grant support from Congressionally Directed Medical Research Program (award No. W81XWH-14-DMRCP-CRI-IRA-MTI), Defense Health Program Work Unit (No. 604110HP.3740.001.A1269), and Uniformed Services University of the Health Sciences (grant No. HU0001-15-2-0028); receives personal fees from Arthroscopy, outside the submitted work; is as editorial board member of Arthroscopy; and is a board member of Society of Military Orthopedic Surgeons, American Orthopedic Society for Sports Medicine, and Arthroscopy Association of North America . J.C.P. is an editorial board member of Arthroscopy. M.P.C. receives personal fees from Arthroscopy, outside the submitted work. A.J.S. receives personal fees from Arthroscopy and grant support from Embody, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material .
Funding Information:
The authors report the following potential conflicts of interest or sources of funding: The MOTION (Military Orthopaedics Tracking Injuries and Outcomes Network) research study was funded through the Congressionally Directed Medical Research Program (award No. W81XWH-14-DMRCP-CRI-IRA-MTI; principal investigator [PI]: J.F.D.), the Defense Health Program Work Unit (No. 604110HP.3740.001.A1269 (PI: J.F.D.), and the Uniformed Services University of the Health Sciences (grant No. HU0001-15-2-0028; PI: Matthew Bradley). D.J.C. is an editorial board member of Arthroscopy and American Academy of Orthopaedic Surgeons Resident Assembly. J.F.D. receives grant support from Congressionally Directed Medical Research Program (award No. W81XWH-14-DMRCP-CRI-IRA-MTI), Defense Health Program Work Unit (No. 604110HP.3740.001.A1269), and Uniformed Services University of the Health Sciences (grant No. HU0001-15-2-0028); receives personal fees from Arthroscopy, outside the submitted work; is as editorial board member of Arthroscopy; and is a board member of Society of Military Orthopedic Surgeons, American Orthopedic Society for Sports Medicine, and Arthroscopy Association of North America. J.C.P. is an editorial board member of Arthroscopy. M.P.C. receives personal fees from Arthroscopy, outside the submitted work. A.J.S. receives personal fees from Arthroscopy and grant support from Embody, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Publisher Copyright:
© 2023
PY - 2023/4
Y1 - 2023/4
N2 - Purpose: To report the frequencies of surgical stabilization procedures performed by military shoulder surgeons and to use decision tree analysis to describe how bipolar bone loss affects surgeons’ decision to perform arthroscopic versus open stabilization procedures. Methods: The Military Orthopaedics Tracking Injuries and Outcomes Network (MOTION) database was queried for anterior shoulder stabilization procedures from 2016 to 2021. A nonparametric decision tree analysis was used to generate a framework for classifying surgeon decision making based on specified injury characteristics (labral tear location, glenoid bone loss [GBL], Hill-Sachs lesion [HSL] size, and on-track vs off-track HSL). Results: A total of 525 procedures were included in the final analysis, with a mean patient age of 25.9 ± 7.2 years and a mean GBL percentage of 3.6% ± 6.8%. HSLs were described based on size as absent (n = 354), mild (n = 129), moderate (n = 40), and severe (n = 2) and as on-track versus off-track in 223 cases, with 17% (n = 38) characterized as off-track. Arthroscopic labral repair (n = 428, 82%) was the most common procedure, whereas open repair (n = 10, 1.9%) and glenoid augmentation (n = 44, 8.4%) were performed infrequently. Decision tree analysis identified a GBL threshold of 17% or greater that resulted in an 89% probability of glenoid augmentation. Shoulders with GBL less than 17% combined with a mild or absent HSL had a 95% probability of an isolated arthroscopic labral repair, whereas a moderate or severe HSL resulted in a 79% probability of arthroscopic repair with remplissage. The presence of an off-track HSL did not contribute to the decision-making process as defined by the algorithm and data available. Conclusions: Among military shoulder surgeons, GBL of 17% or greater is predictive of a glenoid augmentation procedure whereas HSL size is predictive of remplissage for GBL less than 17%. However, the on-track/off-track paradigm does not appear to affect military surgeons’ decision making. Level of Evidence: Level III, retrospective cohort study.
AB - Purpose: To report the frequencies of surgical stabilization procedures performed by military shoulder surgeons and to use decision tree analysis to describe how bipolar bone loss affects surgeons’ decision to perform arthroscopic versus open stabilization procedures. Methods: The Military Orthopaedics Tracking Injuries and Outcomes Network (MOTION) database was queried for anterior shoulder stabilization procedures from 2016 to 2021. A nonparametric decision tree analysis was used to generate a framework for classifying surgeon decision making based on specified injury characteristics (labral tear location, glenoid bone loss [GBL], Hill-Sachs lesion [HSL] size, and on-track vs off-track HSL). Results: A total of 525 procedures were included in the final analysis, with a mean patient age of 25.9 ± 7.2 years and a mean GBL percentage of 3.6% ± 6.8%. HSLs were described based on size as absent (n = 354), mild (n = 129), moderate (n = 40), and severe (n = 2) and as on-track versus off-track in 223 cases, with 17% (n = 38) characterized as off-track. Arthroscopic labral repair (n = 428, 82%) was the most common procedure, whereas open repair (n = 10, 1.9%) and glenoid augmentation (n = 44, 8.4%) were performed infrequently. Decision tree analysis identified a GBL threshold of 17% or greater that resulted in an 89% probability of glenoid augmentation. Shoulders with GBL less than 17% combined with a mild or absent HSL had a 95% probability of an isolated arthroscopic labral repair, whereas a moderate or severe HSL resulted in a 79% probability of arthroscopic repair with remplissage. The presence of an off-track HSL did not contribute to the decision-making process as defined by the algorithm and data available. Conclusions: Among military shoulder surgeons, GBL of 17% or greater is predictive of a glenoid augmentation procedure whereas HSL size is predictive of remplissage for GBL less than 17%. However, the on-track/off-track paradigm does not appear to affect military surgeons’ decision making. Level of Evidence: Level III, retrospective cohort study.
UR - http://www.scopus.com/inward/record.url?scp=85148746143&partnerID=8YFLogxK
U2 - 10.1016/j.asmr.2023.01.007
DO - 10.1016/j.asmr.2023.01.007
M3 - Article
AN - SCOPUS:85148746143
SN - 2666-061X
VL - 5
SP - e403-e409
JO - Arthroscopy, Sports Medicine, and Rehabilitation
JF - Arthroscopy, Sports Medicine, and Rehabilitation
IS - 2
ER -