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Gokce A, Guclu D, Unlu EN, Kazoglu I, Arican M, Ogul H. Comparison of conventional MR arthrography and 3D volumetric MR arthrography in detection of cartilage defects accompanying glenoid labrum pathologies. Skeletal Radiol 2024; 53:1081-1090. [PMID: 38051423 DOI: 10.1007/s00256-023-04536-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVES In this study, we aimed to compare conventional and T1-weighted volumetric magnetic resonance arthrography (MRA) in the diagnosis and grading of glenoid cartilage defects that accompany labral pathologies. MATERIALS AND METHODS A total of 79 patients who were prediagnosed with labrum pathologies based on shoulder magnetic resonance imaging (MRI) had MRA and CTA between December 2021 and May 2022. CTA was regarded as reference standard. CTA images were examined by a radiologist experienced in musculoskeletal radiology, and MRA images were examined by two radiologists independently to determine presence, grade, and localization of any glenoid cartilage defect, if present. Sensitivity, specificity, and accuracy were calculated separately for conventional and T1-weighted volumetric MRA. In addition, at the last stage, two observers examined all MRAs together, and the presence of a cartilage defect was decided by consensus, and the overall sensitivity, specificity, and accuracy were calculated. RESULTS Cartilage defect was detected on CTAs of 48 (60.75%) cases of among 79 patients with labrum pathology. The sensitivity, specificity, and accuracy of conventional MRA for two examiners were 17-19%, 100-100%, and 49-51%, respectively, while those values were 67-65%, 92-97%, and 84-77%, respectively, for T1-weighted volumetric MRA. Inter-examiner agreement was excellent for diagnosis of cartilage defects on all MRAs. The overall sensitivity, specificity, and accuracy for detection of glenoid cartilage lesions by MRA were 69%, 97%, and 80%, respectively. CONCLUSION T1-weighted volumetric MRA seems to demonstrate cartilage defects accompanied with labrum pathologies accurately with high sensitivity, specificity, and excellent inter-examiner agreement.
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Affiliation(s)
- Ayse Gokce
- Department of Radiology, Aksaray Research and Training Hospital, Aksaray, Turkey.
| | - Derya Guclu
- Department of Radiology, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Elif Nisa Unlu
- Department of Radiology, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Ibrahim Kazoglu
- Department of Orthopedics and Traumatology, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Mehmet Arican
- Department of Orthopedics and Traumatology, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Hayri Ogul
- Department of Radiology, Faculty of Medicine, Duzce University, Duzce, Turkey
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Prigmore B, Tabbaa S, Crawford DC. Osteochondral Allograft Transplantation in the Shoulder: A Systematic Review of Indications and Outcomes. Cartilage 2023:19476035231205678. [PMID: 37937538 DOI: 10.1177/19476035231205678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE To collate current literature pertaining to the published reports of indications for, and outcomes of, osteochondral allograft (OCA) transplantations in the shoulder so as to guide surgeons in the management of various etiologies of osteochondral lesions in this joint. DESIGN A systematic review of the current literature was performed in February 2022 in the PubMed, Cochrane, and EMBASE databases using specific search terms and predetermined inclusion/exclusion criteria. RESULTS One-hundred-twenty-three articles were initially identified, 30 full-text articles were assessed for eligibility, and 17 articles met inclusion criteria. Data were collected for study characteristics, etiology, lesion size/location, intervention/type of graft used, follow-up, and outcomes. In total, 83 shoulders were included (n = 83) in the review with an average follow-up of 45.7 months. Nine specific indications for OCA transplantation in the shoulder included: reverse Hill-Sachs lesions (33), Hill-Sachs lesions (22), pain pump chondrolysis (10), recurrent shoulder instability (7), osteoarthritis/degenerative changes (5), radiofrequency chondrolysis (2), prominent suture anchors (2), glenoid lesion (1), and osteochondritis dissecans (1). Seventeen patients had concomitant surgeries and two patients were lost to follow-up. Of the total 83 shoulders, 68 had favorable outcomes and 13 had unfavorable outcomes as determined by graft incorporation, pain scores, functionality/ROM, patient-reported satisfaction, and/or requirement for revision/arthroplasty. Of the 13 with unfavorable outcomes, a disproportionate number had concomitant surgeries and/or were performed for pain pump chondrolysis (6). CONCLUSIONS The use of OCAs appears to be a viable option for a variety of difficult-to-treat shoulder pathologies, particularly those characterized by isolated osteochondral injuries.
