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Zhao L, Fu C, Lu M, He L, Shen Z, Xing J, Wang C, Hou S. Remodeling process and clinical outcomes following all-arthroscopic modified Eden-Hybinette procedure using iliac crest autograft and 1-tunnel double Endobutton fixation system. J Shoulder Elbow Surg 2023; 32:1825-1837. [PMID: 36907316 DOI: 10.1016/j.jse.2023.01.041] [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: 08/15/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Arthroscopically modified Eden-Hybinette procedures for glenohumeral stabilization have been used for a long time. With the advancement of arthroscopic techniques and the development of sophisticated instruments, a double Endobutton fixation system has been used clinically to secure bone graft to the glenoid rim placed through a specifically designed guide. The purpose of this report was to evaluate clinical outcomes and serial glenoid remodeling process following all-arthroscopic anatomical glenoid reconstruction using autologous iliac crest bone grafting technique through 1-tunnel fixation. METHODS Forty-six patients with recurrent anterior dislocations and significant glenoid defects greater than 20% underwent arthroscopic surgery with a modified Eden-Hybinette technique. Instead of firm fixation, autologous iliac bone graft was fixed to the glenoid by double Endobutton fixation system through 1-tunnel placed in the glenoid surface. Follow-up examinations were performed at 3, 6, 12, and 24 months. The patients were followed up for a minimum of two years using the Rowe score, the Constant score, the Subjective Shoulder Value, and the Walch-Duplay score; patient satisfaction with the procedure outcome was also rated. Graft positions, healing, and absorption were evaluated postoperatively with computed tomography imaging. RESULTS At a mean follow-up of 28 months, all patients were satisfied and had a stable shoulder. The Constant score improved from 82.9 to 88.9 points (P < .001), the Rowe score, improved from 25.3 to 89.1 points (P < .001), the Subjective Shoulder Value improved from 31% to 87% (P < .001), and the Walch-Duplay score improved from 52.5 to 85.7 points (P < .001). One donor-site fracture occurred during the follow-up period. All grafts were well-positioned and achieved optimal bone healing with zero excessive absorption. The preoperative glenoid surface (72.6% ± 4.5%) increased significantly immediately after surgery to 116.5% ± 9.6% (P < .001). After a physiological remodeling process, the glenoid surface remained significantly increased at the last follow-up (99.2% ± 7.1%) (P < .001). The glenoid surface area appeared to decrease serially when compared between the first 6 months and 12 months postoperatively, while there was no significant interval change between 12 and 24 months postoperatively. CONCLUSION Patient outcomes were satisfactory following the all-arthroscopic modified Eden-Hybinette procedure using an autologous iliac crest grafting technique through one-tunnel fixation system with double Endobutton. Graft absorption mostly occurred on the edge and outside the ''best-fit'' circle of the glenoid. Glenoid remodeling occurred within the first year after all-arthroscopic glenoid reconstruction with an auto iliac bone graft.
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Affiliation(s)
- Lilian Zhao
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China.
