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Buckup J, Welsch F, Petchennik S, Klug A, Gramlich Y, Hoffmann R, Stein T. Arthroscopic Bankart repair: how many knotless anchors do we need for anatomic reconstruction of the shoulder?-a prospective randomized controlled study. INTERNATIONAL ORTHOPAEDICS 2023; 47:1285-1293. [PMID: 36932219 DOI: 10.1007/s00264-023-05749-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/25/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE The optimal strategy for surgical repair of traumatic anterior shoulder instability remains controversial. While several study groups have reported that the clinical and radiological outcomes of arthroscopic procedures performed with two anchors are not fully adequate, these conclusions are not supported by the findings published in other studies. A prospective randomized study was conducted to compare the structural and clinical outcomes of surgical procedures involving two vs. three anchors. METHODS Patients who underwent arthroscopic Bankart repair were randomly assigned to either Group I, which underwent procedures involving two double-loaded 3.5-mm knotless anchors, or Group II, which underwent procedures involving three single-loaded 2.9-mm knotless anchors. All patients underwent bilateral MRI assessments at a minimum of 12 months and clinical assessment at a minimum of 24 months postoperatively. To evaluate the reconstruction of the labral capsular ligamentous complex (LCLC), the labrum-glenoid height index (LGHI), restored labral height (LH), and labral slope (LS) were measured for both shoulders. For clinical assessment, the redislocation rate and functional outcome scores (Constant score (CS), American Shoulder and Elbow Surgeon score (ASES), Walch Duplay score (WDS), and Rowe score (RS)) were evaluated at follow-up visits. RESULTS Bankart repair with two knotless anchors showed lower values for anterior reconstruction of the LCLC compared to the uninjured contralateral shoulder. Likewise, significant differences were noted when comparing these measurements to those from patients who underwent reconstruction with three anchors. No differences were demonstrated with regard to the reconstruction of the inferior LCLC. Clinical assessment showed good to excellent results in both groups. In total, three patients experienced redislocation of the shoulder: two in group I and one in group II. No significant differences were found with respect to clinical outcomes and redislocation rates. CONCLUSION Bankart repair with both two and three knotless anchors results in effective anatomical reconstruction of the labral capsular ligamentous complex. Although the two-anchor technique yields significantly lower values for the anterior portion compared with the contralateral side, none of these differences reach clinical relevance as per our original definition.
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Affiliation(s)
- Johannes Buckup
- Department of Sports Traumatology, Knee and Shoulder Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt Am Main, Frankfurt, Germany.
- Department for Shoulder Surgery and Sports Medicine, ATOS Klinik Frankfurt Am Main, Frankfurt, Germany.
| | - Frederic Welsch
- Department of Sports Traumatology, Knee and Shoulder Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt Am Main, Frankfurt, Germany
| | - Stanislav Petchennik
- Department of Orthopaedic Surgery and Arthroplasty, Vitos Orthopaedic Clinic Kassel, Kassel, Germany
| | - Alexander Klug
- Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt Am Main, Frankfurt Am Main, Germany
| | - Yves Gramlich
- Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt Am Main, Frankfurt Am Main, Germany
| | - Reinhard Hoffmann
- Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt Am Main, Frankfurt Am Main, Germany
| | - Thomas Stein
- SPORTHOLOGICUM Frankfurt, Medical Center for Sport and Joint Injuries, Frankfurt Am Main, Germany
- Institute of Sports Sciences, Goethe University Frankfurt, Frankfurt, Germany
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Hong IS, Sonnenfeld JJ, Sicat CS, Hong RS, Trofa DP, Schiffern SC, Hamid N, Fleischli JE, Saltzman BM. Outcomes After Arthroscopic Revision Bankart Repair: An Updated Systematic Review of Recent Literature. Arthroscopy 2023; 39:438-451. [PMID: 35398484 DOI: 10.1016/j.arthro.2022.