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Affiliation(s)
- Brian Prigmore
- OHSU Department of Orthopaedics & Rehabilitation, Center for Health & Healing, Portland, OR, USA
| | - Suzanne Tabbaa
- UCSF School of Medicine, Department of Orthopaedic Surgery, San Francisco, CA, USA
| | - Dennis C Crawford
- OHSU Department of Orthopaedics & Rehabilitation, Center for Health & Healing, Portland, OR, USA
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Prigmore B, Tabbaa S, Crawford DC. Avascular necrosis of the proximal humerus: a novel indication for the use of osteochondral allograft transplantation in the shoulder: Case report. J ISAKOS 2023; 8:387-391. [PMID: 37572786 DOI: 10.1016/j.jisako.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/14/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023]
Abstract
Osteochondral allograft (OCA) transplantation is an increasingly available biologic treatment option for a range of intraarticular aetiologies. To our knowledge, no prior publication has documented the use of this technology to treat a lesion of the proximal humerus secondary to avascular necrosis (AVN). We describe our experience treating a 42-year-old female executive with idiopathic AVN of the proximal humerus with a fresh osteochondral allograft. Computed tomography (CT) at 3 months post-op showed full bony incorporation and a restored native joint contour. Over the initial 7 months post-operatively, she reported continued improvements in pain and function as measured by quick Disabilities of the Arm, Shoulder, and Hand (DASH) scores. She was discharged from physical therapy after 6 months, reporting no rest pain, full active and passive range of motion, and unrestricted occupational and recreational activity.
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Affiliation(s)
- Brian Prigmore
- OHSU Department of Orthopaedics & Rehabilitation, Center for Health & Healing, Building 1, 12th Floor 3303 S. Bond Avenue Portland, OR 97239, USA
| | - Suzanne Tabbaa
- UCSF School of Medicine, Department of Orthopaedic Surgery, 1001 Potrero Ave, San Francisco, CA 94110, USA
| | - Dennis C Crawford
- OHSU Department of Orthopaedics & Rehabilitation, Center for Health & Healing, Building 1, 12th Floor 3303 S. Bond Avenue Portland, OR 97239, USA.
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Favier BJC, Janssen DMC. Bilateral osteochondritis dissecans of the shoulder. Acta Orthop Belg 2022; 88:581-587. [PMID: 36791713 DOI: 10.52628/88.3.9419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Osteochondritis dissecans as a pathology is pre-dominantly described in the knee, elbow and ankle. Osteochondritis dissecans of the humeral head is a more uncommon reported injury. We present a case of a bilateral osteochondritis dissecans of the humeral head in a 16-year-old soccer player and an algorithm for treatment of OCD of the humeral head. To our knowledge this has never been described so specifically in literature before.
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Fiegen A, Leland DP, Bernard CD, Krych AJ, Barlow JD, Dahm DL, Camp CL. Articular Cartilage Defects of the Glenohumeral Joint: A Systematic Review of Treatment Options and Outcomes. Cartilage 2021; 13:401S-413S. [PMID: 31441316 PMCID: PMC8808793 DOI: 10.1177/1947603519870858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To report radiographic and magnetic resonance imaging findings, patient-reported outcomes, and complications and/or reoperations following nonarthroplasty surgical intervention for focal glenohumeral cartilage defects. DESIGN A literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Patients were included if they possessed a chondral defect of the humeral head, glenoid, or both, which had been treated with a joint preserving nonarthroplasty procedure. Risk of bias assessment was performed using the Methodological Index for Non-Randomized Studies scoring system. Study demographics, surgical technique, imaging findings, patient-reported outcomes, complications, failures, and reoperations were collected. RESULTS Fourteen studies with 98 patients (100 shoulders) met the inclusion criteria. Patient ages ranged from 7 to 74 years. The nonarthroplasty surgical techniques utilized included microfracture (67 shoulders), osteochondral transplantation (28 shoulders), chondrocyte transplantation (4 shoulders), and internal fixation (1 shoulder). The rates of radiographic union and progression of osteoarthritis ranged between 90% to 100% and 57% to 100%, respectively. Visual analog scores ranged from 0 to 1.9 at final follow-up. Mean postoperative ASES (American Shoulder and Elbow Surgeons) shoulder scores ranged from 75.8-100. Mean postoperative CSS (Constant Shoulder Score) scores ranged from 83.3-94. Mean postoperative SSV (Subjective Shoulder Value) ranged from 70% to 99%. Failure and reoperation rates ranged between 0% to 35% and 0% to 30%, respectively, with the most common reoperation being conversion to prosthetic arthroplasty. CONCLUSIONS In this systematic review, nonarthroplasty surgical techniques demonstrated acceptable rates of radiographic healing, improved patient reported outcomes, minimal complications, and low rates of failure or reoperation. Joint preserving techniques are likely viable options to prolong function of the native shoulder and provide short- to midterm pain relief in young and highly active patients. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | | | | | | | | | | | - Christopher L. Camp
- Mayo Clinic, Rochester, MN, USA,Christopher L. Camp, Department of
Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Hinz M, Imhoff AB, Schmitt A. [Update on the Operative Treatment of Cartilage Defects]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 159:459-475. [PMID: 33975378 DOI: 10.1055/a-1302-8636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Focal cartilage defects lead to swelling, significant pain and loss of function of the affected joint. Additionally, they are linked to early onset of osteoarthritis. Often young and active patients are especially susceptible due to the high stress placed on their joints. A vast amount of treatment options is available to orthopaedic surgeons to cure cartilage defects of the knee, hip, shoulder, elbow and ankle joints. This article serves to give an overview of these available treatment options and to explain the expected outcomes.
