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Do arthroscopic and open stabilization techniques restore equivalent stability to the shoulder in the setting of anterior glenohumeral instability? a systematic review of overlapping meta-analyses. Arthroscopy 2015; 31:355-63. [PMID: 25217207 DOI: 10.1016/j.arthro.2014.07.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 07/01/2014] [Accepted: 07/09/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE Shoulder instability frequently recurs in young patients without operative treatment. Both open and arthroscopic approaches to shoulder stabilization with labral repair and capsulorrhaphy have been described and are routinely used. Multiple trials have been conducted to compare these approaches, with multiple meta-analyses performed to synthesize these trials; however, the results remain controversial. The purpose of this study was to critically evaluate the current meta-analyses to identify the current state of the art. METHODS In this study we evaluate available scientific support for the ability of both arthroscopic and open soft-tissue stabilization techniques to restore stability of the shoulder by performing a systematic review of the literature for previous meta-analyses. Data were extracted for rates of recurrence and patient outcomes. Study quality was measured with the Oxman-Guyatt and QUOROM (Quality of Reporting of Meta-analyses) systems. The Jadad algorithm was applied independently by 4 authors to determine which meta-analysis provided the highest level of available evidence. RESULTS After application of the inclusion and exclusion criteria, 8 meta-analyses were included. Both studies published prior to 2007 concluded that open stabilization provided lower recurrence rates than arthroscopic stabilization, the 3 studies published in 2007 are discordant, and all 3 studies published after 2008 concluded that open and arthroscopic stabilization provided equivalent results. Two meta-analyses had low Oxman-Guyatt scores (<3) signifying major flaws. Four authors independently selected the same meta-analysis as providing the highest quality of evidence using the Jadad algorithm, and this meta-analysis found no difference in recurrence rates between open and arthroscopic stabilization. CONCLUSIONS This systematic review of overlapping meta-analyses comparing arthroscopic and open shoulder stabilization suggests that according to current best available evidence, there are no significant differences in failure rates. LEVEL OF EVIDENCE Level IV, systematic review of Level I through IV studies.
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Abstract
Thorough evaluation of the athlete with persistent shoulder instability and appropriate use of imaging modalities, such as 3-dimensional computed tomography, can help quantify the severity of bony deficiency. Based on obtained imaging and examination, surgical and nonsurgical methods can be considered. In many situations both the humeral- and glenoid-sided bone loss must be addressed. Depending on the extent of bone loss, athletic demands, and surgeon experience, arthroscopic or open surgical options can provide shoulder stability and return athletes to their prior level of activity.
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Berendes TD, Pilot P, Nagels J, Vochteloo AJH, Nelissen RGHH. Survey on the management of acute first-time anterior shoulder dislocation amongst Dutch public hospitals. Arch Orthop Trauma Surg 2015; 135:447-54. [PMID: 25697813 PMCID: PMC4365281 DOI: 10.1007/s00402-015-2156-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Indexed: 10/31/2022]
Abstract
INTRODUCTION The primary aim of this study was to record how orthopaedic surgeons are currently managing acute first-time anterior shoulder dislocation (AFASD) 8 years after introduction of the Dutch national guideline: "acute primary shoulder dislocation, diagnostics and treatment" in 2005. The second aim was to evaluate how these surgeons treat recurrent instability after AFASD. MATERIALS AND METHODS An online questionnaire regarding the management of AFASD and recurrent shoulder instability was held amongst orthopaedic surgeons of all 98 Dutch hospitals. RESULTS The overall response rate was 60%. Of the respondents, 75% had a local protocol for managing AFASD, of which 28% had made changes in their treatment protocol after the introduction of the national guideline. The current survey showed wide variety in the overall treatment policies for AFASD. Twenty-seven percent of the orthopaedic surgeons were currently unaware of the national guideline. The variability in treatment for AFASD was present throughout the whole treatment from which policy at the emergency department; when to operate for recurrent instability; type of surgical technique for stabilization and type of fixation of the labrum. As for the treatment of recurrent instability, the same variability was seen: 36% of the surgeons perform only arthroscopic procedures, 7% only open and 57% perform both open and arthroscopic procedures. CONCLUSIONS Despite the introduction of the national guideline for the initial management of AFASD in 2005, still great variety among orthopaedic surgeons in the Netherlands was present. As for the surgical stabilization technique, the vast majority of the respondents are performing an arthroscopic shoulder stabilization procedure at the expense of the more traditional open procedure as a first treatment option for post-traumatic shoulder instability.
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Affiliation(s)
- T. D. Berendes
- Department of Orthopaedics, Meander Medical Centre, Maatweg 3, Postbox 1502, 3800 BM Amersfoort, The Netherlands ,Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
| | - P. Pilot
- Department of Orthopaedics, Reinier de Graaf Hospital, Delft, The Netherlands
| | - J. Nagels
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - R. G. H. H. Nelissen
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
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Traumatic anterior instability of the pediatric shoulder: a comparison of arthroscopic and open bankart repairs. J Pediatr Orthop 2015; 35:1-6. [PMID: 25489944 DOI: 10.1097/bpo.0000000000000215] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Arthroscopic and open Bankart repairs have proven efficacy in adults with recurrent anterior shoulder instability. Although studies have included children in their analysis, none have previously compared functional outcomes or redislocation rates between these 2 methodologies for anteroinferior glenoid labrum repair in this young population. We hypothesize that open and arthroscopic Bankart repair in children will have similar functional outcomes and redislocation rates, but differing results from adults treated in a similar manner. METHODS A retrospective chart review was performed on all Bankart repairs performed between 2006 and 2010 at a tertiary care children's hospital. A shift in treatment modalities occurred in 2008 creating 2 cohorts, open and arthroscopic. Brachial plexus injury, congenital soft-tissue disorder, or incomplete charts were excluded. Demographics, age at surgery, follow-up length, and sport were recorded. Telephone interviews were then performed obtaining the most current QuickDASH (Disability Arm, Shoulder, or Hand), WOSI (Western Ontario Shoulder Instability Index), SF-12 (Short Form 12), SANE (Single Assessment Numeric Evaluation), and verbal pain scores; as well as, inquiring about recurrent dislocation and further surgery. RESULTS Ninety-nine children (16.9±1.5 y) were included (28 open, 71 arthroscopic). There were no differences in preoperative demographics. Fifty-one patients completed the questionnaires (11 open, 40 arthroscopic). No significant differences in the outcomes scores were seen between the 2 groups. Of the 99 patients, 21 (21%) had redislocation or secondary surgery; there was no significant difference in failure rate between groups (4 open, 17 arthroscopic). A plotted survival curve demonstrated that the adolescent shoulder undergoing Bankart repair for recurrent traumatic anterior instability has a 2-year survival of 86% and a 5-year survival of only 49%, regardless of technique. CONCLUSIONS In adolescents, there is no significant difference in functional outcomes or redislocation rates between open and arthroscopic Bankart repair, yet both demonstrate a very high risk of failure in this young, athletic population which contrasts the results in the historic adult population. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Joshi MA, Young AA, Balestro JC, Walch G. The Latarjet-Patte procedure for recurrent anterior shoulder instability in contact athletes. Orthop Clin North Am 2015; 46:105-11. [PMID: 25435039 DOI: 10.1016/j.ocl.2014.09.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Recurrent anterior shoulder instability is common in contact athletes and the high-energy injuries seen in this group make them more prone to bone loss. Athletes with recurrent instability and associated bone loss have high failure rates when treated with a soft tissue reconstruction procedure. Therefore it is preferred to manage recurrent instability in contact athletes with the Latarjet-Patte procedure. In this article, the authors describe their technique. They have found this procedure to be safe and effective, with very low recurrence and early return to sport. A meticulous surgical technique is important to avoid intraoperative and postoperative complications.
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Affiliation(s)
- Mithun A Joshi
- Sydney Shoulder Specialists, Suite 201, 156 Pacific Highway, St Leonards, Sydney, New South Wales 2065, Australia
| | - Allan A Young
- Sydney Shoulder Specialists, Suite 201, 156 Pacific Highway, St Leonards, Sydney, New South Wales 2065, Australia.
| | - Jean-Christian Balestro
- Sydney Shoulder Specialists, Suite 201, 156 Pacific Highway, St Leonards, Sydney, New South Wales 2065, Australia
| | - Gilles Walch
- Centre Orthopédique Santy, 24 Avenue Paul Santy, Lyon 69008, France
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Chan CM, Behrend C, Shields E, Maloney MD, Voloshin I. Effects of varying locations for biceps tendon tenotomy and superior labral integrity on shoulder stability in a cadaveric concavity-compression model. Arthroscopy 2014; 30:1557-61. [PMID: 25129863 DOI: 10.1016/j.arthro.2014.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 06/04/2014] [Accepted: 06/06/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to examine the location of biceps tenotomy and the integrity of the superior labrum as they relate to superior glenohumeral joint stability in a cadaveric concavity-compression model. METHODS Eight cadaveric glenoid labrums were mounted individually onto a load cell with the corresponding humerus fixed to the loading arm in the hanging-arm position. All surrounding soft tissue was removed except the labrum and proximal stump of the long head of the biceps (LHB) tendon, simulating a biceps tenotomy. A compressive load of 22 N was applied across the glenohumeral joint. The humerus was then translated superiorly until it subluxated over the glenoid labrum. The force resisting superior translation was characterized for each of 50 cycles. Each specimen was tested under the following conditions: (1) with a 4 cm biceps stump after tenotomy, (2) with a 0 cm biceps stump, (3) after full detachment of the superior labrum, and (4) after repair of the labrum. RESULTS Biceps tenotomy performed at the biceps-labral junction resulted in an average decrease in force required to superiorly subluxate the humeral head by 8.6% (P = .01) when compared with leaving 4 cm of biceps stump. Resection of the entire superior labrum resulted in a future decrease to 15.2% (P < .001) from baseline. Repair of the labrum resulted in restoration of stability with a mean of 101.1% (P = .82) and was not statistically different from baseline. The kinematics of the glenohumeral joint was affected by labral repair, with an earlier upslope on the force-to-displacement curve and alteration in the total energy required to cause subluxation of the humeral head noted. CONCLUSIONS In this study, location of the biceps tenotomy and integrity of the superior labrum affected glenohumeral stability during axial loading in the hanging-arm position. Repair of the labrum restored stability for superior subluxation but also changed the kinematics of the subluxation event. CLINICAL RELEVANCE Preservation of superior labrum after biceps tenotomy provides increased resistive force to superior translation in a unidirectional biomechanical model.
