1
|
Inclan PM, Rodeo SA. The History and Evolution of the Open Labral Repair with Capsular Shift for Shoulder Instability. Curr Rev Musculoskelet Med 2024; 17:273-281. [PMID: 38683270 PMCID: PMC11156819 DOI: 10.1007/s12178-024-09901-2] [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] [Accepted: 04/18/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to describe the evolution of the open labral repair with capsular shift, including the current role of this procedure in the treatment of shoulder instability. RECENT FINDINGS Currently, a subset of patients - high-level collision/contact sport athletes, patients with significant inferior or multi-directional instability, and individuals with failed arthroscopic Bankart repair without bone loss - may experience benefit from undergoing open Bankart repair with capsular shift. Surgeons performing open stabilization can benefit from instrumentation and anchors developed to assist with arthroscopic techniques. Understanding the history and evolution behind the procedure not only allows the surgeon to appreciate principles behind an arthroscopic approach, but also permits the utilization of an open approach when required by patient pathology and risk factors.
Collapse
Affiliation(s)
- Paul M Inclan
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 E 71st Street, New York, NY, 10021, USA
| | - Scott A Rodeo
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 E 71st Street, New York, NY, 10021, USA.
| |
Collapse
|
2
|
Ippolito G, Zitiello M, De Marinis G, Di Lucia P, Surace MF, Franceschetti E, Gregori P, Papalia R, Faoro L, Ferraro S. Isolated Large Glenoid Fracture and Acute Glenohumeral Dislocation in Elderly Patients: A Case Series Treated Surgically With Reverse Shoulder Arthroplasty and Augmented Glenoid. J Shoulder Elb Arthroplast 2023; 7:24715492231199344. [PMID: 37692056 PMCID: PMC10486221 DOI: 10.1177/24715492231199344] [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: 02/07/2023] [Accepted: 08/16/2023] [Indexed: 09/12/2023] Open
Abstract
Background One of the most frequent complications in patients affected by traumatic anterior dislocations is bony Bankart lesion. This study evaluates the clinical and functional outcomes of 10 patients with isolated large glenoid fracture and acute glenohumeral dislocation treated with reverse shoulder arthroplasty. Methods Patients older than 69 years who underwent reverse shoulder arthroplasty after isolated large glenoid fracture and acute glenohumeral dislocation between 2016 and 2022 at the same institute were selected. Shoulder range of motion and pain level was assessed. The impact on quality of life has been evaluated through four measures: the constant scale, the simple shoulder test (SST), the OXFORD scale, and The University of California-Los Angeles (UCLA) shoulder scale. Results The mean Constant score was 77.1 (range 68-84), the mean SST score was 9.4 (range 8-10), the Oxford score was 44.3 (range 35-48), and the UCLA shoulder scale was 27.1 (range 24-30). No reoperation was performed on any patient in this series. Conclusion Reverse shoulder arthroplasty for elderly patients with bony Bankart lesion and acute glenohumeral dislocation represents a valuable option in terms of clinical results, patient satisfaction and early- to medium-term complications.
Collapse
Affiliation(s)
- Giorgio Ippolito
- Department of Medical and Surgical Sciences and Biotechnology (DSBMC), Sapienza University of Rome, Latina, Italy
| | - Michele Zitiello
- Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy
| | | | - Pierluca Di Lucia
- Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Michele F Surace
- Circolo Hospital, Macchi Foundation ‘Insubria University’, Varese, Italy
| | - Edoardo Franceschetti
- Fondazione Policlinico Universitario Campus Bio-medico, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Pietro Gregori
- Fondazione Policlinico Universitario Campus Bio-medico, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-medico, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Luca Faoro
- Circolo Hospital, Macchi Foundation ‘Insubria University’, Varese, Italy
| | - Sergio Ferraro
- Circolo Hospital, Macchi Foundation ‘Insubria University’, Varese, Italy
| |
Collapse
|
3
|
Hong IS, Sonnenfeld JJ, Sicat CS, Hong RS, Trofa DP, Schiffern SC, Hamid N, Fleischli JE, Saltzman BM. Outcomes After Arthroscopic Revision Bankart Repair: An Updated Systematic Review of Recent Literature. Arthroscopy 2023; 39:438-451. [PMID: 35398484 DOI: 10.1016/j.arthro.2022.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE To provide an update of recent literature with a specialized focus on clinical outcomes following arthroscopic revision Bankart repair (ARBR) by performing a systematic review of all available literature published between 2013 and 2020. METHODS A literature search reporting clinical outcomes after ARBR was performed. Criteria for inclusion consisted of original studies; Level of Evidence of I-IV; studies focusing on clinical outcomes after ARBR published between January 1, 2013, and January 4, 2021; studies reporting recurrent dislocation or instability rate after ARBR; reoperation/revision following ARBR, return to sport rates following ARBR; and patient-reported outcomes. The primary outcomes of interest were failure defined as recurrent instability or dislocation, return to sport rates, and patient-reported outcomes at follow-up. RESULTS A large proportion of patients undergoing arthroscopic revision Bankart repair were male, ranging between 67.7% and 93.8%. Failure rate and return to sports rate ranged between 6.1% and 46.8% and 25.9% and 88.3%, respectively, when patients with significant or greater than 20% glenoid bone loss was excluded. Patient-reported outcome scores, which included American Shoulder and Elbow Surgeons, Simple Shoulder Test, and visual analog scale, saw significant improvement over mean follow-up of ranging 21.64 to 60 months. CONCLUSIONS Both the failure rate and RTS rates after ARBR had a wide range, given the heterogeneity of the studies included, which varied in patient selection criteria pertaining to patients with greater than 20% glenoid bone. Although there have been advancements in arthroscopic techniques and a trend favoring arthroscopic stabilization procedures, there is a lack of consensus in recent literature for careful patient selection criteria that would minimize failure rates and maximize RTS rates after ARBR. LEVEL OF EVIDENCE Level IV, a systematic review of Level III-IV studies.
Collapse
Affiliation(s)
- Ian S Hong
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, U.S.A.; Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, U.S.A
| | | | - Chelsea Sue Sicat
- School of Medicine, New York Medical College, Valhalla, New York, U.S.A
| | - Robin S Hong
- Schulich School of Medicine & Dentistry, Western University, Medical Sciences Building, London, Ontario, Canada
| | - David P Trofa
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, New York, U.S.A
| | | | - Nady Hamid
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, U.S.A.; Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, U.S.A
| | - James E Fleischli
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, U.S.A.; Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, U.S.A
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, U.S.A.; Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, U.S.A..
| |
Collapse
|
4
|
Bøe B, Støen RØ, Blich I, Moatshe G, Ludvigsen TC. Learning Curve for Arthroscopic Shoulder Latarjet Procedure Shows Shorter Operating Time and Fewer Complications with Experience. Arthroscopy 2022; 38:2391-2398. [PMID: 35157966 DOI: 10.1016/j.arthro.2022.01.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/26/2022] [Accepted: 01/30/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the learning curve of the arthroscopic Latarjet procedure in a consecutive series of 103 shoulders in 102 patients by comparing the early clinical and radiologic outcomes and complications of the first 25 patients with the latter 25 patients. Our hypothesis was that the studied parameters would be enhanced over time. METHODS A consecutive cohort of 103 shoulders in 102 patients treated with arthroscopic Latarjet procedure was prospectively registered from December 2014 until November 2019. Patients in this cohort represent the first cases of arthroscopic Latarjet for the 2 shoulder surgeons. All patients had a double screw fixation technique. The Western Ontario Shoulder Instability Index (WOSI) score preoperatively and at 1-year follow-up and 3-dimensional computed tomography scans preoperatively, postoperatively, and at 1-year follow-up were prospectively registered. Patient demographics, intraoperative data, complications, and reoperations were all recorded. In total, 85 of 103 shoulders (83%) had complete data sets. Patient demographics, WOSI scores, operating time, complications, satisfaction rate, and radiology scores in the first and last 25 patients were compared to evaluate learning curve. RESULTS There was longer operating time in the early group compared with the latter (130 vs 105 minutes, P = .001) and number of complications was reduced with experience (16 vs 4, P = .0005). Serious complications requiring a reoperation were 4 (16%) in the early group compared to 1 (4%) in the latter group (P = .157). Clinical results were good with major improvement in WOSI scores and 84 % satisfaction rates in both groups. CONCLUSIONS Arthroscopic Latarjet was associated with a learning curve where the early group had longer operating time and greater rates of complications. This is a procedure with few serious complications, acceptable surgery time and learning curve. LEVEL OF EVIDENCE Level III, retrospective comparative observation trial.
Collapse
Affiliation(s)
- Berte Bøe
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.
| | | | - Ingvild Blich
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Gilbert Moatshe
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Oslo Sports Trauma Research Center, Oslo, Norway
| | | |
Collapse
|
5
|
Shaha J. Editorial Commentary: Recurrent Anterior Shoulder Instability With Glenoid Bone Loss Requires Restoring the Bone. Arthroscopy 2022; 38:682-683. [PMID: 35248224 DOI: 10.1016/j.arthro.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 02/02/2023]
Abstract
The success of treating anterior glenohumeral instability relies on multiple factors, including glenoid bone loss. Subcritical bone loss (<13.5%) has proven again and again to be a critical consideration when treating this problem. This proves more challenging in a population that participates in contact sports. The importance of restoring native anatomy, including the glenoid bone, is critical in ensuring a successful outcome. This is especially true in the setting of a bony Bankart lesion, where merely repairing the soft tissues and ignoring the bony fragment leads to unfavorable results.
Collapse
|
6
|
Abstract
Posterior shoulder instability occurs when the labrum detaches posteriorly from the glenoid owing to significant trauma and is a relatively uncommon type of shoulder dislocation. Although posterior instability has often been treated with open shoulder stabilization, modern arthroscopic procedures are being rapidly pursued by surgeons as an improved option because of decreased invasiveness and reduced operative times. Arthroscopic stabilization of the posterior glenoid labrum typically involves 2 working portals, but the procedure still yields successful results when performed with a single posterior portal and a suture passer. Our technique involves 1 less portal to reduce invasiveness, lower the risk of nerve damage, and decrease the operative time and postoperative pain. The purpose of this article is to describe an arthroscopic posterior stabilization technique with a single working portal.
Collapse
|
7
|
Dhawan A. Editorial Commentary: Early Detection and Treatment Improves Short-Term Outcomes After Shoulder Anchor Arthropathy, but an Ounce of Prevention Is Worth a Pound of Cure. Arthroscopy 2021; 37:3421-3422. [PMID: 34863379 DOI: 10.1016/j.arthro.2021.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 07/15/2021] [Indexed: 02/02/2023]
Abstract
Anchor arthropathy is a rare, but devastating, complication after arthroscopic labral repair and shoulder stabilization. Early recognition and treatment in the form of removal of anchor and suture material, loose bodies, and potential revision stabilization significantly improve short-term outcomes. The entity of anchor arthropathy may be difficult to diagnose, and a high index of suspicion is needed when a patient presents postoperatively with pain and stiffness beyond atypical for their time in rehab. In the end, while early treatment can be favorable, prevention with meticulous attention to detail on anchor placement, position, and potential use of knotless anchors is strongly recommended.
