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Delgado C, Calvo E, Díaz Heredia J, Cañete P, García Navlet M, Ruiz Ibán MA. Graft Position, Healing, and Resorption in Anterior Glenohumeral Instability: A Comparison of 4 Glenoid Augmentation Techniques. Orthop J Sports Med 2024; 12:23259671241253163. [PMID: 38840788 PMCID: PMC11151773 DOI: 10.1177/23259671241253163] [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: 10/24/2023] [Accepted: 11/16/2023] [Indexed: 06/07/2024] Open
Abstract
Background The success of glenoid augmentation procedures depends on accurate placement and healing of the graft to the glenoid. Different glenoid augmentation techniques have been described, but no comparative studies between them exist. Purpose To assess the bone graft position, healing, and resorption in a group of patients treated with 1 of 4 procedures: arthroscopic anterior bone-block procedure using either (1) fresh-frozen iliac crest allograft or (2) iliac crest autograft, (3) open Latarjet, or (4) arthroscopic Latarjet. Study Design Cohort study; Level of evidence, 3. Methods A total of 40 patients (87.5% men; mean age, 29.5 ± 7.9 years) were included, with 10 patients in each of the procedure groups. The graft position in the axial and sagittal planes was assessed on postoperative computed tomography (CT). Graft healing and resorption were assessed in a second CT scan performed 1 year postoperatively. Qualitative variables were compared between the 4 procedures using the chi-square test, and quantitative variables were compared with the Student t test or Mann-Whitney U test. Results No differences were found between the procedures in the axial or sagittal position. The healing rate was significantly lower in the allograft bone-block group (20%) compared with the autograft bone-block (80%), open Latarjet (90%), and arthroscopic Latarjet (90%) groups (P < .001). Graft resorption developed in 17 of 40 (42.5%) cases overall. Osteolysis occurred in 100% of cases in the allograft bone-block group compared with 50% in the autograft group, 20% in the open Latarjet group, and 0% in the arthroscopic Latarjet group (P < .001). The glenoid surface area on 1-year CT scan was significantly lower in the allograft bone-block group compared with the autograft bone-block, open Latarjet, and arthroscopic Latarjet groups (P < .001). Conclusion Arthroscopic bone-block, open Latarjet, and arthroscopic Latarjet procedures provided accurate bone graft positioning. However, very high rates of osteolysis and nonunion were observed in the iliac crest fresh-frozen allograft bone-block procedure when compared with the other procedures.
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Affiliation(s)
- Cristina Delgado
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Jorge Díaz Heredia
- Shoulder and Elbow Reconstructive Surgery Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Departamento de Cirugía, Ciencias Sanitarias y Medicosociales, Universidad de Alcalá de Henares, Madrid, Spain
| | | | | | - Miguel Angel Ruiz Ibán
- Shoulder and Elbow Reconstructive Surgery Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Departamento de Cirugía, Ciencias Sanitarias y Medicosociales, Universidad de Alcalá de Henares, Madrid, Spain
- Patología Quirurgica, Universidad Ceu San Pablo, Madrid, Spain
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Calvo E, Dzidzishvili L, Valencia M, Calvo C. Outcomes of Arthroscopic Latarjet as a Revision Surgery After Failed Arthroscopic Bankart Repair. Am J Sports Med 2024; 52:190-200. [PMID: 38164667 DOI: 10.1177/03635465231209986] [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] [Indexed: 01/03/2024]
Abstract
BACKGROUND The role of arthroscopic Latarjet as a revision surgery after failed arthroscopic Bankart repair has yet to be established. PURPOSE To compare clinical outcomes, recurrences, and complication rates of arthroscopic Latarjet as a revision procedure after failed arthroscopic Bankart repair versus arthroscopic Latarjet as a primary procedure. DESIGN Cohort study; Level of evidence, 3. METHODS This is a retrospective study of prospectively collected data of patients who were diagnosed with anterior shoulder instability and underwent arthroscopic Latarjet stabilization between 2009 and 2018. Patients were separated into 2 groups depending on whether Latarjet was performed after a previous instability surgery (revision) or as a primary surgery (primary). Rowe score, Western Ontario Shoulder Instability Index (WOSI), Constant-Murley Shoulder Outcome (CMSO) score, and Single Assessment Numeric Evaluation (SANE) were assessed pre- and postoperatively with a minimum 24 months of follow-up. In addition, pre- and postoperative levels of sports activity, dislocations, subluxations, and complications were assessed. RESULTS A total of 97 patients (n = 62 revision; n = 35 primary), with a mean age of 31.0 ± 8.8 and 29.4 ± 7.6 years old in the revision and primary Latajet group, respectively, met the inclusion criteria. The mean follow-up in the revision group was 32 months (24-53) and 35.5 months (27.7-42.2) in the primary Latarjet group. No significant differences between groups were observed in Rowe score (revision = 91.4, primary = 94.1; P = .223), CMSO score (revision = 90.7, primary = 94; P = .105), and SANE (revision = 85.8, primary = 87.3; P = .683) postoperatively. However, the postoperative difference in the WOSI score between the revision and primary Latarjet groups was nearly significant (510 ± 334 vs 403 ± 343, respectively; P = .05). Four (6.4%) postoperative dislocations were reported in the revision and 1 (2.8%) in the primary Latarjet group (P = .14). Patients in the revision group had a lower return to the previous level of sports participation (P = .008) and decreased external rotation with the arm by the side compared with the primary Latarjet group (P = .000). CONCLUSION Arthroscopic Latarjet as a revision surgery is a reasonable surgical option in failed Bankart repair cases. The decision to perform arthroscopic Latarjet stabilization as a revision surgery should not be influenced by the potential risk of future complications as it provides comparable clinical outcomes to the primary Latarjet procedure with a low postoperative recurrence rate. However, a decreased level of postoperative sports participation and external rotation with the arm by the side can be expected.
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Affiliation(s)
- Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Lika Dzidzishvili
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Valencia
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Claudio Calvo
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Delgado C, Luengo-Alonso G, Valencia M, Martínez-Catalán N, Calvo E. Association of Instability History and Off-Track Hill-Sachs Lesions in Anterior Shoulder Instability. Orthop J Sports Med 2023; 11:23259671231213858. [PMID: 38035218 PMCID: PMC10686021 DOI: 10.1177/23259671231213858] [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: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 12/02/2023] Open
Abstract
Background The glenoid track concept is now widely accepted, and its evaluation is considered essential for making decisions about surgery. Purpose To define preoperative descriptive data and clinical and functional features in patients with anterior glenohumeral instability according to glenoid track status and to analyze the influence of off-track Hill-Sachs (HS) lesions on preoperative shoulder function. Study Design Case-control study; Level of evidence, 3. Methods Preoperative magnetic resonance imaging or computed tomography scans were used to measure the glenoid track. Descriptive data and preoperative objective and subjective clinical and functional features were compared between patients with on-track HS lesions versus off-track HS lesions. Multivariate regression analysis was conducted to identify potential risk factors for off-track HS lesion development. Results A total of 235 patients (201 men, 34 women; mean age, 29.6 ± 8.6 years) were included- 134 shoulders (57%) with on-track HS lesions and 101 shoulders (43%) with off-track HS lesions. Age <20 years at first dislocation, number of dislocations, and ≥2 years between first dislocation and surgery were significantly different between the study groups (P = .005, P = .0001, and P = .01, respectively). Regarding these characteristics, the odds ratios for the risk of developing an off-track lesion were 2.67 (95% CI, 1.2-5.99)-1.2 times higher for each additional instability episode (95% CI, 1.025-1.14) and 2.42 times higher (95% CI, 1.176-4.608) for patients whose first dislocation was ≥2 years before surgery, respectively. Patients with off-track HS lesions had a significantly greater degree of instability (P = .04), worse Rowe scores (48.8 ± 15.3 vs 54.8 ± 28.3 for on-track HS lesions; P = .04), and lower Western Ontario Shoulder Instability scores (975 ± 454 vs 1179 ± 428 for on-track HS lesions; P = .01). Conclusion Characteristics related to a history of instability (age <20 years at first instability episode, larger number of dislocations, ≥2 years between first dislocation and surgery) were found to be risk factors for the development of an off-track HS lesion in this study. Off-track lesions led to a higher degree of instability and worse objective and subjective preoperative shoulder function versus on-track HS lesions.
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Affiliation(s)
- Cristina Delgado
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Gonzalo Luengo-Alonso
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Maria Valencia
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Natalia Martínez-Catalán
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Lopez-Fernandez V, Luengo-Alonso G, Valencia M, Martínez-Catalán N, Foruria AM, Calvo E. Comprehensive arthroscopic management without axillary nerve release or subacromial decompression achieves satisfactory and durable results in young patients with glenohumeral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07377-0. [PMID: 37130951 DOI: 10.1007/s00167-023-07377-0] [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: 06/11/2022] [Accepted: 03/01/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE The comprehensive arthroscopic management (CAM) procedure is a useful joint-preserving option for young or active patients with glenohumeral osteoarthritis (GHOA). Our objective was to evaluate the results and prognostic factors of the CAM procedure without direct axillary nerve release or subacromial decompression. METHODS A retrospective observational study among patients with GHOA who underwent the CAM procedure was conducted. Neither axillary nerve neurolysis nor subacromial decompression was performed. Both primary and secondary GHOA were considered; the latter was defined as a history of shoulder pathology (mainly instability or proximal humerus fracture). The American Shoulder and Elbow Surgeons scale, Simple Shoulder Test, Visual Analogue Scale, activity level, Single Assessment Numeric Evaluation, EuroQol 5 Dimensions 3 Levels, Western Ontario Rotator Cuff Index, and active range of motion (aROM) were analysed. RESULTS Twenty-five patients who underwent the CAM procedure met the inclusion criteria. After a mean follow-up of 42.4 ± 22.9 months, we found improvement (p < 0.001) in all postoperative values of the different scales. The procedure increased aROM overall. Patients with arthropathy due to instability showed worse results. The rate of CAM failures, defined as conversion to shoulder arthroplasty, was 12%. CONCLUSIONS This study showed that the CAM procedure without direct axillary nerve neurolysis or subacromial decompression might be a valid alternative in active patients with advanced GHOA to improve shoulder function (aROM and scores), decrease pain, and delay arthroplasty. This technique showed good subjective functional scores, high patient satisfaction, and a low rate of complications. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Vanesa Lopez-Fernandez
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Rey Juan Carlos, Universidad Rey Juan Carlos, Gladiolo, S/N, Mostoles, Madrid, Spain.
| | - Gonzalo Luengo-Alonso
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - María Valencia
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Natalia Martínez-Catalán
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Antonio María Foruria
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Madrid, Spain
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Calvo E, Delgado C. Management of off-track Hill-Sachs lesions in anterior glenohumeral instability. J Exp Orthop 2023; 10:30. [PMID: 36943508 PMCID: PMC10030712 DOI: 10.1186/s40634-023-00588-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/14/2023] [Indexed: 03/23/2023] Open
Abstract
Bone loss has been identified as a risk factor for recurrent shoulder dislocations or failure after soft tissue repair. Although the range for "critical" bone loss is yet to be determined, glenoid and humeral bone defects should not be regarded as independent problems, but the interaction between them during shoulder motion should be evaluated as suggested by the glenoid track concept. The glenoid track concept is now widely accepted and considered essential for making decisions about surgery. Soft-tissue procedures usually work well in patients with on-track Hill-Sachs lesions but in off-track lesions do not. In this situation additional procedures should be performed.Different surgical options have been described to address off-track Hill-Sachs lesions, most commonly remplissage, Latarjet or free bone block procedures. Coracoid graft and free bone grafts convert the off-track Hill-Sachs lesion into on-track by lengthening the glenoid-track, whereas remplissage fill-in the humeral lesion so that it does not engage. In the setting of a Hill-Sachs lesion with little or no glenoid bone loss, remplissage has demonstrated satisfactory outcomes with a low complications and recurrence rate. Favorable results have been reported with glenoid bone grafting when managing isolated Hill-Sachs or bipolar lesions. Studies analyzing Latarjet and Eden-Hybinette procedures show that both procedures are safe and effective in the management of anterior glenohumeral instability. Attention should be paid to those patients with large bone defects not amenable to be restored with an isolated Latarjet that may be better addressed with an Eden-Hybinnete or adding a remplissage to the Latarjet procedure.
