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Alhaskawi A, Zhou H, Dong Y, Ezzi SHA, Zou X, Weijie Z, Yi F, Abdalbary SA, Lu H. Extensor tendon rupture and preoperative mri confirmations of suture anchor prolapse: a case report and literature review. BMC Musculoskelet Disord 2024; 25:355. [PMID: 38704523 PMCID: PMC11069161 DOI: 10.1186/s12891-024-07476-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/26/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND While suture anchors are widely used in medical procedures for their advantages, they can sometimes lead to complications, including anchor prolapse. This article presents a unique case of suture anchor prolapse at the base of the distal phalanx of the little finger after extensor tendon rupture reconstruction surgery. CASE PRESENTATION A 35-year-old male, underwent extensor tendon rupture reconstruction using a non-absorbable suture anchor. After seven years the patient visited our outpatients complaining of stiffness, pain, and protrusion at the surgical site. Initial X-ray imaging suggested suggesting either a fracture of the distal phalanx or tendon adhesion but lacked a definitive diagnosis. Subsequent magnetic resonance imaging (MRI) revealed bone connectivity between the middle and distal phalanges with irregular signal shadow and unclear boundaries while maintaining a regular finger shape. MRI proved superior in diagnosing prolapsed suture anchors, marking the first reported case of its kind. Surgical intervention confirmed MRI findings. CONCLUSIONS Suture anchor complications, such as prolapse, are a concern in medical practice. This case underscores the significance of MRI for accurate diagnosis and the importance of tailored surgical management in addressing this uncommon complication.
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Affiliation(s)
- Ahmad Alhaskawi
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, P. R. China
| | - Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, P. R. China
| | - Yanzhao Dong
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, P. R. China
| | - Sohaib Hasan Abdullah Ezzi
- Department of Orthopedics of the Third Xiangya Hospital, Central South University, Tongzipo Rd, Changsha, Hunan, 410083, China
| | - Xiaodi Zou
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Province, 310003, Hangzhou, P. R. China
| | - Zhou Weijie
- Department of Orthopaedics, Joint Service Assurance Force 903 Hospital, Airport Road, Shangcheng District, Hangzhou City, Zhejiang Province, 310053, P.R. China
| | - Fangyu Yi
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, #548 Binwen Road, Hangzhou, Zhejiang Province, 310053, P.R. China
| | - Sahar Ahmed Abdalbary
- Department of Orthopedic Physical Therapy, Faculty of Physical Therapy, Nahda University in Beni Suef, Beni Suef, Egypt.
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, P. R. China.
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2
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Khan M, Bedi A, Degen R, Warner J, Bhandari M, Khan M, Degen R, Bhandari M, Bedi A, Warner J. A pilot multicenter randomized controlled trial comparing Bankart repair and remplissage with the Latarjet procedure in patients with subcritical bone loss (STABLE): study protocol. Pilot Feasibility Stud 2022; 8:20. [PMID: 35101120 PMCID: PMC8802453 DOI: 10.1186/s40814-022-00987-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 01/20/2022] [Indexed: 12/28/2022] Open
Abstract
Abstract
Introduction
Anterior dislocations, the most common type of shoulder dislocation, are often complicated by subsequent instability. With recurrent dislocations there often is attrition of the labrum and progressive loss of the anterior bony contour of the glenoid. Treatment options for this pathology involve either soft tissue repair or bony augmentation procedure. The optimal management remains unknown and current clinical practice is highly varied.
Methods and analysis
The Shoulder instability Trial comparing Arthroscopic stabilization Benefits compared with Latarjet procedure Evaluation (STABLE) is an ongoing multi-centre, pilot randomized controlled trial of 82 patients who have been diagnosed with recurrent anterior shoulder instability and subcritical glenoid bone loss. Patients are randomized to either soft tissue repair (Bankart + Remplissage) or bony augmentation (Latarjet procedure). The primary outcome for this pilot is to assess trial feasibility and secondary outcomes include recurrent instability as well as functional outcomes up to two years post-operatively.
Conclusions
This trial will help to identify the optimal treatment for patients with recurrent shoulder instability with a focus on determining which treatment option results in reduced risk of recurrent dislocation and improved patient outcomes. Findings from this trial will guide clinical practice and improve care for patients with shoulder instability.
Trial registration
This study has been registered on http://www.ClinicalTrials.gov with the following identifier: ClinicalTrials.gov Identifier: NCT03585491, registered 13 July 2018, https://www.clinicaltrials.gov/ct2/show/NCT03585491?term=NCT03585491&draw=2&rank=1.
Ethics and dissemination
This study has ethics approval from the McMaster University/Hamilton Health Sciences Research Ethics Board (REB) (approval #4942). Successful completion will significantly impact the global management of patients with recurrent instability. This trial will develop a network of collaboration for future high-quality trials in shoulder instability.
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3
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Vascellari A, Ramponi C, Venturin D, Ben G, Coletti N. The Relationship between Kinesiophobia and Return to Sport after Shoulder Surgery for Recurrent Anterior Instability. JOINTS 2021; 7:148-154. [PMID: 34235378 PMCID: PMC8253619 DOI: 10.1055/s-0041-1730975] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 04/18/2021] [Indexed: 11/22/2022]
Abstract
Purpose
To evaluate the relationship between kinesiophobia and patient's return to sport after shoulder stabilization surgery. The hypothesis was that kinesiophobia represents an independent factor correlated to the difference between preinjury and postoperative level of sport.
Methods
This study retrospectively evaluated 66 patients (mean age: 35.5, standard deviation [SD] = 9.9 years) and at a mean follow-up of 61.1 (SD = 37.5) months after arthroscopic Bankart's repair or open Bristow–Latarjet procedure. Kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK); return to the preinjury sport was assessed by the difference between baseline and postoperative degree of shoulder involvement in sport (D-DOSIS) scale. The Western Ontario Shoulder Instability index (WOSI) was used to evaluate participants' perceptions of shoulder function.
Results
TSK showed correlation with D-DOSIS (
ρ
= 0.505,
p <
0.001) and the WOSI score (
ρ
= 0.589,
p
< 0.001). There was significant difference in TSK and WOSI scores between participants who had and had not returned to their previous level of sport participation (
p
= 0.006, and 0.0001, respectively).
Conclusion
This study demonstrated that kinesiophobia is correlated to the return to sport after shoulder stabilization surgery.
Level of Evidence
Level IV, retrospective case series.
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Affiliation(s)
- Alberto Vascellari
- Kinè Physiotherapic and Orthopedic Center, San Vendemiano, Treviso, Italy
| | - Carlo Ramponi
- Kinè Physiotherapic and Orthopedic Center, San Vendemiano, Treviso, Italy
| | - Davide Venturin
- Kinè Physiotherapic and Orthopedic Center, San Vendemiano, Treviso, Italy
| | - Giulia Ben
- High Altitude Pediatric Asthma Center, Misurina Pio XII Institute, Belluno, Italy
| | - Nicolò Coletti
- Department of Orthopaedic and Traumatology, Oderzo Hospital, Oderzo, Treviso, Italy
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4
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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.
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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
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First-time Glenohumeral Dislocations: Current Evidence and Considerations in Clinical Decision Making. Sports Med Arthrosc Rev 2020; 28:122-131. [PMID: 33156225 DOI: 10.1097/jsa.0000000000000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The decision to manage first-time shoulder dislocations conservatively or operatively has become increasingly complex because of conflicting literature. Although shoulder dislocations have traditionally been managed with reduction and immobilization, recent evidence has suggested high rates of subsequent recurrence. Surgical intervention is thought to better restore stability and decrease recurrence rates; however, it also has the potential for additional morbidity and financial cost. As such, recent literature has sought to better define patient risk profiles to identify optimal candidates for both conservative and operative management. The purpose of the current review is to provide a comprehensive and evidence-based assessment of the most recent literature to better delineate an appropriate treatment algorithm for this challenging clinical scenario.
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6
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Algarni AD. Arthroscopic Bankart repair with knotless suture anchors: A comparison of the permanent and absorbable types. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2020. [DOI: 10.1177/2210491720953595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim: The aim of this study was to compare the clinical outcomes of arthroscopic Bankart repair (ABR) using two types of knotless suture anchors (KSAs) in patients with post-traumatic recurrent anterior glenohumeral instability (AGHI). Methods: Thirty-two patients underwent an ABR using KSAs: a permanent KSA (PushLock) and an absorbable counterpart (BioKnotless). There were 16 patients in each group. Pre-and post-operative assessment for shoulder function using the American Shoulder and Elbow Surgeons and Constant–Murley scores, recurrence of instability, post-operative limitation of external rotation (ER) and ability to return to pre-injury level were recorded in both groups. Results: Both groups displayed significant improvements in functional scores ( p < 0.0001) without a significant difference between the groups. Of the 32 patients, 9.4% had recurrence of instability (one re-dislocation in group 1 and two symptomatic subluxations in group 2). Return to pre-injury level occurred in 87.5% and 81.3% of group 1 and group 2, respectively. There was 2° to 3° loss of ER after ABR in both groups; the difference between the groups was not significant ( p = 0.45). Conclusion: ABR for recurrent AGHI using a permanent or absorbable KSA offers comparable successful outcomes; no significant statistical difference was found.
