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Kay J, Heyworth BE, Milewski MD, Kramer DE. Pediatric and Adolescent Shoulder Instability. Curr Rev Musculoskelet Med 2023:10.1007/s12178-023-09837-z. [PMID: 37067690 DOI: 10.1007/s12178-023-09837-z] [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] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE OF REVIEW Traumatic and atraumatic shoulder instability is common in pediatric and adolescent patients. It is well-established that young patients with anterior shoulder dislocation are at high risk of recurrent instability. This review assesses the current literature pertaining to management of both anterior instability and MDI in the pediatric and adolescent populations. RECENT FINDINGS Current research suggests that pediatric and adolescent patients with shoulder instability have excellent outcomes following arthroscopic Bankart repair; however, higher rates of recurrent instability requiring revision surgical management have been identified in patients with more than one dislocation episode pre-operatively, those with Hill-Sachs lesions and those under age 16. The addition of the remplissage procedure to an arthroscopic Bankart repair may be useful in preventing recurrent instability for patients with large Hill-Sachs lesions. Open procedures with bony glenoid augmentation may be indicated in patients with significant glenoid bone loss, or those who have failed primary surgical management, with promising outcomes reported following the Latarjet coracoid process transfer procedure in the adolescent population. Pediatric and adolescent patients with hyperlaxity, and those participating in swimming or gymnastics are more likely to have multidirectional instability (MDI). Non-surgical management with physical therapy is the mainstay of treatment for MDI with positive outcomes reported overall. In young patients with MDI who continue to have symptoms of instability and pain that effects daily activities or sports despite an adequate and appropriate course of rehabilitation, surgical management with capsulorrhaphy may be considered, with promising outcomes reported for both open and arthroscopic techniques. Attentive selection of timing and surgical procedure for pediatric and adolescent patients with anterior shoulder instability may help to prevent recurrent instability following shoulder stabilization. Although most pediatric and adolescent patients with MDI do well following non-surgical management alone, those that fail conservative management have good outcomes following arthroscopic or open capsulorrhaphy.
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Affiliation(s)
- Jeffrey Kay
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA.
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
| | - Benton E Heyworth
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Matthew D Milewski
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Dennis E Kramer
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Imam N, Sudah SY, Manzi JE, Michel CR, Pizzo DM, Menendez ME, Nicholson AD. Pediatric Shoulder Arthroscopy is Effective and Most Commonly Indicated for Instability, Obstetric Brachial Plexus Palsy, and Partial Rotator Cuff Tears. Arthrosc Sports Med Rehabil 2023; 5:e281-e295. [PMID: 36866288 PMCID: PMC9971909 DOI: 10.1016/j.asmr.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/09/2022] [Indexed: 01/03/2023] Open
Abstract
Purpose The purpose of this review was to systematically evaluate the literature on pediatric shoulder arthroscopy and outline its indications, outcomes, and complications. Methods This systematic review was carried out in accordance with PRISMA guidelines. PubMed, Cochrane Library, ScienceDirect, and OVID Medline were searched for studies reporting the indications, outcomes, or complications in patients undergoing shoulder arthroscopy under the age of 18 years. Reviews, case reports, and letters to the editor were excluded. Data extracted included surgical techniques, indications, preoperative and postoperative functional and radiographic outcomes, and complications. The methodological quality of included studies was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) tool. Results Eighteen studies, with a mean MINORS score of 11.4/16, were identified, including a total of 761 shoulders (754 patients). Weighted average age was 13.6 years (range, 0.83-18.8 years) with a mean follow-up time of 34.6 months (range, 6-115). As part of their inclusion criteria, 6 studies (230 patients) recruited patients with anterior shoulder instability and 3 studies recruited patients with posterior shoulder instability (80 patients). Other indications for shoulder arthroscopy included obstetric brachial plexus palsy (157 patients) and rotator cuff tears (30 patients). Studies reported a significant improvement in functional outcomes for arthroscopy indicated for shoulder instability and obstetric brachial plexus palsy. A significant improvement was also noted in radiographic outcomes and range of motion for obstetric brachial plexus palsy patients. The overall rate of complication ranged from 0% to 25%, with 2 studies reporting no complications. The most common complication was recurrent instability (38 patients of 228 [16.7%]). Fourteen of the 38 patients (36.8%) underwent reoperation. Conclusion Among pediatric patients, shoulder arthroscopy was indicated most commonly for instability, followed by brachial plexus birth palsy, and partial rotator cuff tears. Its use resulted in good clinical and radiographic outcomes with limited complications. Level of Evidence Systematic review of Level II to IV studies.
