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Vega J, Malagelada F, Guelfi M, Dalmau-Pastor M. Arthroscopic anterior deltoid plication with bone anchor is an effective procedure to control residual talar anterior translation after lateral ligament repair. Knee Surg Sports Traumatol Arthrosc 2024; 32:2178-2183. [PMID: 39031786 DOI: 10.1002/ksa.12328] [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: 02/23/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE Residual symptoms can be observed after ankle lateral ligament repairs commonly due to hyperlaxity, severe ankle instability or a failed stabilization. In order to increase joint stability, ligament or capsular-ligament plication has been used in other joints. Given that the anterior portion of the deltoid is a stabilizer against anterior talar translation, it could be used as an augmentation to restrict anterior talar translation. The aim of this study was to describe an arthroscopic anterior deltoid plication with a bony anchor as an augmentation to the lateral stabilization. The results in a series of eight patients were presented. METHODS Eight patients (seven males, median age 31 [range, 22-43] years) presented residual instability after arthroscopic all inside lateral collateral ligament repair. Arthroscopic anterior deltoid ligament plication was performed in these patients. Median follow-up was 22 (range, 15-27) months. Using an automatic suture passer and a knotless anchor, the anterior deltoid was arthroscopically plicated to the anterior aspect of the medial malleolus. RESULTS During the arthroscopic procedure, only an isolated detachment of the anterior talofibular ligament was observed without any deltoid open-book injury in any case. All patients reported subjective improvement in their ankle instability after the arthroscopic all-inside ligament repair and the anterior deltoid plication with a bony anchor. On clinical examination, the anterior drawer test was negative in all patients. The median American Orthopedic Foot and Ankle Society score increased from 68 (range, 64-70) preoperatively to 100 (range, 90-100) at final follow-up. CONCLUSION The arthroscopic anterior deltoid plication is a feasible procedure to augment stability and control anterior talar translation when treating chronic ankle instability in cases of residual excessive talar translation. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jordi Vega
- Foot and Ankle Unit, iMove Traumatology, Barcelona, and Olympia, Madrid, Spain
- Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain
- MIFAS by GRECMIP, Merignac, France
| | - Francesc Malagelada
- Department of Trauma and Orthopedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Matteo Guelfi
- Casa di Cura Villa Montallegro, Genoa, Italy
- Department of Orthopaedic Surgery "Gruppo Policlinico di Monza", Clinica Salus, Alessandria, Italy
| | - Miki Dalmau-Pastor
- Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain
- MIFAS by GRECMIP, Merignac, France
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Mercurio AM, Coene RP, Cook DL, Feldman L, Milewski MD. Incidence of arthroscopic and open pediatric shoulder stabilization procedures across the United States: a Pediatric Health Information System database study. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:406-412. [PMID: 39157233 PMCID: PMC11329063 DOI: 10.1016/j.xrrt.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
Background Shoulder instability in pediatric and adolescent patients can be treated operatively via arthroscopic or open procedures, but there a paucity of evidence to support the incidence of these treatment modalities over time. It is hypothesized that the overall rate of arthroscopic shoulder stabilization procedures will increase over time. Given advances in open stabilization techniques, we also hypothesized that the rate of open procedures may be increasing. Methods The Pediatric Health Information System database was queried for patients 19 years or younger who underwent arthroscopic or open surgery for shoulder instability and pediatric orthopedic surgeries between 2009 and 2019. Data from 37 of the 52 pediatric hospitals with Pediatric Health Information System data was included in the analysis. Annual and overall incidence rates were estimated for arthroscopic and open procedures, along with 95% confidence intervals. The yearly incidence for secondary (homolateral revisions) or primary contralateral arthroscopic and open procedures was also examined. Results 4747 patients underwent primary arthroscopic procedures and 384 patients had primary open procedures. There were 8.2 primary open shoulder stabilization procedures per 10,000 orthopedic surgical patients in 2009, which decreased by 19% to 6.7 per 10,000 orthopedic surgical patients in 2019. There was an increase seen in both arthroscopic and open secondary stabilization procedures. In 2009, there were 0.97 secondary arthroscopic procedures per 10,000 orthopedic surgical patients. This increased by 672% to 7.5 per 10,000 orthopedic surgical patients in 2019. No secondary open procedures were recorded in 2009; however, an increase to 2.6 secondary open procedures per 10,000 orthopedic surgical patients was seen by 2019. Conclusion This study shows a rise in primary arthroscopic pediatric shoulder stabilization surgeries across the U.S. over the last decade. There was a slight decrease in the rate of primary open shoulder stabilization surgeries and an increase in both arthroscopic and open secondary (homolateral revisions or primary contralateral) shoulder stabilization surgeries, implying an increasing revision burden in this population.
