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Matsunaga K, Miyake S, Izaki T, Shibata T, Yamamoto T. Serial Magnetic Resonance Arthrography for a Midsubstance Capsular Tear in a Patient With Traumatic Anterior Shoulder Instability. Cureus 2024; 16:e59247. [PMID: 38813310 PMCID: PMC11134486 DOI: 10.7759/cureus.59247] [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: 04/08/2024] [Indexed: 05/31/2024] Open
Abstract
The natural history of midsubstance capsular tears (MCTs) is unclear. We herein describe a case of MCT observed using serial magnetic resonance (MR) arthrography. A 46-year-old woman presented with excessive external rotation of the left glenohumeral joint, resulting in an initial anterior dislocation of the left shoulder. She subsequently developed recurrent shoulder joint dislocations. MR arthrography revealed an MCT without a Bankart lesion three months after the initial dislocation. She opted for nonoperative treatment, but the shoulder instability did not improve. The second MR arthrography, nine months after the initial dislocation, showed no natural healing of the MCT. The third MR arthrography, 12 months after the initial dislocation, also showed no natural healing. Her shoulder instability remained persistent. The patient then decided to have surgery. Arthroscopy revealed a large capsular defect extending from the glenoid to the humeral head in the anterior inferior glenohumeral ligamentous complex. The MCT was repaired with the placement of nonabsorbable sutures in a side-to-side fashion. At the final follow-up, three years postoperatively, the patient had no anterior shoulder instability. The Rowe score was 100 points. MR arthrography showed good repair integrity of the MCT at one year postoperatively. Serial MR arthrography was useful for both the patient and the shoulder surgeon in considering the treatment of the MCT, facilitating an accurate and qualitative assessment of whether natural healing of the MCT had been achieved.
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Affiliation(s)
- Kei Matsunaga
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, JPN
| | - Satoshi Miyake
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, JPN
| | - Teruaki Izaki
- Department of Orthopedic Surgery, Fukuoka University Chikushi Hospital, Fukuoka, JPN
| | - Terufumi Shibata
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, JPN
| | - Takuaki Yamamoto
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, JPN
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Alzahrani WM, Tashkandi NF, Faqeeh MH, Almatrafi WS, Amer Bugnah AA, Kazim AH. Clinical Outcomes and Return to Sports After Arthroscopic Repair of Humeral Avulsion of the Glenohumeral Ligament: A Meta-Analysis. Cureus 2023; 15:e40848. [PMID: 37489209 PMCID: PMC10363328 DOI: 10.7759/cureus.40848] [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: 06/22/2023] [Indexed: 07/26/2023] Open
Abstract
This study aimed to evaluate the clinical outcomes and the frequency of return to sport after the arthroscopic repair of a humeral avulsion of the inferior glenohumeral ligament (HAGL) lesion. Web of Science, Scopus, and Medline via PubMed and OVID were searched to identify the relevant citations. Screening and data extraction were performed independently. The Comprehensive Meta-Analysis software was used for all statistical analyses (CMA; USA version 3.3.070). A total of 18 articles (n = 832 patients; of whom, 379 patients had HAGL) were included. The fixed-effect estimate showed that the percentage of patients who returned to their sports was 89.1% (95% CI = 85% to 92.2%). The mean duration to return was estimated to be 6.65 months (95% CI = 5.10 to 8.20). Postoperatively, the mean Western Ontario Shoulder Instability Index (WOSI), Oxford Shoulder Instability Score (OSIS), and Subjective Shoulder Value (SSV) scores were 88.60 (95% CI = 86.18 to 90.98), 15.02 (95% CI = 7.42 to 22.63), and 86.90 (95% CI = 80.79 to 93.00), respectively. The Rowe score improved significantly postoperatively with a mean difference (MD) of 54.47 (95% CI = 39.28 to 69.66). The University of California - Los Angeles (UCLA) shoulder score increased significantly post-arthroscopic repair (MD = 10.91, 95% CI = 10.07 to 11.76). The current evidence suggests that arthroscopic repair of HAGL lesions is associated with a high percentage of return to sports and improved Rowe score, WOSI, UCLA shoulder score, OSIS scale, and SSV score. The quality of the included studies is moderate; however, these findings are promising and call for further multicenter, prospective studies.