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE To provide an update of recent literature with a specialized focus on clinical outcomes following arthroscopic revision Bankart repair (ARBR) by performing a systematic review of all available literature published between 2013 and 2020. METHODS A literature search reporting clinical outcomes after ARBR was performed. Criteria for inclusion consisted of original studies; Level of Evidence of I-IV; studies focusing on clinical outcomes after ARBR published between January 1, 2013, and January 4, 2021; studies reporting recurrent dislocation or instability rate after ARBR; reoperation/revision following ARBR, return to sport rates following ARBR; and patient-reported outcomes. The primary outcomes of interest were failure defined as recurrent instability or dislocation, return to sport rates, and patient-reported outcomes at follow-up. RESULTS A large proportion of patients undergoing arthroscopic revision Bankart repair were male, ranging between 67.7% and 93.8%. Failure rate and return to sports rate ranged between 6.1% and 46.8% and 25.9% and 88.3%, respectively, when patients with significant or greater than 20% glenoid bone loss was excluded. Patient-reported outcome scores, which included American Shoulder and Elbow Surgeons, Simple Shoulder Test, and visual analog scale, saw significant improvement over mean follow-up of ranging 21.64 to 60 months. CONCLUSIONS Both the failure rate and RTS rates after ARBR had a wide range, given the heterogeneity of the studies included, which varied in patient selection criteria pertaining to patients with greater than 20% glenoid bone. Although there have been advancements in arthroscopic techniques and a trend favoring arthroscopic stabilization procedures, there is a lack of consensus in recent literature for careful patient selection criteria that would minimize failure rates and maximize RTS rates after ARBR. LEVEL OF EVIDENCE Level IV, a systematic review of Level III-IV studies.
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Affiliation(s)
- Ian S Hong
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, U.S.A.; Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, U.S.A
| | | | - Chelsea Sue Sicat
- School of Medicine, New York Medical College, Valhalla, New York, U.S.A
| | - Robin S Hong
- Schulich School of Medicine & Dentistry, Western University, Medical Sciences Building, London, Ontario, Canada
| | - David P Trofa
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, U.S.A
| | | | - Nady Hamid
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, U.S.A.; Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, U.S.A
| | - James E Fleischli
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, U.S.A.; Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, U.S.A
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, U.S.A.; Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, U.S.A..
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Lee HM, Lim JR, Lee WW, Kim SJ, Yoon TH, Chun YM. Comparison of arthroscopic primary and revision Bankart repair for capsulolabral restoration: a matched-pair analysis. Arch Orthop Trauma Surg 2022; 143:3183-3190. [PMID: 36282315 DOI: 10.1007/s00402-022-04651-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/08/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There have been no previous studies comparing serial radiologic results between primary and revision Bankart repair despite the significance of capsulolabral height and slope restoration. The purpose of this study was (1) to compare serially the height and slope of the repaired labrum in the early postoperative period among primary and revision Bankart repair groups, and (2) to compare clinical outcomes between the two groups. MATERIALS AND METHODS This study included each 24 patients who underwent arthroscopic primary Bankart repair (Group A) and revision Bankart repair (Group B) matched by age, sex, and glenoid defect ratio. Postoperative serial radiologic assessment of the repaired labral height and slope was proceeded using magnetic resonance imaging (MRI) or computed tomographic arthrography (CTA) at 3 weeks and 6 months. RESULTS There were no significant differences in labral height and slope at 3 weeks and 6 months postoperatively in Group A. However, significant reductions in labral height and slope were evident between 3 weeks and 6 months postoperatively in Group B (P < 0.05). Group A yielded superior results to Group B with respect to labral height and slope at each time point (P < 0.05) in between-group analyses. The clinical outcomes were not significantly different between the two groups except for the patients' return to their premorbid sports activity level (P = 0.024). CONCLUSIONS The height and slope of the repaired capsulolabral structures in the early postoperative period after arthroscopic revision Bankart repair group were significantly lower than those of the primary Bankart repair group. Also the reduction of labral height and slope was significant in the revision Bankart repair group over time. Nonetheless, clinical outcomes did not differ significantly except return to premorbid sports activity level at final follow-up.