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Affiliation(s)
- Charles M Chan
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - Caleb Behrend
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - Edward Shields
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - Michael D Maloney
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - Ilya Voloshin
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, U.S.A..
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Kephart CJ, Abdulian MH, McGarry MH, Tibone JE, Lee TQ. Biomechanical analysis of the modified Bristow procedure for anterior shoulder instability: is the bone block necessary? J Shoulder Elbow Surg 2014; 23:1792-1799. [PMID: 24925701 DOI: 10.1016/j.jse.2014.03.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 03/05/2014] [Accepted: 03/20/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior shoulder instability with bone loss can be treated successfully with the modified Bristow procedure. Opinions vary regarding the role of the soft-tissue sling created by the conjoined tendon after transfer. Therefore, the aim of this study was to determine the effect of the modified Bristow procedure and conjoined tendon transfer on glenohumeral translation and kinematics after creating anterior instability. METHODS Eight cadaveric shoulders were tested with a custom shoulder testing system. Range-of-motion, translation, and kinematic testing was performed in 60° of glenohumeral abduction in the scapular and coronal planes under the following conditions: intact joint, Bankart lesion with 20% glenoid bone loss, modified Bristow procedure, and soft tissue-only conjoined tendon transfer. RESULTS A Bankart lesion with 20% bone loss resulted in significantly increased external rotation and translation compared with the intact condition (P < .05), as well as an anterior shift of the humeral head apex at all points of external rotation. Both the modified Bristow procedure and soft-tissue Bristow procedure maintained the increase in external rotation but resulted in significantly decreased translation (P < .05). There was no difference in translation between the 2 reconstructions. CONCLUSIONS The increase in external rotation suggests that the modified Bristow procedure does not initially restrict joint motion. Translational stability can be restored in a 20% bone loss model without a bone block, suggesting the importance of the soft-tissue sling.
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Affiliation(s)
- Curtis J Kephart
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael H Abdulian
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Long Beach VA Healthcare System, Long Beach, CA, USA
| | - James E Tibone
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Long Beach VA Healthcare System, Long Beach, CA, USA; Department of Orthopaedic Surgery, University of California, Irvine, CA, USA.
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Dumont GD, Fogerty S, Rosso C, Lafosse L. The arthroscopic latarjet procedure for anterior shoulder instability: 5-year minimum follow-up. Am J Sports Med 2014; 42:2560-6. [PMID: 25117728 DOI: 10.1177/0363546514544682] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The arthroscopic Latarjet procedure combines the benefits of arthroscopic surgery with the low rate of recurrent instability associated with the Latarjet procedure. Only short-term outcomes after arthroscopic Latarjet procedure have been reported. PURPOSE To evaluate the rate of recurrent instability and patient outcomes a minimum of 5 years after stabilization performed with the arthroscopic Latarjet procedure. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who underwent the arthroscopic Latarjet procedure before June 2008 completed a questionnaire to determine whether they had experienced a dislocation, subluxation, or further surgery. The patients also completed the Western Ontario Shoulder Instability Index (WOSI). RESULTS A total of 62 of 87 patients (64/89 shoulders) were contacted for follow-up. Mean follow-up time was 76.4 months (range, 61.2-100.7 months). No patients had reported a dislocation since their surgery. One patient reported having subluxations since the surgery. Thus, 1 patient (1.59%) had recurrent instability after the procedure. The mean ± standard deviation aggregate WOSI score was 90.6% ± 9.4%. Mean WOSI domain scores were as follows: Physical Symptoms, 90.1% ± 8.7%; Sports/Recreation/Work, 90.3% ± 12.9%; Lifestyle, 93.7% ± 9.8%; and Emotions, 88.7% ± 17.3%. CONCLUSION The rate of recurrent instability after arthroscopic Latarjet procedure is low in this series of patients with a minimum 5-year follow-up. Patient outcomes as measured by the WOSI are good.
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Affiliation(s)
- Guillaume D Dumont
- Department of Orthopaedic Surgery & Sports Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Simon Fogerty
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield Royal Infirmary, Huddersfield, UK
| | - Claudio Rosso
- Orthopaedic Department, University Hospital Basel and University of Basel, Basel, Switzerland
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Papalia R, Franceschi F, Diaz Balzani L, D'Adamio S, Denaro V, Maffulli N. The arthroscopic treatment of shoulder instability: bioabsorbable and standard metallic anchors produce equivalent clinical results. Arthroscopy 2014; 30:1173-83. [PMID: 24933591 DOI: 10.1016/j.arthro.2014.03.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/21/2014] [Accepted: 03/27/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate whether there are any differences in clinical outcomes and complications between absorbable and nonabsorbable suture anchors in the treatment of shoulder instability. METHODS We performed a comprehensive search of Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, and the Cochrane Central Registry of Controlled Trials, from inception of the databases, using various combinations of keywords. Only studies focusing on clinical outcomes of patients who underwent arthroscopic shoulder stabilization with suture anchors were selected. Two authors (R.P. and L.D.B.) then evaluated the methodologic quality of each article using the Coleman Methodology Score. RESULTS Ten articles were included. Four were prospective randomized studies, 2 were prospective cohort studies, and 4 were case series. The mean modified Coleman Methodology Score was 76.2. CONCLUSIONS Given the overall good results reported after arthroscopic stabilization of the shoulder using different suture anchors, it is not possible to draw a definite and solid suggestion on which class of device is better advised for routine use. Thus the decision to use one of the anchor systems available may mostly depend on its cost-effectiveness, which should be the focus of future comprehensive research. LEVEL OF EVIDENCE Level IV, systematic review of Level I to IV studies.
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Affiliation(s)
- Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Rome, Italy
| | - Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Rome, Italy
| | - Lorenzo Diaz Balzani
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Rome, Italy
| | - Stefano D'Adamio
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Rome, Italy
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, England; Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.
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Joshi MA, Young AA, Balestro JC, Walch G. The Latarjet-Patte procedure for recurrent anterior shoulder instability in contact athletes. Clin Sports Med 2014; 32:731-9. [PMID: 24079431 DOI: 10.1016/j.csm.2013.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The Latarjet-Patte procedure satisfies all of the requirements for treating recurrent anterior instability in contact athletes and is therefore their preferred management in this patient group.
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Affiliation(s)
- Mithun A Joshi
- Sydney Shoulder Specialists, Suite 201, 156 Pacific Highway, St Leonards, Sydney, New South Wales 2065, Australia
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Mohtadi NGH, Chan DS, Hollinshead RM, Boorman RS, Hiemstra LA, Lo IKY, Hannaford HN, Fredine J, Sasyniuk TM, Paolucci EO. A randomized clinical trial comparing open and arthroscopic stabilization for recurrent traumatic anterior shoulder instability: two-year follow-up with disease-specific quality-of-life outcomes. J Bone Joint Surg Am 2014; 96:353-60. [PMID: 24599195 DOI: 10.2106/jbjs.l.01656] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The literature comparing open and arthroscopic repair for glenohumeral instability is conflicting. We performed a prospective, expertise-based, randomized clinical trial to compare open shoulder stabilization with arthroscopic shoulder stabilization by measuring quality-of-life outcomes and recurrence rates at two years among patients treated for traumatic anterior shoulder instability. METHODS Computer-generated, variable-block-size, concealed randomization allocated 196 patients to either the open-repair group (n = 98) or the arthroscopic-repair group (n = 98). An expertise-based randomization design was employed to avoid a differential bias in terms of physician experience. Outcomes were measured at baseline, at three and six months postoperatively, and at one and two years postoperatively with use of the Western Ontario Shoulder Instability Index (WOSI) and the American Shoulder and Elbow Surgeons (ASES) functional outcome scale. Recurrent instability was also analyzed. RESULTS There were no significant differences in outcome scores at baseline. At two years, seventy-nine patients in the open group and eighty-three patients in the arthroscopic group were available for follow-up. There was no significant difference in mean WOSI scores between the groups; the mean WOSI score (and standard deviation) for the open group was 85.2 ± 20.4 (95% confidence interval [CI] = 80.5 to 89.8), and for the arthroscopic group, 81.9 ± 19.8 (95% CI = 77.4 to 86.4); p = 0.31. There was also no significant difference in mean ASES scores: 91.4 ± 12.7 (95% CI = 88.5 to 94.4) for the open group and 88.2 ± 15.9 (95% CI = 84.6 to 91.8) for the arthroscopic group; p = 0.17. Recurrence rates at two years were significantly different: 11% in the open group and 23% in the arthroscopic group (p = 0.05). Recurrent instability was more likely in patients with a preoperative Hill-Sachs lesion and in male patients who were twenty-five years old and younger. There was no significant difference in shoulder motion between the groups at two years. CONCLUSIONS There was no difference between open and arthroscopic repair in terms of patient quality of life. Open repair resulted in a significantly lower risk of recurrence. Secondary outcome data from this trial suggest that open surgical repair may be recommended to reduce the risk of recurrent instability in younger male patients with a Hill-Sachs lesion.
