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Johnson CM, DeFoor MT, Griswold BG, Bozzone AE, Galvin JW, Parada SA. Functional Anatomy and Biomechanics of Shoulder Instability. Clin Sports Med 2024; 43:547-565. [PMID: 39232565 DOI: 10.1016/j.csm.2024.03.016] [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
The glenohumeral joint is the least congruent and least constrained joint with a complex relationship of static and dynamic stabilizers to balance its native mobility with functional stability. In the young athlete, anterior shoulder instability is multifactorial and can be a challenge to treat, requiring a patient-specific treatment approach. Surgical decision-making must consider patient-specific factors such as age, sport activity and level, underlying ligamentous laxity, and goals for return to activity, in addition to careful scrutiny of the underlying pathology to include humeral and glenoid bone loss and surrounding scapular bone morphology.
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Affiliation(s)
- Craig M Johnson
- Madigan Army Medical Center, 9040 Jackson Avenue, Tacoma, WA 98431, USA
| | - Mikalyn T DeFoor
- San Antonio Military Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78234, USA
| | - Branum Gage Griswold
- Denver Shoulder/Western Orthopaedics, 1830 Franklin Street, Denver, CO 80218, USA
| | - Anna E Bozzone
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| | - Joseph W Galvin
- Orthopaedic Surgery, Madigan Army Medical Center, 9040 Jackson Avenue, Tacoma, WA 98431, USA
| | - Stephen A Parada
- Orthopaedic Research, Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912, USA.
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Fischer CS, Floß M, Ittermann T, Gonser CE, Giordmaina R, Bülow R, Schmidt CO, Lange J. Gender-specific factors influencing the glenoid version and reference values for it. J Orthop Traumatol 2024; 25:39. [PMID: 39152298 PMCID: PMC11329491 DOI: 10.1186/s10195-024-00778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/08/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Glenoid version is an important factor in the evaluation of shoulder stability and shoulder pathologies. However, there are neither established reference values nor known factors that influence the glenoid version, even though valid reference values are needed for diagnostic and orthopaedic surgery like corrective osteotomy and total or reverse shoulder arthroplasty (TSA/RSA). The aim of our population-based study was to identify factors influencing the glenoid version and to establish reference values from a large-scale population cohort. RESULTS Our study explored the glenoid versions in a large sample representing the general adult population. We investigated 3004 participants in the population-based Study of Health in Pomerania (SHIP). Glenoid version was measured for both shoulders via magnetic resonance imaging (MRI). Associations with the glenoid version were calculated for sex, age, body height, body weight and BMI. The reference values for glenoid version in the central European population range between -9° and 7.5°, while multiple factors are associated with the glenoid version. CONCLUSION To achieve a reliable interpretation prior to orthopaedic surgery, sex- and age-adjusted reference values are proposed.
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Affiliation(s)
- Cornelius Sebastian Fischer
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Matthias Floß
- Clinic of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, Ernst-Moritz-Arndt University of Greifswald, Greifswald, Germany
| | - Christoph Emanuel Gonser
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.
- BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany.
| | - Ryan Giordmaina
- Department of Trauma and Orthopaedics, Mater Dei Hospital, University of Malta, Msida, Malta
| | - Robin Bülow
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Carsten-Oliver Schmidt
- Institute for Community Medicine, Ernst-Moritz-Arndt University of Greifswald, Greifswald, Germany
| | - Jörn Lange
- Clinic of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
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Ugur F, Albayrak M. Effectiveness of the Cunningham technique for shoulder dislocation reduction and its role in providing analgesia and muscle relaxation as an adjunctive method. Clinics (Sao Paulo) 2024; 79:100447. [PMID: 39029266 PMCID: PMC11304695 DOI: 10.1016/j.clinsp.2024.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 05/04/2024] [Accepted: 07/03/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Shoulder dislocation, particularly anterior dislocation, is a common orthopedic injury often presenting in emergency care settings, characterized by significant pain and muscle spasms. Prompt reduction is essential to alleviate symptoms and restore function. The Cunningham technique employs gentle pulling and massage motions targeted at the muscles and has emerged as a promising method for reducing anterior shoulder dislocations. However, its reported success rates vary widely across studies, and questions remain regarding its efficacy, particularly in cases of failure. This study aims to evaluate the effectiveness of the Cunningham technique for reducing anterior shoulder dislocations and its potential role in providing analgesia and muscle relaxation as an adjunctive method. METHODS A retrospective study was conducted on patients presenting with acute anterior shoulder dislocation at a single center. Reduction using the Cunningham technique was performed initially, followed by the external rotation technique if unsuccessful. Procedural sedation and analgesia were administered if the reduction was still not achieved, and shoulder dislocation reduction was performed again through the external rotation method. The patients' VAS scores were recorded and evaluated the Cunningham technique's effectiveness in reduction and whether it increases the effectiveness of other techniques applied for reduction by lowering the VAS score, even in cases where it is not effective. RESULTS A total of 61 patients were included in the study. The reduction was performed using the Cunningham technique in 34.4% (21/61) patients, the external rotation technique in 47.5% (29/61) patients, and the external rotation technique with PSA in 18% (11/61) patients. Significant differences were observed in the duration of hospital stay among the three techniques, with ER with PSA resulting in the longest stay. VAS scores showed significant improvements from initial presentation to post-reduction in all three groups. A significant decrease in pre-reduction VAS scores was observed during the transition from the Cunningham technique to other techniques. CONCLUSION The Cunningham technique showed effectiveness in reducing anterior shoulder dislocations, providing analgesia, and muscle relaxation. It demonstrated favorable outcomes as an initial reduction technique, with the external rotation technique used as a subsequent option. Further studies comparing the success rates and complications of the Cunningham technique with other reduction methods are warranted to establish its role in clinical practice.
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Affiliation(s)
- Fatih Ugur
- Kastamonu University School of Medicine, Department of Orthopaedics and Traumatology, Kastamonu, Turkey.
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Cui DD, Long Y, Yan Y, Li C, Yang YT, Zhong JL, Yang R. Three-Dimensional Magnetic Resonance Imaging Fast Field Echo Resembling a Computed Tomography Using Restricted Echo-Spacing Sequence Is Equivalent to 3-Dimensional Computed Tomography in Quantifying Bone Loss and Measuring Shoulder Morphology in Patients With Shoulder Dislocation. Arthroscopy 2024; 40:1777-1788. [PMID: 38154531 DOI: 10.1016/j.arthro.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/30/2023]
Abstract
PURPOSE To evaluate the equivalence of 3-dimensional (3D) magnetic resonance imaging (MRI) (FRACTURE [Fast field echo Resembling A CT Using Restricted Echo-spacing]) and 3D computed tomography (CT) in quantifying bone loss in patients with shoulder dislocation and measuring morphologic parameters of the shoulder. METHODS From July 2022 to June 2023, patients with anterior shoulder dislocation who were aged 18 years or older and underwent both MRI and CT within 1 week were included in the study. The MRI protocol included an additional FRACTURE sequence. Three-dimensional reconstructions of MRI (FRACTURE) and CT were completed by 2 independent observers using Mimics software (version 21.0) through simple threshold-based segmentation. For bone defect cases, 2 independent observers evaluated glenoid defect, percentage of glenoid defect, glenoid track, Hill-Sachs interval, and on-track/off-track. For all cases, glenoid width, glenoid height, humeral head-fitting sphere radius, critical shoulder angle, glenoid version, vault depth, and post-processing time were assessed. The paired t test was used to assess the differences between 3D CT and 3D MRI (FRACTURE). Bland-Altman plots were constructed to evaluate the consistency between 3D CT and 3D MRI (FRACTURE). Interobserver and intraobserver agreement was evaluated with the interclass correlation coefficient. The paired χ2 test and Cohen κ statistic were used for binary variables (on-track/off-track). RESULTS A total of 56 patients (16 with bipolar bone defect, 5 with only Hill-Sachs lesion, and 35 without bone defect) were ultimately enrolled in the study. The measurements of 21 bone defect cases showed no statistically significant differences between 3D CT and 3D MRI: glenoid defect, 4.05 ± 1.44 mm with 3D CT versus 4.16 ± 1.39 mm with 3D MRI (P = .208); percentage of glenoid defect, 16.21% ± 5.95% versus 16.61% ± 5.66% (P = .199); glenoid track, 18.02 ± 2.97 mm versus 18.08 ± 2.98 mm (P = .659); and Hill-Sachs interval, 14.29 ± 1.93 mm versus 14.35 ± 2.07 mm (P = .668). No significant difference was found between 3D CT and 3D MRI in the diagnosis of on-track/off-track (P > .999), and diagnostic agreement was perfect (κ = 1.00, P < .001). There were no statistically significant differences between the 2 examination methods in the measurements of all 56 cases, except that the post-processing time of 3D MRI was significantly longer than that of 3D CT: glenoid height, 34.56 ± 1.98 mm with 3D CT versus 34.67 ± 2.01 mm with 3D MRI (P = .139); glenoid width, 25.32 ± 1.48 mm versus 25.45 ± 1.47 mm (P = .113); humeral head-fitting sphere radius, 22.91 ± 1.70 mm versus 23.00 ± 1.76 mm (P = .211); critical shoulder angle, 33.49° ± 2.55° versus 33.57° ± 2.51° (P = .328); glenoid version, -3.25° ± 2.57° versus -3.18° ± 2.57° (P = .322); vault depth, 37.43 ± 1.68 mm versus 37.58 ± 1.75 mm (P = .164); and post-processing time, 89.66 ± 10.20 seconds versus 360.93 ± 26.76 seconds (P < .001). For all assessments, the Bland-Altman plots showed excellent consistency between the 2 examination methods, and the interclass correlation coefficients revealed excellent interobserver and intraobserver agreement. CONCLUSIONS Three-dimensional MRI (FRACTURE) is equivalent to 3D CT in quantifying bone loss in patients with shoulder dislocation and measuring shoulder morphologic parameters. LEVEL OF EVIDENCE Level II, development of diagnostic criteria (consecutive patients with consistently applied reference standard and blinding).
