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Schmidt RC, O'Neill CN, Gowd AK, Satalich JR, O'Connell RS, Waterman BR, Vap AR. Significant Increase in Early Reoperation After Latarjet-Bristow Procedure Versus Arthroscopic Bankart Repair for Anterior Shoulder Instability: A Propensity-Score Matched Analysis. Arthroscopy 2024; 40:692-698. [PMID: 37532162 DOI: 10.1016/j.arthro.2023.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 07/15/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE To compare the 30-day outcomes, including length of stay, short-term complications, hospital readmission, all-cause reoperation, and death after arthroscopic Bankart (AB) and Latarjet. METHODS Patients in the National Surgical Quality Improvement Program database who had undergone either AB or Latarjet-Bristow (LB) procedures for anterior shoulder instability from 2012 to 2018 were identified using Current Procedural Terminology codes. Nearest neighbor propensity score matching was used to address any potential demographic differences. The 30-day incidence of postoperative complications were compared, and univariate and multivariate logistic regressions were used to identify risk factors associated with the incidence of post-operative complications. RESULTS A total of 7,519 patients were identified, with 6,990 (93.0%) undergoing AB and 529 (7.0%) LB. After propensity score matching, the baseline demographics were not significantly different (P > .05). There was no significant difference in rate of total adverse events between the AB and LB cohorts (P = .06). There was a significant difference in the rate of return to the operating room between LB (1.9%) when compared to AB (0%) (P < .001). Of reoperations, 40% were due to need for revision stabilization (0.8% of all LB cases) and 40% were for irrigation and debridement. There was also a significant difference in operative time (AB = 87 minutes, LB = 131 minutes; P < .0001). CONCLUSIONS Overall 30-day complication rates were low for both groups, with similar rates among AB and LB patients. However, there was a statistically significant increased rate of short-term reoperation or revision stabilization in the LB cohort. LEVEL OF EVIDENCE Level III, retrospective comparative prognostic trial.
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Affiliation(s)
- R Cole Schmidt
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Conor N O'Neill
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A..
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - James R Satalich
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Robert S O'Connell
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Brian R Waterman
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Alexander R Vap
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
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2
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Rodriguez K, Hurley ET, Park CN, Bulleit C, Levin JM, Klifto CS, Dickens JF, Lau BC. Complications following arthroscopic Bankart repair: a systematic review. J Shoulder Elbow Surg 2024; 33:435-440. [PMID: 37774834 DOI: 10.1016/j.jse.2023.08.013] [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: 06/30/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Complications are rare after arthroscopic Bankart repair, and as a result, there is a lack of guidance over rates of complications that can be used to consent patients. The purpose of this study is to systematically review the literature to assess the complications after arthroscopic Bankart repair, other than recurrent instability. METHODS A literature search of MEDLINE, Embase, and the Cochrane Library was performed based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Clinical studies reporting on the complications after arthroscopic Bankart repair were included. RESULTS A total of 194 studies were included in the analysis, with 13,979 patients and 14,019 shoulders undergoing arthroscopic Bankart repair. The overall complication rate was 0.67%, with frozen shoulder being the most common complication occurring in 0.32%. Persistent pain occurred in 0.17%. The rates of nerve, hardware, and wound complications were 0.07%, 0.05%, and 0.03%, respectively. CONCLUSION The arthroscopic Bankart repair has a very low rate of complications. Frozen shoulder and persistent pain are the most frequently encountered complications.
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Affiliation(s)
- Kaitlyn Rodriguez
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Eoghan T Hurley
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - Caroline N Park
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Clark Bulleit
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Jay M Levin
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Jonathan F Dickens
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Brian C Lau
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
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Fares MY, Boufadel P, Daher M, Koa J, Khanna A, Abboud JA. Anterior Shoulder Instability and Open Procedures: History, Indications, and Clinical Outcomes. Clin Orthop Surg 2023; 15:521-533. [PMID: 37529197 PMCID: PMC10375816 DOI: 10.4055/cios23018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/15/2023] [Accepted: 04/16/2023] [Indexed: 08/03/2023] Open
Abstract
The shoulder, being the most mobile joint in the human body, is often susceptible to dislocations and subluxations more so than other joints. As such, shoulder instability constitutes a common complaint among patients worldwide, especially those who are young, participate in contact sports, and have increased innate flexibility in their joints. Management options in the setting of instability vary between conservative and surgical options that aim to mitigate symptoms and allow return of function. Surgical options can be arthroscopic and open, with a general shift among surgeons towards utilizing arthroscopic surgery in the past several decades. Nevertheless, open procedures still play a role in managing shoulder instability patients, especially those with significant bone loss, recurrent instability, coexisting shoulder pathologies, and high risk of failure with arthroscopic surgery. In these clinical settings, open procedures, like the Latarjet procedure, open Bankart repair, glenoid bone augmentation using iliac crest autograft or distal tibial allograft, and salvage options like glenohumeral arthrodesis and arthroplasty may show good clinical outcomes and low recurrence rates. Each of these open procedures possesses its own set of advantages and disadvantages and entails a specific set of indications based on published literature. It is important to cater treatment options to the individual patient in order to optimize outcomes and reduce the risk of complications. Future research on open shoulder stabilization procedures should focus on the long-term outcomes of recently utilized procedures, investigate different graft options for procedures involving bone augmentation, and conduct additional comparative analyses in order to establish concrete surgical management guidelines.
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Affiliation(s)
- Mohamad Y. Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Peter Boufadel
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Mohammad Daher
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Jonathan Koa
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Akshay Khanna
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph A. Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
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4
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Nazzal EM, Herman ZJ, Engler ID, Dalton JF, Freehill MT, Lin A. First-time traumatic anterior shoulder dislocation: current concepts. J ISAKOS 2023; 8:101-107. [PMID: 36706837 DOI: 10.1016/j.jisako.2023.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/16/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
The management of first-time traumatic anterior shoulder dislocations has been a topic of extensive study yet remains controversial. Development of a treatment plan requires an understanding of patient-specific considerations, including demographics, functional demands, and extent of pathology. Each of these can influence rates of recurrence and return to activity. The purpose of this review is to provide a framework for decision-making following a first-time anterior shoulder dislocation, with particular focus on the high-risk young and athletic population. A summary of surgical treatment options and their outcomes is outlined, along with future biomechanical and clinical perspectives.
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Affiliation(s)
- Ehab M Nazzal
- UPMC Freddie Fu Center for Sports Medicine, Department of Orthopaedic Surgery, Pittsburgh, PA, 15203, USA
| | - Zachary J Herman
- UPMC Freddie Fu Center for Sports Medicine, Department of Orthopaedic Surgery, Pittsburgh, PA, 15203, USA
| | - Ian D Engler
- UPMC Freddie Fu Center for Sports Medicine, Department of Orthopaedic Surgery, Pittsburgh, PA, 15203, USA
| | - Jonathan F Dalton
- UPMC Freddie Fu Center for Sports Medicine, Department of Orthopaedic Surgery, Pittsburgh, PA, 15203, USA
| | - Michael T Freehill
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, 15203, USA
| | - Albert Lin
- UPMC Freddie Fu Center for Sports Medicine, Department of Orthopaedic Surgery, Pittsburgh, PA, 15203, USA.
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Panagopoulos G, Picca G, Adamczyk A, Leonidou A, Consigliere P, Sforza G, Atoun E, Rath E, Levy O. The "purse string" technique for anterior glenohumeral instability: long-term results 7-13-year follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03426-5. [PMID: 36350404 DOI: 10.1007/s00590-022-03426-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE The "Purse-String Technique" (PST) is an arthroscopic horizontal mattress suture technique for recurrent anterior shoulder instability that uses a single double-loaded suture anchor at the 4-o' clock position, achieving a Bankart labral repair and an infero-superior capsular shift. In this study, we describe the long-term results of the PST. METHODS The study included 69 individuals (70 shoulders), with a mean age of 30 years, who had recurrent post-traumatic anteroinferior instability. A purse-string suture anchor at the 4-o'clock position was used to address the Bankart lesion and capsular laxity, recreating the anterior glenoid bumper. All patients were assessed via telephone interview at a mean of 116 months after surgery (7-13-year follow-up). RESULTS Postoperatively, the mean Constant score was 94, mean Rowe score was 93 and mean Walch-Duplay score was 89. 89% of patients resumed their preinjury sport activities, with 61% of patients achieving preinjury levels and most professional athletes returning to full activity. Seven patients had recurrent dislocation postoperatively (10% failure rate). Of these patients, three had revision arthroscopic stabilization, one patient had revision arthroscopic stabilization with remplissage, two had a Latarjet procedure, whereas one patient decided to seek no further treatment. CONCLUSION The long-term results of PST are promising, with a low failure rate, high patient satisfaction and a high rate of return to sport. LEVEL OF EVIDENCE Level IV; Case series; Treatment study.