| | - Chuying Fu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mingfeng Lu
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China; Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lilei He
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Zhaoxiong Shen
- 6th Department of Orthopaedics, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Jisi Xing
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Changbing Wang
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Senrong Hou
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
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Mittelsteadt M, Nelson BJ, Rohman EM, Arciero RA, Tompkins MA. Biomechanical Testing of Scapular Spine Autograft for Anterior Glenoid Bone Augmentation. Orthop J Sports Med 2022; 10:23259671221096682. [PMID: 35601735 PMCID: PMC9118475 DOI: 10.1177/23259671221096682] [Citation(s) in RCA: 1] [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: 02/16/2022] [Accepted: 02/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Augmentation of anterior glenoid defects with bone graft can improve shoulder stability and reduce the risk of redislocation. Several characteristics of the scapular spine may make it a suitable harvest site, avoiding the disadvantages associated with other glenoid augmentation procedures. Purpose: To evaluate the capacity of scapular spine autograft to restore the stabilizing joint-reaction forces of the shoulder in simulated scenarios of bony anterior shoulder instability. Study Design: Controlled laboratory study. Methods: We obtained 6 matched pairs of fresh-frozen cadaveric shoulders. Skin, subcutaneous tissues, and non–rotator cuff muscles were removed from the specimens, leaving intact the rotator cuff musculature and shoulder capsule. A customized testing device was used to translate the humerus 1 cm anteriorly on the glenoid under 25 N of axial compression force. The peak joint-reaction force of the glenohumeral joint was then measured under 3 conditions: (1) specimen with intact glenoid, (2) specimen after a bone defect measuring 25% of the maximal width of the glenoid was made in the anteroinferior glenoid, and (3) specimen after size-matched glenoid augmentation with a scapular spine tricortical autograft. The primary outcome was the change in peak joint-reaction forces between the defect state and augmented state. Results: One matched pair was removed from final analysis secondary to anatomic concerns that undermined the accuracy of test results. Among the 10 remaining specimens, all showed a significant decrease in peak joint-reaction force after the glenoid defect was created compared with the intact state (P < .001). All remaining specimens showed an increase in peak joint-reaction force in the augmented state compared with the defect state (P < .001). On average, the augmented state restored 81% of the peak reaction force of the glenohumeral joint compared with the intact state, a nonsignificant difference (P = .07). Conclusion: The study findings indicated that autograft harvested from the scapular spine increased the bony restraint to anterior shoulder dislocation in shoulders with glenoid bone loss. Clinical Relevance: The scapular spine is an alternative for bony augmentation of glenoid defects in shoulder instability.
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Affiliation(s)
- Marcus Mittelsteadt
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Bradley J Nelson
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.,TRIA Orthopedic Center, Bloomington, Minnesota, USA
| | - Eric M Rohman
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robert A Arciero
- Department of Orthopedic Surgery, UConn Health, Farmington, Connecticut, USA
| | - Marc A Tompkins
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.,TRIA Orthopedic Center, Bloomington, Minnesota, USA
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Gilat R, Haunschild ED, Lavoie-Gagne OZ, Tauro TM, Knapik DM, Fu MC, Cole BJ. Outcomes of the Latarjet Procedure Versus Free Bone Block Procedures for Anterior Shoulder Instability: A Systematic Review and Meta-analysis. Am J Sports Med 2021; 49:805-816. [PMID: 32795174 DOI: 10.1177/0363546520925833] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Free bone block (FBB) procedures for anterior shoulder instability have been proposed as an alternative to or bail-out for the Latarjet procedure. However, studies comparing the outcomes of these treatment modalities are limited. PURPOSE To systematically review and perform a meta-analysis comparing the clinical outcomes of patients undergoing anterior shoulder stabilization with a Latarjet or FBB procedure. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS PubMed, Embase, and the Cochrane Library databases were systematically searched from inception to 2019 for human-participants studies published in the English language. The search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement including studies reporting clinical outcomes of patients undergoing Latarjet or FBB procedures for anterior shoulder instability with minimum 2-year follow-up. Case reports and technique articles were excluded. Data were synthesized, and a random effects meta-analysis was performed to determine the proportions of recurrent instability, other complications, progression of osteoarthritis, return to sports, and patient-reported outcome (PRO) improvement. RESULTS A total of 2007 studies were screened; of these, 70 studies met the inclusion criteria and were included in the meta-analysis. These studies reported outcomes on a total of 4540 shoulders, of which 3917 were treated with a Latarjet procedure and 623 were treated with an FBB stabilization procedure. Weighted mean follow-up was 75.8 months (range, 24-420 months) for the Latarjet group and 92.3 months (range, 24-444 months) for the FBB group. No significant differences were found between the Latarjet and the FBB groups in the overall random pooled summary estimate of the rate of recurrent instability (5% vs 3%, respectively; P = .09), other complications (4% vs 5%, respectively; P = .892), progression of osteoarthritis (12% vs 4%, respectively; P = .077), and return to sports (73% vs 88%; respectively, P = .066). American Shoulder and Elbow Surgeons scores improved after both Latarjet and FBB, with a significantly greater increase after FBB procedures (10.44 for Latarjet vs 32.86 for FBB; P = .006). Other recorded PRO scores improved in all studies, with no significant difference between groups. CONCLUSION Current evidence supports the safety and efficacy of both the Latarjet and FBB procedures for anterior shoulder stabilization in the presence of glenoid bone loss. We found no significant differences between the procedures in rates of recurrent instability, other complications, osteoarthritis progression, and return to sports. Significant improvement in PROs was demonstrated for both groups. Significant heterogeneity existed between studies on outcomes of the Latarjet and FBB procedures, warranting future high-quality, comparative studies.