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Gill J, Tytherleigh-Strong G. Osteochondritis dissecans with associated secondary chondromatosis in an adolescent shoulder. Shoulder Elbow 2019; 11:275-281. [PMID: 31316588 PMCID: PMC6620793 DOI: 10.1177/1758573217751653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 12/09/2017] [Accepted: 12/11/2017] [Indexed: 11/15/2022]
Abstract
Osteochondritis dissecans (OCD) of the humeral head is rare and usually occurs in adolescents. Secondary synovial chondromatosis occasionally occurs in the shoulder but has only been reported twice in an adolescent. We describe the case and management of an adolescent male who presented with features of OCD and secondary chondromatosis in his shoulder occurring simultaneously.
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Affiliation(s)
| | - Graham Tytherleigh-Strong
- Graham Tytherleigh-Strong, Division of Orthopaedics, Addenbrooke’s Hospital, Cambridge University Hospitals Trust, Cambridge CB2 2QQ, UK.
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Takamura KM, Chen JB, Petrigliano FA. Nonarthroplasty Options for the Athlete or Active Individual with Shoulder Osteoarthritis. Clin Sports Med 2018; 37:517-526. [PMID: 30201166 DOI: 10.1016/j.csm.2018.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The management of glenohumeral osteoarthritis is difficult in young, active individuals. After nonoperative management fails, arthroscopic debridement with concomitant procedures (eg, loose body removal, capsular release, labral debridement, synovectomy, osteophyte resection, bursectomy, subacromial decompression, microfracture, and biceps tenotomy or tenodesis) to address potential pain generators may be an option in small, contained, unipolar lesions.
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Affiliation(s)
- Karren M Takamura
- Department of Orthopaedic Surgery, University of California Los Angeles, 10833 LeConte Avenue, 76-119 CHS, Los Angeles, CA 90095-6902, USA
| | - James B Chen
- Department of Orthopaedic Surgery, University of California Los Angeles, 10833 LeConte Avenue, 76-119 CHS, Los Angeles, CA 90095-6902, USA
| | - Frank A Petrigliano
- Department of Orthopaedic Surgery, University of California Los Angeles, 10833 LeConte Avenue, 76-119 CHS, Los Angeles, CA 90095-6902, USA.
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Abstract
Articular cartilage defects are not often encountered in the glenohumeral joint. These lesions are typically found in patients with shoulder trauma, recurrent instability, or previous surgical treatment. Diagnosis can be difficult; these defects are often found incidentally during arthroscopic or open surgical management of other pathology. Initial management of isolated glenohumeral chondral defects is nonsurgical and includes physical therapy and/or corticosteroid injections. If nonsurgical treatment is unsuccessful, patients may undergo surgery. Because these lesions occur infrequently, few studies have documented surgical techniques and outcomes. Surgical strategies include arthroscopic débridement, microfracture surgery, osteochondral autograft or allograft transplantation, autologous chondrocyte implantation, and particulated juvenile allograft cartilage implantation.
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10
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Riff AJ, Yanke AB, Shin JJ, Romeo AA, Cole BJ. Midterm results of osteochondral allograft transplantation to the humeral head. J Shoulder Elbow Surg 2017; 26:e207-e215. [PMID: 28162881 DOI: 10.1016/j.jse.2016.11.053] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/20/2016] [Accepted: 11/25/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study evaluated clinical outcomes of osteochondral allograft (OCA) transplantation for humeral head osteochondral defects. We hypothesized that patients with isolated humeral head disease would achieve favorable results and that patients with bipolar disease would experience inferior outcomes. METHODS We identified patients who underwent humeral head OCA transplantation. Subjective questionnaire data were obtained preoperatively and at a minimum of 2 years postoperatively. Radiographs were evaluated for graft incorporation. Failure was defined by conversion to shoulder arthroplasty, American Shoulder and Elbow Surgeons score <50, or dissatisfaction with the surgical result. RESULTS Twenty patients (65% male) met inclusion criteria. Patients were an average age of 24.8 ± 8.1 years. Eleven patients underwent concomitant glenoid surgery (microfracture or meniscal allograft resurfacing). Follow-up was available for 18 patients (90%) at mean of 67 months. All grafts incorporated except 2. Four patients underwent shoulder arthroplasty at mean of 25 months postoperatively (all after pain pump chondrolysis). Eleven of the 20 patients were satisfied (all dissatisfied patients underwent glenoid surgery). Significant improvements (P < .001) were seen for the visual analog scale (from 6.1 to 1.5), Simple Shoulder Test (from 32 to 73), American Shoulder and Elbow Surgeons score (from 39 to 76), and the physical component of the 12-Item Short Form Survey (from 38 to 48). Pain pump patients who did not progress to arthroplasty experienced inferior satisfaction (40% vs. 87.5%, P = .04) and a trend toward inferior outcomes compared with the rest of the cohort. CONCLUSION OCA transplantation is a viable option for young patients with isolated humeral chondral injury. Patients with bipolar disease or a history of intra-articular pain pump have increased failure and decreased subjective outcomes.