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Affiliation(s)
- Nareena Imam
- Robert Wood Johnson Medical School, New Brunswick Chicago, Illinois, U.S.A.,Address correspondence to Nareena Imam, B.A., Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901.
| | - Suleiman Y. Sudah
- Department of Orthopedic Surgery, Monmouth Medical Center, Long Branch Chicago, Illinois, U.S.A
| | - Joseph E. Manzi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York U.S.A
| | - Christopher R. Michel
- Department of Orthopedic Surgery, Monmouth Medical Center, Long Branch Chicago, Illinois, U.S.A
| | - Dane M. Pizzo
- Robert Wood Johnson Medical School, New Brunswick Chicago, Illinois, U.S.A
| | - Mariano E. Menendez
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
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Shoulder Injury Related to Vaccine Administration. J Am Acad Orthop Surg 2021; 29:732-739. [PMID: 34185028 DOI: 10.5435/jaaos-d-21-00021] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/03/2021] [Indexed: 02/01/2023] Open
Abstract
Shoulder injury related to vaccine administration (SIRVA) is a rare yet increasingly recognized complication of immunization. Although a medicolegal term rather than a true diagnosis, SIRVA was introduced in 2010 by the Vaccine Injury Compensation Program after an increase in claims filed for vaccine-related shoulder injury. Patients typically present with severe pain and limited range of motion within 48 hours of vaccination and may experience notable functional limitations. Although the underlying pathophysiology is incompletely understood, the existing literature suggests that SIRVA results from the inflammatory response produced when the vaccine is injected into tissues containing a preexisting antibody. Current treatment modalities include physical therapy, corticosteroid injections, and antiinflammatory medications. In some cases, surgery may be required to treat underlying pathology, such as rotator cuff or biceps tendinopathy. Although the available literature indicates modest improvement in patients with SIRVA undergoing treatment, current data are limited to case series. Larger, high-quality studies are needed to determine the natural history and optimal treatment of this increasingly prevalent condition.
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Shanmugaraj A, Chai D, Sarraj M, Gohal C, Horner NS, Simunovic N, Athwal GS, Ayeni OR. Surgical stabilization of pediatric anterior shoulder instability yields high recurrence rates: a systematic review. Knee Surg Sports Traumatol Arthrosc 2021; 29:192-201. [PMID: 32112125 DOI: 10.1007/s00167-020-05913-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/17/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE The purpose of this systematic review was to assess the surgical techniques, indications outcomes and complications for pediatric patients (≤ 19 years old) undergoing shoulder stabilization procedures for anterior shoulder instability. METHODS The electronic databases MEDLINE, EMBASE, CINAHL, and Web of Science were searched from data inception to March 14, 2019 for articles addressing surgery for pediatric patients with anterior shoulder instability. The Methodological Index for Non-randomized Studies (MINORS) tool was used to assess the quality of included studies. RESULTS Overall 24 studies, with a total of 688 patients (696 shoulders) and a mean age of 16.6 ± 2.5 years met inclusion criteria. Mean follow-up was 49 ± 26 months. The majority (59%) of studies only offered shoulder stabilization procedures to patients with more than one shoulder dislocation, however, three studies reported operating on pediatric patients after first time dislocations. Of the included patients 525 had arthroscopic Bankart repair (78%), 75 had open Bankart repair (11%), 34 had modified Bristow (5%), and 26 had Latarjet (4%) procedures. The overall complication rate was 26%. Patients undergoing arthroscopic Bankart repair experienced the highest recurrence rate of 24%. There were no significant differences in recurrent instability (n.s.) or loss of external rotation (n.s.) in pediatric patients treated with arthroscopic Bankart repair compared to open Latarjet. Patients had a 95% rate of return to sport at any level (i.e. preinjury level or any level of play) postoperatively (95%). CONCLUSIONS Pediatric patients are at high risk of recurrent instability after surgical stabilization. The majority of pediatric patients with anterior shoulder instability were treated with arthroscopic Bankart repair. Most studies recommend surgical stabilization only after more than one dislocation. However, given the high rates of recurrence with non-operative management, it may be reasonable to perform surgery at a first-time dislocation, particularly in those with other risk factors for recurrence. With the current evidence and limited sample sizes, it is difficult to directly compare the surgical interventions and their post-operative efficacy (i.e. re-dislocation rates or range of motion). There was an overall high rate of return to sport after surgical stabilization at final follow-up. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ajaykumar Shanmugaraj
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Darren Chai
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mohamed Sarraj
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Chetan Gohal
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Nolan S Horner
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Nicole Simunovic
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - George S Athwal
- Roth McFarlane Hand and Upper Limb Center, St Joseph's Health Care, London, ON, Canada
| | - Olufemi R Ayeni
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
- McMaster University Medical Centre, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada.
