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Herman ZJ, Reddy RP, Fails A, Lin A, Popchak A. Rehabilitation and Return to Sport following Operative and Nonoperative Treatment of Anterior Shoulder Instability. Clin Sports Med 2024; 43:705-722. [PMID: 39232575 DOI: 10.1016/j.csm.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
There has been growing interest in the rehabilitation process and timing of returning an athlete to sport following the management options for anterior shoulder instability. The purpose of this article is to review the current rehabilitation and return to sport (RTS) protocols for various nonoperative and operative management strategies following anterior shoulder instability events. When appropriate in the rehabilitation protocol, RTS testing should be criteria based, rather than time based, with a special focus given to psychological readiness in order to promote successful return to athletics and prevention of recurrent instability episodes in the future.
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Affiliation(s)
- Zachary J Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA, USA
| | - Rajiv P Reddy
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA, USA
| | - Alex Fails
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA, USA.
| | - Adam Popchak
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA, USA
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Brinkman JC, Damitio E, Tokish JM. Arthroscopic Management of the Contact Athlete with Anterior Instability. Clin Sports Med 2024; 43:601-615. [PMID: 39232569 DOI: 10.1016/j.csm.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Anterior glenohumeral instability is one of the most common injuries suffered from sport. Despite padding and conditioning, the shoulder joint remains particularly vulnerable to injury, especially in the setting of contact. The overall rate of anterior instability is reported to be 0.12 injuries per 1000 athlete exposures, although this is increased up to 0.40 to 0.51 in the contact athlete. Successful treatment requires consideration of restoring stability while minimizing loss of glenohumeral motion. Common treatment strategies involve addressing the pathology that results from anterior shoulder dislocation including labral detachment as well as bony defects to the humeral head and glenoid.
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Affiliation(s)
| | - Elizabeth Damitio
- Institute of Protein Design, University of Washington, Seattle, Washington, USA
| | - John M Tokish
- Department of Orthopedic Surgery Sports Medicine, Mayo Clinic, Phoenix, AZ, USA
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Rupp MC, Horan MP, Garcia AR, Geissbuhler AR, Hinz M, Haskel JD, Millett PJ. Outcomes of primary arthroscopic shoulder stabilization in active patients over 40-results at a mean follow-up of 7 years. JSES Int 2024; 8:970-977. [PMID: 39280160 PMCID: PMC11401590 DOI: 10.1016/j.jseint.2024.05.015] [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] [Indexed: 09/18/2024] Open
Abstract
Background The purpose of this study is to report clinical outcomes, return to activity, redislocation rate, and rate of conversion to arthroplasty for active patients over age 40 undergoing primary arthroscopic shoulder stabilization. Methods Patients over 40 years of age who underwent arthroscopic capsulolabral repair for shoulder instability between December 2005 and January 2018 with a minimum of 2-year postoperative follow-up were enrolled in this retrospective, monocentric study. Clinical outcome scores including the 12-Item Short-Form Survey, American Shoulder and Elbow Surgeons (ASES), Quick Disabilities of the Arm, Shoulder, and Hand, Single-Assessment Numeric Evaluation, and visual analog scale pain were collected. Additionally, it was determined which patients reached the minimal clinically important difference and the patient-acceptable symptom state for the ASES score. Bivariate analysis was utilized to determine if there was any association between baseline demographic and clinical factors with the outcome scores. Results Of a total of 814 patients assessed for eligibility, an aggregate of 40 patients were included and 33 patients (8 females) were available for follow-up. The average age was 49.4 ± 7.6 years. At an average follow-up of 7.0 ± 3.6 years, all the outcome scores significantly improved compared to baseline. These included ASES (69.9 ± 19 to 95.8 ± 7.6, P < .001); the Quick Disabilities of the Arm, Shoulder, and Hand score (29.7 ± 17.7 to 3.9 ± 5.4, P < .002); Single Assessment Numeric Evaluation score (53.5 ± 29.3 to 91.6 ± 14.3, P < .003); the 12-Item Short-Form Survey (45.6 ± 8.8 to 55.2 ± 5.7, P < .001); and the visual analog scale (2.1 ± 2.1 to 0.3 ± 1, P < .002). The minimal clinically important difference was reached by 72.7% of the patients and 81.8% reached the patient-acceptable symptom state threshold for the ASES score. Postoperative shoulder stability improved substantially and significantly. Median postoperative satisfaction was 10/10 (range 1-10). Ninety-five-point-six percent of the patients returned to sport, with 91.0% of the patients able to return to preinjury level. One patient (3%) underwent revision surgery for osteoarthritis, in the form of comprehensive arthroscopic management procedure. The presence of cartilage defects cartilage defects Outerbridge grade >2 (P = .020) and posterior labral lesions (P = .03) at index surgery were significantly associated with inferior outcomes in the ASES score. Conclusion Active patients aged 40 years and older undergoing arthroscopic shoulder stabilization experienced favorable functional outcomes at a mean follow-up of 7 years, with low rates of revision surgery or of progression to clinically relevant osteoarthritis. However, the presence of high-grade cartilage lesions and the presence of a posterior labral tear were associated with inferior clinical outcomes.
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Affiliation(s)
- Marco-Christopher Rupp
- Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Marilee P Horan
- Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA
| | - Alexander R Garcia
- Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA
| | - Annabel R Geissbuhler
- Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA
| | - Maximilian Hinz
- Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Jonathan D Haskel
- Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA
- Center for Outcomes-based Orthopaedic Research, The Steadman Clinic, Vail, CO, USA
| | - Peter J Millett
- Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA
- Center for Outcomes-based Orthopaedic Research, The Steadman Clinic, Vail, CO, USA
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Abdel Khalik H, Lameire DL, Leroux T, Bhandari M, Khan M. Arthroscopic stabilization surgery for first-time anterior shoulder dislocations: a systematic review and meta-analysis. J Shoulder Elbow Surg 2024; 33:1858-1872. [PMID: 38430981 DOI: 10.1016/j.jse.2024.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/04/2024] [Accepted: 01/18/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The optimal management of first-time anterior shoulder dislocations (FTASDs) remains controversial. Therefore, the purpose of this study was to assess the efficacy of arthroscopic stabilization surgery for FTASDs through a systematic review and meta-analysis of existing literature. METHODS MEDLINE, Embase, and Web of Science were searched from inception to December 18, 2022, for single-arm or comparative studies assessing FTASDs managed with arthroscopic stabilization surgery following first-time dislocation. Eligible comparative studies included studies assessing outcomes following immobilization for an FTASD, or arthroscopic stabilization following recurrent dislocations. Eligible levels of evidence were I to IV. Primary outcomes included rates of shoulder redislocations, cumulative shoulder instability, and subsequent shoulder stabilization surgery. RESULTS Thirty-four studies with 2222 shoulder dislocations were included. Of these, 5 studies (n = 408 shoulders) were randomized trials comparing immobilization to arthroscopic Bankart repair (ABR) after a first dislocation. Another 16 studies were nonrandomized comparative studies assessing arthroscopic Bankart repair following first-time dislocation (ABR-F) to either immobilization (studies = 8, n = 399 shoulders) or arthroscopic Bankart repair following recurrent dislocations (ABR-R) (studies = 8, n = 943 shoulder). Mean follow-up was 59.4 ± 39.2 months across all studies. Cumulative loss to follow-up was 4.7% (range, 0%-32.7%). A composite rate of pooled redislocation, cumulative instability, and reoperations across ABR-F studies was 6.8%, 11.2%, and 6.1%, respectively. Meta-analysis found statistically significant reductions in rates of redislocation (odds ratio [OR] 0.09, 95% confidence interval [CI] 0.04-0.3, P < .001), cumulative instability (OR 0.05, 95% CI 0.03-0.08, P < .001), and subsequent surgery (OR 0.08, 95% CI 0.04-0.15, P < .001) when comparing ABR-F to immobilization. Rates of cumulative instability (OR 0.32, 95% CI 0.22-0.47, P < .001) and subsequent surgery rates (OR 0.27, 95% CI 0.09-0.76, P = .01) were significantly reduced with ABR-F relative to ABR-R, with point estimate of effect favoring ABR-F for shoulder redislocation rates (OR 0.59, 95% CI 0.19-1.83, P = .36). Return to sport rates to preoperative levels or higher were 3.87 times higher following ABR-F compared to immobilization (95% CI 1.57-9.52, P < .001), with limited ABR-R studies reporting this outcome. The median fragility index of the 5 included randomized controlled trials (RCTs) was 2, meaning reversing only 2 outcome events rendered the trials' findings no longer statistically significant. CONCLUSION Arthroscopic stabilization surgery for FTASDs leads to lower rates of redislocations, cumulative instability, and subsequent stabilization surgery relative to immobilization or arthroscopic stabilization surgery following recurrence. Although a limited number of RCTs have been published on the subject matter to date, the strength of their conclusions is limited by a small sample size and statistically fragile results.
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Affiliation(s)
- Hassaan Abdel Khalik
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Darius L Lameire
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Timothy Leroux
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Mohit Bhandari
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Moin Khan
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
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Zhang C, Yang S, Wang J, Shao W, Huang Y, Tang X. Prognostic factors for recurrent instability in recreational athletes following arthroscopic Bankart repair: a retrospective study with an average 4.1-year follow-up. BMC Sports Sci Med Rehabil 2024; 16:140. [PMID: 38915076 PMCID: PMC11194893 DOI: 10.1186/s13102-024-00925-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 06/12/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Extensive research has been conducted to investigate the short-term and long-term outcomes of arthroscopic Bankart repair, yielding varying results across different populations. However, there remains a dearth of studies specifically focused on evaluating outcomes in recreational athletes. METHODS A retrospective case series study was conducted on recreational athletes who underwent isolated arthroscopic Bankart repair between 2013 and 2021. The primary outcome assessed was recurrent instability, defined as dislocation or subluxation. Secondary outcomes included patient satisfaction, rates of returning to the same sports (RTS) and RTS at preinjury level, and patient-reported outcomes. Evaluation of the Rowe score, Constant score, American Shoulder and Elbow Surgeons score, and VAS pain score were performed. Prognostic factors for recurrent instability, including demographic and clinical characteristics, as well as postoperative magnetic resonance imaging (MRI) appearance of the labrum were analyzed. RESULTS A total of 191 patients met the selection criteria, with 150 (78.5%) available for the final follow-up. Recurrent instability occurred in 10.7% of patients, with a mean follow-up duration of 4.1 years. Younger age at surgery and more critical glenoid bone loss were significantly associated with recurrent instability (p = .038 and p = .011, respectively). The satisfaction rate regarding surgery was 90.0%. Rates of return to the same sports (RTS) and RTS at preinjury level were 82.0% and 49.3%, respectively. Clinical outcomes measured at the final follow-up were as follows: Rowe score - 92.8; Constant score - 98.0; ASES score - 98.3; VAS pain score - 0.2. Patients with recurrent instability had significantly inferior outcomes in terms of satisfaction rate, RTS at preinjury level rate, Rowe score, and Constant score (p = .000, p = .039, p = .000, and p = .015, respectively). A total of thirty-seven patients underwent MRI examination six months after surgery in our institution. The T2-weighted anterior labrum morphology was found to be poorer in patients with recurrent instability. No significant difference was observed between patients with or without recurrent instability in terms of anterior Slope, anterior labral glenoid height index (LGHI), inferior Slope, inferior LGHI, and T2-weighted inferior labrum morphology. CONCLUSION Arthroscopic Bankart repair can yield satisfactory medium-term outcomes for recreational athletes. Younger age at surgery, more critical glenoid bone loss, and poorer T2-weighted anterior labrum morphology assessed six months postoperatively were significantly associated with recurrent instability.
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Affiliation(s)
- Chunsen Zhang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Songyun Yang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Santai county people's hospital, Mianyang, 621199, China
| | - Jiapeng Wang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wenze Shao
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yizhou Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China hospital, Sichuan University, Chengdu, 610041, China.
| | - Xin Tang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Ralph JE, Hurley ET, Lunn K, Levin JM, Klifto CS, Owens BD, Anakwenze OA, Lau BC, Dickens JF. Outcomes of arthroscopic stabilization for posterior shoulder instability: a systematic review. J Shoulder Elbow Surg 2024:S1058-2746(24)00395-1. [PMID: 38825224 DOI: 10.1016/j.jse.2024.04.006] [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: 02/18/2024] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Posterior shoulder instability makes up approximately 10% of all shoulder instability cases and its diagnosis and treatment is less well understood. Recently, however, there has been increased recognition of posterior instability and posterior stabilization. The purpose of this study was to systematically review the literature to ascertain the outcomes on arthroscopic stabilization of posterior shoulder instability. METHODS Two independent reviewers conducted a systematic literature search based on PRISMA guidelines, utilizing the MEDLINE database. Studies were eligible for inclusion if they reported postoperative outcomes for posterior shoulder instability following arthroscopic stabilization. RESULTS A total of 48 studies met inclusion criteria for review including 2307 shoulders. Majority of patients were male (83.3%), with an average age of 26.1 years and a mean follow-up of 46.8 months. The functional outcome score primarily utilized for postoperative assessment was the American Shoulder and Elbow Surgeons with an average of 84.77. Overall, 90.9% of patients reported being satisfied with their arthroscopic stabilization. Recurrent instability occurred in 7.4% of patients. The total revision rate was 5.2%. 16.6% of patients reported residual pain postoperatively. The rate of return to play was 86.4% with 68.0% of patients returning to play at the same or higher level of play. CONCLUSION Arthroscopic stabilization of posterior shoulder instability resulted in good outcomes with high patient satisfaction and low rates of recurrent instability, revisions, and residual pain.