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Affiliation(s)
- Andrew J Riff
- Department of Orthopaedics, Rush University Medical Center, Chicago, IL, USA.
| | - Adam B Yanke
- Department of Orthopaedics, Rush University Medical Center, Chicago, IL, USA
| | - Jason J Shin
- Department of Orthopaedics, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Anthony A Romeo
- Department of Orthopaedics, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Department of Orthopaedics, Rush University Medical Center, Chicago, IL, USA
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Pham TT, Kany J, Lakhal W, Sales de Gauzy J, Accadbled F. Arthroscopic Osteochondral Autograft Transfer for Juvenile Osteochondritis Dissecans of the Humeral Head: A Case Report. JBJS Case Connect 2017; 7:e63. [PMID: 29252892 DOI: 10.2106/jbjs.cc.17.00003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE Osteochondritis dissecans (OCD) rarely affects the humeral head. We describe a 14-year-old adolescent who, despite conservative treatment, had persistent pain in the left shoulder as well as limited function. Radiographs and a computed tomography (CT) arthrogram revealed an osteochondral defect of the humeral head. He was managed with an arthroscopic osteochondral autograft transfer from the knee, which provided a satisfactory outcome. CONCLUSION Arthroscopic osteochondral autograft transfer is an effective option for the treatment of OCD of the humeral head.
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Affiliation(s)
- Thuy Trang Pham
- Service de Chirurgie Orthopédique Pédiatrique, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - Jean Kany
- Service de Chirurgie Orthopédique, Clinique de l'Union, Saint-Jean, France
| | - Walid Lakhal
- Service de Chirurgie Orthopédique Pédiatrique, Le Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Jérôme Sales de Gauzy
- Service de Chirurgie Orthopédique Pédiatrique, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - Franck Accadbled
- Service de Chirurgie Orthopédique Pédiatrique, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
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Mima Y, Matsumura N, Ogawa K, Iwamoto T, Ochi K, Sato K, Toyama Y. Osteochondritis dissecans on the medial aspect of the humeral head. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2016; 10:89-91. [PMID: 27186062 PMCID: PMC4857537 DOI: 10.4103/0973-6042.180722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The case of a 29-year-old man who had osteochondritis dissecans on the medial aspect of the humeral head is reported. Repetitive micro-trauma at a low elevated arm position was thought to have induced the osteochondral lesion.
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Affiliation(s)
- Yuichiro Mima
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan; Department of Orthopedic Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Kiyohisa Ogawa
- Department of Orthopedic Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan; Department of Orthopedic Surgery, Eiju General Hospital, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kensuke Ochi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazuki Sato
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiaki Toyama
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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13
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Krych AJ, Sousa PL, King AH, Morgan JA, May JH, Dahm DL. The Effect of Cartilage Injury After Arthroscopic Stabilization for Shoulder Instability. Orthopedics 2015; 38:e965-9. [PMID: 26558675 DOI: 10.3928/01477447-20151020-03] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/23/2015] [Indexed: 02/03/2023]
Abstract
This study was undertaken to (1) determine the incidence of articular cartilage injuries in patients with instability of the glenohumeral joint, (2) determine whether recurrent dislocations increased the risk of articular damage, and (3) correlate these injuries with postoperative clinical outcomes. A cohort was identified of consecutive patients who underwent diagnostic magnetic resonance imaging and shoulder arthroscopy for glenohumeral instability with documented dislocation or subluxation between 1997 and 2006 at a single institution. Patients with moderate or severe osteoarthritis were excluded. Arthroscopic findings were recorded, including lesion location and Outerbridge grade. The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) was used to assess outcome in 61 patients who were available for follow-up. Outcomes were compared between shoulders with and without articular lesions. A total of 87 shoulders (83 patients) met the inclusion criteria, with 69 (83%) men and 14 (17%) women. Mean age was 26.1 years (range, 18-64 years), and mean follow-up was 36 months (range, 33-39 months). Cartilage injuries were found in 56 shoulders (64%). Previously documented shoulder dislocation requiring closed reduction (P=.046) and the number of discrete dislocations (P=.032) were significant for glenoid injury. A greater number of dislocations was associated with higher-grade lesions of the glenohumeral joint (P<.001). Overall, mean ASES score was 89.6 (range, 37-100). In patients with an articular cartilage lesion, mean ASES score was 90.4 (range, 58-100) compared with 88.1 (range, 37-100) in those without this injury (P=.75). Although clinical outcomes were not significantly affected, further investigation is warranted to establish a relationship between these injuries and longer-term outcomes.
