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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Hoshika S, Sugaya H, Takahashi N, Matsuki K, Tokai M, Morioka T, Ueda Y, Hamada H, Takeuchi Y. Arthroscopic Soft Tissue Stabilization With Selective Augmentations for Traumatic Anterior Shoulder Instability in Competitive Collision Athletes. Am J Sports Med 2021; 49:1604-1611. [PMID: 33844602 DOI: 10.1177/03635465211003091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many surgeons prefer bony stabilization including Bristow or Latarjet procedures for shoulder instability in collision athletes, even though several potential complications have been reported. There has been a limited number of studies on the midterm outcomes of arthroscopic soft tissue stabilization for anterior shoulder instability in competitive collision athletes. PURPOSE To assess the outcomes of arthroscopic soft tissue stabilization in combination with selective augmentation procedures for collision athletes with traumatic anterior shoulder instability. STUDY DESIGN Case series; Level of evidence, 4. METHODS We retrospectively assessed rugby or American football players (<40 years old) who underwent arthroscopic Bankart or bony Bankart repair with selective augmentations (rotator interval closure and/or Hill-Sachs remplissage) for traumatic anterior shoulder instability between January 2012 and March 2017. Shoulders that required other bony procedures were excluded. Recurrence, complications, return to sport, and functional scores (Rowe score and Subjective Shoulder Value sports score) were investigated. RESULTS This study included 113 shoulders in 100 patients with a mean age of 20 years (range, 15-36 years) at surgery. Rotator interval closure was performed on 36 shoulders in addition to Bankart repair, and rotator interval closure and Hill-Sachs remplissage were performed on 77 shoulders. The mean follow-up period was 44 months (range, 24-72 months). Of the 113 shoulders, 4 (3.5%) experienced postoperative dislocation, but there were no complications. A total of 93 athletes (93%) attained complete or near complete preinjury sports activity levels. The mean Rowe score significantly improved from 36 (range, 10-75) at presurgery to 96 (range, 35-100; P = .003) at postsurgery. The mean Subjective Shoulder Value sports score significantly improved after surgery, from a mean preoperative score of 22 (range, 0-50) to a postoperative score of 92 (range, 64-100; P = .002). CONCLUSION Our treatment strategy, where arthroscopic soft tissue stabilization was combined with selected augmentations, provided good clinical outcomes for competitive collision athletes in terms of low rates of recurrence and complication, a high rate of return to sports, and good shoulder function.
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Affiliation(s)
- Shota Hoshika
- Shoulder and Elbow Service, Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Japan
| | | | - Norimasa Takahashi
- Shoulder and Elbow Service, Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Japan
| | - Keisuke Matsuki
- Shoulder and Elbow Service, Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Japan
| | | | - Takeshi Morioka
- Shoulder and Elbow Service, Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Japan
| | - Yusuke Ueda
- Shoulder and Elbow Service, Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Japan
| | - Hiroshige Hamada
- Shoulder and Elbow Service, Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Japan
| | - Yasutaka Takeuchi
- Shoulder and Elbow Service, Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Japan
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Abstract
Background The Latarjet procedure is an established and popular procedure for recurrent anterior shoulder instability; however, to our knowledge, few studies have reported on the outcomes of revision for failed Latarjet surgery. We reviewed the causes and management of recurrent instability after previous Latarjet stabilization surgery. The outcomes of revision surgery were also evaluated. Methods A retrospective analysis of prospective data in patients undergoing revision surgery after failed Latarjet stabilization was conducted. Data were collected over a 5-year period and included patient demographics, clinical presentation, cause of recurrent instability, indications for revision surgery, intraoperative analysis, outcomes of revision surgery, and return to sport. Results We identified 16 patients (12 male and 4 female patients) who underwent revision surgery for recurrent instability after Latarjet stabilization. Of these patients, 11 were athletes: 9 professional and 2 amateur athletes. The mean age at revision was 29.9 ± 8.9 years (range, 17-50 years). The indications for revision were anterior instability in 11 patients, posterior instability in 4, and both anterior and posterior instability in 1. Of the anterior instability cases, 54.5% were due to coracoid nonunion and 36.4% were due to capsular failure (retear). All posterior instability cases had posterior capsulolabral injuries, and the mean Beighton score in this group was 6 or higher. One patient had a failed Latarjet procedure with coracoid nonunion and a posterior labral tear. Conclusion Coracoid nonunion was the most common cause of recurrence after Latarjet stabilization, requiring an Eden-Hybinette procedure. The patients who returned with posterior instability had a high incidence of hypermobility and could be treated successfully by arthroscopic techniques.