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Affiliation(s)
- Julia E Ralph
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kiera Lunn
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jay M Levin
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brett D Owens
- Department of Orthopaedic Surgery, Alpert Medical School, Providence, RI, USA
| | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jonathan F Dickens
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Sonke C, Wong I. Editorial Commentary: Anterior Shoulder Stabilization Combining Arthroscopic Bankart and Inferior Capsular Shift Avoids Open Surgery in Athletes Without Critical Glenoid Bone Loss. Arthroscopy 2024; 40:1431-1433. [PMID: 38323954 DOI: 10.1016/j.arthro.2023.12.028] [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: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 02/08/2024]
Abstract
Traumatic anterior shoulder dislocations can cause a myriad of injuries, each with their own unique set of challenges with respect to surgical management. The debate of whether open or arthroscopic management is the superior approach is one that predates most currently practicing orthopaedic surgeons yet remains one of the most actively researched areas of orthopaedics. Current trends favor arthroscopic management for anterior instability secondary to a Bankart lesion in patients without other risk factors for instability, such as critical glenoid bone loss. However, excellent results are not guaranteed following arthroscopic Bankart repair, particularly in athletes, due to high rates of recurrence. While the technique of inferior to superior capsular shift is not new, transitioning a historically open technique to the arthroscopic world may represent another tool in the glenohumeral instability management toolbox. While perspectives are evolving, more evidence supporting arthroscopic techniques like the capsular shift are needed to better identify appropriate patient populations.
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Affiliation(s)
| | - Ivan Wong
- Dalhousie University; Nova Scotia Health
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Yildiz TI, Turhan E, Huri G, Ocguder DA, Duzgun I. Cross-education effects on shoulder rotator muscle strength and function after shoulder stabilization surgery: a randomized controlled trial. J Shoulder Elbow Surg 2024; 33:804-814. [PMID: 38122890 DOI: 10.1016/j.jse.2023.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023]
Abstract
HYPOTHESIS This study aimed to investigate the effects of cross education (CE) on rotator cuff (RC) muscle strength recovery and shoulder function in patients who underwent arthroscopic anterior shoulder stabilization surgery. METHODS Twenty-eight patients who underwent shoulder stabilization surgery were included in the study (age, 25 ± 6 years; body mass index, 24.8 ± 3.6 kg/m2). The patients were randomly divided into either the CE group (n = 14) or the control group (n = 14). All patients received a standardized rehabilitation program until the end of the 12th postoperative week. The CE group also received isokinetic training of the nonoperative shoulder focusing on the RC muscles (twice a week, 3 sets of 10 repetitions). RC muscle strength was measured preoperatively and at 3 and 6 months postoperatively using an isokinetic dynamometer at 60°/s and 180°/s angular velocities. Shoulder function was assessed with the Closed Kinetic Chain Upper Extremity Stability Test and Y-Balance Test-Upper Quarter. Analyses of covariance were used for the statistical analyses. RESULTS At 6 months postoperatively, at 60°/s angular velocity, there was higher internal rotator strength in the CE group (P = .02) and similar external rotator strength (P = .62) between the groups. At 180°/s angular velocity, both internal rotator strength (P = .04) and external rotator strength (P = .02) were higher in the CE group. The Closed Kinetic Chain Upper Extremity Stability Test (P = .47), Y-Balance Test-Upper Quarter (P = .95), and Western Ontario Shoulder Instability Index (P = .12) scores were similar between the groups at 6 months after surgery. CONCLUSIONS CE in the early period of postoperative rehabilitation following stabilization surgery improves RC strength recovery. However, it has no effect on functional outcomes. Integrating a CE program into the postoperative rehabilitation protocol may help to improve dynamic shoulder stability but not functional capacity.
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Affiliation(s)
- Taha Ibrahim Yildiz
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Egemen Turhan
- Department of Orthopedy and Traumatology, Hacettepe University, Ankara, Turkey
| | - Gazi Huri
- Department of Orthopedy and Traumatology, Hacettepe University, Ankara, Turkey
| | - Durmus Ali Ocguder
- Department of Orthopedy and Traumatology, Ankara Sehir Hastanesi, Ankara, Turkey
| | - Irem Duzgun
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Cleary BP, Hurley ET, Kilkenny CJ, Robinson J, Khan SU, Davey MS, Anakwenze O, Klifto CS, Mullett H. Return to Play After Surgical Treatment for Acromioclavicular Joint Dislocation: A Systematic Review. Am J Sports Med 2024; 52:1350-1356. [PMID: 37345238 DOI: 10.1177/03635465231178784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Acromioclavicular (AC) joint dislocation is a common clinical problem among young and athletic populations. Surgical management is widely used for high-grade dislocations (Rockwood III-VI) and in high-demand athletes at high risk of recurrence. PURPOSE To systematically review the evidence in the literature to ascertain the rate and timing of return to play (RTP) and the availability of specific criteria for safe RTP after surgical treatment for AC joint dislocation. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic literature search based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted in the PubMed database. Clinical studies were eligible for inclusion if they reported on RTP after surgical treatment for AC joint dislocation. Statistical analysis was performed with SPSS. RESULTS We found 120 studies including 4327 cases meeting our inclusion criteria. The majority of patients were male (80.2%), with a mean age of 37.2 years (range, 15-85) and a mean follow-up of 34.5 months. Most were recreational athletes (79%), and the most common sport was cycling. The overall rate of RTP was 91.5%, with 85.6% returning to the same level of play. Among collision athletes, the rate of RTP was 97.3%, with 97.2% returning to the same level of play. In overhead athletes, the rate of RTP was 97.1%, with 79.2% returning to the same level of play. The mean time to RTP was 5.7 months (range, 1.5-15). Specific RTP criteria were reported in the majority of the studies (83.3%); time to return to play was the most commonly reported item (83.3%). Type III Rockwood injuries had the highest RTP rate at 98.7% and the earliest RTP at 4.9 months. Among the different surgical techniques, Kirschner wire fixation had the highest rate of RTP at 98.5%, while isolated graft reconstruction had the earliest RTP at 3.6 months. CONCLUSION The overall rate of RTP was reportedly high after surgical treatment for AC joint dislocation, with the majority of patients returning to their preinjury levels of sport. There is a lack of consensus in the literature for what constitutes a safe RTP, with further focus on this topic required in future studies.
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Affiliation(s)
| | - Eoghan T Hurley
- Sports Surgery Clinic, Dublin, Ireland
- Duke University, Durham, North Carolina, USA
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10
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Hurley ET, Danilkowicz RM, Paul AV, Myers H, Anakwenze OA, Klifto CS, Lau BC, Taylor DC, Dickens JF. Author Reply to "Can We Conclude That the Arthroscopic Bankart Repair and Open Latarjet Procedure Show Similar Rates of Return to Play and How Should This Conclusion Be Interpreted?". Arthroscopy 2024; 40:657-658. [PMID: 38206248 DOI: 10.1016/j.arthro.2023.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 07/27/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Eoghan T Hurley
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, U.S.A
| | | | - Alexandra V Paul
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, U.S.A
| | - Heather Myers
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, U.S.A
| | - Oke A Anakwenze
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, U.S.A
| | - Christopher S Klifto
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, U.S.A
| | - Brian C Lau
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, U.S.A
| | - Dean C Taylor
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, U.S.A
| | - Jonathan F Dickens
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, U.S.A
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11
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Kim SC, Kim HG, Na SW, Jung JS, Yoo JC. Knotless Bioabsorbable Anchors Placed on the Glenoid Face for Arthroscopic Bankart Repair. Am J Sports Med 2024; 52:613-623. [PMID: 38284285 DOI: 10.1177/03635465231221723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Quantitative analysis of the glenoid face knotless-type anchor placement for arthroscopic Bankart repair has not been reported. PURPOSE To evaluate the clinical and radiologic outcomes after arthroscopic Bankart repair using knotless bioabsorbable anchors depending on the anchor location. STUDY DESIGN Case series, Level of evidence, 4. METHODS A total of 124 patients (113 men and 11 women; age, 25.6 ± 7.5 years; follow-up time, 46.5 ± 18.2 months [range, 6.2-75.5 months]) who underwent arthroscopic Bankart repair with the bioabsorbable knotless anchor between 2017 and 2021 were included in this study. Among them, 118 patients were observed for >2 years (mean, 48.2 ± 16.8 months [range, 24-75.5 months]) and were analyzed for final clinical and radiologic outcomes. Using postoperative 6-month magnetic resonance imaging, remnant glenoid (%) and labral height were measured. Shoulder range of motion (ROM), radiographic osteoarthritic change, dislocation, apprehension test, and return to sports were recorded. Three groups were established based on the remnant glenoid, which represented the percentage of the exposed glenoid anteroposterior diameter to the original diameter using the best-fit circle method-group A: lower quartile; group B: interquartile; and group C: upper quartile-and variables were analyzed. RESULTS Overall, the remnant glenoid was 57% ± 6.4% (range, 41.5%-75%) after the surgery. Osteoarthritic change, dislocations, and positive apprehension tests were observed in 5 (4.2%), 4 (3.4%), and 12 (10.2%) patients, respectively. A total of 34 (28.8%) and 64 (54.2%) patients could return to sports without and with restrictions, respectively. Comparing groups A, B, and C, postoperative labral height (7 ± 1, 7 ± 2, and 7 ± 1 mm; P = .623), final osteoarthritic change (1, 4, and 0; P = .440), positive apprehension tests (5, 5, and 2; P = .387), and return to sports (complete/restricted/unable, 6/18/5, 19/29/11, 9/17/4; P = .769) were not different. All ROM were similar across the groups (all P > .054), except for external rotation (ER) at postoperative 6 months (41.3°± 12.8°; 50.2°± 18.5°; and 49.8°± 15.2°; P = .050). However, ER after 1 year was similar across the groups (all P > .544). In further analysis, patients with positive apprehension tests had lower labral height compared with others (5 [4-6] mm and 7 [6-8] mm; P < .001). CONCLUSION In arthroscopic Bankart repair, the placement of knotless bioabsorbable anchors on the glenoid face, combined with the remplissage procedure or rotator interval closure, resulted in a low recurrence rate and moderate return to sports. However, most patients had some restrictions in returning to sports. Moreover, this technique was not associated with postoperative arthritis and shoulder stiffness, including ER deficit, which was not affected by the position of the anchor on the glenoid face for a minimum 2-year follow-up.
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Affiliation(s)
- Su Cheol Kim
- Samsung Medical Center, Seoul, Republic of Korea
| | - Hyun Gon Kim
- Samsung Medical Center, Seoul, Republic of Korea
| | - Sang Woon Na
- Samsung Medical Center, Seoul, Republic of Korea
| | - Joo Sam Jung
- Samsung Medical Center, Seoul, Republic of Korea
| | - Jae Chul Yoo
- Samsung Medical Center, Seoul, Republic of Korea
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Li ZI, Hurley ET, Garra S, Blaeser AM, Markus DH, Shen M, Campbell KA, Strauss EJ, Jazrawi LM, Gyftopoulos S. Arthroscopic Bankart repair versus nonoperative management for first-time anterior shoulder instability: A cost-effectiveness analysis. Shoulder Elbow 2024; 16:59-67. [PMID: 38435039 PMCID: PMC10902416 DOI: 10.1177/17585732231187123] [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: 03/02/2023] [Revised: 06/10/2023] [Accepted: 06/24/2023] [Indexed: 03/05/2024]
Abstract
Purpose Arthroscopic Bankart repair (ABR) may be more effective than nonoperative management for patients with anterior shoulder instability following first-time dislocation. The purpose of the study was to determine the most cost-effective treatment strategy by evaluating the incremental cost-effectiveness ratio (ICER) for ABR versus nonoperative treatment. Methods This cost-effectiveness study utilized a Markov decision chain and Monte Carlo simulation. Probabilities, health utility values, and outcome data regarding ABR and nonoperative management of first-time shoulder instability derived from level I/II evidence. Costs were tabulated from Centers for Medicaid & Medicare Services. Probabilistic sensitivity analysis was performed using >100,000 repetitions of the Monte Carlo simulation. A willingness-to-pay (WTP) threshold was set at $50,000. Results The expected cost for operative management higher than nonoperative management ($32,765 vs $29,343). However, ABR (5.48 quality-adjusted life years (QALYs)) was the more effective treatment strategy compared to nonoperative management (4.61 QALYs). The ICER for ABR was $3943. Probabilistic sensitivity analysis showed that ABR was the most cost-effective strategy in 100% of simulations. Discussion ABR is more cost-effective than nonoperative management for first-time anterior shoulder dislocation. The threshold analysis demonstrated that when accounting for WTP, ABR was found to be the more cost-effective strategy.
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Affiliation(s)
- Zachary I Li
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Eoghan T Hurley
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Sharif Garra
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Anna M Blaeser
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Danielle H Markus
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Michelle Shen
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Kirk A Campbell
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Eric J Strauss
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
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Hurley ET, Lunn K, Bethell M, Levin J, Pasqualini I, Frangiamore S, Anakwenze O, Klifto CS. Return to play following operative management of anterior shoulder instability in overhead athletes-A systematic review. Shoulder Elbow 2024; 16:15-23. [PMID: 38435042 PMCID: PMC10902415 DOI: 10.1177/17585732231205175] [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: 06/26/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 03/05/2024]
Abstract
Background The purpose of this study was to systematically review the rate and timing of return to play in overhead athletes following operative management of anterior shoulder instability. Methods A systematic literature search based on PRISMA guidelines, utilizing the EMBASE, MEDLINE, and The Cochrane Library Databases. Eligible for inclusion were clinical studies reporting on return to play among overhead athletes following arthroscopic Bankart repair, open Latarjet procedure or Remplissage procedure. Results There are 23 studies included with 961 patients. Among those undergoing arthroscopic Bankart repair, the rate of return to play was 86.2%, with 70.6% returning to the same level of play and the mean time to return to play was 7.1 months. Among those undergoing an open Latarjet procedure, the rate of return to play was 80.9%, with 77.7% returning to the same level of play and the mean time to return to play was 5.1 months. Among those undergoing a Remplissage procedure, the rate of return to play was 70.6%, with 70.0% returning to the same level of play or mean time to return to play. Discussion Overall, there were high rates of return to play following operative management of anterior shoulder instability in overhead athletes.
