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Galasso O, Mercurio M, Gasparini G, Spina G, De Gori M, De Benedetto M, Orlando N, Castricini R. Arthroscopic repair for isolated subscapularis tear: successful functional outcomes and high tendon healing rate can be expected nine years after surgery. J Shoulder Elbow Surg 2024; 33:1285-1292. [PMID: 38036257 DOI: 10.1016/j.jse.2023.10.016] [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: 07/15/2023] [Revised: 10/03/2023] [Accepted: 10/22/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Literature describing outcomes and integrity after isolated subscapularis (SSC) tendon repair is emerging but remains limited to a few small case series with short-term follow-up. The aim of this study was to evaluate the long-term clinical outcomes and repair integrity in patients who underwent arthroscopic repair of isolated SSC tears. METHODS A retrospective study was conducted with the following inclusion criteria: (1) primary and elective shoulder arthroscopy for isolated SSC repair, (2) type III (a full-thickness tear in the upper two-thirds of the tendon) or IV (a complete tear without tendon retraction) SSC tear according to the Lafosse classification, and (3) a minimum 24-month follow-up. Preoperatively, the range of motion (ROM) and the Constant-Murley score (CMS) and at follow-up, the ROM, the University of California-Los Angeles (UCLA) Shoulder Rating Scale, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the CMS were evaluated; an ultrasonographic assessment of tendon healing was performed according to the Sugaya classification. RESULTS The final sample consisted of 45 patients with an average age of 55 ± 9 years. After a mean follow-up time of 107 ± 54 months, the mean UCLA and DASH scores were 8.7 ± 1.3 and 42.2 ± 6.4, respectively. ROM and CMS showed statistically significant improvements (all P < .001). Before surgery, the mean CMS was 49% that of sex- and age-matched healthy individuals, and all patients showed a CMS lower than the normative data. At the final follow-up visit, the mean CMS was 94.2% that of sex- and age-matched healthy individuals, and no patients showed CMS of 30 or less. The mean increase in the CMS was 41.4 ± 9.8 points (range, 23-60 points). The ultrasonographic assessment showed SSC tendon healing in 39 (86.7%) cases; tendon retear was recorded in 5 (13.3%) cases. All scores directly correlated with the healing of the tendon. A higher postoperative DASH score was associated with male sex (P = .039, β = 5.538) and a longer follow-up period (P = .044, β = 0.001). The postoperative CMS (P < .001) and UCLA scores (P = .001) were significantly higher in patients younger than 60 years of age at surgery than in older individuals. CONCLUSION Arthroscopic repair of isolated SSC tears achieves excellent clinical and functional results at a mean of 9 years postoperatively, with a satisfactory healing rate. Better functional outcomes correlate with SSC tendon integrity and were observed in male patients and in those younger than 60 years at surgery.
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Affiliation(s)
- Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy.
| | - Giovanna Spina
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy
| | - Marco De Gori
- Department of Orthopedic and Trauma Surgery, Basso Ionio Hospital, Soverato, Italy
| | - Massimo De Benedetto
- Division of Orthopaedic and Trauma Surgery, "Villa Verde", Fermo, Italy; Department of Orthopaedic and Trauma Surgery, "Villa Maria Cecilia" Hospital, Cotignola, Italy
| | - Nicola Orlando
- Division of Orthopaedic and Trauma Surgery, "Villa Verde", Fermo, Italy; Department of Orthopaedic and Trauma Surgery, "Villa Maria Cecilia" Hospital, Cotignola, Italy
| | - Roberto Castricini
- Division of Orthopaedic and Trauma Surgery, "Villa Verde", Fermo, Italy; Department of Orthopaedic and Trauma Surgery, "Villa Maria Cecilia" Hospital, Cotignola, Italy
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Familiari F, Barone A, De Gori M, Banci L, Palco M, Simonetta R, Gasparini G, Mercurio M, Calafiore G. Short- to Mid-Term Clinical and Radiological Results of Selective Laser Melting Highly Porous Titanium Cup in Primary Total Hip Arthroplasty. J Clin Med 2024; 13:969. [PMID: 38398281 PMCID: PMC10889807 DOI: 10.3390/jcm13040969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: The aim of this study was to evaluate short- to mid-term clinical and radiological results in patients undergoing primary total hip arthroplasty (THA) with the use of a Selective Laser Melting 3D-printed highly porous titanium acetabular cup (Jump System Traser®, Permedica Orthopaedics). (2) Methods: We conducted a retrospective study and collected prospective data on 125 consecutive patients who underwent primary THA with the use of highly porous titanium cup. Each patient was evaluated preoperatively and postoperatively with a clinical and radiological assessment. (3) Results: The final cohort consisted of 104 patients evaluated after a correct value of 52 (38-74) months. The median Harris Hip Score (HHS) significantly improved from 63.7 (16-95.8) preoperatively to 94.8 (38.2-95.8) postoperatively (p < 0.001), with higher improvement associated with higher age at surgery (β = 0.22, p = 0.025). On postoperative radiographs, the average acetabular cup inclination and anteversion were 46° (30°-57°) and 15° (1°-32°), respectively. All cups radiographically showed signs of osseointegration with no radiolucency observed, or component loosening. (4) Conclusions: The use of this highly porous acetabular cup in primary THA achieved excellent clinical, functional, and radiological results at mid-term follow-up. A better clinical recovery can be expected in older patients. The radiological evaluation showed excellent osseointegration of the cup with complete absence of periprosthetic radiolucent lines.
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Affiliation(s)
- Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy
| | - Alessandro Barone
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy
| | | | - Lorenzo Banci
- Clinical Department, Permedica Orthopaedics, 23807 Merate, Italy
| | - Michelangelo Palco
- Division of Orthopaedic and Trauma Surgery, Villa del Sole Clinic, 88100 Catanzaro, Italy
| | - Roberto Simonetta
- Division of Orthopaedic and Trauma Surgery, Villa del Sole Clinic, 88100 Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, Magna Graecia University, 88100 Catanzaro, Italy
| | - Giuseppe Calafiore
- Clinica Città di Parma, 43123 Parma, Italy
- IRCSS Humanitas Research Hospital, 20089 Rozzano, Italy
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Nattfogel EA, Ranebo MC. Patients Have a 15% Redislocation Rate After Arthroscopic Bankart Repair With a Knotless Technique. Arthrosc Sports Med Rehabil 2024; 6:100864. [PMID: 38288032 PMCID: PMC10823114 DOI: 10.1016/j.asmr.2023.100864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 12/13/2023] [Indexed: 01/31/2024] Open
Abstract
Purpose To evaluate the redislocation rate after arthroscopic Bankart repair (ABR) with a standardized knotless anchor technique in a consecutive series of patients with anterior glenohumeral instability. Methods Inclusion criteria were patients who underwent ABR by a single surgeon between January 2008 and December 2018 with a minimum follow up of 2 years. We collected data through phone interviews, Western Ontario Shoulder Instability Index, and review of patient records. The primary outcome was redislocation and secondary outcomes were recurrent subluxations, reoperation, postoperative complications, patient satisfaction, and functional outcomes. We also performed survival analysis and risk factor analysis. Results Of 88 patients (91 shoulders) who underwent ABR during the inclusion period, 70 patients (73 shoulders) were included (follow-up rate 80%). The mean follow-up was 7.5 years (range 2-12 years). Redislocation occurred in 15% (95% confidence interval [CI] 7.8%-25.4%) of patients at a mean of 41 months after surgery (range 6-115 months). The reoperation rate for recurrent redislocation was 4.1%. Overall, 90.4% reported being currently satisfied with their shoulder and the mean Western Ontario Shoulder Instability Index score at follow-up was 73.8% (range 8.3%-99.9%). Patients with redislocation were younger at primary operation than patients with no redislocation (mean 21 years vs 28 years; P = .023) and adjusted hazard ratio for age was 0.86 (95% CI 0.74-0.99; P = .033). It was more common to have less than 3 anchors in patients with redislocation (P = .024), but adjusted hazard ratio was 4.42 (95% CI 0.93-21.02; P = .061). Conclusions The redislocation rate after ABR with a standardized knotless anchor technique in a consecutive series of patients with anterior glenohumeral instability was found to be 15% after a minimum 2-year follow-up (mean 7.5). Level of Evidence Level IV, therapeutic case-series.