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Affiliation(s)
| | - Ryan P. Coene
- Sports Medicine Division, Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Danielle L. Cook
- Sports Medicine Division, Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Lanna Feldman
- Sports Medicine Division, Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Matthew D. Milewski
- Harvard Medical School, Boston, MA, USA
- Sports Medicine Division, Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA, USA
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Rosello O, Barret H, Langlais T, Boileau P. Comparison of Return to Sports and Competition After the Arthroscopic Bristow-Latarjet Procedure Versus Arthroscopic Bankart Repair in Adolescents With Recurrent Anterior Shoulder Instability. Am J Sports Med 2024; 52:1457-1463. [PMID: 38616609 DOI: 10.1177/03635465241245608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND The use of isolated soft tissue repair versus bone block stabilization for the treatment of recurrent anterior shoulder instability in adolescents has no scientific evidence. PURPOSE To compare the clinical outcomes of adolescent patients who underwent isolated arthroscopic Bankart (iB) repair with those who underwent the arthroscopic Bristow-Latarjet procedure in addition to Bankart (BLB) repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 60 shoulders in adolescents (aged 13-18 years) were reviewed with a minimum 2 years' follow-up: iB repair (n = 36) and arthroscopic Bankart repair with an additional Bristow-Latarjet procedure (BLB; n = 24). The characteristics of the patients in each group in terms of age at the first instability episode, age at surgery, hyperlaxity, participation in at-risk sports, and Instability Severity Index Score were comparable. The mean follow-up was longer in the iB group (7.7 vs 4.1 years, respectively), whereas the rates of patients engaged in competition and those with glenoid lesions were higher in the BLB group. The primary outcome measures were failure, defined as the recurrence of instability (clinical dislocation or subluxation), and return to sports. The mean follow-up was 6.2 years (range, 2-16 years). RESULTS At the last follow-up, the rate of recurrence was significantly higher in the iB group, with 22% (8/36) failures, than in the BLB group, with 8% (2/24) instability recurrences (P < .05). The rate of return to sports at the same level was significantly higher after the BLB repair than after iB repair (79% vs 47%, respectively; P < .001). No statistical difference was found in patient-reported outcome scores between treatment groups (P > .05). Although failures occurred early after the BLB repair, 88% of failures after iB repair occurred after 2 years. On multivariate analysis, adolescents in the iB group with >3 episodes of preoperative dislocation and shoulder hyperlaxity (external rotation >90°) had a 60% recurrence rate (P < .005). CONCLUSION Adolescent patients undergoing the BLB repair had a lower rate of recurrent instability and higher rates of return to sports and competition than those undergoing iB repair. Patients with shoulder hyperlaxity (external rotation >90°) and >3 dislocations had an unacceptable failure rate of 60% after iB repair.