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Affiliation(s)
- Georgios Panagopoulos
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK.
| | - Girolamo Picca
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Aleksandra Adamczyk
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Andreas Leonidou
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Paolo Consigliere
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Giuseppe Sforza
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Ehud Atoun
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Levy
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel
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6
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Haase L, Wise K, Kelly B, Harris J, Macalena J. No Difference Between Anchorless and Traditional Suture Anchors in Arthroscopic Bankart Repair: A Clinical Comparison. Cureus 2022; 14:e26988. [PMID: 35989839 PMCID: PMC9385306 DOI: 10.7759/cureus.26988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background Shoulder instability and recurrent dislocations are common problems encountered by orthopedic surgeons and are frequently associated with a Bankart lesion. These are classically treated with either open or arthroscopic repair utilizing traditional suture anchors, though anchorless fixation techniques have recently been developed as an alternate fixation method that reduces native bone loss and has comparable pull-out strength. Methods A retrospective review was performed at a single institution for patients who underwent Bankart repair from January 2008 through February 2014. American Shoulder and Elbow Surgeons (ASES) questionnaires were mailed to 35 patients with anchorless fixation and 35 age-, gender-, and surgeon-matched patients with traditional suture anchors. Statistical analysis was performed comparing re-dislocation, additional surgery, and ASES scores with statistical significance set at p < 0.05. Results Eleven patients in the anchorless implant group and 15 patients in the anchor group completed the questionnaire. The mean follow-up was 4.1 years in the anchorless group and 5.6 years in the anchor group (p=0.04). The number of implants was 4.82 in the anchorless group and 3.87 in the anchor group (p = 0.04). No difference was found in re-dislocation rates (p = 0.80) or additional surgery on the affected shoulder (p = 0.75). ASES scores were found to have no statistical difference (89.89 for the anchorless group versus 85.37 for the anchor group; p = 0.78). Conclusion In patients undergoing arthroscopic Bankart lesion repair with traditional anchors compared to anchorless fixation, there appears to be no difference in shoulder re-dislocation rates, recurrent ipsilateral shoulder surgery, or ASES scores.
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Godinho PC, Godinho AC, Rondon JVDCG, Oliveira Neto FCD, Alves TDA, Godinho GG. Cirurgia de Bankart artroscópica: Resultados clínicos com seguimento mínimo de 10 anos. Rev Bras Ortop 2022; 57:462-466. [PMID: 35785133 PMCID: PMC9246532 DOI: 10.1055/s-0041-1731418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 02/11/2021] [Indexed: 11/21/2022] Open
Abstract
Objective
To evaluate the functional outcome of patients submitted to arthroscopic Bankart repair in the long-term.
Methods
Retrospective evaluation of 41 patients (45 shoulders) operated between 1996 and 2009 followed-up for a mean period of 14.89 years. Functional scores were analyzed by the University of California, Los Angeles (UCLA) and Carter-Rowe scores, physical examination, and analysis of medical records.
Results
The Carter-Rowe score showed an average improvement of 46.11 points, with a final average of 85.89 points, and the UCLA score showed an average improvement of 31.33 points. Ten patients (22.22%) relapsed, with the number of preoperative dislocations being the most correlated factor.
Conclusion
It was demonstrated that the number of preoperative dislocations negatively influenced the failure rate.
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Rafaqat W, Ahmad T, Ibrahim MT, Kumar S, Bluman EM, Khan KS. Is minimally invasive orthopedic surgery safer than open? A systematic review of systematic reviews. Int J Surg 2022; 101:106616. [PMID: 35427798 DOI: 10.1016/j.ijsu.2022.106616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND To assess the safety of minimally invasive surgery (MIS) for orthopedic spinal, upper limb and lower limb procedures, this systematic review of systematic reviews compared their complications with open procedures. MATERIALS AND METHODS A literature search was conducted electronically (PubMed, Cochrane library and Web of Science; May 8, 2021) without language restriction in the past five years. Reviews that consulted at least two databases, compared MIS with open orthopedic surgery, and reported the following: intraoperative, post-operative or total complications, function, ambulation, pain, hospital stay, reoperation rate and operation time were included. Article selection, quality assessment using AMSTAR-2, and data extraction were conducted in duplicate on predesigned forms. In each review, a subset analysis focusing on prospective cohort and randomized studies was additionally performed. PROSPERO CRD42020178171. RESULTS The search yielded 531 articles from which 76 reviews consisting of 1104 primary studies were included. All reviews were assessed as being low quality. Compared to open surgery, MIS had fewer total, postoperative and intraoperative complications in 2/10, 2/11 and 2/5 reviews of spinal procedures respectively, 1/3, 1/4 and 1/2 reviews of upper limb procedures respectively, and 4/6, 2/7 and 0/2 reviews of lower limb procedures respectively. CONCLUSIONS MIS had greater overall safety compared to open surgery in spinal procedures. In upper limb and lower limb procedures, MIS was not outright superior to open procedures in terms of safety hence a general preference of MIS is not justified on the premise of a better safety profile compared to open procedures.
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Eren İ, Büyükdogan K, Yürük B, Aslan L, Birsel O, Demirhan M. Patients without re-dislocation in the short term after arthroscopic knotless Bankart repair for anterior shoulder instability may show residual apprehension and recurrence in the long term after 5 years. J Shoulder Elbow Surg 2022; 31:978-983. [PMID: 34871729 DOI: 10.1016/j.jse.2021.10.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The aim of this study was to report the long-term results, residual instability, and recurrence rate of arthroscopic Bankart repair surgery without a re-dislocation event in the first 5 years. METHODS We performed a retrospective analysis of Bankart repairs performed in a single center, by a single surgeon, with a minimum of 5 years' follow-up. Patients without a re-dislocation in the first 5 years of surgery were included. Patients who underwent open repair, those who underwent revision surgery, and those with critical glenoid bone loss were excluded. A total of 68 shoulders in 66 patients (51 male and 15 female patients) were included. Patients were analyzed in 2 domains: (1) failures defined as re-dislocation and (2) failures defined as apprehension and re-dislocation combined (residual instability). Clinical outcomes were assessed using shoulder range of motion, the American Shoulder and Elbow Surgeons score, and the Western Ontario Shoulder Instability Index (WOSI) score. Pain, residual apprehension, re-dislocations, and additional surgical procedures were recorded. RESULTS The mean age of patients was 31.16 (range, 16-60 years), and the mean follow-up duration was 8.42 ± 2.1 years. The median number of dislocations was 3 (range, 1-20), and the median time from first dislocation to surgery was 16 months (interquartile range, 3-100.5 months). Five patients reported re-dislocations (7.4%) with a mean period of 6.54 ± 2.5 years (range, 5-10.8 years). Seven patients without re-dislocations and 2 patients with re-dislocations reported residual apprehension. Mean shoulder elevation and mean external rotation were 161.3° ± 12.4° and 39.2° ± 11°, respectively. The mean visual analog scale, American Shoulder and Elbow Surgeons, and WOSI scores were 0.5 ± 1.4, 91 ± 11.9, and 88 ± 12.1, respectively. Age was similar in patients with stable shoulders and those with shoulders with re-dislocation or residual instability. The WOSI score was lower in patients with re-dislocation and residual instability (P = .030 and P = .049, respectively). CONCLUSIONS Arthroscopic Bankart repair is a successful surgical option for anterior shoulder instability. The 7.4% re-dislocation rate after 5 years indicates there may be a deterioration of capsulolabral repair in certain patients. The long-term failure pattern may be underestimated in short- to mid-term projections.
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Affiliation(s)
- İlker Eren
- Department of Orthopaedics and Traumatology, School of Medicine, Koc University, Istanbul, Turkey.
| | - Kadir Büyükdogan
- Department of Orthopaedics and Traumatology, Koc University Hospital, Istanbul, Turkey
| | - Batuhan Yürük
- Department of Orthopaedics and Traumatology, School of Medicine, Koc University, Istanbul, Turkey
| | - Lercan Aslan
- Department of Orthopaedics and Traumatology, Koc University Hospital, Istanbul, Turkey
| | - Olgar Birsel
- Department of Orthopaedics and Traumatology, School of Medicine, Koc University, Istanbul, Turkey
| | - Mehmet Demirhan
- Department of Orthopaedics and Traumatology, School of Medicine, Koc University, Istanbul, Turkey
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Anakwenze O. Distal Clavicle Autograft Fixed with Buttons for the Management of Shoulder Instability with Glenoid Defect: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00006. [PMID: 36099453 DOI: 10.2106/jbjs.cc.22.00001] [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: 06/15/2023]
Abstract
CASE In this case report, we presented the case of a 39-year-old male lawyer who presented to our tertiary care clinic with recurrent instability of his right shoulder and significant glenoid bone loss. This patient was treated with arthroscopic glenoid bone augmentation with his distal clavicle fixed with arthroscopic suture buttons. CONCLUSION Use of a distal clavicle autograft with arthroscopic fixation using buttons is a novel and promising solution for the management of patients with shoulder instability and associated glenoid bone loss.
