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Gupta PK, Khanna V, Agrawal N, Gupta P. Minimum 10-year follow-up outcomes of arthroscopic Bankart’s repair with metallic anchors: Reliable results with low redislocation rates. World J Methodol 2024; 14:90280. [DOI: 10.5662/wjm.v14.i2.90280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/23/2024] [Accepted: 03/14/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND With stiff competition from alternative albeit more expensive counterparts, it has become important to establish the applicability of metallic anchors for shoulder instability in the modern era. This can be accomplished, in part, by analysing long-term outcomes.
AIM To analyse minimum 10-year outcomes from 30 patients following arthroscopic anterior stabilisation using metallic anchors.
METHODS Prospectively collected data from arthroscopic Bankart repairs performed using metal anchors during 2007P-2010 were retrospectively analysed in this single-surgeon study. Comprehensive data collection included historical and clinical findings, dislocation details, operative specifics, and follow-up radiological and clinical findings including shoulder scores. The primary outcomes were patient-reported scores (Constant, American Shoulder and Elbow Surgeons [ASES], and Rowe scores) and pain and instability on a visual analogue scale (VAS).
RESULTS A 3% recurrence rate of dislocation was noted at the final follow-up. Total constant scores at 10 years postoperatively measured between 76 and 100 (mean 89) were significantly better than preoperative scores (mean 62.7). Congruous improvements were also noted in the Rowe and ASES scores and VAS at the 10-year review.
CONCLUSION Reliable long-term outcomes with metallic anchors in surgery for shoulder instability can be expected. Our results provide additional evidence of their continued, cost-effective presence in the modern scenario.
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Affiliation(s)
- Prateek Kumar Gupta
- Department of Sports Medicine, Sir Ganga Ram Hospital, New Delhi 110060, India
| | - Vishesh Khanna
- Department of Trauma and Orthopdaedics, Wirral University Teaching Hospital NHS Foundation Trust, Wirral CH49 5PE, United Kingdom
| | - Nikunj Agrawal
- Sports Medicine, Sir Ganga Ram Hospital, Sir Ganga Ram Hospital Marg, Rajinder Nagar, New Delhi 110060, India
| | - Pratyaksh Gupta
- Department of Orthopaedics, Sir Ganga Ram Hospital, New Delhi 110060, India
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Paul AV, Udoh I, Bharadwaj A, Bokshan S, Owens BD, Levine WN, Garrigues GE, Abrams JS, McMahon PJ, Miniaci A, Nagda S, Braman JP, MacDonald P, Riboh JC, Kaar S, Lau B. Preoperative planning with three-dimensional CT vs. three-dimensional magnetic resonance imaging does not change surgical management for shoulder instability. JSES Int 2024; 8:243-249. [PMID: 38464444 PMCID: PMC10920129 DOI: 10.1016/j.jseint.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background This study aims to determine the effect of time and imaging modality (three-dimensional (3D) CT vs. 3D magnetic resonance imaging (MRI)) on the surgical procedure indicated for shoulder instability. The hypothesis is there will be no clinical difference in procedure selection between time and imaging modality. Methods Eleven shoulder surgeons were surveyed with the same ten shoulder instability clinical scenarios at three time points. All time points included history of present illness, musculoskeletal exam, radiographs, and standard two-dimensional MRI. To assess the effect of imaging modality, survey 1 included 3D MRI while survey 2 included a two-dimensional and 3D CT scan. To assess the effect of time, a retest was performed with survey 3 which was identical to survey 2. The outcome measured was whether surgeons made a "major" or "minor" surgical change between surveys. Results The average major change rate was 14.1% (standard deviation: 7.6%). The average minor change rate was 12.6% (standard deviation: 7.5%). Between survey 1 to the survey 2, the major change rate was 15.2%, compared to 13.1% when going from the second to the third survey (P = .68). The minior change rate between the first and second surveys was 12.1% and between the second to third interview was 13.1% (P = .8). Discussion The findings suggest that the major factor related to procedural changes was time between reviewing patient information. Furthermore, this study demonstrates that there remains significant intrasurgeon variability in selecting surgical procedures for shoulder instability. Lastly, the findings in this study suggest that 3D MRI is clinically equivalent to 3D CT in guiding shoulder instability surgical management. Conclusion This study demonstrates that there is significant variability in surgical procedure selection driven by time alone in shoulder instability. Surgical decision making with 3D MRI was similar to 3D CT scans and may be used by surgeons for preoperative planning.
