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Aboalata M, Plath J, Eltair H, Vogt S, Imhoff AB. Long-term results of arthroscopic capsulolabral revision repair for failed anterior shoulder instability repair using suture anchors at a minimum of 10 years follow-up. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05304-7. [PMID: 38693287 DOI: 10.1007/s00402-024-05304-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 03/26/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Arthroscopic revision anterior shoulder instability repair has been proposed, and early clinical results have been promising. However, long-term results after this procedure and the probable risk factors for failure have not been sufficiently discussed in the literature. MATERIALS AND METHODS Thirty-eight patients who were diagnosed with recurrent anteroinferior shoulder instability after failed Bankart repair, treated with ACRR between September 1998 and November 2003 and able to be contacted were included. Of these patients, 2 were excluded from the study due to the use of SureTak anchors for fixation, and 5 other patients refused to participate in the study due to lack of interest (3 patients) or lack of time (2 patients). The remaining shoulders were clinically examined at a minimum of ten years after surgery via the ASES, Constant, AAOS, Rowe, Dawson and VAS scores for pain and stability. Degenerative arthropathy was assessed with the modified Samilson-Prieto score. RESULTS All 31 remaining shoulders were evaluated at a mean time of 11.86 years (142.4 months) after surgery. Six patients (19.35%) reported redisolcation after the revision procedure, 4 of whom were affected by a new significant shoulder trauma. The ROWE and Constant scores improved significantly. Moderate to severe dislocation arthropathy was observed in 19.4% of patients. Five patients (16.2%) were not satisfied with the procedure. CONCLUSION Long-term follow-up after ACRR shows predictable results, with a high degree of patient satisfaction, good to excellent patient-reported outcome scores and minimal radiological degenerative changes. However, with an average recurrence rate of 19.3% after 11.86 years, the redislocation rate appears high. With careful patient selection, recurrence rates can be significantly reduced.
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Affiliation(s)
- Mohamed Aboalata
- Department of orthopaedic Surgery, Mansoura University, Mansoura, Egypt.
- Department of Orthopaedic Surgery, Rhön klinik Campus Bad Neustadt, Bad Neustadt an der Saale, Germany.
| | - Johannes Plath
- Department of Trauma Surgery, Hand and Plastic Surgery, University of Augsburg, Augsburg, Germany
| | - Hani Eltair
- Department of Orthhopedic surgery, Students' hospital Mansoura University, Mansoura, Egypt
- Department of Orthopedic surgery, Bad Windsheim hospital, Bad Windsheim, Germany
| | - Stephan Vogt
- Department of sport orthopaedic, Hessing clinic, Augsburg, Germany
| | - Andreas B Imhoff
- Department of orthopaedic sports medicine, Klinikum Rechts der Isar, TUM, Munich, Germany
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Lho T, Lee J, Oh KS, Chung SW. Latarjet procedure for failed Bankart repair provides better stability and return to sports, but worse postoperative pain and external rotation limitations with more complications, compared to revision Bankart repair: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07410-2. [PMID: 37038019 DOI: 10.1007/s00167-023-07410-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/30/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE This study aimed to compare the clinical results of revision Bankart repair versus the Latarjet procedure for failed Bankart repair. METHODS A literature search was performed in databases, such as Pubmed, Embase, and Scopus Library. The studies were appraised using the Methodological Index for Non-randomized Studies tool. Studies for failed Bankart repair with revision Bankart repair or Latarjet procedure were included. The pain VAS, ROWE score, rate of return to sports and preinjury level of sports, recurrent instability, range of motion, and complications were compared. Additionally, the pain VAS, ROWE score, forward flexion, and external rotation at side were subjected to a meta-analysis. RESULTS Twenty-four articles were included in the systematic review. The functional outcomes in terms of the ROWE score, recurrent instability, return to sports, and the preinjury level of sports was better in the Latarjet procedure group than those in the revision Bankart repair group (ROWE score, 91 vs. 86.7; recurrent instability rate, 3.5% vs. 14.4%; return to sports rate, 100% vs. 87.9%; return to preinjury level of sports rate, 89.9% vs. 74.9%; all P < 0.001). However, the results of postoperative pain and the postoperative limitation of external rotation at side were worse in the Latarjet procedure group than those in the revision Bankart repair group (pain VAS, 1.4 vs. 0.8; postoperative external rotation at side, 38° vs. 60°; all P < 0.001). In addition, the majority of the complications occurred in the Latarjet procedure group. In the meta-analysis, the postoperative ROWE score was significantly higher in the Latarjet procedure group than that in the revision Bankart group (revision Bankart repair: 95% CI 88.9-80.9, I2 = 65.70; Latarjet procedure: 95% CI 95.8-88.1, I2 = 93.37; P = 0.014). However, the pain VAS, forward flexion, and external rotation at side did not reach the significant level in the meta-analysis. CONCLUSION Compared with revision Bankart repair, the Latarjet procedure for failed Bankart repair showed better ROWE scores, stability, and return to sports or preinjury level of sports; however, the postoperative pain and the limitation of external rotation at side were worse with more complications. IRB NO KUMC 2022-01-024. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Taewoo Lho
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, School of Medicine, Konkuk University, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea
| | - JiHwan Lee
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, School of Medicine, Konkuk University, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, School of Medicine, Konkuk University, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, School of Medicine, Konkuk University, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea.
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Slaven SE, Donohue MA, Tardif RA, Foley KA, LeClere LE, Cameron KL, Giuliani JR, Posner MA, Dickens JF. Revision Arthroscopic Bankart Repair Results in High Failure Rates and a Low Return to Duty Rate Without Recurrent Instability. Arthroscopy 2023; 39:913-918. [PMID: 36210031 DOI: 10.1016/j.arthro.2022.08.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE The purpose of this study was to determine, in a military population without critical bone loss, the rate of recurrent instability after revision arthroscopic stabilization for failed primary arthroscopic Bankart repair. METHODS Forty-one revision arthroscopic stabilizations were performed at a single military institution between 2005 to 2016 for recurrent anterior shoulder instability after primary arthroscopic Bankart repair. Minimum follow-up was 2 years, and shoulders with glenoid bone loss >20% were excluded. The primary outcome of interest was the incidence of failure, defined by recurrent instability. RESULTS Age at revision surgery averaged 22.9 ± 4.3 years, and 88% were either service academy cadets or active duty combat arms soldiers. Mean follow-up was 7.8 years. Twenty-three patients (56%) returned to duty without recurrent instability after revision arthroscopic stabilization. Eighteen patients (44%) experienced recurrent instability after return to duty. Glenoid bone loss averaged 6.2% (95% confidence interval [CI], 3.2%-9.2%) in the successful group and 5.7% (95% CI, 3.1%-8.3%) in the failure group (P = .808). CONCLUSIONS Revision arthroscopic stabilization of failed primary arthroscopic Bankart repair has a failure rate of 44% in a young military population. The similar amounts of bone loss between groups indicates that bone loss is not the primary determinant of failure in revision arthroscopic stabilization. LEVEL OF EVIDENCE IV, Case Series.
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Affiliation(s)
- Sean E Slaven
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland; Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | - Michael A Donohue
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York
| | - Robert A Tardif
- Department of Orthopaedics, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Kevin A Foley
- Department of Orthopaedics, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Lance E LeClere
- The Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York
| | | | - Matthew A Posner
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York
| | - Jonathan F Dickens
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland; The Department of Orthopaedics, Duke University, Durham, North Carolina; The Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
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Matache BA, Hurley ET, Wong I, Itoi E, Strauss EJ, Delaney RA, Neyton L, Athwal GS, Pauzenberger L, Mullett H, Jazrawi LM. Anterior Shoulder Instability Part III-Revision Surgery, Rehabilitation and Return to Play, and Clinical Follow-Up-An International Consensus Statement. Arthroscopy 2022; 38:234-242.e6. [PMID: 34332051 DOI: 10.1016/j.arthro.2021.07.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to establish consensus statements via a modified Delphi process on revision surgery, rehabilitation and return to play, and clinical follow-up for anterior shoulder instability. METHODS A consensus process on the treatment using a modified Delphi technique was conducted, with 65 shoulder surgeons from 14 countries across 5 continents participating. Experts were assigned to one of 9 working groups defined by specific subtopics of interest within anterior shoulder instability. RESULTS The primary relative indications for revision surgery include symptomatic apprehension or recurrent instability, additional intra-articular pathologies, and symptomatic hardware failure. In revision cases, the differentiating factors that dictate treatment are the degree of glenohumeral bone loss and rotator cuff function/integrity. The minimum amount of time before allowing athletes to return to play is unknown, but other factors should be considered, including restoration of strength, range of motion and proprioception, and resolved pain and apprehension, as these are prognostic factors of reinjury. Additionally, psychological factors should be considered in the rehabilitation process. Patients should be clinically followed up for a minimum of 12 months or until a return to full, premorbid function/activities. Finally, the following factors should be included in anterior shoulder instability-specific, patient-reported outcome measures: function/limitations impact on activities of daily living, return to sport/activity, instability symptoms, confidence in shoulder, and satisfaction. CONCLUSION Overall, 92% of statements reached unanimous or strong consensus. The statements that reached unanimous consensus were indications and factors affecting decisions for revision surgery, as well as how prior surgeries impact procedure choice. Furthermore, there was unanimous consensus on the role of psychological factors in the return to play, considerations for allowing return to play, as well as prognostic factors. Finally, there was a lack of unanimous consensus on recommended timing and methods for clinical follow-up. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
| | - Eoghan T Hurley
- NYU Langone Health, New York, New York, USA; Sports Surgery Clinic, Dublin, Ireland.
| | - Ivan Wong
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eiji Itoi
- Tohoku University School of Medicine, Sendai, Japan
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Shanmugaraj A, Sakha S, Tejpal T, Leroux T, Kirsch JM, Khan M. Revision Arthroscopic Bankart Repair for Anterior Shoulder Instability After a Failed Arthroscopic Soft-Tissue Repair Yields Comparable Failure Rates to Primary Bankart Repair: A Systematic Review. HSS J 2022; 18:145-155. [PMID: 35082560 PMCID: PMC8753542 DOI: 10.1177/15563316211030606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The management of recurrent instability after arthroscopic Bankart repair remains challenging. Of the various treatment options, arthroscopic revision repairs are of increasing interest due to improved visualization of pathology and advancements in arthroscopic techniques and instrumentation. PURPOSE We sought to assess the indications, techniques, outcomes, and complications for patients undergoing revision arthroscopic Bankart repair after a failed index arthroscopic soft-tissue stabilization for anterior shoulder instability. METHODS We performed a systematic review of studies identified by a search of Medline, Embase, and PubMed. Our search range was from data inception to April 29, 2020. Outcomes include clinical outcomes and rates of complication and revision. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. Data are presented descriptively. RESULTS Twelve studies were identified, comprising 279 patients (281 shoulders) with a mean age of 26.1 ± 3.8 years and a mean follow-up of 55.7 ± 24.3 months. Patients had improvements in postoperative outcomes (eg, pain and function). The overall complication rate was 29.5%, the most common being recurrent instability (19.9%). CONCLUSION With significant improvements postoperatively and comparable recurrent instability rates, there exists a potential role in the use of revision arthroscopic Bankart repair where the glenoid bone loss is less than 20%. Clinicians should consider patient history and imaging findings to determine whether a more rigorous stabilization procedure is warranted. Large prospective cohorts with long-term follow-up and improved documentation are required to determine more accurate failure rates.
