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Scott JA, Dwek JR, Cheng KY, Bryan TP, Edmonds EW. The Buford Complex Redefined: A Pathologic Morphology in Sheep's Clothing. Orthop J Sports Med 2024; 12:23259671241252834. [PMID: 38831874 PMCID: PMC11145989 DOI: 10.1177/23259671241252834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 06/05/2024] Open
Abstract
Background Considered a normal anatomic variant, the Buford complex has not been studied in children. Hypothesis A Buford complex is not a normal anatomic variant and would, therefore, be present at a lower rate than that seen in the adult population. Study Design Cross-sectional study; Level of evidence, 3. Methods Measurements were recorded from magnetic resonance imaging performed over 13 years in children aged ≤11 years for various pathologies unrelated to glenohumeral instability. Interrater reliability was determined to identify Buford complexes, sublabral foramens and tears, and normal shoulders via 16 preadolescent and adolescent patients with confirmed arthroscopic correlation. The Buford complex and labral foramen rates were then compared with a published rate in adults using a binomial probability test. Results A total of 122 children (62 girls; mean age, 6.4 years [age range, 2 months-10.9 years]) were evaluated. Interrater reliability was 0.846 (95% CI, 0.56-1) to identify anterosuperior labral variants. The expected sublabral foramen count was 23 children, but only 1 was identified (P < .001). The expected Buford complex count was 8 children, but none could be identified (P < .001). Conclusion The absence of Buford complexes and the significant reduction in sublabral foramen abundance in younger children suggest that these anatomic variants are more likely to be developmental than congenital. The distinct possibility that these previously considered normal variants are truly pathologic findings cannot be ignored. Evidence of a Buford complex could potentially signify an underlying, long-term shoulder instability issue to the treating provider that warrants further investigation or management.
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Affiliation(s)
- Jasmine A. Scott
- Naval Medical Center San Diego, Department of Orthopedic Surgery, San Diego, California, USA
| | - Jerry R. Dwek
- Rady Children's Hospital, San Diego, Department of Radiology, San Diego, California, USA
| | - Karen Y. Cheng
- University of California, San Diego, Department of Radiology, San Diego, California, USA
| | - Tracey P. Bryan
- Rady Children's Hospital, San Diego, Department of Orthopedic Surgery, San Diego, California, USA
| | - Eric W. Edmonds
- Rady Children's Hospital, San Diego, Department of Orthopedic Surgery, San Diego, California, USA
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Cunningham G, Cochard B, Martz P, Brandariz R. Shoulder Stabilization Technique Using the Medial Glenohumeral Ligament in Patients With the Buford Complex. Arthrosc Tech 2024; 13:102871. [PMID: 38435255 PMCID: PMC10907962 DOI: 10.1016/j.eats.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/27/2023] [Indexed: 03/05/2024] Open
Abstract
The Buford complex is an anatomic variation defined as the association of a cordlike middle glenohumeral ligament (MGHL) and an absent anterosuperior labrum. It can be challenging to properly identify on preoperative imaging and remains mostly an arthroscopic finding. It may, however, lead to problematic situations when encountered during an arthroscopic soft-tissue stabilization procedure, as the treatment of choice in such cases is a bone block. Moreover, reattaching the MGHL to the anterior border of the glenoid rim has traditionally not been recommended because it theoretically leads to severe restriction in external rotation. This technical note describes arthroscopic stabilization for anterior traumatic glenohumeral instability associated with the Buford complex. The cordlike MGHL is used to reconstruct a neo-labrum, associated with an anteroinferior glenohumeral ligament plication. Glenohumeral stabilization using the cordlike MGHL of the Buford complex may be an efficient alternative to a bone block procedure.
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Affiliation(s)
- Gregory Cunningham
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
- Shoulder Center, Hirslanden Clinique La Colline, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Blaise Cochard
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Martz
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Dijon University Hospital, Dijon, France
| | - Rodrigo Brandariz
- Shoulder Center, Hirslanden Clinique La Colline, Geneva, Switzerland
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3
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Benes M, Kachlik D, Kopp L, Kunc V. Prevalence of the anterosuperior capsulolabral anatomical variations and their association with pathologies of the glenoid labrum: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2023; 143:6295-6303. [PMID: 37351607 PMCID: PMC10491707 DOI: 10.1007/s00402-023-04932-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE Differentiating the anatomical variations of the anterosuperior portion of the glenoid labrum from pathologies is important to avoid unnecessary iatrogenic complications resulting from inaccurate diagnosis. Additionally, the presence of several variations was reported to be conductive to lesions involving the glenoid labrum. Thus, the aim of this study was to state the prevalence rates of the sublabral recess, sublabral foramen, and the Buford complex, and to verify their association with labral lesions. METHODS Systematic search of electronic databases was conducted to gain potentially eligible literature. Suitable studies were selected in a two-round screening, and relevant data were subsequently extracted. Calculation of the pooled prevalence estimates, including sub-analyses on cohort size, study type, and geographical variance, was conducted. Pooled analysis of risk ratios (RR) was used to assess the conductive nature of the discussed variants to superior labrum anterior to posterior (SLAP) lesions. RESULTS The screening resulted in selection of 20 studies investigating the morphological features of the glenoid labrum, consisting of 7601 upper limbs. On the bases of random-effects meta-analysis the sublabral recess, sublabral foramen and Buford complex occur with a pooled prevalence of 57.2% (95% CI 30.0-84.4%), 13.5% (95% CI 8.2-18.9%), and 3.0% (95% CI 1.5-4.5), respectively. Moreover, individuals with Buford complex have RR 2.4 (95% CI 1.3-4.7) of developing SLAP lesions, especially type II (95.5%; 95% CI 86.1-100%), whereas such risk for sublabral recess and sublabral foramen was not statistically significant. CONCLUSION Morphological variants of the glenoid labrum posing diagnostic confusion are frequently observed. Gradually, the Buford complex may be a predisposing factor for sustaining a SLAP lesion.
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Affiliation(s)
- Michal Benes
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - David Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lubomir Kopp
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Clinic of Trauma Surgery, Masaryk Hospital, Usti nad Labem, Czech Republic
| | - Vojtech Kunc
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
- Clinic of Trauma Surgery, Masaryk Hospital, Usti nad Labem, Czech Republic.
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Takahashi R, Kajita Y, Harada Y, Iwahori Y. Preemptive middle glenohumeral ligament release in arthroscopic rotator cuff repair does not reduce the postoperative stiffness: a retrospective comparative study. BMC Musculoskelet Disord 2023; 24:490. [PMID: 37322461 DOI: 10.1186/s12891-023-06611-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the efficacy of preemptive middle glenohumeral ligament (MGHL) release in arthroscopic rotator cuff repair (ARCR) to reduce postoperative stiffness. METHODS Patients who underwent ARCR were enrolled and allocated into two groups retrospectively: the preemptive MGHL release group (n = 44) and the preemptive MGHL non-release group (n = 42). Clinical outcomes were assessed and compared between the two groups, including the range of motion, Japanese Orthopedic Association Shoulder Score, Constant Shoulder Score, and the University of California, Los Angeles Score preoperatively and 3 months, 6 months, and 12 months postoperatively and complications. The integrity of the repaired tendon was assessed at the 12-month follow-up using magnetic resonance imaging. RESULTS There were no significant differences between the groups in all range of motion and all functional scores at any of the assessed time points. There was also no significant difference in the healing failure rate 2.3% in the preemptive MGHL group and 2.4% in the preemptive MGHL non-release group (p = .97), and postoperative stiffness was 2.3% in the preemptive MGHL group and 7.1% in the preemptive MGHL non-release group (p = .28). There was no postoperative instability in both group. CONCLUSION ARCR effectively facilitates the recovery of range of motion and function in patients with a rotator cuff tear. However, preemptive MGHL release could not be an effective method to reduce postoperative stiffness.