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Affiliation(s)
- Alexandra V. Paul
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Imoh Udoh
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Ananyaa Bharadwaj
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Steven Bokshan
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brett D. Owens
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - William N. Levine
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Grant E. Garrigues
- Midwest Orthopaedics at RUSH, Rush University Medical Center, Chicago, IL, USA
| | | | | | - Anthony Miniaci
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Jonathan P. Braman
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Peter MacDonald
- Orthopaedic Surgery, Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada
| | | | - Scott Kaar
- Department of Orthopaedic Surgery, Saint Louis University, St. Louis, MO, USA
| | - Brian Lau
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
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Masud S, Momtaz D, Betsch M, Migliorini F, Ghali A, Popa A, Gouveia K, Leroux T, Degen R, Khan M. A comprehensive comparison and evaluation of surgical techniques for anterior shoulder instability: a Bayesian network meta-analysis. J Shoulder Elbow Surg 2023; 32:e531-e547. [PMID: 37541334 DOI: 10.1016/j.jse.2023.07.004] [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: 12/05/2022] [Revised: 06/27/2023] [Accepted: 07/02/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Anterior shoulder instability is a common clinical problem; however, conflicting evidence exists regarding optimal treatment algorithms. We perform a comparative analysis of stabilization techniques used for recurrent anterior shoulder instability to identify the one associated with the lowest rate of recurrent instability. We additionally explore how glenoid bone loss and osseus lesions affect recurrence rates. METHODS PubMed, MEDLINE, Embase, and Cochrane databases were searched for clinical studies comparing surgical techniques for anterior shoulder instability. Two team members independently assessed all potential studies for eligibility and extracted data. Each included study underwent a risk of bias assessment using the Cochrane risk of bias summary tool. The primary outcome of interest was the rate of recurrent instability, which underwent a Bayesian network meta-analysis. Additional analyses were performed relating to the degree of glenoid bone loss and the presence of osseous lesions. RESULTS Of 2699 studies screened, 52 studies with 4209 patients were included. Patients who underwent open Latarjet demonstrated the overall lowest rate of recurrent instability [log odds ratio (LOR) 1.93], whereas patients who underwent arthroscopic Bankart repair demonstrated the highest (LOR 2.87). When glenoid bone loss was 10% to 20%, open Latarjet had significantly lower recurrent instability (P = .0016) compared to arthroscopic Bankart repair. When glenoid bone loss increased from 0%-10% to 10%-20%, arthroscopic Bankart repair had a significantly increased rate of recurrence (P = .021). In the presence of an engaging Hill-Sachs lesion, both open Latarjet (P = .01) and arthroscopic Bankart with remplissage (P = .029) had significantly reduced recurrence rates compared to arthroscopic Bankart repair. Finally, regardless of procedure, the presence of a Hill-Sachs or bony Bankart lesion was associated with an increased risk of recurrent instability (r = 0.44, P = .0003, and r = 0.40, P = .006, respectively). CONCLUSION The open Latarjet has the overall lowest recurrent instability and significantly lower compared to arthroscopic Bankart repair in the setting of increasing glenoid bone loss. Bone loss between 0% and 10% results in similar outcomes across all procedures.
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Affiliation(s)
- Saad Masud
- Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Hospital Mannheim, Medical Faculty of the University Heidelberg, Mannheim, BW, Germany
| | - Filippo Migliorini
- Department of Orthopaedics and Trauma Surgery, University Hospital RWTH Aachen, Aachen, NW, Germany
| | - Abdullah Ghali
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, USA
| | | | - Kyle Gouveia
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Timothy Leroux
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Ryan Degen
- Division of Orthopaedic Surgery, University of Western Ontario, London, ON, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada.
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Hemstock R, Sommer M, McRae S, MacDonald P, Woodmass J, Ogborn D. Characterizing the Practices of Canadian Orthopedic Surgeons in the Management of patients With Anterior Glenohumeral Instability. Clin J Sport Med 2023; 33:611-617. [PMID: 37185225 DOI: 10.1097/jsm.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 03/28/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To determine the practice patterns of Canadian orthopedic surgeons in the management of patients with anterior glenohumeral instability (AGHI). DESIGN Cross-sectional survey. SETTING Canada. PATIENTS OR OTHER PARTICIPANTS Canadian orthopedic surgeons with membership in the Canadian Orthopedic Association or Canadian Shoulder and Elbow Surgeon group who had managed at least 1 patient with AGHI in the previous year. INTERVENTIONS A survey including demographics and questions on the management of patients with AGHI was completed. Statistical comparisons (χ 2 ) were completed with responses stratified using the instability severity index score (ISIS) in practice, years of practice, and surgical volumes. MAIN OUTCOME MEASURES Summary statistics were compiled, and response frequencies were considered for consensus (75%). Case series responses were stratified on use of the ISIS in practice, years of experience, and annual procedure volumes (χ 2 , P < 0.05). RESULTS Eighty orthopedic surgeons responded, with consensus on areas of diagnostic workup of AGHI, nonoperative management, and operative techniques. There was no consensus on indications for soft tissue and bony augmentation or postoperative management. There was no difference in practices based on the use of ISIS, years in practice, or surgical volumes. CONCLUSIONS Canadian orthopedic surgeons manage AGHI consistently with consensus achieved in preoperative diagnostics and operative techniques, although debate remains as to the indications for soft tissue and bony augmentation procedures.
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Affiliation(s)
- Riley Hemstock
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
| | - Micah Sommer
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Sheila McRae
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada; and
- Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
| | - Peter MacDonald
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada; and
| | - Jarret Woodmass
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada; and
| | - Dan Ogborn
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada; and
- Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
