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Klungsøyr JA, Vagstad T, Klungsøyr PJ, Myklebust TÅ, Lund Hanssen H, Hoff SR, Drogset JO. The Arthroscopic Subscapular Sling Procedure Results in Low Recurrent Anterior Shoulder Instability at 24 Months of Follow-Up. Arthroscopy 2024:S0749-8063(24)00167-1. [PMID: 38453096 DOI: 10.1016/j.arthro.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/18/2024] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To analyze the results of the subscapular sling procedure developed for anterior shoulder instability in patients with less than 10% anterior glenoid bone loss. METHODS Patients were treated surgically with the arthroscopic subscapular sling procedure. A semitendinosus graft was used to reconstruct the anterior labrum and to establish a sling suspension around the upper part of the subscapularis tendon. The patients were followed up with radiographs (at 12 and 24 months). Magnetic resonance imaging (MRI) of the shoulder region and clinical examinations were performed at 3, 12, and 24 months. Recurrent dislocation was the primary endpoint. The Western Ontario Shoulder Instability Index (WOSI) and MRI results were secondary outcome measures. An independent physiotherapist assessed residual instability and range of motion. RESULTS Fifteen patients were included with a dislocation rate of 0% after 24 months follow-up. There was a significant clinical improvement of the WOSI score from 57% (904) at baseline to 88% (241) at 24 months (P < .001). The proportion of patients with an improvement in the WOSI Total score larger than the estimated minimal clinically important difference was 100% both at 12 and 24 months. MRI showed an intact sling in all patients. External rotation was not significantly reduced (52° at baseline vs 47° at 24 months, P = .211). Flexion and abduction were significantly improved from 152° to 174° (P = .001) and 141° to 170° (P < .001) after 24 months. The surgical procedures were completed without any intraoperative complications. CONCLUSIONS The subscapular sling procedure resulted in low recurrent shoulder instability and improved patient-reported outcome measures at 24 months of follow-up. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Jan Arild Klungsøyr
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway.
| | - Terje Vagstad
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Peter Johannes Klungsøyr
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Håkon Lund Hanssen
- Department of Radiology and Nuclear Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Solveig Roth Hoff
- Department of Radiology, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jon Olav Drogset
- Department of Orthopedic Surgery, Trondheim University Hospital and Norwegian University of Science and Technology (NTNU) Trondheim, Norway
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Moran FG, Hurley ET, Storme JG, Karavan MP, Downey SA, Klifto CS, Delaney RA, Mullett H. Studies on Bankart Repair for Anterior Shoulder Instability Show Poor Reporting of Data and Reflect Low Level of Evidence: A Systematic Review. Arthroscopy 2024; 40:963-969.e5. [PMID: 37474082 DOI: 10.1016/j.arthro.2023.07.010] [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: 12/14/2022] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE To assess the quality and level of evidence of studies reporting on Bankart repair for anterior shoulder instability. METHODS A search was performed using the PubMed/Medline database for all studies that reported clinical outcomes on Bankart repair for anterior shoulder instability. The search term "Bankart repair" with all results were analyzed via strict inclusion and exclusion criteria. Two independent investigators scored each included study based on the 10 criteria of the Modified Coleman Methodology Score (CMS) out of 100 and gave each study a score out of 25 based on the Anterior Shoulder Instability (ASI) Methodology criteria. RESULTS Two hundred sixty-six studies were included in the analysis and encompassed a total of 19,156 patients and 19,317 surgical procedures for Bankart repair for shoulder instability. Overall, 81.6% of studies were Level III or IV evidence. The mean CMS score for the studies was 55.3 out of 100, and the mean ASI Methodology score for the studies was 12.1 out of 25. Weaknesses in the studies were identified in sample size, description of preoperative investigations and diagnoses, reporting of mean glenoid bone loss, nonsubjective clinical outcome reporting, and description of associated pathologies. CONCLUSIONS A large proportion of studies reporting the clinical outcomes of Bankart repair for anterior shoulder instability are of low methodological quality and have a low level of evidence. CLINICAL RELEVANCE This study emphasizes need for greater reporting of many variables such as body mass index, mean glenoid bone loss, and patient-reported outcomes and provides a framework for future studies reporting.
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Affiliation(s)
| | - Eoghan T Hurley
- Sports Surgery Clinic, Dublin, Ireland; Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A..
| | | | - Mark P Karavan
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A
| | | | - Christopher S Klifto
- Sports Surgery Clinic, Dublin, Ireland; Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A
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Hemstock R, Sommer M, McRae S, MacDonald P, Woodmass J, Ogborn D. Characterizing the Practices of Canadian Orthopedic Surgeons in the Management of patients With Anterior Glenohumeral Instability. Clin J Sport Med 2023; 33:611-617. [PMID: 37185225 DOI: 10.1097/jsm.0000000000001155] [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: 06/29/2022] [Accepted: 03/28/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To determine the practice patterns of Canadian orthopedic surgeons in the management of patients with anterior glenohumeral instability (AGHI). DESIGN Cross-sectional survey. SETTING Canada. PATIENTS OR OTHER PARTICIPANTS Canadian orthopedic surgeons with membership in the Canadian Orthopedic Association or Canadian Shoulder and Elbow Surgeon group who had managed at least 1 patient with AGHI in the previous year. INTERVENTIONS A survey including demographics and questions on the management of patients with AGHI was completed. Statistical comparisons (χ 2 ) were completed with responses stratified using the instability severity index score (ISIS) in practice, years of practice, and surgical volumes. MAIN OUTCOME MEASURES Summary statistics were compiled, and response frequencies were considered for consensus (75%). Case series responses were stratified on use of the ISIS in practice, years of experience, and annual procedure volumes (χ 2 , P < 0.05). RESULTS Eighty orthopedic surgeons responded, with consensus on areas of diagnostic workup of AGHI, nonoperative management, and operative techniques. There was no consensus on indications for soft tissue and bony augmentation or postoperative management. There was no difference in practices based on the use of ISIS, years in practice, or surgical volumes. CONCLUSIONS Canadian orthopedic surgeons manage AGHI consistently with consensus achieved in preoperative diagnostics and operative techniques, although debate remains as to the indications for soft tissue and bony augmentation procedures.
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Affiliation(s)
- Riley Hemstock
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
| | - Micah Sommer
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Sheila McRae
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada; and
- Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
| | - Peter MacDonald
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada; and
| | - Jarret Woodmass
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada; and
| | - Dan Ogborn
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada; and
- Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
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Ji X, Ye L, Hua Y, Zhou X. Arthroscopic repair with transosseous sling-suture technique for acute and chronic bony Bankart lesions. Asia Pac J Sports Med Arthrosc Rehabil Technol 2023; 34:9-14. [PMID: 37744966 PMCID: PMC10511304 DOI: 10.1016/j.asmart.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Background Failure to fix the fractured fragment can result in bony fragment resorption and consequent glenoid bone loss. Current arthroscopic repair techniques might lead to insecure fixation and refracture. The purpose of this study was to evaluate the effectiveness of the transosseous sling-suture technique for bony Bankart lesions, and to compare the clinical outcomes for acute and chronic bony Bankart lesions treated with this technique. Methods A retrospective case series consisting of 46 patients with bony fracture of the glenoid rim following traumatic injury was identified from May 2015 to August 2020. The patients were divided into the acute lesion group and the chronic lesion group according to the time from first injury to surgery. The size of bone fragment was used to group the patients into the small and the medium sized fragment groups. All the patients underwent arthroscopic repairs using the transosseous sling-suture technique. Preoperative and postoperative evaluations including Rowe score, West Ontario Shoulder Instability Index (WOSI), Visual Analogue Scale (VAS) for pain scores, ROMs and number of dislocations were recorded. No significant differences were found in the comparisons of postoperative ROMs ang functional outcomes regarding between the small and the medium sized fragment groups. Results No dislocations occurred for both groups postoperatively. At the last follow-up, all the ROMs (including anterior flexion, abduction, external rotation and internal rotation at the side), the Rowe score, the WOSI score and the VAS score for pain in the both groups were significantly improved compared to the preoperative evaluations (all Ps < 0.001). In the comparisons between the acute and the chronic lesion groups, significantly greater anterior flexion (158.9 ± 8.9° vs. 153.0 ± 6.4°, P = 0.037), abduction (167.7 ± 10.1° vs. 161.0 ± 7.0°, P = 0.035) and external rotation at the side (88.3 ± 6.4° vs. 83.5 ± 5.5°, P = 0.024) were found in the acute lesion group. The comparisons of the Rowe score (86.0 ± 7.5 vs. 87.5 ± 10.6, P = 0.319), the WOSI score (223.5 ± 56.3 vs. 185.0 ± 79.9, P = 0.062), the VAS score for pain (0.4 ± 0.2 vs. 0.3 ± 0.2, P = 0.324) and the internal rotation at the side (74.6 ± 13.2° vs. 80.5 ± 11.1°, P = 0.116) between these two groups did not demonstrate significant differences between the two groups. Conclusion This arthroscopic transosseous sling-suture repair technique for shoulder anterior instability with acute and chronic bony Bankart lesion can restore joint stability, improve clinical outcomes and range of motion postoperatively. The acute bony Bankart lesion using the current technique can produce better range of motion compared to the chronic lesion. Study design Retrospective case series; Level of evidence, 4.