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Affiliation(s)
- Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Kiera Lunn
- School of Medicine, Duke University, Durham, NC, USA
| | | | - Jay Levin
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | | | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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Hurley ET, Danilkowicz RM, Paul AV, Myers H, Anakwenze OA, Klifto CS, Lau BC, Taylor DC, Dickens JF. Majority of Studies Show Similar Rates of Return to Play After Arthroscopic Bankart Repair or Latarjet Procedure: A Systematic Review. Arthroscopy 2024; 40:515-522. [PMID: 37146663 DOI: 10.1016/j.arthro.2023.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE To systematically review the current evidence in the literature to compare return to play following arthroscopic Bankart repair versus open Latarjet procedure for the treatment of anterior shoulder instability. METHODS A literature search was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comparative studies reporting return to play following arthroscopic Bankart repair versus open Latarjet procedure were included. Return to play was compared, with all statistical analysis performed using Review Manager, Version 5.3. RESULTS Nine studies with 1,242 patients (mean age: 15-30 years) were included. The rate of return to play was 61% to 94.1% among those undergoing arthroscopic Bankart repair and 72% to 96.8% in those undergoing an open Latarjet procedure. Two studies (Bessiere et al. and Zimmerman et al.) found a significant difference in favor of the Latarjet procedure (P < .05 for both, I2 = 37%). The rate of return to play at preinjury level was 9% to 83.8% among those undergoing arthroscopic Bankart repair and 19.4% to 80.6% in those undergoing an open Latarjet procedure, with no study finding a significant difference (P > .05 for all, I2 = 0%). The mean time of return to play was 5.4 to 7.3 months among those undergoing arthroscopic Bankart repair and 5.5 to 6.2 months in those undergoing an open Latarjet procedure, with no study finding a significant difference (P > .05 for all, I2 = 39%). CONCLUSIONS Overall, the majority of studies showed no significant difference in rates of return to play or timing following arthroscopic Bankart repair or open Latarjet procedure. Furthermore, no study has found a significant difference in rate of return to play at pre-injury level, or rate of return to play among collision athletes. LEVEL OF EVIDENCE Level III, systematic review of Level I-III studies.
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Affiliation(s)
- Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A..
| | | | - Alexandra V Paul
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Heather Myers
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Dean C Taylor
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Jonathan F Dickens
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A.; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Gibbs D, Mallory N, Hoge C, Jones G, Bishop J, Cvetanovich G, Rauck R. Psychological Factors That Affect Return to Sport After Surgical Intervention for Shoulder Instability: A Systematic Review. Orthop J Sports Med 2023; 11:23259671231207649. [PMID: 38035214 PMCID: PMC10686029 DOI: 10.1177/23259671231207649] [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: 05/10/2023] [Accepted: 06/02/2023] [Indexed: 12/02/2023] Open
Abstract
Background Recent advances have begun to identify the nonphysical factors facilitating successful return to sport (RTS) after shoulder instability surgery, yet little is currently known regarding psychological factors and RTS. Purpose/Hypothesis The purposes of this study were to (1) identify psychological factors associated with RTS, (2) evaluate the prognostic utility of various psychological factors, and (3) evaluate the available metrics used to assess psychological RTS readiness. It was hypothesized that psychological factors would be identified as critical elements influencing a patient's RTS. Study Design Systematic review; Level of evidence, 4. Methods Clinical studies reporting on the psychological determinants of RTS for patients who had surgery for shoulder instability between 1996 and 2022 were identified from MEDLINE, Embase, and Cochrane databases. Demographic, clinical, and psychometric properties were extracted for pooled weighted analysis. Results Of the 969 studies screened, 24 (2.5%) met inclusion criteria. Overall, 2135 patients were included (mean age, 26.0 years; range, 17.4-35.5 years; 84.7% male). The mean time to RTS was 6.8 months (range, 3.7-11.9 months). There was a 76.3% rate of any RTS; of the 1212 patients who reported level of play at return, 305 (25.2%) were unable to perform at their prior level. Psychological reasons were cited by 85% (n = 360) of patients who did not RTS. Fear of reinjury was the most common reason (n = 154; 42.8%); other psychological factors included lack of confidence (n = 46; 12.8%), anxiety (n = 45; 12.5%), depression (n = 44; 12.2%), psychosocial factors (n = 48; 13.3%), and lack of motivation (n = 23; 6.4%). The Shoulder Instability Return to Sport after Injury, Western Ontario Shoulder Instability Index, Quick Inventory of Depressive Symptoms Self Report, Degree of Shoulder Involvement in Sports, Tampa Scale of Kinesiophobia-11, and Veterans Rand 12-Item Health Survey were reported measures for assessing psychology and RTS. Conclusion Fear of reinjury was found to be the most commonly reported impediment to RTS. The psychological characteristics identified through this review may be incorporated into future RTS protocols seeking to address resilience and nonphysical factors associated with RTS.
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Affiliation(s)
- David Gibbs
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Noah Mallory
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Connor Hoge
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Grant Jones
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Julie Bishop
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Gregory Cvetanovich
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ryan Rauck
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Yildiz TI, Turhan E, Ocguder DA, Yaman F, Huri G, Duzgun I. Functional Performance Tests Reveal Promising Results at 6 Months After Shoulder Stabilization Surgery. Sports Health 2023; 15:878-885. [PMID: 36539969 PMCID: PMC10606971 DOI: 10.1177/19417381221141075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Although athletes are mostly allowed to return to play 6 months after shoulder stabilization surgery, there are inadequate data about their functional status during this period. HYPOTHESES Performance tests would reveal insufficiency in the functional capacity of shoulder 6 months after stabilization surgery. STUDY DESIGN Prospective cohort study. LEVEL OF EVIDENCE Level 3. METHODS A total of 32 male athletes with arthroscopic anterior capsulolabral repair (AACR) were included in the study. Shoulder internal and external rotator (IR-ER) strength was assessed using isokinetic dynamometer at 60°/s and 180°/s angular velocities preoperatively and 6 months postoperatively. Shoulder function was assessed with closed kinetic chain upper extremity stability (CKCUES) test, Y balance test-upper quarter (YBT-UQ), and unilateral seated shot-put test (USSPT) at 6 months postoperation. Western Ontario shoulder instability index (WOSI) and Tampa scale of kinesiophobia (TSK) were used for the self-assessment of the shoulder. Mixed-model ANOVA was used to analyze the changes in the IR-ER strength on both shoulders. Limb symmetry index (LSI) was calculated for the IR-ER strength, YBT-UQ, and USSPT scores. RESULTS Shoulder IR strength was higher at 6 months postoperatively compared with preoperatively. The LSI was 76.4% and 76.6% for ER strength, and 94.2% and 94% for IR strength at 60°/s and 180°/s angular velocities, respectively, at the postoperative 6 month timepoint. The mean CKCUES test score was 21.8 ± 2.6 touches and the LSI was 94.7% for the YBT-UQ and 102.5% for the USSPT. WOSI (P < 0.001) and TSK (P = 0.001) scores were significantly lower at 6 months postoperatively. CONCLUSION Functional status of the patients with shoulder stabilization surgery improved considerably 6 months after surgery, yet they did not fully recover function. CLINICAL RELEVANCE Exercise programs focusing on shoulder ER strength and shoulder performance should be emphasized after stabilization surgery.
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Affiliation(s)
- Taha Ibrahim Yildiz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Turkey
| | - Egemen Turhan
- Department of Orthopedy and Traumatology, Hacettepe University, Turkey
| | - Durmus Ali Ocguder
- Department of Orthopedics and Traumatology, Ankara Şehir Hastanesi, Turkey
| | - Firat Yaman
- Department of Orthopedics and Traumatology, Ankara Şehir Hastanesi, Turkey
| | - Gazi Huri
- Department of Orthopedy and Traumatology, Hacettepe University, Turkey
| | - Irem Duzgun
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Turkey
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Albani-Forneris A, Bruchmann MG, Rossi LA, Brandariz R, Di Memmo D, Tanoira I, Ranalletta M. Glenoid index: a new risk factor for recurrence of glenohumeral instability after arthroscopic Bankart repair. JSES Int 2023; 7:532-537. [PMID: 37426923 PMCID: PMC10328783 DOI: 10.1016/j.jseint.2023.02.020] [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] [Indexed: 07/11/2023] Open
Abstract
Background The glenoid index (GI) (glenoid height to width ratio) has been shown to be a risk factor for instability in young healthy athletes. Nevertheless, whether the altered GI is a risk factor for recurrence after a Bankart repair remains unknown. Methods Between 2014 and 2018, 148 patients ≥ 18 years old with anterior glenohumeral instability underwent a primary arthroscopic Bankart repair in our institution. We assessed return to sports, functional outcomes, and complications. We evaluate the association between the altered GI and the probabilities of recurrence in the postoperative period. Intraclass correlation coefficient was used to determine interobserver reliability. Results The mean age at the time of surgery was 25.6 years old (19 to 29), and the mean follow-up was 53.3 months (29 to 89). The 95 shoulders who met the inclusion criteria were divided into 2 cohorts, 47 shoulders had a GI ≤ 1.58 (group A) and 48 had a GI > 1.58 (group B). At the final follow-up, 5 shoulders in group A (10.6%) and 17 shoulders in group B (35.4%) suffered a recurrence of instability. Those patients with a GI > 1.58 had a hazard ratio of 3.86 (95% confidence interval: 1.42-10.48) (P = .004) compared with those with a GI ≤ 1.58 of suffering a recurrence. When correlating GI measurements between raters, we observed an intraclass correlation coefficient of 0.76 (95% confidence interval: 0.63-0.84), these results fall under the qualitative definition of good interobserver agreement. Conclusion In young active patients with an arthroscopic Bankart repair, an increased GI was associated with a significantly higher rate of postoperative recurrences. Specifically, those subjects with a GI > 1.58 had 3.86 times the risk of recurrence than those subjects with a GI ≤ 1.58.
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Affiliation(s)
- Agustin Albani-Forneris
- Institute of Orthopaedics “Carlos E. Ottolenghi” Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Luciano A. Rossi
- Institute of Orthopaedics “Carlos E. Ottolenghi” Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rodrigo Brandariz
- Institute of Orthopaedics “Carlos E. Ottolenghi” Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Damián Di Memmo
- Radiology department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ignacio Tanoira
- Institute of Orthopaedics “Carlos E. Ottolenghi” Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano Ranalletta
- Institute of Orthopaedics “Carlos E. Ottolenghi” Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Markus DH, Morgan AM, Campbell KA, Alaia MJ, Jazrawi LM, Strauss EJ. Outcomes following arthroscopic repair of humeral avulsion of the glenohumeral ligament (HAGL) lesion: A systematic review. J Clin Orthop Trauma 2023; 41:102166. [PMID: 37303496 PMCID: PMC10248864 DOI: 10.1016/j.jcot.2023.102166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/17/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Purpose The purpose of this systematic review was to evaluate patient outcomes following arthroscopic surgical management for a humeral avulsion of the glenohumeral ligament (HAGL) lesion. Methods Based on PRISMA guidelines, two independent reviewers performed a literature search to isolate studies on arthroscopic HAGL repair. The functional outcomes, return to play (RTP), and recurrent instability from each study were extracted and analyzed. Results Overall, 7 manuscripts were included with 49 patients. The patient population was 61.4% male with a mean age of 24.8 years (15-42 years), and 41.9 months of follow-up on average (12-104 months). The Rowe score was the most frequently reported outcome measure with a weighted mean of 89. In total, 81.2% of patients reported being able to RTP post-operatively, with 70.5% reported being able to play at an equal or higher level. There was 1 recurrent dislocation (2%). Conclusion The current study found successful clinical outcomes following the arthroscopic management of HAGL lesions. Recurrent dislocation requiring revision was rare, with high rates of return to play including those who could return to the same level of play. However, the paucity of evidence does not permit a statement of best-practice to be made.
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Affiliation(s)
- Danielle H. Markus
- NYU Langone Health Orthopedics, Division of Sports Medicine, 333 E 38th Street, New York, NY, 10016, USA
| | - Allison M. Morgan
- NYU Langone Health Orthopedics, Division of Sports Medicine, 333 E 38th Street, New York, NY, 10016, USA
| | - Kirk A. Campbell
- NYU Langone Health Orthopedics, Division of Sports Medicine, 333 E 38th Street, New York, NY, 10016, USA
| | - Michael J. Alaia
- NYU Langone Health Orthopedics, Division of Sports Medicine, 333 E 38th Street, New York, NY, 10016, USA
| | - Laith M. Jazrawi
- NYU Langone Health Orthopedics, Division of Sports Medicine, 333 E 38th Street, New York, NY, 10016, USA
| | - Eric J. Strauss
- NYU Langone Health Orthopedics, Division of Sports Medicine, 333 E 38th Street, New York, NY, 10016, USA
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Genena A, Hashem M, Waly A, Hegazy MO. Open Latarjet Versus Arthroscopic Bankart Repair for the Treatment of Traumatic Anterior Shoulder Instability in High-Demand Patients With Minimal Glenoid Bone Loss. Cureus 2023; 15:e37127. [PMID: 37168209 PMCID: PMC10166300 DOI: 10.7759/cureus.37127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND This study compared the clinical outcomes and return to sports/work between open Latarjet and arthroscopic Bankart repair in high-demand patients with traumatic anterior shoulder instability with minimal glenoid bone loss. METHODS We prospectively recruited 30 patients and randomised them to either open Latarjet or arthroscopic Bankart. The mean duration of follow-up in our study was 13.27 months±2.70. All patients were males with a mean age at surgery of 28.6 years (range, 18-41 years). RESULTS The overall mean for the Rowe score in the 30 patients increased from 33.5±14 points preoperatively to 79.6±18 points. However, there was no statistically significant difference in the postoperative ROM (range of motion) and Rowe score among the Bankart and Latarjet groups. The main finding in our study was the time to return to sports/work which was significantly lower in the Latarjet group (5.2 months) compared to the Bankart group (seven months). CONCLUSIONS Open Latarjet is considered a more invasive and non-anatomical procedure, however, it is less costly with a shorter time to return to sports/work compared to the Bankart procedure, which is very crucial for high-demand patients, especially the competitive athletes targeting an early return to sports at the same pre-injury level with minimal incidence of recurrence, making the surgeon's choice very challenging.