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7
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Elamo S, Selänne L, Lehtimäki K, Kukkonen J, Hurme S, Kauko T, Äärimaa V. Bankart versus Latarjet operation as a revision procedure after a failed arthroscopic Bankart repair. JSES Int 2020; 4:292-296. [PMID: 32490416 PMCID: PMC7256887 DOI: 10.1016/j.jseint.2020.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background An arthroscopic Bankart operation is the most common operative procedure to treat shoulder instability. In case of recurrence, both Bankart and Latarjet procedures are used as revision procedures. The purpose of this study was to compare the re-recurrence rate of instability and clinical results after arthroscopic revision Bankart and open revision Latarjet procedures following failed primary arthroscopic Bankart operations. Methods Consecutive patients operatively treated for shoulder instability at Turku University Hospital between 2002 and 2013 were analyzed. Patients who underwent a primary arthroscopic Bankart operation followed by a recurrence of instability and underwent a subsequent arthroscopic Bankart or open Latarjet revision operation with a minimum of 1 year of follow-up were called in for a follow-up evaluation. The re-recurrence of instability, Subjective Shoulder Value, and Western Ontario Shoulder Instability index were assessed. Results Of 69 patients, 48 (dropout rate, 30%) were available for follow-up. Recurrent instability symptoms occurred in 13 patients (43%) after the revision Bankart procedure and none after the revision Latarjet procedure. A statistically and clinically significant difference in the Western Ontario Shoulder Instability index was found between the patients after the revision Bankart and revision Latarjet operations (68% and 88%, respectively; P = .0166). Conclusions The redislocation rate after an arthroscopic revision Bankart operation is high. Furthermore, patient-reported outcomes remain poor after a revision Bankart procedure compared with a revision Latarjet operation. We propose that in cases of recurring instability after a failed primary Bankart operation, an open Latarjet revision should be considered.
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Affiliation(s)
- Sami Elamo
- Division of Musculoskeletal Diseases, Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland.,Department of Orthopaedics and Traumatology, Satakunta Central Hospital, Pori, Finland
| | - Liisa Selänne
- Division of Musculoskeletal Diseases, Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Kaisa Lehtimäki
- Division of Musculoskeletal Diseases, Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Juha Kukkonen
- Department of Orthopaedics and Traumatology, Satakunta Central Hospital, Pori, Finland
| | - Saija Hurme
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Tommi Kauko
- Auria Clinical Informatics, Hospital District of Southwest Finland, Turku, Finland
| | - Ville Äärimaa
- Division of Musculoskeletal Diseases, Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
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8
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Arthroscopic subscapularis augmentation combined with capsulolabral reconstruction is safe and reliable. Knee Surg Sports Traumatol Arthrosc 2019; 27:3997-4004. [PMID: 31377825 DOI: 10.1007/s00167-019-05648-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The study aimed to compare modified arthroscopic subscapularis augmentation (MASA) with tenodesis of the upper third of the subscapularis tendon using a tendon combined with capsulolabral reconstruction (Group A) or Bankart repair (Group B) for recurrent anterior shoulder instability (RASI). METHODS A retrospective series of 49 patients underwent primary surgery for RASI with glenoid bone loss (GBL) < 25%. Outcomes included the Oxford Shoulder Instability Score (OSIS), Visual Analogue Scale (VAS) score, Rowe score, and American Shoulder and Elbow Surgeons (ASES) functional outcome scale score. Recurrent instability, sports activity level, and range of motion (ROM) were also analysed. RESULTS No significant differences were observed at baseline. Forty-six patients were available for more than 2 years of follow-up. At the last follow-up after surgery, the patients in both groups had experienced significant improvements in all outcome scores (P < 0.05 for all), and obvious decreases in forward flexion and external rotation were noted in both groups (P < 0.05 for all). Group A had superior ASES scores, VAS scores, and OSISs (P < 0.05) but did not experience significant differences in either the Rowe score or ROM compared to Group B. Group A had lower rates of recurrent instability and superior outcomes for the return to sports activities. One patient in Group A had subluxation, and 4 patients in Group B had dislocation or subluxation. No patients in either group experienced neurovascular injury, joint stiffness, or surgical wound infection. CONCLUSION For RASI with GBL < 25%, MASA with tenodesis of the upper third of the subscapularis tendon using a tendon combined with capsulolabral reconstruction was a safe technique that produced better outcomes in terms of ASES scores, VAS scores, OSISs, the return to sports, and postoperative recurrent instability and did not decrease the ROM compared to that achieved by arthroscopic Bankart repair. LEVEL OF EVIDENCE III.
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9
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Petrera M, Ogilvie-Harris DJ, Theodoropoulos JS, Chahal J, Wasserstein D, Veillette C, Linda D, Dwyer T. Inter-surgeon variability in the identification of clock face landmarks when placing suture anchors in arthroscopic Bankart repair. Shoulder Elbow 2019; 11:419-423. [PMID: 32269601 PMCID: PMC7094062 DOI: 10.1177/1758573218797964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/30/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The accuracy of surgeons in utilizing the clock face method for anchor placement has never been investigated. Our hypothesis was that shoulder arthroscopy surgeons would be able to place suture anchors at predetermined positions with accuracy and reliability. METHODS Ten cadaveric shoulders were used. Five fellowship-trained shoulder arthroscopy surgeons were directed to place a suture anchor at 3:30, 4:30, and 5:30 clock in two shoulders each. The position of the anchors was determined with computed tomography. The accuracy of placement was calculated and data analyzed with one-way analysis of variance. The intraclass correlation coefficients were calculated. RESULTS The overall accuracy was 57%. The accuracy of anchor placement at the 3:30 position was 40% (average position 2:24 o'clock), it was 50% at the 4:30 position (average position 3:42 o'clock) and 80% at the 5:30 position (average position 5:03 o'clock). No statistical difference in accuracy between the placement of the superior, middle, and inferior anchors (p = 0.145) was seen. The intraclass correlation coefficient for inter-surgeon reliability was 0.4 (fair) while the intraclass correlation coefficient for intra-surgeon reliability was 0.6 (moderate). DISCUSSION The findings of this study suggest a moderate degree of accuracy and fair to moderate inter- and intra-surgeon reliability when using the clock face system to guide anchor placement.
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Affiliation(s)
- Massimo Petrera
- Division of Orthopaedic Surgery,
University
of Ottawa, Ottawa, Canada,Massimo Petrera, Division of Orthopaedics,
University of Ottawa, The Ottawa Hospital – General Campus – CCW Room 1637,
Ottawa, ON K1H 8L6, Canada.
| | - Darrell J Ogilvie-Harris
- University of Toronto Orthopaedic Sports
Medicine (UTOSM) Program, Division of Orthopaedics, Toronto Western Hospital and
Women’s College Hospital, Toronto, Canada
| | - John S Theodoropoulos
- University of Toronto Orthopaedic Sports
Medicine (UTOSM) Program, Division of Orthopaedics, Mount Sinai Hospital and Women’s
College Hospital, Toronto, Canada
| | - Jaskarndip Chahal
- University of Toronto Orthopaedic Sports
Medicine (UTOSM) Program, Division of Orthopaedics, Toronto Western Hospital and
Women’s College Hospital, Toronto, Canada
| | - David Wasserstein
- University of Toronto Orthopaedic Sports
Medicine (UTOSM) Program, Division of Orthopaedics, Sunnybrook Health Sciences
Centre, Toronto, Canada
| | - Christian Veillette
- University of Toronto Orthopaedic Sports
Medicine (UTOSM) Program, Division of Orthopaedics, Toronto Western Hospital,
Toronto, Canada
| | - Dorota Linda
- Joint Department of Medical Imaging,
University of Toronto, Toronto, Canada
| | - Tim Dwyer
- University of Toronto Orthopaedic Sports
Medicine (UTOSM) Program, Division of Orthopaedics, Mount Sinai Hospital and Women’s
College Hospital, Toronto, Canada
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10
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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]
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11
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Alidousti A, Mirzaee F, Bahramian F, Zafarani Z, Mirzaei N, Aslani H. Repair of Massive and Irreparable Rotator Cuff Tear Using Arthroscopic Method. J Lasers Med Sci 2018; 9:168-176. [PMID: 30809327 DOI: 10.15171/jlms.2018.31] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Rotator cuff tear stands as one of the major origins of shoulder discomfort and disability, especially in elderly patients over 60 years. Improvement of performance and reduction of pain hardly occur in patients with contracted rotator cuff tear. Despite therapeutic advances, yet there are many discussions over choosing the best type of treatment for major rotator cuff tear. Complete care of massive rotator cuff tear continues to be a challenge in shoulder surgery. Treatment options have changed in comparison with traditional treatment methods in open or arthroscopic debridement surgery with or without decompression. Recently, many treatments have been introduced, including a range of non-surgical treatments, acromioplasty by debridement, minor repair biceps tenotomy, tuberoplasty by biceps tenotomy, minor repair, mini-open rotator cuff repair, arthroscopic rotator cuff, muscle movement, reverse shoulder arthroscopy, soft tissue reinforcement and hemiarthroplasty. Non-surgical massive rotator cuff control is typically assigned for patients with insignificant pain. This therapy functions by changing activities, proper use of steroid injections and physical therapy with an emphasis on the anterior deltoid exercises. But the main problem is the selection of the best treatment and making the final decision. In general, in the arthroscopic, morbidity, postoperative pain along with hospital stay are less and the operation has better cosmetic results. So this information and our results have prompted us to study a variety of rotator cuff treatment methods with a focus on the arthroscopic treatment.
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Affiliation(s)
- Ardeshir Alidousti
- Islamic Azad University of Medical Sciences Qeshm Knee and Sport Medicine Research and Education Center, Milad Hospital, Tehran, Iran
| | - Fateme Mirzaee
- Knee and Sport Medicine Research and Education Center, Milad hospital, Tehran, Iran
| | - Fateme Bahramian
- Knee and Sport Medicine Research and Education Center, Milad hospital, Tehran, Iran
| | - Zohreh Zafarani
- Knee and Sport Medicine Research and Education Center, Milad hospital, Tehran, Iran
| | - Naeeme Mirzaei
- Islamic Azad University of Medical Sciences Tehran, Knee and Sport Medicine Research and Education Center, Milad Hospital, Tehran, Iran
| | - Hamidreza Aslani
- Knee and Sport Medicine Research and Education Center, Milad hospital, Tehran, Iran
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12
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Abstract
Operative treatment of the unstable shoulder historically has a high success rate. However, the complication rate has risen. This article reviews the pearls and pitfalls to attempt to elucidate the etiology for these complications and failures. Preoperative assessment of the unstable shoulder ultimately is critical to avoid complications, including history, physical examination, and key radiographic features. Intraoperative techniques include appropriate soft tissue mobilization, multiple points of fixation, avoidance of hardware-related problems, and appropriate management of the capsule and bone defects. Finally, postoperative rehabilitation is equally important to regain physiologic range of motion in a safe, supervised fashion.