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Affiliation(s)
- Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Hospital Universitario Fundacion Jimenez Diaz, Universidad Autonoma, Avda Reyes Católicos, 2, Madrid, 28040, Spain.
| | - Cristina Delgado
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Hospital Universitario Fundacion Jimenez Diaz, Universidad Autonoma, Avda Reyes Católicos, 2, Madrid, 28040, Spain
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Sudah SY, Menendez ME. Classifications in Brief: The Instability Severity Index Score for Predicting Recurrent Shoulder Instability After Arthroscopic Bankart Repair. Clin Orthop Relat Res 2023; 481:382-386. [PMID: 36006660 PMCID: PMC9831186 DOI: 10.1097/corr.0000000000002386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/09/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Suleiman Y. Sudah
- Department of Orthopedics, Monmouth Medical Center, Long Branch, NJ, USA
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Arguello AM, Till SE, Reinholz AK, Okoroha KR, Barlow JD, Camp CL. Managing Shoulder Instability in the Overhead Athlete. Curr Rev Musculoskelet Med 2022; 15:552-560. [PMID: 36223035 PMCID: PMC9789295 DOI: 10.1007/s12178-022-09796-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Shoulder instability in the overhead athlete is a difficult problem because of the balance between necessary laxity for athletic movements and stability of the joint. The purpose of this review is to provide an overview of the clinical evaluation of shoulder instability in the overhead athlete and present evidence-based management strategies for each subtype of shoulder instability, including novel techniques and outcomes. RECENT FINDINGS Recent investigation has shown that throwers and other overhead athletes are more likely to present with subtle subluxation events rather than discrete dislocations as their primary symptom. While overhead athletes with discrete anterior dislocation events are likely to begin with non-operative management, many progress on to surgical intervention. Surgical management of glenohumeral joint instability continues to pose challenges due to the potential for over-tensioning for the sake of stability at the expense of the adaptive laxity that often confers performance benefits in the overhead athlete. Novel, individualized, and sport/position specific approaches are needed to address this complex issue. The optimal management of shoulder instability in the overhead athlete continues to be a controversial topic due to the complex work-up, an increasing number of surgical options with varying indications, and low volume of high-quality studies comparing any of the treatment options. The Anterior Shoulder Instability International Consensus Group guidelines from February 2022 offer the most updated guidelines on work-up and management. Overall, high-quality randomized controlled trials are required to determine the optimal treatment for specific pathologies and aid in creating patient-centered management plans.
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Affiliation(s)
- Alexandra M Arguello
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sara E Till
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MN, USA
| | - Anna K Reinholz
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jonathan D Barlow
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MN, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MN, USA.
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Zhou P, Shao H, Zhao M, Yang X, Hao Z, Chen Z, Li S, Zhang P. Suspension fixation of iliac bone grafts under arthroscopy is an effective method for the treatment of unstable bony Bankart disease of the shoulder joint in patients with joint relaxation. Knee Surg Sports Traumatol Arthrosc 2022; 31:1925-1931. [PMID: 36040509 PMCID: PMC10089981 DOI: 10.1007/s00167-022-07127-8] [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: 05/11/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the results of arthroscopic autologous iliac bone graft suspension fixation combined with the Remplissage procedure in the treatment of recurrent shoulder dislocation with bony Bankart lesions and joint hyperlaxity. METHODS From 2018 to 2020, 22 patients with joint laxity underwent arthroscopic autologous iliac bone graft suspension fixation and Bankart repair combined with the Remplissage procedure due to recurrent shoulder dislocation. Clinical assessment included range of motion (forward flexion, abduction, 90° external rotation, conventional external rotation, adduction, and internal rotation), visual analog scale (VAS) score, Rowe score, University of California Los Angeles (UCLA) score, and Western Ontario Shoulder Instability Index (WOSI) score. Post-operatively, the healing of the bone graft was evaluated with computed tomography (CT) scanning. RESULTS All 22 patients were followed up for a mean of 19.3 ± 4.1 months. CT imaging showed that the healing time of the bone graft was 6-8 weeks. The patient satisfaction rate was 100%, there were no cases of redislocation, all patients returned to their preinjury training state, and the fear test was negative. At the final follow-up, the UCLA, VAS, Rowe, and WOSI scores were 29.8 ± 2.1, 2.2 ± 0.8, 89.4 ± 4.2, and 482.3 ± 46.2, respectively (p < 0.001). CONCLUSION Arthroscopic autologous iliac bone graft suspension fixation and Bankart repair combined with the Remplissage procedure are effective in preventing recurrent instability with joint hyperlaxity. Furthermore, no patient had redislocation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Peng Zhou
- Department of Sports Medicine, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu, China
| | - HongBin Shao
- Department of Sports Medicine, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu, China
| | - MaoSheng Zhao
- Department of Sports Medicine, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu, China
| | - XiaoJie Yang
- Department of Sports Medicine, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu, China
| | - Zuobin Hao
- Department of Hand Surgery, The Third People's Hospital of Jinan, Jinan, 250000, Shandong, China
| | - Zhao Chen
- The Third Department of Surgery, Qinghai Province Crops Hospital of Chinese People's Armed Police Forces, Xi'ning, 810000, China
| | - Shensong Li
- Department of Sports Medicine, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu, China.
| | - Peng Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China.
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Dzidzishvili L, Calvo C, Valencia M, Calvo E. Outcomes of Arthroscopic Latarjet Procedure for Anterior Glenohumeral Instability in Patients With Epilepsy: A Case-Control Study. Am J Sports Med 2022; 50:708-716. [PMID: 35020506 DOI: 10.1177/03635465211067531] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Unacceptably high rates of redislocation, reoperation, osteoarthritis, and coracoid nonunion have been reported in patients with a seizure disorder after surgery for shoulder instabilitiy. PURPOSE To evaluate the objective and subjective functional and radiologic results of the arthroscopic Latarjet procedure for anterior shoulder instability in patients with epilepsy and compare them with the results of patients without epilepsy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective and comparative case-control analysis of patients operated for shoulder instability with arthroscopic Latarjet was conducted. Nineteen patients (21 unstable shoulders) with a seizure disorder (epilepsy group) were matched with 21 patients without a history of seizure (control group). Demographics, surgical indications, and imaging data were collected. Clinical outcomes at a minimum 2 years of follow-up (range, 2-9 years) postoperatively included Rowe score, Western Ontario Shoulder Instability Index (WOSI), Constant-Murley Shoulder Outcome (CMSO) score, and Single Assessment Numeric Evaluation (SANE). The incidence of complications, recurrent instability, redislocation, revision surgery, repeated seizure(s), and presence of osteoarthritis, coracoid nonunion, and osteolysis were also examined. RESULTS After a mean follow-up of 4.5 years, no significant differences in functional results were found between patients with and without epilepsy on the average Rowe (P = .917), WOSI (P = .621), CMSO (P = .600), and SANE (P = .859) scores. A total of 5 patients (7 shoulders) continued to have seizures postoperatively, but no seizure-related glenohumeral instability was documented. One dislocation and 1 subluxation were documented while participating in sports in each study group, comprising a recurrence rate of 9.5%, but no significant differences were found at comparison (P = .605). A bone defect did not influence the results, as no significant difference was found between the 2 groups. Osteoarthritic changes of the glenohumeral joint were observed in 5 shoulders (23.8%) in the epilepsy group and in 3 (14.3%) in the control group (P = .451). No case of coracoid nonunion or osteolysis was recorded. There was no statistically significant difference in postoperative athletic activity (P = .660). However, patients with epilepsy had significantly lower pre- and postoperative sports participation (P < .001). CONCLUSION Arthroscopic Latarjet stabilization can lead to improved functional and subjective outcomes and should be considered in patients with epilepsy with recurrent anterior glenohumeral instability. These results can be achieved regardless of the presence of bone defect and the postoperative control of seizures and are similar to those in patients without epilepsy.
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Affiliation(s)
- Lika Dzidzishvili
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Claudio Calvo
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago De Chile, Chile
| | - María Valencia
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Königshausen M, Pätzholz S, Coulibaly M, Nicolas V, Vandemeulebroecke M, Schildhauer TA, Seybold D. Instability and results after non-operative treatment of large anterior glenoid rim fractures: is there a correlation between fragment size or displacement and recurrence? Arch Orthop Trauma Surg 2022; 142:2727-2738. [PMID: 34338888 PMCID: PMC9474463 DOI: 10.1007/s00402-021-04020-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/23/2021] [Indexed: 10/27/2022]
Abstract
INTRODUCTION There is little data available on non-operative treatment of anterior glenoid rim fractures (GRF). Nothing is known about fracture size and displacement in comparison to clinical outcomes and instability in a mainly middle-aged patient population. The aim of this study was to demonstrate the results of non-operative treatment in anterior glenoid rim fractures with the special focus on potential instability/recurrence. METHODS The inclusion criteria were non-operatively treated anterior GRF of at least ≥ 5 mm width using the age- and gender-matched Constant/Murley score (a.-/g.-CMS) and the Western Ontario Instability Index (WOSI). Radiographic parameters (fracture morphology, displacement, major tuberosity fractures and Hill-Sachs lesion using initial CT and radiographs) and the proportion of the fractured glenoid were detected (2D-CT-circle-method) and osteoarthritis (A.P. and axial radiographs) was classified according to Samilson/Prieto. Proportion of fractured glenoid and medial displacement were correlated with the recurrence rate and the clinical scores. RESULTS N = 36 patients could be followed-up after a mean of 4.4 years [12-140 month, average age: 58 (± 13, 33-86) years]. The a.-/g.-CMS was 93 (± 11, 61-100) points, and the WOSI was 81% (± 22%, 35-100%) on average. The mean intraarticular displacement was 4 mm (± 3 mm; 0-14 mm). The 2D-circle-method showed a mean glenoid fracture involvement of 21% (± 11, 10-52%). Two cases of frozen shoulders and one case with biceps pathology were associated with the trauma. Within the followed-up patient group re-instability has occurred in n = 2 patients (6%) within the first two weeks after trauma. Osteoarthritis was found in n = 11 cases. There was no correlation between the scores and the fracture size/displacement [(a.-/g.-CMS vs. displacement: r = - 0.08; p = 0.6; vs. size: r = - 0.29; p = 0.2); (WOSI vs. displacement: r = - 0.14; p = 0.4; vs. size: r = - 0.37; p = 0.06)], but very large (≥ 21%) fractures with displacement ≥ 4 mm showed slightly worse results without significant difference (a.-/g.-CMS p = 0.2; WOSI p = 0.2). The apprehension test was negative in all patients at final follow-up. CONCLUSION Non-operative treatment of anterior GRF was associated with overall good results within a mainly middle-aged larger patient group. Re-instability is rare and is not associated with fragment size but can occur in the first weeks after trauma. Size and dislocation of the fracture is not a criterion for the prognosis of potential instability. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Matthias Königshausen
- Department of General and Trauma Surgery, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Simon Pätzholz
- Department of Radiology and Interventional Radiology, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Marlon Coulibaly
- Department of General and Trauma Surgery, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Volkmar Nicolas
- Department of Radiology and Interventional Radiology, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Marc Vandemeulebroecke
- Biostatistical Sciences and Pharmacometrics, Novartis Pharma AG, Klybeckstrasse, 4057, Basel, Switzerland
| | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Dominik Seybold
- Department of General and Trauma Surgery, University Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
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Ferrando A, Aguilar J, Valencia M, Novo U, Calvo E. The Cartilage Wear Index: A new evaluation method to improve patient selection in surgical treatment of recurrent posterior glenohumeral instability. JSES Int 2022; 6:368-373. [PMID: 35572453 PMCID: PMC9091748 DOI: 10.1016/j.jseint.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background The purpose of this study was to validate glenoid cartilage lesions as a negative prognostic factor and to define a new image-based preoperative evaluation method to identify surgical candidates for arthroscopic labral refixation with suture anchors in posterior shoulder instability. Methods Twenty-six patients who underwent arthroscopic posterior labral repair for shoulder instability were evaluated. Only patients with structural dynamic posterior instability were included. We evaluated on preoperative magnetic resonance arthrogram: glenoid version, humeral head subluxation, type of capsular insertion, and the cartilage lesions using the new Cartilage Wear Index (CWI). Two subgroups were analyzed with regard to the preoperative CWI and shoulder outcome scores: Single Assessment Numerical Evaluation (SANE) and Western Ontario Shoulder Instability Index (WOSI). Results The median age at operation was 28 (interquartile range = 21-33) years. Median overall postoperative outcome assessment demonstrated a SANE of 90 and a WOSI of 385. The median CWI was 1.02. Subgroup analysis revealed worse median WOSI and SANE scores in patients with a CWI >1.02 and a strong correlation between a high preoperative CWI and a higher postoperative WOSI score (R = 0.58; P = .038). Conclusion The CWI can be useful to identify patients who might obtain better outcomes when treated with arthroscopic labral repair in posterior shoulder instability.
