1
|
Gupta PK, Khanna V, Agrawal N, Gupta P. Minimum 10-year follow-up outcomes of arthroscopic Bankart’s repair with metallic anchors: Reliable results with low redislocation rates. World J Methodol 2024; 14:90280. [DOI: 10.5662/wjm.v14.i2.90280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/23/2024] [Accepted: 03/14/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND With stiff competition from alternative albeit more expensive counterparts, it has become important to establish the applicability of metallic anchors for shoulder instability in the modern era. This can be accomplished, in part, by analysing long-term outcomes.
AIM To analyse minimum 10-year outcomes from 30 patients following arthroscopic anterior stabilisation using metallic anchors.
METHODS Prospectively collected data from arthroscopic Bankart repairs performed using metal anchors during 2007P-2010 were retrospectively analysed in this single-surgeon study. Comprehensive data collection included historical and clinical findings, dislocation details, operative specifics, and follow-up radiological and clinical findings including shoulder scores. The primary outcomes were patient-reported scores (Constant, American Shoulder and Elbow Surgeons [ASES], and Rowe scores) and pain and instability on a visual analogue scale (VAS).
RESULTS A 3% recurrence rate of dislocation was noted at the final follow-up. Total constant scores at 10 years postoperatively measured between 76 and 100 (mean 89) were significantly better than preoperative scores (mean 62.7). Congruous improvements were also noted in the Rowe and ASES scores and VAS at the 10-year review.
CONCLUSION Reliable long-term outcomes with metallic anchors in surgery for shoulder instability can be expected. Our results provide additional evidence of their continued, cost-effective presence in the modern scenario.
Collapse
Affiliation(s)
- Prateek Kumar Gupta
- Department of Sports Medicine, Sir Ganga Ram Hospital, New Delhi 110060, India
| | - Vishesh Khanna
- Department of Trauma and Orthopdaedics, Wirral University Teaching Hospital NHS Foundation Trust, Wirral CH49 5PE, United Kingdom
| | - Nikunj Agrawal
- Sports Medicine, Sir Ganga Ram Hospital, Sir Ganga Ram Hospital Marg, Rajinder Nagar, New Delhi 110060, India
| | - Pratyaksh Gupta
- Department of Orthopaedics, Sir Ganga Ram Hospital, New Delhi 110060, India
| |
Collapse
|
2
|
Cucchi D, Walter SG, Baumgartner T, Menon A, Egger L, Randelli PS, Surges R, Wirtz DC, Friedrich MJ. Poor midterm clinical outcomes and a high percentage of unsatisfying results are reported after seizure-related shoulder injuries, especially after posterior proximal humerus fracture-dislocations. J Shoulder Elbow Surg 2024; 33:1340-1351. [PMID: 37879597 DOI: 10.1016/j.jse.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/08/2023] [Accepted: 09/10/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Treating seizure-related shoulder injuries is challenging, and an evidence-based consensus to guide clinicians is lacking. The aim of this prospective single-center observational clinical trial was to evaluate the clinical results of a cohort of patients undergoing treatment of seizure-related shoulder injuries, to categorize them according to the lesion's characteristics, with special focus on patients with proximal humerus fracture-dislocations (PHFDs), and to define groups at risk of obtaining unsatisfactory results. We hypothesized that patients with a PHFD, considered the worst-case scenario among these injuries, would report worse clinical results in terms of the quick Disabilities of the Arm, Shoulder, and Hand questionnaire (qDASH) as compared to the other patients. METHODS Patients referred to a tertiary epilepsy center who have seizure-related shoulder injuries and with a minimum follow-up of 1 year were included. A quality-of-life assessment instrument (EQ-5D-5L), a district-specific patient-reported outcome measure (qDASH), and a pain assessment tool (visual analog scale [VAS]) were used for the clinical outcome evaluation. Subjective satisfaction and fear of new shoulder injuries was also documented. Categorization and subgroup analysis according to the presence and features of selected specific lesions were performed. RESULTS A total of 111 patients were deemed eligible and 83 were available for follow-up (median age 38 years, 30% females), accounting for a total of 107 injured shoulders. After a median follow-up of 3.9 (1.6-8.2) years, overall moderate clinical results were reported. In addition, 34.1% of the patients reported a VAS score ≥35 mm, indicating moderate to severe pain, and 34.1% a qDASH score ≥40 points, indicating severe disability of an upper limb. These percentages rose to, respectively, 45.5% and 48.5% in the subgroup of patients with PHFDs and to 68.8% and 68.8% in patients experiencing posterior PHFD. Overall, 46.9% of the patients considered themselves unsatisfied with the treatment and 62.5% reported a persistent fear of a new shoulder injury. CONCLUSIONS Patients with seizure-related shoulder injuries reported only moderate clinical results at their midterm follow-up. Older age, male sex, and absence or discontinuation of antiepileptic drug (AED) treatment were identified as characterizing features of patients with posterior dislocation episodes. In patients with PHFD, a tendency to worse clinical results was observed, with posterior PHFD patients emerging as a definite subgroup at risk of reporting unsatisfying results after treatment.
Collapse
Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany.
| | - Sebastian Gottfried Walter
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany; Department of Orthopaedics, Trauma Surgery and Plastic-Reconstructive Surgery, University Hospital Cologne, Cologne, Germany
| | | | - Alessandra Menon
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Milan, Italy; Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Dipartimento di Scienze Cliniche e di Comunità, Scuola di Specializzazione in Statistica Sanitaria e Biometria, Università degli Studi di Milano, Milan, Italy
| | - Lisa Egger
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | - Pietro Simone Randelli
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Milan, Italy; Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Universita degli Studi di Milano, Milan, Italy
| | - Rainer Surges
- Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Universita degli Studi di Milano, Milan, Italy
| | | | - Max Julian Friedrich
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| |
Collapse
|
3
|
Jain V, Gupta H, Mehta N, Joshi D, Kataria H. Retrospective Comparative Analysis of Clinical and Functional Outcome After Arthroscopic Bankart Repair using All-Suture Anchor and Metal Anchor. Malays Orthop J 2024; 18:11-18. [PMID: 38638665 PMCID: PMC11023345 DOI: 10.5704/moj.2403.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/19/2023] [Indexed: 04/20/2024] Open
Abstract
Introduction Both knotted all suture anchors and metal anchors are used for arthroscopic Bankart repair. We retrospectively evaluated and compared clinical and functional outcomes after arthroscopic Bankart repair using the knotted all-suture anchors and knotted metal anchors. Materials and methods In a retrospective cohort analysis, patients who underwent arthroscopic Bankart repair without any concomitant additional lesion repair using either all-suture anchors or metal anchors, between January 2015 and May 2018 were identified. Their pre- and post-operative functional and clinical outcomes were compared using Rowe and WOSI scores. The recurrence rate in the two groups was also compared. Results A total of 41 patients in all suture anchors group and 47 in the metal anchors group were identified as per inclusion and exclusion criteria. The demographic profile of both groups was comparable. There was no significant difference in clinical and functional outcome between the two suture anchor groups as per Rowe (pre-operative 40.13+6.51 vs 38.09+6.24 and post-operative 2 years 93.28+7.09 vs 92.55+9.2) and WOSI (pre-operative 943.05+216.64 vs 977.55+165.46 and post-operative 2 years 278.21+227.56 vs 270.94+186.25) scores. There was a significant improvement in both the groups between preoperative and post-operative ROWE and WOSI scores at 6 months and 2 years follow-up as compared to pre-operative scores (p<0.001). Re-dislocation rates were also comparable (4.8% vs 6.3%). Conclusion All-suture anchors showed comparable clinical and functional results as the metal anchors for arthroscopic Bankart repair at two-year follow-up.