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20
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Gouveia K, Harbour E, Athwal GS, Khan M. Return to Sport After Arthroscopic Bankart Repair With Remplissage: A Systematic Review. Arthroscopy 2023; 39:1046-1059.e3. [PMID: 36646363 DOI: 10.1016/j.arthro.2022.12.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/30/2022] [Accepted: 12/30/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE To determine the return-to-sport rate following arthroscopic Bankart repair with remplissage (ABR), including overall rate of return to sport, rate of return to preinjury level of sport, and the rate of return for specific subgroups such as contact or throwing athletes. METHODS EMBASE, PubMed, and MEDLINE were searched from database inception until February 2022. Studies were screened by 2 reviewers independently and in duplicate for data regarding rates of return to sport following ABR. Data on return to sport and functional outcomes were recorded. Data are presented in a descriptive fashion. RESULTS Overall, 20 studies were included with a total of 736 patients (738 shoulders) who underwent ABR. These patients had a mean age of 28 years (range 14-72 years) and were 83% male. Mean follow-up time after surgery was 45 months (range 12-127 months). The rate of return to any level of sport ranged from 60% to 100%, whereas the rate of return to the preinjury level ranged from 63% to 100%. When we excluded those who underwent ABR as a revision procedure, the rate of return to any level of sport was 68% to 100%. Lastly, the return to sport rates for contact or collision athletes ranged from 80% to 100%, whereas for overhead or throwing athletes it was 46% to 79%. The rate of recurrence of instability postoperatively ranged from 0% to 20% in included studies. CONCLUSIONS For athletes with anterior shoulder instability, ABR led to a high rate of return to sport along with a low rate of recurrence of instability. Although most athletes are able to return to the same level of sport, certain groups such as throwing athletes may face greater difficulty. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Kyle Gouveia
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Eric Harbour
- School of Medicine, University of Limerick, Limerick, Ireland
| | - George S Athwal
- Hand and Upper Limb Centre, Western University, London, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
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Zheng ZZ, Zhou CH, Zhang JM, Zhang YH, Zhou M, Hou JY, Yang R. The Longitude-Latitude-Loop Used for Complex Bankart Lesion Repair: An All-Arthroscopic Technique. Arthrosc Tech 2023; 12:e549-e555. [PMID: 37138692 PMCID: PMC10150156 DOI: 10.1016/j.eats.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 12/09/2022] [Indexed: 05/05/2023] Open
Abstract
The most frequent operation for anterior shoulder instability is the arthroscopic Bankart repair, which has a positive outcome and a low rate of complications. A variety of restoration procedures have been reported to reconstruct labral height and reproduce a dynamic concavity-compression reaction. The longitude-latitude loop is a knotless high-strength suture method that simultaneously tightens the joint capsule in the warp and weft direction and resists tearing. The suture method is safe and reproducible. This study aimed to present a longitude-latitude loop suture for joint capsule labral complex repair during Bankart arthroscopy surgery.
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Affiliation(s)
| | | | | | | | | | | | - Rui Yang
- Address correspondence to Rui Yang, M.D, Ph.D., and Jing-Yi Hou, M.D., Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang Road West, Guangzhou, Guangdong 510120, China.
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22
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Bauer A, Engel G, Huth J, Mauch F. Fourteen years of follow-up after first arthroscopic Bankart repair in athletes: functional outcomes and magnetic resonance imaging findings. J Shoulder Elbow Surg 2023; 32:546-554. [PMID: 36273790 DOI: 10.1016/j.jse.2022.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/13/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The arthroscopic Bankart procedure is the most performed surgery for shoulder stabilization. Short-term to midterm results are well studied; however, long-term results over 10 years are rare. PURPOSE This study evaluates the long-term results and magnetic resonance imaging (MRI) findings in athletes at a mean follow-up of 14 years after an arthroscopic Bankart stabilization as well as risk factors for osteoarthritis. METHODS A total of 63 athletes had an arthroscopic Bankart repair between 2001 and 2008, of whom 46 patients (73.0%) participated in the final follow-up. The Constant, Rowe, and Western Ontario Shoulder Instability Index (WOSI) score and the rate of return to sports were evaluated. Glenohumeral osteoarthritis was assessed using the Samilson-Prieto classification. Known risk factors for osteoarthritis were analyzed. MRI findings (bone marrow edema, cysts, and joint effusion) were analyzed. RESULTS The average follow-up was 14 years. Assessment was performed on 46 athletes with an average age of 21.6 at the time of surgery. The overall redislocation rate was 21.7%. The Constant score was 96.7, the Rowe score was 83.4, and the Western Ontario Shoulder Instability Index score was 90.7 out of 100. A total of 84.8% of the athletes returned to their initial sports level. Glenohumeral osteoarthritis occurred in 28.1%. Known risk factors for osteoarthritis were confirmed. Further MRI findings were rare. CONCLUSIONS Arthroscopic Bankart repair in athletes shows good long-term clinical results. However, this is only in patients without osteoarthritis, which was rare, but was confirmed as a risk factor. We assume that resorption of anchors differs in patients. If it does have an impact on developing arthrosis, this should be confirmed in further studies.
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Affiliation(s)
- Anne Bauer
- Department of Sports Orthopaedics, Sportklinik Stuttgart GmbH, Stuttgart, Germany
| | - Guido Engel
- Department of Sports Orthopaedics, Sportklinik Stuttgart GmbH, Stuttgart, Germany
| | - Jochen Huth
- Department of Sports Orthopaedics, Sportklinik Stuttgart GmbH, Stuttgart, Germany.
| | - Frieder Mauch
- Department of Sports Orthopaedics, Sportklinik Stuttgart GmbH, Stuttgart, Germany
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Pasqualini I, Rossi LA, Brandariz R, Tanoira I, Fuentes N, Denard PJ, Ranalletta M. Similar Clinical, Return to Sports, Recurrence, and Revision Outcomes Between Female and Male Athletes Following Arthroscopic Bankart Repair. Arthroscopy 2023; 39:204-210. [PMID: 36191735 DOI: 10.1016/j.arthro.2022.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 08/31/2022] [Accepted: 09/22/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To compare return to sports, functional outcomes, and recurrences rates between female and male athletes following arthroscopic Bankart repair (ABR). METHODS A retrospective comparative study was performed between male and female athletes who underwent an ABR between January 2008 and December 2019. Sports practiced primarily by men in our practice (including rugby, soccer, boxing, and martial arts) were excluded. Functional outcomes included the Rowe score, visual analog scale (VAS) for pain, and shoulder-dependent sports ability measured with the Athletic Shoulder Outcome Scoring System (ASOSS). Return to sport, recurrence, and revisions were evaluated. Additionally, we assessed the period (months) between surgery and recurrence events. RESULTS A total of 58 female and 106 male patients were available for analysis at a median follow-up of 60 (interquartile range [IQR], 36-84) months. Ninety-one percent of the patients (n = 150) returned to sports and 84% (n = 126) returned to their preinjury level at a median of 6 months (IQR, 5-8) postoperatively. There were no differences in the rate of return to sports between females and males (91 vs 92% respectively, P = .997). There were no differences between the groups regarding postoperative functional outcomes, with most patients achieving the minimal clinically significant difference (Rowe: 98% female and 99% male, P = .584; ASOSS: 100% female and 99% male, P = .646). The overall recurrence rate was 9.7% (n = 16), with a rate of 10.3% (n = 6) in female and 9.4% (n = 10) in male athletes (P = .851). Time to event analysis showed that the median time to recurrence was 48 months in both groups (P = .848). The overall revision rate was 3% (n = 4), without significant differences between groups (P = .556). CONCLUSIONS When compared within similar sports, there does not appear to be sex-related differences in functional outcomes, recurrence, or return to play following ABR. LEVEL OF EVIDENCE III, retrospective comparative study.
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Affiliation(s)
| | | | | | | | - Nora Fuentes
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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24
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van Iersel TP, van Spanning SH, Verweij LP, Priester-Vink S, van Deurzen DF, van den Bekerom MP. Why do patients with anterior shoulder instability not return to sport after surgery? A systematic review of 63 studies comprising 3545 patients. JSES Int 2023. [DOI: 10.1016/j.jseint.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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25
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Harada Y, Iwahori Y, Kajita Y, Takahashi R, Yokoya S, Sumimoto Y, Deie M, Adachi N. Return to sports after arthroscopic bankart repair on the dominant shoulder in overhead athletes. J Orthop Sci 2022; 27:1240-1245. [PMID: 34419320 DOI: 10.1016/j.jos.2021.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/02/2021] [Accepted: 07/22/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND Arthroscopic Bankart repair (ABR) yields good results in young athletes with anterior shoulder instability. However, the treatment for overhead athletes is challenging because recovery of range of motion is necessary for return to play and repeated shoulder motion may lead to recurrent instability. The aim of this study was to investigate the clinical outcomes and return to sports after ABR on the dominant shoulder in overhead athletes. METHODS This study included 24 competitive level overhead athletes who underwent ABR on their dominant shoulders. The mean age at surgery was 17.6 years, and the mean follow-up was 39.7 months. The range of bilateral shoulder motion, the Rowe score, the Japanese Shoulder Society Shoulder Instability Score (JSS-SIS), and the Japanese Shoulder Society Shoulder Sports Score (JSS-SSS) were evaluated before the surgery and at the final visit. Recurrent instability, the final level of return to sports, and the duration before returning to sports were confirmed, as well as the pre-, intra- and postoperative factors, which prohibited complete return to play. RESULTS There were no cases of recurrent instability. The Rowe score, JSS-SIS, JSS-SSS, and the range of flexion, abduction, internal rotation significantly improved postoperatively. Fifteen athletes (62.5%) returned to the same or superior levels without any complaint in their shoulders. The mean duration needed for a complete return was 13.3 months. The postoperative external rotation deficit in abduction was larger in the athletes who returned incompletely than those who returned completely, 7.8° and 2.3°, respectively. CONCLUSIONS ABR is a reliable surgery for preventing recurrent instability in overhead athletes, however the rate of a complete return to preinjury level was low and a long duration was needed for complete return to play. The postoperative external rotation may be necessary for a complete return to overhead sports. LEVEL OF EVIDENCE Level IV: Retrospective Case Series.
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Affiliation(s)
- Yohei Harada
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan; Department of Orthopaedic Surgery, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, Japan.
| | - Yusuke Iwahori
- Sports Medicine and Joint Center, Asahi Hospital, 2090, Shimoharacho Azamurahigashi, Kasugai, Aichi, Japan
| | - Yukihiro Kajita
- Department of Orthopaedic Surgery, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, Japan
| | - Ryosuke Takahashi
- Department of Orthopaedic Surgery, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, Japan
| | - Shin Yokoya
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Yasuhiko Sumimoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan
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Itoigawa Y, Uehara H, Koga A, Morikawa D, Kawasaki T, Shiota Y, Maruyama Y, Ishijima M. Arthroscopic Bankart repair with additional footprint fixation using the double-row technique at the 4 o'clock position anatomically restored the capsulolabral complex and showed good clinical results. Knee Surg Sports Traumatol Arthrosc 2022; 30:3827-3834. [PMID: 35428941 DOI: 10.1007/s00167-022-06974-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/29/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the clinical outcome and magnetic resonance imaging (MRI) findings after arthroscopic Bankart repair with additional double anchor footprint fixation (DAFF) at the 4 o'clock position, where the native footprint is widest anatomically, for recurrent anterior shoulder instability. METHODS Forty-two patients (mean age 27.0 years) with recurrent anterior shoulder instability and without severe glenoid bone defects underwent arthroscopic Bankart repair with additional DAFF at the 4 o'clock position. Using three standard portals, single-row repair was performed at the 2, 3, and 5 o'clock positions, and DAFF with the suture bridging technique was conducted at the 4 o'clock position. MRI was performed preoperatively and at 6 months postoperatively. Patients with follow-up periods of ≥1 year were included in the present study and clinically evaluated at the final follow-up. The morphology at the 2 and 4 o'clock positions on radial MRI slices was compared between the preoperative and 6-month postoperative scans, and the footprint of the repaired capsulolabral complex at 6 months postoperatively was compared between the 2 and 4 o'clock positions. RESULTS The average follow-up period was 19.5 ± 6.2 months. The rates of dislocation recurrence and positive apprehension test results were 2.4 and 4.8%, respectively. External rotation was restricted by 3.5°. The University of California at Los Angeles and Rowe scores at the final follow-up were 34.5 ± 1.0 points and 97.2 ± 5.7 points, respectively, representing significant improvements over the preoperative scores (p < 0.01). Although the capsulolabral complex at 6 months postoperatively was firmly repaired at both the 2 and 4 o'clock positions compared to its preoperative state, the footprint of the restored capsulolabral complex was wider at the 4 o'clock position than at the 2 o'clock position (p < 0.01). CONCLUSIONS Additional DAFF at the 4 o'clock position improved the glenohumeral stability and function of the shoulder joint. This study suggests that this technique is a reliable and useful treatment for shoulder instability. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yoshiaki Itoigawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.