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Saltzman BM, Riboh JC, Cole BJ, Yanke AB. Humeral Head Reconstruction With Osteochondral Allograft Transplantation. Arthroscopy 2015; 31:1827-34. [PMID: 25979686 DOI: 10.1016/j.arthro.2015.03.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/26/2015] [Accepted: 03/17/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To synthesize, in a systematic review, the available clinical evidence of osteochondral allograft transplants for large osteochondral defects of the humeral head. METHODS The Medline, Embase, and Cochrane databases were searched for studies reporting clinical or radiographic outcomes of osteochondral allograft transplantation for humeral head defects. Descriptive statistics were provided for all outcomes. After checking for data normality, we compared postoperative and preoperative values using the Student t test. RESULTS We included 12 studies (8 case reports and 4 case series) in this review. The study group consisted of 35 patients. The mean age was 35.4 ± 18.1 years; 77% of patients were male patients. Thirty-three patients had large Hill-Sachs lesions due to instability, 1 had an osteochondritis dissecans lesion, and 1 had an iatrogenic lesion after resection of synovial chondromatosis. The mean lesion size was 3 ± 1.4 cm (anteroposterior) by 2.25 ± 0.3 cm (medial-lateral), representing on average 40.5% ± 4.73% of the native articular surface. Of the 35 patients, 3 received a fresh graft, with all others receiving frozen grafts. Twenty-three femoral heads, 10 humeral heads, and 2 sets of osteochondral plugs were used. The mean length of follow-up was 57 months. Significant improvements were seen in forward flexion at 6 months (68° ± 18.1°, P < .001), forward flexion at 12 months (83.42° ± 18.3°, P < .001), and external rotation at 12 months (38.72° ± 18.8°, P < .001). American Shoulder and Elbow Surgeons scores improved by 14 points (P = .02). Radiographic studies at final follow-up showed allograft necrosis in 8.7% of cases, resorption in 36.2%, and glenohumeral arthritic changes in 35.7%. Complication rates were between 20% and 30%, and the reoperation rate was 26.67%. Although only 3 patients received fresh allografts, there were no reports of graft resorption, necrosis, or arthritic changes in these patients. CONCLUSIONS Humeral head allograft-most commonly used in the setting of large Hill-Sachs lesions due to instability-has shown significant improvements in shoulder motion and American Shoulder and Elbow Surgeons scores as far as 1 year postoperatively. Return-to-work rates and satisfaction levels are high after the intervention. Complication and reoperation rates are substantial, although it is possible that use of fresh allograft tissue may result in less resorption and necrosis. LEVEL OF EVIDENCE Level V, systematic review of Level IV and V studies.
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Affiliation(s)
- Bryan M Saltzman
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Jonathan C Riboh
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Adam B Yanke
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Rabinowitz J, Yanke AB, Cole BJ. Evaluating Healing of Allograft Tissues in the Shoulder—Cartilage and Bone. OPER TECHN SPORT MED 2015. [DOI: 10.1053/j.otsm.2014.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Camp CL, Barlow JD, Krych AJ. Transplantation of a tibial osteochondral allograft to restore a large glenoid osteochondral defect. Orthopedics 2015; 38:e147-52. [PMID: 25665122 DOI: 10.3928/01477447-20150204-92] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/24/2014] [Indexed: 02/03/2023]
Abstract
Osteochondral disease of the glenoid is a well-known cause of shoulder pain and disability in young and active patients. The etiology can be multifactorial, and disease severity can exist across a wide spectrum. Symptoms can often interfere with athletic performance, job responsibilities, and activities of daily living. Although a number of cartilage restoration techniques exist for other joints, such as the hip, knee, ankle, and elbow, restorative options for glenoid osteochondral defects are currently limited. Given the success of osteochondral allograft transplantation in other joints, the authors hypothesized that osteochondral allograft transplantation may be a reasonable option in treating osteochondral disease of the glenoid if a suitable donor source could be identified. After performing the procedure in a cadaveric model, the authors found the articular geometry of the medial tibial plateau to closely resemble that of the glenoid articular surface. This graft option is advantageous because it is readily accessible from allograft tissue banks, whereas glenoid allografts are not currently available. After failure of extensive nonoperative treatment, a former multisport athlete underwent osteochondral allograft transplantation of a large glenoid defect with a medial tibial plateau osteochondral allograft. After 1 year of follow-up, the patient showed significant improvement in the subjective shoulder value (from 40% to 99%), QuickDASH score (from 36 to 2), and American Shoulder and Elbow Score (from 46 to 92). Ultimately, medial tibial plateau allograft was a viable option for treatment of an osteochondral glenoid defect in this patient, and additional study of this treatment strategy is warranted.
