1
|
Adolfsson L. What keeps a shoulder stable - Is there an ideal method for anterior stabilisation? Shoulder Elbow 2024; 16:4-7. [PMID: 38435031 PMCID: PMC10902409 DOI: 10.1177/17585732231224699] [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: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 03/05/2024]
Abstract
The gleno-humeral joint is by far the most mobile in the human body but also afflicted by dislocations, predominantly anterior. Surgical stabilisation is often successful but failures not uncommon. The following review describes potential causes of failure and highlights the need of adapting surgical methods to pathomorphology.
Collapse
Affiliation(s)
- Lars Adolfsson
- Department of Orthopedics, Linköping and Örebro Universities, Linkoping, Sweden
| |
Collapse
|
2
|
Rhee SM, Youn SM, Lee JU, Kim CH, Kim SY, Ham HJ, Rhee YG. Posterior Compression Test: a Provocative Test for Detecting Posterior Labral Tears. Indian J Orthop 2024; 58:48-55. [PMID: 38161393 PMCID: PMC10754776 DOI: 10.1007/s43465-023-01028-9] [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: 08/27/2023] [Accepted: 10/15/2023] [Indexed: 01/03/2024]
Abstract
Purpose The purpose is to assess the diagnostic accuracy of a provocative test coined as the 'posterior compression test' (PCT) in those with the suspected posterior labral tear or lesion. Methods A total of 515 'arthroscopic labral repairs' were identified between April 2013 and September 2020. Excluding those with concomitant shoulder pathologies, and only including those with pre-operative documentation of the PCT and/or the Jerk test, 191 patients were included. For the purposes of the analyses, the patients were divided into 'non-posterior' labral tear group which included the anterior labral tears and/or the superior labral anterior-to-posterior (SLAP) tears, versus 'any posterior' labral tear group which included the isolated posterior labral tears, the SLAP tears with posterior extension and the pan-labral tears. Results When the PCT was performed for the isolated posterior labral tears, the sensitivity was 92.6% with the specificity of 86.5%. The positive predictive value and negative predictive value were 71.4-97%, respectively. The Jerk test's sensitivity was 77.8% but when the two tests were combined, the sensitivity increased up to 96.3%. The combined sensitivity with the Jerk test was still up to 94.6% with the AUC (area under curve) /ROC (receiver operator characteristic) at 0.855. Low 'false-positive' rate with the PCT was observed when the test was performed for the 'non-posterior' labral group, with the sensitivity of 13.5%. Conclusions The posterior compression test correlated well with the arthroscopic diagnoses in a subset of patients with suspected posterior labral pathology, possibly by means of direct stimulation. Level of Evidence III; Diagnostic Study.
Collapse
Affiliation(s)
- Sung Min Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Seung Min Youn
- The Department of Orthopaedic Surgery, Royal Brisbane and Women’s Hospital, Butterfield St, Herston, QLD Australia
| | - Jong Ung Lee
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-Dong, Deokyang-Gu, Goyang-Si, Gyeonggi-Do, 10475 Korea
| | - Cheol Hwan Kim
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-Dong, Deokyang-Gu, Goyang-Si, Gyeonggi-Do, 10475 Korea
| | - Se Yeon Kim
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-Dong, Deokyang-Gu, Goyang-Si, Gyeonggi-Do, 10475 Korea
| | - Hyun Joo Ham
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-Dong, Deokyang-Gu, Goyang-Si, Gyeonggi-Do, 10475 Korea
| | - Yong Girl Rhee
- Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-Dong, Deokyang-Gu, Goyang-Si, Gyeonggi-Do, 10475 Korea
| |
Collapse
|
3
|
Reiter CR, Satalich JR, Johnson MA, Nelson CT, Cyrus JW, Vap AR. Surgical Outcomes and Associated Injuries of Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) Lesions: A Systematic Review. Orthop Rev (Pavia) 2023; 15:74255. [PMID: 37091317 PMCID: PMC10115448 DOI: 10.52965/001c.74255] [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] [Indexed: 04/25/2023] Open
Abstract
Introduction Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) lesions can lead to chronic shoulder instability and repetitive dislocations in active populations. Objective The purpose of this systematic review was to evaluate associated injuries and postoperative outcomes following ALPSA lesion repairs. Methods Medline, Embase, Cochrane, and Web of Science were searched through May 2022 for studies that investigated management and surgical outcomes of ALPSA lesion repair. Data was extracted on the following topics: surgical management, surgical complications, associated injuries, follow-up duration, and outcome parameters, including recurrence rates, functional outcome scores, range-of-motion (ROM), and return to activity. Results A total of 6 studies covering 202 patients met the inclusion criteria. In the included studies, 79% of patient were male with a mean age of 25.1 years. A total of 192 associated injuries were reported amongst 176 patients with the most common being Hill Sachs lesions (84, 43.8%), synovitis (35, 18.2%), SLAP tears (32, 16.7%) and glenoid erosions or lesions (30, 15.6%). All 202 patients were treated arthroscopically with no reported complications. 26 patients (12.9%) experienced operative failure as evidenced by recurrence of shoulder instability over a mean follow-up of 4.3 years. Various clinical outcome scores showed postoperative functional improvement and one study reported a 100% return to activity rate in 26 patients. Conclusion Our findings suggest a high 12.9 % risk of recurrence following ALPSA repair but satisfactory functional outcomes, both of which should be weighed by physicians when considering arthroscopic repair. Physicians should also be cognizant of co-pathologies when examining patients with suspected ALPSA lesions.
