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Massin V, Dawes AM, Cooke HL, Wagner ER, Werthel JD. Geographic Variability in the Management of Anterior Glenohumeral Instability: A Binational Analysis. Orthop J Sports Med 2025; 13:23259671251324515. [PMID: 40353250 PMCID: PMC12065994 DOI: 10.1177/23259671251324515] [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: 08/31/2024] [Accepted: 10/15/2024] [Indexed: 05/14/2025] Open
Abstract
Background The Bankart and Latarjet procedures are the 2 most commonly performed procedures for stabilization of anterior glenohumeral instability around the world. The aim of this study was to describe actual trends in surgery for anterior instability in the United States and in France. Hypothesis Glenohumeral stabilization surgery overall is becoming more frequent in France and in the United States, with an increasing number of Latarjet procedures having been performed in each country in recent years. Study Design Cross-sectional study; Level of evidence, 3. Methods A retrospective review was performed using French and American databases from 2009 to 2018. Procedure codes MEMA005 and MEMC004 were pulled from the French National Health Insurance System and Current Procedural Terminology codes 23455, 29806, and 23462 were pulled from IBM MarketScan. During this period, 73,914 patients underwent anterior shoulder stabilization surgery in France and 391,521 in the United States. For each year and the global period, the estimated number of Bankart procedures in the United States was compared with the number of French procedures. The same comparison was done for Latarjet procedures. The sex ratio was compared using chi-square testing. The mean age was compared using a Student t test. Results The Bankart procedure represents 98% of the shoulder stabilization procedures in the United States, but the Latarjet procedure is becoming more common in the United States, having increased by 154% during the 10-year study period. In France, the Latarjet procedure represents 75% of the surgeries, having increased by 40% during the 10-year study period. However, use of the Bankart procedure in France increased from 11.2/100,000 in 2009 to 13.4/100,000 in 2018. Conclusion This study demonstrated that, overall, use of the Latarjet procedure has been increasing over the last decade in both the United States and France. However, there remains a divergence in the treatment of anterior shoulder instability between the 2 countries. The Latarjet procedure remains the preferred treatment option in France for anterior shoulder instability (75% Latarjet vs 25% Bankart), whereas the Bankart procedure is dominant within the United States (98% Bankart vs 2% Latarjet). When breaking data down by age groups, more Bankart procedures are being performed on younger patients, and in both countries the incidences of women requiring these surgeries are increasing. The authors hope this study will serve as a foundation for future prospective studies establishing evidence-based algorithms to guide the treatment of anterior instability and provide a root cause analysis on why different surgeons choose a specific procedure to treat this problem.
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Affiliation(s)
- Valentin Massin
- Department of Orthopaedic Surgery, Aix Marseille Université, Marseille, France
| | | | - Hayden L. Cooke
- Department of Orthopaedic Surgery, Division of Upper Extremity, Emory University, Atlanta, Georgia, USA
| | - Eric R. Wagner
- Department of Orthopaedic Surgery, Division of Upper Extremity, Emory University, Atlanta, Georgia, USA
| | - Jean-David Werthel
- Department of Orthopaedic Surgery, Hôpital Ambroise Paré, Boulogne-Billancourt, France
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Hachem AI, Gonzalez-Morgado D, Barraza G, Alvarado F, Agullo JL, Lorenz C, Rius X, Scheibel M. Arthroscopic Iliac Crest Autograft Glenoid Augmentation Using Tape Cerclage Fixation for Bony Deficiency and Recurrent Anterior Shoulder Instability Improves Functional Outcomes and Achieves High Union Rates With Graft Resorption in Nonloaded Areas. Arthroscopy 2025:S0749-8063(25)00304-4. [PMID: 40300734 DOI: 10.1016/j.arthro.2025.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 04/03/2025] [Accepted: 04/16/2025] [Indexed: 05/01/2025]
Abstract
PURPOSE To evaluate the clinical outcomes, return-to-sport rate, and graft remodeling after arthroscopic iliac crest bone autograft (ICBA) tape cerclage fixation for glenoid bone loss (GBL) in recurrent anterior shoulder instability. METHODS Case series of patients with recurrent anterior shoulder instability with GBL ≥15% who underwent arthroscopic ICBA metal-free tape cerclage fixation between February 2019 and March 2022 with a minimum follow-up of 2 years. Range of motion, patient-reported outcomes, return to sport, instability recurrence, and complications were collected preoperatively and at postoperative follow-ups. Graft resorption mapping was assessed by evaluating the distribution of articular surface remodeling on sagittal computed tomography scans. The graft surface was divided in 2 columns: the inner (loaded) column and the outer (nonloaded) column. RESULTS Twenty-eight patients with a mean age of 29.1 ± 7.9 years and a mean follow-up of 37.6 ± 5.8 months were included. The mean GBL was 18.4% ± 3.4% (range, 15%-25%). External rotation was 4° lower (P < .001) compared to the uninjured side. Patient-reported outcomes significantly improved from baseline to 2-year follow-up (P < .001): Western Ontario Shoulder Instability Index, 37.2 ± 18.7 to 94.9 ± 8.8; Rowe, 30.2 ± 16.4 to 96.1 ± 11.5; Constant-Murley, 83 ± 13.6 to 98.7 ± 3.2; and Subjective Shoulder Value, 43.5 ± 21.3 to 96.5 ± 8.3. Twenty-one patients (88%) returned to their previous sport level at a mean of 4.8 ± 1.7 months. No recurrent instability was reported. The glenoid surface area increased from 81.6% preoperatively to 120.1% immediately postsurgery (P < .001) and decreased to 101.2% at 1 year (P < .001) and to 98.2% at 2 years postoperative (P = .018). Graft resorption mapping showed higher osteolysis of the graft in the nonloaded area compared to the loaded area at 2 years postoperative (94.2% ± 12.9% vs 8.7% ± 15%, respectively, P < .001). CONCLUSIONS Arthroscopic glenoid reconstruction using ICBA fixed with tape cerclage is a safe and effective treatment for recurrent anterior shoulder instability with GBL greater than 15% at short-term follow-up. The procedure shows a high union rate, with articular graft surface resorption predominantly affecting nonloaded areas. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Abdul-Ilah Hachem
- Department of Orthopedic Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), Hospitalet de Llobregat, Spain.
| | - Diego Gonzalez-Morgado
- Department of Orthopedic Surgery, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Gonzalo Barraza
- Department of Orthopedic Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), Hospitalet de Llobregat, Spain
| | - Fernando Alvarado
- Department of Orthopedic Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), Hospitalet de Llobregat, Spain
| | - Jose Luis Agullo
- Department of Orthopedic Surgery, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Christina Lorenz
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Xavier Rius
- Department of Orthopedic Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), Hospitalet de Llobregat, Spain
| | - Markus Scheibel
- Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland; Center for Musculoskeletal Surgery, Charite-Universitaetsmedizin Berlin, Berlin, Germany
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Heilemann M, Youssef Y, Melcher P, Fischer JP, Schleifenbaum S, Hepp P, Theopold J. Assessment of primary stability of glenoid bone block procedures used for patients with recurrent anterior shoulder instability - a biomechanical study in a synthetic bone model. J Med Eng Technol 2025:1-8. [PMID: 40257375 DOI: 10.1080/03091902.2025.2492127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/04/2025] [Accepted: 04/07/2025] [Indexed: 04/22/2025]
Abstract
Anterior glenoid reconstruction using bone blocks is increasingly recognised as treatment option after critical bone loss. In this study, a biomechanical test setup is used to assess micromotion after bone block augmentation at the glenoid, comparing bone block augmentation with a spina-scapula block to the standard coracoid bone block (Latarjet). Twenty-four synthetic shoulder specimens were tested. Two surgical techniques (coracoid and spina-scapula bone block augmentation) were used on two different types of synthetic bone (Synbone and Sawbone). The specimens were cyclically loaded according to the 'rocking horse' setup defined in ASTM F2028. A mediolateral force of 170 N was applied on the bone block and a complete test comprised 5000 cycles. The Micromotion between bone block and glenoid was measured using a 3D Digital Image Correlation system. The measured micromotion divided into irreversible and reversible displacement of the augmented block. Medial irreversible displacement was the dominant component of the micromotion. The spina-scapula bone block showed a significantly higher irreversible displacement in medial direction compared to the coracoid block, when aggregating both types of synthetic bone (spina: 1.00 ± 0.39 mm, coracoid: 0.56 ± 0.39 mm, p = 0.01). The dominant irreversible medial displacement can be interpreted as initial settling behaviour.
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Affiliation(s)
- Martin Heilemann
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany
- ZESBO - Center for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany
| | - Yasmin Youssef
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - Peter Melcher
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - Jean-Pierre Fischer
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany
- ZESBO - Center for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany
| | - Stefan Schleifenbaum
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany
- ZESBO - Center for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany
| | - Pierre Hepp
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - Jan Theopold
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany
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van Spanning SH, Lafosse T, Athwal GS, Favorito P, Meislin RJ, Lallemand G, Vogels J, Lafosse L, Buijze GA. How to salvage the fractured coracoid during the Latarjet Procedure? An empirical approach. Orthop Traumatol Surg Res 2025; 111:103919. [PMID: 38879002 DOI: 10.1016/j.otsr.2024.103919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/16/2024] [Accepted: 06/12/2024] [Indexed: 07/02/2024]
Abstract
The Latarjet procedure is a frequently used stabilization procedure in case of anterior shoulder instability with critical glenoid bone loss and/or off-track Hill Sachs lesions. Although uncommon, intra-operative graft fractures do occur. When confronted with this potentially challenging intra-operative complication, having a secondary solution is paramount to achieve a successful outcome. This technical note provides a treatment algorithm that may function as a useful guideline to assist surgeons that experience this potentially complex unintended event during a Latarjet procedure. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
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Affiliation(s)
- Sanne H van Spanning
- Alps Surgery institute, Hand, Upper Limb, Peripheral Nerve, Brachial Plexus and Microsurgery Unit, Clinique Générale, Annecy, France; The Amsterdam Shoulder and Elbow Center of Expertise (ASECE), Amsterdam, The Netherlands; Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG hospital, Amsterdam, The Netherlands
| | - Thibault Lafosse
- Alps Surgery institute, Hand, Upper Limb, Peripheral Nerve, Brachial Plexus and Microsurgery Unit, Clinique Générale, Annecy, France
| | - George S Athwal
- St. Joseph's Health Care, Western University, Roth McFarlane Hand and Upper Limb Center, London, ON, Canada
| | - Paul Favorito
- The Christ Hospital. Division Chief of the Shoulder and Upper Extremity Service in the Department of Orthopedics, Cincinnati, OH, USA
| | - Robert J Meislin
- Department of Orthopedic Surgery, New York University Langone Health, NY, NY, USA
| | - Geoffroi Lallemand
- Alps Surgery institute, Hand, Upper Limb, Peripheral Nerve, Brachial Plexus and Microsurgery Unit, Clinique Générale, Annecy, France
| | - Jérôme Vogels
- Institut chirurgical de la main et du membre supérieur, 17 avenue Condorcet, 69100 Villeurbanne, France
| | - Laurent Lafosse
- Alps Surgery institute, Hand, Upper Limb, Peripheral Nerve, Brachial Plexus and Microsurgery Unit, Clinique Générale, Annecy, France
| | - Geert Alexander Buijze
- Alps Surgery institute, Hand, Upper Limb, Peripheral Nerve, Brachial Plexus and Microsurgery Unit, Clinique Générale, Annecy, France; Hand and Upper Extremity Surgery Unit, Department of Orthopaedic Surgery, Lapeyronie Hospital, Montpellier University Medical Center, Montpellier, France; Amsterdam University Medical Center, Department of Orthopaedic Surgery, Amsterdam, The Netherlands.
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Yeramosu T, Taitsman LA, Kates SL. Trends and Complications of Hip Fracture Fixation Among Early Career Orthopaedic Surgeons: An Analysis of the American Board of Orthopaedic Surgery Part II Oral Examination Database. Geriatr Orthop Surg Rehabil 2025; 16:21514593241291792. [PMID: 40103706 PMCID: PMC11915309 DOI: 10.1177/21514593241291792] [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: 06/13/2024] [Revised: 08/19/2024] [Accepted: 09/23/2024] [Indexed: 03/20/2025] Open
Abstract
Background Hip fractures are a major public health concern with a high mortality rate. Numerous risk factors for hip fracture have been identified, and efforts made to reduce complications and improve outcomes. This study aimed to assess recent trends in postoperative complications amongst early-career orthopaedic surgeons. Methods This retrospective study analyzed surgical cases submitted to the American Board of Orthopaedic Surgery (ABOS) for the Part II Oral Examination from 2013 to 2022. The database includes patient demographics and medical and surgical complications. Current Procedural Terminology codes reflecting operative fixation for hip fracture were selected. Data was split into two cohorts: 2013-2016 and 2017-2020. Univariate and multivariable logistic regression analyses were used to identify significant differences between cohorts. Results 49,418 cases were analyzed. Compared to 2013-2016, 2017-2020 had a reduction in the overall medical complication rate (-1.49%, P = 0.0005), saw slight increases in congestive heart failure (+0.18%, P = 0.049), renal failure (+0.37%, P = 0.004), hypotension (+0.41%, P = 0.0007), and hypoxia (+0.41%, P = 0.0016). Minor decreases in myocardial infarction (-0.18%, P = 0.047) and pneumonia (-0.34%, P = 0.021) were noted. No differences occurred in confusion/delirium, deep vein thrombosis/pulmonary embolism, and mortality. There were no significant differences in overall surgical complications. The 90-day readmission rate increased with time (+1.17%, P < 0.0001). Multivariable logistic regression identified a decrease in the likelihood of overall medical complications (Odds Ratio (OR): 0.92 [0.89, 0.96]; P < 0.0001). Decreases were noted for the likelihood of myocardial infarction (OR: 0.81 [0.68, 0.98]; P = 0.031), pneumonia (OR: 0.87 [0.78, 0.97]; P = 0.013), fracture (OR: 0.80 [0.69, 0.92]; P = 0.002), and recurrent/persistent/uncontrolled pain (OR: 0.72 [0.56, 0.92]; P = 0.008). The likelihood of renal failure (OR: 1.18 [1.04, 1.34]; P = 0.009) and readmission increased (OR: 1.14 [1.07, 1.20]; P < 0.0001). Conclusion This study found little change in postoperative complication patterns over the past decade. These findings suggest that more efforts are needed to improve hip fracture care and outcomes.