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Affiliation(s)
| | - Mats C. Ranebo
- Department of Orthopedics, Kalmar County Hospital, Kalmar, Sweden
- Department of Biomedical and Clinical Sciences (BKV), Division of Surgery, Orthopedics and Oncology (KOO), Medical Faculty, Linköping University, Linköping, Sweden
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Boden SA, Charles S, Hughes JD, Miller L, Rodosky M, Popchak A, Musahl V, Lesniak BP, Lin A. Recurrent Instability After Arthroscopic Bankart Repair in Patients With Hyperlaxity and Near-Track Lesions. Orthop J Sports Med 2023; 11:23259671231200231. [PMID: 37781639 PMCID: PMC10540590 DOI: 10.1177/23259671231200231] [Citation(s) in RCA: 1] [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: 04/28/2023] [Accepted: 05/19/2023] [Indexed: 10/03/2023] Open
Abstract
Background Recurrent anterior shoulder instability after arthroscopic Bankart repair presents a challenging clinical problem, with the primary stabilization procedure often portending the best chance for clinical success. Purpose To determine if capsuloligamentous laxity affects failure (recurrent dislocation, subluxation, and/or perceived instability symptoms) after arthroscopic Bankart repair in patients with near-track lesions (ie, those with smaller distance to dislocation [DTD]). Study Design Case-control study; Level of evidence, 3. Methods The authors retrospectively reviewed consecutive patients who underwent primary arthroscopic Bankart repair for recurrent anterior glenohumeral instability at a single institution between 2007 and 2019 and who had at least 2 years of follow-up data. Patients with glenoid bone loss >20%, off-track lesions, concomitant remplissage, or rotator cuff tear were excluded. Capsuloligamentous laxity, or hyperlaxity, was defined as external rotation >85° with the arm at the side and/or grade ≥2 in at least 2 planes with the shoulder at 90° of abduction. Near-track lesions were defined as those with a DTD <10 mm. Results Included were 173 patients (mean age, 20.5 years; mean DTD, 16.2 mm), of whom 16.8% sustained a recurrent dislocation and 6.4% had recurrent subluxations (defined as any subjective complaint of recurrent instability without frank dislocation), for an overall recurrent instability rate of 23.1%. The rate of revision stabilization was 15.6%. The mean time to follow-up was 7.4 years. Independent predictors of recurrent instability were younger age (P = .001), smaller DTD (P = .021), >1 preoperative instability episode (P < .001), and the presence of hyperlaxity during examination under anesthesia (P = .013). Among patients with near-track lesions, those with hyperlaxity had a recurrent instability rate almost double that of patients without hyperlaxity (odds ratio, 34.1; P = .04). The increased rate of failure and recurrent dislocation in the near-track hyperlaxity cohort remained elevated, even in patients with no bone loss. Conclusion Capsuloligamentous shoulder laxity was a significant independent risk factor for failure after primary arthroscopic Bankart repair without remplissage and was more predictive of failure in patients with versus without near-track lesions.
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Affiliation(s)
- Stephanie A. Boden
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shaquille Charles
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jonathan D. Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Liane Miller
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mark Rodosky
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Adam Popchak
- Department of Physical Therapy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bryson P. Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Woods A, Huang Teng W, De Toledo Z, Memon K, Granville-Chapman J. Shoulder instability in military personnel: diagnosis and outcomes of arthroscopic stabilisation. BMJ Mil Health 2023:military-2022-002244. [PMID: 36927686 DOI: 10.1136/military-2022-002244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Shoulder instability is a common problem for military personnel due to the highly physical demands of work and training. This study assessed the pattern of glenoid labrum tears suffered by serving UK military personnel, the reliability of preoperative diagnostic methods (magnetic resonance arthrogram (MRA) vs clinical examination) and, finally, the outcomes of arthroscopic stabilisation in terms of satisfaction, pain, and return to sport and full deployment. METHODS Retrospective demographic and clinical data were collected for all patients within our unit who underwent arthroscopic shoulder stabilisation between September 2016 and January 2019. Patients underwent clinical examination for instability and subsequent imaging with MRA. For service evaluation, patient-reported outcome measure data and occupational outcome data were gathered preoperatively and postoperatively. RESULTS 41 military patients with shoulder instability were treated with arthroscopic stabilisation. 24.4% had an isolated anterior tear, and 41.5% had complex two-zone or pan-labral tears identified on arthroscopy. Clinical examination showed higher sensitivity, accuracy and negative predictive value for all labral tear patterns compared with MRA. Mean preoperative Oxford Shoulder Instability Score score was 18.58 (SE ±1.67) and mean postoperative score was 41.5 (SE ±1.13). 82.14% of the patients returned to full deployment during the study period and 85% had returned to sports. CONCLUSION Complex labral tear patterns are common in military personnel with shoulder instability, and clinical examination appears to be more effective than imaging at predicting injury pattern. Patients respond well to arthroscopic stabilisation with good rates of return to work and sport, regardless of chronicity of injury.
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Affiliation(s)
- Alex Woods
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - W Huang Teng
- Trauma & Orthopaedics, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - Z De Toledo
- Foundation Year 2 Doctor, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - K Memon
- Trauma & Orthopaedics, Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
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Castricini R, Castioni D, De Benedetto M, Cimino M, Massarini A, Galasso O, Gasparini G. Arthroscopic Latarjet for Primary Shoulder Instability With Off-Track Lesions or Revision Surgery Yields Satisfactory Clinical Results and Reliable Return to Sport and Work at Minimum 3-Year Follow-Up. Arthroscopy 2022; 38:2809-2818.e1. [PMID: 35469994 DOI: 10.1016/j.arthro.2022.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To retrospectively evaluate clinical and radiologic outcomes and return to sport and to work of patients after arthroscopic Latarjet stabilization for primary instability or revision surgery; factors influencing and determining results and potential predictors for clinical outcomes also were evaluated. METHODS This is a retrospective study including patients older than 18 years old who underwent arthroscopic Latarjet stabilization for recurrent anterior glenohumeral instability with off-track lesions, or for cases of recurrence after previous surgery, from 2011 to 2017. Patients were assessed preoperatively and at a minimum 3 years of follow-up using the Rowe score, the University of California at Los Angeles Shoulder Score and Simple Shoulder Test score; the range of motion, satisfaction rate, return to work and sport, perception of discomfort during sporting and daily activities, and complications and recurrence after surgery were also evaluated. The integration of the coracoid graft and the position of the screws were examined by computed tomography scan. RESULTS At a mean follow-up time of 6 ± 2 years, 93 patients (95 shoulders) showed significant improvement of all scale scores (P < .001), 97.8% of the patients had returned to the same working condition as before surgery, and all the patients who practiced sports preoperatively (85; 91.4%) returned to sport after surgery; 97.9% of patients were satisfied with surgery. The complication rate was 5.4%, and 2 cases (2.1%) of recurrence occurred, both after high-energy trauma. At an average of 17 ± 13 months postoperatively, computed tomography scans showed 4 (6.6%) stable nonunions, 9 (14.8%) superior, and 1 (1.6%) inferior lyses of the graft; a correct positioning of the graft was observed in 86.9% of the cases. Greater satisfaction, fewer complications, less pain during daily activities, and a lower number of reoperations were associated with a shorter time between the first dislocation episode and surgery (P = .019, P < .001, P = .014, and P = .005, respectively). Complications were directly associated with older patient age at operation (P = .001). A greater number of nonunions was found in patients with increased angle between the line linking the posterior and anterior glenoid rim and the screw axis (P = .040) and a medial axial position or a lower coronal position of the graft (both P = .010). A lower age at the time of surgery predicted better Rowe scores at follow-up (P < .001), and a lower age at the time of the first episode of dislocation predicted better postoperative Simple Shoulder Test scores (P = .026). CONCLUSIONS At a mean 6-year follow-up time, excellent clinical outcomes, and radiological results, with few complications, high rates of satisfaction and return to work and sport and low sports anxiety can be expected after arthroscopic Latarjet procedure. A shorter time between the first dislocation episode and surgery was associated with higher satisfaction, fewer complications, less pain during daily activities and lower reoperations; a lower age at the operation was associated with lower complications.