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Carnero-Martín de Soto P, Zurita-Uroz N, Tamimi-Mariño I, Calvo-Díaz Á. Long-Term Results of Arthroscopic Bankart Repair for Anterior Glenohumeral Instability: Does Associated Postero-inferior Capsulolabral Repair Still Have a Role? Indian J Orthop 2022; 56:1906-1912. [PMID: 36310561 PMCID: PMC9561489 DOI: 10.1007/s43465-022-00701-9] [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: 01/23/2022] [Accepted: 07/05/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To compare the outcomes of arthroscopic anterior Bankart repair with and without associated postero-inferior capsulolabral repair as treatment of anterior glenohumeral instabiliy at minimun 10 year follow-up. METHODS A retrospective comparative study including patients who underwent arthroscopic anterior Bankart repair to treat anterior glenohumeral instability with glenoid bone-loss < 15% between January 2000 and February 2010 was performed. Outcomes were reported as recurrence rate, type of recurrence (dislocation or subluxation), need for revision surgery, range of motion, complications, and functional status. Outcomes were compared depending on whether a postero-inferior capsulolabral repair was added to the anterior Bankart repair. RESULTS 70 shoulders [59 males, mean age 28.2 (range 14-56), mean follow-up 146.1 (range 120-208) months] were included. Recurrence occurred in 9 cases (12.8%), including 3 dislocations and 6 subluxations. Revision surgery was needed in 8 (11.4%). Mean Rowe score improved from 29.7 (11.6) preoperatively to 87.1 (12.3) postoperatively. 83.3% returned to previous sports activities. Mean forward flexion changed from 173.5° (19.2) to 168.4º(10.4) (P < 0.01), external rotation from 81.4° (18) to 75.7° (10.5) (P < 0.01), and internal rotation decreased from 66.2% reaching T12 to 14.1% (P < 0.01). Addition of postero-inferior capsulolabral repair did not influence any of the outcomes significantly. CONCLUSION Postero-inferior capsulolabral repair added to anterior Bankart repair as treatment of anterior glenohumeral instability in abscence of significant glenoid bone-loss did not influence the outcomes in terms of recurrence, range of motion, return to sports, or functional status, compared to isolated anterior Bankart repair at 12.2 year follow-up. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Pablo Carnero-Martín de Soto
- Arthrosport Zaragoza, Avenida Ruiseñores 20, 50006 Zaragoza, Spain
- Hospital Viamed Montecanal, Calle Franz Schubert 2, 500012 Zaragoza, Spain
| | | | - Iskandar Tamimi-Mariño
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Regional Universitario de Málaga, Avenida de Carlos Haya 84, 29010 Málaga, Spain
| | - Ángel Calvo-Díaz
- Arthrosport Zaragoza, Avenida Ruiseñores 20, 50006 Zaragoza, Spain
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Klungsøyr JA, Vagstad T, Klungsøyr PJ, Hellevik AI, Drogset JO. Dynamic and Static Stabilization of Anterior Shoulder Instability With the Subscapular Sling Procedure. Arthrosc Tech 2021; 10:e1773-e1781. [PMID: 34336575 PMCID: PMC8322630 DOI: 10.1016/j.eats.2021.03.027] [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: 01/13/2021] [Accepted: 03/18/2021] [Indexed: 02/03/2023] Open
Abstract
There are numerous arthroscopic techniques available to address anterior shoulder instability. Complications are various, and in pursuit of new treatment options, an alternative arthroscopic technique with less potential for complications has been developed. The novel subscapular sling with a semitendinosus graft provides both dynamic and static stability. This procedure uses a semitendinosus graft as a sling around the upper two-thirds of the subscapular tendon, attached to the anterior glenoid rim. The sling phenomenon present in the Latarjet procedure was the basis of the development. The efficacy of the subscapular sling procedure has been verified in biomechanical studies and further investigated in a clinical pilot study. The procedure can be performed without altering the anatomy of nearby structures such as the coracoid process, the conjoined tendon, and the axillary and musculocutaneous nerves. The authors propose the arthroscopic subscapular sling procedure as an alternative to existing surgical treatment options for recurrent anterior shoulder instability.
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Affiliation(s)
- Jan Arild Klungsøyr
- Norwegian University of Science and Technology (NTNU), Faculty of Medicine and Health Sciences, Trondheim, Norway,Department of Orthopaedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway,Address correspondence to Jan Arild Klungsøyr, M.D., Department of Orthopaedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway.
| | - Terje Vagstad
- Department of Orthopaedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Peter Johannes Klungsøyr
- Department of Orthopaedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Alf Inge Hellevik
- Department of Orthopaedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Jon Olav Drogset
- Department of Orthopedic Surgery, Trondheim University Hospital and Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Minkus M, Königshausen M, Maier D, Mauch F, Stein T, Greiner S, Moursy M, Scheibel M. Immobilization in External Rotation and Abduction Versus Arthroscopic Stabilization After First-Time Anterior Shoulder Dislocation: A Multicenter Randomized Controlled Trial. Am J Sports Med 2021; 49:857-865. [PMID: 33596092 PMCID: PMC7961655 DOI: 10.1177/0363546520987823] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment of first-time shoulder dislocation (FSD) is a topic of debate. After high rates of recurrent instability after nonoperative management were reported in the literature, primary repair of FSD significantly increased. At the same time, new concepts were proposed that had promising results for immobilization in external rotation (ER) and abduction (ABD). PURPOSE The aim of this study was to evaluate the recurrence rates (primary outcome) and clinical outcomes (secondary outcome parameters) of immobilization in ER+ABD versus arthroscopic primary stabilization after FSD. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS In a multicenter randomized controlled trial, patients with FSD were randomized to either treatment with immobilization in 60° of ER plus 30° of ABD (group 1) or surgical treatment with arthroscopic Bankart repair (group 2). Clinical evaluation was performed 1, 3, and 6 weeks as well as 6, 12, and 24 months postoperatively or after reduction, including range of motion, instability testing, subjective shoulder value, Constant-Murley score, Rowe score, and Western Ontario Shoulder Instability Index. Recurrent instability events were prospectively recorded. RESULTS Between 2011 and 2017, a total of 112 patients were included in this study. Of these, 60 patients were allocated to group 1 and 52 to group 2. At the 24-month follow-up, 91 patients (81.3%) were available for clinical examination. The recurrence rate was 19.1% in group 1 and 2.3% in group 2 (P = .016). No significant differences were found between groups regarding clinical shoulder scores (P > .05). Due to noncompliance with the immobilization treatment protocol, 4 patients (6.7%) were excluded. CONCLUSION Immobilization in ER+ABD versus primary arthroscopic shoulder stabilization for the treatment of FSD showed no differences in clinical shoulder scores. However, recurrent instability was significantly higher after nonoperative treatment.
