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Ganokroj P, Adriani M, Whalen RJ, Provencher MT. Treatment of Shoulder Cartilage Defects in Athletes. Sports Med Arthrosc Rev 2024; 32:87-94. [PMID: 38978202 DOI: 10.1097/jsa.0000000000000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Articular cartilage defects in the glenohumeral joint may be found in laborers, the elderly, and young athletes, among others. Various factors can contribute to cartilage damage, including prior surgery, trauma, avascular necrosis, inflammatory arthritis, joint instability, and osteoarthritis. There is a wide variety of treatment options, from conservative treatment, injections, and surgical options, including arthroscopic debridement, microfracture, osteochondral autograft transfer, osteochondral graft transplantation, autologous chondrocyte implantation, and the newly emerging techniques such as biologic augmentation. There is a challenge to determine the optimal treatment options, especially for young athletes, due to limited outcomes in the literature. However, there are many options which are viable to address osteochondral defects of the glenohumeral joint.
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Affiliation(s)
- Phob Ganokroj
- Steadman Philippon Research Institute, Vail, CO
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
| | - Marco Adriani
- Steadman Philippon Research Institute, Vail, CO
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Şahin K, Sarıkaş M, Çeşme DH, Topal M, Kapıcıoğlu M, Bilsel K. Does previous arthroscopic Bankart repair influence coracoid graft osteolysis in Latarjet procedure? A case-control study with computed tomography scan data. J Shoulder Elbow Surg 2024; 33:e223-e230. [PMID: 37757904 DOI: 10.1016/j.jse.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/14/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The Latarjet procedure is commonly performed in the treatment of recurrent shoulder instability and is also indicated as a salvage procedure for recurrence after failed arthroscopic Bankart repair. Although this procedure has shown success, there has been an increased awareness of complications in recent studies, especially graft osteolysis. Most relevant research has focused on the pathophysiology, incidence, or location of graft osteolysis or the risk factors for graft osteolysis; however, the data are limited to primary Latarjet procedures. This study aimed to investigate the effect of previous arthroscopic Bankart repair surgery on coracoid bone graft osteolysis in the Latarjet procedure. METHODS This retrospective case-control study analyzed data from patients who underwent primary Latarjet procedures or revision Latarjet procedures following failed arthroscopic Bankart repair. Clinical outcome measures included range of motion, the Subjective Shoulder Value, and the Rowe score. Volumetric analysis of each transferred coracoid graft was performed using early postoperative and late postoperative computed tomography scan data, and the amount of graft osteolysis was then calculated as the percentage of volume reduction of each graft. RESULTS A total of 32 patients who met the inclusion criteria were included in this study, with 24 patients in the primary Latarjet group (group I) and 8 patients in the revision Latarjet group (group II). The mean age of the patients was 32.5 ± 7.7 years, and the mean follow-up duration was 52.1 ± 8.9 months. Both study groups showed significant improvement in the Subjective Shoulder Value compared with baseline (P < .05). Comparison of postoperative clinical outcome measures showed no significant difference in any outcome parameter between the 2 study groups (P > .05). No recurrence was observed during the follow-up period. A positive apprehension sign was present in 6 patients (25%) in group I and 4 patients (50%) in group II (P > .05). Analysis of radiologic data revealed that all patients underwent some degree of graft osteolysis, with varying osteolysis ratios between 12% and 98%. The mean osteolysis ratio of the coracoid graft was 67.3% ± 22.6% in group I and 69.4% ± 25.6% in group II, with no significant difference between the 2 groups (P > .05). CONCLUSION The findings of this study suggest that a considerable amount of coracoid graft osteolysis is observed after both primary Latarjet procedures and revision Latarjet procedures following failed arthroscopic Bankart repair. Previous arthroscopic Bankart repair did not seem to have a significant influence on the amount of graft osteolysis, and both primary and revision Latarjet procedures showed satisfactory clinical outcomes.
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Affiliation(s)
- Koray Şahin
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Murat Sarıkaş
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Murat Topal
- Department of Orthopedics and Traumatology, Faculty of Medicine, Kastamonu University, Kastamonu, Turkey
| | - Mehmet Kapıcıoğlu
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, Bezmialem Vakif University, Istanbul, Turkey.
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Billaud A, Baverel L, Metais P. Arthroscopic Latarjet yields better union and prevention of instability compared to arthroscopic bony Bankart repair in shoulders with recurrent anterior instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:5994-6005. [PMID: 37980282 DOI: 10.1007/s00167-023-07655-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/24/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE To determine whether arthroscopic Latarjet procedure or arthroscopic bony Bankart repair provide better outcomes in terms of rates of recurrent instability, non-union and complications, as well as clinical scores and range of motion. METHODS An electronic literature search was performed using PubMed, Embase®, and Cochrane databases, applying the following keywords: "Arthroscopic bony Bankart" OR "Arthroscopic osseous Bankart" AND "Arthroscopic Latarjet" OR "Arthroscopic coracoid bone block". RESULTS The systematic search returned 1465 records, of which 29 were included (arthroscopic bony Bankart repair, n = 16; arthroscopic Latarjet, n = 13). 37 datasets were included for data extraction, on 1483 shoulders. Compared to arthroscopic Latarjet, arthroscopic bony Bankart repair had significantly higher instability rates (0.14; CI 0.10-0.18; vs 0.04; CI 0.02-0.06), significantly lower union rates (0.63; CI 0.28-0.91 vs 0.98; CI 0.93-1.00), and significantly lower pain on VAS (0.42; CI 0.17-0.67 vs 1.17; CI 0.96-1.38). There were no significant differences in preoperative glenoid bone loss, follow-up, complication rate, ROWE score, ASES score, external rotation, and anterior forward elevation between arthroscopic Latarjet and arthroscopic bony Bankart repair. CONCLUSION Compared to arthroscopic Latarjet, arthroscopic bony Bankart repair results in significantly (i) higher rates of recurrent instability (14% vs 4%), (ii) lower union rates (63% vs 98%), but (iii) slightly lower pain on VAS (0.45 vs 1.17). There were no differences in complication rates, clinical scores, or postoperative ranges of motion. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Anselme Billaud
- Clinique du Sport, 2 rue Georges Negrevergne, 33700, Mérignac, France
| | | | - Pierre Metais
- Hopital Prive de la Châtaigneraie, ELSAN, Clermont-Ferrand, France
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Zhao Q, Feng Q, Zhang J, Xu J, Wu Z, Huang C, Yuan H. Glenoid segmentation from computed tomography scans based on a 2-stage deep learning model for glenoid bone loss evaluation. J Shoulder Elbow Surg 2023; 32:e624-e635. [PMID: 37308073 DOI: 10.1016/j.jse.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/16/2023] [Accepted: 05/06/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND The best-fitting circle drawn by computed tomography (CT) reconstruction of the en face view of the glenoid bone to measure the bone defect is widely used in clinical application. However, there are still some limitations in practical application, which can prevent the achievement of accurate measurements. This study aimed to accurately and automatically segment the glenoid from CT scans based on a 2-stage deep learning model and to quantitatively measure the glenoid bone defect. MATERIALS AND METHODS Patients who were referred to our institution between June 2018 and February 2022 were retrospectively reviewed. The dislocation group consisted of 237 patients with a history of ≥2 unilateral shoulder dislocations within 2 years. The control group consisted of 248 individuals with no history of shoulder dislocation, shoulder developmental deformity, or other disease that may lead to abnormal morphology of the glenoid. All patients underwent CT examination with a 1-mm slice thickness and a 1-mm increment, including complete imaging of the bilateral glenoid. A residual neural network (ResNet) location model and a U-Net bone segmentation model were constructed to develop an automated segmentation model for the glenoid from CT scans. The data set was randomly divided into training (201 of 248) and test (47 of 248) data sets of control-group data and training (190 of 237) and test (47 of 237) data sets of dislocation-group data. The accuracy of the stage 1 (glenoid location) model, the mean intersection-over-union value of the stage 2 (glenoid segmentation) model, and the glenoid volume error were used to assess the performance of the model. The R2 value and Lin concordance correlation coefficient were used to assess the correlation between the prediction and the gold standard. RESULTS A total of 73,805 images were obtained after the labeling process, and each image was composed of CT images of the glenoid and its corresponding mask. The average overall accuracy of stage 1 was 99.28%; the average mean intersection-over-union value of stage 2 was 0.96. The average glenoid volume error between the predicted and true values was 9.33%. The R2 values of the predicted and true values of glenoid volume and glenoid bone loss (GBL) were 0.87 and 0.91, respectively. The Lin concordance correlation coefficient value of the predicted and true values of glenoid volume and GBL were 0.93 and 0.95, respectively. CONCLUSION The 2-stage model in this study showed a good performance in glenoid bone segmentation from CT scans and could quantitatively measure GBL, providing a data reference for subsequent clinical treatment.
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Affiliation(s)
| | | | | | | | | | | | - Huishu Yuan
- Peking University Third Hospital, Beijing, China.
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Abboud J, Moussa MK, Boushnak MO, Rahal MJH, Robial N. Belt and suspender technique for bipolar bone loss in shoulder instability. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:354-359. [PMID: 37588879 PMCID: PMC10426609 DOI: 10.1016/j.xrrt.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Bipolar glenohumeral bone loss is a challenging condition to address in patients with recurrent anterior shoulder instability. In this category of patients, most isolated soft-tissue procedures such as remplissage or infraspinatus capsulotenodesis are associated with high risk of failure and instability recurrence. Even bony procedures such as Latarjet may fail to provide absolute stability, and instability may eventually recur. For a better understanding of the cause of failure in this particular type of patient, we may refer to the glenoid track concept which has been described as a useful tool for surgical planning. In fact, Latarjet procedure alone may leave a place for engagement of the Hill-Sachs defect on the anterior glenoid resulting in an off-track situation and secondary glenohumeral instability. In this technical note, we present the combination of arthroscopic remplissage and an open Latarjet procedure to treat patients with bipolar glenohumeral bone loss with good results at 31-month follow-up. Our aim is to propose these techniques as a possible rescue procedure for highly unstable shoulders combining engaged Hill-Sachs lesion and glenoid bone loss of more than 25%. We believe this technique would be a good option for patients who present other risk factors of recurrence such as past medical history of epilepsy, laxity, and psychiatric illnesses.