Collapse
|
4
|
Grundshtein A, Kazum E, Chechik O, Dolkart O, Rath E, Bivas A, Maman E. Arthroscopic Repair of Humeral Avulsion of Glenohumeral Ligament Lesions: Outcomes at 2-Year Follow-up. Orthop J Sports Med 2021; 9:23259671211004968. [PMID: 34350297 PMCID: PMC8287368 DOI: 10.1177/23259671211004968] [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: 01/24/2021] [Accepted: 02/24/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Humeral avulsion of the glenohumeral ligament (HAGL) is an uncommon condition but a major contributor to shoulder instability and functional decline. Purpose: To describe the pre- and postoperative HAGL lesion presentations of instability, pain, and functionality and the return-to-sports activities in patients managed arthroscopically for anterior and posterior HAGL lesions. Study Design: Case series; Level of evidence, 4. Methods: Data on patients with HAGL lesions treated with arthroscopic repair between 2009 and 2018 were retrospectively retrieved from medical charts, and the patients were interviewed to assess their level of postoperative functionality. The Rowe; Constant; University of California, Los Angeles; Oxford; and pain visual analog scale (VAS) scores were obtained for both pre- and postoperative status. Return-to-sports activities and level of activities after surgery were compared with the preinjury state, and complications, reoperations, and recurrent instability were recorded and evaluated. Results: There were 23 study patients (12 females and 11 males; mean age, 24 years). The mean follow-up duration was 24.4 months (range, 7-99 months; median, 17 months). In 7 (30.4%) of the patients, HAGL lesions were diagnosed only intraoperatively. A significant improvement was seen in all examined postoperative functional scores and VAS. At the last follow-up visit, 2 patients (8.7%) reported residual instability with no improvement in pain levels and declined any further treatment, and 3 others (13.0%) required revision surgeries for additional shoulder pathologies (reoperations were performed 18-36 months after the index procedure). The remaining 18 patients (78.3%) were free of pain and symptoms. There was a mean of 0.65 coexisting pathologies per patient, mostly superior labral anterior-posterior, Bankart, and rotator cuff lesions. Conclusion: HAGL lesions are often missed during routine workup in patients with symptoms of instability, and a high level of suspicion is essential during history acquisition, clinical examination, magnetic resonance imaging arthrogram interpretation, and arthroscopic evaluation. Arthroscopic repair yields good pain and stability results; however, some high-level athletes may not return to their preinjury level of activity.
Collapse
Affiliation(s)
- Alon Grundshtein
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efi Kazum
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Chechik
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oleg Dolkart
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Bivas
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Maman
- Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
5
|
Estimation of Location and Extent of Labral Tear Based on Preoperative Range of Motion in Patients Undergoing Arthroscopic Stabilization for Anterior Shoulder Instability. Arthrosc Sports Med Rehabil 2020; 2:e711-e721. [PMID: 33364609 PMCID: PMC7754526 DOI: 10.1016/j.asmr.2020.05.014] [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: 02/04/2020] [Accepted: 05/23/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To determine whether range of motion (ROM) varies with the location and extent of labral tear seen in patients undergoing arthroscopic anterior shoulder stabilization. Methods Consecutive patients undergoing arthroscopic anterior shoulder stabilization who were enrolled in the Multicenter Orthopaedic Outcomes Network Shoulder Instability database underwent a preoperative physical examination and intraoperative examination under anesthesia in which ROM was recorded. Intraoperatively, the location and extent of the labral tear was recorded using conventional clock-face coordinates. Patients were grouped by combinations of quadrants involved in the labral tear (G1-G7): G1 = anterior only, G2 = anterior + inferior, G3 = anterior + inferior + posterior, G4 = all quadrants, G5 = superior + anterior, G6 = superior + anterior + inferior, and G7 = posterior + superior + anterior. Statistical analyses were performed with the Kruskal–Wallis rank-sum test. When P < .05, a post-hoc Dunn’s test was performed. For categorical variables, the χ2 test was performed. We performed a series of bivariate negative binomial regression models testing pairwise combinations of ROM parameters predicting the count of labral tear locations (possible: 0-5) within each quadrant. Results A total of 467 patients were included, with 13 (2.8%) in G1, 221 (47.3%) in G2, 40 (8.6%) in G3, 51 (10.9%) in G4, 18 (3.9%) in G5, 121 (25.9%) in G6, and 3 (0.6%) in G7. Multiple statistically significant differences were noted in ROM, specifically active internal rotation at side (IRS) (P = .005), active abduction (P = .02), passive IRS (P = .02), and passive external rotation in abduction (P = .0007). Regression modeling revealed a positive correlation between passive abduction and predicted count of labral tear locations in the superior quadrant and between passive IRS and predicted count of labral tear location in the inferior quadrant. Conclusions In patients undergoing arthroscopic shoulder stabilization for anterior instability, ROM varies with location and extent of labral tear. However, the clinical relevance of such small ROM differences remains undetermined. Level of evidence II, prospective comparative study.