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Affiliation(s)
- Marvin Minkus
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Matthias Königshausen
- Department of Trauma Surgery and Orthopaedics, Ruhr-University Hospital Bergmannsheil Bochum, Bochum, Germany
| | - Dirk Maier
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Frieder Mauch
- Department of Shoulder and Elbow Surgery, Sportklinik Stuttgart, Stuttgart, Germany
| | - Thomas Stein
- Department of Sport Traumatology, Knee and Shoulder Surgery, Berufsgenossenschaftliche Unfallklinik, Frankfurt am Main, Germany,Department of Sports Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Mohamed Moursy
- Orthopedics & Trauma Centre, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany,Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Markus Scheibel
- Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany,Department of Shoulder and Elbow Surgery, Schulthess Clinic Zurich, Zurich, Switzerland,Markus Scheibel, MD, Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany ()
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8
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Toale JP, Hurley ET, Davey MS, Cassidy JT, Pauzenberger L, Mullett H. Return to Play after Arthroscopic Bankart Repair Combined with Open Subpectoral Biceps Tenodesis. Arthrosc Sports Med Rehabil 2020; 2:e499-e503. [PMID: 33134986 PMCID: PMC7588640 DOI: 10.1016/j.asmr.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 05/21/2020] [Indexed: 01/02/2023] Open
Abstract
Purpose To evaluate the clinical outcomes and rate of return to play (RTP) in patients who underwent arthroscopic Bankart repair and open subpectoral biceps tenodesis. Methods A retrospective review of patients who underwent combined arthroscopic Bankart repair and open subpectoral biceps tenodesis by a single surgeon between 2012 and 2016 was performed. RTP, the level of return, and the timing of return were assessed. Visual analog scale for pain, Rowe score, Shoulder Instability-Return to Sport after Injury score, and Subjective Shoulder Value were evaluated. Results The study included 14 patients, with a mean follow-up of 34.2 ± 12.1 months. Of the 14 patients, 13 (92.9%) returned to sport at a mean of 4.8 ± 1.2 months and 9 (64.3%) returned to the same or higher level of sport. At final follow-up, the mean Rowe was 80.0 ± 16.3, the mean Subjective Shoulder Value was 81.0 ± 15.1, the mean Shoulder Instability-Return to Sport after Injury was 57.3 ± 25.6, and the mean visual analog scale score was 2.6 ± 1.5. One patient had a recurrent dislocation, whereas no patients underwent a further operation on the ipsilateral shoulder. Conclusion Patients undergoing arthroscopic Bankart repair combined with open subpectoral biceps tenodesis had a high rate of RTP with a low rate of recurrent instability. Level of Evidence IV, Therapeutic Case Series.
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Affiliation(s)
- James P. Toale
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan T. Hurley
- Sports Surgery Clinic, Dublin, Ireland
- National University of Ireland Galway, Galway, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Address correspondence to Eoghan T. Hurley, M.B., B.Ch., M.Ch., Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, Ireland.
| | - Martin S. Davey
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J. Tristan Cassidy
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
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9
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Moore DM, Hurley ET, Mullett H. Current practices in the management of anterior glenohumeral instability in rugby union players. Surgeon 2020; 19:e88-e94. [PMID: 32933852 DOI: 10.1016/j.surge.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/01/2020] [Accepted: 08/12/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rugby has the highest incidence of traumatic injuries of any sport, and glenohumeral injuries result in the lengthy delay in return to play. The purpose of this study is to survey surgeons from the American Shoulder and Elbow Surgeons (ASES), and the British Elbow and Shoulder Society (BESS) to evaluate the current state of management of anterior glenohumeral instability, and compare the differences in practices. METHODS A survey of surgeons from ASES and BESS was conducted. Treatment options were proposed in a variety of clinical scenarios of glenohumeral instability. The time of immobilization post-operatively, return to play, and attitudes on current contact regulations. Results were compared using the chi-square test or t-test. RESULTS Ninety-seven surgeons responded to the survey. There was a significant difference in treatment between ASES and BESS surgeons in the setting of primary dislocation (p < 0.05), but not recurrent dislocation (p > 0.05). The period of immobilization following injury and surgery was different between both treating groups. There was a significant difference in return to play between ASES and BESS surgeons with arthroscopic stabilization and open Bankart repair (p < 0.05), but not following conservative treatment or the Latarjet procedure (p > 0.05). CONCLUSIONS There remains wide variance on the management of glenohumeral instability in rugby union players among surgeons. While immobilization times post-operatively were similar, the BESS surgeons were more confident in allowing earlier return to play. There is also a significant concern that contact levels should be regulated to protect player safety. LEVEL OF EVIDENCE Level 4 (case series).
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Affiliation(s)
- David M Moore
- Sports Surgery Clinic, Northwood Avenue, Santry Demesne, Dublin 9, Ireland; Royal College of Surgeons in Ireland, Department of Trauma & Orthopaedic Surgery, 123 St. Stephens Green, Dublin 2, Ireland.
| | - Eoghan T Hurley
- Sports Surgery Clinic, Northwood Avenue, Santry Demesne, Dublin 9, Ireland; Royal College of Surgeons in Ireland, Department of Trauma & Orthopaedic Surgery, 123 St. Stephens Green, Dublin 2, Ireland
| | - Hannan Mullett
- Sports Surgery Clinic, Northwood Avenue, Santry Demesne, Dublin 9, Ireland
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10
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Panzram B, Kentar Y, Maier M, Bruckner T, Hetto P, Zeifang F. Mid-term to long-term results of primary arthroscopic Bankart repair for traumatic anterior shoulder instability: a retrospective study. BMC Musculoskelet Disord 2020; 21:191. [PMID: 32220253 PMCID: PMC7102425 DOI: 10.1186/s12891-020-03223-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 03/19/2020] [Indexed: 01/26/2023] Open
Abstract
Background The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. The aim of the study is to determine the mid−/long-term functional outcome, failure rates and predictors of failure after primary arthroscopic Bankart repair for traumatic anterior shoulder instability. Methods A total of 100 patients were primarily operated using arthroscopic Bankart repair after traumatic anterior shoulder instability. Medical records were retrospectively reviewed, and patients were assessed using postal questionnaire after a mean follow-up of 8.3 years [3–14]. Clinical assessment was performed using Constant score, Rowe score, and American Shoulder and Elbow Surgeons score. Results The overall recurrence rate was 22%. The Kaplan-Meier failure-free survival estimates. were 80% at 5 years and 70% at 10 years. Nearly half (54.5%) of recurrences occurred at 2 years postoperative. Compared with normal shoulder, there were statistical differences in all 3 scores. Failure rate was significantly affected by age at the time of surgery with 86% of recurrence cases observed in patients aged 30 years or younger. Nevertheless, Younger age at the time of surgery (P = 0.007) as well age at the time of initial instability (P = 0.03) was found to correlate negatively with early recurrence within 2 years of surgery. Among those with recurrent instability, recurrence rate was found to be higher if there had been more than 5 instability episodes preoperatively (P = 0.01). Return to the preinjury sport and occupational level was possible in 41 and 78%, respectively. Conclusion Failure-free survival rates dropped dramatically over time. Alternative reconstruction techniques should be considered in those aged ≤30 years due to the high recurrence rate.