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Affiliation(s)
- Wael M Alzahrani
- Department of Surgery, College of Medicine, Najran University, Najran, SAU
| | | | - Mawddah H Faqeeh
- Department of Family Medicine, College of Medicine, Umm Al-Qura University, Makkah, SAU
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Anterior mid-portion capsular tear with Bankart lesion in recurrent anterior shoulder dislocation: outcome report and bone defect evaluation. Arch Orthop Trauma Surg 2022; 143:2581-2587. [PMID: 35964261 DOI: 10.1007/s00402-022-04580-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/07/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION This study aimed to report the incidence of anterior mid-portion capsular tears identified during arthroscopic Bankart repair (ABR), the clinical outcomes of repairing this combined lesion, and to evaluate the associated bone defects. METHODS We retrospectively reviewed the records of patients undergoing ABR between January 2014 and December 2017. Data from patients with capsular tears identified during ABR were included and analyzed. Age, number of dislocations, repair technique, follow-up results, and X-rays were reviewed. The size of the glenoid defect and Hill-Sachs lesion were reviewed via magnetic resonance imaging or magnetic resonance arthrography (MRA). RESULTS Records of 95 patients undergoing ABR during the study period were reviewed, and nine were included. The overall incidence of capsular tears was 9.5% and the mean age at surgery was 45.3 ± 14.3 years. All cases had > 3 dislocations before treatment. All patients had labral lesions, and one had a glenoid defect. Hill-Sachs lesions were observed in eight patients. Seven patients underwent MRA examination, and all seven showed axillary pouch disruption. Over 3.9 ± 1.1 years of follow-up, there was no instability recurrence, and Rowe scores improved from 42.2 to 96.7 (p < 0.001). CONCLUSIONS There was no recurrent shoulder instability after combined arthroscopic repair of capsular and Bankart lesions. There were Rowe score improvements over at least three years of follow-up. Although our case number was small, we found that mid-portion capsular tear occurred in patients over 30 years with multiple recurrent dislocations, with or without small glenoid bone defects, and with axillary pouch disruption on MRA images.
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Funakoshi T, Hartzler RU, Stewien E, Burkhart SS. Hill-Sachs Lesion Classification by the Glenoid Track Paradigm in Shoulder Instability: Poor Agreement Between 3-Dimensional Computed Tomographic and Arthroscopic Methods. Arthroscopy 2019; 35:1743-1749. [PMID: 31072719 DOI: 10.1016/j.arthro.2018.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine the amount of agreement between preoperative 3-dimensional computed tomographic (3D-CT) and intraoperative arthroscopic classification of Hill-Sachs lesions (HSLs) according to the glenoid track (GT) paradigm. METHODS Records for patients treated surgically for anterior shoulder instability from a single surgeon's practice from August 2013 until March 2016 were retrospectively reviewed. Inclusion criteria were presence of an HSL, < 25% glenoid bone loss, bilateral 3D-CT, and arthroscopically recorded bone loss measurements. Records for patients with chronic dislocations or prior operations were excluded. Calculations by 3D-CT and arthroscopy were performed as follows: Hill-Sachs interval (HSI) was the distance from rotator cuff insertion to medial edge of the HSL; GT was 83% of the normal glenoid width minus any glenoid defect; on-track was HSI less than GT; off-track was HSI greater than GT. RESULTS Sixteen shoulders with HSL status determined as on- or off-track demonstrated agreement between the 2 methods in 10 of 16 cases (63%, Cohen's κ = 0.16). All 6 cases with disagreement were calculated as on-track by 3D-CT and off-track by arthroscopic measurement. The GT was larger as determined by 3D-CT measurement (22 ± 1 mm [21-24]) compared with arthroscopy (18 ± 1 mm [17-20], P = .002). CONCLUSIONS Preoperative 3D-CT showed slight agreement compared with intraoperative arthroscopic measurements in classifying HSL as on-track versus off-track in the GT paradigm; larger GT size by 3D-CT versus arthroscopy accounted for all discrepancies. Determination of off-track status based on preoperative 3D-CT versus determination with the arthroscopic method would result in fewer HSLs treated with remplissage if the GT treatment paradigm were followed. Surgeons using the GT paradigm to determine treatment of HSL by remplissage should recognize the potential for discordance between arthroscopic and radiographic measurements.