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Affiliation(s)
- Olivier Rosello
- Institut de Chirurgie Réparatrice Locomoteur et Sports, Nice, France
| | - Hugo Barret
- Institut de Chirurgie Réparatrice Locomoteur et Sports, Nice, France
| | - Tristan Langlais
- Institut de Chirurgie Réparatrice Locomoteur et Sports, Nice, France
| | - Pascal Boileau
- Institut de Chirurgie Réparatrice Locomoteur et Sports, Nice, France
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Pasqualini I, Rossi LA, Franco JVA, Denard PJ, Fieiras C, Escobar Liquitay C, Tanoira I, Ranalletta M. Results After Arthroscopic Bankart Repair in Contact Athletes Should Not Be Reported Globally Because of the High Variability in Recurrences Among the Different Contact or Collision Sports: A Systematic Review. Arthroscopy 2024; 40:523-539.e2. [PMID: 37394151 DOI: 10.1016/j.arthro.2023.06.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 06/07/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To describe and compare the recurrence rates in contact or collision (CC) sports after arthroscopic Bankart repair (ABR) and to compare the recurrence rates in CC versus non-collision athletes after ABR. METHODS We followed a prespecified protocol registered with PROSPERO (registration No. CRD42022299853). In January 2022, a literature search was performed using the electronic databases MEDLINE, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials), as well as clinical trials records. Clinical studies (Level I-IV evidence) that evaluated recurrence after ABR in CC athletes with a minimum follow-up period of 2 years postoperatively were included. We assessed the quality of the studies using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool, and we described the range of effects using synthesis without meta-analysis and described the certainty of the evidence using GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). RESULTS We identified 35 studies, which included 2,591 athletes. The studies had heterogeneous definitions of recurrence and classifications of sports. The recurrence rates after ABR varied significantly among studies between 3% and 51% (I2 = 84.9%, 35 studies and 2,591 participants). The range was at the higher end for participants younger than 20 years (range, 11%-51%; I2 = 81.7%) compared with older participants (range, 3%-30%; I2 = 54.7%). The recurrence rates also varied by recurrence definition (I2 = 83.3%) and within and across categories of CC sports (I2 = 83.8%). CC athletes had higher recurrence rates than did non-collision athletes (7%-29% vs 0%-14%; I2 = 29.2%; 12 studies with 612 participants). Overall, the risk of bias of all the included studies was determined to be moderate. The certainty of the evidence was low owing to study design (Level III-IV evidence), study limitations, and inconsistency. CONCLUSIONS There was high variability in the recurrence rates reported after ABR according to the different types of CC sports, ranging from 3% to 51%. Moreover, variations in recurrence among CC sports were observed, with ice hockey players being in the upper range but field hockey players being in the lower range. Finally, CC athletes showed higher recurrence rates when compared with non-collision athletes. LEVEL OF EVIDENCE Level IV, systematic review of Level II, III, and IV studies.
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Affiliation(s)
- Ignacio Pasqualini
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Luciano Andrés Rossi
- Shoulder Unit, Department of Orthopedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Juan Victor Ariel Franco
- Institute of General Practice, Medical Faculty of the Heinrich-Heine - University Dusseldorf, Dusseldorf, Germany
| | | | - Cecilia Fieiras
- Shoulder Unit, Department of Orthopedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Ignacio Tanoira
- Shoulder Unit, Department of Orthopedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano Ranalletta
- Shoulder Unit, Department of Orthopedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Calvo E, Dzidzishvili L, Valencia M, Calvo C. Outcomes of Arthroscopic Latarjet as a Revision Surgery After Failed Arthroscopic Bankart Repair. Am J Sports Med 2024; 52:190-200. [PMID: 38164667 DOI: 10.1177/03635465231209986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND The role of arthroscopic Latarjet as a revision surgery after failed arthroscopic Bankart repair has yet to be established. PURPOSE To compare clinical outcomes, recurrences, and complication rates of arthroscopic Latarjet as a revision procedure after failed arthroscopic Bankart repair versus arthroscopic Latarjet as a primary procedure. DESIGN Cohort study; Level of evidence, 3. METHODS This is a