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Affiliation(s)
- Ryosuke Takahashi
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, 1Jihira, Ichinomiya City, 494-0001, Kaimei, Aichi, Japan.
| | - Yukihiro Kajita
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, 1Jihira, Ichinomiya City, 494-0001, Kaimei, Aichi, Japan
| | - Yohei Harada
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, 734-8551, Hiroshima, Japan
| | - Yusuke Iwahori
- Sports Medicine and Joint Center, Asahi Hospital, 2090 Shimoharacho Azamurahigashi, Kasugai, 486-0819, Aichi, Japan
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Funakoshi T, Takahashi T, Shimokobe H, Miyamoto A, Furushima K. Arthroscopic findings of the glenohumeral joint in symptomatic anterior instabilities: comparison between overhead throwing disorders and traumatic shoulder dislocation. J Shoulder Elbow Surg 2023; 32:776-785. [PMID: 36343790 DOI: 10.1016/j.jse.2022.10.005] [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: 05/16/2022] [Revised: 09/21/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The term shoulder instability refers to a variety of mechanisms and clinical presentations. One of the common pathologies of throwing disorders is internal impingement with anterior instability. Most throwing athletes with symptomatic internal impingement with anterior instability exhibit positive apprehension and relocation test results, whereas those with recurrent anterior shoulder instability display positive apprehension test results. While the glenoid labrum-inferior glenohumeral ligament complex is a significant critical stabilizer for the prevention of anterior shoulder dislocation, the characteristics of the essential lesion in internal impingement with anterior instability have not been determined yet. This study aimed to compare the intra-articular lesion of athletes with internal impingement related to the overhead throwing motion in athletes with a traumatic shoulder dislocation. METHODS Sixty-one athletes (all men; mean age, 25.2 ± 12.6 yr) who underwent an arthroscopic procedure were divided into 2 groups: 25 in the throwing group and 36 in the dislocation group. All shoulders had subtle glenohumeral instability defined by a positive anterior apprehension test and a relocation test. Those with voluntary and multidirectional instability and large glenoid bone loss (more than 25%) were excluded from the current study. All shoulders were evaluated for the following evidence: rotator cuff injury, superior labrum tear anterior and posterior lesions, labral pathologies including Bankart lesions, osteochondral lesions to the humeral head, biceps tendon fraying or rupture, and inferior glenohumeral ligament and middle glenohumeral ligament (MGHL) conditions. RESULTS Arthroscopic findings of the throwing group showed more supraspinatus injuries (92% and 25%, P < .001), type II superior labrum tear anterior and posterior lesions (60% and 3%, P < .001), posterosuperior labral lesions (92% and 39%, P < .001), and hypoplastic MGHLs (56% and 6%, P < .001) and lesser Bankart lesions (8% and 92%, P < .05) than those of the dislocation group. CONCLUSIONS These results indicate that the characteristic lesions of internal impingement with anterior instability in throwing athletes include partial thickness rotator cuff tears, superior labrum tear anterior and posterior lesions, posterosuperior labral tears, and hypoplastic MGHLs. As expected, the physiopathology of internal impingement with anterior instability in throwing athletes may be related to the dysfunction of the anterosuperior glenohumeral capsular ligament, including the MGHL, rather than the inferior glenohumeral ligament as in traumatic anterior shoulder dislocations. These findings would be useful for defining treatment strategies for internal impingement with anterior instability in overhead throwing athletes.
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Diplock B, Hing W, Marks D. The long head of biceps at the shoulder: a scoping review. BMC Musculoskelet Disord 2023; 24:232. [PMID: 36978047 PMCID: PMC10044783 DOI: 10.1186/s12891-023-06346-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND This review aimed to explore the available literature to update our understanding of the long head of biceps (LHB) at the shoulder. Synthesise our findings to identify emergent themes and knowledge gaps to inform future research and management directions. METHODS PubMed, Embase, Cinahl, SportDiscus, CENTRAL, and Web of Science were searched from inception to 31st December 2021. Articles were included if they referenced adult participants > 18 years of age and were written in English. RESULTS 214 articles were included in the final analysis, and results were categorised into six emergent themes: (1) Anatomy - Normal anatomical variation of the biceps from aberrant origins, third and fourth accessory heads, and an absence of the LHB tendon (LHBT) are not necessarily benign, with shoulder pain and instability a commonly reported theme. (2) Function - Bicep's role in glenohumeral elevation and stability in healthy shoulders is minimal. In contrast, LHB has a more significant role in shoulder stability and humeral head depression in subjects with rotator cuff failure or an absent LHBT. (3) Pathology - There is an association between LHB tendinopathy, rotator cuff disease, LHBT instability and occult rotator cuff tears. Early recruitment and hyperactivity of the LHB in subjects with symptomatic rotator cuff tears and instability suggest a potential compensatory role. (4) Assessment - The limited diagnostic utility of special orthopaedic tests in assessing LHBT pathology was a consistent theme. The utility of magnetic resonance imaging and ultrasound to identify full-thickness tendon tears and instability of the LHBT was moderate to high. However, the utility of clinical tests and imaging may be underestimated due to arthroscopy's limitations in fully visualising the proximal LHBT. (5) Non-Surgical Management - Ultrasound-guided injections into the biceps sheath show greater accuracy and patient outcomes than blinded injections; however, the entry of injectate into the intraarticular glenohumeral joint may have unwanted complications. (6) Surgical management - For the surgical management of biceps pathology with or without rotator cuff pathology, both biceps tenodesis and tenotomy report similar improvements in pain without any significant adverse effect on strength or function. Tenodesis favoured higher overall constant scores and a lower incidence of Popeye deformity and cramping arm pain, with tenotomy trending to be more cost and time effective. For patients with a healthy LHBT, rotator cuff repair with adjunctive tenodesis or tenotomy fails to provide additional clinical improvements compared to rotator cuff repair in isolation. CONCLUSIONS The scoping review highlights the variability of biceps anatomy, which is not necessarily benign and suggests a minimal role of the LHB in shoulder elevation and stability in healthy individuals. In contrast, individuals with rotator cuff tears experience proximal humeral migration and demonstrate hyperactivity of the LHB, suggesting a potential compensation role. The observed prevalence of LHBT pathology with rotator cuff tears is well established; however, the cause-and-effect relationship between LHBT pathology and rotator cuff disease is undetermined. The diagnostic utility of clinical tests and imaging to exclude LHBT pathology may be understated due to the limitations of arthroscopy to visualise the proximal LHBT fully. Rehabilitation programs for the LHB are understudied. Similar post-surgical clinical outcomes are observed for tenodesis and tenotomy for biceps and rotator cuff-related shoulder pain. Subjects undergoing biceps tenodesis are less likely to have cramping arm pain and a Popeye deformity than patients undergoing biceps tenotomy. The significance of routine surgical removal of the LHBT and sequelae on rotator cuff tear progression to failure and long-term shoulder function is unknown, and further research is required. PRE-REGISTRATION OSF: https://osf.io/erh9m.
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Affiliation(s)
- Brendan Diplock
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia.
| | - Wayne Hing
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | - Darryn Marks
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
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Funakoshi T, Furushima K, Takahashi T, Miyamoto A, Urata D, Yoshino K, Sugawara M. Anterior glenohumeral capsular ligament reconstruction with hamstring autograft for internal impingement with anterior instability of the shoulder in baseball players: preliminary surgical outcomes. J Shoulder Elbow Surg 2022; 31:1463-1473. [PMID: 35063639 DOI: 10.1016/j.jse.2021.12.021] [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: 09/13/2021] [Revised: 12/08/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder pain and dysfunction are common in baseball players, and although "internal impingement" is recognized as one of the most common pathologies of shoulder dysfunction, the optimal surgical treatment for internal impingement with anterior instability of the shoulder remains controversial. This study evaluated baseball players' preliminary outcomes following anterior glenohumeral capsular ligament reconstruction for internal impingement with anterior instability of the shoulder. METHODS Twelve baseball players (all male; mean age, 20.5 ± 2.2 years) with internal impingement and anterior instability managed via anterior glenohumeral capsular ligament reconstruction were examined. The mean follow-up period was 25.3 ± 4.6 months. Anterior glenohumeral capsular ligament reconstruction was performed with a knee hamstring autograft for balanced stability and laxity with two major targets: to prevent hyperangulation and translation in horizontal abduction and to mimic the individual arm cocking position at the final decision of tension. Preoperative and final follow-up evaluations were performed using Jobe's postoperative grading system; the Kerlan-Jobe Orthopaedic Clinic Overhead Athletes Shoulder and Elbow Score; Disabilities of the Arm, Shoulder and Hand sports module; plain radiographs; and magnetic resonance imaging. RESULTS Jobe's postoperative grading system score, the Kerlan-Jobe Orthopaedic Clinic Overhead Athletes Shoulder and Elbow Score, and the Disabilities of the Arm, Shoulder and Hand sports module score improved significantly from 20.4 ± 12.2, 28.4 ± 8.3, and 80.2 ± 11.1 points preoperatively to 88.8 ± 13.6, 80.8 ± 7.7, and 22.4 ± 18.7 points postoperatively, respectively (P < .001, .0025, <0.001, respectively). Both clinical and imaging evaluations revealed improved internal impingement with anterior instability after anterior glenohumeral capsular ligament reconstruction. The mean external rotation at abduction significantly decreased from 113° preoperatively to 104° postoperatively. At follow-up, 10 of the 12 athletes (83.3%) returned to their prior competitive level. Plain radiographs and magnetic resonance imaging revealed no obvious loosening of the graft or screws. CONCLUSIONS Anterior glenohumeral capsular ligament reconstruction resulted in preferable clinical outcomes for young baseball players who experienced pain during the throwing motion. Stabilization of the glenohumeral joint with autografting of the knee hamstring may thus represent a solution for internal impingement with anterior instability in overhead throwing athletes.
