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Khaleel M, Oladeji LO, Smith CA, DeFroda SF, Nuelle CW. Two-Portal Arthroscopic Knotless All-Suture Anchor Posterior Labral Repair. Arthrosc Tech 2024; 13:102928. [PMID: 38835471 PMCID: PMC11144742 DOI: 10.1016/j.eats.2024.102928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/23/2023] [Indexed: 06/06/2024] Open
Abstract
Isolated posterior shoulder instability accounts for approximately 10% of shoulder instability cases. Patients may present after an acute trauma or with insidious onset and associated posterior shoulder pain. Knotless and all-suture anchor devices have become increasing popular and are often used in arthroscopic shoulder instability cases to avoid knot stacks and allow for the ability to re-tension the fixation. This technical note describes our technique for 2-portal posterior labral repair using knotless all-suture anchors with the patient in the lateral decubitus position.
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Affiliation(s)
- Mubinah Khaleel
- Department of Orthopaedic Surgery, University of Missouri–Columbia, Columbia, Missouri, U.S.A
| | - Lasun O. Oladeji
- Department of Orthopaedic Surgery, University of Missouri–Columbia, Columbia, Missouri, U.S.A
| | - Conor A. Smith
- Department of Orthopaedic Surgery, University of Missouri–Columbia, Columbia, Missouri, U.S.A
| | - Steven F. DeFroda
- Department of Orthopaedic Surgery, University of Missouri–Columbia, Columbia, Missouri, U.S.A
| | - Clayton W. Nuelle
- Department of Orthopaedic Surgery, University of Missouri–Columbia, Columbia, Missouri, U.S.A
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Hassebrock JD, Sylvia SM, McCarthy TP, Stokes DJ, Shinsako KK, Frank RM. Posterior Labral Repair Using Knotless "All-Suture" Suture Anchors. Arthrosc Tech 2023; 12:e1219-e1224. [PMID: 37533896 PMCID: PMC10391341 DOI: 10.1016/j.eats.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/17/2023] [Indexed: 08/04/2023] Open
Abstract
Isolated posterior instability is well described but relatively uncommon, accounting for less than 10% of all shoulder instability cases. When nonoperative management fails, surgical outcomes demonstrate improved patient-reported outcomes with a high level of return to sport. Knotless suture anchor and "all-suture" suture anchor technology are now available and used for instability procedures in the shoulder. This technical description describes knotless "all-suture" suture anchor fixation for isolated posterior labral tears.
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Affiliation(s)
- Jeffrey D. Hassebrock
- University of Colorado Medical Center, Department of Orthopedic Surgery, Boulder, Colorado, U.S.A
| | - Stephen M. Sylvia
- University of Colorado Medical Center, Department of Orthopedic Surgery, Boulder, Colorado, U.S.A
| | - Timothy P. McCarthy
- University of Colorado Medical Center, Department of Orthopedic Surgery, Boulder, Colorado, U.S.A
| | - Daniel J. Stokes
- University of Colorado School of Medicine, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
| | - Kevin K. Shinsako
- University of Colorado School of Medicine, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
| | - Rachel M. Frank
- University of Colorado School of Medicine, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
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Scanaliato JP, Childs BR, Dunn JC, Czajkowski H, Parnes N. Arthroscopic Posterior Labral Repair in Active-Duty Military Patients: A Reliable Solution for an At-Risk Population, Regardless of Anchor Type. Am J Sports Med 2022; 50:3036-3044. [PMID: 35983962 DOI: 10.1177/03635465221111568] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Active-duty servicemembers are a population at risk for the development of posterior shoulder instability. While short-term outcomes after arthroscopic posterior labral repair for posterior shoulder instability are promising, there is a paucity of longer term follow-up data for this procedure. PURPOSES The primary purpose was to report midterm outcomes after arthroscopic posterior labral repair in active-duty military patients for posterior shoulder instability without bone loss. The secondary purpose was to determine if outcomes varied between anchor types used. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Preoperative and postoperative outcomes, with a minimum 3-year follow-up, for a visual analog scale for pain, the Single Assessment Numeric Evaluation (SANE), the American Shoulder and Elbow Surgeons (ASES) score, and the Rowe score were collected and analyzed. A separate subgroup analysis was performed comparing the outcomes of patients who underwent repair with biocomposite anchors versus those who underwent repair with all-suture anchors. RESULTS A total of 73 patients with a mean follow-up of 82.55 ± 24.20 months met the inclusion criteria and were available for analysis. As a whole, the cohort demonstrated statistically and clinically significant improvements in outcome scores at final follow-up. Preoperative and postoperative range of motion did not vary significantly. While the difference in final outcome scores between the 2 anchor types did not reach statistical significance, a statistically significantly larger proportion of patients who underwent repair with all-suture anchors versus those who underwent repair with biocomposite anchors met the Patient Acceptable Symptom State for the SANE (97.14% vs 78.95%, respectively; P = .0180) and the ASES score (88.57% vs 68.42%, respectively; P = .0171). The proportion of patients who achieved the substantial clinical benefit or surpassed the minimal clinically important difference, however, did not vary by anchor type. Overall, 70 patients (95.89%) remained on active duty and were able to return to preinjury work and recreational activity levels. There were 3 patients (4.11%) who had recurrent posterior instability. CONCLUSION This population of active-duty servicemembers undergoing posterior labral repair for posterior labral instability without bone loss demonstrated a statistically and clinically significant improvement in midterm outcomes, a low recurrence rate, and a rate of return to active duty of 95.89%, regardless of the anchor type used.