Collapse
|
8
|
Mc Millan S, Fliegel B, Stark M, Ford E, Pontes M, Markowitz M. Recurrent Instability after Arthroscopic Glenoid Labral Repair with a Minimum of Three Points of Fixation: Do the Number of Anchors or Fixation Points Correlate to Outcomes? Surg Technol Int 2021; 38:433-439. [PMID: 33724436 DOI: 10.52198/21.sti.38.os1411] [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: 06/12/2023]
Abstract
INTRODUCTION The goal of this study was to evaluate the recurrence rate of instability following arthroscopic Bankart repairs in regard to the number and types of fixation utilized. A Bankart lesion is a tear in the anteroinferior capsulolabral complex within the shoulder, occurring in association with an anterior shoulder dislocation. These injuries can result in glenoid bone loss, decreased range of motion, and recurrent shoulder instability. Successful repair of these lesions has been reported in the literature with repair constructs that have three points of fixation. However, the definition of "one point of fixation" is yet to be fully elucidated. MATERIALS AND METHODS A consecutive series of arthroscopically repaired Bankart lesions were evaluated pertaining to the points of fixation required to achieve shoulder stability. This included the number, position, and types of anchors used. Patients consented to complete a series of surveys at a minimum of two years postoperatively. The primary outcome was to determine recurrent instability via the UCLA Shoulder Score, the ROWE Shoulder Instability Score, and the Oxford Shoulder Score. A secondary outcome included pain on a Visual Analog Scale (VAS). RESULTS There were 116 patients reviewed, 46 patients achieved three points of fixation in their surgical repair via two anchors and 70 patients achieved a similar fixation with three or more anchors. There was no significant difference in the mean age, gender, or body mass index (BMI). Patients receiving two anchors demonstrated recurrent instability 8.7% of the time (4 of 46 patients). Patients who received three or more anchors demonstrated recurrent instability 8.6% of the time (6 of 70 patients). Overall, there was no statistical significance between the number/types of anchors used. Between the two cohorts, there was no statistically significant difference found between VAS, ROWE, UCLA, and Oxford Scores. There was a significant difference in pain reported on the VAS scale with an average VAS score of 0.43 versus 2.5 in those without and with recurrent instability respectively. CONCLUSION Contention still exists surrounding the exact definition of "a point of fixation" in arthroscopic Bankart repairs. Three-point constructs can be created through a variety of combinations including anchors and sutures, ultimately achieving the goal of a stable shoulder.
Collapse
Affiliation(s)
- Sean Mc Millan
- Department of Orthopedics, Virtual Health Systems, Burlington, New Jersey
| | - Brian Fliegel
- Department of Orthopedics, Rowan School of Osteopathic Medicine, Stratford, New Jersey
| | - Michael Stark
- Department of Orthopedics, Rowan School of Osteopathic Medicine, Stratford, New Jersey
| | - Elizabeth Ford
- Department of Orthopedics, Inspira Health Network, Vineland, New Jersey
| | - Manuel Pontes
- Department of Orthopedics, Rowan School of Osteopathic Medicine, Stratford, New Jersey
| | - Michael Markowitz
- Department of Orthopedics, Rowan School of Osteopathic Medicine, Stratford, New Jersey
| |
Collapse
|
9
|
Bondar KJ, Damodar D, Schiller NC, McCormick JR, Condron NB, Verma NN, Cole BJ. The 50 Most-Cited Papers on Bankart Lesions. Arthrosc Sports Med Rehabil 2021; 3:e881-e891. [PMID: 34195658 PMCID: PMC8220616 DOI: 10.1016/j.asmr.2021.03.001] [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: 11/18/2020] [Accepted: 03/02/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To analyze the 50 most-cited articles pertaining to “Bankart lesions,” also known as anteroinferior labral tears, by means of citation analysis as well as to provide analysis and summary of the origins and trends of research on Bankart lesions. Methods Scopus was used to query the literature on Bankart lesions. Included articles were related to Bankart lesions and the indications, risk factors, techniques, and outcomes of arthroscopic and open Bankart repair. The 50 most-cited articles were analyzed in the following areas: year of publication, citations in the most recent year, total citation count, contributing authors, institutions, countries, and journals, article classifications, and level of evidence. Results Years of publication ranged from 1938 to 2013. There were 608 total citations in the most recent year. Total citation count was 12,441. Regarding country, journal, and authorship, United States, R. A. Arciero, and Arthroscopy were the highest respective contributors. Rush University had the greatest number of publications. The most common article classification was clinical outcomes. Of 49 clinical articles, the most frequent Level of Evidence was IV. The majority of the top 50 Bankart literature consisted of case series and retrospective studies performed in the United States. Conclusions Our findings are consistent with the hypothesis that the 50 most-cited articles about Bankart lesions are predominantly U.S.-based, produced by academic orthopaedic groups, clinical outcomes articles, and of Level IV and V evidence. This list of articles should serve as a reference tool for any orthopaedist looking to review Bankart literature.
Collapse
Affiliation(s)
- Kevin J Bondar
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Dhanur Damodar
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nicholas C Schiller
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Johnathon R McCormick
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nolan B Condron
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| |
Collapse
|
10
|
Rai S, Tamang N, Sharma LK, Marasini RP, Singh JL, Khanal K, Ghimire KC M, Sherchan B. Comparative study of arthroscopic Bankart repair versus open Latarjet procedure for recurrent shoulder dislocation. J Int Med Res 2021; 49:3000605211007328. [PMID: 33845604 PMCID: PMC8047861 DOI: 10.1177/03000605211007328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The primary aim of this study was to compare the clinical outcomes of patients undergoing arthroscopic Bankart repair and the open Latarjet procedure for recurrent dislocation of the shoulder. The secondary aims were to assess and compare the surgical cost, patient satisfaction, and complications, including recurrence and infection. METHODS We retrospectively compared the clinical outcomes of all consecutive patients undergoing either arthroscopic Bankart repair or the open Latarjet procedure from May 2015 to May 2018 with a minimum 2-year follow-up. Forty-one patients (32 men, 9 women) in the Bankart group and 40 patients (34 men, 6 women) in the Latarjet group were available for the final follow-up. RESULTS There were no statistically significant differences in the demographic parameters or clinical outcomes between the two groups. Functional satisfaction was higher with the Latarjet procedure. Bankart repair had a significantly higher operating cost than the Latarjet procedure. Three patients in the Bankart group and no patients in the Latarjet group developed recurrence. CONCLUSION Both procedures provided satisfactory clinical outcomes. However, the Latarjet group had a higher rate of functional satisfaction and lower operating cost, and there was a trend toward higher recurrence in the arthroscopic Bankart group.
Collapse
Affiliation(s)
- Saroj Rai
- Department of Orthopedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Nira Tamang
- Department of Nursing, Norvic International Hospital, Kathmandu, Nepal
| | - Laxmi Kanta Sharma
- Department of Orthopedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Rudra Prasad Marasini
- Department of Orthopedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Janith Lal Singh
- Department of Orthopedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Kiran Khanal
- Department of Orthopedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Milan Ghimire KC
- Department of Orthopedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Binod Sherchan
- Department of Orthopedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| |
Collapse
|
11
|
Lowenstein NA, Ostergaard PJ, Haber DB, Garvey KD, Matzkin EG. Sex differences in outcomes after arthroscopic bankart repair. BMJ Open Sport Exerc Med 2020; 6:e000965. [PMID: 33437497 PMCID: PMC7780536 DOI: 10.1136/bmjsem-2020-000965] [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] [Accepted: 12/17/2020] [Indexed: 11/06/2022] Open
Abstract
Objectives Risk factors for anterior shoulder dislocation include young age, contact activities and male sex. The influence of sex on patient-reported outcomes of arthroscopic Bankart repair (ABR) is unclear, with few studies reporting potential differences. This study’s purpose was to compare patient-reported outcomes of males and females following ABR. Methods Prospectively collected data was analysed for 281 patients (males: 206, females: 75) after ABR with preoperative, 1-year and 2-year follow-up responses. The Wilcoxon signed-rank and χ2 tests, preoperative, 1 year and 2 year follow-up results were examined to determine differences of scores in males versus females. Results No statistically significant sex differences were observed in Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), Visual Analogue Scale (VAS) or Single Assessment Numerical Evaluation (SANE) Scores at 1-year or 2-year follow-up. Females had lower Veterans RAND 12-item health survey (VR-12) mental health subscores at 2-year follow-up (females: 52.3±9.0, males: 55.8±7.6, p=0.0016). Females were more likely to report that treatment had ‘exceeded expectations’ at 2-year follow-up regarding motion, strength, function and normal sports activities. Conclusion Results of study demonstrate that ABR has similar outcomes for both males and females. There were no statistically significant sex-related differences in SST, ASES, VAS or SANE scores following ABR. VR-12 mental health subscores showed a minimal difference at 2-year follow-up, with lower scores in females. Level of evidence Retrospective cohort study; level II.
Collapse
Affiliation(s)
- Natalie A Lowenstein
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Peter J Ostergaard
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Daniel B Haber
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kirsten D Garvey
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elizabeth G Matzkin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
12
|
Leland DP, Parkes CW, Bernard CD, Krych AJ, Dahm DL, Tokish JM, Camp CL. Significant Changes in the Diagnosis, Injury Severity and Treatment for Anterior Shoulder Instability Over Time in a U.S. Population. Arthrosc Sports Med Rehabil 2020; 2:e761-e769. [PMID: 33364614 PMCID: PMC7754528 DOI: 10.1016/j.asmr.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/21/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose To report the annual incidence of anterior shoulder instability (ASI) diagnosis, injury severity, and surgical stabilization in a U.S. population. Methods An established U.S. geographic database was used to identify patients < 40 years old with diagnoses of ASI from 1994-2016. Medical records were reviewed to obtain patient demographics, histories, imaging results, and surgical details. Age- and sex-specific incidence rates were calculated and adjusted to the 2010 U.S. population. Poisson regression was performed to examine trends by timeline, sex and age. Results The study population consisted of 652 patients with ASI and a mean age of 21.5 years (range, 3.6-39.5). Comparing 2015-2016 to 1994-1999, we found an increase in the number of dislocations (from 1.0-1.9; P = 0.016) and total instability events (from 2.3-3.4; P = 0.041) per patient prior to presentation to a physician. There was a trend in increased diagnosis of bony Bankart and/or Hill-Sachs on MRI over time, with these lesions documented in 96% of patients undergoing MRI in 2015-2018 compared to 52.9% in 1994-1999 (P < .001). The use of arthroscopic procedures increased and peaked in 2005-2009 (90% of surgical cases performed). The proportion of open Latarjet procedures increased from 2010-2014 (14%) and 2015-2018 (31%). Conclusions The age- and sex- adjusted incidence of ASI diagnosis in a U.S. population from 1994-2016 is comparable to that demonstrated in Canadian and European populations. This study demonstrates an increasing number of instability events prior to surgical evaluation, which may correlate with patients’ more commonly presenting with bone loss and requiring more aggressive surgical treatment or that ASI is being more frequently cared for and documented by present-day orthopedic surgeons. Level of Evidence Level III, cross-sectional study.