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18
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Gebhart JJ, Miniaci A, Fening SD. Predictive anthropometric measurements for humeral head curvature. J Shoulder Elbow Surg 2013; 22:842-7. [PMID: 23253814 DOI: 10.1016/j.jse.2012.08.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 07/17/2012] [Accepted: 08/16/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Estimation of size, shape, and curvature of the humeral head is important for shoulder replacement procedures and allograft transplantation, especially as we try to recreate normal anatomy. The purpose of this study was to investigate the value of various anthropometric measurements for predicting humeral head curvature. MATERIALS AND METHODS Cadaveric humeri were scanned with a 3-dimensional laser scanner. Length of the humerus, epicondylar breadth, and humeral head curvature were determined using data from the scans. A linear regression was performed for the length of the humerus, epicondylar breadth, gender, age, height, and weight. A stepwise linear regression with forward and backward substitution (α = 0.15) was performed for the most predictive variables from the initial linear regression. An equation for the prediction of humeral head radius of curvature was generated using this data. RESULTS The most predictive factors (R(2) > 0.5) were epicondylar breadth, height, sex, and humeral length. These 4 factors were included in a forward and backward stepwise regression. The resulting equation had an R(2) value of 0.812. CONCLUSION Of the predicted measurements evaluated, patient height, maximum humeral length, epicondylar breadth, and gender were most correlated with humeral head curvature. Including these 4 factors in a linear regression model increased the R(2) value to 0.812. If only a single measurement can be used to size the humeral head curvature, patient height will give the same accuracy as epicondylar breadth and can more easily be obtained. A patient's height can help accurately predict the patient's humeral head anatomy.
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Affiliation(s)
- Jeremy J Gebhart
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Killian ML, Cavinatto L, Galatz LM, Thomopoulos S. Recent advances in shoulder research. Arthritis Res Ther 2012; 14:214. [PMID: 22709417 PMCID: PMC3446497 DOI: 10.1186/ar3846] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Shoulder pathology is a growing concern for the aging population, athletes, and laborers. Shoulder osteoarthritis and rotator cuff disease represent the two most common disorders of the shoulder leading to pain, disability, and degeneration. While research in cartilage regeneration has not yet been translated clinically, the field of shoulder arthroplasty has advanced to the point that joint replacement is an excellent and viable option for a number of pathologic conditions in the shoulder. Rotator cuff disease has been a significant focus of research activity in recent years, as clinicians face the challenge of poor tendon healing and irreversible changes associated with rotator cuff arthropathy. Future treatment modalities involving biologics and tissue engineering hold further promise to improve outcomes for patients suffering from shoulder pathologies.
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Affiliation(s)
- Megan L Killian
- Department of Orthopaedic Surgery, Washington University, St Louis, MO 63110, USA
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Gobezie R, Lenarz CJ, Wanner JP, Streit JJ. All-arthroscopic biologic total shoulder resurfacing. Arthroscopy 2011; 27:1588-93. [PMID: 21958671 DOI: 10.1016/j.arthro.2011.07.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 06/20/2011] [Accepted: 07/08/2011] [Indexed: 02/02/2023]
Abstract
The treatment of advanced, bipolar glenohumeral osteoarthritis in the young patient is particularly challenging because of the expected failure of a traditional shoulder arthroplasty within the patient's lifetime. We have had early success performing osteochondral allograft resurfacing of the humeral head articular surface and glenoid articular surface, and we describe a new all-arthroscopic technique for performing this procedure. In the context of our new procedure, we have reviewed the available literature on the topic of biologic resurfacing with osteochondral allograft and have provided an overview of the relevant findings. Although only short-term follow-up data are available, our results in young patients have been promising in terms of regained motion, minimal pain, and accelerated rehabilitation. We believe that this new arthroscopic biologic shoulder resurfacing technique has the potential to be superior to other available treatments for this patient population because it preserves bone stock, limits damage to surrounding structures, and allows for early rehabilitation. Although longer-term follow-up is needed, early results have been greatly encouraging.
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Affiliation(s)
- Reuben Gobezie
- Case Shoulder & Elbow Service, Case Western Reserve University-University Hospitals of Cleveland, Cleveland, Ohio, USA.