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Affiliation(s)
- Johnny Abboud
- University of Strasbourg, Faculty of Medicine, Strasbourg, France
- Department of Orthopedic Surgery and Traumatology, Hôpitaux Civils de Colmar, Colmar, France
| | - Mohamad K. Moussa
- Department of Orthopedic Surgery, Grand Hôpital de l’Est Francilien – Site de Meaux, Meaux, France
- Faculty of Medicine, University of Paris, Paris, France
| | - Mohammad O. Boushnak
- Université Libre de Bruxelles, Brussels, Belgium
- Department of Orthopedics and Traumatology, ULB Erasme University Hospital, Brussels, Belgium
| | - Mohammad Jawad H. Rahal
- University of Strasbourg, Faculty of Medicine, Strasbourg, France
- Department of Orthopedic Surgery and Traumatology, Hôpitaux Civils de Colmar, Colmar, France
| | - Nicolas Robial
- University of Strasbourg, Faculty of Medicine, Strasbourg, France
- Department of Orthopedic Surgery and Traumatology, Hôpitaux Civils de Colmar, Colmar, France
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Implant-free iliac crest bone graft procedure shows anatomic remodelling without redislocation in recurrent anterior shoulder instability after short-term follow-up. Arch Orthop Trauma Surg 2022; 142:1047-1054. [PMID: 33486557 DOI: 10.1007/s00402-021-03777-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION With the help of a J-shaped bicortical iliac crest bone graft, the morphology of the glenoid can be augmented without having to use screws to achieve glenohumeral stability. The aim of this retrospective clinical study was to evaluate the clinical stability and function of the shoulder joint as well as the radiological remodelling process and arthropathic outcomes following the J-bone graft technique. MATERIALS AND METHODS 34 patients with recurrent shoulder dislocations and bony glenoid defects were treated with the J-bone graft technique between 2010 and 2018 at our level-I trauma centre. 15 patients (18 shoulders) could be recruited for the study. Pain levels, ASES, UCLA, SST, DASH, Rowe and WOSI Scores were collected using questionnaires. In 13 patients (16 shoulders) the Constant Score, ROM, CT with 3D reconstruction of the glenoid to assess the graft remodelling and X-rays were performed additionally. RESULTS None of the patients suffered subluxations or recurrent dislocations during the follow-up period. The overall complication rate was 11%. The evaluation using objective and subjective shoulder function scores yielded good-to-excellent results. Radiological assessment at follow-up showed a low rate of moderate-to-severe arthritis (12%) and a high rate of shoulders without any signs of arthritic degeneration (53%). The CT scans all revealed an almost complete restoration of the glenoid with none of the grafts being resorbed. A rise in the average glenoid circumference and glenoid area could be demonstrated between preoperative measurements (81.6 and 82.4%, respectively) and follow-up measurements (104 and 102.5%, respectively). CONCLUSION The results of this study show a successful stabilisation of the shoulder joint and a low complication rate following the J-bone graft technique. Remodelling of the bone graft could be demonstrated, which in turn led to an almost perfect glenoid surface area of 100%.
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Sgroi M, Huzurudin H, Ludwig M, Dornacher D, Reichel H, Kappe T. With the exception of the Hill-Sachs interval, CT and MRI show no significant differences in the diagnostic value of the HSL measurement regardless of the measurement technique. Knee Surg Sports Traumatol Arthrosc 2021; 29:3981-3988. [PMID: 34398261 DOI: 10.1007/s00167-021-06695-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/10/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim of the current study was to compare the diagnostic precision and reliability of different methods in measuring Hill-Sachs lesions (HSLs) using MRI and CT. METHODS A total of 80 consecutive patients with a history of anterior shoulder instability were retrospectively included. The preoperative CT and MRI scans of the affected shoulders were analysed. To investigate the ability of the Franceschi grading, Calandra classification, Richards, Hall, and Rowe grading scale, Flatow percentage and "glenoid track" assessment according to Di Giacomo et al. to quantify the extent of humeral bone loss, the results of each measurement method obtained with MRI were compared with those achieved with CT. In addition, the intra- and inter-rater reliabilities of each measurement method using CT and MRI were calculated and compared. RESULTS A significant difference was found between CT and MRI in the determination of the Hill-Sachs interval (HSI) (p = 0.016), but not between the results of any of the other measurement techniques. With the exceptions of the Franceschi grade and Calandra classification, all measurement methods showed good or excellent intra- and inter-rater reliabilities for both MRI and CT. CONCLUSIONS While the determination of the HSI with MRI was more accurate, all other analysed techniques for measuring the amount of humeral bone loss showed similar diagnostic precision. With regard to the intra- and inter-rater reliabilities, all measurement techniques analysed, with the exception of the Franceschi and Calandra classifications, provided good to very good reliabilities with both CT and MRI. LEVEL OF EVIDENCE III.
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Affiliation(s)
- M Sgroi
- Department for Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany.
| | - H Huzurudin
- Department for Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - M Ludwig
- Department for Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - D Dornacher
- Department for Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - H Reichel
- Department for Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - T Kappe
- Department for Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
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Instability Severity Index Score Does Not Predict the Risk of Shoulder Dislocation after a First Episode Treated Conservatively. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212026. [PMID: 34831778 PMCID: PMC8623142 DOI: 10.3390/ijerph182212026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/18/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022]
Abstract
The first purpose of this study was to verify the association between Instability Severity Index Score (ISIS) and Recurrent Shoulder Dislocation (RSD) after a first episode treated conservatively. The second aim is to identify the risk factors associated with RSD after a primary acute shoulder anterior dislocation treated conservatively. A total of 111 patients with first traumatic anterior shoulder dislocation treated at a single trauma centre between January 2014 and March 2016 were enrolled. The main predictive variables of risk factors and the ISIS score were calculated. Among the 85 patients included, 26 cases of RSD were observed (30.6%). Considering the whole population, no significant association between ISIS and RSD were reported. Regarding other risk factors, high-risk working activities and rotator cuff injury had a significantly higher RSD risk. Sex, dominant limb, familiar history, hyperlaxity, contact or overhead sports, competitive sport, post-reduction physiokinesitherapy, return to sports activity time, Hill-Sachs lesion, bony Bankart lesion and great tuberosity fracture did not seem to influence the risk of RSD. No correlation between ISIS score and RSD in patients treated conservatively after a first episode of shoulder dislocation were reported. The only risk factors with a significant association to RSD were high-risk working activities and rotator cuff injury.
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Ruiz Ibán MA, Vega Rodriguez R, Ruiz Díaz R, Pérez Expósito R, Zarcos Paredes I, Diaz Heredia J. Arthroscopic remplissage with all-suture anchors causes cystic lesions in the humerus: a volumetric CT study of 55 anchors. Knee Surg Sports Traumatol Arthrosc 2021; 29:2342-2347. [PMID: 33030611 DOI: 10.1007/s00167-020-06314-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/28/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate with computed tomography (CT) the incidence of implant-related osteolysis after implantation of two types of all-suture anchors during remplissage for the management of Hill-Sachs lesions in shoulder instability. METHODS Single-cohort, observational study with a minimum of 12 months follow-up. Twenty-five participants (19 males and 6 females; mean age 37.4 years [SD: 11.6]) with Hill-Sachs lesions requiring remplissage were evaluated with a CT performed a mean of 14.1 [3.74] months after surgery. Fifty-five all-suture anchors (19 2.3 mm Iconix and 36 1.7 mm Suturefix) were used. The volume of the bone defects was measured in the CT. Every anchor was classified into one of four groups: (1) no bone defect. (2) Partial bone defect (bone defects smaller than the drill used for anchor placement). (3) Tunnel enlargement (bone defect larger than the drill volume but smaller than twice that volume). (4) Cystic lesion (bone defect larger twice the drill volume). RESULTS No bone defect was identified in only two anchors (3.6%, 95% CI 0.4-12.5%). A partial bone defect was found in eight anchors (14.5%, 95% CI 6.5-26.7%). In 35 anchors (63.6%, 95% CI 49.6-76.2%), there was enlargement of the bone defect that was smaller than 200% the size of the drill used. Ten anchors caused bone defects larger than twice the size of the drill used (18.2%, 95% CI 9.1-30.9%). The defect size was a mean of 89 mm3 (SD: 49 mm3, minimum 0 mm3, maximum 230 mm3). CONCLUSION When using all-suture anchors in arthroscopic remplissage during instability surgery, relevant bone osteolytic defects are common at 1-year-follow-up. Cystic defects larger than twice the volume of the resected bone during implantation develop in one in six anchors and significant tunnel widening will develop in another three out of five anchors. This bone loss effectively increases the size and depth of the Hill-Sachs lesions but does not seem to affect short-term clinical outcomes. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Rosa Vega Rodriguez
- Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain
| | - Raquel Ruiz Díaz
- Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain
| | - Roque Pérez Expósito
- Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain
| | - Irene Zarcos Paredes
- Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain
| | - Jorge Diaz Heredia
- Hospital Universitario Ramón y Cajal, Cta Colmenar km 9,100, 28046, Madrid, Spain
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Longo UG, Candela V, Berton A, Naro CD, Migliorini F, Schena E, Denaro V. Epidemiology of shoulder instability in Italy: A 14-years nationwide registry study. Injury 2021; 52:862-868. [PMID: 33642082 DOI: 10.1016/j.injury.2021.02.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/16/2021] [Accepted: 02/12/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study is to estimate the annual number of shoulder dislocation hospitalizations in Italy from 2001 to 2014, to explore geographical variation in access to hospitalizations between the 3 macro-regions of Italy (North, Centre and South) and to perform statistical projections of hospitalizations volumes and rates based on data from 2001 to 2014. MATERIALS AND METHODS Data of the Italian Ministry of Health regarding the National Hospital Discharge records (SDO) were analysed for the period of the survey (2001-2014). These data are anonymous and include the patient's age, sex, domicile, region of hospitalization, length of the hospitalization, and type of reimbursement (public or private). RESULTS During the 14-year study period, 92,784 hospitalizations to treat shoulder dislocation were performed in Italy, which represented an incidence of 11.2 hospitalizations for every 100,000 Italian inhabitants. 56,514 patients underwent hospitalization for non-surgical treatment. 36,270 patients underwent hospitalization for surgical treatment. The higher hospitalizations rate was among males from 15 to 64 years of age. CONCLUSIONS Increasing rates of surgical hospitalization and decreasing rates of hospitalization for non-surgical treatment of shoulder dislocation are observed over a 14-year period. This study confirms that the socioeconomic burden of shoulder dislocation surgery heavily affects the working population. Most shoulder instability procedures were performed on males. The present study provides a description of the frequency and national distribution of shoulder instability in Italy. This study shows an increase in surgical procedures for shoulder instability in Italy.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.
| | - Calogero Di Naro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.
| | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.
| | - Emiliano Schena
- Laboratory of Measurement and Biomedical Instrumentation, Campus Bio-Medico University, Rome, Italy.
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.
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Chou ACC, Kang BJ, Tan AJ, Tjoen Lie DT. Arthroscopic repair is sufficient for treating recurrent shoulder instability in patients with bipolar bone defects and minor glenoid bone loss. J Orthop 2021; 24:5-8. [PMID: 33679020 DOI: 10.1016/j.jor.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/16/2020] [Accepted: 02/07/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Andrew Chia Chen Chou
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
- Duke-National University of Singapore Medical School, Singapore
| | | | - Aaron Junjie Tan
- Duke-National University of Singapore Medical School, Singapore
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Denny Tijauw Tjoen Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
- Duke-National University of Singapore Medical School, Singapore
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Use of allograft to reconstruct anterior bony glenoid defect in chronic glenohumeral instability: a systematic review. Arch Orthop Trauma Surg 2020; 140:1475-1485. [PMID: 32524228 DOI: 10.1007/s00402-020-03511-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Bone-block procedures are well-established in anterior chronic shoulder instability treatment. Autograft with the coracoid process (Bristow-Latarjet procedures) and iliac crest (Eden-Hybbinette) are the most frequent source of bone but the use of allograft is also possible. The objective of this review is to assess clinical and radiographic outcomes after bony allograft reconstruction in anterior glenohumeral instability. MATERIAL AND METHODS Medline, Cochrane, Embase databases were searched for studies reporting on bone allograft reconstruction in anterior glenohumeral instability with glenoid defect. We conducted a systematic review of studies with all levels of evidence reporting on clinical or radiological outcomes or both. LEVEL OF EVIDENCE IV. RESULTS Ten studies met the inclusion criteria for the review; 283 shoulders were included with a mean age of 26 years (17-63) and mean follow-up of 34 months (4-168). Glenoid reconstruction was performed using bone from different source: femoral head (1 study), distal tibia allograft (5 studies), and iliac crest (4 studies). Allografts were fresh in 4 studies, demineralized in 2 studies, and freeze-dried after sterilization in 1 study. All scores performed in the different studies increased between pre-operative and post-operative evaluations (mean + 36.8 points for the ASES). Global rate of recurrence was 3.9% (11 patients) (0-11%), comprising 6 cases of dislocation (2.1%) and 5 subluxations (1.8%). Allograft healing occurred in 93.5% of cases. CONCLUSIONS This systematic review data suggest that allograft reconstructions in anterior glenohumeral instability could be a viable alternative to similar reconstructions with autografts and provide close clinical/radiological outcomes, at short and mid-term follow-up. Prospective randomized studies are needed to confirm these results.
