The effect of eccentric glenoid reaming in reverse shoulder artrhoplasty for glenohumeral osteoarthritis

Background

The objective of this study was to evaluate the abilitiy of eccentric reaming in reverse total shoulder arthroplasty (RSA), in patients with glenohumeral osteoarthritis (GHOA), to correct preoperative glenoid retroversion and to compare with cuff tear arthopaty (CTA) cases.

Methods

Fifty-nine patients who underwent RSA with GHOA or CTA diagnosis between 2013 and 2022 and who had pre- and postoperative computed tomography scans were included in the study. Preoperative glenoid version and postoperative glenoid component versions of 17 patients with GHOA and 40 patients with CTA were measured by Friedman method.

Results

The median preoperative glenoid versions in GHOA and CTA groups were measured as 16° and 4° retroverted respectively (p < 0.01). The median postoperative glenoid component versions in GHOA and CTA groups were 5° and 3° retroverted respectively (p = 0.09). The version change differences between the two groups varied significantly (p < 0.01).

Conclusions

GHOA is related with higher preoperative glenoid retroversion compared to CTA. However; with eccentric glenoid reaming, adequate version correction and similar postoperative glenoid version can be achieved in GHOA compared to CTA when performing a RSA.

Level of evidence

Level III. Retrospective study. Treatment study.

Efficacy and safety of the Latarjet procedure for the treatment of athletes with glenoid bone defects ≥ 20%: a single-arm meta-analysis

BACKGROUND

The shoulder joint is the most commonly dislocated joint in the human body, and the recurrence rate exceeds 50% after nonsurgical treatment. Although surgical treatment reduces the recurrence rate, there is controversy regarding the optimal surgical approach. Previous studies suggest that the Latarjet procedure yields favourable outcomes for specific populations at risk of recurrence, such as competitive athletes with significant glenoid defects. However, most of the existing related research consists of nonrandomized controlled trials with small sample sizes, and there is a lack of strong evidence regarding the efficacy and safety of the Latarjet procedure.

METHODS

The PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched. Athletes with ≥ 20% glenoid defects were selected for inclusion. The following data were extracted: general patient information, instability rates, return to sports (RTS) rates, imaging features (graft positioning rate and graft healing rate), functional assessments [Rowe score, Athletic Shoulder Outcome Scoring System(ASOSS), visual analogue scale (VAS), forward flexion function, and external rotation function], and complications.

RESULTS

After excluding suspected duplicate cases, a total of 5 studies were included in this meta-analysis. The studies involved a total of 255 patients, including 237 males (93%) and 18 females (7%). The average age at the time of surgery was 25.4 ± 8.5 years. All the studies had a minimum follow-up period of 2 years, with an average follow-up time of 48.7 ± 18.9 months. The pooled rate of return to sport (RTS) was 94.3% (95% CI: 87.3%, 98.8%), and 86.1% (95% CI: 78.2%, 92.5%) of patients returned to their preoperative level of activity. The pooled redislocation rate was 1.1% (95% CI: 0%, 3.8%). Regarding the imaging results, the combined graft retention rate was 92.1% (95% CI: 88.1%, 95.5%), and the graft healing rate was 92.1% (95% CI: 88%, 95.4%). Postoperative functional evaluation revealed that the combined Rowe score, ASOSS score, and VAS score were 93.7 ± 6.5 points, 88.5 ± 4.4 points, and 1.1 ± 10 points, respectively. The forward flexion and external rotation angles were 170.9 ± 6.9 degrees and 65.6 ± 4.5 degrees, respectively. After excluding one study with unclear complications, the combined complication rate was 9.4% (95% CI: 1.0%, 23.6%).

CONCLUSION

For athletes with shoulder instability and a total of ≥ 20% glenoid bone defects, the Latarjet procedure can achieve excellent functional outcomes, with the majority of patients returning to preoperative levels of sports activity. This procedure also leads to a low recurrence rate. Therefore, the Latarjet procedure has been proven to be a safe and effective treatment.

Reconstruction of recurrent shoulder dislocation with glenoid bone defect with 3D-printed titanium alloy pad: outcomes at 2-year minimum follow-up

BACKGROUND

To evaluate the outcome of shoulder arthroscopy-assisted implantation of three-dimensional (3D)-printed titanium pads for recurrent shoulder dislocation with glenoid bone defects.

METHODS

From June 2019 to May 2020, the clinical efficacy of 3D printed titanium pad implantation assisted by shoulder arthroscopy, for the treatment of recurrent shoulder dislocations with shoulder glenoid defects was retrospectively analyzed. The American Shoulder and Elbow Surgeons (ASES) shoulder, Rowe, and Constant scores were recorded before surgery and at 3 months, 6 months, 1 year, and 2 years after surgery. 3D computed tomography (CT) and magnetic resonance imaging were used to evaluate the location of the glenoid pad, bone ingrowth, joint degeneration, and osteochondral damage.