Collapse
|
6
|
Tanghe KK, Peebles LA, Ridley T, Provencher MT. Latarjet Procedure With Coracoclavicular Ligament Augmentation for Traumatic Coracoid Fracture and Recurrent Anterior Glenohumeral Instability in an Elite Contact Athlete. Arthrosc Tech 2020; 9:e1689-e1696. [PMID: 33294327 PMCID: PMC7695577 DOI: 10.1016/j.eats.2020.07.010] [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: 04/07/2020] [Accepted: 07/11/2020] [Indexed: 02/03/2023] Open
Abstract
Coracoid fractures are relatively uncommon injuries and are typically treated conservatively or with open reduction and internal fixation of displaced fractures. In rare cases, coracoid fractures coincide with glenohumeral instability. Although glenohumeral instability is frequently treated with Bankart procedures, the Latarjet procedure (or transfer of the coracoid process) is used in patients with significant glenoid bone loss, recurrent instability, or prior failed Bankart procedures. However, in some cases, surgeons opt for the Latarjet procedure in patients who are at risk for recurrent instability, such as the elite contact athlete presented in this case. This Technical Note describes the transfer of a previously fractured coracoid fragment to the anterior glenoid rather than reduction of the fracture with concurrent coracoclavicular ligament augmentation to restore anterior shoulder stability.
Collapse
Affiliation(s)
- Kira K. Tanghe
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Liam A. Peebles
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - T.J. Ridley
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,The Steadman Clinic, Vail, Colorado, U.S.A
| | - Matthew T. Provencher
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,The Steadman Clinic, Vail, Colorado, U.S.A.,Address correspondence to Matthew T. Provencher, MD, CAPT, MC, USNR, Steadman Philippon Research Institute, The Steadman Clinic, 181 West Meadow Dr, Ste 400,Vail, CO 81657, U.S.A.
| |
Collapse
|
7
|
Ernat JJ, Yheulon CG, Shaha JS. Arthroscopic Repair of 270- and 360-Degree Glenoid Labrum Tears: A Systematic Review. Arthroscopy 2020; 36:307-317. [PMID: 31708356 DOI: 10.1016/j.arthro.2019.07.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/09/2019] [Accepted: 07/22/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To review the current literature available and evaluate the efficacy of arthroscopic repair of 270° and 360° labral tears, as well as the complication rates associated with such. In addition, we intend to investigate whether consistent clinical findings can be observed in these patients. METHODS This review is registered in the PROSPERO database. The MEDLINE, Cochrane Library, Scopus, and EMBASE databases were queried, and additional searches were performed manually. Studies that reported outcomes after arthroscopic repair of a minimum of 270° of glenoid labrum were included. Technique articles, repairs of less than 270°, studies on atraumatic multidirectional instability, and studies that lacked observable outcomes were excluded. RESULTS In total, 3031 studies/documents were identified from database and manual searching. Screening, removal of duplicates, and assessment for inclusion/exclusion criteria resulted in 6 level IV studies for review. History and physical examination, as well as advanced imaging findings, were variable across studies. All studies reported satisfactory outcomes at short- to mid-term follow-up, although there was heterogeneity in type of outcomes used. Return to sport ranged from 75% to 100%. Complication rates ranged from 10% to 30%. Notably, recurrence of instability and need for secondary surgery occurred in up to 15% of patients. CONCLUSIONS The current literature suggests that although clinical and radiographic variability exist in the diagnosis of 270° and 360° glenoid labrum tears, successful outcomes and return to work/sport can be achieved with arthroscopic management at an average minimum follow-up of 1 year. These figures, however, are limited by heterogenous studies containing small numbers of patients. Complications occur in up to 30% of cases, including an instability recurrence rate of up to 15%. LEVEL OF EVIDENCE Systematic review of Level IV evidence.
Collapse
Affiliation(s)
- Justin J Ernat
- Blanchfield Army Community Hospital. Fort Campbell, Kentucky, U.S.A..
| | | | - James S Shaha
- Landstuhl Regional Medical Center, Landstuhl, Germany
| |
Collapse
|
8
|
O'Reilly OC, Andrews KA, Siparsky PN. Understanding the Glenoid Avulsion of the Glenohumeral Ligaments as a Cause of Shoulder Instability: Surgical and Postsurgical Management. Arthrosc Tech 2019; 8:e1153-e1158. [PMID: 31921589 PMCID: PMC6948128 DOI: 10.1016/j.eats.2019.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/08/2019] [Indexed: 02/03/2023] Open
Abstract
In adolescents and young adults, instability is a common shoulder pathology with a myriad of coexisting soft tissue and bony lesions. When evaluating a patient for the cause of instability, care must be given to assess for the infrequent lesions, including glenoid avulsion of the glenohumeral ligaments. This case example illustrates key points in the diagnosis, surgical, and postsurgical management of this less common cause of anterior shoulder instability.