| | - Hirohisa Uehara
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Akihisa Koga
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Daichi Morikawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Takayuki Kawasaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yuki Shiota
- Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Yuichiro Maruyama
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
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Nicholson AD, Carey EG, Mathew JI, Pinnamaneni S, Jahandar A, Kontaxis A, Dines DM, Dines JS, Blaine TA, Fu MC, Rodeo SA, Warren RF, Gulotta LV, Taylor SA. Biomechanical analysis of anterior stability after 15% glenoid bone loss: comparison of Bankart repair, dynamic anterior stabilization, dynamic anterior stabilization with Bankart repair, and Latarjet. J Shoulder Elbow Surg 2022; 31:2358-2365. [PMID: 35597534 DOI: 10.1016/j.jse.2022.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Dynamic anterior shoulder stabilization (DAS) with Bankart repair is a recently described stabilization technique thought to be more robust than an isolated Bankart repair while avoiding many coracoid transfer-related complications and technical demands. DAS involves transfer of the long head biceps through a subscapularis split to the anterior glenoid to create a sling effect. We hypothesize that DAS with Bankart repair will restore anterior stability in a human-cadaveric model with subcritical (15%) glenoid bone loss. METHODS Eight cadaveric shoulders were tested using an established shoulder simulator to record glenohumeral translations with an accuracy of ±0.2 mm. Shoulders were tested in 5 states-intact soft tissues, Bankart defect with 15% bone loss, isolated Bankart repair, DAS with Bankart repair, isolated DAS, and Latarjet. A 45 N anterior force was applied through the pectoralis major tendon, and translation of the humeral head was recorded and compared with repeated measures analysis of variance. RESULTS The anterior translation in the intact (native) glenoid was 4.7 mm at neutral position and 4.6 mm at 45° external rotation. Anterior translation significantly increased after introducing a Bankart defect with 15% glenoid bone loss to 9.1 mm (neutral, P = .002) and 9.5 mm (45° external rotation, P < .001). All repair conditions showed a significant decrease in anterior translation relative to Bankart defect. DAS with Bankart repair decreased anterior translation compared with the Bankart defect: 2.7 mm (neutral, P < .001) and 2.1 mm (45° external rotation, P < .001). DAS with Bankart repair significantly decreased anterior translation compared with the isolated Bankart repair (2.7 mm vs. 4.7 mm, P = .023) and the isolated DAS (2.7 mm vs. 4.3 mm, P = .041) in neutral position. The Latarjet procedure resulted in the greatest reduction in anterior translation compared with the Bankart defect: 1.2 mm (neutral, P < .001) and 1.9 mm (45° external rotation, P < .001). CONCLUSIONS DAS with Bankart repair is a viable alternative to restore anterior glenohumeral stability with a 15% glenoid defect at a greater degree than either DAS or Bankart repair alone. The Latarjet procedure was the most effective in reducing anterior translation but restrained the anterior translation significantly more than the native glenoid.
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Affiliation(s)
- Allen D Nicholson
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA.
| | - Edward G Carey
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Joshua I Mathew
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Sridhar Pinnamaneni
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Amirhossein Jahandar
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Andreas Kontaxis
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - David M Dines
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Joshua S Dines
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Theodore A Blaine
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Michael C Fu
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Scott A Rodeo
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Russell F Warren
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Lawrence V Gulotta
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Samuel A Taylor
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
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Davey MS, Hurley ET, Davey MG, Fried JW, Hughes AJ, Youm T, McCarthy T. Criteria for Return to Play After Hip Arthroscopy in the Treatment of Femoroacetabular Impingement: A Systematic Review. Am J Sports Med 2022; 50:3417-3424. [PMID: 34591697 DOI: 10.1177/03635465211038959] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a common pathology in athletes that often requires operative management in the form of hip arthroscopy. PURPOSE To systematically review the rates and level of return to play (RTP) and the criteria used for RTP after hip arthroscopy for FAI in athletes. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of the literature, based on the PRISMA guidelines, was performed using PubMed, Embase, and Scopus databases. Studies reporting outcomes after the use of hip arthroscopy for FAI were included. Outcomes analyzed were RTP rate, RTP level, and criteria used for RTP. Statistical analysis was performed using SPSS software. RESULTS Our review found 130 studies, which included 14,069 patients (14,517 hips) and had a mean methodological quality of evidence (MQOE) of 40.4 (range, 5-67). The majority of patients were female (53.7%), the mean patient age was 30.4 years (range, 15-47 years), and the mean follow-up was 29.7 months (range, 6-75 months). A total of 81 studies reported RTP rates, with an overall RTP rate of 85.4% over a mean period of 6.6 months. Additionally, 49 studies reported the rate of RTP at preinjury level as 72.6%. Specific RTP criteria were reported in 97 studies (77.2%), with time being the most commonly reported item, which was reported in 80 studies (69.2%). A total of 45 studies (57.9%) advised RTP at 3 to 6 months after hip arthroscopy. CONCLUSION The overall rate of reported RTP was high after hip arthroscopy for FAI. However, more than one-fourth of athletes who returned to sports did not return at their preinjury level. Development of validated rehabilitation criteria for safe return to sports after hip arthroscopy for FAI could potentially improve clinical outcomes while also increasing rates of RTP at preinjury levels.
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Affiliation(s)
- Martin S Davey
- Sports Surgery Clinic, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan T Hurley
- Sports Surgery Clinic, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland.,NYU Langone, New York, New York, USA
| | | | | | - Andrew J Hughes
- Sports Surgery Clinic, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
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Pasqualini I, Rossi LA, De Cicco FL, Tanoira I, Alonso Hidalgo I, Bongiovanni S, Giunta DH, Ranalletta M. The playing position significantly influences return to sports and recurrences after an arthroscopic Bankart repair in competitive rugby players. Shoulder Elbow 2022; 14:29-37. [PMID: 35845626 PMCID: PMC9284259 DOI: 10.1177/1758573221993089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The purpose of our study was to investigate the influence of the different rugby playing positions on return to sports, functional outcomes, and recurrences after an arthroscopic Bankart repair. METHODS A total of 88 rugby players were treated for anterior shoulder instability in our institution between 2010 and 2018. Functional outcomes, return to sports, recurrences, complications, and revisions rates were evaluated according to the playing position. RESULTS Overall, 73.8% of the patients returned to rugby and 60% returned at the same level as before the injury. The tight forwards and outside backs experienced a significant decrease in their competitive level after surgery, and showed the lowest functional outcomes. The tight forwards and outside backs showed a statistically significant increase in recurrence and revision rates, and an OR for recurrence of 12.8 and 9.6, respectively. DISCUSSION The playing position significantly influenced return to sports and recurrences after an arthroscopic Bankart repair in competitive rugby players. Specifically, the tight forwards and outside backs have returned to a lower level than they had before surgery, showed the lowest functional outcomes, and a significant increase in recurrences and revisions rates than the other groups.
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30
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Pasqualini I, Rossi LA, Tanoira I, Ranalletta M. Return to sports, functional outcomes, and recurrences after arthroscopic Bankart repair in soccer players. Shoulder Elbow 2022; 14:16-20. [PMID: 35845617 PMCID: PMC9284261 DOI: 10.1177/1758573220928926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a shortage of relevant reports about the results obtained after shoulder stabilization in soccer players. Therefore, this retrospective study aims to report return to sports, functional outcomes, and recurrences after arthroscopic Bankart repair in soccer players. METHODS A total of 156 soccer players were treated for anterior shoulder instability at a single institution between 2008 and 2017. The Rowe score and Athletic Shoulder Outcome Scoring System were used to assess functional outcomes. Return to sport and recurrence rates were also evaluated. RESULTS The Rowe and Athletic Shoulder Outcome Scoring System scores showed statistical improvement after surgery (P < .001). Overall, 148 soccer players (94.8%) returned to sports, and 122 (78.2%) returned to the same level. The mean time to return to sport was 4.8 months. The recurrence rate was 5.2%. DISCUSSION Soccer players who underwent an arthroscopic isolated Bankart repair for anterior glenohumeral instability have shown remarkable outcomes, with most of the patients returning to sports, and at the same level they had before surgery with a low rate of recurrence.
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Affiliation(s)
| | - Luciano A Rossi
- Luciano A Rossi, Peron 4190 (C1199ABB),
Buenos Aires, Argentina.
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31
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Chen AZ, Greaves KM, deMeireles AJ, Fortney TA, Saltzman BM, Trofa DP. Clinical Outcomes of Arthroscopic Bony Bankart Repair for Anterior Instability of the Shoulder: A Systematic Review. Am J Sports Med 2022:3635465221094832. [PMID: 35749344 DOI: 10.1177/03635465221094832] [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: 01/31/2023]
Abstract
BACKGROUND Individual studies reporting the clinical outcomes of arthroscopic bony Bankart repair for anterior shoulder instability have reported excellent results but have been limited by their small sample sizes. No systematic review of the literature has been performed examining the clinical outcomes of arthroscopic bony Bankart repair. PURPOSE To provide a systematic review of the literature to examine the functional outcomes, recurrence rate, and return to sports rate after arthroscopic bony Bankart repair for anterior instability of the shoulder. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of the literature based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted using the Cochrane Database of Systematic Reviews, Ovid/Embase, PubMed, and Web of Science. Studies that examined clinical outcomes after arthroscopic bony Bankart repair for anterior shoulder instability were included. Data pertaining to study characteristics and design, patient demographic characteristics, and clinical results, including functional outcomes, recurrence rate, and return to sports, were collected. The results from the studies were pooled, and weighted means and overall rates were calculated. RESULTS In total, 21 studies with 769 patients were included for analysis. Most patients were male (91.7%), the mean age was 26.7 years (range, 12-71 years), and the mean follow-up was 42.7 months (range, 6-120 months). The most commonly reported functional outcome score was the Rowe score (12 studies), which improved on average from 41.9 preoperatively to 90.8 postoperatively. The rate of recurrent instability was reported by all 21 studies, and the overall recurrence rate was 11.9% (88/738). Return to sports after arthroscopic bony Bankart repair was reported by 11 studies, with a pooled return to sports rate of 91.0% (264/290). CONCLUSION Arthroscopic bony Bankart repair for anterior shoulder instability resulted in improvements in functional outcomes, a low rate of recurrent instability, and a high rate of return to sports. Although these findings are extremely promising, future prospective studies with larger sample sizes are needed to further evaluate the clinical outcomes of arthroscopic bony Bankart repair.
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Affiliation(s)
- Aaron Z Chen
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Kaylre M Greaves
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Alirio J deMeireles
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Thomas A Fortney
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute (MSKI), Charlotte, North Carolina, USA
| | - David P Trofa
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
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Kim M, Haratian A, Fathi A, Kim DR, Patel N, Bolia IK, Hasan LK, Petrigliano FA, Weber AE. Can We Identify Why Athletes Fail to Return to Sports After Arthroscopic Bankart Repair: A Systematic Review and Meta-analysis. Am J Sports Med 2022:3635465221089980. [PMID: 35658631 DOI: 10.1177/03635465221089980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND No previous systematic reviews have reported on athletes who fail to return to sports after arthroscopic Bankart repair. PURPOSE To review the literature on athletes who fail to return to sports after arthroscopic Bankart repair to determine the rate of athletes who did not return to sports and to identify the specific reasons for failure to return to sports by nonreturning athletes. STUDY DESIGN Systematic review and meta-analysis. METHODS A meta-analysis was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Three electronic databases (PubMed, Scopus, Web of Science) were queried for articles meeting the inclusion criteria. Studies were considered eligible only if reporting the rate of failure for return to sports and providing the specific reasons why athletes were unable to return to sports. All records were screened by title, abstract, and full text by 2 authors independently, with any discrepancies resolved by a third senior author. For articles selected for inclusion, data were collected on the number of athletes, average age, average follow-up time, type of sport played, rate of failure to return to sports, and specific reasons for failure to return. A random-effects model was used to conduct the meta-analysis. RESULTS Seventeen studies were selected for inclusion reporting on a total of 813 athletes. The calculated weighted rate of failure to return to sports after arthroscopic Bankart repair was 15.6% (95% CI, 10.9%-21.1%). A significantly higher proportion of athletes cited shoulder-dependent versus shoulder-independent reasons for failure to return to sports (81.7% vs 18.3%; P < .0001). The most cited reasons for failure to return included recurrent or persistent instability (33.3%), fear of reinjury (17.7%), apprehension (9.9%), changes in priorities or personal interest (8.5%), lack of time (7.1%), and discomfort or pain with sports (6.4%). CONCLUSION Our study estimated the rate of failure to return to sports after arthroscopic Bankart repair to be 15.6%, with most athletes citing shoulder-related reasons as the primary factor precluding return. Identifying the potential reasons preventing successful return to sports can guide surgeons in counseling athletes regarding postoperative expectations and addressing hesitations for returning to sports.
