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Brinkman JC, Damitio E, Tokish JM. Arthroscopic Management of the Contact Athlete with Anterior Instability. Clin Sports Med 2024; 43:601-615. [PMID: 39232569 DOI: 10.1016/j.csm.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Anterior glenohumeral instability is one of the most common injuries suffered from sport. Despite padding and conditioning, the shoulder joint remains particularly vulnerable to injury, especially in the setting of contact. The overall rate of anterior instability is reported to be 0.12 injuries per 1000 athlete exposures, although this is increased up to 0.40 to 0.51 in the contact athlete. Successful treatment requires consideration of restoring stability while minimizing loss of glenohumeral motion. Common treatment strategies involve addressing the pathology that results from anterior shoulder dislocation including labral detachment as well as bony defects to the humeral head and glenoid.
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Affiliation(s)
| | - Elizabeth Damitio
- Institute of Protein Design, University of Washington, Seattle, Washington, USA
| | - John M Tokish
- Department of Orthopedic Surgery Sports Medicine, Mayo Clinic, Phoenix, AZ, USA
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de Cabo G, González-Martín D, de Aragón AM, Rubio JA, Leyes M. Anterior Shoulder Instability Treated Through an Anterior Arthroscopic Approach. Arthrosc Tech 2023; 12:e387-e394. [PMID: 37013020 PMCID: PMC10066418 DOI: 10.1016/j.eats.2022.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/06/2022] [Indexed: 04/05/2023] Open
Abstract
Anterior shoulder instability remains one of the main indications for shoulder surgery. We present a modified way of treating anterior shoulder instability in the beach-chair position from an anterior arthroscopic approach through the rotator interval. This technique opens the rotator interval, which increases the working area and allows us to work without cannulae. Through this approach, we can treat all injuries comprehensively and, if necessary, switch to other arthroscopic techniques used for instability such as arthroscopic Latarjet or anterior ligamentoplasties.
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Affiliation(s)
- Gonzalo de Cabo
- Department of Orthopedic Surgery and Traumatology, Olympia, Quirón Salud, Madrid, Spain
| | - David González-Martín
- Department of Orthopedic Surgery and Traumatology, Olympia, Quirón Salud, Madrid, Spain
- Address correspondence to David González-Martín, M.D., PhD., Department of Orthopedic Surgery and Traumatology, Olympia, Quirón Salud, Clínica OLYMPIA (Equipo del Dr.Leyes, Flores & Co). IE Tower. Paseo de la Castellana, 259E, 28046, Madrid, Spain
| | | | | | - Manuel Leyes
- Department of Orthopedic Surgery and Traumatology, Olympia, Quirón Salud, Madrid, Spain
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Hwang ST, Horinek JL, Ardebol J, Menendez ME, Denard PJ. Arthroscopic Remplissage for the Treatment of Anterior Shoulder Instability: Current and Evolving Concepts. JBJS Rev 2022; 10:01874474-202211000-00004. [PMID: 36574456 DOI: 10.2106/jbjs.rvw.22.00151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
➢ A Hill-Sachs lesion (HSL) is a compression fracture on the posterolateral humeral head that can increase the risk of recurrent shoulder instability after isolated arthroscopic Bankart repair. ➢ Remplissage involves capsulotenodesis of the infraspinatus tendon and posterior capsule into the HSL to prevent its engagement with the glenoid rim through extra-articular conversion and restraint against humeral head anterior translation. ➢ The glenoid track concept can be applied preoperatively and intraoperatively to evaluate risk of recurrence and help direct clinical management options for recurrent shoulder instability. ➢ Recent literature supports expanding indications for remplissage to include patients with on-track HSLs who are at increased risk of recurrence including collision athletes, military personal, and patients with joint hyperlaxity. ➢ New techniques and suture constructs have demonstrated improved biomechanical strength while avoiding the need to access the subacromial space.
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Affiliation(s)
- Simon T Hwang
- Shoulder Surgery, Oregon Shoulder Institute, Medford, Oregon
| | | | - Javier Ardebol
- Shoulder Surgery, Oregon Shoulder Institute, Medford, Oregon
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Arauz S, González-Martín D, Quiroga M, Guillén P. Arthroscopic Modified McLaughlin Procedure and Remplissage for Treatment of Simultaneous Reverse Hill-Sachs and Hill-Sachs Lesions. Arthrosc Tech 2022; 11:e1473-e1478. [PMID: 36061462 PMCID: PMC9437510 DOI: 10.1016/j.eats.2022.03.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/29/2022] [Indexed: 02/03/2023] Open
Abstract
Hill-Sachs lesions (HSLs) can be present after a primary shoulder dislocation and may go unrecognized; this can alter the necessary bony constraint within the glenohumeral joint. To deal with HSLs, remplissage is a safe procedure with low complication rates, low recurrent instability rates, and good patient outcome scores compared with many of the other alternative techniques. On the other hand, a great number of techniques have been described to treat reverse Hill-Sachs lesions (RHSLs). In this article, we propose a method of treatment for combined simultaneous HSL and RHSL shoulder injuries. However, consensus on a specific treatment is yet to be established. We present an arthroscopic treatment guideline for patients with shoulder instability due to anterior and posterior labral lesions, HSL, and RHSL.