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Affiliation(s)
- Xiaoxi Ji
- Sports Medicine Center of Fudan University, Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Shanghai, China
| | - Lingchao Ye
- Department of Sports Medicine, Orthopedics, Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang Province, China
| | - Yinghui Hua
- Sports Medicine Center of Fudan University, Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Shanghai, China
| | - Xiaobo Zhou
- Department of Sports Medicine, Orthopedics, Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang Province, China
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Aleem AW, Rai MF, Cai L, Brophy RH. Gene Expression in Glenoid Articular Cartilage Varies Across Acute Instability, Chronic Instability, and Osteoarthritis. J Bone Joint Surg Am 2023:00004623-990000000-00776. [PMID: 37011069 DOI: 10.2106/jbjs.22.01124] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND Shoulder instability is a common pathology associated with an elevated risk of osteoarthritis (OA). Little is known about gene expression in the cartilage of the glenohumeral joint after dislocation events, particularly as it relates to the risk of posttraumatic OA. This study tested the hypothesis that gene expression in glenoid cartilage varies among acute instability (<3 dislocations), chronic instability (≥3 dislocations), and OA. METHODS Articular cartilage was collected from the anteroinferior glenoid of consenting patients undergoing shoulder stabilization surgery (n = 17) or total shoulder arthroplasty (n = 16). Digital quantitative polymerase chain reaction was used to assess the relative expression of 57 genes (36 genes from OA risk allele studies, 21 genes from differential expression studies), comparing (1) OA versus instability (acute and chronic combined), (2) acute versus chronic instability, (3) OA versus acute instability, and (4) OA versus chronic instability. RESULTS The expression of 11 genes from OA risk allele studies and 9 genes from differential expression studies was significantly different between cartilage from patients with instability and those with OA. Pro-inflammatory genes from differential expression studies and genes from OA risk allele studies were more highly expressed in cartilage in the OA group compared with the instability group, which expressed higher levels of extracellular matrix and pro-anabolic genes. The expression of 14 genes from OA risk allele studies and 4 genes from differential expression studies, including pro-inflammatory genes, anti-anabolic genes, and multiple genes from OA risk allele studies, was higher in the acute instability group compared with the chronic instability group. Cartilage in the OA group displayed higher expression of CCL3, CHST11, GPR22, PRKAR2B, and PTGS2 than cartilage in the group with acute or chronic instability. Whereas cartilage in both the acute and chronic instability groups had higher expression of collagen genes, cartilage in the OA group had expression of a subset of genes from OA risk allele studies or from differential expression studies that was lower than in the acute group and higher than in the chronic group. CONCLUSIONS Glenoid cartilage has an inflammatory and catabolic phenotype in shoulders with OA but an anabolic phenotype in shoulders with instability. Cartilage from shoulders with acute instability displayed greater (cellular) metabolic activity compared with shoulders with chronic instability. CLINICAL RELEVANCE This exploratory study identified genes of interest, such as CCL3, CHST11, GPR22, PRKAR2B, and PTGS2, that have elevated expression in osteoarthritic glenoid cartilage. These findings provide new biological insight into the relationship between shoulder instability and OA, which could lead to strategies to predict and potentially modify patients' risk of degenerative arthritis due to shoulder instability.
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Affiliation(s)
- Alexander W Aleem
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Muhammad Farooq Rai
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
- Department of Cell Biology & Physiology, Washington University School of Medicine, St. Louis, Missouri
| | - Lei Cai
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
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Hettrich CM, Magnuson JA, Baumgarten KM, Brophy RH, Kattan M, Bishop JY, Bollier MJ, Bravman JT, Cvetanovich GL, Dunn WR, Feeley BT, Frank RM, Kuhn JE, Lansdown DA, Benjamin Ma C, Marx RG, McCarty EC, Neviaser AS, Ortiz SF, Seidl AJ, Smith MV, Wright RW, Zhang AL, Cronin KJ, Wolf BR. Predictors of Bone Loss in Anterior Glenohumeral Instability. Am J Sports Med 2023; 51:1286-1294. [PMID: 36939180 DOI: 10.1177/03635465231160286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Anterior shoulder instability can result in bone loss of both the anterior glenoid and the posterior humerus. Bone loss has been shown to lead to increased failure postoperatively and may necessitate more complex surgical procedures, resulting in worse clinical outcomes and posttraumatic arthritis. HYPOTHESIS/PURPOSE The purpose of this study was to investigate predictors of glenoid and humeral head bone loss in patients undergoing surgery for anterior shoulder instability. It was hypothesized that male sex, contact sport participation, traumatic dislocation, and higher number of instability events would be associated with greater bone loss. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 892 patients with anterior shoulder instability were prospectively enrolled in the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort. The presence and amount of anterior glenoid bone loss and accompanying Hill-Sachs lesions were quantified. Descriptive information and injury history were used to construct proportional odds models for the presence of any bone defect, for defects >10% of the anterior glenoid or humeral head, and for combined bony defects. RESULTS Anterior glenoid bone loss and Hill-Sachs lesions were present in 185 (20.7%) and 470 (52.7%) patients, respectively. Having an increased number of dislocations was associated with bone loss in all models. Increasing age, male sex, and non-White race were associated with anterior glenoid bone defects and Hill-Sachs lesions. Contact sport participation was associated with anterior glenoid bone loss, and Shoulder Actitvity Scale with glenoid bone loss >10%. A positive apprehension test was associated with Hill-Sachs lesions. Combined lesions were present in 19.4% of patients, and for every additional shoulder dislocation, the odds of having a combined lesion was 95% higher. CONCLUSION An increasing number of preoperative shoulder dislocations is the factor most strongly associated with glenoid bone loss, Hill-Sachs lesions, and combined lesions. Early surgical stabilization before recurrence of instability may be the most effective method for preventing progression to clinically significant bone loss. Patients should be made aware of the expected course of shoulder instability, especially in athletes at high risk for recurrence and osseous defects, which may complicate care and worsen outcomes. REGISTRATION NCT02075775 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Carolyn M Hettrich
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Robert H Brophy
- Department of Orthopedics, Washington University Saint Louis, St. Louis, Missouri, USA
| | - Michael Kattan
- Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, Ohio, USA
| | | | - Julie Y Bishop
- The Ohio State University Sports Medicine Center, Columbus, Ohio, USA
| | | | - Jonathan T Bravman
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Warren R Dunn
- Fondren Orthopedic Group, Orthopedic Surgery, Houston, Texas, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Rachel M Frank
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John E Kuhn
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Robert G Marx
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Shannon F Ortiz
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Adam J Seidl
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Matthew V Smith
- Department of Orthopedics, Washington University Saint Louis, St. Louis, Missouri, USA
| | - Rick W Wright
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | | | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Investigation performed at multicenter facilities and the primary site is at University of Iowa, Iowa City, Iowa, USA
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Fox MA, Drain NP, Rai A, Zheng A, Carlos NB, Serrano Riera R, Sabzevari S, Hughes JD, Popchak A, Rodosky MW, Lesniak BP, Lin A. Increased Failure Rates After Arthroscopic Bankart Repair After Second Dislocation Compared to Primary Dislocation With Comparable Clinical Outcomes. Arthroscopy 2023; 39:682-688. [PMID: 36740291 DOI: 10.1016/j.arthro.2022.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/23/2022] [Accepted: 10/10/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to compare rates of recurrent dislocation and postsurgical outcomes in patients undergoing arthroscopic Bankart repair for anterior shoulder instability immediately after a first-time traumatic anterior dislocation versus patients who sustained a second dislocation event after initial nonoperative management. METHODS A retrospective chart review was performed of patients undergoing primary arthroscopic stabilization for anterior shoulder instability without concomitant procedures and minimum 2-year clinical follow-up. Primary outcome was documentation of a recurrent shoulder dislocation. Secondary clinical outcomes included range of motion, Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons Shoulder Score (ASES), and Shoulder Activity Scale (SAS). RESULTS Seventy-seven patients (mean age 21.3 years ± 7.3 years) met inclusion criteria. Sixty-three shoulders underwent surgical stabilization after a single shoulder dislocation, and 14 underwent surgery after 2 dislocations. Average follow-up was 35.9 months. The rate of recurrent dislocation was significantly higher in the 2-dislocation group compared to single dislocations (42.8% vs 14.2%, P = .03). No significant difference was present in range of motion, VAS, ASES, and SAS scores. The minimal clinically important difference (MCID) was 1.4 for VAS and 1.8 for SAS scores. The MCID was met or exceeded in the primary dislocation group in 31/38 (81.6%) patients for VAS, 23/31 (74.1%) for ASES, and 24/31 for SES (77.4%) scores. For the second dislocation cohort, MCID was met or exceeded in 7/9 (77.8%) for VAS, 4/7 (57.1%) for ASES, and 5/7 for SES (71.4%) scores. CONCLUSION Immediate arthroscopic surgical stabilization after a first-time anterior shoulder dislocation significantly decreases the risk of recurrent dislocation in comparison to those who undergo surgery after 2 dislocation events, with comparable clinical outcome scores. These findings suggest that patients who return to activities after a primary anterior shoulder dislocation and sustain just 1 additional dislocation event are at increased risk of a failing arthroscopic repair. STUDY DESIGN Retrospective comparative study; Level of evidence, 3.