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Kim JH, Kim CW. Clinical Outcome after Surgical Treatment of Recurrent Shoulder Dislocation with Small Bony Bankart. Clin Shoulder Elb 2015. [DOI: 10.5397/cise.2015.18.3.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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The pathology of the anterior capsule in patients over forty years of age with recurrent shoulder dislocation. INTERNATIONAL ORTHOPAEDICS 2015; 40:81-6. [DOI: 10.1007/s00264-015-2864-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
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Anterior shoulder capsular tears in professional baseball players. J Shoulder Elbow Surg 2014; 23:e173-8. [PMID: 24560469 DOI: 10.1016/j.jse.2013.11.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 11/20/2013] [Accepted: 11/22/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tearing of the anterior capsule of the shoulder is a rare but debilitating injury for throwing athletes. However, there is very little in the literature to guide its diagnosis and treatment. In this case series, we outline our experience with anterior capsular tears of the shoulder in professional baseball players. METHODS Five professional baseball players were diagnosed with midsubstance tears of their anterior capsule. A trial of rest and rehabilitation failed in all patients, and they eventually underwent surgery. These patients were retrospectively reviewed. The presenting symptoms and findings were documented, and outcomes were assessed by the player's ability to return to play. RESULTS The mean age was 33.5 years (range, 31-37 years), and all patients presented with anterior shoulder pain and the inability to throw. No patient had an acute traumatic injury. Magnetic resonance imaging provided the correct diagnosis in 4 patients, and the diagnosis was made with diagnostic arthroscopy in the fifth. Three underwent arthroscopic repair, and 2 underwent open repair of the anterior capsule. Of the 5 players, 4 (80%) returned to their preinjury level by a mean of 13.3 months (range, 8-18 months). CONCLUSIONS Anterior capsular tears can occur in older throwing athletes. Surgical repair, whether arthroscopic or open, can yield good results in most patients.
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Effect of Bankart repair on the loss of range of motion and the instability of the shoulder joint for recurrent anterior shoulder dislocation. J Shoulder Elbow Surg 2014; 23:888-94. [PMID: 24295836 DOI: 10.1016/j.jse.2013.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 08/28/2013] [Accepted: 09/04/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bankart repair postoperative complications include loss of shoulder motion and shoulder instability. The primary reason that postoperative complications develop may be excessive imbrication of the anterior band of the inferior glenohumeral ligament (AIGHL) or inadequate repair position. The purpose of this study was to quantitatively evaluate the influence of inadequate repair by computer simulation for a normal shoulder joint. METHODS Magnetic resonance images of 10 normal shoulder joints were acquired for 7 positions every 30° from the maximum internal rotation to the maximum external rotation with the arm abducted at 90°. The shortest 3-dimensional path of the AIGHL in each rotational orientation was calculated. We used computer simulations to anticipate the loss of motion and instability by changing the AIGHL length and insertion sites on the glenoid. RESULTS The AIGHL length measured 50 ± 5 mm at the maximum external shoulder rotation. AIGHL shortening by 3, 6, and 9 mm made the angle of maximum external rotation 80°, 68°, and 54°, respectively. A superior deviation of 3, 6, and 9 mm on the glenoid insertion resulted in a maximum external rotation angle of 85°, 79°, and 77°. An inferior deviation of 3, 6, and 9 mm produced humeral head translation of 1.7, 2.9, and 3.6 mm. CONCLUSION Simulation of both excessive imbrication and deviation of the insertion position led to quantitative prediction of the resulting loss of motion and instability. These findings will be useful for anticipating complications after Bankart repair. LEVEL OF EVIDENCE Basic science study, computer modeling, imaging.