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Affiliation(s)
- Hyung-Min Lee
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon-Ryul Lim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won-Woo Lee
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Jae Kim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hwan Yoon
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopaedic Surgery, Gang-Nam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Shanmugaraj A, Sakha S, Tejpal T, Leroux T, Kirsch JM, Khan M. Revision Arthroscopic Bankart Repair for Anterior Shoulder Instability After a Failed Arthroscopic Soft-Tissue Repair Yields Comparable Failure Rates to Primary Bankart Repair: A Systematic Review. HSS J 2022; 18:145-155. [PMID: 35082560 PMCID: PMC8753542 DOI: 10.1177/15563316211030606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The management of recurrent instability after arthroscopic Bankart repair remains challenging. Of the various treatment options, arthroscopic revision repairs are of increasing interest due to improved visualization of pathology and advancements in arthroscopic techniques and instrumentation. PURPOSE We sought to assess the indications, techniques, outcomes, and complications for patients undergoing revision arthroscopic Bankart repair after a failed index arthroscopic soft-tissue stabilization for anterior shoulder instability. METHODS We performed a systematic review of studies identified by a search of Medline, Embase, and PubMed. Our search range was from data inception to April 29, 2020. Outcomes include clinical outcomes and rates of complication and revision. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. Data are presented descriptively. RESULTS Twelve studies were identified, comprising 279 patients (281 shoulders) with a mean age of 26.1 ± 3.8 years and a mean follow-up of 55.7 ± 24.3 months. Patients had improvements in postoperative outcomes (eg, pain and function). The overall complication rate was 29.5%, the most common being recurrent instability (19.9%). CONCLUSION With significant improvements postoperatively and comparable recurrent instability rates, there exists a potential role in the use of revision arthroscopic Bankart repair where the glenoid bone loss is less than 20%. Clinicians should consider patient history and imaging findings to determine whether a more rigorous stabilization procedure is warranted. Large prospective cohorts with long-term follow-up and improved documentation are required to determine more accurate failure rates.
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Affiliation(s)
- Ajaykumar Shanmugaraj
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Seaher Sakha
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Tushar Tejpal
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Timothy Leroux
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jacob M Kirsch
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada,Moin Khan, MD, MSc, FRCSC, McMaster University, Hamilton, ON, Canada.
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Haskel JD, Wang KH, Hurley ET, Markus DH, Campbell KA, Alaia MJ, Millett PJ, Jazrawi LM. Clinical outcomes of revision arthroscopic Bankart repair for anterior shoulder instability: a systematic review of studies. J Shoulder Elbow Surg 2022; 31:209-216. [PMID: 34358668 DOI: 10.1016/j.jse.2021.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/12/2021] [Accepted: 06/28/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to review the literature to ascertain the functional outcomes, recurrence rates, and subsequent revision rates following revision arthroscopic Bankart repair. METHODS Two independent reviewers performed a literature search based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using the Embase, MEDLINE, and Cochrane Library databases. Studies in which arthroscopic Bankart repair was performed as a revision procedure were included. The clinical outcomes extracted and analyzed were functional outcomes, return to play, and recurrent instability. RESULTS Fourteen studies with 433 patients met the inclusion criteria. The majority of patients were male patients (63.7%); the average age was 26.1 years (range, 14-58 years), and the mean follow-up period was 37.6 months (range, 10-144 months). The mean Rowe score was 84.2, and 79.7% of patients had good to excellent outcomes. The rate of return to play was 78.5%, with 47.5% of patients returning to their preinjury level of play across 10 studies. The rate of recurrent instability was reported in 12 studies, with 328 shoulders demonstrating 86 instability events (26.2%). The rate of recurrent instability due to dislocation was reported in 7 studies (n = 176), with 19 events (10.8%), whereas the rate of subluxation was reported in 4 studies (n = 76), with 6 events (7.9%). CONCLUSIONS Revision arthroscopic Bankart repair for anterior shoulder instability was shown to result in a high rate of recurrent shoulder instability. There was a relatively poor rate of return to sport among athletes, and only about half of the patients were able to return at or above their preoperative level of ability.