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Affiliation(s)
| | | | - John C Dunn
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | | | - Nata Parnes
- Carthage Area Hospital, Carthage, New York, USA.,Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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Marcaccio SE, O’Donnel RM, Schilkowsky R, Owens MBD, Bokshan SL. Posterior Glenoid Osteotomy With Capsulolabral Repair Improves Resistance Forces in a Critical Glenoid Bone Loss Model. Orthop J Sports Med 2022; 10:23259671221083579. [PMID: 35309235 PMCID: PMC8928394 DOI: 10.1177/23259671221083579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background: There is no widespread consensus on the surgical treatment of posterior shoulder instability with critical posterior glenoid bone loss. Hypothesis: That opening posterior glenoid wedge osteotomy with soft tissue repair would improve the resistance forces of instability when compared with soft tissue repair alone in the setting of 20% critical bone lose. Study Design: Controlled laboratory study. Methods: Native glenoid retroversion was measured on 9 shoulders using computed tomography (CT) scans. The humerus was potted in 90° of forward flexion and 30° of internal rotation relative to the scapula, and a posterior dislocation was performed to create a posterior capsulolabral injury model. The specimens were each taken through a fixed sequence of testing: (1) posteroinferior capsulolabral tear, (2) no glenoid bone loss with posteroinferior capsulolabral repair, (3) 20% posterior glenoid bone loss with posteroinferior capsulolabral repair, and (4) 20% glenoid bone loss with posterior glenoid opening wedge osteotomy and posteroinferior capsulolabral repair. Bone loss was created using a sagittal saw. The resultant peak forces with 1 cm of posterior translation were measured. A 1-way repeated-measures analysis of variance was used to compare mean force values. Results: After the initial dislocation event, all shoulders had a resultant posterior capsulolabral injury. The resulting labral injury was extended from 6- to 9-o’clock in all specimens to homogenize the extent of injury. Repairing the capsulolabral complex in the 20% posterior glenoid bone loss group did not result in a statistically significant increase in resistance force compared with the labral deficient group (34.1 vs 22.2 N; P = .068). When 20% posterior bone loss was created, the posterior glenoid osteotomy with capsulolabral repair was significantly stronger (43.8 N) than the posterior repair alone both with (34.1 N) and without (31.8 N) bone loss (P = .008 and .045, respectively). Conclusion: In the setting of critical posterior glenoid bone loss, an opening wedge posterior glenoid osteotomy with capsulolabral repair improved resistance to posterior humeral translation significantly compared with capsulolabral repair alone. Clinical Relevance: The results of this biomechanical cadaveric study may aid in surgical planning for this complex patient population.