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Affiliation(s)
| | | | | | | | - Daigo Urata
- Keiyu Orthopaedic Hospital, Tatebayashi, Japan
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Kaptan AY, Özer M, Alim E, Perçin A, Ayanoğlu T, Öztürk BY, Kanatli U. The middle glenohumeral ligament: a classification based on arthroscopic evaluation. J Shoulder Elbow Surg 2022; 31:e85-e91. [PMID: 34474136 DOI: 10.1016/j.jse.2021.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/11/2021] [Accepted: 07/26/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although middle glenohumeral ligament (MGHL) variations have been shown in the literature, their clinical effect and relationship with intra-articular pathologies have yet to be revealed, except for the Buford complex. This study was designed to classify MGHL and to reveal its relationship with clinical pathologies. METHODS A total of 843 consecutive shoulder arthroscopies were evaluated retrospectively, and a classification system was proposed for MGHL with regard to its structure and its relation to the anterior labrum. The associations of each MGHL type with superior labrum anterior-posterior (SLAP) lesions, subscapularis tears, and anterior instability were investigated. RESULTS MGHL variations were grouped into 6 types according to the classification. A significant difference in favor of type 6 MGHL (Buford complex) was observed in the distribution of SLAP lesions (P < .001). There was no significant difference between MGHL types and the distribution of anterior instability history (P = .131) and subscapularis tears (P = .324). CONCLUSION SLAP lesions accompany type 6 MGHLs (Buford complex) significantly more frequently than other types. There is also a negative relation between the anterior instability and thicker MGHL variants.
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Affiliation(s)
- Ahmet Yiğit Kaptan
- Department of Orthopaedics & Traumatology, Harran University School of Medicine, Şanlıurfa, Turkey.
| | - Mustafa Özer
- Department of Orthopaedics & Traumatology, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Ece Alim
- Department of Anatomy, Gazi University School of Medicine, Ankara, Turkey
| | - Ali Perçin
- Department of Orthopaedics & Traumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Tacettin Ayanoğlu
- Department of Orthopaedics & Traumatology, Abant İzzet Baysal University School of Medicine, Bolu, Turkey
| | - Burak Yağmur Öztürk
- Department of Orthopaedics & Traumatology, International Knee and Joint Center, Abu Dhabi, United Arab Emirates
| | - Ulunay Kanatli
- Department of Orthopaedics & Traumatology, Gazi University School of Medicine, Ankara, Turkey
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Simmer Filho J, Kautsky RM. Arthroscopy Limits on Anterior Shoulder Instability. Rev Bras Ortop 2022; 57:14-22. [PMID: 35198104 PMCID: PMC8856842 DOI: 10.1055/s-0041-1731357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/15/2021] [Indexed: 10/26/2022] Open
Abstract
Much is discussed about the limits of the treatment of anterior shoulder instability by arthroscopy. The advance in understanding the biomechanical repercussions of bipolar lesions on shoulder stability, as well as in the identification of factors related to the higher risk of recurrence have helped us to define, more accurately, the limits of arthroscopic repair. We emphasize the importance of differentiation between glenoid bone loss due to erosion (GBLE) and glenoid edge fractures, because the prognosis of treatment differs between these forms of glenoid bone failure. In this context, we understand that there are three types of bone failure: a) bone Bankart (fracture); b) combined; and c) glenoid bone loss due to anterior erosion (GBLE), and we will address the suggested treatment options in each situation. Until recently, the choice of surgical method was basically made by the degree of bone involvement. With the evolution of knowledge, the biomechanics of bipolar lesions and the concept of glenoid track , the cutoff point of critical injury, has been altered with a downward trend. In addition to bone failures or losses, other variables were added and made the decision more complex, but a little more objective. The present update article aims to make a brief review of the anatomy with the main lesions found in instability; to address important details in arthroscopic surgical technique, especially in complex cases, and to bring current evidence on the issues of greatest divergence, seeking to guide the surgeon in decision making.
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10
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Hodgetts C, Walker B. Epidemiology, common diagnoses, treatments and prognosis of shoulder pain: A narrative review. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Özer M, Kaptan AY, Ataoglu MB, Cetinkaya M, Ayanoglu T, Ince B, Kanatli U. The Buford complex: prevalence and relationship with labral pathologies. J Shoulder Elbow Surg 2021; 30:1356-1361. [PMID: 32949757 DOI: 10.1016/j.jse.2020.08.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/16/2020] [Accepted: 08/24/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to determine the prevalence of the Buford complex and to investigate its association with labral pathologies (superior labrum anterior-posterior [SLAP] lesion and anterior, posterior, or multidirectional instability) using a very large patient database. Furthermore, the prevalence of the Buford complex in patients without any labral pathology was also determined. METHODS A total of 3129 consecutive shoulder arthroscopy procedures were retrospectively evaluated for the presence of the Buford complex and coexisting labral pathologies. The relationships between the Buford complex and SLAP lesions, as well as instability, were evaluated statistically. RESULTS The Buford complex was observed in 83 shoulders (2.65%). SLAP lesions were significantly more frequent in patients with the Buford complex than in those without it (81.9% vs. 33.1%, P < .001) Shoulders with the Buford complex presented a lower frequency of anterior instability (10.8% vs. 19.3%, P = .052) and a higher frequency of posterior instability (1.2% vs. 0.9%, P = .789). The prevalence of the Buford complex in patients with and without labral pathologies was 4.6% and 0.3%, respectively (P < .001). CONCLUSIONS This study, to our knowledge, includes the largest cohort in the literature reporting the prevalence of the Buford complex (2.65%). In the 1461 patients without labral tears or multidirectional instability, the prevalence of the Buford complex was 0.3%. This result suggests that the real prevalence of the Buford complex might be lower than that reported previously. In addition to the aforementioned conclusions, the identification of the Buford complex should prompt a thorough evaluation for concomitant SLAP lesions.
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Affiliation(s)
- Mustafa Özer
- Department of Orthopaedics & Traumatology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey.
| | - A Yigit Kaptan
- Department of Orthopaedics & Traumatology, Dr. Sami Ulus Education and Research Hospital, Ankara, Turkey
| | - M Baybars Ataoglu
- Department of Orthopaedics & Traumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Mehmet Cetinkaya
- Spinal Unit of Orthopaedics, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, Western Cape, South Africa
| | - Tacettin Ayanoglu
- Department of Orthopaedics & Traumatology, Bolu Abant İzzet Baysal University, Bolu, Turkey
| | - Bulent Ince
- Department of Orthopaedics & Traumatology, Magnet Hospital, Ankara, Turkey
| | - Ulunay Kanatli
- Department of Orthopaedics & Traumatology, Gazi University School of Medicine, Ankara, Turkey
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Fox AJS, Fox OJK, Schär MO, Chaudhury S, Warren RF, Rodeo SA. The glenohumeral ligaments: Superior, middle, and inferior: Anatomy, biomechanics, injury, and diagnosis. Clin Anat 2021; 34:283-296. [PMID: 33386636 DOI: 10.1002/ca.23717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/13/2020] [Accepted: 12/20/2020] [Indexed: 01/03/2023]
Abstract
The three glenohumeral ligaments (superior, middle, and inferior) are discrete thickenings of the glenohumeral joint capsule and are critical to shoulder stability and function. Injuries to this area are a cause of significant musculoskeletal morbidity. A literature search was performed by a review of PubMed, Google Scholar, and OVID for all relevant articles published up until 2020. This study highlights the anatomy, biomechanical function, and injury patterns of the glenohumeral ligaments, which may be relevant to clinical presentation and diagnosis. A detailed understanding of the normal anatomy and biomechanics is a necessary prerequisite to understanding the injury patterns and clinical presentations of disorders involving the glenohumeral ligaments of the shoulder.
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Affiliation(s)
- Alice J S Fox
- Hawkesbury District Health Service, Windsor, New South Wales, Australia
| | - Olivia J K Fox
- University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
| | - Michael O Schär
- Department of Orthopaedic Surgery and Traumatology, University of Bern, Switzerland
| | - Salma Chaudhury
- Department of Orthopaedic Surgery, University of Oxford, Oxford, UK
| | - Russell F Warren
- Department of Orthopaedic Surgery and Sports Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Scott A Rodeo
- Department of Orthopaedic Surgery and Sports Medicine, Hospital for Special Surgery, New York, New York, USA
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Alali A, Li D, Monteiro S, Choudur H. Feasibility of high resolution ultrasound for SLAP tears of the shoulder compared to MR arthrogram. BJR Open 2019; 1:20190007. [PMID: 33178939 PMCID: PMC7592471 DOI: 10.1259/bjro.20190007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/25/2019] [Accepted: 06/01/2019] [Indexed: 12/11/2022] Open
Abstract
Objectives: The purpose of this prospective pilot study was to evaluate the feasibility and accuracy of high resolution ultrasound in the detection of superior labral anteroposterior (SLAP) tears of the shoulder compared to MR arthrogram. Methods and materials: 48 adult patients were included in the study. All patients had high resolution ultrasound of the superior labrum and biceps labral anchor prior to MR arthrogram. Ultrasound and MR arthrograms were evaluated separately for the presence or absence of SLAP tear using the same grading. The presence or absence of a tear and grading of the tears on MR arthrograms and ultrasound were compared and evaluated using κ statistics. Results: Both MRI and ultrasound demonstrated a SLAP tear in 27 of the 48 patients. MRI and ultrasound were in agreement on the absence of a tear in 19 patients. There was a disagreement between MRI and ultrasound in 2 of the 48 patients regarding the existence of a tear. The two modalities demonstrated substantial agreement on the presence or absence of a tear ( κ = 91.4 %, p < 0.001) as well as the grading of the tear ( κ = 84.4 %, p < 0.001). Conclusions: In this pilot study, the feasibility and accuracy of high resolution ultrasound for SLAP tears were evaluated and compared with MR arthrogram. MRI and ultrasound demonstrated substantial agreement on the presence or absence of SLAP tears and grading of the tears. Advances in knowledge: This pilot study explores and supports the use of ultrasound as a screening tool for SLAP tears, especially as it is readily available, fast and inexpensive.