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Affiliation(s)
- Jonathan D Haskel
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.
| | - Karina H Wang
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Eoghan T Hurley
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Danielle H Markus
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Kirk A Campbell
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Michael J Alaia
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | | | - Laith M Jazrawi
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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Jeon YD, Kim HS, Rhee SM, Jeong MG, Oh JH. Clinical Outcomes of Revision Arthroscopic Capsulolabral Repair for Recurrent Anterior Shoulder Instability With Moderate Glenoid Bone Defects: A Comparison With Primary Surgery. Orthop J Sports Med 2021; 9:23259671211059814. [PMID: 34938820 PMCID: PMC8685727 DOI: 10.1177/23259671211059814] [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: 08/08/2021] [Accepted: 08/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background: The optimal revision surgery for failed primary arthroscopic capsulolabral repair (ACR) has yet to be determined. Revision ACR has shown promising results. Purpose: To compare the functional, strength, and radiological outcomes of revision ACR and primary ACR for anterior shoulder instability. Study Design: Cohort study; Level of evidence, 3. Methods: Between March 2007 and April 2017, a total of 85 patients underwent ACR (revision: n = 23; primary: n = 62). Functional outcome scores and positive apprehension signs were evaluated preoperatively, at 1 year, and then annually. Isokinetic internal and external rotation strengths were evaluated preoperatively and at 1 year after surgery. Results: The mean follow-up was 36.5 ± 10.2 months (range, 24-105 months). There was no significant difference between the revision and primary groups in the glenoid bone defect size at the time of surgery (17.3% ± 4.8% vs 15.4% ± 5.1%, respectively; P = .197). At the final follow-up, no significant differences were found in the American Shoulder and Elbow Surgeons score (97.6 ± 3.1 vs 98.0 ± 6.2, respectively; P = .573), Western Ontario Shoulder Instability Index score (636.7 ± 278.1 vs 551.1 ± 305.4, respectively; P = .584), or patients with a positive apprehension sign (17.4% [4/23] vs 11.3% [7/62], respectively; P = .479) between the revision and primary groups. There was no significant difference between the revision and primary groups for returning to sports at the same preoperative level (65.2% vs 80.6%, respectively; P = .136) and anatomic healing failure at 1 year after surgery (13.0% vs 3.2%, respectively; P = .120). Both groups recovered external rotation strength at 1 year after surgery (vs before surgery), although the strength was weaker than in the uninvolved shoulder. In the revision group, a larger glenoid bone defect was significantly related to a positive apprehension sign (22.0% ± 3.8%) vs a negative apprehension sign (16.0% ± 3.2%; cutoff = 20.5%; P = .003). Conclusion: In patients with moderate glenoid bone defect sizes (10%-25%), clinical outcomes after revision ACR were comparable to those after primary ACR. However, significant glenoid bone loss was related to a positive remaining apprehension sign in the revision group. Surgeons should consider these findings when selecting their revision strategy for patients with failed anterior shoulder stabilization.