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Affiliation(s)
- Roberto Castricini
- Division of Orthopaedic and Trauma Surgery, "Villa Verde" Hospital, Fermo, Italy
| | - Davide Castioni
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Massimo De Benedetto
- Division of Orthopaedic and Trauma Surgery, "Villa Verde" Hospital, Fermo, Italy
| | - Monica Cimino
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Alessandro Massarini
- Division of Orthopaedic and Trauma Surgery, "Villa Verde" Hospital, Fermo, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, "Mater Domini" University Hospital, Catanzaro, Italy.
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, "Mater Domini" University Hospital, Catanzaro, Italy
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van Iersel TP, van Spanning SH, Verweij LPE, Priester-Vink S, van Deurzen DFP, van den Bekerom MPJ. Bony reconstruction after failed labral repair is associated with higher recurrence rates compared to primary bony reconstruction: a systematic review and meta-analysis of 1319 shoulders in studies with a minimum of 2-year follow-up. J Shoulder Elbow Surg 2022; 31:1982-1991. [PMID: 35430365 DOI: 10.1016/j.jse.2022.02.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is uncertainty with regard to the optimal revision procedure after failed labral repair for anterior shoulder instability. An overview of outcomes of these procedures with quantitative analysis is not available in literature. The aim of this review is (1) to compare recurrence rates after revision labral repair (RLR) and revision bony reconstruction (RBR), both following failed labral repair. In addition, (2) recurrence rates after RBR following failed labral repair and primary bony reconstruction (PBR) are compared to determine if a previous failed labral repair influences the outcomes of the bony reconstruction. METHODS Randomized controlled trials and cohort studies with a minimum follow-up of 2 years and reporting recurrence rates of (1) RBR following failed labral repair and PBR and/or (2) RLR following failed labral repair and RBR following failed labral repair were identified by searching PubMed, Embase/Ovid, Cochrane Database of Systematic Reviews/Wiley, Cochrane Central Register of Controlled Trials/Wiley, and Web of Science/Clarivate Analytics. RESULTS Thirteen studies met the inclusion criteria and comprised 1319 shoulders. Meta-analyses showed that RBR has a significantly higher recurrence rate than PBR (risk ratio [RR] 0.51, P < .008) but found no significant difference in the recurrence rates for RLR and RBR (RR 1.40, P < .49). Also, no significant differences were found between PBR and RBR in return to sport (RR 1.07, P < .41), revision surgery (RR 0.8, P < .44), and complications (RR 0.84, P < .53). Lastly, no significant differences between RLR and RBR for revision surgery (RR 3.33, P < .19) were found. CONCLUSION The findings of this meta-analyses show that (1) RBR does not demonstrate a significant difference in recurrence rates compared with RLR and that (2) RBR has a significantly higher recurrence rate than PBR.
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Affiliation(s)
- Theodore P van Iersel
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.
| | - Sanne H van Spanning
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Lukas P E Verweij
- Amsterdam UMC, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, the Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | | | - Derek F P van Deurzen
- Trauma Unit & Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Michel P J van den Bekerom
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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8
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Stirling PHC, Crighton EA, Butterworth G, Elias-Jones C, Brooksbank AJ, Jenkins PJ. Glenoid track measurement using magnetic resonance imaging arthrography is predictive of recurrent instability following arthroscopic shoulder stabilisation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1313-1317. [PMID: 34477957 DOI: 10.1007/s00590-021-03100-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/12/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The primary aim of this study was to investigate medium-term survivorship following arthroscopic Bankart repair (ABR) for anterior glenohumeral instability. The secondary aim was to determine whether the pre-operative magnetic resonance (MR) arthrography glenoid track measurement predicted recurrent instability following ABR. METHODS Over a 9-year period (2008-2017), 215 patients underwent ABR. Median age was 26 years (IQR 22-32.5; range 14-77). There were 173 males (81%). 175 patients (81%) had available pre-operative MR arthrography, which was used to determine the presence of "off-track" bone loss. Retrospective analysis was undertaken to determine recurrence of instability at a median follow-up of 76 months (range 21-125 months). Survivorship analysis was undertaken using Kaplan-Meier methodology: the endpoints examined were repeat dislocation, revision stabilisation, and symptomatic instability. RESULTS 56 patients (26%) presented with further instability, including 29 patients with recurrent dislocation and 15 patients required revision stabilisation. Cumulative incidence of instability was 10% at 1 year, 27% at 5 years and 28% at 7 years. No significant difference in instability was seen between men and women 7 years after stabilisation (19% vs 17%; p = 0.87). Age at time of surgery did not predict recurrence. "Off-track" lesions were identified in 29 patients (16.1%). The incidence of redislocation was significantly higher in these patients (24% vs 3%; p = 0.01; relative risk 7.2; 95% CI 2.45-20.5; p = 0.001). Recurrent instability without frank redislocation was also significantly higher in this group (60% vs 18%; RR 3.33, 95% CI 2.02-5.20; p < 0.0001). CONCLUSIONS This study has reported a significant rate of recurrent instability in longer-term follow-up after ABR. It has also identified pre-operative MR arthrography as an important predictor of recurrent instability, which may be used to risk stratify patients with anterior instability in a typical UK population. LEVEL OF EVIDENCE III (cohort study).
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Affiliation(s)
| | - E A Crighton
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland
| | | | - C Elias-Jones
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland
| | - A J Brooksbank
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland
| | - P J Jenkins
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland.
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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.