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Affiliation(s)
- Teja Yeramosu
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Lisa A Taitsman
- Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Stephen L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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6
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Fury MS, Cirino CM, Jahandar A, Rauck RC, Gulotta LV, Dines DM, Dines JS, Blaine TA, Fu MC, Warren RF, Kontaxis A, Taylor SA. The Effect of Concavity Restoration on Glenohumeral Stability in a Glenoid Bone Loss Model: Comparing Distal Tibial Allograft Reconstruction to Classic Latarjet. Am J Sports Med 2025; 53:928-934. [PMID: 39920605 DOI: 10.1177/03635465251318337] [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: 02/09/2025]
Abstract
BACKGROUND Distal tibial allograft (DTA) reconstruction for glenoid bone loss (GBL) has gained popularity. While recent studies have demonstrated that glenoid concavity is an important factor in native glenohumeral stability, there remains a paucity of data regarding concavity restoration during reconstructive procedures for GBL and its biomechanical effect. PURPOSE To compare the restoration of anterior glenohumeral stability and glenoid concavity after DTA and classic Latarjet procedures. STUDY DESIGN Controlled laboratory study. METHODS Nine human cadaveric specimens (mean age, 62.2 years; range, 52-69 years) underwent pretesting computed tomography (CT) to assess native glenoid concavity as determined by the glenoid depth and bony shoulder stability ratio (BSSR). GBL was created so the DTA and Latarjet graft could restore 100% of the native glenoid width. The rotator cuff tendons were loaded, and anterior stability testing was performed using a KUKA robot to apply a controlled anterior force with the shoulder in 90° of abduction and neutral external rotation. A motion capture system recorded humeral head translation. The following conditions were tested: intact, soft tissue Bankart lesion; bone loss model with DTA reconstruction; classic Latarjet procedure without conjoint tendon loaded; and classic Latarjet procedure with conjoint tendon loaded (sling effect). All specimens underwent posttesting CT to measure the BSSR of the DTA and Latarjet reconstructions. A repeated-measures analysis of variance was performed to compare the BSSR and anterior translations between the DTA and Latarjet reconstructions. RESULTS DTA produced greater concavity than the Latarjet procedure (BSSR: 0.45 vs 0.35; P < .001). There was no difference in anterior translation between the DTA and Latarjet procedures with the sling effect (5.1 mm vs 4.7 mm; P > .999). However, maximum anterior translation was decreased after the DTA procedure when compared with the Latarjet technique without the sling effect (5.1 mm vs 10.3 mm; P = .045). CONCLUSION DTA produces a more concave reconstruction and decreased anterior translation compared with the flatter reconstruction produced by the classic Latarjet procedure without the sling effect. DTA and the classic Latarjet procedure with conjoint tendon loading, however, yielded equivalent reductions in anterior translation. CLINICAL RELEVANCE Distal tibial allograft reconstruction is a biomechanically equivalent alternative to the classic Latarjet due to the restoration of glenoid concavity in addition to glenoid width. Surgeons should consider the role of concavity when addressing glenohumeral instability with bone loss.
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Affiliation(s)
- Matthew S Fury
- Baton Rouge Orthopaedic Clinic, Baton Rouge, Louisiana, USA
| | - Carl M Cirino
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Amirhossein Jahandar
- The Leon Root, M.D. Motion Analysis Laboratory, Hospital for Special Surgery, New York, New York, USA
| | - Ryan C Rauck
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Lawrence V Gulotta
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - David M Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Joshua S Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Theodore A Blaine
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Michael C Fu
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Russell F Warren
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Andreas Kontaxis
- The Leon Root, M.D. Motion Analysis Laboratory, Hospital for Special Surgery, New York, New York, USA
| | - Samuel A Taylor
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
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7
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van Spanning SH, Verweij LPE, Geervliet PC, van den Borne MPJ, van den Bekerom MPJ, Benner JL. Similar patient-reported outcomes but lower redislocation and higher revision rates following primary Latarjet vs. primary arthroscopic Bankart repair in patients with 10%-20% glenoid bone loss at a minimum 2-year follow-up. J Shoulder Elbow Surg 2025:S1058-2746(25)00094-1. [PMID: 39894338 DOI: 10.1016/j.jse.2024.12.020] [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: 04/09/2024] [Revised: 12/12/2024] [Accepted: 12/13/2024] [Indexed: 02/04/2025]
Abstract
BACKGROUND The amount of glenoid bone loss is closely related to the success rate of surgical treatment following anterior shoulder dislocations. There is an ongoing debate on the most successful treatment in patients with a subcritical amount (10%-20%) of glenoid bone loss (GBL). This study aimed to compare patient-reported outcome measures (PROMs) following primary open Latarjet procedure and primary arthroscopic Bankart repair (ABR) in patients with 10%-20% GBL at a minimum 2-year follow-up. METHODS This multicenter retrospective cohort study included 53 patients with traumatic anterior shoulder dislocations treated with Latarjet or ABR between 2011 and 2019. PROMs included the Western Ontario Shoulder Instability Index (WOSI) and Oxford Shoulder Instability Score (OSIS). Secondary outcomes included recurrence, complications, revision surgery, patient satisfaction, and return to sport (RTS). RESULTS The mean follow-up was 77 ± 31.7 months. Baseline characteristics were similar between ABR and Latarjet, except for time to follow-up (91 ± 30 vs. 61 ± 26 months, P < .001) and percentage GBL (15 ± 3 vs. 17 ± 3, P = .024). WOSI scores were higher in Latarjet patients compared with ABR; however, this difference was not statistically significant (220 vs. 457, P = .10). OSIS scores were similar following ABR and Latarjet (42 vs. 45, P = .33). Recurrence rates were higher in ABR patients (7 [24%] vs. 0 [0%] recurrences, P = .01), whereas revision rates were higher in Latarjet patients (4 vs. 0 revisions, P = .04). Patient satisfaction and complications were not different between the 2 procedures and neither achieved RTS and RTS to preinjury level. CONCLUSION The null hypothesis in which Latarjet and ABR show similar patient-reported outcomes could not be rejected based on the underpowered analysis. Patients treated with Latarjet did not have any recurrences vs. 7 in the ABR group (P = .01). However, revision rates were higher in Latarjet patients (4 vs. 0 revisions, P = .04).
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Affiliation(s)
- Sanne H van Spanning
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands; Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Department of Orthopaedic Surgery, CORAL Centre for Orthopaedic Research Alkmaar, Northwest Clinics, Alkmaar, the Netherlands.
| | - Lukas P E Verweij
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, the Netherlands
| | - Pieter C Geervliet
- Department of Orthopaedic Surgery, CORAL Centre for Orthopaedic Research Alkmaar, Northwest Clinics, Alkmaar, the Netherlands
| | | | - Michel P J van den Bekerom
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands; Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands
| | - Joyce L Benner
- Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Department of Orthopaedic Surgery, CORAL Centre for Orthopaedic Research Alkmaar, Northwest Clinics, Alkmaar, the Netherlands
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8
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Thakkar AP, Reyes SG, Jadidi S, Bhatia S, Bare AA. Trends in anterior shoulder instability procedures over the last decade in the United States. Shoulder Elbow 2025:17585732241303874. [PMID: 39877835 PMCID: PMC11770688 DOI: 10.1177/17585732241303874] [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] [Received: 03/17/2024] [Revised: 09/28/2024] [Accepted: 09/29/2024] [Indexed: 01/31/2025]
Abstract
Background The treatment algorithm for traumatic shoulder instability has evolved, emphasizing the significance of glenoid bone loss and the glenoid track, addressing humeral, and glenoid vault bone deficiencies. This study examines trends and demographics of anterior shoulder instability procedures in the United States from 2010 to 2020. Methods PearlDiver database was queried for patients who underwent traumatic anterior shoulder instability procedures. Student t and multiple regression analysis tests were used for statistical comparisons and trends analysis (P < 0.05 significant). Results Arthroscopic anterior labral repair showed an annual decline of approximately 10% compared to the substantial growth of Latarjet coracoid transfer procedures in the first half of the decade (2010-2015), followed by a plateau in the second half (2016-2020). Arthroscopic anterior labral repair was most prevalent in the 15 to 19 age range, while Latarjet was most prevalent in the 20 to 24 age group. Latarjet procedures were three times more common in males than females, whereas arthroscopic anterior labral repairs occurred approximately twice as frequently in males compared to females. Discussion Latarjet procedures showed a general increase in annual growth rate, while arthroscopic anterior labral repairs have consistently declined. Open anterior capsulorrhaphy with bone block, open capsular shift, and open capsulolabral repairs have shown a steady decrease in incidence.
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Affiliation(s)
- Akshar P Thakkar
- Department of Orthopaedics, Northwestern Medicine, Warrenville, IL, USA
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Samuel G Reyes
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shaheen Jadidi
- Department of Orthopaedic Surgery, Endeavor Health, Woodridge, IL, USA
| | - Sanjeev Bhatia
- Department of Orthopaedics, Northwestern Medicine, Warrenville, IL, USA
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Aaron A Bare
- Department of Orthopaedics, Northwestern Medicine, Warrenville, IL, USA
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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9
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Shao Z, Jiang Y, Song Q, Wang H, Luo H, Cheng X, Cui G. Short-Term Complications of Arthroscopic Bristow or Latarjet Procedure with Screw Versus Suture-Button Fixation: A Prospective Study of 308 Consecutive Cases by a Single Surgeon. J Bone Joint Surg Am 2024; 106:1776-1784. [PMID: 39325870 DOI: 10.2106/jbjs.23.00390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
BACKGROUND This study aimed to investigate the short-term complications (minimum 1-year follow-up) after either an arthroscopic Bristow or Latarjet procedure for anterior shoulder instability utilizing screw or suture-button fixation. METHODS Patients undergoing arthroscopic Bristow or Latarjet procedures between November 2016 and April 2021 were enrolled. Data were collected at baseline, 3 months, 6 months, and every year after surgery. Risks of postoperative complications and unplanned reoperations were assessed. A multivariable regression model was used to identify risk factors for complications and to determine the association of complications with patient-reported outcomes. RESULTS A total of 412 patients (425 shoulders) undergoing arthroscopic Bristow or Latarjet procedures performed by a single surgeon between November 2016 and April 2021 were reviewed. Two hundred and ninety-nine patients (308 shoulders, 76.2% of 404 eligible) with a mean follow-up of 22.3 ± 4.2 months were included for analysis. Two hundred and sixty-nine shoulders (87.3%) underwent a Bristow procedure (165 with screw and 104 with suture-button fixation), while 39 (12.7%) underwent a Latarjet procedure (18 with screw and 21 with suture-button fixation). Eighty-two patients (83 shoulders) reported a total of 85 complications within 2 years after surgery, with an overall complication rate of 26.9%. The rates of recurrent dislocation or subluxation and infection were 1.9% and 0.6%, respectively, while a total of 4 (1.3%) of the shoulders had unplanned reoperations. The most common complications were graft-related (11.7%), followed by complications involving neurologic symptoms (10.7%). The overall, graft, and neurologic complication rates following Bristow or Latarjet procedures were 27.1% versus 25.6%, 12.3% versus 7.7%, and 10.0% versus 15.4%, respectively. Compared with the Bristow technique with screw fixation, Bristow with suture-button fixation yielded a lower risk of any complications (odds ratio [OR], 0.55; p = 0.04). Paying with rural insurance and poor sleep quality prior to surgery were associated with increased risk of any complications. CONCLUSIONS Compared with arthroscopic Bristow procedures with screw fixation, Bristow procedures with suture-button fixation resulted in a lower overall complication risk. Both patient demographic and implant-specific factors were associated with the development of a complication. LEVEL OF EVIDENCE Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Zhenxing Shao
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, People's Republic of China
- Beijing Key Laboratory of Sports Injuries, Beijing, People's Republic of China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, People's Republic of China
| | - Yanfang Jiang
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, People's Republic of China
- Beijing Key Laboratory of Sports Injuries, Beijing, People's Republic of China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, People's Republic of China
| | - Qingfa Song
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, People's Republic of China
- Beijing Key Laboratory of Sports Injuries, Beijing, People's Republic of China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, People's Republic of China
| | - Hangle Wang
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, People's Republic of China
- Beijing Key Laboratory of Sports Injuries, Beijing, People's Republic of China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, People's Republic of China
| | - Hao Luo
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, People's Republic of China
- Beijing Key Laboratory of Sports Injuries, Beijing, People's Republic of China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, People's Republic of China
| | - Xu Cheng
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, People's Republic of China
- Beijing Key Laboratory of Sports Injuries, Beijing, People's Republic of China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, People's Republic of China
| | - Guoqing Cui
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, People's Republic of China
- Beijing Key Laboratory of Sports Injuries, Beijing, People's Republic of China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, People's Republic of China
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Tuncez M, Bayraktar ÖB. Comparison of the Latarjet Procedure and Iliac Crest Bone Graft Transfer in Bone Bankart Lesions in Recurrent Anterior Shoulder Dislocations. Cureus 2024; 16:e66176. [PMID: 39105204 PMCID: PMC11299470 DOI: 10.7759/cureus.66176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2024] [Indexed: 08/07/2024] Open
Abstract
OBJECTIVE There are various treatment modalities for bony Bankart lesions following glenohumeral joint dislocations. In this research, we aimed to compare the radiological and clinical results of patients who underwent the Latarjet procedure and iliac crest bone graft transfer. MATERIALS AND METHODS Clinical and radiological data of 15 patients were retrospectively evaluated. Inclusion criteria were a history of at least two dislocations, being between 18-65 years of age and having at least 10% glenoid bone loss. The exclusion criteria were defined as follows: patients who underwent only soft tissue procedures, patients who did not attend the follow-up, patients with other pathology in the upper extremity (fracture, cuff tear, etc.), and patients with a follow-up period of less than 12 months time. Nine patients underwent the Latarjet procedure and six underwent iliac crest bone graft transfer. Clinical evaluation, age, gender, body mass index, range of motion, Quick Disabilities of the Arm, Shoulder and Hand (QDASH) score, Constant score, and Visual Analogue Scale (VAS) score were evaluated. Radiographic evaluation was performed with preoperative and postoperative direct radiographs and computed tomography. Mann-Whitney U test, t-test, and Fisher exact tests were used for group comparisons. RESULTS The mean age of the patients was 32.6 years and the mean follow-up period was 24.9 months. When the two groups were compared, no statistical difference was found in terms of age, gender, body mass index, range of motion, Constant score, VAS score, glenoid cartilage stepping, and bone defect (p>0.05). The operation time was longer in the iliac crest bone graft transfer group compared to the Latarjet group (p<0.05). CONCLUSION Latarjet and iliac crest bone graft transfer can be used successfully in the treatment of bony Bankart in recurrent anterior shoulder dislocations. The operation time is longer in iliac crest bone graft transfer compared to the Latarjet procedure.