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Longo UG, Ciuffreda M, Locher J, Casciaro C, Mannering N, Maffulli N, Denaro V. Posterior shoulder instability: a systematic review. Br Med Bull 2020; 134:34-53. [PMID: 32419023 DOI: 10.1093/bmb/ldaa009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 03/14/2020] [Accepted: 03/17/2020] [Indexed: 11/12/2022]
Abstract
INTRODUCTION This review aims to provide information on outcomes of surgical procedures for soft tissue or bony glenoid and/or humeral abnormalities in case of posterior shoulder instability. SOURCE OF DATA A systematic review of the literature according to the PRISMA guidelines was performed. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, Ovid and Google Scholar databases using various combinations of the keywords 'shoulder', 'posterior instability', 'dislocation', 'reversed bony bankart', 'reversed Hill Sachs', and 'capsulolabral' was performed. AREAS OF AGREEMENT A total of 847 shoulders in 810 patients were included. A redislocation event occurred in 33 (8.7%) of 411 shoulders with soft tissue abnormalities and in 12 (9.1%) of 132 shoulders with bony abnormalities of the glenoid, humeral head or both. AREAS OF CONTROVERSY The optimal treatment modalities for posterior shoulder dislocation remain to be defined. GROWING POINTS Operative stabilization for posterior shoulder instability should be lesion-specific and should correct all components of the posterior instability. AREAS TIMELY FOR DEVELOPING RESEARCH Future prospective studies should aim to establish the optimal treatment modalities for posterior shoulder instability.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Mauro Ciuffreda
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Joel Locher
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Carlo Casciaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Nicholas Mannering
- The University of Melbourne, Melbourne Medical School, Melbourne VIC 3010, Australia
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno 84081, Italy
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London E1 2AD, UK
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
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Bois AJ, Mayer MJ, Fening SD, Jones MH, Miniaci A. Management of bone loss in recurrent traumatic anterior shoulder instability: a survey of North American surgeons. JSES Int 2020; 4:574-583. [PMID: 32939489 PMCID: PMC7479034 DOI: 10.1016/j.jseint.2020.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Management of bone loss in recurrent traumatic anterior shoulder instability remains a topic of debate and controversy in the orthopedic community. The purpose of this study was to survey members of 4 North American orthopedic surgeon associations to assess management trends for bone loss in recurrent anterior shoulder instability. Methods An online survey was distributed to all members of the American Shoulder and Elbow Surgeons, American Orthopaedic Society for Sports Medicine, and Canadian Orthopaedic Association and to fellow members of the Arthroscopy Association of North America. The survey comprised 3 sections assessing the demographic characteristics of survey respondents, the influence of prognostic factors on surgical decision making, and the operative management of 12 clinical case scenarios of varying bone loss that may be encountered in clinical practice. Results A total of 150 survey responses were returned. The age of the patient and quantity of bone loss were consistently considered important prognostic criteria. However, little consensus was reached for critical thresholds of bone loss and how this affected the timing (ie, primary or revision surgery) and type of bony augmentation procedure to be performed once a critical threshold was reached, especially in the context of critical humeral and bipolar bone loss. Conclusions Consistent trends were found for the management of recurrent anterior shoulder instability in cases in which no bone loss existed and when isolated critical glenoid bone loss was present. However, inconsistencies were observed when isolated critical humeral bone loss and bipolar bone loss were present.
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Affiliation(s)
- Aaron J Bois
- Section of Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Michelle J Mayer
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Stephen D Fening
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Morgan H Jones
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anthony Miniaci
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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Taverna E, Longo UG, Guarrella V, Garavaglia G, Perfetti C, Sconfienza LM, Broffoni L, Denaro V. A new mini-open technique of arthroscopically assisted Latarjet. BMC Musculoskelet Disord 2020; 21:285. [PMID: 32380996 PMCID: PMC7206729 DOI: 10.1186/s12891-020-03307-0] [Citation(s) in RCA: 3] [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] [Received: 11/29/2019] [Accepted: 04/22/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The aim is to describe a new arthroscopically assisted Latarjet technique. METHODS We evaluated the clinical and radiological findings of 60 patients with chronic recurrent anterior gleno-humeral instability who underwent, between September 2013 and November 2014, an arthroscopically-assisted Latarjet procedure with double round endobutton fixation. Inclusion criteria were: chronic anterior recurrent instability, Instability Severity Index Score (ISIS) greater than three points, a glenoid bone defect > 15% or a Hill Sachs lesion with concomitant glenoid bone defect > 10%. During surgery the joint capsule and the anterior glenoid labrum were detached. Two drill tunnels perpendicular to the neck of the glenoid were made through a guide. An accessible pilot hole through the glenoid was created to allows the passage of guidewires for coracoid guidance and final fixation onto the anterior glenoid. Through a restricted deltopectoral access a coracoid osteotomy was made. Finally, the graft was prepared, inserted and secured using half-stitches. RESULTS The mean follow-up was 32.5 months (range 24-32 months). At a mean follow-up, 56 of the 60 subjects claimed a stable shoulder without postoperative complaints, two (3.3%) had an anterior dislocation after new traumatic injury, and two (3.3%) complained of subjective instability. At the latest follow-up, four subjects complained of painful recurrent anterior instability during abduction-external rotation with apprehension. At 1 year, the graft had migrated in one patient (1.7%) and judged not healed and high positioned in another patient (1.7%). Moreover, a glenoid bony gain of 26.3% was recorded. At the latest follow-up, three patients had grade 1 according to Samilson and Prieto classification asymptomatic degenerative changes. Nerve injuries and infections were not detected. None of the 60 patients underwent revision surgery. Healing rate of the graft was 96.7%. CONCLUSIONS This technique of arthroscopically assisted Latarjet combines mini-open and arthroscopic approach for improving the precision of the bony tunnels in the glenoid and coracoid placement, minimizing any potential risk of neurologic complications. It can be an option in subjects with anterior gleno-humeral instability and glenoid bone defect. Further studies should be performed to confirm our preliminary results. TRIAL REGISTRATION Trial registration number 61/int/2017 Name of registry: ORS Date of registration 11.5.2017 Date of enrolment of the first participant to the trial: September 2013 'retrospectively registered' LEVEL OF EVIDENCE: IV.
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Affiliation(s)
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy.
| | | | - Guido Garavaglia
- Servizio di Chirurgia dell'Arto Superiore, OBV, Mendrisio, Switzerland
| | | | | | - Laura Broffoni
- Servizio di Chirurgia dell'Arto Superiore, OBV, Mendrisio, Switzerland
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy
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Longo UG, Salvatore G, Locher J, Ruzzini L, Candela V, Berton A, Stelitano G, Schena E, Denaro V. Epidemiology of Paediatric Shoulder Dislocation: A Nationwide Study in Italy from 2001 to 2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2834. [PMID: 32326066 PMCID: PMC7215533 DOI: 10.3390/ijerph17082834] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/06/2023]
Abstract
Limited knowledge is accessible concerning the tendencies of hospitalization for skeletally immature patients with episodes of shoulder dislocation. Our research aim was to evaluate annual hospitalizations for shoulder dislocation in paediatric patients in Italy from 2001 to 2014, on the basis of the official data source as hospitalization reports. The second purpose was to investigate geographical diversification in hospitalization for shoulder dislocation in regions of Italy. The last aim was to make statistical predictions of the number of shoulder dislocation hospitalization volumes and rates in skeletally immature patients based on data from 2001 to 2014. An examination of the National Hospital Discharge records (SDO) kept at the Italian Ministry of Health regarding the 14 years of our study (2001 through 2014) was conducted. These data are anonymous and include patient's age, gender, domicile, region and time of hospitalization, and the kind of reimbursement (public or private). In the 14-year study time, 344 hospitalizations for shoulder dislocation of patients aged 0-14 years took place in Italy. The male/female hospitalization ratio varied from a maximum of 3.0 (2001) to a minimum of 1.1 (2013), with a mean average ratio in the 2001-2014 timespan of 2.0. Almost half of the hospitalizations (49.1%) were performed in the South. The mean incidence of hospitalizations in Italy for shoulder dislocation in patients with less than 14 years was 0.3 for every 100,000 inhabitants in the same class of age. The most common treatment was a closed reduction (60.8%), followed by open stabilization (16.6%) and arthroscopic procedures (13.7%). The present registry study shows a low incidence of hospitalization for shoulder dislocation in young patients. The most common treatment for a shoulder dislocation in paediatric patients is a closed shoulder reduction. Regions from the south and the centre of Italy are marked by an inferior number of operations and a higher number of hospitalization for closed shoulder reduction.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (G.S.); (J.L.); (V.C.); (A.B.); (G.S.); (V.D.)
| | - Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (G.S.); (J.L.); (V.C.); (A.B.); (G.S.); (V.D.)
| | - Joel Locher
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (G.S.); (J.L.); (V.C.); (A.B.); (G.S.); (V.D.)
| | - Laura Ruzzini
- Department of Orthopedics, Children’s Hospital Bambino Gesù, Via Torre di Palidoro, Palidoro, 00165 Rome, Italy;
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (G.S.); (J.L.); (V.C.); (A.B.); (G.S.); (V.D.)
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (G.S.); (J.L.); (V.C.); (A.B.); (G.S.); (V.D.)
| | - Giovanna Stelitano
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (G.S.); (J.L.); (V.C.); (A.B.); (G.S.); (V.D.)
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy;
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (G.S.); (J.L.); (V.C.); (A.B.); (G.S.); (V.D.)
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Di Giacomo G, Pugliese M, Lie DTT, Chou ACC, Chen J, Rosenberg N, Itoi E. How to handle minor and major bone loss in the shoulder? Current concepts. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000378] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Anterior shoulder instability is a significant problem in orthopaedic surgery. It carries a heavy burden on quality of life, especially in young, active patients. Surgical treatment is therefore often carried out in this population. Several strategies can effectively address this issue. Yet, the consensus is lacking on the parameters which favour one technique over another, especially when bone loss is present. This is because of the complex, dynamic interplay between bone loss on the humeral side (ie, Hill-Sachs lesion) and glenoid bone loss, which is a common occurrence and defined as ‘bipolar’. There is an ongoing debate over the percentage of glenoid bone loss warranting bone block procedures: 13.5–15% is an indicator for such procedures (ie, Latarjet), although this value is still considered controversial and not uniformly accepted. A multitude of other factors (ie, age, sex, level of activity and so on) come into play alongside bipolar bone loss and the weight of each factor has yet to be fully elucidated. Also, refining the algorithm for the right procedure in the right patients will reduce the number of side effects stemming from initial, suboptimal treatment choice. Knowing how to manage previous surgical treatment failure is also key for the treating orthopaedic surgeon, who must be able to address the root cause of failure and react accordingly and effectively. This paper analyses key factors in treatment choice, the current stance of the literature on varying degrees of bone loss and choices on surgical treatment failure, lack of evidence and need for future research.