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Affiliation(s)
- De-Dong Cui
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Long
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan Yan
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Cheng Li
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi-Tao Yang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing-Lian Zhong
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Yang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Hu Q, Zhou Z, Sun B, Zhang G, Zhu Q, Zhang X, Wu D, He Y. Association of the Stability Ratio With Postoperative Clinical Function and Recurrence of Instability in Patients With Anterior Shoulder Instability: A Retrospective Cohort Study. Orthop J Sports Med 2024; 12:23259671241238216. [PMID: 38699650 PMCID: PMC11064755 DOI: 10.1177/23259671241238216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 05/05/2024] Open
Abstract
Background The stability ratio (SR) is used to assess the stability of the glenoid in anterior shoulder instability (ASI). However, the association between the SR and postoperative clinical function and instability recurrence after arthroscopic Bankart repair is unknown. Hypothesis Patients with a higher SR would have better postoperative clinical scores and a lower incidence of recurrent instability than patients with a lower SR after arthroscopic Bankart repair. Study Design Cohort study; Level of evidence, 3. Methods A total of 62 patients who underwent arthroscopic Bankart repair for ASI between 2013 and 2019 were enrolled. All patients had at least 2 years of follow-up data. The preoperative SR was calculated via biomechanical testing based on patient-specific 3-dimensional glenoid models, and patients were evenly divided into 2 groups: high SR (≥16.13%) and low SR (<16.13%). Baseline information (patient characteristics, clinical history, bone defect area [BDA], and SR), clinical scores at the final follow-up (Single Assessment Numerical Evaluation, Western Ontario Shoulder Index, and American Shoulder and Elbow Surgeons), and instability recurrence were compared between the 2 groups. Results No significant differences were found in the baseline information between the high- and low-SR groups, except for the BDA (8.5% [high-SR group] vs 11.9% [low-SR group]; P = .01). No patients in the high-SR group had recurrent instability, while 6 patients (19.4%) had recurrent instability in the low-SR group (P = .02). Patients in the high-SR group had superior clinical outcomes compared with those in the low-SR group in terms of postoperative Western Ontario Shoulder Index scores (median, 205 vs 410, respectively; P = .006) and American Shoulder and Elbow Surgeons scores (median, 98.3 vs 95, respectively; P = .02). Conclusion In the present study, the SR was significantly associated with postoperative clinical function and recurrence of instability after arthroscopic Bankart repair in patients with ASI.
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Affiliation(s)
- Qingxiang Hu
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhekun Zhou
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Benben Sun
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guangcheng Zhang
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Zhu
- Department of Orthopedics, Jinshan District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Xiaofeng Zhang
- Department of Orthopedics, Jinshan District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Di Wu
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaohua He
- Department of Orthopedics, Jinshan District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, China
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Haase L, Ina J, Harlow E, Chen R, Gillespie R, Calcei J. The Influence of Component Design and Positioning on Soft-Tissue Tensioning and Complications in Reverse Total Shoulder Arthroplasty: A Review. JBJS Rev 2024; 12:01874474-202404000-00002. [PMID: 38574183 DOI: 10.2106/jbjs.rvw.23.00238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
» Reverse total shoulder arthroplasty was designed to function in the rotator cuff deficient shoulder by adjusting the glenohumeral center of rotation (COR) to maximize deltoid function.» Adjustments in the COR ultimately lead to changes in resting tension of the deltoid and remaining rotator cuff, which can affect implant stability and risk of stress fracture.» Soft-tissue balance and complication profiles can be affected by humeral component (version, neck shaft angle, and inlay vs. onlay) and glenoid component (sagittal placement, version, inclination, and lateralization) design and application.» A good understanding of the effects on soft-tissue balance and complication profile is critical for surgeons to best provide optimal patient outcomes.
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Affiliation(s)
- Lucas Haase
- University Hospitals of Cleveland, Cleveland, Ohio
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Hong G, Kong X, Zhang L, Zheng Y, Fan N, Zang L. Changes in the Lateral Acromion Angle in Rotator Cuff Tear Patients with Acromioplasty. Orthop Surg 2024; 16:471-480. [PMID: 38112436 PMCID: PMC10834229 DOI: 10.1111/os.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Arthroscopic surgery has been established as an efficacious intervention for the treatment of rotator cuff tears. The primary aim of this study was to analyze the modifications in the lateral acromial angle (LAA) subsequent to rotator cuff repair surgery using single-row rivet fixation and double-row rivet fixation techniques. Furthermore, we sought to investigate the influence of LAA on the prognosis of rotator cuff repair surgery. METHOD This observational study retrospectively enrolled 105 patients diagnosed with degenerative rotator cuff tears who underwent arthroscopic rotator cuff repair between 2016 and 2019. Following the exclusion of two patients with subscapularis or superior labrum anterior and posterior (SLAP) tears, as well as three patients who were lost to follow-up, a cohort of 100 patients was included for clinical and imaging evaluation. Among these individuals, 50 were assigned to the double-row repair group, whereas the remaining 50 comprised the single-row repair group. Bilateral shoulder magnetic resonance imaging (MRI) scans were conducted no less than 24 months post-surgery. Experienced arthroscopic surgeons, blinded to the LAA measurements, assessed the rotator interval (RI) using a control MRI. Functional assessment was performed using the University of California, Los Angeles (UCLA) quick disability of the shoulder and arm, shoulder and hand (qDASH) score. The Wilcoxon signed-rank test for dependent samples was employed to compare data between the pre- and post-intervention groups. Pearson correlation coefficients were calculated to evaluate the relationship between different parameters. RESULTS The study population consisted of 73 female patients and 27 male patients, with a mean age of 58.32 ± 5.29 years and a mean follow-up duration of 25.88 ± 8.11 months. Preoperatively, the mean LAA was 75.81° ± 11.28°, RI was 4.78 ± 0.62, UCLA score was 17.54 ± 2.44, and qDASH score was 2.45 ± 0.25. The average tear size was 8.95 ± 2.11 mm. A statistically significant difference in LAA was observed between the preoperative and postoperative measurements, with the double-row repair group exhibiting a greater LAA than the single-row repair group. Finally, a significant correlation was identified between LAA, RI, and qDASH scores after a 24-month follow-up period. CONCLUSION According to our findings, the utilization of double-row rivet fixation has a greater LAA angle than single-row rivet fixation. Moreover, this preservation of LAA is significantly associated with the functional recovery of the shoulder joint.
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Affiliation(s)
- Gang Hong
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaochuan Kong
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Le Zhang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yingfeng Zheng
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Verweij LPE, Sierevelt IN, van der Woude HJ, Hekman KMC, Veeger HEJD, van den Bekerom MPJ. Surgical Intervention Following a First Traumatic Anterior Shoulder Dislocation Is Worthy of Consideration. Arthroscopy 2023; 39:2577-2586. [PMID: 37597706 DOI: 10.1016/j.arthro.2023.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/21/2023]
Abstract
Up to 60% of patients experience recurrence after a first traumatic anterior shoulder dislocation (FTASD), which is often defined as having experienced either dislocation or subluxation. Thus surgical intervention after FTASD is worthy of consideration and is guided by the number of patients who need to receive surgical intervention to prevent 1 redislocation (i.e., number needed to treat), (subjective) health benefit, complication risk, and costs. Operative intervention through arthroscopic stabilization can be successful in reducing recurrence risk in FTASD, as has been shown in multiple randomized controlled trials. Nevertheless, there is a large "gray area" for the indication of arthroscopic stabilization, and it is therefore heavily debated which patients should receive operative treatment. Previous trials showed widely varying redislocation rates in both the intervention and control group, meta-analysis shows 2% to 19% after operative and 20% to 75% after nonoperative treatment, and redislocation rates may not correlate with patient-reported outcomes. The literature is quite heterogeneous, and a major confounder is time to follow-up. Furthermore, there is insufficient standardization of reporting of outcomes and no consensus on definition of risk factors. As a result, surgery is a reasonable intervention for FTASD patients, but in which patients it best prevents redislocation requires additional refinement.
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Affiliation(s)
- Lukas P E Verweij
- Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, the Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands.