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Affiliation(s)
- Michael A Fox
- Pittsburgh Shoulder Institute, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Nicholas P Drain
- Pittsburgh Shoulder Institute, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ajinkya Rai
- Pittsburgh Shoulder Institute, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Aaron Zheng
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Noel B Carlos
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rafael Serrano Riera
- Pittsburgh Shoulder Institute, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Soheil Sabzevari
- Pittsburgh Shoulder Institute, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonathan D Hughes
- Pittsburgh Shoulder Institute, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Adam Popchak
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark W Rodosky
- Pittsburgh Shoulder Institute, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bryson P Lesniak
- Pittsburgh Shoulder Institute, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Albert Lin
- Pittsburgh Shoulder Institute, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Wang Y, Li Q, Zhang Q. Modified Double-Row and Double-Pulley Technique for the Treatment of Type Ia Scapular Glenoid Fractures. Orthop Surg 2022; 14:1518-1526. [PMID: 35638594 PMCID: PMC9251277 DOI: 10.1111/os.13305] [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: 07/26/2020] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the efficacy of the double‐row and double‐pulley technique in treating anterior shoulder glenoid fracture (Ideberg type Ia) using shoulder arthroscopy. Methods Thirty‐six patients with Ideberg type Ia admitted from March 1, 2017, to March 1, 2020, were retrospectively reviewed. Data of the patients' history included age, sex, side of the affected arm, the mean time from injury to surgery, the surgical duration, the average blood loss, and the average total duration of hospital stay. The double‐row and double‐pulley technique was used to repair the scapular glenoid fracture under arthroscopy. Computed tomography (CT) was used to evaluate fracture healing after surgery. The American Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder joint scoring system, and the Constant–Murley shoulder function score were used to assess the function of the affected shoulder. Results The surgical duration was 90–150 min, with a mean of 127 min. The average blood loss was 90 mL (range, 60–120 mL), and the average total duration of hospital stay was 9.2 days (range, 3 to 14 days). At 9 months after surgery, the CT results showed that all fractures healed, and all patients returned to their previous levels of activity and regained an excellent range of motion. The visual analog scale (VAS) score was 7.55 ± 1.32 before surgery, and the VAS score significantly decreased to 1.24 ± 0.72 at 12 months after the operation (p < 0.05). The Constant, ASES, and UCLA shoulder function scores were 44.38 ± 2.16, 43.47 ± 12.76, and 21.80 ± 1.16 before the surgery, respectively, which improved to 93.52 ± 2.82, 91.34 ± 8.28, and 33.24 ± 1.64, respectively, in the following 12 months. One patient experienced fat liquefaction. However, no cases of deep venous thrombosis, iatrogenic neurovascular compromise, wound infection, or neurovascular injury were identified. Conclusion The double‐row and double‐pulley technique for treating Ideberg type Ia under shoulder arthroscopy has minor surgical trauma, reliable fracture reduction and fixation, less postoperative pain, and fewer postoperative complications and significantly improves the patient's shoulder joint function.
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Affiliation(s)
- Yizhong Wang
- Department of Sports medicine, Honghui Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qingxian Li
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qingsong Zhang
- Department of Sports Medicine, Wuhan Forth Hospital, Wuhan, 430033, China
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Athletes with primary glenohumeral instability demonstrate lower rates of bone loss than those with recurrent instability and failed prior stabilization. J Shoulder Elbow Surg 2022; 31:813-818. [PMID: 34687918 DOI: 10.1016/j.jse.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/19/2021] [Accepted: 10/06/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to compare the preoperative magnetic resonance arthrography findings in patients who underwent glenohumeral stabilization with a history of primary instability, recurrent instability, or failed stabilization. METHODS All patients who presented with glenohumeral instability and underwent stabilization performed by a single surgeon in our institution between 2008 and 2020 were considered for inclusion in this study. The magnetic resonance arthrography findings of all patients were recorded. Imaging findings were compared between patients with primary instability, those with recurrent instability, and those with failed prior stabilization. P < .05 was considered statistically significant. RESULTS Overall, 871 patients were included, of whom 814 (93.5%) were male patients; the mean age was 23.1 years (range, 13-57 years). There were 200 patients with primary instability, 571 with recurrent instability, and 100 who required revision stabilization surgery, with no significant differences in demographic characteristics between the groups. A significantly higher amount of glenoid bone loss was noted in patients with recurrent instability (43.4%) and failed prior stabilization (56%) than in those with primary instability (26.5%) (P < .0001). Additionally, a significantly higher number of Hill-Sachs lesions were observed in patients with recurrent instability (70.1%) and failed prior stabilization (89%) than in those with primary instability (67.5%) (P < .0001). We found no significant differences between the groups regarding articular cartilage damage, glenolabral articular disruption, anterior labral periosteal sleeve avulsion, humeral avulsion of the glenohumeral ligaments, or superior labral anterior-posterior tears (P > .05). CONCLUSION Patients presenting for stabilization with recurrent instability or following a failed stabilization procedure have higher rates of glenohumeral bone loss than those with primary instability. Therefore, stabilization of primary instability, particularly in high-functioning athletes with a view to preventing recurrence, may reduce the overall progression of glenohumeral bone loss and potential subsequent inferior clinical outcomes.
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Frank RM, Salem HS, Richardson C, O'Brien M, Newgren JM, Cole BJ, Verma NN, Nicholson GP, Romeo AA. Clinical Outcomes of Shoulder Stabilization in Females With Glenoid Bone Loss. Orthop J Sports Med 2021; 9:23259671211007525. [PMID: 34036113 PMCID: PMC8127764 DOI: 10.1177/23259671211007525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/21/2020] [Indexed: 01/06/2023] Open
Abstract
Background Nearly all studies describing shoulder stabilization focus on male patients. Little is known regarding the clinical outcomes of female patients undergoing shoulder stabilization, and even less is understood about females with glenoid bone loss. Purpose To assess the clinical outcomes of female patients with recurrent anterior shoulder instability treated with the Latarjet procedure. Study Design Case series; Level of evidence, 4. Methods All cases of female patients who had recurrent anterior shoulder instability with ≥15% anterior glenoid bone loss and underwent the Latarjet procedure were analyzed. Patients were evaluated after a minimum 2-year postoperative period with scores of the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale. Results Of the 22 patients who met our criteria, 5 (22.7%) were lost to follow-up, leaving 17 (77.2%) available for follow-up with a mean ± SD age of 31.7 ± 12.9 years. Among these patients, 16 (94.1%) underwent 1.6 ± 0.73 ipsilateral shoulder operations (range, 1-3) before undergoing the Latarjet procedure. Preoperative indications for surgery included recurrent instability with bone loss in all cases. After a mean follow-up of 40.2 ± 22.9 months, patients experienced significant score improvements in the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale (P < .05 for all). There were 2 reoperations (11.8%). There were no cases of neurovascular injuries or other complications. Conclusion Female patients with recurrent shoulder instability with glenoid bone loss can be successfully treated with the Latarjet procedure, with outcomes similar to those of male patients in the previously published literature. This information can be used to counsel female patients with recurrent instability with significant anterior glenoid bone loss.