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Editorial Commentary: Unsolved Problems in Shoulder Instability-The Dilemma of Bone Loss! Arthroscopy 2019; 35:1267-1268. [PMID: 30954118 DOI: 10.1016/j.arthro.2019.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 02/01/2019] [Accepted: 02/04/2019] [Indexed: 02/02/2023]
Abstract
Bone loss in the setting of shoulder instability is an unsolved problem. Procedures restoring bone stock on the glenoid side vary from minimally invasive arthroscopic techniques of arthroscopic bone block procedures to traditional transposition of the coracoid or bone transplant. These techniques are evolving, and several tips and tricks have been optimized to improve outcomes and to reduce the risk of complications, even though the most terrible complication of transposition of the coracoid remains osteoarthritis in the young adult. The major innovation in the past few years has been the use of remplissage. The aim of our surgical procedures is to restore the anatomy as much as possible. Therefore, gentle handling of bone defects on both the humeral and glenoid sides by means of an arthroscopic bone block and combined remplissage seems to be the future of our surgical procedures.
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Nzeako O, Bakti N, Bawale R, Singh B. Bone block procedures for glenohumeral joint instability. J Clin Orthop Trauma 2019; 10:231-235. [PMID: 30828183 PMCID: PMC6383128 DOI: 10.1016/j.jcot.2018.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/10/2018] [Indexed: 12/18/2022] Open
Abstract
Glenoid bone loss is a well established cause of instability and long term morbidity if not adequadely addressed. Anterior glenohumeral instability due an anterior glenoid defect is significantly more common, and for many years has been well treated with open anterior bone block augmentation procedures, most commonly the latarjet procedure. However, with refinement of this technique and some interest in reducing morbidity associated with iliac crest bone harvest, arthroscopic bone block procedures with allograft has become more popular. In this article we will review some of the key available evidence. We will also review management of the less common and more challenging posterior glenoid defects associated with posterior instability.
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Schmiddem U, Hawi N, Liodakis E, Dratzidis A, Kraemer M, Hurschler C, Page R, Meller R. Monocortical fixation of the coracoid in the Latarjet procedure is significantly weaker than bicortical fixation. Knee Surg Sports Traumatol Arthrosc 2019; 27:239-244. [PMID: 29332226 DOI: 10.1007/s00167-018-4837-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/08/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE A crucial step of the Latarjet procedure is the fixation of the coracoid process onto the glenoid. Multiple problems associated with the fixation have been described, including lesions of the suprascapular nerve due to prominence of the screw or bicortical drilling. The purpose of the present study was to evaluate whether monocortical fixation, without perforating the posterior glenoid cortex, would provide sufficient graft stability. METHODS Coracoid transfer was performed in 14 scapula models (Sawbones®, Composite Scapula, 4th generation). Two groups were assigned: in one group, fixation was achieved with two screws that did not perforate the posterior cortex of the glenoid neck (monocortical fixation), in the other group, fixation was achieved with perforation of the posterior cortex (bicortical fixation). The ultimate failure load and mode of failure were evaluated biomechanically. RESULTS Monocortical fixation was a significantly weaker construct than bicortical fixation (median failure load 221 N, interquartile range 211-297 vs. median failure load 423 N, interquartile range 273-497; p = 0.017). Failure was either due to a pullout of the screws from the socket or a fracture of the glenoid. There was no significant difference in the mode of failure between the two groups (n.s.). CONCLUSION Monocortical fixation was significantly weaker than bicortical fixation. However, bicortical drilling and overly long screws may jeopardize the suprascapular nerve. Thus, anatomic knowledge about the safe zone at the posterior rim of the glenoid is crucial. Until further research has evaluated, if the inferior stability is clinically relevant, clinicians should be cautious to use a monocortical fixation technique for the coracoid graft.
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Affiliation(s)
- Uli Schmiddem
- Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Nael Hawi
- Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Emmanouil Liodakis
- Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Antonios Dratzidis
- Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Manuel Kraemer
- Laboratory of Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
| | - Christof Hurschler
- Laboratory of Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
| | - Richard Page
- Orthopaedic Department, St. John of God Hospital and University Hospital Geelong, School of Medicine, Deakin University, Geelong, Australia
| | - Rupert Meller
- Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Buckle-Down Technique for the Bony Reconstruction of Large Anterior Glenoid Defects. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2018. [DOI: 10.1097/bte.0000000000000151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Park I, Lee JH, Hyun HS, Oh MJ, Shin SJ. Effects of Bone Incorporation After Arthroscopic Stabilization Surgery for Bony Bankart Lesion Based on Preoperative Glenoid Defect Size. Am J Sports Med 2018; 46:2177-2184. [PMID: 29791191 DOI: 10.1177/0363546518773317] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recurrent shoulder instability occurs more frequently after soft tissue surgery when the glenoid defect is greater than 20%. However, for lesions less than 20%, no scientific guidance is available regarding what size of bone fragments may affect shoulder functional restoration after bone incorporation. Purpose/Hypothesis: The purpose was to analyze how preoperative glenoid defect size and bone fragment incorporation alter postoperative clinical outcomes, we compared the functional outcomes of shoulders with and without bony Bankart lesion. It was hypothesized that differences in postoperative clinical outcomes between patients with and without bony fragments would be found only in patients with a larger glenoid defect. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 223 patients who underwent arthroscopic stabilization surgery for recurrent anterior shoulder instability were divided into two groups based on the presence of anterior glenoid bone fragments. In each group, postoperative shoulder functional outcomes, sports activity level, and recurrence rates were evaluated according to preoperative glenoid defect size (small, <10%; medium, 10%-15% and 15%-20%; large, >20%). RESULTS In patients with small or medium defects, no significant differences were found in postoperative clinical outcomes and sports activity levels between the two groups. However, in patients with a large defect, the patients with bone fragments (mean ± SD American Shoulder and Elbow Surgeons [ASES] score, 92.3 ± 2.7; Rowe score, 90.9 ± 5.4) showed significantly superior clinical outcomes compared with patients who did not have fragments (ASES score, 87.3 ± 6.2, P = .02; Rowe score, 84.8 ± 7.3, P = .04). Among patients without bone fragments, recurrence increased significantly with increasing preoperative glenoid defect size (recurrence rates: 0% in small defects, 7.4% in medium defects, 22.2% in large defects), whereas patients with bone fragments showed no tendency for increasing or decreasing recurrence rates (0% in small defects, 7.9% in medium defects, 5.9% in large defects). CONCLUSION In the treatment of bony Bankart lesion, the effect of bone fragment incorporation was different according to preoperative glenoid defect size. In patients with preoperative glenoid defects less than 20% of the glenoid width, bone fragment incorporation after arthroscopic bony Bankart repair did not alter clinical outcomes, sports activity levels, or recurrence rates, whereas in patients with defects greater than 20% of the glenoid width, bone fragment incorporation improved clinical outcomes and recurrence rates.
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Affiliation(s)
- In Park
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Jae-Hoo Lee
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Hwan-Sub Hyun
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Min-Joon Oh
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Sang-Jin Shin
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
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Paulino Pereira NR, van der Linde JA, Alkaduhimi H, Longo UG, van den Bekerom MPJ. Are collision athletes at a higher risk of re-dislocation after an open Bristow-Latarjet procedure? A systematic review and meta-analysis. Shoulder Elbow 2018; 10:75-86. [PMID: 29560032 PMCID: PMC5851127 DOI: 10.1177/1758573217728290] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/09/2017] [Accepted: 08/03/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND The primary aim of the present study was to review, summarize and compare the redislocation risk for collision athletes and noncollision athletes after an open Bristow-Latarjet procedure. Our secondary aim was to summarize return to sport, satisfaction, pain and complications. METHODS We conducted a systematic review in PubMed and EMBASE of articles until 1 July 2016. We included all studies describing Bristow-Latarjet like procedures as a result of glenohumeral instability, mentioning redislocation rates in collision athletes with >2 years of follow-up. We pooled the data using random-effects meta-analysis for redislocation risk-differences (RD) between collision and noncollision athletes, and assessed heterogeneity with I2 and Tau2 tests. RESULTS From 475 titles and abstracts, 11 studies were included and eight studies were meta-analyzed. The pooled RD to develop a postoperative redislocation between collision athletes and noncollision athletes was -0.00 (95% confidence interval: -0.03 to 0.03, p = 0.370). Return to sports rates were high (67-100%), and patients reported high satisfaction scores (93-100% satisfied) and low pain scores (mean visual analogue scale score of 1.6); however, postoperative complication rates varied from 0.8% to 19.2%. CONCLUSIONS Collision athletes are not more at risk for redislocation rates after an open Bristow-Latarjet procedure compared to noncollision athletes. Overall postoperative outcomes were good, although numerous complications occurred.
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Affiliation(s)
- Nuno Rui Paulino Pereira
- Massachusetts General Hospital, Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Just A. van der Linde
- Onze lieve Vrouwe Gasthuis Amsterdam, Orthopaedic Research Center, Amsterdam, The Netherlands
| | - Hassanin Alkaduhimi
- Onze lieve Vrouwe Gasthuis Amsterdam, Orthopaedic Research Center, Amsterdam, The Netherlands,Hassanin Alkaduhimi, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
| | - Umile Giuseppe Longo
- Campus Bio-Medico University, Department of Orthopaedic and Trauma Surgery, Rome, Italy
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Fate of coracoid grafts after the Latarjet procedure: will be analogous to the original glenoid by remodelling. Knee Surg Sports Traumatol Arthrosc 2018; 26:926-932. [PMID: 29198018 DOI: 10.1007/s00167-017-4808-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the location, magnitude, and change over time of osteolysis of coracoid grafts after Latarjet procedure. METHODS This is a retrospective study of 54 patients (55 shoulders) who underwent the Latarjet procedure. Three-dimensional computed tomography (CT) scans were performed preoperatively, immediately postoperatively, and at follow-up (mean 7.7 and 31.7 months postoperative). "En face" views of the glenoid, size of glenoid defect and changes in the glenoid surface area postoperatively were measured relative to the area of an assumed outer-fitting circle. On the oblique sagittal planes, location and subsequent severity of osteolysis of the graft at follow-up were documented. RESULTS The mean glenoid surface area increased significantly from 79.7 ± 4.8% of the original circle preoperatively to 111.3 ± 8.0% immediately postoperatively. At 7.7 and 31.7 months of follow-up, glenoid surface area decreased to 102.2 ± 6.0% and 100.3 ± 5.3%, respectively. Osteolysis occurred on the outer side of the graft in all cases, but did not occur on the inner side. Maximum osteolysis was observed in the superior third of the graft (78.5 ± 17.1%), followed by the middle third (15.8 ± 10.4%), and the inferior third (8.0 ± 5.1%). No significant difference in magnitude of osteolysis was observed between 7.7 and 31.7 months of follow-up. CONCLUSION Osteolysis of the grafted coracoid mainly occurred on the outer side of the superior portion, resulting in reshaping of the rectangular shape of graft coracoids after Latarjet procedure. Coracoid graft remodelling was almost completed approximately 8 months postoperatively to reach the original glenoid dish with no further changes thereafter. These results may help surgeons to understand changes of grafts after the surgery. LEVEL OF EVIDENCE IV.