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Affiliation(s)
- Ajaykumar Shanmugaraj
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Seaher Sakha
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Tushar Tejpal
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Timothy Leroux
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jacob M Kirsch
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada,Moin Khan, MD, MSc, FRCSC, McMaster University, Hamilton, ON, Canada.
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Haskel JD, Wang KH, Hurley ET, Markus DH, Campbell KA, Alaia MJ, Millett PJ, Jazrawi LM. Clinical outcomes of revision arthroscopic Bankart repair for anterior shoulder instability: a systematic review of studies. J Shoulder Elbow Surg 2022; 31:209-216. [PMID: 34358668 DOI: 10.1016/j.jse.2021.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/12/2021] [Accepted: 06/28/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to review the literature to ascertain the functional outcomes, recurrence rates, and subsequent revision rates following revision arthroscopic Bankart repair. METHODS Two independent reviewers performed a literature search based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using the Embase, MEDLINE, and Cochrane Library databases. Studies in which arthroscopic Bankart repair was performed as a revision procedure were included. The clinical outcomes extracted and analyzed were functional outcomes, return to play, and recurrent instability. RESULTS Fourteen studies with 433 patients met the inclusion criteria. The majority of patients were male patients (63.7%); the average age was 26.1 years (range, 14-58 years), and the mean follow-up period was 37.6 months (range, 10-144 months). The mean Rowe score was 84.2, and 79.7% of patients had good to excellent outcomes. The rate of return to play was 78.5%, with 47.5% of patients returning to their preinjury level of play across 10 studies. The rate of recurrent instability was reported in 12 studies, with 328 shoulders demonstrating 86 instability events (26.2%). The rate of recurrent instability due to dislocation was reported in 7 studies (n = 176), with 19 events (10.8%), whereas the rate of subluxation was reported in 4 studies (n = 76), with 6 events (7.9%). CONCLUSIONS Revision arthroscopic Bankart repair for anterior shoulder instability was shown to result in a high rate of recurrent shoulder instability. There was a relatively poor rate of return to sport among athletes, and only about half of the patients were able to return at or above their preoperative level of ability.
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Affiliation(s)
- Jonathan D Haskel
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.
| | - Karina H Wang
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Eoghan T Hurley
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Danielle H Markus
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Kirk A Campbell
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Michael J Alaia
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | | | - Laith M Jazrawi
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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Sinha S, Mehta N, Goyal R, Goyal A, Joshi D, Arya RK. Is Revision Bankart Repair with Remplissage a Viable Option for Failed Bankart Repair in Non-contact Sports Person Aiming to Return to Sports? Indian J Orthop 2021; 55:359-365. [PMID: 34306548 PMCID: PMC8275742 DOI: 10.1007/s43465-021-00415-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/28/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Failure of a well-executed Bankart repair in non-contact athletes is difficult to predict and its management is a lesser investigated area with uncertain outcome in terms of return to sports (RTS). This study analyses effectiveness of revision Bankart repair with remplissage for failed Bankart repair in non-contact athletes, focusing on time and level of RTS. MATERIALS AND METHODS Fifty-five consecutive non-contact athletes with evidence of instability after primary arthroscopic Bankart repair having glenoid loss < 25% and off-track Hill-Sachs lesion were included in the study according to algorithm mentioned. All cases underwent revision arthroscopic Bankart repair with remplissage and followed-up for 24 months. Rowe, UCLA, WOSI and Quick-DASH scores were recorded preoperative and at 24 months. RTS was allowed after unilateral seated shot-put test. RESULTS Out of 55 cases, 6 were excluded because of poor tissue quality, 7 were lost to follow-up. Forty-two cases with a mean age of 28.2 ± 5.2 years were included. Mean duration between primary surgery and failure was 7.3 ± 1.4 months with a mean 1.9 redislocations. The mean Rowe, WOSI, UCLA, Quick-DASH scores improved from 37 to 89, 39.3 to 83.7%, 18.4 to 30.5, 45.3 to 18.7 at 24 months. Thirty-five cases could RTS in a mean time 15.4 ± 1.4 months. Out of seven cases who could not RTS, four had instability, one had pain and two voluntarily quit sports. CONCLUSION Revision Bankart repair with remplissage is a feasible option for failed primary Bankart repair in non-contact athletes who have glenoid bone loss < 25% with off-track Hill-Sachs. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Skand Sinha
- Sports Injury Centre, VMMC and Safdarjung Hospital, New Delhi, 110023 India
| | - Nitin Mehta
- Sports Injury Centre, VMMC and Safdarjung Hospital, New Delhi, 110023 India
| | - Rakesh Goyal
- Sports Injury Centre, VMMC and Safdarjung Hospital, New Delhi, 110023 India
| | - Ankit Goyal
- Sports Injury Centre, VMMC and Safdarjung Hospital, New Delhi, 110023 India
| | - Deepak Joshi
- Sports Injury Centre, VMMC and Safdarjung Hospital, New Delhi, 110023 India
| | - R. K. Arya
- Sports Injury Centre, VMMC and Safdarjung Hospital, New Delhi, 110023 India
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Calvo E, Luengo G, Morcillo D, Foruria AM, Valencia M. Revision Arthroscopic Bankart Repair Versus Arthroscopic Latarjet for Failed Primary Arthroscopic Stabilization With Subcritical Bone Loss. Orthop J Sports Med 2021; 9:23259671211001809. [PMID: 34017877 PMCID: PMC8114265 DOI: 10.1177/23259671211001809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/12/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Limited evidence is available regarding the recommended technique of revision surgery for recurrent shoulder instability. Only 1 previous study has compared the results of soft tissue repair and the Latarjet technique in patients with persistent shoulder instability after primary surgical stabilization. Purpose/Hypothesis: To evaluate the results of revision surgery in patients with previous surgical stabilization failure and subcritical glenoid bone defects, comparing repeated Bankart repair versus arthroscopic Latarjet technique. The hypothesis was that Latarjet would be superior to soft tissue procedures in terms of objective and subjective functional scores, recurrence rates, and range of movement. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 45 patients (mean age, 29.1 ± 8.9 years) with subcritical bone loss (<15% of articular surface) who had undergone revision anterior shoulder instability repair after failed Bankart repair. Of these, 17 patients had arthroscopic Bankart repair and 28 had arthroscopic Latarjet surgery. Patients were evaluated at a minimum of 2 years postoperatively with the Rowe score, Western Ontario Shoulder Instability Index, and Subjective Shoulder Value. Subluxation or dislocation episodes were considered failures. Results: No statistically significant differences were found between groups in age, sex, sporting activity, preoperative Rowe score, or the presence of hyperlaxity or bony lesions. At revision arthroscopy, 20 shoulders showed a persistent Bankart lesion, 13 a medially healed labrum, and 6 a bony Bankart. In 6 patients, no abnormalities were present that could explain postoperative recurrence. In the Bankart repair group, 7 patients underwent isolated Bankart procedures; in the remaining 10 cases, a capsular shift was added. No significant differences were found between the Bankart and Latarjet groups in outcome scores, recurrence rate (11.8% vs 17.9%, respectively), or postoperative athletic activity level. The mean loss of passive external rotation at 0° and 90° of abduction was similar between groups. Conclusion: Arthroscopic Latarjet did not lead to superior results compared with repeated Bankart repair in patients with subcritical glenoid bone loss and recurrent anterior shoulder instability after Bankart repair.
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Affiliation(s)
- Emilio Calvo
- Department of Orthopaedic Surgery and Traumatology, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Gonzalo Luengo
- Department of Orthopaedic Surgery and Traumatology, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Diana Morcillo
- Department of Orthopaedic Surgery and Traumatology, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Antonio M Foruria
- Department of Orthopaedic Surgery and Traumatology, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - María Valencia
- Department of Orthopaedic Surgery and Traumatology, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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Lau BC, Pineda LB, Johnston TR, Gregory BP, Wu M, Fletcher AN, Ledbetter L, Riboh JC. Return to Play After Revision Anterior Shoulder Stabilization: A Systematic Review. Orthop J Sports Med 2021; 9:2325967120982059. [PMID: 33748304 PMCID: PMC7940729 DOI: 10.1177/2325967120982059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/04/2020] [Indexed: 11/16/2022] Open
Abstract
Background Revision shoulder stabilizations are becoming increasingly common. Returning to play after revision shoulder stabilizations is important to patients. Purpose To evaluate the return-to-play rate after revision anterior shoulder stabilization using arthroscopic, open, coracoid transfer, or free bone block procedures. Study Design Systematic review; Level of evidence, 4. Methods All English-language studies published between 2000 and 2020 that reported on return to play after revision anterior shoulder stabilization were reviewed. Clinical outcomes that were evaluated included rate of overall return to play, level of return to play, and time to return to play. Study quality was evaluated using the Downs and Black quality assessment score. Results Eighteen studies (1 level 2; 17 level 4; mean Downs and Black score, 10.1/31) on revision anterior shoulder stabilization reported on return to play and met inclusion criteria (7 arthroscopic, 5 open, 3 Latarjet, and 3 bony augmentation), with a total of 564 revision cases (mean age, 27.9 years; 84.1% male). The weighted mean length of follow-up was 52.5 months. The overall weighted rate of return to play was 80.1%. The weighted mean rate of return to play was 84.0% (n = 153) after arthroscopic revision, 91.5% (n = 153) after open revision, 88.1% (n = 149) after Latarjet, and 73.8% (n = 65) after bone augmentation. The weighted mean rate of return to same level of play was 69.7% for arthroscopic revision, 70.0% for open revision, 67.1% for Latarjet revision, and 61.8% after bone block revision. There were 5 studies that reported on time to return to play, with a weighted mean of 7.75 months (4 arthroscopic) and 5.2 months (1 Latarjet). The weighted mean rates of complication (for studies that provided it) were 3.3% after arthroscopic revision (n = 174), 3.5% after open revision (n = 110), 9.3% after Latarjet revision (n = 108), and 45.8% after bone block revision (n = 72). Conclusion Revision using open stabilization demonstrated the highest return-to-play rate. Revision using Latarjet had the quickest time to return to play but had higher complication rates. When evaluated for return to same level of play, arthroscopic, open, and Latarjet had similar rates, and bone block had lower rates. The choice of an optimal revision shoulder stabilization technique, however, depends on patient goals. Higher-quality studies are needed to compare treatments regarding return to play after revision shoulder stabilization.
