1
|
McMurtrie JT, Field LD. Arthroscopic Management Strategies for Glenohumeral Articular Cartilage Lesions and Defects. Arthrosc Tech 2022; 11:e1127-e1132. [PMID: 35782835 PMCID: PMC9244852 DOI: 10.1016/j.eats.2022.02.020] [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: 11/15/2021] [Accepted: 02/09/2022] [Indexed: 02/03/2023] Open
Abstract
Glenoid articular cartilage lesions are a source of shoulder pain and can occur in the setting of glenohumeral instability and degenerative shoulder disease. Glenolabral articular disruption lesions have been reported to be associated with worse outcomes after arthroscopic repair of labral tears. There are relatively few published studies evaluating outcomes after surgical treatment of glenoid articular lesions; however, it is generally accepted that management should consist of restoring the glenoid articular surface, minimizing exposed articular defect, and re-establishing capsulolabral integrity to achieve stability. We present arthroscopic strategies to manage these glenoid articular defects through debridement, abrasion, microfracture, capsulolabral advancement and labral interposition.
Collapse
Affiliation(s)
| | - Larry D. Field
- Address correspondence to Larry D. Field, M.D., Mississippi Sports Medicine and Orthopaedic Center, 1325 E. Fortification St., Jackson, MS 39202.
| |
Collapse
|
2
|
Wermers J, Schliemann B, Raschke MJ, Dyrna F, Heilmann LF, Michel PA, Katthagen JC. The Glenolabral Articular Disruption Lesion Is a Biomechanical Risk Factor for Recurrent Shoulder Instability. Arthrosc Sports Med Rehabil 2021; 3:e1803-e1810. [PMID: 34977634 PMCID: PMC8689271 DOI: 10.1016/j.asmr.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/17/2021] [Indexed: 02/07/2023] Open
Abstract
Purpose To investigate the biomechanical effect of a glenolabral articular disruption (GLAD) lesion on glenohumeral laxity. Methods Human cadaveric glenoids (n = 10) were excised of soft tissue, including the labrum to focus on the biomechanical effects of osteochondral surfaces. Glenohumeral dislocations were performed in a robotic test setup, while displacement forces and three-dimensional morphometric properties were measured. The stability ratio (SR), a biomechanical characteristic for glenohumeral stability, was used as an outcome parameter, as well as the path of least resistance, determined by a hybrid robot displacement. The impacts of chondral and bony defects were analyzed related to the intact glenoid. Statistical comparison of the defect states on SR and the path of least resistance was performed using repeated-measures ANOVA and Tukey’s post hoc test for multiple comparisons (P < .05). The relationship between concavity depth and SR was approximated in a nonlinear regression. Results The initial SR of the intact glenoid (28.3 ± 7.8%) decreased significantly by 4.7 ± 3% in case of a chondral defect (P = .002). An additional loss of 3.2 ± 2.3% was provoked by a 20% bony defect (P = .004). The path of least resistance was deflected significantly more inferiorly by a GLAD lesion (2.9 ± 1.8°, P = .002) and even more by a bony defect (2.5 ± 2.9°, P = .002). The nonlinear regression with concavity depth as predictor for the SR resulted in a high correlation coefficient (r = .81). Conclusions Chondral integrity is an important contributor to the SR. Chondral defects as present in GLAD lesions may cause increased laxity, influence the humeral track on the glenoid during dislocation, and represent a biomechanical risk factor for a recurrent instability. Clinical Relevance Cartilage deficiency corresponding to GLAD lesions may be a risk factor for impaired surgical outcomes.
