@article{ref1,
title="Significant changes in the diagnosis, injury severity and treatment for anterior  shoulder instability over time in a U.S. population",
journal="Arthroscopy, sports medicine, and rehabilitation",
year="2020",
author="Leland, Devin P. and Parkes, Chad W. and Bernard, Christopher D. and Krych, Aaron J. and Dahm, Diane L. and Tokish, John M. and Camp, Christopher L.",
volume="2",
number="6",
pages="e761-e769",
abstract="PURPOSE: To report the annual incidence of anterior shoulder instability (ASI)  diagnosis, injury severity, and surgical stabilization in a U.S. population. <br><br>METHODS: An established U.S. geographic database was used to identify patients < 40  years old with diagnoses of ASI from 1994-2016. Medical records were reviewed to  obtain patient demographics, histories, imaging results, and surgical details. Age-  and sex-specific incidence rates were calculated and adjusted to the 2010 U.S. population. Poisson regression was performed to examine trends by timeline, sex and  age. <br><br>RESULTS: The study population consisted of 652 patients with ASI and a mean age  of 21.5 years (range, 3.6-39.5). Comparing 2015-2016 to 1994-1999, we found an  increase in the number of dislocations (from 1.0-1.9; P = 0.016) and total  instability events (from 2.3-3.4; P = 0.041) per patient prior to presentation to a  physician. There was a trend in increased diagnosis of bony Bankart and/or  Hill-Sachs on MRI over time, with these lesions documented in 96% of patients  undergoing MRI in 2015-2018 compared to 52.9% in 1994-1999 (P <.001). The use of  arthroscopic procedures increased and peaked in 2005-2009 (90% of surgical cases  performed). The proportion of open Latarjet procedures increased from 2010-2014  (14%) and 2015-2018 (31%). <br><br>CONCLUSIONS: The age- and sex- adjusted incidence of ASI  diagnosis in a U.S. population from 1994-2016 is comparable to that demonstrated in  Canadian and European populations. This study demonstrates an increasing number of  instability events prior to surgical evaluation, which may correlate with patients'  more commonly presenting with bone loss and requiring more aggressive surgical  treatment or that ASI is being more frequently cared for and documented by  present-day orthopedic surgeons. LEVEL OF EVIDENCE: Level III, cross-sectional  study.<p /> <p>Language: en</p>",
language="en",
issn="2666-061X",
doi="10.1016/j.asmr.2020.06.012",
url="http://dx.doi.org/10.1016/j.asmr.2020.06.012"
}