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Affiliation(s)
- Oke Anakwenze
- Department of Orthopedics, Duke University Hospital, Durham, North Carolina
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11
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Reichert B. Traumatische anteriore Schulterluxation – aktuelles Forschungswissen. MANUELLE MEDIZIN 2021. [DOI: 10.1007/s00337-021-00833-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Kukkonen J, Elamo S, Flinkkilä T, Paloneva J, Mäntysaari M, Joukainen A, Lehtinen J, Lepola V, Holstila M, Kauko T, Aarimaa V. Arthroscopic Bankart versus open Latarjet as a primary operative treatment for traumatic anteroinferior instability in young males: a randomised controlled trial with 2-year follow-up. Br J Sports Med 2021; 56:327-332. [PMID: 34551902 PMCID: PMC8899479 DOI: 10.1136/bjsports-2021-104028] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 12/02/2022]
Abstract
Objectives To compare the success rates of arthroscopic Bankart and open Latarjet procedure in the treatment of traumatic shoulder instability in young males. Design Multicentre randomised controlled trial. Setting Orthopaedic departments in eight public hospitals in Finland. Participants 122 young males, mean age 21 years (range 16–25 years) with traumatic shoulder anteroinferior instability were randomised. Interventions Arthroscopic Bankart (group B) or open Latarjet (group L) procedure. Main outcome measures The primary outcome measure was the reported recurrence of instability, that is, dislocation at 2-year follow-up. The secondary outcome measures included clinical apprehension, sports activity level, the Western Ontario Shoulder Instability Index, the pain Visual Analogue Scale, the Oxford Shoulder Instability Score, the Constant Score and the Subjective Shoulder Value scores and the progression of osteoarthritic changes in plain films and MRI. Results 91 patients were available for analyses at 2-year follow-up (drop-out rate 25%). There were 10 (21%) patients with redislocations in group B and 1 (2%) in group L, p=0.006. One (9%) patient in group B and five (56%) patients in group L returned to their previous top level of competitive sports (p=0.004) at follow-up. There was no statistically significant between group differences in any of the other secondary outcome measures. Conclusions Arthroscopic Bankart operation carries a significant risk for short-term postoperative redislocations compared with open Latarjet operation, in the treatment of traumatic anteroinferior instability in young males. Patients should be counselled accordingly before deciding the surgical treatment. Trial registration number NCT01998048.
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Affiliation(s)
- Juha Kukkonen
- Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland .,Faculty of Medicine, University of Turku, Turku, Finland
| | - Sami Elamo
- Surgery, Division of Orthopaedic and Trauma Surgery, Satakunta Central Hospital, Pori, Finland
| | - Tapio Flinkkilä
- Surgery, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland
| | - Juha Paloneva
- Orthopaedics and Traumatology, Central Finland Central Hospital, Jyvaskyla, Finland
| | - Miia Mäntysaari
- Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Antti Joukainen
- Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | - Janne Lehtinen
- Orthopaedic Unit, Tays Hatanpää Hospital, Tampere University Hospital, Tampere, Finland
| | | | - Milja Holstila
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Tommi Kauko
- Auria Clinical Informatics, Turku University Hospital, Turku, Finland
| | - Ville Aarimaa
- Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland.,Faculty of Medicine, University of Turku, Turku, Finland
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Hurley ET, Maye AB, Thompson K, Anil U, Resad S, Virk M, Strauss EJ, Alaia MJ, Campbell KA. Pain Control After Shoulder Arthroscopy: A Systematic Review of Randomized Controlled Trials With a Network Meta-analysis. Am J Sports Med 2021; 49:2262-2271. [PMID: 33321046 DOI: 10.1177/0363546520971757] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shoulder arthroscopy is one of the most commonly performed orthopaedic procedures used to treat a variety of conditions, with >500,000 procedures performed each year. PURPOSE To systematically review the randomized controlled trials (RCTs) on pain control after shoulder arthroscopy in the acute postoperative setting and to ascertain the best available evidence in managing pain after shoulder arthroscopy to optimize patient outcomes. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic review of the literature was performed based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. Studies were included if they were RCTs evaluating interventions to reduce postoperative pain after shoulder arthroscopy: nerve blocks, nerve block adjuncts, subacromial injections, patient-controlled analgesia, oral medications, or other modalities. Meta-analyses and network meta-analyses were performed where appropriate. RESULTS Our study included 83 RCTs. Across 40 studies, peripheral nerve blocks were found to significantly reduce postoperative pain and opioid use, but there was no significant difference among the variable nerve blocks in the network meta-analysis. However, continuous interscalene block did have the highest P-score at most time points. Nerve block adjuncts were consistently shown across 18 studies to prolong the nerve block time and reduce pain. Preoperative administration was shown to significantly reduce postoperative pain scores (P < .05). No benefit was found in any of the studies evaluating subacromial infusions. CONCLUSION Continuous interscalene block resulted in the lowest pain levels at most time points, although this was not significantly different when compared with the other nerve blocks. Additionally, nerve block adjuncts may prolong the postoperative block time and improve pain control. There is promising evidence for some oral medications and newer modalities to control pain and reduce opioid use. However, we found no evidence to support the use of subacromial infusions or patient-controlled analgesia.
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Affiliation(s)
| | - Andrew B Maye
- New York University Langone Health, New York, New York, USA
| | | | - Utkarsh Anil
- New York University Langone Health, New York, New York, USA
| | - Sehar Resad
- New York University Langone Health, New York, New York, USA
| | - Mandeep Virk
- New York University Langone Health, New York, New York, USA
| | - Eric J Strauss
- New York University Langone Health, New York, New York, USA
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García-Vega M, De La Cuadra-Virgil P, Jiménez-Cristobal J, Occhi-Gómez B, Boserman-Pérez-de Villaamil M. Arthroscopic bankart repair for the management of anterior shoulder instability: Mid- and long-term results. ACTA ACUST UNITED AC 2021. [PMID: 34112445 DOI: 10.1016/j.recote.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Arthroscopic stabilisation is a well-recognised surgical technique with a variable rate of failure reported between 0-35%. The aim of this study was to evaluate the outcome of this technique and our second aim was to identify risk factors that could be associated to recurrence rate. MATERIAL AND METHODS 41 patients that underwent arthroscopic shoulder stabilisation for glenohumeral instability between 2001-2015 were included. Different items such as epidemiologic, recurrence, age at first dislocation, preoperative sport practice, and number of fixation devices used were collected. The results were evaluated using functional scales (WOSI, Rowe y Walch-Duplay) and radiological study was assessed using the Samilson-Prieto score. Data from the medical history were recognised in order to assess possible risk factors. RESULTS The overall redislocation rate was 9.4%. The average follow-up was 83 months. The 54.3% of the patients achieved excellent/good results in the functional assessment scales. The range of motion was complete in 90% of the cases. On the radiographs, only 4.88% of the patients present advanced osteoarthritis. It was not possible to identify risk factors related to a worse outcome after surgery. CONCLUSION The arthroscopic Bankart repair with suture anchors is considered the gold standard for treatment of anterior glenohumeral instability. The long-term follow-up shows a favourable outcome, with a redislocation rate of 9% and low complication rate.
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Affiliation(s)
- M García-Vega
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | | | | | - B Occhi-Gómez
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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15
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Matache BA, Hurley ET, Kanakamedala AC, Jazrawi LM, Virk M, Strauss EJ, Campbell KA. Knotted Versus Knotless Anchors for Labral Repair in the Shoulder: A Systematic Review. Arthroscopy 2021; 37:1314-1321. [PMID: 33307150 DOI: 10.1016/j.arthro.2020.11.056] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare biomechanical and clinical outcomes between knotless and knotted anchors in arthroscopic labral repair, specifically in (1) Bankart repair, (2) SLAP repair, (3) posterior labral repair, and (4) remplissage augmentation of Bankart repair. METHODS MEDLINE, EMBASE, and the Cochrane Library were searched according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to find biomechanical and clinical studies comparing knotted and knotless anchors using the search term "knotless anchor." RESULTS Overall, 17 studies met inclusion criteria. There were 7 studies evaluating the biomechanical outcomes, of which 5 found mixed results between knotted and knotless anchors for arthroscopic Bankart repair, 1 demonstrated a difference for SLAP repair favoring knotless anchors, and 2 showed no significant difference for Remplissage in terms of ultimate load-to-failure. Four studies evaluated knotless labral anchors compared with knotted anchors in patients undergoing arthroscopic Bankart repair with no significant differences in outcomes reported between the 2 anchor types, except in one study that found an improved visual analog scale score and a lower recurrence and revision rate with knotted anchors. Five studies evaluated knotless anchors compared with knotted anchors in patients undergoing SLAP repair, and none of the included studies found any significant differences in the patient reported outcome measures or revision rates. Of the 5 studies comparing operative time, 4 found a reduced time with knotless anchors. CONCLUSIONS The clinical results show no significant differences in outcomes between knotless and knotted anchors for labral repair in the shoulder, including Bankart repair, SLAP repair, and posterior labral repair. However, there was conflicting evidence supporting knotless or knotted anchors in the biomechanical studies. However, operative times may be reduced with the use of knotless anchors. LEVEL OF EVIDENCE III, A Systematic Review of Level II and III studies.
