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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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2
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Mojica ES, Schwartz LB, Hurley ET, Gonzalez-Lomas G, Campbell KA, Jazrawi LM. Posterior glenoid bone block transfer for posterior shoulder instability: a systematic review. J Shoulder Elbow Surg 2021; 30:2904-2909. [PMID: 34298145 DOI: 10.1016/j.jse.2021.06.013] [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: 03/09/2021] [Revised: 06/08/2021] [Accepted: 06/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study is to systematically review the literature and evaluate patient-reported outcomes and complication/revision rates of bone block augmentation in the treatment of posterior shoulder instability (PSI). METHODS PubMed was searched according to PRIMSA guidelines to find clinical studies evaluating patient-reported outcomes, revision, and complication rates in posterior bone block for PSI. A literature search of MEDLINE, EMBASE, and the Cochrane Library was performed based on the PRISMA guidelines. Clinical studies reporting on the complications following posterior bone block were included. RESULTS Overall, 11 studies (level of evidence [LOE] III: 2, LOE IV: 9) met inclusion criteria, with 225 shoulders. Recurrent instability after the posterior bone block was found to be 9.8%. The overall complication rate was 13.8%, with 0.89% having graft complications, 11.1% having hardware complications, 0.4% having wound complications, 0.4% having nerve complications, and 0.89% having other complications. Residual pain was found in 11.6% of shoulders operated on. Patient-reported outcomes were evaluated most commonly by Rowe (81.4%), Constant (84.6%), and Walch-Duplay scores (81.6%). CONCLUSION There is a moderate rate of recurrence following posterior bone block for PSI. However, the patient-reported outcomes are high despite there being commonly reported persistent shoulder pain postoperatively.
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Affiliation(s)
- Edward S Mojica
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA.
| | - Luke B Schwartz
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Eoghan T Hurley
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Guillem Gonzalez-Lomas
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Kirk A Campbell
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Laith M Jazrawi
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
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Calvo E, Itoi E, Landreau P, Arce G, Yamamoto N, Ma J, Sparavalo S, Wong I. Anterior and posterior glenoid bone augmentation options for shoulder instability: state of the art. J ISAKOS 2021; 6:308-317. [PMID: 34145077 DOI: 10.1136/jisakos-2019-000413] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/24/2021] [Accepted: 04/08/2021] [Indexed: 11/04/2022]
Abstract
Bony lesions are highly prevalent in anterior shoulder instability and can be a significant cause of failure of stabilisation procedures if they are not adequately addressed. The glenoid track concept describes the dynamic interaction between the humeral head and glenoid defects in anterior shoulder instability. It has been beneficial for understanding the role played by bone defects in this entity. As a consequence, the popularity of glenoid augmentation procedures aimed to treat anterior glenoid bone defects; reconstructing the anatomy of the glenohumeral joint has risen sharply in the last decade. Although bone defects are less common in posterior instability, posterior bone block procedures can be indicated to treat not only posterior bony lesions, attritional posterior glenoid erosion or dysplasia but also normal or retroverted glenoids to provide an extended glenoid surface to increase the glenohumeral stability. The purpose of this review was to analyse the rationale, current indications and results of surgical techniques aimed to augment the glenoid surface in patients diagnosed of either anterior or posterior instability by assessing a thorough review of modern literature. Classical techniques such as Latarjet or free bone block procedures have proven to be effective in augmenting the glenoid surface and consequently achieving adequate shoulder stability with good clinical outcomes and early return to athletic activity. Innovations in surgical techniques have permitted to perform these procedures arthroscopically. Arthroscopy provides the theoretical advantages of lower morbidity and faster recovery, as well as the identification and treatment of concomitant pathologies.
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Affiliation(s)
- Emilio Calvo
- Department of Orthopaedic Surgery and Traumatology, Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz, Universidad Autonoma, Madrid, Spain
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | | | - Guillermo Arce
- Department of Orthopedic Surgery, Instituto Argentino de Diagnostico y Tratamiento (IADT), Buenos Aires, Argentina
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Jie Ma
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sara Sparavalo
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ivan Wong
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Zhao J. Whole Glenoid Reconstruction for Multidirectional Instability of the Shoulder. Arthrosc Tech 2021; 10:e629-e637. [PMID: 33738195 PMCID: PMC7953041 DOI: 10.1016/j.eats.2020.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/22/2020] [Indexed: 02/03/2023] Open
Abstract
The surgical results of shoulder multidirectional instability are not satisfactory. To address the structural and biological factors that are related to the low success rate of surgical treatment, we developed a whole glenoid reconstruction technique, which includes mainly 270° glenoid bone grafting and capsule labrum reconstruction, and glenohumeral ligament reconstruction. Our clinical experience indicates that the application of this technique can result in optimal shoulder stability. We consider the introduction of this technique will shed light on the surgical treatment of shoulder multidirectional instability.
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Affiliation(s)
- Jinzhong Zhao
- Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233, China.