Collapse
Affiliation(s)
- Jens Wermers
- University Hospital Münster, Department of Trauma, Hand, and Reconstructive Surgery, Münster, Germany
| | - Benedikt Schliemann
- University Hospital Münster, Department of Trauma, Hand, and Reconstructive Surgery, Münster, Germany
| | - Michael J Raschke
- University Hospital Münster, Department of Trauma, Hand, and Reconstructive Surgery, Münster, Germany
| | - Felix Dyrna
- University Hospital Münster, Department of Trauma, Hand, and Reconstructive Surgery, Münster, Germany
| | - Lukas F Heilmann
- University Hospital Münster, Department of Trauma, Hand, and Reconstructive Surgery, Münster, Germany
| | - Philipp A Michel
- University Hospital Münster, Department of Trauma, Hand, and Reconstructive Surgery, Münster, Germany
| | - J Christoph Katthagen
- University Hospital Münster, Department of Trauma, Hand, and Reconstructive Surgery, Münster, Germany
| |
Collapse
|
3
|
11% complications rate after Latarjet procedure at up to 14 years follow-up. Musculoskelet Surg 2021; 106:227-237. [PMID: 33469890 DOI: 10.1007/s12306-021-00697-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Evaluate complications in correlation with radiological findings after an open Latarjet procedure performed on 140 shoulders with recurrent anterior instability with follow-up from 8 to 174 months. METHODS Retrospectively, 140 shoulders, diagnosed with recurrent anterior glenohumeral instability, which were surgically treated with the open Latarjet procedure in our hospital, between January 2004 and November 2017, had been analysed. Mean age of operated patients was 29.5 years. One hundred and twenty-three patients were male (88.5%) and 16 were female (11.5%). Average length of follow-up was 110 months. Radiographs and CT scans of 16 patients with complications had been evaluated and correlations between radiological findings and observed complications had been analysed. RESULTS Complications occurred in 16 shoulders (11%). Rates of individual complications were: 1. persistent pain (9%), 2. limited ROM (7%), 3. recurrent instability (6%), 4. neurologic injury (2%), 5. persistent apprehension (2%), 6. reduced strength (2%), 7. hematoma (1%) and 8. intraoperative coracoid graft fracture (0.8%). Mean postoperative ASES score and ROWE score were statistically significantly lower in the group with complications, compared to the group without complications. Good or excellent results were reported by 87.9% patients. CONCLUSION Open Latarjet procedure is an effective and safe method for the treatment of recurrent shoulder instability, resulting in good to excellent outcomes in 87.9% of our cases. However, it is related to a higher postoperative complication rate compared to some other treatment options. Overall, very good results with high level of patient satisfaction have been demonstrated.
Collapse
|
4
|
Porcellini G, Cecere AB, Giorgini A, Micheloni GM, Tarallo L. The GLAD Lesion: are the definition, diagnosis and treatment up to date? A Systematic Review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020020. [PMID: 33559615 PMCID: PMC7944697 DOI: 10.23750/abm.v91i14-s.10987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Although GLAD lesions are quite common, only sporadic case reports describe surgical techniques and clinical outcomes. Even if cartilage defects can result from various pathogenic mechanisms, the resulting defect has some similarities with GLAD, and its management can be a starting point to treat both types of lesion. Aim of the present study is to find a commonly accepted definition for GLAD lesions in order to understand its pathogenesis, diagnosis and possible treatments. METHODS A search of PubMed (MEDLINE) database has been performed in June 2020 to identify relevant articles including a combination of the following search terms: "GlenoLabral Articular Disruption" OR "GLAD" AND "shoulder" AND "cartilage, articular". RESULTS Abstract evaluation included 31 articles in the full-text review. Various studies showed that the performance of MR arthrography in the detection of glenohumeral cartilage lesions, including GLAD lesions, was moderate. Different therapeutic solutions have been described. Arthroscopic debridement of the lesion and reattachment of the labrum have been often used. In case of large articular defects, the labrum could be advanced in the cartilage defect to cover it. In case of cartilage flap with reparable margins, this could be reattached with different suture constructs. Neglected GLAD lesions following a chronic trauma or shoulder instability have not been described in literature. CONCLUSIONS The definition of GLAD injury has changed over the time. Many authors associate this lesion with shoulder instability, with trauma in abduction and extra rotation, while Neviaser's original definition described stable shoulders following a trauma in adduction.
Collapse
Affiliation(s)
- Giuseppe Porcellini
- 1 Orthopaedic Department, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Antonio Benedetto Cecere
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, University "Campana Luigi Vanvitelli", Naples, Italy.
| | - Andrea Giorgini
- Orthopaedic Department, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | | | - Luigi Tarallo
- Orthopaedic Department, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| |
Collapse
|
5
|
Cohen M, Fonseca R, Moraes R, Pereira MR, Motta G. Arthroscopic Fixation of a Large Osteochondral Fragment From the Glenoid After First Episode Dislocation. Arthrosc Tech 2020; 9:e663-e667. [PMID: 32489842 PMCID: PMC7253778 DOI: 10.1016/j.eats.2020.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/14/2020] [Indexed: 02/03/2023] Open
Abstract
Osteochondral lesions of the glenoid are not so uncommon after traumatic cases of shoulder dislocation and can be a challenge to the shoulder surgeon because of the technical difficulty and the potential to progression to shoulder arthritis. An all-arthroscopic technique of fixation of a large osteochondral fragment is used to allow optimal visualization and reduction, minimize the morbidity of the open approach, and provide good functional results.