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Affiliation(s)
- Albert Ferrando
- Shoulder Unit, Hospital Universitari Sant Joan de Reus, Reus, Spain
- Corresponding author: Albert Ferrando, MD, PhD, Avinguda del Doctor Josep Laporte, 2, 43204 Reus, Tarragona, Spain.
| | - Juan Aguilar
- Shoulder and Elbow Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Maria Valencia
- Shoulder and Elbow Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ulrike Novo
- Musculoskeletal radiology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Emilio Calvo
- Shoulder and Elbow Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Calvo C, Calvo J, Rojas D, Valencia M, Calvo E. Clinical Relevance of Persistent Off-Track Hill-Sachs Lesion After Arthroscopic Latarjet Procedure. Am J Sports Med 2021; 49:2006-2012. [PMID: 34101519 DOI: 10.1177/03635465211019979] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Latarjet procedure is often used to address off-track Hill-Sachs lesions (OFF-HS) in shoulders with anterior instability. There are concerns as to whether the Latarjet procedure is able to convert all OFF-HS into on-track Hill-Sachs lesions (ON-HS) and whether this limitation could explain the cases of recurrent postoperative instability. HYPOTHESIS Latarjet surgery converts many preoperative OFF-HS lesions, but not all of them, and there is a difference in the failure rate between shoulders with converted lesions and those with persistent OFF-HS lesions. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients with anterior shoulder instability and an OFF-HS lesion treated with an arthroscopic classic Latarjet procedure between January 2010 and September 2017 were retrospectively evaluated. Patients with moderate or severe shoulder arthrosis, rotator cuff tears, or age older than 50 years were excluded. Glenoid track (GT), HS, HS interval (HSI), and the difference between HSI and GT (ΔHSI-GT) were measured preoperatively. A postoperative computed tomography scan and a clinical evaluation, including the Rowe and Western Ontario Shoulder Instability scores, were performed at a minimum 1- and 2-year follow-up, respectively. Postoperatively, 2 groups of patients were obtained: (1) patients with postoperative persistent OFF-HS; (2) patients with postoperative ON-HS. Clinical and imaging data were compared between the 2 groups. RESULTS A total of 51 patients (n = 51 shoulders), with a mean age of 29.8 ± 8.4 years (range, 15-50 years), met the inclusion criteria. Six shoulders (11.8%) still showed OFF-HS lesions despite Latarjet surgery. There were no postoperative dislocations, but 3 patients reported subluxations. The subluxation rate was significantly higher in the postoperative persistent OFF-HS group (2 [33%] vs 1 [2.2%]; P = .033). There was a wider preoperative HSI (29.8 ± 2.4 mm vs 22.9 ± 3.5 mm; P < .001) and a larger preoperative ΔHSI-GT (12.2 ± 3.8 mm vs 4.82 ± 3.2 mm; P < .001) in the persistent OFF-HS group. A receiver operating characteristic curve was performed based on preoperative ΔHSI-GT values. A preoperative ΔHSI-GT value ≥7.45 mm predicted a persistent OFF-HS after Latarjet surgery (sensitivity, 100%; specificity, 87%; positive predictive value, 50%; and negative predictive value, 100%). CONCLUSION Latarjet surgery converted many preoperative OFF-HS lesions into ON-HS lesions, but not all of them. Six patients (11.8%) retained an OFF-HS and had a statistically significantly higher failure rate after Latarjet surgery compared with those with postoperative ON-HS lesions. Because there were few postoperative OFF-HS lesions and few recurrences, findings are statistically fragile and should be confirmed with larger series.
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Affiliation(s)
- Claudio Calvo
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago De Chile, Chile
| | - Javier Calvo
- Hospital Universitario San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Daniel Rojas
- Department of Orthopaedic Surgery, Hospital Regional de Talca, Universidad Católica del Maule, Talca, Chile
| | - María Valencia
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Calvo E, Itoi E, Landreau P, Arce G, Yamamoto N, Ma J, Sparavalo S, Wong I. Anterior and posterior glenoid bone augmentation options for shoulder instability: state of the art. J ISAKOS 2021; 6:308-317. [PMID: 34145077 DOI: 10.1136/jisakos-2019-000413] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/24/2021] [Accepted: 04/08/2021] [Indexed: 11/04/2022]
Abstract
Bony lesions are highly prevalent in anterior shoulder instability and can be a significant cause of failure of stabilisation procedures if they are not adequately addressed. The glenoid track concept describes the dynamic interaction between the humeral head and glenoid defects in anterior shoulder instability. It has been beneficial for understanding the role played by bone defects in this entity. As a consequence, the popularity of glenoid augmentation procedures aimed to treat anterior glenoid bone defects; reconstructing the anatomy of the glenohumeral joint has risen sharply in the last decade. Although bone defects are less common in posterior instability, posterior bone block procedures can be indicated to treat not only posterior bony lesions, attritional posterior glenoid erosion or dysplasia but also normal or retroverted glenoids to provide an extended glenoid surface to increase the glenohumeral stability. The purpose of this review was to analyse the rationale, current indications and results of surgical techniques aimed to augment the glenoid surface in patients diagnosed of either anterior or posterior instability by assessing a thorough review of modern literature. Classical techniques such as Latarjet or free bone block procedures have proven to be effective in augmenting the glenoid surface and consequently achieving adequate shoulder stability with good clinical outcomes and early return to athletic activity. Innovations in surgical techniques have permitted to perform these procedures arthroscopically. Arthroscopy provides the theoretical advantages of lower morbidity and faster recovery, as well as the identification and treatment of concomitant pathologies.
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Affiliation(s)
- Emilio Calvo
- Department of Orthopaedic Surgery and Traumatology, Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz, Universidad Autonoma, Madrid, Spain
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | | | - Guillermo Arce
- Department of Orthopedic Surgery, Instituto Argentino de Diagnostico y Tratamiento (IADT), Buenos Aires, Argentina
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Jie Ma
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sara Sparavalo
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ivan Wong
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Laboute E, Hoffmann R, Bealu A, Ucay O, Verhaeghe E. Recurrence and return to sport after surgery for shoulder instability: arthroscopic Bankart versus Latarjet procedure. JSES Int 2021; 5:609-615. [PMID: 34223404 PMCID: PMC8245985 DOI: 10.1016/j.jseint.2021.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Surgeons differ in their preferences concerning the best surgical technique for treating shoulder instability in sportspeople. The purpose was to evaluate the risk of recurrence and the likelihood of return to sport for the 2 principal shoulder stabilization techniques used to treat shoulder instability in sportspeople. Methods We screened sportspeople who had undergone shoulder stabilization for inclusion in this cohort study. For eligibility, patients had to have undergone surgery by one of the 2 techniques: Latarjet or arthroscopic Bankart between 2005 and 2011, and aged from 18 to 35 years. We excluded acromioclavicular dislocation, tendinous lesion, global or posterior instability, bone fracture or severe glenoid bone loss, neurological lesion, other surgical technique, and orthopedic treatment. Patients were contacted by telephone between 2009 and 2012 and asked to participate in follow-up after surgery. The primary endpoint was recurrence, evaluated by determining frequency and time to recurrence (or censoring) with Cox models. The secondary endpoint was the return to sport (training and competition). Results Follow-up telephone interviews were conducted with 120 sportspeople (response rate of 61.5%), one of whom was excluded due to the occurrence of a new contralateral dislocation before returning to sport after surgery (Latarjet n = 80, Bankart n = 39). The risk of recurrence was significantly higher (P < .001) for Bankart (n = 7, 17.9%) than for Latarjet (n = 2, 2.5%) interventions. Being under the age of 20 years was a significant risk factor for recurrence (P = .007). Return to sport was significantly more frequent among sportspeople undergoing Latarjet procedures, for both training (P = .031) and competition (P = .038), and was also significantly more rapid for training (P = .034) with a mean time to return to training of 5.1 months for Latarjet procedures, versus 6.4 months for Bankart procedures. Conclusion The Latarjet surgical technique results in fewer recurrences than the Bankart technique, with a higher rate of return to sport (training, competition) and a faster return to training for sportspeople practicing potentially risky sports in competition. Age was also identified as an additional risk factor for recurrence. It is important to take these factors into account when considering the indications for surgery.
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Affiliation(s)
- Eric Laboute
- C.E.R.S., Groupe Ramsay Santé, Capbreton, France
| | | | - Alexia Bealu
- C.E.R.S., Groupe Ramsay Santé, Capbreton, France
| | - Olivier Ucay
- C.E.R.S., Groupe Ramsay Santé, Capbreton, France
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15
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Calvo E, Luengo G, Morcillo D, Foruria AM, Valencia M. Revision Arthroscopic Bankart Repair Versus Arthroscopic Latarjet for Failed Primary Arthroscopic Stabilization With Subcritical Bone Loss. Orthop J Sports Med 2021; 9:23259671211001809. [PMID: 34017877 PMCID: PMC8114265 DOI: 10.1177/23259671211001809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/12/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Limited evidence is available regarding the recommended technique of revision surgery for recurrent shoulder instability. Only 1 previous study has compared the results of soft tissue repair and the Latarjet technique in patients with persistent shoulder instability after primary surgical stabilization. Purpose/Hypothesis: To evaluate the results of revision surgery in patients with previous surgical stabilization failure and subcritical glenoid bone defects, comparing repeated Bankart repair versus arthroscopic Latarjet technique. The hypothesis was that Latarjet would be superior to soft tissue procedures in terms of objective and subjective functional scores, recurrence rates, and range of movement. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 45 patients (mean age, 29.1 ± 8.9 years) with subcritical bone loss (<15% of articular surface) who had undergone revision anterior shoulder instability repair after failed Bankart repair. Of these, 17 patients had arthroscopic Bankart repair and 28 had arthroscopic Latarjet surgery. Patients were evaluated at a minimum of 2 years postoperatively with the Rowe score, Western Ontario Shoulder Instability Index, and Subjective Shoulder Value. Subluxation or dislocation episodes were considered failures. Results: No statistically significant differences were found between groups in age, sex, sporting activity, preoperative Rowe score, or the presence of hyperlaxity or bony lesions. At revision arthroscopy, 20 shoulders showed a persistent Bankart lesion, 13 a medially healed labrum, and 6 a bony Bankart. In 6 patients, no abnormalities were present that could explain postoperative recurrence. In the Bankart repair group, 7 patients underwent isolated Bankart procedures; in the remaining 10 cases, a capsular shift was added. No significant differences were found between the Bankart and Latarjet groups in outcome scores, recurrence rate (11.8% vs 17.9%, respectively), or postoperative athletic activity level. The mean loss of passive external rotation at 0° and 90° of abduction was similar between groups. Conclusion: Arthroscopic Latarjet did not lead to superior results compared with repeated Bankart repair in patients with subcritical glenoid bone loss and recurrent anterior shoulder instability after Bankart repair.