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Affiliation(s)
- Umair Khan
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,The Arm Clinic, The Wilmslow Hospital, Wilmslow, UK
| | - Emma Torrance
- The Arm Clinic, The Wilmslow Hospital, Wilmslow, UK.,School of Health Sciences, University of Salford, Salford, UK
| | - Mohammad Hussain
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,The Arm Clinic, The Wilmslow Hospital, Wilmslow, UK
| | - Lennard Funk
- The Arm Clinic, The Wilmslow Hospital, Wilmslow, UK.,School of Health Sciences, University of Salford, Salford, UK.,Wrightington Hospital, Wigan, UK
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Bahl JS, Nelson MJ, Taylor M, Solomon LB, Arnold JB, Thewlis D. Biomechanical changes and recovery of gait function after total hip arthroplasty for osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2018; 26:847-63. [PMID: 29474993 DOI: 10.1016/j.joca.2018.02.897] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 02/04/2018] [Accepted: 02/12/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the change in walking gait biomechanics after total hip arthroplasty (THA) for osteoarthritis (OA) compared to the pre-operative gait status, and to compare the recovery of gait following THA with healthy individuals. METHODS Systematic review with meta-analysis of studies investigating changes in gait biomechanics after THA compared to (1) preoperative levels and (2) healthy individuals. Data were pooled at commonly reported time points and standardised mean differences (SMDs) were calculated in meta-analyses for spatiotemporal, kinematic and kinetic parameters. RESULTS Seventy-four studies with a total of 2,477 patients were included. At 6 weeks postoperative, increases were evident for walking speed (SMD: 0.32, 95% confidence intervals (CI) 0.14, 0.50), stride length (SMD: 0.40, 95% CI 0.19, 0.61), step length (SMD: 0.41, 95% CI 0.23, 0.59), and transverse plane hip range of motion (ROM) (SMD: 0.36, 95% CI 0.05, 0.67) compared to pre-operative gait. Sagittal, coronal and transverse hip ROM was significantly increased at 3 months (SMDs: 0.50 to 1.07). At 12 months postoperative, patients demonstrated deficits compared with healthy individuals for walking speed (SMD: -0.59, 95% CI -1.08 to -0.11), stride length (SMD: -1.27, 95% CI -1.63, -0.91), single limb support time (SMD: -0.82, 95% CI -1.23, -0.41) and sagittal plane hip ROM (SMD: -1.16, 95% CI -1.83, -0.49). Risk of bias scores ranged from seven to 24 out of 26. CONCLUSIONS Following THA for OA, early improvements were demonstrated for spatiotemporal and kinematic gait patterns compared to the pre-operative levels. Deficits were still observed in THA patients compared to healthy individuals at 12 months.
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Ranalletta M, Rossi LA, Bertona A, Tanoira I, Hidalgo IA, Maignon GD, Bongiovanni SL. Modified Latarjet Without Capsulolabral Repair in Rugby Players With Recurrent Anterior Glenohumeral Instability and Significant Glenoid Bone Loss. Am J Sports Med 2018; 46:795-800. [PMID: 29320219 DOI: 10.1177/0363546517749586] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The optimal management of recurrent anterior shoulder instability with significant glenoid bone loss in high-demand collision athletes remains a challenge. PURPOSE To analyze the time to return to sport, clinical outcomes, and recurrences following a modified Latarjet procedure without capsulolabral repair in rugby players with recurrent anterior shoulder instability and significant glenoid bone loss. STUDY DESIGN Case series; Level of evidence, 4. METHODS Between June 2008 and June 2015, 50 competitive rugby players (practice >2 times per week and competition during weekends) with recurrent anterior shoulder instability underwent operation with the modified congruent arc Latarjet procedure without capsulolabral repair in our institution. Cases included 18 primary repairs and 32 revisions. Return to sports, range of motion (ROM), the Rowe score, a visual analog scale for pain in sport activity (VAS), and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed with computed tomography. The final analysis included 49 shoulders in 48 patients (31 revision cases). RESULTS The mean follow-up was 48 months (range, 24-108 months) and the mean age at the time of operation was 22.8 years (range, 17-35 years). Forty-five patients (93.7%) returned to playing rugby, all at their preinjury level of play. No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe, VAS, and ASOSS scores showed statistically significant improvement after operation ( P < .001). The Rowe score increased from a mean of 39.5 points preoperatively to 94 points postoperatively ( P < .01). The VAS score decreased from 3.6 points preoperatively to 1.2 points postoperatively ( P < .01). The ASOSS score improved significantly from a mean of 44 points preoperatively to 89.5 points postoperatively ( P < .01). No recurrence of shoulder dislocation or subluxation was noted. The bone block healed in 43 shoulders (88%). CONCLUSION In rugby players with recurrent anterior shoulder instability and significant glenoid bone loss, the modified Latarjet procedure without capsulolabral repair produced excellent functional outcomes, with most athletes returning to rugby at their preinjury level of play without recurrences.