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Affiliation(s)
- Nicholas G H Mohtadi
- University of Calgary Sport Medicine Centre, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada. E-mail address for N.G.H. Mohtadi:
| | - Denise S Chan
- University of Calgary Sport Medicine Centre, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada. E-mail address for N.G.H. Mohtadi:
| | - Robert M Hollinshead
- University of Calgary Sport Medicine Centre, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada. E-mail address for N.G.H. Mohtadi:
| | - Richard S Boorman
- University of Calgary Sport Medicine Centre, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada. E-mail address for N.G.H. Mohtadi:
| | | | - Ian K Y Lo
- University of Calgary Sport Medicine Centre, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada. E-mail address for N.G.H. Mohtadi:
| | - Heather N Hannaford
- University of Calgary Sport Medicine Centre, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada. E-mail address for N.G.H. Mohtadi:
| | - Jocelyn Fredine
- University of Calgary Sport Medicine Centre, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada. E-mail address for N.G.H. Mohtadi:
| | | | - Elizabeth Oddone Paolucci
- Departments of Surgery and Community Health Science, University of Calgary, Faculty of Medicine, Foothills Medical Centre, North Tower, Room #1026, 1403 29 Street N.W., Calgary, AB T2N 2T9, Canada
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Lee KH, Soeharno H, Chew CP, Lie D. Arthroscopic Bankart repair augmented by plication of the inferior glenohumeral ligament via horizontal mattress suturing for traumatic shoulder instability. Singapore Med J 2013; 54:555-9. [PMID: 24154579 DOI: 10.11622/smedj.2013199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study aimed to evaluate the two-year clinical outcomes of arthroscopic Bankart repair augmented by plication of the inferior glenohumeral ligament (IGHL) via horizontal mattress suturing. METHODS This study was a retrospective analysis of 76 arthroscopic Bankart repairs by a single surgeon from 2004 to 2008. Bioabsorbable suture anchors were used, with anchors placed at the 5:30, 4 and 3 o'clock positions of the right shoulder (correspondingly at the 6:30, 8 and 9 o'clock positions for the left shoulder). The lower most anchor was tied via horizontal mattress suture with plication of the IGHL, while the remaining two anchors were tied using simple sutures. The patients were postoperatively assessed, clinically and using the University of California Los Angeles (UCLA) shoulder rating scale. RESULTS The mean age of the patients at the time of presentation was 24.09 ± 7.98 years, and the mean duration of follow-up was 28.7 months. The postoperative recurrence rate of dislocation was 7.89% (six shoulders), of which five shoulders required revision surgeries. Excluding the revision cases, clinical assessment of the strength of the supraspinatus and the range of motion of the operated shoulders at two years post operation were either maintained or full in all patients. Analysis of the UCLA results showed pre- and postoperative mean scores of 25.94 ± 3.43 and 33.77 ± 3.07, respectively (p < 0.05). CONCLUSION Arthroscopic Bankart repair augmented by plication of the IGHL and anchored via horizontal mattress suturing is a safe and reliable treatment for shoulder instability, with good clinical outcomes and low recurrence rates.
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Affiliation(s)
- Kong Hwee Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
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Abstract
Thorough evaluation of the athlete with persistent shoulder instability and appropriate use of imaging modalities, such as 3-dimensional computed tomography, can help quantify the severity of bony deficiency. Based on obtained imaging and examination, surgical and nonsurgical methods can be considered. In many situations both the humeral- and glenoid-sided bone loss must be addressed. Depending on the extent of bone loss, athletic demands, and surgeon experience, arthroscopic or open surgical options can provide shoulder stability and return athletes to their prior level of activity.
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Affiliation(s)
- Justin W Griffin
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
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64
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Harris JD, Romeo AA. Arthroscopic Management of the Contact Athlete with Instability. Clin Sports Med 2013; 32:709-30. [DOI: 10.1016/j.csm.2013.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wasserstein D, Dwyer T, Veillette C, Gandhi R, Chahal J, Mahomed N, Ogilvie-Harris D. Predictors of dislocation and revision after shoulder stabilization in Ontario, Canada, from 2003 to 2008. Am J Sports Med 2013; 41:2034-40. [PMID: 23788683 DOI: 10.1177/0363546513492952] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Factors contributing to recurrent dislocation, revision stabilization, and complications requiring reoperation after an initial shoulder stabilization procedure for instability have not been evaluated on a population level. PURPOSE (1) To define the rate of ipsilateral revision stabilization, contralateral primary stabilization, postoperative dislocation, and complications after primary shoulder stabilization in a population cohort. (2) To understand which risk factors among patient, surgical, and provider factors influence these outcomes. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All residents of Ontario, Canada, aged 16 to 60 years undergoing primary shoulder stabilization between July 2003 and December 2008 were identified from billing and hospital databases. Separate Cox proportional hazards survivorship models were built for the outcomes revision stabilization and postoperative physician-documented shoulder relocation (minimum 2-year follow-up). Model covariates included patient demographics (age, sex, preoperative dislocations), provider characteristics (surgeon volume, hospital academic status), and type of surgery (open, arthroscopic). The frequency and risk factors for contralateral stabilization were identified. RESULTS A total of 5904 patients (80.6% male; median age, 29 years) were identified. Arthroscopic stabilization was used in ~60% of cases in 2003, increasing to ~80% in 2008. The rates of postoperative dislocation were 6.9%, revision stabilization 4%, and contralateral primary stabilization 3.9%. Patients aged younger than 20 years had a 7.7% revision rate (hazard ratio [HR], 2.7; 95% confidence interval [CI], 1.7-4.2; P < .0001) and a 12.6% rate of postoperative physician-documented dislocation (HR, 2.4; 95% CI, 1.8-3.4; P < .0001), compared with 2.8% and 5.5%, respectively, in patients 29 years old (median cohort age). Patients with 3 or more preoperative dislocations in Ontario had an increased risk of revision (HR, 2.1; 95% CI, 1.5-3.0; P < .0001) and postoperative dislocation (HR, 10.6; 95% CI, 8.1-14.0; P < .0001). Revision was more common after arthroscopic (4.3%) compared with open (3.5%) stabilization (HR, 1.4; 95% CI, 1.02-1.98; P = .04). No provider factor was predictive, including surgeon volume. Reoperation rate for complications not related to recurrent instability was 0.23% (infection, 0.07%; manipulation under anesthesia, 0.15%). CONCLUSION The risks of revision stabilization and postoperative (either shoulder) dislocation were most influenced by young age (<20 years) and having had 3 or more preoperative dislocations. Complications requiring surgery are rare.
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Affiliation(s)
- David Wasserstein
- University of Toronto Orthopaedic Sports Medicine (UTOSM) at Women’s College Hospital, Toronto, Ontario, Canada.
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Saccomanni B. Early outcome of arthroscopic Bankart's repair for recurrent traumatic anterior shoulder instability. J Clin Orthop Trauma 2013; 4:129-34. [PMID: 26403552 PMCID: PMC3921397 DOI: 10.1016/j.jcot.2013.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND/OBJECTIVES Despite the improvements in the methods of arthroscopic stabilization of anterior shoulder instability, a recurrence rate of as high as 30% is reported in the literature. In this context, we report the outcome of arthroscopic Bankart repair in anterior shoulder instability, with the use of bio-absorbable suture anchors for patients that were followed up for at least two years from the date of surgery. The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. We would like to report the 2-year clinical outcomes of bio-absorbable suture anchors used in traumatic anterior dislocations of the shoulder. METHODS Data from 79 shoulders in 74 patients were collected over 4 years (2005-2009). Each patient was followed up over a period of 2 years. The patients underwent arthroscopic Bankart repair using bio-absorbable suture anchors for their anterior shoulder instability. These surgeries were performed at a single institution by a single surgeon over the time period. The patients were assessed with two different outcome measurement tools. The University of California at Los Angeles (UCLA) shoulder rating scale and the Simple Shoulder Test (SST) score. The scores were calculated before surgery and at the 2-year follow-up. The recurrence rates, range of motion as well post-operative function and return to sporting activities were evaluated. RESULTS SST results from the 12 domains showed a significant improvement from a mean of 6.1 ± 3.1 to 11.1 ± 1.8 taken at the 2-year follow-up (p < 0.0001). Data from the UCLA scale showed a pre and post-operative mean of 20.2 ± 5.0 and 32.4 ± 4.6 respectively (p < 0.0001). 34 had excellent post-operative scores, 35 had good scores, 1 had fair score and 3 had poor scores. 75% of the patients returned to sports while 7.6% developed a recurrence of shoulder dislocation or subluxation. CONCLUSION Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method, with good clinical outcomes, excellent post-operative shoulder motion and low recurrence rates.
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Affiliation(s)
- Bernardino Saccomanni
- Ambulatorio di Ortopedia, Via della Conciliazione, 65, CAP 74014 Laterza (TA), Italy,Orthopaedic and Trauma Surgery, Viale Regina Margherita, 70022 Altamura (BARI), Italy,Tel.: +39 3208007854.
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Monk AP, Garfjeld Roberts P, Logishetty K, Price AJ, Kulkarni R, Rangan A, Rees JL. Evidence in managing traumatic anterior shoulder instability: a scoping review. Br J Sports Med 2013; 49:307-11. [DOI: 10.1136/bjsports-2013-092296] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Outcome after modified Putti-Platt procedure for recurrent traumatic anterior shoulder dislocations. Strategies Trauma Limb Reconstr 2013; 8:141-7. [PMID: 23929509 PMCID: PMC3800514 DOI: 10.1007/s11751-013-0171-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 07/24/2013] [Indexed: 12/30/2022] Open
Abstract
Most recent studies on procedures for stabilizing the glenohumeral joint focus on arthroscopic techniques. A relatively simple open procedure is the modified Putti-Platt procedure. The aim of these retrospective case series was to evaluate the functional outcome, patient satisfaction, and quality of life of patients who underwent this procedure. After a median follow-up time of 4.7 (P25–P75 1.7–6.8) years, fifty-one patients could be enrolled with a mean age of 25 (21–39) years. Five patients (10 %) reported re-dislocations. The median Constant score for the affected side was 84 (P25–P75 75–91). Median loss of motion in abduction, elevation, external rotation, and external rotation in 90° of abduction did not exceed 10° when compared to the healthy shoulder. A median Rowe score of 92 (P25–P75 75–95) was measured. The WOSI score and SF-36 showed excellent quality of life. The VAS proved high patient satisfaction with the outcome; 7.9 (6.8–9.5). We concluded that the modified Putti-Platt procedure leads to excellent outcome scores and only marginal restriction in range of motion combined with a high patient satisfaction. Our data prove that excellent results can be obtained with a relatively simple open procedure.
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Petrera M, Dwyer T, Tsuji MRS, Theodoropoulos JS. Outcomes of arthroscopic Bankart repair in collision versus noncollision athletes. Orthopedics 2013; 36:e621-6. [PMID: 23672915 DOI: 10.3928/01477447-20130426-25] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of the study was to compare the recurrence rate of arthroscopic Bankart repair with suture anchors in collision vs noncollision athletes. Sixty-four patients who underwent arthroscopic shoulder stabilization using suture anchors for recurrent anterior dislocation were identified. Forty-three patients (22 collision and 21 noncollision) were evaluated at a minimum 24-month follow-up. The recurrence rate was reported, and functional outcomes (American Shoulder and Elbow Society, Western Ontario Shoulder Index, and Short Form 12) were evaluated. Statistical analysis was performed using chi-square test and Student's t test with a 95% confidence interval and a significance level set at a P value less than .05. The overall dislocation recurrence rate was 4.6% (2 of 43 patients); the dislocation recurrence rate in collision athletes was 9% (2 of 22 patients), and no redislocations occurred in noncollision athletes. No statistical differences existed in Western Ontario Shoulder Index score (73.5% in collision and 73.4% in noncollision athletes; P=.831), American Shoulder and Elbow Society score (91.2 in collision and 80.7 in noncollision athletes; P=.228), and Short Form 12 score (108.5 in collision and 101.2 in noncollision athletes; P=.083). Average external rotation loss was 6.8° in collision and 5.5° in noncollision athletes (P=.864). Ninety percent of collision athletes vs 95% of noncollision athletes were satisfied. Seventy-three percent of collision and 81% of noncollision athletes were able to return to sport at their preinjury levels. Collision athletes had higher recurrence rates after arthroscopic shoulder stabilization compared with noncollision athletes, but no statistical difference was found. Functional outcomes according to American Shoulder and Elbow Society, Western Ontario Shoulder Index, and Short Form 12 were similar.