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Emami MJ, Solooki S, Meshksari Z, Vosoughi AR. The effect of open Bristow-Latarjet procedure for anterior shoulder instability: a 10-year study. Musculoskelet Surg 2011; 95:231-235. [PMID: 21691734 DOI: 10.1007/s12306-011-0149-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 06/08/2011] [Indexed: 05/30/2023]
Abstract
Operative procedures are the usual treatment for patients with anterior traumatic shoulder instabilities. Soft tissue procedures, Bankart repair, cannot be performed in some patients. They need Bristow-Latarjet one. We decided to determine midterm results of this procedure in almost all types of anterior shoulder instability, even shoulders with Bankart lesion in non-athletic cases. Thirty patients after Bristow-Latarjet procedure from 1997 to 2007 were followed 2-8 years. Clinical outcomes, consisted of muscle strength, range of motion (mean 8.66 degrees decreased in external rotation with arm in neutral position and 18.33 with arm in 90 degrees of abduction), recurrent instability (no relapse), and Rowe score (mean 77.66) showed good to excellent results. We had no screw-related or neurovascular complications. Thirty percent of cases had signs of mild arthropathy. Although Bankart procedure is the preferred method in patients with isolated Bankart lesion, but we can perform Bristow-Latarjet for all types of anterior traumatic shoulder instability in non-athletics cases with acceptable results.
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Affiliation(s)
- Mohammad Jafar Emami
- Department of Orthopedics, Research Center for Bone & Joint Diseases, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Kim SH. Orthopedic disease and sports medicine in shoulder joint. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2011. [DOI: 10.5124/jkma.2011.54.7.705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Seung-Ho Kim
- Department of Orthopaedic Surgery, Madi Hospital, Seoul, Korea
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Wolf EM, Siparsky PN. Glenoid avulsion of the glenohumeral ligaments as a cause of recurrent anterior shoulder instability. Arthroscopy 2010; 26:1263-7. [PMID: 20810083 DOI: 10.1016/j.arthro.2010.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 06/01/2010] [Accepted: 06/03/2010] [Indexed: 02/02/2023]
Abstract
Although the Bankart lesion is accepted as the primary pathology responsible for recurrent shoulder instability, recognition of other soft-tissue lesions has improved the surgical treatment for this common problem. Whereas humeral avulsion of the glenohumeral ligaments has been acknowledged as a cause of anterior shoulder instability, we have not found any reported cases of glenoid avulsion of the glenohumeral ligaments. We describe 3 cases of recurrent anterior shoulder instability due to glenoid avulsion of the glenohumeral ligaments. The avulsed ligaments were repaired to the labrum and glenoid, restoring the glenohumeral ligament-labral complex.
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Affiliation(s)
- Eugene M Wolf
- Sportsmed Orthopaedic Group, San Francisco, California, USA
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Yamamoto N, Sano H, Itoi E. Conservative treatment of first-time shoulder dislocation with the arm in external rotation. J Shoulder Elbow Surg 2010; 19:98-103. [PMID: 20188274 DOI: 10.1016/j.jse.2009.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 12/28/2009] [Accepted: 12/28/2009] [Indexed: 02/01/2023]
Abstract
Nonoperative treatment of traumatic first-time shoulder dislocation has remained the same for a long time. The recurrence rate of nonoperative treatment is unacceptably high, especially in young and active patients. In an earlier study, we demonstrated the superiority of immobilization in external rotation over conventional treatment. Arthroscopic stabilization is being increasingly recommended after a first-time dislocation; however, surgical stabilization after a first-time dislocation still remains controversial. In this paper, we introduce a basic study that provides evidence for the development of immobilization in external rotation, recent clinical outcomes, and future perspective. Furthermore, how to choose the treatment options for first-time dislocations is discussed.