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Affiliation(s)
- Benjamin Panzram
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany. .,Heidelberg University Hospital, Clinic for Orthopaedics and Trauma Surgery, Schlierbacher Landstraße 200A, 69118, Heidelberg, Germany.
| | - Yasser Kentar
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Michael Maier
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Pit Hetto
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
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11
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Abstract
Background The Latarjet procedure is an established and popular procedure for recurrent anterior shoulder instability; however, to our knowledge, few studies have reported on the outcomes of revision for failed Latarjet surgery. We reviewed the causes and management of recurrent instability after previous Latarjet stabilization surgery. The outcomes of revision surgery were also evaluated. Methods A retrospective analysis of prospective data in patients undergoing revision surgery after failed Latarjet stabilization was conducted. Data were collected over a 5-year period and included patient demographics, clinical presentation, cause of recurrent instability, indications for revision surgery, intraoperative analysis, outcomes of revision surgery, and return to sport. Results We identified 16 patients (12 male and 4 female patients) who underwent revision surgery for recurrent instability after Latarjet stabilization. Of these patients, 11 were athletes: 9 professional and 2 amateur athletes. The mean age at revision was 29.9 ± 8.9 years (range, 17-50 years). The indications for revision were anterior instability in 11 patients, posterior instability in 4, and both anterior and posterior instability in 1. Of the anterior instability cases, 54.5% were due to coracoid nonunion and 36.4% were due to capsular failure (retear). All posterior instability cases had posterior capsulolabral injuries, and the mean Beighton score in this group was 6 or higher. One patient had a failed Latarjet procedure with coracoid nonunion and a posterior labral tear. Conclusion Coracoid nonunion was the most common cause of recurrence after Latarjet stabilization, requiring an Eden-Hybinette procedure. The patients who returned with posterior instability had a high incidence of hypermobility and could be treated successfully by arthroscopic techniques.
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Affiliation(s)
- Umair Khan
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,The Arm Clinic, The Wilmslow Hospital, Wilmslow, UK
| | - Emma Torrance
- The Arm Clinic, The Wilmslow Hospital, Wilmslow, UK.,School of Health Sciences, University of Salford, Salford, UK
| | - Mohammad Hussain
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,The Arm Clinic, The Wilmslow Hospital, Wilmslow, UK
| | - Lennard Funk
- The Arm Clinic, The Wilmslow Hospital, Wilmslow, UK.,School of Health Sciences, University of Salford, Salford, UK.,Wrightington Hospital, Wigan, UK
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12
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Kitagawa T, Matsui N, Nakaizumi D. Impact of combination of therapeutic exercise and psychological intervention for a patient with first-time traumatic shoulder dislocation. J Phys Ther Sci 2019; 31:850-854. [PMID: 31645818 PMCID: PMC6801349 DOI: 10.1589/jpts.31.850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/04/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] A young female with first-time traumatic shoulder dislocation showed a good
outcome at the 1 year follow-up in returning to work and sports after undergoing a
combination of exercise therapy and psychological intervention. [Participant and Methods]
A 24-year-old female who worked as an occupational therapist and played badminton for
recreation had dislocated her shoulder in a fall. We evaluated her compliance with
home-exercise, range of motion, return to work, fear of movement, sports activity level,
and instability of shoulder joint using the modified Rowe score at each timepoint
necessary. During early sessions of the physical therapy, the range of motion and
instability score for the shoulder joint were poor. We treated her using a phase-based
approach, and subsequently, added the Watson program to restore normal kinematics. Because
of a psychological problem during middle sessions of the physical therapy, we provided
psychological education and support. [Results] At the final session of the therapy, her
compliance with home-exercise was good. She had achieved almost a full range of motion.
The fear of movement decreased, and she could play sports again. The modified Rowe score
improved from 5 to 85. [Conclusion] As a conservative treatment for patients with
first-time traumatic shoulder instability, a combination of therapeutic exercise and
psychological intervention may be useful.
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Affiliation(s)
- Takashi Kitagawa
- Department of Physical Therapy, School of Health Sciences, Shinshu University: 3-1-1 Asahi, Matsumoto, Nagano 390-8621 Japan
| | - Nobumasa Matsui
- Department of Rehabilitation, Japanese Red Cross Kanazawa Hospital, Japan
| | - Dai Nakaizumi
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, Japan
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13
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Prada C, Bhandari M. Cochrane in CORR®: Conservative Management Following Closed Reduction of Traumatic Anterior Dislocation of the Shoulder. Clin Orthop Relat Res 2019; 477:1984-1990. [PMID: 31415013 PMCID: PMC7000072 DOI: 10.1097/corr.0000000000000907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/05/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Carlos Prada
- C. Prada, M. Bhandari, Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON Canada, Centre for Evidence-Based Orthopaedics, 293 Wellington St. N, Suite 110, Hamilton, ON L8L 8E7 Canada
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14
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Braun C, McRobert CJ. Conservative management following closed reduction of traumatic anterior dislocation of the shoulder. Cochrane Database Syst Rev 2019; 5:CD004962. [PMID: 31074847 PMCID: PMC6510174 DOI: 10.1002/14651858.cd004962.pub4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Acute anterior shoulder dislocation, which is the most common type of dislocation, usually results from an injury. Subsequently, the shoulder is less stable and is more susceptible to re-dislocation or recurrent instability (e.g. subluxation), especially in active young adults. After closed reduction, most of these injuries are treated with immobilisation of the injured arm in a sling or brace for a few weeks, followed by exercises. This is an update of a Cochrane Review first published in 2006 and last updated in 2014. OBJECTIVES To assess the effects (benefits and harms) of conservative interventions after closed reduction of traumatic anterior dislocation of the shoulder. These might include immobilisation, rehabilitative interventions or both. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, PEDro and trial registries. We also searched conference proceedings and reference lists of included studies. Date of last search: May 2018. SELECTION CRITERIA We included randomised or quasi-randomised controlled trials comparing conservative interventions with no treatment, a different intervention or a variant of the intervention (e.g. a different duration) for treating people after closed reduction of a primary traumatic anterior shoulder dislocation. Inclusion was regardless of age, sex or mechanism of injury. Primary outcomes were re-dislocation, patient-reported shoulder instability measures and return to pre-injury activities. Secondary outcomes included participant satisfaction, health-related quality of life, any instability and adverse events. DATA COLLECTION AND ANALYSIS Both review authors independently selected studies, assessed risk of bias and extracted data. We contacted study authors for additional information. We pooled results of comparable groups of studies. We assessed risk of bias with the Cochrane 'Risk of bias' tool and the quality of the evidence with the GRADE approach. MAIN RESULTS We included seven trials (six randomised controlled trials and one quasi-randomised controlled trial) with 704 participants; three of these trials (234 participants) are new to this update. The mean age across the trials was 29 years (range 12 to 90 years), and 82% of the participants were male. All trials compared immobilisation in external rotation (with or without an additional abduction component) versus internal rotation (the traditional method) following closed reduction. No trial evaluated any other interventions or comparisons, such as rehabilitation. All trials provided data for a follow-up of one year or longer; the commonest length was two years or longer.All trials were at some risk of bias, commonly performance and detection biases given the lack of blinding. Two trials were at high risk of selection bias and some trials were affected by attrition bias for some outcomes. We rated the certainty of the evidence as very low for all outcomes.We are uncertain whether immobilisation in external rotation makes a difference to the risk of re-dislocation after 12 months' or longer follow-up compared with immobilisation in internal rotation (55/245 versus 73/243; risk ratio (RR) 0.67, 95% confidence interval (CI) 0.38 to 1.19; 488 participants; 6 studies; I² = 61%; very low certainty evidence). In a moderate-risk population with an illustrative risk of 312 per 1000 people experiencing a dislocation in the internal rotation group, this equates to 103 fewer (95% CI 194 fewer to 60 more) re-dislocations after immobilisation in external rotation. Thus this result covers the possibility of a benefit for each intervention.Individually, the four studies (380 participants) reporting on validated patient-reported outcome measures for shoulder instability at a minimum of 12 months' follow-up found no evidence of a clinically important difference between the two interventions.We are uncertain of the relative effects of the two methods of immobilisation on resumption of pre-injury activities or sports. One study (169 participants) found no evidence of a difference between interventions in the return to pre-injury activity of the affected arm. Two studies (135 participants) found greater return to sports in the external rotation group in a subgroup of participants who had sustained their injury during sports activities.None of the trials reported on participant satisfaction or health-related quality of life.We are uncertain whether there is a difference between the two interventions in the number of participants experiencing instability, defined as either re-dislocation or subluxation (RR 0.84, 95% CI 0.62 to 1.14; 395 participants, 3 studies; very low certainty evidence).Data on adverse events were collected only in an ad hoc way in the seven studies. Reported "transient and resolved adverse events" were nine cases of shoulder stiffness or rigidity in the external rotation group and two cases of axillary rash in the internal rotation group. There were three "important" adverse events: hyperaesthesia and moderate hand pain; eighth cervical dermatome paraesthesia; and major movement restriction between 6 and 12 months. It was unclear to what extent these three events could be attributed to the treatment. AUTHORS' CONCLUSIONS The available evidence from randomised trials is limited to that comparing immobilisation in external versus internal rotation. Overall, the evidence is insufficient to draw firm conclusions about whether immobilisation in external rotation confers any benefit over immobilisation in internal rotation.Considering that there are several unpublished and ongoing trials evaluating immobilisation in external versus internal rotation, the main priority for research on this question consists of the publication of completed trials and the completion and publication of ongoing trials. Meanwhile, evaluation of other interventions, including rehabilitation, is warranted. There is a need for sufficiently large, good-quality, well-reported randomised controlled trials with long-term follow-up. Future research should aim to determine the optimal immobilisation duration, precise indications for immobilisation, optimal rehabilitation interventions, and the acceptability of these different interventions.
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Affiliation(s)
- Cordula Braun
- Medical Center ‐ University of FreiburgInstitute for Evidence in Medicine (for Cochrane Germany Foundation)Breisacher Str. 153FreiburgGermany79110
| | - Cliona J McRobert
- Institute of Clinical Sciences, University of LiverpoolSchool of Health SciencesBrownlow HillLiverpoolMerseysideUKL69 3GB
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15
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Kavaja L, Lähdeoja T, Malmivaara A, Paavola M. Treatment after traumatic shoulder dislocation: a systematic review with a network meta-analysis. Br J Sports Med 2018; 52:1498-1506. [PMID: 29936432 PMCID: PMC6241619 DOI: 10.1136/bjsports-2017-098539] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 05/08/2018] [Accepted: 05/16/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To review and compare treatments (1) after primary traumatic shoulder dislocation aimed at minimising the risk of chronic shoulder instability and (2) for chronic post-traumatic shoulder instability. DESIGN Intervention systematic review with random effects network meta-analysis and direct comparison meta-analyses. DATA SOURCES Electronic databases (Ovid MEDLINE, Cochrane Clinical Trials Register, Cochrane Database of Systematic Reviews, Embase, Scopus, CINAHL, Ovid MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily, DARE, HTA, NHSEED, Web of Science) and reference lists were searched from inception to 15 January 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised trials comparing any interventions either after a first-time, traumatic shoulder dislocation or chronic post-traumatic shoulder instability, with a shoulder instability, function or quality of life outcome. RESULTS Twenty-two randomised controlled trials were included. There was moderate quality evidence suggesting that labrum repair reduced the risk of future shoulder dislocation (relative risk 0.15; 95% CI 0.03 to 0.8, p=0.026), and that with non-surgical management 47% of patients did not experience shoulder redislocation. Very low to low-quality evidence suggested no benefit of immobilisation in external rotation versus internal rotation. There was low-quality evidence that an open procedure was superior to arthroscopic surgery for preventing shoulder redislocations. CONCLUSIONS There was moderate-quality evidence that half of the patients managed with physiotherapy after a first-time traumatic shoulder dislocation did not experience recurrent shoulder dislocations. If chronic instability develops, surgery could be considered. There was no evidence regarding the effectiveness of surgical management for post-traumatic chronic shoulder instability.