RESULTS

The mean age of the 12 patients was 21.4 (19-24) years and the mean follow-up time was 27.6 (24-35) months. The Visual Analog Scale score significantly improved from 5.67 ± 1.98 preoperatively to 0.83 ± 0.58 postoperatively (p = 0.012). The postoperative ASES score was significantly increased to 87.91 ± 3.47 compared with preoperative ASES score (46.79 ± 6.45) (p < 0.01). Rowe and Constant scores also improved from 22.5 ± 12.34 and 56.58 ± 7.59 preoperatively to 90.83 ± 4.69 and 90.17 ± 1.89 at 2 years postoperatively, respectively. CT performed 2 years after surgery showed that the pad perfectly replenished the bone-defective part of the shoulder glenoid and restored the articular surface curvature of the shoulder glenoid in the anterior-posterior direction, and the bone around the central riser of the pad was tightly united. Magnetic resonance imaging 2 years after surgery showed that the humeral head osteochondral bone was intact, and there was no obvious osteochondral damage.

CONCLUSIONS

3D printed titanium pads are a reliable, safe, and effective surgical procedure for treating recurrent shoulder dislocations with glenoid bone defects.

Evaluation of the inter and intraobserver reproducibility of the "defect coverage index method", a new computed tomography assessment method of sagittal graft positioning in arthroscopic bone block procedures

PURPOSE

To assess the reproducibility of a new 2-dimensional computed tomography (CT) method of assessing graft positioning in arthroscopic bone block procedure.

METHODS

This is a prospective observational study. Twenty-seven patients, (all men, mean [Standard deviation] age at surgery 30.9 [8.49] years) were included. Vertical graft position was assessed on the sagittal view by measuring the amount of glenoid bone defect covered by the graft. The length of the bone defect and the amount of graft covering the defect were measured. Positioning of the graft on the sagittal plane was classified as accurate if the graft covered at least 90% of the defect. Intraobserver and interobserver reproducibility was analyzed using intraclass correlation coefficients (ICC) and Kappa coefficient with 95% confidence.

RESULTS

Excellent intraobserver reproducibility was found, with an ICC of 0.94 (CI 95%, 0.86-0.97). Interobserver reproducibility was good, with the ICC value of 0.71, ranging from 0.45 to 0.86 (CI 95%).

CONCLUSION

This new method of assessing graft positioning in arthroscopic bone block procedures on 2-dimensional computed tomography scans is reliable, with an excellent intraobserver and good interobserver reproducibility.

LEVEL OF EVIDENCE

III.

Outcomes of Open Bankart Repair Plus Inferior Capsular Shift Compared with Latarjet Procedure in Contact Athletes with Recurrent Anterior Shoulder Instability

Background

Open Bankart repair plus inferior capsular shift (OBICS) and Latarjet procedure (LA) are considered appropriate treatment alternatives for high-performance athletes. The purpose of this study was to evaluate the functional outcomes and recurrence rate of each surgery. Our hypothesis: there were no differences between the two treatments.

Methods

A prospective cohort study was conducted with n=90 contact athletes divided into two groups of 45 patients. One group was treated with OBICS, and the other one with LA. The mean follow-up period was 25 (24-32) months for the OBICS group and 26 (24-31) months for the LA group. Primary functional outcomes of each group were assessed at baseline, six months, one year, and two years after surgery. The functional outcomes were also compared between the groups. The evaluation tools used were the Western Ontario Shoulder Instability score (WOSI) and the American Shoulder and Elbow Surgeons scale (ASES). In addition, recurrent instability and range of motion (ROM) were also evaluated.

Results

In each group, significant changes were found in the WOSI score and ASES scale from pre-op to postop. However, there were no significant differences between the functional outcomes of the groups at the final follow-up (P-values 0.73 and 0.19). Three dislocations and one subluxation (8.8%) were reported in the OBICS group, and three subluxations were reported in the LA group (6.6%), revealing no significant differences between the groups (P=0.37). Moreover, there were no significant differences between preoperative and postoperative ROM in each group or in terms of external rotation (ER) and ER in 90º abduction between the groups.

Conclusion

No differences were found between OBICS and LA surgery. Both procedures can be indicated according to the surgeon's preference to reduce recurrence rates in contact athletes with recurrent anterior shoulder instability.

Anterior mid-portion capsular tear with Bankart lesion in recurrent anterior shoulder dislocation: outcome report and bone defect evaluation

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.

A novel method for localization of the maximum glenoid bone defect during reverse shoulder arthroplasty

Background

Management of glenoid bone defects during reverse shoulder arthroplasty remains a challenge. The aim of our study was to preoperatively localize the maximal depth of glenoid bone defects in relation to glenoid reaming.