Collapse
Affiliation(s)
- Olivia C. O'Reilly
- Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa,Address correspondence to Olivia C. O'Reilly, M.D., The University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01019 JPP, Iowa City, IA 52242, U.S.A.
| | - Kyle A. Andrews
- Department of Orthopedic Surgery, The University of Toledo, Toledo, Ohio, U.S.A
| | - Patrick N. Siparsky
- Department of Orthopedic Surgery, The University of Toledo, Toledo, Ohio, U.S.A
| |
Collapse
|
9
|
Karovalia S, Collett DJ, Bokor D. Rotator interval closure: inconsistent techniques and its association with anterior instability. A literature review. Orthop Rev (Pavia) 2019; 11:8136. [PMID: 31616551 PMCID: PMC6784589 DOI: 10.4081/or.2019.8136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/07/2019] [Indexed: 12/16/2022] Open
Abstract
The Rotator interval (RI) is an anatomic space in the anterosuperior part of the glenohumeral joint. An incompetent or lax RI has been implicated in various conditions of shoulder instability and therefore RI has been frequently touted as an area that is important in preserving stability of the shoulder. Biomechanical studies have shown that repair of RI ligamentous and capsular structures decreases glenohumeral joint laxity in various directions. Clinical studies have reported successful outcomes after repair or plication of these structures in patients undergoing shoulder stabilization procedures. Although varieties of methods have been described for its closure, the optimal surgical technique is unclear with various inconsistencies in incorporation of the closure tissue. This in particular makes the analysis of the RI closure very difficult. The purposes of this study are to review the structures of the RI and their contribution to shoulder instability, to discuss the biomechanical and clinical effects of plication of RI structures in particular to anterior glenohumeral instability, to delineate the differences between an arthroscopic and open RI closure. Additionally, we have proposed a new classification system describing various techniques used during RI closure.
Collapse
Affiliation(s)
- Shahin Karovalia
- Orthopedic Unit, Faculty of Medicine and Health Sciences, Macquarie University, Sydney
| | - David J Collett
- The Australian School of Advanced Medicine, Macquarie University, Macquarie
| | - Desmond Bokor
- Department of Orthopedics and Sport Medicine, Macquarie University Hospital, Macquarie, Australia
| |
Collapse
|
10
|
Southworth TM, Naveen NB, Otte RS, Cole BJ. Open Distal Tibial Allograft Augmentation. OPER TECHN SPORT MED 2019. [DOI: 10.1053/j.otsm.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
11
|
Coracohumeral Ligament Reconstruction for Patients With Multidirectional Shoulder Instability. Arthrosc Tech 2019; 8:e561-e565. [PMID: 31334011 PMCID: PMC6620624 DOI: 10.1016/j.eats.2019.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/28/2019] [Indexed: 02/03/2023] Open
Abstract
Coracohumeral ligament pathology arises from acute trauma, capsular thickening, or congenital connective tissue disorders within the glenohumeral joint. Recent studies have highlighted the significance of this pathology in multidirectional shoulder instability because insufficiency of the rotator interval has become increasingly recognized and attributed to failed shoulder stabilization procedures. The diagnosis and subsequent treatment of coracohumeral ligament pathology can be challenging, however, because patients usually present with a history of failed surgical stabilization and persistent laxity. At the time of presentation, most patients have undergone failed nonoperative treatments and are indicated for surgical intervention. One of the options for the treatment of coracohumeral ligament pathology is reconstruction. The purpose of this Technical Note is to describe our preferred surgical technique for the reconstruction of the coracohumeral ligament. Research was performed at the Steadman Philippon Research Institute.
Collapse
|
12
|
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.
Collapse
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
| | | |
Collapse
|
13
|
Frank RM, Romeo AA. Arthroscopic soft tissue reconstruction in anterior shoulder instability. DER ORTHOPADE 2019; 47:121-128. [PMID: 29435624 DOI: 10.1007/s00132-018-3532-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Anterior glenohumeral instability remains a difficult problem in the athletic and working patient populations. Treatment strategies are variable and range from nonoperative approaches incorporating immobilization and rehabilitation to surgical management. Surgical decision-making can be challenging, especially with a high-level patient who wishes to return to high-demand activities. Operative options range from open soft tissue stabilization to arthroscopic soft tissue stabilization, with both open and arthroscopic options for bony reconstruction in the setting of clinically significant anterior glenoid bone loss. In all cases, understanding appropriate indications and utilizing sound surgical techniques are critical for achieving a successful result. For the majority of patients with anterior shoulder instability, arthroscopic soft tissue reconstruction with suture anchors is a successful, minimally invasive approach that results in a stable shoulder with excellent outcomes and low complication rates.
Collapse
Affiliation(s)
- R M Frank
- CU Sports Medicine, Department of Orthopedics, University of Colorado School of Medicine, 2150 Stadium Drive, 80309, Boulder, CO, USA
| | - A A Romeo
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, 60612, Chicago, IL, USA.