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Affiliation(s)
- Akeel Alali
- Department of Radiology, McMaster University, Hamilton, Canada
| | - David Li
- Department of Radiology, McMaster University, Hamilton, Canada
| | - Sandra Monteiro
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Hema Choudur
- Department of Radiology, McMaster University, Hamilton, Canada
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Collotte P, Nové-Josserand L. Arthroscopic anatomy of the middle glenohumeral ligament. Surg Radiol Anat 2018; 40:1363-1370. [PMID: 30220000 DOI: 10.1007/s00276-018-2100-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/03/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE The middle glenohumeral ligament (MGHL) has seldom been studied and its function is unknown. The aim of this study was to describe its anatomical presentations. METHODS A prospective study was conducted of MGHL anatomy in 107 arthroscopies, with a description of its shape and superior and inferior insertion in the articular surface of the subscapularis tendon. The MGHL was investigated dynamically during internal rotation of the glenohumeral joint. RESULTS Sixty-three percent (68/107) of the MGHLs were found to be leaf-like, and 27% (28/107) cord-like, 5.5% (6/107) vestigial, and 2% (2/107) had several strands. The MGHL was absent for 2% of patients (2/107). The inferior insertion point of the MGHL was lateral, masked by the humeral head, in 34% of cases (36/105), intermediate, in front of the glenohumeral joint line, in 57% of cases (60/105), and medial, in front of the labrum, in 9% of cases (9/105). During internal rotation, 46% (48/105) of the MGHLs were observed to retract medially, the subscapularis tendon moving away from the anterior glenoid rim, while 54% (57/105) remained visible in front of the glenohumeral joint and came into contact with the articular surface of the subscapularis tendon. CONCLUSIONS The MGHL has many anatomical variations.
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Affiliation(s)
- Philippe Collotte
- Ramsay Générale de Santé, Hôpital Privé Jean Memoz, Centre Orthopédique Santy, 24 avenue Paul Santy, 69008, Lyon, France
| | - Laurent Nové-Josserand
- Ramsay Générale de Santé, Hôpital Privé Jean Memoz, Centre Orthopédique Santy, 24 avenue Paul Santy, 69008, Lyon, France.
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15
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Abstract
Anterior shoulder dislocations, subluxations, and recurrent instability of the shoulder joint are common problems usually affecting a young active population. However, it can be a problem for patients up to the late decades in life and can lead to major shoulder arthropathy if left untreated or improperly treated. This article discusses the natural history, pathologic morphologic changes of the shoulder joint associated with anterior instability along with normal anatomic variants. We will also discuss current treatment recommendations and possible causes of the patient with recurrent instability despite prior stabilization procedures.
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Lee BI, Kim YB, Won SH, Hwang SC, Choi SW, Nho JH, Chun DI. Isolated tear of the cord-like middle glenohumeral ligament in Buford complex: A case report. Medicine (Baltimore) 2017; 96:e8604. [PMID: 29137087 PMCID: PMC5690780 DOI: 10.1097/md.0000000000008604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE We describe a rare case of the isolated tear in the cord-like middle glenohumeral ligament (MGHL) in Buford complex. To the best of our knowledge, this is the first report in the English literature about the isolated tear of cord-like MGHL in Buford complex. The present report describes in detail our experience with the diagnosis of isolated tear of the cord-like MGHL in Buford complex and management. PATIENT CONCERNS A 50-year-old female patient visited our hospital with pain and stiffness in the right shoulder that lasted for 9 months. DIAGNOSES The clinical impression was frozen shoulder by primary impingement syndrome of right shoulder and the magnetic resonance (MR) images showed tear of cord-like MGHL. INTERVENTIONS We repaired the torn MGHL with the arthroscopic technique. OUTCOMES Positive outcome by arthroscopic repair demonstrates that this disease entity is one of spectrum of pathologic condition in shoulder joint. LESSONS Isolated tear of cord-like MGHL should be restored to the original anatomy for positive outcome.
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Affiliation(s)
| | - Yong Beom Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Sung Hun Won
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Shu Chiang Hwang
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Sung-Woo Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Jae-Hwi Nho
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Dong-il Chun
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea
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Hantes M, Raoulis V. Arthroscopic Findings in Anterior Shoulder Instability. Open Orthop J 2017; 11:119-132. [PMID: 28400880 PMCID: PMC5366393 DOI: 10.2174/1874325001711010119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 04/20/2016] [Accepted: 04/20/2016] [Indexed: 01/26/2023] Open
Abstract
Background: In the last years, basic research and arthroscopic surgery, have improved our understanding of shoulder anatomy and pathology. It is a fact that arthroscopic treatment of shoulder instability has evolved considerably over the past decades. The aim of this paper is to present the variety of pathologies that should be identified and treated during shoulder arthroscopy when dealing with anterior shoulder instability cases. Methods: A review of the current literature regarding arthroscopic shoulder anatomy, anatomic variants, and arthroscopic findings in anterior shoulder instability, is presented. In addition, correlation of arthroscopic findings with physical examination and advanced imaging (CT and MRI) in order to improve our understanding in anterior shoulder instability pathology is discussed. Results: Shoulder instability represents a broad spectrum of disease and a thorough understanding of the pathoanatomy is the key for a successful treatment of the unstable shoulder. Patients can have a variety of pathologies concomitant with a traditional Bankart lesion, such as injuries of the glenoid (bony Bankart), injuries of the glenoid labrum, superiorly (SLAP) or anteroinferiorly (e.g. anterior labroligamentous periosteal sleeve avulsion, and Perthes), capsular lesions (humeral avulsion of the glenohumeral ligament), and accompanying osseous-cartilage lesions (Hill-Sachs, glenolabral articular disruption). Shoulder arthroscopy allows for a detailed visualization and a dynamic examination of all anatomic structures, identification of pathologic findings, and treatment of all concomitant lesions. Conclusion: Surgeons must be well prepared and understanding the normal anatomy of the glenohumeral joint, including its anatomic variants to seek for the possible pathologic lesions in anterior shoulder instability during shoulder arthroscopy. Patient selection criteria, improved surgical techniques, and implants available have contributed to the enhancement of clinical and functional outcomes to the point that arthroscopic treatment is considered nowadays the standard of care.
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Affiliation(s)
- Michael Hantes
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece
| | - Vasilios Raoulis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece
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18
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Abstract
Imaging of the shoulder forms an important adjunct in clinical decision making in patients with shoulder instability. The typical lesions related with classic anterior and anteroinferior shoulder dislocation are an anteroinferior labral avulsion with or without bony fragment of bone loss – a (bony) Bankart lesion – and a posterolateral humeral head impaction fracture – the Hill-Sachs lesions. These are relatively straightforward to identify on imaging, although normal variants of the inferior labrum and variants of labral damage may cause confusion. Other capsuloligamentous lesions, often associated with less typical types of instability, are much more difficult to identify correctly on imaging, as they occur in the anterosuperior part of the glenohumeral joint with its many normal variants or because they result in more subtle, and therefore easily overlooked, changes in morphology or signal intensity. This paper aims at describing the appearance of the normal and pathologic glenohumeral joint related to shoulder instability. Ample reference will be given as to why identification of abnormalities, whether normal or pathologic, is important to the surgeon facing a treatment decision.
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Abstract
Glenohumeral joint instability is usually an intimidating topic for most radiologists due to both the complexity of related anatomical and biomechanical considerations and the increasing number of classifications and acronyms reported in the literature in association with this condition. In this short review, we aim to demystify glenohumeral instability by first focusing on the relevant anatomy and pathophysiology. Second, we will review what the important imaging findings are and how to describe them for the clinician in the most relevant yet simple way. The role of the radiologist in assessing glenohumeral instability lesions is to properly describe the stabilizing structures involved (bone, soft-tissue stabilizers, and their periosteal insertion) to localize them and to attempt to characterize them as acute or chronic. Impaction fractures on the glenoid and humeral sides are important to specify, locate, and quantify. In particular, the description of soft-tissue stabilizers should include the status of the periosteal insertion of the capsulo-labro-ligamentous complex. Finally, any associated cartilaginous or rotator cuff tendon lesion should be reported to the clinician.