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Affiliation(s)
- Massimo Petrera
- University of Toronto Orthopaedic Sports Medicine Program, Mount Sinai Hospital and Women’s College Hospital, Toronto, Ontario, Canada.
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Gillis RC, Donaldson CT, Kim H, Love JM, Dreese JC. Arthroscopic suture anchor capsulorrhaphy versus labral-based suture capsulorrhaphy in a cadaveric model. Arthroscopy 2012; 28:1615-21. [PMID: 22943847 DOI: 10.1016/j.arthro.2012.04.149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 04/22/2012] [Accepted: 04/23/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to establish whether suture anchor capsulorrhaphy (SAC) is biomechanically superior to suture capsulorrhaphy (SC) in the management of recurrent anterior shoulder instability without a labral avulsion. METHODS Twelve matched pairs of shoulders were randomized to either SC or SAC. Specimens were mounted in 60° of abduction and 90° of external rotation. Testing was conducted on an MTS servohydraulic load testing device (MTS, Eden Prairie, MN). A compressive load of 22 N was applied, followed by a 2-N anterior and posterior force to establish a 0 point. Translation with 10-N anterior and posterior loads was recorded for baseline laxity measurement. Arthroscopic capsulorrhaphy was performed with either 3 solitary sutures or 3 suture anchors. Specimens were remounted and returned to the 0 point. Translation was measured with 10-N anterior and posterior loads to determine reduction in translation. Specimens were then loaded to failure to the 0 point at a rate of 0.1 mm/s. RESULTS Load to failure was significantly greater (P = .02) in the SC group (13.6 ± 1.0 N) versus the SAC group (20.5 ± 2.8 N). No differences were found between SC (2.7 ± 0.7 mm) and SAC (2.3 ± 0.6 mm) when we compared reduction of anterior translation with a 10-N load. The percent reduction of anterior displacement with a 10-N load was similar for the SC (49.9%) and SAC (49.6%) groups. The dominant mode of failure in the study was suture pull-through of the capsular tissue. CONCLUSIONS Our study indicates that labral-based SC and SAC similarly reduce anterior glenohumeral translation at low loading conditions. Load-to-failure studies indicate that SAC exhibits significantly greater resistance to translation at higher loading conditions. Our study suggests that the use of a suture anchor when one is performing a capsulorrhaphy may provide biomechanical advantage at high loading conditions. CLINICAL RELEVANCE Our study suggests that when one is performing capsulorrhaphy, the use of a suture anchor may provide biomechanical advantages at high loading conditions.
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Affiliation(s)
- Robert C Gillis
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, USA
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Ng C, Bialocerkowski A, Hinman R. Effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability. INT J EVID-BASED HEA 2012; 5:182-207. [PMID: 21631787 DOI: 10.1111/j.1479-6988.2007.00064.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Anterior instability is a frequent complication following a traumatic glenohumeral dislocation. Frequently the underlying pathology associated with recurrent instability is a Bankart lesion. Surgical correction of Bankart lesions and other associated pathology is the key to successful treatment. Open surgical glenohumeral stabilisation has been advocated as the gold standard because of consistently low postoperative recurrent instability rates. However, arthroscopic glenohumeral stabilisation could challenge open surgical repair as the gold standard treatment for traumatic anterior glenohumeral instability. Objectives Primary evidence that compared the effectiveness of arthroscopic versus open surgical glenohumeral stabilisation was systematically collated regarding best-practice management for adults with traumatic anterior glenohumeral instability. Search strategy A systematic search was performed using 14 databases: MEDLINE, Cumulative Index of Nursing and Allied Health (CINAHL), Allied and Complementary Medicine Database (AMED), ISI Web of Science, Expanded Academic ASAP, Proquest Medical Library, Evidence Based Medicine Reviews, Physiotherapy Evidence Database, TRIP Database, PubMed, ISI Current Contents Connect, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Studies published between January 1984 and December 2004 were included in this review. No language restrictions were applied. Selection criteria Eligible studies were those that compared the effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability, which had more than 2 years of follow up and used recurrent instability and a functional shoulder questionnaire as primary outcomes. Studies that used non-anatomical open repair techniques, patient groups that were specifically 40 years or older, or had multidirectional instability or other concomitant shoulder pathology were excluded. Data collection and analysis Two independent reviewers assessed the eligibility of each study for inclusion into the review, the study design used and its methodological quality. Where any disagreement occurred, consensus was reached by discussion with an independent researcher. Studies were assessed for homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format; otherwise a meta-analysis was conducted. Results Eleven studies were included in the review. Two were randomised controlled trials. Evidence comparing arthroscopic and open surgical glenohumeral stabilisation was of poor to fair methodological quality. Hence, the results of primary studies should be interpreted with caution. Observed clinical heterogeneity in populations and outcomes was highlighted and should be considered when interpreting the meta-analysis. Authors also used variable definitions of recurrent instability and a variety of outcome measures, which made it difficult to synthesise results. When comparable data were pooled, there were no significant differences (P > 0.05) between the arthroscopic and open groups with respect to recurrent instability rates, Rowe score, glenohumeral external rotation range and complication rates. Conclusions Statistically, it appears that both surgical techniques are equally effective in managing traumatic anterior glenohumeral instability. In light of the methodological quality of the included studies, it is not possible to validate arthoscopic stabilisation to match open surgical stabilisation as the gold standard treatment. Further research using multicentred randomised controlled trials with sufficient power and instability-specific questionnaires with sound psychometric properties is recommended to build on current evidence. The choice of treatment should be based on multiple factors between the clinician and the patient.
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Affiliation(s)
- Choong Ng
- Centre for Health, Exercise and Sports Medicine and Rehabilitation Sciences Research Centre, School of Physiotherapy, The University of Melbourne, Melbourne, Victoria, and Centre for Allied Health Evidence (a collaborating centre of The Joanna Briggs Institute), University of South Australia, Adelaide, South Australia, Australia
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Kersten AD, Fabing M, Ensminger S, Demetropoulos CK, Cooper R, Baker KC, Anderson K. Suture capsulorrhaphy versus capsulolabral advancement for shoulder instability. Arthroscopy 2012; 28:1344-51. [PMID: 22920288 DOI: 10.1016/j.arthro.2012.04.140] [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: 10/11/2011] [Revised: 04/06/2012] [Accepted: 04/11/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to test the strength of a suture capsulorrhaphy repair versus a capsulolabral repair with knotless suture anchors in a cadaveric model with anteroinferior shoulder instability. METHODS Fourteen cadaveric shoulders were tested with either a suture capsulorrhaphy to the intact labrum or a capsulolabral advancement using a knotless suture anchor into the glenoid. Specimens were translated with the shoulder in an abducted, externally rotated position to failure. RESULTS The capsulolabral advancement showed a significantly higher load to failure than did the suture capsulorrhaphy group (P = .030). CONCLUSIONS Capsulolabral advancement with suture anchors may offer greater initial strength when compared with a suture capsulorrhaphy. In the setting of shoulder instability without evidence of a labral tear, the capsulolabral advancement technique may be considered biomechanically superior. CLINICAL RELEVANCE In the setting of shoulder instability due to capsular insufficiency, the capsulolabral advancement may be considered biomechanically superior to a traditional suture capsulorrhaphy.
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Affiliation(s)
- Andrew D Kersten
- Department of Orthopaedic Surgery, William Beaumont School of Medicine, Oakland University, Royal Oak, Michigan 48073, USA
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Kim KC, Shin HD, Cha SM, Kim JH. Arthroscopic double-loaded single-row repair in chronic traumatic anterior shoulder dislocation. Arch Orthop Trauma Surg 2012; 132:1515-20. [PMID: 22714004 DOI: 10.1007/s00402-012-1571-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE We evaluated the clinical results of arthroscopic double-loaded single-row repair for chronic anterior shoulder dislocation. METHODS From January 2007 to December 2008, of the 47 shoulders with chronic anterior shoulder dislocation that consecutively underwent arthroscopic double-loaded single-row repair using bio-absorbable suture anchors containing two non-absorbable braided sutures, 45 shoulders (95.7 %) had successful follow-up for a minimum of 2 years. The mean age of patients was 23.7 years, the mean frequency of dislocations before surgery was 6.8 events, and the mean interval between the initial dislocation and surgery was 47.9 months. Clinical results were evaluated using ASES, Rowe, VAS score, and range of motion before surgery and at the final follow-up. RESULTS The mean number of suture anchors was 3.38 (range 2-6) and the mean number of stitches was 6.32 (range 4-10). Four of the 45 cases had recurrence (8.9 %). Of these four, three cases underwent re-operation using the same method and the other one case showed no specific discomfort except a one-time dislocation that underwent conservative treatment. The preoperative and the final follow-up ASES and Rowe scores were statistically significantly improved (P < 0.001, each) and instability VAS score was significantly decreased (P < 0.001). No significant difference in forward flexion, extension, abduction, or internal rotation was found (P > 0.05), but external rotation at the side was significantly decreased (P = 0.001). CONCLUSIONS Arthroscopic double-loaded single-row repair using suture anchors, containing two sutures in chronic anterior shoulder dislocation, is a reliable procedure with respect to recurrence rate, range of motion, and shoulder function.
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Affiliation(s)
- Kyung Cheon Kim
- Department of Orthopaedic Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, 640 Daesa-Dong, Jung-Gu, Daejeon 301-721, South Korea.