retrospective study of prospectively collected data of patients who were diagnosed with anterior shoulder instability and underwent arthroscopic Latarjet stabilization between 2009 and 2018. Patients were separated into 2 groups depending on whether Latarjet was performed after a previous instability surgery (revision) or as a primary surgery (primary). Rowe score, Western Ontario Shoulder Instability Index (WOSI), Constant-Murley Shoulder Outcome (CMSO) score, and Single Assessment Numeric Evaluation (SANE) were assessed pre- and postoperatively with a minimum 24 months of follow-up. In addition, pre- and postoperative levels of sports activity, dislocations, subluxations, and complications were assessed. RESULTS A total of 97 patients (n = 62 revision; n = 35 primary), with a mean age of 31.0 ± 8.8 and 29.4 ± 7.6 years old in the revision and primary Latajet group, respectively, met the inclusion criteria. The mean follow-up in the revision group was 32 months (24-53) and 35.5 months (27.7-42.2) in the primary Latarjet group. No significant differences between groups were observed in Rowe score (revision = 91.4, primary = 94.1; P = .223), CMSO score (revision = 90.7, primary = 94; P = .105), and SANE (revision = 85.8, primary = 87.3; P = .683) postoperatively. However, the postoperative difference in the WOSI score between the revision and primary Latarjet groups was nearly significant (510 ± 334 vs 403 ± 343, respectively; P = .05). Four (6.4%) postoperative dislocations were reported in the revision and 1 (2.8%) in the primary Latarjet group (P = .14). Patients in the revision group had a lower return to the previous level of sports participation (P = .008) and decreased external rotation with the arm by the side compared with the primary Latarjet group (P = .000). CONCLUSION Arthroscopic Latarjet as a revision surgery is a reasonable surgical option in failed Bankart repair cases. The decision to perform arthroscopic Latarjet stabilization as a revision surgery should not be influenced by the potential risk of future complications as it provides comparable clinical outcomes to the primary Latarjet procedure with a low postoperative recurrence rate. However, a decreased level of postoperative sports participation and external rotation with the arm by the side can be expected.
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Affiliation(s)
- Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Lika Dzidzishvili
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Valencia
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Claudio Calvo
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Minokawa S, Shibata Y, Shibata T, Kosaka H, Izaki T. Bone formation of the coracoid bone graft after the Bristow procedure assessed using three-dimensional computed tomography. J Orthop Sci 2023:S0949-2658(23)00324-X. [PMID: 38030446 DOI: 10.1016/j.jos.2023.11.010] [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: 07/31/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND The Bristow procedure has been shown to be a reliable method to prevent recurrent anterior shoulder instability by compensating for glenoid bone loss and producing the sling effect. The degree of postoperative morphological change in the coracoid bone graft is speculated to influence glenohumeral joint stability; however, the details of these changes after the Bristow procedure remain unknown. This study was performed to quantify the postoperative change in the coracoid bone graft volume as assessed by three-dimensional computed tomography (3D-CT). METHODS The Bristow procedure was performed on 17 shoulders in 17 patients from August 2018 to January 2020. All patients were men, and their mean age at surgery was 17.9 years. The mean follow-up duration was 21.4 months. Within the first week after the operation (Time 0) and at the final follow-up, 3D-CT was used to determine the total coracoid bone graft volume. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) shoulder score, the University of California Los Angeles (UCLA) shoulder score, and the Western Ontario Shoulder Instability Index (WOSI). RESULTS The mean volume of the total coracoid bone graft was 1.26 ± 0.29 cm3 at Time 0 and 1.90 ± 0.36 cm3 at the final follow-up (p < 0.0001). The mean JOA score, UCLA score, and WOSI were significantly better at the final follow-up than preoperatively (p < 0.001). No postoperative infection, neurovascular injury, or recurrent instability of the glenohumeral joint occurred. CONCLUSIONS In the Bristow procedure, the volume of the total coracoid bone graft as shown by 3D-CT was significantly greater at the final follow-up than at Time 0, and bone formation of the coracoid bone graft was found after the Bristow procedure.