Collapse
Affiliation(s)
- V Jain
- Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - H Gupta
- Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - N Mehta
- Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - D Joshi
- Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - H Kataria
- Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| |
Collapse
|
4
|
Huang B, Yang M, Kou Y, Jiang B. Absorbable implants in sport medicine and arthroscopic surgery: A narrative review of recent development. Bioact Mater 2024; 31:272-283. [PMID: 37637087 PMCID: PMC10457691 DOI: 10.1016/j.bioactmat.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/29/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023] Open
Abstract
Over the past two decades, advances in arthroscopic and minimally invasive surgical techniques have led to significant growth in sports medicine surgery. Implants such as suture anchors, interference screws, and endo-buttons are commonly used in these procedures. However, traditional implants made of metal or inert materials are not absorbable, leading to complications that affect treatment outcomes. To address this issue, absorbable materials with excellent mechanical properties, good biocompatibility, and controlled degradation rates have been developed and applied in clinical practice. These materials include absorbable polymers, absorbable bioceramics, and absorbable metals. In this paper, we will provide a comprehensive summary of these absorbable materials from the perspective of clinicians, and discuss their clinical applications and related research in sport medicine.
Collapse
Affiliation(s)
- Boxuan Huang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
| | - Ming Yang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
| | - Yuhui Kou
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
| | - Baoguo Jiang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
- Medical School, Shenzhen University, Shenzhen, 518060, Guangdong, China
- Shenzhen University General Hospital, Shenzhen, 518055, Guangdong, China
| |
Collapse
|
5
|
Knapik DM, Kuhn AW, Ganapathy A, Gibian JT, Yaeger LH, Matava MJ, Smith MV, Brophy RH. Global variations in treatment and outcomes reported for anterior shoulder instability: a systematic review of the literature. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:469-476. [PMID: 37928980 PMCID: PMC10625007 DOI: 10.1016/j.xrrt.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Anterior shoulder instability is a common problem around the world, with a high risk for recurrence following the index dislocation. Surgical stabilization is commonly indicated for persistent instability, particularly in patients at high risk for recurrence, to minimize the risk of further labral injury and glenoid bone loss. However, there is little known about global geographic differences in the surgical management of anterior shoulder instability. As such, the purpose of this study was to evaluate and systematically review regional differences in the surgical treatment of anterior shoulder instability, particularly the indications for and outcomes from bony stabilization procedures compared to soft tissue procedures. Methods A systematic review, in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was performed. Inclusion criteria consisted of level I and II evidence studies evaluating indications, techniques, and outcomes following operative management of anterior shoulder instability published from January 2000 to September 2021. Studies meeting inclusion criteria were grouped into four global regions (Asia, Europe, North America, South America) based on primary study location. Patient demographics, procedural details, patient reported outcomes, and complications (recurrence and reoperation rates) were compared between regions. Results Sixty (n = 60) studies (5480 patients) were identified. Eighty-six percent of all patients were male, with a mean age of 26.7 years. There was no difference in mean patient age, though patients undergoing bony stabilization procedures were older than those undergoing soft-tissue stabilization procedures (P = .0002) in all regions. The proportion of bony versus soft-tissue procedure groups did not differ significantly among regions. The indications for bony stabilization procedures varied significantly. Mean final follow-up was 3.5 years. Recurrent instability was 5.0% and did not vary across regions. However, recurrent instability occurred more frequently following soft-tissue compared to bony stabilization procedures (P = .017). South American studies utilized fewer anchors during soft tissue stabilization (P < .0001) and reported a higher reoperation rate compared to other regions (P = .009). Conclusion There is global variation in the reporting of outcomes following surgery for anterior shoulder instability. The proportion of bony and soft-tissue procedures is similar, irrespective of geographic region. Recurrent instability does not vary by region but occurs more frequently following soft-tissue compared to bony stabilization procedures. There are a number of potential medical and nonmedical factors that may affect global variation in the surgical treatment of anterior shoulder instability.