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Neer modification of open Bankart procedure: what are the rates of recurrent instability, functional outcome, and arthritis? Clin Orthop Relat Res 2012; 470:2554-60. [PMID: 22395874 PMCID: PMC3830094 DOI: 10.1007/s11999-012-2296-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 02/16/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Neer modified the Bankart procedure by combining a superoinferior capsular shift with the labral reattachment. The theoretical advantages of the modification were that such a procedure would restore the patient's anatomy and also treat the repeated capsular stretching encountered in anteroinferior instability without limiting external rotation and, thereby reducing the risk of arthritis. QUESTIONS/PURPOSES We therefore determined: (1) the rate of recurrent instability after this modification, (2) patient function, and (3) the incidence and stage of glenohumeral osteoarthritis at greater than 2 years followup in patients with traumatic anteroinferior instability. METHODS We retrospectively reviewed all 64 patients (average age, 27 years) who had the modified Bankart procedure for recurrent dislocations (n = 39) or subluxation (n = 25) from 1991 to 1997. The labrum was reattached with suture anchors and a superoinferior capsular shift was added. We determined the rate of recurrent instability, Rowe and Walch-Duplay scores and shoulder ROM, and the presence of glenohumeral osteoarthritis (modified Samilson and Prieto classification). The minimum followup was 24 months (median, 40 months; range, 24-120 months). RESULTS Recurrent instability occurred in seven of the 64 patients (11%) at an average of 25 months postoperatively (range, 7 days to 6 years); in six patients the recurrence was associated with trauma; five of the six patients underwent reoperation with a Latarjet procedure. Eight additional patients (13%) presented with persistent shoulder apprehension or discomfort. The average Rowe score was 83% (range, 20-100%) and average Walch-Duplay score 83% (range, 15-100%). However, only 36 of 64 (56%) patients could return to the same sport at the same level. The loss of external rotation was 13° compared with the contralateral side. Glenohumeral osteoarthritis incidence increased from 4% preoperatively to 17% postoperatively. CONCLUSIONS The open Bankart procedure modified by Neer provided high function scores but a relatively low rate of return to sport and high rate of recurrent instability. Our rate of recurrent instability, similar to that obtained with arthroscopic Bankart procedures, has prompted us to abandon the open procedure.
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Archetti Netto N, Tamaoki MJS, Lenza M, dos Santos JBG, Matsumoto MH, Faloppa F, Belloti JC. Treatment of Bankart lesions in traumatic anterior instability of the shoulder: a randomized controlled trial comparing arthroscopy and open techniques. Arthroscopy 2012; 28:900-8. [PMID: 22342199 DOI: 10.1016/j.arthro.2011.11.032] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 11/21/2011] [Accepted: 11/22/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of this study was to compare the functional assessments of arthroscopy and open repair for treating Bankart lesion in traumatic anterior shoulder instability. METHODS Fifty adult patients, aged less than 40 years, with traumatic anterior shoulder instability and the presence of an isolated Bankart lesion confirmed by diagnostic arthroscopy were included in the study. They were randomly assigned to receive open or arthroscopic treatment of an isolated Bankart lesion. In all cases of both groups, the lesion was repaired with metallic suture anchors. The primary outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS After a mean follow-up period of 37.5 months, 42 patients were evaluated. On the DASH scale, there was a statistically significant difference favorable to the patients treated with the arthroscopic technique, but without clinical relevance. There was no difference in the assessments by University of California, Los Angeles and Rowe scales. There was no statistically significant difference regarding complications and failures, as well as range of motion, for the 2 techniques. CONCLUSIONS On the basis of this study, the open and arthroscopic techniques were effective in the treatment of traumatic anterior shoulder instability. The arthroscopic technique showed a lower index of functional limitation of the upper limb, as assessed by the DASH questionnaire; this, however, was not clinically relevant.
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Affiliation(s)
- Nicola Archetti Netto
- Division of Hand and Upper Limb Surgery, Department of Orthopedics and Trauma, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil
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Zaffagnini S, Marcheggiani Muccioli GM, Giordano G, Bonanzinga T, Grassi A, Nitri M, Bruni D, Ravazzolo G, Marcacci M. Long-term outcomes after repair of recurrent post-traumatic anterior shoulder instability: comparison of arthroscopic transglenoid suture and open Bankart reconstruction. Knee Surg Sports Traumatol Arthrosc 2012; 20:816-21. [PMID: 21932077 DOI: 10.1007/s00167-011-1674-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 09/05/2011] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study is to report long-term outcomes of the arthroscopic modified Caspari technique compared to an open capsular shift surgery to treat post-traumatic anterior shoulder recurrent instability. The hypothesis was that the open surgery group would show higher degenerative changes than to the modified Caspari technique group after a follow-up from 10 to 17 years. METHODS One hundred and ten nonrandomized consecutive patients who underwent a surgical repair of recurrent unilateral anterior shoulder instability between 1990 and 1999 were retrospectively analyzed. Eighty-two patients were available for long-term follow-up. In particular, 49 patients (59.8%) (group A) were treated with arthroscopic transglenoid modified Caspari suturing technique (mean follow-up 13.7 ± 2.2 years), whereas 33 patients (40.2%) (group B) were treated with combined open capsular shift and Bankart repair (mean follow-up 15.7 ± 2.2 years). Patients were evaluated according to the failure rate (re-dislocation), Rowe, UCLA, and Constant scores. Radiological osteoarthritis changes were ranked according to Samilson score. RESULTS There were no statistically significant differences between the two groups concerning the failure rate (n.s.), Rowe (n.s.), UCLA (n.s.), and Constant (n.s.) scores. Group A: re-dislocation rate 12.5% (6 re-dislocations), Rowe 85.0 ± 22.6, UCLA 26.4 ± 4.8, and Constant 86.3 ± 16.7. Group B: re-dislocation rate 9% (3 re-dislocations), Rowe 83.2 ± 24.4, UCLA 26.9 ± 4.2, and Constant 87.4 ± 14.1. Radiographic findings of osteoarthritis: 2 severe (4%), 4 moderate (8%), and 12 mild (25%) in group A; 2 severe (6%), 4 moderate (12%), and 9 mild (27%) in group B; differences between groups were not statistically significant (n.s). CONCLUSIONS The results after both techniques were good in majority of patients, with no significant differences in terms of re-dislocation and osteoarthritis development. Compared to the current literature, the recurrence rate was high in both groups. The modified Caspari technique could be an arthroscopic alternative for older, non-athletic shoulders. LEVEL OF EVIDENCE Therapeutic Study-Retrospective Comparative Study, Level III.
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Affiliation(s)
- Stefano Zaffagnini
- Laboratorio di Biomeccanica, Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10, 40136, Bologna, Italy.
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Arce G, Arcuri F, Ferro D, Pereira E. Is selective arthroscopic revision beneficial for treating recurrent anterior shoulder instability? Clin Orthop Relat Res 2012; 470:965-71. [PMID: 21811898 PMCID: PMC3293954 DOI: 10.1007/s11999-011-2001-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgeons have traditionally treated recurrent shoulder dislocation by open methods. With the advent of arthroscopic repair techniques some surgeons reported higher recurrence rates than with open methods but some of those reports included patients with a variety of problems, including bone loss and those continuing in contact sports. It is unclear whether recurrence rates would be higher in patients without bone loss and those willing to forego contact sports. QUESTIONS/PURPOSES We therefore determined recurrence rates and functional scores after arthroscopic revision shoulder stabilization in patients without bone loss and those not subsequently participating in contact sports. PATIENTS AND METHODS We retrospectively reviewed 16 patients who underwent a revision arthroscopic Bankart repair using suture anchors. An arthroscopic approach was selected in patients with a unilateral traumatic injury and mild to moderate bone loss. Arthroscopic stabilization was contraindicated in patients with (1) multidirectional shoulder instability; (2) greater than 25% glenoid bone loss; (3) a Hill Sachs lesion involving more than one-third of the articular surface of the humeral head; and (4) patients electing to continue pursuing contact sports. At followup, physical examination of both shoulders was conducted. Several functional scores (Rowe, UCLA, and Constant & Murley) were compiled. The minimum followup was 24 months (mean, 31 months; range, 24-46 months). RESULTS The UCLA score (22-31), Constant & Murley score (69-80), and Rowe score (33-80) all improved. Shoulder instability recurred in three of the 16 patients, two sustaining dislocations and one a subluxation. One recurrence was the result of new trauma and this patient underwent an open Latarjet procedure; the other two patients refused further surgery. CONCLUSIONS Revision arthroscopic Bankart repair using suture anchors was associated with a low recurrence rate and restoration of acceptable function in patients without bone loss and not participating in contact sports. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Guillermo Arce
- Instituto Argentino de Diagnóstico y Tratamiento, Marcelo T. de Alvear 2400, Buenos Aires, Argentina
| | - Francisco Arcuri
- Instituto Argentino de Diagnóstico y Tratamiento, Marcelo T. de Alvear 2400, Buenos Aires, Argentina
| | - Diego Ferro
- Instituto Argentino de Diagnóstico y Tratamiento, Marcelo T. de Alvear 2400, Buenos Aires, Argentina
| | - Enrique Pereira
- Instituto Argentino de Diagnóstico y Tratamiento, Marcelo T. de Alvear 2400, Buenos Aires, Argentina
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Kavaja L, Pajarinen J, Sinisaari I, Savolainen V, Björkenheim JM, Haapamäki V, Paavola M. Arthrosis of glenohumeral joint after arthroscopic Bankart repair: a long-term follow-up of 13 years. J Shoulder Elbow Surg 2012; 21:350-5. [PMID: 21813296 DOI: 10.1016/j.jse.2011.04.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 04/13/2011] [Accepted: 04/22/2011] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The purpose of the study was to establish radiologic and clinical occurrence of glenohumeral arthrosis after arthroscopic Bankart repair. MATERIALS AND METHODS Between January 1994 and December 1998, an arthroscopic Bankart repair was performed in 187 patients at our institution. We were able to assess clinical and radiologic glenohumeral arthrosis in 72 of the 101 patients who met the inclusion criteria (74 shoulders) (71%) after a 13-year follow-up. An additional 9 patients were interviewed by telephone. Radiologic arthrosis was evaluated with the Samilson-Prieto classification and clinical arthrosis with an arthrosis-specific quality-of-life questionnaire (Western Ontario Osteoarthritis of the Shoulder test). In addition, functional impairment was assessed with the Constant score and subjective satisfaction with a questionnaire. RESULTS Radiologic arthrosis was diagnosed in 50 of 74 shoulders (68%), with 40 (80%) of them classified as mild. The mean score on the Western Ontario Osteoarthritis of the Shoulder questionnaire was 280 points (85% of the best possible score), which is considered relatively good. The mean Constant score was 78 points, and 75% of the patients were extremely satisfied or satisfied with the final results of operative treatment. DISCUSSION The radiologic evaluation and self-assessment of the patients imply that the incidence of glenohumeral arthrosis after arthroscopic Bankart repair is quite common but the symptoms are generally mild and comparable to nonoperative treatment. CONCLUSION Arthrosis rarely causes more than minor subjective symptoms or a minor objectively perceived disadvantage during 13 years' follow-up.