Collapse
Affiliation(s)
- Marcio Cohen
- Address correspondence to Marcio Cohen, National Institute of Traumatology and Orthopedics (INTO), Almirante Guilhem 127, Leblon, Rio de Janeiro, Brazil.
| | | | | | | | | |
Collapse
|
6
|
Lim JBT, Tan AHC. Intra-articular Loose Body with Concomitant Bankart Lesion after a Traumatic Shoulder Dislocation: A Case Report. J Orthop Case Rep 2017; 7:66-69. [PMID: 28819606 PMCID: PMC5553840 DOI: 10.13107/jocr.2250-0685.754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: The spectrum of pathoanatomic lesions encountered in anterior shoulder dislocation is broad. There could be a presence of loose bodies, chondral and osteochondral, in the shoulder joint and also concomitant rotator cuff partial tears resulting from acute and chronic shoulder instability. Case Report: We present one case report of a 46-year-old male Chinese with an uncommon case of Bankart lesion, with a full thickness chondral defect over the superior glenoid articular surface manifesting as a large intra-articular loose cartilaginous body. The patient presented with persistent shoulder pain with signs of shoulder instability. He underwent arthroscopic repair of his Bankart lesion with the removal of intra-articular loose body. We aim to discuss the diagnosis, radiological imaging, as well as, arthroscopic treatment of loose body in the glenohumeral joint due to anterior shoulder dislocation in our report. Conclusion: In our case report, we highlight the importance to identify other associated injuries from the history and examination after an episode of traumatic anterior shoulder dislocation. Arthroscopic treatment is a useful minimally invasive option to remove the large fragment of intra-articular loose body and also repair the Bankart lesion in the same setting. Both of these lesions must be treated as they are crucial for pain relief, as well as stabilizing the shoulder, to prevent further episodes of dislocation.
Collapse
Affiliation(s)
- Jason B T Lim
- Department of Orthopaedic Surgery, Singapore General Hospital, Academia, Level 4, Singapore 169865, Republic of Singapore
| | - Andrew H C Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Academia, Level 4, Singapore 169865, Republic of Singapore
| |
Collapse
|
7
|
Hantes M, Raoulis V. Arthroscopic Findings in Anterior Shoulder Instability. Open Orthop J 2017; 11:119-132. [PMID: 28400880 PMCID: PMC5366393 DOI: 10.2174/1874325001711010119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 04/20/2016] [Accepted: 04/20/2016] [Indexed: 01/26/2023] Open
Abstract
Background: In the last years, basic research and arthroscopic surgery, have improved our understanding of shoulder anatomy and pathology. It is a fact that arthroscopic treatment of shoulder instability has evolved considerably over the past decades. The aim of this paper is to present the variety of pathologies that should be identified and treated during shoulder arthroscopy when dealing with anterior shoulder instability cases. Methods: A review of the current literature regarding arthroscopic shoulder anatomy, anatomic variants, and arthroscopic findings in anterior shoulder instability, is presented. In addition, correlation of arthroscopic findings with physical examination and advanced imaging (CT and MRI) in order to improve our understanding in anterior shoulder instability pathology is discussed. Results: Shoulder instability represents a broad spectrum of disease and a thorough understanding of the pathoanatomy is the key for a successful treatment of the unstable shoulder. Patients can have a variety of pathologies concomitant with a traditional Bankart lesion, such as injuries of the glenoid (bony Bankart), injuries of the glenoid labrum, superiorly (SLAP) or anteroinferiorly (e.g. anterior labroligamentous periosteal sleeve avulsion, and Perthes), capsular lesions (humeral avulsion of the glenohumeral ligament), and accompanying osseous-cartilage lesions (Hill-Sachs, glenolabral articular disruption). Shoulder arthroscopy allows for a detailed visualization and a dynamic examination of all anatomic structures, identification of pathologic findings, and treatment of all concomitant lesions. Conclusion: Surgeons must be well prepared and understanding the normal anatomy of the glenohumeral joint, including its anatomic variants to seek for the possible pathologic lesions in anterior shoulder instability during shoulder arthroscopy. Patient selection criteria, improved surgical techniques, and implants available have contributed to the enhancement of clinical and functional outcomes to the point that arthroscopic treatment is considered nowadays the standard of care.