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Harmsen K, Huijsmans PE. Management of Glenoid Defects in Anterior Shoulder Instability: A Review of Current Concepts. Open Orthop J 2018; 11:934-945. [PMID: 29403566 PMCID: PMC5780676 DOI: 10.2174/1874325001711010934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 10/22/2016] [Accepted: 10/28/2016] [Indexed: 11/24/2022] Open
Abstract
Background: Bone defects of the glenoid are often found in patients with traumatic
anterior glenohumeral instability. There is no consensus regarding which
glenoid defects need to be treated surgically. The aim of this review is to
describe the management of glenoid defects in anterior shoulder instability
in patients with traumatic anterior glenohumeral instability. Methods: We conducted a review of the literature through a Pubmed search. Results: The management of glenoid defects in anterior shoulder instability consists
of conservative or operative treatment. There is a wide variety in the
treatment options. Also, the diagnostics of the presence and size of a
glenoid bone defect is still debated on in literature. Conclusion: Based on the current available literature, we advise to begin management of
traumatic anterior shoulder instability combined with glenoid defects with
conservative treatment. Operative treatment can be used when the bone
fragment consists of a large glenoid surface and the patient is active, or
in the case of a chronic defect or recurrent instability.
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Affiliation(s)
- Kennard Harmsen
- Department of Orthopaedics, Haga Hospital, Sportlaan 600, 2566 MJ, The Hague, The Netherlands
| | - Polydoor E Huijsmans
- Department of Orthopaedics, Haga Hospital, Sportlaan 600, 2566 MJ, The Hague, The Netherlands
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Hardy A, Gerometta A, Granger B, Massein A, Casabianca L, Pascal-Moussellard H, Loriaut P. Preoperative CT planning of screw length in arthroscopic Latarjet. Knee Surg Sports Traumatol Arthrosc 2018; 26:24-30. [PMID: 27562373 DOI: 10.1007/s00167-016-4286-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 08/09/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The Latarjet procedure has shown its efficiency for the treatment of anterior shoulder dislocation. The success of this technique depends on the correct positioning and fusion of the bone block. The length of the screws that fix the bone block can be a problem. They can increase the risk of non-union if too short or be the cause of nerve lesion or soft tissue discomfort if too long. Suprascapular nerve injuries have been reported during shoulder stabilisation surgery up to 6 % of the case. Bone block non-union depending on the series is found around 20 % of the cases. The purpose of this study was to evaluate the efficiency of this CT preoperative planning to predict optimal screws length. The clinical importance of this study lies in the observation that it is the first study to evaluate the efficiency of CT planning to predict screw length. METHODS Inclusion criteria were patients with chronic anterior instability of the shoulder with an ISIS superior to 4. Exclusion criteria were patients with multidirectional instability or any previous surgery on this shoulder. Thirty patients were included prospectively, 11 of them went threw a CT planning, before their arthroscopic Latarjet. Optimal length of both screws was calculated, adding the size of the coracoid at 5 and 15 mm from the tip to the glenoid. Thirty-two-mm screws were used for patients without planning. On a post-operative CT scan with 3D reconstruction, the distance between the screw tip and the posterior cortex was measured. A one-sample Wilcoxon test was used to compare the distance from the tip of the screw to an acceptable positioning of ±2 mm from the posterior cortex. RESULTS In the group without planning, screw 1 tended to differ from the acceptable positioning: mean 3.44 mm ± 3.13, med 2.9 mm, q1; q3 [0.6; 4.75] p = 0.1118, and screw 2 differed significantly from the acceptable position: mean 4.83 mm ± 4.11, med 3.7 mm, q1; q3 [1.7; 5.45] p = 0.0045. In the group with planning, position of screw 1 or 2 showed no significant difference from the acceptable position: mean 2.45 mm ± 2.07 med 1.8 mm, q1; q3 [1; 3.3] p = 1; mean 2.75 mm ± 2.32 med 2.3 mm, q1; q3 [1.25; 3.8] p = 0.5631. CONCLUSION Unplanned Latarjet can lead to inaccurate screw length especially in the lower screw and can increase the risk of non-union and nerve damage. The clinical relevance of this article is that CT planning of screw length before surgery showed good results on post-operative CT.
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Affiliation(s)
- Alexandre Hardy
- Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - Antoine Gerometta
- Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - Benjamin Granger
- Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - Audrey Massein
- Department of Radiology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - Laurent Casabianca
- Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - Hugues Pascal-Moussellard
- Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - Philippe Loriaut
- Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l'Hôpital, 75013, Paris, France.
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27
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Magnetic Resonance Imaging and Arthroscopic Correlation in Shoulder Instability. Sports Med Arthrosc Rev 2017; 25:172-178. [DOI: 10.1097/jsa.0000000000000163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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28
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Rouleau DM, Garant-Saine L, Canet F, Sandman E, Ménard J, Clément J. Measurement of combined glenoid and Hill-Sachs lesions in anterior shoulder instability. Shoulder Elbow 2017; 9:160-168. [PMID: 28588656 PMCID: PMC5444602 DOI: 10.1177/1758573216681208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/28/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recurrent glenohumeral anterior instability (RGAI) frequently induces combined glenoid and Hill-Sachs bone lesions and is a risk factor for soft tissue repair failure. This cohort study describes a simple preoperative quantification method for bone loss, the Clock method, the first that combines glenoid and humeral lesions. METHODS Computed tomography scans of 34 shoulders with RGAI were twice reviewed by three independent observers, who measured bone lesions using the new Clock method and existing validated methods. Intra- and inter-observer reliability of the Clock method was evaluated (intraclass correlation coefficient). Pearson correlation was used to correlate Clock method with existing methods, and with function (Western Ontario Shoulder Instability, Quick-Disabilities of the Arm, Shoulder and Hand). RESULTS Thirty-two patients met the inclusion criteria: three females and 29 males, mean age 28 years. The intra- and inter-observer reliability was excellent, with intraclass correlation coefficient ranging from 0.817 to 0.938 for the novel Clock method. Humeral Clock and Glenoid Clock strongly correlated with Humeral Ratio (r = 0.882, p < 0.001) and Glenoid Surface Area and Glenoid Ratio (r = 0.793 and 0.717, p < 0.001), respectively. The classic threshold of 25% of the glenoid diameter with the Glenoid Ratio method corresponds to 4 hours with the Glenoid Clock method. CONCLUSIONS The Clock method is quick and reliable, with more studies being needed to investigate whether it is correlated with surgical outcomes.
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Affiliation(s)
- Dominique M. Rouleau
- Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada,Dominique M. Rouleau, HSCM, 5400 boul. Gouin Ouest, Local K-3035, Montreal, QC H4J 1C5, Canada.
| | | | - Fanny Canet
- Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
| | - Emilie Sandman
- Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
| | - Jérémie Ménard
- Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
| | - Julien Clément
- Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
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29
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Russo R, Della Rotonda G, Cautiero F, Ciccarelli M, Maiotti M, Massoni C, Di Pietto F, Zappia M. Arthroscopic Bankart repair associated with subscapularis augmentation (ASA) versus open Latarjet to treat recurrent anterior shoulder instability with moderate glenoid bone loss: clinical comparison of two series. Musculoskelet Surg 2017; 101:75-83. [PMID: 28004306 DOI: 10.1007/s12306-016-0446-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/07/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The treatment of chronic anterior shoulder instability with glenoid bone loss is still debated. The purpose of this study is to compare short-term results of two techniques treating chronic shoulder instability with moderate glenoid bone loss: bone block according to open Latarjet-Patte procedure and arthroscopic Bankart repair in association with subscapularis augmentation. METHODS Ninety-one patients with moderate anterior glenoid bone loss underwent from 2011 to 2015. From these patients, two groups of 20 individuals each have been selected. The groups were homogeneous in terms of age, gender, dominance and glenoid bone loss. In group A, an open Latarjet procedure has been performed, and in group B, an arthroscopic Bankart repair associated with subscapularis augmentation has been performed. The mean follow-up in group A was 21 months (20-39 months), while in group B was 20 months (15-36 months). QuickDash score, Constant and Rowe shoulder scores, were used for evaluations of results. RESULTS The mean preoperative rate of QuickDash score was 3.6 for group A and 4.0 for group B; Rowe Score was 50.0 for group A and 50.0 for group B. Preoperative mean Constant score was 56.2 for Latarjet-Patte and 55.2 for Bankart plus ASA. Postoperative mean QuickDash score was in group A 1.8 and 1.7 in group B; Rowe Score was 89.8 and 91.6; Constant Score was 93.3 and 93.8. No complications related to surgery have been observed for both procedures. Not statistically significant difference was reported between the two groups (p > .05). Postoperatively, the mean deficit of external rotation in ER1 was -9° in group A and -8 in group B; In ER2, the mean deficit was -5° in both groups (p = .0942). CONCLUSIONS Arthroscopic subscapularis augmentation of Bankart repair is an effective procedure for the treatment of recurrent anterior shoulder instability with glenoid bone loss without any significant difference in comparison with the well-known open Latarjet procedure.
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Affiliation(s)
- R Russo
- Orthopedic and Traumatology Unit, Pellegrini Hospital, Naples, Italy
| | - G Della Rotonda
- Orthopedic and Traumatology Unit, Pellegrini Hospital, Naples, Italy.
| | - F Cautiero
- Orthopedic and Traumatology Unit, Pellegrini Hospital, Naples, Italy
| | - M Ciccarelli
- Orthopedic and Traumatology Unit, Pellegrini Hospital, Naples, Italy
| | - M Maiotti
- Sport Traumatology Unit, San Giovanni Addolorata Hospital, Rome, Italy
| | - C Massoni
- Sport Traumatology Unit, San Giovanni Addolorata Hospital, Rome, Italy
| | - F Di Pietto
- Diagnostic Imaging Department AORN A. Cardarelli, Naples, Italy
| | - M Zappia
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
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30
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Skupiński J, Piechota MZ, Wawrzynek W, Maczuch J, Babińska A. The Bony Bankart Lesion: How to Measure the Glenoid Bone Loss. Pol J Radiol 2017; 82:58-63. [PMID: 28243338 PMCID: PMC5304945 DOI: 10.12659/pjr.898566] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/16/2016] [Indexed: 01/26/2023] Open
Abstract
An osseous Bankart lesion is commonly seen in patients with an anterior shoulder dislocation. It is defined as a detachment of the anteroinferior labrum associated with a glenoid rim fracture. Radiological studies are crucial not only for detecting glenoid bone defects but also for measuring the amount of bone loss. The precise quantification of the bony defect is crucial for the therapeutic desicion-making and clinical outcomes. Although we know that major glenoid bone loss requires surgical intervention, none of the studies performed so far answered the question what size of the defect should be an indication for open surgery procedures. Moreover, there is still no consensus on the exact percentage of glenoid loss that results in a higher risk of re-dislocations. In our opinion, there is a strong need for a consensus on universally accepted measuring techniques of the glenoid defect as well as on algorithms with validated glenoid bone loss threshold values for therapeutic decision-making. In this study, we review the techniques described so far in the literature and try to assess if any of these techniques should be treated as a leading method of detecting and quantifying osseous glenoid lesions.