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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
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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; 30:e85-e102. [PMID: 32721507 DOI: 10.1016/j.jse.2020.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023]
Abstract
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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Affiliation(s)
- Brian C Lau
- Duke Sport Science Institute, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Carolyn A Hutyra
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Juan Marcos Gonzalez
- Duke University School of Medicine, Department of Population Health Sciences, Durham, NC, USA
| | - Richard C Mather
- Duke Sport Science Institute, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brett D Owens
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - William N Levine
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Grant E Garrigues
- Midwest Orthopaedics at RUSH, Rush University Medical Center, Chicago, IL, USA
| | - John D Kelly
- Penn Perelman School of Medicine, Philadelphia, PA, USA
| | - David Kovacevic
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | | | - Frances Cuomo
- Department of Orthopaedic Surgery, Montefiore, New York, NY, USA
| | | | - Scott Kaar
- Department of Orthopaedic Surgery, Saint Louis University, St. Louis, MO, USA
| | | | - Anthony Miniaci
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Jonathan P Braman
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Alicia K Harrison
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Peter MacDonald
- Orthopaedic Surgery, Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada
| | - Jonathan C Riboh
- Duke Sport Science Institute, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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11
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Verweij LPE, van Spanning SH, Grillo A, Kerkhoffs GMMJ, Priester-Vink S, van Deurzen DFP, van den Bekerom MPJ. Age, participation in competitive sports, bony lesions, ALPSA lesions, > 1 preoperative dislocations, surgical delay and ISIS score > 3 are risk factors for recurrence following arthroscopic Bankart repair: a systematic review and meta-analysis of 4584 shoulders. Knee Surg Sports Traumatol Arthrosc 2021; 29:4004-4014. [PMID: 34420117 PMCID: PMC8595227 DOI: 10.1007/s00167-021-06704-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/13/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Determining the risk of recurrent instability following an arthroscopic Bankart repair can be challenging, as numerous risk factors have been identified that might predispose recurrent instability. However, an overview with quantitative analysis of all available risk factors is lacking. Therefore, the aim of this systematic review is to identify risk factors that are associated with recurrence following an arthroscopic Bankart repair. METHODS Relevant studies were identified by searching PubMed, Embase/Ovid, Cochrane Database of Systematic Reviews/Wiley, Cochrane Central Register of Controlled Trials/Wiley, CINAHL/Ebsco, and Web of Science/Clarivate Analytics from inception up to November 12th 2020. Studies evaluating risk factors for recurrence following an arthroscopic Bankart repair with a minimal follow-up of 2 years were included. RESULTS Twenty-nine studies met the inclusion criteria and comprised a total of 4582 shoulders (4578 patients). Meta-analyses were feasible for 22 risk factors and demonstrated that age ≤ 20 years (RR = 2.02; P < 0.00001), age ≤ 30 years (RR = 2.62; P = 0.005), participation in competitive sports (RR = 2.40; P = 0.02), Hill-Sachs lesion (RR = 1.77; P = 0.0005), off-track Hill-Sachs lesion (RR = 3.24; P = 0.002), glenoid bone loss (RR = 2.38; P = 0.0001), ALPSA lesion (RR = 1.90; P = 0.03), > 1 preoperative dislocations (RR = 2.02; P = 0.03), > 6 months surgical delay (RR = 2.86; P < 0.0001), ISIS > 3 (RR = 3.28; P = 0.0007) and ISIS > 6 (RR = 4.88; P < 0.00001) were risk factors for recurrence. Male gender, an affected dominant arm, hyperlaxity, participation in contact and/or overhead sports, glenoid fracture, SLAP lesion with/without repair, rotator cuff tear, > 5 preoperative dislocations and using ≤ 2 anchors could not be confirmed as risk factors. In addition, no difference was observed between the age groups ≤ 20 and 21-30 years. CONCLUSION Meta-analyses demonstrated that age ≤ 20 years, age ≤ 30 years, participation in competitive sports, Hill-Sachs lesion, off-track Hill-Sachs lesion, glenoid bone loss, ALPSA lesion, > 1 preoperative dislocations, > 6 months surgical delay from first-time dislocation to surgery, ISIS > 3 and ISIS > 6 were risk factors for recurrence following an arthroscopic Bankart repair. These factors can assist clinicians in giving a proper advice regarding treatment. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Lukas P. E. Verweij
- Amsterdam UMC, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, Netherlands
| | - Sanne H. van Spanning
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands
| | - Adriano Grillo
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands
| | - Gino M. M. J. Kerkhoffs
- Amsterdam UMC, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, Netherlands
| | | | | | - Michel P. J. van den Bekerom
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands ,Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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12
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Patel BH, Lu Y, Agarwalla A, Puzzitiello RN, Nwachukwu BU, Cvetanovich GL, Chahla J, Forsythe B. Maximal Medical Improvement Following Shoulder Stabilization Surgery May Require up to 1 Year: A Systematic Review. HSS J 2020; 16:534-543. [PMID: 33380993 PMCID: PMC7749924 DOI: 10.1007/s11420-020-09773-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is increased emphasis on properly allocating healthcare resources to optimize value within orthopedic surgery. Establishing time to maximal medical improvement (MMI) can inform clinical decision-making and practice guidelines. PURPOSE We sought (1) to evaluate the time to MMI as predicted by commonly used patient-reported outcome measures (PROMs) for evaluation of shoulder stabilization and (2) to evaluate typical time to return to sports and employment following surgery. METHODS A systematic review of the Medline database was conducted to identify outcome studies reporting sequential follow-up at multiple time points, up to a minimum of 2 years after shoulder stabilization surgery. The included studies examined the outcomes of arthroscopic or open surgical techniques on anterior instability. Clinically significant improvements were evaluated utilizing the minimal clinically important difference specific to each PROM. Secondary outcomes included range of motion, return to sport/work, and recurrent instability. RESULTS Ten studies comprising 590 surgically managed cases of anterior shoulder instability were included (78% arthroscopic, 22% open). Clinically significant improvements in PROMs were achieved up to 1 year post-operatively for Rowe, Western Ontario Instability Index (WOSI), American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) scores. For the three most utilized tools (Rowe, WOSI, ASES), the majority of improvement occurred in the first 6 post-operative months. Clinically significant improvements in Constant Score and Oxford Shoulder Instability Score (OSIS) were achieved up to 6 months and 2 years after surgery, respectively. No clinically significant improvements were achieved on the Disabilities of the Arm, Shoulder, and Hand (DASH) tool. CONCLUSION Maximal medical improvement as determined by commonly utilized PROMs occurs by 1 year after operative management of anterior shoulder instability. The DASH tool does not appear to demonstrate a reliable time frame for clinically significant outcome improvement.
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Affiliation(s)
- Bhavik H. Patel
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL USA
| | - Yining Lu
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN USA
| | - Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY USA
| | | | | | - Gregory L. Cvetanovich
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL USA
| | - Brian Forsythe
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL USA
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External versus endoscopic ultrasound: Non-inferiority assessment for visualization of various structures of interest in the shoulder. Orthop Traumatol Surg Res 2020; 106:1153-1157. [PMID: 32917579 DOI: 10.1016/j.otsr.2020.05.013] [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: 03/13/2020] [Revised: 04/23/2020] [Accepted: 05/04/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Certain structures and pathologies can be difficult to reveal under videoscopy alone during arthroscopic surgery. Ultrasound can be a useful contribution in arthroscopic diagnostic and therapeutic procedures. The main aim of the present study was to assess equivalence between endoscopic and external ultrasound for shoulder exploration. Secondary objectives comprised qualitative assessment of endoscopic ultrasound images and comparative assessment of acquisition time between the two techniques. MATERIAL AND METHODS An anatomic non-inferiority study was conducted on 6 shoulders from 3 subjects with a mean age of 84 years. After ultrasound examination by a radiologist specializing in osteoarticular imaging, shoulder arthroscopy was performed by a single specialized surgeon, using an ultrasound endoscope. Number of visualized structures and image quality were assessed by independent observers. RESULTS Ten of the 11 structures of interest (91%) were visualizable on endoscopic ultrasound, versus 4 (36%) on external ultrasound (p<0.05). Mean endoscopic acquisition time was 9.5±6.3minutes [range, 5;22]. In the 11 structures, image quality was better on endoscopic than external ultrasound, except for the acromioclavicular joint, where quality was better on external ultrasound, and the lateral side of the rotator cuff, where quality was equivalent. CONCLUSION The present study demonstrated equivalence between endoscopic and external ultrasound for shoulder exploration. LEVEL OF EVIDENCE IV, Non-inferiority cadaver study.
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14
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Cordasco FA, Lin B, Heller M, Asaro LA, Ling D, Calcei JG. Arthroscopic shoulder stabilization in the young athlete: return to sport and revision stabilization rates. J Shoulder Elbow Surg 2020; 29:946-953. [PMID: 31812584 DOI: 10.1016/j.jse.2019.09.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder instability in young athletes is a complex problem with higher recurrence, higher reoperation, and lower return to sport (RTS) rates after arthroscopic shoulder stabilization compared with adults. METHODS This is a prospective case series of young athletes with anterior shoulder instability after arthroscopic stabilization surgery. Primary outcomes were RTS and revision surgery, minimum follow-up was 24 months. Exclusion criteria were more than 3 preoperative episodes of instability, significant bone loss, or primary posterior instability. Demographic data, recurrent instability, revision surgery, sports pre- and postsurgery, patient satisfaction, level of RTS, time to RTS, and Single Assessment Numeric Evaluation (SANE) scores were analyzed. RESULTS Sixty-seven athletes met inclusion criteria, 19 females and 48 males, with a mean age of 17.5 years (range, 13-21 years). Fifty-nine (88%) athletes returned to sport at an average of 7.1 months (standard deviation, ±1.8); 50 (75%) returned to the same level or higher. Football and lacrosse were the most common sports. Four of 67 athletes (6%), all male, underwent revision stabilization at 11-36 months for recurrent instability. The overall mean SANE score was 88. CONCLUSION This study demonstrates that when the high-risk athlete, 21 years old or younger, is appropriately selected for arthroscopic shoulder stabilization by excluding those with 3 or more preoperative shoulder instability episodes and those with off-track and engaging instability patterns, excellent outcomes can be achieved with low revision surgery rates, high RTS rates, and high patient satisfaction.