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Affiliation(s)
- Michael Kim
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Aryan Haratian
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Amir Fathi
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Daniel R Kim
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Nilay Patel
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Laith K Hasan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
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Hickey IPM, Davey MS, Hurley ET, Gaafar M, Delaney RA, Mullett H. Return to play following open Bankart repair in collision athletes aged 18 years or less. J Shoulder Elbow Surg 2022; 31:S8-S12. [PMID: 34906680 DOI: 10.1016/j.jse.2021.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/07/2021] [Accepted: 11/07/2021] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The purpose of this study was to evaluate clinical outcomes, return to play (RTP), and recurrence rates in patients aged 18 years or less who underwent open Bankart repair (OBR) for anterior shoulder instability. METHODS A retrospective review of collision athletes under 18 years old who underwent OBR by 2 surgeons between the years 2010 and 2019 was carried out. An OBR using a subscapularis split was performed in all patients. Recurrent instability, rate of RTP, and time to RTP were recorded. The Shoulder Instability Return to Sport after Injury score, Subjective Shoulder Value score, and visual analog scale scores were also evaluated. RESULTS The study included 34 male collision athletes with a mean age of 16.5 ± 1.3 years (range, 15-18 years). The mean follow-up for patients was 49.5 ± 30.7 months. A total of 30 patients (88.2%) returned to full sport at a mean time of 5.8 ± 2.2 months, with 27 (90%) managing to return at their preinjury level of participation. The mean Subjective Shoulder Value score for patients at the final follow-up was 86.8 ± 17.5, the mean Shoulder Instability Return to Sport after Injury score was 86.3 ± 22.6, and the mean visual analog scale score was 1.6 ± 1.8. Eight patients (23.5%) re-dislocated their shoulder, with 4 of them requiring a further surgery. Two patients (5.8%) reported having incidents of subluxation that did not require reduction. CONCLUSION This study found high rates of patient-reported satisfaction, excellent functional outcomes, and high rates of RTP in the medium term among young collision athletes aged 18 years or less who underwent OBR for anterior shoulder instability. However, there were high rates of recurrence with moderate rates of revision surgical stabilization in the medium term.
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Affiliation(s)
- Ian P M Hickey
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
| | - Martin S Davey
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
| | - Eoghan T Hurley
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland.
| | - Mohamed Gaafar
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
| | - Ruth A Delaney
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
| | - Hannan Mullett
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
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Evaluation of factors associated with successful 5-year outcomes following arthroscopic Bankart repair in athletes. Knee Surg Sports Traumatol Arthrosc 2022; 30:2092-2098. [PMID: 34811577 DOI: 10.1007/s00167-021-06803-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the outcomes of athletes 5-years post-operatively following arthroscopic Bankart repair, and to evaluate factors associated with satisfaction and shoulder function, as defined by subjective shoulder value. METHODS A retrospective review of athletes who underwent arthroscopic Bankart repair, with a minimum of 5-year follow-up was performed. Recurrence, Visual Analogue Scale (VAS) score, Subjective Shoulder Value (SSV), satisfaction, and whether they would undergo the same surgery again, and rate, level and timing of return to play, and Shoulder Instability-Return to Sport after Injury (SIRSI) score were evaluated. Multi-linear regression models were used to evaluate factors affecting postoperative Satisfaction, and SSV level. RESULTS Overall, 144 athletes who underwent arthroscopic Bankart repair were included, with a mean age of 26.9 years (SD: 8.1), 132 (91.7%) were males, and mean follow-up of 75.7 months. At final follow up, 82.6% were satisfied/very satisfied, and the mean SSV was 85.8 (SD: 14.4). Overall, the rate of return to play was 80.5%, with 63.9% returning at the same level at a mean of 6.2 months (SD: 2.7). Overall, there was 18 (12.5%) had recurrent instability, and a further procedure was performed in 15 (10.4%) patients. Linear regression revealed that the SIRSI score (p < 0.0001), SSV (p < 0.0001), VAS (p < 0.0031), no sleep trouble (p = 0.0129) was associated with satisfaction. Logistic regression revealed whether a patient required revision surgery (p = 0.0029), or had re-dislocation (p = 0.0031) was also associated with satisfaction. Linear regression revealed that the SIRSI score (p < 0.0001), VAS score (p < 0.0001), and no sleep trouble (p < 0.0001), were associated with SSV score. CONCLUSION There was a high rate of satisfaction at 5-year follow-up, with excellent patient-reported outcomes and a high rate of return to play among athletes. However, there was a moderate rate of recurrent instability and further revision surgery. This study identified that the SIRSI score, VAS score, no sleep trouble and ability to return to play at the same level were associated with both satisfaction and SSV score. LEVEL OF EVIDENCE III.
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No Difference in Outcomes After Arthroscopic Bankart Repair With Remplissage or Arthroscopic Latarjet Procedure for Anterior Shoulder Instability. Arthrosc Sports Med Rehabil 2022; 4:e853-e859. [PMID: 35747622 PMCID: PMC9210364 DOI: 10.1016/j.asmr.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/13/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the outcomes of arthroscopic Bankart repair with remplissage (ABRR) compared with the arthroscopic Latarjet (AL) procedure for anterior shoulder instability in patients with a labral tear and a concomitant engaging Hill-Sachs lesion. Methods A retrospective review of patients who underwent either ABRR or the AL procedure for a diagnosis of anterior shoulder instability with a concomitant engaging Hill-Sachs lesion between 2011 and 2019 was performed. Recurrent instability, the visual analog scale score, the Subjective Shoulder Value, the Western Ontario Shoulder Instability score, patient satisfaction, willingness to undergo surgery again, and return to work or sport were evaluated. Results Our study included 41 patients treated with ABRR and 26 treated with the AL procedure. At final follow-up, there was no difference between patients who underwent ABRR and those who underwent the AL procedure in the reported Western Ontario Shoulder Instability score (21.8% vs 28.2%, P = .33) or any of its components, the visual analog scale score (0.9 vs 1.4, P = .32), the Subjective Shoulder Value (78.4 vs 74.5, P = .6062), the rate of satisfaction (81.6% vs 85.6%, P = .54), or whether patients would undergo surgery again (81.6% vs 96.1%, P = .16). Overall, 5 patients in the ABRR group and 2 patients in the AL group had recurrent instability events (12.2% vs 7.8%, P = .70), with no significant difference in the rate of recurrent dislocation (12.2% vs 3.8%, P = .39). Conclusions In patients with anterior shoulder instability and a concomitant Hill-Sachs lesion, both ABRR and the AL procedure were shown to be reliable treatments, with a low rate of recurrent instability and excellent patient-reported outcomes in appropriately selected patients. However, our study could not determine whether there was critical glenoid bone loss in patients undergoing ABRR, and surgeons should still exercise caution in performing ABRR in patients with high-grade glenoid bone loss or in those with failed prior stabilizations. Level of Evidence Level III, retrospective cohort study.
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Takeno K, Ingersoll CD, Glaviano NR, Khuder S, Norte GE. Neuromuscular function of the shoulder girdle and upper extremity musculature in individuals with a history of glenohumeral labral repair. Scand J Med Sci Sports 2022; 32:1377-1388. [PMID: 35612722 DOI: 10.1111/sms.14196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/10/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to compare neuromuscular function in the upper extremity musculature between individuals with glenohumeral labrum repair and uninjured controls. This cross-sectional study examined 16 individuals with a primary, unilateral glenohumeral labral repair (male/female: 13/3, age: 24.1 ± 5.0 years, time from surgery: 36.7 ± 33.3 months) and 14 uninjured individuals (male/female: 11/3, age: 23.8 ± 2.7 years) matched by age, sex, activity level, and limb dominance participated. Mass-normalized shoulder abduction and wrist flexion maximal voluntary isometric contraction (MVIC) torque, motoneuron pool excitability of the flexor carpi radialis (Hoffmann reflex), and corticospinal excitability of the upper trapezius, middle deltoid, and flexor carpi radialis (active motor threshold [AMT]) were evaluated. Dependent and independent t-tests were used to assess between-limb and between-group comparisons. Cohen's d effect sizes with 95% confidence intervals were used to quantify the magnitude of differences observed. Within the injured group, the involved limb had lesser shoulder abduction MVIC torque (p < 0.001, d = 1.16) and higher AMT for the upper trapezius (p = 0.01, d = 0.81) compared with the contralateral limb. The labral repair group had lesser shoulder abduction MVIC torque (p < 0.001, d = 1.17) and Hoffmann reflex (p = 0.01, d = 0.99), as well as higher AMT for the upper trapezius (p < 0.001, d = 1.23) in their involved limb compared with the control group. Large magnitude neuromuscular impairments are present beyond 6 months from glenohumeral labral repair, suggesting potential origins of impairments to be addressed during post-operative rehabilitation.
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Affiliation(s)
- Katsumi Takeno
- Department of Kinesiology, University of North Georgia, Dahlonega, Georgia, USA
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Eren İ, Büyükdogan K, Yürük B, Aslan L, Birsel O, Demirhan M. Patients without re-dislocation in the short term after arthroscopic knotless Bankart repair for anterior shoulder instability may show residual apprehension and recurrence in the long term after 5 years. J Shoulder Elbow Surg 2022; 31:978-983. [PMID: 34871729 DOI: 10.1016/j.jse.2021.10.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The aim of this study was to report the long-term results, residual instability, and recurrence rate of arthroscopic Bankart repair surgery without a re-dislocation event in the first 5 years. METHODS We performed a retrospective analysis of Bankart repairs performed in a single center, by a single surgeon, with a minimum of 5 years' follow-up. Patients without a re-dislocation in the first 5 years of surgery were included. Patients who underwent open repair, those who underwent revision surgery, and those with critical glenoid bone loss were excluded. A total of 68 shoulders in 66 patients (51 male and 15 female patients) were included. Patients were analyzed in 2 domains: (1) failures defined as re-dislocation and (2) failures defined as apprehension and re-dislocation combined (residual instability). Clinical outcomes were assessed using shoulder range of motion, the American Shoulder and Elbow Surgeons score, and the Western Ontario Shoulder Instability Index (WOSI) score. Pain, residual apprehension, re-dislocations, and additional surgical procedures were recorded. RESULTS The mean age of patients was 31.16 (range, 16-60 years), and the mean follow-up duration was 8.42 ± 2.1 years. The median number of dislocations was 3 (range, 1-20), and the median time from first dislocation to surgery was 16 months (interquartile range, 3-100.5 months). Five patients reported re-dislocations (7.4%) with a mean period of 6.54 ± 2.5 years (range, 5-10.8 years). Seven patients without re-dislocations and 2 patients with re-dislocations reported residual apprehension. Mean shoulder elevation and mean external rotation were 161.3° ± 12.4° and 39.2° ± 11°, respectively. The mean visual analog scale, American Shoulder and Elbow Surgeons, and WOSI scores were 0.5 ± 1.4, 91 ± 11.9, and 88 ± 12.1, respectively. Age was similar in patients with stable shoulders and those with shoulders with re-dislocation or residual instability. The WOSI score was lower in patients with re-dislocation and residual instability (P = .030 and P = .049, respectively). CONCLUSIONS Arthroscopic Bankart repair is a successful surgical option for anterior shoulder instability. The 7.4% re-dislocation rate after 5 years indicates there may be a deterioration of capsulolabral repair in certain patients. The long-term failure pattern may be underestimated in short- to mid-term projections.
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Affiliation(s)
- İlker Eren
- Department of Orthopaedics and Traumatology, School of Medicine, Koc University, Istanbul, Turkey.
| | - Kadir Büyükdogan
- Department of Orthopaedics and Traumatology, Koc University Hospital, Istanbul, Turkey
| | - Batuhan Yürük
- Department of Orthopaedics and Traumatology, School of Medicine, Koc University, Istanbul, Turkey
| | - Lercan Aslan
- Department of Orthopaedics and Traumatology, Koc University Hospital, Istanbul, Turkey
| | - Olgar Birsel
- Department of Orthopaedics and Traumatology, School of Medicine, Koc University, Istanbul, Turkey
| | - Mehmet Demirhan
- Department of Orthopaedics and Traumatology, School of Medicine, Koc University, Istanbul, Turkey
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Davey MS, Hurley ET, Doyle TR, Dashti H, Gaafar M, Mullett H. The Fragility Index of Statistically Significant Findings From Randomized Controlled Trials Comparing the Management Strategies of Anterior Shoulder Instability. Am J Sports Med 2022:3635465221077268. [PMID: 35414266 DOI: 10.1177/03635465221077268] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Debate centering on the management of anterior shoulder instability (ASI) in recent years has led to many randomized controlled trials (RCTs) being published on the topic. The fragility index (FI) has subsequently emerged as a novel method of assessing significant findings reported in RCTs, particularly those with small sample sizes. PURPOSE To evaluate the FI of statistically significant findings in RCTs that reported the outcomes of management strategies of patients with ASI. STUDY DESIGN Systematic review; Level of evidence, 1. METHODS Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 2 independent reviewers performed a systematic review of RCTs focusing on the outcomes of management strategies of patients with ASI. There were 3 main categories of RCTs included: (1) nonoperative management in internal rotation (IR) versus external rotation (ER), (2) nonoperative management versus a surgical intervention, and (3) surgical management with arthroscopic Bankart repair versus open Bankart repair. The Fisher exact test was utilized to calculate the FI for the reversal of statistical significance in all statistically significant dichotomous outcomes. RESULTS A total of 21 RCTs were included, including 1589 shoulders (mean age, 29.4 years) with a mean follow-up of 26.8 months. There were 10 RCTs (831 shoulders) that reported outcomes after the nonoperative management of ASI in IR versus ER, with a mean FI of 6.8. There were 5 RCTs (324 shoulders) that reported outcomes comparing the nonoperative and operative management of ASI, with a mean FI of 3.5. There were 6 RCTs (434 shoulders) that reported outcomes after the operative management of ASI with either arthroscopic Bankart repair or open Bankart repair, with a mean FI of 9.6. CONCLUSION The overall FI of RCTs reporting the outcomes of management strategies for patients with ASI was high, suggesting a moderate fragility of statistically significant outcomes including recurrence, revision stabilization, and return to play.