| | - Inger N Sierevelt
- Xpert Clinics, Department of Orthopedic Surgery, Amsterdam, the Netherlands; Spaarnegasthuis Academy, Orthopedic Department, Hoofddorp, the Netherlands
| | - Henk-Jan van der Woude
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Department of Radiology, OLVG, Amsterdam, the Netherlands
| | - Karin M C Hekman
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Shoulder Center IBC Amstelland, Amstelveen, the Netherlands
| | - H E J DirkJan Veeger
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Department of Orthopedic Surgery, Medical Center Jan van Goyen, Amsterdam, the Netherlands; Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Moore TK, Kilkenny CJ, Hurley ET, Magee BM, Levin JM, Khan SU, Dickens JF, Mullett H. Posterior Shoulder Instability but Not Anterior Shoulder Instability Is Related to Glenoid Version. Arthrosc Sports Med Rehabil 2023; 5:100794. [PMID: 37711163 PMCID: PMC10497783 DOI: 10.1016/j.asmr.2023.100794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 08/08/2023] [Indexed: 09/16/2023] Open
Abstract
Purpose To assess and compare glenoid version in patients with anterior shoulder instability (ASI), posterior shoulder instability (PSI), and a control group. Methods The operative notes of all patients that had undergone arthroscopic shoulder instability repair between January 2017 and May 2022 were retrospectively reviewed. Magnetic resonance imaging scans were then analyzed, and glenoid version was measured by a single blinded observer. A P value <.05 was considered statistically significant. Results There were 100 patients included in the ASI group, 65 in PSI group, and 100 in the control group. The mean glenoid versions for the ASI group were -16°, -9.1°, and -9.2° for the vault version, simplified vault version, and chondrolabral version, respectively. The mean glenoid versions for the PSI group were -21°, -13.4°, and -16.6° for the vault version, simplified vault version, and chondrolabral version, respectively. The mean versions for the control group were -17.8°, -9.5°, and -9.8° for the vault version, simplified vault version and chondrolabral version, respectively. ANOVA testing and post hoc comparisons revealed the PSI group to be significantly more retroverted than both other groups P < .001. The ASI group's degree of glenoid version was not significantly different to that of the control P = .009. Conclusion Patients with PSI have a higher degree of retroversion in comparison to those with ASI and control. There is no significant difference in glenoid version among patients with ASI when compared with control. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Thomas K. Moore
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Conor J. Kilkenny
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan T. Hurley
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Duke University, Durham, North Carolina, U.S.A
| | | | | | | | | | - Hannan Mullett
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Kıvrak A, Ulusoy İ. Effect of Glenohumeral Joint Bone Morphology on Anterior Shoulder Instability: A Case-Control Study. J Clin Med 2023; 12:4910. [PMID: 37568312 PMCID: PMC10419457 DOI: 10.3390/jcm12154910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/07/2023] [Accepted: 06/24/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE Glenohumeral joint compatibility and bone morphology are among the most critical factors in shoulder stabilization. Our study investigated the effect of the bone morphological structure of the shoulder joint on anterior shoulder dislocation. METHODS In our study, people with a history of shoulder dislocation were selected as the patient group. In the control group, patients with shoulder MRIs for any reason and no history of shoulder dislocation were included. Those who have a fracture around the shoulder, a congenital deformity in the shoulder region, arthrosis of the shoulder, those whose MRI images cannot be measured, those with Hill-Sachs lesion, connective tissue diseases (such as Ehler Danlos), who are unsure of their diagnosis, or who have incomplete and incorrect suspicious information in their patient file have been excluded. In our retrospective case-control study, glenoid width, glenoid height, glenoid's height-to-width ratio, glenoid's depth, glenoid's version, glenoid's inclination, humerus radius of curvature, glenoid radius of curvature, and bony shoulder stability ratio were measured on MRI images of the patients. The sample size for each group was determined using a power analysis method. The intra-class coefficient (ICC) assessed interobserver and intraobserver reliability. RESULTS A total of 80 patients, 40 each in the control and patient groups, were included in the study. Glenoid width was measured as 24.27 ± 1.58 in the patient group, 25.61 ± 1.72 in the control group; glenoid height was as measured 36.49 ± 2.26 in the patient group, 36.74 ± 1.99 in the control group; height-to-width ratio was measured as 1.5 ± 0.08 in the patient group, 1.43 ± 0.05 in the control group; glenoid version was as measured -0.53 ± 1.17 in the patient group, -1.44 ± 1.1 in the control group; glenoid inclination was measured as 1.44 ± 3.93 patient group, 2.64 ± 3.81 in the control group; glenoid depth was measured as 1.69 ± 0.41 in the patient group, 2.12 ± 0.53 in the control group; humerus radius of curvature was measured as 29.70 ± 6.76 in the patient group, 24.98 ± 3.22 in the control group; glenoid axial radius of curvature was measured as 61.8 ± 13.52 in the patient group, 52.53 ± 15.69 in the control group; glenoid coronal radius of curvature was measured as 43.01 ± 7.47 in the patient group, 37.74 ± 6.89 in the control group; the bony shoulder stability ratio was measured as 0.35 ± 0.06 in the patient group and 0.44 ± 0.06 in the control group. In the statistical evaluation, the glenoid width (p < 0.001), the glenoid height/width ratio (p < 0.001), the glenoid version (p < 0.001), the depth of the glenoid cavity (p < 0.001), and the radius of curvature measurements of the humeral head (p < 0.001) and the glenoid (axial, p < 0.007; coronal, p < 0.001) were found to be significantly different. Glenoid height and inclination were similar in both groups. CONCLUSIONS The detection of bone morphological features that constitute risk factors for shoulder dislocations plays an important role in preventing shoulder dislocations. In this way, it provides essential data on personalized rehabilitation programs and treatment selection for recurrent dislocations.
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Affiliation(s)
| | - İbrahim Ulusoy
- Department of Orthopedic Surgery, Selahhadin Eyyubi State Hospital, 21100 Diyarbakır, Turkey
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Özer M, Yaka H, Türkmen F, Kaçira BK, Kaptan AY, Kanatli U. Evaluation of the relationship between scapula morphology and anterior shoulder dislocation accompanying greater tuberosity fracture. Injury 2023:S0020-1383(23)00397-2. [PMID: 37183089 DOI: 10.1016/j.injury.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/27/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTıON: It is estimated that 5-30% of traumatic anterior shoulder dislocations are accompanied by greater tuberosity fracture (GTF), and the pathomechanism of these fractures is not yet clear. Our hypothesis is to examine the relationship between the scapula morphology and anterior shoulder dislocation (ASD) accompanying GTF. MATERıALS AND METHODS: The patients were divided into two groups according to the accompanying GTF. 40 patients with isolated traumatic ASD and 31 patients with accompanying GTF were included in the study. Critical shoulder angle (CSA), glenoid inclination (GI), acromial index (AI) and greater tuberosity angle (GTA) values were measured in two sessions by two independent observers in the standard antero-posterior radiographs of the patients in both groups. RESULTS: The mean CSA was 40.82°±3.19° and 35.49°±2.19° in accompanying GTF group and the isolated ASD group, respectively. The mean CSA was significantly higher in accompanying GTF group than isolated ASD group(P<0.001). The GI was significantly higher in the isolated ASD than in accompanying GTF group (P = 0.001). The mean GI was 18.7°±6.85° and 10.45°±4.87° in accompanying GTF group and the isolated ASD, respectively. Cut-off value of CSA and GI was 38° (88.2% sensitivity,88.9% specificity) and 14.5° (70.6% sensitivity and 72.2% specificity), respectively. There was no significant difference regarding the mean GTA and AI values between GTF group and the isolated ASD group (P = 0.98, P = 0.63). CONCLUSıONS: Increased CSA and GI values are associated with traumatic anterior shoulder dislocation accompanied by greater tuberosity fracture.
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Affiliation(s)
- Mustafa Özer
- Konya City Hospital, Department of Orthopaedics & Traumatology, Konya 42020, Turkey
| | - Haluk Yaka
- Necmettin Erbakan University School of Medicine, Department of Orthopaedics & Traumatology, Konya, Turkey.
| | - Faik Türkmen
- Necmettin Erbakan University School of Medicine, Department of Orthopaedics & Traumatology, Konya, Turkey
| | | | - Ahmet Yiğit Kaptan
- Harran University Hospital, Department of Orthopaedics & Traumatology, Şanlıurfa, Turkey
| | - Ulunay Kanatli
- Gazi University School of Medicine, Department of Orthopaedics & Traumatology, Ankara, Turkey
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12
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Wilder L, Simon P, Reyes J, Diaz M, Munassi S, Frankle MA. Three-Dimensional Scapular Border Method for Glenoid Version Measurements. JB JS Open Access 2023; 8:JBJSOA-D-22-00105. [PMID: 36733708 PMCID: PMC9886516 DOI: 10.2106/jbjs.oa.22.00105] [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] [Indexed: 02/04/2023] Open
Abstract
Variations among methods to measure glenoid version have created uncertainty regarding which method provides the most consistent measurements of morphology. Greater deformity may also make accurate depiction of the native morphology more challenging. This study examined 4 current methods (Friedman, corrected Friedman, Ganapathi-Iannotti, and Matsumura) and an experimental scapular border-derived coordinate system method, to compare measurement inconsistencies between methods and reference systems and assess the impact of glenoid deformity on measured glenoid version. Methods Three-dimensional scapulae were created from computed tomography (CT) scans of 74 shoulders that had undergone arthroplasty (28 A2, 22 B2, 10 B3, and 14 C glenoids) and 34 shoulders that had not undergone arthroplasty. Glenoid version measurements were made in Mimics using the 4 methods. For the experimental method, scapulae were reconstructed, and 3 orthogonal global coordinate planes (GCPs) were derived from the medial and lateral borders. Version was measured as the angle between the sagittal reference plane and an anterior-posterior glenoid vector. The intraclass correlation coefficient (ICC) was calculated for the Friedman and corrected Friedman methods. Inconsistencies were assessed for all methods using the interquartile range, mean and standard deviation, and repeated-measures analysis of variance. Concordance correlation coefficients (CCCs) were calculated to assess agreement among the methods. Results Scapular plane-based methods (experimental, Friedman, and corrected Friedman) yielded an average version between -10° and -12°, with average measurement differences among these methods of <2°. Vault methods (Ganapathi-Iannotti and Matsumura) overestimated or underestimated version by an average of 5° to 7° compared with scapular plane-based methods, and showed significant differences of >12° when compared with each other. Scapular plane-based methods maintained consistency with increasing deformity. Conclusions The other methods of version measurement using the scapular planes as the reference were highly comparable with the corrected Friedman method. However, when the reference plane was the glenoid vault, version measurements were inconsistent with scapular plane-based methods, which is attributed to differences in the reference systems. In surgical planning, the coordinate system utilized will impact version measurements, which can result in variations in the planned surgical solutions. Additionally, as glenoid deformity increases, this variation resulting from the utilization of different coordinate systems is magnified.
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Affiliation(s)
- Lauren Wilder
- Foundation for Orthopaedic Research and Education, Tampa, Florida
| | - Peter Simon
- Foundation for Orthopaedic Research and Education, Tampa, Florida,Department of Medical Engineering, College of Engineering and Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Justin Reyes
- Department of Pathology & Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Miguel Diaz
- Foundation for Orthopaedic Research and Education, Tampa, Florida
| | - Steven Munassi
- Foundation for Orthopaedic Research and Education, Tampa, Florida
| | - Mark A. Frankle
- Shoulder & Elbow Department, Florida Orthopaedic Institute, Tampa, Florida,Department of Orthopaedics and Sports Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida,Email for corresponding author:
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Comparison of computed tomography and 3D magnetic resonance imaging in evaluating glenohumeral instability bone loss. J Shoulder Elbow Surg 2022; 31:2217-2224. [PMID: 35931334 DOI: 10.1016/j.jse.2022.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/07/2022] [Accepted: 06/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND To determine whether the addition of 3-dimensional (3D) magnetic resonance imaging (MRI) to standard MRI sequences is comparable to 3D computed tomographic (CT) scan evaluation of glenoid and humeral bone loss in glenohumeral instability. METHODS Eighteen patients who presented with glenohumeral instability were prospectively enrolled and received both MRI and CT within 1 week of each other. The MRI included an additional sequence (volumetric interpolated breath-hold examination [VIBE]) that underwent postprocessing for reformations. The addition of a VIBE protocol, on average, is an additional 4-4.5 minutes in the scanner. CT data also underwent 3D postprocessing, and therefore each patient had 4 imaging modalities (2D CT, 2D MRI, 3D CT reformats, and 3D MRI reformats). Each sequence underwent the following measurements from 2 separate reviewers: glenoid defect, glenoid defect percentage, humeral defect, humeral defect percentage, and evaluation of glenoid track and version. Paired t tests were used to assess differences between imaging modalities and χ2 for glenoid track. Intra- and interobserver reliability were evaluated. Bland-Altman tests were also performed to assess the agreement between CT and MRI. In addition, we determined the cost of each imaging modality at our institution. RESULTS 3D MRI measurements for glenoid and humeral bone loss measurements were comparable to 3D CT (Table 1). There were no significant differences for glenoid defect size and percentage, or humeral defect size and percentage (P > .05) (Table 2). Bland-Altman analysis demonstrated strong agreement, with small measurement errors for 3D CT and 3D MRI percentage glenoid bone loss. There was also no difference in evaluation for determining on vs. off track between any of the imaging modalities. Inter- and intrarater reliability was good to excellent for all CT and MRI measurements (r ≥ 0.7). CONCLUSION 3D MRI measurements for bone loss in glenohumeral instability through use of VIBE sequence were equivalent to 3D CT. At our institution, undergoing MRI with 3D reconstruction was 1.67 times cheaper than MRI and CT with 3D reconstructions. 3D MRI may be a useful adjuvant to standard MRI sequences to allow concurrent soft tissue and accurate assessment of glenoid and humeral bone loss in glenohumeral instability.
