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Castillo de la Peña J, Ma J, Wong I. Arthroscopic capsular shift from inferior to superior has an exceptional safety profile and short-term outcomes. J ISAKOS 2024; 9:314-318. [PMID: 38403194 DOI: 10.1016/j.jisako.2024.02.005] [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] [Received: 11/27/2023] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES Arthroscopic Bankart for anterior shoulder instability has a good safety profile but with a relatively high recurrence index. Open surgery has been used to decrease recurrence rates but with a higher complication rate. Arthroscopic capsular shift from inferior to superior (ACSIS) was designed to decrease the recurrence rates without the added morbidity of open surgery. METHODS An observational retrospective study was conducted to analyze perioperative complications and patient reported outcomes of patients treated with ACSIS to determine the safety profile of the procedure. The patients with anterior traumatic shoulder instability treated with ACSIS between January 2015 and December 2021 were included for the study. The analysis was conducted using SPSS (Version 27). The pre vs. postoperative Western Ontario Shoulder Instability Index scores were compared using a paired sample t-test or Wilcoxon signed ranks test depending on the results of the normality test and Levene's test. The significance level was 0.05 in all analyses. Thirty-six patients were included in this study, the mean age of the population is 30.8 ± 11.4 years, with a male dominance of 86.1% (N = 31), and a mean clinical follow-up of 2.7 ± 1.2 years. RESULTS No intraoperative complications, including bleeding or neurovascular injury, were noted. Additionally, no early postoperative complications, including infection or hospital readmission, were noted. During the follow-up, one patient (3%) had persistent apprehension. The mean Western Ontario Shoulder Instability index decreased from 66.6 ± 13.10% to 27.9 ± 22% postoperatively (P < 0.001). CONCLUSIONS ACSIS procedure is safe and has good short-term outcomes with a low recurrence rate at 1-year minimum follow-up. LEVEL OF EVIDENCE 3 (Observational study).
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Affiliation(s)
- Jose Castillo de la Peña
- Division of Orthopaedics, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, B3H 2E1, Canada
| | - Jie Ma
- Division of Orthopaedics, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, B3H 2E1, Canada
| | - Ivan Wong
- Division of Orthopaedics, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, B3H 2E1, Canada.
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2
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Latarjet procedure versus open capsuloplasty in traumatic anterior shoulder dislocation: long-term clinical and functional results. INTERNATIONAL ORTHOPAEDICS 2018; 43:237-242. [PMID: 30306218 DOI: 10.1007/s00264-018-4195-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/02/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE To compare the results of two different open surgical techniques (open capsuloplasty and Bristow-Latarjet procedure) at a mid- to long-term follow-up (6 years) in patients with recurrent traumatic anterior shoulder dislocations. METHODS Seventy-three patients (73 shoulders, 48 males; 25 females) fulfilled inclusion and exclusion criteria. Patients were classified as group A if operated on with a Bristow-Latarjet procedure (40 patients, 24 males; 16 females) or group B if operated on with an open capsuloplasty (33 patients, 24 males; 9 females). All patients were followed up with physical examination and functional evaluation scores (UCLA, ROWE and WOSI). RESULTS In group A, no further episodes of dislocation or subluxation were reported; in group B, one patient (3.3%) reported a new episode of anterior dislocation as a result of a new trauma. No statistical difference in regard of new episodes of shoulder dislocation was found between the two groups (p > 0.05). At physical examination, two patients (5%) of group A and four patients of group B (13.3%) showed a positive apprehension test (p > 0.05); anterior drawer test was positive in six patients (15%) of group A and in nine patients (30%) of group B (p > 0.05). Statistical analysis showed better external rotation in group A (Latarjet group) than in group B. (p = 0.0176). No statistical differences were detected in regard to the scale scores (UCLA, WOSI, Rowe) (p > 0.05). Regarding the return to sport, 29 patients (72.5%) of group A and 18 patients (60%) of group B reported they resumed the same sports activity at the same pre-operative level (p > 0.05). CONCLUSION Open capsuloplasty and Bristow-Latarjet procedure are both validated surgical techniques for the treatment of recurrent shoulder anterior instability. We found no statistical difference in terms of recurrent dislocation rates, clinical shoulder stability tests, and scoring scales. The rate of patients returning to sport was similar after both techniques. However, patients with open capsuloplasty reported a significantly lower recovery of external rotation than patients operated via the Latarjet procedure.