| |
Collapse
|
14
|
Moeller EA, Houck DA, McCarty EC, Seidl AJ, Bravman JT, Vidal AF, Frank RM. Outcomes of Arthroscopic Posterior Shoulder Stabilization in the Beach-Chair Versus Lateral Decubitus Position: A Systematic Review. Orthop J Sports Med 2019; 7:2325967118822452. [PMID: 30719483 PMCID: PMC6348524 DOI: 10.1177/2325967118822452] [Citation(s) in RCA: 10] [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] [Indexed: 12/19/2022] Open
Abstract
Background: Arthroscopic posterior shoulder stabilization can be performed with patients in the beach-chair (BC) and the lateral decubitus (LD) positions; however, the impact of patient positioning on clinical outcomes has not been evaluated. Purpose: To compare clinical outcomes and recurrence rates after arthroscopic posterior shoulder stabilization performed in the BC and LD positions. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review using PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines was performed by searching PubMed, Embase, and the Cochrane Library for studies reporting the clinical outcomes of patients undergoing arthroscopic posterior shoulder stabilization in either the BC or LD position. All English-language studies from 1990 to 2017 reporting clinical outcomes after arthroscopic posterior shoulder stabilization with a minimum 2-year follow-up were reviewed by 2 independent reviewers. Data on the recurrent instability rate, return to activity or sport, range of motion, and patient-reported outcome scores were collected. Study methodological quality was evaluated using the Modified Coleman Methodology Score (MCMS) and Quality Appraisal Tool (QAT). Results: A total of 15 studies (11 LD, 4 BC) with 731 shoulders met the inclusion criteria, including 626 shoulders in the LD position (mean patient age, 23.9 ± 4.1 years; mean follow-up, 37.5 ± 10.0 months) and 105 shoulders in the BC position (mean patient age, 27.8 ± 2.2 years; mean follow-up, 37.9 ± 16.6 months). There was no significant difference in the overall mean recurrent instability rate between the LD and BC groups (4.9% ± 3.6% vs 4.4% ± 5.1%, respectively; P = .83), with similar results in a subanalysis of studies utilizing only suture anchor fixation (4.9% ± 3.6% vs 3.2% ± 5.6%, respectively; P = .54). There was no significant difference in the return-to-sport rate between the BC and LD groups (96.2% ± 5.4% vs 88.6% ± 9.1%, respectively; P = .30). Range of motion and other patient-reported outcome scores were not provided consistently across studies to allow for statistical comparisons. Conclusion: Low rates of recurrent shoulder instability and high rates of return to sport can be achieved after arthroscopic posterior shoulder stabilization in either the LD or the BC position. Additional long-term randomized trials comparing these positions are needed to better understand the potential advantages and disadvantages of surgical positioning for posterior shoulder stabilization.
Collapse
Affiliation(s)
- Ellie A Moeller
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Darby A Houck
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Adam J Seidl
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jonathan T Bravman
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Armando F Vidal
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rachel M Frank
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
15
|
Pogorzelski J, Fritz EM, Horan MP, Katthagen JC, Provencher MT, Millett PJ. Failure following arthroscopic Bankart repair for traumatic anteroinferior instability of the shoulder: is a glenoid labral articular disruption (GLAD) lesion a risk factor for recurrent instability? J Shoulder Elbow Surg 2018; 27:e235-e242. [PMID: 29730139 DOI: 10.1016/j.jse.2018.02.055] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/06/2018] [Accepted: 02/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recurrent instability is a frequent complication following arthroscopic Bankart repair. The purpose of this study was to investigate risk factors for poor patient-reported clinical outcome scores and failure rates. METHODS Patients who underwent arthroscopic Bankart repair at least 2 years earlier were included. Preoperative and postoperative Single Assessment Numeric Evaluation; Quick Disabilities of the Arm, Shoulder and Hand; American Shoulder and Elbow Surgeons; and satisfaction scores were collected. The relationship of the following factors with outcomes and failure rates was assessed: (1) previous arthroscopic stabilization, (2) 3 or more dislocations prior to surgery, (3) glenoid labral articular disruption (GLAD) lesion, (4) concurrent superior labral anterior-to-posterior tear repair, and (5) concurrent biceps tenodesis. RESULTS The study included 72 patients with a median age of 23 years (range, 14-49 years). Subsequent revision was required in 9 (12.5%); 1 additional patient (1.4%) had recurrent dislocation. Outcome data were available at a median follow-up of 3 years (range, 2-9 years). All scores significantly improved from preoperatively to postoperatively (P <.05); the mean patient satisfaction score was 9, with a median of 10 (range, 1-10). None of the analyzed factors were associated with worse postoperative outcome scores. GLAD lesions were significantly associated with a higher rate of failure (P = .007). No other analyzed factors had a significant association with failure rates (P > .05). CONCLUSIONS Patients with arthroscopic Bankart repair for traumatic anteroinferior shoulder instability had excellent outcomes, even in the context of previous arthroscopic stabilization surgery, 3 or more dislocations prior to surgery, concurrent superior labral anterior-to-posterior tear repair, or concurrent biceps tenodesis. However, GLAD lesions were associated with higher rates of failure, and the presence of a GLAD lesion may herald the presence of changes in the articular version or other as-yet-undetermined factors that could predispose patients to failure.