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14
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The Effect of Glenoid Version on Glenohumeral Instability. J Am Acad Orthop Surg 2022; 30:e1165-e1178. [PMID: 36166388 DOI: 10.5435/jaaos-d-22-00148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/01/2022] [Indexed: 02/01/2023] Open
Abstract
In recent years, an appreciation for the dynamic relationship between glenoid and humeral-sided bone loss and its importance to the pathomechanics of glenohumeral instability has substantially affected modern treatment algorithms. However, comparatively less attention has been paid to the influence of glenoid version on glenohumeral instability. Limited biomechanical data suggest that alterations in glenoid version may affect the forces necessary to destabilize the glenohumeral joint. However, this phenomenon has not been consistently corroborated by the results of clinical studies. Although increased glenoid retroversion may represent an independent risk factor for posterior glenohumeral instability, this relationship has not been reliably observed in the setting of anterior glenohumeral instability. Similarly, the effect of glenoid version on the failure rates of surgical stabilization procedures remains poorly understood.
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15
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Paopongthong N, Atthakomol P, Phornphutkul C. The relationship of glenoid version and severity of glenoid bone loss in anterior shoulder instability patients: A retrospective cohort study. Asia Pac J Sports Med Arthrosc Rehabil Technol 2022; 28:25-30. [PMID: 35465463 PMCID: PMC9018216 DOI: 10.1016/j.asmart.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/13/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background/objective The effect of glenoid version on the severity of glenoid bone loss is not completely understood, although the variation of glenoid version angles is considered to reflect the degree of glenoid bone loss in anterior shoulder instability cases. The objective of this retrospective case-control study is to determine the relationship of the glenoid version and the severity of glenoid bone loss in a group of previously documented recurrent anterior shoulder dislocation patients. Methods We retrospectively collected magnetic resonance arthrogram (MRA) data from 72 patients with unidirectional recurrent anterior shoulder instability. The best-fit circle method was used to identify the percentage of glenoid bone loss. Measurements of glenoid labral, chondral, and bony versions were performed using the Friedman method. Results Using univariate regression analysis, it was found that a retroversion angle of more than 4 degrees was associated with an increased risk ratio for the occurrence of a critical glenoid defect by approximately 5 times. Conclusions 24 Univariate logistic regression analysis, used to determine the presence of a critical glenoid bone defect, showed that both the bony version angle and the number of previous dislocations were significantly associated with the extent of glenoid bone loss. A retroversion angle of more than 4 degrees was associated with an approximately five-fold increase in the odds ratio for the presence of a critical glenoid defect. Surgeons may use the value of the measured glenoid version in prediction the required version of the reconstructive treatment.
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Affiliation(s)
- Nattakorn Paopongthong
- Department of Orthopaedics, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand
| | - Pichitchai Atthakomol
- Department of Orthopaedics, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand
| | - Chanakarn Phornphutkul
- Department of Orthopaedics, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand
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Kunze KN, Alter TD, Newhouse AC, Bessa FS, Williams JC, Nho SJ. Association Between Orientation and Magnitude of Femoral Torsion and Propensity for Clinically Meaningful Improvement After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Computed Tomography Analysis. Am J Sports Med 2021; 49:2466-2474. [PMID: 34166125 DOI: 10.1177/03635465211021610] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoral torsion imaging measurements and classifications are heterogeneous throughout the literature, and the influence of femoral torsion on clinically meaningful outcome improvement after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has not been well studied. PURPOSE To (1) perform a computed tomography (CT)-based analysis to quantify femoral torsion in patients with FAIS and (2) explore the relationship between the orientation and magnitude of femoral torsion and the propensity for clinically meaningful outcome improvement after hip arthroscopy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Consecutive patients who underwent hip arthroscopy for FAIS between January 2012 and April 2018 were identified. Inclusion criteria were the presence of preoperative CT imaging with transcondylar slices of the knee and minimum 2-year outcome measures. Exclusion criteria were revision hip arthroscopy, Tönnis grade >1, congenital hip condition, hip dysplasia (lateral center-edge angle <20°), and concomitant gluteus medius or minimus repair. Torsion groups were defined as severe retrotorsion (SR; <0°), moderate retrotorsion (MR; 0°-5°), normal torsion (N; 5°-20°), moderate antetorsion (MA; 20°-25°), and severe antetorsion of antetorsion (SA; >25°). Treatment did not differ based on femoral torsion. Patient characteristics and clinical outcomes were analyzed, including the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool (iHOT-12), visual analog scale (VAS) for pain, and VAS for satisfaction. Achievement of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) by torsion stratification was analyzed using the chi-square test. Inter- and intrarater reliabilities for CT measurements were 0.980 (P < .001) and 0.974 (P < .001), respectively. RESULTS The study included 573 patients with a mean ± SD age and body mass index of 32.6 ± 11.8 years and 25.6 ± 10.6, respectively. The mean ± SD femoral torsion for the study population was 12.3°± 9.3°. After stratification, the number of patients within each group and the mean ± SD torsion for each group were as follows: SR (n = 36; -6.5°± 7.1°), MR (n = 80; 2.8°± 1.4°), N (n = 346; 12.3°± 4.1°), MA (n = 64; 22.2°± 1.4°), and SA (n = 47; 30.3°± 3.7°). No significant differences in age, body mass index, sex, tobacco use, workers' compensation status, or participation in physical activity were observed at baseline. No significant differences were seen in pre- and postoperative VAS pain, mHHS, HOS-ADL, HOS-SS, iHOT-12, or postoperative VAS satisfaction among the cohorts. Furthermore, no statistically significant differences were found in the proportion of patients who achieved the MCID or the PASS for any outcome among the groups. CONCLUSION The orientation and severity of femoral torsion at the time of hip arthroscopy for FAIS did not influence the propensity for clinically significant outcome improvement.
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Affiliation(s)
- Kyle N Kunze
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA.,Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York, USA
| | - Thomas D Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander C Newhouse
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Felipe S Bessa
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Joel C Williams
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
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Kadantsev PM, Logvinov AN, Ilyin DO, Ryazantsev MS, Afanasiev AP, Korolev AV. [Shoulder instability: review of current concepts of diagnosis and treatment]. Khirurgiia (Mosk) 2021:109-124. [PMID: 33977706 DOI: 10.17116/hirurgia2021051109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To conduct a systematic review of modern literature data on the modern approaches in diagnosis and treatment of shoulder instability. MATERIAL AND METHODS Searching for literature data was performed using the Pubmed and Google Scholar databases. RESULTS The authors analyzed the results of conservative treatment of patients with shoulder instability and emphasized higher risk of instability recurrence, degeneration of anatomical structures and functional impairment in these patients. Surgery is advisable to restore shoulder stability and normalize its function. Several methods for stabilizing the shoulder have been proposed. The approaches to diagnosis and treatment of shoulder instability have been updated. CONCLUSION Successful treatment of shoulder instability is based on qualitative and complete assessment of soft tissues and bone structures. An individual approach considering bone tissue deficiency and individual needs of the patient is required.
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Affiliation(s)
- P M Kadantsev
- European Clinic of Sports Traumatology and Orthopedics (ECSTO), Moscow, Russia.,Peoples Friendship University of Russia, Moscow, Russia
| | - A N Logvinov
- European Clinic of Sports Traumatology and Orthopedics (ECSTO), Moscow, Russia
| | - D O Ilyin
- European Clinic of Sports Traumatology and Orthopedics (ECSTO), Moscow, Russia.,Peoples Friendship University of Russia, Moscow, Russia
| | - M S Ryazantsev
- European Clinic of Sports Traumatology and Orthopedics (ECSTO), Moscow, Russia
| | - A P Afanasiev
- European Clinic of Sports Traumatology and Orthopedics (ECSTO), Moscow, Russia
| | - A V Korolev
- European Clinic of Sports Traumatology and Orthopedics (ECSTO), Moscow, Russia.,Peoples Friendship University of Russia, Moscow, Russia
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Li RT, Sheean A, Wilson K, Sa DD, Kane G, Lesniak B, Lin A. Decreased Glenoid Retroversion Is a Risk Factor for Failure of Primary Arthroscopic Bankart Repair in Individuals With Subcritical Bone Loss Versus No Bone Loss. Arthroscopy 2021; 37:1128-1133. [PMID: 33307148 DOI: 10.1016/j.arthro.2020.11.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether glenoid retroversion is an independent risk factor for failure after arthroscopic Bankart repair. METHODS This was a retrospective review of patients with a minimum 2-year follow-up. In part 1 of the study, individuals with no glenoid bone loss on magnetic resonance imaging (MRI) and who failed arthroscopic Bankart repair (cases) were compared with individuals who did not fail Bankart repair (controls). In part 2 of the study, cases with subcritical (<20%) glenoid bone loss as measured on sagittal T1 MRI sequences who failed arthroscopic Bankart repair were compared with controls who did not. For each part of the study, glenoid version was measured using axial T2 MRI sequences. Positive angular measurements were designated to represent glenoid anteversion, whereas negative measurements were designated to represent glenoid retroversion. Independent t tests were conducted to determine the association between glenoid version and failure after arthroscopic Bankart repair. RESULTS There were 20 cases and 40 controls in part 1 of the study. In part 2, there were 19 cases and 21 controls. There was no difference in baseline characteristics between cases and controls. Among individuals with no glenoid bone loss, there was no difference in glenoid version between cases and controls (cases: 6.0° ± 8.1° vs controls: 5.1° ± 7.8°, P = .22). Among individuals with subcritical bone loss, cases (3.8° ± 4.4°) were associated with significantly less mean retroversion compared with controls (7.1° ± 2.8°, P = .0085). Decreased retroversion (odds ratio 1.34; 95% confidence interval 1.05-1.72, P = 20) was a significant independent predictor of failure using univariable logistic regression. CONCLUSIONS While glenoid retroversion is not associated with failure after arthroscopic Bankart repair in individuals with no glenoid bone loss, decreased retroversion is associated with failure in individuals with subcritical bone loss. LEVEL OF EVIDENCE Level 3: Retrospective review.