Collapse
Affiliation(s)
- Devin P Leland
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Chad W Parkes
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christopher D Bernard
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Diane L Dahm
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - John M Tokish
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Scottsdale, Arizona, U.S.A
| | - Christopher L Camp
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| |
Collapse
|
13
|
Lemme NJ, Kuczmarski AS, Goodman AD, Ready LV, Dickens JF, Owens BD. Management and Outcomes of In-Season Anterior Shoulder Instability in Athletes. JBJS Rev 2019; 7:e2. [DOI: 10.2106/jbjs.rvw.19.00010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
14
|
Arıcan M, Turhan Y. Comparison of Clinical and Functional Results After Arthroscopic Bankart Repair With The Conventional Metal Anchor and The All-Soft Suture Anchor. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2019. [DOI: 10.33631/duzcesbed.584210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
15
|
Khoo JK, Lee JH, Lam PH, Wei AQ, Ronquillo J, Murrell GA. Cytotoxicity and biomechanics of suture anchors used in labral repairs. JSES OPEN ACCESS 2019; 3:29-36. [PMID: 30976733 PMCID: PMC6443838 DOI: 10.1016/j.jses.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Biodegradable suture anchors are associated with higher redislocation rates. This study examined whether the biocompatibility and/or biomechanical properties of suture anchors contribute to the increase in complications. Methods Human glenohumeral capsule cells were cultured with 4 types of suture anchors, Opus LabraFix (titanium alloy; ArthroCare, Austin, TX, USA), PushLock (poly-ether-ether-ketone; Arthrex, Naples, FL, USA), BioKnotless (poly-l-lactic acid; DePuy Mitek, Warsaw, IN, USA), and Suretac II (polyglycolic acid; Smith & Nephew, London, UK), to measure cell viability and pH. Four groups of 6 ovine shoulders were used to repair the labrum, which was completely detached from the glenoid rim anteroinferiorly and reattached with 2 suture anchors and subject to failure load testing. Results In cell culture, BioKnotless at 48 and 72 hours (85.2% ± 2.1% and 84.5% ± 3.6%) and Suretac II groups (33.9% ± 3.1% and 42.8% ± 6.4%) had fewer viable cells compared with control (P = .048). The pH of Suretac II was lower than control (7.51 to 7.65) at 24 hours (7.31 ± 0.08, P = .049), 48 hours (7.25 ± 0.02, P = .046), and 72 hours (7.29 ± 0.04, P = .04). During mechanical testing, 83% of repairs failed by the capsule tearing. Among the anchors, the BioKnotless repair group had a significantly lower failure load (37 ± 5 N) compared with the PushLock (61 ± 7 N), Opus (60 ± 6 N), and Suretac II (57 ± 7 N) groups (P = .038). Conclusion BioKnotless and Suretac II anchors are cytotoxic. The BioKnotless biodegradable anchor has significantly lower failure load. Absorbable suture anchors may cause higher redislocation of arthroscopic Bankart repair.
Collapse
Affiliation(s)
| | | | | | | | | | - George A.C. Murrell
- Corresponding author: George A. C. Murrell, MD, DPhil, Research and Education Centre, Level 2, 4-10 South Street, Kogarah, Sydney, NSW 2217, Australia.
| |
Collapse
|
16
|
Abstract
Because of the lack of bony restraints and minimal articular contact, the glenohumeral joint can attain significant range of motion; however, this results in the propensity for instability. The most generic form of instability, traumatic anterior instability, reliably produces a series of pathoanatomic findings. While reliable, these findings contribute to the complexities of caring for patients after an initial instability event. Numerous studies have examined this issue and determined that careful consideration of patient factors can guide successful treatment, whether it be surgical or nonsurgical, after initial instability. Such forms of treatment have shown to provide a good functional outcome and decreases morbidity. To be able to provide successful treatment requires a thorough understanding of the pathoanatomic of an instability event and the intricacies of the evaluation of a patient after an initial instability event.
Collapse
|
17
|
Russo R, Maiotti M, Taverna E, Rao C. Arthroscopic Bone Graft Procedure Combined With Arthroscopic Subscapularis Augmentation for Recurrent Anterior Instability With Glenoid Bone Defect. Arthrosc Tech 2018; 7:e623-e632. [PMID: 29955568 PMCID: PMC6020248 DOI: 10.1016/j.eats.2018.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/17/2018] [Indexed: 02/03/2023] Open
Abstract
Glenoid bone loss and capsular deficiency represent critical points of arthroscopic Bankart repair failures. The purpose of this Technical Note is to present an all-arthroscopic bone block procedure associated with arthroscopic subscapularis augmentation for treating glenohumeral instability with glenoid bone loss and anterior capsulolabral deficiency. Two glenoid tunnels are set up from the posterior to the anterior side using a dedicated bone block guide, and 4 buttons are used to fix the graft to the glenoid. The subscapularis tenodesis is performed using a suture tape anchor. This combined arthroscopic technique (bone block associated with arthroscopic subscapularis augmentation) could be a valid and safe alternative to the arthroscopic or open Latarjet procedures.
Collapse
Affiliation(s)
- Raffaele Russo
- Orthopedics and Traumatology Unit, Pellegrini Hospital, Naples, Italy
| | - Marco Maiotti
- Sports Medicine Unit and Orthopedic Center, San Giovanni Addolorata Hospital, Rome, Italy
| | - Ettore Taverna
- Orthopedics and Traumatology Unit, Galeazzi Hospital, Milan, Italy
| | - Cecilia Rao
- Orthopedics and Traumatology Unit, University of Tor Vergata, Rome, Italy
| |
Collapse
|
18
|
Variability of Outcome Reporting Following Arthroscopic Bankart Repair in Adolescent Athletes: A Systematic Review. Arthroscopy 2018; 34:1288-1294. [PMID: 29373288 DOI: 10.1016/j.arthro.2017.10.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/15/2017] [Accepted: 10/15/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To conduct a systematic review of the literature to assess the variability of the reporting of outcome measures after arthroscopic Bankart repair for traumatic anterior shoulder instability in the adolescent population. METHODS A systematic review was conducted investigating all studies reporting outcomes after arthroscopic Bankart repair in the adolescent population. Four databases (Medline, EMBASE, Ovid, and Google Scholar) were screened for clinical studies involving the arthroscopic management of anterior shoulder instability in adolescents. A full-text review of eligible studies was conducted. Inclusion and exclusion criteria were applied to the searched studies. A quality assessment was completed for each included study using the Methodological Index for Nonrandomized Studies instrument and the Center for Evidence-Based Medicine's Levels of Evidence Scale. RESULTS We identified 8 eligible studies involving 274 patients (282 shoulders). There was considerable variation with regard to reported outcomes after arthroscopic Bankart repair for anterior shoulder instability in the adolescent population. The most common patient-reported outcomes included the Rowe Score (50%), Single Assessment Numeric Evaluation (37.5%), American Shoulder and Elbow Surgeons Shoulder Outcome Score (25%), and the Constant Score (25%). Clinical outcomes reported included recurrence (100%), return to sport (62.5%), patient satisfaction (37.5%), stability (37.5%), pain scores (37.5%), and range of motion (12.5%). CONCLUSIONS There is considerable variation in reported clinical outcome measurements after arthroscopic Bankart repair for traumatic shoulder instability in the adolescent population. This study supports the need for standardized outcome reporting after arthroscopic anterior shoulder instability surgery in adolescents. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
Collapse
|
19
|
Ciccotti MC, Syed U, Hoffman R, Abboud JA, Ciccotti MG, Freedman KB. Return to Play Criteria Following Surgical Stabilization for Traumatic Anterior Shoulder Instability: A Systematic Review. Arthroscopy 2018; 34:903-913. [PMID: 29146162 DOI: 10.1016/j.arthro.2017.08.293] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 08/23/2017] [Accepted: 08/28/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify and describe in the existing literature any criteria used for return to play following surgical stabilization for traumatic, anterior shoulder instability. METHODS We performed a systematic review evaluating surgical stabilization for primary traumatic anterior shoulder instability in skeletally mature patients with a minimum of 1-year follow-up using Level I to IV studies in PubMed and EMBASE from January 1994 to January 2017. RESULTS Fifty-eight studies with at least 1 explicitly stated criterion for return to play were identified from a review of more than 5,100 published articles. Seven different categories of return to play criteria were identified, the most common of which were time from surgery (89.6%), strength (18.9%), and range of motion (13.8%). Pain, stability, proprioception, and postoperative radiographic evaluation were also used. As hypothesized, in 75.8% of the included studies (44/58), time was the only criterion explicitly used. The most commonly used time for return to play was 6 months. CONCLUSIONS This systematic review identifies 7 criteria that have been used in the available literature to determine when patients are ready to return to play; however, consistent with our hypothesis, 75% of studies used time from surgery as the sole listed criterion, with the most commonly used time point of 6 months postoperative. All of these criteria can be used in future research to develop a comprehensive checklist of functional criteria in hopes of reducing recurrent injury. LEVEL OF EVIDENCE Level IV, systematic review.
Collapse
Affiliation(s)
| | - Usman Syed
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Ryan Hoffman
- Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Joseph A Abboud
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Michael G Ciccotti
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Kevin B Freedman
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A..
| |
Collapse
|
20
|
Russo R, Maiotti M, Taverna E. Arthroscopic bone graft procedure combined with arthroscopic subscapularis augmentation (ASA) for recurrent anterior instability with glenoid bone defect: a cadaver study. J Exp Orthop 2018; 5:5. [PMID: 29484517 PMCID: PMC5826913 DOI: 10.1186/s40634-018-0121-0] [Citation(s) in RCA: 6] [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: 10/28/2017] [Accepted: 02/14/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Glenoid bone loss and capsular deficiency represent critical points of arthroscopic Bankart repair failures. The purpose of this study was to evaluate an all-arthroscopic bone block procedure associated with arthroscopic subscapularis augmentation (ASA) for treating gleno-humeral instability with glenoid bone loss (GBL) and anterior capsulo-labral deficiency. Our hypothesis was that these two procedures could be combined arthroscopically. The feasibility of this technique and its reproducibility, and potential neurovascular complications were evaluated. METHODS A tricortical bone graft was harvested from the cadaveric clavicle, and in one case a Xenograft was used. An anterior-inferior GBL of about 25% was created. Two glenoid tunnels were set up from the posterior to the anterior side using a dedicated bone block guide, and four buttons were used to fix the graft to the glenoid. The subscapularis tenodesis was performed using a suture tape anchor. Afterwards, the shoulder was dissected to study the relationship between all portals and nerves. The size of the bone block, its position on the glenoid and the relationship with the subscapularis tendon were investigated. RESULTS In all seven specimens (five left and two right shoulders), the bone block was flush with the cartilage and fixed to the anterior-inferior part of the glenoid. No lesions of the surrounding neurovascular structures were observed. No interference was found between the two bone block tunnels and the anchor tunnel used for the tenodesis. CONCLUSIONS This study demonstrated the feasibility and reproducibility of this combined arthroscopic technique (bone block associated with ASA) in the treatment of anterior shoulder instability associated with anterior bone loss and anterior capsular deficiency.