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Affiliation(s)
- Frank A Cordasco
- Hospital for Special Surgery, Sports Medicine and Shoulder Service, New York, NY, USA.
| | - Brian Lin
- Hospital for Special Surgery, Sports Medicine and Shoulder Service, New York, NY, USA
| | - Michael Heller
- Hospital for Special Surgery, Sports Medicine and Shoulder Service, New York, NY, USA
| | - Lori Ann Asaro
- Hospital for Special Surgery, Sports Medicine and Shoulder Service, New York, NY, USA
| | - Daphne Ling
- Hospital for Special Surgery, Sports Medicine and Shoulder Service, New York, NY, USA
| | - Jacob G Calcei
- Hospital for Special Surgery, Sports Medicine and Shoulder Service, New York, NY, USA
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15
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Arthroscopic stabilisation for shoulder instability. J Clin Orthop Trauma 2020; 11:S402-S411. [PMID: 32523301 PMCID: PMC7275285 DOI: 10.1016/j.jcot.2019.07.006] [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] [Received: 07/23/2018] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 12/11/2022] Open
Abstract
Since its first description over 30 years ago arthroscopic stabilisation has evolved. With improvements in knowledge, surgical techniques and materials technology, arthroscopic bankart repair has become the most widely used method for treating patients with symptomatic anterior shoulder instability. These procedures are typically performed in a younger, high demand patient population after a primary dislocation or to treat recurrent instability. A thorough clinical evaluation is required in the clinic setting not only to fully understand the injury pattern but also consider patient expectations prior to embarking on surgery. Diagnostic imaging will aid the clinician in determining the soft tissue pathology as well as assessing bone loss, which facilitates surgical decision-making. Selected patients may benefit from adjunctive procedures such as a remplissage for an "engaging" Hill-sachs lesion. This review will focus on the indications, pre-operative considerations, surgical techniques and outcomes of arthroscopic stabilisation.
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Galasso O, Tarducci L, De Benedetto M, Orlando N, Mercurio M, Gasparini G, Castricini R. Modified Weaver-Dunn Procedure for Type 3 Acromioclavicular Joint Dislocation: Functional and Radiological Outcomes. Orthop J Sports Med 2020; 8:2325967120905022. [PMID: 32215276 PMCID: PMC7065288 DOI: 10.1177/2325967120905022] [Citation(s) in RCA: 4] [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: 10/20/2019] [Accepted: 11/19/2019] [Indexed: 11/16/2022] Open
Abstract
Background Controversy surrounds the indication for treatment of type 3 acromioclavicular joint dislocation, and the optimal reconstructive technique has not yet been defined. Since the first description of the Weaver-Dunn procedure, several studies have described the clinical and radiological results that can be expected postoperatively; however, few studies have evaluated the outcomes of this technique for chronic type 3 acromioclavicular joint dislocation. Purpose/Hypothesis The purpose of this study was to evaluate the functional and radiographic mid- to long-term outcomes of a modified Weaver-Dunn procedure for chronic Rockwood type 3 acromioclavicular joint dislocation. We hypothesized that (1) functional outcomes comparable with sex- and age-matched healthy individuals could be achieved with the modified Weaver-Dunn procedure and (2) joint stability could be restored after surgery. Study Design Case series; Level of evidence, 4. Methods Out of 30 patients who sustained a chronic type 3 acromioclavicular joint dislocation, 27 had a minimum 12-month follow-up and were included in the study. All patients underwent a modified Weaver-Dunn procedure. The Constant-Murley score was used to assess patient postoperative function. Subjective evaluation of patient satisfaction with surgery was also recorded. Radiological assessment was performed postoperatively to evaluate superoinferior and anteroposterior joint stability. Results After a mean follow-up period of 51.6 months, the mean Constant-Murley score was 90.1, which was 97.2% that of a group of sex- and age-matched healthy individuals. In the multivariate analysis, higher Constant-Murley score was associated with male sex (β = 0.385; P = .043) and higher subjective satisfaction scale (β = 0.528; P = .003). All patients returned to their previous work and sport activity levels having high satisfaction with surgery. Successful vertical acromioclavicular joint reduction was obtained in all but 1 patient; however, horizontal joint stability was not completely restored with the modified Weaver-Dunn procedure. No intraoperative complications occurred, and the postoperative complication rate was 7.4%. Conclusion In patients with chronic type 3 acromioclavicular joint dislocation, the modified Weaver-Dunn procedure is an effective technique to restore vertical but not horizontal joint stability 4 years after surgery. High levels of satisfaction with surgery and functional outcomes comparable with sex- and age-matched healthy individuals can be achieved.
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Affiliation(s)
- Olimpio Galasso
- Magna Græcia University, Mater Domini University Hospital, Catanzaro, Italy
| | - Lorenzo Tarducci
- Magna Græcia University, Mater Domini University Hospital, Catanzaro, Italy
| | - Massimo De Benedetto
- Division of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy
| | - Nicola Orlando
- Division of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy
| | - Michele Mercurio
- Magna Græcia University, Mater Domini University Hospital, Catanzaro, Italy
| | - Giorgio Gasparini
- Magna Græcia University, Mater Domini University Hospital, Catanzaro, Italy
| | - Roberto Castricini
- Division of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy
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Ruiz Ibán MA, Asenjo Gismero CV, Moros Marco S, Ruiz Díaz R, Del Olmo Hernández T, Del Monte Bello G, García Navlet M, Ávila Lafuente JL, Díaz Heredia J. Instability severity index score values below 7 do not predict recurrence after arthroscopic Bankart repair. Knee Surg Sports Traumatol Arthrosc 2019; 27:3905-3911. [PMID: 30955072 DOI: 10.1007/s00167-019-05471-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/04/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the efficacy of the Instability Severity Index Score (ISIS) in predicting an increased recurrence risk after an arthroscopic Bankart repair. METHODS Retrospective review of a cohort of patients operated in three different centres. The inclusion criteria (recurrent anterior instability [dislocation or subluxation] with or without hyperlaxity, arthroscopic Bankart repair) and the exclusion criteria (concomitant rotator cuff lesion, acute first-time dislocation, surgery after a previous anterior stabilization, surgery for an unstable shoulder without true dislocation or subluxation; multidirectional instability) were those used in the study that defined the ISIS score. The medical records and a telephone interview were used to identify the six variables that define the ISIS and identify recurrences. RESULTS One hundred and sixty-three shoulders met the inclusion and exclusion criteria. Of these, 140 subjects (22 females/118 males; mean age 35.5 ± 7.9) with 142 (89.0%) shoulders were available for follow-up after 5.3 (1.1) (range 3.1-7.4) years. There were 20 recurrences (14.1%). The mean (SD) preoperative ISIS was 1.8 (1.6) in the patients without recurrence and 1.8 (1.9) in the patients with recurrence (n.s.). In the 117 subjects with ISIS between 0 and 3 the recurrence rate was 12.8%; in the 25 with ISIS 4 to 6 the rate was 20% (n.s.). CONCLUSION For subjects with anterior shoulder instability in which an arthroscopic Bankart repair is being considered, the use of the ISIS, when the values obtained are ≤ 6 was not useful to predict an increased recurrence risk in the midterm in this retrospectively evaluated case series. The efficacy of the ISIS score in defining a group of subjects with a preoperative increased risk of recurrence after an arthroscopic Bankart instability repair is limited in lower risk populations (with ISIS scores ≤ 6). LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Affiliation(s)
- Miguel Angel Ruiz Ibán
- Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Cta Colmenar Km 9, 100, 28034, Madrid, Spain.