Collapse
Affiliation(s)
- Jonas Pogorzelski
- Steadman Philippon Research Institute, Vail, CO, USA; Department of Orthopaedic Sports Medicine, Hospital Rechts der Isar, Technical University of Munich, München, Germany
| | - Erik M Fritz
- Steadman Philippon Research Institute, Vail, CO, USA
| | | | - J Christoph Katthagen
- Steadman Philippon Research Institute, Vail, CO, USA; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Munster, Munster, Germany
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA.
| |
Collapse
|
16
|
Somford MP, Van der Linde JA, Wiegerinck JI, Hoornenborg D, Van den Bekerom MPJ, Van Deurzen DFP. Eponymous terms in anterior shoulder stabilization surgery. Orthop Traumatol Surg Res 2017; 103:1257-1263. [PMID: 28942024 DOI: 10.1016/j.otsr.2017.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 05/21/2017] [Accepted: 07/10/2017] [Indexed: 02/02/2023]
Abstract
UNLABELLED Shoulder dislocation and its treatment are probably as old as time. Surgical treatment has gained acceptance recently, especially in recurrent cases. Within roughly the last 100years, numerous treatment strategies have been developed and questions elucidated regarding the entity of shoulder instability. Shoulder instability holds many eponymous terms. By means of literature and historical research, we present the biographical background of some common eponymous terms and the original publication on which those terms are based. We describe the Perthes lesion, Bankart lesion and repair, Hill-Sachs lesion, Bristow-Latarjet procedure and Eden-Hybbinette procedure. Shoulder instability has been recognized and treated for many centuries. Before the invention of X-rays and the ability to intervene surgically, empirical reduction and time were the only feasible treatment options. Understanding of the pathophysiology of this problem and its corresponding treatment has kept increasing since the 19th century. The originators involved still have their name attached to the different signs and procedures. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- M P Somford
- Department of Orthopedic Surgery, Rijnstate Hospital Arnhem, Wagnerlaan 55, 6814AD Arnhem, Netherlands.
| | - J A Van der Linde
- Department of Orthopedic Surgery, OLVG Hospital Amsterdam, Netherlands
| | - J I Wiegerinck
- Department of Orthopedic Surgery, AMC Hospital Amsterdam, Netherlands
| | - D Hoornenborg
- Department of Orthopedic Surgery, Slotervaart Hospital Amsterdam, Netherlands
| | | | - D F P Van Deurzen
- Department of Orthopedic Surgery, OLVG Hospital Amsterdam, Netherlands
| |
Collapse
|
17
|
Marco SM, Lafuente JLÁ, Ibán MAR, Heredia JD. Controversies In The Surgical Management Of Shoulder Instability: Associated Soft Tissue Procedures. Open Orthop J 2017; 11:989-1000. [PMID: 28979603 PMCID: PMC5612025 DOI: 10.2174/1874325001711010989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 10/24/2016] [Accepted: 10/28/2016] [Indexed: 01/02/2023] Open
Abstract
Background: The glenohumeral joint is a ball-and-socket joint that is inherently unstable and thus, susceptible to dislocation. The traditional and most common anatomic finding is the Bankart lesion (anterior-inferior capsule labral complex avulsion), but there is a wide variety of anatomic alterations that can cause shoulder instability or may be present as a concomitant injury or in combination, including bone loss (glenoid or humeral head), complex capsule-labral tears, rotator cuff tears, Kim´s lesions (injuries to the posterior-inferior labrum) and rotator interval pathology. Methods: A review of articles related to shoulder anatomy and soft tissue procedures that are performed during shoulder instability arthroscopic management was conducted by querying the Pubmed database and conclusions and controversies regarding this injury were exposed. Results: Due to the complex anatomy of the shoulder and the large range of movement of this joint, a wide variety of anatomic injuries and conditions can lead to shoulder instability, specially present in young population. Recognizing and treating all of them including Bankart repair, capsule-labral plicatures, SLAP repair, circumferential approach to pan-labral lesions, rotator interval closure, rotator cuff injuries and HAGL lesion repair is crucial to achieve the goal of a stable, full range of movement and not painful joint. Conclusion: Physicians must be familiarized with all the lesions involved in shoulder instability, and should be able to recognize and subsequently treat them to achieve the goal of a stable non-painful shoulder. Unrecognized or not treated lesions may result in recurrence of instability episodes and pain while overuse of some of the techniques previously described can lead to stiffness, thus the importance of an accurate diagnosis and treatment when facing a shoulder instability.
Collapse
Affiliation(s)
- Santos Moros Marco
- Hospital MAZ - Orthopaedics and trauma surgery Avda Academia General Militar nº74, Zaragoza 50015, Spain
| | - José Luis Ávila Lafuente
- Hospital MAZ - Orthopaedics and trauma surgery Avda Academia General Militar nº74, Zaragoza 50015, Spain
| | - Miguel Angel Ruiz Ibán
- Hospital MAZ - Orthopaedics and trauma surgery Avda Academia General Militar nº74, Zaragoza 50015, Spain
| | - Jorge Diaz Heredia
- Hospital MAZ - Orthopaedics and trauma surgery Avda Academia General Militar nº74, Zaragoza 50015, Spain
| |
Collapse
|
18
|
Abstract
Posterior glenohumeral instability is an increasingly important clinical finding in athletic patients. Over the last decade, basic and clinical research has improved our understanding of the pathoanatomy and biomechanics of this challenging disorder, as well as our ability to diagnose and appropriately treat it. Although recurrent posterior shoulder instability is not as common as anterior instability, it is prevalent among specific populations, including football and rugby players, and may be overlooked by clinicians who are unaware of the typical physical examination and radiographic findings.