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Affiliation(s)
- Brian C Lau
- Duke Sports Science Institute, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Lorena Bejarano Pineda
- Duke Sports Science Institute, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Tyler R Johnston
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Irvine, California, USA
| | - Bonnie P Gregory
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Texas Health Science Center, Houston, Texas, USA
| | - Mark Wu
- Duke Sports Science Institute, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Amanda N Fletcher
- Duke Sports Science Institute, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Leila Ledbetter
- Medical Center Library, Duke University, Durham, North Carolina, USA
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Yon CJ, Cho CH, Kim DH. Revision Arthroscopic Bankart Repair: A Systematic Review of Clinical Outcomes. J Clin Med 2020; 9:E3418. [PMID: 33113855 PMCID: PMC7693917 DOI: 10.3390/jcm9113418] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 12/19/2022] Open
Abstract
Although the frequency of arthroscopic revision surgery is increasing in patients with recurrent dislocation after a primary shoulder stabilization, the literature describing arthroscopic revision Bankart repair has been limited. Preferred reporting items for systematic meta-analyses guidelines were followed by utilizing PubMed, EMBASE, Scopus, and Cochrane Library databases. Keywords included shoulder dislocation, anterior shoulder instability, revision surgery, stabilization, and arthroscopic Bankart repair. Quality assessments were performed with criteria from the methodological index for nonrandomized studies (MINORS). A total of 14 articles were included in this analysis. The mean MINORS score was 12.43. A total of 339 shoulders (337 patients) were included (281 males and 56 females). The mean follow-up period was 36.7 months. Primary surgeries were as follows: arthroscopic procedures (n = 172, 50.7%), open procedure (n = 87, 25.7%), and unknown (n = 80, 23.6%). The mean rate of recurrent instability after revision arthroscopic Bankart repair was 15.3% (n = 52), and an additional re-revision procedure was needed in 6.5% of cases (n = 22). Overall, there were 18.0% (n = 61) of complications reported. This systematic review suggests that arthroscopic revision Bankart repair can lead to an improvement in functional outcomes and reasonable patient satisfaction with proper patient selection.
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Affiliation(s)
| | | | - Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea; (C.-J.Y.); (C.-H.C.)
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11
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Chalmers PN, Hillyard B, Kawakami J, Christensen G, O'Neill D, Childress V, Tashjian RZ. Double-loaded suture anchors in the treatment of anteroinferior glenohumeral instability. JSES Int 2020; 4:587-591. [PMID: 32939491 PMCID: PMC7479039 DOI: 10.1016/j.jseint.2020.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Hypothesis The purpose of this study was to determine the clinical outcomes of arthroscopic labral repair for anteroinferior glenohumeral instability with the use of double-loaded suture anchors. Methods This study evaluated a series of consecutive patients treated after the senior author changed from single- to double-loaded suture anchors for the treatment of anteroinferior glenohumeral instability with a minimum follow-up period of 2 years. We collected the following outcomes at final follow-up: visual analog scale pain score, Simple Shoulder Test score, American Shoulder and Elbow Surgeons score, and instability recurrence data. Results A total of 41 consecutive patients underwent arthroscopic labral repair with double-loaded anchors, of whom 30 (71%) were able to be contacted at a minimum of 2 years postoperatively. These patients included 4 contact or collision athletes (13%). The patients had an average of 12 ± 13 prior dislocations over an average period of 56 ± 57 months preoperatively. Mean glenoid bone loss measured 16% ± 10%, and 67% (18 of 27 patients) had glenoid bone loss ≥ 13.5%. Intraoperatively, 3.2 ± 0.4 anchors were used. No posterior repairs or remplissage procedures were performed. At an average of 6.7 ± 2.7 years' follow-up, the visual analog scale pain score was 0.8 ± 1.4; Simple Shoulder Test score, 11 ± 2; and American Shoulder and Elbow Surgeons score, 90 ± 14. Patients with bone loss < 13.5% had a 0% redislocation rate and 11% subluxation rate, whereas those with bone loss ≥ 13.5% had a 6% reoperation rate, 22% redislocation rate, and 22% subluxation rate. Conclusion Arthroscopic labral repair with double-loaded anchors provides satisfactory clinical results at early to mid-term outcome assessment when glenoid bone loss is <13.5%.
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Affiliation(s)
- Peter N. Chalmers
- Corresponding author: Peter N. Chalmers, MD, Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84105, USA.
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Fanning E, Maher N, Cools A, Falvey EC. Outcome Measures After Shoulder Stabilization in the Athletic Population: A Systematic Review of Clinical and Patient-Reported Metrics. Orthop J Sports Med 2020; 8:2325967120950040. [PMID: 32984424 PMCID: PMC7498977 DOI: 10.1177/2325967120950040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/07/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Athletic endeavor can require the “athletic shoulder” to tolerate significant
load through supraphysiological range and often under considerable
repetition. Outcome measures are valuable when determining an athlete’s safe
return to sport. Few data are available to guide a clinician’s choice from
the variety of measures available. Purpose: To describe the use of quantifiable objective outcome measures and
patient-reported outcome tools after glenohumeral joint stabilization,
specifically in an athletic population. The secondary aim of our study was
to assess whether the method of measurement used was clearly described and
standardized to aid clinical interpretation. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of MEDLINE, Scopus, SPORTDiscus, and Web of Science
databases was performed in December 2018 based on the PRISMA (Preferred
Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. After
the application of selection criteria, a full review of identified papers,
and screening of reference lists, a total of 62 studies were included in the
review. All studies were independently appraised for quality, predefined
data fields were populated and cross-checked for accuracy, and results were
then summarized from these data fields. Results: Of the 62 included studies, 94% used a quantifiable objective clinical
outcome. A majority (85%) of the studies measured range of motion, 21%
recorded muscle strength, 5% measured electromyographic activity, 5%
examined shoulder kinematics, and 3% assessed joint proprioception after
surgery. However, only 18% of the studies clearly described a standardized
method of measuring the outcome. Nearly all (95%) of the studies used at
least 1 patient-reported outcome measure. The Rowe score was most commonly
used (35%). Conclusion: We must standardize and clearly describe the use of quantifiable objective
outcome measures to aid clinical interpretation. A concerted effort should
also be made to standardize the use of patient-reported outcome tools after
shoulder stabilization in the athletic population.
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Affiliation(s)
- Edel Fanning
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland.,University College Cork, Cork, Ireland
| | - Natasha Maher
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, West Yorkshire, UK
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Gent, Belgium
| | - Eanna C Falvey
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland.,University College Cork, Cork, Ireland
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13
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Abstract
Primary arthroscopic Bankart repair is a common procedure that is increasing in popularity; however, failure rates can approach up to 6% to 30%. Factors commonly attributed to failure include repeat trauma, poor or incomplete surgical technique, humeral and/or glenoid bone loss, hyperlaxity, or a failure to identify and address rare pathology such as a humeral avulsion of the glenohumeral ligament lesion. A thorough clinical and radiographic assessment may provide insight into the etiology, which can assist the clinician in making treatment recommendations. Surgical management of a failed primary arthroscopic Bankart repair without bone loss can include revision arthroscopic repair or open repair; however, in the setting of bone loss, the anterior-inferior glenoid can be reconstructed using a coracoid transfer, tricortical iliac crest, or structural allograft, whereas posterolateral humeral head bone loss (the Hill-Sachs defect) can be addressed with remplissage, structural allograft, or partial humeral head implant. In addition to the technical demands of revision stabilization surgery, patient and procedure selection to optimize outcomes can be challenging. This review will focus on the etiology, evaluation, and management of patients after a failed primary arthroscopic Bankart repair, including an evidence-based treatment algorithm.
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14
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Storti TM, Lima RDA, Costa EDBES, Simionatto JE, Simionatto C, Paniago AF. Postoperative Evaluation of Patients Submitted to Arthroscopic Repair of Anterior Shoulder Instability. Rev Bras Ortop 2020; 55:339-346. [PMID: 32616980 PMCID: PMC7316536 DOI: 10.1055/s-0039-3402467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 02/05/2019] [Indexed: 11/24/2022] Open
Abstract
Objective
To clinically evaluate the results of patients undergoing arthroscopic surgical treatment of anterior shoulder instability.
Methods
A retrospective study of 94 patients. With a minimum follow-up of 24 months, we sought to correlate the characteristics of the patients and the surgery, such as age, gender, type of injury (traumatic or atraumatic) and the patient's position during surgery (lateral decubitus and beach chair) with the results obtained, the recurrence rate, the lateral rotation loss, the residual pain, and the functional scores of Carter-Rowe, University of California at Los Angeles (UCLA), and Constant-Murley.
Results
We observed a recurrent dislocation rate of 11.7%, lateral rotation loss in 37.23% of the patients, and some degree of residual pain in 51.6% of them. We obtained a mean Carter Rowe score of 85.37, representing 86% of good/excellent results. In the UCLA score, we obtained 88% of good/excellent results, similar to those obtained in the Constant-Murley score (86%).
Conclusion
The arthroscopic treatment of the anterior instability of the shoulder presents satisfactory results and low index of important complications, being the method of choice for most patients.