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Affiliation(s)
- Emilio Calvo
- Department of Orthopaedic Surgery and Traumatology, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Gonzalo Luengo
- Department of Orthopaedic Surgery and Traumatology, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Diana Morcillo
- Department of Orthopaedic Surgery and Traumatology, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Antonio M Foruria
- Department of Orthopaedic Surgery and Traumatology, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - María Valencia
- Department of Orthopaedic Surgery and Traumatology, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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Alkaduhimi H, Connelly JW, van Deurzen DFP, Eygendaal D, van den Bekerom MPJ. High Variability of the Definition of Recurrent Glenohumeral Instability: An Analysis of the Current Literature by a Systematic Review. Arthrosc Sports Med Rehabil 2021; 3:e951-e966. [PMID: 34195665 PMCID: PMC8220632 DOI: 10.1016/j.asmr.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/11/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose To determine the definitions for recurrence used in the literature, assess the consensus in using these definitions, and determine the impact of these definitions on recurrence rates. Methods A literature search was performed in PubMed and EMBASE including studies from 2000 to 2020 reporting on recurrence rates after anterior arthroscopic shoulder instability surgery. Dislocation, apprehension, subluxation and recurrence rates were compared. Results Ninety-one studies were included. In 68% of the eligible studies, recurrence rates are not well defined. Thirty (33%) studies did not report on dislocations, 45 (49%) did not report on subluxations, and 58 (64%) did not report on apprehension. Seventeen different definitions for recurrence of instability, 4 definitions of dislocations, and 8 definitions of subluxation were used. Conclusion Recurrence rates are poorly specified and likely underreported in the literature, hampering comparison with results of other studies. This highlights the need for a consensus on definition of recurrence across shoulder instability studies. We recommend not using the definition recurrence of instability anymore. We endorse defining dislocations as a radiographically confirmed dislocation or a dislocation that is manually reduced, subluxations as the feeling of a dislocation that can be (spontaneously) reduced without the need for a radiographically confirmed dislocation, and a positive apprehension sign as fear of imminent dislocation when placing the arm in abduction and external rotation during physical examination. Reporting on the events resulting in a dislocation or subluxation aids in making an estimation of the severity of instability. Level of Evidence Level IV, systematic review.
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Affiliation(s)
| | - James W Connelly
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | | | - Denise Eygendaal
- Orthopaedic Department, Amphia Ziekenhuis, Breda, the Netherlands.,Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Michel P J van den Bekerom
- Shoulder and Elbow Unit, Joint Research, Amsterdam, the Netherlands.,Amsterdam University Medical Centres, Amsterdam, the Netherlands
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Housset V, Chevallier R, Nourissat G. Open Trillat Procedure for Recurrent Anterior Instability of the Shoulder in Elderly Patients. Arthrosc Tech 2021; 10:e1211-e1216. [PMID: 34141533 PMCID: PMC8185572 DOI: 10.1016/j.eats.2021.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/22/2021] [Indexed: 02/03/2023] Open
Abstract
Among the many different procedures available in the treatment of shoulder instability, the Trillat procedure remains indicated in case of recurrent shoulder instability in elderly patient with an irreparable cuff tear or in case of hyperlaxity. Despite the constantly increasing number of arthroscopic assisted techniques, the open procedure remains a simple, reliable and fast surgical procedure with a shorter learning curve than the arthroscopic techniques. It consists in a partial osteotomy of the anterior cortical of the coracoid process which is then tilted and fixed with a screw into the anterior part of the scapula downwards and medially to obtain a re-centering effect due to the conjoint tendon on the humeral head when rotational movement are applied. This article aims to present a stepwise approach for the open surgical technique.
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Affiliation(s)
- Victor Housset
- Address correspondence to Victor Housset, M.D., Clinique Maussins-Nollet, Sorbonne Université, Paris, France.
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Parvaresh KC, Vargas-Vila M, Bomar JD, Pennock AT. Anterior Glenohumeral Instability in the Adolescent Athlete. JBJS Rev 2021; 8:e0080. [PMID: 32015270 DOI: 10.2106/jbjs.rvw.19.00080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Glenohumeral instability is multifactorial and has both static and dynamic elements. The initial management of first-time dislocations has become increasingly controversial, although recent evidence supports operative treatment for adolescents who participate in contact sports. Risk factors for recurrent glenohumeral instability include adolescent age, hyperlaxity, glenoid bone loss, off-track Hill-Sachs lesions, and fixation with <=3 anchors. High rates of return to sport can be expected when the surgical plan is tailored to individual pathology.
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Affiliation(s)
| | | | | | - Andrew T Pennock
- University of California, San Diego, San Diego, California.,Rady Children's Hospital, San Diego, California
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Rosenberg SI, Padanilam SJ, Pagni BA, Tjong VK, Sheth U. A lower Instability Severity Index score threshold may better predict recurrent anterior shoulder instability after arthroscopic Bankart repair: a systematic review. J ISAKOS 2021; 6:295-301. [DOI: 10.1136/jisakos-2020-000584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/11/2020] [Accepted: 01/05/2021] [Indexed: 01/27/2023]
Abstract
ImportanceThe Instability Severity Index (ISI) score was developed to evaluate a patient’s risk of recurrent shoulder instability following arthroscopic Bankart repair. While patients with an ISI score of >6 were originally recommended to undergo an open procedure (ie, Latarjet) to minimise the risk of recurrence, recent literature has called into question the utility of the ISI score.ObjectiveThe purpose of this systematic review was to evaluate the efficacy of the ISI score as a tool to predict postoperative recurrence among patients undergoing arthroscopic Bankart procedures.Evidence reviewArticles were included if study participants underwent arthroscopic Bankart repair for anterior shoulder instability and reported postoperative recurrence by ISI score at a minimum of 2 years of follow-up. Methodological study quality was assessed using the Methodological Index for Non-Randomized Studies criteria. Pearson’s χ2 test was used to compare recurrence rates among patients above and below an ISI score of 4. Sensitivity, specificity, mean ISI scores and predictive value of individual factors of the ISI score were qualitatively reviewed.FindingsFour studies concluded the ISI score was effective in predicting postoperative recurrence following arthroscopic Bankart repair; however, these studies found threshold values lower than the previously proposed score of >6 may be more predictive of recurrent instability. A pooled analysis of these studies found patients with an ISI score <4 to experience significantly lower recurrence rates when compared with patients with a score ≥4 (6.3% vs 26.0%, p<0.0001). The mean ISI score among patients who experienced recurrent instability was also significantly higher than those who did not.Conclusions and relevanceThe ISI score as constructed by Balg and Boileau may have clinical utility to help predict recurrent anterior shoulder instability following arthroscopic Bankart repair. However, this review found the threshold values published in their seminal article to be insufficient predictors of recurrent instability. Instead, a lower score threshold may provide as a better predictor of failure. The paucity of level I and II investigations limits the strength of these conclusions, suggesting a need for further large, prospective studies evaluating the predictive ability of the ISI score.Level of evidenceIV.
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Verweij LPE, van Spanning SH, Grillo A, Kerkhoffs GMMJ, Priester-Vink S, van Deurzen DFP, van den Bekerom MPJ. Age, participation in competitive sports, bony lesions, ALPSA lesions, > 1 preoperative dislocations, surgical delay and ISIS score > 3 are risk factors for recurrence following arthroscopic Bankart repair: a systematic review and meta-analysis of 4584 shoulders. Knee Surg Sports Traumatol Arthrosc 2021; 29:4004-4014. [PMID: 34420117 PMCID: PMC8595227 DOI: 10.1007/s00167-021-06704-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/13/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Determining the risk of recurrent instability following an arthroscopic Bankart repair can be challenging, as numerous risk factors have been identified that might predispose recurrent instability. However, an overview with quantitative analysis of all available risk factors is lacking. Therefore, the aim of this systematic review is to identify risk factors that are associated with recurrence following an arthroscopic Bankart repair. METHODS Relevant studies were identified by searching PubMed, Embase/Ovid, Cochrane Database of Systematic Reviews/Wiley, Cochrane Central Register of Controlled Trials/Wiley, CINAHL/Ebsco, and Web of Science/Clarivate Analytics from inception up to November 12th 2020. Studies evaluating risk factors for recurrence following an arthroscopic Bankart repair with a minimal follow-up of 2 years were included. RESULTS Twenty-nine studies met the inclusion criteria and comprised a total of 4582 shoulders (4578 patients). Meta-analyses were feasible for 22 risk factors and demonstrated that age ≤ 20 years (RR = 2.02; P < 0.00001), age ≤ 30 years (RR = 2.62; P = 0.005), participation in competitive sports (RR = 2.40; P = 0.02), Hill-Sachs lesion (RR = 1.77; P = 0.0005), off-track Hill-Sachs lesion (RR = 3.24; P = 0.002), glenoid bone loss (RR = 2.38; P = 0.0001), ALPSA lesion (RR = 1.90; P = 0.03), > 1 preoperative dislocations (RR = 2.02; P = 0.03), > 6 months surgical delay (RR = 2.86; P < 0.0001), ISIS > 3 (RR = 3.28; P = 0.0007) and ISIS > 6 (RR = 4.88; P < 0.00001) were risk factors for recurrence. Male gender, an affected dominant arm, hyperlaxity, participation in contact and/or overhead sports, glenoid fracture, SLAP lesion with/without repair, rotator cuff tear, > 5 preoperative dislocations and using ≤ 2 anchors could not be confirmed as risk factors. In addition, no difference was observed between the age groups ≤ 20 and 21-30 years. CONCLUSION Meta-analyses demonstrated that age ≤ 20 years, age ≤ 30 years, participation in competitive sports, Hill-Sachs lesion, off-track Hill-Sachs lesion, glenoid bone loss, ALPSA lesion, > 1 preoperative dislocations, > 6 months surgical delay from first-time dislocation to surgery, ISIS > 3 and ISIS > 6 were risk factors for recurrence following an arthroscopic Bankart repair. These factors can assist clinicians in giving a proper advice regarding treatment. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Lukas P. E. Verweij
- Amsterdam UMC, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, Netherlands
| | - Sanne H. van Spanning
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands
| | - Adriano Grillo
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands
| | - Gino M. M. J. Kerkhoffs
- Amsterdam UMC, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, Netherlands
| | | | | | - Michel P. J. van den Bekerom
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands ,Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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21
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Storti TM, Lima RDA, Costa EDBES, Simionatto JE, Simionatto C, Paniago AF. Postoperative Evaluation of Patients Submitted to Arthroscopic Repair of Anterior Shoulder Instability. Rev Bras Ortop 2020; 55:339-346. [PMID: 32616980 PMCID: PMC7316536 DOI: 10.1055/s-0039-3402467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 02/05/2019] [Indexed: 11/24/2022] Open
Abstract
Objective
To clinically evaluate the results of patients undergoing arthroscopic surgical treatment of anterior shoulder instability.