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Affiliation(s)
- Bogdan A Matache
- Department of Orthopaedic Surgery, New York University Langone Health, New York, New York, U.S.A..
| | - Eoghan T Hurley
- Department of Orthopaedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Ajay C Kanakamedala
- Department of Orthopaedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Laith M Jazrawi
- Department of Orthopaedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Mandeep Virk
- Department of Orthopaedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Eric J Strauss
- Department of Orthopaedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Kirk A Campbell
- Department of Orthopaedic Surgery, New York University Langone Health, New York, New York, U.S.A
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16
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García-Vega M, De La Cuadra-Virgil P, Jiménez-Cristobal J, Occhi-Gómez B, Boserman-Pérez-de Villaamil M. Arthroscopic bankart repair for the management of anterior shoulder instability: Mid- and long- term results. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [PMID: 33773949 DOI: 10.1016/j.recot.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Arthroscopic stabilization is a well-recognized surgical technique with a variable rate of failure reported between 0-35%. The aim of this study was to evaluate the outcome of this technique and our second aim was to identify risk factors that could be associated to recurrence rate. MATERIAL AND METHODS 41 patients that underwent arthroscopic shoulder stabilization for glenohumeral instability between 2001-2015 were included. Different items such as epidemiologic, recurrence, age at first dislocation, preoperative sport practice, and number of fixation devices used were collected. The results were evaluated using functional scales (WOSI, Rowe y Walch-Duplay) and radiological study was assessed using the Samilson-Prieto score. Data from the medical history were recognized in order to assess possible risk factors. RESULTS The overall redislocation rate was 9.4%. The average follow-up was 83 months. The 54.3% of the patients achieved excellent / good results in the functional assessment scales. The range of motion was complete in 90% of the cases. On the radiographs, only 4.88% of the patients present advanced osteoarthritis. It was not possible to identify risk factors related to a worse outcome after surgery. CONCLUSION The arthroscopic Bankart repair with suture anchors is considered the gold standard for treatment of anterior glenohumeral instability. The long-term follow-up shows a favorable outcome, with a redislocation rate of 9% and low complication rate.
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Affiliation(s)
- M García-Vega
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
| | | | | | - B Occhi-Gómez
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
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17
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Eberbach H, Jaeger M, Bode L, Izadpanah K, Hupperich A, Ogon P, Südkamp NP, Maier D. Arthroscopic Bankart repair with an individualized capsular shift restores physiological capsular volume in patients with anterior shoulder instability. Knee Surg Sports Traumatol Arthrosc 2021; 29:230-239. [PMID: 32240344 PMCID: PMC8324623 DOI: 10.1007/s00167-020-05952-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 03/23/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Capsular volume reduction in the context of anterior arthroscopic shoulder stabilization represents an important but uncontrolled parameter. The aim of this study was to analyse capsular volume reduction by arthroscopic Bankart repair with an individualized capsular shift in patients with and without ligamentous hyperlaxity compared to a control group. METHODS In the context of a prospective controlled study, intraoperative capsular volume measurements were performed in 32 patients with anterior shoulder instability before and after arthroscopic Bankart repair with an individualized capsular shift. The results were compared to those of a control group of 50 patients without instability. Physiological shoulder joint volumes were calculated and correlated with biometric parameters (sex, age, height, weight and BMI). RESULTS Patients with anterior shoulder instability showed a mean preinterventional capsular volume of 35.6 ± 10.6 mL, which was found to be significantly reduced to 19.3 ± 5.4 mL following arthroscopic Bankart repair with an individualized capsular shift (relative capsular volume reduction: 45.9 ± 21.9%; P < 0.01). Pre-interventional volumes were significantly greater in hyperlax than in non-hyperlax patients, while post-interventional volumes did not differ significantly. The average shoulder joint volume of the control group was 21.1 ± 7.0 mL, which was significantly correlated with sex, height and weight (P < 0.01). Postinterventional capsular volumes did not significantly differ from those of the controls (n.s.). CONCLUSION Arthroscopic Bankart repair with an individualized capsular shift enabled the restoration of physiological capsular volume conditions in hyperlax and non-hyperlax patients with anterior shoulder instability. Current findings allow for individual adjustment and intraoperative control of capsular volume reduction to avoid over- or under correction of the shoulder joint volume. Future clinical studies should evaluate, whether individualized approaches to arthroscopic shoulder stabilization are associated with superior clinical outcome.
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Affiliation(s)
- Helge Eberbach
- Department of Orthopaedic and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - Martin Jaeger
- Department of Orthopaedic and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Lisa Bode
- Department of Orthopaedic and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Kaywan Izadpanah
- Department of Orthopaedic and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Andreas Hupperich
- Department of Orthopaedic and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Peter Ogon
- Center of Orthopaedic Sports Medicine, Breisacher Str. 84, 79110, Freiburg, Germany
| | - Norbert P Südkamp
- Department of Orthopaedic and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Dirk Maier
- Department of Orthopaedic and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
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Maalouly J, Aouad D, Tawk A, El Rassi G. Fracture Dislocation of the Anatomical Neck of the Proximal Humerus: Case Report and Literature Review. CASE REPORTS IN ORTHOPEDIC RESEARCH 2020. [DOI: 10.1159/000509818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Fractures of the anatomical neck of the humerus are an extremely rare pathological entity in the field of orthopedic surgery. One of the most feared complications associated with anatomical neck fracture of the humerus is avascular necrosis (AVN). The literature does not contain clear, evidence-based guidelines for the surgical management. This case report highlights the case of a 33-year-old male patient who presented with anatomical neck humerus fracture dislocation after a snowboarding accident. Computed tomography showed a comminuted displaced fracture involving the right humeral neck associated with anterior dislocation of the right shoulder. A small bony fragment adjacent to the glenoid posteriorly was also revealed. The patient was treated with open reduction and internal fixation (ORIF). After 3 years of follow-up, the patient is fully recovered with a normal range of motion of his right shoulder joint. The patient did not show any signs of AVN of the humeral head throughout the course of the 3-year follow-up. Anatomical neck fractures of the humerus are uncommon injuries in the literature. Due to the poor vascularization and the absence of attachment to soft tissue, there is a significantly high risk of AVN associated with fractures of the anatomical neck of the humerus. The patient presented in our report was treated with ORIF since it allows preservation of the humeral head.
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19
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Hohmann E. Editorial Commentary: Posterior Shoulder Instability and Anatomic Capsular-Labral Reconstruction: Repair the Posterior Inferior Glenohumeral Ligament to the Glenoid Neck at the 7 O'Clock Position. Arthroscopy 2020; 36:2820-2821. [PMID: 33172581 DOI: 10.1016/j.arthro.2020.08.022] [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: 08/15/2020] [Accepted: 08/20/2020] [Indexed: 02/02/2023]
Abstract
Posteroinferior glenohumeral instability occurs in 10% of all instability cases but is observed increasingly more often. Arthroscopic posterior capsulolabral repair is the current standard for surgical management if nonoperative treatment fails. In contrast to the anterior inferior glenohumeral ligament (IGHL), the posterior IGHL inserts onto the glenoid surface rather than onto the labrum. This implies that suture anchors should be placed on the glenoid rim when repairing these defects. However, clinical studies demonstrate excellent clinical outcomes irrespective of the location of the suture anchor.
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20
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Functional outcome and tendon integrity of rotator cuff reconstruction after primary traumatic glenohumeral dislocation. Arch Orthop Trauma Surg 2020; 140:1073-1079. [PMID: 32236714 DOI: 10.1007/s00402-020-03416-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Rotator cuff tears (rct) subsequent to glenohumeral dislocation are relevant concomitant injuries, can lead to impaired shoulder function and increase risk of recurrent dislocation. AIM The aim of this study was to determine the functional outcome, recurrent dislocation rate and tendon integrity after rotator cuff repair after primary traumatic shoulder dislocation. MATERIALS AND METHODS In this retrospective case series, 23 patients (age 56.4 years ± 6.3) who underwent a rotator cuff reconstruction after primary traumatic shoulder dislocation with confirmed combination of full-thickness RCT and Bankart lesion were enrolled after a minimum follow-up of 2 years. Clinical outcome (age and gender adjusted Constant Murley Score (CMS), DASH, Rowe Score) (n = 23) and sonographic tendon integrity (n = 19) were studied. RESULTS After a mean follow-up of 58 ± 32 months, a CMS of 85.1% ± 14.7, DASH of 14.2 ± 20.5, and Rowe Score of 82.4 ± 15.2 indicated good functional outcome. In 4 of 19 patients (21.1%) a re-tear was found during sonographic evaluation. In 3 cases (13%), a revision was performed (2 × stiff shoulder, 1 × postoperative infection). One patient had a single traumatic re-dislocation (4.3%). CONCLUSIONS Patients undergone reconstruction of the rotator cuff following a primary traumatic shoulder dislocation can achieve good functional results and a low rate of recurrent dislocation. Postoperative tendon integrity is comparable with known data about non traumatic tears.
