Selective capsular shift technique for anterior and anterior-inferior glenohumeral instability

Latarjet procedure versus open capsuloplasty in traumatic anterior shoulder dislocation: long-term clinical and functional results

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.

Latarjet procedure: evolution of the bone block and correspondent clinical relevance-a clinical and radiological study

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.

The American Society of Shoulder and Elbow Therapists' consensus rehabilitation guideline for arthroscopic anterior capsulolabral repair of the shoulder

This manuscript describes the consensus rehabilitation guideline developed by the American Society of Shoulder and Elbow Therapists. The purpose of this guideline is to facilitate clinical decision making during the rehabilitation of patients following arthroscopic anterior capsulolabral repair of the shoulder. This guideline is centered on the principle of the gradual application of stress to the healing capsulolabral repair through appropriate integration of range of motion, strengthening, and shoulder girdle stabilization exercises during rehabilitation and daily activities. Components of this guideline include a 0- to 4-week period of absolute immobilization, a staged recovery of full range of motion over a 3-month period, a strengthening progression beginning at postoperative week 6, and a functional progression for return to athletic or demanding work activities between postoperative months 4 and 6. This document represents the first consensus rehabilitation guideline developed by a multidisciplinary society of international rehabilitation professionals specifically for the postoperative care of patients following arthroscopic anterior capsulolabral repair of the shoulder.

Selective capsular repair for the treatment of anterior-inferior shoulder instability: review of seventy-nine shoulders with seven years' average follow-up

HYPOTHESIS

Selective capsular repair for the treatment of antero-inferior shoulder instability gives satisfactory results at mid-range follow-up.

MATERIALS AND METHODS

Seventy-five patients (79 shoulders) with anterior instability underwent selective tightening of the anterior capsule and repair of any labral lesion.

RESULTS

At an average of seven years (5-12 years), results according to the Duplay-Walch score and Rowe score were satisfactory in 80% and 92% of the cases, respectively. Most patients (84%) were able to return to their previous sports activity at the same level, and 90% were satisfied with their surgery. Recurrence of instability was observed in 10 patients (12.6%). Restriction of motion was limited to external rotation and averaged a loss of 12.6 degrees elbow at the side, and 6 degrees at 90 degrees of abduction. Dynamometric evaluation found slight decrease in strength in internal rotation in 32 shoulders. According to the Samilson and Prieto classification, signs of osteoarthritis were present in 52% of the cases. Older age at the first episode of instability was the only factor correlated with development of postoperative osteoarthritis.

DISCUSSION

This study supports the results of other studies that anatomic stabilization of the shoulder demonstrates high levels of recovery of shoulder stability (recurrence rates 12.6%), with minimum restriction of range-of-motion, but with a relatively high incidence of possible development of osteoarthritis.

CONCLUSION

This retrospective study from a single center revealed that selective capsular repair for the treatment of posttraumatic anterior glenohumeral instability yielded a 90% of satisfaction rate and 80% excellent and good functional results.

LEVEL OF EVIDENCE

Level 4; Retrospective case series, no control group.

Open operative treatment for anterior shoulder instability: when and why?

The treatment of anterior glenohumeral instability continues to evolve. Open capsulolabral repairs are time-tested and reliable. In an era in which arthroscopic techniques continue to improve, open surgery remains an acceptable option, and there are still certain injury patterns that cannot be adequately addressed arthroscopically. Decision-making regarding surgery for instability is influenced by the surgeon's experience and the relevant pathological findings. Open operative treatment is the preferred approach in many instances of recurrent anterior instability, particularly when there is bone and soft-tissue loss and in revision settings.

Multi-axis passive and active stiffnesses of the glenohumeral joint

OBJECTIVE

To investigate passive and active glenohumeral stiffness in the anterior, posterior, superior, and inferior directions at different lateral positions of the humerus.

DESIGN

Glenohumeral stiffness along multiple axes was determined in fresh-frozen shoulder specimens under both passive (no simulated muscle contraction) and active (with simulated muscle contraction) conditions.

BACKGROUND

Glenohumeral laxity has been evaluated in various studies with focus on one of the multiple directions. However, glenohumeral stiffness characterizing the force-displacement relationship and stability has not been evaluated in all four directions under passive and active conditions.

METHODS

The humeral head was translated in the posterior, anterior, inferior and superior directions relative to the glenoid with different lateral positions, and multi-axis glenohumeral stiffness generated by passive and active structures were investigated.

RESULTS

Without muscle loading, glenohumeral stiffness in the superior direction ( Ksup = 5.83 N/mm) was higher than that in the inferior ( Kinf = 4.32 ), anterior ( Kant = 3.67 ), and posterior ( Kpost = 2.89 ) directions ( P < 0.008 ), and Kinf was higher than Kpost ( P = 0.011 ). Stiffness in the different directions were correlated to each other ( P < 0.001 ), and shifting the humerus laterally increased stiffness in all directions ( P < 0.05 ) except for the superior direction. With moderate muscle loads, the glenohumeral joint became significantly stiffer in all four directions ( P < 0.05 ) with less difference among different directions.

CONCLUSIONS

Glenohumeral stiffnesses are different in the different directions but are correlated to each other and contribute jointly to glenohumeral stability. Muscle contractions can increase glenohumeral stiffness significantly.

Thermal capsulorrhaphy to treat shoulder instability

The contemporary therapeutic approach of glenohumeral instability is directed at the restoration of anatomy. Thermal capsular modification to treat shoulder instability is a relatively recent modality. Early successful clinical applications have led to a wide use of this low demanding technique. Currently, however, the indications for thermal capsulorrhaphy are defined poorly, clinical outcome has not been shown to be superior to conventional stabilization procedures, and long-term effects on joint biology and mechanics are not known. Based on a critical review of the literature and personal clinical experience, the authors conclude that additional experimental and clinical investigations are necessary to add this procedure to the accepted modalities applied for the treatment of shoulder instability.