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Affiliation(s)
- Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Aoba-ku, Sendai, Japan
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Min WK, Kim JE, Cho HS, Kim PT, Jeon IH. Arthroscopic Evaluation on Intra-Articular Pathology in Recurrent Shoulder Dislocation Aged Over 40 Years. Clin Shoulder Elb 2009. [DOI: 10.5397/cise.2009.12.2.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Nho SJ, Reiff SN, Van Thiel GS, Romeo AA. Arthroscopic repair of L-shaped tear of the anterior band of the inferior glenohumeral ligament complex in a pediatric patient: a technical note. Knee Surg Sports Traumatol Arthrosc 2009; 17:1454-7. [PMID: 19238358 DOI: 10.1007/s00167-009-0740-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 01/23/2009] [Indexed: 10/21/2022]
Abstract
The present study reports on a case of a 10-year-old patient with recurrent right shoulder instability after a traumatic event leading to a mid-substance tear of the anterior band of the inferior glenohumeral ligament complex in an L-shaped pattern. Arthroscopic repair consisting of a 2.4 mm bioabsorbable suture anchor at the apex and a four PDS sutures placed through the capsulolabral junction leads to an anatomic repair with excellent short-term results similar to those found in other studies. The injury pattern is thought to be about 1% of shoulder dislocations, but tear pattern recognition is critical for a successful repair and clinical result.
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Affiliation(s)
- Shane Jay Nho
- Section of Shoulder and Elbow Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, 1725 West Harrison Street, Suite 1063, Chicago, IL 60612, USA.
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Abstract
Evaluation of patients with shoulder disorders often presents challenges. Among the most troublesome are revision surgery in patients with massive rotator cuff tear, atraumatic shoulder instability, revision arthroscopic stabilization surgery, adhesive capsulitis, and bicipital and subscapularis injuries. Determining functional status is critical before considering surgical options in the patient with massive rotator cuff tear. When nonsurgical treatment of atraumatic shoulder stability is not effective, inferior capsular shift is the treatment of choice. Arthroscopic revision of failed arthroscopic shoulder stabilization procedures may be undertaken when bone and tissue quality are good. Arthroscopic release is indicated when idiopathic adhesive capsulitis does not respond to nonsurgical treatment; however, results of both nonsurgical and surgical treatment of posttraumatic and postoperative adhesive capsulitis are often disappointing. Patients not motivated to perform the necessary postoperative therapy following subscapularis repair are best treated with arthroscopic débridement and biceps tenotomy.
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Seybold D, Schliemann B, Heyer CM, Muhr G, Gekle C. Which labral lesion can be best reduced with external rotation of the shoulder after a first-time traumatic anterior shoulder dislocation? Arch Orthop Trauma Surg 2009; 129:299-304. [PMID: 18379801 DOI: 10.1007/s00402-008-0618-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Immobilization in external rotation after a first-time traumatic anterior shoulder dislocation has been shown to improve the position of the labroligamentous lesion relative to the glenoid rim. The purpose of the present study was to evaluate the effect of the external rotation position of the shoulder on different types of labroligamentous lesions in patients with first-time traumatic anterior shoulder dislocation by using MRI. PATIENTS AND METHODS We performed a standardized MRI in internal and external rotation of the shoulder after initial reduction in 34 patients with a first-time traumatic anterior shoulder dislocation. Labroligamentous lesions were classified as Bankart, Perthes, or nonclassifiable. Four distinct grades were used to classify the amount of plastic deformation of the anterior labroligamentous structures. The position of the labrum was defined relative to the tip of the glenoid rim by measuring the dislocation and separation. RESULTS In all patients, dislocation and separation of the labrum relative to the rim of the glenoid were significantly improved in shoulders in the external rotation position compared to those in the internal rotation position. We observed 15 Bankart, 15 Perthes, and 4 non-classifiable lesions. No HAGL or GLAD lesions were found. Fourteen patients showed a plastic deformation grade I, 16 showed grade II, 3 showed grade III, and 1 showed grade IV. In regression analysis, the odds ratio was 1.100 for the type of lesion and 1.660 for the grade of plastic deformation. Perthes lesions (with an intact anterior scapular periosteum) and grade I plastic deformations showed the best labral reduction on the external rotation MRI. CONCLUSION Placing the shoulder in external rotation after a first-time traumatic shoulder dislocation, significantly improves the position of the labroligamentous lesion on the glenoid rim. Perthes lesions that showed a low grade of plastic deformation displayed better reduction in external rotation and then compared to Bankart or other lesions that showed a high grade of plastic deformation. In conclusion, immobilization of the shoulder after a first-time traumatic shoulder dislocation is most effective in patients with Perthes lesions that show low grade plastic deformation.