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Ernstbrunner L, De Nard B, Olthof M, Beeler S, Bouaicha S, Gerber C, Wieser K. Long-term Results of the Arthroscopic Bankart Repair for Recurrent Anterior Shoulder Instability in Patients Older Than 40 Years: A Comparison With the Open Latarjet Procedure. Am J Sports Med 2020; 48:2090-2096. [PMID: 32579397 DOI: 10.1177/0363546520931090] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Long-term results of the arthroscopic Bankart repair in patients older than 40 years are unknown and may be favorable in terms of postoperative glenohumeral arthritis as opposed to the long-term results of the open Latarjet procedure in patients older than 40 years. PURPOSE To analyze our long-term results of the arthroscopic Bankart repair for recurrent anterior shoulder instability in patients older than 40 years of age and to compare these results with previously published long-term results of the Latarjet procedure in a cohort of similar age. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 35 consecutive patients (36 shoulders) with a mean age of 47 years (range, 40-69) at time of the arthroscopic Bankart repair were studied at a mean 13.2 years (range, 8-18) after surgery. Clinical and radiographic results were then compared with those of our previous study of 39 consecutive patients (40 shoulders) of a same age group who had been treated for the same pathology with an open Latarjet procedure. RESULTS Six shoulders (17%) sustained a recurrent shoulder dislocation after a mean 5.3 years; subluxation occurred in 3 shoulders (8%); and apprehension persisted in 3 shoulders (8%). Revision surgery was performed in 8 patients (22%): 2 Bankart and 6 open Latarjet. The relative preoperative Constant score and Subjective Shoulder Value were significantly improved (P < .001) at final follow-up. Arthropathy of stabilization was advanced in the shoulders of 16 patients (47%) and had progressed by at least 2 grades in 21 patients (62%). There were significantly higher rates of redislocation and subluxation when compared with the open Latarjet procedure (9 vs 3; P = .037), and the mean final Subjective Shoulder Value was significantly lower in the Bankart group (86% vs 91%; P = .011). There were no significant differences in final advanced arthropathy (16 vs 14; P = .334) and revision rates (8 vs 7; P = .409) when compared with the Latarjet procedure. CONCLUSION Arthroscopic Bankart repair for recurrent anterior shoulder instability in patients older than 40 years was associated with reliable pain relief and patient satisfaction similar to that after the open Latarjet procedure. Restoration of stability was significantly less successful and development of arthropathy no better than the open Latarjet procedure in patients older than 40 years.
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Affiliation(s)
- Lukas Ernstbrunner
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Bianca De Nard
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Maurits Olthof
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Silvan Beeler
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Samy Bouaicha
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christian Gerber
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Updegrove GF, Buckley PS, Cox RM, Selverian S, Patel MS, Abboud JA. Latarjet Procedure for Anterior Glenohumeral Instability: Early Postsurgical Complications for Primary Coracoid Transfer Versus Revision Coracoid Transfer After Failed Prior Stabilization. Orthop J Sports Med 2020; 8:2325967120924628. [PMID: 32587873 PMCID: PMC7294484 DOI: 10.1177/2325967120924628] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 02/15/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The Latarjet procedure (coracoid transfer) is often used to successfully treat failed instability procedures. However, given the reported increased complication rates in primary Latarjet surgery, there is a heightened concern for complications in performing the Latarjet procedure as revision surgery. PURPOSE To evaluate the early outcomes and complications of the Latarjet procedure as primary surgery compared with revision surgery. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 157 patients were included and retrospectively reviewed: 103 patients in the revision group and 54 patients in the primary group. Patients were evaluated by physical examination findings as well as by documentation of complications and reoperations extracted from their electronic medical records. RESULTS The mean follow-up was 7.8 ± 11.0 months for the primary group and 7.0 ± 13.2 months for the revision group. There were no significant differences in overall complication rates between the primary and revision groups (16.7% vs 8.7%, respectively; P = .139). The complication rate was significantly higher in patients in the revision group who had undergone a prior open procedure compared with those who had undergone only arthroscopic procedures (30.0% vs 4.1%, respectively; P < .001). Of those patients who sustained a complication, 7 of the 9 underwent a reoperation in the primary group (13.0%), and 7 of the 9 did so in the revision group (6.8%); the risk of reoperations was not different between groups (P = .198). There were 4 patients in the primary group (7.4%) and 5 patients in the revision group (4.9%) who experienced recurrent dislocations during the follow-up period (P = .513). There was no difference in postoperative range of motion. CONCLUSION The Latarjet procedure is a reasonable option for the treatment of failed arthroscopic instability repair with an early complication rate similar to that found in primary Latarjet surgery.
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Affiliation(s)
- Gary F. Updegrove
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Patrick S. Buckley
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ryan M. Cox
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Stephen Selverian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Manan S. Patel
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph A. Abboud
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Arthroscopic stabilisation for shoulder instability. J Clin Orthop Trauma 2020; 11:S402-S411. [PMID: 32523301 PMCID: PMC7275285 DOI: 10.1016/j.jcot.2019.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 12/11/2022] Open
Abstract
Since its first description over 30 years ago arthroscopic stabilisation has evolved. With improvements in knowledge, surgical techniques and materials technology, arthroscopic bankart repair has become the most widely used method for treating patients with symptomatic anterior shoulder instability. These procedures are typically performed in a younger, high demand patient population after a primary dislocation or to treat recurrent instability. A thorough clinical evaluation is required in the clinic setting not only to fully understand the injury pattern but also consider patient expectations prior to embarking on surgery. Diagnostic imaging will aid the clinician in determining the soft tissue pathology as well as assessing bone loss, which facilitates surgical decision-making. Selected patients may benefit from adjunctive procedures such as a remplissage for an "engaging" Hill-sachs lesion. This review will focus on the indications, pre-operative considerations, surgical techniques and outcomes of arthroscopic stabilisation.
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Panzram B, Kentar Y, Maier M, Bruckner T, Hetto P, Zeifang F. Mid-term to long-term results of primary arthroscopic Bankart repair for traumatic anterior shoulder instability: a retrospective study. BMC Musculoskelet Disord 2020; 21:191. [PMID: 32220253 PMCID: PMC7102425 DOI: 10.1186/s12891-020-03223-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 03/19/2020] [Indexed: 01/26/2023] Open
Abstract
Background The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. The aim of the study is to determine the mid−/long-term functional outcome, failure rates and predictors of failure after primary arthroscopic Bankart repair for traumatic anterior shoulder instability. Methods A total of 100 patients were primarily operated using arthroscopic Bankart repair after traumatic anterior shoulder instability. Medical records were retrospectively reviewed, and patients were assessed using postal questionnaire after a mean follow-up of 8.3 years [3–14]. Clinical assessment was performed using Constant score, Rowe score, and American Shoulder and Elbow Surgeons score. Results The overall recurrence rate was 22%. The Kaplan-Meier failure-free survival estimates. were 80% at 5 years and 70% at 10 years. Nearly half (54.5%) of recurrences occurred at 2 years postoperative. Compared with normal shoulder, there were statistical differences in all 3 scores. Failure rate was significantly affected by age at the time of surgery with 86% of recurrence cases observed in patients aged 30 years or younger. Nevertheless, Younger age at the time of surgery (P = 0.007) as well age at the time of initial instability (P = 0.03) was found to correlate negatively with early recurrence within 2 years of surgery. Among those with recurrent instability, recurrence rate was found to be higher if there had been more than 5 instability episodes preoperatively (P = 0.01). Return to the preinjury sport and occupational level was possible in 41 and 78%, respectively. Conclusion Failure-free survival rates dropped dramatically over time. Alternative reconstruction techniques should be considered in those aged ≤30 years due to the high recurrence rate.
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Affiliation(s)
- Benjamin Panzram
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany. .,Heidelberg University Hospital, Clinic for Orthopaedics and Trauma Surgery, Schlierbacher Landstraße 200A, 69118, Heidelberg, Germany.