Collapse
Affiliation(s)
- Raffaele Russo
- Orthopedics and Traumatology Unit, Pellegrini Hospital, Via Portamedina alla Pignasecca 41, 80134 Naples, Italy
| | - Marco Maiotti
- Sports Medicine Unit & Orthopedic Center, San Giovanni Addolorata Hospital, Via dell’Amba Aradam 9, 00184 Rome, Italy
| | - Ettore Taverna
- Orthopedics and Traumatology Unit, Galeazzi Hospital, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| |
Collapse
|
21
|
Boddapati V, Fu MC, Schairer WW, Ranawat AS, Dines DM, Taylor SA, Dines JS. Increased Shoulder Arthroscopy Time Is Associated With Overnight Hospital Stay and Surgical Site Infection. Arthroscopy 2018; 34:363-368. [PMID: 28941946 DOI: 10.1016/j.arthro.2017.08.243] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/06/2017] [Accepted: 08/07/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to characterize the rates of short-term postoperative complications, readmissions, and overnight hospital stays as a function of shoulder arthroscopy procedure time. A secondary aim of this current study was to identify baseline patient risk factors for adverse outcomes. METHODS This study used the American College of Surgeons National Surgical Quality Improvement Program registry from 2012 to 2015. Shoulder arthroscopy cases were categorized based on operative time, either <45 minutes, between 45 and 90 minutes, or >90 minutes. The rates of 30-day postoperative complications, readmissions, and overnight hospital stays were compared with bivariate and multivariate analysis. RESULTS In total, 33,095 shoulder arthroscopy procedures were identified. Of these, 7,027 (21.2%) were <45 minutes, 16,610 (50.2%) were between 45 and 90 minutes, and 9,458 (28.6%) were >90 minutes. Multivariate analysis identified increased the risk of superficial surgical site infections (SSIs) for procedures lasting between 45 and 90 minutes (odds ratio [OR] = 3.63; P = .036) and for procedures >90 minutes (OR = 4.40; P = .019), compared with procedures <45 minutes. Furthermore, there was an increased risk of overnight hospital stay for patients who had a shoulder arthroscopy lasting between 45 and 90 minutes (OR = 1.33) and >90 minutes (OR = 2.14), compared with procedures <45 minutes. A body mass index >30 kg/m2 was an independent predictor of both overnight hospital stay and superficial SSI (P = .020). Age >60, female gender, American Society of Anesthesiologists class ≥3, and a history of diabetes mellitus, hypertension, or chronic obstructive pulmonary disease were additional predictors of overnight hospital stay (P < .001 for all comparisons, unless otherwise noted). CONCLUSIONS Increased shoulder arthroscopy procedure time is associated with adverse short-term outcomes, particularly superficial SSI and overnight hospital stay. This information may be useful for patient counseling and postoperative risk stratification, as operative time is an easily measured surrogate for surgical complexity or difficulty. LEVEL OF EVIDENCE Retrospective cohort study, Level III.
Collapse
Affiliation(s)
- Venkat Boddapati
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York, U.S.A..
| | - Michael C Fu
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York, U.S.A
| | - William W Schairer
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York, U.S.A
| | - Anil S Ranawat
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York, U.S.A
| | - David M Dines
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York, U.S.A
| | - Samuel A Taylor
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York, U.S.A
| | - Joshua S Dines
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York, U.S.A
| |
Collapse
|
22
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the epidemiology, pathoanatomy, diagnosis, and clinical management of pediatric and adolescent patients following a first-time shoulder dislocation. RECENT FINDINGS Shoulder instability is becoming increasingly common as pediatric and adolescent patients engage in earlier organized sports competition. Recommended treatment following a first-time glenohumeral dislocation event in adolescents depends on several factors, but surgical stabilization is becoming more frequently performed. Surgical indications include bony Bankart lesion, ALPSA lesion, bipolar injury (e.g. Hill-Sachs humeral head depression fracture) or off-season injury in an overhead or throwing athlete. Complications following surgical treatment are rare but most commonly are associated with recurrent instability. Young children (eg. open proximal humerus growth plate), individuals averse to surgery, or in-season athletes who accept the risk of redislocation may complete an accelerated rehabilitation program for expedited return to play in the absence of the structural abnormalities listed above. SUMMARY Following a first-time dislocation event in pediatric and adolescent patients, a detailed discussion of the risks and benefits of nonoperative versus operative management is critical to match the recommended treatment with the patient's injury pattern, risk factors, and activity goals.
Collapse
|
23
|
Elsenbeck MJ, Dickens JF. Return to Sports After Shoulder Stabilization Surgery for Anterior Shoulder Instability. Curr Rev Musculoskelet Med 2017; 10:491-498. [PMID: 29076041 PMCID: PMC5685962 DOI: 10.1007/s12178-017-9440-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW Young athletes continue to experience traumatic shoulder instability and are often plagued by recurrent instability, limiting their return to sport. The purpose of this paper was to review return to sport in athletes after shoulder stabilization surgery for anterior shoulder instability. RECENT FINDINGS Athletes managed nonoperatively demonstrate unacceptably high rates of recurrent instability and are less likely to successfully return to sport. Operative management includes capsuloligamentous repair (arthroscopic versus open) and bone augmentation techniques. While modern arthroscopic techniques have provided favorable outcomes, open techniques have demonstrated lower recurrence rates among young collision athletes. A subset of athletes continue to experience recurrent instability, leading to further investigation of concomitant pathologies, which may put patients at risk of failure following Bankart repair. Bony augmentation procedures remain favorable for patients with glenoid bone loss; however, what constitutes critical bone loss in the decision between anterior labral repair versus bone augmentation has recently been questioned. Operative management of anterior shoulder instability provides superior results, including lower recurrent instability and return to sport. Future research on patient-specific risk factors may aid surgical decision-making and optimization of outcomes.
Collapse
Affiliation(s)
- Michael J Elsenbeck
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bldg. 19, Fl 2, Bethesda, MD, 20889, USA
| | - Jonathan F Dickens
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bldg. 19, Fl 2, Bethesda, MD, 20889, USA.
| |
Collapse
|
24
|
Ialenti MN, Mulvihill JD, Feinstein M, Zhang AL, Feeley BT. Return to Play Following Shoulder Stabilization: A Systematic Review and Meta-analysis. Orthop J Sports Med 2017; 5:2325967117726055. [PMID: 28944249 PMCID: PMC5602217 DOI: 10.1177/2325967117726055] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Anterior shoulder instability can be a disabling condition for the young athlete; however, the best surgical treatment remains controversial. Traditionally, anterior shoulder instability was treated with open stabilization. More recently, arthroscopic repair of the Bankart injury with suture anchor fixation has become an accepted technique. HYPOTHESIS No systematic reviews have compared the rate of return to play following arthroscopic Bankart repair with suture anchor fixation with the Bristow-Latarjet procedure and open stabilization. We hypothesized that the rate of return to play will be similar regardless of surgical technique. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS We performed a systematic review and meta-analysis focused on return to play following shoulder stabilization. Inclusion criteria included studies in English that reported on rate of return to play and clinical outcomes following primary arthroscopic Bankart repair with suture anchors, the Latarjet procedure, or open stabilization. Statistical analyses included Student t tests and analyses of variance. RESULTS Sixteen papers reporting on 1036 patients were included. A total of 545 patients underwent arthroscopic Bankart repair with suture anchors, 353 with the Latarjet procedure, and 138 with open repair. No significant difference was found in patient demographic data among the studies. Patients returned to sport at the same level of play (preinjury level) more consistently following arthroscopic Bankart repair (71%) or the Latarjet procedure (73%) than open stabilization (66%) (P < .05). Return to play at any level and postoperative Rowe scores were not significantly different among studies. Recurrent dislocation was significantly less following the Latarjet procedure (3.5%) than after arthroscopic Bankart repair (6.6%) or open stabilization (6.7%) (P < .05). CONCLUSION This systematic review demonstrates a greater rate of return to play at the preinjury level following arthroscopic Bankart repair and the Latarjet procedure than open stabilization. Despite this difference, >65% of all treated athletes returned to sport at their preinjury levels, with other outcome measures being similar among the treatment groups. Therefore, arthroscopic Bankart repair, the Latarjet procedure, and open stabilization remain good surgical options in the treatment of the athlete with anterior shoulder instability.
Collapse
Affiliation(s)
- Marc N Ialenti
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Jeffrey D Mulvihill
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Max Feinstein
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, USA
| |
Collapse
|
25
|
Abstract
Background: Optimal surgical management of anterior shoulder instability remains controversial. There is a need to assess the most recent trends for primary and revision shoulder stabilization surgery using a national database significantly larger than those previously utilized. Hypothesis: Most shoulder stabilization procedures are performed arthroscopically. Examining revision procedures, we hypothesized that open procedures would result in decreased revision stabilizations compared with arthroscopic procedures and that most revision procedures would be open Bankart or bone transfer procedures regardless of the index procedure technique. Study Design: Descriptive epidemiology study. Methods: The MarketScan Database was searched using International Classification of Diseases–Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes to identify patients who underwent any shoulder stabilization procedure between 2008 and 2012. Regression analysis was used to evaluate trends between patient groups. The Cochran-Armitage trend test was used to identify differences in trends seen yearly. Odds ratios (ORs) were calculated to compare the likelihood of undergoing a revision stabilization procedure. Results: A total of 66,564 shoulder stabilization procedures were identified from 2008 through 2012: 60,248 arthroscopic stabilization procedures (90.5%) and 6316 open stabilization procedures (9.5%), including 1623 bone block procedures. Arthroscopic stabilization procedures increased in total number and percentage of all procedures in each year of the study. Bone block procedures increased in number each year, although other open procedures decreased during the study period. Males underwent more stabilization procedures, while patients between the ages of 10 and 19 years were most likely to undergo any procedure. Patients who underwent bone block stabilization were significantly less likely to undergo a second stabilization procedure during the study period when compared with open Bankart repair (OR, 0.582; 95% CI, 0.405-0.836; P < .05) and arthroscopic Bankart repair (OR, 0.587; 95% CI, 0.418-0.824; P < .05). No statistically significant difference in revision stabilization was seen when comparing arthroscopic versus open Bankart repair (OR, 0.934; 95% CI, 0.863-1.139). Conclusion: Although the number of arthroscopic shoulder stabilization surgeries continues to increase, our data show a consistent increase, not seen in prior studies, in the number of bone block procedures. Contrary to some studies, there was no significant difference in the likelihood of a second procedure between patients initially undergoing arthroscopic compared with open Bankart repair.