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Godenèche A, Mansat P, Barth J, Nourissat G. No difference in outcomes of surgical treatment for traumatic and atraumatic posterior shoulder instability. Orthop Traumatol Surg Res 2020; 106:667-670. [PMID: 32461095 DOI: 10.1016/j.otsr.2020.03.010] [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: 09/06/2019] [Revised: 01/23/2020] [Accepted: 03/02/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Posterior shoulder instability is a rare pathology and accounts for 2-10% of all shoulder instabilities. The purpose of this study was to compare pain and functional scores following surgical treatment of traumatic and atraumatic PSI. HYPOTHESIS The authors hypothesize that patients with traumatic PSI are at greater risks of residual pain and recurrent subluxation. MATERIAL AND METHODS The records of 150 patients operated for PSI between 2000 and 2015 at 10 different centers were analysed. Inclusion criteria were symptomatic PSI (subluxation and/or pain) with radiographic signs of posterior glenoid erosion or fracture, posterior labral tears, or reverse Hill Sachs lesions. One hundred and seventeen patients were eligible, of which 84% presented symptoms of subluxation and/or dislocation, and 16% were painful without clinical symptoms of subluxation and/or dislocation. Patients were evaluated at 48±33months (range: 12-159) using the Constant, Walch-Duplay and Rowe scores, with pain on Visual Analogic Scale (pVAS). RESULTS Compared to atraumatic PSI, traumatic PSI was more prevalent in men (84.4% vs 61.9%, p=0.031), and tended to have fewer pain symptoms (15.8% vs 23.8%, n.s). Atraumatic PSI was more likely to affect the dominant arm, although the difference was not significant (81.0% vs 59.4%, n.s.). Traumatic PSI did not differ from atraumatic PSI in terms of preoperative lesional characteristics, procedures performed, or postoperative pain and instability. Although these differences were not statistically significant, it is worth noting that traumatic PSI patients experienced more recurrence of instability (15.6% vs 4.8%, p=0.298), and lower pain on VAS (1.5±2.3 vs 2.6±3.0, n.s.) compared to atraumatic PSI. DISCUSSION Functional scores did not significantly differ between traumatic and atraumatic PSI after surgery, although traumatic PSI patients tended to have a higher recurrence of instability, while atraumatic PSI patients tended to remain more painful. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- Arnaud Godenèche
- Ramsay Générale de Santé, Hôpital privé Jean-Mermoz, Centre Orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France.
| | - Pierre Mansat
- Hôpital de Purpan, CHU Toulouse, 1, place du Docteur-Baylac, 31059 Toulouse, France
| | - Johannes Barth
- Centre Ostéoarticulaire des Cèdres, 5, chemin des Tropiques, Parc Sud Galaxie, 38130 Échirolle, France
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- Société Francophone d'Arthroscopie, 15, rue Ampère, 92500 Rueil-Malmaison, France
| | - Geoffroy Nourissat
- Ramsay Générale de Santé, Groupe Maussins, Clinique Maussins, 67, rue de Romainville, 75019 Paris, France
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Weel H, Krekel PR, Willigenburg N, Willems WJ, Randelli P, Compagnoni R, van Deurzen DFP. Dynamic contact area ratio in shoulder instability: an innovative diagnostic technique measuring interplay of bony lesions. Knee Surg Sports Traumatol Arthrosc 2020; 28:2361-2366. [PMID: 31807834 PMCID: PMC7347673 DOI: 10.1007/s00167-019-05816-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 11/27/2019] [Indexed: 12/04/2022]
Abstract
PURPOSE The hypothesis of this study is that Dynamic Contact Area Ratio of the humerus and glenoid, measured with CT scans, is significantly reduced in patients with anterior shoulder instability compared to the Dynamic Contact Area Ratio in a control group of people without shoulder instability. METHODS Preoperative CT scans of patients who underwent surgery for anterior shoulder instability were collected. Additionally, the radiologic database was searched for control subjects. Using a validated software tool (Articulis) the CT scans were converted into 3-dimensional models and the amount the joint contact surface during simulated motion was calculated. RESULTS CT scans of 18 patients and 21 controls were available. The mean Dynamic Contact Area Ratio of patients was 25.2 ± 6.7 compared to 30.1 ± 5.1 in healthy subjects (p = 0.014). CONCLUSION Dynamic Contact Area Ratio was significantly lower in patients with anterior shoulder instability compared to controls, confirming the hypothesis of the study. The findings of this study indicate that calculating the Dynamic Contact Area Ratio based on CT scan images may help surgeons in diagnosing anterior shoulder instability. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hanneke Weel
- Amsterdam University Medical Centres, Amsterdam, The Netherlands.
| | | | | | - W. Jaap Willems
- grid.440209.bOnze Lieve Vrouwe Gasthuis Oost, Amsterdam, The Netherlands ,Clinical Graphics, Delft, The Netherlands ,grid.7177.60000000084992262Amsterdam University Medical Centres, Amsterdam, The Netherlands ,Lairesse Kliniek, Amsterdam, The Netherlands
| | - Pietro Randelli
- grid.4708.b0000 0004 1757 2822Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy ,1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Riccardo Compagnoni
- grid.4708.b0000 0004 1757 2822Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy ,1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
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