| | - Yasser Kentar
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Michael Maier
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Pit Hetto
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
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Arthroscopic Versus Open Bankart Repairs in Recurrent Anterior Shoulder Instability: A Systematic Review of the Association Between Publication Date and Postoperative Recurrent Instability in Systematic Reviews. Arthroscopy 2020; 36:862-871. [PMID: 31870747 DOI: 10.1016/j.arthro.2019.10.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To systematically review the results of systematic studies regarding open versus arthroscopic Bankart repairs for recurrent anterior shoulder instability and quantitatively analyze the effect of primary-literature publication dates on reported outcomes in these systematic studies. METHODS A systematic search was conducted to identify systematic studies reporting outcomes of both arthroscopic and open Bankart repairs for recurrent anterior shoulder instability. Patient-reported outcome measures, recurrent instability rates, definitions of instability, and procedure types reported by included study characteristics were qualitatively analyzed. Correlation coefficient analyses were performed to investigate if a systematic study's proportion of included primary literature published after 1999, 2000, 2001, or 2002 affected that study's reported mean difference in instability recurrence between open and arthroscopic procedures. The Assessment of Multiple Systematic Reviews criteria were used to assess the risk of bias of the included studies. RESULTS Of 130 identified articles, 6 met the inclusion criteria. Patient-reported outcome measures were poorly reported. Among mean differences in instability recurrence rates, the results were indeterminate: Although 5 studies reported arthroscopic surgical procedures as having a higher recurrence rate, only 1 reported a statistically significant difference. Within the 5 included systematic reviews reporting the number of included studies, 37 of 56 observations were published after 2000. The proportion of studies published after 2000 (Pearson r = 0.88, P = .052) was positively associated with differences in instability recurrence rates between open and arthroscopic procedures. CONCLUSIONS Systematic studies that included newer studies (published after 2000) were associated with more favorable arthroscopic outcomes. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Lemmex D, Cárdenas G, Ricks M, Woodmass J, Chelli M, Boileau P. Arthroscopic Management of Anterior Glenoid Bone Loss. JBJS Rev 2020; 8:e0049. [DOI: 10.2106/jbjs.rvw.19.00049] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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van Gastel ML, Willigenburg NW, Dijksman LM, Lindeboom R, van den Bekerom MPJ, van der Hulst VPM, Willems WJ, van Deurzen DFP. Ten percent re-dislocation rate 13 years after the arthroscopic Bankart procedure. Knee Surg Sports Traumatol Arthrosc 2019; 27:3929-3936. [PMID: 31123795 DOI: 10.1007/s00167-019-05534-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 05/07/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the present study was to determine the long-term outcome after the arthroscopic Bankart procedure, in terms of recurrent instability, shoulder function, glenohumeral arthropathy and patient satisfaction. METHODS Patients who underwent the arthroscopic Bankart procedure between January 1999 and the end of December 2005 were invited to complete a set of Patient Reported Outcome Measures (PROMs) and visit the hospital for clinical and radiological assessment. PROMs included the Western Ontario Shoulder Instability Index (WOSI), the Oxford Shoulder Instability Score (OSIS) and additional questions on shoulder instability and patient satisfaction. Clinical assessment included the apprehension test and the Constant-Murley score. The Samilson-Prieto classification was used to assess arthropathy on standard radiographs. The primary outcome was a re-dislocation that needed reduction. Secondary outcomes in terms of recurrent instability included patient-reported subluxation and a positive apprehension test. RESULTS Of 104 consecutive patients, 71 patients with a mean follow-up of 13.1 years completed the PROMs, of which 53 patients (55 shoulders) were also available for clinical and radiological assessment. Re-dislocations had occurred in 7 shoulders (9.6%). Subluxations occurred in 23 patients (31.5%) and the apprehension test was positive in 30 (54.5%) of the 55 shoulders examined. Median functional outcomes were 236 for WOSI, 45 for OSIS, and 103 for the normalized Constant-Murley score. Of all 71 patients (73 shoulders), 29 (39.7%) reported being completely satisfied, 33 (45.2%) reported being mostly satisfied and 8 (11%) reported being somewhat satisfied. Glenohumeral arthropathy was observed in 33 (60%) of the shoulders. CONCLUSION Despite 10% re-dislocations and frequent other signs of recurrent instability, shoulder function and patient satisfaction at 13 years after arthroscopic Bankart repair were good. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | | | - Lea M Dijksman
- Quality and Safety Department, Unit Value-Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Robert Lindeboom
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - W Jaap Willems
- Department of Orthopedics, OLVG, Amsterdam, The Netherlands.,Lairesse Kliniek, Amsterdam, The Netherlands
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Oh JH, Shin SJ, Cho CH, Seo HJ, Park JS, Rhee YG. Reliability of the Instability Severity Index Score as a Predictor of Recurrence after Arthroscopic Anterior Capsulolabral Reconstruction: A Multicenter Retrospective Study. Clin Orthop Surg 2019; 11:445-452. [PMID: 31788168 PMCID: PMC6867924 DOI: 10.4055/cios.2019.11.4.445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background Although the instability severity index score (ISIS) is widely used to predict recurrence after arthroscopic anterior instability surgery, its reliability, especially on the weightings and cutoff values, is questionable. The goal of the current retrospective study was to investigate recurrence after arthroscopic capsulolabral reconstruction to evaluate whether each domain of the ISIS has the appropriate predictive power for recurrence by using logistic regression analyses with odds ratios (ORs). Methods This study included 120 consecutive patients who underwent arthroscopic capsulolabral reconstruction between 2004 and 2016. We retrospectively reviewed patients' preoperative history and radiographs, postoperative recurrence or sensation of instability, and risk factors related to the ISIS. The mean postoperative follow-up was 27.6 months (range, 12 to 96 months; median, 21 months). Twenty-six patients with recurrence or positive apprehension were classified as the recurrence group; 94 patients without any symptoms were classified as the non-recurrence group. Logistic regression analyses with ORs were used to verify the utility of each domain of the ISIS for predicting recurrence. Results The mean ISIS did not differ significantly between the recurrence and non-recurrence groups (4.3 ± 1.8 vs. 3.4 ± 2.1 points; p = 0.063). Among the domains of ISIS, factors related to bone defects, the presence of a Hill-Sachs lesion and glenoid bone loss had the lowest ORs (0.77 and 0.38, respectively). Conclusions Not all ISIS domains accurately predicted recurrence after arthroscopic capsulolabral reconstruction. The ISIS may not be a proper reference for determining Latarjet procedure in patients with anterior shoulder instability.
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Affiliation(s)
- Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Jin Shin
- Department of Orthopaedic Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - Chul-Hyun Cho
- Department of Orthopaedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Hyuk Jun Seo
- Department of Orthopaedic Surgery, Daegu Chamtntn Hospital, Daegu, Korea
| | - Ji Soon Park
- Department of Orthopaedic Surgery, Sheikh Khalifa Specialty Hospital, Ras al Khaimah, United Arab Emirates
| | - Yong Girl Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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Ono Y, Dávalos Herrera DA, Woodmass JM, Lemmex DB, Carroll MJ, Yamashita S, Thornton GM, Lo IK. Long-term outcomes following isolated arthroscopic Bankart repair: a 9- to 12-year follow-up. JSES OPEN ACCESS 2019; 3:189-193. [PMID: 31720496 PMCID: PMC6835116 DOI: 10.1016/j.jses.2019.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background The long-term outcomes following arthroscopic Bankart repair have been rarely reported. Because of its relative novelty, little is known about recurrent instability, postoperative arthritis, and patient satisfaction, particularly for well-established modern procedures. The purpose of the study was to evaluate the long-term outcomes following arthroscopic Bankart repair. Methods Patients who underwent isolated arthroscopic Bankart repair from 2003 to 2006 were retrospectively reviewed. Recurrent instability, radiographic, and clinical scores (American Shoulder and Elbow Surgeons [ASES], Simple Shoulder Test [SST], and Rowe scores) were evaluated. Patient factors (ie, age, gender, side, number of instability episodes, contact sports, and bone loss) were analyzed to determine the correlation with outcome measures. Results Among the 98 patients (102 shoulders), we were able to contact 50 patients (51 shoulders, mean age 27.0 years, mean follow-up 121.2 months). Significant bone loss in glenoid and humerus was arthroscopically observed in 16 (31.4%) and 28 (54.9%) shoulders, respectively. Sixteen shoulders (31.4%) experienced recurrent instability. Recent radiographs were obtained for 38 shoulders, 14 (36.8%) of which showed moderate to severe arthritis. Clinical outcomes at follow-up were 89.3, 10.8, and 76.0 for ASES, SST, and Rowe scores, respectively. Neither recurrent instability nor arthritis was correlated with any patient factors. Conclusion When isolated arthroscopic Bankart repair was used in all patients with shoulder instability regardless of bony defect, postoperative recurrent instability and arthritis rates were unacceptably high. Additional procedures should be chosen after careful consideration of multiple patient factors.
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Affiliation(s)
- Yohei Ono
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Department of Orthopedic Surgery, East Hokkaido Hospital, Kushiro, Japan
| | | | - Jarret M Woodmass
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Devin B Lemmex
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Michael J Carroll
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Satoshi Yamashita
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Gail M Thornton
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Ian K Lo
- Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
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Gowd AK, Liu JN, Cabarcas BC, Garcia GH, Cvetanovich GL, Provencher MT, Verma NN. Management of Recurrent Anterior Shoulder Instability With Bipolar Bone Loss: A Systematic Review to Assess Critical Bone Loss Amounts. Am J Sports Med 2019; 47:2484-2493. [PMID: 30148653 DOI: 10.1177/0363546518791555] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is increasing evidence to suggest that the amount of glenoid bone loss to indicate bone block procedures may be lower than previously thought, particularly in the presence of a Hill-Sachs defect. PURPOSE To better establish treatment recommendations for anterior shoulder instability among patients with bipolar bone lesions. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS A systematic review of the literature was performed with PubMed, EMBASE, Cochrane Library, and Scopus databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Studies evaluating outcomes of operative management in anterior shoulder instability that also reported glenoid bone loss in the presence of Hill-Sachs defects were included. Recurrence rates, glenoid bone loss, and humeral bone loss were pooled and analyzed with forest plots stratified by surgical procedure. Methods of quantification were analyzed for each article qualitatively. RESULTS Thirteen articles were included in the final analysis, with a total of 778 patients. The mean ± SD age was 24.9 ± 8.6 years. The mean follow-up was 30.1 months (range, 11-240 months). Only 13 of 408 (3.2%) reviewed bipolar bone loss articles quantified humeral and/or glenoid bone loss. Latarjet procedures had the greatest glenoid bone loss (21.7%; 95% CI, 14.8%-28.6%), followed by Bankart repairs (13.1%; 95% CI, 9.0%-17.2%), and remplissage (11.7%; 95% CI, 5.5%-18.0%). Humeral bone loss was primarily reported as percentage bone loss (22.2%; 95% CI, 13.1%-31.3% in Bankart repairs and 31.7%; 95% CI, 21.6%-41.1% in Latarjet) or as volumetric defects (439.1 mm3; 95% CI, 336.3-541.9 mm3 in Bankart repairs and 366.0 mm3; 95% CI, 258.4-475.4 mm3 in remplissage). Recurrence rates were as follows: Bankart repairs, 19.5% (95% CI, 14.5%-25.8%); remplissage, 4.4% (95% CI, 1.3%-14.0%); and Latarjet, 8.7% (95% CI, 5.0%-14.7%). Bankart repairs were associated with significantly greater recurrence of instability in included articles (P = .013). CONCLUSION There exists a need for universal and consistent preoperative measurement of humeral-sided bone loss. The presence of concomitant Hill-Sachs defects with glenoid pathology should warrant more aggressive operative management through use of bone block procedures. Previously established values of critical glenoid bone loss are not equally relevant in the presence of bipolar bone loss.