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20
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Anatomy of the capsulolabral complex and rotator interval related to glenohumeral instability. Knee Surg Sports Traumatol Arthrosc 2016; 24:343-9. [PMID: 26704796 DOI: 10.1007/s00167-015-3892-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/17/2015] [Indexed: 11/27/2022]
Abstract
The glenohumeral joint with instability is a common diagnosis that often requires surgery. The aim of this review was to present an overview of the anatomy of the glenohumeral joint with emphasis on instability based on the current literature and to describe the detailed anatomy and anatomical variants of the glenohumeral joint associated with anterior and posterior shoulder instability. A review was performed using PubMed/MEDLINE using key words: Search terms were "glenohumeral", "shoulder instability", "cadaver", "rotator interval", "anatomy", and "anatomical study". During the last decade, the interest in both arthroscopic repair techniques and surgical anatomy of the glenohumeral ligament (superior, middle, and inferior), labrum, and rotator interval has increased. Understanding of the rotator interval and attachment of the inferior glenohumeral ligament on the glenoid or humeral head have evolved significantly. The knowledge of the detailed anatomy and anatomical variations is essential for the surgeon in order to understand the pathology, make a correct diagnosis of instability, and select proper treatment options. Proper understanding of anatomical variants can help us avoid misdiagnosis. Level of evidence V.
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21
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Taylor SA, O’Brien SJ. Clinically Relevant Anatomy and Biomechanics of the Proximal Biceps. Clin Sports Med 2016; 35:1-18. [DOI: 10.1016/j.csm.2015.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Yoshida M, Goto H, Nozaki M, Nishimori Y, Takenaga T, Murase A, Nagaya Y, Iguchi H, Kobayashi M, Sugimoto K, Nishiyama T, Otsuka T. Quantitative analysis of attachment of the labrum to the glenoid fossa: a cadaveric study. J Orthop Sci 2015; 20:823-9. [PMID: 26169109 DOI: 10.1007/s00776-015-0742-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE This study investigated the direct and continuous attachment of the labrum to the glenoid fossa, including the fibrocartilaginous tissue, using image-analysis software and histology. METHODS Twenty-six cadaveric shoulders (11 male, 15 female; mean age 80.1 years; age range 36-103 years) were used. The glenoid of each specimen was divided into six pie-slice-shaped pieces from the center perpendicular to the articular surface by radial incisions at the 2, 4, 6, 8, 10, and 12 o'clock positions. The general distribution of the labrum, including the fibrocartilage, was assessed in hematoxylin and eosin-, Safranin O- and Azan-Mallory-stained sections. The continuous length of attachment of the labrum to the glenoid was measured using image-analysis software. The width of attachment to the articular surface of the glenoid was assessed in each position. RESULTS The labrum attached to both the articular surface and the neck of the glenoid in all shoulders (100 %) in the 4 and 6 o'clock positions. The mean length of the entire attachment to the glenoid was 4.6 mm (range 3.2-6.1 mm). The width of attachment from the bony edge of the glenoid to the edge of the labrum on the articular surface ranged from 0 to 4.3 mm. The length of the entire attachment of the labrum was shortest in the 2 o'clock position (p = 0.229). Additionally, the length of the entire attachment of the labrum was longest in the 4 o'clock position. The width of attachment to the articular surface of the glenoid was greatest in the 4 o'clock position (p < 0.01). CONCLUSION In the 4 and 6 o'clock positions, the labrum attached to both the articular surface and neck of the glenoid in all of the shoulders (100 %). The length of the entire attachment to the labrum, including the fibrocartilage, was shortest in the 2 o'clock position. The width of attachment to the articular surface of the glenoid was greatest in the 4 o'clock position (p < 0.01).
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Affiliation(s)
- Masahito Yoshida
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Hideyuki Goto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
| | - Masahiro Nozaki
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Yasuhiro Nishimori
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Tetsuya Takenaga
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Atsunori Murase
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Yuko Nagaya
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Hirotaka Iguchi
- Department of Arthroplastic Medicine, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Masaaki Kobayashi
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | | | - Takeshi Nishiyama
- Department of Public Health, Aichi Medical University, Nagakute, Japan
| | - Takanobu Otsuka
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
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Clavert P. Glenoid labrum pathology. Orthop Traumatol Surg Res 2015; 101:S19-24. [PMID: 25596985 DOI: 10.1016/j.otsr.2014.06.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 06/13/2014] [Accepted: 06/26/2014] [Indexed: 02/02/2023]
Abstract
The glenoid labrum is the fibrocartilage of the shoulder joint, anchoring the joint capsule and shoulder ligaments. Morphology varies regionally, especially in the superior and anterior region; these variants can sometimes be confused with pathological aspects. The labrum is often involved in shoulder pathology, by single trauma or, more often, repeated microtrauma. It seems logical to classify and to describe tears according to two criteria: the sector involved, and associated pain or instability. In the superior labrum, SLAP lesions are the most frequent. These combine labral lesion and lesion of the proximal insertion of the long head of the biceps brachii tendon. The most frequent form is SLAP II. They may be associated with instability or not. In the antero-inferior and postero-inferior labrum, lesions are mainly due to instability, particularly Bankart lesions (capsulolabral avulsion) anteriorly and Kim's lesion posteriorly. Circumferential labral lesions may be found in unstable shoulder. Finally, postero-superior lesions involve Walch's internal impingement: repeated contact between the deep surface of the cuff and the labrum, which takes on a degenerative aspect, with a kissing lesion of the cuff. There is no general rule for management: some labral lesions are resected and others fixed. The cause (which is usually shoulder instability), however, needs to be assessed and treated.
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Affiliation(s)
- P Clavert
- Service de chirurgie du membre supérieur, hôpitaux universitaires-CCOM, 10, avenue Baumann, 67400 Illkirch, France.
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24
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Abstract
Throwers, or athletes who engage in repetitive overhead motions, are a unique subset of athletes that experience distinct shoulder injuries. Athletes engaged in baseball comprise the majority of patients seeking orthopedic care for throwing related injuries. Injuries specific to throwers most commonly involve the labrum and the undersurface of the rotator cuff. In addition, tissue changes in both the anterior and posterior glenohumeral capsule are common with repetitive overhead motions. These capsular changes alter. This article will examine the pathomechanics of injuries to throwers, elaborate means of diagnoses of cuff and labral injury and discuss recent advances in both non-operative and operative interventions, including preventative principles.
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Affiliation(s)
- Stuart D Kinsella
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Stephen J Thomas
- Division of Nursing and Health Sciences, Neumann University, 1 Neumann Drive, Aston, PA 19104, USA
| | - G Russell Huffman
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 34th and Spruce Street, Philadelphia, PA 19104, USA
| | - John D Kelly
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 34th and Spruce Street, Philadelphia, PA 19104, USA.
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25
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Strauss EJ, Salata MJ, Sershon RA, Garbis N, Provencher MT, Wang VM, McGill KC, Bush-Joseph CA, Nicholson GP, Cole BJ, Romeo AA, Verma NN. Role of the superior labrum after biceps tenodesis in glenohumeral stability. J Shoulder Elbow Surg 2014; 23:485-91. [PMID: 24090980 DOI: 10.1016/j.jse.2013.07.036] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 07/14/2013] [Accepted: 07/16/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known about the role that a torn superior labrum (SLAP) plays in glenohumeral stability after biceps tenodesis. This biomechanical study evaluated the contribution of a type II SLAP lesion to glenohumeral translation in the presence of biceps tenodesis. The authors hypothesize that subsequent to biceps tenodesis, a torn superior labrum does not affect glenohumeral stability and therefore does not require anatomic repair in an overhead throwing athlete. METHODS Baseline anterior, posterior, and abduction and maximal external rotation glenohumeral translation data were collected from 20 cadaveric shoulders. Translation testing was repeated after the creation of anterior (n = 10) and posterior (n = 10) type II SLAP lesions. Translation re-evaluation after biceps tenodesis was performed for each specimen. Finally, anatomic SLAP lesion repair and testing were performed. RESULTS Anterior and posterior SLAP lesions led to significant increases in glenohumeral translation in all directions (P < .0125). Biceps tenodesis showed no significance in stability compared with SLAP alone (P > .0125). Arthroscopic repair of anterior SLAP lesions did not restore anterior translation compared with the baseline state (P = .0011) but did restore posterior (P = .823) and abduction and maximal external rotation (P = .806) translations. Repair of posterior SLAP lesions demonstrated no statistical difference compared with the baseline state (P > .0125). CONCLUSIONS With no detrimental effect on glenohumeral stability in the presence of a SLAP lesion, biceps tenodesis may be considered a valid primary or revision surgery for patients suffering from symptomatic type II SLAP tears. However, biceps tenodesis should be considered with caution as the primary treatment of SLAP lesions in overhead throwing athletes secondary to its inability to completely restore translational stability.