Collapse
Affiliation(s)
- Derrick M. Knapik
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew W. Kuhn
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Joseph T. Gibian
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Lauren H. Yaeger
- Becker Medical Library, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew J. Matava
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew V. Smith
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert H. Brophy
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
6
|
Anzai A, Utino A, Tosello G, Katayama H, Spir IAZ, Nery MM, Anhesini M, Spir PRN, Otani P, Bernardo WM. Use of absorbable versus nonabsorbable anchors in the treatment of glenohumeral instability. Rev Assoc Med Bras (1992) 2022; 68:982-986. [PMID: 36134823 PMCID: PMC9574994 DOI: 10.1590/1806-9282.2022d688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Adriano Anzai
- Unimed, Center for Evidence-Based Medicine - Presidente Prudente (SP), Brazil
| | - Armelin Utino
- Unimed, Center for Evidence-Based Medicine - Presidente Prudente (SP), Brazil
| | - Giuliano Tosello
- Unimed, Center for Evidence-Based Medicine - Presidente Prudente (SP), Brazil
| | - Haroldo Katayama
- Unimed, Center for Evidence-Based Medicine - Presidente Prudente (SP), Brazil
| | - Ighor A Z Spir
- Unimed, Center for Evidence-Based Medicine - Presidente Prudente (SP), Brazil
| | - Mary Martins Nery
- Unimed, Center for Evidence-Based Medicine - Presidente Prudente (SP), Brazil
| | - Mauricio Anhesini
- Unimed, Center for Evidence-Based Medicine - Presidente Prudente (SP), Brazil
| | - Patricia R N Spir
- Unimed, Center for Evidence-Based Medicine - Presidente Prudente (SP), Brazil
| | - Pericles Otani
- Unimed, Center for Evidence-Based Medicine - Presidente Prudente (SP), Brazil
| | | |
Collapse
|
7
|
Maleitzke T, Reinke P, Agres AN, Alves SA, Akyüz L, Fleckenstein FN, Bichmann A, Ofir R, Perka C, Duda GN, Winkler T. Intramuscular and intratendinous placenta-derived mesenchymal stromal-like cell treatment of a chronic quadriceps tendon rupture. J Cachexia Sarcopenia Muscle 2022; 13:434-442. [PMID: 34985203 PMCID: PMC8818634 DOI: 10.1002/jcsm.12894] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/17/2021] [Accepted: 11/22/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Quadriceps tendon ruptures (QTRs) are rare but debilitating injuries, often associated with chronic metabolic conditions or long-term steroid treatment. While the surgical treatment for acute QTRs is described thoroughly, no common strategy exists for the often frustrating treatment of chronic, reoccurring QTRs. The pro-angiogenic and immunomodulatory properties of placenta-derived adherent mesenchymal stromal-like (PLX-PAD) cells have been described to protect musculoskeletal tissues from inflammation and catabolic cytokine migration, yet little is known about the regenerative potential of PLX-PAD cells in repetitively damaged tendon tissue. CASE We report the case of an 80-year-old male patient with a chronic three-time QTR of his right knee. The quadriceps tendon was reconstructed applying a conventional suture anchor repair procedure combined with a synthetic mesh augmentation and additional intramuscular and intratendineous PLX-PAD cell injections as an individualized treatment approach. No adverse events were reported, and excellent radiological and functional outcomes with a passive range of motion of 0/0/120° knee extension-flexion were observed at the 12 month follow-up. Gait analysis confirmed restoration of joint motion, including gait speed, deficit in step length, and knee extensor muscle strength (pre-surgery: 0.98 m/s, 40 cm, 42.4 ± 12.4 N; 9 months post-surgery: 1.07 m/s, 0 cm, 10.4 ± 18.9 N) as well as hyperextension throughout stance and late swing phases (pre-surgery: -11.2 ± 0.9°; 9 months post-surgery: -2.7 ± 1.6°). Postoperative lymphocyte and cytokine analyses from the patient's peripheral blood serum suggested a systemic short-term immunoregulatory reaction with postoperatively increased interleukin (IL)-6 (pre-surgery: 0.79 pg/mL; day 1: 139.97 pg/mL; day 5: 5.58 pg/mL; 9 months: 1.76 pg/mL) and IL-10 (pre-surgery: 0.9 pg/mL; day 1: 1.21 pg/ mL; day 5: 0.3 pg/mL; 9 months: 0.34 pg/mL) levels that decreased again over time. CONCLUSIONS Herein, we demonstrate a successfully treated chronic QTR with a synergistic surgical and biological reconstructive treatment approach. This local add-on treatment with PLX-PAD cells may be considered in specific cases of chronic QTRs, not susceptible to traditional suture anchor procedures and which exhibit a high risk of treatment failure. Further scientific engagement is warranted to explore underlying immunomodulatory mechanisms of action behind PLX-PAD cell treatment for tendon injuries.
Collapse
Affiliation(s)
- Tazio Maleitzke
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,BIH Charité Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany
| | - Petra Reinke
- Department of Nephrology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alison N Agres
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sónia A Alves
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Levent Akyüz
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Florian N Fleckenstein
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anna Bichmann
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Winkler
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
8
|
Knotless PEEK and double-loaded biodegradable suture anchors ensure comparable clinical outcomes in the arthroscopic treatment of traumatic anterior shoulder instability: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2022; 30:3835-3841. [PMID: 35435470 PMCID: PMC9568484 DOI: 10.1007/s00167-022-06969-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/29/2022] [Indexed: 10/29/2022]
Abstract
PURPOSE To compare the clinical outcome of arthroscopic capsulolabral repair for traumatic anterior shoulder instability with PEEK knotless and knotted biodegradable suture anchors. METHODS Arthroscopic stabilization was performed in 78 patients with recurrent traumatic anterior shoulder instability. They were divided into 2 groups of 39 patients each, according to suture anchors used: knotless PEEK anchors in group 1, and biodegradable anchors in group 2. Exclusion criteria were: instability without dislocation, posterior or multidirectional instability, glenoid bone loss > 20%, off-track lesions, concomitant rotator cuff tears and previous surgery. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) self-administered questionnaire. Secondary outcomes were: Work-DASH, Sport-DASH, Rowe score, recurrent instability and subsequent surgery. The following independent variables were considered: age, gender, dominance, generalized ligamentous hyperlaxity, duration of symptoms, age at first dislocation, number of dislocations, type of work, type of sport, sports activity level, capsule-labral injury pattern, SLAP lesion and number of anchors. Differences between groups for numerical variables were analyzed by use of the Student's t-test or Mann-Whitney U-test. Fisher's exact test was used for analysis of categorical variables. Significance was set at p < 0.05. RESULTS Seven patients (9%) were lost at follow-up, 5 from group 1 and 2 from group 2. Follow-up ranged from 36 to 60 months (median: 44; IQR: 13). Comparison between groups did not show significant differences for each independent variable considered. No differences could be found either for DASH (n.s.) or Rowe (p = n.s.) scores between the two groups. Overall recurrence rate was 7%. Three re-dislocations were reported in group 1 and two in group 2 (n.s.). Only one patient in each group underwent re-operation. CONCLUSIONS The study showed no significant differences in clinical outcomes after arthroscopic treatment of traumatic anterior shoulder instability using PEEK knotless or biodegradable knotted anchors at mid-term follow-up. LEVEL OF EVIDENCE I.
Collapse
|
9
|
Ruiz Ibán MA, Vega Rodriguez R, Díaz Heredia J, Pérez Expósito R, Zarcos Paredes I, Ruiz Díaz R. Arthroscopic Bankart repair with all-suture anchors does not cause important glenoid bone osteolysis: a volumetric CT study of 143 anchors. Knee Surg Sports Traumatol Arthrosc 2021; 29:2152-2158. [PMID: 32754864 DOI: 10.1007/s00167-020-06192-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate with computed tomography (CT) the incidence of anchor-related osteolysis after implantation of two types of all-suture anchors for the management of labral lesions in shoulder instability. METHODS Single-cohort, observational study with 12-month follow-up. Thirty-three participants (27 males/6 females; age 38.3 years [SD 11.3]) with anterior labral lesions in which 143 all-suture anchors (71 Iconix 1.4 mm and 72 Suturefix 1.7 mm) were implanted were evaluated with a CT performed a mean of 15.4 [3.85] months after surgery. The volume of the bone defects was measured in the CT. Every anchor was classified into one of four groups: (1) no bone defect. (2) Partial bone defect (defects smaller than the drill used for anchor placement). (3) Tunnel enlargement (defects larger than the drill volume but smaller than twice that volume). (4) Cystic lesion (defects larger than twice the drill volume). RESULTS No bone defect was identified in 16 anchors (11.2%, [95% CI 6.5-17.5%]). A partial bone defect was found in 84 anchors (58.7% [50.2-66.9%]). Tunnel enlargement was found in 43 anchors (30.11% [22.6-37.6%]). No anchor caused cystic lesions (0% [0-2.5%]). The defect volume was a mean of 27.8 mm3 (SD 18.4 mm3, minimum 0 mm3, maximum 94 mm3). Neither the position in the glenoid nor the type of implant used had a significant effect in the type or size of the defects. CONCLUSION When using all-suture anchors in the glenoid during instability surgery, relevant bone osteolytic defects are rare at 1-year follow-up. Most anchor insertion tunnels will fill completely (11%) or partially (59%) with bone. Tunnel enlargement will develop in 30% of anchors. No cystic defects larger than 0.125 cm3 were observed. There is a low risk that all-suture anchors cause significant osteolytic bone defects in the glenoid. These implants can be used safely. Level of evidence IV.