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Affiliation(s)
- Thiago Medeiros Storti
- Instituto do Ombro de Brasília, Brasília, DF, Brasil.,Grupo do Ombro, Instituto de Pesquisa e Ensino HOME (IPE HOME), Brasília, DF, Brasil
| | | | - Eloíse de Barros E Silva Costa
- Grupo do Ombro, Instituto de Pesquisa e Ensino HOME (IPE HOME), Brasília, DF, Brasil.,Departamento de Ortopedia, Centro Universitário de Brasília (UniCEUB), Brasília, DF, Brasil
| | | | | | - Alexandre Firmino Paniago
- Instituto do Ombro de Brasília, Brasília, DF, Brasil.,Grupo do Ombro, Instituto de Pesquisa e Ensino HOME (IPE HOME), Brasília, DF, Brasil
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15
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Lau BC, Johnston TR, Gregory BP, Bejarano Pineda L, Wu M, Fletcher AN, Hu JH, Ledbetter L, Riboh JC. Outcomes After Revision Anterior Shoulder Stabilization: A Systematic Review. Orthop J Sports Med 2020; 8:2325967120922571. [PMID: 32528993 PMCID: PMC7263126 DOI: 10.1177/2325967120922571] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 02/12/2020] [Indexed: 12/24/2022] Open
Abstract
Background Primary shoulder stabilization is successful, but there continues to be a risk of recurrence after operative repair, particularly in the young athlete. It is important for surgeons to understand the outcomes after various revision stabilization techniques to best counsel patients and manage expectations. Purpose To analyze recurrent instability and revision surgery rates in patients who underwent revision anterior glenohumeral stabilization procedures with either arthroscopic repair, open repair, coracoid transfer, free bone block, or capsular reconstruction. Study Design Systematic review; Level of evidence, 4. Methods We performed a systematic review of level 2 to 4 evidence studies using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Clinical studies of revision anterior glenohumeral stabilization (arthroscopic repair, open repair, coracoid transfer, free bone block, or capsular reconstruction) with a minimum 2-year follow-up were analyzed. The rate of recurrent instability, rate of revision surgery, patient-reported outcomes, and range of motion were extracted and reported. Study methodological quality was evaluated using the Downs and Black quality assessment score. Results A total of 37 studies met inclusion criteria and were available for analysis: 20 studies evaluated arthroscopic repair, 8 evaluated open repair, 5 evaluated Latarjet procedure, 3 evaluated bone block, and 2 evaluated capsular reconstruction. There was 1 study included in both arthroscopic and Latarjet procedures, for a total of 1110 revision cases. There was 1 level 2 study, and the remainder were level 3 or 4 with poor Downs and Black scores. Participants analyzed were most commonly young (weighted mean age, 26.1 years) and male (78.4%). The weighted mean clinical follow-up after revision surgery was 47.8 months. The weighted mean rate of recurrent instability was 3.8% (n = 245) after the Latarjet procedure, 13.4% (n = 260) after open repair, 16.0% (n = 531) after arthroscopic repair, 20.8% (n = 72) after bone block, and 31.0% (n = 35) after capsular reconstruction. The weighted mean rate of additional revision surgery was 0.0% after bone block, 0.02% after the Latarjet procedure, 9.0% after arthroscopic repair, 9.3% after open repair, and 22.8% after capsular reconstruction. Patient-reported outcomes and objective measures of range of motion and strength improved with all revision techniques. Conclusion The current review identifies a deficiency in the literature pertaining to consistent meaningful outcomes and the effect of bone loss after revision shoulder stabilization. Published studies demonstrate, however, that revision shoulder stabilization using arthroscopic, open, coracoid transfer, or bone block techniques yielded satisfactory objective and patient-reported outcomes. The Latarjet procedure exhibited the lowest recurrent instability rate. This study confirms that recurrent instability remains a common problem, despite revision shoulder stabilization. The quality of research in revision shoulder stabilization remains poor, and higher quality studies are needed to establish best practices for treatment of this complex problem.
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Affiliation(s)
- Brian C Lau
- Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Tyler R Johnston
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of California at Irvine, Irvine, California, USA
| | - Bonnie P Gregory
- Division of Sports Medicine, Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Lorena Bejarano Pineda
- Division of Sports Medicine, Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mark Wu
- Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Amanda N Fletcher
- Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Jessica H Hu
- Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Leila Ledbetter
- Medical Center Library and Archives, Duke University, Durham, North Carolina, USA
| | - Jonathan C Riboh
- Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
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16
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Werthel JD, Sabatier V, Schoch B, Amsallem L, Nourissat G, Valenti P, Kany J, Deranlot J, Solignac N, Hardy P, Vigan M, Hardy A. Outcomes of the Latarjet Procedure for the Treatment of Chronic Anterior Shoulder Instability: Patients With Prior Arthroscopic Bankart Repair Versus Primary Cases. Am J Sports Med 2020; 48:27-32. [PMID: 31877090 PMCID: PMC7052410 DOI: 10.1177/0363546519888909] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/27/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND It remains unclear whether results differ between a Latarjet procedure performed after a failed arthroscopic Bankart repair and one performed as the primary operation. PURPOSE To compare the postoperative outcomes of the Latarjet procedure when performed as primary surgery and as revision for a failed arthroscopic Bankart repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A multicenter retrospective comparative case-cohort analysis was performed for all patients undergoing a Latarjet procedure for recurrent anterior shoulder instability. Patients were separated into 2 groups depending on if the Latarjet procedure was performed after a failed arthroscopic Bankart repair (group 1) or as the first operation (group 2). Outcome measures included recurrent instability, reoperation rates, complications, pain, Walch-Duplay scores, and Simple Shoulder Test. RESULTS A total of 308 patients were eligible for participation in the study; 72 (23.4%) did not answer and were considered lost to follow-up, leaving 236 patients available for analysis. Mean follow-up was 3.4 ± 0.8 years. There were 20 patients in group 1 and 216 in group 2. Despite similar rates of recurrent instability (5.0% in group 1 vs 2.3% in group 2; P = .5) and revision surgery (0% in group 1 vs 6.5% in group 2; P = .3), group 1 demonstrated significantly worse pain scores (2.56 ± 2.7 vs 1.2 ± 1.7; P = .01) and patient-reported outcomes (Walch-Duplay: 52 ± 25.1 vs 72.2 ± 25.0; P = .0007; Simple Shoulder Test: 9.3 ± 2.4 vs 10.7 ± 1.9; P = .001) when compared with those patients undergoing primary Latarjet procedures. CONCLUSION Functional outcome scores and postoperative pain are significantly worse in patients undergoing a Latarjet procedure after a failed arthroscopic Bankart repair when compared with patients undergoing primary Latarjet. The assumption that a failed a Bankart repair can be revised by a Latarjet with a similar result to a primary Latarjet appears to be incorrect. Surgeons should consider these findings when deciding on the optimal surgical procedure for recurrent shoulder instability.
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Affiliation(s)
| | | | - Bradley Schoch
- Department of Orthopedic Surgery, Mayo
Clinic, Jacksonville, Florida, USA
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17
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Abstract
BACKGROUND In arthroscopic Bankart repair, anchor positions can affect glenoid labral height and functional outcomes. PURPOSE To evaluate anchor placement on the glenoid during Bankart lesion repair and determine which placement would lead to better functional outcomes. STUDY DESIGN Cohort study; Level of evidence, 3. METHOD This study included 90 patients (74 males, 16 females; average age, 23.7 years; range, 18-47 years) who underwent surgery for Bankart lesions between December 2009 and March 2014. The mean follow-up duration was 32.7 months (range, 26-48 months). We divided anchor positions into 2 groups: on the glenoid face and at the glenoid edge. The anchor position on the glenoid and the labral height were examined with computed tomography (CT) arthrography at 4.5-month follow-up, and Rowe scores were calculated at 2-year follow-up. RESULTS The group with the anchor placed on the glenoid face contained 63 patients, and the group with the anchor placed at the glenoid edge or rim contained 27 patients. Mean labral heights at 4.5 months postoperatively in the 2 groups were 5.4 ± 0.22 mm and 3.2 ± 0.16 mm, respectively ( P < .01), and mean Rowe scores at 2 years were 94.7 and 79.5, respectively ( P < .01). Rowe scores calculated at 2-year follow-up were significantly related to anchor position ( P < .01). CONCLUSION Anchors positioned on the glenoid face resulted in the greatest restored labral height and better functional outcome (Rowe score). Thus, anchor placement on the glenoid face should be considered, as it may yield better functional outcome in arthroscopic Bankart repair.
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Affiliation(s)
- Jin-Young Park
- Center for Shoulder, Elbow and Sports at NEON Orthopaedic Clinic, Seoul, Republic of Korea
| | - Jae-Hyung Lee
- Center for Shoulder, Elbow and Sports at NEON Orthopaedic Clinic, Seoul, Republic of Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University Hospital, Seoul, Republic of Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Konkuk University Hospital, Seoul, Republic of Korea
| | - Young Min Noh
- Department of Orthopaedic Surgery, Dong-A University Hospital, Pusan, Republic of Korea
| | - Seong-Jun Kim
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul, Republic of Korea
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Abstract
BACKGROUND Recurrent anterior instability following a failed Bankart repair in the shoulder represents a challenging clinical scenario. Few studies have examined the role of arthroscopic revision anterior stabilization as a treatment option in these cases. The purpose of this study was to evaluate the outcomes of arthroscopic revision anterior stabilization for patients with recurrent instability after a failed index procedure. METHODS Ninety-two patients underwent arthroscopic revision anterior stabilization after a failed index (open or arthroscopic) stabilization procedure. Sixty-five patients with a minimum of 2 years of follow-up were included in this study. The mean age at the time of revision surgery was 26 years (range, 15 to 57 years). The rate of recurrent instability and risk factors for failure were evaluated; the mean duration of follow-up was 4.7 years (range, 2 to 10.8 years). Glenoid and humeral bone loss were quantitatively assessed using preoperative T1-weighted magnetic resonance arthrograms to determine if the lesions were on-track or off-track. RESULTS Twenty-seven (42%) of the patients experienced recurrent instability at a mean of 2.3 years after arthroscopic revision anterior stabilization. On multivariate analysis, the presence of an off-track lesion, an age of <22 years, and ligamentous laxity were independent predictors of recurrence (p = 0.022, 0.028, and 0.031, respectively). Among a cohort with these risk factors excluded, the failure rate was 19%. CONCLUSIONS Arthroscopic revision anterior stabilization is associated with a high rate of recurrent instability, and patient selection is of critical importance in order to minimize recurrence. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Favian Su
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Marcin Kowalczuk
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Stephenson Ikpe
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hannah Lee
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Soheil Sabzevari
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Abstract
PURPOSE OF THE REVIEW The goal of this review is to provide a guide on surgical decision-making options for complex anterior shoulder instability using a case-based approach. RECENT FINDINGS Arthroscopic Bankart repair is well documented for having successful outcomes in patients with isolated labral tear involvement with minimal bone loss. Latarjet is a generally accepted procedure in patients with 20-30% glenoid bone loss. When bone loss exceeds that which cannot be managed through Latarjet, a range of options exist and are highly dependent upon the extent of osseous deficiency on both the glenoid and humeral sides, surgeon experience, and patient-specific factors. The use of reverse total shoulder arthroplasty for the management of chronic locked shoulder dislocations has been described as a successful management option. Treatment options for complex anterior shoulder instability range widely based on patients' presenting exam, surgical history, amount of glenoid bone loss, size of Hill-Sachs lesion, and surgeon preference. When selecting the appropriate surgical intervention, the treating surgeon must consider the patient history, physical exam, and preoperative imaging along with patient expectations.
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Affiliation(s)
- Nathan Olszewski
- Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Michael Gustin
- Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Emily J Curry
- Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Xinning Li
- Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, 02118, USA.
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20
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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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Makhni EC, Lamba N, Swart E, Steinhaus ME, Ahmad CS, Romeo AA, Verma NN. Revision Arthroscopic Repair Versus Latarjet Procedure in Patients With Recurrent Instability After Initial Repair Attempt: A Cost-Effectiveness Model. Arthroscopy 2016; 32:1764-70. [PMID: 27132770 DOI: 10.1016/j.arthro.2016.01.062] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/21/2016] [Accepted: 01/21/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the cost-effectiveness of arthroscopic revision instability repair and Latarjet procedure in treating patients with recurrent instability after initial arthroscopic instability repair. METHODS An expected-value decision analysis of revision arthroscopic instability repair compared with Latarjet procedure for recurrent instability followed by failed repair attempt was modeled. Inputs regarding procedure cost, clinical outcomes, and health utilities were derived from the literature. RESULTS Compared with revision arthroscopic repair, Latarjet was less expensive ($13,672 v $15,287) with improved clinical outcomes (43.78 v 36.76 quality-adjusted life-years). Both arthroscopic repair and Latarjet were cost-effective compared with nonoperative treatment (incremental cost-effectiveness ratios of 3,082 and 1,141, respectively). Results from sensitivity analyses indicate that under scenarios of high rates of stability postoperatively, along with improved clinical outcome scores, revision arthroscopic repair becomes increasingly cost-effective. CONCLUSIONS Latarjet procedure for failed instability repair is a cost-effective treatment option, with lower costs and improved clinical outcomes compared with revision arthroscopic instability repair. However, surgeons must still incorporate clinical judgment into treatment algorithm formation. LEVEL OF EVIDENCE Level IV, expected value decision analysis.