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Affiliation(s)
- Jarosław Skupiński
- Department of Radiology, District Hospital of Orthopedics and Trauma Surgery, Piekary śląskie, Poland
| | - Małgorzata Zofia Piechota
- Department of Radiology, District Hospital of Orthopedics and Trauma Surgery, Piekary śląskie, Poland
| | - Wojciech Wawrzynek
- Department of Radiology, District Hospital of Orthopedics and Trauma Surgery, Piekary śląskie, Poland
| | - Jarosław Maczuch
- Department of Radiology, District Hospital of Orthopedics and Trauma Surgery, Piekary śląskie, Poland
| | - Anna Babińska
- Department of Radiology, District Hospital of Orthopedics and Trauma Surgery, Piekary śląskie, Poland
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31
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Mathews S, Burkhard M, Serrano N, Link K, Häusler M, Frater N, Franke I, Bischofberger H, Buck FM, Gascho D, Thali M, Serowy S, Müller-Gerbl M, Harper G, Qureshi F, Böni T, Bloch HR, Ullrich O, Rühli FJ, Eppler E. Glenoid morphology in light of anatomical and reverse total shoulder arthroplasty: a dissection- and 3D-CT-based study in male and female body donors. BMC Musculoskelet Disord 2017; 18:9. [PMID: 28068966 PMCID: PMC5223371 DOI: 10.1186/s12891-016-1373-4] [Citation(s) in RCA: 18] [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: 09/22/2016] [Accepted: 12/19/2016] [Indexed: 11/19/2022] Open
Abstract
Background Placement of the glenoid baseplate is of paramount importance for the outcome of anatomical and reverse total shoulder arthroplasty. However, the database around glenoid size is poor, particularly regarding small scapulae, for example, in women and smaller individuals, and is derived from different methodological approaches. In this multimodality cadaver study, we systematically examined the glenoid using morphological and 3D-CT measurements. Methods Measurements of the glenoid and drill hole tunnel length for superior baseplate screw placement were recorded to define size of the glenoid and the distance to the scapular notch on cadaveric specimens. Glenoid angles were determined on both, 3D-CT-scans of the thoraxes using the Friedman method and on subsequently isolated scapulae from 18 male and female donors (average 84 years, range 60–98 years). Results Mean glenoid height was 36.6 mm ± 3.6, and width 27.8 mm ± 3.1 with a significant sex dimorphism (p ≤ 0.001): in males, glenoid height 39.5 mm ± 3.5, and width 30.3 mm ± 3.3, and in females, glenoid height 34.8 mm ± 2.2, and width 26.2 mm ± 1.6. The average distance from the superior screw entry to its exit in the scapular notch measured by calliper was 27.2 mm ± 6.0 with a sex difference: in males, 29.4 mm ± 5.7, and in females, 25.8 mm ± 5.9 mm with a minimum recorded distance of 15 mm. Measured by CT, the mean inclination angle for male and female donors combined was 13.0° ± 7.0, and the ante-/retroversion angle −1.0° ± 4.0°. Conclusion This study is one of the first to combine dissection, including drill holes, with anatomical measurements and radiological data. In some women and smaller individuals, smaller baseplates should be selected. The published safe zone of 20 mm is generally feasible for superior screw placement, however, in small patients this distance may be substantially shorter than expected and start as of 13 and 15 mm, respectively. No correlation between glenoid height or width with the length of our drilling canal towards the scapular notch was found. Preoperative CT-based treatment planning to determine version and inclination angles is recommended.
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Affiliation(s)
- Sandra Mathews
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.
| | - Marco Burkhard
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Nabil Serrano
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.,Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Karl Link
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.,Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Martin Häusler
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.,Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Nakita Frater
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland
| | - Ingeborg Franke
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Helena Bischofberger
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Florian M Buck
- Medical Radiology Institute, Schulthess Clinic, Zurich, Switzerland.,Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Dominic Gascho
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Michael Thali
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Steffen Serowy
- Institute of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Magdalena Müller-Gerbl
- Musculoskeletal Research Unit, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Gareth Harper
- Shoulder Unit, Queen Alexandra Hospital, Portsmouth, UK
| | - Ford Qureshi
- Shoulder Unit, Doncaster Royal Infirmary, Doncaster, UK
| | - Thomas Böni
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.,Technical Orthopedics Unit, University Hospital Balgrist, Zurich, Switzerland
| | | | - Oliver Ullrich
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Frank-Jakobus Rühli
- Institute of Evolutionary Medicine (IEM), University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland
| | - Elisabeth Eppler
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland.,Institute of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany.,Musculoskeletal Research Unit, Department of Biomedicine, University of Basel, Basel, Switzerland
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Assunção JH, Gracitelli MEC, Borgo GD, Malavolta EA, Bordalo-Rodrigues M, Ferreira Neto AA. Tomographic evaluation of Hill-Sachs lesions: is there a correlation between different methods of measurement? Acta Radiol 2017; 58:77-83. [PMID: 26924834 DOI: 10.1177/0284185116633918] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 01/19/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Several methods are currently available to evaluate and quantify the glenoid or humeral bone loss; however, none is universally accepted, particularly in the case of Hill-Sachs (HS) lesions. PURPOSE To establish whether there is correlation among different methods of measuring HS lesions, and to investigate the correlation between glenoid bone loss and the various HS lesion measurements and to assess the inter-observer reliability of such measurements. MATERIAL AND METHODS We assessed computed tomography (CT) or arthro-CT scans taken from individuals with recurrent anterior glenohumeral dislocation. The scans were independently assessed by two examiners. The parameters assessed were as follows: HS lesion width and depth on the axial and coronal planes, articular arc loss on the axial plane, and percentage of glenoid bone loss on the sagittal plane. RESULTS Scans from 50 shoulders were assessed. The percentage of articular arc loss and HS lesion width on the axial plane were the only measurements that exhibited strong correlation (r = 0.83; P < 0.001). The values of the correlation coefficient corresponding to HS lesion depth on the coronal plane were the lowest. Most of the measurements exhibited moderate correlation. The inter-examiner reliability was good relative to all measurements except for HS lesion width and depth on the coronal plane, for which it was moderate. CONCLUSION The measurements of articular arc loss and HS lesion width on the axial plane exhibited strong correlation. The inter-examiner reliability relative to articular arc loss, HS lesion width and depth on the axial plane, and glenoid bone loss was good.
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Affiliation(s)
- Jorge Henrique Assunção
- Shoulder and Elbow Group, Institute of Orthopedics and Traumatology, University of São Paulo (Universidade de São Paulo - USP), São Paulo, Brazil
| | - Mauro Emilio Conforto Gracitelli
- Shoulder and Elbow Group, Institute of Orthopedics and Traumatology, University of São Paulo (Universidade de São Paulo - USP), São Paulo, Brazil
| | - Gustavo Dias Borgo
- Shoulder and Elbow Group, Institute of Orthopedics and Traumatology, University of São Paulo (Universidade de São Paulo - USP), São Paulo, Brazil
| | - Eduardo Angeli Malavolta
- Shoulder and Elbow Group, Institute of Orthopedics and Traumatology, University of São Paulo (Universidade de São Paulo - USP), São Paulo, Brazil
| | | | - Arnaldo Amado Ferreira Neto
- Shoulder and Elbow Group, Institute of Orthopedics and Traumatology, University of São Paulo (Universidade de São Paulo - USP), São Paulo, Brazil
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Abstract
Radiography remains pivotal to the workup of instability lesions of the shoulder, both in the acute as well as the chronic settings. The goal of radiography is to detect osseous abnormalities and locate them in order to determine the direction of instability. In antero-inferior instability, Hill-Sachs lesions are often visible at radiography and should not be confused with various differential diagnoses, which are usually more laterally located. Bankart lesions are more difficult to detect on conventional radiography, but there are less false positives than for Hill-Sachs lesions. The Garth view represents an excellent radiographic view to detect antero-inferior instability impaction fractures at both the humeral and glenoid sides. Accurate quantification of bony abnormalities and detection of lesions to the soft-tissue stabilizers of the shoulder however require advanced cross-sectional imaging techniques.
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34
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Sheean AJ, De Beer JF, Di Giacomo G, Itoi E, Burkhart SS. Shoulder instability: State of the Art. J ISAKOS 2016. [DOI: 10.1136/jisakos-2016-000070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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35
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Katthagen JC, Anavian J, Tahal DS, Millett PJ. Arthroscopic Remplissage and Open Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability With Severe Bipolar Bone Loss. Arthrosc Tech 2016; 5:e1135-e1141. [PMID: 28224068 PMCID: PMC5310187 DOI: 10.1016/j.eats.2016.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/21/2016] [Indexed: 02/03/2023] Open
Abstract
Bipolar bone loss in patients with anterior glenohumeral instability is challenging to treat. The goal of the treatment is to restore stability by ensuring that the humeral head remains within the glenoid vault. This can be achieved either with the combination of an arthroscopic Bankart procedure and remplissage (glenoid bone loss <25%), or with a Latarjet procedure (glenoid bone loss >25%). In cases with more severe bipolar bone loss of both the glenoid and the humeral head, the conventional approach has been to lengthen the articular arc of the glenoid and to ignore the Hill-Sachs lesion. However, it has recently been shown that this can still lead to an "off-track" situation with persistent shoulder instability from engagement of the Hill-Sachs on the anterior glenoid. In these cases, the combination of a Hill-Sachs remplissage and the Latarjet procedure can be effective in preventing persistent instability. In this technical note, the surgical technique of an arthroscopic Hill-Sachs remplissage in combination with an open Latarjet procedure is presented.
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Affiliation(s)
| | | | | | - Peter J. Millett
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- The Steadman Clinic, Vail, Colorado, U.S.A
- Address correspondence to Peter J. Millett, M.D., M.Sc., The Steadman Clinic & Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657, U.S.A.The Steadman Clinic & Center for Outcomes-based Orthopaedic ResearchSteadman Philippon Research Institute181 West Meadow DriveSuite 1000VailCO81657U.S.A.
