Age, labral lesion type, and lesion location are key risk factors for recurrence following arthroscopic labrum repair in patients with anterior shoulder instability: a minimum 10-year follow-up study

Background: A limited number of studies have reported the long-term effects of the labral lesion types and locations on final instability status after arthroscopic labrum repair. The present study aims to evaluate the outcomes after arthroscopic labrum repair in patients with anterior shoulder instability and to identify recurrence risk factors at a minimum 10-year follow-up. Methods: A retrospective review was performed to identify patients who underwent arthroscopic labrum repair between 2006 and 2014 by a single surgeon, and all eligible patients were invited to participate in a clinical examination. Patient characteristics and intraoperative parameters were recorded. After a minimum follow-up of 10 years, patient-reported outcomes including the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score and the Western Ontario Shoulder Instability Index (WOSI) score were assessed. The current instability status was classified into 3 groups: stable, apprehensive, and redislocated. To determine the potential risk factors and their hazard ratios (HRs), regression analysis was performed. Results: A total of 133 patients were evaluated. The mean age of the patients at surgery was 27.7 ± 7.9 years. The mean follow-up period was 12.3 ± 2.1 years. The mean outcome scores at the last follow-up were as follows: ASES score, 83.3 ± 12.3; WOSI score, 81.2 ± 13.8. At the final follow-up, 22 patients (16.5%) reported a subjective apprehension without redislocation and 16 patients (12.0%) reported redislocation after arthroscopic labrum repair. The mean redislocation time was 3.8 ± 3.1 years (range, 1-10 years). Regression analysis demonstrated that age <20 years at the time of surgery (HR = 3.53, P = .012), presence of ALPSA (anterior labroligamentous periosteal sleeve avulsion) lesion (HR = 3.11, P = .028), and labral lesion from the 3-5-o'clock position (HR = 8.65, P = .041) were significantly associated with redislocation. Conclusion: The current study demonstrated that age (<20 years), presence of ALPSA lesion, and labral lesion location (from 3 to 5 o'clock) were significant risk factors for recurrence following arthroscopic labrum repair in patients with anterior shoulder instability in the long term. These factors should be considered when counseling patients on postoperative expectations and the risk of redislocation.