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Affiliation(s)
- Dominik Seybold
- Chirurgische Klinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Germany.
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Yiannakopoulos CK, Mataragas E, Antonogiannakis E. A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy 2007; 23:985-90. [PMID: 17868838 DOI: 10.1016/j.arthro.2007.05.009] [Citation(s) in RCA: 204] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of the study was to compare the incidence of secondary intra-articular shoulder lesions in patients with acute and chronic anterior shoulder instability. The occurrence of glenoid shape alterations (inverted pear glenoid) in recurrent instability was especially examined. METHODS Data for all arthroscopically ascertained intra-articular shoulder lesions in a series of 127 patients with acute and chronic traumatic anterior instability were recorded. RESULTS Hemarthrosis was evident in all patients with acute dislocation and in 7 patients with chronic laxity who underwent surgery shortly after a dislocation episode. In both groups the presence of a chondral or osteochondral Hill-Sachs lesion was noted in 112 patients (88.1%), a Bankart lesion was noted in 106 patients (83.46%), an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion was noted in 13 patients (10.23%), a SLAP lesion was noted in 26 patients (20.47%), a humeral avulsion of the glenohumeral ligament (HAGL) lesion was noted in 2 acutely dislocated shoulders (1.57%), and capsular laxity was noted in 33 patients (25.98%). All ALPSA lesions were noted in patients with chronic instability (P = .044), and both HAGL lesions were found in patients with acute dislocations (P = .002). In patients with acute dislocations the incidence of Bankart lesions was 78.2% (18/23), whereas in chronic cases the incidence of Bankart or ALPSA lesions was 97.11% (101/104) (P = .002). In the group with acute dislocations there was a Hill-Sachs lesion in 15 cases (65.21%) and chronic recurrent instability accounted for 97 cases (93.26%) (P = .001). The capsule was considered lax in 2 patients with acute instability and 31 patients with chronic instability (8.69% v 29.8%, P = .037). The overall frequency of SLAP lesions was not statistically significant between acute and chronic cases (P = .868), unlike their distribution. In acute cases there were 3 type I and 2 type II SLAP lesions, whereas in chronic cases there were 4 type I, 13 type II, 3 type III, and 1 type IV SLAP lesions. Loose bodies were found and removed in 17 chronic and 4 acute cases (16.34% v 13.04%, P = .903). A partial-thickness articular rotator cuff tear was found in 14 patients: 12 with chronic dislocations and 2 with acute dislocations (11.53% v 8.69%, P = .694). The cuff tears were partial articular surface tears, involving less than 25% of the cuff thickness, and were treated with debridement, and cuff repair was not necessary in any case. The inverted pear configuration of the glenoid was found in 16 cases with chronic instability (15.38%), whereas no patient with an acutely dislocated shoulder had an inverted pear-shaped glenoid (P = .044). CONCLUSIONS Associated, secondary intra-articular lesions are more frequent in patients with chronic compared with acute shoulder instability, probably as a result of the repeated dislocation or subluxation episodes. LEVEL OF EVIDENCE Level IV, prognostic case series.
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