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Affiliation(s)
- Ron Gilat
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Eric D Haunschild
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | | | - Tracy M Tauro
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Derrick M Knapik
- University Hospitals Cleveland Medical Center, Department of Orthopaedic Surgery, Cleveland, Ohio, USA
| | - Michael C Fu
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
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Provencher MT, Peebles AM. Editorial Commentary: Preoperative 3-Dimensional Imaging for Shoulder Instability Is Vital for Determination of Off-Track Lesions and May Indicate Bankart Repair Plus Remplissage. Arthroscopy 2021; 37:457-459. [PMID: 33546784 DOI: 10.1016/j.arthro.2020.11.019] [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: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 02/02/2023]
Abstract
The on- and off-track concept is gaining momentum for surgeons who treat patients with anterior shoulder instability. Preoperative imaging is critical for improving our outcomes. Determination of an off-track lesion prior to surgery using 3-dimensional computed tomography allows for improvement in outcomes by indicating remplissage. Intraoperative determination with the patient under anesthesia is not as good or as accurate. However, although Bankart repair plus remplissage shows good outcomes, bony procedures such as Latarjet, distal tibia allograft, and iliac crest or other bone graft procedures are preferred for large defects. Still, perhaps it is time to truly look at posterior adjuncts to anterior instability such as remplissage in patients who have off-track lesions, even with notable bipolar bone loss.
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Use of allograft to reconstruct anterior bony glenoid defect in chronic glenohumeral instability: a systematic review. Arch Orthop Trauma Surg 2020; 140:1475-1485. [PMID: 32524228 DOI: 10.1007/s00402-020-03511-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Bone-block procedures are well-established in anterior chronic shoulder instability treatment. Autograft with the coracoid process (Bristow-Latarjet procedures) and iliac crest (Eden-Hybbinette) are the most frequent source of bone but the use of allograft is also possible. The objective of this review is to assess clinical and radiographic outcomes after bony allograft reconstruction in anterior glenohumeral instability. MATERIAL AND METHODS Medline, Cochrane, Embase databases were searched for studies reporting on bone allograft reconstruction in anterior glenohumeral instability with glenoid defect. We conducted a systematic review of studies with all levels of evidence reporting on clinical or radiological outcomes or both. LEVEL OF EVIDENCE IV. RESULTS Ten studies met the inclusion criteria for the review; 283 shoulders were included with a mean age of 26 years (17-63) and mean follow-up of 34 months (4-168). Glenoid reconstruction was performed using bone from different source: femoral head (1 study), distal tibia allograft (5 studies), and iliac crest (4 studies). Allografts were fresh in 4 studies, demineralized in 2 studies, and freeze-dried after sterilization in 1 study. All scores performed in the different studies increased between pre-operative and post-operative evaluations (mean + 36.8 points for the ASES). Global rate of recurrence was 3.9% (11 patients) (0-11%), comprising 6 cases of dislocation (2.1%) and 5 subluxations (1.8%). Allograft healing occurred in 93.5% of cases. CONCLUSIONS This systematic review data suggest that allograft reconstructions in anterior glenohumeral instability could be a viable alternative to similar reconstructions with autografts and provide close clinical/radiological outcomes, at short and mid-term follow-up. Prospective randomized studies are needed to confirm these results.