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Kowalski TJ, Khan AZ, Cohen JR, Lord EL, Ishmael C, Soohoo NF, McAllister DR, Gulotta LV, Wang JC, Petrigliano FA. Open shoulder stabilization: current trends and 1-year postoperative complications. JSES OPEN ACCESS 2017; 1:72-78. [PMID: 30675543 PMCID: PMC6340864 DOI: 10.1016/j.jses.2017.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Shoulder instability is commonly treated by arthroscopic stabilization. However, open stabilization procedures remain important in management of complex instability. Despite continued use of these procedures, the relative frequency of related complications remains poorly described. This study investigates current trends in open shoulder stabilization and characterizes major postoperative complications. Methods PearlDiver, a national insurance database of orthopedic patients, was used to identify open shoulder stabilization procedures from 2007 to 2010. Current Procedural Terminology codes for 4 procedures—Bankart repair, coracoid transfer, and anterior and posterior glenoid bone grafting—were used to track procedural trends. The 1-year postoperative complications were identified and categorized into 5 groups: dislocation treated with closed reduction, closed manipulation under anesthesia, reoperation with arthroscopy, reoperation with open surgery, and others. χ2 analysis determined statistical significance. Results There were 2678 open shoulder stabilization procedures performed, with a 1-year complication rate of 12.3%. Relative proportion of open Bankart repairs decreased (82.5% to 69.8%), whereas proportion of coracoid transfers increased (7.7% to 19%). Posterior glenoid bone grafting had the highest complication rate (20.7%). Rate of total complications was 9.8% in patients 10-24 years, 13.6% in patients 25-54 years, and 25.9% in patients >55 years. Conclusions Based on our patient database sample, a significant decline in the relative use of open Bankart repair was observed. Our analysis indicates that the use of bone transfer procedures was correlated with significantly higher reoperation rates than open Bankart repair, particularly in the older patient cohort. Further studies comparing open stabilization procedures with contemporary arthroscopic techniques are indicated.
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Affiliation(s)
- Tomasz J Kowalski
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Adam Z Khan
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeremiah R Cohen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Elizabeth L Lord
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Chad Ishmael
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nelson F Soohoo
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - David R McAllister
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Lawrence V Gulotta
- Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jeffrey C Wang
- Department of Orthopedics, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Frank A Petrigliano
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Vadalà A, Lanzetti RM, De Carli A, Lupariello D, Guzzini M, Desideri D, Ferretti A. Latarjet procedure: evolution of the bone block and correspondent clinical relevance-a clinical and radiological study. Musculoskelet Surg 2017; 101:113-120. [PMID: 28756510 DOI: 10.1007/s12306-017-0482-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/05/2017] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to correlate the bone block graft position, its dimension, its reabsorption and its integration with clinical outcome in patients operated on for recurrent anterior shoulder instability. METHODS Twenty-four patients affected by recurrent anterior shoulder dislocation and operated on using the Latarjet procedure were enrolled in this study. At 6 and 24 months, patients were evaluated with the following scales: ROWE, WOSI, Oxford instability score, UCLA, DASH and Constant score. Patients underwent two postoperative CT scans: immediately after surgery (T0) and at 24 months post-op (T1). RESULTS At 24 months, none of the 24 patients reported further episodes of dislocation. Clinically at the final follow-up, we found excellent results in all the evaluation scales. Mean reduction in bone graft from T0 to T1 was 42% of the overall volume; similarly reduction in the overall surface was 29.3%; decrease in length, width and depth was, respectively, 3.4, 2.2 and 1.0 mm; all these parameters decreased significantly (p < 0.05). No correlations were found between radiological parameters and clinical and functional outcomes. CONCLUSIONS The results confirm that a lack of integration or a significant reabsorption of the graft is present in the Latarjet procedure, but they do not significantly affect the clinical and functional results.