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Affiliation(s)
- Eric J Strauss
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael J Salata
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Robert A Sershon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Nickolas Garbis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew T Provencher
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Vincent M Wang
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kevin C McGill
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Gregory P Nicholson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Anthony A Romeo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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27
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Pappas ND, Hall DC, Lee DH. Prevalence of labral tears in the elderly. J Shoulder Elbow Surg 2013; 22:e11-5. [PMID: 23237722 DOI: 10.1016/j.jse.2012.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 08/14/2012] [Accepted: 08/16/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND The prevalence of SLAP (superior labrum antero-posterior) tears in the general population is not well known. The purpose of this study is to determine the prevalence of SLAP tears in the elderly using a cadaveric population. METHODS One hundred two embalmed cadaveric shoulders were dissected by a single, experienced orthopaedic shoulder surgeon (D.H.L.). The average age of the cadavers was 80.6 years (range, 57-96). There were 40 female and 62 male shoulders. For each shoulder dissection, the labrum, rotator cuff, and glenohumeral articular cartilage were inspected. RESULTS SLAP tears were found in 10 out of 102 shoulders (9.8%), 9 (8.8%) of which were classified as type I and 1 (0.98%) as type II. Twenty-one shoulders (20.6%) were found to have an anterior sublabral foramen, which had an average length of 7 mm (range, 3-11). Seven shoulders (6.9%) had a Buford complex. CONCLUSION The prevalence of SLAP tears in the elderly is very low. However, there are a significant number of normal anatomic labral variants (eg, sublabral foramina, Buford complexes), which can resemble SLAP tears. These findings add to our knowledge of the prevalence of SLAP tears and will assist future researchers in determining both why the incidence of SLAP repair is increasing and whether it is justified.
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Affiliation(s)
- Nick D Pappas
- Greenville Hospital System/Steadman Hawkins Clinic of Carolinas/Hawkins Research Foundation, Greenville, SC, USA
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28
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Garber AC, Argintar E, Shin SJ, McGarry MH, Tibone JE, Lee TQ. Kinematic effect of MGHL incorporation into Bankart repair. Orthopedics 2013; 36:653-8. [PMID: 23672898 DOI: 10.3928/01477447-20130426-31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Surgical treatment for traumatic shoulder instability has progressed in tandem with the evolution of the current understanding of the anatomy and biomechanics of the shoulder. Proponents of incorporating the middle glenohumeral ligament (MGHL) in Bankart repair believe this technique could increase repair strength. The purpose of this biomechanical study was to compare the range of motion and humeral head kinematic changes that result from including the MGHL in a Bankart repair in an effort to identify possible changes in shoulder biomechanics as a result of this addition in surgical repair.Six cadaveric shoulders were tested in 4 conditions: intact, Bankart lesion, repair excluding the MGHL, and repair including the MGHL. Each condition was tested for range of motion, glenohumeral translation, and humeral head apex position. Standard Bankart repair and repair with MGHL inclusion resulted in decreased range of motion, but no statistically significant difference was found between the 2 repair types (P=.846). Anterior translation was significantly reduced with both the Bankart repair (4.8 ± .9; P=.049) and included MGHL repair (4.6 ± 0.9; P=.029). No statistically significant difference was found between both repairs (P=.993). Although both repairs showed posterior displacement of the humeral head apex when in external rotation, this trend only reached statistical significance when compared with the Bankart lesion in 90° of external rotation (P=.0456); however, no significant difference was found between the 2 repairs (P=.999). Inclusion or exclusion of the MGHL in a Bankart repair does not significantly affect the range of motion, translation, or kinematics of the glenohumeral joint.
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Affiliation(s)
- Alexander C Garber
- Department of Orthopedic Surgery, University of Southern California, Los Angeles, California, USA
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Tuite MJ, Currie JW, Orwin JF, Baer GS, del Rio AM. Sublabral clefts and recesses in the anterior, inferior, and posterior glenoid labrum at MR arthrography. Skeletal Radiol 2013; 42:353-62. [PMID: 22893302 DOI: 10.1007/s00256-012-1496-0] [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: 06/04/2012] [Revised: 07/24/2012] [Accepted: 07/25/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the prevalence of a normal variant cleft/recess at the labral-chondral junction in the anterior, inferior, and posterior portions of the shoulder joint. MATERIALS AND METHODS One hundred and three consecutive patients (106 shoulders) who had a direct MR arthrogram followed by arthroscopic surgery were enrolled in this IRB-approved study. Scans were carried out on a 1.5-T scanner with an eight-channel shoulder coil. The glenoid rim was divided into eight segments and the labrum in all but the superior and anterosuperior segments was evaluated by two radiologists for the presence of contrast between the labrum and articular cartilage. We measured the depth of any cleft/recess and correlated the MR findings with surgical results. Generalized estimating equation models were used to correlate patient age and gender with the presence and depth of a cleft/recess, and Cohen's kappa values were calculated for interobserver variability. RESULTS For segments that were normal at surgery, a cleft/recess was present within a segment on MR arthrogram images in as few as 7 % of patients (within the posteroinferior segment by observer 1), and in up to 61 % of patients (within the posterosuperior segment by observer 1). 55-83 % of these were only 1 mm deep. A 2- to 3-mm recess was seen within 0-37 % of the labral segments, most commonly in the anterior, anteroinferior, and posterosuperior segments. Age and gender did not correlate with the presence of a cleft/recess, although there was an association between males and a 2- to 3-mm deep recess (p = 0.03). The interobserver variability for each segment ranged between 0.15 and 0.49, indicating slight to moderate agreement. CONCLUSION One-mm labral-chondral clefts are not uncommon throughout the labrum. A 2- to 3-mm deep smooth, medially curved recess in the anterior, anteroinferior or posterosuperior labrum can rarely be seen, typically as a continuation of a superior recess or anterosuperior labral variant.
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Affiliation(s)
- Michael J Tuite
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792-3252, USA.
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Bain GI, Galley IJ, Singh C, Carter C, Eng K. Anatomic study of the superior glenoid labrum. Clin Anat 2012; 26:367-76. [DOI: 10.1002/ca.22145] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 07/13/2012] [Accepted: 07/09/2012] [Indexed: 11/06/2022]
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Anatomic Variants and Pitfalls of the Labrum, Glenoid Cartilage, and Glenohumeral Ligaments. Magn Reson Imaging Clin N Am 2012; 20:213-28, x. [DOI: 10.1016/j.mric.2012.01.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Superior Labrum Anterior and Posterior Lesions and Microinstability. Magn Reson Imaging Clin N Am 2012; 20:277-94, x-xi. [DOI: 10.1016/j.mric.2012.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Jakanani GC, Botchu R, Rennie WJ. The MR arthrographic anatomy of the biceps labral insertion and its morphological significance with labral tears in patients with shoulder instability. Eur J Radiol 2012; 81:3390-3. [PMID: 22465122 DOI: 10.1016/j.ejrad.2012.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 02/29/2012] [Accepted: 03/01/2012] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Most of the fibres of the long head of biceps tendon attach on the superior labrum just posterior to the supraglenoid tubercle. AIM Our hypothesis was that posteriorly attached biceps tendons predispose to posterior superior labral tears and SLAP lesions. METHODS AND MATERIALS A prospective analysis of all MR shoulder arthrograms for shoulder instability referred from the shoulder specialist clinics, performed during a one year period were reviewed by two independent observers who were blinded to clinical history. The biceps attachment was classified into four groups according to the method described in an earlier cadaveric study into four groups; posterior-type 1, predominantly posterior-type 2, equal contributions to both anterior and posterior labrum-type 3 and predominantly anterior labral attachment-type 4. Data was analysed using Kappa statistics and Fischer's exact test. RESULTS 48 patients (33 males and 15 females) were included in this study with a mean age of 32 years. Majority, 22 patients (46%) had a type 1 attachment of the biceps on the superior labrum. There was moderate intra-observer and good interobserver agreement with a Kappa of 0.58 and 0.63 respectively. There was a significant association between a type 2 attachment and posterior tears (p≤0.04) and also between a type 2 attachment and SLAP tears (p≤0.04). CONCLUSION Our results suggest that variation in anatomy of biceps origin influences the type of labral tears that occur in patients with shoulder instability. The importance of these findings could influence selection of individuals in throwing sports like cricket and baseball.
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Tischer T, Vogt S, Kreuz PC, Imhoff AB. Arthroscopic anatomy, variants, and pathologic findings in shoulder instability. Arthroscopy 2011; 27:1434-43. [PMID: 21871774 DOI: 10.1016/j.arthro.2011.05.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 04/22/2011] [Accepted: 05/31/2011] [Indexed: 02/02/2023]
Abstract
Shoulder instability is a common diagnosis that often requires surgical treatment. A detailed knowledge of the shoulder anatomy and its stabilizing structures is of utmost importance for successful treatment of shoulder instabilities. Identifying anatomic variants (e.g., sublabral hole, meniscoid labrum, cordlike middle glenohumeral ligament, and Buford complex) and distinguishing them from pathologic findings may be especially difficult, as shown by the high interobserver variability. Over the last decade, basic research and arthroscopic surgery have improved our understanding of the shoulder anatomy and pathology. In the context of shoulder instability, injuries of the glenoid (bony Bankart), injuries of the glenoid labrum superiorly (SLAP) or anteroinferiorly (e.g., Bankart, anterior labroligamentous periosteal sleeve avulsion, and Perthes), capsular lesions (humeral avulsion of the glenohumeral ligament), accompanying cartilage lesions (Hill-Sachs, glenolabral articular disruption), and rotator interval and pulley lesions, as well as signs of dynamic instability impingement (posterior-superior impingement, anterior-superior impingement) can be exactly diagnosed (magnetic resonance imaging with intra-articular gadolinium, arthroscopy) and treated (arthroscopy). Therefore the purpose of this article is to review the current literature concerning shoulder anatomy/pathology related to shoulder stability/instability to improve clinical diagnosis and surgical treatment of our patients.