Methods
A retrospective study of 94 patients. With a minimum follow-up of 24 months, we sought to correlate the characteristics of the patients and the surgery, such as age, gender, type of injury (traumatic or atraumatic) and the patient's position during surgery (lateral decubitus and beach chair) with the results obtained, the recurrence rate, the lateral rotation loss, the residual pain, and the functional scores of Carter-Rowe, University of California at Los Angeles (UCLA), and Constant-Murley.
Results
We observed a recurrent dislocation rate of 11.7%, lateral rotation loss in 37.23% of the patients, and some degree of residual pain in 51.6% of them. We obtained a mean Carter Rowe score of 85.37, representing 86% of good/excellent results. In the UCLA score, we obtained 88% of good/excellent results, similar to those obtained in the Constant-Murley score (86%).
Conclusion
The arthroscopic treatment of the anterior instability of the shoulder presents satisfactory results and low index of important complications, being the method of choice for most patients.
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Affiliation(s)
- Thiago Medeiros Storti
- Instituto do Ombro de Brasília, Brasília, DF, Brasil.,Grupo do Ombro, Instituto de Pesquisa e Ensino HOME (IPE HOME), Brasília, DF, Brasil
| | | | - Eloíse de Barros E Silva Costa
- Grupo do Ombro, Instituto de Pesquisa e Ensino HOME (IPE HOME), Brasília, DF, Brasil.,Departamento de Ortopedia, Centro Universitário de Brasília (UniCEUB), Brasília, DF, Brasil
| | | | | | - Alexandre Firmino Paniago
- Instituto do Ombro de Brasília, Brasília, DF, Brasil.,Grupo do Ombro, Instituto de Pesquisa e Ensino HOME (IPE HOME), Brasília, DF, Brasil
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22
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Shinagawa K, Sugawara Y, Hatta T, Yamamoto N, Tsuji I, Itoi E. Immobilization in External Rotation Reduces the Risk of Recurrence After Primary Anterior Shoulder Dislocation: A Meta-analysis. Orthop J Sports Med 2020; 8:2325967120925694. [PMID: 32596407 PMCID: PMC7297495 DOI: 10.1177/2325967120925694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/25/2019] [Indexed: 11/15/2022] Open
Abstract
Background The best method for nonsurgical treatment after primary dislocation of the shoulder is not clear. The efficacy of immobilization with the arm in external rotation (ER) compared with internal rotation (IR) remains controversial. Purpose To determine the efficacy of ER immobilization versus IR immobilization on recurrence rate after primary dislocation of the shoulder from the evidence of randomized controlled trials. Study Design Systematic review; Level of evidence, 2. Methods Electronic databases (MEDLINE [Ovid SP], PubMed, Web of Science, EBM reviews, and CINAHL) and available proceedings according to the abstracts of major international meetings related to or including shoulder injuries and trauma were used to search for randomized controlled trials. Two independent investigators determined eligibility and carried out data extraction from the selected studies. Results A total of 9 studies (817 patients) were selected for this meta-analysis. They included 668 male and 149 female patients, with a mean age ranging from 20.3 to 37.5 years. In the 9 pooled studies, the recurrence rate of shoulder dislocation was 21.5% (84/390) in the ER group versus 34.9% (130/373) in the IR group. ER immobilization significantly reduced the recurrence rate compared with IR immobilization (risk ratio, 0.56; P = .007). In the subgroup analysis of those immobilized full-time, ER immobilization was significantly more effective than IR immobilization in reducing the recurrence rate (risk ratio, 0.57; P = .01). In the subgroup analysis of age, ER immobilization was significantly more effective than IR immobilization in those aged 20 to 40 years but not in those younger than 20 years. Conclusion This meta-analysis demonstrates that ER immobilization reduces the recurrence rate after primary shoulder dislocation compared with IR immobilization in patients older than 20 years. When treating a patient with primary shoulder dislocation, the clinician should provide this information to the patient before a treatment method is selected.
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Affiliation(s)
- Kiyotsugu Shinagawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Yumi Sugawara
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
| | - Taku Hatta
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Ichiro Tsuji
- Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
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23
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Arthroscopic stabilisation for shoulder instability. J Clin Orthop Trauma 2020; 11:S402-S411. [PMID: 32523301 PMCID: PMC7275285 DOI: 10.1016/j.jcot.2019.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 12/11/2022] Open
Abstract
Since its first description over 30 years ago arthroscopic stabilisation has evolved. With improvements in knowledge, surgical techniques and materials technology, arthroscopic bankart repair has become the most widely used method for treating patients with symptomatic anterior shoulder instability. These procedures are typically performed in a younger, high demand patient population after a primary dislocation or to treat recurrent instability. A thorough clinical evaluation is required in the clinic setting not only to fully understand the injury pattern but also consider patient expectations prior to embarking on surgery. Diagnostic imaging will aid the clinician in determining the soft tissue pathology as well as assessing bone loss, which facilitates surgical decision-making. Selected patients may benefit from adjunctive procedures such as a remplissage for an "engaging" Hill-sachs lesion. This review will focus on the indications, pre-operative considerations, surgical techniques and outcomes of arthroscopic stabilisation.
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24
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Friedman LGM, Lafosse L, Garrigues GE. Global Perspectives on Management of Shoulder Instability: Decision Making and Treatment. Orthop Clin North Am 2020; 51:241-258. [PMID: 32138862 DOI: 10.1016/j.ocl.2019.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The glenohumeral joint is prone to instability. Patients with instability should have a physical examination. Imaging studies can provide additional information. Classification schemes that into account soft tissue pathology, neuromuscular control, bone loss, and activity level. An arthroscopic Bankart repair is the mainstay for unidirectional instability. Bone block procedures are indicated for patients with bone loss or a failed attempt at stabilization surgery. The arthroscopic Latarjet is a promising option for these patients. For patients with multidirectional instability, prolonged rehabilitation is indicated, followed by capsular plication or inferior capsular shift if instability is unresponsive to physical therapy.
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Affiliation(s)
- Lisa G M Friedman
- Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 West Harrison Street, Chicago, IL 60612, USA.
| | - Laurent Lafosse
- Clinique Générale, Alps Surgery Institute, 4 Chemin de la Tour la Reine, 74000 Annecy, France
| | - Grant E Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 West Harrison Street, Chicago, IL 60612, USA. https://twitter.com/Grant_Garrigues
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25
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Panzram B, Kentar Y, Maier M, Bruckner T, Hetto P, Zeifang F. Mid-term to long-term results of primary arthroscopic Bankart repair for traumatic anterior shoulder instability: a retrospective study. BMC Musculoskelet Disord 2020; 21:191. [PMID: 32220253 PMCID: PMC7102425 DOI: 10.1186/s12891-020-03223-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 03/19/2020] [Indexed: 01/26/2023] Open
Abstract
Background The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. The aim of the study is to determine the mid−/long-term functional outcome, failure rates and predictors of failure after primary arthroscopic Bankart repair for traumatic anterior shoulder instability. Methods A total of 100 patients were primarily operated using arthroscopic Bankart repair after traumatic anterior shoulder instability. Medical records were retrospectively reviewed, and patients were assessed using postal questionnaire after a mean follow-up of 8.3 years [3–14]. Clinical assessment was performed using Constant score, Rowe score, and American Shoulder and Elbow Surgeons score. Results The overall recurrence rate was 22%. The Kaplan-Meier failure-free survival estimates. were 80% at 5 years and 70% at 10 years. Nearly half (54.5%) of recurrences occurred at 2 years postoperative. Compared with normal shoulder, there were statistical differences in all 3 scores. Failure rate was significantly affected by age at the time of surgery with 86% of recurrence cases observed in patients aged 30 years or younger. Nevertheless, Younger age at the time of surgery (P = 0.007) as well age at the time of initial instability (P = 0.03) was found to correlate negatively with early recurrence within 2 years of surgery. Among those with recurrent instability, recurrence rate was found to be higher if there had been more than 5 instability episodes preoperatively (P = 0.01). Return to the preinjury sport and occupational level was possible in 41 and 78%, respectively. Conclusion Failure-free survival rates dropped dramatically over time. Alternative reconstruction techniques should be considered in those aged ≤30 years due to the high recurrence rate.
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Affiliation(s)
- Benjamin Panzram
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany. .,Heidelberg University Hospital, Clinic for Orthopaedics and Trauma Surgery, Schlierbacher Landstraße 200A, 69118, Heidelberg, Germany.
| | - Yasser Kentar
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Michael Maier
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Pit Hetto
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
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26
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Valencia M, Fernández-Bermejo G, Martín-Ríos MD, Fernández-Jara J, Morcillo-Barrenechea D, Coifman-Lucena I, Foruria AM, Calvo E. Subscapularis structural integrity and function after arthroscopic Latarjet procedure at a minimum 2-year follow-up. J Shoulder Elbow Surg 2020; 29:104-112. [PMID: 31409562 DOI: 10.1016/j.jse.2019.05.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Subscapularis function after arthroscopic Bankart repair has been widely studied. However, data regarding subscapularis performance after arthroscopic Latarjet procedures are lacking. This study aimed to evaluate subscapularis clinical and radiologic performance after arthroscopic Latarjet procedures. METHODS We included 40 patients who underwent arthroscopic Latarjet procedure with a minimum 2-year follow-up. Clinical evaluation included Western Ontario Shoulder Instability Index and Rowe scores, specific subscapularis isokinetic study, and lift-off tests. Contralateral measurements were used for comparison. Computed tomographic evaluation included graft consolidation, muscle dimensions, and degree of fatty atrophy, calculated as the mean muscle attenuation (MMA). RESULTS There was a decrease of 8.3% of maximum internal rotation peak torque in the operated arm (P = .02). However, there was no significant difference in the agonist-antagonist ratio: 76.9% in the operated arm and 76% in the contralateral (P = .82). Lift-off strength test demonstrated a decrease in the first year but not at final follow-up (P = .38). There was a significant decrease in lift-off distance of 23% compared to the contralateral side (P < .001). Subscapularis MMA was diminished when compared to the infraspinatus/teres minor (P < .001) at the expense of its upper part (P = .03). Hyperlaxity and number of dislocation episodes were correlated to a lower MMA (P = .046 and P = .005). CONCLUSION Arthroscopic Latarjet procedures provide satisfactory clinical results. There seems to be a diminished subscapularis MMA depending on its superior half. Hyperlaxity and number of previous dislocations were correlated to a lower MMA. Although there was a decrease in the maximum internal rotation peak torque, we did not find any difference in the agonist-antagonist ratio or in the final lift-off strength between sides.
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Affiliation(s)
- María Valencia
- Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Gloria Fernández-Bermejo
- Physical Medicine and Rehabilitation Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - María D Martín-Ríos
- Department of Epidemiology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Javier Fernández-Jara
- Musculoskeletal Radiology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Diana Morcillo-Barrenechea
- Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ismael Coifman-Lucena
- Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Antonio M Foruria
- Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Emilio Calvo
- Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
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27
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Oh JH, Shin SJ, Cho CH, Seo HJ, Park JS, Rhee YG. Reliability of the Instability Severity Index Score as a Predictor of Recurrence after Arthroscopic Anterior Capsulolabral Reconstruction: A Multicenter Retrospective Study. Clin Orthop Surg 2019; 11:445-452. [PMID: 31788168 PMCID: PMC6867924 DOI: 10.4055/cios.2019.11.4.445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background Although the instability severity index score (ISIS) is widely used to predict recurrence after arthroscopic anterior instability surgery, its reliability, especially on the weightings and cutoff values, is questionable. The goal of the current retrospective study was to investigate recurrence after arthroscopic capsulolabral reconstruction to evaluate whether each domain of the ISIS has the appropriate predictive power for recurrence by using logistic regression analyses with odds ratios (ORs). Methods This study included 120 consecutive patients who underwent arthroscopic capsulolabral reconstruction between 2004 and 2016. We retrospectively reviewed patients' preoperative history and radiographs, postoperative recurrence or sensation of instability, and risk factors related to the ISIS. The mean postoperative follow-up was 27.6 months (range, 12 to 96 months; median, 21 months). Twenty-six patients with recurrence or positive apprehension were classified as the recurrence group; 94 patients without any symptoms were classified as the non-recurrence group. Logistic regression analyses with ORs were used to verify the utility of each domain of the ISIS for predicting recurrence. Results The mean ISIS did not differ significantly between the recurrence and non-recurrence groups (4.3 ± 1.8 vs. 3.4 ± 2.1 points; p = 0.063). Among the domains of ISIS, factors related to bone defects, the presence of a Hill-Sachs lesion and glenoid bone loss had the lowest ORs (0.77 and 0.38, respectively). Conclusions Not all ISIS domains accurately predicted recurrence after arthroscopic capsulolabral reconstruction. The ISIS may not be a proper reference for determining Latarjet procedure in patients with anterior shoulder instability.