Collapse
Affiliation(s)
- Nicholas A Bonazza
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Penn State Health, Hershey, Pennsylvania, USA
| | - Guodong Liu
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Douglas L Leslie
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Aman Dhawan
- Department of Orthopaedics and Rehabilitation, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Penn State Health, Hershey, Pennsylvania, USA
| |
Collapse
|
26
|
Blonna D, Bellato E, Caranzano F, Assom M, Rossi R, Castoldi F. Arthroscopic Bankart Repair Versus Open Bristow-Latarjet for Shoulder Instability: A Matched-Pair Multicenter Study Focused on Return to Sport. Am J Sports Med 2016; 44:3198-3205. [PMID: 27501835 DOI: 10.1177/0363546516658037] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The arthroscopic Bankart repair and open Bristow-Latarjet procedure are the 2 most commonly used techniques to treat recurrent shoulder instability. PURPOSE To compare in a case control-matched manner the 2 techniques, with particular emphasis on return to sport after surgery. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A study was conducted in 2 hospitals matching 60 patients with posttraumatic recurrent anterior shoulder instability with a minimum follow-up of 2 years (30 patients treated with arthroscopic Bankart procedure and 30 treated with open Bristow-Latarjet procedure). Patients with severe glenoid bone loss and revision surgeries were excluded. In one hospital, patients were treated with arthroscopic Bankart repair using anchors; in the other, patients underwent the Bristow-Latarjet procedure. Patients were matched according to age at surgery, type and level of sport practiced before shoulder instability (Degree of Shoulder Involvement in Sports [DOSIS] scale), and number of dislocations. The primary outcomes were return to sport (Subjective Patient Outcome for Return to Sports [SPORTS] score), rate of recurrent instability, Oxford Shoulder Instability Score (OSIS), Subjective Shoulder Value (SSV), Western Ontario Shoulder Instability Index (WOSI), and range of motion (ROM). RESULTS After a mean follow-up of 5.3 years (range, 2-9 years), patients who underwent arthroscopic Bankart repair obtained better results in terms of return to sport (SPORTS score: 8 vs 6; P = .02) and ROM in the throwing position (86° vs 79°; P = .01), and they reported better subjective perception of the shoulder (SSV: 86% vs 75%; P = .02). No differences were detectable using the OSIS or WOSI. The rate of recurrent instability was not statistically different between the 2 groups (Bankart repair 10% vs Bristow-Latarjet 0%; P = .25), although the study may have been underpowered to detect a clinically important difference in this parameter. The multiple regression analysis showed that the independent variables associated with return to sport were preoperative DOSIS scale, type of surgery, and recurrent dislocations after surgery. Patients who played sports with high upper extremity involvement (eg, swimming, rugby, martial arts) at a competitive level (DOSIS scale 9 or 10) had a lower level of return to sport with both repair techniques. CONCLUSION Arthroscopic stabilization using anchors provided better return to sport and subjective perception of the shoulder compared with the open Bristow-Latarjet procedure in the population studied. Recurrence may be higher in the arthroscopic Bankart group; further study is needed on this point.
Collapse
Affiliation(s)
- Davide Blonna
- Mauriziano-Umberto I Hospital, Orthopedics and Traumatology Department, University of Turin Medical School, Turin, Italy
| | - Enrico Bellato
- Città della Salute e della Scienza, CTO-Maria Adelaide Hospital, Orthopedics and Traumatology Department, University of Turin Medical School, Turin, Italy
| | - Francesco Caranzano
- Mauriziano-Umberto I Hospital, Orthopedics and Traumatology Department, University of Turin Medical School, Turin, Italy
| | - Marco Assom
- Mauriziano-Umberto I Hospital, Orthopedics and Traumatology Department, University of Turin Medical School, Turin, Italy
| | - Roberto Rossi
- Mauriziano-Umberto I Hospital, Orthopedics and Traumatology Department, University of Turin Medical School, Turin, Italy
| | - Filippo Castoldi
- Città della Salute e della Scienza, CTO-Maria Adelaide Hospital, Orthopedics and Traumatology Department, University of Turin Medical School, Turin, Italy
| |
Collapse
|
27
|
Koyonos L, Kraeutler MJ, O'Brien DF, Ciccotti MG, Dodson CC. A prospective cohort study investigating the effect of generalized joint hypermobility on outcomes after arthroscopic anterior shoulder stabilization. PHYSICIAN SPORTSMED 2016; 44:380-384. [PMID: 27737608 DOI: 10.1080/00913847.2016.1248225] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Generalized joint laxity has been proposed as a significant risk factor for failure after arthroscopic anterior shoulder stabilization. The purpose of this study was to prospectively measure joint mobility in patients undergoing arthroscopic anterior shoulder stabilization and to determine whether hypermobility is a risk factor for worse outcomes compared with patients having normal joint mobility. METHODS Patients with anterior shoulder instability were prospectively enrolled. Generalized joint hypermobility was measured using the Beighton Hypermobility Score and the Rowe, UCLA, SANE, SST, and WOSI scores were administered and reported as patient outcomes preoperatively and following arthroscopic anterior shoulder stabilization at 6 weeks, 6 months, 12 months, and 24 months postoperatively. Patients were stratified into two groups based on their Beighton Hypermobility Score, with scores ≥ 4/9 indicative of joint hypermobility. RESULTS Sixteen patients with joint hypermobility (JH) and 18 non-hypermobile patients (NJH) were enrolled. At baseline, there were no significant differences in demographic characteristics or baseline patient-reported outcomes. Significantly more patients in the NJH group had SLAP tears (n = 10) compared to the JH group (n = 2) (p = .013). At all follow-up times, there were no significant differences between the NJH and JH groups with regard to patient-reported outcome scores (p > .05). In the JH group, 17% of patients reported recurrent instability at two years postoperatively compared to 25% of patients in the NJH group. There was no significant difference in failure rate (p = .67). CONCLUSION There was no significant difference in patient-reported outcomes or recurrent instability in patients with versus without joint hypermobility undergoing arthroscopic anterior shoulder stabilization.
Collapse
Affiliation(s)
- Loukas Koyonos
- a Department of Orthopedics , Kaiser Permanente Rock Creek , Lafayette , CO , USA
| | - Matthew J Kraeutler
- b Department of Orthopedics , University of Colorado School of Medicine , Aurora , CO , USA
| | - Daniel F O'Brien
- c Department of Orthopaedic Surgery , University of Connecticut , Farmington , CT , USA
| | - Michael G Ciccotti
- d The Rothman Institute , Thomas Jefferson University , Philadelphia , PA , USA
| | | |
Collapse
|
28
|
Mid-term results of arthroscopic Bankart repair: A review of 31 cases. Orthop Traumatol Surg Res 2016; 102:541-8. [PMID: 27364966 DOI: 10.1016/j.otsr.2016.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 04/12/2016] [Accepted: 04/25/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The goal of this study was to assess the overall function (Walch-Duplay score), stability, time and because it is time of return to sport and level of return to sport, and satisfaction of patients who underwent an arthroscopic Bankart repair for chronic anterior shoulder instability at 5 years' follow-up. In addition, the potential correlation between the postoperative Walch-Duplay score and the presence of risk factors for recurrence, the ISIS score, associated labral lesions discovered intraoperatively and clinical presentation was determined. MATERIAL AND METHODS This was a retrospective, single-centre study of 30 patients (31 arthroscopic Bankart procedures) operated between January 2003 and December 2012. The Walch-Duplay score, recurrence rate (dislocation or subluxation), return to sports and subjective satisfaction were evaluated. RESULTS The mean postoperative Duplay score was 77.4 points (100-15)±30.6. At review, 25.8% of patients had recurrence of the preoperative symptoms, including 16.1% glenohumeral dislocation and 9.7% subluxation. Patients requiring revision surgery (Bristow-Latarjet procedure) had no additional instability episodes. Among the athletes, 16 (66.6%) returned to their pre-injury level, four (16.6%) changed to a different sport and four stopped participating (16.6%). The subjective evaluation of the procedure was satisfactory in 75% of cases. No risk factors for recurrence were significantly related to the Walch-Duplay score. CONCLUSION Despite satisfactory Walch-Duplay scores and subjective results, this mid-term follow-up study revealed a significant number of patients with recurrent instability after arthroscopic Bankart repair, confirming published data. Careful patient selection is essential prior to proposing this procedure and patients should be informed of the potential risk of revision surgery. LEVEL OF EVIDENCE Level IV, retrospective study.
Collapse
|
29
|
Virk MS, Manzo RL, Cote M, Ware JK, Mazzocca AD, Nissen CW, Shea KP, Arciero RA. Comparison of Time to Recurrence of Instability After Open and Arthroscopic Bankart Repair Techniques. Orthop J Sports Med 2016; 4:2325967116654114. [PMID: 27570783 PMCID: PMC4999537 DOI: 10.1177/2325967116654114] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: The results of open and arthroscopic instability repairs have been shown to be equivalent in recent literature. Purpose: To compare the time to recurrence (TTR) of instability and disease-specific outcome measures in patients undergoing open and arthroscopic Bankart repair. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with recurrent traumatic anterior shoulder instability and a Bankart lesion on diagnostic arthroscopy underwent either open Bankart repair (OB) or arthroscopic Bankart and suture capsulorrhaphy (ABSC) using suture anchors. There was a minimum follow-up of 24 months. The primary outcome measures included Western Ontario Shoulder Instability Index (WOSI) score and time to recurrence of instability (dislocation or subluxation). Rowe score, Simple Shoulder Test, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Short Form–12 (SF-12) score were also compared. Results: A total of 82 shoulders in 80 patients (ABSC, n = 58; OB, n = 24) were evaluated at a mean of 39 months postoperatively. There were 4 clinical failures in the OB group (4 dislocations) and 7 clinical failures in the ABSC group (2 dislocations and 5 subluxations; P = .72 vs OB). The mean time to recurrence of postoperative instability was significantly shorter in the ABSC group (12.6 ± 2.7 months) compared with the OB group (34.2 ± 12 months; P = .04). The WOSI score in the OB group (265 ± 48.1) was better but not statistically significantly compared with the ABSC group (449.8 ± 63.8; P = .06). Conclusion: The time to recurrence of instability after open Bankart repair is significantly longer compared with arthroscopic Bankart repair. Clinical Relevance: Delayed time to recurrence after open Bankart repair suggests that the open technique may be more suited to withstand the high stress and demands of a heavy-duty profession (contact athletes and heavy manual labor).