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Affiliation(s)
- Stephen E. Marcaccio
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
| | - Ryan M. O’Donnel
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
| | - Rachel Schilkowsky
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
| | - Meng Brett D. Owens
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
| | - Steven L. Bokshan
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
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Comfort SM, Peebles AM, Ruzbarsky JJ, Akamefula RA, Provencher MT. Arthroscopic Labral Repair Using Knotless Suture Anchors in the Setting of a 270° Labral Tear of the Shoulder. Arthrosc Tech 2021; 10:e2319-e2324. [PMID: 34754740 PMCID: PMC8556671 DOI: 10.1016/j.eats.2021.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/01/2021] [Indexed: 02/03/2023] Open
Abstract
Extensive glenoid labral tears, whether the result of repetitive instability or first-time dislocation, compromise the mechanical stability of the glenohumeral joint due to disruption of the anterior, inferior, posterior, and/or superior portions of the labrum. These lesions often result in recurrent multiplanar instability and pain that is nonresponsive to conservative management and difficult to diagnose due to variability in clinical presentation and advanced imaging findings. Arthroscopic repair techniques to address symptomatic shoulder instability have showed positive patient-reported outcomes, low failure rates, and high return-to-sport rates. The evolution of knotless suture anchors offers a fixation method that has proven to be functionally equivalent to knotted suture anchors while avoiding the risks of knotted anchors (knot loosening, knot migration, articular abrasion) and allowing easier placement and decreased operative time. The purpose of this technique is to describe our preferred method to treat a 270° labral tear through arthroscopic knotless anchor repair and demonstrate the expanded application of this technique for extensive glenoid labral pathology.
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Affiliation(s)
| | | | - Joseph J. Ruzbarsky
- Steadman Philippon Research Institute, Vail, Colorado, United States,The Steadman Clinic, Vail, Colorado, United States
| | | | - Matthew T. Provencher
- Steadman Philippon Research Institute, Vail, Colorado, United States,The Steadman Clinic, Vail, Colorado, United States,Address correspondence to CAPT Matthew T. Provencher, M.D., M.B.A., M.C., U.S.N.R. (Ret.), Steadman Philippon Research Institute, The Steadman Clinic, 181 W Meadow Drive, Suite 400, Vail, CO 81657, U.S.A.
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Vaswani R, Arner J, Freiman H, Bradley JP. Risk Factors for Revision Posterior Shoulder Stabilization in Throwing Athletes. Orthop J Sports Med 2020; 8:2325967120967652. [PMID: 33330737 PMCID: PMC7720310 DOI: 10.1177/2325967120967652] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/18/2020] [Indexed: 01/15/2023] Open
Abstract
Background Revision posterior shoulder capsulolabral repair has inferior outcomes compared with primary surgery. Risk factors for revision in throwing athletes are unknown. Purpose/Hypothesis The purpose of this study was to characterize the revision rate and risk factors for revision surgery in throwing athletes. It was hypothesized that female athletes and those with smaller glenoid bone width would be at higher risk for revision surgery. Study Design Case-control study; Level of evidence, 3. Methods A total of 105 throwing athletes who underwent arthroscopic posterior capsulolabral repair of their throwing shoulder were reviewed at a minimum of 2-year follow-up, and patients who required a revision were compared with those who did not. Collected data compared between the revision and no-revision groups included age, sex, contact sport participation, and return to sport (RTS). American Shoulder and Elbow Surgeons (ASES) score, Kerlan-Jobe Orthopaedic Clinic (KJOC) score, stability, pain, strength, range of motion (ROM), and patient satisfaction. Radiographic parameters including glenoid bone version, cartilage version, labral version, bone width, labral width, glenoid labral version and width weight were also compared between both groups. Results Nine throwers required revision (8.6%) at an average of 2.8 years postoperatively. There were more female athletes in the revision than no-revision group (55.5% vs 23.4%; P = .03). There was no significant difference in age, proportion of contact athletes, rotator cuff tears, glenoid bone version, cartilage version, labral version, labral version weight, bone width, labral width, or labral width weight. Both groups had similar preoperative, postoperative, and change in ASES, KJOC, pain, strength, stability, and ROM scores. The proportion of patients with full strength and with full ROM, as well as patients who were satisfied with outcomes was similar between groups. Fewer patients in the revision group returned to sports compared with those in the no-revision group (14.3% vs 83.6%; P < .001), although return to sports at same level was not significantly different between groups (14.3% vs 37.2%; P = .41). Conclusion The revision rate of arthroscopic posterior shoulder stabilization in throwers was 8.6%. Female athletes were at higher risk for revision, and return to sports was lower in patients who underwent revision surgery.