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Affiliation(s)
- A Vadalà
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Via grotta rossa 1053, 00100, Rome, Italy
| | - R M Lanzetti
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Via grotta rossa 1053, 00100, Rome, Italy
| | - A De Carli
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Via grotta rossa 1053, 00100, Rome, Italy
| | - D Lupariello
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Via grotta rossa 1053, 00100, Rome, Italy.
| | - M Guzzini
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Via grotta rossa 1053, 00100, Rome, Italy
| | - D Desideri
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Via grotta rossa 1053, 00100, Rome, Italy
| | - A Ferretti
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Via grotta rossa 1053, 00100, Rome, Italy
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C T, S B, E S, E I. "8 plate": an alternative device to fix highly recurrent traumatic anterior gleno-humeral instability in patients with severe impairment of the anterior capsule. Open Orthop J 2015; 8:457-61. [PMID: 25621080 PMCID: PMC4298807 DOI: 10.2174/1874325001408010457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 11/13/2014] [Accepted: 11/16/2014] [Indexed: 11/24/2022] Open
Abstract
Background: There is still debate about the best treatment option for highly recurrent anterior shoulder dislocation in patients with severe impairment of the anterior capsule and/or recurrence after either arthroscopic or open capsulorrhaphy.
Materials and Methods: The clinical and radiological findings of 7 patients treated with an open capsulorrhaphy stabilized with an “8 plate” for a highly recurrent traumatic anterior shoulder dislocation with severe impairment of the anterior capsule and a large Bankart lesion were retrospectively reviewed. Follow-up evaluation included VAS for pain, Constant-Murley, Simple Shoulder Test, ASES, UCLA, Quick DASH, Rowe, Walsch-Duplay scores, as well as X-rays of the operated shoulder.
Results: At follow-up none of the patients reported subsequent dislocations. Range of motion of the shoulder was complete in all cases, but one. Results of the functional scoring systems were satisfactory. X-rays showed no osteolysis and good position of the plate.
Conclusion: To our knowledge, this is the first report in the literature about an open capsular tensioning and Bankart lesion repair performed with an “8 plate”. We believe that this is a reliable and effective procedure to address traumatic anterior re-dislocation of the gleno-humeral joint when the capsule is extensively torn and frayed or in revision cases. Moreover the “8 plate” is ideal to be applied in such a narrow space on the slant surface of the scapular neck close to the glenoid rim.
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Affiliation(s)
- Tudisco C
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, 81 Oxford Street, 00133 Rome, Italy
| | - Bisicchia S
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, 81 Oxford Street, 00133 Rome, Italy
| | - Savarese E
- Department of Orthopaedic Surgery, San Carlo Hospital, Potito Petrone Steet, 85100, Potenza, Italy
| | - Ippolito E
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, 81 Oxford Street, 00133 Rome, Italy
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Zhang AL, Montgomery SR, Ngo SS, Hame SL, Wang JC, Gamradt SC. Arthroscopic versus open shoulder stabilization: current practice patterns in the United States. Arthroscopy 2014; 30:436-43. [PMID: 24560907 DOI: 10.1016/j.arthro.2013.12.013] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 12/16/2013] [Accepted: 12/18/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate current trends in arthroscopic and open shoulder stabilization in the United States. METHODS Patients who underwent arthroscopic shoulder stabilization (Current Procedural Terminology code 29806) or open stabilization (Current Procedural Terminology codes 23455 [open Bankart repair], 23460 [anterior bone block], and 23462 [coracoid transfer]) were identified using a national database of insurance billing records during the years 2004 through 2009. Demographic data were recorded for each patient. RESULTS From 2004 through 2009, there were 23,096 cases of shoulder stabilization, of which 84% (19,337) were arthroscopic and 16% (3,759) were open procedures. There were 17,241 male patients (75%) and 5,855 female patients (25%). The incidence of arthroscopic shoulder stabilization nearly doubled during the period studied, increasing from 11.8 cases for every 10,000 patients in 2004 to 22.9 cases for every 10,000 patients in 