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Affiliation(s)
- Lauri Kavaja
- Medical Faculty, University of Helsinki, Helsinki, Finland.
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Mishra A, Sharma P, Chaudhary D. Analysis of the functional results of arthroscopic Bankart repair in posttraumatic recurrent anterior dislocations of shoulder. Indian J Orthop 2012; 46:668-74. [PMID: 23325970 PMCID: PMC3543885 DOI: 10.4103/0019-5413.104205] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The Bankart lesion represents the most common form of labro-ligamentous injury in patients with traumatic dislocations of the shoulder leading to shoulder instability. We report the clinical outcome of arthroscopic repair of Bankart lesion in 50 patients. MATERIALS AND METHODS Sixty five patients with posttraumatic anterior dislocation of shoulder were treated by arthroscopic repair from Jan 2005 to Nov 2008. Fifty patients, with an average age of 26.83 years (range 18-45 years), were reviewed in the study. The average followup period was 27 months (range 24-36 months). University of California Los Angeles shoulder rating scale was used to determine the outcome after surgery. The recurrence rates, range of motion, as well as postoperative function and return to sporting activities were evaluated. RESULTS Thirty six patients (72.0%) had excellent results, whereas seven patients (14.0%) had good results. The mean pre- and postoperative range of external rotation was 80.38° and 75.18°, respectively. Eighty-six percent patients had stability compared with the normal sided shoulder and were able to return to sports. There were no cases of redislocation observed in this study; however, three cases had mild laxity of the joint. CONCLUSION Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method, with good clinical outcomes, excellent postoperative shoulder motion and low recurrence rates.
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Affiliation(s)
- Amit Mishra
- Department of Orthopaedics, Central Institute of Orthopedics, VMMC and Safdarjung Hospital, New Delhi, India
| | - Pulak Sharma
- Department of Orthopaedics, Central Institute of Orthopedics, VMMC and Safdarjung Hospital, New Delhi, India,Address for correspondence: Dr. Pulak Sharma, Central Institute of Orthopaedics, VMMC and Safdarjang Hospital, New Delhi, India. E-mail:
| | - Deepak Chaudhary
- Sports Injury Centre, VMMC and Safdarjung Hospital, New Delhi, India
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80
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Mauro CS, Voos JE, Hammoud S, Altchek DW. Failed anterior shoulder stabilization. J Shoulder Elbow Surg 2011; 20:1340-50. [PMID: 21831664 DOI: 10.1016/j.jse.2011.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 04/01/2011] [Accepted: 05/08/2011] [Indexed: 02/01/2023]
Affiliation(s)
- Craig S Mauro
- Burke and Bradley Orthopedics, University of Pittsburgh Medical Center, Pittsburgh, PA 15215, USA.
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van der Linde JA, van Kampen DA, Terwee CB, Dijksman LM, Kleinjan G, Willems WJ. Long-term results after arthroscopic shoulder stabilization using suture anchors: an 8- to 10-year follow-up. Am J Sports Med 2011; 39:2396-403. [PMID: 21803980 DOI: 10.1177/0363546511415657] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic stabilization using suture anchors is widely used to restore stability after anterior shoulder dislocations and is associated with low recurrence rates in short-term follow-up studies. PURPOSE To evaluate the long-term follow-up after arthroscopic stabilization for traumatic recurrent anterior instability using suture anchors with emphasis on both redislocations and subjective shoulder function. STUDY DESIGN Case series; Level of evidence, 4. METHODS We included 67 consecutive patients with 70 affected shoulders. After 8 to 10 years, patients were asked to report the presence and course of their redislocations. Subjective shoulder function was addressed using the Oxford Instability Score (OIS), the Western Ontario Shoulder Instability Index (WOSI), and the Simple Shoulder Test (SST). Patients rated their health status using the Short Form-36 (SF-36). RESULTS Sixty-five patients with 68 affected shoulders (97%) were evaluated for follow-up; 35% reported a redislocation. Median shoulder function scores were 16 of 12 to 60, 22 of 0 to 210, and 12 of 0 to 12 for the OIS, WOSI, and SST, respectively. There was a significant difference in subjective function between patients with and without recurrent instability, respectively, 16 versus 24 for the OIS (P = .004), and 16 versus 47 for the WOSI (P = .05). We found a trend for an inverse relationship between the number of suture anchors and recurrent instability, with 2 having a higher recurrence rate than 3 or more (P = .06). Another trend was found with the presence of a Hill-Sachs defect slightly increasing the risk of a redislocation (P = .07). CONCLUSION With a follow-up of 97%, about one third of the stabilized shoulders experienced at least one redislocation after 8 to 10 years. The presence of a Hill-Sachs defect and the use of less than 3 suture anchors might increase the chance of a redislocation. Patients without a redislocation have a significantly better shoulder function compared with patients with a redislocation.
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Affiliation(s)
- Just A van der Linde
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
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83
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Tjoumakaris FP, Bradley JP. The rationale for an arthroscopic approach to shoulder stabilization. Arthroscopy 2011; 27:1422-33. [PMID: 21872422 DOI: 10.1016/j.arthro.2011.06.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 04/18/2011] [Accepted: 06/03/2011] [Indexed: 02/02/2023]
Abstract
The gold standard of treatment for glenohumeral instability has traditionally been viewed as open shoulder stabilization. With the increased awareness of complex instability patterns and the ability to preoperatively detect concomitant pathology with advanced imaging modalities, an evidence-based shift to an all-arthroscopic approach to shoulder stabilization surgery is occurring. Current data suggest that patients who meet eligibility criteria for arthroscopic stabilization (those without significant bony lesions or significant deformity) can expect equivalent rates of recurrence, better functional outcomes, and less morbidity. Modern arthroscopic techniques using suture anchors and capsular plication have resulted in a significant improvement over previous reports in the orthopaedic literature. An argument is put forth on the benefits of an all-arthroscopic approach to shoulder stabilization in athletes and nonathletes alike based on a review of the current orthopaedic literature comparing the evolved arthroscopic technique with more traditional open methods.
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Affiliation(s)
- Fotios P Tjoumakaris
- Department of Orthopaedic Surgery, Rothman Institute Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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84
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Franceschi F, Papalia R, Del Buono A, Vasta S, Maffulli N, Denaro V. Glenohumeral osteoarthritis after arthroscopic Bankart repair for anterior instability. Am J Sports Med 2011; 39:1653-9. [PMID: 21543624 DOI: 10.1177/0363546511404207] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few data on shoulder arthropathy in patients undergoing arthroscopic repair for glenohumeral instability are available. HYPOTHESIS Arthroscopic stabilization of Bankart lesions does not prevent the development of postoperative glenohumeral osteoarthritis. STUDY DESIGN Case series; Level of evidence, 4. METHODS Clinical (Rowe and Constant scores) and radiographic preoperative and postoperative data from 60 patients who underwent arthroscopic Bankart repair were compared. Osteoarthritis was graded preoperatively and postoperatively with the Buscayret classification grading system. The average age at surgery was 27.6 years, and follow-up averaged 8.0 years. RESULTS The postoperative incidence of osteoarthritis in patients with no preoperative degenerative changes was 21.8% (12 of 55 patients). The incidence of degenerative joint disease of the glenohumeral joint showed evidence of a statistically significant association with older age at first dislocation and at surgery, increased length of time from the first episode to surgery, increased number of preoperative dislocations, increased length of time from the initial dislocation until surgery, increased number of anchors used at surgery, and more degenerated labrum at surgery. A higher number of preoperative dislocations, a greater length of follow-up, and reduced external rotation in abduction influenced Rowe and Constant scores. CONCLUSION The number of anchors used and the state of the labrum are the most important factors associated with a higher risk of radiographic degenerative changes. Longer follow-up investigations are needed to draw meaningful conclusions.
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Affiliation(s)
- Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, the University Campus Bio-Medico of Rome, Rome, Italy
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85
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Godin J, Sekiya JK. Systematic review of arthroscopic versus open repair for recurrent anterior shoulder dislocations. Sports Health 2011; 3:396-404. [PMID: 23016034 PMCID: PMC3445197 DOI: 10.1177/1941738111409175] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT It remains unknown if arthroscopic repair of recurrent anterior shoulder instability is as effective as open repair. OBJECTIVE The purpose of this study is to analyze the literature to provide clinical recommendations regarding the most appropriate therapeutic intervention for recurrent anterior shoulder instability. STUDY DESIGN Systematic review of level I and II studies. DATA SOURCES PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and secondary references from 1967 to March 2010 were appraised for studies that met the inclusion criteria. STUDY SELECTION Inclusion criteria were English-language level I or level II trials involving the treatment of recurrent anterior shoulder instability. Exclusion criteria included non-English-language studies; level III, IV, or V studies; and trials examining treatment of first-time shoulder dislocation, posterior shoulder dislocation, or diagnoses other than recurrent anterior shoulder dislocations. DATA EXTRACTION Included studies underwent quality appraisal independently by each author identifying strengths, weaknesses, and biases. RESULTS Four randomized controlled trials compared the use of arthroscopic and open repair for recurrent anterior shoulder dislocations. These studies show no statistically significant difference between the 2 operative approaches. No long-term follow-up data describing the effects of either surgical approach are available at this time. Each investigation had weaknesses in study design that decreased the validity of its findings. CONCLUSIONS While limited, the available evidence from randomized controlled trials does not show a statistically significant difference in redislocation rates, return to activity, and functional outcomes between the arthroscopic and open repair groups. Range of motion is marginally better following arthroscopic treatment when compared with open repair. Recommendations on the optimal surgical intervention cannot be provided.