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Affiliation(s)
- Mahmut Tuncez
- Department of Orthopedics and Traumatology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, TUR
| | - Ömer Berkay Bayraktar
- Department of Orthopedics and Traumatology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, TUR
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Vagstad T, Klungsøyr JA, Bjerknes C, Klungsøyr P, Skrede A, Dalen A, Drogset JO, Myklebust TÅ, Hermansen E. Biomechanical comparison shows increased stability of an arthroscopic subscapular sling procedure compared to an open Latarjet reconstruction for anterior shoulder instability in specimens with major glenoid bone defect. J Exp Orthop 2024; 11:e70015. [PMID: 39314811 PMCID: PMC11417344 DOI: 10.1002/jeo2.70015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 08/26/2024] [Accepted: 08/28/2024] [Indexed: 09/25/2024] Open
Abstract
Purpose Recurrent anterior glenohumeral instability (RASI) is commonly treated with arthroscopic techniques, though their effectiveness in providing stability may diminish in cases of critical glenoid bone loss. This study aimed to compare the stability outcomes and range of motion (ROM) associated with an arthroscopic subscapular sling procedure (SSP), first introduced in 2015. Methods Sixteen fresh-frozen human cadaveric shoulder specimens were biomechanically evaluated in four conditions: native, injured, post-SSP and post-LP. Glenohumeral translations were measured under anterior, anteroinferior and inferior loading, while external rotation ROM was assessed in neutral and abducted positions. Testing was conducted using a robotic system for precise force and torque application. Specimens were prepared with a 20% glenoid bone defect and subjected to stability testing sequentially. Results The SSP significantly reduced glenohumeral translations compared to LP, particularly under anterior loading in neutral (p < 0.001), external rotation (p = 0.007) and abduction (p < 0.001) positions. Although the SSP demonstrated superior stability in these key positions, it did not consistently outperform the LP across all scenarios, as stability was similar between the two in the abducted and rotated position under anterior loading (p = 0.379). Under anteroinferior loading, the SSP showed comparatively better stability at neutral (p = 0.003) and abduction (p < 0.001), whereas the LP led to greater anteroinferior translations in these same positions (p = 0.002 and p = 0.014, respectively). The SSP outperformed the LP under inferior loading in neutral (p = 0.005) and abduction (p = 0.02) positions, though it did not fully restore stability to native shoulder levels. The SSP maintained ROM similar to native shoulders. LP allowed greater ROM, potentially compromising stability. Conclusion The SSP provided greater stability than the open Latarjet in most positions and did not limit ROM, suggesting it could be a viable, less invasive option for managing shoulder instability. Level of Evidence Not applicable.
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Affiliation(s)
- Terje Vagstad
- Department of ICT and Natural SciencesNorwegian University of Science and Technology (NTNU)ÅlesundNorway
| | - Jan Arild Klungsøyr
- Orthopedic DepartmentMøre and Romsdal Hospital TrustÅlesundNorway
- Department of Neuromedicine and Movement ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | | | - Petter Klungsøyr
- Orthopedic DepartmentMøre and Romsdal Hospital TrustÅlesundNorway
| | - Aleksander Skrede
- Department of ICT and Natural SciencesNorwegian University of Science and Technology (NTNU)ÅlesundNorway
| | - Andreas Dalen
- Orthopedic DepartmentMøre and Romsdal Hospital TrustÅlesundNorway
| | - Jon Olav Drogset
- Department of Neuromedicine and Movement ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Orthopedic DepartmentTrondheim University HospitalTrondheimNorway
| | - Tor Åge Myklebust
- Department of Research and InnovationMøre and Romsdal Hospital TrustÅlesundNorway
| | - Erland Hermansen
- Department of Research and InnovationMøre and Romsdal Hospital TrustÅlesundNorway
- Department of Health SciencesNorwegian University of Science and Technology (NTNU)ÅlesundNorway
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Karavan MP, Hurley ET, Mills FB, Pasqualini I, Rossi L, Dickens JF, Anakwenze O, Mullett H, Millett PJ, Klifto CS. Primary Latarjet procedure versus Latarjet in the setting of previously failed Bankart repair: a systematic review. J ISAKOS 2023; 8:490-496. [PMID: 37666300 DOI: 10.1016/j.jisako.2023.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/16/2023] [Accepted: 08/27/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES The purpose of this study is to systematically review the comparative studies in the literature to compare the outcomes of the Latarjet procedure in the setting of a previously failed Bankart repair versus those undergoing the Latarjet procedure as a primary surgery for anterior shoulder instability. METHODS A systematic search in Pubmed, EMBASE, and The Cochrane Library databases was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Cohort studies comparing outcomes in the Latarjet procedure as a primary surgery versus the Latarjet procedure in the setting of a previously failed Bankart repair were included. RESULTS Ten studies with 1913 patients were included. There was a significantly lower rate of recurrent instability in those with a Latarjet procedure as a primary surgery (4.8% vs 12.1%, p = 0.007). There was also a significantly lower rate of complications with the Latarjet procedure as a primary surgery (6.2% vs 10.2%, p = 0.03). Furthermore, there was a significant difference in the rate of revision surgery in favour of the Latarjet procedure as a primary surgery (4.8% vs 10.9%, p = 0.02). However, there were similar rates of redislocations (2.8% vs 3.4%, p = 0.82) and return to play (67.7% vs 78.5%, p = 0.30) between the two cohorts. CONCLUSION This study found that the Latarjet procedure as a revision procedure for a previously failed Bankart repair resulted in higher rates of complications, recurrent instability, and revisions than the Latarjet procedure performed as a primary procedure. LEVEL OF EVIDENCE Level III, Systematic Review & Meta-Analysis of Level III studies.
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Affiliation(s)
- Mark P Karavan
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27709, USA
| | - Eoghan T Hurley
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27709, USA.
| | - F Baker Mills
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27709, USA
| | - Ignacio Pasqualini
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27709, USA
| | - Luciano Rossi
- Italian Hospital Buenos Aires, Buenos Aires, Argentina
| | - Jonathan F Dickens
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27709, USA
| | - Oke Anakwenze
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27709, USA
| | | | | | - Christopher S Klifto
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, 27709, USA
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13
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Menendez ME, Wong I, Tokish JM, Denard PJ. Free Bone Block Procedures for Glenoid Reconstruction in Anterior Shoulder Instability. J Am Acad Orthop Surg 2023; 31:1103-1111. [PMID: 37476855 DOI: 10.5435/jaaos-d-22-00837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 06/23/2023] [Indexed: 07/22/2023] Open
Abstract
Advances in the understanding and management of bone loss in shoulder instability have led to the development of free bone block techniques as an alternative to the Latarjet procedure. These techniques have been proposed as a theoretically safer option to Latarjet, and there is growing clinical enthusiasm in their use. The purpose of this article was to contextualize the utilization of free bone block procedures in the current treatment paradigm of anterior shoulder instability and to review the history and common types of bone autograft (eg, iliac crest, distal clavicle, scapular spine) and allograft (eg, distal tibia, preshaped blocks) techniques and approaches, as well as their clinical effectiveness and safety.
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Affiliation(s)
- Mariano E Menendez
- From the Oregon Shoulder Institute at Southern Oregon Orthopedics, Medford, OR (Menendez and Denard), the Department of Surgery, Dalhousie University, Halifax, Nova Scotia (Wong), the Department of Orthopedic Surgery, Mayo Clinic Arizona, Scottsdale, AZ (Tokish)
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14
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Youssef Y, Heilemann M, Melcher P, Fischer JP, Schleifenbaum S, Hepp P, Theopold J. Assessment of micromotion at the bone-bone interface after coracoid and scapular-spine bone-block augmentation for the reconstruction of critical anterior glenoid bone loss-a biomechanical cadaver study. BMC Musculoskelet Disord 2023; 24:790. [PMID: 37798626 PMCID: PMC10552292 DOI: 10.1186/s12891-023-06914-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Glenoid bone loss is among the most important risk factors for recurrent anterior shoulder instability, and a bony reconstruction is recommended in cases of critical bone loss (> 15%). The commonly used surgical techniques, including coracoid transfer, are associated with considerable complications. The aim of this study was to assess the motion at the glenoid-bone-block interface after coracoid and spina-scapula bone-block reconstruction of the anterior glenoid. METHODS Twelve cadaveric shoulders were tested. A 20% bone defect of the anterior glenoid was created, and the specimens were randomly assigned for glenoid augmentation using a coracoid bone block (n = 6) or a scapular spine bone block (n = 6). The glenoid-bone interface was cyclically loaded for 5000 cycles with a force of 170 N. The micromotion was tracked using an optical measurement system (GOM ARMIS) and was evaluated with the GOM Correlate Pro software. RESULTS The most dominant motion component was medial irreversible displacement for the spina-scapula (1.87 mm; SD: 1.11 mm) and coracoid bone blocks (0.91 mm; SD: 0.29 mm) (n.s.). The most medial irreversible displacement took place during the first nine cycles. The inferior reversible displacement was significantly greater for spina-scapula bone blocks (0.28 mm, SD: 0.16 mm) compared to coracoid bone blocks (0.06 mm, SD: 0.10 mm) (p = 0.02). CONCLUSIONS The medial irreversible displacement is the dominant motion component in a bone-block reconstruction after a critical bone loss of the anterior glenoid. The spina-scapula and coracoid bone blocks are comparable in terms of primary stability and extent of motion. Thus, spina-scapula bone blocks may serve as alternatives in bony glenoid reconstruction from a biomechanical point of view.
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Affiliation(s)
- Yasmin Youssef
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany.
| | - Martin Heilemann
- ZESBO-Center for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany
| | - Peter Melcher
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - Jean-Pierre Fischer
- ZESBO-Center for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany
| | - Stefan Schleifenbaum
- ZESBO-Center for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany
| | - Pierre Hepp
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - Jan Theopold
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany
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15
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Maiotti M, Massoni C. Arthroscopic Xenograft With Cerclage Fixation: A Method for Glenoid Bone Loss Reconstruction With Cerclage Fixation Using a Specific Posterior Guide. Arthrosc Tech 2023; 12:e1657-e1664. [PMID: 37942095 PMCID: PMC10627986 DOI: 10.1016/j.eats.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/27/2023] [Indexed: 11/10/2023] Open
Abstract
Large glenoid bone defects are closely associated with high failure rates after arthroscopic Bankart repair in chronic anterior shoulder instability; therefore nowadays the glenoid bone grafting reconstruction procedure is strictly recommended. On the contrary, the optimal grafting procedure is still controversial because there is considerable concern about the resorption rate of allografts, donor site morbidity of the autografts, and sequelae caused by the use of metal fixation devices in proximity of the shoulder joint. We describe an all-arthroscopic technique for anatomic reconstruction of the glenoid that uses a previously shaped xenograft assembled with a metal-free fixation device using 2 ultra-high-strength sutures (FiberTape Cerclage System; Arthrex, Naples, FL), using a specific posterior guide (Arthrex, Naples, FL) in combination with upper third subscapularis augmentation.
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Affiliation(s)
- Marco Maiotti
- Villa Stuart Hospital, Rome, Italy
- Mediterranea Hospital, Naples, Italy
| | - Carlo Massoni
- Villa Stuart Hospital, Rome, Italy
- Mediterranea Hospital, Naples, Italy
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Araujo BVD, Lara PHS, Pochini ADC, Ejnisman B, Figueiredo EAD, Belangero PS. Bristow-Latarjet Surgery: A Current Overview in Brazil. Rev Bras Ortop 2023; 58:e734-e741. [PMID: 37908520 PMCID: PMC10615603 DOI: 10.1055/s-0043-1776131] [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: 05/16/2022] [Accepted: 05/05/2023] [Indexed: 11/02/2023] Open
Abstract
Objective To provide a current overview of the Bristow-Latarjet surgery in Brazil. Materials and Methods This cross-sectional study was based on an electronic questionnaire with 26 items, which was sent to active members of the Brazilian Society of Shoulder and Elbow Surgery (Sociedade Brasileira de Cirurgia do Ombro e Cotovelo, SBCOC, in Portuguese). The questionnaire addressed training, surgical technique, complications, and postoperative management. Results We sent the questionnaire to 845 specialists from April 20 to May 12, 2021, and 310 of them answered i in full. During their specialization, most specialists participated in up to ten Bristow-Latarjet procedures. The most frequent complication was graft fracture, while the most common technical difficulty was screw positioning. In total, 50.6% and 73.9% reported having experienced intraoperative and postoperative complications respectively; 57.1% declared performing subscapularis suture; 99.7% indicated postoperative immobilization; and 61.9% considered graft consolidation fundamental. Conclusion Most specialists participated in up to ten Bristow-Latarjet procedures during the specialization, but 13.5% of them graduated without participating in the surgery. The most frequent complication was graft fracture. The most common technical difficulty was screw positioning. Most participants prefer postoperative immobilization since they believe graft consolidation is essential to resume the practiced of sports. The highest complication rate occurred with specialists who have obtained their titles 11 to 15 years ago. In Brazil, the Southeast region is the largest producer of specialists and has the highest concentration of these professionals.
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Affiliation(s)
- Bruno Vierno de Araujo
- Cirurgião ortopedico, Centro de Traumatologia do Esporte, Departamento de Ortopedia e Traumatologias, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Paulo Henrique Schmidt Lara
- Cirurgião ortopedico, Centro de Traumatologia do Esporte, Departamento de Ortopedia e Traumatologias, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Alberto de Castro Pochini
- Cirurgião ortopedico, Centro de Traumatologia do Esporte, Departamento de Ortopedia e Traumatologias, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Benno Ejnisman
- Cirurgião ortopedico, Centro de Traumatologia do Esporte, Departamento de Ortopedia e Traumatologias, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Eduardo Antônio de Figueiredo
- Cirurgião ortopedico, Centro de Traumatologia do Esporte, Departamento de Ortopedia e Traumatologias, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil
| | - Paulo Santoro Belangero
- Cirurgião ortopedico, Centro de Traumatologia do Esporte, Departamento de Ortopedia e Traumatologias, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil
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Best MJ, Wang KY, Nayar SK, Agarwal AR, Kreulen RT, Sharma S, McFarland EG, Srikumaran U. Epidemiology of shoulder instability procedures: A comprehensive analysis of complications and costs. Shoulder Elbow 2023; 15:398-404. [PMID: 37538528 PMCID: PMC10395401 DOI: 10.1177/17585732221116814] [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: 04/07/2022] [Revised: 06/24/2022] [Accepted: 07/12/2022] [Indexed: 08/05/2023]
Abstract
Background Recurrent shoulder instability is a debilitating condition that can lead to chronic pain, decreased function, and inability to return to activities or sport. This retrospective epidemiology study was performed to report 90-day postoperative complications and costs of Latarjet, anterior bone block reconstruction, arthroscopic, and open Bankart repair for shoulder instability. Methods Patients 18 years and older who underwent four primary shoulder surgeries from 2010 to 2019 were identified using national claims data. Patient demographics, comorbidities, and 90-day postoperative complications were analyzed using univariate analysis and multivariable logistic regression. Total and itemized 90-day reimbursements were determined for each procedure. Results The 90-day medical and surgery-specific complication rates were highest for anterior bone block reconstruction, followed by Latarjet. Arthroscopic Bankart repair had the highest 90-day costs and primary procedure costs compared to other procedures. Conclusion Anterior bone block reconstruction and Latarjet procedures were associated with the highest rates of 90-day medical and surgery-specific complications, while arthroscopic Bankart repair was associated with the highest costs.