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Affiliation(s)
- Thomas Tischer
- Department of Orthopaedic Surgery, University of Rostock, Rostock, Germany
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Superior Labral Anteroposterior Lesions of the Shoulder: Part 1, Anatomy and Anatomic Variants. AJR Am J Roentgenol 2011; 197:596-603. [DOI: 10.2214/ajr.10.7236] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Sandhu B, Sanghavi S, Lam F. Superior Labrum Anterior to Posterior (SLAP) lesions of the shoulder. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.mporth.2010.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Omoumi P, Teixeira P, Lecouvet F, Chung CB. Glenohumeral joint instability. J Magn Reson Imaging 2011; 33:2-16. [PMID: 21182115 DOI: 10.1002/jmri.22343] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Due to the configuration of its bony elements, the glenohumeral joint is the most mobile joint of the body, but also an inherently unstable articulation. Stabilization of the joint is linked to a complex balance between static and dynamic soft tissue stabilizers. Because of complex biomechanics, and the existence of numerous classifications and acronyms to describe shoulder instability lesions, this remains a daunting topic for most radiologists. In this article we provide a brief review of the anatomy of the glenohumeral joint, as well as the classifications and the pathogenesis of shoulder instability. Technical aspects related to the available imaging techniques (including computed tomography [CT] arthrography, magnetic resonance imaging [MRI], and MR arthrography) are reviewed. We then describe the imaging findings related to shoulder instability, focusing on those elements that are important to the clinician.
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Affiliation(s)
- Patrick Omoumi
- Department of Radiology, Cliniques Universitaires Saint Luc, Académie Universitaire de Louvain, Brussels, Belgium
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Crockett HC, Wingert NC, Wright JM, Bonner KF. Repair of SLAP lesions associated with a Buford complex: a novel surgical technique. Arthroscopy 2011; 27:314-21. [PMID: 21126845 DOI: 10.1016/j.arthro.2010.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 08/24/2010] [Accepted: 09/08/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to analyze outcomes of a novel arthroscopic repair technique for type II SLAP lesions associated with a Buford complex. METHODS Patients selected for study enrollment had a symptomatic, isolated type II SLAP lesion and the Buford complex anatomic variant. Excluded were patients undergoing any concomitant shoulder procedure (e.g., subacromial decompression) or with any history of shoulder surgery. In addition to standard type II SLAP repair using suture anchors, the described technique also transects the cordlike middle glenohumeral ligament (MGHL) at the equator of the glenoid. This decreases postoperative stress on the repair and allows incorporation of the proximal MGHL segment for repair augmentation. The stout proximal MGHL segment is fixed to the anterosuperior glenoid rim, which is devoid of labral tissue, to enhance fixation of the SLAP repair anterior to the biceps anchor. The distal MGHL segment is left free so as to not impair external rotation. A single surgeon performed all procedures using the same surgical technique. Outcomes were assessed by University of California, Los Angeles (UCLA) and Constant shoulder scoring indexes. RESULTS Twenty-one patients were evaluated. Both UCLA and Constant shoulder scores showed a statistically significant improvement after surgery. The mean UCLA score increased from 14.3 preoperatively to 32.1 postoperatively (P < .0001). The mean Constant score improved from 39.7 to 85.0 (P < .0001). Follow-up examination was performed at a mean of 44 months after surgery (range, 23 to 75 months). No patients had evidence of postoperative instability. CONCLUSIONS For patients with a symptomatic type II SLAP tear and an associated Buford complex, using the proximal Buford MGHL to enhance repair and releasing the distal Buford MGHL segment resulted in significant improvement in outcomes at intermediate follow-up. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Yin B, Vella J, Levine WN. Arthroscopic alphabet soup: recognition of normal, normal variants, and pathology. Orthop Clin North Am 2010; 41:297-308. [PMID: 20497807 DOI: 10.1016/j.ocl.2010.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The capsule, labrum, glenohumeral ligaments, and rotator cuff represent the static and dynamic stabilizers of the glenohumeral joint. Various injuries can occur to one or more of these structures during traumatic shoulder dislocation, predisposing the patient to recurrent instability. Improved understanding of shoulder anatomy and biomechanics, and advancements in arthroscopic technique led to the recognition of various pathologic lesions that may contribute to instability. The ability to identify and address these lesions during arthroscopy will allow the surgeon to more fully tailor operative treatments for each individual patient suffering from shoulder instability. Furthermore, the ability to differentiate pathologic lesions from normal anatomic variants is critical to avoid inadvertent repair that will lead to loss of normal function and worsening symptoms.
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Affiliation(s)
- Bob Yin
- Department of Orthopedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH-11 Center, New York, NY 10032, USA
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del Rey FC, Vázquez DGG, López DN. Glenohumeral instability associated with Buford complex. Knee Surg Sports Traumatol Arthrosc 2009; 17:1489-92. [PMID: 19629434 DOI: 10.1007/s00167-009-0882-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 07/08/2009] [Indexed: 11/28/2022]
Abstract
Buford complex is described as a normal anatomical variant of the anterosuperior part of the glenoid consisting of the absence of the anterosuperior labrum with the presence of a cord-like middle glenohumeral ligament. Traditionally, reattachment to the glenoid has been discouraged. We present a case of a Buford complex associated with glenohumeral instability. The patient was operated for recurrent instability without a preoperative diagnosis of Buford complex. The diagnosis was made during shoulder arthroscopy and reattachment to the glenoid was performed with a satisfactory outcome. Here, we discuss the relationship of the Buford complex with intraarticular pathology and the surgical treatment in cases when this variant is associated with instability.
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Affiliation(s)
- Fernando Canillas del Rey
- Orthopaedic Surgery Service, Hospital Central de la Cruz Roja San José y Santa Adela, Avda. Reina Victoria 22-26, 28003 Madrid, Spain
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Lin E. Magnetic Resonance Arthrography of Superior Labrum Anterior-Posterior Lesions: A Practical Approach to Interpretation. Curr Probl Diagn Radiol 2009; 38:91-7. [DOI: 10.1067/j.cpradiol.2008.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Gobezie R, Zurakowski D, Lavery K, Millett PJ, Cole BJ, Warner JJP. Analysis of interobserver and intraobserver variability in the diagnosis and treatment of SLAP tears using the Snyder classification. Am J Sports Med 2008; 36:1373-9. [PMID: 18354142 DOI: 10.1177/0363546508314795] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Superior labral anterior posterior lesions are a relatively rare entity, and classification as a basis for selection of treatment has remained a point of controversy. HYPOTHESIS There will be substantial interobserver and intraobserver variability in the diagnosis and treatment of superior labral anterior posterior tears by experienced arthroscopic specialists. STUDY DESIGN Cohort study (diagnosis), Level of evidence, 2. METHODS Compact discs containing 22 video vignettes of approximately 15 seconds duration were sent to the membership of the Arthroscopy Association of North America, American Shoulder and Elbow Society, and AOSSM. Each surgeon was asked to review the vignettes, classify the superior labral anterior posterior lesion type, and provide a treatment recommendation for each vignette. Seventy-three expert surgeons responded to the solicitation with a completed analysis. The same CD-ROM was re-sent to each of these 73 surgeons at a minimum of 12 months after the first viewing to obtain data on intraobserver reliability. Seventeen of the 73 surgeons returned this second CD-ROM with a complete analysis. Demographic data were also obtained from each surgeon. Multivariable logistic regression analysis was used to analyze the data, and 95% confidence intervals were established for each superior labral anterior posterior type (I-IV) with regard to diagnosis and treatment decision. RESULTS The 22 vignettes analyzed by 73 surgeons resulted in 1606 responses. Several significant trends were noticed with regard to diagnosis and treatment from the responses: (1) surgeons had difficulty distinguishing type III lesions from type IV lesions, (2) the treatment of type III lesions is much more variable than that of any other subtype, and (3) surgeons had difficulty distinguishing normal shoulders from type II superior labral anterior posterior tears. No relationship was identified between correct treatment decisions based on diagnosis and any of the demographic factors analyzed. Our analysis of intraobserver variability showed only moderate agreement. The analysis of interobserver variability improved significantly when the diagnoses were analyzed based on treatment decision. CONCLUSIONS There is substantial interobserver and intraobserver variability among experienced shoulder arthroscopic specialists with regard to diagnosis and treatment of superior labral anterior posterior tears. Intraobserver agreement using the Snyder classification indicated only moderate agreement. Analysis of interobserver agreement based on treatment decisions results in superior concordance among experienced surgeons for the diagnosis of superior labral anterior posterior lesions.