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Affiliation(s)
- William N Levine
- Department of Orthopedic Surgery, NYP/Columbia University Orthopedics, 622 West 168th Street, PH-1130, New York, NY 10032, USA.
| | - Julian J Sonnenfeld
- Department of Orthopedic Surgery, NYP/Columbia University Orthopedics, 622 West 168th Street, PH-1130, New York, NY 10032, USA
| | - Brian Shiu
- Department of Orthopedic Surgery, NYP/Columbia University Orthopedics, 622 West 168th Street, PH-1130, New York, NY 10032, USA
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13
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Arealis G, Rodrigues JB, Hope N, Levy O. The "Purse-string" Technique for Shoulder Stabilization, Description of the Technique, Long term Results and Literature Review. Open Orthop J 2017; 11:183-188. [PMID: 28400885 PMCID: PMC5366384 DOI: 10.2174/1874325001711010183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/14/2016] [Accepted: 04/20/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Over the last 2 decades arthroscopic stabilization and Bankart repair has gained popularity due to the advances in materials and surgical techniques. Results of arthroscopic stabilization have been similar to open without the risks of it. The number of anchors used has been suggested to be very important in "spot-weld" arthroscopic stabilization however the "purse-string" technique (PST) can achieve similar results using only one anchor. We describe technique and long term results from using the PST and search the literature for other papers regarding PST. METHODS Between 2003 and 2013 a total of 193 patients were operated. Patients included those with anterior instability. Using PubMed relevant studies reporting results of PST were identified. RESULTS Mean follow up was 2 (range 0.5 to 3) years. 9 (4.7%) patients experienced recurrent instability. Almost all patients (97%) returned to their sporting and leisure activities and all professional athletes went back to the same sport. One more UK centre reported 6.1% recurrence in 114 patients at 4 years follow up. These results are similar to the published 11% recurrence of instability after "spot-weld" arthroscopic techniques at 11 years clinical follow-up. CONCLUSION This study indicates that PST is safe and effective alternative method for the treatment of anterior shoulder instability. In this technique with one anchor simultaneous repair of labrum, creation of an anterior bumper and capsular shift can be achieved. It has the advantage of being cheaper, faster yet efficient with good long term results and leaves space for revision anchors in case of recurrence.
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Affiliation(s)
- Georgios Arealis
- Reading Shoulder Unit, Royal Berkshire and Berkshire Independent Hospitals, Swallows Croft, Wensley Road, Coley Park, Reading, RG1 6UZ, United Kingdom
| | - Joana Bento Rodrigues
- Reading Shoulder Unit, Royal Berkshire and Berkshire Independent Hospitals, Swallows Croft, Wensley Road, Coley Park, Reading, RG1 6UZ, United Kingdom
| | - Natalie Hope
- Reading Shoulder Unit, Royal Berkshire and Berkshire Independent Hospitals, Reading, UK
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire and Berkshire Independent Hospitals, Reading, UK
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14
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Zimmermann SM, Scheyerer MJ, Farshad M, Catanzaro S, Rahm S, Gerber C. Long-Term Restoration of Anterior Shoulder Stability: A Retrospective Analysis of Arthroscopic Bankart Repair Versus Open Latarjet Procedure. J Bone Joint Surg Am 2016; 98:1954-1961. [PMID: 27926676 DOI: 10.2106/jbjs.15.01398] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Various operative techniques are used for treating recurrent anterior shoulder instability, and good mid-term results have been reported. The purpose of this study was to compare shoulder stability after treatment with the 2 commonly performed procedures, the arthroscopic Bankart soft-tissue repair and the open coracoid transfer according to Latarjet. METHODS A comparative, retrospective case-cohort analysis of 360 patients (364 shoulders) who had primary repair for recurrent anterior shoulder instability between 1998 and 2007 was performed. The minimum duration of follow-up was 6 years. Reoperations, overt recurrent instability (defined as recurrent dislocation or subluxation), apprehension, the subjective shoulder value (SSV), sports participation, and overall satisfaction were recorded. RESULTS An open Latarjet procedure was performed in 93 shoulders, and an arthroscopic Bankart repair was done in 271 shoulders. Instability or apprehension persisted or recurred after 11% (10) of the 93 Latarjet procedures and after 41.7% (113) of the 271 arthroscopic Bankart procedures. Overt instability recurred after 3% of the Latarjet procedures and after 28.4% (77) of the Bankart procedures. In the Latarjet group, 3.2% of the patients were not satisfied with their result compared with 13.2% in the Bankart group (p = 0.007). Kaplan-Meier analysis of survivorship, with apprehension (p < 0.001), redislocation (p = 0.01), and operative revision (p < 0.001) as the end points, documented the substantial superiority of the Latarjet procedure and the decreasing effectiveness of the arthroscopic Bankart repair over time. Twenty percent of the first recurrences after arthroscopic Bankart occurred no earlier than 91 months postoperatively, as opposed to the rare recurrences after osseous reconstruction, which occurred in the early postoperative period, with only rare late failures. CONCLUSIONS In this retrospective cohort study, the arthroscopic Bankart procedure was inferior to the open Latarjet procedure for repair of recurrent anterior shoulder dislocation. The difference between the 2 procedures with respect to the quality of outcomes significantly increased with follow-up time. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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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.
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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
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Parnes N, Blevins M, Carr B, Carey P. Arthroscopic Repair of Inferior Labrum Anterior to Posterior Lesions of the Shoulder Using a Combined "Double-Pulley" Simple Knot Technique. Arthrosc Tech 2016; 5:e685-e690. [PMID: 27709022 PMCID: PMC5039351 DOI: 10.1016/j.eats.2016.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 02/09/2016] [Indexed: 02/03/2023] Open
Abstract
Inferior labrum anterior to posterior lesions as an isolated injury or as part of an extensive traumatic labral tear are uncommon and may present as multidirectional instability of the shoulder. These lesions are hard to visualize radiographically and many times are diagnosed only during surgery. Arthroscopic repair of these lesions requires advanced arthroscopic skills and is required for restoration of glenohumeral stability. We report a combined double-pulley simple knot technique that anatomically reconstructs the inferior labrum while overcoming the typical technical challenges, providing a large footprint for healing along the inferior glenoid rim and minimizing the amount of suture material in direct contact with the articular cartilage and the risk of knot migration.
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Affiliation(s)
- Nata Parnes
- Tri-County Orthopedics, Carthage, New York, U.S.A
| | | | - Brian Carr
- Department of Orthopaedic Surgery, Guthrie Army Health Clinic, Fort Drum, New York, U.S.A
| | - Paul Carey
- Department of Orthopaedic Surgery, Guthrie Army Health Clinic, Fort Drum, New York, U.S.A.,Address correspondence to Paul Carey, M.D., Department of Orthopaedic Surgery, Guthrie Army Health Clinic, 11050 Mt Belvedere Rd, Ft Drum, NY 13602-5004, U.S.A.Department of Orthopaedic SurgeryGuthrie Army Health Clinic11050 Mt Belvedere RdFt DrumNY13602-5004U.S.A.
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17
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History of surgical intervention of anterior shoulder instability. J Shoulder Elbow Surg 2016; 25:e139-50. [PMID: 27066962 DOI: 10.1016/j.jse.2016.01.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 01/13/2016] [Accepted: 01/22/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior glenohumeral instability most commonly affects younger patients and has shown high recurrence rates with nonoperative management. The treatment of anterior glenohumeral instability has undergone significant evolution over the 20th and 21 centuries. METHODS This article presents a retrospective comprehensive review of the history of different operative techniques for shoulder stabilization. RESULTS Bankart first described an anatomic suture repair of the inferior glenohumeral ligament and anteroinferior labrum in 1923. Multiple surgeons have since described anatomic and nonanatomic repairs, and many of the early principles of shoulder stabilization have remained even as the techniques have changed. Some methods, such as the Magnusson-Stack procedure, Putti-Platt procedure, arthroscopic stapling, and transosseous suture fixation, have been almost completely abandoned. Other strategies, such as the Bankart repair, capsular shift, and remplissage, have persisted for decades and have been adapted for arthroscopic use. DISCUSSION The future of anterior shoulder stabilization will continue to evolve with even newer practices, such as the arthroscopic Latarjet transfer. Further research and clinical experience will dictate which future innovations are ultimately embraced.
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Sodl JF, McGarry MH, Campbell ST, Tibone JE, Lee TQ. Biomechanical effects of anterior capsular plication and rotator interval closure in simulated anterior shoulder instability. Knee Surg Sports Traumatol Arthrosc 2016; 24:365-73. [PMID: 24509881 DOI: 10.1007/s00167-014-2878-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 01/24/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this study was to determine the effect of a stepwise arthroscopic anterior plication and arthroscopic-equivalent rotator interval (RI) closure on glenohumeral range of motion, kinematics, and translation in the setting of anterior instability. METHODS Six cadaveric shoulders were stretched to 10 % beyond maximum external rotation (ER) to create an anterior shoulder instability model. Range of motion, kinematics, and glenohumeral translations were recorded for the following conditions: (1) intact, (2) stretched, (3) after anterior capsular plication, and (4) after RI closure. RESULTS The total range of motion after capsular stretching increased significantly in the 60° abduction position (p = 0.037). Average ER and total rotation were significantly decreased from the intact and stretched conditions by both repair conditions at 60° and 0° of glenohumeral abduction (p < 0.05), with no significant difference between plication and additional RI closure. At 0° abduction and 0° ER, glenohumeral translation decreased significantly from the stretched condition after RI closure with 10 and 15 N anterior and 10 N posterior loads (p < 0.05). At 30° ER, translation after RI closure was significantly less than both the intact and stretched conditions with 10 N anterior loads (p = 0.009; p = 0.004). These changes in translational stability were not seen with plication alone. CONCLUSIONS Anterior capsular plication reduced glenohumeral range of motion back to the intact state, and often tighter. RI closure did not contribute significantly to the reduction in the range of motion, but had implications regarding glenohumeral translation. Caution should be taken when performing anterior plication and combined repairs to avoid overtightening. Intraoperative translations could be useful when debating RI closure in patients with unidirectional anterior glenohumeral instability.