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Affiliation(s)
- Rachel M Frank
- Department of Orthopaedic Surgery, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Hytham S Salem
- Department of Orthopaedic Surgery, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Catherine Richardson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael O'Brien
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jon M Newgren
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Gregory P Nicholson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Anthony A Romeo
- Department of Orthopaedic Surgery, DuPage Medical Group, Joliet, Illinois, USA
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Nakagawa S, Sahara W, Kinugasa K, Uchida R, Mae T. Bipolar Bone Defects in Shoulders With Primary Instability: Dislocation Versus Subluxation. Orthop J Sports Med 2021; 9:23259671211003553. [PMID: 34036111 PMCID: PMC8127765 DOI: 10.1177/23259671211003553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022] Open
Abstract
Background: In shoulders with traumatic anterior instability, a bipolar bone defect has been recognized as an important indicator of the prognosis. Purpose: To investigate bipolar bone defects at primary instability and compare the difference between dislocation and subluxation. Study Design: Cohort study; Level of evidence, 3. Methods: There were 156 shoulders (156 patients) including 91 shoulders with dislocation and 65 shoulders with subluxation. Glenoid defects and Hill-Sachs lesions were classified into 5 size categories on 3-dimensional computed tomography (CT) scans and were allocated scores ranging from 0 (no defect) to 4 points (very large defect). To assess the combined size of the glenoid defect and Hill-Sachs lesion, the scores for both lesions were summed (range, 0-8 points). Patients in the dislocation and subluxation groups were compared regarding the prevalence of a glenoid defect, a bone fragment of bony Bankart lesion, a Hill-Sachs lesion, a bipolar bone defect, and an off-track Hill-Sachs lesion. Then, the combined size of the bipolar bone defects was compared between the dislocation and subluxation groups and among patients stratified by age at the time of CT scanning (<20, 20-29, and ≥30 years). Results: Hill-Sachs lesions were observed more frequently in the dislocation group (75.8%) compared with the subluxation group (27.7%; P < .001), whereas the prevalence of glenoid defects was not significantly different between groups (36.3% vs 29.2%, respectively; P = .393). The combined defect size was significantly larger in the dislocation versus subluxation group (mean ± SD combined defect score, 2.1 ± 1.6 vs 0.8 ± 0.9 points, respectively; P < .001) due to a larger Hill-Sachs lesion at dislocation than subluxation (glenoid defect score, 0.5 ± 0.9 vs 0.3 ± 0.6 points [P = .112]; Hill-Sachs lesion score, 1.6 ± 1.2 vs 0.4 ± 0.7 points [P < .001]). Combined defect size was larger in older patients than younger patients in the setting of dislocation (combined defect score, <20 years, 1.6 ± 1.2 points; 20-29 years, 1.9 ± 1.5 points; ≥30 years, 3.4 ± 1.6 points; P < .001) but was not different in the setting of subluxation (0.8 ± 1.0, 0.7 ± 0.9, and 0.8 ± 0.8 points, respectively; P = .885). An off-track Hill-Sachs lesion was observed in 2 older patients with dislocation but was not observed in shoulders with subluxation. Conclusion: The bipolar bone defect was significantly more frequent, and the combined size was greater in shoulders with primary dislocation and in older patients (≥30 years).
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
- Shigeto Nakagawa, MD, PhD, Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan ()
| | - Wataru Sahara
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan
| | - Kazutaka Kinugasa
- Department of Orthopaedic Sports Medicine, Osaka Rosai Hospital, Sakai, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, Amagasaki, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan
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12
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Abstract
Neuralgic amyotrophy (NA) is markedly underdiagnosed in clinical practice, and
its actual incidence rate is about 1 per 1000 per year. In the current article,
we provide an overview of essential information about NA, including the
etiology, clinical manifestations, diagnostic investigations, differential
diagnosis, treatment, and prognosis. The causes of NA are multifactorial and
include immunological, mechanical, or genetic factors. Typical clinical findings
are a sudden onset of pain in the shoulder region, followed by patchy flaccid
paralysis of muscles in the shoulder and/or arm. A diagnosis of NA is based on a
patient’s clinical history and physical examination. Gadolinium-enhanced
magnetic resonance imaging and high-resolution magnetic resonance neurography
are useful for confirming the diagnosis and choosing the appropriate treatment.
However, before a diagnosis of NA is confirmed, other disorders with similar
symptoms, such as cervical radiculopathy or rotator cuff tear, need to be ruled
out. The prognosis of NA depends on the degree of axonal damage. In conclusion,
many patients with motor weakness and pain are encountered in clinical practice,
and some of these patients will exhibit NA. It is important that clinicians
understand the key features of this disorder to avoid misdiagnosis.
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Affiliation(s)
- Tae Uk Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Dankook University, Cheonan, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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13
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Erickson BJ, Shishani Y, Jones S, Romeo AA, Gobezie R. Clinical and radiographic outcomes after Latarjet using suture-button fixation. JSES Int 2021; 5:175-180. [PMID: 33681834 PMCID: PMC7910742 DOI: 10.1016/j.jseint.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Latarjet has become a common treatment option for patients with shoulder instability in the setting of bone loss. The coracoid is commonly secured with screws Methods All patients who underwent Latarjet with suture-button fixation with minimum 1-year follow-up were eligible for inclusion. Preoperative demographic and clinical outcome data including American Shoulder and Elbow Surgeons (ASES), Single Assessment Numerical Evaluation (SANE), and Visual Analog Scale (VAS) were recorded and compared with postoperative scores. Radiographs were reviewed for signs of nonunion. Complications were recorded. Results Overall 21 patients (76% male, average age: 30.4 ± 11.3 years) underwent Latarjet with suture-button fixation. Significant improvements at 1 year were seen in ASES (P < 0.001), SANE (P < 0.001), and VAS (P = 0.011) scores compared with preoperative scores. Of the 21 patients who had reached 1-year follow-up, 17 (81%) reached 2-year follow-up. For the 17 patients who reached 2-year follow-up, there were significant improvements in ASES (P = 0.001), SANE (P = 0.001), and VAS (P = 0.005) scores from preoperative values. When isolating the 17 patients with 2-year follow-up, there were no significant differences between their 1-year and 2-year ASES (P = 0.73), SANE (P = 0.17), and VAS (P = 0.37) scores. Overall, 3 patients (14%) sustained a complication (one redislocation, one with coracoid migration and a fibrous union, and one superior labral tear requiring biceps tenodesis and superior labral repair). Conclusion Suture-button fixation of the coracoid during the Latarjet provides encouraging clinical and radiographic outcomes at 1 and 2 years.
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Affiliation(s)
| | | | - Stacy Jones
- Cleveland Shoulder Institute, Beachwood, OH, USA
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14
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Hettrich CM, Zacharias A, Ortiz SF, Westgate P, Wolf BR, Jacobs C. Are there racial differences between patients undergoing surgery for shoulder instability? Data from the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability Group. J Shoulder Elbow Surg 2021; 30:229-236. [PMID: 33166646 DOI: 10.1016/j.jse.2020.09.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to identify differences related to race in preoperative and intraoperative findings of patients undergoing operative treatment for shoulder instability. METHODS Data from the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort were used. Of 1010 patients, 995 provided race and ethnicity information and were included in the analyses. Demographic characteristics, injury history, radiographic and intraoperative findings, and preoperative patient-reported instability, pain, and function were compared (1) between white and minority patients and (2) in a subgroup analysis between white patients and the 3 largest minority groups. The Distressed Communities Index (DCI) score was recorded for each patient's home ZIP code. Multiple logistic regressions were performed to determine whether models consisting of race/ethnicity, insurance carrier, and/or DCI score were predictive of bone and cartilage loss at the time of surgery. RESULTS Compared with white patients, a greater percentage of US minority patients had ≥2 dislocations (68.0% vs. 57.1%, P = .01), which corresponded with more frequent articular cartilage lesions (62.2% vs. 51.0%, P = .007) and increased frequencies of glenoid bone loss > 10% (16.2% vs. 8.7%, P = .03) and Hill-Sachs lesions (68.6% vs. 56.0%, P = .004). Specifically, when compared with white patients, African American and Asian patients showed significantly increased frequencies of glenoid bone loss > 10% (19.7% of African American patients, 18.4% of Asian patients, and 8.9% of white patients; P = .01) and Hill-Sachs lesions (65.6%, 71.7%, and 52.4%, respectively; P = .02). Race was an independent predictor of articular cartilage lesions (P = .04) and the presence of Hill-Sachs lesions (P = .01). A higher DCI score (P = .03) and race (P = .04) were both predictive of having glenoid bone loss > 10%. CONCLUSION We found that minority race was associated with increased number of preoperative dislocations and increased frequency of articular cartilage and Hill-Sachs lesions at the time of surgery, and both minority race and an increased DCI score were associated with glenoid bone loss > 10%. Further research is needed to understand the underlying reason for these differences and to optimize care for all patients with shoulder instability.