2009. The percentage of arthroscopic stabilizations increased from 71% of stabilization procedures in 2004 to 89% in 2009, whereas the percentage of open stabilizations decreased from 29% in 2004 to 11% in 2009 (P < .0001). Among open procedures, a significant decline in the incidence of open Bankart repair was observed, from 4.5 cases for every 10,000 patients in 2004 to 2.2 cases for every 10,000 patients in 2009 (P < .0001), whereas the performance of open coracoid transfer increased from 0.17 cases per 10,000 patients in 2004 to 0.40 cases per 10,000 patients in 2009 (P < .0001). For both arthroscopic and open stabilization, the group aged 10 to 19 years had the highest rate of surgery (29%), followed by the group aged 20 to 29 years (25%). CONCLUSIONS The current data indicate that arthroscopic stabilization is performed in nearly 90% of shoulder stabilization surgeries and nearly doubled in incidence from 2004 to 2009 in the United States. Additional research is needed to further investigate the long-term clinical outcomes of this practice pattern. LEVEL OF EVIDENCE Level IV, retrospective database review.
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Affiliation(s)
- Alan L Zhang
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Scott R Montgomery
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Stephanie S Ngo
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Sharon L Hame
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Seth C Gamradt
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, California, U.S.A
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Bois AJ, Wirth MA. Revision open capsular shift for atraumatic and multidirectional instability of the shoulder. J Bone Joint Surg Am 2012; 94:748-56. [PMID: 22517392 DOI: 10.2106/jbjs.l00090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Aaron J Bois
- The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 7774, San Antonio, TX 78229, USA.
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Drury NJ, Ellis BJ, Weiss JA, McMahon PJ, Debski RE. Finding consistent strain distributions in the glenohumeral capsule between two subjects: implications for development of physical examinations. J Biomech 2011; 44:607-13. [PMID: 21144519 PMCID: PMC3042532 DOI: 10.1016/j.jbiomech.2010.11.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 11/09/2010] [Accepted: 11/10/2010] [Indexed: 11/16/2022]
Abstract
The anterior-inferior glenohumeral capsule is the primary passive stabilizer to the glenohumeral joint during anterior dislocation. Physical examinations following dislocation are crucial for proper diagnosis of capsule pathology; however, they are not standardized for joint position which may lead to misdiagnoses and poor outcomes. To suggest joint positions for physical examinations where the stability provided by the capsule may be consistent among patients, the objective of this study was to evaluate the distribution of maximum principal strain on the anterior-inferior capsule using two validated subject-specific finite element models of the glenohumeral joint at clinically relevant joint positions. The joint positions with 25 N anterior load applied at 60° of glenohumeral abduction and 10°, 20°, 30° and 40° of external rotation resulted in distributions of strain that were similar between shoulders (r² ≥ 0.7). Furthermore, those positions with 20-40° of external rotation resulted in capsule strains on the glenoid side of the anterior band of the inferior glenohumeral ligament that were significantly greater than in all other capsule regions. These findings suggest that anterior stability provided by the anterior-inferior capsule may be consistent among subjects at joint positions with 60° of glenohumeral abduction and a mid-range (20-40°) of external rotation, and that the glenoid side has the greatest contribution to stability at these joint positions. Therefore, it may be possible to establish standard joint positions for physical examinations that clinicians can use to effectively diagnose pathology in the anterior-inferior capsule following dislocation and lead to improved outcomes.
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Affiliation(s)
- Nicholas J. Drury
- Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Benjamin J. Ellis
- Department of Bioengineering, University of Utah, Salt Lake City, UT
| | - Jeffrey A. Weiss
- Department of Bioengineering, University of Utah, Salt Lake City, UT
| | - Patrick J. McMahon
- Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Richard E. Debski
- Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
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