Collapse
Affiliation(s)
- Miguel Angel Ruiz Ibán
- Investigation Performed at Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain.
| | - Rosa Vega Rodriguez
- Investigation Performed at Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain
| | - Jorge Díaz Heredia
- Investigation Performed at Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain
| | - Roque Pérez Expósito
- Investigation Performed at Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain
| | - Irene Zarcos Paredes
- Investigation Performed at Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain
| | - Raquel Ruiz Díaz
- Investigation Performed at Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain
| |
Collapse
|
10
|
Alkaduhimi H, Connelly JW, van Deurzen DFP, Eygendaal D, van den Bekerom MPJ. High Variability of the Definition of Recurrent Glenohumeral Instability: An Analysis of the Current Literature by a Systematic Review. Arthrosc Sports Med Rehabil 2021; 3:e951-e966. [PMID: 34195665 PMCID: PMC8220632 DOI: 10.1016/j.asmr.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/11/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose To determine the definitions for recurrence used in the literature, assess the consensus in using these definitions, and determine the impact of these definitions on recurrence rates. Methods A literature search was performed in PubMed and EMBASE including studies from 2000 to 2020 reporting on recurrence rates after anterior arthroscopic shoulder instability surgery. Dislocation, apprehension, subluxation and recurrence rates were compared. Results Ninety-one studies were included. In 68% of the eligible studies, recurrence rates are not well defined. Thirty (33%) studies did not report on dislocations, 45 (49%) did not report on subluxations, and 58 (64%) did not report on apprehension. Seventeen different definitions for recurrence of instability, 4 definitions of dislocations, and 8 definitions of subluxation were used. Conclusion Recurrence rates are poorly specified and likely underreported in the literature, hampering comparison with results of other studies. This highlights the need for a consensus on definition of recurrence across shoulder instability studies. We recommend not using the definition recurrence of instability anymore. We endorse defining dislocations as a radiographically confirmed dislocation or a dislocation that is manually reduced, subluxations as the feeling of a dislocation that can be (spontaneously) reduced without the need for a radiographically confirmed dislocation, and a positive apprehension sign as fear of imminent dislocation when placing the arm in abduction and external rotation during physical examination. Reporting on the events resulting in a dislocation or subluxation aids in making an estimation of the severity of instability. Level of Evidence Level IV, systematic review.
Collapse
Affiliation(s)
| | - James W Connelly
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | | | - Denise Eygendaal
- Orthopaedic Department, Amphia Ziekenhuis, Breda, the Netherlands.,Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Michel P J van den Bekerom
- Shoulder and Elbow Unit, Joint Research, Amsterdam, the Netherlands.,Amsterdam University Medical Centres, Amsterdam, the Netherlands
| |
Collapse
|
11
|
Pantekidis I, Malahias MA, Kokkineli S, Brilakis E, Antonogiannakis E. Comparison between all-suture and biocomposite anchors in the arthroscopic treatment of traumatic anterior shoulder instability: A retrospective cohort study. J Orthop 2021; 24:264-270. [PMID: 33867751 DOI: 10.1016/j.jor.2021.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 02/01/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022] Open
Abstract
Purpose Suture anchors have revolutionized arthroscopic surgery, enabling direct soft tissue-to-bone repair. There are many types of anchors still used in arthroscopic shoulder operations. We sought to compare the clinical outcome of all-suture and biocomposite anchors when used in arthroscopic Bankart repair for patients suffering from anterior shoulder instability. Methods A single-center retrospective cohort study of 30 patients (mean age: 26.6 years, SD: 8.8 years, male/female ratio: 5/1, mean follow up: 28 months, SD: 23.8, range: 12-92) with anterior shoulder instability was conducted. Patients were divided into 2 groups based upon the type of suture anchors used for the Bankart repair: group A (14 patients) used only all-suture anchors and group B (16 patients) used only biocomposite anchors. Outcomes reported were postoperative dislocations, positive shoulder apprehension test, self-reported sense of shoulder instability, return to activities of daily living, return to sports, patient satisfaction and complications. Patient reported outcome measures (PROMs) used were the Rowe Score for Instability, Constant Shoulder Score, Walch Duplay Score, The American Shoulder and Elbow Surgeons (ASES) Shoulder Score, Oxford Shoulder Instability Score and external rotation at 90° of arm abduction, external rotation at 0° of arm abduction, forward flexion, abduction, adduction and internal rotation. Results Rates of postoperative shoulder dislocation demonstrated no significant difference between the 2 groups (p > .05). Four postoperative dislocations happened, two in each group (14.3% and 12.5% for all suture only and biocomposite only groups, respectively), with three of them being traumatic. In addition, no significant differences were observed amongst groups regarding shoulder apprehension test (group A: 85.7% vs. group B: 93.8%), sense of shoulder instability (7.1% vs. 6.3%), return to activities of daily living (group A: 85.7% vs. group B: 93.8%), return to sports (group A: 85.7% vs. group B: 87.5%), patient satisfaction (moderate level: group A 21.4% vs. group B 12.5%), and PROMs. Conclusion The short-term failure rate and clinical/functional outcomes of arthroscopic Bankart repair using all-suture anchors is similar to the use of biocompatible anchors. Level of evidence Level III, retrospective cohort study.