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Affiliation(s)
- So Minokawa
- Department of Orthopaedic Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-8502, Japan.
| | - Yozo Shibata
- Department of Orthopaedic Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-8502, Japan
| | - Terufumi Shibata
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Hidetomo Kosaka
- Department of Orthopaedic Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-8502, Japan
| | - Teruaki Izaki
- Department of Orthopaedic Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-8502, Japan
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Min KS, Horng J, Cruz C, Ahn HJ, Patzkowski J. Glenoid Bone Loss in Recurrent Shoulder Instability After Arthroscopic Bankart Repair: A Systematic Review. J Bone Joint Surg Am 2023; 105:1815-1821. [PMID: 37643239 DOI: 10.2106/jbjs.23.00388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Glenoid bone loss has been reported to occur in as many as 86% of patients with recurrent shoulder stability. This systematic review evaluated the amount of glenoid bone loss associated with recurrent shoulder dislocation or subluxation and with worse patient-reported outcomes after arthroscopic Bankart repair. We hypothesized that the percentage of glenoid bone loss associated with recurrent instability after arthroscopic Bankart repair is lower than the previously proposed critical value of 25%. METHODS The systematic review included 528 patients with glenoid bone loss from 3 clinical studies. The percentage of bone loss was the value quantified and reported in each study. Failure was defined as recurrent dislocation or subluxation. The percentage of glenoid bone loss associated with recurrent shoulder dislocation or subluxation after arthroscopic Bankart labral repair was analyzed with receiver operating characteristic (ROC) curve analysis. RESULTS Recurrent dislocation or subluxation occurred in 23.7% (125) of 528 patients in the pooled study cohort. There was a significant difference in age between those in whom the arthroscopic Bankart repair failed and those in whom it did not (22.9 versus 24.3 years; p = 0.009). The ROC curve analysis demonstrated that ≥16.0% glenoid bone loss was predictive of recurrent shoulder dislocation or subluxation (Youden index = 0.59, sensitivity = 80%, specificity = 80%). In patients who did not sustain a recurrent dislocation or subluxation, the ROC curve analysis demonstrated that 20.0% glenoid bone loss was predictive of a Single Assessment Numeric Evaluation (SANE) score of <85% (Youden index = 0.93, sensitivity = 93%, specificity = 100%). CONCLUSIONS The critical amount of glenoid bone loss associated with an increased risk of persistent instability was found to be less than previously reported. Glenoid bone loss of ≥16.0% was found to place patients at higher risk for recurrent shoulder dislocation or subluxation after treatment with arthroscopic Bankart repair alone. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kyong S Min
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii
- Uniformed Services University, Bethesda, Maryland
- John A. Burns School of Medicine, Honolulu, Hawaii
| | | | - Christian Cruz
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii
| | | | - Jeanne Patzkowski
- Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, Texas
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Johnson AH, Brennan JC, Lashgari CJ, Petre BM, Turcotte JJ, Redziniak DE. Clinical Results of Knot-tying Versus Knotless Suture Anchors in Arthroscopic Anteroinferior Labral Repair. Cureus 2023; 15:e40292. [PMID: 37448384 PMCID: PMC10337236 DOI: 10.7759/cureus.40292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
Background Arthroscopic repair of glenohumeral instability is becoming an increasingly common procedure. These repairs can be undertaken using knot-tying and knotless suture anchors; there is currently no clear consensus in the literature about what type of repair is most cost-effective and provides superior outcomes. The purpose of this study is to examine postoperative outcomes of patients undergoing arthroscopic anteroinferior labral repair (AALR) with either knot-tying or knotless anchors. Methods A single institution retrospective observational cohort study of 122 patients undergoing AALR from January 2014 to June 2021 was conducted. Univariate statistics were used to assess differences in demographics, operative characteristics, and postoperative outcomes between repair types; multivariate analysis was used to evaluate risk factors for recurrent instability and reoperation. Results Patients undergoing AALR with knotless anchors had a shorter case duration than those with knot-tying anchors (112.64 vs. 89.86 minutes, p<0.001). There were no significant differences between groups in the size of labral tear, presence of a glenoid bone defect, or Hill-Sachs lesion. After controlling for age, BMI, sex, glenoid bone defect, number of preoperative dislocations, and fixation type, only age (OR=0.896, p=0.010) and female sex (OR=5.341, p=0.008) were independent risk factors for recurrent instability and no factors were independent predictors of reoperation. Conclusion Patients undergoing AALR experienced similar rates of reoperation and recurrent instability regardless of whether a knot-tying or knotless repair was performed. The use of knotless suture anchors may improve cost-effectiveness due to decreased surgical time without diminishing postoperative outcomes.