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Affiliation(s)
- Jeffrey F Sodl
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System (09/151), 5901 East 7th. Street, Long Beach, CA, 90822, USA.,Department of Orthopedic Surgery and Sports Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System (09/151), 5901 East 7th. Street, Long Beach, CA, 90822, USA
| | - Sean T Campbell
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System (09/151), 5901 East 7th. Street, Long Beach, CA, 90822, USA
| | - James E Tibone
- Department of Orthopedic Surgery and Sports Medicine, University of Southern California, Los Angeles, CA, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System (09/151), 5901 East 7th. Street, Long Beach, CA, 90822, USA. .,Department of Orthopaedic Surgery, University of California, Irvine, Irvine, CA, USA. .,Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA.
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Haughton BA, Serrano-Pedraza I, Boada E, Candal-Couto JJ. The Neviaser portal for superior glenoid anchor insertion: an anatomic study. J Orthop Surg (Hong Kong) 2015; 23:301-3. [PMID: 26715705 DOI: 10.1177/230949901502300308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To measure the angular relationship between the Neviaser portal and the superior glenoid labrum in 60 cadaveric specimens to determine whether this portal can be used for reliable anchor placement. METHODS The Neviaser portal of 30 left and 30 right unpaired dry cadaveric scapulae with clavicles were measured by a single observer using an analogue vernier caliper. The angular relationship between the Neviaser portal and the 12 o'clock position of the glenoid labrum was calculated. RESULTS 13 of the 60 scapulae were excluded from analysis, because the Neviaser portal was medial to the glenoid rim making safe anchor insertion unfeasible. For the remaining 47 scapulae, the mean angles α and β were 58.2º and 57.9º, respectively. Compared with the ideal angles α and β of 30º and 0º, respectively, all the 47 Neviaser portals were more posterior (relative to the 12 o'clock position) and closer to the transverse plane, making insertion of suture anchors in the optimum position unfeasible, except for one that was within 10º of the ideal angles in both planes. CONCLUSION Reliable insertion of suture anchors at the 12 o'clock position of the glenoid labrum through the Neviaser portal is unfeasible in most patients.
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Affiliation(s)
| | - Ignacio Serrano-Pedraza
- Department of Experimental Psychology, Faculty of Psychology, Complutense University of Madrid, Spain
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20
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Ostermann RC, Hofbauer M, Platzer P, Moen TC. The "Labral Bridge": A Novel Technique for Arthroscopic Anatomic Knotless Bankart Repair. Arthrosc Tech 2015; 4:e91-5. [PMID: 26052499 PMCID: PMC4454790 DOI: 10.1016/j.eats.2014.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 11/07/2014] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic Bankart repair with suture anchors is widely considered a mainstay for surgical treatment of anterior shoulder instability after recurrent anterior shoulder dislocations. Traditionally, the displaced capsulolabral complex is restored and firmly attached to the glenoid by placing multiple suture anchors individually from a 5- to 3-o'clock position. A variety of different techniques using different anchor designs and materials have been described. Knotless anchors are widely used nowadays for shoulder instability repair, providing a fast and secure way of labral fixation with favorable long-term outcomes. However, these techniques result in a concentrated point load of the reduced labrum to the glenoid at each suture anchor. We describe a technique, developed by the first author, using a 1.5-mm LabralTape (Arthrex, Naples, FL) in combination with knotless suture anchors (3.5-mm PEEK [polyether ether ketone] PushLock anchors; Arthrex), for hybrid fixation of the labrum. The LabralTape is used to secure the torn labrum to the glenoid between each suture anchor, thus potentially providing a more even pressure distribution.
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Affiliation(s)
- Roman C. Ostermann
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
- Address correspondence to Roman C. Ostermann, M.D., Department of Trauma Surgery, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria.
| | - Marcus Hofbauer
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Patrick Platzer
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
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21
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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.
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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
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22
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The rising incidence of rotator cuff repairs. J Shoulder Elbow Surg 2013; 22:1628-32. [PMID: 23466172 DOI: 10.1016/j.jse.2013.01.006] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 12/13/2012] [Accepted: 01/07/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff repairs (RCRs) have become increasingly common. Several studies have shown variation in the indications for this procedure. We chose to track the incidence of RCRs in New York State (NYS) from 1995 to 2009. We hypothesized that after the introduction of the Current Procedural Terminology (CPT) code 29827 for arthroscopic RCR, there would be a significant increase in the rate of RCRs performed in NYS. MATERIALS AND METHODS The NYS Department of Health's Statewide Planning and Research Cooperative System (SPARCS) database was queried for reported RCRs between the years 1995 and 2009. Using the International Classification of Diseases, Ninth Revision, Clinical Modification procedural code 83.63 and CPT codes 23410, 23412, 23420, and 29827, we collected and analyzed data on RCR procedures. RESULTS A total of 168,780 RCRs were performed in NYS from 1995 to 2009. In 1995, the population incidence of RCRs was 23.5 per 100,000. In comparison, in 2009, the population incidence was 83.1 per 100,000, an increase of 238% (P < .0001). The percentage of individuals aged between 45 and 65 years undergoing RCR increased from 53.0% to 64.2% during this same period. CONCLUSIONS There has been a notable increase in the volume of RCRs performed in NYS. In addition, after the introduction of CPT code 29827 in 2003, the increase in the incidence of RCRs became significantly more pronounced. LEVEL OF EVIDENCE Level III, cross-sectional design, epidemiology study.
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Gwathmey FW, Warner JJP. Management of the athlete with a failed shoulder instability procedure. Clin Sports Med 2013; 32:833-63. [PMID: 24079439 DOI: 10.1016/j.csm.2013.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The athlete with a failed instability procedure requires a thoughtful and systematic approach to achieve a good outcome. Goals of treatment should be defined and realistic expectations should be set. Revision stabilization has a high rate of recurrent instability, low rates of return to play, and low clinical outcome scores. Fundamental to successful revision surgery is choosing the correct procedure. The decision is straightforward in athletes with clear factors that predict recurrence (significant glenoid bone loss, engaging Hill-Sachs lesions) because only a bony procedure can restore the articular arc of the glenoid. Arthroscopic revision Bankart repair may be appropriate in those athletes who have an obvious Bankart tear and no bone loss after a traumatic reinjury. The challenge for the shoulder surgeon is identifying the best surgery for the athlete who does not have such clear-cut indications. Each factor that has the potential to lead to a poor outcome needs to be collected and calculated. Patient factors (age, laxity, type and level of sport), injury factors (mechanism of injury, capsulolabral injury, glenoid bone loss, Hill-Sachs lesion), and technical factors (previous surgery performed, integrity of repair, scarring) must be integrated into the treatment algorithm. Based on this collection of factors, the shoulder surgeon should be prepared to provide the athlete with the surgery that provides the best chance to return to playing sports and the lowest risk of recurrent instability.
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Affiliation(s)
- F Winston Gwathmey
- Orthopaedic Sports Medicine, Massachusetts General Hospital, 175 Cambridge Street, 4th Floor, Boston, MA 02114, USA
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Garber AC, Argintar E, Shin SJ, McGarry MH, Tibone JE, Lee TQ. Kinematic effect of MGHL incorporation into Bankart repair. Orthopedics 2013; 36:653-8. [PMID: 23672898 DOI: 10.3928/01477447-20130426-31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Surgical treatment for traumatic shoulder instability has progressed in tandem with the evolution of the current understanding of the anatomy and biomechanics of the shoulder. Proponents of incorporating the middle glenohumeral ligament (MGHL) in Bankart repair believe this technique could increase repair strength. The purpose of this biomechanical study was to compare the range of motion and humeral head kinematic changes that result from including the MGHL in a Bankart repair in an effort to identify possible changes in shoulder biomechanics as a result of this addition in surgical repair.Six cadaveric shoulders were tested in 4 conditions: intact, Bankart lesion, repair excluding the MGHL, and repair including the MGHL. Each condition was tested for range of motion, glenohumeral translation, and humeral head apex position. Standard Bankart repair and repair with MGHL inclusion resulted in decreased range of motion, but no statistically significant difference was found between the 2 repair types (P=.846). Anterior translation was significantly reduced with both the Bankart repair (4.8 ± .9; P=.049) and included MGHL repair (4.6 ± 0.9; P=.029). No statistically significant difference was found between both repairs (P=.993). Although both repairs showed posterior displacement of the humeral head apex when in external rotation, this trend only reached statistical significance when compared with the Bankart lesion in 90° of external rotation (P=.0456); however, no significant difference was found between the 2 repairs (P=.999). Inclusion or exclusion of the MGHL in a Bankart repair does not significantly affect the range of motion, translation, or kinematics of the glenohumeral joint.