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Surgical delay for traumatic recurrent shoulder dislocations leads to inferior functional outcomes. J Clin Orthop Trauma 2022; 28:101849. [PMID: 35494489 PMCID: PMC9043676 DOI: 10.1016/j.jcot.2022.101849] [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: 05/02/2021] [Revised: 12/31/2021] [Accepted: 03/23/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The effect of time interval between injury and surgery on outcomes of Bankart repair surgery has not been published previously. The purpose of this study was to assess the effect of surgical delay on functional outcomes after arthroscopic Bankart repair. METHOD One hundred and five athletes who underwent arthroscopic Bankart repair ± remplissage were enrolled in the study. Patients were divided into 2 groups depending upon the injury to surgery time- < 12 months (n = 19), and ≥12 months (n = 86). Depending upon the number of episodes of dislocation, patients were further categorized into 2 groups- <10 episodes (n = 66) and ≥10 episodes (n = 39). All patients were assessed post-operatively for functional outcomes (Modified Rowe's score, Constant Murley score) and return to sports at a minimum of 2 years of follow-up. RESULTS The mean injury to surgery time was 31.7 ± 23.1 months. The average number of episodes of dislocation before surgery were 10 (range 3-50). 49/105 (46.7%) patients returned to sports after a mean post-operative duration of 10.9 months. Athletes operated after a surgical delay of ≥12 months had inferior functional outcomes (Modified Rowe's score-89.5 ± 8.9 vs.77.4 ± 21.4; p = 0.02), lower rate of return to sports (14/19 vs. 35/86; p = 0.02) and higher mean time to return to sports (8.7 ± 1.9 vs. 11.5 ± 2.6; p < 0.05). Similarly, athletes who had ≥10 dislocations before surgery had inferior functional outcomes (Modified Rowe's score-84.5 ± 15.2 vs.72.9 ± 25.6; p = 0.004), lower rate of return to sports (37/66 vs. 12/39; p = 0.02) and higher mean time to return to sports (10.3 ± 2.4 vs. 12.6 ± 2.5; p < 0.05). CONCLUSION A delay in surgery (≥12 months) or dislocation episodes of ≥10 are associated with inferior functional outcomes, lower rate of return to sports and higher surgical failure rate. LEVEL OF EVIDENCE Level III; Prospective cohort study.
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Rossi LA, Pasqualini I, Tanoira I, Ranalletta M. Factors That Influence the Return to Sport After Arthroscopic Bankart Repair for Glenohumeral Instability. Open Access J Sports Med 2022; 13:35-40. [PMID: 35401017 PMCID: PMC8985826 DOI: 10.2147/oajsm.s340699] [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: 12/21/2021] [Accepted: 03/25/2022] [Indexed: 11/23/2022] Open
Abstract
Numerous studies have reported high rates of return to sports following arthroscopic Bankart repair (ABR) However, there is enormous controversy regarding the optimal management of these patients in the postoperative period. Controversy issues include rehabilitation, criteria for returning to sports, and the specific management of each athlete according to the sport they practice. Even though there are several rehabilitation protocols published in the literature, wide variability exists concerning the key elements of rehabilitation after an ABR. Regarding criteria for return to sports, there is a wide variation across the different published studies. The type of sports has been shown to affect an athlete's decision to return to sports. Nevertheless, most research is evaluated by classifications that cluster different sports into categories that may have other influences in return to sports when analyzed separately. Finally, in addition to physical readiness, the athlete's psychological state is crucial for returning to sports. However, the contribution of psychological readiness to an athlete's return to sports after shoulder instability surgery remains uncertain and unexplored.
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Affiliation(s)
- Luciano Andrés Rossi
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
| | - Ignacio Pasqualini
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
| | - Ignacio Tanoira
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
| | - Maximiliano Ranalletta
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
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Scanaliato JP, Dunn JC, Fares AB, Czajkowski H, Parnes N. Outcomes of 270° Labral Repair for Combined Shoulder Instability in Active-Duty Military Patients: A Retrospective Study. Am J Sports Med 2022; 50:334-340. [PMID: 34898288 DOI: 10.1177/03635465211061602] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a high prevalence of combined shoulder instability in military patients. Short-term outcomes after 270° labral repair are promising; however, there is a paucity of longer term outcome data in this high-demand group of patients. PURPOSE To report the midterm outcomes of active-duty military patients treated with 270° labral repair for combined shoulder instability. STUDY DESIGN Case series; Level of evidence, 4. METHODS All consecutive patients between January 2011 and January 2019 who underwent 270° labral repair by the senior surgeon with complete outcome scores were identified. All patients had experienced a shoulder dislocation after a traumatic event and had magnetic resonance imaging and intraoperative findings consistent with combined-type instability. A total of 52 patients met the inclusion criteria for the study, and all were active-duty servicemembers at the time of surgery. RESULTS The mean follow-up was 78.21 months (range, 24-117 months). There was a statistically significant increase in the mean American Shoulder and Elbow Surgeons score (from 44.92 to 89.31; P < .0001), Single Assessment Numeric Evaluation score (from 52.32 to 93.17; P < .0001), and Rowe instability score (from 46.63 to 91.35; P < .0001) from preoperatively to postoperatively. Mean pain decreased significantly as measured by the visual analog scale for pain (from 8.04 to 1.44; P < .0001). Range of motion in forward flexion (from 155.29° to 155.96°; P = .6793), external rotation (from 67.50° to 65.29°; P = .0623), and internal rotation (from T9.58 to T9.56; P = .9650) did not change significantly postoperatively. Outcomes did not differ significantly for patients who underwent surgery on their dominant shoulder versus those who underwent surgery on their nondominant shoulder, nor did outcomes vary with the type of anchor utilized (biocomposite vs all-suture). The overall rate of return to active duty was 92.31%. CONCLUSION Midterm outcomes in this population of active-duty patients undergoing 270° labral repair for combined shoulder instability demonstrated a statistically and clinically significant improvement in patient-reported outcome scores, a significant decrease in pain, and an overall rate of return to active duty of 92.31%.
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Affiliation(s)
| | - John C Dunn
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Austin B Fares
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | | | - Nata Parnes
- Carthage Area Hospital, Carthage, New York, USA.,Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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Davey MS, Hurley ET, Gaafar M, Delaney R, Mullett H. Clinical Outcomes in Patients With Humeral Avulsion Glenohumeral Ligament Lesions in the Setting of Anterior Shoulder Instability: A Retrospective Comparative Study. Am J Sports Med 2022; 50:327-333. [PMID: 35137638 DOI: 10.1177/03635465211063917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Humeral avulsion glenohumeral ligament (HAGL) lesions are often underreported but have been shown to occur in up to 10% of cases of anterior shoulder instability. PURPOSE To compare clinical outcomes and recurrence rates of patients with HAGL lesions undergoing open stabilization for anterior shoulder instability versus a pair-matched control. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective review of all patients who underwent both arthroscopic and open stabilization procedures with a minimum 24-month follow-up was performed. Patients with HAGL lesions were pair-matched in a 1:6 ratio for age, sex, sport, level of preoperative play, and follow-up length with those without HAGL lesions who underwent arthroscopic Bankart repair alone. Return to play (RTP), the level of return, and the timing of return were assessed. In addition, recurrence, visual analog scale for pain (VAS), Subjective Shoulder Value (SSV), Rowe score, satisfaction, and whether they would undergo the same surgery again were compared. RESULTS A total of 15 patients with HAGL lesions who underwent shoulder stabilization procedures were included, with a mean age of 21.5 ± 4.1 years and mean follow-up of 53.5 ± 17.4 months, and were pair-matched to 90 patients without HAGL lesions. Overall, there was no significant difference in any of the clinical outcome scores (VAS, Rowe, SSV, satisfaction) used between the 2 groups (1.6 vs 1.7, P = .86; 83.4 vs 88.0, P = .06; 85.7 vs 87.2, P = .76; and 86.7% vs 94.5%, P = .26, respectively). In addition, there were no significant differences in terms of overall rates, levels, and timing of RTP between the 2 groups (93.3% vs 90.0%, P > .99; 80.0% vs 78.9%, P > .99; and 5.3 ± 2.2 vs 5.9 ± 2.9 months, P = .45, respectively). There was no significant difference in the rates of apprehension, subluxation, and recurrent instability between the HAGL and pair-matched control groups (26.7% vs 26.7%, P > .99; 6.7% vs 3.3%, P = .47; and 13.3% vs 6.7% months, P = .32, respectively). CONCLUSION Patients with anterior shoulder instability undergoing surgical stabilization with open HAGL repair demonstrate excellent functional outcomes and high rates of RTP, with low rates of recurrence in the medium term compared with a control group without HAGL lesions who underwent arthroscopic Bankart repair alone.
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Affiliation(s)
- Martin S Davey
- Sports Surgery Clinic, Dublin, Ireland.,National University of Ireland Galway, Galway, Ireland
| | - Eoghan T Hurley
- Sports Surgery Clinic, Dublin, Ireland.,National University of Ireland Galway, Galway, Ireland
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Hurley ET, Ben Ari E, Lorentz NA, Mojica ES, Colasanti CA, Matache BA, Jazrawi LM, Virk M, Meislin RJ. Both Open and Arthroscopic Latarjet Result in Excellent Outcomes and Low Recurrence Rates for Anterior Shoulder Instability. Arthrosc Sports Med Rehabil 2021; 3:e1955-e1960. [PMID: 34977653 PMCID: PMC8689257 DOI: 10.1016/j.asmr.2021.09.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 09/28/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose The purpose of this study is to evaluate the patient-reported outcomes of open Latarjet (OL) compared to arthroscopic Latarjet (AL) for anterior shoulder instability. Methods A retrospective review of patients who underwent either OL or AL for anterior shoulder instability between 2011 and 2019 was performed. Recurrent instability, visual analog scale (VAS) score, Shoulder Instability-Return to Sport after Injury (SIRSI), Subjective Shoulder Value (SSV), Western Ontario Shoulder Instability (WOSI) score, patient satisfaction, willingness to undergo surgery again, and return to work/sport (RTW/RTS) were evaluated. A P value of < .05 was considered to be statistically significant. Results Our study included 102 patients in total; 72 patients treated with OL, and 30 treated with AL. There were no demographic differences between the two groups (P > .05 for all). At final follow up (mean of 51.3 months), there was no difference between those that underwent OL or AL in the reported WOSI, VAS, VAS during sports, SSV, and SIRSI scores, nor in patient satisfaction, or whether they would undergo surgery again (P > .05). Overall, there was no significant difference in the total rate of RTP (65% vs 60.9%; P = .74), or timing of RTP (8.1 months vs 7 months; P = .35). Additionally, there was no significant difference in the total rate of RTW (93.5% vs 95.5%; P = .75). Overall, 3 patients in the OL group and 2 patients in the AL group had recurrent instability events (6.9% vs 6.7%; P = .96), with no significant difference in the rate of recurrent dislocation (4.2% vs 3.3%; P = .84). Conclusion In patients with anterior shoulder instability, both the OL and AL are reliable treatment options, with a low rate of recurrent instability, and similar patient-reported outcomes.
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Davey MS, Hurley ET, Mullett H. Clinical outcomes of Gaelic Athletic Association athletes after surgical stabilization in the setting of anterior shoulder instability. JSES Int 2021; 6:259-263. [PMID: 35252923 PMCID: PMC8888160 DOI: 10.1016/j.jseint.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Gaelic Athletic Association (GAA) games are collision sports played at an amateur level, which represent the most popular sports played on the island of Ireland. Each year, many GAA players in Ireland require surgical stabilization with either arthroscopic Bankart repair (ABR) or open Latarjet (OL) procedures in the setting of anterior shoulder instability. The purpose of this study was to evaluate the clinical outcomes, recurrence, and return to play (RTP) in athletes who play GAA games having undergone surgical stabilization with either ABR or OL procedures in the setting of anterior shoulder instability. Methods A retrospective review of all patients with anterior shoulder instability whom had stabilization with either ABR or OL under a single surgeon between 2012 and 2018 was performed. Patients who were athletes partaking in GAA sports were followed up by chart review and telephone survey to assess their clinical outcomes including satisfaction, pain as measured on the visual analog scale score, the Subjective Shoulder Value, recurrence, complications, and revision surgeries. In addition, RTP rates, time to RTP, level of RTP, and Shoulder Instability–Return to Sport after Injury scores were evaluated. Results A total of 200 GAA athletes (194 males) with a mean age of 23.9 ± 6.1 years with mean follow-up of 50.4 ± 24 months were included in this study. A total of 98.1% patients were satisfied with their procedure at the latest follow-up, with an overall recurrence rate of 5%. A total of 6.5% of athletes required revision surgery, of whom 4% required revision stabilization (all of whom had recurrence). The overall rate of RTP was 88% at mean 6.0 ± 1.7 months postoperatively, with 75% of athletes returning at the same or higher levels than their preinjury level. There were no significant differences for all outcome measures analyzed between patients who had ABR or OL procedures. Conclusion GAA athletes with anterior shoulder instability treated with either ABR or OL procedures report excellent clinical outcomes at medium-term follow-up, with high satisfaction rates, excellent functional outcomes, and high rates of RTP. Furthermore, this cohort demonstrates low rates of recurrence after stabilization with few requiring revision surgery.