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Affiliation(s)
| | - Jane C Brennan
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
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Brzoska R, Laprus H, Malik SS, Solecki W, Juszczak B, Blasiak A. Return to Preinjury-Level Sports After Arthroscopic Latarjet for Recurrent Anterior Shoulder Instability in Professional Athletes. Orthop J Sports Med 2023; 11:23259671231166371. [PMID: 37162759 PMCID: PMC10164259 DOI: 10.1177/23259671231166371] [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: 12/12/2022] [Accepted: 01/27/2023] [Indexed: 05/11/2023] Open
Abstract
Background The Latarjet procedure is recommended to treat recurrent anterior shoulder instability with glenoid bone loss. Longer return-to-sport (RTS) times have been reported after the open Latarjet when compared with the arthroscopic Latarjet. Purpose To assess the clinical outcomes and RTS in athletes who underwent an arthroscopic Latarjet. Study Design Case series; Level of evidence, 4. Methods This study included 46 professional athletes with recurrent anterior shoulder instability who underwent an arthroscopic Latarjet between 2010 and 2016. Patients were divided by type of sport: noncollision and nonoverhead (n = 22), collision and martial arts (n = 13), and overhead (n = 11). Sport activity was evaluated with the Kerlan-Jobe Orthopaedic Clinic (KJOC) score, Subjective Patient Outcome for Return to Sports score, and RTS time. Clinical results were evaluated by Constant-Murley score, Walch-Duplay score, and range of external and internal rotation. Complication rates, recurrence of shoulder instability, and number of revision procedures were recorded. Correlation tests were used to assess the relationship between measured parameters. Results The mean ± SD patient age was 27.1 ± 7.3 years, and the mean follow-up was 50.7 ± 18 months. Overall, 44 patients (95.7%) returned to their previously practiced sports, and 40 (87%) returned to their preinjury levels. The RTS time was 5 ± 1.4 months, with no significant difference among sport types. KJOC and Subjective Patient Outcome for Return to Sports scores were 95.2 ± 5.6 and 9.5 ± 1, respectively. Significant pre- to postoperative improvement was seen on the Constant-Murley score (from 54.3 ± 9.4 to 87.9 ± 8.2; P = .001) and Walch-Duplay score (from 53.7 ± 7.3 to 88.1 ± 10.7; P = .001). Mean postoperative external and internal rotation was 72.8° ± 18.6° and 81.3° ± 11.3°. Procedure-related complications occurred in 10 patients (21.7%); recurrence of shoulder instability was observed in 4 (8.7%); and 4 (8.7%) underwent revision surgery. A worse Walch-Duplay score was significantly associated with longer RTS time (r = -0.39; P = .019) and lower KJOC score (r = 0.29; P = .03). Conclusion There was a 95.7% RTS rate after the arthroscopic Latarjet procedure, although the procedure was not free from complications.