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Affiliation(s)
- Ryan T Li
- Department of Orthopaedic Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina, U.S.A
| | - Andrew Sheean
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, Texas, U.S.A
| | - Kevin Wilson
- Orthopedic Surgery, Mount Nittany Health, State College, Pennsylvania, U.S.A
| | - Darren de Sa
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada, Centre for Evidence-Based Orthopaedics, Hamilton, Ontario, Canada
| | - Gillian Kane
- Department of Orthopaedic Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Bryson Lesniak
- Department of Orthopaedic Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Albert Lin
- Department of Orthopaedic Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A..
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Vaswani R, Como C, Fourman M, Wilmot A, Borrero C, Vyas D, Lin A. Glenoid Radius of Curvature and Humeral Head Volume Are Associated With Postoperative Dislocation After Arthroscopic Bankart Repair. Arthrosc Sports Med Rehabil 2021; 3:e565-e571. [PMID: 34027470 PMCID: PMC8129454 DOI: 10.1016/j.asmr.2020.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 12/29/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose To measure bony morphologic parameters and identify their association with arthroscopic Bankart repair failure. Methods This was a retrospective comparative study. The inclusion criteria were primary arthroscopic Bankart repair, no prior shoulder surgery, traumatic cause, and had a Bankart (soft tissue and bony) lesion evident on magnetic resonance imaging (MRI). The exclusion criteria were posterior labral pathology, multidirectional instability, connective tissue disorder, rotator cuff pathology, and those who underwent concomitant shoulder procedures. Patients who had a postoperative redislocation (unstable group) were compared with matched patients who did not (stable group). Data were obtained by chart review and from preoperative MRI. Comparisons were made using the Student t test, Fisher exact test, or χ2 test. Statistical significance was defined as P < .05. Inter-rater reliability was measured between reviewers. Results A total of 45 patients experienced a postoperative dislocation and were matched to 90 patients without a postoperative dislocation. There were no differences in demographic and radiographic variables. The radius of curvature (ROC) of the glenoid was larger (shallower) in the unstable group (23.6 mm vs 22.6 mm, P = .05). The humeral head volume (HHV) trended higher in the unstable group (68.9 mL vs 62.9 mL, P = .06). The glenoid volume was not significantly different. A greater percentage of patients with a glenoid ROC of 24.5 mm or greater (62.1% vs 26.4%, P = .0003) and an HHV of 80 mm3 or greater (60.8% vs 28.9%, P = .003) experienced a redislocation compared with patients without these factors. Patients with a glenoid ROC of 24.5 mm or more and an HHV of 80 mm3 or more had greater than 4 times the odds of redislocation (odds ratio, 4.56; 95% confidence interval, 1.44-14.43; P = .0098). Strong inter-rater reliability was found for the HHV, glenoid volume, glenoid ROC, and humeral head ROC measurements (r = 0.94, r = 0.88, r = 0.89, and r = 0.95, respectively). Conclusions This study shows that large ROC (shallow) glenoids in conjunction with large humeral heads may predispose patients to failure after arthroscopic Bankart repair. Level of Evidence Level III, retrospective comparative trial.
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Affiliation(s)
- Ravi Vaswani
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Christopher Como
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Mitch Fourman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Andrew Wilmot
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Camilo Borrero
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Dharmesh Vyas
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
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Mehl J, Hedgecock J, Otto A, Flaherty E, Jacoby B, DiVenere J, Cote M, Mazzocca AD. Glenoid version is associated with different labrum tear patterns in shoulder instability. J Shoulder Elbow Surg 2020; 29:1642-1649. [PMID: 32713468 DOI: 10.1016/j.jse.2020.03.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 03/07/2020] [Accepted: 03/11/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies have evaluated glenoid version as a risk factor for anterior and posterior shoulder instability. However, the association of glenoid version with combined anterior-inferior-posterior (>180°) labrum injuries is unknown. The purpose of the present study was to investigate various parameters of glenoid morphology, including version, in >180° labral tears and to compare these values with isolated anterior and isolated posterior tears. METHODS Magnetic resonance imaging studies from a consecutive series of shoulder instability patients were reviewed by 3 independent observers to measure the parameters of glenoid morphology including superior-inferior and anterior-posterior diameter, diameter ratio, glenoid version using the glenoid vault method, and percentage of glenoid bone loss using the best-fit circle method. These parameters were compared between patients with anterior (group 1), posterior (group 2), and >180° labral tears (group 3). Interobserver reliability coefficients were calculated for all measurements assessed. RESULTS There were statistically significant differences for all group comparisons regarding the glenoid version, with group 2 having the most retroversion (19.9° ± 4.71°) followed by group 3 (14.21° ± 4.59°) and group 1 (11.24° ± 5.3°). Group 3 showed the lowest amount of glenoid bone loss; however, the group differences did not reach statistical significance. There was also no statistically significant group difference for the other measured parameters. Interobserver reliability was in the good to excellent range for all measurements. CONCLUSIONS Combined anterior-inferior-posterior labral tears are associated with an increased amount of glenoid retroversion compared with isolated anterior labral tears. Isolated posterior labral tears have the largest amount of glenoid retroversion of all tear patterns.
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Affiliation(s)
- Julian Mehl
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA; Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany.
| | - Jon Hedgecock
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Alexander Otto
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA; Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany; Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Eilish Flaherty
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Brigitte Jacoby
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Jessica DiVenere
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Mark Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
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Influence of coracoid anatomy on the location of glenoid rim defects in anterior shoulder instability: 3D CT-scan evaluation of 51 patients. Surg Radiol Anat 2020; 42:895-901. [PMID: 32405787 DOI: 10.1007/s00276-020-02492-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/30/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Glenoid bony lesions play a role in approximately half of anterior shoulder instability cases. The purpose of this study is to see if the anatomy of the coracoid affects the location of glenoid rim defects. We hypothesized that a prominent coracoid (lower and lateral) would be more likely to cause an anterior-inferior glenoid lesion, and a less prominent coracoid more prone to cause an anterior lesion. The null hypothesis being the absence of correlation. METHODS Fifty-one shoulder CT-scans from a prospective database, with 3D reconstruction, were analyzed. The position of glenoid lesions was identified using the validated clock method, identifying the beginning and end time. The size of bony glenoid defects was calculated using the validated glenoid ratio method. The position of the coracoid tip was measured in three orthogonal planes. RESULTS Analysis included 25 right shoulders and 26 left shoulders in seven females and 41 males. The vertical position of the coracoid tip relative to the top of the glenoid was highly correlated to the location of the glenoid defect on the profile view (r = -0.625; 95% CI 0.423-0.768; p = 0.001). Thus, higher coracoids were associated with anterior lesions, while lower coracoids were associated with anterior-inferior lesions. A more laterally prominent coracoid was also correlated with anterior-inferior lesions (r = 0.433; 95% CI 0.179-0.633; p = 0.002). CONCLUSION This study shows that coracoid anatomy affects the location of bony Bankart defects in anterior shoulder instability. Lower and laterally prominent coracoids are associated with anterior-inferior lesions. This variation in anatomy should be considered during pre-op planning for surgeries involving bone graft. LEVEL OF EVIDENCE Level 4 basic science.
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Bhatia DN, Kandhari V. Bone defect-induced alteration in glenoid articular surface geometry and restoration with coracoid transfer procedures: a cadaveric study. J Shoulder Elbow Surg 2019; 28:2418-2426. [PMID: 31324501 DOI: 10.1016/j.jse.2019.04.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study analyzed the alteration in glenoid articular geometry with increasing anterior bone loss, as well as its subsequent correction with 2 modifications of the Latarjet procedure. METHODS Anterior defects were simulated by creating glenoid osteotomies (10%, 20%, 30%, and 40%), and defects were reconstructed using 2 Latarjet modifications (classic and congruent arc). A total of 108 computed tomography scans were performed (1) on intact scapulae (n = 12), (2) after each bone defect (n = 48), and (3) after each reconstruction (n = 48). Glenoid parameters (width, area, arc length, and version) were analyzed on computed tomography scans. Statistical analysis was used to determine significant differences between intact, deficient, and reconstructed glenoids. RESULTS All parameters were reduced with every 10% defect increment (mean change in width, 2.5 mm; area, 64 mm2; version, 2.2°; and arc length, 2.2 mm). Width correction with the classic Latarjet procedure was not statistically significant in 30% and 40% defects. Area correction in 30% defects was not significant with the classic Latarjet procedure and was significantly undercorrected in 40% defects. Version correction was not significant after the classic Latarjet procedure in 20%, 30%, and 40% defects. Arc-length correction was not significant in 20% and 30% defects with the classic Latarjet procedure and was significantly undercorrected in 40% defects. The congruent-arc Latarjet procedure overcorrected glenoid parameters in all defects; however, area and arc length were not significantly different from intact glenoids in 40% defects (P < .05). CONCLUSION Glenoid articular geometry is progressively altered with a sequential increase in anterior bone defects from 0% to 40%. The classic Latarjet procedure provided significant correction in bone defects of 10% and 20%. The congruent-arc Latarjet procedure restored and overcorrected most parameters even in 40% glenoid defects.