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Davey MS, Hurley ET, Gaafar M, Mullett H, Pauzenberger L. Arthroscopic Bankart Repair for Primary Versus Recurrent Anterior Instability in Athletes Results in Excellent Clinical Outcomes, High Rates of Return to Play, and Low Recurrence Rates. Arthrosc Sports Med Rehabil 2021; 3:e1499-e1504. [PMID: 34746848 PMCID: PMC8551395 DOI: 10.1016/j.asmr.2021.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/20/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To compare the outcomes of athletes who have been treated for either primary or recurrent anterior shoulder instability with arthroscopic Bankart repair (ABR). Methods A retrospective review of patients who underwent ABR for anterior shoulder instability, with a minimum of 24 months’ follow-up, was performed. Those who underwent ABR for primary instability were matched in a 1:1 ratio for age, sex, sport, and level of preoperative play to those who underwent ABR for recurrent instability. The rate, level, and timing of return to play (RTP), as well as the Shoulder Instability–Return to Sport After Injury score, were evaluated. Additionally, the recurrence rate, visual analog scale score, Subjective Shoulder Value, Rowe score, satisfaction, and whether patients would undergo the same operation again were compared. Results After analysis of 467 patients, 100 athletes who underwent ABR for primary instability were identified and subsequently pair matched to 100 patients who underwent ABR for recurrent instability, with a mean age of 27.2 years, 87% male patients, 68% collision athletes, and a mean follow-up period of 61.9 months. There was no significant difference between the groups in the rate of RTP (80% vs 79%, P = .86) or RTP at the preinjury level (65% vs 65%, P >. 999); however, there was a significant difference in time to RTP (6.9 ± 2.9 months vs 5.9 ± 2.5 months, P = .02). There were no significant differences in visual analog scale score, Shoulder Instability–Return to Sport After Injury score, Subjective Shoulder Value, Rowe score, patient satisfaction, and whether patients would undergo the operation again (P > .05 for all). There was no difference in the rate of recurrent instability after ABR (10% vs 16%, P = .29). Conclusions ABR results in excellent clinical outcomes, high rates of RTP, and low recurrence rates for both athletes with primary instability and those with recurrent instability. Level of Evidence Level III, retrospective comparative cohort study.
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Affiliation(s)
- Martin S Davey
- Sports Surgery Clinic, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan T Hurley
- Sports Surgery Clinic, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland.,National University of Ireland, Galway, Galway, Ireland
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Hurley ET, Davey MS, Montgomery C, O'Doherty R, Gaafar M, Pauzenberger L, Mullett H. Arthroscopic Bankart Repair Versus Open Latarjet for Recurrent Shoulder Instability in Athletes. Orthop J Sports Med 2021; 9:23259671211023801. [PMID: 34527752 PMCID: PMC8436306 DOI: 10.1177/23259671211023801] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/28/2021] [Indexed: 11/15/2022] Open
Abstract
Background: In athletes with recurrent shoulder instability, arthroscopic Bankart repair (ABR) and the open Latarjet procedure (OL) are commonly indicated to restore stability and allow them to return to play (RTP). Purpose: To compare the outcomes of ABR and OL in athletes with recurrent shoulder instability. Study Design: Cohort study; Level of evidence, 3. Methods: We performed a retrospective review of patients with recurrent shoulder instability who underwent ABR and OL and had a minimum 24-month follow-up. Indications for OL over ABR in this population were those considered at high risk for recurrence, including patients with glenohumeral bone loss. The patients were pair-matched in a 1:1 ratio (OL and ABR) by age, sex, sport, and level of preoperative play. We evaluated the rate, level, and timing of RTP, and the Shoulder Instability–Return to Sport after Injury (SIRSI) score between procedures. Additionally we compared the recurrence rate, visual analog scale (VAS) pain score, Subjective Shoulder Value (SSV), Rowe score, satisfaction, and whether patients would undergo the same surgery again. Results: Participants included 62 athletes who underwent ABR and 62 who underwent OL, with a mean follow-up of 47.7 months. There was no significant difference between ABR and OL in rate of RTP, return to preinjury level, time to return, SIRSI score, VAS score, SSV, or patient satisfaction. OL resulted in a significantly lower recurrence rate (1.6% vs 16.1% for ABR; P = .009) and a significantly higher Rowe score (mean ± SD, 90.5 ± 12.2 vs 82.2 ± 20.8 for ABR; P = .008). In collision athletes, there was no significant difference between ABR and OL regarding RTP rate (89.1% vs 94.5%; P = .489) or SIRSI score (70.4 ± 24.8 vs 73.8 ± 19.6; P = .426), but OL resulted in a lower recurrence rate (14.5% vs 1.8%; P = .031). Conclusion: ABR and OL resulted in excellent clinical outcomes, with high rates of RTP in athletes. However, lower recurrence rates were seen with OL.
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Hurley ET, Davey MS, Mojica ES, Montgomery C, Gaafar M, Jazrawi LM, Mullett H, Pauzenberger L. Analysis of patients unable to return to play following arthroscopic Bankart repair. Surgeon 2021; 20:e158-e162. [PMID: 34366225 DOI: 10.1016/j.surge.2021.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/07/2021] [Accepted: 06/16/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of this study was to analyze patients that did not return to play (RTP) following arthroscopic Bankart repair (ABR) compared to those who did RTP, and analyze factors associated with not returning to play. METHODS A retrospective review of patients who underwent ABR, and subsequently did not RTP after a minimum of 24-month follow-up was performed. Additionally, these were pair matched in a 3:1 ratio for age, gender, sport and level of pre-operative play with a control group who RTP. Patients were evaluated for their psychological readiness to return to sport using the SIRSI score. Multivariate regression models were used to evaluate factors affecting RTP. RESULTS The study included a total of 52 patients who were unable to RTP and 156 who returned to play. Ten patients (19.2 %) who did not RTP passed the SIRSI benchmark of 56 with a mean overall score of 39.8 ± 24.6, in those who returned 73.0 % passed the SIRSI benchmark of 56 with a mean overall score of 68.9 ± 22.0 (p < 0.0001 for both). The most common primary reasons for not returning were 27 felt physically unable to return, whilst 21 felt it was a natural end to their career or their lifestyle had changed. Multi-logistic regression revealed that 4 of the 12 components of the SIRSI score (p < 0.05 for all) and SSV (p = 0.0049), were the factors that were associated with RTP. CONCLUSION Following ABR, those that do not return to play exhibit poor psychological readiness to return to play, with multi-linear regression revealing the SIRSI questions associated with fear of re-injury were associated with a lower rate of RTP. Additionally, functional limitations were found to be associated with a lower rate of RTP. LEVEL OF EVIDENCE Level III; Retrospective Comparative Cohort Study.
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Affiliation(s)
- Eoghan T Hurley
- Sports Surgery Clinic, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland; National University of Ireland, Galway, Galway, Ireland; NYU Langone Health, New York, NY, USA.
| | - Martin S Davey
- Sports Surgery Clinic, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland; National University of Ireland, Galway, Galway, Ireland
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Hurley ET, Davey MS, Montgomery C, O’Doherty R, Gaafar M, Pauzenberger L, Mullett H. Arthroscopic Bankart Repair Versus Open Latarjet for First-Time Dislocators in Athletes. Orthop J Sports Med 2021; 9:23259671211023803. [PMID: 34485583 PMCID: PMC8414621 DOI: 10.1177/23259671211023803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/28/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In athletes with a first-time shoulder dislocation, arthroscopic Bankart repair (ABR) and the open Latarjet procedure (OL) are the most commonly utilized surgical procedures to restore stability and allow them to return to play (RTP). PURPOSE To compare the outcomes of ABR and OL in athletes with a first-time shoulder dislocation. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We performed a retrospective review of patients with first-time shoulder dislocation who underwent primary ABR and OL and had a minimum 24-month follow-up. Indications for OL over ABR in this population were those considered at high risk for recurrence, including patients with glenohumeral bone loss. Patients who underwent ABR were pair-matched in a 2:1 ratio with patients who underwent OL by age, sex, sport, and level of preoperative play. The rate, level, and timing of RTP, as well as the Shoulder Instability-Return to Sport after Injury (SIRSI) score were evaluated. Additionally, we compared recurrence, visual analog scale pain score, Subjective Shoulder Value, Rowe score, satisfaction, and whether patients would undergo the surgery again. RESULTS Overall, 80 athletes who underwent ABR and 40 who underwent OL were included, with a mean follow-up of 50.3 months. There was no significant difference between ABR and OL in rate of RTP, return to preinjury level, time to return, or recurrent dislocation rate. There were also no differences between ABR and OL in patient-reported outcome scores or patient satisfaction. When collision athletes were compared between ABR and OL, there were no differences in RTP, SIRSI score, or redislocation rate. CONCLUSION ABR and OL resulted in excellent clinical outcomes, with high rates of RTP and low recurrence rates. Additionally, there were no differences between the procedures in athletes participating in collision sports.
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Pavlik A, Tátrai M, Tátrai A, Tállay A. Outcomes After Arthroscopic Anterior Shoulder Stabilization in Professional Handball Players. Orthop J Sports Med 2021; 9:23259671211011614. [PMID: 34368376 PMCID: PMC8299888 DOI: 10.1177/23259671211011614] [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: 12/10/2020] [Accepted: 01/12/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Although numerous studies have reported on the redislocation rate and functional results of arthroscopic treatment for anterior shoulder instability in athletes, they have not disclosed outcomes in the high-risk group of elite handball players. Purpose: To investigate the postoperative outcomes of arthroscopic treatment for anterior shoulder instability as well as the return-to-sport (RTS) rate in professional handball players. Study Design: Case series; Level of evidence, 4. Methods: Involved in this study were 44 competitive handball players (47 shoulders) who underwent arthroscopic anterior capsulolabral reconstruction between 2010 and 2018 and had a minimum follow-up of 24 months. After surgery, patients completed a questionnaire that collected Rowe and American Shoulder and Elbow Surgeons (ASES) scores and RTS data, and we compared these results with their preoperative scores. We also compared results according to the following subgroups: true dislocations versus recurrent subluxations, younger (<20 years) versus older (≥20 years) age, male versus female sex, and shorter versus longer duration of instability. Statistical analysis included the paired-samples t test and nonparametric Fisher exact test. Results: The mean follow-up period was 52.2 ± 21.4 months. There were 4 shoulders (9%) with recurrent instability. There were significant preoperative to postoperative improvements in the mean Rowe score (from 45.2 to 91.8) and mean ASES score (from 70.6 to 95.7) (P < .001 for both). Overall, the RTS rate was 83%, and 64% (30/47 shoulders) were able to return to their preinjury level. The RTS rate was significantly lower in the younger players than in the older players (46% vs 86%, respectively; P = .005). Conclusion: The study results indicated that handball players with anterior shoulder instability can be treated using arthroscopic labral reconstruction successfully and 83% of the athletes were able to RTS activity. The handball players aged ≥20 years returned to their preinjury level of sport at a higher rate than did those aged <20 years.
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Affiliation(s)
- Attila Pavlik
- Department of Sport Surgery, National Institute for Sports Medicine, Budapest, Hungary.,Department of Sport Surgery, National Institute for Sports Medicine, Budapest, Hungary.,Department of Sport Surgery, National Institute for Sports Medicine, Budapest, Hungary
| | - Miklós Tátrai
- Department of Sport Surgery, National Institute for Sports Medicine, Budapest, Hungary.,Kastélypark Clinic, Tata, Hungary
| | | | - András Tállay
- Department of Sport Surgery, National Institute for Sports Medicine, Budapest, Hungary.,Faculty of Sport Medicine, Semmelweis University, Budapest, Hungary.,Kastélypark Clinic, Tata, Hungary
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Rossi LA, Tanoira I, Brandariz R, Pasqualini I, Ranalletta M. Reasons Why Athletes Do Not Return to Sports After Arthroscopic Bankart Repair: A Comparative Study of 208 Athletes With Minimum 2-Year Follow-up. Orthop J Sports Med 2021; 9:23259671211013394. [PMID: 34368378 PMCID: PMC8299894 DOI: 10.1177/23259671211013394] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background: There is a lack of information regarding the reasons why patients do not return to sports after an arthroscopic Bankart repair and whether there is a relationship between return to sports and functional outcomes. Purpose: To evaluate the reasons why competitive athletes who underwent arthroscopic Bankart repair did not return to sports and whether there was a relationship between returning to sports and postoperative outcome scores and complications. Study Design: Cohort study; Level of evidence, 3. Methods: Of 217 competitive athletes who underwent arthroscopic Bankart repair for isolated anterior glenohumeral instability between June 2014 and December 2017, a total of 208 athletes (96%) were evaluated at minimum 2-year follow-up. Return to sports, the level of sports achieved, and the time between surgery and return to competition were assessed, and patients who did not return to sports were asked to provide the reasons for cessation. The Rowe score and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences, reoperations, and complications were also evaluated. Results: The mean patient age was 24 years (range, 18-30 years), and the mean follow-up was 44 months (range, 24-90 months). Of the 208 athletes, 73% were able to return to sports (65% returned to their preinjury level), and 27% did not return to sports. Of those who did not return, the most frequent reasons were fear of reinjury (44%), lack of confidence in their shoulder (12%), and concern about a new rehabilitation process in case of recurrence (10%). The Rowe and ASOSS scores showed significant postoperative improvement in all patients (P < .001), with no significant differences between the 2 study groups at the final follow-up. There were 21 recurrences (10%) and 5 complications (2.4%), and 11 patients (5.3%) underwent revision surgery, with no significant differences in these rates between the groups. Conclusion: Of patients who did not return to sports, 74% left for a reason independent of shoulder function, with the most frequent causes being fear of reinjury and a concern about new rehabilitation process. Neither outcome scores nor complications varied significantly between patients who returned and those who did not return to sports.
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