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22
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Abstract
Management of the unstable shoulder after a failed stabilization procedure can be difficult and challenging. Detailed understanding of the native shoulder anatomy, including its static and dynamic restraints, is necessary for determining the patient’s primary pathology. In addition, evaluation of the patient’s history, physical exam, and imaging is important for identifying the cause for failure after the initial procedure. Common mistakes include under-appreciation of bony defects, failure to recognize capsular laxity, technical errors, and missed associated pathology. Many potential treatment options exist for revision surgery, including open or arthroscopic Bankart repair, bony augmentation procedures, and management of Hill Sachs defects. The aim of this narrative review is to discuss in-depth the common risk factors for post-surgical failure, components for appropriate evaluation, and the different surgical options available for revision stabilization. Level of evidence Level V.
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Affiliation(s)
- Anthony G Ho
- Department of Orthopaedic Surgery, Beaumont Health, 3535 W. Thirteen Mile Rd, Suite 744, Royal Oak, MI, 48073, USA
| | - Ashok L Gowda
- Department of Orthopaedic Surgery, Beaumont Health, 3535 W. Thirteen Mile Rd, Suite 744, Royal Oak, MI, 48073, USA
| | - J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Health, 3535 W. Thirteen Mile Rd, Suite 744, Royal Oak, MI, 48073, USA.
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Shin JJ, Mascarenhas R, Patel AV, Yanke AB, Nicholson GP, Cole BJ, Romeo AA, Verma NN. Clinical outcomes following revision anterior shoulder arthroscopic capsulolabral stabilization. Arch Orthop Trauma Surg 2015. [PMID: 26198057 DOI: 10.1007/s00402-015-2294-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Traditionally surgeons have treated failed shoulder instability with open capsulolabral repair. Despite improved instrumentation, technique and familiarity in shoulder arthroscopy, few studies have reported the outcomes of arthroscopic revision shoulder instability repair. The purpose of this study was to assess clinical outcomes in patients following revision shoulder arthroscopic anterior capsulolabral stabilization. MATERIALS AND METHODS Sixty-two patients (63 shoulders) with failure of primary instability repairs were treated with revision arthroscopic anterior shoulder stabilization at a mean follow-up of 46.9 ± 16.8 months (range 18-78). Clinical outcomes were evaluated using validated patient-reported outcome questionnaires including the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, visual analog pain scale and Western Ontario Shoulder Instability Index. In addition, patients were queried for recurrent instability events (subluxation or dislocation) or revision surgery. RESULTS At final follow-up, the mean postoperative Western Ontario Shoulder Instability normalized score was 80.1 ± 18.7 (range 15.0-100). There were clinically significant improvements in American Shoulder and Elbow Surgeons scores, Simple Shoulder Test scores and ten-point visual analog scale for pain (P < 0.001). Recurrent instability occurred in 12 shoulders (19.0 %), with number of prior surgeries and hyperlaxity found to be significant risk factor for failure (P < 0.001 and P = 0.04, respectively). CONCLUSION Revision arthroscopic anterior stabilization of the shoulder can result in satisfactory outcomes in appropriately selected patients who have failed previous capsulolabral repair. An increased number of prior surgeries and hyperlaxity are predictive of poor outcome. STUDY DESIGN Case series, LOE IV.
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Affiliation(s)
- Jason J Shin
- Department of Orthopedic Surgery, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Randy Mascarenhas
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Anish V Patel
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Adam B Yanke
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Gregory P Nicholson
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Anthony A Romeo
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Flinkkilä T, Sirniö K. Open Latarjet procedure for failed arthroscopic Bankart repair. Orthop Traumatol Surg Res 2015; 101:35-8. [PMID: 25555805 DOI: 10.1016/j.otsr.2014.11.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/28/2014] [Accepted: 11/13/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This retrospective study assessed the functional results of open Latarjet operation for recurrence of instability after arthroscopic Bankart repair in a consecutive series of patients. MATERIALS AND METHODS Fifty two patients (mean age 28.4 [range 17-62] years, 45 men) were operated on using open Latarjet operation after one (n=46) or two (n=6) failed arthroscopic Bankart repairs. The indication for revision surgery was recurrent dislocation or subluxation. Fifty patients had a Hill-Sachs lesion and 32 patients had glenoid bone lesions on plain radiographs. No attempt was made to grade the severity of bony pathology. Functional outcome and stability of 49 shoulders were assessed after an average follow-up of 38 (range 24-85) months using Western Ontario Shoulder Instability (WOSI) score, Oxford shoulder instability score, and subjective shoulder value (SSV). RESULTS Forty-two patients had a stable shoulder at follow-up. Seven of 49 (14%) had symptoms of instability; one patient had recurrent dislocation, and six patients had subluxations. Mean WOSI, Oxford, and SSV scores were 83.9, 19.9, and 84.9, respectively. All scores were significantly better in patients who had a stable shoulder compared with those who had an unstable shoulder (WOSI 86.8 vs. 64.3; Oxford 18.2 vs. 30.8; and SSV 88.3 vs. 61.7; P<0.01). One patient needed a reoperation. There were no intraoperative or postoperative complications. CONCLUSIONS Open Latarjet operation is a good option for failed arthroscopic Bankart repair. The instability recurrence rate is acceptable and the reoperation rate was low. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- T Flinkkilä
- Oulu University Hospital, Division of Orthopedic and Trauma Surgery, Department of Surgery, PO Box 21, Kajaanintie, 90029 OYS Oulu, Finland.
| | - K Sirniö
- Oulu University Hospital, Division of Orthopedic and Trauma Surgery, Department of Surgery, PO Box 21, Kajaanintie, 90029 OYS Oulu, Finland
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Forsythe B, Frank RM, Ahmed M, Verma NN, Cole BJ, Romeo AA, Provencher MT, Nho SJ. Identification and treatment of existing copathology in anterior shoulder instability repair. Arthroscopy 2015; 31:154-66. [PMID: 25200942 DOI: 10.1016/j.arthro.2014.06.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 06/10/2014] [Accepted: 06/11/2014] [Indexed: 02/02/2023]
Abstract
Recurrent anterior instability is a common finding after traumatic glenohumeral dislocation in the young, athletic patient population. A variety of concomitant pathologies may be present in addition to the classic Bankart lesion, including glenoid bone loss; humeral head bone loss; rotator interval pathology; complex/large capsular injuries including humeral avulsions of the glenohumeral ligaments (HAGL lesions), SLAP tears, near circumferential labral tears, and anterior labral periosteal sleeve avulsions (ALPSA lesions); and rotator cuff tears. Normal anatomic variations masquerading as pathology also may be present. Recognition and treatment of these associated pathologies are necessary to improve function and symptoms of pain and to confer anterior shoulder stability. This review will focus on the history, physical examination findings, imaging findings, and recommended treatment options for common sources of copathology in anterior shoulder instability repair.
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Affiliation(s)
- Brian Forsythe
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Rachel M Frank
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Mohammed Ahmed
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anthony A Romeo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Matthew T Provencher
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Shane J Nho
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Blackman AJ, Krych AJ, Kuzma SA, Chow RM, Camp C, Dahm DL. Results of revision anterior shoulder stabilization surgery in adolescent athletes. Arthroscopy 2014; 30:1400-5. [PMID: 25085048 DOI: 10.1016/j.arthro.2014.05.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 05/10/2014] [Accepted: 05/21/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine failure rates, functional outcomes, and risk factors for failure after revision anterior shoulder stabilization surgery in high-risk adolescent athletes. METHODS Adolescent athletes who underwent primary anterior shoulder stabilization were reviewed. Patients undergoing subsequent revision stabilization surgery were identified and analyzed. Failure rates after revision surgery were assessed by Kaplan-Meier analysis. Failure was defined as recurrent instability requiring reoperation. Functional outcomes included the Marx activity score; American Shoulder and Elbow Surgeons score; and University of California, Los Angeles score. The characteristics of patients who required reoperation for recurrent instability after revision surgery were compared with those of patients who required only a single revision to identify potential risk factors for failure. RESULTS Of 90 patients who underwent primary anterior stabilization surgery, 15 (17%) had failure and underwent revision surgery (mean age, 16.6 years; age range, 14 to 18 years). The mean follow-up period was 5.5 years (range, 2 to 12 years). Of the 15 revision patients, 5 (33%) had recurrent dislocations and required repeat revision stabilization surgery at a mean of 50 months (range, 22 to 102 months) after initial revision. No risk factors for failure were identified. The Kaplan-Meier reoperation-free estimates were 86% (95% confidence interval, 67% to 100%) at 24 months and 78% (95% confidence interval, 56% to 100%) at 48 months after revision surgery. The mean final Marx activity score was 14.8 (range, 5 to 20); American Shoulder and Elbow Surgeons score, 82.1 (range, 33 to 100); and University of California, Los Angeles score, 30.8 (range, 16 to 35). CONCLUSIONS At 5.5 years' follow-up, adolescent athletes had a high failure rate of revision stabilization surgery and modest functional outcomes. We were unable to convincingly identify specific risk factors for failure of revision surgery. LEVEL OF EVIDENCE Level IV, retrospective therapeutic case series.
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Stein T, Buckup J, Mehling AP, Hoffmann R, Efe T, von Eisenhart-Rothe R, Welsch F. Restoration of joint congruency and the glenoidal labrum after arthroscopic revision Bankart repair: a MRI match-paired analysis comparing primary Bankart repair and the uninjured labrum. Arch Orthop Trauma Surg 2014; 134:1121-34. [PMID: 24899252 DOI: 10.1007/s00402-014-1990-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE The restoration of joint congruency and labrum slope and height after arthroscopic revision Bankart repair (RB) compared to the primary arthroscopic Bankart repair (PB) remain unclear. METHODS Twenty-three consecutive patients after RB with minor glenoid deficits were matched to 23 patients after PB and retrospectively followed by a score system and native 1.5 T magnetic resonance imaging (MRI) assessment. Bankart repair surgeries were performed using double-loaded knotless suture anchors. The glenoidal (GAA) and labral articulation arc (LAA), labrum slope, height index and morphology were assessed separately for the anterior and inferior glenoid and compared to 23 healthy volunteers [radiologic control group (RC)]. RESULTS Arthroscopic revision Bankart repair showed 28.0 months post-operative equivalent anterior labral congruency (LAA, 9.3°/PB 9.9°/RC 10.1°) and inferior (LAA 9.9°/PB 9.6°/RC 10.5°). The anterior GAA remain decreased (54.6°/PB 55.7°/RC 58.0°) with an original inferior GAA (85.1°/PB 83.2°/RC 83.8°). The RB labrum was slightly decreased anteriorly (slope 22.9°/PB 23.9°/RC 24.6°; height index 2.4/PB 3.0/RC 3.2). The inferior portion had an equivalent labrum slope (23.8°/PB 24.7°/RC 25.1°), but a decreased height index (2.1/PB 2.2/RC 2.3). Morphologic labrum analysis revealed significant changes between all three groups. The clinical outcome after revision surgery was good-to-excellent, but inferior to the primary stabilization and without influence of joint congruency and labrum morphology to the clinical outcome. CONCLUSION A properly applied arthroscopic revision of a Bankart repair generates sufficient restoration of the anteroinferior labral joint congruency and good clinical results. STUDY DESIGN Case series.