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Affiliation(s)
- Young Dae Jeon
- Department of Orthopaedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyong Suk Kim
- Department of Orthopaedic Surgery, Seoul Nalgae Hospital, Seoul, Republic of Korea
| | - Sung-Min Rhee
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Myeong Gon Jeong
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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Lau BC, Johnston TR, Gregory BP, Bejarano Pineda L, Wu M, Fletcher AN, Hu JH, Ledbetter L, Riboh JC. Outcomes After Revision Anterior Shoulder Stabilization: A Systematic Review. Orthop J Sports Med 2020; 8:2325967120922571. [PMID: 32528993 PMCID: PMC7263126 DOI: 10.1177/2325967120922571] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 02/12/2020] [Indexed: 12/24/2022] Open
Abstract
Background Primary shoulder stabilization is successful, but there continues to be a risk of recurrence after operative repair, particularly in the young athlete. It is important for surgeons to understand the outcomes after various revision stabilization techniques to best counsel patients and manage expectations. Purpose To analyze recurrent instability and revision surgery rates in patients who underwent revision anterior glenohumeral stabilization procedures with either arthroscopic repair, open repair, coracoid transfer, free bone block, or capsular reconstruction. Study Design Systematic review; Level of evidence, 4. Methods We performed a systematic review of level 2 to 4 evidence studies using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Clinical studies of revision anterior glenohumeral stabilization (arthroscopic repair, open repair, coracoid transfer, free bone block, or capsular reconstruction) with a minimum 2-year follow-up were analyzed. The rate of recurrent instability, rate of revision surgery, patient-reported outcomes, and range of motion were extracted and reported. Study methodological quality was evaluated using the Downs and Black quality assessment score. Results A total of 37 studies met inclusion criteria and were available for analysis: 20 studies evaluated arthroscopic repair, 8 evaluated open repair, 5 evaluated Latarjet procedure, 3 evaluated bone block, and 2 evaluated capsular reconstruction. There was 1 study included in both arthroscopic and Latarjet procedures, for a total of 1110 revision cases. There was 1 level 2 study, and the remainder were level 3 or 4 with poor Downs and Black scores. Participants analyzed were most commonly young (weighted mean age, 26.1 years) and male (78.4%). The weighted mean clinical follow-up after revision surgery was 47.8 months. The weighted mean rate of recurrent instability was 3.8% (n = 245) after the Latarjet procedure, 13.4% (n = 260) after open repair, 16.0% (n = 531) after arthroscopic repair, 20.8% (n = 72) after bone block, and 31.0% (n = 35) after capsular reconstruction. The weighted mean rate of additional revision surgery was 0.0% after bone block, 0.02% after the Latarjet procedure, 9.0% after arthroscopic repair, 9.3% after open repair, and 22.8% after capsular reconstruction. Patient-reported outcomes and objective measures of range of motion and strength improved with all revision techniques. Conclusion The current review identifies a deficiency in the literature pertaining to consistent meaningful outcomes and the effect of bone loss after revision shoulder stabilization. Published studies demonstrate, however, that revision shoulder stabilization using arthroscopic, open, coracoid transfer, or bone block techniques yielded satisfactory objective and patient-reported outcomes. The Latarjet procedure exhibited the lowest recurrent instability rate. This study confirms that recurrent instability remains a common problem, despite revision shoulder stabilization. The quality of research in revision shoulder stabilization remains poor, and higher quality studies are needed to establish best practices for treatment of this complex problem.
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Affiliation(s)
- Brian C Lau
- Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Tyler R Johnston
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of California at Irvine, Irvine, California, USA
| | - Bonnie P Gregory
- Division of Sports Medicine, Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Lorena Bejarano Pineda
- Division of Sports Medicine, Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mark Wu
- Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Amanda N Fletcher
- Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Jessica H Hu
- Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Leila Ledbetter
- Medical Center Library and Archives, Duke University, Durham, North Carolina, USA
| | - Jonathan C Riboh
- Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