Collapse
Affiliation(s)
- Mandeep S Virk
- Department of Orthopaedic Surgery, Division of Shoulder & Elbow, New York University Hospital for Joint Diseases, New York, New York, USA
| | | | - Mark Cote
- Department of Orthopaedic Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - James K Ware
- Department of Orthopaedic Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Carl W Nissen
- Department of Orthopaedic Surgery, Elite Sports Medicine, Children's Connecticut Medical Center, Farmington, Connecticut, USA
| | - Kevin P Shea
- Department of Orthopaedic Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Robert A Arciero
- Department of Orthopaedic Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| |
Collapse
|
30
|
Clinical and radiological outcome after mini-open Latarjet technique with fixation of coracoid with Arthrex wedge mini-plate. J Clin Orthop Trauma 2016; 7:23-9. [PMID: 26908972 PMCID: PMC4735561 DOI: 10.1016/j.jcot.2015.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 09/15/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Technical faults leading to coracoid fractures during screw insertion and coracoid graft osteolysis are concerns with standard screw fixation techniques in Latarjet procedure. The purpose of this study is to share our experience using Arthrex wedge profile plate with mini-open technique for graft fixation, that ensures better load distribution between coracoid graft and glenoid. METHODS We did retrospective analysis of 24 patients with recurrent anterior shoulder instability after failed arthroscopic Bankart's repair. Arthroscopic examination of affected shoulder was done in lateral position before making patient supine for open Latarjet. A low profile wedge plate (Arthrex) with two screws was used for the procedure. CT analysis was performed post-operatively at 6 months to see graft union and results were evaluated using the Rowe and Walch Duplay score. RESULTS Mean follow-up time was 26 months. Postoperatively, mean forward elevation was 170.6 + 4.6° (loss of average 5.9°) and mean external rotation was 42.5 + 5.3° (loss of average 3.1°). All patients returned to their previous occupation. None reported to be having any recurrent subluxation. Functional assessment done using Rowe score and Walch Duplay score showed statistically significant improvement (p value 0.034). There were no implant-related complications and no case of coracoid graft osteolysis. CONCLUSIONS Mini-open Latarjet with graft fixation with Arthrex mini-plate provides satisfactory outcome in patients who require reoperation due to dramatic bone loss and failed soft tissue reconstruction. The modified incision improves exposure enabling plate fixation and the secure fixation accelerates rehabilitation.
Collapse
|
31
|
Poehling-Monaghan KL, Krych AJ, Dahm DL. Arthroscopic Repair of a Posterior Bony Bankart Lesion. Arthrosc Tech 2015; 4:e669-73. [PMID: 26870644 PMCID: PMC4738367 DOI: 10.1016/j.eats.2015.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 07/14/2015] [Indexed: 02/03/2023] Open
Abstract
Posterior bony defects of the glenoid rim, particularly those associated with instability, are often a frustrating challenge for arthroscopists because of the defects' inaccessibility from standard portals. This challenge is enhanced when the lesion is chronic and fibrous malunion of the fragment makes mobilization difficult. We present our technique for arthroscopic repair of the relatively uncommon chronic posterior bony Bankart lesion. By use of lateral positioning and a standard anterior viewing portal and posterior working portal, as well as a strategically placed posterolateral accessory portal, the lesion is first freed from its malreduced position and ultimately repaired using suture anchor fixation of the bony fragment along with its associated labrum directly to the remaining glenoid rim. This technique, facilitated by precise portal placement, results in satisfactory fragment reduction, appropriate capsular tension, and restoration of anatomy.
Collapse
Affiliation(s)
- Kirsten L. Poehling-Monaghan
- Address correspondence to Kirsten L. Poehling-Monaghan, M.D., Department of Orthopedic Surgery, Mayo Clinic, 300 First St SW, Rochester, MN 55905, U.S.A.
| | | | | |
Collapse
|
32
|
Yamamoto N, Kijima H, Nagamoto H, Kurokawa D, Takahashi H, Sano H, Itoi E. Outcome of Bankart repair in contact versus non-contact athletes. Orthop Traumatol Surg Res 2015; 101:415-9. [PMID: 25907514 DOI: 10.1016/j.otsr.2015.03.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 02/03/2015] [Accepted: 03/09/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The clinical results of arthroscopic Bankart repair for contact athletes varies according to published reports. The purposes of this study were to analyze the clinical outcome of open or arthroscopic Bankart repair and to investigate the results in contact and non-contact athletes. HYPOTHESIS Clinical outcome of arthroscopic Bankart repair is similar to that of open procedure. PATIENTS AND METHODS One hundred patients with recurrent anterior shoulder dislocation without a large bony defect were retrospectively reviewed. Fifty-one contact and 49 non-contact athletes were found with a mean follow-up of 17 months. Forty-nine shoulders underwent arthroscopic Bankart repairs; 51 shoulders had open Bankart repairs. RESULTS In non-contact athletes, there was a 5% (1/22 cases) recurrence rate in the open group and 4% (1/27 cases) in the arthroscopic group. In contrast, in contact athletes, there was a 10% (3/29 cases) recurrence rate in the open group and 14% (3/22 cases) in the arthroscopic group. There was no significant difference in the recurrence rate between contact and non-contact athletes, although contact athletes showed two to three times a higher recurrence rate than that of non-contact athletes. The Rowe score and Constant score showed no significant difference between the two procedures and between the contact and non-contact athletes. The rate of the complete return to sports showed no significant difference between contact and non-contact athletes. CONCLUSION The recurrence rate of Bankart repair in the contact athletes was 2 times higher in the open group and 3 times higher in the arthroscopic group than in the non-contact athletes. Clinical outcome of arthroscopic Bankart repair was similar to that of open procedure.
Collapse
Affiliation(s)
- N Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - H Kijima
- Department of Orthopaedic Surgery, Akita University School of Medicine, Akita, Japan
| | - H Nagamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - D Kurokawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - H Takahashi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - H Sano
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - E Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
| |
Collapse
|
33
|
Irion V, Cheah M, Jones GL, Bishop JY. The isolated inferior glenohumeral labrum injury, anterior to posterior (the ILAP): A case series. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2015; 9:13-9. [PMID: 25709240 PMCID: PMC4325385 DOI: 10.4103/0973-6042.150218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION We describe the presentation, exam findings, surgical repair techniques, and short-term outcomes in a series of patients with isolated inferior labral tears. MATERIALS AND METHODS A retrospective chart review was performed at a large academic medical center. Isolated inferior labral tears were defined as between the 4 o'clock and 8 o'clock position of the glenoid as determined by direct arthroscopic visualization. Tears that were smaller were also included but were required to cross the 6 o'clock point, having anterior and posterior components. Patients were excluded if they had any other pathology or treatment of the shoulder. 1-year follow-up was required. RESULTS Of the 17 patients who met inclusion criteria for review, 12 were available for a minimum 1-year follow-up. Average total follow-up for patients to complete the phone interview/Oxford Shoulder Instability Score (OSIS) was an average of 37.7 months (range: 16-79 months). Postoperatively, all reported symptom improvement or resolution since surgery. The mean preoperative pain on a scale of 0-10 was 6.3 (range: 0-10). Mean postoperative pain on a scale of 0-10 was 2.25 (range: 0-5). Eleven of 12 patients (91.7%) had returned to the level of activity desired. The mean OSIS was 41.4 (median: 43; range: 27-47). Eleven of 12 patients (91.7%) had good or excellent scores. Ten of 12 patients (83.3%) had a feeling of stability in the shoulder. All 12 patients reached were satisfied with the procedure and would undergo surgery again in a similar situation. CONCLUSIONS We have presented our series of patients with isolated inferior labral injury, and have shown that when surgically treated, outcomes of this uncommon injury are good to excellent and a full return to sports can be expected.
Collapse
Affiliation(s)
- Val Irion
- Department of Orthopaedics, OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael Cheah
- Department of Orthopaedics, OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Grant L Jones
- Department of Orthopaedics, OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julie Y Bishop
- Department of Orthopaedics, OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
34
|
Abstract
Thorough evaluation of the athlete with persistent shoulder instability and appropriate use of imaging modalities, such as 3-dimensional computed tomography, can help quantify the severity of bony deficiency. Based on obtained imaging and examination, surgical and nonsurgical methods can be considered. In many situations both the humeral- and glenoid-sided bone loss must be addressed. Depending on the extent of bone loss, athletic demands, and surgeon experience, arthroscopic or open surgical options can provide shoulder stability and return athletes to their prior level of activity.
Collapse
|
35
|
Traumatic anterior instability of the pediatric shoulder: a comparison of arthroscopic and open bankart repairs. J Pediatr Orthop 2015; 35:1-6. [PMID: 25489944 DOI: 10.1097/bpo.0000000000000215] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Arthroscopic and open Bankart repairs have proven efficacy in adults with recurrent anterior shoulder instability. Although studies have included children in their analysis, none have previously compared functional outcomes or redislocation rates between these 2 methodologies for anteroinferior glenoid labrum repair in this young population. We hypothesize that open and arthroscopic Bankart repair in children will have similar functional outcomes and redislocation rates, but differing results from adults treated in a similar manner. METHODS A retrospective chart review was performed on all Bankart repairs performed between 2006 and 2010 at a tertiary care children's hospital. A shift in treatment modalities occurred in 2008 creating 2 cohorts, open and arthroscopic. Brachial plexus injury, congenital soft-tissue disorder, or incomplete charts were excluded. Demographics, age at surgery, follow-up length, and sport were recorded. Telephone interviews were then performed obtaining the most current QuickDASH (Disability Arm, Shoulder, or Hand), WOSI (Western Ontario Shoulder Instability Index), SF-12 (Short Form 12), SANE (Single Assessment Numeric Evaluation), and verbal pain scores; as well as, inquiring about recurrent dislocation and further surgery. RESULTS Ninety-nine children (16.9±1.5 y) were included (28 open, 71 arthroscopic). There were no differences in preoperative demographics. Fifty-one patients completed the questionnaires (11 open, 40 arthroscopic). No significant differences in the outcomes scores were seen between the 2 groups. Of the 99 patients, 21 (21%) had redislocation or secondary surgery; there was no significant difference in failure rate between groups (4 open, 17 arthroscopic). A plotted survival curve demonstrated that the adolescent shoulder undergoing Bankart repair for recurrent traumatic anterior instability has a 2-year survival of 86% and a 5-year survival of only 49%, regardless of technique. CONCLUSIONS In adolescents, there is no significant difference in functional outcomes or redislocation rates between open and arthroscopic Bankart repair, yet both demonstrate a very high risk of failure in this young, athletic population which contrasts the results in the historic adult population. LEVEL OF EVIDENCE Level III-retrospective comparative study.