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Friedman LGM, Griesser MJ, Miniaci AA, Jones MH. Recurrent instability after revision anterior shoulder stabilization surgery. Arthroscopy 2014; 30:372-81. [PMID: 24581262 DOI: 10.1016/j.arthro.2013.11.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 11/19/2013] [Accepted: 11/19/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to perform a systematic review of the literature to compare outcomes of revision anterior stabilization surgeries based on technique. This study also sought to compare the impact of bone defects on outcomes. METHODS A systematic review of the electronic databases PubMed, Cochrane Central Register of Controlled Trials, and Scopus was performed in July 2012 and March 2013. Of 345 articles identified in the search, 17 studies with Level I to IV Evidence satisfied the inclusion criteria and were analyzed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Recurrent instability was defined as redislocation, resubluxation, or a positive apprehensive test after revision surgery. Procedures were categorized as arthroscopic Bankart repair, open Bankart repair, Bristow-Latarjet procedure, and other open procedures. RESULTS In total, 388 shoulders were studied. Male patients comprised 74.1% of patients, 66.7% of cases involved the dominant shoulder, the mean age was 28.2 years, and the mean follow-up period was 44.2 months. The surgical procedures classified as "other open procedures" had the highest rate of recurrent instability (42.7%), followed by arthroscopic Bankart repair (14.7%), the Bristow-Latarjet procedure (14.3%), and open Bankart repair (5.5%). Inconsistent reporting of bone defects precluded drawing significant conclusions. CONCLUSIONS A number of different procedures are used to address recurrent instability after a primary operation for anterior shoulder instability has failed. There is significant variability in the rate of recurrent instability after revision anterior shoulder stabilization surgery. LEVEL OF EVIDENCE Level IV, systematic review of Level I to IV studies.
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Affiliation(s)
| | - Michael J Griesser
- Performance Orthopaedics and Sports Medicine, Clinton Memorial Hospital, Wilmington, Ohio, U.S.A
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Saccomanni B. Early outcome of arthroscopic Bankart's repair for recurrent traumatic anterior shoulder instability. J Clin Orthop Trauma 2013; 4:129-34. [PMID: 26403552 PMCID: PMC3921397 DOI: 10.1016/j.jcot.2013.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND/OBJECTIVES Despite the improvements in the methods of arthroscopic stabilization of anterior shoulder instability, a recurrence rate of as high as 30% is reported in the literature. In this context, we report the outcome of arthroscopic Bankart repair in anterior shoulder instability, with the use of bio-absorbable suture anchors for patients that were followed up for at least two years from the date of surgery. The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. We would like to report the 2-year clinical outcomes of bio-absorbable suture anchors used in traumatic anterior dislocations of the shoulder. METHODS Data from 79 shoulders in 74 patients were collected over 4 years (2005-2009). Each patient was followed up over a period of 2 years. The patients underwent arthroscopic Bankart repair using bio-absorbable suture anchors for their anterior shoulder instability. These surgeries were performed at a single institution by a single surgeon over the time period. The patients were assessed with two different outcome measurement tools. The University of California at Los Angeles (UCLA) shoulder rating scale and the Simple Shoulder Test (SST) score. The scores were calculated before surgery and at the 2-year follow-up. The recurrence rates, range of motion as well post-operative function and return to sporting activities were evaluated. RESULTS SST results from the 12 domains showed a significant improvement from a mean of 6.1 ± 3.1 to 11.1 ± 1.8 taken at the 2-year follow-up (p < 0.0001). Data from the UCLA scale showed a pre and post-operative mean of 20.2 ± 5.0 and 32.4 ± 4.6 respectively (p < 0.0001). 34 had excellent post-operative scores, 35 had good scores, 1 had fair score and 3 had poor scores. 75% of the patients returned to sports while 7.6% developed a recurrence of shoulder dislocation or subluxation. CONCLUSION Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method, with good clinical outcomes, excellent post-operative shoulder motion and low recurrence rates.
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Affiliation(s)
- Bernardino Saccomanni
- Ambulatorio di Ortopedia, Via della Conciliazione, 65, CAP 74014 Laterza (TA), Italy,Orthopaedic and Trauma Surgery, Viale Regina Margherita, 70022 Altamura (BARI), Italy,Tel.: +39 3208007854.
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Abstract
PURPOSE Failed anterior shoulder stabilization procedures have traditionally been treated with open procedures. Recent advances in arthroscopic techniques have allowed for certain failed stabilization procedures to be treated by arthroscopic surgery. The aim of this systematic review was to determine the outcomes of revision arthroscopic Bankart repair. METHODS We searched Medline, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) for articles on revision arthroscopic Bankart repairs. Key words included shoulder dislocation, anterior shoulder instability, revision surgery, and arthroscopic Bankart repair. Two reviewers selected studies for inclusion, assessed methodologic quality, and extracted data. RESULTS We included 16 studies comprising 349 patients. All studies were retrospective (1 Level II study and 15 Level IV studies). The mean incidence of recurrent instability after revision arthroscopic Bankart repair was 12.7%, and the mean follow-up period was 35.4 months. The most common cause for failure of the primary surgeries was a traumatic injury (62.1%), and 85.1% of patients returned to playing sports. The reasons for failure of revision cases included glenohumeral bone loss, hyperlaxity, and return to contact sports. CONCLUSIONS With proper patient selection, the outcomes of revision arthroscopic Bankart repair appear similar to those of revision open Bankart repair. Prospective, randomized clinical trials are required to confirm these findings. LEVEL OF EVIDENCE Level IV, systematic review of Level II and Level IV studies.
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Abstract
The athlete with a failed instability procedure requires a thoughtful and systematic approach to achieve a good outcome. Goals of treatment should be defined and realistic expectations should be set. Revision stabilization has a high rate of recurrent instability, low rates of return to play, and low clinical outcome scores. Fundamental to successful revision surgery is choosing the correct procedure. The decision is straightforward in athletes with clear factors that predict recurrence (significant glenoid bone loss, engaging Hill-Sachs lesions) because only a bony procedure can restore the articular arc of the glenoid. Arthroscopic revision Bankart repair may be appropriate in those athletes who have an obvious Bankart tear and no bone loss after a traumatic reinjury. The challenge for the shoulder surgeon is identifying the best surgery for the athlete who does not have such clear-cut indications. Each factor that has the potential to lead to a poor outcome needs to be collected and calculated. Patient factors (age, laxity, type and level of sport), injury factors (mechanism of injury, capsulolabral injury, glenoid bone loss, Hill-Sachs lesion), and technical factors (previous surgery performed, integrity of repair, scarring) must be integrated into the treatment algorithm. Based on this collection of factors, the shoulder surgeon should be prepared to provide the athlete with the surgery that provides the best chance to return to playing sports and the lowest risk of recurrent instability.
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Affiliation(s)
- F Winston Gwathmey
- Orthopaedic Sports Medicine, Massachusetts General Hospital, 175 Cambridge Street, 4th Floor, Boston, MA 02114, USA
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Yamamoto N, Muraki T, Sperling JW, Steinmann SP, Itoi E, Cofield RH, An KN. Does the "bumper" created during Bankart repair contribute to shoulder stability? J Shoulder Elbow Surg 2013; 22:828-34. [PMID: 23021904 DOI: 10.1016/j.jse.2012.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 08/07/2012] [Accepted: 08/16/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to determine the optimal repair configuration for anterior shoulder instability after a labral tear. MATERIALS AND METHODS Nine fresh, frozen shoulders were used. With a 50-N axial force, the humeral head was translated anteriorly, and the translational force was measured. The measurement was performed with the capsule intact, after creating a Bankart lesion, and after the Bankart repair at 5 different positions: glenoid rim, glenoid surface-2 mm (on the glenoid surface 2 mm from the glenoid rim), glenoid surface-5 mm, scapular neck-2 mm (on the scapular neck 2 mm from the glenoid rim), and scapular neck-5 mm. Glenoid rim fixation was done with and without a "bumper." The "bumper" was created by plicating the capsule to form a thickened mass of tissue. RESULTS The translational force was restored to the intact level after the glenoid rim fixation. However, there was no significant difference in force after the Bankart repair with and without a "bumper" nor after the glenoid rim fixation and glenoid surface-2 mm. The force significantly decreased after scapular neck-2 mm and scapular neck-5 mm compared with the glenoid rim fixation. CONCLUSION The anchor fixation on the glenoid face does not increase the translational force compared with the glenoid rim placement, but the placement on the scapular neck decreases the translational force.
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Abstract
BACKGROUND Surgeons have traditionally treated recurrent shoulder dislocation by open methods. With the advent of arthroscopic repair techniques some surgeons reported higher recurrence rates than with open methods but some of those reports included patients with a variety of problems, including bone loss and those continuing in contact sports. It is unclear whether recurrence rates would be higher in patients without bone loss and those willing to forego contact sports. QUESTIONS/PURPOSES We therefore determined recurrence rates and functional scores after arthroscopic revision shoulder stabilization in patients without bone loss and those not subsequently participating in contact sports. PATIENTS AND METHODS We retrospectively reviewed 16 patients who underwent a revision arthroscopic Bankart repair using suture anchors. An arthroscopic approach was selected in patients with a unilateral traumatic injury and mild to moderate bone loss. Arthroscopic stabilization was contraindicated in patients with (1) multidirectional shoulder instability; (2) greater than 25% glenoid bone loss; (3) a Hill Sachs lesion involving more than one-third of the articular surface of the humeral head; and (4) patients electing to continue pursuing contact sports. At followup, physical examination of both shoulders was conducted. Several functional scores (Rowe, UCLA, and Constant & Murley) were compiled. The minimum followup was 24 months (mean, 31 months; range, 24-46 months). RESULTS The UCLA score (22-31), Constant & Murley score (69-80), and Rowe score (33-80) all improved. Shoulder instability recurred in three of the 16 patients, two sustaining dislocations and one a subluxation. One recurrence was the result of new trauma and this patient underwent an open Latarjet procedure; the other two patients refused further surgery. CONCLUSIONS Revision arthroscopic Bankart repair using suture anchors was associated with a low recurrence rate and restoration of acceptable function in patients without bone loss and not participating in contact sports. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Guillermo Arce
- Instituto Argentino de Diagnóstico y Tratamiento, Marcelo T. de Alvear 2400, Buenos Aires, Argentina
| | - Francisco Arcuri
- Instituto Argentino de Diagnóstico y Tratamiento, Marcelo T. de Alvear 2400, Buenos Aires, Argentina
| | - Diego Ferro
- Instituto Argentino de Diagnóstico y Tratamiento, Marcelo T. de Alvear 2400, Buenos Aires, Argentina
| | - Enrique Pereira
- Instituto Argentino de Diagnóstico y Tratamiento, Marcelo T. de Alvear 2400, Buenos Aires, Argentina
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Mauro CS, Voos JE, Hammoud S, Altchek DW. Failed anterior shoulder stabilization. J Shoulder Elbow Surg 2011; 20:1340-50. [PMID: 21831664 DOI: 10.1016/j.jse.2011.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 04/01/2011] [Accepted: 05/08/2011] [Indexed: 02/01/2023]
Affiliation(s)
- Craig S Mauro
- Burke and Bradley Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, PA 15215, USA.