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Hesse EM, Navarro RA, Daley MF, Getahun D, Henninger ML, Jackson LA, Nordin J, Olson SC, Zerbo O, Zheng C, Duffy J. Risk for Subdeltoid Bursitis After Influenza Vaccination: A Population-Based Cohort Study. Ann Intern Med 2020; 173:253-261. [PMID: 32568572 DOI: 10.7326/m19-3176] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Subdeltoid bursitis has been reported as an adverse event after intramuscular vaccination in the deltoid muscle. Most published case reports involved influenza vaccine. OBJECTIVE To estimate the risk for subdeltoid bursitis after influenza vaccination. DESIGN Retrospective cohort study. SETTING The Vaccine Safety Datalink, which contains health encounter data for 10.2 million members of 7 U.S. health care organizations. PATIENTS Persons who received an inactivated influenza vaccine during the 2016-2017 influenza season. MEASUREMENTS Potential incident cases were identified by searching administrative data for persons with a shoulder bursitis diagnostic code within 180 days after receiving an injectable influenza vaccine in the same arm. The date of reported bursitis symptom onset was abstracted from the medical record. A self-controlled risk interval analysis was used to calculate the incidence rate ratio of bursitis in a risk interval of 0 to 2 days after vaccination versus a control interval of 30 to 60 days, which represents the background rate. The attributable risk was also estimated. RESULTS The cohort included 2 943 493 vaccinated persons. Sixteen cases of symptom onset in the risk interval and 51 cases of symptom onset in the control interval were identified. The median age of persons in the risk interval was 57.5 years (range, 24 to 98 years), and 69% were women. The incidence rate ratio was 3.24 (95% CI, 1.85 to 5.68). The attributable risk was 7.78 (CI, 2.19 to 13.38) additional cases of bursitis per 1 million persons vaccinated. LIMITATION The results may not be generalizable to vaccinations done in other types of health care settings. CONCLUSION Although an increased risk for bursitis after vaccination was present, the absolute risk was small. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Elisabeth M Hesse
- Epidemic Intelligence Service and Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia (E.M.H., J.D.)
| | - Ronald A Navarro
- Kaiser Permanente South Bay Medical Center, Harbor City, California (R.A.N.)
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado (M.F.D.)
| | | | | | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (L.A.J.)
| | - James Nordin
- HealthPartners Institute for Education and Research, Minneapolis, Minnesota (J.N.)
| | - Scott C Olson
- Marshfield Clinic Research Institute, Center for Clinical Epidemiology and Population Health, Marshfield, Wisconsin (S.C.O.)
| | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Oakland, California (O.Z.)
| | - Chengyi Zheng
- Kaiser Permanente, Pasadena, California (D.G., C.Z.)
| | - Jonathan Duffy
- Epidemic Intelligence Service and Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia (E.M.H., J.D.)