Collapse
Affiliation(s)
- Ioannis Pantekidis
- 3rd Orthopaedic Department, HYGEIA Hospital, Erythrou Stavrou 4, Marousi, 15123, Athens, Greece
| | | | - Stefania Kokkineli
- 3rd Orthopaedic Department, HYGEIA Hospital, Erythrou Stavrou 4, Marousi, 15123, Athens, Greece
| | - Emmanouil Brilakis
- 3rd Orthopaedic Department, HYGEIA Hospital, Erythrou Stavrou 4, Marousi, 15123, Athens, Greece
| | | |
Collapse
|
12
|
Chen J, Sharma A, Akoh CC, Kadakia R, Parekh SG. Clinical Safety and Efficacy of a Novel Ultrasound-Assisted Bioabsorbable Suture Anchor in Foot and Ankle Surgeries. Foot Ankle Int 2020; 41:1073-1078. [PMID: 32578440 DOI: 10.1177/1071100720935122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Suture anchors have been used for soft tissue repair in orthopedic surgery for decades. Recently, bioabsorbable suture anchors have increased in popularity and have spurred the introduction of ultrasound-assisted systems. The purpose of our study was to determine the clinical safety and efficacy of a new ultrasound-assisted suture anchor system for foot and ankle procedures. METHODS We retrospectively reviewed 50 cases using the ultrasound-assisted suture anchor with at least 24 months of follow-up. We reviewed demographic data including comorbidities, type of procedure, adverse events, and clinical outcomes using the Foot and Ankle Outcome Score (FAOS) and visual analog scale (VAS) score. We divided complications into minor and major, with major complications requiring revision surgery or leading to long-term morbidity. Our primary outcome was complication rates and our secondary outcome was improvement in clinical scores. RESULTS The most frequent cases using the anchor included lateral ankle ligament reconstruction (n = 19), insertional Achilles repair (n = 15), lateral ligament reconstruction in conjunction with a total ankle arthroplasty (n = 6), and plantar plate repair (n = 3). There were 5 superficial wound infections that resolved with wound care and/or oral antibiotics. There were 3 major complications (6%): a deep wound infection that required an irrigation and debridement, a deep venous thrombosis, and a recurrence of varus deformity in a patient who underwent a total ankle arthroplasty with lateral ligament reconstruction. Only the varus deformity recurrence case could possibly be directly linked to the suture anchor (2% of all cases). VAS scores improved from 6.0 to 1.2 (P < .001) and FAOS improved from 54.7 to 94.2 (P < .001). CONCLUSION This bioabsorbable anchor was a safe device with low failure rates, and it was used for soft tissue repair cases in the foot and ankle with successful clinical outcomes. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
- Jie Chen
- Department of Orthopaedic Surgery, Duke University Medical Center, Chapel Hill, NC, USA
| | - Akhil Sharma
- Duke University Medical Center, Chapel Hill, NC, USA
| | - Craig Chike Akoh
- Department of Orthopaedic Surgery, Duke University Medical Center, Chapel Hill, NC, USA
| | - Rishin Kadakia
- Department of Orthopaedic Surgery, Duke University Medical Center, Chapel Hill, NC, USA
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, Chapel Hill, NC, USA
| |
Collapse
|
13
|
Gül O, Okutan AE, Ayas MS. Arthroscopic glenoid labral lesion repair using all-suture anchor for traumatic anterior shoulder instability: short-term results. J Shoulder Elbow Surg 2019; 28:1991-1997. [PMID: 31101476 DOI: 10.1016/j.jse.2019.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study presents the preliminary clinical results of arthroscopic glenoid labral lesion repair using all-suture anchors in the treatment of recurrent traumatic anterior shoulder instability. METHODS Seventy patients who underwent arthroscopic shoulder stabilization for traumatic anterior shoulder instability were evaluated in this single center-based retrospective study. Patients with a glenoid defect greater than 20%, off-track engaging Hills-Sachs lesion, multidirectional instability, and generalized ligamentous laxity were excluded. The 62 included patients treated with arthroscopic glenoid labral lesion repair using all-suture anchors were evaluated. The Rowe and Constant scores were used to assess the results. RESULTS We evaluated 62 patients with a mean age of 26.7 ± 12 years. The mean Rowe and Constant scores were 35 ± 7.2 and 65 ± 6.3, respectively, preoperatively and increased to 93.6 ± 5.3 and 92 ± 4.3, respectively, postoperatively at the mean follow-up of 28.8 months (range, 24-48 months) (P < .001). The redislocation rate was 8.1%. Of the patients, 91.9% had good to excellent clinical scores. Younger age and contact sports were associated with a higher risk of recurrent dislocation (P = .012 and P = .041, respectively). The postoperative functional results were not significantly correlated with the findings concerning the number of dislocations, time until surgery, degree of anterior translation, and number of anchors. CONCLUSION The use of all-suture anchors for arthroscopic glenoid labral lesion repair for the treatment of recurrent traumatic anterior shoulder instability yields satisfactory clinical results and is a safe and effective option.
Collapse
Affiliation(s)
- Orkun Gül
- Department of Orthopaedic Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ahmet Emin Okutan
- Department of Orthopaedic Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
| | - Muhammet Salih Ayas
- Department of Orthopaedic Surgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| |
Collapse
|
14
|
Khoo JK, Lee JH, Lam PH, Wei AQ, Ronquillo J, Murrell GA. Cytotoxicity and biomechanics of suture anchors used in labral repairs. JSES OPEN ACCESS 2019; 3:29-36. [PMID: 30976733 PMCID: PMC6443838 DOI: 10.1016/j.jses.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Biodegradable suture anchors are associated with higher redislocation rates. This study examined whether the biocompatibility and/or biomechanical properties of suture anchors contribute to the increase in complications. Methods Human glenohumeral capsule cells were cultured with 4 types of suture anchors, Opus LabraFix (titanium alloy; ArthroCare, Austin, TX, USA), PushLock (poly-ether-ether-ketone; Arthrex, Naples, FL, USA), BioKnotless (poly-l-lactic acid; DePuy Mitek, Warsaw, IN, USA), and Suretac II (polyglycolic acid; Smith & Nephew, London, UK), to measure cell viability and pH. Four groups of 6 ovine shoulders were used to repair the labrum, which was completely detached from the glenoid rim anteroinferiorly and reattached with 2 suture anchors and subject to failure load testing. Results In cell culture, BioKnotless at 48 and 72 hours (85.2% ± 2.1% and 84.5% ± 3.6%) and Suretac II groups (33.9% ± 3.1% and 42.8% ± 6.4%) had fewer viable cells compared with control (P = .048). The pH of Suretac II was lower than control (7.51 to 7.65) at 24 hours (7.31 ± 0.08, P = .049), 48 hours (7.25 ± 0.02, P = .046), and 72 hours (7.29 ± 0.04, P = .04). During mechanical testing, 83% of repairs failed by the capsule tearing. Among the anchors, the BioKnotless repair group had a significantly lower failure load (37 ± 5 N) compared with the PushLock (61 ± 7 N), Opus (60 ± 6 N), and Suretac II (57 ± 7 N) groups (P = .038). Conclusion BioKnotless and Suretac II anchors are cytotoxic. The BioKnotless biodegradable anchor has significantly lower failure load. Absorbable suture anchors may cause higher redislocation of arthroscopic Bankart repair.