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Glenohumeral arthritis in the young patient. J Shoulder Elbow Surg 2011; 20:S30-40. [PMID: 21281920 DOI: 10.1016/j.jse.2010.11.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 11/23/2010] [Accepted: 11/23/2010] [Indexed: 02/01/2023]
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Hayes ML, Collins MS, Morgan JA, Wenger DE, Dahm DL. Efficacy of diagnostic magnetic resonance imaging for articular cartilage lesions of the glenohumeral joint in patients with instability. Skeletal Radiol 2010; 39:1199-204. [PMID: 20411385 DOI: 10.1007/s00256-010-0922-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 03/04/2010] [Accepted: 03/15/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was primarily to assess the diagnostic performance of magnetic resonance imaging (MRI) in detecting articular cartilage injuries in patients with glenohumeral instability. A secondary purpose was to assess the diagnostic performance of MRI for detection of Hill-Sachs and Bankart lesions. MATERIALS AND METHODS A cohort of 87 consecutive patients who underwent diagnostic MRI and shoulder arthroscopy for instability from 1997 to 2006 were identified. Fifty-five patients (63.2%) underwent MRI with intra-articular contrast medium and 32 patients (36.8%) underwent MRI without contrast medium. MR images were reviewed by two radiologists and interpreted by consensus for the presence of articular cartilage lesions (including Hill-Sachs and Bankart lesions), which were then confirmed by reviewing the operative report and images recorded at arthroscopy. RESULTS Mean patient age was 27.0 ± 10.2 years with a mean clinical and radiographic follow-up of 29 (range 3-72) months. Cartilage injuries were detected arthroscopically in 55 patients (63%). Bankart and Hill-Sachs lesions were identified arthroscopically in 66 patients (75.9%) and 55 patients (63.2%) respectively. The overall sensitivity and specificity for detection of glenohumeral articular cartilage lesions by MRI were 87.2% and 80.6% respectively. The sensitivity and specificity of MRI in detecting Bankart lesions was 98.4% (95% CI 91.9, 99.7) and 95.2% (95% CI 77.3, 99.2) respectively. The sensitivity and specificity of MRI in detecting Hill-Sachs lesions was 96.3% (95% CI 87.6, 98.9%) and 90.6% (95% CI 75.7, 96.9) respectively. No statistically significant difference was found between MRI examinations with and without intra-articular gadolinium (p = 0.89). CONCLUSION Magnetic resonance imaging demonstrates high sensitivity and specificity for the diagnosis of articular cartilage injuries in patients with glenohumeral instability. MRI with or without intra-articular contrast medium in this study were equally reliable as a non-invasive method for assessment of articular cartilage damage of the glenohumeral joint prior to diagnostic arthroscopy.
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Provencher MT, LeClere LE, Ghodadra N, Solomon DJ. Postsurgical glenohumeral anchor arthropathy treated with a fresh distal tibia allograft to the glenoid and a fresh allograft to the humeral head. J Shoulder Elbow Surg 2010; 19:e6-11. [PMID: 20554452 DOI: 10.1016/j.jse.2010.03.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 03/07/2010] [Accepted: 03/20/2010] [Indexed: 02/01/2023]
Affiliation(s)
- Matthew T Provencher
- Division of Shoulder and Sports Surgery, Naval Medical Center San Diego, San Diego, CA 92134-1112, USA.
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Elser F, Braun S, Dewing CB, Millett PJ. Glenohumeral joint preservation: current options for managing articular cartilage lesions in young, active patients. Arthroscopy 2010; 26:685-96. [PMID: 20434669 DOI: 10.1016/j.arthro.2009.10.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 10/20/2009] [Accepted: 10/21/2009] [Indexed: 02/02/2023]
Abstract
This is a review of joint-preservation techniques for the shoulder. Whereas the management of diffuse articular cartilage loss in the glenohumeral joints of elderly and less active patients by total shoulder arthroplasty is well accepted, significant controversy persists in selecting and refining successful operative techniques to repair symptomatic glenohumeral cartilage lesions in the shoulders of young, active patients. The principal causes of focal and diffuse articular cartilage damage in the glenohumeral joint, including previous surgery, trauma, acute or recurrent dislocation, osteonecrosis, infection, chondrolysis, osteochondritis dissecans, inflammatory arthritides, rotator cuff arthropathy, and osteoarthritis, are discussed. Focal cartilage lesions of the glenohumeral joint are often difficult to diagnose and require a refined and focused physical examination as well as carefully selected imaging studies. This review offers a concise guide to surgical decision making and up-to-date summaries of the current techniques available to treat both focal chondral defects and more massive structural osteochondral defects. These techniques include microfracture, osteoarticular transplantation (OATS [Osteochondral Autograft Transfer System]; Arthrex, Naples, FL), autologous chondrocyte implantation, bulk allograft reconstruction, and biologic resurfacing. As new approaches to glenohumeral cartilage repair and shoulder joint preservation evolve, there continues to be a heightened need for collaborative research and well-designed outcomes analysis to facilitate successful patient care.
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Affiliation(s)
- Florian Elser
- Steadman Hawkins Research Foundation, Vail, Colorado 81657, USA
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Abstract
The use of osteochondral allografts to treat focal osteochondral lesions continues to gain popularity, supported by long-term results. Clinicians must be knowledgeable concerning the possible risks of disease transmission, graft rejection, infection, and graft failure to advise the patient and obtain an informed consent. With advancing scientific and clinical research, future operative indications will likely continue to expand. A significant amount of literature regarding storage methods has recently been published; it is hoped that continued research will lead to techniques for prolonged graft storage to prevent availability concerns.
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Affiliation(s)
- Christian Lattermann
- University of Kentucky Department of Orthopaedic Surgery and Sports Medicine, 740 S. Limestone, Suite K-408, Lexington, KY 40536-0284, USA.