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Hesse EM, Atanasoff S, Hibbs BF, Adegoke OJ, Ng C, Marquez P, Osborn M, Su JR, Moro PL, Shimabukuro T, Nair N. Shoulder Injury Related to Vaccine Administration (SIRVA): Petitioner claims to the National Vaccine Injury Compensation Program, 2010-2016. Vaccine 2020; 38:1076-1083. [PMID: 31771864 PMCID: PMC9169064 DOI: 10.1016/j.vaccine.2019.11.032] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Since 2010, petitioner claims of shoulder injury related to vaccine administration (SIRVA) to the National Vaccine Injury Compensation Program (VICP) have been increasing. OBJECTIVE To conduct a scientific review of clinical characteristics of SIRVA petitions to the VICP. METHODS We queried the VICP's Injury Compensation System database for medical reports of alleged SIRVA and SIRVA-like injuries. Medical reports are summaries of petitioner claims and supporting documentation along with a VICP clinician reviewer diagnosis and assessment of criteria for concession. We conducted a descriptive analysis of SIRVA petitioner claims recommended by the VICP for concession as SIRVA injuries. RESULTS We identified 476 petitioner claims recommended for concession. Claims per year increased from two in 2011, the first full year in the analytic period, to 227 in 2016. Median age was 51 years, 82.8% were women, and median body mass index was 25.1 (range 17.0-48.9). Four hundred cases (84.0%) involved influenza vaccine. Pharmacy or store (n = 168; 35.3%) was the most common place of vaccination followed by doctor's office (n = 147; 30.9%). Fewer than half of cases reported a suspected administration error; 172 (36.1%) reported 'injection too high' on the arm. Shoulder pain, rotator cuff problems, and bursitis were common initial diagnoses. Most (80.0%) cases received physical or occupational therapy, 60.1% had at least one steroid injection, and 32.6% had surgery. Most (71.9%) healthcare providers who gave opinions on causality considered the injury was caused by vaccination. A minority (24.3%) of cases indicated that symptoms had resolved by the last visit available in medical records. CONCLUSIONS Most conceded claims for SIRVA were in women and involved influenza vaccines. Injection too high on the arm could be a factor due to the risk of injecting into underlying non-muscular tissues. Healthcare providers should be aware of proper injection technique and anatomical landmarks when administering vaccines.
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Affiliation(s)
- Elisabeth M Hesse
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 1600 Clifton Rd, MS V24-5, Atlanta, GA 30329, United States; Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 1600 Clifton Rd, MSV18-4, Atlanta, GA 30329, United States.
| | - Sarah Atanasoff
- National Vaccine Injury Compensation Program, Health Resources and Services Administration, U.S. Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857, United States
| | - Beth F Hibbs
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 1600 Clifton Rd, MSV18-4, Atlanta, GA 30329, United States
| | - Oluwasegun J Adegoke
- Public Health Informatics Fellowship Program, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, United States; Global Immunizations Division, Center for Global Health, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 1600 Clifton Rd, MS H24-2, Atlanta, GA 30329, United States
| | - Carmen Ng
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 1600 Clifton Rd, MSV18-4, Atlanta, GA 30329, United States
| | - Paige Marquez
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 1600 Clifton Rd, MSV18-4, Atlanta, GA 30329, United States
| | - Mark Osborn
- National Vaccine Injury Compensation Program, Health Resources and Services Administration, U.S. Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857, United States
| | - John R Su
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 1600 Clifton Rd, MSV18-4, Atlanta, GA 30329, United States
| | - Pedro L Moro
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 1600 Clifton Rd, MSV18-4, Atlanta, GA 30329, United States
| | - Tom Shimabukuro
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 1600 Clifton Rd, MSV18-4, Atlanta, GA 30329, United States
| | - Narayan Nair
- National Vaccine Injury Compensation Program, Health Resources and Services Administration, U.S. Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857, United States