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Affiliation(s)
- Carolyn M Hettrich
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Anthony Zacharias
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY, USA.
| | - Shannon F Ortiz
- Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA
| | - Philip Westgate
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY, USA
| | | | - Brian R Wolf
- Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA
| | - Cale Jacobs
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY, USA
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15
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Kim K, Saper MG. Postoperative Management Following Arthroscopic Bankart Repair in Adolescents and Young Adults: A Systematic Review. Arthrosc Sports Med Rehabil 2020; 2:e839-e845. [PMID: 33364615 PMCID: PMC7754521 DOI: 10.1016/j.asmr.2020.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/24/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The purpose of this study was to review systematically the literature concerning postoperative management following arthroscopic Bankart repair for traumatic anterior shoulder instability in adolescent and young adult (≤ 25 years) athletes. METHODS The Pubmed, Medline, EMBASE, EBSCO (CINAHL), and Google Scholar databases were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify all studies reporting postoperative rehabilitation guidelines following arthroscopic Bankart repair in the adolescent and young adult population. The Methodological Index for Nonrandomized Studies instrument and Modified Coleman Methodology Score were used for quality assessment of the included studies. All aspects of rehabilitation were extracted and analyzed, including type/duration of immobilization, range of motion, strength, and return to sport (RTS) criteria. RESULTS Screening yielded 17 eligible studies with a total of 675 patients and an average age of 18.3 years. There was considerable variation with regard to reported postoperative rehabilitation guidelines. Of the 17 studies, 15 reported the duration of immobilization; there was a mean of 4 weeks (range, 2-6 weeks). Range of motion and strength restrictions were reported in 15 (88.2%) and 13 (76.4%) studies, respectively. All of the 17 studies included an expected timeframe for RTS, but only 5 of the studies (29.4%) included either subjective or objective criteria to determine safe RTS. Differences in outcomes were unable to be assessed due to large study heterogeneity. CONCLUSION Considerable variation is reported in postoperative rehabilitation guidelines following arthroscopic Bankart repair for traumatic shoulder instability in the adolescent and young adult population. All studies used time-based criteria for determining RTS, but subjective and/or objective criteria were lacking in the majority of studies. The current literature lacks data to generate evidence-based rehabilitation protocols in this young athletic population. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Katie Kim
- Pacific Northwest University of Health Sciences, College of Osteopathic Medicine, Yakima, Washington, U.S.A
| | - Michael G Saper
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, U.S.A.,Seattle Children's Department of Orthopedics and Sports Medicine, Seattle, Washington, U.S.A
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16
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Ji X, Ye L, Hua Y, Zhou X. Rotator Cuff Repair Improves Clinical Function and Stability in Patients Older Than 50 Years With Anterior Shoulder Dislocations and Massive Rotator Cuff Tears. Orthop J Sports Med 2020; 8:2325967120969213. [PMID: 33403216 PMCID: PMC7747109 DOI: 10.1177/2325967120969213] [Citation(s) in RCA: 4] [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: 04/28/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Older patients with shoulder instability have a higher prevalence of rotator
cuff tears and anterior capsular lesions. Simultaneous rotator cuff repair
and labral repair are commonly performed to improve shoulder stability and
function. Purpose: To investigate the clinical outcomes of arthroscopic rotator cuff repair for
older patients with shoulder dislocations combined with massive rotator cuff
tears and intact labral tissue. Study Design: Case series; Level of evidence, 3. Methods: A cohort consisting of 11 patients older than 50 years with shoulder
dislocations and massive rotator cuff tears undergoing arthroscopic rotator
cuff repair was identified between December 2015 and January 2018. Rotator
cuff repair was performed after Bankart, superior labral anterior-posterior,
and humeral avulsion of the glenohumeral ligament lesions were excluded
during arthroscopic surgery. Preoperative and 12-month postoperative
outcomes including modified University of California Los Angeles (UCLA),
American Shoulder and Elbow Surgeons (ASES), Western Ontario Shoulder
Instability Index (WOSI), and visual analog scale for pain scores as well as
range of motion (ROM) were recorded. Results: The supraspinatus tendon was torn in all patients. Also, 36.4% of the
patients had 3 rotator cuff tendons torn. For shoulder function, the
preoperative UCLA score (12.1 ± 2.5 [range, 9-16]) and ASES score (35.4 ±
12.7 [range, 24-44]) significantly improved to 29.4 ± 4.3 (range, 24-35;
P < .001) and 79.4 ± 16.0 (range, 45-95;
P < .001), respectively, at 12 months
postoperatively. None of the patients experienced shoulder redislocations at
12 months after surgery. For shoulder stability, the postoperative WOSI
score (156.8 ± 121.0 [range, 45-365]) was significantly better than was the
preoperative score (713.0 ± 238.6 [range, 395-1090]) (P
< .001). For comparisons between preoperative and postoperative ROM,
forward flexion, abduction, and external and internal rotation at the side
significantly improved. Conclusion: For patients older than 50 years with shoulder dislocations combined with
massive rotator cuff tears and an intact labrum, arthroscopic rotator cuff
repair alone achieved satisfactory functional outcomes and ROM without the
recurrence of dislocations.
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Affiliation(s)
- Xiaoxi Ji
- Huashan Hospital, Fudan University, Shanghai, China
| | | | - Yinghui Hua
- Huashan Hospital, Fudan University, Shanghai, China
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17
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First-time Glenohumeral Dislocations: Current Evidence and Considerations in Clinical Decision Making. Sports Med Arthrosc Rev 2020; 28:122-131. [PMID: 33156225 DOI: 10.1097/jsa.0000000000000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The decision to manage first-time shoulder dislocations conservatively or operatively has become increasingly complex because of conflicting literature. Although shoulder dislocations have traditionally been managed with reduction and immobilization, recent evidence has suggested high rates of subsequent recurrence. Surgical intervention is thought to better restore stability and decrease recurrence rates; however, it also has the potential for additional morbidity and financial cost. As such, recent literature has sought to better define patient risk profiles to identify optimal candidates for both conservative and operative management. The purpose of the current review is to provide a comprehensive and evidence-based assessment of the most recent literature to better delineate an appropriate treatment algorithm for this challenging clinical scenario.