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Affiliation(s)
- Maximiliano Ranalletta
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina
| | - Luciano A Rossi
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina
| | - Agustin Bertona
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina
| | - Ignacio Tanoira
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina
| | - Ignacio Alonso Hidalgo
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina
| | - Gastón D Maignon
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina
| | - Santiago L Bongiovanni
- Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina
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Abstract
Traumatic anterior glenohumeral subluxations comprise the majority of glenohumeral instability events and are endemic in young athletes. Unlike the definitive complete dislocation event, subluxation events may often be more subtle in presentation and, therefore, may be overlooked by clinicians. Glenohumeral subluxation events are associated with a high rate of labral tears as well as humeral head defects. While less is known of the natural history of these injuries, young athletes are at risk for recurrent instability events if not properly diagnosed and treated. While reports of surgical treatment outcomes isolated to subluxation events are limited, arthroscopic and open Bankart repair have been shown to result in excellent outcomes. The purpose of this paper is to review the etiology and pathoanatomy of traumatic anterior glenohumeral subluxations as well as to review the appropriate evaluation and management of patients with this injury.
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Affiliation(s)
- Joseph A Gil
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Steven DeFroda
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Brett D Owens
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
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Poland SG, Gitelis ME, Thorsness RJ, Cole BJ. Decision-Making, Bracing, and Other Adjuncts for Management of In-Season Contact Athletes With Shoulder Instability. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2016.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cools AM, Borms D, Castelein B, Vanderstukken F, Johansson FR. Evidence-based rehabilitation of athletes with glenohumeral instability. Knee Surg Sports Traumatol Arthrosc 2016; 24:382-9. [PMID: 26704789 DOI: 10.1007/s00167-015-3940-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/09/2015] [Indexed: 01/14/2023]
Abstract
PURPOSE To give an overview of current knowledge and guidelines with respect to evidence-based rehabilitation of athletes with glenohumeral instability. METHODS This narrative review combines scientific evidence with clinical guidelines based on the current literature to highlight the different components of the rehabilitation of glenohumeral instability. RESULTS Depending on the specific characteristics of the instability pattern, the severity, recurrence, and direction, the therapeutic approach may be adapted to the needs and demands of the athlete. In general, attention should go to (1) restoration of rotator cuff strength and inter-muscular balance, focusing on the eccentric capacity of the external rotators, (2) normalization of rotational range of motion with special attention to the internal rotation ROM, (3) optimization of the flexibility and muscle performance of the scapular muscles, and (4) gradually increasing the functional sport-specific load on the shoulder girdle. The functional kinetic chain should be implemented throughout all stages of the rehabilitation program. Return to play should be based on subjective assessment as well as objective measurements of ROM, strength, and function. CONCLUSIONS This paper summarizes evidence-based guidelines for treatment of glenohumeral instability. These guidelines may assist the clinician in the prevention and rehabilitation of the overhead athlete. LEVEL OF EVIDENCE Expert opinion, Level V.
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Affiliation(s)
- Ann M Cools
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, De Pintelaan 185, 2B3, 9000, Ghent, Belgium.
| | - Dorien Borms
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, De Pintelaan 185, 2B3, 9000, Ghent, Belgium
| | - Birgit Castelein
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, De Pintelaan 185, 2B3, 9000, Ghent, Belgium
| | - Fran Vanderstukken
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, De Pintelaan 185, 2B3, 9000, Ghent, Belgium
| | - Fredrik R Johansson
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University Hospital Ghent, De Pintelaan 185, 2B3, 9000, Ghent, Belgium.,Department of Environmental Medicine, Musculoskeletal and Sports Injury Epidemiology Center (MUSIEC), Karolinska Institute, Stockholm, Sweden
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