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Affiliation(s)
- Alexander C Garber
- Department of Orthopedic Surgery, University of Southern California, Los Angeles, California, USA
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Coracoid bone block versus arthroscopic Bankart repair: a comparative paired study with 5-year follow-up. Orthop Traumatol Surg Res 2013; 99:123-30. [PMID: 23481699 DOI: 10.1016/j.otsr.2012.12.010] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Revised: 08/09/2012] [Accepted: 12/30/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The hypothesis of this study was that the rate of recurrence of anterior instability of the shoulder after arthroscopic Bankart repair with suture anchors is higher than after coracoid bone block (Latarjet procedure). MATERIALS AND METHODS This continuous retrospective monocentric study included a cohort of patients who underwent surgery for post-traumatic recurrent antero-inferior instability (2004-2005): 51 patients who underwent an open Latarjet procedure were paired for age at surgery to 51 patients who underwent an arthroscopic Bankart repair. All patients were evaluated with a questionnaire and 50% were evaluated in a follow-up consultation with X-rays. Recurrent instability was defined by at least one episode of anterior dislocation or subluxation. RESULTS Demographic data, soft tissue and bone lesions were statistically similar between the groups. At 5 years follow-up, the recurrence rate was 24% in the Bankart group and 12% in the Latarjet group (P=012). In the Bankart group, age under 25 years old (P=0.01), competitive sports after surgery (P=0.01), and glenoid erosion (P=0.02) were independent risk factors of recurrence. In the Latarjet group, five technical errors were identified out of six cases of recurrence. Fifteen of the 18 cases of recurrence did not undergo revision surgery because patients remained satisfied with their results. DISCUSSION AND CONCLUSIONS At 5 years of follow-up, the rate of recurrent instability following arthroscopic Bankart repair was two times higher than that following the coracoid bone block procedure. Young patients who wish to practice a competitive sport or present with glenoid erosion are poor candidates for arthroscopic Bankart repair. The rate of recurrence is extremely high in unselected patients. The open Latarjet procedure results in a fairly high rate of recurrence due to technical errors. LEVEL OF EVIDENCE Level IV (retrospective study).
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Myer DM, Caldwell PE. ORV Arthroscopic Transosseous Bony Bankart Repair. Arthrosc Tech 2012; 1:e193-9. [PMID: 23766995 PMCID: PMC3678650 DOI: 10.1016/j.eats.2012.07.006] [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: 06/12/2012] [Accepted: 07/20/2012] [Indexed: 02/03/2023] Open
Abstract
The arthroscopic treatment of the "bony Bankart lesion" continues to evolve. We present a novel technique that we developed at Orthopaedic Research of Virginia, the "transosseous bony Bankart repair," which incorporates several essential concepts to provide for optimal healing and rehabilitation. We promote arthroscopic repair emphasizing bone preservation, a fracture interface without interposing sutures, the ability to reduce capsular volume, and multiple points of stable glenolabral fixation. Our technique positions suture anchors within the subchondral bone of the intact glenoid to allow for an anatomic reduction of the bony fragment. By use of an arthroscopic drill, spinal needle, and nitinol suture passing wire, the sutures are passed in a retrograde fashion through the bony Bankart fragment and anterior capsule in a mattress configuration. Additional inferior and superior anchors are placed to further provide stability and reduce capsular volume. While maximizing fracture surface area and optimizing bony healing, the end result is an anatomic reduction of the bony fragment and the glenoid articular surface.
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Affiliation(s)
- Daniel M. Myer
- Orthopaedic Research of Virginia, Richmond, Virginia, U.S.A
| | - Paul E. Caldwell
- Orthopaedic Research of Virginia, Richmond, Virginia, U.S.A
- Tuckahoe Orthopaedic Associates, Ltd, Richmond, Virginia, U.S.A
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Stephenson DR, Hurt JH, Mair SD. Rotator cuff injury as a complication of portal placement for superior labrum anterior-posterior repair. J Shoulder Elbow Surg 2012; 21:1316-21. [PMID: 22056325 DOI: 10.1016/j.jse.2011.08.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 08/01/2011] [Accepted: 08/06/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND An accessory trans-rotator cuff portal is commonly used in shoulder arthroscopy, primarily in the repair of SLAP (superior labrum anterior-posterior) lesions. Improper placement of the trans-rotator cuff portal can result in damage to the rotator cuff near its attachment site. METHODS Six patients were studied, having been referred to our clinic after previous shoulder arthroscopy with SLAP repair. Review of operative notes showed that the rotator cuff had been described as normal in 5 patients and having a mild partial-thickness tear of the supraspinatus in 1 patient at the time of the first surgery. All patients underwent repeat shoulder arthroscopy within 10 to 22 months. RESULTS All 6 patients were found to have full-thickness rotator cuff tears at the time of the second surgery. The rotator cuff injuries appeared to be associated with portal placement from the previous SLAP repair. All patients underwent rotator cuff repair, and 3 had concomitant revision SLAP repair. All patients had clinical improvement, with a mean preoperative American Shoulder and Elbow Surgeons score of 45.3 and mean postoperative score of 90.5. Mean follow-up was 58.3 months. CONCLUSIONS Proper placement of a trans-rotator cuff portal should be performed cautiously, traversing the rotator cuff medial to the muscle-tendon junction. This report highlights the potential for injury to the rotator cuff tendons with improper placement of this portal. In patients with persistent pain after previous SLAP repair with a trans-rotator cuff portal technique, rotator cuff injury may be the source of symptoms. Revision surgery with rotator cuff repair can provide improvement.
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Ockert B, Braunstein V, Sprecher CM, Shinohara Y, Milz S. Fibrocartilage in various regions of the human glenoid labrum. An immunohistochemical study on human cadavers. Knee Surg Sports Traumatol Arthrosc 2012; 20:1036-41. [PMID: 21971940 DOI: 10.1007/s00167-011-1686-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 09/15/2011] [Indexed: 01/02/2023]
Abstract
PURPOSE The nature and the distribution of fibrocartilage at the human glenoid labrum are unclear, and a better understanding may help to restore its function in open and arthroscopic Bankart repair. Aim of this study was to describe the fibrocartilage extent within the labrum at clinically relevant sites of the glenoid in order to relate the molecular composition of the labrum to its mechanical environment. METHODS Twelve fresh frozen human cadaveric shoulders (mean age 38 years) were obtained, and sections perpendicular to the glenoid rim at the 12, 2, 3, 4, 6 and 9 o' clock position were labelled with antibodies against collagen I and II, aggrecan and link protein. RESULTS A fibrocartilaginous transition zone with a characteristic collagen fibre orientation was found in 81% of cases, evenly distributed (83-92%) around the glenoid rim. The percentage of labrum cross-sectional area comprised of fibrocartilage averaged 28% and ranged from 26% at 12 o'clock on the glenoid clock face to 30% at 3 o'clock. The highest amount of fibrocartilage (82%) was found in the region neighbouring the hyaline articular cartilage. In the region beyond the bony edge of the glenoid, fibrocartilage cross-sectional area did not exceed 12-17%. CONCLUSION Fibrocartilage is present at all examined positions around the glenoid rim and constitutes up to 1/3 of the cross-sectional area of the labrum. In turn, the percentage of fibrocartilage in different regions of its cross-section varies considerably. The findings suggest that the penetration of fibrocartilaginous tissue may be reduced by avoiding the highly fibrocartilage transition zone during restoration of labral detachment.
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Affiliation(s)
- Ben Ockert
- AO Research Institute Davos, AO Foundation, Davos, Switzerland.
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Kavaja L, Pajarinen J, Sinisaari I, Savolainen V, Björkenheim JM, Haapamäki V, Paavola M. Arthrosis of glenohumeral joint after arthroscopic Bankart repair: a long-term follow-up of 13 years. J Shoulder Elbow Surg 2012; 21:350-5. [PMID: 21813296 DOI: 10.1016/j.jse.2011.04.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 04/13/2011] [Accepted: 04/22/2011] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The purpose of the study was to establish radiologic and clinical occurrence of glenohumeral arthrosis after arthroscopic Bankart repair. MATERIALS AND METHODS Between January 1994 and December 1998, an arthroscopic Bankart repair was performed in 187 patients at our institution. We were able to assess clinical and radiologic glenohumeral arthrosis in 72 of the 101 patients who met the inclusion criteria (74 shoulders) (71%) after a 13-year follow-up. An additional 9 patients were interviewed by telephone. Radiologic arthrosis was evaluated with the Samilson-Prieto classification and clinical arthrosis with an arthrosis-specific quality-of-life questionnaire (Western Ontario Osteoarthritis of the Shoulder test). In addition, functional impairment was assessed with the Constant score and subjective satisfaction with a questionnaire. RESULTS Radiologic arthrosis was diagnosed in 50 of 74 shoulders (68%), with 40 (80%) of them classified as mild. The mean score on the Western Ontario Osteoarthritis of the Shoulder questionnaire was 280 points (85% of the best possible score), which is considered relatively good. The mean Constant score was 78 points, and 75% of the patients were extremely satisfied or satisfied with the final results of operative treatment. DISCUSSION The radiologic evaluation and self-assessment of the patients imply that the incidence of glenohumeral arthrosis after arthroscopic Bankart repair is quite common but the symptoms are generally mild and comparable to nonoperative treatment. CONCLUSION Arthrosis rarely causes more than minor subjective symptoms or a minor objectively perceived disadvantage during 13 years' follow-up.
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Affiliation(s)
- Lauri Kavaja
- Medical Faculty, University of Helsinki, Helsinki, Finland.
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Kim JW, Kang HJ. Short-Term Results of Subpectoral Tenodesis of the Proximal Biceps Tendon Using by Interference Screw. Clin Shoulder Elb 2010. [DOI: 10.5397/cise.2010.13.1.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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31
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Park JS, Won YY, Yoo JH, Park YW, Noh KC, Chung KJ, Kim HK, Hwang JH, Lee YB, Suh IW. Arthroscopic Transosseous Suture Repair for Bankart Lesion with a Flexible Drill Device - An Experimental and Preliminary Clinical Report -. Clin Shoulder Elb 2010. [DOI: 10.5397/cise.2010.13.1.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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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.