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36
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Longo UG, Rizzello G, Ciuffreda M, Locher J, Berton A, Salvatore G, Denaro V. Humeral Avulsion of the Glenohumeral Ligaments: A Systematic Review. Arthroscopy 2016; 32:1868-76. [PMID: 27180149 DOI: 10.1016/j.arthro.2016.03.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze clinical outcomes, range of motion, rate of recurrence, and complications after procedures to manage shoulder instability in patients with humeral avulsion of the glenohumeral ligament (HAGL) lesions. METHODS A systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with a PRISMA checklist and algorithm was performed. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the Keywords "shoulder," "HAGL," "treatment," "lesion," "dislocation," "instability," "clinical," "outcome," "Bankart" since inception of databases to 2015 was performed. All the investigators independently extracted the following data: demographics, types of lesions and associated injuries, treatment, outcome measurements, range of motion, recurrent instability, and complications. RESULTS Eleven articles were included in which 42 shoulders with HAGL lesions were evaluated. Patients were assessed at a median follow-up period of 25.5 months, ranging from 12 to 54 months. The overall rate of recurrence was 0% (0 of 25) in case of surgery and 90% (9 of 10) in case of nonoperative treatment. The surgical approach was associated with lower rate of recurrence when compared with nonoperative treatment (odds ratio 0.05, 95% confidence interval 0.01 to 0.42, and P = .006). Only 2 papers reported loss of external rotation after surgery. No complications were reported after surgery. Complications after nonoperative treatment were not discussed. CONCLUSIONS Recognizing HAGL lesions is important to manage patients with glenohumeral instability. Patients' complaints are often nonspecific. A high index of suspicion is required in patients with prior failed shoulder surgery. HAGL lesions are often associated with other shoulder lesions. Arthroscopic or open repairs of HAGL lesions are associated with good clinical outcomes and a lower rate of recurrence compared with nonoperative treatment. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy.
| | - Giacomo Rizzello
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Mauro Ciuffreda
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Joel Locher
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy
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Longo UG, van der Linde JA, Loppini M, Coco V, Poolman RW, Denaro V. Surgical Versus Nonoperative Treatment in Patients Up to 18 Years Old With Traumatic Shoulder Instability: A Systematic Review and Quantitative Synthesis of the Literature. Arthroscopy 2016; 32:944-52. [PMID: 26921126 DOI: 10.1016/j.arthro.2015.10.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/11/2015] [Accepted: 10/27/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the outcome of surgical and nonoperative treatment in patients aged 18 years or younger with traumatic shoulder instability. METHODS A systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A complete search of PubMed, Medline, Cochrane, CINAHL, Embase, and Google Scholar databases was performed using various combinations of the keywords "shoulder," "instability," "glenohumeral instability," "pediatric," "adolescent," "skeletally immature," "young," "open physis," "children," "management," "treatment," "surgical," "stabilization," and "recurrence." There was no time restriction. RESULTS Fifteen articles met our inclusion criteria, including a total of 693 patients with 705 shoulders aged 18 years or younger. Of 411 shoulders, 293 (71.3%) treated with a nonoperative approach experienced a redislocation compared with 55 of 314 shoulders (17.5%) that received surgical treatment. The results of the quantitative synthesis showed that the recurrence rate was significantly lower in the surgical group compared with the nonoperative group. CONCLUSIONS The recurrence rate is lower in patients undergoing surgical treatment. Further studies are necessary to clarify several points in the treatment of skeletally immature patients with traumatic shoulder instability. LEVEL OF EVIDENCE Level III, systematic review of Level II and III studies and 1 case series.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Rome, Italy.
| | - Just A van der Linde
- Onze Lieve Vrouwe Gasthuis, Joint Research, Department of Orthopaedic and Trauma Surgery, Postbus, Amsterdam, The Netherlands
| | - Mattia Loppini
- Department of Orthopaedic and Trauma Surgery, Humanitas Research Hospital, Via Alessandro Manzoni, Rozzano, Milan, Italy
| | - Vito Coco
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Rome, Italy
| | - Rudolf W Poolman
- Onze Lieve Vrouwe Gasthuis, Joint Research, Department of Orthopaedic and Trauma Surgery, Postbus, Amsterdam, The Netherlands
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Rome, Italy
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Randelli P, Cucchi D, Ingala Martini L, Fossati C. Hill-Sachs lesion is not a significant prognostic factor for recurrence of shoulder redislocation after arthroscopic Bankart repair. J ISAKOS 2016. [DOI: 10.1136/jisakos-2015-000017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Taverna E, Garavaglia G, Ufenast H, D'Ambrosi R. Arthroscopic treatment of glenoid bone loss. Knee Surg Sports Traumatol Arthrosc 2016; 24:546-56. [PMID: 26658567 DOI: 10.1007/s00167-015-3893-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/19/2015] [Indexed: 01/19/2023]
Abstract
Recurrent anterior instability of the glenohumeral joint has long been an arduous problem to solve surgically, owing to its difficulty to the need to restore both osseous and dynamic constraints in the unstable shoulder. Biomechanical studies have indicated that glenoid bone loss shortens the safe arc through which the glenoid can resist axial forces; in these cases, a soft tissue repair alone may be insufficient to maintain stability. Clinical studies have confirmed that major bone loss is associated with an unfavourable outcome. The benefits of using arthroscopic procedures for surgical stabilization of the shoulder include smaller incisions and less soft tissue dissection, better access for repair and, potentially, the maximum respect for the undamaged anatomical structures. The biggest disadvantage of arthroscopic procedures until recently was the inability to successfully treat a significant bone defect. Over the last 10 years, several new arthroscopic techniques have been developed, providing new surgical options for successfully treating soft tissues and bony lesions in anterior-inferior glenohumeral instability. Level of evidence V.
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Affiliation(s)
- Ettore Taverna
- U.O. Chirurgia della Spalla II, Istituto Ortopedico Galeazzi, Milan, Italy
| | - Guido Garavaglia
- Upper Limb Unit, Department of Surgery, OBV, Mendrisio, Switzerland
| | - Henri Ufenast
- Upper Limb Unit, Department of Surgery, OBV, Mendrisio, Switzerland
| | - Riccardo D'Ambrosi
- U.O. Chirurgia della Spalla II, Istituto Ortopedico Galeazzi, Milan, Italy. .,Universtià degli Studi di Milano, Milan, Italy.
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The biomechanical effect of shoulder remplissage combined with Bankart repair for the treatment of engaging Hill-Sachs lesions. Knee Surg Sports Traumatol Arthrosc 2016; 24:585-92. [PMID: 24912574 DOI: 10.1007/s00167-014-3092-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/22/2014] [Indexed: 01/15/2023]
Abstract
PURPOSE The purpose of this study was to determine the biomechanical effects of the remplissage repair combined with Bankart repair for engaging Hill-Sachs lesions on range of motion (ROM), translation, and glenohumeral kinematics. METHODS Six cadaveric shoulders were tested using a custom shoulder testing system. ROM, kinematics, and anterior-posterior (AP) and superior-inferior glenohumeral translations were quantified at 0° and 60° glenohumeral abduction. Six conditions were tested: intact, Bankart lesion, Bankart with 40 % Hill-Sachs lesion, Bankart repair, Bankart repair with remplissage, and remplissage repair alone. RESULTS Humeral external rotation (ER) and total range of motion increased significantly after the creation of the Bankart lesion at both 0° and 60° abduction. The Bankart repair restored ER to intact values at 0° and 60° abduction, and the addition of the remplissage repair did not significantly alter range of motion from the Bankart repair alone. AP translation increased following the creation of the Bankart and Hill-Sachs lesions and was restored with the Bankart repair; the remplissage did not alter translation from the Bankart repair alone. At maximum ER at 60° abduction, the apex of the humeral head shifted posteriorly and inferiorly with remplissage repair. CONCLUSIONS The addition of the remplissage procedure combined with Bankart repair for treatment of large Hill-Sachs lesions had no statistically significant effect on ROM or translation, but altered the kinematics of the glenohumeral joint. Thus, by addressing the humeral bone defect following an anterior shoulder dislocation, the remplissage technique with concurrent Bankart repair may be a relatively minimally invasive option for converting engaging Hill-Sachs lesions to non-engaging and promoting shoulder stability, though further biomechanical and clinical studies are warranted.
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Longo UG, Rizzello G, Locher J, Salvatore G, Florio P, Maffulli N, Denaro V. Bone loss in patients with posterior gleno-humeral instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016; 24:612-7. [PMID: 25051908 DOI: 10.1007/s00167-014-3161-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 06/28/2014] [Indexed: 01/19/2023]
Abstract
PURPOSE The aim of this systematic review was to analyse outcomes of surgical procedures for glenoid and/or humeral bony defects, performed singularly or in combination, in patients with posterior gleno-humeral instability. A secondary aim was to establish in clinical settings which percentage of glenoid or humeral bone loss should be treated with a bony procedure to avoid recurrence of dislocation. METHODS A systematic review of the literature according to the PRISMA guidelines was performed. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, Ovid, and Google Scholar databases was performed using various combinations of the keywords "shoulder", "posterior instability", "dislocation", "bone loss", "reversed bony Bankart", "osseous glenoid defects", "glenoid bone grafting", "glenoid", "humeral head", "surgery", "gleno-humeral", "reversed Hill-Sachs", over the years 1966-2014. Data were independently extracted by all the investigators: demographics, previous surgery, imaging assessment, bone defect measurement, diagnosis, surgical management, return to sport, complications, and outcome measurements. The outcome parameters were recurrence of dislocation and clinical scores. RESULTS Nineteen articles, describing patients with glenoid bony defects, humeral bony defects, or both in the setting of posterior gleno-humeral instability were included. A total of 328 shoulders in 321 patients were included, with a median age at surgery of 33.4 years, ranging from 14 to 79 years. Patients were assessed at a median follow-up period of 3.6 years (ranging from 8 months to 22 years). A redislocation event occurred in 32 (10 %) shoulders. The redislocation event occurred in 2 (10 %) of 20 shoulders with glenoid bony defect and in 12 (11 %) of 114 shoulders with humeral bony defect. CONCLUSION Even though the general principle of treating recognized glenoid and humeral bone defects in patients with posterior gleno-humeral instability is widely accepted, to date few studies in the literature accurately establish which bone defects should be treated with bony procedures and the exact correlation between percentage of bone loss and higher risk of redislocation in clinical settings. A limitation to the present systematic review is the small number of included patients, due to the rare entity of posterior bone defects/reversed Hill-Sachs. The clinical relevance is that the results of this systematic review can be helpful to guide clinicians in the management of patients with posterior gleno-humeral instability and glenoid and/or humeral bony defects. This manuscript also highlights the need for accurate description of results in further investigations. The main drawback of the available articles in the topic is that they rarely clarify the percentage of bone loss in patients undergoing a redislocation event. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Trigoria Rome, Italy.
| | - Giacomo Rizzello
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Trigoria Rome, Italy
| | - Joel Locher
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Trigoria Rome, Italy
| | - Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Trigoria Rome, Italy
| | - Pino Florio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Trigoria Rome, Italy
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, Mann Ward, 275 Bancroft Road, London, E1 4DG, UK
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Trigoria Rome, Italy
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Bipolar bone defect in the shoulder anterior dislocation. Knee Surg Sports Traumatol Arthrosc 2016; 24:479-88. [PMID: 26704802 DOI: 10.1007/s00167-015-3927-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/04/2015] [Indexed: 10/22/2022]
Abstract
In the anterior shoulder instability with glenoid bone loss among 25 % or more of the inferior glenoid diameter (inverted-pear glenoid), the consensus of recent authors is that glenoid bone grafting (Latarjet procedure) should be performed. The engaging Hill-Sachs lesion has been recognized as a risk factor for recurrent anterior shoulder instability. We have developed a method using radiographic and arthroscopic studies and the concept of the glenoid track to determine whether a Hill-Sachs lesion will engage the anterior glenoid rim, whether or not there is concomitant anterior glenoid bone loss. If the Hill-Sachs lesion engages, it is called an "off-track" Hill-Sachs lesion; if it does not engage, it is an "on-track" lesion. On the basis of our quantitative method, we have developed a treatment paradigm with specific surgical criteria for all patients with anterior shoulder instability (first dislocation or recurrent dislocation), both with and without bipolar bone loss.