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Affiliation(s)
- Matthew J Best
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Suresh K Nayar
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Amil R Agarwal
- George Washington University School of Medicine, Washington DC, USA
| | - R Timothy Kreulen
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sribava Sharma
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edward G McFarland
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Jovan JD, Marcel AJ, Myrick KM, Feinn RS, Blaine T. Resident Involvement in Shoulder-Stabilization Procedures Is Not Associated With an Increased Risk of 30-Day Postoperative Complications. Arthrosc Sports Med Rehabil 2023; 5:100764. [PMID: 37533975 PMCID: PMC10391657 DOI: 10.1016/j.asmr.2023.100764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/14/2023] [Indexed: 08/04/2023] Open
Abstract
Purpose To examine the 30-day postoperative outcomes of resident involvement in shoulder-stabilization surgical procedures using the American College of Surgeons National Surgical Quality Improvement database. Methods We conducted a retrospective review of the National Surgical Quality Improvement database for all shoulder-stabilization procedures from 2010 to 2018. Procedures included arthroscopic Bankart, arthroscopic Bankart with SLAP repair, arthroscopic Bankart with Remplissage, open Bankart, anterior bone block, posterior bone block, Latarjet coracoid process transfer, and capsular shift/capsulorrhaphy for multidirectional instability. Data included preoperative demographics, comorbidities, and 30-day postoperative outcomes. Cases were categorized into 2 groups: "attending alone" and "attending and resident." Statistical analysis comparing groups on demographics and comorbidities included independent t-test for continuous variables and Pearson χ2 or Fischer exact for categorical variables. A logistic regression model including propensity score was used to calculate adjusted odds ratio for outcomes. Results A total of 3,954 patients undergoing shoulder-stabilization procedures were included in the study and 28.8% of patients had a resident involved in their procedure. Residents were more likely to be involved in procedure for patients who were of minority ethnicity (P < .001), a lower body mass index (P < .001) and less likely to have a history of chronic obstructive pulmonary disease (P = .029). Resident involvement resulted in statistically significant longer total operation time (91 vs 85 minutes, P < .001). In terms of postsurgical outcomes, complication rates were low for both groups (∼0.8%). Resident involvement was not associated with any significant increase in 30-day postsurgical complications. Conclusions Our results show that resident involvement in shoulder-stabilization surgery is associated with a significant increase in operative time without any significant increase in 30-day postsurgical complications. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- John D. Jovan
- Frank H. Netter M.D. School of Medicine, Quinnipiac University, North Haven, Connecticut, U.S.A
| | - Aaron J. Marcel
- Frank H. Netter M.D. School of Medicine, Quinnipiac University, North Haven, Connecticut, U.S.A
| | - Karen M. Myrick
- Frank H. Netter M.D. School of Medicine, Quinnipiac University, North Haven, Connecticut, U.S.A
| | - Richard S. Feinn
- Frank H. Netter M.D. School of Medicine, Quinnipiac University, North Haven, Connecticut, U.S.A
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Maiotti M, Massoni C, Di Pietto F, Romano M, Guastafierro A, Della Rotonda G, Russo R. Arthroscopic Subscapularis Augmentation With Xenograft Glenoid Bone Block in Patients With Recurrent Anterior Shoulder Instability. Arthrosc Sports Med Rehabil 2023; 5:e809-e816. [PMID: 37388873 PMCID: PMC10300584 DOI: 10.1016/j.asmr.2023.04.008] [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] [Received: 12/09/2022] [Accepted: 04/16/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction The purpose of this study was to investigate the clinical and radiographic outcomes at 2 years for patients who underwent an arthroscopic xenograft bone block procedure plus ASA for recurrent anteroinferior gleno-humeral instability. Methods This retrospective study was conducted on patients affected by chronic anteroinferior shoulder instability. The inclusion criteria were as follows: patients must be aged 18 years or older; have recurrent anteroinferior shoulder instability, a glenoid defect >10%, assessment by the Pico area measurement system, anterior capsular insufficiency, and an engaging Hill-Sachs lesion. The exclusion criteria were as follows: multidirectional instability, glenoid bone defect <10%, arthritis, and minimum follow-up less than 24 months. Clinical outcomes were evaluated according to Western Ontario Shoulder Instability Index (WOSI) and Rowe scale. Computed tomography (CT) results were evaluated to assess any signs of resorption or displacement of the xenograft at 24 months follow-up. Results Twenty patients that met all the inclusion criteria underwent arthroscopic xenograft bone block procedure and ASA. The mean preoperative Rowe score was 38.3 points, and it significantly improved (P < .001), increasing to 95.5 points. ROWE level at follow-up was excellent for 18 patients (90%), fair for 1 patient (5%), and poor for another patient (5%). The mean preoperative WOSI score was 1242 points, and it improved significantly (P <.0001), with a mean score of 120 points at follow-up. In all patients, the comparative study between CT scans performed postoperatively and at final follow-up did not reveal a volume reduction of the xenografts (P > .05) and absence areas affected by signs of resorption and breakage with 34.4% of postprocedural increase of the glenoid surface, were seen. Conclusions The combination of ASA and bone block procedure with a xenograft was effective in the glenoid reconstruction and restoration of shoulder stability. No radiographic evidence of graft resorption, graft displacement, or glenohumeral arthritis were observed at 24-month follow-up. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Marco Maiotti
- Villa Stuart Hospital, Rome, Italy
- Shoulder and Knee Unit, Mediterranea Hospital, Naples, Italy
| | - Carlo Massoni
- Shoulder and Knee Unit, Mediterranea Hospital, Naples, Italy
| | | | | | - Antonio Guastafierro
- Department of Orthopaedic Surgery, Pineta Grande Hospital, Castelvolturno (CE), Italy
| | | | - Raffaele Russo
- Department of Orthopaedic Surgery, Pineta Grande Hospital, Castelvolturno (CE), Italy
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20
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The Glenoid Track Paradigm Does Not Reliably Affect Military Surgeons’ Approach to Managing Shoulder Instability. Arthrosc Sports Med Rehabil 2023; 5:e403-e409. [PMID: 37101867 PMCID: PMC10123446 DOI: 10.1016/j.asmr.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/17/2023] [Indexed: 02/20/2023] Open
Abstract
Purpose To report the frequencies of surgical stabilization procedures performed by military shoulder surgeons and to use decision tree analysis to describe how bipolar bone loss affects surgeons' decision to perform arthroscopic versus open stabilization procedures. Methods The Military Orthopaedics Tracking Injuries and Outcomes Network (MOTION) database was queried for anterior shoulder stabilization procedures from 2016 to 2021. A nonparametric decision tree analysis was used to generate a framework for classifying surgeon decision making based on specified injury characteristics (labral tear location, glenoid bone loss [GBL], Hill-Sachs lesion [HSL] size, and on-track vs off-track HSL). Results A total of 525 procedures were included in the final analysis, with a mean patient age of 25.9 ± 7.2 years and a mean GBL percentage of 3.6% ± 6.8%. HSLs were described based on size as absent (n = 354), mild (n = 129), moderate (n = 40), and severe (n = 2) and as on-track versus off-track in 223 cases, with 17% (n = 38) characterized as off-track. Arthroscopic labral repair (n = 428, 82%) was the most common procedure, whereas open repair (n = 10, 1.9%) and glenoid augmentation (n = 44, 8.4%) were performed infrequently. Decision tree analysis identified a GBL threshold of 17% or greater that resulted in an 89% probability of glenoid augmentation. Shoulders with GBL less than 17% combined with a mild or absent HSL had a 95% probability of an isolated arthroscopic labral repair, whereas a moderate or severe HSL resulted in a 79% probability of arthroscopic repair with remplissage. The presence of an off-track HSL did not contribute to the decision-making process as defined by the algorithm and data available. Conclusions Among military shoulder surgeons, GBL of 17% or greater is predictive of a glenoid augmentation procedure whereas HSL size is predictive of remplissage for GBL less than 17%. However, the on-track/off-track paradigm does not appear to affect military surgeons' decision making. Level of Evidence Level III, retrospective cohort study.
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21
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Abstract
BACKGROUND In cases of recurrent anterior shoulder instability with a glenoid defect, Latarjet procedures are widely used for stabilization. Although complications with this procedure have been reported, few studies have comprehensively analyzed issues related to the Latarjet procedure. PURPOSE To identify the overall complication rate of the Latarjet procedure used for anterior shoulder instability and to compare the rate of complications between arthroscopic and open approaches. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed by using the PubMed, EMBASE, Scopus, and Cochrane Library databases. Data on complications were extracted and classified as intraoperative, postoperative, or instability-related for further analysis. Quality assessments were performed with criteria from the Methodological Index for Nonrandomized Studies (MINORS). A quantitative synthesis of data was conducted to compare the complication rates between arthroscopic and open approaches. RESULTS A total of 35 articles were included in this analysis. The MINORS score was 11.89. A total 2560 Latarjet procedures (2532 patients) were included. The overall complication rate was 16.1% (n = 412). The intraoperative complication rate was 3.4% (n = 87) and included a 1.9% (n = 48) incidence of nerve injuries and a 1.0% (n = 25) incidence of iatrogenic fractures. Screw problems, vascular injuries, and conversion arthroscopic to open surgery each occurred at a rate of <1%. The postoperative complication rate was 6.5% (n = 166), and the most common complication was nonunion (1.3%; n = 33). The instability-related complication rate was 6.2% (n = 159) and included a 1.5% (n = 38) rate of redislocation, a 2.9% (n = 75) rate of positive apprehension test, and a 1.0% (n = 26) rate of instability. Overall, 2.6% (n = 66) of patients required an unplanned secondary operation after the initial surgery. The arthroscopic approach was associated with a higher rate of intraoperative complications compared with the open approach (5.0% vs 2.9%; P =.020) and a lower rate of instability-related complications (3.1% vs 7.2%; P < .001). CONCLUSION The Latarjet procedure for anterior shoulder instability results in an overall complication rate of 16.1% and a reoperation rate of 2.6%. However, serious complications at short-term follow-up appear rare. When the arthroscopic approach was used, the rate of intraoperative complications was higher, although instability-related complications were lower when compared with the open approach.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Sang Soo Na
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Byung-Chan Choi
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
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22
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Kuan FC, Hsu KL, Lin FH, Hong CK, Chen Y, Shih CA, Su WR. Morphometric and Biomechanical Comparison of the Scapular Spine and Coracoid Graft in Anterior Shoulder Instability. Am J Sports Med 2022; 50:3625-3634. [PMID: 36190171 DOI: 10.1177/03635465221124277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The scapular spine has been described as a relatively new bone graft alternative used in glenoid augmentation. The classic Latarjet procedure, which transfers the coracoid as a graft, is regarded as the gold standard. The comparison of these 2 techniques has not been fully reported. PURPOSE To compare the anatomic and biomechanical properties of glenoid augmentation using scapular spine graft or coracoid graft. STUDY DESIGN Controlled laboratory study. METHODS The study used 20 fresh-frozen human cadaveric shoulders. A 25% anterior glenoid defect was created, and the specimens were divided randomly to receive glenoid augmentation by scapular spine or coracoid grafts. For both procedures, the grafts were secured to the glenoid defect with 2 screws. Morphometric data, including the glenoid articular area, amount of restoration, and graft dimensions, were obtained. A biomechanical test was conducted in a direct-loading scenario. The construct stiffness, cyclic displacement, and ultimate failure of each specimen were collected. RESULTS No significant difference was found in glenoid articular restoration between the scapular spine group and the coracoid group (31% vs 33%, respectively; P = .311). Morphometric analysis indicated that coracoid grafts exhibited significantly greater thickness and height than scapular spine grafts. In biomechanical results, the scapular spine group exhibited significantly greater construct stiffness than the coracoid group (206.3 ± 58.8 vs 148.3 ± 76.0 N/mm, respectively; P = .023). The average failure load in the scapular spine group was not significantly higher than that in the coracoid group. No significant differences in cyclic displacement were found between the 2 techniques. CONCLUSION In a simulated 25% anterior glenoid bony defect, a scapular spine graft was comparable with the classic Latarjet procedure in restoring the glenoid articular dimension and exhibited superior construct stiffness in a cadaveric model. CLINICAL RELEVANCE The scapular spine may serve as an alternative graft choice in glenoid augmentation surgery considering the amount of articular restoration and initial fixation stability.
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Affiliation(s)
- Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
| | - Fang-Hsien Lin
- Department of Physical Medicine and Rehabilitation, Tainan Municipal An-Nan Hospital, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
| | - Yueh Chen
- Department of Orthopaedic Surgery, Sin Lau Christian Hospital, Tainan, Taiwan
| | - Chien-An Shih
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
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23
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Boileau P, Gendre P, Saliken DJ, Thélu CÉ, Trojani C. Tensioning device increases coracoid bone block healing rates in arthroscopic Latarjet procedure with suture-button fixation. J Shoulder Elbow Surg 2022; 31:1451-1462. [PMID: 35172210 DOI: 10.1016/j.jse.2022.01.126] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is growing interest in using suture buttons for coracoid fixation to avoid the complications associated with screws during the Latarjet procedure. However, achieving bone block healing is critical for successful shoulder stabilization and return to sport. The purpose of this study was to assess and compare the healing rates and positioning of the coracoid bone block fixed with cortical suture buttons that were either manually tensioned (using a knot pusher) or mechanically tensioned (using a tensioning device) during arthroscopic Latarjet procedures. METHODS This prospective, nonrandomized, comparative study enrolled 69 consecutive patients (mean age, 27 years) who underwent an arthroscopic guided Latarjet procedure with suture-button fixation. Hand tensioning was performed in the first 34 shoulders, whereas the next 35 shoulders underwent mechanical tensioning. Twelve patients (17%) had a history of failed Bankart stabilization. The characteristics of the patients in each group in terms of age, sex, type of sport, bone loss, number of previous failed surgical procedures, smoking, and length of follow-up were comparable. Intraoperatively, the tensioning device was set at 100 N successively 3 times until complete immobilization of the bone block was confirmed, as assessed with a probe. The primary outcome measure was coracoid bone block union and position on computed tomography scan images at 6 months' follow-up. Secondary outcome measures included functional outcome scores, shoulder stability, return to sports, and complications at last follow-up. RESULTS Overall, the rate of bone block healing was 74% (25 of 34 patients) in the hand-tensioning group and 94% (33 of 35 patients) in the mechanical tensioning group (P = .043). Smoking was an independent risk factor associated with nonunion (P < .001) in each group. Patient age, size of the preoperative glenoid bone defect (<20% or >20%), and a history of surgery were not found to have any influence. The tensioning modality did not affect the bone block position, which was subequatorial in 92% of the cases and flush with the glenoid rim in 92%. At a mean of 34 months of follow-up (range, 24-62 months), 96% of the patients (65 of 69) had a stable shoulder and 87% returned to sports. At final follow-up, no significant difference in clinical scores was noted between the groups; no neurologic or hardware complications were observed. CONCLUSION Mechanical tensioning achieves significantly higher healing rates than hand tensioning during the arthroscopic Latarjet procedure with suture-button fixation. The use of a suture-tensioning device is a key step to the suture-button fixation technique during arthroscopic Latarjet procedures. By making the suture-button construct rigid, the tensioning device transforms the initially flexible suture into a "rigid fixation", similar to a bolt (or a rivet).