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18
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Hagesæter AN, Løvold T, Juul-Kristensen B, Blomquist J, Hole R, Eshoj H, Magnussen LH. Feasibility of the SINEX program for patients with traumatic anterior shoulder instability. Pilot Feasibility Stud 2020; 6:148. [PMID: 33042568 PMCID: PMC7541274 DOI: 10.1186/s40814-020-00679-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 09/08/2020] [Indexed: 11/17/2022] Open
Abstract
Background An optimal treatment for traumatic anterior shoulder instability (TASI) remains to be identified. A shoulder instability neuromuscular exercise (SINEX) program has been designed for patients with TASI, but has not yet been tested in patients eligible for surgery. The purpose of this study was to investigate and evaluate the feasibility and safety of the SINEX program for patients diagnosed with TASI and eligible for surgery. Methods A feasibility study with an experimental, longitudinal design using both quantitative and qualitative research methods. A total of seven participants underwent the SINEX program, a 12-week exercise program including physiotherapist-supervised sessions. Feasibility data on recruitment, retention, compliance, acceptability and safety was collected through observation and individual semi-structured interviews. Clinical tests and self-report questionnaires were completed at baseline and 12 weeks follow-up. Clinical assessments included apprehension and relocation tests, shoulder joint position sense (SJPS), shoulder sensorimotor control measured by center of pressure path length (COPL) on a force platform, isometric strength measured by Constant Score-Isometric Maximal Voluntary Contraction (CS-iMVC), self-report questionnaires including Western Ontario Shoulder Instability Index (WOSI), Tampa Scale of Kinesiophobia (TSK) and Global Perceived Effect questionnaire (GPE). Results With one participant recruited every 2 weeks, the recruitment rate was 50% lower than expected. Two of seven participants achieved compliance, defined as at least 66% completion of the scheduled home exercises and at least 50% attendance for the physiotherapist supervised sessions. Barriers for successful compliance were (1) inability to take along exercise equipment when travelling, (2) sick leave, (3) holidays and (4) lack of time/busy days. Four adverse events occurred, one of which was related to the intervention (patellar redislocation). All participants expressed satisfaction with the intervention and felt safe during the exercises. All participants improved in the GPE. Change greater than minimal detectable change (MDC) was reported in four participants in some of the outcome assessments. One of the seven participants declined surgery. Conclusion Further assessment is required on several areas before performing an RCT evaluating the efficacy of the SINEX program for patients with TASI considered eligible for surgery. No adverse events suggest that the program is safe, but patients with general hypermobility may need additional adjustments to prevent adverse events in other areas of the body. Trial registration ClinicalTrials.gov: NCT04152304, retrospectively registered
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Affiliation(s)
- Amalie Nilssen Hagesæter
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tonje Løvold
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jesper Blomquist
- Department of Orthopedic Surgery, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Randi Hole
- Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Henrik Eshoj
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Liv Heide Magnussen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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Surgical Stabilization of Shoulder Instability in Patients With or Without a History of Seizure: A Comparative Analysis. Arthroscopy 2020; 36:2664-2673.e3. [PMID: 32540371 PMCID: PMC7751058 DOI: 10.1016/j.arthro.2020.05.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare patients from a large multicenter cohort with a history of seizure and those without a history of seizure regarding preoperative and intraoperative findings and surgical procedures performed. METHODS Patients undergoing shoulder stabilization from 2011 to 2018 at 11 orthopaedic centers were prospectively enrolled. Those with a history of seizure were identified and compared with non-seizure controls. Preoperative demographic, history, physical examination, and imaging findings were collected. Intraoperative findings and surgical procedures performed were recorded. The Mann-Whitney test, χ2 test, and logistic regression analysis were used to examine differences between the groups and define independent risk factors. Owing to the number of statistical tests performed, the false discovery method was used to determine adjusted P values to achieve α < .05. RESULTS During enrollment, 25 of 1,298 shoulder stabilization patients (1.9%) had a history of seizure. The sex ratio and age were similar between groups, as was posterior instability incidence (23.2% in control group vs 28.0% in seizure group). Seizure patients more frequently had more than 5 dislocations in the year preceding surgery (P = .016) and had increased preoperative radiographic evidence of bone loss (P < .001). Intraoperatively, seizure patients had a higher prevalence of reverse Hill-Sachs lesions (P < .001) and large (>30% of glenoid fossa) bony Bankart lesions (P < .001). Arthroscopic Bankart repair was the most common procedure in both groups. However, open procedures were performed in 15.6% of controls and 40.0% of seizure patients (P = .001). These procedures were most commonly bony procedures. CONCLUSIONS Seizure patients had more prior dislocations, had more preoperative bone loss, and underwent more open stabilization procedures than controls because of bone loss. Studies examining recurrence after stabilization will help establish appropriate management practices in this population. LEVEL OF EVIDENCE Level III, retrospective review of prospectively collected cohort.
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20
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Chalmers PN, Uffman W, Christensen G, Greis P, Aoki S, Nelson R, Yoo M, Tashjian RZ. A single-institution analysis of factors affecting costs in the arthroscopic treatment of glenohumeral instability. JSES Int 2020; 4:297-301. [PMID: 32490417 PMCID: PMC7256881 DOI: 10.1016/j.jseint.2020.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Although surgical shoulder stabilization is a substantial cost nationally within the United States, little information exists to analyze this cost. The purpose of this study was to identify factors associated with variation in direct costs with the arthroscopic treatment of glenohumeral instability. Methods This was a retrospective study of all patients who underwent arthroscopic treatment of glenohumeral instability between January 12, 2012 and July 11, 2017. Patient and procedure factors were collected. Direct perioperative costs were collected using a validated internal tool. Patient and procedure characteristics significantly associated with costs were identified using multivariate generalized linear models. Results The study included 302 patients, of whom 12% were undergoing revision and 32% were contact or collision athletes. Anterior instability was present in 73%, whereas 14% had posterior and 10% had multidirectional instability. Of the patients, 67% were recurrent dislocators and 33% were first-time dislocators or subluxators. Remplissage was performed in 13%; biceps tenodesis, 5%; and rotator cuff repair, 3%. An average of 4.0 ± 1.4 anchors were used. Of costs, 39% were operative facility utilization costs and 41% were implant costs. Factors associated with cost increase included an increased number of anchors (P < .0001), posterior vs. anterior instability (P = .001), recurrent instability vs. first-time dislocation (P = .025), remplissage (P = .006), rotator interval closure (P = .021), bicep tenodesis (P = .020), rotator cuff repair (P < .0001), an inpatient stay (P = .003), and repair of humeral avulsion of the glenohumeral ligaments (P = .012). Conclusion Most perioperative costs associated with the arthroscopic treatment of glenohumeral instability are facility utilization and implant costs. Nonmodifiable factors associated with increased cost included posterior direction of instability and recurrent instability. Modifiable factors included additional procedures and inpatient stay.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
| | - William Uffman
- Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Garrett Christensen
- Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Patrick Greis
- Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Stephen Aoki
- Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Richard Nelson
- Department of Epidemiology, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Minkyoung Yoo
- Department of Economics, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
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Bois AJ, Mayer MJ, Fening SD, Jones MH, Miniaci A. Management of bone loss in recurrent traumatic anterior shoulder instability: a survey of North American surgeons. JSES Int 2020; 4:574-583. [PMID: 32939489 PMCID: PMC7479034 DOI: 10.1016/j.jseint.2020.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Management of bone loss in recurrent traumatic anterior shoulder instability remains a topic of debate and controversy in the orthopedic community. The purpose of this study was to survey members of 4 North American orthopedic surgeon associations to assess management trends for bone loss in recurrent anterior shoulder instability. Methods An online survey was distributed to all members of the American Shoulder and Elbow Surgeons, American Orthopaedic Society for Sports Medicine, and Canadian Orthopaedic Association and to fellow members of the Arthroscopy Association of North America. The survey comprised 3 sections assessing the demographic characteristics of survey respondents, the influence of prognostic factors on surgical decision making, and the operative management of 12 clinical case scenarios of varying bone loss that may be encountered in clinical practice. Results A total of 150 survey responses were returned. The age of the patient and quantity of bone loss were consistently considered important prognostic criteria. However, little consensus was reached for critical thresholds of bone loss and how this affected the timing (ie, primary or revision surgery) and type of bony augmentation procedure to be performed once a critical threshold was reached, especially in the context of critical humeral and bipolar bone loss. Conclusions Consistent trends were found for the management of recurrent anterior shoulder instability in cases in which no bone loss existed and when isolated critical glenoid bone loss was present. However, inconsistencies were observed when isolated critical humeral bone loss and bipolar bone loss were present.