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Affiliation(s)
- Deepak N Bhatia
- Sportsmed, Mumbai, India; Department of Orthopaedic Surgery, Seth GS Medical College, King Edward VII Memorial Hospital, Mumbai, India.
| | - Vikram Kandhari
- Sportsmed, Mumbai, India; Department of Orthopaedic Surgery, Seth GS Medical College, King Edward VII Memorial Hospital, Mumbai, India
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Willigenburg NW, Bouma RA, Scholtes VAB, van der Hulst VPM, van Deurzen DFP, van den Bekerom MPJ. Does the innate relative size of the humeral head and glenoid affect the risk of anterior shoulder instability? Shoulder Elbow 2019; 11:424-429. [PMID: 32269602 PMCID: PMC7094061 DOI: 10.1177/1758573218805099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/14/2018] [Accepted: 08/18/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bony lesions after shoulder dislocation reduce the joint contact area and increase the risk of recurrent instability. It is unknown whether the innate relative sizes of the humeral head and glenoid may predispose patients to shoulder instability. This study evaluated whether anterior shoulder instability is associated with a larger innate humeral head/glenoid ratio (IHGR). METHODS We evaluated CT scans of 40 shoulders with anterior shoulder instability and 48 controls. We measured axial humeral head diameter and glenoid diameter following native contours, discarding any bony lesions, and calculated IHGR by dividing both diameters. Multivariate logistic regression determined whether the IHGR, corrected for age and gender as potential confounders, was associated with anterior shoulder instability. RESULTS Mean IHGR was 1.48 ± 0.23 in the group with anterior shoulder instability and 1.42 ± 0.20 in the group without anterior shoulder instability. Measurements for axial humeral head and axial glenoid diameters demonstrated excellent intra-rater reliability (ICC range: 0.94-0.95). IHGR was not significantly associated with anterior shoulder instability (OR = 1.105, 95%CI = 0.118-10.339, p = 0.930). DISCUSSION The innate ratio of humeral head and glenoid diameters was not significantly associated with anterior shoulder instability in this retrospective sample of 88 shoulder CT scans.
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Affiliation(s)
- NW Willigenburg
- JointResearch, Department of Orthopaedic
Surgery, OLVG Amsterdam, the Netherlands
| | - RA Bouma
- JointResearch, Department of Orthopaedic
Surgery, OLVG Amsterdam, the Netherlands
| | - VAB Scholtes
- JointResearch, Department of Orthopaedic
Surgery, OLVG Amsterdam, the Netherlands
| | | | - DFP van Deurzen
- JointResearch, Department of Orthopaedic
Surgery, OLVG Amsterdam, the Netherlands,Shoulder and Elbow Unit, Department of
Orthopaedic Surgery, OLVG Amsterdam, the Netherlands
| | - MPJ van den Bekerom
- JointResearch, Department of Orthopaedic
Surgery, OLVG Amsterdam, the Netherlands,Shoulder and Elbow Unit, Department of
Orthopaedic Surgery, OLVG Amsterdam, the Netherlands,MPJ van den Bekerom, OLVG, Locatie Oost
Secretariaat Orthopedie t.a.v. M.P.J. van den Bekerom Postbus 95500, 1090 HM
Amsterdam, The Netherlands.
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Saygi B, Karahan N, Karakus O, Demir AI, Ozkan OC, Soylu-Boy FN. Analysis of glenohumeral morphological factors for anterior shoulder instability and rotator cuff tear by magnetic resonance imaging. J Orthop Surg (Hong Kong) 2019; 26:2309499018768100. [PMID: 29635957 DOI: 10.1177/2309499018768100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate whether there are glenohumeral morphological differences between normal population, glenohumeral instability, and rotator cuff pathology. METHOD In this study, shoulder magnetic resonance (MR) images of 150 patients were evaluated. Patients included in the study were studied in three groups of 50 individuals: patients with anterior shoulder instability in group 1, patients with rotator cuff tear in group 2, and control subjects without shoulder pathology in group 3. RESULTS There were statistically significant differences between groups in evaluations for glenoid version, glenoid coronal height, glenoid coronal diameter, humeral axial and coronal diameters, and coracohumeral interval distances. Significant differences were observed between groups 2 and 3 in glenoid axial diameter, glenoid coronal height, glenoid depth, humeral coronal diameter, and coracohumeral distances. CONCLUSION The results obtained in this study suggest that glenoid version, glenoid coronal height and diameter, humeral diameter, and coracohumeral interval parameters in glenohumeral morphology-related parameters in patients with anterior instability are different from those of normal population and patients with rotator cuff pathology. In cases where there is a clinically difficult diagnosis, these radiological measurements will be helpful to clinicians in diagnosis and treatment planning, especially in cases of treatment-resistant cases.
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Affiliation(s)
- B Saygi
- 1 Department of Orthopedics and Traumatology, Fatih Sultan Mehmet Teaching and Research Hospital, Maltepe University, Istanbul, Turkey
| | - N Karahan
- 2 Department of Orthopedics and Traumatology, Fatih Sultan Mehmet Teaching and Research Hospital Istanbul, Selahaddin Eyyubi State Hospital, Dıyarbakır, Turkey
| | - O Karakus
- 3 Department of Orthopedics and Traumatology, Fatih Sultan Mehmet Teaching and Research Hospital, Istanbul, Omer Halisdemir University Hospital, Nıǧde, Turkey
| | - A I Demir
- 4 Department of Orthopedics and Traumatology, Fatih Sultan Mehmet Teaching and Research Hospital, Istanbul, Turkey
| | - O C Ozkan
- 4 Department of Orthopedics and Traumatology, Fatih Sultan Mehmet Teaching and Research Hospital, Istanbul, Turkey
| | - F N Soylu-Boy
- 5 Department of Radiology, Fatih Sultan Mehmet Teaching and Research Hospital, Istanbul, Turkey
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Meyer DC, Ernstbrunner L, Boyce G, Imam MA, El Nashar R, Gerber C. Posterior Acromial Morphology Is Significantly Associated with Posterior Shoulder Instability. J Bone Joint Surg Am 2019; 101:1253-1260. [PMID: 31318804 DOI: 10.2106/jbjs.18.00541] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this paper was to determine whether acromial morphology influences anteroposterior shoulder stability. We hypothesized that a more horizontal and higher position of the acromion in the sagittal plane would be associated with posterior instability. METHODS In this retrospective study, patients with unidirectional posterior instability were age and sex-matched to a cohort of patients with unidirectional anterior instability. Both cohorts were compared with a control group of patients with no instability and no degenerative glenohumeral (rotator cuff and/or joint surface) or acromial changes. Measurements on radiographs included posterior acromial tilt, anterior and posterior acromial coverage (AAC and PAC), posterior acromial height (PAH), and the critical shoulder angle (CSA). RESULTS The number of patients enrolled in each instability group was 41, based on a priori power analysis. The control group consisted of 53 shoulders. Of the measured anatomic factors, PAH showed the most significant association with posterior instability (odds ratio [OR] = 1.8; p < 0.001) in the logistic regression model. PAH was significantly greater in the posterior instability group compared with the anterior instability group (30.9 versus 19.5 mm; p < 0.001). With a cutoff value of PAH of 23 mm, the OR for posterior instability was 39. Shoulders with posterior instability were also significantly different from normal shoulders with regard to PAH (p < 0.001), AAC (p < 0.001), and PAC (p < 0.001) whereas, in the shoulders with anterior instability, all of these values except the AAC (p = 0.011) did not differ from those of normal shoulders. CONCLUSIONS Specific acromial morphology is significantly associated with the direction of glenohumeral instability. In shoulders with posterior instability, the acromion is situated higher and is oriented more horizontally in the sagittal plane than in normal shoulders and those with anterior instability; this acromial position may provide less osseous restraint against posterior humeral head translation. A steep "Swiss chalet roof-type" acromion virtually excluded recurrent posterior instability in an albeit relatively small cohort of patients. Additional investigation is needed to determine the relevance of these findings for future treatment. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Dominik C Meyer
- Division of Shoulder and Elbow Surgery, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Lukas Ernstbrunner
- Division of Shoulder and Elbow Surgery, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Glenn Boyce
- Division of Shoulder and Elbow Surgery, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Mohamed A Imam
- Division of Shoulder and Elbow Surgery, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Rany El Nashar
- Division of Shoulder and Elbow Surgery, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Christian Gerber
- Division of Shoulder and Elbow Surgery, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
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Jacxsens M, Elhabian SY, Brady SE, Chalmers PN, Tashjian RZ, Henninger HB. Coracoacromial morphology: a contributor to recurrent traumatic anterior glenohumeral instability? J Shoulder Elbow Surg 2019; 28:1316-1325.e1. [PMID: 30928394 PMCID: PMC6591074 DOI: 10.1016/j.jse.2019.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/02/2019] [Accepted: 01/06/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although scapular morphology contributes to glenohumeral osteoarthritis and rotator cuff disease, its role in traumatic glenohumeral instability remains unknown. We hypothesized that coracoacromial and glenoid morphology would differ between healthy subjects and patients with recurrent traumatic anterior shoulder instability. METHODS Computed tomography scans of 31 cadaveric control scapulae and 54 scapulae of patients with recurrent traumatic anterior shoulder instability and Hill-Sachs lesions were 3-dimensionally reconstructed. Statistical shape modeling identified the modes of variation between the scapulae of both groups. Corresponding measurements quantified these modes in relation to the glenoid center (linear offset measures), defined by the best-fit circle of the inferior glenoid, or the glenoid center plane (angles), which bisects the glenoid longitudinally. Distances were normalized for glenoid size. RESULTS Compared with controls, the unstable coracoids were shorter (P = .004), with a more superior and medial offset of the tip (mean difference [MD], 7 and 3 mm, respectively; P < .001) and an origin closer to the 12-o'clock position (MD, 6°; P < .001). The unstable scapular spines originated closer to the 9-o'clock position (MD, 4°; P = .012), and the unstable acromions were more vertically oriented (MD, 6°; P < .001). The unstable glenoids had an increased height-width index (MD, 0.04; P = .021), had a flatter anterior-posterior radius of curvature (MD, 77 mm; P < .001), and were more anteriorly tilted (MD, 5°; P = .005). CONCLUSIONS Coracoacromial and glenoid anatomy differs between individuals with and without recurrent traumatic anterior shoulder instability. This pathologic anatomy is not addressed by current soft-tissue stabilization procedures and may contribute to instability recurrence.
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Affiliation(s)
- Matthijs Jacxsens
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Shireen Y Elhabian
- Scientific Computing and Imaging Institute, School of Computing, University of Utah, Salt Lake City, UT, USA
| | - Sarah E Brady
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Peter N Chalmers
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Heath B Henninger
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Scientific Computing and Imaging Institute, School of Computing, University of Utah, Salt Lake City, UT, USA; Department of Bioengineering, University of Utah, Salt Lake City, UT, USA.