Collapse
|
36
|
Dickens JF, Owens BD, Cameron KL, Kilcoyne K, Allred CD, Svoboda SJ, Sullivan R, Tokish JM, Peck KY, Rue JP. Return to play and recurrent instability after in-season anterior shoulder instability: a prospective multicenter study. Am J Sports Med 2014; 42:2842-50. [PMID: 25378207 DOI: 10.1177/0363546514553181] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [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 no consensus on the optimal treatment of in-season athletes with anterior shoulder instability, and limited data are available to guide return to play. PURPOSE To examine the likelihood of return to sport and the recurrence of instability after an in-season anterior shoulder instability event based on the type of instability (subluxation vs dislocation). Additionally, injury factors and patient-reported outcome scores administered at the time of injury were evaluated to assess the predictability of eventual successful return to sport and time to return to sport during the competitive season. STUDY DESIGN Cohort study (prognosis); Level of evidence, 2. METHODS Over 2 academic years, 45 contact intercollegiate athletes were prospectively enrolled in a multicenter observational study to assess return to play after in-season anterior glenohumeral instability. Baseline data collection included shoulder injury characteristics and shoulder-specific patient-reported outcome scores at the time of injury. All athletes underwent an accelerated rehabilitation program without shoulder immobilization and were followed during their competitive season to assess the success of return to play and recurrent instability. RESULTS Thirty-three of 45 (73%) athletes returned to sport for either all or part of the season after a median 5 days lost from competition (interquartile range, 13). Twelve athletes (27%) successfully completed the season without recurrence. Twenty-one athletes (64%) returned to in-season play and had subsequent recurrent instability including 11 recurrent dislocations and 10 recurrent subluxations. Of the 33 athletes returning to in-season sport after an instability event, 67% (22/33) completed the season. Athletes with a subluxation were 5.3 times more likely (odds ratio [OR], 5.32; 95% CI, 1.00-28.07; P = .049) to return to sport during the same season when compared with those with dislocations. Logistic regression analysis suggests that the Western Ontario Shoulder Instability Index (OR, 1.05; 95% CI, 1.00-1.09; P = .037) and Simple Shoulder Test (OR, 1.03; 95% CI, 1.00-1.05; P = .044) administered after the initial instability event are predictive of the ability to return to play. Time loss from sport after a shoulder instability event was most strongly and inversely correlated with the Simple Shoulder Test (P = .007) at the time of initial injury. CONCLUSION In the largest prospective study evaluating shoulder instability in in-season contact athletes, 27% of athletes returned to play and completed the season without subsequent instability. While the majority of athletes who return to sport complete the season, recurrent instability events are common regardless of whether the initial injury was a subluxation or dislocation.
Collapse
Affiliation(s)
- Jonathan F Dickens
- Uniformed Services University of Health Sciences, Bethesda, Maryland, USA John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Brett D Owens
- Uniformed Services University of Health Sciences, Bethesda, Maryland, USA John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Kenneth L Cameron
- John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Kelly Kilcoyne
- Uniformed Services University of Health Sciences, Bethesda, Maryland, USA Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - C Dain Allred
- United States Air Force Academy, Colorado Springs, Colorado, USA
| | - Steven J Svoboda
- Uniformed Services University of Health Sciences, Bethesda, Maryland, USA John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Robert Sullivan
- United States Air Force Academy, Colorado Springs, Colorado, USA
| | - John M Tokish
- Uniformed Services University of Health Sciences, Bethesda, Maryland, USA Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Karen Y Peck
- John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - John-Paul Rue
- Naval Heath Clinic Annapolis, United States Naval Academy, Annapolis, Maryland, USA
| |
Collapse
|
37
|
Mohtadi NGH, Chan DS, Hollinshead RM, Boorman RS, Hiemstra LA, Lo IKY, Hannaford HN, Fredine J, Sasyniuk TM, Paolucci EO. A randomized clinical trial comparing open and arthroscopic stabilization for recurrent traumatic anterior shoulder instability: two-year follow-up with disease-specific quality-of-life outcomes. J Bone Joint Surg Am 2014; 96:353-60. [PMID: 24599195 DOI: 10.2106/jbjs.l.01656] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The literature comparing open and arthroscopic repair for glenohumeral instability is conflicting. We performed a prospective, expertise-based, randomized clinical trial to compare open shoulder stabilization with arthroscopic shoulder stabilization by measuring quality-of-life outcomes and recurrence rates at two years among patients treated for traumatic anterior shoulder instability. METHODS Computer-generated, variable-block-size, concealed randomization allocated 196 patients to either the open-repair group (n = 98) or the arthroscopic-repair group (n = 98). An expertise-based randomization design was employed to avoid a differential bias in terms of physician experience. Outcomes were measured at baseline, at three and six months postoperatively, and at one and two years postoperatively with use of the Western Ontario Shoulder Instability Index (WOSI) and the American Shoulder and Elbow Surgeons (ASES) functional outcome scale. Recurrent instability was also analyzed. RESULTS There were no significant differences in outcome scores at baseline. At two years, seventy-nine patients in the open group and eighty-three patients in the arthroscopic group were available for follow-up. There was no significant difference in mean WOSI scores between the groups; the mean WOSI score (and standard deviation) for the open group was 85.2 ± 20.4 (95% confidence interval [CI] = 80.5 to 89.8), and for the arthroscopic group, 81.9 ± 19.8 (95% CI = 77.4 to 86.4); p = 0.31. There was also no significant difference in mean ASES scores: 91.4 ± 12.7 (95% CI = 88.5 to 94.4) for the open group and 88.2 ± 15.9 (95% CI = 84.6 to 91.8) for the arthroscopic group; p = 0.17. Recurrence rates at two years were significantly different: 11% in the open group and 23% in the arthroscopic group (p = 0.05). Recurrent instability was more likely in patients with a preoperative Hill-Sachs lesion and in male patients who were twenty-five years old and younger. There was no significant difference in shoulder motion between the groups at two years. CONCLUSIONS There was no difference between open and arthroscopic repair in terms of patient quality of life. Open repair resulted in a significantly lower risk of recurrence. Secondary outcome data from this trial suggest that open surgical repair may be recommended to reduce the risk of recurrent instability in younger male patients with a Hill-Sachs lesion.
Collapse
Affiliation(s)
- Nicholas G H Mohtadi
- University of Calgary Sport Medicine Centre, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada. E-mail address for N.G.H. Mohtadi:
| | - Denise S Chan
- University of Calgary Sport Medicine Centre, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada. E-mail address for N.G.H. Mohtadi:
| | - Robert M Hollinshead
- University of Calgary Sport Medicine Centre, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada. E-mail address for N.G.H. Mohtadi:
| | - Richard S Boorman
- University of Calgary Sport Medicine Centre, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada. E-mail address for N.G.H. Mohtadi:
| | | | - Ian K Y Lo
- University of Calgary Sport Medicine Centre, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada. E-mail address for N.G.H. Mohtadi:
| | - Heather N Hannaford
- University of Calgary Sport Medicine Centre, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada. E-mail address for N.G.H. Mohtadi:
| | - Jocelyn Fredine
- University of Calgary Sport Medicine Centre, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada. E-mail address for N.G.H. Mohtadi:
| | | | - Elizabeth Oddone Paolucci
- Departments of Surgery and Community Health Science, University of Calgary, Faculty of Medicine, Foothills Medical Centre, North Tower, Room #1026, 1403 29 Street N.W., Calgary, AB T2N 2T9, Canada
| |
Collapse
|
38
|
Abstract
Shoulder arthroscopic procedures have become common in today's orthopedic practice. The safety of shoulder arthroscopy though well established, is not without complications both minor and significant. The true incidence of complications is difficult to identify in the current literature. However, as with all procedures, complications associated with shoulder arthroscopy do occur. General complications (ie, infection), those specific to shoulder arthroscopy (ie, positioning) and those associated with specific procedures (ie, failure) all have been recognized. The purpose of this article is to review the current literature regarding complications in shoulder arthroscopy, provide insight into the risk factors and types of complications and to provide guidelines on the prevention and management of complications if and when they occur.
Collapse
|
39
|
Ozturk BY, Maak TG, Fabricant P, Altchek DW, Williams RJ, Warren RF, Cordasco FA, Allen AA. Return to sports after arthroscopic anterior stabilization in patients aged younger than 25 years. Arthroscopy 2013; 29:1922-31. [PMID: 24286794 DOI: 10.1016/j.arthro.2013.09.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 09/08/2013] [Accepted: 09/10/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To prospectively evaluate the return-to-sports rates after arthroscopic anterior stabilization in patients aged younger than 25 years. METHODS Fifty-eight patients underwent arthroscopic capsulolabral repair for isolated anterior instability. The mean age at the time of surgery was 19.5 years (range, 12 to 24 years). At a mean follow-up of 27 months (range, 20 to 32 months), 53 patients (42 male and 11 female patients) were assessed with American Shoulder and Elbow Surgeons, L'Insalata, and visual analog scale scores, as well as physical examination. The rate of return to sports and risk factors for postoperative recurrence were evaluated. RESULTS The overall rate of return to sports at final follow-up was 87%. Forty patients returned to a preinjury level of sports activity after surgery. Six patients returned to less competitive activities. Seven patients who had a subsequent traumatic event resulting in dislocation or subluxation did not return to sports activities. Open revision repairs were performed in 5 patients with recurrent instability. The American Shoulder and Elbow Surgeons and L'Insalata scores improved from 66.9 to 83.2 and from 60.4 to 79.2, respectively (P < .001). The visual analog scale score improved from 3.1 to 1 (P < .001). No significant loss of external rotation was noted postoperatively (mean, 79°). Mattress repair was associated with a higher return-to-sports rate (P < .05). Multiple instability episodes (>5) and the presence of a Hill-Sachs lesion were associated with postoperative failure (P < .05). CONCLUSIONS Arthroscopic stabilization is a feasible surgical option in the young, athletic population. Mattress labral repair was associated with a higher rate of return to sports, whereas patients who had ligamentous laxity, multiple instability episodes (>5), and Hill-Sachs lesions had the greatest risk of recurrence. These factors should be given consideration in planning the appropriate treatment for anterior instability in this age group. LEVEL OF EVIDENCE Level IV, therapeutic case series.
Collapse
Affiliation(s)
- Burak Yagmur Ozturk
- Sports Medicine and Shoulder Surgery Service, Hospital for Special Surgery, New York, New York, U.S.A
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
Thorough evaluation of the athlete with persistent shoulder instability and appropriate use of imaging modalities, such as 3-dimensional computed tomography, can help quantify the severity of bony deficiency. Based on obtained imaging and examination, surgical and nonsurgical methods can be considered. In many situations both the humeral- and glenoid-sided bone loss must be addressed. Depending on the extent of bone loss, athletic demands, and surgeon experience, arthroscopic or open surgical options can provide shoulder stability and return athletes to their prior level of activity.
Collapse
Affiliation(s)
- Justin W Griffin
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | | |
Collapse
|
41
|
Harris JD, Romeo AA. Arthroscopic Management of the Contact Athlete with Instability. Clin Sports Med 2013; 32:709-30. [DOI: 10.1016/j.csm.2013.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
42
|
Recent advances in management of shoulder instability. APOLLO MEDICINE 2012. [DOI: 10.1016/j.apme.2012.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
43
|
Abstract
Shoulder dislocation and subluxation injuries are common in young athletes and most frequently occur during the competitive season. Controversy exists regarding optimal treatment of an athlete with an in-season shoulder dislocation, and limited data are available to guide treatment. Rehabilitation may facilitate return to sport within 3 weeks, but return is complicated by a moderate risk of recurrence. Bracing may reduce the risk of recurrence, but it restricts motion and may not be tolerated in patients who must complete certain sport-specific tasks such as throwing. Surgical management of shoulder dislocation or subluxation with arthroscopic or open Bankart repair reduces the rate of recurrence; however, the athlete is unable to participate in sport for the remainder of the competitive season. When selecting a management option, the clinician must consider the natural history of shoulder instability, pathologic changes noted on examination and imaging, sport- and position-specific demands, duration of treatment, and the athlete's motivation.