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Affiliation(s)
- Aaron J Bois
- Section of Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Michelle J Mayer
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Stephen D Fening
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Morgan H Jones
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anthony Miniaci
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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22
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Cordasco FA, Lin B, Heller M, Asaro LA, Ling D, Calcei JG. Arthroscopic shoulder stabilization in the young athlete: return to sport and revision stabilization rates. J Shoulder Elbow Surg 2020; 29:946-953. [PMID: 31812584 DOI: 10.1016/j.jse.2019.09.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder instability in young athletes is a complex problem with higher recurrence, higher reoperation, and lower return to sport (RTS) rates after arthroscopic shoulder stabilization compared with adults. METHODS This is a prospective case series of young athletes with anterior shoulder instability after arthroscopic stabilization surgery. Primary outcomes were RTS and revision surgery, minimum follow-up was 24 months. Exclusion criteria were more than 3 preoperative episodes of instability, significant bone loss, or primary posterior instability. Demographic data, recurrent instability, revision surgery, sports pre- and postsurgery, patient satisfaction, level of RTS, time to RTS, and Single Assessment Numeric Evaluation (SANE) scores were analyzed. RESULTS Sixty-seven athletes met inclusion criteria, 19 females and 48 males, with a mean age of 17.5 years (range, 13-21 years). Fifty-nine (88%) athletes returned to sport at an average of 7.1 months (standard deviation, ±1.8); 50 (75%) returned to the same level or higher. Football and lacrosse were the most common sports. Four of 67 athletes (6%), all male, underwent revision stabilization at 11-36 months for recurrent instability. The overall mean SANE score was 88. CONCLUSION This study demonstrates that when the high-risk athlete, 21 years old or younger, is appropriately selected for arthroscopic shoulder stabilization by excluding those with 3 or more preoperative shoulder instability episodes and those with off-track and engaging instability patterns, excellent outcomes can be achieved with low revision surgery rates, high RTS rates, and high patient satisfaction.
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Affiliation(s)
- Frank A Cordasco
- Hospital for Special Surgery, Sports Medicine and Shoulder Service, New York, NY, USA.
| | - Brian Lin
- Hospital for Special Surgery, Sports Medicine and Shoulder Service, New York, NY, USA
| | - Michael Heller
- Hospital for Special Surgery, Sports Medicine and Shoulder Service, New York, NY, USA
| | - Lori Ann Asaro
- Hospital for Special Surgery, Sports Medicine and Shoulder Service, New York, NY, USA
| | - Daphne Ling
- Hospital for Special Surgery, Sports Medicine and Shoulder Service, New York, NY, USA
| | - Jacob G Calcei
- Hospital for Special Surgery, Sports Medicine and Shoulder Service, New York, NY, USA
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23
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Lansdown DA, Cvetanovich GL, Zhang AL, Feeley BT, Wolf BR, Hettrich CM, Baumgarten KM, Bishop JY, Bollier MJ, Bravman JT, Brophy RH, Cox CL, Frank RM, Grant JA, Jones GL, Kuhn JE, Marx RG, McCarty EC, Miller BS, Ortiz SF, Smith MV, Wright RW, Ma CB. Risk Factors for Intra-articular Bone and Cartilage Lesions in Patients Undergoing Surgical Treatment for Posterior Instability. Am J Sports Med 2020; 48:1207-1212. [PMID: 32150443 DOI: 10.1177/0363546520907916] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with posterior shoulder instability may have bone and cartilage lesions (BCLs) in addition to capsulolabral injuries, although the risk factors for these intra-articular lesions are unclear. HYPOTHESIS We hypothesized that patients with posterior instability who had a greater number of instability events would have a higher rate of BCLs compared with patients who had fewer instability episodes. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Data from the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group instability patient cohort were analyzed. Patients aged 12 to 99 years undergoing primary surgical treatment for shoulder instability were included. The glenohumeral joint was evaluated by the treating surgeon at the time of surgery, and patients were classified as having a BCL if they had any grade 3 or 4 glenoid or humeral cartilage lesion, reverse Hill-Sachs lesion, bony Bankart lesion, or glenoid bone loss. The effects of the number of instability events on the presence of BCLs was investigated by use of Fisher exact tests. Logistic regression modeling was performed to investigate the independent contributions of demographic variables and injury-specific variables to the likelihood of having a BCL. Significance was defined as P < .05. RESULTS We identified 271 patients (223 male) for analysis. Bone and cartilage lesions were identified in 54 patients (19.9%) at the time of surgical treatment. A glenoid cartilage injury was most common and was identified in 28 patients (10.3%). A significant difference was noted between the number of instability events and the presence of BCLs (P = .025), with the highest rate observed in patients with 2 to 5 instability events (32.3%). Multivariate logistic regression modeling indicated that increasing age (P = .019) and 2 to 5 reported instability events (P = .001) were significant independent predictors of the presence of BCLs. For bone lesions alone, the number of instability events was the only significant independent predictor; increased risk of bone lesion was present for patients with 1 instability event (OR, 6.1; P = .012), patients with 2 to 5 instability events (OR, 4.2; P = .033), and patients with more than 5 instability events (OR, 6.0; P = .011). CONCLUSION Bone and cartilage lesions are seen significantly more frequently with increasing patient age and in patients with 2 to 5 instability events. Early surgical stabilization for posterior instability may be considered to potentially limit the extent of associated intra-articular injury. The group of patients with more than 5 instability events may represent a different pathological condition, as this group showed a decrease in the likelihood of cartilage injury, although not bony injury.
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Affiliation(s)
- Drew A Lansdown
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Gregory L Cvetanovich
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Alan L Zhang
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Brian T Feeley
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Brian R Wolf
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Carolyn M Hettrich
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
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- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Keith M Baumgarten
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Julie Y Bishop
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Matthew J Bollier
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Jonathan T Bravman
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Robert H Brophy
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Charles L Cox
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Rachel M Frank
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - John A Grant
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Grant L Jones
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - John E Kuhn
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Robert G Marx
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Eric C McCarty
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Bruce S Miller
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Shannon F Ortiz
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Matthew V Smith
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - Rick W Wright
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
| | - C Benjamin Ma
- Investigation performed at University of California, San Francisco, San Francisco, California, USA
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24
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Surgical outcomes in the Frequency, Etiology, Direction, and Severity (FEDS) classification system for shoulder instability. J Shoulder Elbow Surg 2020; 29:784-793. [PMID: 32197767 PMCID: PMC7197435 DOI: 10.1016/j.jse.2019.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 12/01/2019] [Accepted: 12/10/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Frequency, Etiology, Direction, and Severity (FEDS) system was developed as a simple but reliable method for classifying shoulder instability based on 4 factors attainable by history and physical examination: frequency (solitary, occasional, or frequent); etiology (traumatic or atraumatic); direction (anterior, posterior, or inferior); and severity (subluxation or dislocation). This study investigated the epidemiology and 2-year surgical outcomes for the FEDS categories in the prospective Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort. METHODS At the time of surgery, 1204 patients were assigned to the FEDS categories. Follow-up data were available for 636 of 734 patients (86.6%) who had undergone surgery at least 2 years prior to analysis. The most common categories were further analyzed by patient-reported outcomes (PROs) (American Shoulder and Elbow Surgeons, Western Ontario Shoulder Instability index, Single Assessment Numeric Evaluation scores) and rates of recurrent subluxation, recurrent dislocation, and revision surgery. RESULTS Of the 36 FEDS categories, 16 represented at least 1% of patients. Occasional traumatic anterior dislocation (OTAD) was the most common category, with 16.4% of patients. Five other anterior categories (solitary traumatic anterior subluxation, occasional traumatic anterior subluxation [OTAS], frequent traumatic anterior subluxation [FTAS], solitary traumatic anterior dislocation, and frequent traumatic anterior dislocation) and one posterior category (solitary traumatic posterior subluxation [STPS]) represented at least 5% of patients. PROs improved significantly for each category. The highest rates of recurrent subluxation occurred in FTAS, OTAS, and OTAD cases; dislocation, OTAS and FTAS cases; and further surgery, OTAD cases. The lowest rates of failure occurred in STPS cases. Downward trends in PROs and higher failure rates were noted with an increasing number of preoperative dislocations. CONCLUSION Different FEDS categories showed varying degrees of improvement and failure rates, indicating that the system can be used to provide prognostic insight for presurgical education. Overall, outcomes decreased with a higher number of preoperative dislocations.