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Affiliation(s)
- Brad S Sparks
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, 210 East Gray Street, Louisville, KY 40202, USA
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Jeong JH, Shin SJ. Arthroscopic removal of proud metallic suture anchors after Bankart repair. Arch Orthop Trauma Surg 2009; 129:1109-15. [PMID: 19271227 DOI: 10.1007/s00402-009-0847-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Indexed: 02/09/2023]
Abstract
INTRODUCTION This study presents an arthroscopic removal technique for proud metallic suture anchor after Bankart repair and analyzes the cause of anchor failures. PATIENTS Six male patients with an average age 23 years who had proud anchor on the glenoid surface were included. The diagnosis of six patients at the time of the primary surgery was traumatic anterior shoulder instability. Four patients had arthroscopic repair and two had open Bankart repair previously. Four patients complained of pain accompanying a metallic clicking sound during shoulder motion which increased with abduction and external rotation. One patient had pain with apprehension of dislocation and another patient suffered from only pain. Most symptoms had been revealed during the rehabilitation period (average 8.3 months) and confused with postoperative pain. The protruded anchors were detected through plain radiographs in four patients and during arthroscopic examination in two patients. METHOD To extract the proud anchor arthroscopically, a screw driver of a larger diameter than that of the proud suture anchor was used to retrieve the anchor. A larger screw driver was striked with a hammer along the previous suture anchor hole to make a room between the suture anchor and the adjacent glenoid bone so that the hole of the suture anchor became larger. After the hole was widened, the suture anchor had enough room to move freely and it could be removed with a grasper or a mosquito easily. The location of the proud anchor was 2, 3 and 5 o'clock in three patients and 4 o'clock in three patients. In two patients, the suture anchor was malpositioned about 5 mm medial from the anterior glenoid rim. All patients had chondral damage on the humeral head. RESULTS Following the procedure none had shoulder instability in 3 years of follow-up. Preoperative visual analog scale score for pain was an average of 3.5. The visual analog scale score for pain was decreased to 1.2 after surgery. All patients had a slight limitation of external rotation preoperatively, and they showed a normal range of motion postoperatively. Constant score improved from 65 to 89, and similarly, American Shoulder and Elbow Society score increased from 67 to 88 after the operation. CONCLUSION Despite small numbers of patients, a successful removal of proud metal suture anchors was achieved using a large empty suture anchor screw driver, which is a simple and reproducible method to remove a proud metallic suture anchor arthroscopically.
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Affiliation(s)
- Jae-Hoon Jeong
- Department of Orthopaedic Surgery, Seoul Wooridul Hospital, Seoul, Korea
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Kang RW, Frank RM, Nho SJ, Ghodadra NS, Verma NN, Romeo AA, Provencher MT. Complications associated with anterior shoulder instability repair. Arthroscopy 2009; 25:909-20. [PMID: 19664511 DOI: 10.1016/j.arthro.2009.03.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 03/10/2009] [Accepted: 03/10/2009] [Indexed: 02/02/2023]
Abstract
Anterior shoulder instability is a common orthopaedic problem, and the surgical treatment, both open and arthroscopic, has been shown to effectively restore stability and prevent recurrence. However, despite success with these surgical techniques, there are several clinically relevant complications associated with both open and arthroscopic techniques for anterior shoulder stabilization. These complications can be subdivided into preoperative, intraoperative, and postoperative and include entities such as nerve injury, chondrolysis, incomplete treatment of associated lesions, and subscapularis dysfunction. When they occur, complications may significantly impact patient outcomes and function. Therefore, surgeon awareness and identification of the factors associated with these complications may help prevent occurrence. Although failure of instability repair can be classified as a complication of surgery, it requires an entirely separate discussion and is therefore not addressed in this article. Because most of the previously published studies on anterior shoulder instability have emphasized surgical technique and clinical outcomes, the purpose of this article is to define the complications associated with anterior instability repair and provide recommendations on techniques that may be used to help avoid them.
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Affiliation(s)
- Richard W Kang
- Section of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, IL 60611, USA
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Rispoli DM, Athwal GS, Sperling JW, Cofield RH. The macroscopic delineation of the edge of the glenoid labrum: an anatomic evaluation of an open and arthroscopic visual reference. Arthroscopy 2009; 25:603-7. [PMID: 19501289 DOI: 10.1016/j.arthro.2008.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 11/22/2008] [Accepted: 12/26/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE Our purpose was to evaluate the distance from the bony edge of the glenoid to the visible (or macroscopic) demarcation at the junction of the labrum and the articular cartilage. METHODS Ten fresh-frozen cadaveric upper extremity specimens were dissected. The shoulder was disarticulated and periarticular structures were removed, leaving the glenoid with the labrum attached. The macroscopic edge of the glenoid was then marked with a drill at the 3-, 4-, 5-, 6-, 7, 8-, and 9-o'clock positions, as defined by a clock face (right) and a reverse clock face (left). Soft tissue and cartilage were then removed, and the distance from the outer edge of the drill hole to the bony rim was measured. RESULTS The mean distance from the bony edge in hourly intervals starting at the 3-o'clock position anteriorly and extending to the 9-o'clock position posteriorly was 4.03 mm (range, 2.1 to 5.21 mm; SD, 0.96 mm), 4.2 mm (range, 2.1 to 5.31 mm; SD, 0.97 mm), 4.51 mm (range, 3.1 to 5.2 mm; SD, 0.91 mm), 5.14 mm (range, 3.1 to 7 mm; SD, 1.38 mm), 3.24 mm (range, 1.1 to 5.2 mm; SD, 1.4 mm), 3.78 mm (range, 1 to 6 mm; SD, 1.6 mm), and 4.28 mm (range, 2.1 to 7.3 mm; SD, 1.51 mm), respectively. A trend was noted for significant differences between locations, but this did not reach statistical significance (analysis of variance, P = .086). CONCLUSIONS The macroscopic edge of the labrum on the glenoid face does not correspond to the bony edge of the glenoid. The labrum overlaps onto the bony surface of the glenoid from a minimum of 1.6 mm to a maximum of 7.3 mm. CLINICAL RELEVANCE Our findings provide anatomic data that enhances the arthroscopist's ability to anatomically reconstruct the glenoid labrum.
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Affiliation(s)
- Damian M Rispoli
- Wilford Hall Medical Center, Lackland Air Force Base, Texas 78236-5300, USA.
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Banerjee S, Weiser L, Connell D, Wallace AL. Glenoid rim fracture in contact athletes with absorbable suture anchor reconstruction. Arthroscopy 2009; 25:560-2. [PMID: 19409314 DOI: 10.1016/j.arthro.2008.10.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2008] [Revised: 10/06/2008] [Accepted: 10/23/2008] [Indexed: 02/02/2023]
Abstract
Absorbable suture anchors are widely used in arthroscopic shoulder reconstruction procedures and provide a good solution for stabilization in athletes. In our practice we identified a group of 3 patients who had participated in contact sports and in whom traumatic instability developed. Subluxation of the shoulder followed repair by use of absorbable suture anchors. Each patient had a new injury characterized by a glenoid rim fracture that was not amenable to further arthroscopic reconstruction and was revised by use of a modified Latarjet procedure. All patients successfully returned to contact sports. We conclude that resorption defects resulting from the use of absorbable anchors contribute to an increased risk of rim fracture.
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Cyclic loading comparison of Bio-SutureTak-#2 FiberWire and Bio Mini-Revo-#2 Hi-Fi suture anchor-sutures in cadaveric scapulae. Knee Surg Sports Traumatol Arthrosc 2008; 16:317-25. [PMID: 18026932 DOI: 10.1007/s00167-007-0445-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 10/22/2007] [Indexed: 10/22/2022]
Abstract
This study compared tap-in Bio-SutureTak suture anchor-#2 FiberWire suture (Group 1) and screw-in Bio Mini-Revo suture anchor-#2 Hi-Fi suture (Group 2) fixation in the glenoid region of interest for Bankart repair, in addition to evaluation of isolated suture loop biomechanical properties under progressive incremental cyclic loads. With knowledge of glenoid apparent bone mineral density (BMD), implant preparation and fit characteristics, and following application of a light manual tensile load, the primary investigator scored each specimen for perceived within group biomechanical test performance using a 0-10 point modified visual analog scale. After scoring, 12 paired constructs were placed in a servo hydraulic device clamp, preloaded to 25 N, and cycled between 25 and 50 Hz with a 25 N load increase every 25 cycles. Group 2 withstood greater load (104.1 +/- 56 vs. 70 +/- 36.9 N, P = 0.04) and displaced more at failure (13 +/- 4.5 vs. 8.6 +/- 3.3 mm, P = 0.04). All Group 1 specimens failed prior to reaching 150 N, whereas 25% of Group 2 specimens (n = 3) failed at 200 N. All specimens failed by anchor pullout except for three Group 2 specimens that failed by eyelet breakage at 200 N. Isolated suture testing revealed that Group 1 sutures displaced less at each cyclic load (P = 0.028) and withstood greater failure loads (P = 0.028) than that of Group 2 sutures. Group 2 constructs displayed moderately strong relationships between perceived within group biomechanical test performance and ultimate load (r (2) = 0.55) and displacement at failure (r (2) = 0.67). Group 1 did not display significant relationships. Similar biomechanical performance between 50 and 125 N, greater load at failure, and superior biomechanical test prediction accuracy suggest that the screw-in type Bio Mini-Revo suture anchor-#2 Hi-Fi suture combination may be preferred for Bankart lesion repair in low apparent BMD glenoid processes. The #2 Hi-Fi suture, however, allowed significantly greater displacement than the #2 FiberWire suture at each progressive cyclic load interval.