| | | | | | - Raquel Ruiz Díaz
- Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Cta Colmenar Km 9, 100, 28034, Madrid, Spain
| | | | | | | | | | - Jorge Díaz Heredia
- Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Cta Colmenar Km 9, 100, 28034, Madrid, Spain
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Sebastiá-Forcada E, Martínez-Rico S, Vizcaya-Moreno M, Lizaur-Utrilla A. Prospective study on effectiveness and safety of arthroscopic Bankart using a single anterior portal for patients with anterior shoulder instability. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Assunção JH, Malavolta EA, Souza FJD, Gracitelli MEC, Ferreira Neto AA. Anterior Glenohumeral Instability: Systematic Review of Outcomes Assessment Used in Brazil. Rev Bras Ortop 2019; 54:483-490. [PMID: 31686709 PMCID: PMC6819158 DOI: 10.1016/j.rbo.2017.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/07/2017] [Indexed: 11/23/2022] Open
Abstract
A review involving the six major international orthopedic journals has been published recently. It described the tools used for the evaluation of outcomes in the surgical treatment of recurrent anterior dislocation of the shoulder. There are no studies that exhibit the main outcome tools for this disease in Brazil. The authors evaluated the outcomes of clinical studies involving anterior glenohumeral instability that were published in the last decade in the two leading Brazilian orthopedic journals, Revista Brasileira de Ortopedia and Acta Ortopédica Brasileira . A review of the literature was performed, including all clinical papers published between 2007 and 2016 describing at least one outcome measure before and after surgical intervention. The outcomes were range of motion, muscle strength, physical examination testing, patient satisfaction, return to sports, imaging, complications, and functional outcomes scores. Twelve studies evaluating the clinical outcomes of surgical treatment for anterior shoulder instability were published. Ten studies (83%) were case series (level of evidence IV), 1 (8%) was a case-control study (III), and 1 was a retrospective cohort (III). On average, the number of outcomes assessed was 3.7 ± 1.7. The Rowe score was used in 9 studies (75%), and 7 (58%) papers used the University of California Los Angeles (UCLA) scale. Ten studies (83%) reported complications related to surgical treatment. The complication most frequently reported was recurrent instability, found in 9 studies (75%). The national studies have preferentially used scales considered to be of low reliability, responsiveness, and internal consistency.
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Affiliation(s)
- Jorge Henrique Assunção
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Eduardo Angeli Malavolta
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Fernando José de Souza
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Mauro Emilio Conforto Gracitelli
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Arnaldo Amado Ferreira Neto
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
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Sebastiá-Forcada E, Martínez-Rico S, Vizcaya-Moreno MF, Lizaur-Utrilla A. Prospective study on effectiveness and safety of arthroscopic Bankart using a single anterior portal for patients with anterior shoulder instability. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:431-438. [PMID: 31285179 DOI: 10.1016/j.recot.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 01/24/2019] [Accepted: 05/27/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness and safety of the arthroscopic Bankart repair technique using a single anterior portal in patients with anterior shoulder instability. PATIENTS AND METHODS Prospective study of 82 patients who underwent arthroscopic Bankart repair using a single anterior portal. Comparison with a historical series of 69 patients treated with two anterior portals. The patients were evaluated by the Rowe scale, and DASH (Disability of the Arm, Shoulder and Hand) and OIS (Oxford Instability Shoulder) questionnaires, range of motion and visual analogue scales for pain and patient satisfaction. RESULTS After a mean follow-up of 36 months, there were no significant differences between groups regarding clinical or functional scores, quality of life or patient satisfaction. Surgical time was significantly shorter in the 1-portal group. In group 1-portal there were 2 patients with neurapraxias and 2 re-dislocations, while in group 2-portals were 1 and 2, respectively. The worst functional results were associated with the presence of a type III SLAP lesion. CONCLUSIONS Both techniques were satisfactory regarding functional outcomes and complications, except for type III SLAP lesions. Using only one anterior portal, the surgical time was shorter, and the costs were lower when dispensing with a second cannula and a suture passing instrument.
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Affiliation(s)
- E Sebastiá-Forcada
- Unidad de Miembro Superior, Hospital Universitario de Elda, Elda, Alicante, España
| | - S Martínez-Rico
- Unidad de Miembro Superior, Hospital Universitario de Elda, Elda, Alicante, España
| | - M F Vizcaya-Moreno
- Unidad de Investigación, Facultad de Ciencias de la Salud, Universidad de Alicante, San Vicente del Raspeig, Alicante, España
| | - A Lizaur-Utrilla
- Unidad de Miembro Superior, Hospital Universitario de Elda, Elda, Alicante, España.
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Kanatli U, Özer M, Gem M, Öztürk BY, Ataoğlu MB, Çetinkaya M, Ayanoğlu T. Multiple Subscapularis Tendon Sign: A New Risk Factor for Recurrence After Arthroscopic Anterior Shoulder Instability Surgery. Orthop J Sports Med 2019; 7:2325967119853507. [PMID: 31276003 PMCID: PMC6598329 DOI: 10.1177/2325967119853507] [Citation(s) in RCA: 5] [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] [Indexed: 11/29/2022] Open
Abstract
Background: Being able to predict recurrence after the treatment of shoulder instability would be helpful in planning the appropriate treatment. Purpose: To define the multiple subscapularis tendon sign (MSTS) as a novel anatomic variant and a possible risk factor for the recurrence of shoulder instability after anterior stabilization and to evaluate it, together with the other risk factors as described in the literature. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 87 patients met the study criteria and underwent arthroscopic stabilization for anterior shoulder instability. The MSTS was evaluated in this study group. Age, sex, hand dominance, number of preoperative shoulder dislocations, history of overhead or contact sports participation, type of labral lesion, number of anchors used in surgery, presence of the drive-through sign, presence of the MSTS, Oxford Shoulder Score results, and the association of these parameters with recurrence were assessed. The mean follow-up time was 81.0 ± 27.9 months (range, 48-139 months). Results: Nine (10.3%) patients experienced recurrent instability. The presence of the MSTS (P = .009), existence of an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion (P = .04), and history of overhead or contact sports participation (P = .04) were significant risk factors for recurrence. The recurrence rates were as follows: 30.7% with the MSTS; 40% with the MSTS and an ALPSA lesion; and 75% with the MSTS, an ALPSA lesion, and a history of overhead or contact sports participation. Conclusion: The MSTS is a variation of the anterior shoulder joint capsule. It is a sign of capsular insufficiency or thinning, which may be a risk factor for recurrence after anterior stabilization. Considering the low success rates of anterior capsulolabral repair in patients participating in overhead or contact sports, especially when an ALPSA lesion is present, encountering the MSTS during surgery in this at-risk group may be an indicator for the surgeon to choose the surgical procedure more carefully.