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Affiliation(s)
- Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Jin Shin
- Department of Orthopaedic Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - Chul-Hyun Cho
- Department of Orthopaedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Hyuk Jun Seo
- Department of Orthopaedic Surgery, Daegu Chamtntn Hospital, Daegu, Korea
| | - Ji Soon Park
- Department of Orthopaedic Surgery, Sheikh Khalifa Specialty Hospital, Ras al Khaimah, United Arab Emirates
| | - Yong Girl Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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28
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Arenas-Miquelez A, Karargyris O, Zumstein M. All-Arthroscopic, 270° Reconstruction of the Inferior Glenohumeral Ligament With Palmaris Longus Autograft. Arthrosc Tech 2019; 8:e1145-e1151. [PMID: 31921588 PMCID: PMC6948136 DOI: 10.1016/j.eats.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/08/2019] [Indexed: 02/03/2023] Open
Abstract
Numerous factors play a role in anterior shoulder stability. The inferior glenohumeral ligament, especially the anterior band, is the main passive anterior stabilizer in the end range of motion. Surgical treatment of this pathology continues to be a challenge in patients with capsular deficiency, in whom the recurrence rate of soft-tissue arthroscopic repair increases significantly. There is not yet a fair solution for these patients without glenoid bone loss, in whom the poor tissue quality determines recurrent instability. We present an all-arthroscopic technique for reconstruction of the inferior glenohumeral ligament by means of palmaris longus autograft as an alternative to nonanatomic bone block procedures.
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Affiliation(s)
| | | | - Matthias Zumstein
- Address correspondence to Matthias Zumstein, M.D., Shoulder and Elbow Division, Orthopaedics Department, Inselspital, Universitätsspital Bern, Freiburgstrasse, Bern CH-3010, Switzerland.
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29
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Carlson Strother CR, McLaughlin RJ, Krych AJ, Sanchez-Sotelo J, Camp CL. Open Shoulder Stabilization for Instability: Anterior Labral Repair With Capsular Shift. Arthrosc Tech 2019; 8:e749-e754. [PMID: 31485402 PMCID: PMC6714345 DOI: 10.1016/j.eats.2019.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/10/2019] [Indexed: 02/07/2023] Open
Abstract
Although anterior shoulder instability is most commonly treated with arthroscopic fixation, open labral repair with capsular shift may be best for select patients and in cases of revision stabilization without significant bone loss. The technique described in this article uses the deltopectoral interval; it involves careful dissection of the subscapularis from the anterior capsule, repair of the Bankart lesion, and a lateral and superior capsular shift using all-suture anchors in the humeral head. Advantages of this technique include meticulous control of anchor placement and the ability to provide additional stability via a lateral and superiorly directed capsular shift. This operation can be performed in a reliable, efficient, and reproducible manner.
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Affiliation(s)
| | | | | | | | - Christopher L. Camp
- Address correspondence to Christopher L. Camp, M.D., Mayo Clinic, 200 1st St SW, Rochester, MN 55905, U.S.A.
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30
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Bishop JY, Hidden KA, Jones GL, Hettrich CM, Wolf BR, Bollier M, Bravman J, McCarty EC, Brophy RH, Smith MV, Wright RW, Cox C, Kuhn J, Feely B, Ma CB, Zhang A, Grant J, Miller B, Marx RG. Factors Influencing Surgeon's Choice of Procedure for Anterior Shoulder Instability: A Multicenter Prospective Cohort Study. Arthroscopy 2019; 35:2014-2025. [PMID: 31208919 DOI: 10.1016/j.arthro.2019.02.035] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/15/2019] [Accepted: 02/17/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate preoperative factors associated with selection of surgical treatment for anterior shoulder instability. METHODS Patient demographics, initial physical examinations, and patient-oriented outcome questionnaires were collected prospectively from 26 shoulder surgeons at 10 sites. Symptom duration, number of dislocations, sport, history of prior stabilization procedure, Hill-Sachs/glenoid bone loss, pain level, and failure of conservative treatment were recorded. Statistical analysis was performed with Fisher's exact test and logistic regression analysis. RESULTS A total of 564 patients who underwent surgical treatment for anterior shoulder instability from November 2012 to June 2017 were enrolled. Of these, 426 shoulders underwent arthroscopic stabilization alone, 38 underwent arthroscopic stabilization with remplissage, 28 underwent open Bankart repair, and 72 underwent a Latarjet procedure. Predictors for undergoing Latarjet (P < .003) were symptom duration (75% had symptoms for >1 year), number of dislocations (47% had >5 dislocations), revision surgery (69%), Hill-Sachs lesion size (45% had a lesion between 11% and 20% of the humeral head), and glenoid bone loss (75% of Latarjet patients had 11% to 30% loss). Predictors for undergoing open Bankart repair (P < .001) were number of dislocations (32% had >5 dislocations), revision surgeries (54%), and glenoid bone loss (11% of open Bankart patients had 11% to 20% loss). History of prior shoulder surgery was the only significant predictor of open versus arthroscopic Bankart procedure. Prediction models showed athletes involved in high-risk sports were 2.61 times more likely to have a Latarjet (P < .01). CONCLUSIONS Indications for the Latarjet were: humeral and glenoid bone loss, duration of symptoms, number of dislocations, and revision stabilizations. Athletes involved in high-risk sports were more likely to undergo the Latarjet procedure, even if other predictive factors were not present. The open Bankart procedure was the least common procedure performed, with a history of prior shoulder surgery being the only predictor for use when treating recurrent instability. LEVEL OF EVIDENCE Level II, prospective prognostic cohort investigation.
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Affiliation(s)
- Julie Y Bishop
- The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A..
| | - Krystin A Hidden
- The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Grant L Jones
- The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
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31
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Chan AG, Kilcoyne KG, Chan S, Dickens JF, Waterman BR. Evaluation of the Instability Severity Index score in predicting failure following arthroscopic Bankart surgery in an active military population. J Shoulder Elbow Surg 2019; 28:e156-e163. [PMID: 30685274 DOI: 10.1016/j.jse.2018.11.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/02/2018] [Accepted: 11/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Instability Severity Index (ISI) score is a preoperative risk stratification tool used to identify patients at heightened risk of recurrent anterior instability after an arthroscopic Bankart procedure. The primary objective of this study was to validate the utility of the ISI score in predicting failure of primary arthroscopic Bankart surgery in an active-duty military population. METHODS A retrospective study was performed to compare all military service members undergoing primary arthroscopic Bankart repairs at a single military treatment facility between 2007 and 2014. The primary outcome of interest was surgical failure due to recurrent instability. The ISI framework was used to stratify each patient for recurrence, and multivariate analysis was performed to evaluate the composite ISI score and individual domains between patients with and patients without failed Bankart repairs. RESULTS A total of 131 patients were identified, with a mean patient age of 26.8 years (range, 19-47 years), among whom 42 patients (32%) were identified as having a higher-demand military occupation. At a minimum 2-year follow-up, 34 patients (26%) sustained recurrent anterior shoulder instability. The mean ISI score of patients in the failed Bankart repair group was not statistically different than that of patients with a successful repair (3.41 vs 3.5, P = .74), and no individual ISI domains were identified as independent risk factors for subsequent surgical failure or revision stabilization. CONCLUSION Contrary to the findings of previous validation studies, the composite ISI score and its individual risk factors were not predictive of subsequent surgical failure after primary arthroscopic Bankart repair in an active military population.
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Affiliation(s)
- Andrew G Chan
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA.
| | - Kelly G Kilcoyne
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Stephen Chan
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Jonathan F Dickens
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Brian R Waterman
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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32
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Olds MK, Ellis R, Parmar P, Kersten P. Who will redislocate his/her shoulder? Predicting recurrent instability following a first traumatic anterior shoulder dislocation. BMJ Open Sport Exerc Med 2019; 5:e000447. [PMID: 30899544 PMCID: PMC6407568 DOI: 10.1136/bmjsem-2018-000447] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2019] [Indexed: 11/14/2022] Open
Abstract
Objective To develop a multivariate tool that would predict recurrent instability after a first-time traumatic anterior shoulder dislocation. Methods Participants (aged 16–40 years) were recruited across New Zealand into a prospective cohort study. Baseline data were collected during a telephone interview and through examination of radiology records. Variables associated with recurrent instability were selected for the multivariate logistic regression model using backwards selection (p<0.10). Coefficients for those variables retained in the model were used to develop the predictive tool. Results Among the 128 participants, 36% had redislocated at least once in the first 12 months. Univariate analysis showed an increased likelihood of recurrent dislocation with bony Bankart lesions (OR=3.65, 95% CI 1.05 to 12.70, p=0.04) and participants who had: not been immobilised in a sling (OR = 0.38, 95% CI 0.15 to 0.98, p=0.05), higher levels of shoulder activity (OR=1.13, 95% CI 1.01 to 1.27, p=0.03), higher levels of pain and disability (OR=1.03, 95% CI 1.01 to 1.06, p=0.02), higher levels of fear of reinjury (OR=1.12, 95% CI 1.01 to 1.26, p=0.04) and decreased quality of life (OR=1.01, 95% CI 1.00 to 1.02, p=0.05). There was no significant difference in those with non-dominant compared with dominant shoulder dislocations (p=0.10) or in those aged 16–25 years compared with 26–40 years (p=0.07). Conclusion Six of seven physical and psychosocial factors can be used to predict recurrent shoulder instability following a first-time traumatic anterior shoulder dislocation.
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Affiliation(s)
| | - Richard Ellis
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Priya Parmar
- Department of Biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand
| | - Paula Kersten
- School of Health Sciences, University of Brighton, Brighton, UK
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Haeni DL, Lafosse T, Haggerty C, Plath J, Kida Y, Sanchez-Brass M, Wolf F, Calvo E, Müller AM, Barbero A, Lafosse L. Tissue on the Transferred Coracoid Graft After Latarjet Procedure: Histological and Morphological Findings. Am J Sports Med 2019; 47:704-712. [PMID: 30716278 DOI: 10.1177/0363546518819825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior shoulder instability is a debilitating condition that can require stabilization via a Latarjet procedure. PURPOSE The aim of this study was to characterize the histological composition of the articular-sided surface of the coracoid bone graft after Latarjet procedure. Specific features of cells isolated from the coracoid and graft tissues were assessed. STUDY DESIGN Case series; Level of evidence, 4. METHODS Tissue samples were harvested from 9 consecutive patients undergoing arthroscopic debridement and screw removal after arthroscopic or open Latarjet procedure. Tissues were processed histologically. In 2 patients, the samples were analyzed to assess specific cellular properties. RESULTS Safranin O staining indicated that glenoid tissues contained variable amounts of glycosaminoglycan (GAG) and round chondrocytic cells mainly organized in clusters. Graft tissues contained less GAG and were more cellular but were not organized in clusters and had variable morphological features. An association appeared to exist between the cartilage quality of glenoid tissues and that of the graft tissues. Cells isolated from glenoid and graft tissues exhibited similar proliferation capacity. CONCLUSION The results of our analysis show that cells located at the articular-sided surface of transferred coracoid grafts demonstrate fibrocartilaginous properties and may have the capacity for chondral proliferation. Further studies are needed to confirm this observation and future application.