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Affiliation(s)
- Jonathan Godin
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan
| | - Jon K. Sekiya
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
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87
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Cho CH, Jung GH, Sin HK, Lee YK, Park JH. Coracoclavicular Ligament Augmentation Using Endobutton for Unstable Distal Clavicle Fractures - Preliminary Report -. Clin Shoulder Elb 2011. [DOI: 10.5397/cise.2011.14.1.001] [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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88
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Ee GWW, Mohamed S, Tan AHC. Long term results of arthroscopic Bankart repair for traumatic anterior shoulder instability. J Orthop Surg Res 2011; 6:28. [PMID: 21672187 PMCID: PMC3127762 DOI: 10.1186/1749-799x-6-28] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 06/14/2011] [Indexed: 01/24/2023] Open
Abstract
Background The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. We would like to report the 2 year clinical outcomes of bio-absorbable suture anchors used in traumatic anterior dislocations of the shoulder. Methods Data from 79 shoulders in 74 patients were collected over 4 years (2004 - 2008). Each patient was followed-up over a period of 2 years. The patients underwent arthroscopic Bankart repair using bio-absorbable suture anchors for their shoulder instability. These surgeries were performed at a single institution by a single surgeon over the time period. The patients were assessed with two different outcome measurement tools. The University of California at Los Angeles (UCLA) shoulder rating scale and the Simple Shoulder Test (SST) score. The scores were calculated before surgery and at the 2-year follow-up. The recurrence rates, range of motion as well post-operative function and return to sporting activities were evaluated. Results SST results from the 12 domains showed a significant improvement from a mean of 6.1 ± 3.1 to 11.1 ± 1.8 taken at the 2-year follow-up (p < 0.0001). Data from the UCLA scale showed a Pre and Post Operative Mean of 20.2 ± 5.0 and 32.4 ± 4.6 respectively (p < 0.0001). 34 had excellent post-operative scores, 35 had good scores, 1 had fair score and 3 had poor scores. 75% of the patients returned to sports while 7.6% developed a recurrence of shoulder dislocation or subluxation. Conclusion Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method, with good clinical outcomes, excellent post-operative shoulder motion and low recurrence rates.
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Affiliation(s)
- Gerard W W Ee
- Department of Orthopaedics, Singpapore General Hospital, Outram Road, Singapore 169608, Singapore.
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89
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Krueger D, Kraus N, Pauly S, Chen J, Scheibel M. Subjective and objective outcome after revision arthroscopic stabilization for recurrent anterior instability versus initial shoulder stabilization. Am J Sports Med 2011; 39:71-7. [PMID: 20855555 DOI: 10.1177/0363546510379336] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The value of arthroscopic revision shoulder stabilization after failed instability repair is still a matter of debate. HYPOTHESIS Arthroscopic revision shoulder stabilization using suture anchors provides equivalent subjective and objective results compared with initial arthroscopic instability repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Twenty consecutive patients who underwent arthroscopic revision shoulder stabilization using suture anchors (group 2) were matched for age, gender, and handedness (dominant or nondominant) with 20 patients who had initial arthroscopic instability repair using the same technique (group 1). At the time of follow-up, a complete physical examination of both shoulders and evaluation with the Rowe score, Walch-Duplay score, Melbourne Instability Shoulder Score, Western Ontario Shoulder Instability Index, and the Subjective Shoulder Value were performed. In addition, standard radiographs (true AP and axillary views) were taken to evaluate signs of osteoarthritis. RESULTS After a minimum follow-up of 24 months, no recurrent dislocations were observed in either group. The apprehension sign was positive in 2 cases of revision surgery (0 vs 2; P > .05). No significant differences in the Rowe score (89 vs 81.8 points) were found between groups 1 and 2 (P > .05). However, group 2 revealed significantly lower scores in the Walch-Duplay score (85.3 vs 75.5 points), Melbourne Instability Shoulder Score (90.2 vs 73.7 points), Western Ontario Shoulder Instability Index (89.8% vs 68.9%), and Subjective Shoulder Value (91.8% vs 69.2%) (P < .05). Signs of instability arthropathy were found more often in patients with arthroscopic revision surgery (2 vs 5; P > .05). CONCLUSION Arthroscopic revision shoulder stabilization is associated with a lower subjective outcome compared with initial arthroscopic stabilization. The objective results found in this study may overestimate the clinical outcome in this patient population.
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Affiliation(s)
- David Krueger
- Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Germany
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90
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Petrera M, Patella V, Patella S, Theodoropoulos J. A meta-analysis of open versus arthroscopic Bankart repair using suture anchors. Knee Surg Sports Traumatol Arthrosc 2010; 18:1742-7. [PMID: 20237768 DOI: 10.1007/s00167-010-1093-5] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 02/15/2010] [Indexed: 11/28/2022]
Abstract
Purpose of this study is to conduct a meta-analysis comparing the results of open and arthroscopic Bankart repair using suture anchors in recurrent traumatic anterior shoulder instability. Using Medline Pubmed, Cochrane and Embase databases we performed a search of all published articles. We included only studies that compared open and arthroscopic repair using suture anchors. Statistical analysis was performed using chi-square test. Six studies met the inclusion criteria. The total number of patients was 501, 234 suture anchors and 267 open. The rate of recurrent instability in the arthroscopic group was 6% versus 6.7% in the open group; rate of reoperation was 4.7% in the arthroscopic group vs. 6.6% in open (difference not statistically significant). The difference was statistically significant only in the studies after 2002 (2.9% of recurrence in the arthroscopic group vs. 9.2% in open; 2.2% of reoperation in the arthroscopic group vs. 9.2% in open). Results regarding function couldn't be combined because of non-homogeneous scores reported in the original articles, but the arthroscopic treatment led to better functional results. Arthroscopic repair using suture anchors results in similar redislocation and reoperation rate compared to open Bankart repair; however, we need larger and more homogeneous prospective studies to confirm these findings.
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Affiliation(s)
- M Petrera
- Division of Orthopaedic Surgery, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada.
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91
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Milano G, Grasso A, Salvatore M, Saccomanno MF, Deriu L, Fabbriciani C. Arthroscopic rotator cuff repair with metal and biodegradable suture anchors: a prospective randomized study. Arthroscopy 2010; 26:S112-9. [PMID: 20692119 DOI: 10.1016/j.arthro.2010.01.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 12/11/2009] [Accepted: 01/28/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare the clinical outcome of arthroscopic rotator cuff repair with metal and biodegradable suture anchors. METHODS Arthroscopic rotator cuff repair was performed in 110 patients with a full-thickness rotator cuff tear. They were divided into 2 groups of 55 patients each, according to suture anchors used: metal anchors in group 1 and biodegradable anchors in group 2. Results were evaluated by use of the Disabilities of the Arm, Shoulder and Hand (DASH) and Work-DASH self-administered questionnaires, as well as the Constant score normalized for age and sex. On analyzing the results at 2 years' follow-up, we considered the following independent variables: baseline scores; age; sex; arm dominance; location, shape, and retraction of cuff tear; fatty degeneration; treatment of biceps tendon; rotator cuff repair technique (anchors or anchors and side to side); and number of anchors. Univariate and multivariate statistical analyses were performed to determine which variables were independently associated with the outcome. Significance was set at P < .05. RESULTS Of the patients, 9 (8.2%) were lost to follow-up. Comparison between groups did not show significant differences for each variable considered. Overall, according to the results, the mean DASH scores were 17.6 +/- 17.2 points in group 1 and 22.8 +/- 19.9 points in group 2; the mean Work-DASH scores were 24.9 +/- 28.1 points and 22.5 +/- 24.1 points, respectively; and the mean Constant scores were 104 +/- 20.5 points and 98.6 +/- 14.3 points, respectively. Differences between groups 1 and 2 were not significant. Univariate and multivariate analysis showed that only baseline score, age, tear location, and fatty degeneration significantly and independently influenced the outcome. CONCLUSIONS At a short-term follow-up, differences between arthroscopic repair of full-thickness rotator cuff tears with metal and biodegradable suture anchors were not significant. LEVEL OF EVIDENCE Level I, high-quality randomized controlled trial with no statistically significant differences but narrow confidence intervals.
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Affiliation(s)
- Giuseppe Milano
- Department of Orthopaedics and Traumatology, Catholic University, Rome, Italy.
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92
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Abstract
As our understanding of the pathoanatomy of glenohumeral instability has improved, surgical techniques for the treatment of anterior instability have progressed. Many stabilization procedures are now successfully performed arthroscopically; open capsular shift, however, continues to play an important role in the management of instability in certain patients, providing an accurate and selective means of capsular plication. When performed with proper surgical technique, shoulder range of motion can be preserved with low recurrence rates and high subjective satisfaction, making the open capsular shift a durable and effective option in the modern management of shoulder instability.
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Affiliation(s)
- Karen J Boselli
- Center for Shoulder, Elbow and Sports Medicine, Department of Orthopaedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH 11, New York, NY 10032, USA
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93
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Provencher MT, Ghodadra N, Romeo AA. Arthroscopic management of anterior instability: pearls, pitfalls, and lessons learned. Orthop Clin North Am 2010; 41:325-37. [PMID: 20497809 DOI: 10.1016/j.ocl.2010.02.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite advances in the understanding of anterior shoulder instability, failure rates after open and arthroscopic surgery have been reported to be as high as 30%. In general, a successful operative outcome for patients with shoulder instability requires the surgeon to perform a complete preoperative evaluation, a thorough diagnostic arthroscopy to evaluate for concomitant co-pathology, and implement an effective postoperative therapy program tailored to the repair strategy. In addition to the Bankart lesion, the treating surgeon must be aware of other co-pathologies, such as the HAGL lesion, ALPSA lesion, and SLAP tears, that can occur in concert with capsular pathology and present as potential barriers to a successful outcome. This article focuses specifically on the pearls and pitfalls that are important to recognize in the preoperative workup, intraoperative evaluation, and arthroscopic surgery to optimize surgical outcomes for anterior instability.
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Affiliation(s)
- Matthew T Provencher
- Division of Shoulder and Sports Surgery, Department of Orthopedics Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 112, San Diego, CA 92134-1112, USA.