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Kasik CS, Rosen MR, Saper MG, Zondervan RL. High rate of return to sport in adolescent athletes following anterior shoulder stabilisation: a systematic review. J ISAKOS 2018; 4:33-40. [PMID: 31044093 DOI: 10.1136/jisakos-2018-000224] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Traumatic anterior shoulder instability remains common for the adolescent athletes. Aim or objective To perform a systematic review on the outcomes and return to sport (RTS) following Bankart repair in adolescent athletes. Evidence review A systematic review using the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines was conducted of studies reporting outcomes following open and/or arthroscopic Bankart repair using modern suture anchors following traumatic anterior shoulder dislocations in adolescent patients (ages 10-19 years). Quality assessment was evaluated with ROBINS-I and MINORS instruments. The outcomes analysed included RTS, timetable to unrestricted activity, recurrent instability and revision surgery. Findings This systematic review identified 11 studies comprising 461 adolescent athletes with a mean age of 15.7 years (range, 11-19 years) and an average follow-up of 48.8 months (range, 22-85.2 months). A total of 392 patients (400 shoulders) underwent arthroscopic Bankart repair, while the remaining 69 patients (69 shoulders) underwent an open procedure. The average MINORS score was 9.6 for non-comparative studies and 17 for comparative studies. ROBINS-I revealed six studies to have a moderate risk of bias, while the remaining five studies presented serious risk of bias. There was an overall 81.5% rate of RTS to preinjury levels of athletic competition at an average of 5.3 months following Bankart repair for traumatic anterior shoulder instability. The overall total mean incidence of recurrent instability was 18.5%, while the mean incidence of revision surgery was 12.1%. Contact athletes had a 31.1% and 13% rate of recurrence and revision surgery, respectively. In comparison, collision athletes were shown to have a 10.4% and 1.4% incidence of recurrent instability and revision surgery, respectively. Conclusions and relevance Adolescent athletes who undergo Bankart repair for traumatic anterior shoulder instability have an 81.5% rate of RTS to preinjury levels of play at an average of 5 months following surgery. The overall total mean incidence of recurrent instability in the adolescent population is 18.5%, while the mean incidence of revision surgery is 12.1%. The results of anterior shoulder stabilisation in contact athletes is much less predictable, with higher reported rates of recurrent instability and revision surgery. Level of evidence Level IV.
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Affiliation(s)
- Connor S Kasik
- Department of Orthopaedic Surgery, McLaren Greater Lansing, Lansing, Michigan, USA
| | - Michael R Rosen
- Department of Orthopaedic Surgery, McLaren Greater Lansing, Lansing, Michigan, USA
| | - Michael G Saper
- Department of Orthopedics and Sports Medicine, Seattle Children's, Seattle, Washington, USA
| | - Robert L Zondervan
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
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Variability of Outcome Reporting Following Arthroscopic Bankart Repair in Adolescent Athletes: A Systematic Review. Arthroscopy 2018; 34:1288-1294. [PMID: 29373288 DOI: 10.1016/j.arthro.2017.10.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/15/2017] [Accepted: 10/15/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To conduct a systematic review of the literature to assess the variability of the reporting of outcome measures after arthroscopic Bankart repair for traumatic anterior shoulder instability in the adolescent population. METHODS A systematic review was conducted investigating all studies reporting outcomes after arthroscopic Bankart repair in the adolescent population. Four databases (Medline, EMBASE, Ovid, and Google Scholar) were screened for clinical studies involving the arthroscopic management of anterior shoulder instability in adolescents. A full-text review of eligible studies was conducted. Inclusion and exclusion criteria were applied to the searched studies. A quality assessment was completed for each included study using the Methodological Index for Nonrandomized Studies instrument and the Center for Evidence-Based Medicine's Levels of Evidence Scale. RESULTS We identified 8 eligible studies involving 274 patients (282 shoulders). There was considerable variation with regard to reported outcomes after arthroscopic Bankart repair for anterior shoulder instability in the adolescent population. The most common patient-reported outcomes included the Rowe Score (50%), Single Assessment Numeric Evaluation (37.5%), American Shoulder and Elbow Surgeons Shoulder Outcome Score (25%), and the Constant Score (25%). Clinical outcomes reported included recurrence (100%), return to sport (62.5%), patient satisfaction (37.5%), stability (37.5%), pain scores (37.5%), and range of motion (12.5%). CONCLUSIONS There is considerable variation in reported clinical outcome measurements after arthroscopic Bankart repair for traumatic shoulder instability in the adolescent population. This study supports the need for standardized outcome reporting after arthroscopic anterior shoulder instability surgery in adolescents. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Zaremski JL, Galloza J, Sepulveda F, Vasilopoulos T, Micheo W, Herman DC. Recurrence and return to play after shoulder instability events in young and adolescent athletes: a systematic review and meta-analysis. Br J Sports Med 2016; 51:177-184. [DOI: 10.1136/bjsports-2016-096895] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 11/04/2022]