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Affiliation(s)
- Anirudh K Gowd
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Brandon C Cabarcas
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Grant H Garcia
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Gregory L Cvetanovich
- Department of Orthopaedics, the Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | | | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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Frank RM, Romeo AA. Arthroscopic soft tissue reconstruction in anterior shoulder instability. DER ORTHOPADE 2019; 47:121-128. [PMID: 29435624 DOI: 10.1007/s00132-018-3532-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Anterior glenohumeral instability remains a difficult problem in the athletic and working patient populations. Treatment strategies are variable and range from nonoperative approaches incorporating immobilization and rehabilitation to surgical management. Surgical decision-making can be challenging, especially with a high-level patient who wishes to return to high-demand activities. Operative options range from open soft tissue stabilization to arthroscopic soft tissue stabilization, with both open and arthroscopic options for bony reconstruction in the setting of clinically significant anterior glenoid bone loss. In all cases, understanding appropriate indications and utilizing sound surgical techniques are critical for achieving a successful result. For the majority of patients with anterior shoulder instability, arthroscopic soft tissue reconstruction with suture anchors is a successful, minimally invasive approach that results in a stable shoulder with excellent outcomes and low complication rates.
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Affiliation(s)
- R M Frank
- CU Sports Medicine, Department of Orthopedics, University of Colorado School of Medicine, 2150 Stadium Drive, 80309, Boulder, CO, USA
| | - A A Romeo
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, 60612, Chicago, IL, USA.
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Long-term clinical outcome of arthroscopic Bankart repair with suture anchors. J Shoulder Elbow Surg 2019; 28:e137-e143. [PMID: 30577997 DOI: 10.1016/j.jse.2018.09.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/17/2018] [Accepted: 09/22/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The most common surgical technique in traumatic anterior shoulder instability is the arthroscopic Bankart repair, which has excellent short-term results. The long-term results of the arthroscopic Bankart repair are less frequently studied, with a high recurrence rate of 23% to 35%. The aim of this study was to evaluate the medium-term to long-term results of arthroscopic Bankart repair using suture anchors and to identify specific risk factors for recurrent instability. METHODS Included were 147 patients after traumatic anterior shoulder dislocation who underwent an arthroscopic Bankart repair. The primary outcome was recurrent instability, defined as dislocation or subluxation as perceived by the patients. The secondary outcome was subjective shoulder stability and function as well as quality of life, evaluated using the Western Ontario Shoulder Instability Index, the Simple Shoulder Test, and the 12-Item Short Form Health Survey. Prognostic factors for recurrent instability were analyzed. RESULTS Recurrent instability occurred in 22% of patients with a mean follow-up of 6.3 years. Survival at 5 and 10 years without recurrent instability was 79% and 78%, respectively (95% confidence interval, 72%-85% and 71%-85%, respectively). The Western Ontario Shoulder Instability Index score, the Simple Shoulder Test score, and the 12-item Short Form Physical Component Summary improved significantly in the nonrecurrence group (P < .001, P = .004, and P = .002, respectively). Younger age and use of fewer than 3 anchors were associated with a higher risk of recurrent dislocation (P = .008 and P = .039, respectively). CONCLUSION We found an overall recurrent instability rate of 22% (dislocation or subluxation). Good long-term results were observed after arthroscopic Bankart repair in patients older than 20 years with 3 or more suture anchors used.
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Lacheta L, Siebenlist S, Imhoff AB, Willinger L. [Recurrent instability and instability arthropathy]. Unfallchirurg 2019; 121:142-151. [PMID: 28875360 DOI: 10.1007/s00113-017-0408-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Capsulolabral reconstruction (Bankart repair) is recommended as the first line treatment in young and functionally demanding active patients with anteroinferior shoulder instability, due to the high tendency to recurrent dislocation. This has become established both for arthroscopic and open primary shoulder stabilization with good clinical outcome; nevertheless, recurrence of dislocation is reported in up to 25% of patients. Risk factors for failed surgery are patient (e.g. young age, male gender and contact sports) and surgery (e.g. primarily underestimated glenoid bone loss, Hill-Sachs lesion, non-treatment of bipolar defects or malpositioned anchors) related. In the management of recurrent instability, it is necessary to carry out a thorough clinical investigation in addition to extended diagnostics with X‑ray and computed tomography. A second Bankart repair is only indicated in patients with low demands and without any glenoid bone loss. In the majority of patients, bony augmentation of the glenoid is necessary and realized by coracoid or iliac crest bone block transfer. The Latarjet procedure is biomechanically advantageous due to the additional sling effect of the conjoined tendons and both techniques show good clinical outcomes and a low recurrence rate. Furthermore, engaging Hill-Sachs lesions also require additional treatment. Remplissage of the infraspinatus muscle, iliac crest bone block transfer and partial joint replacement are viable options. A final consensus for treatment of Hill-Sachs lesions has yet to be defined. Dislocation arthropathy is an underestimated complication as a result of frequent recurrent dislocations. After development of dislocation arthropathy, patients reported a painful restriction of range of motion rather than instability. Arthroscopic arthrolysis and comprehensive arthroscopic management (CAM procedure) are possible joint-preserving treatment options.
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Affiliation(s)
- L Lacheta
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - S Siebenlist
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - A B Imhoff
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - L Willinger
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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Loppini M, Delle Rose G, Borroni M, Morenghi E, Pitino D, Domínguez Zamora C, Castagna A. Is the Instability Severity Index Score a Valid Tool for Predicting Failure After Primary Arthroscopic Stabilization for Anterior Glenohumeral Instability? Arthroscopy 2019; 35:361-366. [PMID: 30611589 DOI: 10.1016/j.arthro.2018.09.027] [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] [Received: 04/25/2018] [Revised: 09/08/2018] [Accepted: 09/08/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the validity of the Instability Severity Index Score in predicting the rate of recurrence of dislocation in patients undergoing arthroscopic Bankart repair. METHODS The inclusion criteria were recurrent anterior traumatic glenohumeral instability and a minimum follow-up of 5 years. According to the preoperative Instability Severity Index Score, patients were divided into the following groups: ≤3 points (A), 4 to 6 points (B), and >6 points (C). The recurrence rate was determined by telephone interviews. The estimated overall rate of success at 5 years was defined as the estimated overall percentage of patients free of recurrence at 5 years. RESULTS Six hundred seventy patients (572 men and 98 women) were included. The average age was 27 years (range, 18 to 39 years) at the time of surgery. One hundred fourteen of 670 patients had a recurrence of instability, with an overall recurrence rate of 17% (95% confidence interval [CI] 14.2%-19.9%). The Instability Severity Index Score had a significant association with recurrence. Compared with patients in group A, those in group B had double the risk of recurrence (hazard ratio [HR] = 2.43, 95% CI 1.38-4.28, P = .002), and patients in group C a 9 times greater risk of recurrence (HR = 9.42, 95% CI 5.20-17.7, P < .001). The estimated overall rate of success at 5 years was 84.8% (95% CI 81.8-87.3). The rate of success with an Instability Severity Index Score ≤3 points was 93.7% (95% CI 89.6-96.2), but it dropped to 85.7% (95% CI 81.7-88.9) in those with an Instability Severity Index Score of 4 to 6 points and became 54.6% (95% CI 42.8-64.9) in those with an Instability Severity Index Score >6 points. On multivariable analysis, the Instability Severity Index Score was found to significantly affect the risk of recurrence, corrected by type of sport and glenoid bone loss. CONCLUSIONS The Instability Severity Index Score is a validated tool with which to assess the recurrence rate of dislocation after arthroscopic surgery in patients with shoulder instability. Arthroscopic stabilization in patients with an Instability Severity Index Score ≤3 is associated with a significantly lower risk of recurrence of glenohumeral instability compared with that in patients with an Instability Severity Index Score >3 points. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
| | - Giacomo Delle Rose
- Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Mario Borroni
- Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Emanuela Morenghi
- Biostatistic Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Dario Pitino
- Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | | | - Alessandro Castagna
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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Arthroscopic Remplissage for Anterior Shoulder Instability: A Systematic Review of Clinical and Biomechanical Studies. Arthroscopy 2019; 35:617-628. [PMID: 30612762 DOI: 10.1016/j.arthro.2018.09.029] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the clinical outcomes and biomechanical data supporting the use of the remplissage procedure. METHODS A query of the Embase, PubMed, Scopus, and Web of Science databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from 2000 to 2017. Data were extracted from included studies for a qualitative review of both clinical and biomechanical outcomes. RESULTS After review, 18 clinical and 10 biomechanical studies were available for analysis; 10 of 18 clinical studies (55.6%) were Level IV evidence. Within the clinical studies, there were 567 patients (570 shoulders) evaluated with follow-up ranging from 6 to 180 months. Overall, 5.8% of shoulders (33 of 570) displayed recurrent instability after arthroscopic remplissage. Of the shoulders with recurrent instability, 42.4% of shoulders (14 of 33) underwent further surgical management. In all studies evaluating pre- and postoperative patient-reported outcomes, the arthroscopic remplissage procedure improved patient-reported outcomes a statistically significant amount postoperatively. Within individual clinical studies, external rotation with the arm in neutral was the most consistently limited range of motion (ROM) parameter, with deficits compared with the contralateral shoulder ranging from 9° to 14°. Biomechanical analysis appeared to corroborate the clinical results, although significant conclusions were limited by heterogeneity of reporting. CONCLUSIONS Arthroscopic remplissage performed in conjunction with arthroscopic Bankart repair is a safe and effective procedure for patients with engaging Hill-Sachs lesions and subcritical glenoid bone loss. Although both the included clinical and biomechanical studies would suggest minimal changes in glenohumeral ROM following the remplissage procedure, strong conclusions are limited by the heterogeneity in reporting ROM data and lack of comparative studies. LEVEL OF EVIDENCE IV, systematic review.
