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Gao R, Fleet CT, Jin W, Johnson JA, Faber KJ, Athwal GS. The Kouvalchouk procedure vs. distal tibial allograft for treatment of posterior shoulder instability: the deltoid "hammock" effect exists. J Shoulder Elbow Surg 2024:S1058-2746(24)00346-X. [PMID: 38750787 DOI: 10.1016/j.jse.2024.03.047] [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: 09/23/2023] [Revised: 03/10/2024] [Accepted: 03/25/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND In 1993, Kouvalchouk described an acromial bone block with a pedicled deltoid flap for the treatment of posterior shoulder instability. This procedure provides a "double blocking" effect in that the acromial autograft restores posterior glenoid bone loss and the deltoid flap functions as a muscular "hammock" resembling the sling effect of the conjoint in the Latarjet procedure. The primary aim of this study was to compare the Kouvalchouk procedure to distal tibial allograft (DTA) reconstruction for the management of posterior shoulder instability with associated bone loss, while the secondary aim was to evaluate the deltoid hammock effect. METHODS Ten upper extremity cadavers were evaluated using a validated shoulder testing apparatus in 0° and 60° of glenohumeral abduction in the scapular plane. Testing was first performed on the normal shoulder state and was followed by the creation of a 20% posterior glenoid defect. Subsequently, the Kouvalchouk and DTA procedures were conducted. Forces of 0N, 5N, 10N, and 15N were applied to the posterior deltoid tendinous insertion on the Kouvalchouk graft along the physiological muscle line-of-action to evaluate the 'hammock" effect of this procedure. Testing was additionally performed on the Kouvalchouk bone graft with the deltoid muscle sectioned from its bony attachment. For all test states, a posteriorly directed force was applied to the humeral head perpendicular to the direction of the glenoid bone defect, with the associated translation quantified using an optical tracking system. The outcome variable was posterior translation of the humeral head at an applied force magnitude of 30N. RESULTS The Kouvalchouk procedure with the loaded deltoid flap (10N: P = .039 and 15N: P < .001) was significantly better at reducing posterior humeral head translation than the DTA. Overall, increased glenohumeral stability was observed with increased force applied to the posterior deltoid flap in the Kouvalchouk procedure. The 15 N Kouvalchouk was most effective at preventing posterior humeral translation, and the difference was statistically significant compared with the 20% glenoid defect (P = .003), detached Kouvalchouk (P < .001), and 0N Kouvalchouk (P < .001). The 15 N Kouvalchouk procedure restored posterior shoulder joint stability to near normal levels, such that it was not significantly different from the intact state (P = .203). CONCLUSIONS The Kouvalchouk procedure with load applied to the deltoid was found to be biomechanically superior to the DTA for the management of posterior shoulder instability with associated bone loss. Additionally, the results confirmed the presence and effectiveness of the deltoid "hammock" effect.
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Affiliation(s)
- Ryan Gao
- Roth | McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Canada.
| | - Cole T Fleet
- Roth | McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Canada; Department of Mechanical and Materials Engineering, Western University, London, Canada
| | - Winston Jin
- Roth | McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Canada
| | - James A Johnson
- Roth | McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Canada; Department of Mechanical and Materials Engineering, Western University, London, Canada
| | - Kenneth J Faber
- Roth | McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Canada; Department of Surgery, Western University, London, Canada
| | - George S Athwal
- Roth | McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Canada; Department of Surgery, Western University, London, Canada
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Levins JG, Hoffman RA, Green A. Bilateral Posterior Bone Graft Augmentation for Severe Glenoid Hypoplasia Without Instability: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00031. [PMID: 37976377 DOI: 10.2106/jbjs.cc.23.00274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
CASE A 40-year-old man with shoulder pain secondary to severe bilateral glenoid hypoplasia without posterior instability was treated successfully with bilateral posterior glenoid bone graft augmentation. CONCLUSION While glenoid hypoplasia is associated with a variety of patient presentations, treatment of the stable and nonarthritic shoulder is rarely described. A posterior glenoid bone graft can be used to augment deficient posterior glenoids, increasing the articulating surface area, restoring function, and potentially facilitating future shoulder arthroplasty.