Collapse
Affiliation(s)
| | | | | | | | | | - George A.C. Murrell
- Corresponding author: George A. C. Murrell, MD, DPhil, Research and Education Centre, Level 2, 4-10 South Street, Kogarah, Sydney, NSW 2217, Australia.
| |
Collapse
|
15
|
Kavaja L, Lähdeoja T, Malmivaara A, Paavola M. Treatment after traumatic shoulder dislocation: a systematic review with a network meta-analysis. Br J Sports Med 2018; 52:1498-1506. [PMID: 29936432 PMCID: PMC6241619 DOI: 10.1136/bjsports-2017-098539] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 05/08/2018] [Accepted: 05/16/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To review and compare treatments (1) after primary traumatic shoulder dislocation aimed at minimising the risk of chronic shoulder instability and (2) for chronic post-traumatic shoulder instability. DESIGN Intervention systematic review with random effects network meta-analysis and direct comparison meta-analyses. DATA SOURCES Electronic databases (Ovid MEDLINE, Cochrane Clinical Trials Register, Cochrane Database of Systematic Reviews, Embase, Scopus, CINAHL, Ovid MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily, DARE, HTA, NHSEED, Web of Science) and reference lists were searched from inception to 15 January 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised trials comparing any interventions either after a first-time, traumatic shoulder dislocation or chronic post-traumatic shoulder instability, with a shoulder instability, function or quality of life outcome. RESULTS Twenty-two randomised controlled trials were included. There was moderate quality evidence suggesting that labrum repair reduced the risk of future shoulder dislocation (relative risk 0.15; 95% CI 0.03 to 0.8, p=0.026), and that with non-surgical management 47% of patients did not experience shoulder redislocation. Very low to low-quality evidence suggested no benefit of immobilisation in external rotation versus internal rotation. There was low-quality evidence that an open procedure was superior to arthroscopic surgery for preventing shoulder redislocations. CONCLUSIONS There was moderate-quality evidence that half of the patients managed with physiotherapy after a first-time traumatic shoulder dislocation did not experience recurrent shoulder dislocations. If chronic instability develops, surgery could be considered. There was no evidence regarding the effectiveness of surgical management for post-traumatic chronic shoulder instability.
Collapse
Affiliation(s)
- Lauri Kavaja
- Medical Faculty, University of Helsinki, Helsinki, Finland
- Department of Surgery, South Carelia Central Hospital, Lappeenranta, Finland
| | - Tuomas Lähdeoja
- Medical Faculty, University of Helsinki, Helsinki, Finland
- Finnish Center of Evidence-based Orthopaedics (FICEBO), University of Helsinki, Helsinki, Finland
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Töölö Hospital, Helsinki, Finland
| | - Antti Malmivaara
- Centre for Health and Social Economics, Institute of Health and Welfare, Helsinki, Finland
- Orton Orthopaedic Hospital and Orton Research Institute, Orton Foundation, Helsinki, Finland
| | - Mika Paavola
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Töölö Hospital, Helsinki, Finland
| |
Collapse
|
16
|
Alkaduhimi H, Saarig A, van der Linde JA, Willigenburg NW, van Deurzen DFP, van den Bekerom MPJ. An assessment of quality of randomized controlled trials in shoulder instability surgery using a modification of the clear CLEAR-NPT score. Shoulder Elbow 2018; 10:238-249. [PMID: 30214489 PMCID: PMC6134533 DOI: 10.1177/1758573218754370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 11/19/2017] [Accepted: 12/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The present study aimed to evaluate the methodological quality and determine the quality of reporting of randomized controlled trials (RCTs) that assess surgical treatment for shoulder instability. METHODS A Cochrane, Pubmed, EMBASE and Trip database search was performed, including the relevant literature, regarding RCTs that report on shoulder instability published between January 1994 and January 2017. Methodological quality was assessed with a modification of the Checklist to Evaluate A Report of a Nonpharmacologic Trial (CLEAR-NPT). Points were assigned based on 18 items regarding patient characteristics, randomization, care provider characteristics, surgical details and blinding, with a total score ranging from 0 points to 18 points. Missing items were verified with the corresponding authors of the studies. Quality of reporting corresponds to the total scores including the items that were additionally provided by the authors. RESULTS We included 22 studies. Of these, nine corresponding authors provided additional information. The average methodological quality was 16.9 points (11 studies) and the average quality of reporting was 9.5 points (22 studies). Items scoring worst included information regarding the surgeon's experience, the patients' level of activity, comorbidities, analyzing according to 'intention-to-treat' principles, and blinding of care providers, participants and assessors. CONCLUSIONS RCTs reporting on shoulder instability surgery are well performed but poorly reported.
Collapse
Affiliation(s)
- Hassanin Alkaduhimi
- Hassanin Alkaduhimi, Oosterpark 9, 1091 AC
Amsterdam, The Netherlands. E-mail:
| | | | | | | | | | | |
Collapse
|
17
|
Cagle PJ, Olujimi V, Parsons BO. Arthroscopic Treatment of Labral Tears: A Critical Analysis Review. JBJS Rev 2018; 6:e4. [PMID: 29634588 DOI: 10.2106/jbjs.rvw.17.00081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Paul J Cagle
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY
| | | | | |
Collapse
|
18
|
A Comparison of Permanent Anchors Versus Biodegradable Anchors and Tacks for Arthroscopic Shoulder Stabilization. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2018. [DOI: 10.1097/bte.0000000000000106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
19
|
Brown L, Rothermel S, Joshi R, Dhawan A. Recurrent Instability After Arthroscopic Bankart Reconstruction: A Systematic Review of Surgical Technical Factors. Arthroscopy 2017; 33:2081-2092. [PMID: 28866342 DOI: 10.1016/j.arthro.2017.06.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 05/04/2017] [Accepted: 06/20/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Recurrent instability remains of concern after arthroscopic Bankart reconstruction. We evaluated various technical factors including anchor design, anchor material, number of anchors used, and interval closure on risk of recurrent instability after arthroscopic Bankart reconstruction. METHODS A systematic review of MEDLINE and Cochrane databases was conducted, following PRISMA guidelines. Extracted data were recorded on a standardized form. Methodological index for non-randomized studies (MINORS) and Newcastle-Ottawa Scale (NOS) were used to assess study quality and risk bias. Because of study heterogeneity and low levels of evidence, meta-analysis was not possible. Pooled weighted means were calculated and individual study evaluation and comparisons (qualitative analysis) were performed for systematic review. RESULTS Of 2097 studies identified, 26 met criteria for systematic review. Pooled weighted means revealed 11.4% versus 15% recurrent instability with 3 or more suture anchors versus fewer than 3 anchors, 10.1% versus 7.8% with absorbable versus nonabsorbable suture anchors, respectively, and 8.0% versus 9.4% with knotless versus standard anchors, respectively. Interval closure did not qualitatively decrease recurrent instability or decrease range of motion. CONCLUSIONS Our systematic review reveals that despite individual study, and previous systematic reviews pointing to the contrary, the composite contemporary published literature would support no difference in the risk of recurrent instability after arthroscopic Bankart reconstruction with rotator interval closure, differing numbers of anchors used for the repair, use of knotless versus standard anchors, or use of bioabsorbable versus nonabsorbable anchors. We recommend surgeons focus on factors that have been shown to modify the risk factors after arthroscopic Bankart reconstruction, such as patient selection. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
Collapse
Affiliation(s)
- Landon Brown
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Shane Rothermel
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Rajat Joshi
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Aman Dhawan
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A..