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Affiliation(s)
- Ulunay Kanatli
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mustafa Özer
- Department of Orthopaedics and Traumatology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Gem
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Burak Yağmur Öztürk
- Department of Orthopaedics and Traumatology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Muhammet Baybars Ataoğlu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Çetinkaya
- Department of Orthopaedics and Traumatology, Mengucek Gazi Training and Research Hospital, Erzincan University, Erzincan, Turkey
| | - Tacettin Ayanoğlu
- Department of Orthopaedics and Traumatology, Yozgat City Hospital, Yozgat, Turkey
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Castricini R, La Camera F, De Gori M, Orlando N, De Benedetto M, Galasso O, Gasparini G. Functional outcomes and repair integrity after arthroscopic repair of partial articular supraspinatus tendon avulsion. Arch Orthop Trauma Surg 2019; 139:369-375. [PMID: 30269221 DOI: 10.1007/s00402-018-3044-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Partial-thickness rotator cuff tears are a common cause of shoulder pain and disability. Arthroscopic repair is an effective treatment for partial articular supraspinatus tendon avulsion (PASTA) lesions, and transtendon repair and completion of the tear and repair are the surgical techniques commonly used to treat such lesions. Our aim was to retrospectively evaluate the minimum 24-month clinical and radiological results of PASTA. MATERIALS AND METHODS Patients suffering from PASTA lesion who underwent arthroscopic repair with a minimum 24-month follow-up were included in this study. The Constant and Murley score (CMS) was used to assess the patients' functionality pre- and postoperatively. The postoperative patient assessment included the simple shoulder test (SST). Postoperative tendon integrity was evaluated by ultrasound examination. RESULTS 151 patients (153 shoulders) were retrospectively evaluated 73.9 (24-142) months after a completion-repair (94 cases) or transtendon repair (59 cases) of a PASTA lesion. The CMS significantly improved from 47.7 (22-63) preoperatively to 84.2 (62-100) postoperatively (p < 0.001). The mean postoperative SST score was 10.1 (5-12), and 95% of patients were satisfied with the surgery. No significant differences were noted between the two techniques in terms of postoperative CMS, SST score and satisfaction. Seventy-four and 43 cases treated with completion and repair and transtendon repair, respectively, performed ultrasound examination 66.1 (24-142) months after surgery. The overall retear rate was 13.7%, supraspinatus retears were observed in ten shoulder subjected to completion and repair (13.5%) and six shoulders subjected to transtendon repair (13.9%), and no significant differences were noted between the two techniques as for CMS (p = 0.896), SST (p = 0.973), satisfaction (p = 0.621) and retear (p = 0.999). Males and younger patients had a higher postoperative CMS (p values < 0.001), and SST score (p < 0.001 and p = 0.038, respectively). CONCLUSIONS Arthroscopic repair of PASTA lesion achieves high rates of repair integrity regardless of repair type and high levels of functional recovery and patient satisfaction 6 years after surgery.
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Affiliation(s)
- Roberto Castricini
- Department of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy
| | - Francesco La Camera
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, V.le Europa, (loc. Germaneto), 88100, Catanzaro, Italy
| | - Marco De Gori
- Department of Orthopaedic and Trauma Surgery Alessandria, SS. Antonio and Biagio and Cesare Arrigo" Hospital, Alessandria, Italy
| | - Nicola Orlando
- Department of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy
| | - Massimo De Benedetto
- Department of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Cotignola, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, V.le Europa, (loc. Germaneto), 88100, Catanzaro, Italy.
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, V.le Europa, (loc. Germaneto), 88100, Catanzaro, Italy
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23
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Surgical treatment outcomes after primary vs recurrent anterior shoulder instability. J Clin Orthop Trauma 2019; 10:222-230. [PMID: 30828182 PMCID: PMC6383179 DOI: 10.1016/j.jcot.2018.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/16/2018] [Accepted: 10/20/2018] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION The aim of this study is to compare the outcomes of surgical management after primary anterior shoulder dislocation to the outcomes of patients who have surgical stabilization after recurrent anterior shoulder instability. METHODS A Medline (PubMed) search was performed in November of 2016 using the following key terms: shoulder, labrum, Bankart, instability, repair, outcome, recurrent. In May 2017 a Cochrane search was performed using similar key terms to ensure we included all studies. Only level I and II studies were included. RESULTS There were three studies that compared primary repair to delayed repair. In all three studies, the rate of recurrence was higher in group R than group S. When pooled, there was not a statistically significant difference between these groups, but there was a slightly higher odds of recurrence in group R (pooled OR 2.08, CI 0.69-6.26, p = 0.19). No significant differences were appreciated in functional outcomes or complications in these two groups. CONCLUSION Further level I and level II studies to compare surgical treatment after first time and recurrent instability are needed. This study failed to find a statistically significant difference in recurrence rates in patients who had stabilization acutely after a single episode compared to patients with recurrent instability events, although results suggest there may be a small benefit in primary stabilization.
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Hughes JL, Bastrom T, Pennock AT, Edmonds EW. Arthroscopic Bankart Repairs With and Without Remplissage in Recurrent Adolescent Anterior Shoulder Instability With Hill-Sachs Deformity. Orthop J Sports Med 2018; 6:2325967118813981. [PMID: 30574517 PMCID: PMC6295689 DOI: 10.1177/2325967118813981] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Recurrent shoulder dislocation after surgical intervention in adolescents with anterior instability is now understood to occur with a relatively high frequency. The remplissage procedure is successfully used in the adult population to mitigate the ability of a Hill-Sachs lesion to engage the anterior glenoid and can be used during an arthroscopic Bankart repair for anterior shoulder instability. Purpose: To compare the clinical outcomes in adolescent patients who underwent a Bankart repair with or without remplissage for treatment of recurrent anterior shoulder instability and associated Hill-Sachs defects. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was conducted on adolescents who underwent a remplissage procedure for recurrent anterior shoulder instability from 2009 to 2017 at a single institution. Controls were identified in a cohort of patients who underwent a Bankart repair only and were matched based on age, sex, and size of Hill-Sachs lesion. All patients were then contacted to determine instability recurrence as well as to complete the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) and the Pediatric Adolescent Shoulder Score (PASS) outcome surveys. Results: Twenty-one adolescents underwent a remplissage procedure, and 20 matched controls underwent only a Bankart procedure. A significantly higher rate of recurrence was noted in the Bankart-only patients (8/17) compared with remplissage patients (2/15) (P = .04). No statistical difference was found in patient-reported outcome scores between treatment groups or in range of motion measurements (P > .05). In a subset of patients in the remplissage group with pre- and postoperative surveys available, mean ± SD scores for PASS (77 ± 11) and QuickDASH (19 ± 12) improved when compared with preoperative scores (PASS, 54 ± 16; QuickDASH, 35 ± 28), but only the PASS score was statistically improved (PASS, P = .003; QuickDASH, P = .23). Conclusion: The addition of the remplissage procedure to a Bankart repair is a reasonable surgical option to treat a Hill-Sachs deformity in adolescents with anterior shoulder instability. The success of this additional procedure may be due to filling the Hill-Sachs defect, or perhaps it augments stability through a mechanism of posterior capsulorrhaphy. Either way, this young athletic population appears to have a lower rate of recurrence and improved patient-reported outcomes with a remplissage procedure to address the Hill-Sachs deformity.
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Affiliation(s)
| | | | - Andrew T Pennock
- Rady Children's Hospital, San Diego, California, USA.,University of California, San Diego, San Diego, California, USA
| | - Eric W Edmonds
- Rady Children's Hospital, San Diego, California, USA.,University of California, San Diego, San Diego, California, USA
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Castricini R, Familiari F, De Gori M, Riccelli DA, De Benedetto M, Orlando N, Galasso O, Gasparini G. Tenodesis is not superior to tenotomy in the treatment of the long head of biceps tendon lesions. Knee Surg Sports Traumatol Arthrosc 2018. [PMID: 28623414 DOI: 10.1007/s00167-017-4609-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the effectiveness of tenodesis and tenotomy in the treatment of long head of the biceps tendon (LHBT) lesions. The null hypothesis was that there is no difference in functional scores between the tenotomy and tenodesis groups. METHODS A total of 69 patients with a combined supraspinatus tear and LHBT lesion aged over 40 years entered this prospective comparative study and were randomly assigned to the arthroscopic LHB tenotomy or tenodesis group. Fifty-five patients (31 in the tenotomy group and 24 in the tenodesis group) were available for the 6- and 24-month post-operative evaluations. RESULTS There were no statistically significant differences in post-operative Constant and Murley score, quality of life, pain, and strengths between groups. Higher rates of Popeye's sign were noted 6 and 24 months post-operatively in the tenotomy group compared to tenodesis. CONCLUSIONS Although tenotomy is affected by a higher incidence of cosmetic deformity, there is no superiority of arthroscopic tenodesis over tenotomy in the treatment of LHBT lesion as a concomitant procedure to an arthroscopic repair of the supraspinatus tendon in terms of functional outcomes, quality of life, pain, and strength measured 6 and 24 months post-operatively. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Roberto Castricini
- Department of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Catanzaro, Italy
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University and "Mater Domini" University Hospital, V.le Europa (loc. Germaneto), 88100, Catanzaro, Italy
| | - Marco De Gori
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University and "Mater Domini" University Hospital, V.le Europa (loc. Germaneto), 88100, Catanzaro, Italy
| | - Daria Anna Riccelli
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University and "Mater Domini" University Hospital, V.le Europa (loc. Germaneto), 88100, Catanzaro, Italy
| | - Massimo De Benedetto
- Department of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Catanzaro, Italy
| | - Nicola Orlando
- Department of Orthopaedic and Trauma Surgery, Villa Maria Cecilia Hospital, Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University and "Mater Domini" University Hospital, V.le Europa (loc. Germaneto), 88100, Catanzaro, Italy.