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Affiliation(s)
- James G Levins
- Department of Orthopedic Surgery, University of Vermont Medical Center, Burlington, VT
| | - Ryan A Hoffman
- Department of Orthopedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD
| | - Andrew Green
- Division of Shoulder and Elbow Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Ernstbrunner L, Borbas P, Ker AM, Imhoff FB, Bachmann E, Snedeker JG, Wieser K, Bouaicha S. Biomechanical Analysis of Posterior Open-Wedge Osteotomy and Glenoid Concavity Reconstruction Using an Implant-Free, J-Shaped Iliac Crest Bone Graft. Am J Sports Med 2022; 50:3889-3896. [PMID: 36305761 PMCID: PMC9729978 DOI: 10.1177/03635465221128918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Posterior open-wedge osteotomy and glenoid reconstruction using a J-shaped iliac crest bone graft showed promising clinical results for the treatment of posterior instability with excessive glenoid retroversion and posteroinferior glenoid deficiency. PURPOSE To evaluate the biomechanical performance of the posterior J-shaped graft to restore glenoid retroversion and posteroinferior deficiency in a cadaveric shoulder instability model. STUDY DESIGN Controlled laboratory study. METHODS A posterior glenoid open-wedge osteotomy was performed in 6 fresh-frozen shoulders, allowing the glenoid retroversion to be set at 0°, 10°, and 20°. At each of these 3 preset angles of glenoid retroversion, the following conditions were simulated: (1) intact joint, (2) posterior Bankart lesion, (3) 20% posteroinferior glenoid deficiency, and (4) posterior J-shaped graft (at 0° of retroversion). With the humerus in the Jerk position (60° of glenohumeral anteflexion, 60° of internal rotation), stability was evaluated by measuring posterior humeral head (HH) translation (in mm) and peak translational force (in N) to translate the HH over 25% of the glenoid width. Glenohumeral contact patterns were measured using pressure-sensitive sensors. Fixation of the posterior J-graft was analyzed by recording graft micromovements during 3000 cycles of 5-mm anteroposterior HH translations. RESULTS Reconstructing the glenoid with a posterior J-graft to 0° of retroversion significantly increased stability compared with a posterior Bankart lesion and posteroinferior glenoid deficiency in all 3 preset degrees of retroversion (P < .05). There was no significant difference in joint stability comparing the posterior J-graft with an intact joint at 0° of retroversion. The posterior J-graft restored mean contact area and contact pressure comparable with that of the intact condition with 0° of retroversion (222 vs 223 mm2, P = .980; and 0.450 vs 0.550 MPa, P = .203). The mean total graft displacement after 3000 cycles of loading was 43 ± 84 µm, and the mean maximal mediolateral graft bending was 508 ± 488 µm. CONCLUSION Biomechanical analysis of the posterior J-graft demonstrated reliable restoration of initial glenohumeral joint stability, normalization of contact patterns comparable with that of an intact shoulder joint with neutral retroversion, and secure initial graft fixation in the cadaveric model. CLINICAL RELEVANCE This study confirms that the posterior J-graft can restore stability and glenohumeral loading conditions comparable with those of an intact shoulder.
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Affiliation(s)
- Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia,Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia,Lukas Ernstbrunner, MD, PhD, Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050, Australia ()
| | - Paul Borbas
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Andrew M. Ker
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Florian B. Imhoff
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Elias Bachmann
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland,Laboratory for Orthopaedic Biomechanics, ETH Zurich, University of Zurich, Zurich, Switzerland
| | - Jess G. Snedeker
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland,Laboratory for Orthopaedic Biomechanics, ETH Zurich, University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Samy Bouaicha
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Calvo E, Itoi E, Landreau P, Arce G, Yamamoto N, Ma J, Sparavalo S, Wong I. Anterior and posterior glenoid bone augmentation options for shoulder instability: state of the art. J ISAKOS 2021; 6:308-317. [PMID: 34145077 DOI: 10.1136/jisakos-2019-000413] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/24/2021] [Accepted: 04/08/2021] [Indexed: 11/04/2022]
Abstract
Bony lesions are highly prevalent in anterior shoulder instability and can be a significant cause of failure of stabilisation procedures if they are not adequately addressed. The glenoid track concept describes the dynamic interaction between the humeral head and glenoid defects in anterior shoulder instability. It has been beneficial for understanding the role played by bone defects in this entity. As a consequence, the popularity of glenoid augmentation procedures aimed to treat anterior glenoid bone defects; reconstructing the anatomy of the glenohumeral joint has risen sharply in the last decade. Although bone defects are less common in posterior instability, posterior bone block procedures can be indicated to treat not only posterior bony lesions, attritional posterior glenoid erosion or dysplasia but also normal or retroverted glenoids to provide an extended glenoid surface to increase the glenohumeral stability. The purpose of this review was to analyse the rationale, current indications and results of surgical techniques aimed to augment the glenoid surface in patients diagnosed of either anterior or posterior instability by assessing a thorough review of modern literature. Classical techniques such as Latarjet or free bone block procedures have proven to be effective in augmenting the glenoid surface and consequently achieving adequate shoulder stability with good clinical outcomes and early return to athletic activity. Innovations in surgical techniques have permitted to perform these procedures arthroscopically. Arthroscopy provides the theoretical advantages of lower morbidity and faster recovery, as well as the identification and treatment of concomitant pathologies.