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Affiliation(s)
- Santiago Arauz
- Department of Orthopaedic Surgery and Traumatology, Clínica CEMTRO, Madrid, Spain
| | - David González-Martín
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario de Canarias, Tenerife, Spain,Universidad de La Laguna, Tenerife, Spain,Address correspondence to David González-Martín, M.D., Ph.D., Department of Orthopaedic Surgery and Traumatology, Hospital Universitario de Canarias, Tenerife, Spain and Universidad de La Laguna, Tenerife, Spain.
| | - Marcelo Quiroga
- Department of Orthopaedic Surgery and Traumatology, Clínica CEMTRO, Madrid, Spain
| | - Pedro Guillén
- Department of Orthopaedic Surgery and Traumatology, Clínica CEMTRO, Madrid, Spain
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Scanaliato JP, Dunn JC, Fitzpatrick KV, Czajkowski H, Parnes N. Double-Pulley Remplissage in Active-Duty Military Population With Off-Track Anterior Shoulder Instability Results in Improved Outcomes and Low Recurrence at Minimum 4-Year Follow-Up. Arthroscopy 2022; 38:743-749. [PMID: 34530108 DOI: 10.1016/j.arthro.2021.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/03/2021] [Accepted: 09/07/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To report mid-term outcomes of active-duty patients with anterior shoulder instability following our technique for double-pulley remplissage (DPR) with concomitant anterior labral repair. METHODS All consecutive patients from 1/2010 through 12/2016 that underwent DPR by the senior surgeon with complete outcome scores were identified. All patients had experienced a shoulder dislocation following a traumatic event, and had subsequent instability recalcitrant to conservative management. Patients were excluded if they were lost to follow-up (3) of if they underwent stabilization procedures other than DPR (148). Outcome measures were completed by patients within 1 week prior to surgery and at latest follow-up. Twenty-four patients met the inclusion criteria for the study, and all were active-duty military at the time of surgery. RESULTS 20/24 (83.3%) patients met the patient acceptable symptomatic state (PASS), while 21/24 (87.5%) achieved substantial clinical benefit (SCB) and 22/24 (91.7%) exceeded the minimal clinically important difference (MCID) for their operative shoulder, as determined by the American Shoulder and Elbow Surgeons (ASES) Score. 21/24 (87.5%) patients met the PASS, while 19/24 (79.2%) achieved SCB and 20/24 (83.3%) exceeded the MCID for their operative shoulder, as determined by the single assessment numeric evaluation (SANE). In addition, 23/24 (95.8%) patients exceeded the MCID for their operative shoulder, as determined by the Rowe Instability score. Preoperative and postoperative range of motion did not vary significantly. All patients had decreased pain postoperatively (P < .0001); 22/24 (91.67%) of patients remained on active-duty status. Failure rate, defined as recurrent subluxation or dislocation, was 4.2%. CONCLUSIONS Mid-term outcomes in this population of active-duty patients undergoing DPR for shoulder instability without glenoid bone loss demonstrate a statistically and clinically significant improvement in patient-reported outcomes, a significant decrease of pain and an overall return to active-duty rate of 91.67%. LEVEL OF EVIDENCE IV, therapeutic case series.
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Affiliation(s)
- John P Scanaliato
- William Beaumont Army Medical Center, Department of Orthopaedic Surgery, El Paso, Texas, U.S.A..
| | - John C Dunn
- William Beaumont Army Medical Center, Department of Orthopaedic Surgery, El Paso, Texas, U.S.A
| | - Kelly V Fitzpatrick
- William Beaumont Army Medical Center, Department of Orthopaedic Surgery, El Paso, Texas, U.S.A
| | | | - Nata Parnes
- Carthage Area Hospital, Carthage, New York, U.S.A.; Claxton-Hepburn Medical Center, Ogdensburg, New York
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Arthroscopic stabilisation for shoulder instability. J Clin Orthop Trauma 2020; 11:S402-S411. [PMID: 32523301 PMCID: PMC7275285 DOI: 10.1016/j.jcot.2019.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 12/11/2022] Open
Abstract
Since its first description over 30 years ago arthroscopic stabilisation has evolved. With improvements in knowledge, surgical techniques and materials technology, arthroscopic bankart repair has become the most widely used method for treating patients with symptomatic anterior shoulder instability. These procedures are typically performed in a younger, high demand patient population after a primary dislocation or to treat recurrent instability. A thorough clinical evaluation is required in the clinic setting not only to fully understand the injury pattern but also consider patient expectations prior to embarking on surgery. Diagnostic imaging will aid the clinician in determining the soft tissue pathology as well as assessing bone loss, which facilitates surgical decision-making. Selected patients may benefit from adjunctive procedures such as a remplissage for an "engaging" Hill-sachs lesion. This review will focus on the indications, pre-operative considerations, surgical techniques and outcomes of arthroscopic stabilisation.