Collapse
|
19
|
Abstract
The surgical treatment of anterior shoulder instability can present a dilemma. Historically, an open Bankart repair was the benchmark solution. Over the last decade as surgeons became more arthroscopically savvy, the pendulum swung and a paradigm shift occurred. However, more recent studies have challenged this trend and, subsequently, revived interest in open repair. Thus, we feel it is critical to provide a more contemporary stepwise description of a procedure that has become essentially abandoned. The goal is to provide tips and pearls to achieve optimal exposure and, ultimately, a robust repair for a notoriously challenging operation.
Collapse
|
20
|
McHale KJ, Lavery KP, Vachon T. Imaging Instability in the Contact Athlete: What to Look For. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
21
|
Flury M, Rickenbacher D, Audigé L. Arthroscopic treatment of anterior shoulder instability associated with a HAGL lesion-a case series. J Shoulder Elbow Surg 2016; 25:1989-1996. [PMID: 27131577 DOI: 10.1016/j.jse.2016.02.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/11/2016] [Accepted: 02/24/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Restoration of shoulder stability after humeral avulsion of glenohumeral ligament (HAGL) lesions can be achieved with arthroscopy, yet limited evidence exists on its benefit. We evaluated objective and subjective outcomes after arthroscopic refixation of a HAGL lesion. METHODS Between 2009 and 2012, 8 patients were treated arthroscopically for anterior shoulder instability associated with a HAGL lesion and invited for a follow-up examination. Radiographic assessment of joint centering and osteoarthritis, clinical assessment including Constant and Rowe scores, and complications as well as functional outcomes using the Western Ontario Shoulder Instability Index, Subjective Shoulder Value, and Simple Shoulder Test were documented. RESULTS Six patients were postoperatively examined at a median time of 29 months (range, 12-38). Four patients had up to 6 previous luxation events. Two patients had a concomitant labral lesion, and another 2 had an associated rotator cuff tear. Positive preoperative apprehension and relocation test results for 5 patients were negative at follow-up. No neurologic lesion was noted both before and after surgery. Shoulder motion did not improve significantly; lower internal and external rotation relative to the contralateral shoulder was reported. The Rowe score improved significantly from baseline (median score change, 65 points; P = .027), with 2 and 4 patients rating "good" and "excellent" at follow-up, respectively. Final median Constant score, Western Ontario Shoulder Instability Index, Subjective Shoulder Value, and Simple Shoulder Test scores were 77.3 points, 91.0 points, 90%, and 87.5 points, respectively. CONCLUSION Arthroscopic stabilization of a HAGL lesion is a safe, feasible, and reproducible technique. In our patient cohort, good shoulder stability could be achieved with high patient satisfaction.
Collapse
Affiliation(s)
- Matthias Flury
- Upper Extremities Department, Schulthess Clinic, Zürich, Switzerland.
| | | | - Laurent Audigé
- Research and Development Department, Schulthess Clinic, Zürich, Switzerland
| |
Collapse
|
22
|
Sheean AJ, De Beer JF, Di Giacomo G, Itoi E, Burkhart SS. Shoulder instability: State of the Art. J ISAKOS 2016. [DOI: 10.1136/jisakos-2016-000070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
23
|
Mollon B, Mahure SA, Ensor KL, Zuckerman JD, Kwon YW, Rokito AS. Subsequent Shoulder Surgery After Isolated Arthroscopic SLAP Repair. Arthroscopy 2016; 32:1954-1962.e1. [PMID: 27083535 DOI: 10.1016/j.arthro.2016.01.053] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 01/23/2016] [Accepted: 01/27/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify the incidence of and identify the risk factors for subsequent shoulder procedures after isolated SLAP repair. METHODS New York's Statewide Planning and Research Cooperative System database was searched between 2003 and 2014 to identify individuals with the sole diagnosis of a SLAP lesion who underwent isolated arthroscopic SLAP repair. Patients were longitudinally followed up for a minimum of 3 years to analyze for subsequent ipsilateral shoulder procedures. RESULTS Between 2003 and 2014, 2,524 patients met our inclusion criteria. After 3 to 11 years of follow-up, 10.1% of patients (254 of 2,524) underwent repeat surgical intervention on the same shoulder as the initial SLAP repair. The mean time to repeat shoulder surgery was 2.3 ± 2.1 years. Subsequent procedures included subacromial decompression (35%), debridement (26.7%). repeat SLAP repair (19.7%), and biceps tenodesis or tenotomy (13.0%). After isolated SLAP repair, patients aged 20 years or younger were more likely to undergo arthroscopic Bankart repair (odds ratio [OR], 2.91; 95% confidence interval [CI], 1.36-6.21; P = .005), whereas age older than 30 years was an independent risk factor for subsequent acromioplasty (OR, 2.3; 95% CI, 1.4-3.7; P < .001) and distal clavicle resection (OR, 2.5; 95% CI, 1.1-5.5; P = .030). The need for a subsequent procedure was significantly associated with Workers' Compensation cases (OR, 2.4; 95% CI, 1.7-3.2; P < .001). CONCLUSIONS We identified a 10.1% incidence of subsequent surgery after isolated SLAP repair, often related to an additional diagnosis, suggesting that clinicians should consider other potential causes of shoulder pain when considering surgery for patients with SLAP lesions. In addition, the number of isolated SLAP repairs performed has decreased over time, and management of failed SLAP repair has shifted toward biceps tenodesis or tenotomy over revision SLAP repair in more recent years. LEVEL OF EVIDENCE Level III, case-control study.