| |
Collapse
|
20
|
Abstract
Shoulder joint dislocation is the most common joint dislocation seen in the emergency department.Traumatic dislocation may cause damage to the soft-tissues surrounding the shoulder joint and sometimes to the bone. The treatment, which aims at restoration of a fully functioning, pain-free and stable shoulder, includes either conservative or surgical management preceded by closed reduction of the acute dislocation.Conservative management usually requires a period of rest, generally involving immobilisation of the arm in a sling, even though it is still debated whether to immobilise the shoulder in internal or external rotation.Operative management, with no significant differences in term of re-dislocation rates between open and arthroscopic repair, incorporates soft-tissue reconstructions and/or bony procedures and is recommended in young male adults engaged in highly demanding physical activities.At our institution, non-operative management is favoured particularly for patients with multi-directional instability or soft-tissue laxity. Conservative measures are often preferred in older patients or younger patients that are not actively engaged in overhead activities. Immediate surgery on all first-time dislocations may subject many patients to surgery who would not have had any future subluxation.For these reasons, initially we will always try physical therapy and activity modification for the vast majority of our patients. Cite this article: EFORT Open Rev 2017;2:35-40.DOI: 10.1302/2058-5241.2.160018.
Collapse
Affiliation(s)
- Michele Boffano
- Oncology and Reconstructive Department, CTO Hospital, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Stefano Mortera
- Oncology and Reconstructive Department, CTO Hospital, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Raimondo Piana
- Oncology and Reconstructive Department, CTO Hospital, AOU Citta' della Salute e della Scienza, Turin, Italy
| |
Collapse
|
21
|
Conservative treatment of traumatic shoulder instability: a case series study. Musculoskelet Surg 2015; 99:133-7. [PMID: 25982089 DOI: 10.1007/s12306-015-0373-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this case series study was to evaluate the efficacy of a rehabilitative approach to restoring stability, range of motion, and function of shoulder joint in non-operated adults presenting a first episode of traumatic anterior shoulder dislocation. METHODS In this case series study, we evaluated patients aged from 20 to 44 years, with diagnosis of first episode of traumatic anterior shoulder dislocation. All participants underwent a conservative treatment protocol, lasting 3 months. The primary outcome measure was the Rowe score for instability. Follow-up evaluations were done at 3, 6, 12, and 24 months. RESULTS We evaluated 32 participants mean aged 27.94 ± 2.23 years. At the baseline (T 0), the participants had a mean Rowe score of instability of 44.53 ± 7.00 SD, where 81.25% had a poor score and 18.75% had a fair score. At 24 months (T 4), the Rowe score for instability was 79.84 ± 6.66 SD. 21.88% of patients had a fair score, 71.87% had a good score, and 6.25% had an excellent score. CONCLUSIONS We showed that our rehabilitative approach seems to be effective in the conservative management of shoulder instability in adults with first episode of traumatic anterior shoulder dislocation, not involved in sport activity, and not overhead workers.
Collapse
|
22
|
Papalia R, Franceschi F, Diaz Balzani L, D'Adamio S, Denaro V, Maffulli N. The arthroscopic treatment of shoulder instability: bioabsorbable and standard metallic anchors produce equivalent clinical results. Arthroscopy 2014; 30:1173-83. [PMID: 24933591 DOI: 10.1016/j.arthro.2014.03.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/21/2014] [Accepted: 03/27/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate whether there are any differences in clinical outcomes and complications between absorbable and nonabsorbable suture anchors in the treatment of shoulder instability. METHODS We performed a comprehensive search of Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, and the Cochrane Central Registry of Controlled Trials, from inception of the databases, using various combinations of keywords. Only studies focusing on clinical outcomes of patients who underwent arthroscopic shoulder stabilization with suture anchors were selected. Two authors (R.P. and L.D.B.) then evaluated the methodologic quality of each article using the Coleman Methodology Score. RESULTS Ten articles were included. Four were prospective randomized studies, 2 were prospective cohort studies, and 4 were case series. The mean modified Coleman Methodology Score was 76.2. CONCLUSIONS Given the overall good results reported after arthroscopic stabilization of the shoulder using different suture anchors, it is not possible to draw a definite and solid suggestion on which class of device is better advised for routine use. Thus the decision to use one of the anchor systems available may mostly depend on its cost-effectiveness, which should be the focus of future comprehensive research. LEVEL OF EVIDENCE Level IV, systematic review of Level I to IV studies.
Collapse
Affiliation(s)
- Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Rome, Italy
| | - Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Rome, Italy
| | - Lorenzo Diaz Balzani
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Rome, Italy
| | - Stefano D'Adamio
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Rome, Italy
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, England; Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.
| |
Collapse
|
23
|
Gamulin A, Dayer R, Lübbeke A, Miozzari H, Hoffmeyer P. Primary open anterior shoulder stabilization: a long-term, retrospective cohort study on the impact of subscapularis muscle alterations on recurrence. BMC Musculoskelet Disord 2014; 15:45. [PMID: 24555837 PMCID: PMC3932796 DOI: 10.1186/1471-2474-15-45] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/18/2014] [Indexed: 08/25/2023] Open
Abstract
Background Post-traumatic anterior shoulder instability patients may present histopathologic lesions within the subscapularis muscle compatible with a scarring process associated with disuse atrophy. We hypothesized that such lesions identified on intraoperative biopsy at the time of primary anterior shoulder stabilization would predict a higher risk of postoperative instability recurrence. Methods Of 52 eligible patients (52 shoulders) who had undergone subscapularis muscle biopsy during primary anterior open labral repair and capsulorrhaphy, 35 (mean age at surgery, 27.2 years; male sex, 71.4%) were retrospectively evaluated (mean follow-up, 12.9 years; range, 10.9-14.5 years). Primary outcome was shoulder instability recurrence. Secondary outcomes included shoulder range of motion, functional scores, and radiological analysis of glenohumeral joint degenerative changes. Results Overall five patients (14.3%) presented shoulder instability recurrence. Twelve patients with histopathologic lesions had significantly more instability recurrence than 23 without histopathologic changes (33.3% vs. 4.3%; risk difference, 29% [95% CI 1; 57]; p = 0.038). Patients without histopathologic changes had significantly reduced external rotation with arm at side (ER1; -11.9°; p = 0.001) and with shoulder abducted to 90° (ER2; -14.9°; p = 0.001) on the operated side when compared to the contralateral side. Patients with histopathologic lesions had only ER2 significantly reduced (-8.9°; p = 0.031). There was no substantial difference regarding functional and quantitative radiological scores between both patients’ groups. Conclusions Histopathologic changes within the subscapularis muscle at the time of primary open labral repair and capsulorrhaphy were associated with an increased risk of shoulder instability recurrence. Further investigations are needed to assess the impact of dedicated postoperative rehabilitation programs for patients presenting these lesions. Their recognition on preoperative magnetic resonance imaging should also be investigated; non-anatomical repairs could be an option in these cases.