Collapse
|
44
|
Shapiro TA, Gupta A, McGarry MH, Tibone JE, Lee TQ. Biomechanical effects of arthroscopic capsulorrhaphy in line with the fibers of the anterior band of the inferior glenohumeral ligament. Am J Sports Med 2012; 40:672-80. [PMID: 22178582 DOI: 10.1177/0363546511430307] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is no consensus as to the amount and direction of capsular plication necessary to correct anterior shoulder instability without overconstraining the joint. HYPOTHESIS An arthroscopic capsulorrhaphy in line with the fibers of the inferior glenohumeral ligament (IGHL) in an anterior laxity model will restore glenohumeral kinematics to normal. STUDY DESIGN Controlled laboratory study. METHODS Six cadaveric specimens were tested in both the scapular and coronal plane in 3 conditions: intact, anterior instability, and plicated. The anterior instability model was created by stretching the shoulder 20% beyond the physiological external rotational range of motion, and plication was achieved by performing a 10-mm arthroscopic plication in line with the fibers of the anterior band of the IGHL. RESULTS Stretching significantly increased the rotational range of motion, while plication restored it back to that of the intact condition (P < .05). There were few significant changes in humeral head apex position across all 3 testing conditions. Plication significantly reduced anterior translation compared with the stretched condition (P < .05). Stretching and plication both significantly reduced contact area relative to the intact condition (P < .05). There were no significant differences between any of the 3 conditions for contact pressure and only few significant differences between the conditions for contact peak pressure. CONCLUSION A 10-mm capsular plication in line with the fibers of the anterior band of the IGHL effectively reduces capsular laxity without overconstraining the joint. CLINICAL RELEVANCE The fibers of the anterior band of the IGHL provide a useful arthroscopic anatomic landmark for the direction of anterior capsulorrhaphy.
Collapse
Affiliation(s)
- Todd A Shapiro
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System, Long Beach, CA 90822, USA
| | | | | | | | | |
Collapse
|
45
|
Privitera DM, Bisson LJ, Marzo JM. Minimum 10-year follow-up of arthroscopic intra-articular Bankart repair using bioabsorbable tacks. Am J Sports Med 2012; 40:100-7. [PMID: 22064607 DOI: 10.1177/0363546511425891] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are few long-term studies evaluating functional outcomes and rates of arthrosis after arthroscopic Bankart repair with bioabsorbable tacks. PURPOSE We evaluated the clinical and radiographic results of arthroscopic Bankart repair using intra-articular bioabsorbable tacks at a minimum of 10 years' follow-up. STUDY DESIGN Case series; Level of evidence, 4. METHODS Thirty-two consecutive patients were retrospectively identified. Twenty patients (63%) were evaluated at a mean follow-up of 13.5 years (range, 10.75-17.5 years) and average age of 43 years (range, 28-73 years). The surgical shoulder (SS) was compared with a healthy control shoulder (CS) in 15 of 20 patients. Outcome tools included the Western Ontario Shoulder Instability Index (WOSI) and Disabilities of the Shoulder, Arm, and Hand (DASH). Blinded, independent evaluators performed physical examinations and reviewed radiographs. RESULTS Thirteen patients (65%) had stable shoulders, 5 of 7 (25%) failed by dislocation, and 2 of 7 (10%) failed by signs of anterior instability on examination. Three patients underwent revision stabilization surgery. Average time to failure was 4.2 years (range, 0.25-14.7 years). Average WOSI and DASH scores were 80% and 7.3, respectively. The CS faired better than SS in WOSI scores (97% vs 83%, respectively; P = .008), main DASH scores (0.39 vs 6.79, respectively; P = .024), and the DASH sports module (0.00 vs 10.94, respectively; P = .043). Patients lost 5.9° of passive forward flexion (P = .031) and 4.3° of passive external rotation (P = .001). Forty percent returned to their preoperative sports level. Higher grades of arthrosis were seen in the SS (20% absent, 40% mild, 25% moderate, and 15% severe) versus CS (P = .002). CONCLUSION At long-term follow-up, 65% of patients treated with an arthroscopic Bankart repair using bioabsorbable tacks had a well-functioning, stable shoulder. Disability scores were greatest with sports; however, the majority of patients had well-preserved ranges of motion and good functional WOSI scores. Despite this, 40% had evidence of moderate to severe glenohumeral arthrosis.
Collapse
Affiliation(s)
- David M Privitera
- Department of Orthopaedics, State University of New York at Buffalo, Buffalo, NY 14215, USA.
| | | | | |
Collapse
|
46
|
Abstract
Dislocation of the shoulder joint is a common injury. Initial management takes the form of urgent reduction, for which many methods have been described. Associated injuries carry significant morbidity and must be recognised. Further post-reduction treatment for the first-time dislocator has traditionally been non-operative; however, increasing evidence suggests a role for acute surgical arthroscopic stabilisation in certain patient groups. This article aims to give an evidence-based overview of the epidemiology, pathology and initial and further treatment options for shoulder dislocation.
Collapse
Affiliation(s)
- Tim McBride
- South Birmingham Trauma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | | |
Collapse
|
47
|
Godin J, Sekiya JK. Systematic review of arthroscopic versus open repair for recurrent anterior shoulder dislocations. Sports Health 2011; 3:396-404. [PMID: 23016034 PMCID: PMC3445197 DOI: 10.1177/1941738111409175] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT It remains unknown if arthroscopic repair of recurrent anterior shoulder instability is as effective as open repair. OBJECTIVE The purpose of this study is to analyze the literature to provide clinical recommendations regarding the most appropriate therapeutic intervention for recurrent anterior shoulder instability. STUDY DESIGN Systematic review of level I and II studies. DATA SOURCES PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and secondary references from 1967 to March 2010 were appraised for studies that met the inclusion criteria. STUDY SELECTION Inclusion criteria were English-language level I or level II trials involving the treatment of recurrent anterior shoulder instability. Exclusion criteria included non-English-language studies; level III, IV, or V studies; and trials examining treatment of first-time shoulder dislocation, posterior shoulder dislocation, or diagnoses other than recurrent anterior shoulder dislocations. DATA EXTRACTION Included studies underwent quality appraisal independently by each author identifying strengths, weaknesses, and biases. RESULTS Four randomized controlled trials compared the use of arthroscopic and open repair for recurrent anterior shoulder dislocations. These studies show no statistically significant difference between the 2 operative approaches. No long-term follow-up data describing the effects of either surgical approach are available at this time. Each investigation had weaknesses in study design that decreased the validity of its findings. CONCLUSIONS While limited, the available evidence from randomized controlled trials does not show a statistically significant difference in redislocation rates, return to activity, and functional outcomes between the arthroscopic and open repair groups. Range of motion is marginally better following arthroscopic treatment when compared with open repair. Recommendations on the optimal surgical intervention cannot be provided.
Collapse
Affiliation(s)
- Jonathan Godin
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan
| | - Jon K. Sekiya
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
48
|
Brophy RH, Gill CS, Lyman S, Barnes RP, Rodeo SA, Warren RF. Effect of shoulder stabilization on career length in national football league athletes. Am J Sports Med 2011; 39:704-9. [PMID: 21084659 DOI: 10.1177/0363546510382887] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shoulder instability and surgical stabilization are common in college football athletes. The effect of shoulder stabilization during college on the length of an athlete's career in the National Football League (NFL) has not been well examined. HYPOTHESIS Athletes with a history of shoulder stabilization before the NFL combine have a shorter career than do matched controls. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A database containing the injury history and career NFL statistics of athletes from 1987 to 2000 was used to match athletes with a history of shoulder stabilization and no other surgery or significant injury to controls without a history of any previous surgery or significant injury. Athletes were matched by position, year drafted, round drafted, and additional minor injury history. RESULTS Forty-two athletes with a history of shoulder stabilization were identified and matched with controls. A history of shoulder stabilization significantly reduced the length of career in terms of years (5.2 ± 3.9 vs 6.9 ± 3.6 years; P = .01) and games played (56 ± 53 vs 77 ± 50, P = .03) as compared with controls. By position, linemen and linebackers (20 athletes) with a history of shoulder stabilization had a significantly shorter career in years (4.7 ± 3.8 vs 6.7 ± 3.4 years; P = .049) and games played (51 ± 58 vs 81 ± 48; P = .046) than did controls. Among the other positions (22 athletes), the difference was not statistically significant in this small cohort. CONCLUSION A history of shoulder stabilization shortens the expected career of a professional football player, particularly for linemen and linebackers. Further research is warranted to better understand how these injuries and surgeries affect an athlete's career and what can be done to improve the long-term outcome after treatment.
Collapse
Affiliation(s)
- Robert H Brophy
- Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
| | | | | | | | | | | |
Collapse
|
49
|
Abstract
As our understanding of the pathoanatomy of glenohumeral instability has improved, surgical techniques for the treatment of anterior instability have progressed. Many stabilization procedures are now successfully performed arthroscopically; open capsular shift, however, continues to play an important role in the management of instability in certain patients, providing an accurate and selective means of capsular plication. When performed with proper surgical technique, shoulder range of motion can be preserved with low recurrence rates and high subjective satisfaction, making the open capsular shift a durable and effective option in the modern management of shoulder instability.
Collapse
Affiliation(s)
- Karen J Boselli
- Center for Shoulder, Elbow and Sports Medicine, Department of Orthopaedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH 11, New York, NY 10032, USA
| | | | | |
Collapse
|
50
|
Sparks BS, Nyland J, Nawab A, Blackburn E, Krupp R, Caborn DNM. Biomechanical comparison of screw-in suture anchor-suture combinations used for Bankart repair. Arch Orthop Trauma Surg 2010; 130:321-7. [PMID: 19572140 DOI: 10.1007/s00402-009-0926-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Bankart repair laxity may contribute to pathologic joint instability. This biomechanical study compared two screw-in suture anchor-suture combinations under tensile loads. METHODS Twelve pairs of scapulae were implanted with either a 3 mm diameter, 14 mm long poly-L/D-lactide suture anchor with a suture eyelet (Group 1) or a 3.1 mm diameter, 11 mm long polylactide suture anchor with a molded eyelet (Group 2). Constructs were cyclically loaded between 25 and 50 N with a 25 N load increase every 25 cycles. RESULTS Group 2 displayed greater displacement at failure, had more specimens with > or =2 mm displacement by the 50 N interval (P = 0.014), and had displaced more by 100 N (P < or = 0.046). Group 1 displayed a stronger load-displacement at failure relationship than Group 2 (r (2) = 0.67 vs. r (2) = 0.37). CONCLUSION Construct differences may influence decisions regarding the required number of suture anchor-suture loops, the rehabilitation timetable, and the timing of return to unrestricted activities.
Collapse
Affiliation(s)
- Brad S Sparks
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, 210 East Gray Street, Louisville, KY 40202, USA
| | | | | | | | | | | |
Collapse
|