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Rahu M, Kartus JT, Põldoja E, Kolts I, Kask K. Hill-Sachs Remplissage Procedure Based on Posterosuperior Capsulomuscular Anatomy. Arthrosc Tech 2019; 8:e623-e627. [PMID: 31334020 PMCID: PMC6624184 DOI: 10.1016/j.eats.2019.02.009] [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: 11/19/2018] [Accepted: 02/16/2019] [Indexed: 02/03/2023] Open
Abstract
The remplissage technique is a procedure designed to fill a posterosuperior humeral head defect with the infraspinatus tendon and posterior-superior capsule in patients with engaging Hill-Sachs lesions. We describe a remplissage technique using 2 posterior working portals that respects the anatomy of the posterior-superior area of the glenohumeral joint without compromising the vascularization.
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Affiliation(s)
- Madis Rahu
- Sports Trauma Centre, Sports Medicine and Rehabilitation Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Anatomy, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Jüri-Toomas Kartus
- Sports Trauma Centre, Sports Medicine and Rehabilitation Clinic, Tartu University Hospital, Tartu, Estonia
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, NU Hospital Group, Trollhättan, Sweden
| | - Elle Põldoja
- Department of Anatomy, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Ivo Kolts
- Department of Anatomy, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Kristo Kask
- Orthopaedic Centre of Surgery Clinic, North Estonia Medical Centre, Tallinn, Estonia
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Chakrabarti MO, Gwosdz J, Rosinski A, Guzman AJ, McGahan PJ, Chen JL. Arthroscopic Double-Pulley Remplissage Using a 2-Portal Technique for Hill-Sachs Lesions in Recurrent Anterior Shoulder Instability. Arthrosc Tech 2019; 8:e527-e533. [PMID: 31334006 PMCID: PMC6620479 DOI: 10.1016/j.eats.2019.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 01/25/2019] [Indexed: 02/03/2023] Open
Abstract
Hill-Sachs lesions of the humeral head are associated with recurrent anterior shoulder instability. Arthroscopic double-pulley remplissage has emerged as the leading alternative to the open Latarjet procedure to address recurrent shoulder instability with comparable recurrence rates and favorable complication rates. This Technical Note describes our adaptation of the double-pulley remplissage technique by using 2 portals, with the anterior portal used as the viewing portal and suture passage through the posterior portal. This technique eliminates the need for a lateral percutaneous portal, consequently minimizing operative time and postoperative morbidity. Furthermore, using the anterior portal as the viewing portal allows for direct visualization of the reduction of the infraspinatus into the Hill-Sachs defect. The drawback of this technique is that there is no view of the subacromial space during knot tying.
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Affiliation(s)
- Moyukh O. Chakrabarti
- Address correspondence to Moyukh O. Chakrabarti, M.B.B.S., Advanced Orthopaedics and Sports Medicine, 450 Sutter St, Ste 400, San Francisco, CA 94108, U.S.A.
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Fox JA, Sanchez A, Zajac TJ, Provencher MT. Understanding the Hill-Sachs Lesion in Its Role in Patients with Recurrent Anterior Shoulder Instability. Curr Rev Musculoskelet Med 2017; 10:469-479. [PMID: 29101634 PMCID: PMC5685959 DOI: 10.1007/s12178-017-9437-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW The purpose of this study is to provide an update to the orthopedic field in regard to treatment of the Hill-Sachs lesion and anterior shoulder instability. The review highlights the most current knowledge of epidemiology, clinical evaluation, and surgical methods used to treat Hill-Sachs lesions. It also details the relevant clinical and surgical findings that have been made throughout the literature in the past couple of years. RECENT FINDINGS The most recent literature covering the Hill-Sachs lesion has focused on the relatively new and unexplored topic of the importance of concomitant injuries while treating a humeral head defect. The glenoid track concept has been clinically validated as a method to predict engagement. 3D-CT has become the "gold standard" for Hill-Sachs imaging; however, it has been noted that 3D-MRI produces results that are not significantly different from CT. Also, it has been found that when the arm is in a position of abduction during the primary injury, there is a higher risk of engagement and subsequent dislocation. Recent studies have demonstrated successful results stemming from purely arthroscopic procedures in treating Hill-Sachs lesions. Anterior shoulder instability, specifically the Hill-Sachs lesion, is an area of orthopedic study that is highly active and constantly producing new studies in an attempt of gaining the best outcomes for patients. The past few years have yielded many excellent discoveries, but there is still much more work to be done in order to fully understand the role of the Hill-Sachs lesion in anterior shoulder instability.
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Affiliation(s)
- Jake A Fox
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA
| | - Anthony Sanchez
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA
| | | | - Matthew T Provencher
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA.
- The Steadman Clinic, Vail, CO, USA.
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