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25
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McNeil D, Provencher M, Wong IH. Arthroscopic anatomic glenoid reconstruction demonstrates its safety with short-term to medium-term results for anteroinferior shoulder instability: a systematic review. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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26
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Nakagawa S, Hirose T, Uchida R, Tanaka M, Mae T. Postoperative Recurrence of Instability After Arthroscopic Bankart Repair for Shoulders With Primary Instability Compared With Recurrent Instability: Influence of Bipolar Bone Defect Size. Am J Sports Med 2020; 48:48-55. [PMID: 31684736 DOI: 10.1177/0363546519880496] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In shoulders with traumatic anterior instability, a bipolar bone defect has recently been recognized as an important indicator of the prognosis. PURPOSE To investigate the influence of bipolar bone defects on postoperative recurrence after arthroscopic Bankart repair performed at primary instability. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The study group consisted of 45 patients (45 shoulders) who underwent arthroscopic Bankart repair at primary instability before recurrence and were followed for at least 2 years. The control group consisted of 95 patients (95 shoulders) with recurrent instability who underwent Bankart repair and were followed for at least 2 years. Glenoid defects and Hill-Sachs lesions were classified into 5 size categories on 3-dimensional computed tomography and were allocated scores ranging from 0 for no defect to 4 for the largest defect. The shoulders were classified according to the total score for both lesions (0-8 points). The postoperative recurrence rate was investigated for each score of bipolar bone defects and was compared between patients with primary instability and patients with recurrent instability. The same analysis was performed for the age at operation (<20 years, 20-29 years, or ≥30 years) and for the presence of an off-track Hill-Sachs lesion. RESULTS Bipolar bone defects were smaller in shoulders with primary instability (mean ± SD defect score, 1.4 ± 1.5 points) than in those with recurrent instability (3.6 ± 1.9 points) and were larger in older patients than in younger patients at the time of primary instability. The postoperative recurrence rate was low (6.7%) in shoulders with primary instability regardless of the size of the bipolar bone defect and the patient's age, whereas the postoperative recurrence rate was high (23.2%) in shoulders with recurrent instability, especially among patients younger than 20 years with bipolar bone defects of 2 points or greater. An off-track Hill-Sachs lesion was found in only 1 patient in the oldest age group (2.2%) at primary instability, but it was found in 19 patients (20%) at recurrent instability, including 14 patients younger than 30 years. Among patients with an off-track lesion, the postoperative recurrence rate was significantly higher in patients younger than 20 years with recurrent instability (recurrence rates: <20 years, 71.4%; 20-29 years, 14.3%; ≥30 years, 0%). CONCLUSION The recurrence rate was consistently low in patients with primary instability and was significantly influenced by bipolar bone defect size and patient age in patients with recurrent instability.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Takehito Hirose
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Makoto Tanaka
- Department of Orthopaedic Surgery, Daini Osaka Police Hospital, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan
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27
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Affiliation(s)
- Robert Z Tashjian
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Peter N Chalmers
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah
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28
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Early surgical treatment of first-time anterior glenohumeral dislocation in a young, active population is superior to conservative management at long-term follow-up. INTERNATIONAL ORTHOPAEDICS 2019; 43:2799-2805. [DOI: 10.1007/s00264-019-04382-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
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29
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Carlson Strother CR, McLaughlin RJ, Krych AJ, Sanchez-Sotelo J, Camp CL. Open Shoulder Stabilization for Instability: Anterior Labral Repair With Capsular Shift. Arthrosc Tech 2019; 8:e749-e754. [PMID: 31485402 PMCID: PMC6714345 DOI: 10.1016/j.eats.2019.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/10/2019] [Indexed: 02/07/2023] Open
Abstract
Although anterior shoulder instability is most commonly treated with arthroscopic fixation, open labral repair with capsular shift may be best for select patients and in cases of revision stabilization without significant bone loss. The technique described in this article uses the deltopectoral interval; it involves careful dissection of the subscapularis from the anterior capsule, repair of the Bankart lesion, and a lateral and superior capsular shift using all-suture anchors in the humeral head. Advantages of this technique include meticulous control of anchor placement and the ability to provide additional stability via a lateral and superiorly directed capsular shift. This operation can be performed in a reliable, efficient, and reproducible manner.
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Affiliation(s)
| | | | | | | | - Christopher L. Camp
- Address correspondence to Christopher L. Camp, M.D., Mayo Clinic, 200 1st St SW, Rochester, MN 55905, U.S.A.
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30
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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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31
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Ro K, Kim MS, Kim JD, Rhee YG. Arthroscopic Findings and Clinical Outcomes in Patients 40 Years of Age and Older With Recurrent Shoulder Dislocation. Arthroscopy 2019; 35:314-322. [PMID: 30611590 DOI: 10.1016/j.arthro.2018.08.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/12/2018] [Accepted: 08/12/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The present study investigates the intra-articular findings and clinical outcomes after arthroscopic surgery in patients after age 40 with chronic anterior shoulder instability. METHODS Fifty patients older than 40 years who underwent arthroscopic stabilization for recurrent anterior shoulder dislocation were analyzed. RESULTS The mean age at the time of surgery was 44.8 years (range, 40-72 years), and the mean duration of follow-up was 45 months (range, 28-150 months). The mean visual analog scale score for pain with motion significantly improved from 4.1 preoperatively to 1.7 at the last follow-up (P < .001). The range of motion in the affected shoulder revealed limitations of 9.4° in forward flexion and 17.8° in external rotation compared with the unaffected shoulder. Both the Constant and Rowe scores significantly improved (P < .001 and P < .001, respectively). Recurrence, which includes dislocation and subluxation, occurred in 14% postoperatively. Anteroinferior labral lesion was seen in 92% of patients. Associated lesions included superior labrum anterior to posterior lesion (22%), midsubstance capsular tear (10%), and Hill-Sachs lesion (92%). Rotator cuff tears were found in 18%-partial-thickness tear in 10% and full-thickness tear, which was repaired with suture anchor, in 8%. Among the intra-articular lesions, there was no significant relation with recurrent instability or functional outcome as a single factor. CONCLUSIONS In patients with chronic anterior shoulder instability who were older than 40 years, the clinical results after arthroscopic surgery showed statistically significant improvement with good muscle strength recovery. The quality of labral lesion, size of the Hill-Sachs lesion, and glenoid defect showed positive correlation with the number of preoperative dislocation. The intra-articular pathologies were varied, however no single articular lesion had significant impact on the recurrence rate. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Kyunghan Ro
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Myung Seo Kim
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jong Dae Kim
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
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32
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Godin JA, Altintas B, Horan MP, Hussain ZB, Pogorzelski J, Fritz EM, Millett PJ. Midterm Results of the Bony Bankart Bridge Technique for the Treatment of Bony Bankart Lesions. Am J Sports Med 2019; 47:158-164. [PMID: 30485124 DOI: 10.1177/0363546518808495] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The arthroscopic "bony Bankart bridge" (BBB) repair technique was recently shown to successfully restore shoulder stability at short-term follow-up, but longer-term outcomes have not yet been described. PURPOSE To report the outcomes at minimum 5-year follow-up after BBB repair for anterior shoulder instability with a bony Bankart lesion. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients were included if they sustained a bony Bankart lesion, were treated with a BBB technique, and were at least 5 years postoperative. Patients were excluded if they underwent concomitant rotator cuff repair or an open bone fragment reduction. All patients were assessed with the following measures preoperatively and at final evaluation: QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand), American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, and 12-Item Short Form Health Survey (SF-12) Physical Component Summary. RESULTS From 2008 to 2012, 13 patients who underwent BBB met the inclusion criteria with a mean age of 39.6 years (range, 19.1-68.8 years) and a mean follow-up of 6.7 years (range, 5.1-9.0 years). Mean time from most recent injury to surgery was 6.3 months (range, 1 day-36 months). The mean glenoid bone loss was 22.5% (range, 9.1%-38.6%). Mean SF-12 scores demonstrated significant improvement from 45.8 (SD, 9.7) preoperatively to 55.1 (SD, 5.9) at a mean follow-up of 6.7 years. At final follow-up, the mean American Shoulder and Elbow Surgeons score was 93.1 (range, 68.3-100); the mean QuickDASH score, 6.2 (range, 0-25); and the mean Single Assessment Numeric Evaluation score, 92.8 (range, 69-99). None of the patients progressed to further shoulder surgery. Three of 13 patients (23%) reported subjective recurrent instability. At final follow-up, 9 of 12 (75%) patients indicated that their sports participation levels were equal to their preinjury levels. Median patient satisfaction at final follow-up was 10 of 10 points (range, 3-10). CONCLUSION The arthroscopic BBB technique for patients with anterior bony Bankart lesions can restore shoulder stability, yield durable improvements in clinical outcomes, and provide a high return-to-sport rate at a minimum 5-year follow-up. Three of 13 patients experienced postoperative symptoms of instability but did not undergo further stabilization surgery.
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Affiliation(s)
- Jonathan A Godin
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Burak Altintas
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | - Jonas Pogorzelski
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Department of Orthopaedic Sports Medicine, Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Erik M Fritz
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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