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Affiliation(s)
- Pascal Boileau
- Institut de Chirurgie Réparatrice (ICR)-Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France.
| | | | | | | | - Christophe Trojani
- Institut de Chirurgie Réparatrice (ICR)-Groupe KANTYS, Institute for Sports & Reconstructive Surgery, Nice, France
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24
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Trends in utilization and patient demographics for shoulder instability procedures from 2010 to 2019. J Shoulder Elbow Surg 2022; 31:S13-S17. [PMID: 35063643 DOI: 10.1016/j.jse.2021.12.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Improved techniques and increased surgeon experience have optimized surgical care in patients with recurrent shoulder instability. Several techniques are used for surgical repair of shoulder instability, yet there are limited data on how utilization has changed over the past decade. The aim of this study was to assess trends in the utilization rate and patient demographic characteristics (age and sex) from 2010 to 2019 for 4 shoulder instability procedures: coracoid transfer/Latarjet procedure (LP), anterior bone block (ABB), open Bankart repair (OBR), and arthroscopic Bankart repair (ABR). METHODS We identified >87,000 patients using an all-payer claims database. The utilization rate was defined as the number of cases of a procedure divided by the total number of surgical cases for shoulder instability for any given year. Age was divided into 3 groups: <25 years, 25-35 years, and >35 years. Trends were reported in terms of the compounded annual growth rate (CAGR). RESULTS Although ABR was the most common shoulder instability procedure overall (91% utilization rate), the LP had the greatest increase in utilization from 2010 to 2019 (2.0% to 4.5%; CAGR, +9.8%). In comparison, the utilization of ABB procedures increased by 4.3% annually whereas that of OBR declined by 6.9% annually. The utilization of ABR showed minimal change. Notably, the LP was performed more frequently in younger patients over time. The percentage of patients aged < 25 years who underwent the LP increased from 30% to 41% from 2010 to 2019 (CAGR, +3.4%). There was a trend toward the performance of more LPs in men than in women (+1.2% vs. -3.5%, P < .05), although most cases (68%) were still performed in men. CONCLUSION ABR continues to account for most shoulder instability procedures. The LP had the greatest increase in the utilization rate from 2010 to 2019 and has now surpassed OBR in the utilization rate. ABB procedures are also being more frequently performed but only represent a minority of stabilization cases. During the course of the study period, a greater percentage of patients undergoing shoulder instability procedures were male individuals and were aged < 25 years.
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25
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Moroder P, Kathi T, Lacheta L, Karpinski K, Paksoy A, Akgün D. Arthroscopic Bone Block Cerclage Technique Using a Tricortical Scapular Spine Autograft for Glenoid Reconstruction in Patients With Anterior Shoulder Instability. Arthrosc Tech 2022; 11:e379-e383. [PMID: 35256979 PMCID: PMC8897580 DOI: 10.1016/j.eats.2021.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/08/2021] [Indexed: 02/03/2023] Open
Abstract
In the treatment of anterior shoulder instability with glenoid bone loss, free bone graft transfers have proven to be a viable anatomic alternative to the commonly performed, nonanatomic Latarjet procedure. Implant-free fixation of the free bone grafts, in particular, has rendered excellent short- and long-term results. However, a drawback remains the source of the graft. We describe an arthroscopic bone block cerclage technique using a tricortical scapular spine autograft, which provides an anatomic arthroscopic glenoid reconstruction with the combined benefit of sparing the subscapularis, metal-free fixation, and intraregional donor site for autograft harvesting.
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Affiliation(s)
| | | | | | | | | | - Doruk Akgün
- Address correspondence to Doruk Akgün, M.D., Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Augustenburger Platz 1, Berlin 13353, Germany.
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Danilkowicz RM, Crook B, Kim J, Robinette JP, O’Donnell J, Grimm NL. Patient Factors Associated With Increased Risk for Complications After the Latarjet Procedure. Orthop J Sports Med 2022; 10:23259671211062573. [PMID: 35198640 PMCID: PMC8859666 DOI: 10.1177/23259671211062573] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/24/2021] [Indexed: 11/15/2022] Open
Abstract
Background: The open Latarjet has become the most common method of addressing significant glenoid bone loss in patients with recurrent glenohumeral instability. Purpose: To describe national trends in Latarjet procedures and risk factors for complications associated with this procedure. Study Design: Cohort study; Level of evidence, 3. Methods: Eligible patients were identified through the National Surgical Quality Improvement Program (NSQIP) data set over the years 2014 to 2018 by using the Current Procedural Terminology (CPT) code for “capsulorrhaphy anterior with coracoid process transfer” (CPT 23462). Patient and surgical outcome variables were extracted and analyzed from the NSQIP database. Logistic regression analysis and odds ratios (ORs) were performed to evaluate the relative risk of complications. Results: The authors identified 458 patients (399 men and 59 women) from the data set. The mean body mass index was 27.4 kg/m2, and mean operative time was 130.2 minutes. Statistically significant variables included smoking status and sex, which were further stratified. Smokers were 2.19 times more likely to experience at least 1 adverse outcome, including deep vein thrombosis (DVT), pulmonary embolism, reoperation, wound infection, unplanned readmission, or readmission (95% CI, 0.62-7.82). Specifically, smokers were 7.8 times more likely to have a DVT (95% CI, 0.58-105.96), 1.4 times more likely to undergo reoperation (95% CI, 0.14-5.73), and 2.4 times more likely to have an unplanned readmission (95% CI, 0.19-28.68). Women were 2.2 times more likely to experience at least 1 adverse outcome. Specifically, women were found to be 6.4 times more likely to have a DVT (95% CI, 0.76-54.87), 4.1 times more likely to have an unplanned readmission (95% CI, 0.00-106.21), and 4.7 times more likely to have a readmission (95% CI, 0.00-13.92). Conclusion: The results indicate that smokers and female patients are at a higher risk of experiencing adverse outcomes and may require additional pre- and postprocedural precautions when undergoing the Latarjet procedure. With the increase in frequency, providers should be aware of patient-related factors that may lead to adverse outcomes.
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Affiliation(s)
- Richard M. Danilkowicz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Bryan Crook
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jaewhan Kim
- Department of Physical Therapy, University of Utah College of Health, Salt Lake City, Utah, USA
- Study Design and Biostatistics Center, University of Utah College of Health, Salt Lake City, Utah, USA
| | - Jesse Patton Robinette
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeffrey O’Donnell
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
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27
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Salem HS, Vasconcellos AL, Sax OC, Doan KC, Provencher MT, Romeo AA, Freedman KB, Frank RM. Intra-articular Versus Extra-articular Coracoid Grafts: A Systematic Review of Capsular Repair Techniques During the Latarjet Procedure. Orthop J Sports Med 2022; 10:23259671211068371. [PMID: 35097145 PMCID: PMC8793475 DOI: 10.1177/23259671211068371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/20/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Various methods exist for managing the joint capsule during the Latarjet procedure. Repairing the capsule to the native glenoid rim results in an extra-articular bone block, while repairing it to the remnant coracoacromial ligament stump of the coracoid graft renders it intra-articular. The technique that optimizes patient outcomes is not well defined. Purpose: To compare the outcomes of intra-articular and extra-articular bone block techniques for the Latarjet procedure. Study Design: Systematic review; Level of evidence, 4. Methods: Using PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines, we queried the PubMed, EMBASE, and the Cochrane Library for all studies reporting outcomes of the Latarjet procedure with a clearly defined method of capsular repair that rendered the coracoid graft intra-articular or extra-articular. The included levels of evidence and degree of heterogeneity in this study precluded meta-analysis. Outcomes of interest included preoperative variables, surgical technique, rehabilitation protocols, functional outcome assessments, recurrent instability, range of motion, and radiographic findings. Results: A total of 16 studies including 816 patients were included. A total of 8 studies employed an intra-articular bone block in 338 patients, while the other 8 employed an extra-articular technique in 478 patients. There was variation among studies in reference to baseline patient characteristics, surgical techniques, rehabilitation, methods for assessing patient outcomes, and follow-up times. Rates of postoperative instability were reported in 8 intra-articular (0%, 0%, 2.1%, 2.7%, 3.2%, 5%, 5.4%, 5.9%) and 7 extra-articular (0%, 0%, 1.2%, 2%, 3.9%, 6.3%, 14%) bone block studies. Postoperative osteoarthritis or progression of preoperative osteoarthritis was reported in 5 intra-articular bone block studies (0%, 5.6%, 23.5%, 23.5%, 25%) and 4 extra-articular bone block studies (0%, 1.9%, 5.2%, 8.6%). Conclusion: Varying capsular repair methods appeared to provide similar outcomes regarding stability. There was an apparent trend toward higher rates of post-traumatic arthritis among studies in which an intra-articular bone block technique was employed; however, it is possible that this was influenced by substantially different follow-up times between groups and other various sources of heterogeneity among the included studies. There were no studies in the literature directly comparing intra-articular and extra-articular bone block techniques. Large-scale randomized controlled trials or comparative studies are needed to draw stronger conclusions comparing the 2 techniques.
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Affiliation(s)
- Hytham S. Salem
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | | | - Oliver C. Sax
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Kent C. Doan
- CU Sports Medicine, University of Colorado School of Medicine, Boulder, Colorado, USA
| | | | - Anthony A. Romeo
- Sports Medicine/Shoulder Elbow Division, Rothman Institute, New York, New York, USA
| | - Kevin B. Freedman
- Sports Medicine/Shoulder Elbow Division, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Rachel M. Frank
- CU Sports Medicine, University of Colorado School of Medicine, Boulder, Colorado, USA
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Kellam PJ, Harrast J, Weinberg M, Martin DF, Davidson NP, Saltzman CL. Complications of Hardware Removal. J Bone Joint Surg Am 2021; 103:2089-2095. [PMID: 34398858 DOI: 10.2106/jbjs.20.02231] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND While hardware removal may improve patient function, the procedure carries risks of unexpected outcomes. Despite being among the most commonly performed orthopaedic procedures, scant attention has been given to its complication profile. METHODS We queried the American Board of Orthopaedic Surgery (ABOS) de-identified database of Part II surgical case lists from 2013 through 2019 for American Medical Association Current Procedural Terminology (CPT) implant-removal codes (20680, 20670, 22850, 22852, 22855, 26320). Hardware removal procedures that were performed without any other concurrent procedure ("HR-only procedures") were examined for associated complications. RESULTS In the 7 years analyzed, 13,089 HR-only procedures were performed, representing 2.1% (95% confidence interval [CI], 2.1% to 2.2%) of the total of 609,150 surgical procedures during that period. A complication was reported to have occurred in association with 1,256 procedures (9.6% [95% CI, 9.1% to 10.1%]), with surgical complications reported in association with 1,151 procedures (8.8% [95% CI, 8.3% to 9.3%]) and medical/anesthetic complications reported in association with 196 procedures (1.5% [95% CI, 1.3% to 1.7%]). Wound-healing delay/failure (2.1% [95% CI, 1.8% to 2.3%]) and infection (1.6% [95% CI, 1.4% to 1.8%]) were among the most commonly reported complications after HR-only procedures, but other serious events were reported as well, including unexpected reoperations (2.5% [95% CI, 2.2% to 2.7%]), unexpected readmissions (1.6% [95% CI, 1.4% to 1.8%]), continuing pain (95% CI, 1.2% [1.0% to 1.4%]), nerve injury (0.6% [95% CI, 0.4% to 0.7%]), bone fracture (0.5% [95% CI, 0.4% to 0.6%]), and life-threatening complications (0.4% [95% CI, 0.3% to 0.5%]). CONCLUSIONS Hardware removal is one of the most commonly performed orthopaedic procedures and was associated with an overall complication rate of 9.6% (95% CI, 9.1% to 10.1%) in a cohort of recently trained orthopaedic surgeons in the United States. Although specific complications such as infection, refractures, and nerve damage were reported to have relatively low rates of occurrence, and associated life-threatening complications occurred rarely, surgeons and patients should be aware that hardware removal carries a definite risk. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Patrick J Kellam
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | | | - Maxwell Weinberg
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - David F Martin
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Nathan P Davidson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Charles L Saltzman
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
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Zeng Z, Liu C, Liu Y, Huang Y. Early outcomes of the arthroscopic Latarjet procedure in a series of 37 patients with shoulder instability. BMC Musculoskelet Disord 2021; 22:845. [PMID: 34600519 PMCID: PMC8487569 DOI: 10.1186/s12891-021-04726-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background Anterior shoulder dislocation remains a clinical challenge. This study aimed to assess the graft position and clinical outcomes of the arthroscopic Latarjet procedure and capsular repair for the treatment of recurrent anterior shoulder dislocation with significant glenoid bone loss in 37 patients. Methods Between 2017 and 2017, 37 patients underwent arthroscopic Latarjet plus capsular repair procedure for recurrent anterior shoulder dislocation combined with significant glenoid bone loss. In follow-up examinations, Walch-Duplay scores, subjective shoulder value (SSV) scores, Rowe scores, and active range of motion (AROM) were assessed. Three-dimensional computed tomography (CT) was used to evaluate coracoid graft position and bone resorption. A new method of evaluating the position of the coracoid bone block after Latarjet (H-Z method) was developed. Results Thirty-seven patients were included in this study. Follow-up ranged from 6 to 36 months postoperatively (with an average of 13 months). No recurrent dislocation occurred at the final follow-up, and there was no significant effect on the AROM (all p > 0.05). Rowe (from 42.2 ± 5.6 to 91.1 ± 3.3), Walch-Duplay (from 31.5 ± 8.0 to 92.6 ± 3.7), and SSV (from 63.9 ± 6.1 to 79.3% ± 5.0%) scores were improved significantly after surgery (all p < 0.001). CT showed that the 29 patients had varying degrees of bone resorption, and 23 recovered to the preinjury level of motional function within 6–12 months after surgery. Conclusions In active patients with recurrent anterior shoulder dislocations and significant glenoid bone loss, the arthroscopic Latarjet procedure plus capsular repair could restore shoulder stability satisfactory.