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Risk factors for anterior shoulder instability: a matched case-control study. J Shoulder Elbow Surg 2019; 28:869-874. [PMID: 30509611 DOI: 10.1016/j.jse.2018.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/09/2018] [Accepted: 09/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anatomic skeletal features of the shoulder play important roles in anterior shoulder dislocation. However, studies on the effect of the humeral structure are few. This case-control study aimed to analyze the risk factors of anterior shoulder instability, including glenoid and humeral factors. METHODS Anterior shoulder instability was found in 64 of 10,035 individuals who underwent magnetic resonance imaging. Propensity score matching was used to select controls matched for age, sex, height, and weight. We analyzed the glenoid and humeral structural data using conditional logistic regression analysis and identified cutoff points using receiver operating characteristic curve analysis. RESULTS Significant differences were found between the control and dislocation groups in the depth-to-width ratio (0.119 ± 0.034 vs. 0.105 ± 0.037, P = .021), height-to-width ratio (1.51 ± 0.13 vs. 1.67 ± 0.16, P < .001), humeral head diameter-to-glenoid fossa diameter ratio (1.56 ± 0.11 vs. 1.64 ± 0.20, P < .001), and humeral containing angle (67.3° ± 5.9° vs. 60.4° ± 5.9°, P < .001). The humeral containing angle (odds ratio, 0.95; P = .024) and the glenoid height-to-width ratio (odds ratio, 7.88; P = .002), adjusted for the depth-to-width ratio and diameter ratio, were associated with anterior shoulder instability. The cutoff point for the humeral containing angle was 64° and for the height-to-width ratio was 1.60. CONCLUSIONS This study revealed significant risk factors for shoulder instability in the Chinese Han population. The humeral containing angle and the glenoid height-to-width ratio were risk factors for anterior shoulder instability.
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Glenoid and rotator interval dimension in patients older than 40 years after traumatic anterior shoulder dislocation. Arch Orthop Trauma Surg 2019; 139:181-187. [PMID: 30367255 DOI: 10.1007/s00402-018-3054-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The number of patients above 40 years suffering an anterior shoulder dislocation for the first time has recently increased. This study investigated the role of glenoid version, inclination and rotator interval dimension in patients older than 40 years with an anterior shoulder dislocation. We hypothesize that the rotator interval plays a more important role than the osseus alignment in older patients. MATERIALS AND METHODS Patients aged older than 40 years with a traumatic shoulder dislocation were compared with patients who had undergone magnetic resonance imaging (MRI) for a different reason. The MRIs of 61 dislocation group patients were compared with MRIs of 73 comparison group patients. Two shoulder surgeons measured glenoid version, inclination, height and width, rotator interval (RI) height, base (width) and area. The study and comparison group consisted of 61 patients with a mean age of 59 ± 9 years and 73 patients with a mean age of 57 ± 12, respectively. RESULTS The mean glenoid version of the dislocation group was - 4.9° ± 4.4° (retroversion) and mean inclination was 9.8° ± 8° (reclination). Mean rotator interval base, height and the rotator interval area was 46 ± 6 mm, 14 ± 5 mm and 33 ± 14 mm2, respectively. The comparison group had a mean glenoid version of - 5.4° ± 5.4° and a mean inclination of 10.8° ± 6.2°. The rotator interval base was 41 ± 6 mm, the height was 16 ± 4 mm and the area was 34 ± 11 mm2. The between-group differences were statistically significant for rotator interval height and base (p < 0.0001). A significant difference was revealed for the height-width ratio of the glenoid (p = 0.0001). CONCLUSIONS In patients older than 40 years who have suffered anterior shoulder dislocation, the shape of the glenoid rather than its spatial position is of significance. A wide and high rotator interval promotes anterior shoulder dislocation in these patients.
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Abstract
Shoulder stability depends on several factors, either anatomical or functional. Anatomical factors can be further subclassified under soft tissue (shoulder capsule, glenoid rim, glenohumeral ligaments etc) and bony structures (glenoid cavity and humeral head). Normal glenohumeral stability is maintained through factors mostly pertaining to the scapular side: glenoid version, depth and inclination, along with scapular dynamic positioning, can potentially cause decreased stability depending on the direction of said variables in the different planes. No significant factors in normal humeral anatomy seem to play a tangible role in affecting glenohumeral stability. When the glenohumeral joint suffers an episode of acute dislocation, either anterior (more frequent) or posterior, bony lesions often develop on both sides: a compression fracture of the humeral head (or Hill–Sachs lesion) and a bone loss of the glenoid rim. Interaction of such lesions can determine ‘re-engagement’ and recurrence. The concept of ‘glenoid track’ can help quantify an increased risk of recurrence: when the Hill–Sachs lesion engages the anterior glenoid rim, it is defined as ‘off-track’; if it does not, it is an ‘on-track’ lesion. The position of the Hill–Sachs lesion and the percentage of glenoid bone loss are critical factors in determining the likelihood of recurrent instability and in managing treatment. In terms of posterior glenohumeral instability, the ‘gamma angle concept’ can help ascertain which lesions are prone to recurrence based on the sum of specific angles and millimetres of posterior glenoid bone loss, in a similar fashion to what happens in anterior shoulder instability.
Cite this article: EFORT Open Rev 2018;3:632-640. DOI: 10.1302/2058-5241.3.180028
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Affiliation(s)
| | | | - Mattia Pugliese
- Università degli Studi di Roma La Sapienza, Dipartimento di Medicina Sperimentale, Trauma and Orthopaedics, Rome, Italy
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30
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Griffin JW, Collins M, Leroux TS, Cole BJ, Bach BR, Forsythe B, Verma NN, Romeo AA, Yanke AB. The Influence of Bone Loss on Glenoid Version Measurement: A Computer-Modeled Cadaveric Analysis. Arthroscopy 2018; 34:2319-2323. [PMID: 29937344 DOI: 10.1016/j.arthro.2018.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To characterize how increasing computed tomography (CT)-quantified glenoid bone loss influences measured version. METHODS Six embalmed cadaveric shoulders were used for this study. Glenoid bone defects were computer modeled in cadaveric shoulders; CT images were obtained and segmented using OsiriX software, creating 3-dimensional en face glenoids. Glenoid defects were made on CT images of intact glenoids superimposed with a glenoid clock face viewed en face to simulate anterior and posterior bone loss. Bony defects in various positions comprising 3%, 9.5%, and 19.5% were created posteriorly. Best-fit circles were superimposed to represent 10% and 25% defects anteriorly. Version was measured using the Friedman method. RESULTS The average glenoid version measured 4° of retroversion, 2° after 10% anterior bone loss, and neutral version in the 25% bone loss group. Version was significantly altered when we compared intact glenoids versus 10% and 25% anterior glenoid bone loss (P < .001). Increasing from 10% to 25% bone loss showed a significant difference in measured version (P = .025). Posterior defects from the 6:30 to 8:30 clock-face position averaged 4.6° of retroversion; from the 6:30 to 9:30 clock-face position, 6.2° of retroversion; and from the 6:30 to 10:30 clock-face position, 8.7° of retroversion. When comparing glenoid defects at the 6:30 to 8:30 clock-face position with those involving the 6:30 to 9:30 and 6:30 to 10:30 clock-face positions (P < .001), a 1° correction may be used for every 5% of bone loss to account for version changes seen with bone loss. CONCLUSIONS In this cadaveric analysis, glenoid version was altered in the setting of increasing posterior and anterior bone loss. A correction factor may be considered to account for this. When comparing glenoid defects at the 6:30 to 8:30 clock-face position with those involving the 6:30 to 9:30 and 6:30 to 10:30 clock-face positions (P < .001), a 1° correction may be used for every 5% of bone loss to account for version changes seen with bone loss. CLINICAL RELEVANCE This cadaveric study shows that glenoid bone loss alters glenoid version, as measured by CT, in a meaningful way. This information is important in managing anterior and posterior shoulder instability, and correction of measured version should be considered in this setting to provide an accurate and comprehensive evaluation.
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Affiliation(s)
- Justin W Griffin
- Jordan-Young Institute for Orthopaedic Surgery & Sports Medicine, Eastern Virginia Medical School, Virginia Beach, Virginia, U.S.A..
| | - Michael Collins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Timothy S Leroux
- Department of Orthopaedic Surgery, University of Toronto, Toronto, Canada
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bernard R Bach
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian Forsythe
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anthony A Romeo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Adam B Yanke
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Konieczka C, Gibson C, Russett L, Dlot L, MacDermid J, Watson L, Sadi J. What is the reliability of clinical measurement tests for humeral head position? A systematic review. J Hand Ther 2018; 30:420-431. [PMID: 28802538 DOI: 10.1016/j.jht.2017.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 04/24/2017] [Accepted: 06/15/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review. INTRODUCTION Physiotherapists routinely assess the position of the humeral head (HH) in patients with shoulder pain. PURPOSE OF THE STUDY To conduct a systematic review to determine the quality and content of studies that evaluated the reliability of clinical measurement methods for assessing the HH position. METHODS Five databases and gray literature were searched for studies fitting the eligibility criteria. After abstract and full-text review, the included studies were appraised using the Quality Appraisal of Reliability Studies checklist. Articles were considered of high quality if 8 was achieved on the checklist, and the overall quality of evidence was classified using prespecified criteria. Multiple raters extracted and performed quality ratings; a consensus process was used to finalize the reliability data that were synthesized and presented in a narrative synthesis. Reliability was classified as excellent if the intracorrelation coefficients or intercorrelation coefficients (ICCs) reported exceeded 0.75. RESULTS Fifteen studies on the reliability of ultrasound (US) and 3 studies on palpation were included. The methodologic quality was moderate in 17 of 18 studies. The intrarater reliability for all studies was excellent (ICC, 0.76-0.99) with the exception of the 90° abduction in internal rotation position (ICC, 0.48) for palpation. The inter-rater reliability tended to be lower (ICC, 0.48-0.68) for palpation and higher (ICC, 0.66-0.99) for US. Physiotherapists demonstrated excellent intrarater reliability across different levels of training in ultrasonography. DISCUSSION Our study found a moderate overall level of evidence to support the use of US for assessing HH position in symptomatic or asymptomatic subjects. CONCLUSION A moderate overall level of evidence exists for the use of US to reliably assess the HH position. Limited research supports the methods used for palpation within a clinical setting. LEVEL OF EVIDENCE 2a.
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Affiliation(s)
- Christine Konieczka
- Faculty of Health Science, School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada
| | - Christine Gibson
- Faculty of Health Science, School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada
| | - Leeann Russett
- Faculty of Health Science, School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada
| | - Leah Dlot
- Faculty of Health Science, School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada
| | - Joy MacDermid
- Faculty of Health Science, School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada
| | - Lyn Watson
- LifeCare, Prahran Sports Medicine Centre, Prahran, Victoria, Australia
| | - Jackie Sadi
- Faculty of Health Science, School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada.