Collapse
Affiliation(s)
- Axel Gamulin
- Division of Orthopedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14, Switzerland.
| | | | | | | | | |
Collapse
|
24
|
Monk AP, Garfjeld Roberts P, Logishetty K, Price AJ, Kulkarni R, Rangan A, Rees JL. Evidence in managing traumatic anterior shoulder instability: a scoping review. Br J Sports Med 2013; 49:307-11. [DOI: 10.1136/bjsports-2013-092296] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
25
|
Elmlund AO, Ejerhed L, Sernert N, Rostgård LC, Kartus J. Dislocation arthropathy and drill hole appearance in a mid- to long-term follow-up study after arthroscopic Bankart repair. Knee Surg Sports Traumatol Arthrosc 2012; 20:2156-62. [PMID: 22644076 DOI: 10.1007/s00167-012-2076-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 05/10/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to perform a prospective mid- to long-term clinical and radiographic follow-up after arthroscopic Bankart repair using absorbable tacks with special emphasis on the development of dislocation arthropathy. METHODS Thirty-four shoulders in 32 patients with post-traumatic shoulder instability were included in the study. Clinical and radiographic follow-ups took place after approximately 2 and 8 years. RESULTS Thirty-four of 34 (100 %) shoulders in 32 patients returned for the follow-up examination after 95 (53-129) months. Pre-operatively, none of the shoulders had any arthropathy changes. At follow-up, 8/34 (24 %) had minor changes, 6/34 (18 %) had moderate changes, and none had severe arthropathy changes, a significant increment compared with the pre-operative figures (p = 0.005). At follow-up, the drill holes in 24 % of the shoulders still had not healed radiographically. The failure rate in terms of stability was 3/34 (9 %) re-dislocations and 3/34 (9 %) subluxations. CONCLUSION Eight years after arthroscopic Bankart repair using absorbable tacks, 41 % of the shoulders displayed some degree of radiographic arthropathy changes and in 24 % the drill holes had not yet radiographically healed. There was no correlation between clinical outcome or drill hole appearance and the development of arthropathy changes. LEVEL OF EVIDENCE III.
Collapse
|
26
|
Risk factors for recurrence after Bankart repair a systematic review. Knee Surg Sports Traumatol Arthrosc 2012; 20:2129-38. [PMID: 22836228 DOI: 10.1007/s00167-012-2140-1] [Citation(s) in RCA: 177] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 07/09/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Arthroscopic Bankart repair of anterior shoulder instability is a common practice in orthopedics. The aim of this study was to evaluate pre-operative risks factors associated with recurrent instability and to delineate possible indications for revision surgery. METHODS A systematic review was performed including the following keywords: arthroscopy, Bankart repair, anterior shoulder instability, recurrence of instability, suture anchors and treatment outcome. Studies eligible for inclusion in the review were clinical trials published in the last 10 years investigating patients with anterior shoulder instability managed by an arthroscopic repair technique with suture anchors. The studies had to report data about recurrence of instability and investigational parameters (risk factors) that influenced the results referred to the rate of recurrence. Twenty-four articles were identified that met the inclusion criteria and underwent further review. Data from these studies were collected, and the risk of treatment failure was statistically recalculated. An estimate of the overall recurrence rate was obtained by pooling data about failure from the trials. RESULTS The rate of recurrent instability at 10 years of follow-up ranged from 3.4 to 35 %. Epidemiological parameters significantly associated with the recurrence of instability were age below 22 years old, male gender, the number of preoperative dislocations and participation in competitive sports. Surgical parameters significantly associated with recurrence of instability were repair with fewer than three anchors and the use of knotless anchors. The patho-anatomical factors significantly associated with recurrences were substantial associated glenoid or humeral head bone loss and the presence of anterior labroligamentous periosteal sleeve avulsion. CONCLUSIONS Knowledge of risk factors for post-operative outcomes allows surgeons to provide appropriate preoperative counselling to patients and support more realistic expectations. An accurate analysis of causes of failure should enable the correct revision strategy to be adopted. LEVEL OF EVIDENCE II.
Collapse
|
27
|
Archetti Netto N, Tamaoki MJS, Lenza M, dos Santos JBG, Matsumoto MH, Faloppa F, Belloti JC. Treatment of Bankart lesions in traumatic anterior instability of the shoulder: a randomized controlled trial comparing arthroscopy and open techniques. Arthroscopy 2012; 28:900-8. [PMID: 22342199 DOI: 10.1016/j.arthro.2011.11.032] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 11/21/2011] [Accepted: 11/22/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of this study was to compare the functional assessments of arthroscopy and open repair for treating Bankart lesion in traumatic anterior shoulder instability. METHODS Fifty adult patients, aged less than 40 years, with traumatic anterior shoulder instability and the presence of an isolated Bankart lesion confirmed by diagnostic arthroscopy were included in the study. They were randomly assigned to receive open or arthroscopic treatment of an isolated Bankart lesion. In all cases of both groups, the lesion was repaired with metallic suture anchors. The primary outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS After a mean follow-up period of 37.5 months, 42 patients were evaluated. On the DASH scale, there was a statistically significant difference favorable to the patients treated with the arthroscopic technique, but without clinical relevance. There was no difference in the assessments by University of California, Los Angeles and Rowe scales. There was no statistically significant difference regarding complications and failures, as well as range of motion, for the 2 techniques. CONCLUSIONS On the basis of this study, the open and arthroscopic techniques were effective in the treatment of traumatic anterior shoulder instability. The arthroscopic technique showed a lower index of functional limitation of the upper limb, as assessed by the DASH questionnaire; this, however, was not clinically relevant.
Collapse
Affiliation(s)
- Nicola Archetti Netto
- Division of Hand and Upper Limb Surgery, Department of Orthopedics and Trauma, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil
| | | | | | | | | | | | | |
Collapse
|