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Affiliation(s)
- Zheng Zeng
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Chuan Liu
- Department of Orthopaedic Sports Medicine, the 7th center of PLAGH, Beijing, 100700, China
| | - Yang Liu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
| | - Yan Huang
- Department of Orthopaedic Sports Medicine, the 7th center of PLAGH, Beijing, 100700, China.
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Hendy BA, Padegimas EM, Kane L, Harper T, Abboud JA, Lazarus MD, Romeo AA, Namdari S. Early postoperative complications after Latarjet procedure: a single-institution experience over 10 years. J Shoulder Elbow Surg 2021; 30:e300-e308. [PMID: 33010440 DOI: 10.1016/j.jse.2020.09.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/30/2020] [Accepted: 09/08/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Latarjet procedure is an effective procedure for the treatment of anterior glenohumeral joint instability; however, the complications are concerning. The purpose of this study was to review a single institution's experience with the Latarjet procedure for recurrent anterior glenohumeral instability specifically focusing on early complications. METHODS This was a retrospective review of all Latarjet procedures performed at a single institution from August 2008 to July 2018. The 90-day complication rate and associated risk factors for all complications and graft failure were recorded. Postoperative radiographs were reviewed for coracoid graft position and screw divergence. RESULTS During the study period, 190 Latarjet procedures were performed with 90-day follow-up. The average age was 28.7 ± 11.3 years, male patients comprised 84.2% of the population, and 62.6% of patients had undergone a prior stabilization procedure. We observed 15 complications, for a 90-day complication rate of 9.0%; of the patients, 8 (4.2%) underwent reoperations. Graft or hardware failure occurred in 9 patients (4.7%) with loosened or broken screws, and 6 required reoperations (revision Latarjet procedure in 4, distal tibia allograft in 1, and iliac crest autograft in 1). Fixation with only 1 screw (P < .001) and an increased screw divergence angle (37° ± 8° vs. 24° ± 11°, P = .0257) were statistically associated with graft failure, whereas the use of cannulated screws (P = .487) was not. There were 6 nerve injuries (3.2%), including 2 combined axillary and suprascapular nerve injuries, 1 musculocutaneous nerve injury, 1 brachial plexopathy, 1 peripheral sensory nerve deficit (likely axillary), and 1 sensory plexopathy. Suprascapular nerve injury at the spinoglenoid notch was associated with a longer superior screw (41.0 ± 1.4 mm vs. 33.5 ± 3.5 mm, P = .035) and increased screw divergence angle (40° ± 6° vs. 24° ± 11°, P = .0197). The coracoid graft was correctly positioned in the axial plane in 71% of cases and in the coronal plane in 73% of cases. CONCLUSION The Latarjet procedure is a procedure that can reliably restore shoulder stability; however, graft- and nerve-related complications are relatively common. Two-thirds of the graft failures required reoperations, and half of the nerve injuries in this study led to residual symptoms. Fixation with only 1 screw and an increased screw divergence angle were significant predictors of graft failure. Suprascapular nerve injury at the spinoglenoid notch was associated with an increased screw divergence angle and longer superior screw.
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Affiliation(s)
- Benjamin A Hendy
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Eric M Padegimas
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Liam Kane
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Thomas Harper
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Joseph A Abboud
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Mark D Lazarus
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Anthony A Romeo
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Surena Namdari
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
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Trends in Spinal Surgery Performed by American Board of Orthopaedic Surgery Part II Candidates (2008 to 2017). J Am Acad Orthop Surg 2021; 29:e563-e575. [PMID: 32947350 DOI: 10.5435/jaaos-d-20-00437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/30/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The American Board of Orthopaedic Surgery (ABOS) Part II Oral Examination is typically taken two calendar years after fellowship completion. Despite previous studies using ABOS Part II Oral Examination data in other subspecialties, types of cases performed by spine surgeons in initial independent practice have not been well-studied. Such data may help trainees anticipate case composition observed in early practice and allow spine fellowship programs to understand emerging trends. METHODS We retrospectively reviewed surgical cases submitted to the ABOS by candidates taking the Part II Oral Examination between 2008 and 2017 whose designated subspecialty was spine. A hierarchical, restrictive algorithm was used to determine procedures based on candidate-reported International Classification of Diseases 9th/10th Revision and Current Procedural Terminology codes. Adjusted multivariable Poisson regression analyses were used to assess changes in procedure incidence rates over time. RESULTS We identified 37,539 cases, averaging 3,754 cases/yr, and an average of 49 cases per candidate per 6-month collection period. The most common procedures were lumbar diskectomy (22% of all procedures), posterolateral spinal fusion (PSF) (19%), and anterior cervical diskectomy and fusion (ACDF) (17%). Rates of ACDF and cervical disk arthroplasty significantly increased over time (incidence rate ratios of 1.41 and 23.3 times higher, respectively, at the end of the study period), whereas rates of cervical foraminotomy, lumbar diskectomy, PSF, and structural autograft use decreased (incidence rate ratios of 0.35, 0.84, 0.55, and 0.30). Rates of anterior lumbar interbody fusion/lateral lumbar interbody fusion and transforaminal lumbar interbody fusion did not significantly change over the study period. DISCUSSION Recent spine fellowship graduates are performing more cervical disk arthroplasties and ACDFs while decreasingly using structural autograft as well as performing fewer PSFs and lumbar diskectomies. Techniques such as anterior lumbar interbody fusion/lateral lumbar interbody fusions and transforaminal lumbar interbody fusions have not changed significantly over the last decade. LEVEL OF EVIDENCE Level IV (retrospective case series study).
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Frank RM, Salem HS, Richardson C, O'Brien M, Newgren JM, Cole BJ, Verma NN, Nicholson GP, Romeo AA. Clinical Outcomes of Shoulder Stabilization in Females With Glenoid Bone Loss. Orthop J Sports Med 2021; 9:23259671211007525. [PMID: 34036113 PMCID: PMC8127764 DOI: 10.1177/23259671211007525] [Citation(s) in RCA: 4] [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: 11/20/2020] [Accepted: 12/21/2020] [Indexed: 01/06/2023] Open
Abstract
Background Nearly all studies describing shoulder stabilization focus on male patients. Little is known regarding the clinical outcomes of female patients undergoing shoulder stabilization, and even less is understood about females with glenoid bone loss. Purpose To assess the clinical outcomes of female patients with recurrent anterior shoulder instability treated with the Latarjet procedure. Study Design Case series; Level of evidence, 4. Methods All cases of female patients who had recurrent anterior shoulder instability with ≥15% anterior glenoid bone loss and underwent the Latarjet procedure were analyzed. Patients were evaluated after a minimum 2-year postoperative period with scores of the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale. Results Of the 22 patients who met our criteria, 5 (22.7%) were lost to follow-up, leaving 17 (77.2%) available for follow-up with a mean ± SD age of 31.7 ± 12.9 years. Among these patients, 16 (94.1%) underwent 1.6 ± 0.73 ipsilateral shoulder operations (range, 1-3) before undergoing the Latarjet procedure. Preoperative indications for surgery included recurrent instability with bone loss in all cases. After a mean follow-up of 40.2 ± 22.9 months, patients experienced significant score improvements in the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale (P < .05 for all). There were 2 reoperations (11.8%). There were no cases of neurovascular injuries or other complications. Conclusion Female patients with recurrent shoulder instability with glenoid bone loss can be successfully treated with the Latarjet procedure, with outcomes similar to those of male patients in the previously published literature. This information can be used to counsel female patients with recurrent instability with significant anterior glenoid bone loss.
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Affiliation(s)
- Rachel M Frank
- Department of Orthopaedic Surgery, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Hytham S Salem
- Department of Orthopaedic Surgery, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Catherine Richardson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael O'Brien
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jon M Newgren
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Gregory P Nicholson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Anthony A Romeo
- Department of Orthopaedic Surgery, DuPage Medical Group, Joliet, Illinois, USA
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Bonnevialle N, Girard M, Dalmas Y, Martinel V, Faruch M, Mansat P. Short-Term Bone Fusion With Arthroscopic Double-Button Latarjet Versus Open-Screw Latarjet. Am J Sports Med 2021; 49:1596-1603. [PMID: 33830790 DOI: 10.1177/03635465211001095] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recently, arthroscopic double-button Latarjet (AL) has provided an alternative to conventional open Latarjet (OL) in the treatment of anterior shoulder instability with glenoid bone loss. Therefore, theoretically, the faster fusion is obtained, the sooner return to sports under safe conditions can occur. The emerging flexible fixation of the bone block has clearly offered a new approach to achieve bone fusion. However, the period required to achieve this goal remains controversial. PURPOSE/HYPOTHESIS The purpose was to compare computed tomography (CT) scan results of AL and OL in the early postoperative period. It was hypothesized that the bone block fusion with AL would require a longer time than that with OL. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS In a retrospective 1-year study, the authors compared 17 primary double-button AL to 22 primary 2-screw OL procedures indicated for anterior shoulder instability in patients with an Index Severity Instability Score >3 points. These patients were reviewed with a CT scan at 1 day, 3 months, and 6 months postoperatively. The characteristics for the 2 groups were comparable. CT scans aimed to analyze graft position, bone contact area with the scapula, and fusion at 3 and 6 months. Clinical assessment was based on the Walch-Duplay and Rowe scores. RESULTS The mean preoperative Index Severity Instability Score was 5.3 ± 1.9 points, with a mean anterior glenoid bone loss of 9.1% ± 4.6%. At 3 months, the rates of fusion were 41% and 100% for the AL and OL groups, respectively (P < .001). This rate increased to 70% in the AL group at 6 months (P = .006). In the axial and sagittal planes, there was no difference in graft position between the AL group and the OL group. The bone block was longer and there was a more extensive bone contact area in the OL group (AL, 131 mm2 vs OL, 223 mm2; P < .001). At 6 months of follow-up, no significant difference in clinical scores was noted between the groups: Walch-Duplay score, 93.0 ± 10.9 points versus 91.8 ± 12.5 points (P = .867); and Rowe score, 99.0 ± 2.2 points versus 95.0 ± 8.4 points (P = .307) for the AL and OL groups, respectively. CONCLUSION AL required more time to achieve bone block fusion than OL. This finding should be taken into account when considering this procedure for patients in a hurry to return to sports involving the shoulder.
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Affiliation(s)
- Nicolas Bonnevialle
- Département d'Orthopédie Traumatologie du CHU de Toulouse, Toulouse, France.,Institut de Recherche Riquet (I2R), Toulouse, France.,Clinique Universitaire du Sport, Toulouse, France
| | - Mathieu Girard
- Département d'Orthopédie Traumatologie du CHU de Toulouse, Toulouse, France.,Clinique Universitaire du Sport, Toulouse, France
| | - Yoann Dalmas
- Département d'Orthopédie Traumatologie du CHU de Toulouse, Toulouse, France.,Clinique Universitaire du Sport, Toulouse, France
| | | | - Marie Faruch
- Département de Radiologie du CHU de Toulouse, Toulouse, France
| | - Pierre Mansat
- Département d'Orthopédie Traumatologie du CHU de Toulouse, Toulouse, France.,Institut de Recherche Riquet (I2R), Toulouse, France.,Clinique Universitaire du Sport, Toulouse, France
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Complication Events After Spinal Surgery Performed by American Board of Orthopaedic Surgery (ABOS) Part II Candidates (2008-2017). Spine (Phila Pa 1976) 2021; 46:101-106. [PMID: 33038197 DOI: 10.1097/brs.0000000000003741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To evaluate complications following spine surgery using American Board of Orthopaedic Surgeons (ABOS) Part II examination data from 2008 to 2017. SUMMARY OF BACKGROUND DATA Recent research has demonstrated the importance of surgical experience and clinical volume in minimizing complications after spine surgery. This may be challenging for orthopedic spine surgeons who are just starting their practice. METHODS We performed a retrospective review of surgical cases submitted to the ABOS by candidates taking the Part II Spine examination between 2008 and 2017. Complications, including peri-operative mortality as reported by candidates to the ABOS, were tracked over time. Complications were classified as surgical or medical using a predefined algorithm. Multivariable Poisson regression analyses adjusting for confounders were used to assess rates of complications and mortality over time. All analyses controlled for biologic sex, age, surgical diagnosis, and surgical location. RESULTS A total of 37,539 spine surgical patients were analyzed, with an average of 3754 cases performed each year. Following adjusted Poisson analysis, we determined that cases in 2017 had an increased likelihood of complications when compared to those treated in 2008 (IRR 1.20; 95% CI 1.09, 1.32). Similar findings were encountered for surgical complications (IRR 1.20; 95% CI 1.07, 1.34). In contrast, spine surgical cases reported to the ABOS in 2017 had a 55% lower likelihood of mortality when compared to procedures performed in 2008 (IRR 0.45; 95% CI 0.24, 0.84; P = 0.01). CONCLUSIONS Our analysis of ABOS Part II candidates demonstrates that reported complication rates may be increasing while mortality is decreasing. The etiologies behind these findings are likely multifactorial. Encouragingly, we believe that observed reductions in mortality suggest overall improvements in patient safety following spine surgery. At a minimum, our data provide benchmarks through which spine surgeons, hospitals, and residency or fellowship programs can evaluate performance.Level of Evidence: 4.
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Leland DP, Parkes CW, Bernard CD, Krych AJ, Dahm DL, Tokish JM, Camp CL. Significant Changes in the Diagnosis, Injury Severity and Treatment for Anterior Shoulder Instability Over Time in a U.S. Population. Arthrosc Sports Med Rehabil 2020; 2:e761-e769. [PMID: 33364614 PMCID: PMC7754528 DOI: 10.1016/j.asmr.2020.06.012] [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] [Received: 01/16/2020] [Accepted: 06/21/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose To report the annual incidence of anterior shoulder instability (ASI) diagnosis, injury severity, and surgical stabilization in a U.S. population. Methods An established U.S. geographic database was used to identify patients < 40 years old with diagnoses of ASI from 1994-2016. Medical records were reviewed to obtain patient demographics, histories, imaging results, and surgical details. Age- and sex-specific incidence rates were calculated and adjusted to the 2010 U.S. population. Poisson regression was performed to examine trends by timeline, sex and age. Results The study population consisted of 652 patients with ASI and a mean age of 21.5 years (range, 3.6-39.5). Comparing 2015-2016 to 1994-1999, we found an increase in the number of dislocations (from 1.0-1.9; P = 0.016) and total instability events (from 2.3-3.4; P = 0.041) per patient prior to presentation to a physician. There was a trend in increased diagnosis of bony Bankart and/or Hill-Sachs on MRI over time, with these lesions documented in 96% of patients undergoing MRI in 2015-2018 compared to 52.9% in 1994-1999 (P < .001). The use of arthroscopic procedures increased and peaked in 2005-2009 (90% of surgical cases performed). The proportion of open Latarjet procedures increased from 2010-2014 (14%) and 2015-2018 (31%). Conclusions The age- and sex- adjusted incidence of ASI diagnosis in a U.S. population from 1994-2016 is comparable to that demonstrated in Canadian and European populations. This study demonstrates an increasing number of instability events prior to surgical evaluation, which may correlate with patients’ more commonly presenting with bone loss and requiring more aggressive surgical treatment or that ASI is being more frequently cared for and documented by present-day orthopedic surgeons. Level of Evidence Level III, cross-sectional study.