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Affiliation(s)
- Emilio Calvo
- Department of Orthopaedic Surgery and Traumatology, Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz, Universidad Autonoma, Madrid, Spain
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | | | - Guillermo Arce
- Department of Orthopedic Surgery, Instituto Argentino de Diagnostico y Tratamiento (IADT), Buenos Aires, Argentina
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Jie Ma
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sara Sparavalo
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ivan Wong
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Camenzind RS, Martin Becerra J, Gossing L, Serane-Fresnel J, Wagner ER, Lafosse L. Acceptable Long-Term Outcomes of Arthroscopic Bone Grafting for Recurrent Posterior Shoulder Instability: Minimum Follow-Up of 5 Years. Arthroscopy 2021; 37:816-823. [PMID: 33385491 DOI: 10.1016/j.arthro.2020.10.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the long-term clinical outcome associated with arthroscopically placed autologous iliac crest bone graft (ICBG) for recurrent posterior shoulder instability. METHODS From January 2008 to December 2013, patients treated with posterior ICBG and a minimum follow-up of 5 years were included. Clinical outcome of patients operated with a posterior ICBG was analyzed with multiple patient-reported outcome measures included Constant (CS), American Shoulder and Elbow Surgeons (ASES), Walch-Duplay, and Rowe scores, shoulder subjective value, and pain visual analog score. Patient satisfaction was assessed by asking the patients their overall level of satisfaction at last follow-up on a 1 to 10 scale. RESULTS In total, 18 patients (19 shoulders) were included. At a mean follow-up of 7.3 years (range, 5-10 years), patients had significant improvements in their mean CS from 63 (standard deviation [SD] 18) to 80 (SD 18; P = .005), ASES from 57 (SD 18) to 81 (SD 18; P = .003), Walch-Duplay from 34 (SD 31) to 79 (SD 22; P < .001), and Rowe score from 37 (SD 23) to 79 (SD 24; P < .001). Pain level decreased from 5.6 (SD 2.5) preoperative to 2.3 (SD 2.3; P < .001) and shoulder subjective value improved 58 (SD 20) to 76 (SD 24; P = .002). Global satisfaction with the procedure was 8.4 (SD 2.1). Clinical significance was met or exceeded by 84% for CS and 89% of the patients for ASES and 95% met or exceeded satisfaction threshold for CS. There were 7 shoulders (37%) reoperated for symptomatic screw irritation. CONCLUSIONS This series reporting on the long-term follow-up after arthroscopic posterior ICBG for recurrent posterior shoulder instability demonstrates, despite a high number of reoperations for symptomatic screw irritation, its effectiveness with acceptable clinical outcomes and satisfied patients. LEVEL OF EVIDENCE IV, therapeutic case series.
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Affiliation(s)
- Roland Stefan Camenzind
- Alps Surgery Institute, Clinique Générale Annecy, Annecy, France; Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zurich, Switzerland.