Methods

Thirty preoperative shoulder computed tomography scans were collected. Three assessors created standardized surgical plans, using 3-dimensional (3D) computed tomography–based Blueprint planning software in which the reaming axis was held constant at zero degrees of version and inclination. Each plan resulted in a 2-dimensional (2D) image of the reamer’s contact on the glenoid and a corresponding 3D representation of the glenoid bone defect. The position of the maximum glenoid defect was localized on both the 2D and 3D images. Descriptive statistics were calculated. The correlation between angles from 2D and 3D images was assessed, and intraclass correlation was used to assess inter-rater and intrarater reliability.

Results

Twenty-eight patients were included. The overall mean difference between 2D and 3D angles was 5.4° (standard deviation 5.2°). The correlation between 2D and 3D angles was almost perfect. Intraclass correlation results demonstrated near-perfect agreement. The maximal glenoid defect was within 5% of a circle (or +/- 9°) from perpendicular to the high-side ream line in 85.1% of comparisons and was within 10% of a circle in 97.6% of comparisons.

Conclusion

Using Blueprint planning software, we have demonstrated with almost perfect agreement among 3 assessors that when the reaming axis is held constant, the maximum glenoid bone defect is reliably located perpendicular to the glenoid ream line.

Instability, complications, and functional outcomes after reverse shoulder arthroplasty and anatomic shoulder arthroplasty for chronic neglected shoulder dislocation: a systematic review

Background

Chronic shoulder dislocation has been treated by either anatomic shoulder arthroplasty (ASA) or reverse shoulder arthroplasty (RSA) with encouraging results. Although good results have been reported after both the procedures, several complications such as instability and glenoid failures have also been highlighted. The aim of this study was to aggregate the results that have been reported with the use of ASA or RSA in chronic shoulder dislocation and analyze the instability rates, complication rates, and functional outcomes.

Methods

A comprehensive search was performed in May 2020 using PubMed, EMBASE, and Cochrane Library databases. Studies that reported on the outcomes after either ASA or RSA for chronic anterior dislocation (CAD) or chronic posterior dislocation (CPD) were included in the systematic review. Methodologic quality was assessed using the Methodological Index for Nonrandomized Studies appraisal tool for observational studies.

Results

We aggregated 13 studies that included data on 128 patients with CAD and 51 patients with CPD. The combined weighted postoperative instability rate in the CAD group was significantly higher after ASA than after RSA (P = .04). There was no significant difference in the combined weighted instability rate between ASA in the CAD group and ASA in the CPD group (P = .37). The complications of RSA in CAD included glenoid base plate loosening, humeral shaft fractures, late infection, acromion fractures, and instability. The complications of the ASA in CAD and CPD included glenoid loosening and erosions, severe pain necessitating revision, severe superior migration of the head, redislocation with rupture of the cuff tendons, bone graft migration, instability, and 2 cases of neuropathies (median nerve and axillary nerve) that eventually resolved.

Conclusion

Postoperative instability was significantly more common after ASA than after RSA for chronic shoulder dislocations, but both RSA and ASA had a high complication rate in CAD. Shoulder arthroplasty improved the range of motion, functional outcomes, and pain in patients with chronic shoulder dislocation.

Comparison of best-fit circle versus contralateral comparison methods to quantify glenoid bone defect

BACKGROUND

Several measurement techniques have been reported to quantify glenoid bone defect in patients with anterior shoulder instability. Among them, the method that uses a best-fit circle and another that uses the contralateral glenoid as a control are most commonly used. However, to our knowledge, no study has been reported that compared the reliability of these methods. The purpose of this study, therefore, was to determine which of these methods has higher reproducibility.

METHOD

In this study, 3-dimensional computed tomography data from 94 patients (mean age 29 years) with unilateral anterior shoulder instability were used. Three examiners measured the glenoid bone defect of each patient 3 times using 2 techniques: the best-fit circle method and the contralateral comparison method. Intra- and interobserver reliabilities were measured using intraclass correlation coefficient (ICC).

RESULTS

The intraobserver reliability was found to be 0.91 for the best-fit circle method and 0.98 for the contralateral comparison method. The interobserver reliability was 0.77 for the best-fit circle method and 0.88 for the contralateral method. The percentage of glenoid defect was 11.5% when using the best-fit circle and 10.7% with the contralateral method.

CONCLUSION

The contralateral comparison method was more reliable than the best-fit circle method for quantifying the amount of glenoid bone loss.