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Hobby J, Griffin D, Dunbar M, Boileau P. Is arthroscopic surgery for stabilisation of chronic shoulder instability as effective as open surgery? A systematic review and meta-analysis of 62 studies including 3044 arthroscopic operations. ACTA ACUST UNITED AC 2008; 89:1188-96. [PMID: 17905956 DOI: 10.1302/0301-620x.89b9.18467] [Citation(s) in RCA: 152] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A systematic search of the literature published between January 1985 and February 2006 identified 62 studies which reported the results of arthroscopic procedures for chronic anterior shoulder instability or comparisons between arthroscopic and open surgery. These studies were classified by surgical technique and research methodology, and when appropriate, were included in a meta-analysis. The failure rate of arthroscopic shoulder stabilisation using staples or transglenoid suture techniques appeared to be significantly higher than that of either open surgery or arthroscopic stabilisation using suture anchors or bio-absorbable tacks. Arthroscopic anterior stabilisation using the most effective techniques has a similar rate of failure to open stabilisation after two years.
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Affiliation(s)
- J Hobby
- North Hampshire Hospitals, NHS Trust, Aldermaston Road, Basingstoke, Hampshire RG24 9NA, UK
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Collins KJ, Mukherjee DP, Ogden AL, Sadasivan KK, Albright JA, Pietrzak WS. A biomechanical study of bankart lesion fixation - biodegradable ArthroRivet tack vs. suture repair. J INVEST SURG 2007; 20:157-66. [PMID: 17613690 DOI: 10.1080/08941930701364740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Bioabsorbable fixation is commonly used in soft tissue procedures performed in the shoulder. ArthroRivettrade mark tacks (referred to as rivets here), made from a copolymer of 82% poly-L-lactic acid and 18% polyglycolic acid, were developed for the Bankart procedure. Although a previous in vivo study demonstrated favorable comparison of the fixation strength and absorption characteristics of this device with that of polyglyconate bioabsorbable tacks, there have been no published biomechanical studies of this rivet in the shoulder. Fourteen shoulders were harvested from fresh-frozen cadavers of average age 74 years (46-89). Biomechanical testing was performed by measuring the energy, or work, required to anteriorly displace the humeral head 6 mm from the glenoid. Each shoulder was tested intact, vented, and before and after repair of a simulated Bankart lesion at 0, 45, and 90 degrees of abduction with and without maximal external rotation. Overall, the average work required ranged from 54.7 N-mm to 178.27 N-mm. Although the biomechanical performance of the rivet, based on resistance to anterior displacement of the humeral head, was indistinguishable from that of the suture repair, the statistical power of the test was low due to the large variance in the cadaver specimens. The results, in general, correlated well with those of previously published studies, suggesting the suitability of the bioabsorbable rivet for use in Bankart repair.
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Affiliation(s)
- Kevin J Collins
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, 71130, USA
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John M, Nebelung W, Röpke M, Ender SA, Urbach D. Arthroscopic labrum reconstruction with capsular shift in anterior shoulder instability: improved midterm results by using a standardized suprabicipital camera position. Arthroscopy 2007; 23:688-95. [PMID: 17637402 DOI: 10.1016/j.arthro.2007.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the midterm results of a standardized arthroscopic technique for labrum reconstruction by using a third suprabicipital portal for better visualization of the anterior glenoid rim. METHODS Thirty-three of 36 patients treated for recurrent anterior shoulder dislocation were followed up by telephone and/or in clinical examinations. The average age of the patients (12 women and 21 men) at the time of surgery was 25.2 years, with a mean follow-up of 35 months. On average, 7.8 dislocations occurred between the first dislocation and the stabilization procedure (mean, 45.4 months). RESULTS Two patients suffered again from redislocations (recurrence rate 6.1%), and 3 patients had 1 or 2 subluxations (9.1%) at the time of follow-up. In the Rowe score, the patients reached 77.5 points on average; 81.8% of the patients returned to sports and leisure activities as in the time before the first dislocation, and 18.2% (6 patients) did not. Limitations for external rotation were 7.8 degrees on average postoperatively. No statistical correlation between the number of preoperative dislocations and the level of the postoperative Rowe score was found. CONCLUSIONS The arthroscopic labrum reconstruction with capsular shift using the 3-portal technique combined with a standardized suprabicipital camera position revealed a recurrence rate and midterm results that were close to results achieved after open procedures. The failure rate, according to the number of dislocations, was 6.1% based on the patient's satisfaction of 12.1%. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Michael John
- Orthopädische Universitätsklinik Otto-von-Guericke, Magdeburg, Germany
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Abstract
Laxity testing is an important part of the examination of any joint. In the shoulder, it presents unique challenges because of the complexity of the interactions of the glenohumeral and scapulothoracic joints. Many practitioners believe that laxity testing of the shoulder is difficult, and they are unclear about its role in evaluation of patients. The objectives of the various laxity and instability tests differ, but the clinical signs of such tests can provide helpful information about joint stability. This article summarizes the principles of shoulder laxity testing, reviews techniques for measuring shoulder laxity, and evaluates the clinical usefulness of the shoulder laxity tests. Shoulder laxity evaluation can be a valuable element of the shoulder examination in patients with shoulder pain and instability.
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Affiliation(s)
- Michael Bahk
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD 21224-2780, USA.
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Levy O, Matthews T, Even T. The "purse-string" technique: an arthroscopic technique for stabilization of anteroinferior instability of the shoulder with early and medium-term results. Arthroscopy 2007; 23:57-64. [PMID: 17210428 DOI: 10.1016/j.arthro.2006.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE We report the early and midterm results of the "purse-string" technique, a simple, new arthroscopic technique for stabilization of anteroinferior instability of the glenohumeral joint that addresses both the Bankart lesion and capsular stretching. METHODS The patients comprised 36 individuals (37 shoulders), with a mean age of 26 years, who had recurrent anteroinferior post-traumatic instability as a result of a traumatic Bankart lesion. They had sustained a mean of 5 dislocations per shoulder (range, 1 to 11). The cohort included 5 professional and 6 semiprofessional athletes, all of whom were involved in collision or overhead sports. A purse-string suture anchor at the 4-o'clock position was used to ensure a purse-string effect in tightening the capsule in the inferior-superior plane and creation of anterior glenoid bumper. All of the patients were assessed by an independent investigator (T.M.) at a mean of 36 months (range, 27 to 87 months) after surgery. RESULTS Postoperatively, the mean Rowe score was 93 (range, 55 to 100), the mean Walch-Duplay score was 93 (range, 70 to 100), and the mean Constant score was 97 (range, 77 to 100). Of the patients, 97% returned to the same sport that they had played before injury. Furthermore, 66% of patients returned to their preinjury level of sports, and all of the professional athletes resumed full activities. One patient continued to have symptoms of instability, and one patient had a further dislocation after a new traumatic event. CONCLUSIONS The early and medium-term results obtained are very encouraging, with a rate of failure of only 5.4%, a high level of return to preinjury sporting activities (with 97% of patients returning to the same sport and 66% returning to their preinjury level of sports), and a high patient satisfaction rate (with excellent or good results in 94% of patients). LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, England.
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van Oostveen DPH, Schild FJA, van Haeff MJ, Saris DBF. Suture anchors are superior to transglenoid sutures in arthroscopic shoulder stabilization. Arthroscopy 2006; 22:1290-7. [PMID: 17157727 DOI: 10.1016/j.arthro.2006.07.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Revised: 05/28/2006] [Accepted: 07/06/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE We retrospectively compared 2 groups of high-demand patients with post-traumatic anterior shoulder instability to determine whether arthroscopic stabilization was superior with transglenoid suture or suture anchors. METHODS In a retrospective comparative study we investigated the results of 246 high-demand patients, with post-traumatic anterior shoulder instability, who underwent arthroscopic capsulolabral reconstruction: 165 (mean age, 27.5 years; mean follow-up, 80 months) were evaluated after treatment with transglenoid sutures, and 81 (mean age, 26.6 years; mean follow-up, 27 months) were treated with suture anchors in a consecutive period. We compared both techniques with regard to recurrence rate, postoperative complications, range of motion, sport activity, work, and patient satisfaction. RESULTS In the anchor group recurrent dislocation after surgery occurred in 7 patients (8.7%), all within 18 months postoperatively. This finding was significantly (P = .009) better than that in the transglenoid group, in which recurrent postoperative dislocation occurred in 57 patients (34%), in a period of 0 to 115 months after surgery. Postoperative complications were seen in 4 of 81 patients in the suture anchor group, whereas a significantly (P = .01) higher rate was found in the transglenoid suture group, with 36 complications in 35 of 165 patients. CONCLUSIONS The data presented in this study suggest that the modern suture anchor technique results in a better outcome after shoulder stabilization, with fewer complications and lower recurrence rates, than the transglenoid repair. We conclude that the suture anchor technique should be a preferred method for arthroscopic shoulder stabilization surgery. LEVEL OF EVIDENCE Level III, retrospective, comparative therapeutic study.
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Affiliation(s)
- Dirk P H van Oostveen
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
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Bottoni CR, Smith EL, Berkowitz MJ, Towle RB, Moore JH. Arthroscopic versus open shoulder stabilization for recurrent anterior instability: a prospective randomized clinical trial. Am J Sports Med 2006; 34:1730-7. [PMID: 16735589 DOI: 10.1177/0363546506288239] [Citation(s) in RCA: 165] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic stabilization for anterior shoulder instability has been reported to result in a higher rate of recurrent instability compared to traditional open techniques. PURPOSE To test the null hypothesis that there is no difference in the clinical outcomes in patients with recurrent anterior shoulder instability treated with open or arthroscopic stabilization. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A consecutive series of 64 patients with recurrent anterior shoulder instability were randomized to receive either arthroscopic or open stabilization by a single surgeon. Magnetic resonance arthrogram studies were obtained preoperatively. These findings were compared to arthroscopic findings. Postoperative evaluations included range of motion, stability, and subjective assessments including Single Assessment Numeric Evaluation, Simple Shoulder Test, Western Ontario Instability Index, and University of California, Los Angeles evaluation. Failure was defined as a second dislocation, recurrent subluxation, or symptoms precluding return to previous work or unrestricted active military duty. RESULTS Sixty-one patients, 29 who received open stabilization and 32 who received arthroscopic stabilization, were evaluated at a mean of 32 months postoperatively (range, 24-48 months). Patient demographics were equivalent. Preoperative magnetic resonance arthrogram findings were confirmed at arthroscopic examination. The mean operative time was significantly shorter for the arthroscopic repairs (59 vs 149 minutes; P < .001). There were 3 clinical failures (2 open stabilizations, 1 arthroscopic stabilization) by the established criteria. There was a statistically significant improvement from preoperative to postoperative Single Assessment Numeric Evaluation scores in both groups (P < .001). The mean loss of motion (compared to the contralateral shoulder) was greater in the open shoulders. Subjective evaluations were equal in both groups. CONCLUSION Clinical outcomes after arthroscopic and open stabilization were comparable. Preoperative magnetic resonance arthrograms in shoulders with anterior instability allow an accurate diagnosis of intra-articular abnormality that correlates well with operative findings. Arthroscopic stabilization for recurrent anterior shoulder instability can be performed safely; the clinical outcomes are comparable to those after traditional open stabilization.