| | - Javier Martin Becerra
- Alps Surgery Institute, Clinique Générale Annecy, Annecy, France; Ortomove, Centro Medico ABC, Mexico City, Mexico
| | - Louis Gossing
- Alps Surgery Institute, Clinique Générale Annecy, Annecy, France; Department of Orthopaedic Surgery, Braine-l'Alleud-Waterloo Hospital, Centre Hospitalier Interrégional Edith Cavell (CHIREC), Braine-l'Alleud, Belgium
| | - Julien Serane-Fresnel
- Alps Surgery Institute, Clinique Générale Annecy, Annecy, France; IECEM Research Unit, Polyclinique Saint Côme, Compiègne, France
| | - Eric R Wagner
- Alps Surgery Institute, Clinique Générale Annecy, Annecy, France; Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - Laurent Lafosse
- Alps Surgery Institute, Clinique Générale Annecy, Annecy, France
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Gilat R, Haunschild ED, Tauro T, Evuarherhe A, Fu MC, Romeo A, Verma N, Cole BJ. Distal Tibial Allograft Augmentation for Posterior Shoulder Instability Associated With Glenoid Bony Deficiency: A Case Series. Arthrosc Sports Med Rehabil 2020; 2:e743-e752. [PMID: 33364612 PMCID: PMC7754527 DOI: 10.1016/j.asmr.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/08/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose To report the clinical history and preliminary outcomes of patients who underwent posterior glenoid reconstruction using a distal tibial allograft (DTA) for the management of posterior shoulder instability with glenoid bone loss. Methods Patients who underwent posterior shoulder stabilization with a DTA in our institution between 2011 and 2019 were retrospectively reviewed. Demographic characteristics, operative reports, and clinical and functional outcomes were recorded. Outcomes included postoperative range of motion (ROM), recurrent instability, complications, and revision surgery. All patients underwent at least 1 year of follow-up, except 2 patients who underwent revision surgery. Preoperative and postoperative ROM was compared using the 2-tailed Student t test for paired samples. Results Ten patients who underwent DTA augmentation for posterior instability were included, comprising 2 female and 8 male patients with an average age of 24 years (range, 17-35 years). Five patients had a prior sports-related traumatic event, and 2 patients had a seizure disorder. Seven patients had undergone a prior stabilization procedure. The average reverse bony Bankart lesion was 26% of the glenoid diameter. Concomitant procedures included 4 capsular repairs, 2 labral repairs, 2 capsular plications, and 1 repair for humeral avulsion of the glenohumeral ligament. One patient reported recurrent instability after surgery. Two patients underwent revision surgery, with one removal of symptomatic hardware and one early revision owing to screw penetration into the glenoid. There was no significant difference in preoperative versus postoperative ROM. Conclusions Posterior shoulder instability with significant bony deficiency can be managed using DTA augmentation with good outcomes and a reasonable complication rate in these challenging cases. Level of Evidence Level IV, case series.
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Affiliation(s)
- Ron Gilat
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A.,Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Eric D Haunschild
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Tracy Tauro
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Aghogho Evuarherhe
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Michael C Fu
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anthony Romeo
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil Verma
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
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Godenèche A, Mansat P, Barth J, Nourissat G. No difference in outcomes of surgical treatment for traumatic and atraumatic posterior shoulder instability. Orthop Traumatol Surg Res 2020; 106:667-670. [PMID: 32461095 DOI: 10.1016/j.otsr.2020.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/23/2020] [Accepted: 03/02/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Posterior shoulder instability is a rare pathology and accounts for 2-10% of all shoulder instabilities. The purpose of this study was to compare pain and functional scores following surgical treatment of traumatic and atraumatic PSI. HYPOTHESIS The authors hypothesize that patients with traumatic PSI are at greater risks of residual pain and recurrent subluxation. MATERIAL AND METHODS The records of 150 patients operated for PSI between 2000 and 2015 at 10 different centers were analysed. Inclusion criteria were symptomatic PSI (subluxation and/or pain) with radiographic signs of posterior glenoid erosion or fracture, posterior labral tears, or reverse Hill Sachs lesions. One hundred and seventeen patients were eligible, of which 84% presented symptoms of subluxation and/or dislocation, and 16% were painful without clinical symptoms of subluxation and/or dislocation. Patients were evaluated at 48±33months (range: 12-159) using the Constant, Walch-Duplay and Rowe scores, with pain on Visual Analogic Scale (pVAS). RESULTS Compared to atraumatic PSI, traumatic PSI was more prevalent in men (84.4% vs 61.9%, p=0.031), and tended to have fewer pain symptoms (15.8% vs 23.8%, n.s). Atraumatic PSI was more likely to affect the dominant arm, although the difference was not significant (81.0% vs 59.4%, n.s.). Traumatic PSI did not differ from atraumatic PSI in terms of preoperative lesional characteristics, procedures performed, or postoperative pain and instability. Although these differences were not statistically significant, it is worth noting that traumatic PSI patients experienced more recurrence of instability (15.6% vs 4.8%, p=0.298), and lower pain on VAS (1.5±2.3 vs 2.6±3.0, n.s.) compared to atraumatic PSI. DISCUSSION Functional scores did not significantly differ between traumatic and atraumatic PSI after surgery, although traumatic PSI patients tended to have a higher recurrence of instability, while atraumatic PSI patients tended to remain more painful. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- Arnaud Godenèche
- Ramsay Générale de Santé, Hôpital privé Jean-Mermoz, Centre Orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France.