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Affiliation(s)
- Lauri Kavaja
- Medical Faculty, University of Helsinki, Helsinki, Finland
- Department of Surgery, South Carelia Central Hospital, Lappeenranta, Finland
| | - Tuomas Lähdeoja
- Medical Faculty, University of Helsinki, Helsinki, Finland
- Finnish Center of Evidence-based Orthopaedics (FICEBO), University of Helsinki, Helsinki, Finland
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Töölö Hospital, Helsinki, Finland
| | - Antti Malmivaara
- Centre for Health and Social Economics, Institute of Health and Welfare, Helsinki, Finland
- Orton Orthopaedic Hospital and Orton Research Institute, Orton Foundation, Helsinki, Finland
| | - Mika Paavola
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Töölö Hospital, Helsinki, Finland
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16
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Mid-term clinical results of an arthroscopic glenoid rim reconstruction technique for recurrent anterior shoulder instability. Arch Orthop Trauma Surg 2018; 138:1557-1562. [PMID: 29948225 DOI: 10.1007/s00402-018-2964-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Glenoid bone loss in recurrent anterior instability of the shoulder needs to be addressed to restore joint stability. Over the last years, several arthroscopic methods have been described to treat this condition. However, no clinical mid-term results have been presented for arthroscopic iliac crest bone grafting procedures. METHODS We included 32 patients with significant glenoid bone loss and repetitive dislocations of the shoulder who were treated in our shoulder unit with a previously described all-arthroscopic reconstruction technique. All patients filled out a questionnaire evaluating repetitive dislocations, consumption of pain medicine, Constant Score (CS, adapted to age and gender), activities of daily living (ADL), visual analogue scale for pain (VAS) as well as the Western Ontario Shoulder Instability Index (WOSI). Additionally, all complications were recorded. RESULTS After a mean follow-up of 42 months, three traumatic dislocations had been observed. With an ADL of 25 points (95% CI 24-27), a WOSI of 71% (95% CI 65-76) and CS of 87 points (95% CI 82-92), our patients showed good functional results. The VAS result for pain was 2.1 (95% CI 1.5-2.6). No patient reported the regular usage of pain medicine related to the shoulder instability at final follow-up. CONCLUSION The all-arthroscopic glenoid reconstruction using iliac crest grafts shows good functional results with a recurrence rate of 9%. At final follow-up 42 months after surgery, our patients showed low pain levels and acceptable complications.
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17
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Wang SI. Management of the First-time Traumatic Anterior Shoulder Dislocation. Clin Shoulder Elb 2018; 21:169-175. [PMID: 33330172 PMCID: PMC7726393 DOI: 10.5397/cise.2018.21.3.169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/28/2018] [Accepted: 07/30/2018] [Indexed: 11/25/2022] Open
Abstract
Traumatic anterior dislocation of the shoulder is one of the most common directions of instability following a traumatic event. Although the incidence of shoulder dislocation is similar between young and elderly patients, most studies have traditionally focused on young patients due to relatively high rates of recurrent dislocations in this population. However, shoulder dislocations in older patients also require careful evaluation and treatment selection because they can lead to persistent pain and disability due to rotator cuff tears and nerve injuries. This article provides an overview of the nature and pathology of acute primary anterior shoulder dislocation, widely accepted management modalities, and differences in treatment for young and elderly patients.
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Affiliation(s)
- Sung Il Wang
- Department of Orthopaedic Surgery, Chonbuk National University Medical School, Research Insitute for Endocrine Sciences and Research Insitute of Clinical Medicine of Chonbuk National University-Biomedical Research Insitute of Chonbuk National University Hospital, Jeonju, Korea
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18
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Konrads C, Jovic S, Rueckl K, Fenwick A, Barthel T, Rudert M, Plumhoff P. Surgical technique and clinical outcome of arthroscopic shoulder stabilization via suture anchors using the lasso-loop stitch. J Orthop 2018; 15:553-557. [PMID: 29881192 DOI: 10.1016/j.jor.2018.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/06/2018] [Indexed: 12/21/2022] Open
Abstract
During arthroscopic Bankart-repair the lasso-loop-stitch can be used. The clinical outcome of this technical modification to a broadly used procedure is not known. We followed-up 24 patients treated with this technique over 30 months. We found an excellent clinical outcome in 96% of all cases. The average Rowe-score was 96.3 points. The mean QuickDash was 2.8 points. Using the lasso-loop-stitch in arthroscopic Bankart-repair is safe and results in very good clinical outcomes. It might lead to an accentuated labral bump and enables secure knot-tying with knot-positioning away from the articular cartilage while avoiding the suture cutting through the tissue.