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The arthroscopic Bankart repair procedure enables complete quantitative labrum restoration in long-term assessments. Knee Surg Sports Traumatol Arthrosc 2018; 26:3788-3796. [PMID: 29632978 DOI: 10.1007/s00167-018-4922-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The restoration of the labrum complex and the influence on secondary osteoarthritis after arthroscopic Bankart repair on magnetic resonance imaging (MRI) remain unclear. METHODS Twenty-one patients were retrospectively followed after unilateral primary arthroscopic Bankart repair with knot-tying suture anchors (8.8 ± 2.5 years after surgery, age 25.3 ± 6.3 years). Bilateral structural MRI was performed to assess labrum-glenoid restoration by measurements of the labrum slope angle, height index, and labrum interior morphology according to the Randelli classification. Osteoarthritic status was bilaterally assessed by a modified assessment based on the Samilson-Prieto classification. RESULTS MRI assessment revealed full labrum-glenoid complex restoration with equivalent parameters for anterior slope angle (mean ± SD: 21.3° ± 2.6° after Bankart repair vs. 21.9° ± 2.6° control) and height index (2.34 ± 0.4 vs. 2.44 ± 0.4), as well as the inferior slope angle (23.1° ± 2.9° vs. 23.3° ± 2.1°) and height index (2.21 ± 0.3 vs. 2.21 ± 0.3) (all n.s.). The labrum morphology showed only for the anterior labrum significant alterations (1.4 ± 0.9 vs. 0.6 ± 0.7, p < 0.05), the inferior labrum occurred similarly (1.3 ± 0.8 vs. 0.8 ± 0.5, n.s.). Osteoarthritic changes were significantly increased after Bankart repair compared to the uninjured shoulder (4.8 ± 5.1 mm vs. 2.5 ± 1.0 mm; p < 0.05), with a significant correlation of osteoarthritis status between both shoulders (p < 0.05). Scores generally decreased after Bankart repair (constant 84.6 ± 9.5 vs. 94.5 ± 4.9 control, p < 0.05; Rowe 84.5 ± 6.5 vs. 96.2 ± 4.2, p < 0.05; Walch-Duplay 82.4 ± 7.0 vs. 94.3 ± 4.0, p < 0.05) with a strong correlation with osteoarthritis status (p < 0.05). CONCLUSIONS Arthroscopic Bankart repair enabled good clinical outcomes and complete quantitative labrum restoration parameters. Next to several well-known parameters, secondary osteoarthritis after arthroscopic Bankart repair significantly correlated with osteoarthritic status of the uninjured contralateral shoulder but was not influenced by quantitative labrum restoration. The recommendation for arthroscopic Bankart repair should be based on clinical parameters and not on prevention of secondary osteoarthritis. STUDY DESIGN Case series. LEVEL OF EVIDENCE IV.
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Buckup J, Welsch F, Hoffmann R, Roessler PP, Schüttler KF, Stein T. Rotator cuff muscular integrity after arthroscopic revision of a Bankart repair. Arch Orthop Trauma Surg 2018; 138:155-163. [PMID: 29101541 DOI: 10.1007/s00402-017-2831-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Recurrent shoulder instability after arthroscopic Bankart repair is still a common complication. For primary Bankart repair studies have shown that the rotator cuff can recover completely. The ability of muscles to regenerate after arthroscopic revision Bankart repair (ARBR) has not been studied. Does the ARBR using a three-portal method allows complete muscle integrity compared with an uninjured imaging control group (ICG)? MATERIALS AND METHODS Twenty-two (1 female, 21 males) physically active patients (mean age at follow-up 28.5 ± 7.1 years; mean follow-up 27.5 months ± 8.5) were assessed. ARBR with a three-portal method was carried out in all patients according to previous primary arthroscopic stabilization of the shoulder (revision Bankart group). Muscle atrophy of the subscapularis muscle (SSC), supraspinatus muscle (SSP) and infraspinatus muscle (ISP) was assessed by making lateral and vertical measurements by magnetic resonance imaging (MRI). Fatty infiltration was detected by standardized assessment from variations in intensity. Detailed clinical examination of the rotator cuff was carried out. MRI assessment was compared with that of a control group of 22 healthy volunteers of same age and activity level (ICG). RESULTS For the SSC, no muscle impairment was noted compared with the ICG [superior atrophy index (sAISSC), p = 0.439; inferior atrophy index (iAISSC), p = 0.555; superior fatty infiltration index (sFDISSC), p = 0.294; inferior fatty infiltration index (iFDISSC), p = 0.62]. In investigation of the SSP and ISP, fatty infiltration was not shown (FDISSP, p = 0.454; sFDIISP, p = 0.504), though persistent muscle atrophy was found even > 2 years after surgery compared with the ICG (AISSP, p = 0.0025; sAIISP, p = 0.0009; iAIISP, p = 0.0004). CONCLUSION ARBR using a three-portal method allowed good muscular integrity compared with the ICG, but with persistent slight muscular atrophy of the SSP and ISP.
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Affiliation(s)
- Johannes Buckup
- Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany.
| | - Frederic Welsch
- Department of Sports traumatology, Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
| | - Reinhard Hoffmann
- Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
| | - Philip P Roessler
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany
| | - Karl F Schüttler
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Thomas Stein
- Department of Sports traumatology, Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
- Department of Sports Science, University of Bielefeld, Bielefeld, Germany
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