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Denard PJ, Narbona P, Lädermann A, Burkhart SS. Bankart augmentation for capsulolabral deficiency using a split subscapularis tendon flap. Arthroscopy 2011; 27:1135-41. [PMID: 21704469 DOI: 10.1016/j.arthro.2011.02.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 02/18/2011] [Accepted: 02/23/2011] [Indexed: 02/02/2023]
Abstract
Traumatic anterior shoulder instability is a frequent problem and often requires surgical management. In the absence of significant bone deficiency, arthroscopic capsulolabral repair is associated with low recurrence rates and good functional outcome. However, capsulolabral deficiency, particularly after multiple previous attempts at repair, may preclude traditional arthroscopic Bankart techniques. Previous reports have described the use of autograft or allograft augmentation or coracoid transfer in the treatment of this difficult problem. The purpose of this report is to describe a novel technique of arthroscopic Bankart augmentation of capsulolabral deficiency using a split subscapularis tendon flap to reinforce a damaged capsule. In the absence of bone deficiency, this technique can restore anterior shoulder restraint without excessively constraining the glenohumeral joint.
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Ee GWW, Mohamed S, Tan AHC. Long term results of arthroscopic Bankart repair for traumatic anterior shoulder instability. J Orthop Surg Res 2011; 6:28. [PMID: 21672187 PMCID: PMC3127762 DOI: 10.1186/1749-799x-6-28] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 06/14/2011] [Indexed: 01/24/2023] Open
Abstract
Background The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. We would like to report the 2 year clinical outcomes of bio-absorbable suture anchors used in traumatic anterior dislocations of the shoulder. Methods Data from 79 shoulders in 74 patients were collected over 4 years (2004 - 2008). Each patient was followed-up over a period of 2 years. The patients underwent arthroscopic Bankart repair using bio-absorbable suture anchors for their shoulder instability. These surgeries were performed at a single institution by a single surgeon over the time period. The patients were assessed with two different outcome measurement tools. The University of California at Los Angeles (UCLA) shoulder rating scale and the Simple Shoulder Test (SST) score. The scores were calculated before surgery and at the 2-year follow-up. The recurrence rates, range of motion as well post-operative function and return to sporting activities were evaluated. Results SST results from the 12 domains showed a significant improvement from a mean of 6.1 ± 3.1 to 11.1 ± 1.8 taken at the 2-year follow-up (p < 0.0001). Data from the UCLA scale showed a Pre and Post Operative Mean of 20.2 ± 5.0 and 32.4 ± 4.6 respectively (p < 0.0001). 34 had excellent post-operative scores, 35 had good scores, 1 had fair score and 3 had poor scores. 75% of the patients returned to sports while 7.6% developed a recurrence of shoulder dislocation or subluxation. Conclusion Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method, with good clinical outcomes, excellent post-operative shoulder motion and low recurrence rates.
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Affiliation(s)
- Gerard W W Ee
- Department of Orthopaedics, Singpapore General Hospital, Outram Road, Singapore 169608, Singapore.
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37
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Abstract
BACKGROUND Open capsulolabral repair is still considered the standard revision procedure for a failed anterior shoulder instability repair. To date, only a few studies have evaluated the outcome of arthroscopic revision instability repair. PURPOSE This study was undertaken to assess the clinical outcome and postoperative sports activity level of arthroscopic revision stabilization using defined inclusion criteria and a standardized operative revision technique. STUDY DESIGN Case series; Level of evidence, 4. METHODS Fifty-six patients with recurrent anterior shoulder instability after an anatomic index procedure (open or arthroscopic) were included in the study. Arthroscopic revision repair was performed by a single surgeon using standardized suture anchor repair technique via an anteroinferior 5:30-o'clock approach. Patients were evaluated after a mean follow-up of 37 months (range, 25-72 months) with the Rowe, the Constant score, and the Simple Shoulder Test (SST). Return to sports, including sports level and discipline, were evaluated with a sports activity assessment tool. RESULTS For the revision repair, a minimum of 3 anchors were placed in the lower glenoid half. Recurrent instability after the revision procedure was found in 6 cases (11%). There were 4 recurrent instability cases caused by trauma and 2 atraumatic cases. Arthroscopic revision repair did not result in an additional loss of external rotation or additional subscapularis muscle insufficiency. The Rowe and Constant scores and the SST were significantly improved by the procedure. Eighty-six percent of the patients rated their result as good or excellent. Sports activity level was significantly improved by the procedure and the majority of patients returned to their previous sports level. CONCLUSION Arthroscopic capsulolabral revision repair via the anteroinferior 5:30-o'clock approach achieves results comparable with open revision repairs with a low recurrent instability rate. Arthroscopic revision repair reached a high patient satisfaction, good clinical outcomes, and a high rate of return to sports. The results suggest that arthroscopic revision repair is a viable treatment option for selected patients with a failed index repair.
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Affiliation(s)
- Christoph Bartl
- Department of Orthopaedic Sports Medicine, Technical University Munich, Munich, Germany.
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38
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Abstract
Arthroscopic stabilization of primary, recurrent anterior shoulder instability has become the procedure of choice with infrequent exceptions. Failures of stabilization can and do occur. This is a Level IV retrospective analysis of arthroscopic revision Bankart surgery performed on 15 non-consecutive patients over a 4-year period with an average 22-month follow-up. The average patient age was 27.5 with 12 men and 3 women. Four of the 15 failures were from the senior author's (R.K.N.R.) practice with the remaining 11 referred for treatment. Four of the 15 failures resulted from open surgery while the remaining 11 failed an arthroscopic stabilization procedure. Four contact/collision athletes were included, and significant bone loss was recorded in 5 patients. Operative findings included 10 recurrent Bankart lesions while 9 patients were felt to demonstrate capsular attenuation. Fourteen of the 15 had a Hill-Sachs lesion while chondromalacic change involving the anterior glenoid was noted in 13 of the 15 patients. A suture anchor technique was used with an average of 2.5 double-loaded suture anchors. In this series, 4 failures occurred after revision arthroscopic stabilization (27%) with an average SANE score of 86 (range, 65-100). One of the 5 patients with significant bone loss sustained a recurrence while 1 of 4 contact athletes failed the revision arthroscopic stabilization. Two of the 4 failures in this study subsequently underwent an open bone block procedure. Arthroscopic revision Bankart repair can be an effective alternative, but should only be considered in the properly selected patient.
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Krueger D, Kraus N, Pauly S, Chen J, Scheibel M. Subjective and objective outcome after revision arthroscopic stabilization for recurrent anterior instability versus initial shoulder stabilization. Am J Sports Med 2011; 39:71-7. [PMID: 20855555 DOI: 10.1177/0363546510379336] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The value of arthroscopic revision shoulder stabilization after failed instability repair is still a matter of debate. HYPOTHESIS Arthroscopic revision shoulder stabilization using suture anchors provides equivalent subjective and objective results compared with initial arthroscopic instability repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Twenty consecutive patients who underwent arthroscopic revision shoulder stabilization using suture anchors (group 2) were matched for age, gender, and handedness (dominant or nondominant) with 20 patients who had initial arthroscopic instability repair using the same technique (group 1). At the time of follow-up, a complete physical examination of both shoulders and evaluation with the Rowe score, Walch-Duplay score, Melbourne Instability Shoulder Score, Western Ontario Shoulder Instability Index, and the Subjective Shoulder Value were performed. In addition, standard radiographs (true AP and axillary views) were taken to evaluate signs of osteoarthritis. RESULTS After a minimum follow-up of 24 months, no recurrent dislocations were observed in either group. The apprehension sign was positive in 2 cases of revision surgery (0 vs 2; P > .05). No significant differences in the Rowe score (89 vs 81.8 points) were found between groups 1 and 2 (P > .05). However, group 2 revealed significantly lower scores in the Walch-Duplay score (85.3 vs 75.5 points), Melbourne Instability Shoulder Score (90.2 vs 73.7 points), Western Ontario Shoulder Instability Index (89.8% vs 68.9%), and Subjective Shoulder Value (91.8% vs 69.2%) (P < .05). Signs of instability arthropathy were found more often in patients with arthroscopic revision surgery (2 vs 5; P > .05). CONCLUSION Arthroscopic revision shoulder stabilization is associated with a lower subjective outcome compared with initial arthroscopic stabilization. The objective results found in this study may overestimate the clinical outcome in this patient population.
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Affiliation(s)
- David Krueger
- Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Germany
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40
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Bedi A, Dines J, Dines DM, Kelly BT, O'Brien SJ, Altchek DW, Allen AA. Use of the 70° arthroscope for improved visualization with common arthroscopic procedures. Arthroscopy 2010; 26:1684-96. [PMID: 20855180 DOI: 10.1016/j.arthro.2010.04.070] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 04/14/2010] [Accepted: 04/14/2010] [Indexed: 02/02/2023]
Abstract
The vast majority of common arthroscopic procedures are performed with a 30° arthroscope for visualization. Although the 70° arthroscope has been described for a myriad of applications, its utility has recently been forgotten. We have explored the use of the 70° arthroscope for a myriad of arthroscopic procedures and identified a number of circumstances in which it offers superior visualization to a 30° arthroscope. These procedures include arthroscopic shoulder stabilization, distal clavicle resection, acromioclavicular joint reconstruction, rotator cuff repair, elbow arthroscopy, anterior cruciate ligament reconstruction, posterior cruciate ligament reconstruction, arthroscopy of the posterior knee compartments, hip arthroscopy, and subdeltoid shoulder arthroscopy.