| | - Pierre Mansat
- Hôpital de Purpan, CHU Toulouse, 1, place du Docteur-Baylac, 31059 Toulouse, France
| | - Johannes Barth
- Centre Ostéoarticulaire des Cèdres, 5, chemin des Tropiques, Parc Sud Galaxie, 38130 Échirolle, France
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- Société Francophone d'Arthroscopie, 15, rue Ampère, 92500 Rueil-Malmaison, France
| | - Geoffroy Nourissat
- Ramsay Générale de Santé, Groupe Maussins, Clinique Maussins, 67, rue de Romainville, 75019 Paris, France
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8
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Nourissat G, Hardy MB, Garret J, Mansat P, Godenèche A. Glenoid Cartilage Lesions Compromise Outcomes of Surgical Treatment for Posterior Shoulder Instability. Orthop J Sports Med 2020; 8:2325967119898124. [PMID: 32047831 PMCID: PMC6984428 DOI: 10.1177/2325967119898124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/16/2019] [Indexed: 12/26/2022] Open
Abstract
Background: Posterior shoulder instability is associated with nonspecific symptoms, including pain, subluxation, and functional impairment, which complicate its diagnosis and management. Owing to the rarity of the condition, there are no present decision tools for its diagnosis and treatment. Purpose: To investigate demographic, lesional, and surgical factors that influence functional outcomes in patients treated for posterior shoulder instability. Study Design: Case-control study; Level of evidence, 3. Methods: We analyzed the clinical and radiographic records of 150 patients treated surgically for isolated posterior shoulder instability at 10 centers between 2000 and 2015, of which 144 were eligible for inclusion: 114 men (79%) and 30 women (21%) (mean ± SD age, 28.7 ± 9.6 years). The mean time between onset of symptoms and surgery was 66 ± 75 months. Shoulder instability was of traumatic origin in 115 patients (80%). The primary treatment was bone-block procedures for 65 patients (45%), posterior Bankart repair for 67 (47%), and capsular plication for 12 (8%). Patients were assessed with the Constant and Walch-Duplay scores at a mean follow-up of 51 ± 32 months (range, 12-159 months). Uni- and multivariable regression analyses were performed to determine associations between clinical scores and sex, age, traumatic origin, type of lesion, type of procedure, and follow-up. Results: At final follow-up, subluxations or dislocations recurred in 24 patients (17%). The overall Constant score was 86.2 ± 14.5, with a pain component of 12.6 ± 3.5. The Walch-Duplay score was 79.8 ± 24.2. Multivariable regressions revealed that the presence of a glenoid cartilage lesion was the only factor associated with worse Constant score (beta = –10; P = .013) and Walch-Duplay score (beta = –16.7; P = .024) across all subcomponents. Conclusion: The only factor that jeopardized functional outcomes of posterior instability surgery was the presence of glenoid cartilage lesions. Knowing that shoulders with glenoid cartilage lesions are at greater risk of residual pain or instability could help manage patient expectation and justify faster intervention before lesions deteriorate.
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Affiliation(s)
- Geoffroy Nourissat
- Groupe Maussins, Clinique Maussins Ramsay Générale de Santé, Paris, France
| | | | | | | | - Arnaud Godenèche
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
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9
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Qi W, Zhan J, Yan Z, Lin J, Xue X, Pan X. Arthroscopic treatment of posterior instability of the shoulder with an associated reverse Hill-Sachs lesion using an iliac bone-block autograft. Orthop Traumatol Surg Res 2019; 105:819-823. [PMID: 31331799 DOI: 10.1016/j.otsr.2019.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/10/2019] [Accepted: 03/27/2019] [Indexed: 02/02/2023]
Abstract
Posterior dislocation of the shoulder is often accompanied by an impression fracture in the anterior surface of the humeral head, called a reverse Hill-Sachs injury. This bone defect can engage on the posterior glenoid rim, which can lead to recurrent instability and progressive joint destruction. We describe a new arthroscopic procedure that fills the reverse Hill-Sachs lesion with an iliac bone-block autograft and repairs the posterior articular capsule arthroscopically, which can stabilize the posterior shoulder. It avoids the need to detach the subscapularis tendon and can reduce the risks associated with open procedures. LEVEL OF EVIDENCE: V, technical note.
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Affiliation(s)
- Weihui Qi
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325000, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jingdi Zhan
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325000, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zijian Yan
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325000, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jian Lin
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325000, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinghe Xue
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325000, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaoyun Pan
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China; Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325000, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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