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Osteochondritis dissecans of the glenoid associated with the nontraumatic, painful throwing shoulder in a professional baseball player: a case report. J Shoulder Elbow Surg 2008; 17:e9-12. [PMID: 18325796 DOI: 10.1016/j.jse.2007.11.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 10/08/2007] [Accepted: 11/12/2007] [Indexed: 02/01/2023]
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27
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Stanley RJ, Edwards TB. Biological Resurfacing of the Humerus in the Athlete. OPER TECHN SPORT MED 2008. [DOI: 10.1053/j.otsm.2008.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mahirogullari M, Chloros GD, Wiesler ER, Ferguson C, Poehling GG. Osteochondritis dissecans of the humeral head. Joint Bone Spine 2007; 75:226-8. [PMID: 17983832 DOI: 10.1016/j.jbspin.2007.04.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 04/26/2007] [Indexed: 10/22/2022]
Abstract
Osteochondritis dissecans (OCD), although common in other regions, is exceptional in the shoulder. We present a rare case of OCD of the humeral head in a young patient that remained undiagnosed for a 3-year period.
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Affiliation(s)
- Mahir Mahirogullari
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
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Shindle MK, Foo LF, Kelly BT, Khanna AJ, Domb BG, Farber A, Wanich T, Potter HG. Magnetic resonance imaging of cartilage in the athlete: current techniques and spectrum of disease. J Bone Joint Surg Am 2006; 88 Suppl 4:27-46. [PMID: 17142433 DOI: 10.2106/jbjs.f.00614] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michael K Shindle
- Department of Radiology and Imaging, MRI Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Arthroscopic osteochondral autograft transfer in the treatment of an osteochondral defect of the humeral head: report of one case. J Shoulder Elbow Surg 2006; 15:e31-6. [PMID: 17126234 DOI: 10.1016/j.jse.2005.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Accepted: 10/18/2005] [Indexed: 02/01/2023]
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Affiliation(s)
- Simon Görtz
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA 92037, USA
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Pydisetty RV, Prasad SS, Kaye JC. Osteochondritis dissecans of the humeral head in an amateur boxer. J Shoulder Elbow Surg 2002; 11:630-2. [PMID: 12469092 DOI: 10.1067/mse.2002.127300] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Cole BJ, Warner JJ. Arthroscopic versus open Bankart repair for traumatic anterior shoulder instability. Clin Sports Med 2000; 19:19-48. [PMID: 10652663 DOI: 10.1016/s0278-5919(05)70294-5] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
After more than 15 years of experience, arthroscopic shoulder stabilization is becoming less controversial. Historically, recurrence rates following arthroscopic stabilization have been higher than with open stabilization. Although a negligible advantage may exist in terms of expedited postoperative rehabilitation and improved postoperative recovery of motion, critics suggest that its use in contact athletes be limited. The indications for arthroscopic stabilization are expanding, in part, because of improved understanding of the pathophysiology of shoulder instability. Understanding the mechanism of recurrent instability following arthroscopic stabilization offers clues to how physicians can prevent unsatisfactory results in the future. With newer instrumentation and the ability to thermally treat capsular tissue, coexisting pathology, such as capsular plastic deformation, rotator interval lesions, and unrecognized intra-articular pathology, can now be addressed arthroscopically. The judicious use of these techniques is warranted until long-term study results become available. Ideal patients for arthroscopic Bankart repair have a discrete Bankart lesion; a robust, well-developed IGHL; no significant capsular laxity or intraligamentous injury; and an absence of concomitant intra-articular pathology. Additional findings on MR imaging or CT evidence of a discrete labral lesion and pure unidirectional anterior instability during EUA are also good prognostic indicators for arthroscopic Bankart repair. Arthroscopic criteria that render patients less appropriate for an arthroscopic repair include capsular injury, capsular laxity, a bony Bankart lesion, glenohumeral arthritis, and a rotator cuff tear. The authors' believe that either absent or patulous, poorly developed glenohumeral ligaments represent a poor prognostic indicator for a successful outcome following standard arthroscopic Bankart repair. Individuals with poor-quality tissue are more predictably managed using open capsulorrhaphy. Patients with pathologic ligamentous laxity in the absence of a Bankart lesion or any apparent intraligamentous injury to the IGHL are also good candidates for treatment with an open capsulorrhaphy. Findings determined from a thorough physical examination, EUA, and the pathology appreciated during diagnostic arthroscopy help to appropriately choose the surgical procedure that effectively addresses pathology in patients who present with recurrent traumatic anterior instability. Patient preferences and surgical experience are important determinants of procedure selection, and current arthroscopic techniques lack the versatility to uniformly address the entire spectrum of pathology that may be associated with traumatic anterior shoulder instability. Surgeons should always be prepared to convert to an open-stabilization technique if the arthroscopic technique is deficient in addressing all pathology identified at the time of surgery.
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Affiliation(s)
- B J Cole
- Department of Orthopaedics, Rush Medical College of Rush University, Chicago, Illinois, USA
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