Collapse
Affiliation(s)
- Michael Hantes
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece
| | - Vasilios Raoulis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece
| |
Collapse
|
8
|
Somford MP, Nieuwe Weme RA, van Dijk CN, IJpma FFA, Eygendaal D. Are eponyms used correctly or not? A literature review with a focus on shoulder and elbow surgery. ACTA ACUST UNITED AC 2016; 21:163-71. [DOI: 10.1136/ebmed-2016-110453] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
9
|
Advanced imaging of glenohumeral instability: the role of MRI and MDCT in providing what clinicians need to know. Emerg Radiol 2016; 24:95-103. [DOI: 10.1007/s10140-016-1429-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/05/2016] [Indexed: 10/21/2022]
|
10
|
Randelli P, Cucchi D, Ingala Martini L, Fossati C. Hill-Sachs lesion is not a significant prognostic factor for recurrence of shoulder redislocation after arthroscopic Bankart repair. J ISAKOS 2016. [DOI: 10.1136/jisakos-2015-000017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
11
|
Teunis T, Lubberts B, Reilly BT, Ring D. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. J Shoulder Elbow Surg 2014; 23:1913-1921. [PMID: 25441568 DOI: 10.1016/j.jse.2014.08.001] [Citation(s) in RCA: 331] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/12/2014] [Accepted: 08/13/2014] [Indexed: 02/01/2023]
Abstract
UNLABELLED Hypothesis and background: Abnormalities of the rotator cuff are more common with age, but the exact prevalence of abnormalities and the extent to which the presence of an abnormality is associated with symptoms are topics of debate. Our aim was to review the published literature to establish the prevalence of abnormalities of the rotator cuff and to determine if the prevalence of abnormalities increases with older age in 10-year intervals. In addition, we assessed prevalence in 4 separate groups: (1) asymptomatic patients, (2) general population, (3) symptomatic patients, and (4) patients after shoulder dislocation. METHODS We searched PubMed, EMBASE, and the Cochrane Library up to February 24, 2014, and included studies reporting rotator cuff abnormalities by age. Thirty studies including 6112 shoulders met our criteria. We pooled the individual patient data and calculated proportions of patients with and without abnormalities per decade (range, younger than 20 years to 80 years and older). RESULTS Overall prevalence of abnormalities increased with age, from 9.7% (29 of 299) in patients aged 20 years and younger to 62% (166 of 268) in patients aged 80 years and older (P < .001) (odds ratio, 15; 95% confidence interval, 9.6-24; P < .001). There was a similar increasing prevalence of abnormalities regardless of symptoms or shoulder dislocation. DISCUSSION AND CONCLUSION The prevalence of rotator cuff abnormalities in asymptomatic people is high enough for degeneration of the rotator cuff to be considered a common aspect of normal human aging and to make it difficult to determine when an abnormality is new (e.g., after a dislocation) or is the cause of symptoms.
Collapse
Affiliation(s)
- Teun Teunis
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA
| | - Bart Lubberts
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA
| | - Brian T Reilly
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital-Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
12
|
Dumont GD, Fogerty S, Rosso C, Lafosse L. The arthroscopic latarjet procedure for anterior shoulder instability: 5-year minimum follow-up. Am J Sports Med 2014; 42:2560-6. [PMID: 25117728 DOI: 10.1177/0363546514544682] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The arthroscopic Latarjet procedure combines the benefits of arthroscopic surgery with the low rate of recurrent instability associated with the Latarjet procedure. Only short-term outcomes after arthroscopic Latarjet procedure have been reported. PURPOSE To evaluate the rate of recurrent instability and patient outcomes a minimum of 5 years after stabilization performed with the arthroscopic Latarjet procedure. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who underwent the arthroscopic Latarjet procedure before June 2008 completed a questionnaire to determine whether they had experienced a dislocation, subluxation, or further surgery. The patients also completed the Western Ontario Shoulder Instability Index (WOSI). RESULTS A total of 62 of 87 patients (64/89 shoulders) were contacted for follow-up. Mean follow-up time was 76.4 months (range, 61.2-100.7 months). No patients had reported a dislocation since their surgery. One patient reported having subluxations since the surgery. Thus, 1 patient (1.59%) had recurrent instability after the procedure. The mean ± standard deviation aggregate WOSI score was 90.6% ± 9.4%. Mean WOSI domain scores were as follows: Physical Symptoms, 90.1% ± 8.7%; Sports/Recreation/Work, 90.3% ± 12.9%; Lifestyle, 93.7% ± 9.8%; and Emotions, 88.7% ± 17.3%. CONCLUSION The rate of recurrent instability after arthroscopic Latarjet procedure is low in this series of patients with a minimum 5-year follow-up. Patient outcomes as measured by the WOSI are good.
Collapse
Affiliation(s)
- Guillaume D Dumont
- Department of Orthopaedic Surgery & Sports Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Simon Fogerty
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield Royal Infirmary, Huddersfield, UK
| | - Claudio Rosso
- Orthopaedic Department, University Hospital Basel and University of Basel, Basel, Switzerland
| | | |
Collapse
|