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Massive graft resorption after iliac crest allograft reconstruction for glenoid bone loss in recurrent anterior shoulder instability. Arch Orthop Trauma Surg 2020; 140:895-903. [PMID: 32090290 DOI: 10.1007/s00402-020-03380-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Donor site morbidity constitutes the most prevalent source of complications during anatomic glenoid reconstruction. Therefore, the aim of this study was to evaluate the clinical and radiologic results of arthroscopic anatomic glenoid reconstruction using an allogenic, tricortical iliac crest bone graft for glenoid bone loss in recurrent anterior shoulder instability. MATERIALS AND METHODS Ten patients [one female/nine male, mean age 31.9 years (range, 26-40)] underwent allogenic iliac crest bone grafting and were evaluated clinically [range of motion, subscapularis tests, apprehension sign, Constant score (CS), Rowe score (RS), Walch-Duplay score (WD), Western Ontario Shoulder Instability Index (WOSI), Subjective Shoulder Value (SSV)] and radiographically [3-dimensional computed tomography (CT) scans]. RESULTS After 23.2 months, the CS averaged 90 points (range, 84-98), RS 83 points (range, 50-100), WD 81 points (range, 50-100), WOSI 72% (range, 41-86) and the SSV 83% (range, 70-95). All patients showed a free range of motion and intact subscapularis muscle function. The apprehension sign was positive in three patients (30%) with a recurrent subluxation in one patient (10%). The glenoid surface area increased significantly from 84.4% (range, 73.5-92.1) preoperatively to 118.4% (range, 105.6-131.2) after surgery, while the glenoid defect was significantly reduced from 16.2% (range, 9.2-26.5) to 0.6% (range, 0-1.6). One year postoperative, total resorption of the allografts was observed with a glenoid surface area of 86.6% (range, 76.4-98.0) and corresponding increase of the glenoid defect to 14.0% (range, 2.9-23.6). CONCLUSION Arthroscopic glenoid reconstruction using an iliac crest bone allograft achieves satisfactory clinical results and glenohumeral stability during a short-term follow-up. However, this procedure was not observed to accomplish an anatomic reconstruction of the glenoid concavity due to excessive graft resorption. LEVEL OF EVIDENCE Level IV, case series, therapeutic study.
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Malik SS, Elashry S, Jordan RW, Choudhary S, Kalogrianitis S. Is there a difference in outcome of arthroscopic iliac crest autograft and allograft in recurrent anterior shoulder instability? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1453-1461. [DOI: 10.1007/s00590-020-02722-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/16/2020] [Indexed: 12/19/2022]
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Moroder P, Schulz E, Wierer G, Auffarth A, Habermeyer P, Resch H, Tauber M. Neer Award 2019: Latarjet procedure vs. iliac crest bone graft transfer for treatment of anterior shoulder instability with glenoid bone loss: a prospective randomized trial. J Shoulder Elbow Surg 2019; 28:1298-1307. [PMID: 31129017 DOI: 10.1016/j.jse.2019.03.035] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 03/01/2019] [Accepted: 03/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Latarjet and iliac crest bone graft transfer (ICBGT) procedures are competing treatment options for anterior shoulder instability with glenoid bone loss. METHODS In this bicentric prospective randomized study, 60 patients with anterior shoulder instability and glenoid bone loss were included and randomized to either an open Latarjet or open ICBGT (J-bone graft) procedure. Clinical evaluation was completed before surgery and 6, 12, and 24 months after surgery, including the Western Ontario Shoulder Instability index, Rowe score, Subjective Shoulder Value, pain level, satisfaction level, and work and sports impairment, as well as assessment of instability, range of motion, and strength. Adverse events were prospectively recorded. Radiographic evaluation included preoperative, postoperative, and follow-up computed tomography analysis. RESULTS None of the clinical scores showed a significant difference between the 2 groups (P > .05). Strength and range of motion showed no significant differences except for diminished internal rotation capacity in the Latarjet group at every follow-up time point (P < .05). A single postoperative traumatic subluxation event occurred in 2 ICBGT patients and 1 Latarjet patient. The type and severity of other adverse events were heterogeneous. Donor-site sensory disturbances were observed in 27% of the ICBGT patients. Computed tomography scans revealed a larger glenoid augmentation effect of the ICBGTs; this, however, was attenuated at follow-up. CONCLUSION The Latarjet and ICBGT procedures for the treatment of anterior shoulder instability with glenoid bone loss showed no difference in clinical and radiologic outcomes except for significantly worse internal rotation capacity in the Latarjet group and frequently noted donor-site sensory disturbances in the ICBGT group.