Collapse
Affiliation(s)
- Brent Mollon
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, U.S.A
| | - Siddharth A Mahure
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, U.S.A..
| | - Kelsey L Ensor
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, U.S.A
| | - Joseph D Zuckerman
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, U.S.A
| | - Young W Kwon
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, U.S.A
| | - Andrew S Rokito
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, U.S.A
| |
Collapse
|
24
|
Abstract
Shoulder arthroscopic and related surgeons may require expertise in use of the 70° arthroscope, biologic patch augmentation, repair of massive rotator cuff tears, the Latarjet procedure and related glenoid bone augmentation, and reverse total shoulder arthroplasty.
Collapse
|
25
|
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]
|
26
|
Taverna E, Garavaglia G, Ufenast H, D'Ambrosi R. Arthroscopic treatment of glenoid bone loss. Knee Surg Sports Traumatol Arthrosc 2016; 24:546-56. [PMID: 26658567 DOI: 10.1007/s00167-015-3893-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/19/2015] [Indexed: 01/19/2023]
Abstract
Recurrent anterior instability of the glenohumeral joint has long been an arduous problem to solve surgically, owing to its difficulty to the need to restore both osseous and dynamic constraints in the unstable shoulder. Biomechanical studies have indicated that glenoid bone loss shortens the safe arc through which the glenoid can resist axial forces; in these cases, a soft tissue repair alone may be insufficient to maintain stability. Clinical studies have confirmed that major bone loss is associated with an unfavourable outcome. The benefits of using arthroscopic procedures for surgical stabilization of the shoulder include smaller incisions and less soft tissue dissection, better access for repair and, potentially, the maximum respect for the undamaged anatomical structures. The biggest disadvantage of arthroscopic procedures until recently was the inability to successfully treat a significant bone defect. Over the last 10 years, several new arthroscopic techniques have been developed, providing new surgical options for successfully treating soft tissues and bony lesions in anterior-inferior glenohumeral instability. Level of evidence V.
Collapse
Affiliation(s)
- Ettore Taverna
- U.O. Chirurgia della Spalla II, Istituto Ortopedico Galeazzi, Milan, Italy
| | - Guido Garavaglia
- Upper Limb Unit, Department of Surgery, OBV, Mendrisio, Switzerland
| | - Henri Ufenast
- Upper Limb Unit, Department of Surgery, OBV, Mendrisio, Switzerland
| | - Riccardo D'Ambrosi
- U.O. Chirurgia della Spalla II, Istituto Ortopedico Galeazzi, Milan, Italy. .,Universtià degli Studi di Milano, Milan, Italy.
| |
Collapse
|
27
|
Frank RM, Taylor D, Verma NN, Romeo AA, Mologne TS, Provencher MT. The Rotator Interval of the Shoulder: Implications in the Treatment of Shoulder Instability. Orthop J Sports Med 2015; 3:2325967115621494. [PMID: 26779554 PMCID: PMC4710125 DOI: 10.1177/2325967115621494] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Biomechanical studies have shown that repair or plication of rotator interval (RI) ligamentous and capsular structures decreases glenohumeral joint laxity in various directions. Clinical outcomes studies have reported successful outcomes after repair or plication of these structures in patients undergoing shoulder stabilization procedures. Recent studies describing arthroscopic techniques to address these structures have intensified the debate over the potential benefit of these procedures as well as highlighted the differences between open and arthroscopic RI procedures. The purposes of this study were to review the structures of the RI and their contribution to shoulder instability, to discuss the biomechanical and clinical effects of repair or plication of rotator interval structures, and to describe the various surgical techniques used for these procedures and outcomes.
Collapse
Affiliation(s)
- Rachel M Frank
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Dean Taylor
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Anthony A Romeo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Matthew T Provencher
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
28
|
Arthroscopic Repair of a Glenoid Avulsion of the Glenohumeral Ligament. Arthrosc Tech 2015; 4:e795-9. [PMID: 27284513 PMCID: PMC4886453 DOI: 10.1016/j.eats.2015.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/31/2015] [Indexed: 02/03/2023] Open
Abstract
Injury to the glenohumeral capsulolabral complex is the critical lesion in anterior shoulder instability. Various injury patterns have been described including the classic Bankart lesion, the bony Bankart lesion, and humeral avulsion of the glenohumeral ligament. A rare injury variant is a glenoid avulsion of the glenohumeral ligament (GAGL lesion). Careful patient setup and surgical technique are required to identify and arthroscopically repair these lesions. We describe a suture anchor-based arthroscopic GAGL repair performed with the patient in the lateral decubitus position through standard anterior and posterior portals and an accessory posterolateral 7-o'clock portal.
Collapse
|
29
|
Lubowitz JH. Editorial Commentary: Platelet-Rich Plasma Improves Knee Pain and Function in Patients With Knee Osteoarthritis. Arthroscopy 2015; 31:2222-3. [PMID: 26542203 DOI: 10.1016/j.arthro.2015.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 02/02/2023]
Abstract
Systematic review of overlapping meta-analyses shows that platelet-rich plasma improves knee pain and function in patients with knee osteoarthritis. Ultimately, biologics hold promise for chondroprotection in addition to symptomatic relief.
Collapse
|