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Affiliation(s)
- Reuben Gobezie
- The Case Shoulder & Elbow Service, Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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Ilahi OA, Cosculluela PE, Ho DM. Classification of anterosuperior glenoid labrum variants and their association with shoulder pathology. Orthopedics 2008; 31:226. [PMID: 19292248 DOI: 10.3928/01477447-20080301-18] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED This prospective study of 367 consecutive shoulder arthroscopies assessed variants of the anterosuperior glenoid labrum and associated shoulder pathology. Thirty-three shoulders were excluded because of prior surgery, septic arthritis, or adhesive capsulitis. Anterosuperior glenoid variants were classified as: type I, cordlike middle glenohumeral ligament without sublabral foramen; type II, sublabral foramen without a cordlike middle glenohumeral ligament; type III, sublabral foramen with a cordlike middle glenohumeral ligament; and type IV, absent anterosuperior labrum with the anterior aspect of the superior labrum continuous with a cordlike middle glenohumeral ligament. The presence of these variants was correlated with the incidence of shoulder pathology found on arthroscopic inspection. Of 334 shoulders, 118 (35.3%) had variants of the anterosuperior glenoid labrum. Of these, 32 (27.1%) were type I, 27 (22.9%) were type II, 34 (28.8%) were type III, and 25 (21.2%) were type IV. The incidence of advanced superior labrum anterior-posterior lesions in the 86 shoulders displaying a type II, III, or IV variant was significantly higher than in shoulders with no anterosuperior variant (48.8% versus 23.6%, P<.001). Other pathologic findings were not significantly increased in shoulders with variants compared to those without. LEVEL OF EVIDENCE Level 1.
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Affiliation(s)
- Omer A Ilahi
- Texas Arthroscopy and Sports Medicine Institute, 6560 Fannin, Suite 1016, Houston, TX 77030, USA
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Brué S, Valentin A, Yllner G. Slap lesion type IV and a Buford complex: a case report. Knee Surg Sports Traumatol Arthrosc 2008; 16:86-9. [PMID: 17982742 DOI: 10.1007/s00167-007-0440-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 09/19/2007] [Indexed: 01/02/2023]
Abstract
The improvement of shoulder arthroscopy during the last decades has led to the description of several new conditions or anatomical variations and their associated pathologies. The variable pathologies of the superior labral complex represent a difficult entity to diagnose and treat for every shoulder surgeon. Interpretation and proper treatment of superior labral pathologies could also be further complicated by anatomical variations. We describe a rare case of a SLAP lesion type IV associated with a Buford Complex in a young patient with a painful shoulder after a trauma.
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Affiliation(s)
- Stefano Brué
- Capio Artro Clinic, Stockholm Sport Trauma Research Center, Sophiahemmet, 11427 Stockholm, Sweden.
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Ghalayini SRA, Board TN, Srinivasan MS. Anatomic variations in the long head of biceps: contribution to shoulder dysfunction. Arthroscopy 2007; 23:1012-8. [PMID: 17868842 DOI: 10.1016/j.arthro.2007.05.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Accepted: 05/07/2007] [Indexed: 02/02/2023]
Abstract
The long head of the biceps (LHB) is a subject of interest to shoulder surgeons and physiotherapist alike. Since the advent of shoulder arthroscopy, knowledge of and interest in the LHB has increased. We discuss the current knowledge on anatomic variants of the LHB. Several cadaveric studies have refined the standard textbook description of the LHB origin, showing that it originates from the superior glenoid labrum and the supraglenoid tubercle. These studies have provided important information for the assessment of the LHB, guiding the treatment of lesions such as superior labral anterior posterior (SLAP) tears. Described variants to the anterosuperior glenoid labrum should be noted, from the superior sublabral recess to the Buford complex. Congenital absence of the LHB should be appreciated. Only 4 previous cases have been reported. We have experience in treating 3 further cases. Further information on the function of the LHB has been gleaned from electomyographic, cadaveric, and clinical studies. These have shown that it has a role in stabilizing the humeral head. It has been stated that it may have a proprioceptive function. Classification systems for symptomatic LHB lesions and congenital absence of the LHB tendon are proposed. The management of LHB lesions is also discussed.
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Dutcheshen NT, Reinold MM, Gill TJ. Superior Labrum Anterior Posterior Lesions in the Overhead Athlete: Current Options for Treatment. OPER TECHN SPORT MED 2007. [DOI: 10.1053/j.otsm.2007.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Dinauer PA, Flemming DJ, Murphy KP, Doukas WC. Diagnosis of superior labral lesions: comparison of noncontrast MRI with indirect MR arthrography in unexercised shoulders. Skeletal Radiol 2007; 36:195-202. [PMID: 17139503 DOI: 10.1007/s00256-006-0237-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Revised: 10/15/2006] [Accepted: 10/17/2006] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To prospectively compare the accuracy of noncontrast magnetic resonance imaging (MRI) with indirect MR arthrography (I-MRa) of unexercised shoulders for diagnosis of superior glenoid labral lesions. MATERIALS AND METHODS Institutional Review Board approval and patient informed consent were obtained for this prospective study. Superior labral findings on shoulder MRI and unexercised I-MRa studies of 104 patients were correlated with findings at arthroscopic shoulder surgery. Two musculoskeletal radiologists independently reviewed the two sets of MR images while blinded to arthroscopic results. For each radiologist, the McNemar test was used to detect statistically significant differences between techniques. RESULTS The superior labrum was intact in 24 and abnormal in 80 subjects. For detection of superior labral lesions by each radiologist, I-MRa was more sensitive (84-91%) than MRI (66-85%), with statistically significant improvement in sensitivity for one reader (p = 0.003). However, I-MRa was less specific (58-71%) than MRI (75-83%). Overall, accuracy was slightly improved on I-MRa (78-86%) compared with MRI (70-83%), but this difference was not statistically significant for either reader. CONCLUSION Compared with noncontrast MRI, I-MRa was more sensitive for diagnosis of superior glenoid labral lesions. However, the diagnostic value of I-MRa in shoulders remaining at rest is potentially limited by decreased specificity of the technique.
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Affiliation(s)
- Philip A Dinauer
- Department of Radiology, Walter Reed Army Medical Center, Washington, DC 20307, USA.
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Castagna A, Nordenson U, Garofalo R, Karlsson J. Minor shoulder instability. Arthroscopy 2007; 23:211-5. [PMID: 17276230 DOI: 10.1016/j.arthro.2006.11.025] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 11/27/2006] [Accepted: 11/28/2006] [Indexed: 02/02/2023]
Abstract
The wide spectrum of shoulder instability is difficult to include in 1 classification. The distinction between traumatic, unidirectional, and atraumatic multidirectional instability is still widely used, even though this classification is not sufficiently precise to include all the different pathological findings of shoulder instability. We present "minor instability," which is a pathological condition causing a dysfunction of the glenohumeral articulation, especially in combination with microtrauma, repetitive or not, or after a period of immobilization or inactivity. When "minor shoulder instability" is suspected, the patient's history and detailed clinical examination represent the most important factors when establishing the diagnosis. In particular, the apprehension test stressing the middle glenohumeral ligament (MGHL)/labral complex in the position of midabduction and external rotation may be painful and may even reveal anterior instability or subluxation. Conventional radiographs are negative in most cases, as is magnetic resonance imaging arthrography. It is only after an accurate arthroscopic assessment that the pathological lesion can be found. The major pathological process can be identified at the level of the anterior superior labrum, in particular the MGHL complex, and appears as hyperemia, fraying, stretching, loosening, thinning, hypoplasia, or even absence. It may, however, be difficult to distinguish between a normal variant and a pathological lesion. Clinical symptoms and examination should always be correlated with arthroscopic findings. Recommended treatment is to restore shoulder stability and thereby prevent shoulder pain secondary to the increase in laxity. A reduction in range of motion should be expected during the postoperative phase, at least up to six to nine months. External rotation is usually permanently reduced by a few degrees.
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Affiliation(s)
- Alessandro Castagna
- Unità di Chirurgia della Spalla IRCCS Instituto Clinico Humanitas, Milan, Italy
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Abstract
The glenohumeral ligaments, particularly the inferior one, are the major passive stabilizers of the joint, and the labrum functions as a site of ligamentous attachment. The strong union between the collagen fibers of the glenohumeral ligaments and the glenoid labrum is more resistant to injury than the union between the glenoid rim and the labrum. Labral tears associated with glenohumeral instability are therefore usually secondary to avulsion rather than impaction. This article reviews the normal MR imaging anatomy, variants and pitfalls of the glenohumeral ligaments, and the basic biomechanics of the glenohumeral ligaments. Examples of injuries involving these structures are provided.
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Affiliation(s)
- Jenny T Bencardino
- Musculoskeletal Radiology, Medical Arts Radiology Group, PC, Huntington Hospital, North Shore-Long Island Jewish Health System, 270 Park Avenue, Huntington, NY 11743, USA.
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