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Affiliation(s)
- Philipp Moroder
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
| | - Eva Schulz
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Guido Wierer
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Alexander Auffarth
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Peter Habermeyer
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany
| | - Herbert Resch
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Mark Tauber
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany
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McCoy BW, Miniaci A. The Glenojet Procedure: A Bone Preserving Alternative. OPER TECHN SPORT MED 2019. [DOI: 10.1053/j.otsm.2019.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Smucny M, Miniaci A. Pre-shaped Allograft for Glenoid Reconstruction in Anterior Shoulder Instability. Arthrosc Tech 2018; 7:e343-e348. [PMID: 29868402 PMCID: PMC5982359 DOI: 10.1016/j.eats.2017.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/07/2017] [Indexed: 02/03/2023] Open
Abstract
Anteroinferior glenoid bone loss plays a significant role in recurrent glenohumeral instability. Current surgical strategies to reconstruct the glenoid include coracoid transfer (Bristow-Latarjet procedure), iliac crest autograft, and allograft (osteochondral and iliac crest). These may carry drawbacks of technical difficulty, increased surgical time, neurovascular injury, and nonanatomic reconstruction. We report a technique to manage glenoid bone loss using a pre-shaped, predrilled allograft (Glenojet; Arthrosurface) that matches the native contour of the glenoid. The surgical technique and outcomes are described with an accompanying video and figures.
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Affiliation(s)
| | - Anthony Miniaci
- Address correspondence to Anthony Miniaci, M.D., F.R.C.S.C., Sports Health Center, Cleveland Clinic Foundation, 5555 Transportation Blvd, Garfield Heights, OH 44125, U.S.A.
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Chou YC, Lee D, Chang TM, Hsu YH, Yu YH, Chan EC, Liu SJ. Combination of a biodegradable three-dimensional (3D) – printed cage for mechanical support and nanofibrous membranes for sustainable release of antimicrobial agents for treating the femoral metaphyseal comminuted fracture. J Mech Behav Biomed Mater 2017; 72:209-218. [DOI: 10.1016/j.jmbbm.2017.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 04/28/2017] [Accepted: 05/02/2017] [Indexed: 11/29/2022]
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Ho AG, Gowda AL, Michael Wiater J. Evaluation and treatment of failed shoulder instability procedures. J Orthop Traumatol 2016; 17:187-97. [PMID: 27306444 PMCID: PMC4999377 DOI: 10.1007/s10195-016-0409-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/25/2016] [Indexed: 12/15/2022] Open
Abstract
Management of the unstable shoulder after a failed stabilization procedure can be difficult and challenging. Detailed understanding of the native shoulder anatomy, including its static and dynamic restraints, is necessary for determining the patient’s primary pathology. In addition, evaluation of the patient’s history, physical exam, and imaging is important for identifying the cause for failure after the initial procedure. Common mistakes include under-appreciation of bony defects, failure to recognize capsular laxity, technical errors, and missed associated pathology. Many potential treatment options exist for revision surgery, including open or arthroscopic Bankart repair, bony augmentation procedures, and management of Hill Sachs defects. The aim of this narrative review is to discuss in-depth the common risk factors for post-surgical failure, components for appropriate evaluation, and the different surgical options available for revision stabilization. Level of evidence Level V.
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Affiliation(s)
- Anthony G Ho
- Department of Orthopaedic Surgery, Beaumont Health, 3535 W. Thirteen Mile Rd, Suite 744, Royal Oak, MI, 48073, USA
| | - Ashok L Gowda
- Department of Orthopaedic Surgery, Beaumont Health, 3535 W. Thirteen Mile Rd, Suite 744, Royal Oak, MI, 48073, USA
| | - J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Health, 3535 W. Thirteen Mile Rd, Suite 744, Royal Oak, MI, 48073, USA.
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