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42
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Abstract
Traumatic anterior shoulder dislocations are the most frequent type of joint dislocation and affect approximately 1.7% of the general population. The literature supports the consideration of primary stabilization in high-risk patients because of reported recurrences as high as 80% to 90% with nonoperative treatment regimens. Successful stabilization of anterior glenohumeral instability relies on not only good surgical techniques but also careful patient selection. Failure rates after open and arthroscopic stabilization have been reported to range from 2% to 8% and 4% to 13%, respectively. Recurrent shoulder instability leads to increased morbidity to the patient, increased pain, decreased activity level, prolonged time away from work and sports, and a general decrease in quality of life. This article reviews the potential pitfalls in anterior shoulder stabilization and discusses appropriate methods of addressing them in revision surgery.
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Affiliation(s)
- Julienne L Boone
- Department of Orthopedic Surgery, Washington University School of Medicine,660 South Euclid Avenue, St Louis, MO 63110, USA
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43
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Abstract
Glenohumeral instability is an intrinsic pathological condition of the shoulder, owing to its ample range of mobility that predisposes this joint to a somewhat limited degree of stability. Several techniques have been employed for the treatment of instability. Among these, one is the Latarjet procedure, recommended for cases of substantial bone deficit on the humeral head or on the anterior region of the glenoid. Such technique gives generally good, long-term results, considering the low incidence of recurrence. However, potential complications such as glenohumeral arthrosis, absorption of the bone block, breakage, malpositioning or mobilization of the screws, infections, neurological or vascular complications can be serious. Moreover, as a result of further severe trauma, the shoulder can become again globally unstable. In such cases, the question arises of which technique to employ in surgical revision, since the Latarjet procedure determines substantial subversion of glenohumeral anatomy. The aim of the study was the analysis of arthroscopical treatment after failure of a Latarjet procedure and to describe the related definitive results. During the period between January 2000 and June 2007, we treated 17 patients (18 shoulders) using arthroscopy, following failure of an open Latarjet surgical procedure. One patient was operated bilaterally. Clinical revision according to the Constant Score, ROWE, ASES, UCLA and the VAS scale for pain evaluation was carried out during follow-up examination after an average period of 5 years and 9 months (min. 2 years-max. 9 years) from latest surgery. The system of evaluation according to the Constant Score indicated an average score of 78.4/100 at follow-up examination; UCLA indicated 27.2/35; ASES 99.6/120; ROWE 75.2/100. With regard to pain, the VAS Scale indicated an average score of 2.9/10. As criteria for relapse, we considered classic cases of dislocation and subluxations, or sprains with subluxation, and subjectively experienced apprehension and pain to a degree that seriously inhibited the patient's daily life. The incidence of relapse following the final surgical operation (taking into consideration both frank dislocations and subluxations) was 16.7%. At clinical revision, one patient showed dislocation due to relatively modest trauma approximately 1 year following the second surgery (5.6%). Episodes of subluxation or sprains continued in 2 shoulders (11.1% relapse). In 11 cases (61%), return to sports activities was achieved. Arthroscopy technique using anchors and sutures can, in selected cases, lead to satisfactory results, allowing, by means of minimal surgical invasion, identification and treatment also of intra-articular lesions, where associated.
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Sparks BS, Nyland J, Nawab A, Blackburn E, Krupp R, Caborn DNM. Biomechanical comparison of screw-in suture anchor-suture combinations used for Bankart repair. Arch Orthop Trauma Surg 2010; 130:321-7. [PMID: 19572140 DOI: 10.1007/s00402-009-0926-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Bankart repair laxity may contribute to pathologic joint instability. This biomechanical study compared two screw-in suture anchor-suture combinations under tensile loads. METHODS Twelve pairs of scapulae were implanted with either a 3 mm diameter, 14 mm long poly-L/D-lactide suture anchor with a suture eyelet (Group 1) or a 3.1 mm diameter, 11 mm long polylactide suture anchor with a molded eyelet (Group 2). Constructs were cyclically loaded between 25 and 50 N with a 25 N load increase every 25 cycles. RESULTS Group 2 displayed greater displacement at failure, had more specimens with > or =2 mm displacement by the 50 N interval (P = 0.014), and had displaced more by 100 N (P < or = 0.046). Group 1 displayed a stronger load-displacement at failure relationship than Group 2 (r (2) = 0.67 vs. r (2) = 0.37). CONCLUSION Construct differences may influence decisions regarding the required number of suture anchor-suture loops, the rehabilitation timetable, and the timing of return to unrestricted activities.
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Affiliation(s)
- Brad S Sparks
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, 210 East Gray Street, Louisville, KY 40202, USA
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45
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Abstract
BACKGROUND Only a few studies have provided homogeneous analysis of open revision surgery after a failed arthroscopic Bankart procedure. HYPOTHESIS Open Bankart revision surgery will be effective in a failed arthroscopic anterior stabilization but inevitably results in a loss of range of motion, especially external rotation. STUDY DESIGN Case series; Level of evidence, 4. METHODS Twenty-six shoulders that went through traditional open Bankart repair as revision surgery after a failed arthroscopic Bankart procedure for traumatic anterior shoulder instability were enrolled for this study. The mean patient age at the time of revision surgery was 24 years (range, 16-38 years), and the mean duration of follow-up was 42 months (range, 25-97 months). RESULTS The preoperative mean range of motion was 173 degrees in forward flexion and 65 degrees in external rotation at the side. After revision surgery, the ranges measured 164 degrees and 55 degrees, respectively (P = .024 and .012, respectively). At the last follow-up, the mean Rowe score was 81 points, with 88.5% of the patients reporting good or excellent results. After revision surgery, redislocation developed in 3 shoulders (11.5%), all of which had an engaging Hill-Sachs lesion and associated hyperlaxity (2+ or greater laxity on the sulcus sign). CONCLUSION Open revision Bankart surgery for a failed arthroscopic Bankart repair can provide a satisfactory outcome, including a low recurrence rate and reliable functional return. In open revision Bankart surgery after failed stabilization for traumatic anterior shoulder instability, the surgeon should keep in mind the possibility of a postoperative loss of range of motion and a thorough examination for not only a Bankart lesion but also other associated lesions, including a bone defect or hyperlaxity, to lower the risk of redislocation.
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Affiliation(s)
- Nam Su Cho
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea.
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46
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47
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Abstract
We have investigated the outcome of arthroscopic revision surgery for recurrent instability of the shoulder after failed primary anterior stabilisation. We identified 40 patients with failed primary open or arthroscopic anterior stabilisation of the shoulder who had been treated by revision arthroscopic capsulolabral reconstruction and followed up for a mean of 36 months (12 to 87). There were 34 men and six women with a mean age of 33.1 years (15 to 48). Details of the patients, the technique of the primary procedure, the operative findings at revision and the clinical outcome were evaluated by reviewing the medical records, physical examination and the use of the Western Ontario shoulder instability index score, the American Shoulder and Elbow Surgeons score and the health status questionnaire 12. Recurrent instability persisted in four patients after the revision arthroscopic procedure. At the final follow-up, the mean American Shoulder and Elbow Surgeons score was 81.1 (17.5 to 99.5) and the mean Western Ontario shoulder instability index score was 68.2 (20 to 98.2). Quality-of-life scoring showed good to excellent results in most patients. Arthroscopic revision capsulolabral reconstruction can provide a satisfactory outcome in selected patients for recurrent instability of the shoulder provided that no large Hill-Sachs lesion is present.
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Affiliation(s)
- R. V. Patel
- Department of Trauma and Orthopaedics, University of British Columbia, 3114-910, West 10th Avenue, Vancouver, British Columbia V5Z 4E3, Canada
| | - K. Apostle
- Department of Trauma and Orthopaedics, University of British Columbia, 3114-910, West 10th Avenue, Vancouver, British Columbia V5Z 4E3, Canada
| | - J. M. Leith
- Department of Trauma and Orthopaedics, University of British Columbia, 3114-910, West 10th Avenue, Vancouver, British Columbia V5Z 4E3, Canada
| | - W. D. Regan
- Department of Trauma and Orthopaedics, University of British Columbia, 3114-910, West 10th Avenue, Vancouver, British Columbia V5Z 4E3, Canada
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48
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Flury M, Schwyzer HK. Revision nach offener oder arthroskopischer Schulterstabilisierung. Arthroskopie 2008. [DOI: 10.1007/s00142-008-0452-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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49
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Franceschi F, Longo UG, Ruzzini L, Rizzello G, Maffulli N, Denaro V. Arthroscopic salvage of failed arthroscopic Bankart repair: a prospective study with a minimum follow-up of 4 years. Am J Sports Med 2008; 36:1330-6. [PMID: 18375787 DOI: 10.1177/0363546508314403] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Data on arthroscopic salvage of failed arthroscopic Bankart repair are lacking. PURPOSE To prospectively evaluate the surgical outcome of arthroscopic salvage of failed arthroscopic Bankart repair. STUDY DESIGN Case series; Level of evidence, 4. METHODS Operations were performed on 10 patients (8 male and 2 female; mean age at revision, 25.6 years; range, 18-41 years). The mean interval from the time of the revision surgery to the final follow-up was 68 months (range, 46-83 months). Objective testing included preoperative and postoperative range of motion. Outcome measures included the rating system of the University of California at Los Angeles. The surgical procedure was performed in a consistent manner: capsular plications, suture anchor repair of the displaced labrum, and, when indicated, rotator interval closure. RESULTS The University of California at Los Angeles rating system showed a statistically significant improvement from a preoperative mean rating of 11.7 (range, 6-14) to a mean of 31.7 (range, 29-35) postoperatively (P < .05). All patients had a full and equal postoperative range of motion compared with the preoperative range of motion. One patient experienced recurrent dislocations after the salvage procedure. None of the other 9 patients experienced a recurrent dislocation, with all returning to their previous sports levels. CONCLUSION Arthroscopic Bankart revision surgery is a reliable procedure with respect to recurrence rate, range of motion, and shoulder function in carefully selected patients.
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Affiliation(s)
- Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Rome, Italy
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50
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Abstract
We identified ten patients who underwent arthroscopic revision of anterior shoulder stabilisation between 1999 and 2005. Their results were compared with 15 patients, matched for age and gender, who had a primary arthroscopic stabilisation during the same period. At a mean follow-up of 37 and 36 months, respectively, the scores for pain and shoulder function improved significantly between the pre-operative and follow-up visits in both groups (p = 0.002), with no significant difference between them (p = 0.4). The UCLA and Rowe shoulder scores improved significantly (p = 0.004 and p = 0.002, respectively), with no statistically significant differences between groups (p = 0.6). Kaplan-Meier analysis for time to recurrent instability showed no differences between the groups (p = 0.2). These results suggest that arthroscopic revision anterior shoulder stabilisation is as reliable as primary arthroscopic stabilisation for patients who have had previous open surgery for recurrent anterior instability.
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Affiliation(s)
- N. L. Millar
- West of Scotland Orthopaedic Training Programme, c/o 143 Wilton Street, Glasgow G20 6DQ, UK
| | - G. A. C. Murrell
- Orthopaedic Research Institute, Research and Education Centre, Level 2, St George Hospital, 4 - 10 South Street, Kogarah, Sydney, New South Wales 2217, Australia
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