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Affiliation(s)
- Ravi Vaswani
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Justin Arner
- Burke and Bradley Orthopaedics, Pittsburgh, Pennsylvania, USA
| | | | - James P Bradley
- Burke and Bradley Orthopaedics, Pittsburgh, Pennsylvania, USA
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Hachem AI, Rondanelli S R, Costa D'O G, Verdalet I, Rius X. Arthroscopic "Bone Block Cerclage" Technique for Posterior Shoulder Instability. Arthrosc Tech 2020; 9:e1171-e1180. [PMID: 32874898 PMCID: PMC7451436 DOI: 10.1016/j.eats.2020.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/25/2020] [Indexed: 02/03/2023] Open
Abstract
Many open and arthroscopic techniques have been described to treat posterior glenohumeral instability. Multifactorial features of posterior shoulder instability pathoanatomy and varied patient characteristics have challenged the understanding of this condition and have led to dissimilar results, without a strong consensus for the most adequate technique to treat it. We describe an arthroscopic anatomical metal-free posterior glenoid reconstruction technique, using a tricortical iliac crest allograft with 2 ultra-high strength sutures (FiberTape Cerclage System; Arthrex, Naples, FL) with concomitant posterior capsulolabral complex reconstruction procedure.
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Affiliation(s)
- Abdul-ilah Hachem
- Department of Orthopedic and Traumatology Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain,Address correspondence to Abdul-ilah Hachem, M.D., C/ Feixa Llarga S/ N Hospital de Bellvitge Pl. 10 Traumatology and Orthopedic Secretary, Hospital Universitari de Bellvitge (L’Hospitalet de Llobregat), Barcelona, Spain, 08907.
| | - Rafael Rondanelli S
- University of Barcelona Shoulder Surgery Master Fellowship, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Gino Costa D'O
- University of Barcelona Shoulder Surgery Master Fellowship, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Iñigo Verdalet
- University of Barcelona Shoulder Surgery Master Fellowship, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Xavier Rius
- Department of Orthopedic and Traumatology Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
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Aydin N, Karaismailoglu B, Harbiyeli E, Ozsahin MK. Can capsular plication compensate the lack of one suture anchor in an arthroscopic three suture anchor Bankart repair? A comparative study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:266-271. [PMID: 31047773 PMCID: PMC6739254 DOI: 10.1016/j.aott.2019.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 03/10/2019] [Accepted: 04/05/2019] [Indexed: 11/25/2022]
Abstract
Objective The aim of this study was to compare the complication rates and clinical results of labral repair with two suture anchors and capsular plication, and labral repair with three suture anchor fixation in artroscopic Bankart surgery. Methods Sixty-nine patients (60 males, 9 females; mean age: 28.2 ± 7.8 years (range: 16–50)) who had undergone arthroscopic repair of a labral Bankart lesion were evaluated. Group A underwent an arthroscopic Bankart repair with three knotless suture anchors, while group B underwent a modified arthroscopic Bankart repair with two knotless suture anchors and an additional capsular plication procedure. The mean follow-up was 52.5 months. Constant Shoulder Score (CSS), Rowe Score (RS), modified UCLA Shoulder Score (mUSS) and range of motion (ROM) were used as outcome measures. Results In both groups, a significant improvement was detected in functional outcomes at postoperative last follow-up compared to the preoperative period. No statistically significant difference was found (p > 0.05) in clinical scores (CSS; Group A: 89.7, Group B: 80.2) (RS; Group A: 88.2, Group B: 80.2) (mUSS; Group A: 26.3, Group B: 25.7) external rotation loss (At neutral; Group A: 4.5°, Group B: 5.2°. At abduction; Group A: 4.3°, Group B: 5.7°) and recurrence rates (Group A: 13.3%, Group B: 20.8%). Although the difference was not statistically significant, the recurrence rate was higher in group B (20.8%), compared to group A (13.3%), despite the shorter average follow-up time of group B (p = 0.417). Conclusions Arthroscopic repair of labral Bankart lesions with both techniques showed good functional outcomes and stability at the latest follow-up. Higher recurrence rate despite the shorter average follow-up of group B suggests that two anchor usage might not be sufficient for Bankart repair in terms of better stability and less recurrence risk. Level of evidence Level III, Therapeutic Study.
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Affiliation(s)
- Nuri Aydin
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Orthopaedics and Traumatology Department, Fatih, Istanbul, Turkey.
| | - Bedri Karaismailoglu
- Sinop Ayancik State Hospital, Orthopaedics and Traumatology Clinic, Sinop, Turkey.
| | - Emir Harbiyeli
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Orthopaedics and Traumatology Department, Fatih, Istanbul, Turkey.
| | - Mahmut Kursat Ozsahin
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Orthopaedics and Traumatology Department, Fatih, Istanbul, Turkey.
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