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Affiliation(s)
- Christian Konrads
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, Center of Musculoskeletal Research, University of Wuerzburg, Wuerzburg, Germany.,Department of Orthopaedic Trauma, Institute of Trauma Research, BG Trauma Center Tuebingen, University Medical Center Tuebingen, Tuebingen, Germany
| | - Sebastian Jovic
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, Center of Musculoskeletal Research, University of Wuerzburg, Wuerzburg, Germany
| | - Kilian Rueckl
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, Center of Musculoskeletal Research, University of Wuerzburg, Wuerzburg, Germany
| | - Annabel Fenwick
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, Center of Musculoskeletal Research, University of Wuerzburg, Wuerzburg, Germany
| | - Thomas Barthel
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, Center of Musculoskeletal Research, University of Wuerzburg, Wuerzburg, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, Center of Musculoskeletal Research, University of Wuerzburg, Wuerzburg, Germany
| | - Piet Plumhoff
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, Center of Musculoskeletal Research, University of Wuerzburg, Wuerzburg, Germany
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Frank RM, Chalmers PN, Moric M, Leroux T, Provencher MT, Romeo AA. Incidence and Changing Trends of Shoulder Stabilization in the United States. Arthroscopy 2018; 34:784-792. [PMID: 29225018 DOI: 10.1016/j.arthro.2017.08.289] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/16/2017] [Accepted: 08/16/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the incidence and demographic characteristics of shoulder stabilization in the United States, with particular focus on age, sex, and inpatient versus outpatient treatment. METHODS The National Hospital Discharge Survey and the National Survey of Ambulatory Surgery databases were searched using a combination of International Classification of Diseases, Ninth Revision diagnosis and procedure codes, encompassing open and arthroscopic shoulder stabilization procedures. Incidence was determined using National Survey of Ambulatory Surgery, National Hospital Discharge Survey, and US census data, and the results were stratified by age, sex, facility, and concomitant diagnoses. Data were analyzed between 1994 and 2006, the most recent year for which data are available within these sources. RESULTS The incidence of shoulder stabilization in the United States was 5.84 per 100,000 person-years (n = 15,514; 95% confidence interval, 11,975-19,053) in 1994 to 1996 and 6.89 per 100,000 person-years (n = 20,588; 95% confidence interval, 16,254-24,922) in 2006 (P = .0697). The number of inpatient procedures decreased significantly whereas the number of outpatient procedures increased significantly over the same period (P < .0001 for both). The incidence of stabilization increased in patients aged 45 to 64 years (P < .0001) and patients aged 65 years or older (P = .0008) but was unchanged in patients aged 44 years or younger (P = .4745). The average age of patients undergoing stabilization increased over the study period, from 30 years to 47 years for inpatients (P = .01) and from 27 years to 34 years for ambulatory patients (P = .05). The incidence of stabilization increased significantly in male patients (P = .0075) but remained stable in female patients (P = .8057) over the same period. Diagnoses related to rotator cuff pathology and shoulder derangement were the most common concurrent diagnosis codes. CONCLUSIONS The overall incidence of shoulder stabilization in the United States is 6.89 per 100,000 person-years. The incidence increased by 18% between 1994 and 2006. During the study period, shoulder stabilization shifted to become a largely outpatient procedure, and the average age increased significantly. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Rachel M Frank
- CU Sports Medicine, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, U.S.A..
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Farmington, Utah, U.S.A
| | - Mario Moric
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Timothy Leroux
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Anthony A Romeo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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20
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Abstract
PURPOSE OF REVIEW The purpose of this review is to outline the natural history and best clinical practices for nonoperative management of anterior shoulder instability. RECENT FINDINGS Recent studies continue to demonstrate a role for nonoperative treatment in the successful long-term management of anterior glenohumeral instability. The success of different positions of shoulder immobilization is reviewed as well. There are specific patients who may be best treated with nonoperative means after anterior glenohumeral instability. There are also patients who are not good nonoperative candidates based on a number of factors that are outlined in this review. There continues to be no definitive literature regarding the return to play of in-season athletes. Successful management requires a thorough understanding of the epidemiology, pathoanatomy, history, physical examination, diagnostic imaging modalities, and natural history of operative and nonoperative treatment.
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21
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Anthony J, Varughese I, Glatt V, Tetsworth K, Hohmann E. Influence of the Labrum on Version and Diameter of the Glenoid: A Morphometric Study Using Magnetic Resonance Images. Arthroscopy 2017; 33:1442-1447. [PMID: 28412061 DOI: 10.1016/j.arthro.2017.01.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 01/17/2017] [Accepted: 01/25/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To use magnetic resonance imaging to determine the influence of the labrum on both the osseous version and effective diameter of the glenoid. METHODS This was a retrospective, cross-sectional study of patients with shoulder pain who underwent MRI between February 2014 and February 2015. The morphology of the glenoid labrum and glenoid was scanned with a 3-T magnetic resonance imaging scanner, and variables were measured by use of IntelliSpace PACS Enterprise. Patients were included if they were aged between 18 and 40 years and the radiologist reported a normal glenohumeral joint or if they were young patients aged less than 30 years with acute traumatic isolated partial- or full-thickness tears of the rotator cuff with a history of symptoms of less than 3 months. A pilot study was conducted with 3 observers and 3 repeated measurements at intervals to determine the interobserver and intraobserver reliability. Data analysis included descriptive statistics of measured variables, as well as paired Student t tests to determine the relative difference between labral and osseous morphometric variables. RESULTS Excellent inter-rater reliability (0.95-0.96) and intrarater reliability (0.93-0.98) were obtained in the pilot study of 20 patients. The study population was composed of 100 patients with a mean age of 37.3 years (standard deviation [SD], 11.8 years), having a gender distribution of 56 male and 44 female patients; there were 53 right and 47 left shoulders. The glenoid osseous version measured -5.7° (SD, 5.3°), and the labral version measured -10° (SD, 5.5°); the glenoid osseous diameter measured 28.0 mm (SD, 3.3 mm), and the labral diameter measured 31.9 mm (SD, 3.2 mm). The labrum significantly increased the version by 4.3° (P = .001) and significantly increased the diameter by 3.9 mm (P = .001). CONCLUSIONS The results of this study showed that the labrum increased the effective glenoid version by 75% (4.3° of retroversion) and the effective glenoid diameter by 14% (3.9 mm). LEVEL OF EVIDENCE Level IV, prognostic case series.
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Affiliation(s)
- Joyce Anthony
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Ibin Varughese
- Department of Orthopaedic Surgery, The Prince Charles Hospital, Chermside, Australia
| | - Vaida Glatt
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia; Department of Surgery, School of Medicine, University of Queensland, Brisbane, Australia; Queensland University of Technology, Brisbane, Australia; Orthopaedic Research Institute of Australia, Sydney, Australia
| | - Erik Hohmann
- Department of Orthopaedic Surgery, Clinical Medical School, University of Queensland, Brisbane, Australia.
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