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Affiliation(s)
- Devin P Leland
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Chad W Parkes
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christopher D Bernard
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Diane L Dahm
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - John M Tokish
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Scottsdale, Arizona, U.S.A
| | - Christopher L Camp
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
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Hudson PW, Pinto MC, Brabston EW, Hess MC, Cone BM, Williams JF, Brooks WS, Momaya AM, Ponce BA. Distal clavicle autograft for anterior-inferior glenoid augmentation: A comparative cadaveric anatomic study. Shoulder Elbow 2020; 12:404-413. [PMID: 33281945 PMCID: PMC7689607 DOI: 10.1177/1758573219869335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 07/12/2019] [Accepted: 07/14/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The aim of this study was to anatomically compare distal clavicle and coracoid autografts and their potential to augment anterior-inferior glenoid bone loss. METHODS Ten millimeters of distal clavicle and 20 mm of coracoid were harvested bilaterally from 32 cadavers. Length, weight, and height were measured and surface area and density were calculated. For each graft, ipsilateral measurements were compared and the ability to restore corresponding glenoid bone loss was calculated. RESULTS Distal clavicle grafts were larger than coracoid grafts with respect to length (22.3 mm versus 17.7 mm; p < 0.001), height (12.49 mm versus 9.65 mm; p < 0.001), mass (2.72 g versus 2.45 g; p = 0.0437), and volume (2.36 cm3 versus 1.96 cm3; p = 0.002). Coracoid grafts had larger widths (14.56 mm versus 10.52 mm; p < 0.001) and greater density (1.24 g/cm3 versus 1.18 g/cm3; p < 0.001). Distal clavicle surface area was greater on both the articular (2.93 cm2 versus 1.5 cm2; p < 0.001) and superior surfaces (2.76 cm2 versus 1.5 cm2; p < 0.001) when compared to lateral coracoid surface area. DISCUSSION Distal clavicle grafts were larger and restored larger bony defects but had greater variability and lower density than coracoid grafts. Clinical studies are needed to compare these graft options.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Brent A Ponce
- Brent A Ponce, Department of Orthopaedic Surgery, University of Alabama at Birmingham, HGLD 209, 1720 2nd Ave S, Birmingham, AL 35294, USA.
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Agarwalla A, Yao K, Gowd AK, Amin NH, Leland JM, Romeo AA, Liu JN. Assessment and Trends in the Methodological Quality of the Top 50 Most Cited Articles in Shoulder Instability. Orthop J Sports Med 2020; 8:2325967120967082. [PMID: 33816639 PMCID: PMC8008137 DOI: 10.1177/2325967120967082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/15/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Citation counts have often been used as a surrogate for the scholarly impact of a particular study, but they do not necessarily correlate with higher-quality investigations. In recent decades, much of the literature regarding shoulder instability is focused on surgical techniques to correct bone loss and prevent recurrence. PURPOSE To determine (1) the top 50 most cited articles in shoulder instability and (2) if there is a correlation between the number of citations and level of evidence or methodological quality. STUDY DESIGN Cross-sectional study. METHODS A literature search was performed on both the Scopus and the Web of Science databases to determine the top 50 most cited articles in shoulder instability between 1985 and 2019. The search terms used included "shoulder instability," "humeral defect," and "glenoid bone loss." Methodological scores were calculated using the Modified Coleman Methodology Score (MCMS), Jadad scale, and Methodological Index for Non-Randomized Studies (MINORS) score. RESULTS The mean number of citations and mean citation density were 222.7 ± 123.5 (range, 124-881.5) and 16.0 ± 7.9 (range, 6.9-49.0), respectively. The most common type of study represented was the retrospective case series (evidence level, 4; n = 16; 32%) The overall mean MCMS, Jadad score, and MINORS score were 61.1 ± 10.1, 1.4 ± 0.9, and 16.0 ± 3.0, respectively. There were also no correlations found between mean citations or citation density versus each of the methodological quality scores. CONCLUSION The list of top 50 most cited articles in shoulder instability comprised studies with low-level evidence and low methodological quality. Higher-quality study methodology does not appear to be a significant factor in whether studies are frequently cited in the literature.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Kaisen Yao
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York, USA
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University Medical Center, Winston-Salem, North Carolina, USA
| | - Nirav H Amin
- Veterans Administration Loma Linda, Loma Linda, California, USA
| | - J Martin Leland
- University Hospitals Geauga Medical Center, Cleveland, Ohio, USA
| | - Anthony A Romeo
- Department of Orthopaedic Surgery, The Rothman Institute, New York, New York, USA
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
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Weick JW, Kalia V, Pacheco E, Jacobson JA, Freehill MT. Osseous Healing With Nonrigid Suture Fixation in the Arthroscopic Latarjet Procedure. Orthop J Sports Med 2020; 8:2325967120964489. [PMID: 33244477 PMCID: PMC7678400 DOI: 10.1177/2325967120964489] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/11/2020] [Indexed: 11/16/2022] Open
Abstract
Background: The Latarjet procedure is a popular means to surgically address anterior glenohumeral joint instability. Although the Latarjet procedure is becoming increasingly common, challenges persist and include postoperative complications secondary to use of the conventional 2 bicortical fixation screws. Recently, a novel surgical technique using a guided surgical approach for graft positioning with nonrigid fixation via a suture suspensory system has been described. Purpose: To evaluate healing rates and stability of the grafts in patients who underwent this new Latarjet technique. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively gathered anonymized computed tomography (CT) data sets from a total of 107 patients who underwent nonrigid suture fixation using a cortical button fixation for anterior glenohumeral instability. Of the 107 patients, 45 had CT scans performed at 2 different time periods. The CT scans of each patient were compared by 2 fellowship-trained musculoskeletal radiologists. Data recorded included age, sex, date of scan, initial graft position on the glenoid, presence and degree of graft migration relative to the equator on follow-up scan, and percentage of osseous healing (as assessed by osseous bridging) on the follow-up scan. Descriptive statistics were calculated to evaluate the average migration and average percentage of healing at both time points. Results: Our population (n = 45) consisted of 38 men (84.4%) and 7 women (15.6%). The mean age was 27.1 ± 1.1 years. The mean time between initial CT scan (2 weeks postoperatively) and follow-up CT scan was 26 ± 2 weeks. On follow-up scan, reviewer 1 found 75.6% of patients had greater than 75% healing, and reviewer 2 found 70.2% of patients had greater than 75% healing. The center of the graft was measured at or below the equator on follow-up examination in 43 of 45 (95.6%) patients by reviewer 1 and 44 of 45 (97.8%) patients by reviewer 2. Conclusion: Based on these findings, nonrigid suture fixation using a cortical button device offers an effective alternative to traditional screw fixation for the Latarjet procedure with a high level of osseous healing and minimal graft migration.
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Affiliation(s)
- Jack W Weick
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Vivek Kalia
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily Pacheco
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jon A Jacobson
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael T Freehill
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
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Rehabilitation After Shoulder Instability Surgery: Keys for Optimizing Recovery. Sports Med Arthrosc Rev 2020; 28:167-171. [PMID: 33156232 DOI: 10.1097/jsa.0000000000000284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The specific approach to rehabilitation after surgical management of the unstable shoulder is dependent on the severity and chronicity of the instability. Establishing dynamic stability throughout the athlete's functional range of movement is critical to a successful outcome. The pace progression is guided by surgical (technique, injury pattern, and strength of repair) and patient factors (healing potential, prior health status, and psychosocial factors). The primary goal of treatment is to restore function and return the athlete to sport. The process should be guided by surpassing functional criteria for progression and tissue healing time.
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Villatte G, Erivan R, Barth J, Bonnevialle N, Descamps S, Boisgard S. Progression and projection for shoulder surgery in France, 2012-2070: Epidemiologic study with trend and projection analysis. Orthop Traumatol Surg Res 2020; 106:1067-1077. [PMID: 32863170 DOI: 10.1016/j.otsr.2020.04.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Shoulder surgery has been rapidly expanding over the past 20 years and now makes up a large share of orthopedic surgery practice. Data on how this activity has changed is not available in France due to a lack of registries. The study objectives were to: (1) quantify the number of shoulder surgeries in France, (2) predict how this activity will change over the next 50 years based on extreme scenarios. METHODS This study involved an analysis of shoulder surgery data taken from the French hospital discharge database (PMSI). Two mathematical scenarios were applied to define the change over time: the first only considered the evolution in the population and changes in the age brackets over time; the second extrapolated the trends observed over the past few years (2012 to 2018). RESULTS In 2018, there were 234,612 procedures coded as primary shoulder surgery procedures in France. This activity increased 24.5% between 2012 and 2018 and is projected to increase 18% to 161% from now to 2050, depending on the scenario (p<0.0001). Rotator cuff surgery procedures were done 173,799 times - of which 61,055 were tendon repair - representing 74% of all shoulder procedures. The scenarios point to an increase of 13.6% to more than 300% (p<0.0001). Primary shoulder arthroplasty corresponded to 17,043 procedures in 2018 (7.3% of all procedures), with a 47% increase between 2012 and 2018. Between 2018 and 2050, the number of total shoulder arthroplasty procedures is expected to increase 31% to 322% (p<0.0001). The total number of revision arthroplasty procedures was 1508, increasing by 39% from 2012 to 2018. There were 14,229 procedures done for anterior or posterior instability in 2018 (6% of total). Bone block procedures made up 53% of these cases. This increased 17% between 2012 and 2018, with a projected increase of 5% to 82% up to 2050 (p<0.01). DISCUSSION Shoulder surgery is the third largest activity in the orthopedic realm after hip and knee surgery, although it has seen the largest increases in recent years. This growth in shoulder procedures should continue over the next decades. LEVEL OF EVIDENCE IV, descriptive epidemiology study.
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Affiliation(s)
- Guillaume Villatte
- Université Clermont Auvergne, CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France; Université Clermont Auvergne, Service d'orthopédie, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France.
| | - Roger Erivan
- Université Clermont Auvergne, CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France; Université Clermont Auvergne, Service d'orthopédie, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Johannes Barth
- Service de chirurgie orthopédique, Centre Ostéoarticulaire des Cèdres, Grenoble, France
| | - Nicolas Bonnevialle
- Département d'Orthopédie Traumatologie, Centre Hospitalier Universitaire de Toulouse Purpan, Hôpital Riquet, Université Toulouse 3-Paul Sabatier, Toulouse, France
| | - Stéphane Descamps
- Université Clermont Auvergne, CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France; Université Clermont Auvergne, Service d'orthopédie, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- Université Clermont Auvergne, CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France; Université Clermont Auvergne, Service d'orthopédie, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
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Editorial Commentary: Open or Arthroscopic Surgery? Practice Makes Perfect…We Do Best What We Do Most Often. Arthroscopy 2020; 36:872-874. [PMID: 32139064 DOI: 10.1016/j.arthro.2019.11.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 02/02/2023]
Abstract
The reported outcomes of Bankart procedures performed after 2000 are significantly better than those reported prior to that date. The cause of this improvement can be found in adherence to the specific steps outlined in the Arthroscopy Association of North America Proficiency-Based Training program, improvements in instrumentation and implants and more appropriate patient selection. What is defined as an arthroscopic Bankart has also expanded. Patient-selection criteria have also changed dramatically over the past 2 decades, reflecting a better understanding of anterior shoulder instability and altering the choice of patients who should receive arthroscopic Bankart procedures. The arthroscopic Bankart with dual suture anchor remplissage is arguably the current arthroscopic gold standard for anterior shoulder "off-track" instability.
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Malahias MA, Chytas D, Raoulis V, Chronopoulos E, Brilakis E, Antonogiannakis E. Iliac Crest Bone Grafting for the Management of Anterior Shoulder Instability in Patients with Glenoid Bone Loss: a Systematic Review of Contemporary Literature. SPORTS MEDICINE-OPEN 2020; 6:12. [PMID: 32048101 PMCID: PMC7013021 DOI: 10.1186/s40798-020-0240-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/27/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND A number of clinical trials have been published assessing the role of iliac crest bone grafting for the management of recurrent anterior instability with glenoid bone loss in contemporary practice. We therefore performed a systematic review of contemporary literature to examine the effect of iliac crest bone grafting on postoperative outcomes of these patients. Our hypothesis is that contemporary iliac crest bone block techniques are associated with low reoperation and complication rates combined with satisfactory functional results. METHODS The US National Library of Medicine (PubMed/MEDLINE), the Cochrane Database of Systematic Reviews, and EMBASE were searched between January 2008 and December 2019 for relevant publications. RESULTS Following the application of the inclusion-exclusion criteria, nine articles were found eligible for our analysis. In total, 261 patients (mean age range, 25.5-37.5 years; mean follow-up range, 20.6-42 months) were included in the studies of the current review. The mean modified Coleman score was 48.6 (range 37-65), indicating an overall low-to-moderate methodological quality. In the short term, the overall all-cause reoperation rate was 6.1%, while the rate of recurrent instability was 4.8%. The graft non-union rate was 2.2%, while the rate of osteolysis, graft fracture, and infection was 0.4%, 0.9%, and 1.7%, respectively. Finally, hardware-related complications, such as screw breakage or symptomatic mechanical irritation around the screw insertion, occurred in 3.9% of the patients. CONCLUSIONS Iliac crest bone block techniques in contemporary practice are safe and effective in the short-term (< 4 years) follow-up for the management of anterior shoulder instability with substantial glenoid bone deficiency. However, further studies of higher quality and longer follow-up are required to establish the therapeutic value of these techniques as well as to clarify whether there are differences in the outcomes of arthroscopic and open iliac crest bone block procedures.