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Affiliation(s)
- David L Haeni
- Orthopaedic Department, Children's Hospital, University of Basel, Basel, Switzerland
| | | | | | | | - Yoshikazu Kida
- Pioneer Peek Orthopedics, Palmer, Alaska, USA.,Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Françine Wolf
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Emilio Calvo
- Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, Madrid, Spain
| | - Andreas M Müller
- Orthopaedic Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andrea Barbero
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
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Cagle PJ, Olujimi V, Parsons BO. Arthroscopic Treatment of Labral Tears: A Critical Analysis Review. JBJS Rev 2018; 6:e4. [PMID: 29634588 DOI: 10.2106/jbjs.rvw.17.00081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Paul J Cagle
- Leni & Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY
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35
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Ciccotti MC, Syed U, Hoffman R, Abboud JA, Ciccotti MG, Freedman KB. Return to Play Criteria Following Surgical Stabilization for Traumatic Anterior Shoulder Instability: A Systematic Review. Arthroscopy 2018; 34:903-913. [PMID: 29146162 DOI: 10.1016/j.arthro.2017.08.293] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 08/23/2017] [Accepted: 08/28/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify and describe in the existing literature any criteria used for return to play following surgical stabilization for traumatic, anterior shoulder instability. METHODS We performed a systematic review evaluating surgical stabilization for primary traumatic anterior shoulder instability in skeletally mature patients with a minimum of 1-year follow-up using Level I to IV studies in PubMed and EMBASE from January 1994 to January 2017. RESULTS Fifty-eight studies with at least 1 explicitly stated criterion for return to play were identified from a review of more than 5,100 published articles. Seven different categories of return to play criteria were identified, the most common of which were time from surgery (89.6%), strength (18.9%), and range of motion (13.8%). Pain, stability, proprioception, and postoperative radiographic evaluation were also used. As hypothesized, in 75.8% of the included studies (44/58), time was the only criterion explicitly used. The most commonly used time for return to play was 6 months. CONCLUSIONS This systematic review identifies 7 criteria that have been used in the available literature to determine when patients are ready to return to play; however, consistent with our hypothesis, 75% of studies used time from surgery as the sole listed criterion, with the most commonly used time point of 6 months postoperative. All of these criteria can be used in future research to develop a comprehensive checklist of functional criteria in hopes of reducing recurrent injury. LEVEL OF EVIDENCE Level IV, systematic review.
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Affiliation(s)
| | - Usman Syed
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Ryan Hoffman
- Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Joseph A Abboud
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Michael G Ciccotti
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Kevin B Freedman
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A..
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36
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Olszewski N, Gustin M, Curry EJ, Li X. Management of Complex Anterior Shoulder Instability: a Case-Based Approach. Curr Rev Musculoskelet Med 2017; 10:480-490. [PMID: 28988351 PMCID: PMC5685960 DOI: 10.1007/s12178-017-9438-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF THE REVIEW The goal of this review is to provide a guide on surgical decision-making options for complex anterior shoulder instability using a case-based approach. RECENT FINDINGS Arthroscopic Bankart repair is well documented for having successful outcomes in patients with isolated labral tear involvement with minimal bone loss. Latarjet is a generally accepted procedure in patients with 20-30% glenoid bone loss. When bone loss exceeds that which cannot be managed through Latarjet, a range of options exist and are highly dependent upon the extent of osseous deficiency on both the glenoid and humeral sides, surgeon experience, and patient-specific factors. The use of reverse total shoulder arthroplasty for the management of chronic locked shoulder dislocations has been described as a successful management option. Treatment options for complex anterior shoulder instability range widely based on patients' presenting exam, surgical history, amount of glenoid bone loss, size of Hill-Sachs lesion, and surgeon preference. When selecting the appropriate surgical intervention, the treating surgeon must consider the patient history, physical exam, and preoperative imaging along with patient expectations.
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Affiliation(s)
- Nathan Olszewski
- Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Michael Gustin
- Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Emily J Curry
- Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Xinning Li
- Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, MA, 02118, USA.
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37
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IKEMOTO ROBERTOYUKIO, MURACHOVSKY JOEL, NASCIMENTO LUISGUSTAVOPRATA, BUENO ROGERIOSERPONE, ALMEIDA LUIZHENRIQUEOLIVEIRA, KOJIMA CLAUDIO. EVALUATION OF SURGICAL TREATMENT OF PATIENTS WITH SHOULDER INSTABILITY. ACTA ORTOPEDICA BRASILEIRA 2017; 25:266-269. [PMID: 29375257 PMCID: PMC5782861 DOI: 10.1590/1413-785220172506166548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the results of arthroscopic surgery in patients with traumatic anterior shoulder dislocation. METHODS This retrospective study analyzed 76 patients with a mean age of 28 and mean postoperative follow-up period of 62 months. Evaluation consisted of physical examination, and X-rays; results were classified according to the UCLA and Rowe scales. RESULTS Patients showed decrease of range of motion in all planes, except elevation and lateral rotation with 90º abduction. According to the Rowe score, significant postoperative improvement was found compared with preoperative evaluations, with 89.4% of satisfactory results. According to the UCLA score, good or excellent results were observed in 97.4% of the cases. We found a 6.5% rate of recurrence. CONCLUSION Arthroscopic treatment for traumatic anterior shoulder dislocation is effective, as long as indications are used. Level of Evidence IV, Case Series.
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38
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Knapik DM, Gillespie RJ, Salata MJ, Voos JE. Prevalence and Impact of Glenoid Augmentation in American Football Athletes Participating in the National Football League Scouting Combine. Orthop J Sports Med 2017; 5:2325967117722945. [PMID: 28840148 PMCID: PMC5555500 DOI: 10.1177/2325967117722945] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Bony augmentation of the anterior glenoid is used in athletes with recurrent shoulder instability and bone loss; however, the prevalence and impact of repair in elite American football athletes are unknown. Purpose: To evaluate the prevalence and impact of glenoid augmentation in athletes invited to the National Football League (NFL) Scouting Combine from 2012 to 2015. Study Design: Case series; Level of evidence, 4. Methods: A total of 1311 athletes invited to the NFL Combine from 2012 to 2015 were evaluated for history of either Bristow or Latarjet surgery for recurrent anterior shoulder instability. Athlete demographics, surgical history, imaging, and physical examination results were recorded using the NFL Combine database. Prospective participation data with regard to draft status, games played, games started, and status after the athletes’ first season in the NFL were gathered using publicly available databases. Results: Surgical repair was performed on 10 shoulders in 10 athletes (0.76%), with the highest prevalence in defensive backs (30%; n = 3). Deficits in shoulder motion were exhibited in 70% (n = 7) of athletes, while 40% (n = 4) had evidence of mild glenohumeral arthritis and 80% demonstrated imaging findings consistent with a prior instability episode (8 labral tears, 2 Hill-Sachs lesions). Prospectively, 40% (n = 4) of athletes were drafted into the NFL. In the first season after the combine, athletes with a history of glenoid augmentation were not found to be at significant risk for diminished participation with regard to games played or started when compared with athletes with no history of glenoid augmentation or athletes undergoing isolated shoulder soft tissue repair. After the conclusion of the first NFL season, 60% (n = 6 athletes) were on an active NFL roster. Conclusion: Despite being drafted at a lower rate than their peers, there were no significant limitations in NFL participation for athletes with a history of glenoid augmentation when compared with athletes without a history of shoulder surgery or those with isolated soft tissue shoulder repair. Glenohumeral arthritis and advanced imaging findings of labral tearing and Hill-Sachs lesions in elite American football players with a history of glenoid augmentation did not significantly affect NFL participation 1 year after the combine.
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Affiliation(s)
- Derrick M Knapik
- University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA
| | | | - Michael J Salata
- University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA
| | - James E Voos
- University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA
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Lavery KP, McHale KJ, Rossy WH, Sanchez G, Provencher MT. Bony Augmentation for Anterior and Posterior Glenohumeral Instability in the Contact Athlete. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2016.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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40
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Burns DM, Chahal J, Shahrokhi S, Henry P, Wasserstein D, Whyne C, Theodoropoulos J, Ogilvie-Harris D, Dwyer T. Diagnosis of Engaging Bipolar Bone Defects in the Shoulder Using 2-Dimensional Computed Tomography: A Cadaveric Study. Am J Sports Med 2016; 44:2771-2777. [PMID: 27496905 DOI: 10.1177/0363546516655797] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anatomic studies have demonstrated that bipolar glenoid and humeral bone loss have a cumulative effect on shoulder instability and that these defects may engage in functional positions depending on their size and location, potentially resulting in failure of stabilization procedures. Determining which lesions pose a risk for engagement remains challenging, with arthroscopic assessments and a 3-dimensional computed tomography (CT)-based glenoid track method being accepted approaches at this time. PURPOSE The purpose was to investigate the interaction of humeral and glenoid bone defects on shoulder engagement in a cadaveric model. Two alternative approaches to predicting engagement were evaluated: (1) CT of the shoulder in abduction and external rotation (ABER) and (2) measurement of the glenoid lesion width and measurement of a novel parameter, the intact anterior articular angle (IAAA), on conventional 2-dimensional multiplane reformats. STUDY DESIGN Controlled laboratory study. METHODS Hill-Sachs and glenoid defects of varying sizes were created in 12 cadaveric upper limbs, producing 45 bipolar defect combinations. The defect characteristics were assessed using CT with the shoulder in a neutral position. ABER CT was performed with the shoulder positioned in 60° of glenohumeral abduction (corresponding to 90° of abduction relative to the trunk) and 90° of external rotation. The IAAA was measured as the cartilage arc angle anterior to the Hill-Sachs defect on the axial slice bisecting the humeral head. The performance of the ABER CT and IAAA approaches to predicting engagement were compared with the glenoid track method. RESULTS Of the 45 defect combinations, 24 (53%) were classified as engaging using the glenoid track method. ABER CT predicted engagement accurately in 43 of 45 (96%), with a sensitivity and specificity of 92% and 100%, respectively. A logistic model based on the glenoid defect width and IAAA provided a prediction accuracy of 87%, with a sensitivity and specificity of 92% and 81%, respectively. CONCLUSION/CLINICAL RELEVANCE Bipolar lesions at risk for engagement can be identified accurately using an ABER CT scan or by performing 2-dimensional measurements of the glenoid defect width and IAAA on conventional CT multiplane reformats. This information will be useful for surgical planning in the setting of bipolar bone defects before shoulder stabilization.