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Weel H, Tromp W, Krekel PR, Randelli P, van den Bekerom MPJ, van Deurzen DFP. International survey and surgeon's preferences in diagnostic work-up towards treatment of anterior shoulder instability. Arch Orthop Trauma Surg 2016; 136:741-6. [PMID: 26975396 PMCID: PMC4870311 DOI: 10.1007/s00402-016-2443-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE Recurrent anterior shoulder instability after surgical treatment can be caused by bony defects. Several diagnostic tools have been designed to measure the extent of these bony lesions. Currently, there is no consensus which measurement tool to use and decide which type of surgery is most appropriate. We therefore performed an evaluation of agreement in surgeons' preference of diagnostic work-up and surgical treatment of anterior shoulder instability. METHODS An international survey was conducted amongst orthopaedic shoulder surgeons. The survey contained questions about surgeons' experience, clinical and radiological examination and the subsequent treatment for anterior shoulder instability. Descriptive statistics were used to present the data, and percentages of responding surgeons were calculated. RESULTS The questionnaire was completed by 197 delegates from 46 countries. 55 % of the respondents think evidence in current literature is sufficient on diagnostic work-up for anterior shoulder instability. Anamnestic, number of dislocations was most frequently asked (by 95 % of respondents), the most frequently used test is the apprehension test (91 %). For imaging, conventional X-ray in various directions was most performed, followed by MR arthrography and plane CT scan respectively. The responding surgeons perform surgery (labrum repair or Latarjet) in 51 % of the patients. A median of 25 % glenoid bone loss was given by the respondents, as cut-off from when to perform a bony repair. CONCLUSION Many different diagnostic examinations for assessing shoulder instability are used and a high variety is seen in the use of diagnostic tools. Also no consensus is seen in the use of different surgical options (arthroscopic and open procedures). This implies the need for more research on diagnostic imaging and the correlation with specific subsequent surgical treatment. LEVEL OF EVIDENCE Survey, level of evidence IV.
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Affiliation(s)
- Hanneke Weel
- />Department of Orthopaedics, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | | | | | - Pietro Randelli
- />2nd Department of Orthopaedics, IRCCS Policlinico San Donato, Università degli Studi di Milano, Via Mangiagalli 30, San Donato Milanese, 20097 Milan, Italy
| | - Michel P. J. van den Bekerom
- />Department of Orthopaedics and Traumasurgery, Onze Lieve Vrouwe Gasthuis, Oosterpark, 91091 AC Amsterdam, The Netherlands
| | - Derek F. P. van Deurzen
- />Department of Orthopaedics and Traumasurgery, Onze Lieve Vrouwe Gasthuis, Oosterpark, 91091 AC Amsterdam, The Netherlands
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Longo UG, Rizzello G, Loppini M, Locher J, Buchmann S, Maffulli N, Denaro V. Multidirectional Instability of the Shoulder: A Systematic Review. Arthroscopy 2015. [PMID: 26208802 DOI: 10.1016/j.arthro.2015.06.006] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze outcomes of surgical and conservative treatment options for multidirectional instability (MDI). METHODS A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. A comprehensive search of the PubMed, MEDLINE, CINAHL, Cochrane, EMBASE, and Google Scholar databases using various combinations of the keywords "shoulder," "multidirectional instability," "dislocation," "inferior instability," "capsulorrhaphy," "capsular plication," "capsular shift," "glenoid," "humeral head," "surgery," and "glenohumeral," over the years 1966 to 2014 was performed. RESULTS Twenty-four articles describing patients with open capsular shift, arthroscopic treatment, and conservative or combined management in the setting of atraumatic MDI of the shoulder were included. A total of 861 shoulders in 790 patients was included. The median age was 24.3 years, ranging from 9 to 56 years. The dominant side was involved in 269 (58%) of 468 shoulders, whereas the nondominant side was involved in 199 (42%) shoulders. Patients were assessed at a median follow-up period of 4.2 years (ranging from 9 months to 16 years). Fifty-two of 253 (21%) patients undergoing physiotherapy required surgical intervention for MDI management, whereas the overall occurrence of redislocation was seen in 61 of 608 (10%) shoulders undergoing surgical procedures. The redislocation event occurred in 17 of 226 (7.5%) shoulders with open capsular shift management, in 21 of 268 (7.8%) shoulders with arthroscopic plication management, in 12 of 49 (24.5%) shoulders undergoing arthroscopic thermal shrinkage, and in 11 of 55 (22%) shoulders undergoing arthroscopic laser-assisted capsulorrhaphy. CONCLUSIONS Arthroscopic capsular plication and open capsular shift are the best surgical procedures for treatment of MDI after failure of rehabilitative management. Arthroscopic capsular plication shows results comparable to open capsular shift. LEVEL OF EVIDENCE Level IV, systematic review of Level I to IV studies.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy.
| | - Giacomo Rizzello
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Mattia Loppini
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Joel Locher
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Stefan Buchmann
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, London, England; Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Surgery, Salerno, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
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Abstract
BACKGROUND AND INTRODUCTION The incapacity with respect to work following anterior-inferior shoulder dislocation and subsequent Bankart repair has not been previously examined. The objective of this study was to examine a patient's incapacity according to the classification by the REFA Association. The recovery time was measured and the outcome of patients with heavy workload was compared to those with lower workloads. MATERIALS AND METHODS A total of 74 patients who underwent isolated arthroscopic Bankart repair fulfilled the inclusion criteria. The Constant-Murley Score, UCLA Shoulder Score and ROWE Score for Shoulder Instability were recorded for clinical assessment. The mean follow-up time was 43.1 months (SD ± 17.4; 24-110 months) with a mean age of 34.7 years (SD ± 12.6). Workload was classified as per the REFA Association classification system. Postoperative duration of a patient's incapacity with respect to work and other subjective ratings were provided by the patients themselves. RESULTS The mean incapacity of work was 2.73 months (95 % CI 1.19-5.36). The incapacity of work was 2.06 months (95 % CI 1.55-2.68) in the group with low physical strains at work (REFA 0-1) and 3.40 months (95 % CI 2.70-4.24) in the group with heavy workload (REFA 2-4/p = 0.005). Overall, the mean Constant-Murley Score was 87.7 (SD ± 13.5). The average UCLA Shoulder Score summed up to 31.9 (SD ± 3.87) and the mean ROWE Score was 87.6 (SD ± 21.7). 13 (17.5 %) patients had problems to compete in their jobs. Three patients had to change the job postoperatively. CONCLUSION In this study, a relationship between the time of incapacity of work and the workload was observed; patients with low physical strains returned significantly earlier to work after arthroscopic Bankart repair (p = 0.005). In general, the clinical results as measured in the Constant/UCLA/Rowe score were comparable to other studies.
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Recurrent anterior shoulder dislocation with engaging Hill–Sachs defect: remplissage or Latarjet? ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s12570-015-0313-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Longo UG, Forriol F, Loppini M, Lanotte A, Salvatore G, Maffulli N, Denaro V. The safe zone for avoiding suprascapular nerve injury in bone block procedures for shoulder instability. A cadaveric study. Knee Surg Sports Traumatol Arthrosc 2015; 23:1506-1510. [PMID: 24531358 DOI: 10.1007/s00167-014-2900-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of the study is to identify the safe zone in which the surgeon can place the screws for fixation of the coracoid graft during the Latarjet procedure to avoid injuries of the suprascapular nerve with the shoulder in internal and external rotation. METHODS The dissection on twelve fresh-frozen shoulders was performed according to a standard posterior approach to the gleno-humeral joint. The suprascapular nerve and its branches for the infraspinatus muscle were identified at the spinoglenoid notch region. Then, the distance between the glenoid and the suprascapular nerve at the spinoglenoid notch region was measured by using a ruler with the shoulder at 90° internal rotation and at 90° of external rotation. RESULTS The median distance between the glenoid and the suprascapular nerve was 12 mm (range 6-15 mm) with the shoulder at 90° of internal rotation and 19 mm (range 11-23 mm) with the shoulder at 90° of external rotation. The distance between the glenoid and the suprascapular nerve was statistically significantly greater with the shoulder at 90° of external rotation than 90° of internal rotation (P = 0.002). CONCLUSIONS The suprascapular nerve is furthest away from the glenoid with the shoulder at 90° of external rotation. Therefore, the placement of screws in external rotation of the humerus during glenoid bone block procedures likely reduces the risk of iatrogenic injuries of the suprascapular nerve.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - Francisco Forriol
- Orthopaedic Department, School of Medicine, University CEU Campus de Montepríncipe, 28886, Boadilla del Monte, Madrid, Spain
| | - Mattia Loppini
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Angela Lanotte
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Nicola Maffulli
- Barts and The London School of Medicine and Dentistry, William Harvey Research Institute, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, UK
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Rome, Italy
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Willemot LB, Eby SF, Thoreson AR, Debeer P, Victor J, An KN, Verborgt O. Iliac bone grafting of the intact glenoid improves shoulder stability with optimal graft positioning. J Shoulder Elbow Surg 2015; 24:533-40. [PMID: 25457786 PMCID: PMC4369161 DOI: 10.1016/j.jse.2014.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 09/03/2014] [Accepted: 09/12/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bone grafting procedures are increasingly popular for the treatment of anterior shoulder instability. In patients with a high risk of recurrence, open coracoid transplantation is preferred but can be technically demanding. Free bone graft glenoid augmentation may be an alternative strategy for high-risk patients without significant glenoid bone loss. This biomechanical cadaveric study assessed the stabilizing effect of free iliac crest bone grafting of the intact glenoid and the importance of sagittal graft position. METHODS Eight fresh frozen cadaveric shoulders were tested. The bone graft was fixed on the glenoid neck at 3 sagittal positions (50%, 75%, and 100% below the glenoid equator). Displacement and reaction force were monitored with a custom device while translating the humeral head over the glenoid surface in both anterior and anteroinferior direction. RESULTS Peak force (PF) increased significantly from the standard labral repair to the grafted conditions in both anterior (14.7 ± 5.5 N vs 27.3 ± 6.9 N) and anteroinferior translation (22.0 ± 5.3 N vs 29.3 ± 6.9 N). PF was significantly higher for the grafts at the 50% and 75% positions compared with the grafts 100% below the equator with anterior translation. Anteroinferior translation resulted in significantly higher values for the 100% and 75% positions compared with the 50% position. CONCLUSIONS This biomechanical study confirms improved anterior glenohumeral stability after iliac crest bone graft augmentation of the anterior glenoid. The results also demonstrate the importance of bone graft position in the sagittal plane, with the ideal position determined by the direction of dislocation.
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Affiliation(s)
- Laurent B Willemot
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA; Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Sarah F Eby
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA; Mayo Medical School, Mayo Graduate School, and Medical Scientist Training Program, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andrew R Thoreson
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA
| | - Phillipe Debeer
- Division of Orthopaedics, Department of Development and Regeneration, KU Leuven, University Hospitals Leuven, Pellenberg, Belgium
| | - Jan Victor
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Kai-Nan An
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA.
| | - Olivier Verborgt
- Department of Orthopaedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium; Department of Orthopaedic Surgery and Traumatology, University Hospital Antwerp, Edegem, Belgium
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50
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Fabricant PD, Taylor SA, McCarthy MM, Gausden EB, Moran CJ, Kang RW, Cordasco FA. Open and Arthroscopic Anterior Shoulder Stabilization. JBJS Rev 2015; 3:01874474-201502000-00004. [PMID: 27490744 DOI: 10.2106/jbjs.rvw.n.00060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Peter D Fabricant
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Samuel A Taylor
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Moira M McCarthy
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | | | - Cathal J Moran
- Sports Surgery Clinic, Suite 17, Santry, Dublin 9, Ireland
| | - Richard W Kang
- The University of Chicago, 5841 S. Maryland Avenue, MC 3079, Chicago, IL 60637
| | - Frank A Cordasco
- Hospital for Special Surgery, Belaire Building, 525 East 71st Street, New York, NY 10021
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