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Affiliation(s)
- Craig R Bottoni
- Orthopaedic Surgery Service, Tripler Army Medical Center, Honolulu, Hawaii, USA.
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Tan CK, Guisasola I, Machani B, Kemp G, Sinopidis C, Brownson P, Frostick S. Arthroscopic stabilization of the shoulder: a prospective randomized study of absorbable versus nonabsorbable suture anchors. Arthroscopy 2006; 22:716-20. [PMID: 16843806 DOI: 10.1016/j.arthro.2006.03.017] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2005] [Revised: 11/22/2005] [Accepted: 03/12/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to evaluate, prospectively, outcomes following arthroscopic Bankart repair performed with 2 types of suture anchor--the G II (DePuy Mitek, Raynham, MA) nonabsorbable anchor and the Panalok (DePuy Mitek) absorbable anchor. METHODS Patients with a diagnosis of recurrent traumatic anterior instability of the shoulder who were seen in a single unit between April of 2000 and June of 2003 were considered for inclusion in the study. Patients were assessed preoperatively and postoperatively by means of a subjective, patient-related outcome measurement tool (Oxford Instability Score), a visual analogue scale for pain and instability (VAS Pain and VAS Instability), and a quality-of-life questionnaire (Short Form-12 [SF-12]). Length of follow-up was 1.5 to 5 years (mean, 2.6 y). The incidence of recurrent instability and the level of sporting ability were recorded. Patients were randomized to undergo surgical repair with nonabsorbable or absorbable anchors. RESULTS A total of 130 patients were included in this study, of whom 6 were lost to follow-up; therefore 124 patients (95%) completed the study. Both types of anchor were highly effective. No differences in rate of recurrence or in any of the scores were noted between the 2 groups. In all, 4 patients in the nonabsorbable group and 3 in the absorbable group experienced additional episodes of dislocation after a traumatic event. Rate of redislocation in the whole series was therefore 6%. In addition, 4 patients, all of them from the absorbable group (4%), described ongoing symptoms of instability but no true dislocations. In all, 85% of the patient group have returned to their previous level of sporting activity. CONCLUSIONS No differences in outcomes of arthroscopic Bankart repair were seen whether absorbable or nonabsorbable anchors were used. Both are highly effective, with a redislocation rate of 6%. LEVEL OF EVIDENCE Level I, therapeutic randomized controlled trial.
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Affiliation(s)
- Chin Khoon Tan
- Department of Trauma and Orthopaedics, University of Liverpool, Liverpool, England
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Abstract
PURPOSE The purpose of this study was to describe the clinical presentation and sensitivity of testing of unstable isolated SLAP (superior labrum anterior posterior) lesions and to evaluate the efficacy of arthroscopic treatment. TYPE OF STUDY Case series. METHODS A retrospective review was made of 44 unstable SLAP lesions in 41 patients (40 male, 1 female) who did not have other pathologic shoulder findings. The mean follow-up period was 33 months (range, 25 to 67 months) and the mean age at the time of surgery was 24 years (range, 17 to 43 years). Twenty-six patients had an injury on the dominant shoulder and 3 had bilateral shoulder involvement. Arthroscopic fixation was performed with the use of a biodegradable tack (Suretac; Acufex, Mansfield, MA) in 14 cases, and with a screw-type metallic suture anchor (mini-Revo; Linvatec, Largo, FL) in 30 cases. RESULTS Pain (100%) and clicking (57%) were the most common symptoms. The compression-rotation test was positive in 84% of the patients before surgery. The average UCLA score at the last follow-up was 32.3 points; 22 cases were graded excellent, 16 good, and 6 poor. Based on the postoperative performance data collected from 33 athletes, 25 of them (76%) were able to return to their athletic activities. Among them, throwing athletes showed statistically better performance than did nonthrowing athletes (P = .011). CONCLUSIONS Pain, followed by clicking, was the most common symptom, and the most common sign was a positive compression rotation test. Arthroscopic treatment of unstable isolated SLAP lesions resulted in good or excellent UCLA scores in 86% of the patients. Throwing athletes showed more satisfactory results than nonthrowing athletes. LEVEL OF EVIDENCE Type IV, case series with no, or historical, control group.
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Affiliation(s)
- Yong Girl Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea.
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Abstract
The intensity of training and competition among young athletes can place them at increased risk of acute and chronic injuries, which occur in patterns unique to the skeletally immature athlete. Prompt recognition and treatment of these injuries are critical to prevent long-term functional disability and deformity. Children and adolescents participating in recreational and organized sports are particularly susceptible to a broad spectrum of shoulder and elbow injuries involving both osseous and soft-tissue structures. Understanding the relevant functional anatomy, biomechanics of throwing, and pathophysiology of injury can help the clinician manage common acute traumatic injuries, some of which may result in chronic problems. Over-use injuries occur more frequently than do acute, traumatic injuries, and early recognition, coupled with appropriate treatment or prevention, can help restore and maintain normal shoulder and elbow function.
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Affiliation(s)
- Frank S Chen
- Sports Medicine Department, Palo Alto Medical Foundation, Palo Alto, CA, USA
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Mazzocca AD, Brown FM, Carreira DS, Hayden J, Romeo AA. Arthroscopic anterior shoulder stabilization of collision and contact athletes. Am J Sports Med 2005; 33:52-60. [PMID: 15610999 DOI: 10.1177/0363546504268037] [Citation(s) in RCA: 220] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Repair of the anterior labrum (Bankart lesion) with tightening of the ligaments (capsulorrhaphy) is the recommended treatment for recurrent anterior glenohumeral dislocations. Current evidence suggests that arthroscopic anterior stabilization methods yield similar failure rates for resubluxation and redislocation when compared to open techniques. STUDY DESIGN Case series; Level of evidence, 4 PURPOSE To examine the results of arthroscopic anterior shoulder stabilization of high-demand collision and contact athletes. METHODS Thirteen collision and 5 contact athletes were identified from the senior surgeon's case registry. Analysis was limited to patients younger than 20 years who were involved in collision (football) or contact (wrestling, soccer) athletics. Objective testing included preoperative and postoperative range of motion and stability. Outcome measures included the American Shoulder and Elbow Society shoulder score, Simple Shoulder Test, SF-36, and Rowe scores. The surgical procedure was performed in a consistent manner: suture anchor repair of the displaced labrum, capsulorrhaphy with suture placement supplemented with thermal treatment of the capsule when indicated, and occasional rotator interval closure. Average follow-up was 37 months (range, 24-66 months). RESULTS Two of 18 contact and collision athletes (11%) experienced recurrent dislocations after the procedure; both were collision athletes. One returned to play 3 years of high school football but failed after diving into a pool. One patient failed in his second season after his stabilization (>2 years) when making a tackle. None of the contact athletes experienced a recurrent dislocation, with all of them returning to high school or college athletics. CONCLUSIONS One hundred percent of all collision and contact athletes returned to organized high school or college sports. Fifteen percent of those collision athletes had a recurrence, which has not required treatment. Participation in collision and contact athletics is not a contraindication for arthroscopic anterior shoulder stabilization using suture anchors, proper suture placement, capsulorrhaphy, and occasional rotator interval plication.
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Affiliation(s)
- Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut School of Medicine, Farmington, Connecticut 06034, USA.
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Abstract
PURPOSE We present 5 cases of iatrogenic arthropathy after arthroscopic Bankart reconstruction using a metallic suture anchor. TYPE OF STUDY Retrospective case series. METHODS Five patients with pain and crepitus on motion were referred to our institution for further evaluation of the previous procedure on anterior shoulder instability. Screw-type metallic suture anchors were used in all cases. All patients were men, with an average age of 23 years (range, 21 to 26). Surgical records on previous procedure were reviewed, and the clinical symptoms were evaluated using a visual analogue scale (VAS), the Simple Shoulder Test (SST), and the Rowe scoring system. The secondary surgery for each patient was performed at an average of 12 months (range, 7 to 20) after the initial arthroscopic stabilization, except in one patient who wanted to postpone the revision surgery. RESULTS Protrusion of the anchor tip was seen in all and chondral defects in the humeral head with some degree of synovitis were also seen. Slight differences between preoperative and postoperative pain were seen, but almost no improvement in function, including range of motion, stability, and average Rowe score were seen after the second procedure. Patients who underwent revision surgery were dissatisfied with the final outcomes. CONCLUSIONS Careful attention should be paid when using a metallic suture anchor. A secure, buried placement of the anchor is required in arthroscopic Bankart reconstruction. Poorly placed suture anchors may damage the glenohumeral joint, and if these are not corrected either at arthroscopic surgery or shortly after, the results can be suboptimal. If a patient complains of unusual mechanical symptoms after using anchors, radiographs should be performed. This kind of serious complication can be discovered earlier to prevent the severe destruction of the glenohumeral joint. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, South Korea.
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