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Affiliation(s)
- David M Burns
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jaskarndip Chahal
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Orthopedic Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - Shahram Shahrokhi
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Orthopedic Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Henry
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Orthopedic Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - David Wasserstein
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Orthopedic Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Cari Whyne
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - John Theodoropoulos
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Orthopedic Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - Darrell Ogilvie-Harris
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Orthopedic Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - Tim Dwyer
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Orthopedic Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
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41
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Luo TD, Poehling GG, Freehill MT. Review of Arciero's article (1994) on arthroscopic Bankart repair versus non-operative treatment for acute, initial anterior shoulder dislocations: does the same hold true in 2016? J ISAKOS 2016. [DOI: 10.1136/jisakos-2016-000091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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42
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Milchteim C, Tucker SA, Nye DD, Lamour RJ, Liu W, Andrews JR, Ostrander RV. Outcomes of Bankart Repairs Using Modern Arthroscopic Technique in an Athletic Population. Arthroscopy 2016; 32:1263-70. [PMID: 27039965 DOI: 10.1016/j.arthro.2016.01.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 11/07/2015] [Accepted: 01/13/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To report a large number of highly active patients who underwent arthroscopic Bankart repair at our institution over the last decade. METHODS A retrospective analysis of patients who underwent primary and revision arthroscopic Bankart repairs using bioabsorbable anchors was performed. Outcome measures included recurrence of dislocation, American Shoulder and Elbow Scores (ASES), Rowe, visual analog scale (VAS), return to sports, and satisfaction scores. RESULTS A total of 94 shoulders met the inclusion criteria. The recurrence rate was 6/94 (6.4%) at a mean follow-up of 5 years (range, 3 to 8.3). The mean postoperative scores were as follows: ASES = 91.5/100; Rowe = 84.3/100; VAS = 0.8/10; satisfaction = 8.8/10. In those who attempted to return to sports, 82.5% were able to return to the same level of competition. Statistical analyses revealed a significant increase in risk of recurrence among high school and recreational athletes. No recurrences were observed among professional or college-level athletes. No significant difference in recurrence rates was observed in regards to age, time to surgery, type of athlete (collision v limited contact), repair of SLAP lesion, number of anchors, or revision surgery. CONCLUSIONS Although several repair techniques exist for traumatic anterior shoulder instability, arthroscopic repair remains a viable option even in a highly active patient population. This study uniquely identified high school and recreational athletes at higher risk for recurrence. This is perhaps due to inferior shoulder development and technique as well as to limited access to postoperative physical therapy. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Charles Milchteim
- Andrews Research and Education Institute, Gulf Breeze, Florida, U.S.A..
| | - Scott A Tucker
- Andrews Research and Education Institute, Gulf Breeze, Florida, U.S.A
| | - Darin D Nye
- Andrews Research and Education Institute, Gulf Breeze, Florida, U.S.A
| | - Richard J Lamour
- Andrews Research and Education Institute, Gulf Breeze, Florida, U.S.A
| | - Wei Liu
- Andrews Research and Education Institute, Gulf Breeze, Florida, U.S.A.; Department of Kinesiology, Auburn University, Auburn, Alabama, U.S.A
| | - James R Andrews
- Andrews Research and Education Institute, Gulf Breeze, Florida, U.S.A
| | - Roger V Ostrander
- Andrews Research and Education Institute, Gulf Breeze, Florida, U.S.A
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Suprascapular nerve palsy after arthroscopic Latarjet procedure: a case report and review of literature. Knee Surg Sports Traumatol Arthrosc 2016; 24:601-3. [PMID: 24839042 DOI: 10.1007/s00167-014-3075-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 05/08/2014] [Indexed: 10/25/2022]
Abstract
The Bristow and Latarjet procedures have become popular among orthopaedic surgeons thanks to the development of new instruments that allow the use of arthroscopic techniques to treat cases of glenohumeral instability with bone defects or capsular deficiency. Nonetheless, several complications have been reported after Latarjet procedures, including neurological injuries. This report describes surgical damage to the suprascapular nerve, an unusual complication. Level of evidence Expert opinion, Level V.
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44
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Phadnis J, Arnold C, Elmorsy A, Flannery M. Utility of the Instability Severity Index Score in Predicting Failure After Arthroscopic Anterior Stabilization of the Shoulder. Am J Sports Med 2015; 43:1983-8. [PMID: 26122385 DOI: 10.1177/0363546515587083] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The redislocation rate after arthroscopic stabilization for anterior glenohumeral instability is up to 30%. The Instability Severity Index Score (ISIS) was developed to preoperatively rationalize the risk of failure, but it has not yet been validated by an independent group. PURPOSE To assess the utility of the ISIS in predicting failure of arthroscopic anterior shoulder stabilization and to identify other preoperative factors for failure. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A case-control study was performed on 141 consecutive patients, comparing those who suffered failure of arthroscopic stabilization with those who had successful arthroscopic stabilization. The mean follow-up time was 47 months (range, 24-132 months). The ISIS was applied retrospectively, and an analysis was performed to establish independent risk factors for failure. A receiver operator coefficient curve was constructed to set a threshold ISIS for considering alternative surgery. RESULTS Of 141 patients, 19 (13.5%) suffered recurrent instability. The mean ISIS of the failed stabilization group was higher than that of the successful stabilization group (5.1 vs 1.7; P < .001). Independent risk factors for failure were Hill-Sachs lesion (P < .001), glenoid bone loss (P < .001), age <21 years at the time of surgery (P < .001), age at first dislocation (P = .01), competitive-level participation in sports (P < .001), and participation in contact or overhead sports (P = .03). The presence of glenoid bone loss carried the highest risk of failure (70%). There was a 70% risk of failure if the ISIS was ≥4, as opposed to a 4% risk of failure if the ISIS was <4. CONCLUSION This is the first completely independent study to confirm that the ISIS is a useful preoperative tool. It is recommended that surgeons consider alternative forms of stabilization if the ISIS is ≥4.
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45
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Acharya P, Arora B, Pinto N. Arthroscopy Assisted Percutaneous Fixation of Ideberg Type Iii Glenoid Fractures. J Orthop Case Rep 2015; 5:41-3. [PMID: 27299041 PMCID: PMC4722587 DOI: 10.13107/jocr.2250-0685.270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Intra-articular glenoid fractures are extremely rare and may be associated with other injuries. Traditionally open reduction and internal fixation has been recommended in displaced intra-articular glenoid fractures. However open reduction is difficult and it may not be possible to address the associated intra-articular soft tissue injuries. A few reports of arthroscopic assisted fixation of these fractures have been recently published. We are reporting a case of Ideberg type 3 glenoid fracture and its treatment. Case Report: We are presenting our case where a 52 year old man presented with Type 3 intra-articular glenoid fracture. The fracture was fixed percutaneously under simultaneous arthroscopic and fluoroscopic guidance. Conclusion: Intra-articular glenoid fractures are uncommon and difficult to treat. Arthroscopy assisted percutaneous fixation technique can be a valuable adjunct for the surgeon in dealing with not only the fracture but also the associated soft-tissue injuries.
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Affiliation(s)
- Prashant Acharya
- Department of Orthopedics, Father Muller Medical College Hospital, Mangalore - 575002, India
| | - Bakul Arora
- Department of Orthopedics, Father Muller Medical College Hospital, Mangalore - 575002, India
| | - Nelson Pinto
- Department of Orthopedics, Concetta Hospital, Kinnigoli, Mangalore- 575002, India
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46
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Abstract
The glenohumeral joint is the most frequently dislocated major joint, and most cases involve an anterior dislocation. Young male athletes competing in contact sports are at especially high risk of recurrent instability. Surgical timing and selection of surgical technique continue to be debated. Full characterization of the injury requires an accurate history and physical examination. Diagnostic imaging assists in identifying the underlying anatomic lesions, which range from no discernible lesion to significant bone loss of the glenoid or humeral head and/or capsulolabral stretching or avulsion from the glenoid or humerus. Historically, open Bankart repair has been considered to be the standard method of managing capsulolabral injuries, but comparable results have been achieved with arthroscopic techniques. In the setting of anterior glenoid bone loss >20% of the articular surface, iliac crest bone grafting or coracoid transfer via the Bristow or Latarjet procedures has demonstrated satisfactory outcomes. Favorable results have been reported with bone grafting or remplissage for engaging Hill-Sachs lesions and those that affect >30% of the humeral circumference.
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Lópiz-Morales Y, Alcobe-Bonilla J, García-Fernández C, Francés-Borrego A, Otero-Fernández R, Marco-Martínez F. [Results of revision after failed surgical treatment for traumatic anterior shoulder instability]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013; 57:208-16. [PMID: 23746919 DOI: 10.1016/j.recot.2013.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 03/07/2013] [Accepted: 03/08/2013] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Persistent or recurrent glenohumeral instability after a previous operative stabilization can be a complex problem. Our aim is to establish the incidence of recurrence and its revision surgery, and to analyse the functional results of the revision instability surgery, as well as to determine surgical protocols to perform it. MATERIALS AND METHODS A retrospective analysis was conducted on 16 patients with recurrent instability out of 164 patients operated on between 1999 and 2011. The mean follow-up was 57 months and the mean age was 29 years. To evaluate functional outcome we employed Constant, Rowe, UCLA scores and the visual analogue scale. RESULTS Of the 12 patients who failed the initial arthroscopic surgery, 6 patients underwent an arthroscopic antero-inferior labrum repair technique, 4 using open labrum repair techniques, and 2 coracoid transfer. The two cases of open surgery with recurrences underwent surgery for coracoid transfer. Results of the Constant score were excellent or good in 64% of patients. CONCLUSIONS Surgical revision of instability is a complex surgery essentially for two reasons: the difficulty in recognising the problem, and the technical demand (greater variety and the increasingly complex techniques).
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Affiliation(s)
- Y Lópiz-Morales
- Departamento de Traumatología y Cirugía Ortopédica, Hospital Clínico San Carlos, Madrid, Spain.
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Results of revision after failed surgical treatment for traumatic anterior shoulder instability. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013. [DOI: 10.1016/j.recote.2013.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Itoi E, Hatakeyama Y, Itoigawa Y, Omi R, Shinozaki N, Yamamoto N, Sano H. Is protecting the healing ligament beneficial after immobilization in external rotation for an initial shoulder dislocation? Am J Sports Med 2013; 41:1126-32. [PMID: 23524151 DOI: 10.1177/0363546513480620] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Immobilization in external rotation is one of the treatment options for an initial dislocation of the shoulder. However, it remains unclear how long it takes for a Bankart lesion to heal. HYPOTHESIS Protection of a healing Bankart lesion from stretching would promote the healing process and decrease the recurrence rate after an initial dislocation of the shoulder. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS This was a multicenter, prospective randomized study. Between January 2005 and August 2009, 109 patients (71 male and 38 female; mean age, 30 years) with an initial traumatic dislocation of the shoulder were enrolled. After 3 weeks of immobilization in external rotation, a shoulder motion restriction band designed to avoid stretching the anteroinferior shoulder capsule was used for 0 weeks (36 patients), 3 weeks (37 patients), or 6 weeks (36 patients). After using the band, patients were allowed to use their shoulders freely, but they were advised to avoid vigorous sport activities for at least 3 months after the injury. Any recurrent dislocation and return to sports were assessed at 2-year follow-up. RESULTS Of 109 patients, 90 were followed up for 2 years. The compliance rates were 60% to 72% among the groups (P = .54). The recurrence rate of dislocation was 28% in the 0-week group, 33% in the 3-week group, and 32% in the 6-week group (P = .88) according to the intention-to-treat analysis, and they were a respective 24%, 28%, and 27% according to the per-protocol analysis (P = .95). Based on the sport activity level, the recurrence rates for patients involved in contact sports (7/15, 47%) and those involved in noncontact sports (19/51, 37%) were significantly higher than for those not involved in sport activities (2/24, 8.3%) (P = .0076). Among the 3 groups, there were no significant differences in the recurrence rates. There was no significant difference in the rate of return to sports (P = .39). CONCLUSION No difference in the recurrence rate was seen with the use of a shoulder motion restriction band after 3 weeks of immobilization in external rotation after an initial dislocation of the shoulder.
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Affiliation(s)
- Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
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Smith GCS, Chesser TJS, Packham IN, Crowther MAA. First time traumatic anterior shoulder dislocation: a review of current management. Injury 2013; 44:406-8. [PMID: 23380238 DOI: 10.1016/j.injury.2013.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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