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Detterline AJ, Provencher MT, Ghodadra N, Bach BR, Romeo AA, Verma NN. A new arthroscopic technique to determine anterior-inferior glenoid bone loss: validation of the secant chord theory in a cadaveric model. Arthroscopy 2009; 25:1249-56. [PMID: 19896046 DOI: 10.1016/j.arthro.2009.05.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 03/09/2009] [Accepted: 05/23/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE The accuracy of a previously described method using the glenoid bare spot (GBS) as a reference point was compared with a new method using the secant chord theory (SCT), which relies on the circular geometry of the inferior glenoid to calculate bone loss. METHODS In 7 embalmed cadaveric shoulders a digital image of the glenoid face was used to calculate the area of the best-fit circle of the inferior glenoid. Osteotomy templates from the 3-o'clock to 6-o'clock position were created to make a simulated anterior-inferior bone defect of 12.5% and 25% of the area of the circle. Measurements were taken with an arthroscopic probe from 2 simulated posterior portal positions (9 and 10 o'clock) by use of 2 techniques-SCT and GBS-in the intact, 12.5% loss, and 25% loss states. RESULTS In the intact state, measurements showed a mean SCT loss of 4.1% and GBS loss of 4.4%. In the 12.5% loss state, mean percent bone loss with GBS was 23.1% compared with 14.8% with SCT (P = .0001) at the 10-o'clock portal and 22.2% compared with 15.9% (P = .006) at the 9-o'clock portal. In the 25% loss state, mean percent bone loss with GBS was 31.5% compared with 26.6% with SCT (P = .002) at the 10-o'clock portal and 30.4% compared with 28.9% (P = .48) at the 9-o'clock portal. CONCLUSIONS The SCT is shown to be a more accurate method of determining glenoid bone loss in an arthroscopic model; however, additional mathematic calculations are necessary. As shown in the intact state, there is an inherent small error of approximately 4% when arthroscopically determining bone loss. CLINICAL RELEVANCE The technique may aid the clinician in quantifying glenoid bone loss and help determine when bone augmentation may be advisable.
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Affiliation(s)
- Alvin J Detterline
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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Abstract
BACKGROUND The shoulder is the most common joint to develop recurrent instability. Repair of labral tears of the joint and reconstruction of damaged capsule and torn ligaments either by open or arthroscopic methods remain the cornerstone of current management. OBJECTIVES To compare the effectiveness of various surgical interventions performed to treat recurrent anterior instability of the shoulder in adults. SEARCH STRATEGY We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (December 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 1), MEDLINE (1950 to March 2008), EMBASE and other databases. We searched conference proceedings and the reference lists of papers. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing different surgical interventions for treating anterior shoulder instability in adults. DATA COLLECTION AND ANALYSIS The authors independently selected trials, assessed methodological quality and extracted data. Only limited pooling was done. MAIN RESULTS Included are three randomised controlled trials involving 184 people (predominantly active young men) with unidirectional anterior shoulder instability generally following a traumatic event. All three trials compared arthroscopic versus open surgery, generally involving the repair of Bankart lesions. The three trials were inadequately reported but appeared well-conducted with minimum follow-ups of two years.Pooled results showed no statistically significant difference between the two groups in recurrent instability or re-injury (7/92 versus 5/85, risk ratio (RR) 0.89, 95% confidence interval (CI) 0.09 to 8.72; random-effects model), in subsequent instability-related surgery (RR 0.66, 95% CI 0.05 to 8.97; random-effects model) or surgery for all reasons (RR 0.55, 95% CI 0.04 to 7.18; random-effects model). For other outcomes, including shoulder function, there were either no statistically significant differences between the two groups or the differences were clinically insignificant where statistically significant differences occurred. AUTHORS' CONCLUSIONS There is insufficient evidence from randomised trials comparing arthroscopic with open surgery for treating anterior shoulder instability. Further research is needed on this subject and for other surgical interventions. Sufficiently powered, good quality, well reported randomised controlled trials with validated outcome measures and long-term follow up are required.
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Affiliation(s)
- Ramnadh S Pulavarti
- Department of Orthopaedics and Traumatology, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Preston, Lancashire, UK, PR2 9HT
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Elmlund AO, Kartus J, Rostgård-Christensen L, Sernert N, Magnusson L, Ejerhed L. A 7-year prospective, randomized, clinical, and radiographic study after arthroscopic Bankart reconstruction using 2 different types of absorbable tack. Am J Sports Med 2009; 37:1930-7. [PMID: 19483074 DOI: 10.1177/0363546509335197] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent studies have shown that techniques for arthroscopic Bankart reconstruction using suture anchors or tacks can equal the results after an open procedure in the treatment of posttraumatic, recurrent, unidirectional shoulder instability. Which kind of technique and which implants to be used still need further study. PURPOSE The aim of this study was to compare the clinical and radiographic results after arthroscopic Bankart reconstruction using 2 different types of absorbable implants. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A randomized series of 40 patients who had recurrent shoulder instability underwent reconstruction involving either polygluconate-B polymer or self-reinforced poly-L-lactic acid polymer tack implants. The patients underwent radiographic and clinical assessments preoperatively and at 7 years. Blood levels of C-reactive protein were analyzed preoperatively and postoperatively. RESULTS The radiographic visibility of the drill holes was significantly (P = .0001) greater in the poly-L-lactic acid polymer group than in the polygluconate-B polymer group. The failure rate in terms of stability was 5 of 36 (14%) after 7 years and, as previously reported by Magnusson et al, 2 of 40 (5%) after 2 years. Analyses preoperatively and postoperatively of C-reactive protein revealed no significant difference between the groups. No significant differences were found between the groups in terms of strength in abduction, range of motion, and Rowe or Constant scores. CONCLUSION Seven years after Bankart repair using either implant, the overall clinical results were satisfactory. The visibility of the drill holes was significantly greater after using poly-L-lactic acid polymer implants.
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Affiliation(s)
- Anna O Elmlund
- Department of Orthopedics, NU Hospital, Trollhättan and Uddevalla, Sweden.
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97
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Abstract
Shoulder dislocations are a frequent event and the severity is often underestimated. A thorough clinical investigation and adapted imaging diagnostics are able to detect age-dependent injury patterns. A biphasic conservative treatment keeping the arm in a neutral to mild external rotation for 3 weeks has proven to be most effective and should be followed by an intensive physiotherapy. Nevertheless, conservative treatment protocols show unacceptable recurrence rates particularly in young men active in sport, therefore, surgical stabilisation is recommended. In the past open procedures were accepted as the gold standard, but today arthroscopic Bankart repair using suture anchors shows comparable recurrence rates. However, the clinical outcome with respect to the shoulder function is much better without compromising the subscapularis muscle.
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98
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Abstract
INTRODUCTION Anterior dislocation of the shoulder is commonly seen in accident and emergency (A&E) and trauma clinics. In this article, we review the existing literature on the injury and the recent trends in management. MATERIALS AND METHODS We have discussed this condition with our colleagues and performed a Medline search ('anterior shoulder dislocation') of the relevant papers. We also describe key historical publications and recent developments regarding immobilisation of the joint. RESULTS Management decisions regarding this condition continue to vary between units, especially for recurrent and posterior dislocation. This paper lays some emphasis on the choice of analgesic agent when attempting shoulder reduction in the A&E setting. A summary of the data from our own department has provided a graphical representation of the classical age and sex distribution for this condition. CONCLUSIONS Shoulder dislocation is a common injury. Delays in diagnosis remain the single biggest obstacle to optimum results in this group of patients. A significant proportion will require eventual surgery and up to a third of these patients will go on to develop long-term shoulder arthritis. Even patients who have experienced a single episode of dislocation may go on to develop long-term sequelae.
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Affiliation(s)
- Steven Cutts
- Department of Orthopaedics and Trauma Surgery, University Hospitals of Coventry and Warwickshire, UK.
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99
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Lützner J, Krummenauer F, Lübke J, Kirschner S, Günther KP, Bottesi M. Fuctional outcome after open and arthroscopic bankart repair for traumatic shoulder instability. Eur J Med Res 2009; 14:18-24. [PMID: 19258206 PMCID: PMC3352200 DOI: 10.1186/2047-783x-14-1-18] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose Both open and arthroscopic Bankart repair are established procedures in the treatment of anterior shoulder instability. While the open procedure is still considered as the "golden standard" functional outcome is supposed to be better in the arthroscopic procedure. The aim of this retrospective study was to compare the functional outcome between open and arthroscopic Bankart repair. Materials and methods In 199 patients a Bankart procedure with suture anchors was performed, either arthroscopically in presence of an detached, but not elongated capsulolabral complex (40) or open (159). After a median time of 31 months (12 to 67 months) 174 patients were contacted and agreed to follow-up, 135 after open and 39 after arthroscopic Bankart procedure. Results Re-dislocations occurred in 8% after open and 15% after arthroscopic Bankart procedure. After open surgery 4 of the 11 re-dislocations occurred after a new adequate trauma and 1 of the 6 re-dislocations after arthroscopic surgery. Re-dislocations after arthroscopic procedure occured earlier than after open Bankart repair. An external rotation lag of 20° or more was observed more often (16%) after open than after arthroscopic surgery (3%). The Rowe score demonstrated "good" or "excellent" functional results in 87% after open and in 80% patients after arthroscopic treatment. Conclusion In this retrospective investigation the open Bankart procedure demonstrated good functional results. The arthroscopic treatment without capsular shift resulted in a better range of motion, but showed a tendency towards more frequently and earlier recurrence of instability. Sensitive patient selection for arthroscopic Bankart repair is recommended especially in patients with more than five dislocations.
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Affiliation(s)
- Jörg Lützner
- Department of Orthopedic Surgery, University Hospital Carl Gustav Carus, Medical Faculty of the Technical University of Dresden, Fetscherstr. 74 (bd 29), 01307 Dresden, Germany.
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100
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Brophy RH, Marx RG. The treatment of traumatic anterior instability of the shoulder: nonoperative and surgical treatment. Arthroscopy 2009; 25:298-304. [PMID: 19245994 DOI: 10.1016/j.arthro.2008.12.007] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 12/12/2008] [Accepted: 12/15/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE Traumatic anterior instability of the shoulder is a common condition associated with a high recurrence rate in young patients. The role of nonoperative versus operative treatment and the optimal surgical approach for this condition is debated. The purpose of this study was to review the literature for the latest evidence comparing outcomes of treatment for traumatic anterior instability of the shoulder. METHODS A systematic review of the literature was performed to identify studies comparing operative versus nonoperative treatment for traumatic anterior shoulder instability and studies comparing open versus arthroscopic stabilization for traumatic anterior shoulder instability. RESULTS Surgical treatment was associated with a significantly lower rate of recurrent instability at 2 years of follow-up (7% v 46%) and at longer-term follow-up (10% v 58%) for first-time traumatic anterior shoulder dislocation, all in younger patients. The rates of recurrent instability were roughly equal after arthroscopic stabilization with suture anchors and open stabilization with anchors (open, 8.2%; arthroscopic, 6.4%). CONCLUSIONS Rates of recurrent instability after a first-time anterior shoulder dislocation, particularly in young active male patients, are reduced by surgical intervention compared with nonoperative treatment. If surgical treatment is indicated, an arthroscopic approach using suture anchors appears to have similar results in terms of recurrent instability to an open approach using suture anchors.
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Affiliation(s)
- Robert H Brophy
- Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri, USA.
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