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University and "Mater Domini" University Hospital, V.le Europa (loc. Germaneto), 88100, Catanzaro, Italy
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Ranalletta M, Rossi LA, Sirio A, Diaz Dilernia F, Bertona A, Maignon GD, Bongiovanni SL. Return to Sports and Recurrences After Arthroscopic Anterior Shoulder Stabilization in Martial Arts Athletes. Orthop J Sports Med 2017; 5:2325967117725031. [PMID: 28932751 PMCID: PMC5600303 DOI: 10.1177/2325967117725031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: The high demands to the glenohumeral joint and the violent shoulder blows
experienced during martial arts (MA) could compromise return to sports and
increase the recurrence rate after arthroscopic stabilization for anterior
shoulder instability in these athletes. Purpose: To report the functional outcomes, return to sports, and recurrences in a
series of MA athletes with anterior shoulder instability treated with
arthroscopic stabilization with suture anchors. Study Design: Case series; Level of evidence, 4. Methods: A total of 20 consecutive MA athletes were treated for anterior shoulder
instability at a single institution between January 2008 and December 2013.
Range of motion (ROM), the Rowe score, a visual analog scale (VAS), and the
Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess
functional outcomes. Return-to-sport and recurrence rates were also
evaluated. Results: The mean age at the time of surgery was 25.4 years (range, 18-35 years), and
the mean follow-up was 71 months (range, 36-96 months). No significant
difference in preoperative and postoperative shoulder ROM was found. The
Rowe, VAS, and ASOSS scores showed statistical improvement after surgery
(P < .001). In all, 19 athletes (95%) returned to
sports. However, only 60% achieved ≥90% recovery after surgery. The
recurrence rate was 20%. Conclusion: In this retrospective study of a consecutive cohort of MA athletes,
arthroscopic anterior shoulder stabilization significantly improved
functional scores. However, only 60% of the athletes achieved the same level
of competition, and there was a 20% recurrence rate.
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Affiliation(s)
- Maximiliano Ranalletta
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luciano A Rossi
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Adrian Sirio
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Fernando Diaz Dilernia
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Agustin Bertona
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Gastón D Maignon
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Santiago L Bongiovanni
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Abstract
Background: Optimal surgical management of anterior shoulder instability remains controversial. There is a need to assess the most recent trends for primary and revision shoulder stabilization surgery using a national database significantly larger than those previously utilized. Hypothesis: Most shoulder stabilization procedures are performed arthroscopically. Examining revision procedures, we hypothesized that open procedures would result in decreased revision stabilizations compared with arthroscopic procedures and that most revision procedures would be open Bankart or bone transfer procedures regardless of the index procedure technique. Study Design: Descriptive epidemiology study. Methods: The MarketScan Database was searched using International Classification of Diseases–Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes to identify patients who underwent any shoulder stabilization procedure between 2008 and 2012. Regression analysis was used to evaluate trends between patient groups. The Cochran-Armitage trend test was used to identify differences in trends seen yearly. Odds ratios (ORs) were calculated to compare the likelihood of undergoing a revision stabilization procedure. Results: A total of 66,564 shoulder stabilization procedures were identified from 2008 through 2012: 60,248 arthroscopic stabilization procedures (90.5%) and 6316 open stabilization procedures (9.5%), including 1623 bone block procedures. Arthroscopic stabilization procedures increased in total number and percentage of all procedures in each year of the study. Bone block procedures increased in number each year, although other open procedures decreased during the study period. Males underwent more stabilization procedures, while patients between the ages of 10 and 19 years were most likely to undergo any procedure. Patients who underwent bone block stabilization were significantly less likely to undergo a second stabilization procedure during the study period when compared with open Bankart repair (OR, 0.582; 95% CI, 0.405-0.836; P < .05) and arthroscopic Bankart repair (OR, 0.587; 95% CI, 0.418-0.824; P < .05). No statistically significant difference in revision stabilization was seen when comparing arthroscopic versus open Bankart repair (OR, 0.934; 95% CI, 0.863-1.139). Conclusion: Although the number of arthroscopic shoulder stabilization surgeries continues to increase, our data show a consistent increase, not seen in prior studies, in the number of bone block procedures. Contrary to some studies, there was no significant difference in the likelihood of a second procedure between patients initially undergoing arthroscopic compared with open Bankart repair.
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Affiliation(s)
- Nicholas A Bonazza
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Penn State Health, Hershey, Pennsylvania, USA
| | - Guodong Liu
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Douglas L Leslie
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Aman Dhawan
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Penn State Health, Hershey, Pennsylvania, USA
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Quality of Life and Functional Results of Arthroscopic Partial Repair of Irreparable Rotator Cuff Tears. Arthroscopy 2017; 33:261-268. [PMID: 27614389 DOI: 10.1016/j.arthro.2016.06.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/05/2016] [Accepted: 06/10/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the minimum 2-year results and possible outcomes of arthroscopic partial repair in different patterns of irreparable rotator cuff tears (RCTs). METHODS Patients suffering from an irreparable supraspinatus and a reparable infraspinatus tendons who underwent arthroscopic partial repair with a minimum 24-month follow-up were included in this study. The Constant and Murley score (CMS) was used to assess patients' functionality pre- and postoperatively. Postoperative patient assessment included the Simple Shoulder Test (SST) and the Short Form Health Survey questionnaire (SF-36). A postoperative range of motion, CMS, and strength were compared with the contralateral side. Postoperative SF-36 was compared with age- and sex-matched norms. RESULTS Ninety patients (95 shoulders) were reviewed after a mean follow-up of 7 (range 2-12) years. The subscapularis tendon was intact in 80 shoulders and torn but completely reparable in the remaining 15 shoulders. The CMS improved from 39.1 ± 8.4 (10-61) to 76.3 ± 9.7 (32-93) (P < .001). The mean postoperative SST was 9.1 ± 2.2 (1-12). Although the patients had lower postoperative abduction and internal rotation, strength in abduction and CMS in comparison with the measurements from the contralateral side, the median postoperative SF-36 physical and mental component summaries were 98% and 100% of the matched norms. No significant differences were found in postoperative outcomes according to the RCT pattern. Males showed significantly higher strengths in abduction (B = -1.384, 95% confidence interval [CI] -2.144 to -0.624, η2 = 0.123, P < .001, 95% power), external rotation (B = -3.646, 95% CI -5.2 to -2.092, η2 = 0.189, P < .001, 100% power), and internal rotation (B = -3.867, 95% CI -5.676 to -2.057, η2 = 0.162, P < .001, 99% power) than females. Significantly higher ranges of abduction (η2 = 0.431, P = .019, 98% power) and external rotation (η2 = 0.417, P < .03, 97% power) were noted in younger patients. Higher strengths in abduction (η2 = 0.495, P = .002, 100% power) and internal rotation (η2 = 0.464, P = .006, 99% power) were also reported in these patients. CONCLUSIONS When there is an irreparable supraspinatus but there is still the possibility to repair the infraspinatus and subscapularis, the arthroscopic partial cuff repair should be considered as an effective surgical option. Indeed, a significant clinical improvement can be achieved and, differently from pure symptomatic surgical procedures, this technique represents a reasonable effort to restore, at least in part, the shoulder joint functionality. Successful and reliable results can be expected at an average 7-year follow-up, regardless of the RCT pattern. Female and older patients have a greater likelihood of lower functional outcomes. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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