Results of Open Bankart Surgery for Recurrent Anterior Shoulder Dislocation with Glenoid Bone Defect and Concomitant Hill-Sachs Lesion

BACKGROUND

Open Bankart surgery is the main treatment procedure in patients with recurrent anterior shoulder dislocation, especially in cases with glenoid bone defect. The goal of this study was to determine the outcomes after open Bankart surgery in cases of recurrent anterior shoulder dislocation with glenoid bone defects and concomitant Hill-Sachs lesions.

METHODS

Between 2006 and 2010, 89 patients with recurrent anterior shoulder dislocation and concomitant glenoid bone defects (10-30%) and Hill-Sachs lesions undergoing open Bankart surgery were reviewed. The mean follow-up after surgery was 7 years (5.5-9.5 years). The recurrence rate as well as the degree of shoulder pain and daily activity level was determined subjectively based on the visual analogue scale (VAS) and activity daily living scale (ADLs). Shoulder range of motion (ROM) in abduction and external rotation was compared with contralateral side; and finally, the American shoulder and elbow score (ASES) and constant-Murley score (CMS) were calculated.

RESULTS

Over 7 years of follow-up, a total of 15 patients (16.8%) undergoing surgery were found to have instability (3 patients (3.3%) with dislocation and 12 patients with (13.4%) subluxation). Patients with postsurgical instability had significantly larger glenoid bone defects (P=0.0001) and Hill-Sachs lesions (P=0.019) compared to those without instability. The mean loss of forward flexion compared with the normal contralateral side was 4º while the mean loss of external rotation between both sides was 5º. At the final visit, the average VAS was 0.4 (out of 10); ADL was 28.97 (range: 25-30); ASES was 96.1(range: 78.3-100); and the mean CMS value was 93.9(range: 82-100).

CONCLUSION

Open Bankart surgery with anteroinferior capsular shift for recurrent anterior shoulder dislocation with up to 30% glenoid bone defect and Hill-Sachs lesion provided desirable results in terms of shoulder function and recurrence rate. Bankart surgery is a successful and practical option in these patients and can be considered as an alternative to other procedures.

Customized tantalum-augmented reverse shoulder arthroplasty for glenoid bone defect and excessive medialization: description of the technique

BACKGROUND

Glenoid bone defect and excessive medialization could represent challenging issues during reverse shoulder arthroplasty, especially in the setting of revision surgery. Although a solution is offered by the Boileau's BIO-RSA technique in primary cases, only autologous iliac crest bone graft and homologous graft from bone banks are available for revision surgeries, with known disadvantages and risk of graft resorption and implant failure.

MATERIALS AND METHODS

We describe in this work a new technique based on a customized porous tantalum device to be used in salvage situations, aimed at lateralization of the glenoid component of a reverse shoulder arthroplasty. Between 2014 and 2015, five patients received a customized tantalum-augmented RSA at our institution. The augments we applied are actually on the market for acetabular bone loss management: these were opportunely prepared and fixed to the metal back of the glenoid component before implantation.

RESULTS

In the five cases treated, no major or minor complications have been recorded to date. Despite the short follow-up, all the implants are still in situ. All of the patients referred complete subjective satisfaction and return to their daylife activities without pain within 4 months after surgery.

CONCLUSIONS

The customized tantalum-augmented RSA technique represents in our experience a useful and safe solution in managing glenoid bone loss and medialization. Adaptability to virtually every device in the market should be regarded as important point of strength of this technique.

The effect of the arthroscopic augmentation of the subscapularis tendon on shoulder instability and range of motion: A biomechanical study

BACKGROUND

Anterior shoulder dislocation is common. The treatment of recurrence with glenoid bone defect is still considered controversial. A new arthroscopic subscapularis augmentation has recently been described that functions to decrease the anterior translation of the humeral head. The purpose of the presented study was to examine the biomechanical effect on glenohumeral joint motion and stability.

METHODS

Eight fresh frozen cadaver shoulders were studied by use of a force guided industrial robot fitted with a six-component force-moment sensor to which the humerus was attached. The testing protocol includes measurement of glenohumeral translation in the anterior, anterior-inferior and inferior directions at 0°, 30° and 60° of glenohumeral abduction, respectively, with a passive humerus load of 30N in the testing direction. The maximum possible external rotation was measured at each abduction angle applying a moment of 1Nm. Each specimen was measured in a physiologic state, as well as after Bankart lesion with an anterior bone defect of 15-20% of the glenoid, after arthroscopic subscapularis augmentation and after Bankart repair.

FINDINGS

The arthroscopic subscapularis augmentation decreased the anterior and anterior-inferior translation. The Bankart repair did not restore the mechanical stability compared to the physiologic shoulder group. External rotation was decreased after arthroscopic subscapularis augmentation compared to the physiologic state, however, the limitation of external rotation was decreased at 60° abduction.

INTERPRETATION

The arthroscopic subscapularis augmentation investigated herein was observed to restore shoulder stability in an experimental model.