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Peri-operative complications in pediatric and adolescent shoulder arthroscopy. J Child Orthop 2014; 8:341-4. [PMID: 24880815 PMCID: PMC4128943 DOI: 10.1007/s11832-014-0595-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/12/2014] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Shoulder arthroscopy is not common in the pediatric and adolescent population, but the frequency may be on the rise. The purpose of the study was to determine the incidence of acute complications of arthroscopic shoulder surgery in children and adolescents. METHODS A retrospective, cross-sectional review was performed identifying patients aged 18 years or less who underwent an arthroscopic shoulder procedure from 1997 to 2009 at Institution 1 and 2007 to 2010 at Institution 2. Exclusion criteria included open procedures and missing records. Demographic and surgical data were collected, including intra-operative and post-operative complications during the first 6 months. The complications were divided into minor (no secondary treatment) and major (secondary treatment rendered). RESULTS Two hundred children, mean age 15.9 years, met criteria and 73 % were boys. All procedures were performed under general anesthesia, but 51 % included inter-scalene regional anesthesia. There were 16 (8.0 %) total complications recorded. Major complications occurred in five (2.5 %) patients, including two tendinitis/bursitis requiring injections, one broken pain pump catheter requiring an accessory incision to retrieve, one pain control readmission, and one laceration of the cephalic vein requiring ligation. Minor complications occurred in 11 (5.5 %) patients, including allergic reactions, transient dysesthesias, headaches, bronchitis, syncope, transient hypotension, and uvula swelling. CONCLUSION Although we found no seriously deleterious outcomes, it is important to recognize that an additional service was rendered for 2.5 % of children undergoing shoulder arthroscopy. The events that did occur may be preventable and this study should serve as a baseline to improve quality and safety of shoulder arthroscopy in the pediatric population.
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Abstract
PURPOSE With increased sports participation and medical community awareness, there appears to be an increase in pediatric musculoskeletal injuries. Our purpose was to identify the intra-articular injury pattern seen within the pediatric shoulder. METHODS A retrospective review was performed at two tertiary-care children's hospitals between 2008 and 2011 on all patients who underwent magnetic resonance imaging (MRI) and subsequent shoulder arthroscopy. Exclusion criteria included: girls >14 years old and boys >16 years old. Demographics, MRI and arthroscopic findings were recorded. Labral pathology was grouped: Zone I (Bankart lesions, 3-6 o'clock for right shoulder), Zone II (posterior labral lesions, 6-11 o'clock), Zone III (SLAP lesions, 11-1 o'clock), and Zone IV (anatomic variants, 1-3 o'clock). RESULTS One hundred and fifteen children met criteria, mean age 14.4 years (range 8-16). There were 24 girls and 91 boys, with 70 right shoulders. Of 108 children, labral pathology involved: 72 Zone I (16 isolated anterior), 56 Zone II (15 isolated posterior), 38 Zone III (four isolated superior), and three had an isolated Buford complex. Seventy had more than one labral zone injured, and 31 (30 %) had more than two zones injured. Non-labral pathology included partial rotator cuff tears and humeral avulsions of the glenohumeral ligament. CONCLUSION With 94 % of intra-articular pathology being labral tears, the distribution of proportion in children differs from adults; moreover, 23 % involved only the posterior or posterosuperior labrum. Treating surgeons should be prepared to find anterior tears extending beyond the zone of a classic Bankart lesion and an association with C rotator cuff tears.
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Abstract
Instability of the shoulder is a common issue faced by sports medicine providers caring for pediatric and adolescent patients. A thorough history and physical examination can help distinguish traumatic instability from multidirectional or voluntary instability. A systematic understanding of the relevant imaging characteristics and individual patient disease and goals can help guide initial treatment. Given the high risk of recurrent instability, young, active patients who seek to return to competitive contact sports should consider arthroscopic stabilization after a first-time instability event. MDI should be treated initially with conservative rehabilitation. Patients who fail extensive conservative treatment may benefit from surgical stabilization. Arthroscopic techniques may now approach the results found from traditional open capsular shift procedures. Future studies should be designed to examine the outcomes in solely pediatric and adolescent populations after both conservative and operative treatment of shoulder instability.
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Affiliation(s)
- Matthew D Milewski
- Elite Sports Medicine, Connecticut Children's Medical Center, 399 Farmington Avenue, Farmington, CT 06032, USA; University of Connecticut School of Medicine, Farmington, CT, USA.
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