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36
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Nelson FRT. Managing Bony Defects of the Shoulder Joint that Occur in Association with Dislocation. Open Orthop J 2019. [DOI: 10.2174/1874325001913010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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Coughlin RP, Bullock GS, Shanmugaraj A, Sell TC, Garrigues GE, Ledbetter L, Taylor DC. Outcomes After Arthroscopic Rotator Interval Closure for Shoulder Instability: A Systematic Review. Arthroscopy 2018; 34:3098-3108.e1. [PMID: 30297156 DOI: 10.1016/j.arthro.2018.05.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 03/25/2018] [Accepted: 05/01/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) To systematically assess the clinical outcomes of arthroscopic rotator interval closure (RIC) procedures for shoulder instability and (2) to report the different technical descriptions and surgical indications for this procedure. METHODS Two independent reviewers searched 4 databases (PubMed, Embase, Web of Science, and Cochrane) from database inception until October 15, 2017. The inclusion criteria were studies that reported outcomes of shoulder stabilization using arthroscopic RIC as an isolated or adjunctive surgical procedure. The methodologic quality of studies was assessed with the Methodological Index for Non-Randomized Studies tool and Grading of Recommendations Assessment, Development and Evaluation system for randomized controlled trials. RESULTS Fifteen studies met our search criteria (524 patients). Of the studies, 12 were graded Level IV evidence; 2, Level III; and 1, Level II. Six different RIC technique descriptions were reported, with 2 studies not defining the details of the procedure. The most common method of RIC was arthroscopic plication of the superior glenohumeral ligament to the middle glenohumeral ligament (8 of 15 studies). The most commonly used patient-reported outcome measure was the Rowe score, with all studies reporting a minimum postoperative score of 80 points. The rate of return to preinjury level of sport ranged from 22% to 100%, and the postoperative redislocation rate ranged from 0% to 16%. CONCLUSIONS The indications for RIC were poorly reported, and the surgical techniques were inconsistent. Although most studies reported positive clinical results, the heterogeneity of outcome measures limited our ability to make definitive statements about which types of rotator interval capsular closure are warranted for select subgroups undergoing arthroscopic shoulder stabilization. LEVEL OF EVIDENCE Level IV, systematic review of Level II through IV studies.
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Affiliation(s)
- Ryan P Coughlin
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Garrett S Bullock
- Division of Physical Therapy, Duke University, Durham, North Carolina, U.S.A
| | - Ajaykumar Shanmugaraj
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Timothy C Sell
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Leila Ledbetter
- Medical Center Library, Duke University, Durham, North Carolina, U.S.A
| | - Dean C Taylor
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A..
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Cohen BH, Thome AP, Tabaddor RR, Owens BD. Open Surgical Stabilization of Glenohumeral Dislocations. JBJS Essent Surg Tech 2018; 8:e17. [PMID: 30233989 DOI: 10.2106/jbjs.st.17.00052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Traumatic anterior shoulder dislocations are the most common dislocations of the shoulder, and the recurrence rate is high when they are treated nonoperatively in young patients (<30 years old). This has led to a trend toward early surgical stabilization. Originally open Bankart repair was considered the standard of care, with good clinical outcomes and a low recurrence rate. However, the majority of Bankart repairs are now performed with newer arthroscopic techniques because of their potential advantages and similar results. Both open and arthroscopic repairs have been shown to decrease the recurrence rate to 6% to 23%. Although arthroscopic Bankart repair is now more common, open repair should be considered for younger patients participating in contact sports or military activity, osseous Bankart lesions, revision cases, shoulder instability with "subcritical" (20% to 25%) glenoid bone loss, ligamentous laxity, or cases not considered repairable with arthroscopic techniques. Therefore, knowing how to perform an open Bankart repair is essential. The major steps of the procedure are (1) preoperative planning, (2) induction of anesthesia, (3) patient positioning and setup, (4) examination under anesthesia, (5) possible arthroscopic examination of the shoulder, (6) incision along the anterior axillary fold, (7) exposure using the deltopectoral interval, (8) clavipectoral fascia incision, (9) vertical tenotomy of the subscapularis tendon, (10) dissection of the capsule from the subscapularis, (11) assessment of the quality of the capsule, (12) "T" capsulotomy, (13) repair of the Bankart lesion, (14) anterior capsulorrhaphy, (15) subscapularis repair, (16) possible closure of the rotator interval, (17) wound closure, and (18) postoperative rehabilitation. Studies have shown that surgical stabilization after traumatic anterior shoulder instability decreases the recurrence rate, and open and arthroscopic techniques have similar clinical outcomes.
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Affiliation(s)
- Brian H Cohen
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Andrew P Thome
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Ramin R Tabaddor
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Brett D Owens
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
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Comparison of shoulder replacement to treat osteoarthritis secondary to instability surgery and primary osteoarthritis: a retrospective controlled study of patient outcomes. INTERNATIONAL ORTHOPAEDICS 2018; 42:2147-2157. [DOI: 10.1007/s00264-018-3969-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/30/2018] [Indexed: 12/13/2022]
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Carver TJ, Schrock JB, Kraeutler MJ, McCarty EC. The Evolving Treatment Patterns of NCAA Division I Football Players by Orthopaedic Team Physicians Over the Past Decade, 2008-2016. Sports Health 2018; 10:234-243. [PMID: 29298161 PMCID: PMC5958450 DOI: 10.1177/1941738117745488] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Previous studies have analyzed the treatment patterns used to manage injuries
in National Collegiate Athletic Association (NCAA) Division I football
players. Hypothesis: Treatment patterns used to manage injuries in NCAA Division I football
players will have changed over the study period. Study Design: Descriptive epidemiology study. Level of Evidence: Level 5. Methods: The head orthopaedic team physicians for all 128 NCAA Division I football
teams were asked to complete a survey containing questions regarding
experience as team physician, medical coverage of the team, reimbursement
issues, and treatment preferences for some of the most common injuries
occurring in football players. Responses from the current survey were
compared with responses from the same survey sent to NCAA Division I team
physicians in 2008. Results: Responses were received from 111 (111/119, 93%) NCAA Division I orthopaedic
team physicians in 2008 and 115 (115/128, 90%) orthopaedic team physicians
between April 2016 and April 2017. The proportion of team physicians who
prefer a patellar tendon autograft for primary anterior cruciate ligament
reconstruction (ACLR) increased from 67% in 2008 to 83% in 2016
(P < 0.001). The proportion of team physicians who
perform anterior shoulder stabilization arthroscopically increased from 69%
in 2008 to 93% in 2016 (P < 0.0001). Of team physicians
who perform surgery for grade III posterior cruciate ligament (PCL)
injuries, the proportion who use the arthroscopic single-bundle technique
increased from 49% in 2008 to 83% in 2016 (P < 0.0001).
The proportion of team physicians who use Toradol injections prior to a game
to help with nagging injuries decreased from 62% in 2008 to 26% in 2016
(P < 0.0001). Conclusion: Orthopaedic physicians changed their injury treatment preferences for NCAA
Division I football players over the study period. In particular, physicians
have changed their preferred techniques for ACLR, anterior shoulder
stabilization, and PCL reconstruction. Physicians have also become more
conservative with pregame Toradol injections. Clinical Relevance: These opinions may help guide treatment decisions and lead to better care of
all athletes.
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Affiliation(s)
- Trevor J Carver
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - John B Schrock
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Matthew J Kraeutler
- Department of Orthopaedics, Seton-Hall Hackensack Meridian School of Medicine, South Orange, New Jersey
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
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