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Bockmann B, Venjakob AJ, Gebing R, Reichwein F, Hagenacker M, Nebelung W. Bone grafts used for arthroscopic glenoid reconstruction restore the native glenoid anatomy. Knee Surg Sports Traumatol Arthrosc 2018; 26:299-305. [PMID: 29063152 DOI: 10.1007/s00167-017-4757-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Recurrent anterior instability of the glenohumeral joint is a demanding condition, especially in cases of glenoid bone loss. Various treatment options have been described, such as arthroscopic grafting techniques and the Latarjet procedure. In this study, the degree to which an arthroscopically applied iliac crest graft restores the glenoid anatomy was evalutated. METHODS Nine patients (three women and six men) with an average age of 31 ± 9 years (21-46 years) who were treated with an arthroscopic iliac crest graft technique were included in this study. After a mean follow up of 34 ± 10 months (19-50 months) after the procedure, MRI scans of both shoulders were performed and the glenoid width, Glenoid Index (GI), Pixel Signal intensity (PSI), thickness of the tissue covering the articular aspect of the graft, inclination, version, concavity and balance stability angle were measured. RESULTS All scans showed the cultivation of tissue on the graft, which visually resembled the cartilage of the native ipsilateral glenoid. Additionally, reshaping of the graft to repair the glenoid configuration could be observed. Glenoid width (p = 0.022) and GI (p < 0.001) increased significantly through surgery. The tissue examined on the graft showed a significant pixel intensity gap (p = 0.017) but comparable thickness (n.s.) in relation to native cartilage. The remaining parameters did not differ significantly between both shoulders. CONCLUSION In the cohort presented, iliac crest grafts were able to restore the glenoid configuration, and the glenoid was re-shaped to its native contour. Additionally, cartilage-like scar tissue with similar thickness as healthy cartilage was formed on the articular side of the graft. These results suggest that glenoid reconstruction is not only important for prevention of recurrence, but also for restoration of the native glenoid anatomy. LEVEL OF EVIDENCE Level III-retrospective cohort study.
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Affiliation(s)
- Benjamin Bockmann
- Department of Rheumatology and Arthroscopy, Marienkrankenhaus Düsseldorf-Kaiserswerth, An St Swidbert 17, Düsseldorf, Germany.
| | - Arne Johannes Venjakob
- Department of Rheumatology and Arthroscopy, Marienkrankenhaus Düsseldorf-Kaiserswerth, An St Swidbert 17, Düsseldorf, Germany
| | - Rolf Gebing
- Department of Diagnostic Radiology, St. Vinzenz Hospital, Schloßstraße 85, Düsseldorf, Germany
| | - Frank Reichwein
- Department of Rheumatology and Arthroscopy, Marienkrankenhaus Düsseldorf-Kaiserswerth, An St Swidbert 17, Düsseldorf, Germany
| | - Marthe Hagenacker
- Department of Rheumatology and Arthroscopy, Marienkrankenhaus Düsseldorf-Kaiserswerth, An St Swidbert 17, Düsseldorf, Germany
| | - Wolfgang Nebelung
- Department of Rheumatology and Arthroscopy, Marienkrankenhaus Düsseldorf-Kaiserswerth, An St Swidbert 17, Düsseldorf, Germany
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Abstract
PURPOSE OF REVIEW The purpose of this review is to outline the natural history and best clinical practices for nonoperative management of anterior shoulder instability. RECENT FINDINGS Recent studies continue to demonstrate a role for nonoperative treatment in the successful long-term management of anterior glenohumeral instability. The success of different positions of shoulder immobilization is reviewed as well. There are specific patients who may be best treated with nonoperative means after anterior glenohumeral instability. There are also patients who are not good nonoperative candidates based on a number of factors that are outlined in this review. There continues to be no definitive literature regarding the return to play of in-season athletes. Successful management requires a thorough understanding of the epidemiology, pathoanatomy, history, physical examination, diagnostic imaging modalities, and natural history of operative and nonoperative treatment.
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Anthony J, Varughese I, Glatt V, Tetsworth K, Hohmann E. Influence of the Labrum on Version and Diameter of the Glenoid: A Morphometric Study Using Magnetic Resonance Images. Arthroscopy 2017; 33:1442-1447. [PMID: 28412061 DOI: 10.1016/j.arthro.2017.01.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 01/17/2017] [Accepted: 01/25/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To use magnetic resonance imaging to determine the influence of the labrum on both the osseous version and effective diameter of the glenoid. METHODS This was a retrospective, cross-sectional study of patients with shoulder pain who underwent MRI between February 2014 and February 2015. The morphology of the glenoid labrum and glenoid was scanned with a 3-T magnetic resonance imaging scanner, and variables were measured by use of IntelliSpace PACS Enterprise. Patients were included if they were aged between 18 and 40 years and the radiologist reported a normal glenohumeral joint or if they were young patients aged less than 30 years with acute traumatic isolated partial- or full-thickness tears of the rotator cuff with a history of symptoms of less than 3 months. A pilot study was conducted with 3 observers and 3 repeated measurements at intervals to determine the interobserver and intraobserver reliability. Data analysis included descriptive statistics of measured variables, as well as paired Student t tests to determine the relative difference between labral and osseous morphometric variables. RESULTS Excellent inter-rater reliability (0.95-0.96) and intrarater reliability (0.93-0.98) were obtained in the pilot study of 20 patients. The study population was composed of 100 patients with a mean age of 37.3 years (standard deviation [SD], 11.8 years), having a gender distribution of 56 male and 44 female patients; there were 53 right and 47 left shoulders. The glenoid osseous version measured -5.7° (SD, 5.3°), and the labral version measured -10° (SD, 5.5°); the glenoid osseous diameter measured 28.0 mm (SD, 3.3 mm), and the labral diameter measured 31.9 mm (SD, 3.2 mm). The labrum significantly increased the version by 4.3° (P = .001) and significantly increased the diameter by 3.9 mm (P = .001). CONCLUSIONS The results of this study showed that the labrum increased the effective glenoid version by 75% (4.3° of retroversion) and the effective glenoid diameter by 14% (3.9 mm). LEVEL OF EVIDENCE Level IV, prognostic case series.
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Affiliation(s)
- Joyce Anthony
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Ibin Varughese
- Department of Orthopaedic Surgery, The Prince Charles Hospital, Chermside, Australia
| | - Vaida Glatt
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia; Department of Surgery, School of Medicine, University of Queensland, Brisbane, Australia; Queensland University of Technology, Brisbane, Australia; Orthopaedic Research Institute of Australia, Sydney, Australia
| | - Erik Hohmann
- Department of Orthopaedic Surgery, Clinical Medical School, University of Queensland, Brisbane, Australia.
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Aygün Ü, Duran T, Oktay O, Sahin H, Calik Y. Comparison of Magnetic Resonance Imaging and Computed Tomography Scans of the Glenoid Version in Anterior Dislocation of the Shoulder. Orthopedics 2017; 40:e687-e692. [PMID: 28558115 DOI: 10.3928/01477447-20170522-01] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/03/2017] [Indexed: 02/03/2023]
Abstract
The glenoid version is an important factor in the etiology of anterior dislocation of the shoulder and the planning of shoulder surgery. Few reports compare the magnetic resonance imaging (MRI) measurements of the glenoid version with those of computed tomography (CT). This study aimed to show that it is possible to use MRI instead of CT, which is accepted as the gold standard today for the evaluation of the glenoid version. A total of 55 patients with a history of 1 nonsurgically treated unilateral anterior dislocation of the shoulder who had both MRI and CT records for the dislocated shoulders constituted the study group. The glenoid version was measured in the axial plane on MRI and CT. Mean glenoid version measured by the observers was -1.6°±4.7° (95% confidence interval, -2.3° to -0.8°) and -1.8°±4.3° (95% confidence interval, -2.5° to -1.2°) by CT and MRI, respectively (P=.126). The evaluation of the CT and MRI measurements made by the 3 observers (X, Y, and Z) revealed no significant difference, as the P values of X CT - X MRI, Y CT - Y MRI, and Z CT - Z MRI were .550, .406, and .238, respectively. Interclass correlation among the 3 observers for CT and MRI was 0.996 and 0.981, respectively. The imaging methods of MRI and CT can be interchangeably used in the evaluation of the glenoid version in cases of anterior dislocation of the shoulder. [Orthopedics. 2017; 40(4):e687-e692.].
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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]
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The importance of glenoid version in patients with anterior dislocation of the shoulder. J Shoulder Elbow Surg 2016; 25:1930-1936. [PMID: 27855874 DOI: 10.1016/j.jse.2016.09.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 08/22/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although increased retroversion of the glenoid has been shown to be an important factor in posterior instability of the shoulder, there are few studies reporting glenoid bone structure as a risk factor in anterior dislocation of the shoulder. This study aimed to compare glenoid version in patients with anterior dislocation of the shoulder and individuals in a control group with no shoulder problems before undergoing computed tomography and to assess a possible relationship between demographic characteristics and glenoid version angle. METHODS The study group comprised 63 patients (12 women and 51 men; mean age, 35.71 years) with 1 or multiple unilateral anterior dislocations of the shoulder (dislocated group), whereas 63 individuals (11 women and 52 men; mean age, 35.38 years) with no history of shoulder complaints and no signs of instability constituted the control group. The glenoid version angle was measured on an axial cut of the computed tomography scan. RESULTS The glenoid version angles on the dislocated side in the study group were significantly more anteverted than those of the dominant (P < .001) and nondominant (P = .023) shoulders of the control group. The version angles of dislocated shoulders significantly differed from those of nondislocated shoulders of both men (P = .041) and women (P = .049). There was no significant relationship between the glenoid version angle on the dislocated side and dislocation mechanism (P = .883), age group (P = .356), or number of dislocations (P = .971). CONCLUSIONS Glenoid version is an important factor for the development of anterior dislocation of the shoulder.
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Piponov HI, Savin D, Shah N, Esposito D, Schwartz B, Moretti V, Goldberg B. Glenoid version and size: does gender, ethnicity, or body size play a role? INTERNATIONAL ORTHOPAEDICS 2016; 40:2347-2353. [DOI: 10.1007/s00264-016-3201-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/11/2016] [Indexed: 11/25/2022]
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