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Affiliation(s)
| | - Dimitrios Chytas
- 2nd Orthopaedic Department, School of Medicine, National & Kapodistrian University of Athens, Agias Olgas 3, Nea Ionia, 14233, Athens, Greece
| | - Vasileios Raoulis
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Efstathios Chronopoulos
- 2nd Orthopaedic Department, School of Medicine, National & Kapodistrian University of Athens, Agias Olgas 3, Nea Ionia, 14233, Athens, Greece
| | - Emmanouil Brilakis
- 3rd Orthopaedic Department, Hygeia Hospital, Erythrou Stavrou 4, Marousi, 15123, Athens, Greece
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Beletsky A, Cancienne JM, Manderle BJ, Mehta N, Wilk KE, Verma NN. A Comparison of Physical Therapy Protocols Between Open Latarjet Coracoid Transfer and Arthroscopic Bankart Repair. Sports Health 2020; 12:124-131. [PMID: 31916920 DOI: 10.1177/1941738119887396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Recent studies examining return to sport after traumatic shoulder instability suggest faster return-to-sport time lines after bony stabilization when compared with soft tissue stabilization. The purpose of the current study was to define variability across online Latarjet rehabilitation protocols and to compare Latarjet with Bankart repair rehabilitation time lines. EVIDENCE ACQUISITION Online searches were utilized to identify publicly available rehabilitation protocols from Accreditation Council for Graduate Medical Education (ACGME)-accredited academic orthopaedic surgery programs. STUDY DESIGN Descriptive epidemiology study. LEVEL OF EVIDENCE Level 3. RESULTS Of the 183 ACGME-accredited orthopaedic programs reviewed, 14 institutions (7.65%) had publicly available rehabilitation protocols. A web-based search yielded 17 additional protocols from private sports medicine practices. Of the 31 protocols included, 31 (100%) recommended postoperative sling use and 26 (84%) recommended elbow, wrist, and hand range of motion exercises. Full passive forward flexion goals averaged 3.22 ± 2.38 weeks postoperatively, active range of motion began on average at 5.22 ± 1.28 weeks, and normal scapulothoracic motion by 9.26 ± 4.8 weeks postoperatively. Twenty (65%) protocols provided specific recommendations for return to nonoverhead sport-specific activities, beginning at an average of 17 ± 2.8 weeks postoperatively. This was compared with overhead sports or throwing activities, for which 18 (58%) of protocols recommended beginning at a similar average of 17.1 ± 3.3 weeks. CONCLUSION Similar to Bankart repair protocols, Latarjet rehabilitation protocols contain a high degree of variability with regard to exercises and motion goal recommendations. However, many milestones and start dates occur earlier in Latarjet protocols when compared with Bankart-specific protocols. Consequently, variability in the timing of rehabilitation goals may contribute to earlier return to play metrics identified in the broader literature for the Latarjet procedure when compared with arthroscopic Bankart repair. STRENGTH OF RECOMMENDATION TAXONOMY (SORT) Level C.
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Affiliation(s)
- Alexander Beletsky
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
| | | | - Brandon J Manderle
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
| | - Nabil Mehta
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
| | - Kevin E Wilk
- Champion Sports Medicine, American Sports Medicine Institute, Birmingham, Alabama
| | - Nikhil N Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois
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Barber FA, Howard MS. Editorial Commentary: Glenoid Track Instability Management Score or Instability Severity Index Score-Will This Decrease Latarjet Abuse? Arthroscopy 2020; 36:68-70. [PMID: 31864599 DOI: 10.1016/j.arthro.2019.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/04/2019] [Indexed: 02/02/2023]
Abstract
Open treatment of anterior shoulder instability using a coracoid transfer, such as the Latarjet procedure, is associated with low recurrence rates but with significant complications such as nerve injury, arthrosis, and graft osteolysis. However, an arthroscopic Bankart procedure, although less invasive and with a low complication rate, has the possibility of a higher recurrent instability rate. Scoring systems such as the Instability Severity Index Score, created to select patients for an arthroscopic Bankart procedure or coracoid transfer, have varying levels of success. Often, the scoring system selects a relatively high percentage of patients for the coracoid transfer, possibly undermining its widespread adoption. The relation between glenoid and humeral bone loss has produced the concept of "on-track" and "off-track," which impacts recurrent instability rates. Merging the on-track and off-track concept with the new Glenoid Track Instability Management Score may produce an algorithm that more accurately assesses the need for the Latarjet procedure or arthroscopic stabilization.
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Rohman E, Gronbeck K, Tompkins M, Mittelsteadt M, Kirkham JA, Arciero RA. Scapular Spine Dimensions and Suitability as a Glenoid Bone Graft Donor Site. Am J Sports Med 2019; 47:2469-2477. [PMID: 31310727 DOI: 10.1177/0363546519861965] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current structural bone graft options used for glenoid augmentation in glenohumeral instability have known drawbacks. The scapular spine may be a possible alternative graft choice, but its dimensions and anatomy are not fully reported. HYPOTHESIS The scapular spine's harvestable graft dimensions will be similar to harvestable dimensions of the coracoid and iliac crest. STUDY DESIGN Descriptive laboratory study. METHODS The scapular spine, coracoid, and iliac crest dimensions were recorded and compared bilaterally in 50 patients with 3-dimensional computed tomography imaging. The portion of the scapular spine with the largest harvestable dimensions was quantified and its location defined. Measurements were independently taken by 2 investigators and averaged for the final result. RESULTS The scapular spine has 81.5 mm of harvestable length and a "flare" located approximately 49.6 mm lateral to the medial scapular border, where the widest harvestable cross section is located (mean harvestable dimensions: 10.9-mm height, 11.5-mm width). Mean coracoid dimensions were 24-mm length, 14.2-mm height, and 10.6-mm width. Mean iliac crest width was 14.7 mm. In sum, 96% of scapular spines, 85% of coracoids, and 100% of iliac crests exceeded minimum dimensions of 8 mm × 8 mm × 20 mm. The coronal radius of curvature of the glenoid was significantly different from the corresponding plane of all measured structures. CONCLUSION/CLINICAL RELEVANCE The scapular spine has dimensions similar to the coracoid and iliac crest in the majority of patients and is therefore appropriate for further investigation as a potential graft choice in glenohumeral instability. A harvest location 49.6 mm lateral to the medial scapular border will provide the largest cross-sectional graft while avoiding the acromial base.
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Affiliation(s)
- Eric Rohman
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kyle Gronbeck
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marc Tompkins
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.,TRIA Orthopaedic Center, Bloomington, Minnesota, USA
| | - Marcus Mittelsteadt
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - James A Kirkham
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robert A Arciero
- Department of Orthopedics, University of Connecticut Health Center, Farmington, Connecticut, USA
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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: 37] [Impact Index Per Article: 6.2] [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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47
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Frank RM, Romeo AA. Arthroscopic soft tissue reconstruction in anterior shoulder instability. DER ORTHOPADE 2019; 47:121-128. [PMID: 29435624 DOI: 10.1007/s00132-018-3532-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Anterior glenohumeral instability remains a difficult problem in the athletic and working patient populations. Treatment strategies are variable and range from nonoperative approaches incorporating immobilization and rehabilitation to surgical management. Surgical decision-making can be challenging, especially with a high-level patient who wishes to return to high-demand activities. Operative options range from open soft tissue stabilization to arthroscopic soft tissue stabilization, with both open and arthroscopic options for bony reconstruction in the setting of clinically significant anterior glenoid bone loss. In all cases, understanding appropriate indications and utilizing sound surgical techniques are critical for achieving a successful result. For the majority of patients with anterior shoulder instability, arthroscopic soft tissue reconstruction with suture anchors is a successful, minimally invasive approach that results in a stable shoulder with excellent outcomes and low complication rates.
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Affiliation(s)
- R M Frank
- CU Sports Medicine, Department of Orthopedics, University of Colorado School of Medicine, 2150 Stadium Drive, 80309, Boulder, CO, USA
| | - A A Romeo
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, 60612, Chicago, IL, USA.
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Boileau P, Saliken D, Gendre P, Seeto BL, d'Ollonne T, Gonzalez JF, Bronsard N. Arthroscopic Latarjet: Suture-Button Fixation Is a Safe and Reliable Alternative to Screw Fixation. Arthroscopy 2019; 35:1050-1061. [PMID: 30857907 DOI: 10.1016/j.arthro.2018.11.012] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 11/05/2018] [Accepted: 11/05/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate mid-term clinical outcomes, complications, bone-block healing, and positioning using suture-button fixation for an arthroscopic Latarjet procedure. METHODS Patients with traumatic recurrent anterior instability and glenoid bone loss underwent guided arthroscopic Latarjet with suture-button fixation. We included patients with anterior shoulder instability, glenoid bone loss >20%, and radiographic and clinical follow-up minimum of 24 months. Patients with glenoid bone loss <20% or those that refused computed tomography imaging were excluded. Bone-block fixation was accomplished with 2 cortical buttons connected with a looped suture (4 strands). The looped suture was tied posteriorly with a sliding-locking knot. After transfer of the bone block on the anterior neck of the scapula, compression (100 N) was obtained with the help of a tensioning device. Clinical assessment was performed at 2 weeks, 3 months, 6 months, and then yearly with computed tomography completed at 2 weeks and 6 months to confirm bony union. RESULTS A consecutive series of 136 patients underwent arthroscopic Latarjet with 121 patients (89%; mean age 27 years) available at final follow-up (mean follow-up, 26 months; range, 24-47 months). No neurologic complications or hardware failures were observed; no patients had secondary surgery for implant removal. The transferred coracoid process healed to the scapular neck in 95% of the cases (115/121). The bone block did not heal in 4 patients; it was fractured in 1 and lysed in another. Smoking was a risk factor associated with nonunion (P < .001). The coracoid graft was positioned flush to the glenoid face in 95% (115/121) and below the equator in 92.5% (112/121). At final follow-up, 93% had returned to sports, whereas 4 patients (3%) had a recurrence of shoulder instability. The subjective shoulder value for sports was 94 ± 3.7%. Mean Rowe and Walch-Duplay scores were 90 (range, 40-100) and 91 (range, 55-100), respectively. CONCLUSIONS Suture-button fixation is an alternative to screw fixation for the Latarjet procedure, obtaining predictable healing with excellent graft positioning, and avoiding hardware-related complications. There was no need for hardware removal after suture-button fixation. The systematic identification of the axillary and musculocutaneous nerves reduced risk of neurologic injury. A low instability recurrence rate and excellent return to pre-injury activity level was found. Suture-button fixation is simple, safe, and may be used for both open and arthroscopic Latarjet procedure. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Pascal Boileau
- Institut Universitaire Locomoteur & Sport (iULS), Hôpital Pasteur 2, University of Côte d'Azur, Nice, France.
| | - David Saliken
- Institut Universitaire Locomoteur & Sport (iULS), Hôpital Pasteur 2, University of Côte d'Azur, Nice, France
| | - Patrick Gendre
- Institut Universitaire Locomoteur & Sport (iULS), Hôpital Pasteur 2, University of Côte d'Azur, Nice, France
| | - Brian L Seeto
- Institut Universitaire Locomoteur & Sport (iULS), Hôpital Pasteur 2, University of Côte d'Azur, Nice, France
| | - Thomas d'Ollonne
- Institut Universitaire Locomoteur & Sport (iULS), Hôpital Pasteur 2, University of Côte d'Azur, Nice, France
| | - Jean-François Gonzalez
- Institut Universitaire Locomoteur & Sport (iULS), Hôpital Pasteur 2, University of Côte d'Azur, Nice, France
| | - Nicolas Bronsard
- Institut Universitaire Locomoteur & Sport (iULS), Hôpital Pasteur 2, University of Côte d'Azur, Nice, France
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Frank RM, Gregory B, O'Brien M, Bernardoni E, Verma NN, Cole BJ, Nicholson GP, Romeo AA. Ninety-day complications following the Latarjet procedure. J Shoulder Elbow Surg 2019; 28:88-94. [PMID: 30121152 DOI: 10.1016/j.jse.2018.06.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 06/03/2018] [Accepted: 06/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to describe the rate and type of complications occurring within 90 days following the Latarjet procedure for anterior glenohumeral instability. METHODS Consecutive patients undergoing the Latarjet procedure by fellowship-trained surgeons from a single institution between 2007 and 2016 were included for analysis. Indications for the Latarjet procedure included primary or recurrent anterior instability with clinically significant anterior glenoid bone loss and/or failed prior arthroscopic stabilization. Patients undergoing the Latarjet procedure after prior glenoid bone grafting were excluded. All complications that occurred within 90 days of surgery were analyzed and correlated with demographic factors. RESULTS A total of 146 consecutive patients (146 shoulders) were included. Of these patients, 11 were lost to follow-up and 2 were excluded for having undergone prior open bone grafting. Among the remaining 133 patients (average age, 28.5 ± 11.8 years; 75% male patients), 10 total complications occurred within 90 days of surgery, for an overall short-term complication rate of 7.5%. Of these 10 complications, 6 required subsequent surgery, with recurrent instability in 2 cases (overall rate, 1.50%), infection in 2 (overall rate, 1.50%), musculocutaneous nerve palsy in 1 (overall rate, 0.75%), and postoperative pain in 1 (overall rate, 0.75%). The remaining 4 complications were transient, resolving with nonoperative treatment. No cases of hardware failure or graft osteolysis were reported. CONCLUSIONS The overall 90-day complication rate following the Latarjet procedure for anterior shoulder stabilization was 7.5%. In 6 of the 10 cases, complications led to subsequent surgery, including recurrent instability in 2, while in the remaining 4 cases, the complications were transient and resolved with nonoperative treatment.
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Affiliation(s)
- Rachel M Frank
- CU Sports Medicine, Department of Orthopedics, University of Colorado School of Medicine, Boulder, CO, USA.
| | - Bonnie Gregory
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael O'Brien
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Eamon Bernardoni
- Department of Orthopaedic Surgery, University of Wisconsin, Madison, WI, USA
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Gregory P Nicholson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Russo R, Maiotti M, Taverna E, Rao C. Arthroscopic Bone Graft Procedure Combined With Arthroscopic Subscapularis Augmentation for Recurrent Anterior Instability With Glenoid Bone Defect. Arthrosc Tech 2018; 7:e623-e632. [PMID: 29955568 PMCID: PMC6020248 DOI: 10.1016/j.eats.2018.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/17/2018] [Indexed: 02/03/2023] Open
Abstract
Glenoid bone loss and capsular deficiency represent critical points of arthroscopic Bankart repair failures. The purpose of this Technical Note is to present an all-arthroscopic bone block procedure associated with arthroscopic subscapularis augmentation for treating glenohumeral instability with glenoid bone loss and anterior capsulolabral deficiency. Two glenoid tunnels are set up from the posterior to the anterior side using a dedicated bone block guide, and 4 buttons are used to fix the graft to the glenoid. The subscapularis tenodesis is performed using a suture tape anchor. This combined arthroscopic technique (bone block associated with arthroscopic subscapularis augmentation) could be a valid and safe alternative to the arthroscopic or open Latarjet procedures.
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Affiliation(s)
- Raffaele Russo
- Orthopedics and Traumatology Unit, Pellegrini Hospital, Naples, Italy
| | - Marco Maiotti
- Sports Medicine Unit and Orthopedic Center, San Giovanni Addolorata Hospital, Rome, Italy
| | - Ettore Taverna
- Orthopedics and Traumatology Unit, Galeazzi Hospital, Milan, Italy
| | - Cecilia Rao
- Orthopedics and Traumatology Unit, University of Tor Vergata, Rome, Italy
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