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Affiliation(s)
| | - Hubert Laprus
- St Luke’s Hospital, Bielsko-Biala, Poland
- Hubert Laprus, MD, PhD, St Luke’s Hospital, Bystrzanska 94B 43-309 Bielsko-Biala, Poland ()
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Hirose T, Tanaka M, Nakai H, Hanai H, Kotani Y, Kuratani K, Hayashida K. Association Between Preoperative Glenoid Bone Loss and Postoperative Outcomes After Coracoid Transfer Combined With Open Bankart Repair: Comparison of the Bristow and Latarjet Techniques. Orthop J Sports Med 2023; 11:23259671231172219. [PMID: 37260581 PMCID: PMC10227879 DOI: 10.1177/23259671231172219] [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: 02/09/2023] [Accepted: 02/26/2023] [Indexed: 06/02/2023] Open
Abstract
Background Whether the extent of glenoid bone loss (GBL) affects clinical outcome after coracoid process transfer (CPT) is still unclear. Purpose To evaluate postoperative outcomes after CPT combined with open Bankart repair in young rugby players in terms of the extent of GBL and between the Bristow and Latarjet techniques. Study Design Cohort study; Level of evidence, 3. Methods The authors investigated 101 shoulders in 91 competitive rugby players who underwent CPT combined with open Bankart repair by the Bristow (group B; 66 shoulders) or Latarjet (group L; 35 shoulders) procedure between 2007 and 2017. The extent of GBL was calculated from the en face view of the glenoid on preoperative 3-dimensional computed tomography scans and was used to categorize shoulders into 4 grades (grade 0, 0%; grade 1, >0% and ≤10%; grade 2, >10% and ≤20%; grade 3, >20%). At the minimum 2-year follow-up, the authors analyzed the relationship between GBL or GBL grade and postoperative outcome scores (American Shoulder and Elbow Surgeons score, Rowe score, Western Ontario Shoulder Instability Index, and patient satisfaction), return-to-play (RTP) times, graft failure (insufficient union or translocation), and recurrence. Results The mean GBL in all shoulders was 10.9% ± 9.2% and was not significantly different between the 2 groups. There were no significant correlations between GBL and any outcome measure in either group. The mean RTP time was significantly shorter in group L versus group B (4.8 ± 1.1 vs 5.8 ± 1.8 months, respectively; P = .002), but it was not associated with GBL. In group B, the rate of graft failure was not significantly higher in shoulders with grade 0 or 1 GBL versus grade 2 or 3 GBL (8 [25.0%] vs 4 [11.8%], respectively; P = .21). In group B, graft failure was confirmed in 12 shoulders (18.2%), compared with 1 shoulder (2.9%) in group L. Postoperative recurrence occurred in significantly fewer shoulders in group B than in group L (2 [3.0%] vs 5 [14.3%], respectively; P = .047). Conclusion The extent of GBL did not affect outcome scores after CPT, regardless of operative procedure.
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Affiliation(s)
- Takehito Hirose
- Department of Orthopaedic Surgery,
Daini Osaka Police Hospital, Osaka, Japan
| | - Makoto Tanaka
- Department of Orthopaedic Surgery,
Daini Osaka Police Hospital, Osaka, Japan
- Center for Sports Medicine, Daini Osaka
Police Hospital, Osaka, Japan
| | - Hidekazu Nakai
- Department of Orthopaedic Surgery,
Daini Osaka Police Hospital, Osaka, Japan
| | - Hiroto Hanai
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuki Kotani
- Department of Orthopaedic Surgery,
Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kosuke Kuratani
- Department of Orthopaedic Surgery, JCHO
Osaka Hospital, Osaka, Japan
| | - Kenji Hayashida
- Department of Orthopaedic Surgery,
Osaka Central Hospital, Osaka, Japan
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11
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Genena A, Hashem M, Waly A, Hegazy MO. Open Latarjet Versus Arthroscopic Bankart Repair for the Treatment of Traumatic Anterior Shoulder Instability in High-Demand Patients With Minimal Glenoid Bone Loss. Cureus 2023; 15:e37127. [PMID: 37168209 PMCID: PMC10166300 DOI: 10.7759/cureus.37127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND This study compared the clinical outcomes and return to sports/work between open Latarjet and arthroscopic Bankart repair in high-demand patients with traumatic anterior shoulder instability with minimal glenoid bone loss. METHODS We prospectively recruited 30 patients and randomised them to either open Latarjet or arthroscopic Bankart. The mean duration of follow-up in our study was 13.27 months±2.70. All patients were males with a mean age at surgery of 28.6 years (range, 18-41 years). RESULTS The overall mean for the Rowe score in the 30 patients increased from 33.5±14 points preoperatively to 79.6±18 points. However, there was no statistically significant difference in the postoperative ROM (range of motion) and Rowe score among the Bankart and Latarjet groups. The main finding in our study was the time to return to sports/work which was significantly lower in the Latarjet group (5.2 months) compared to the Bankart group (seven months). CONCLUSIONS Open Latarjet is considered a more invasive and non-anatomical procedure, however, it is less costly with a shorter time to return to sports/work compared to the Bankart procedure, which is very crucial for high-demand patients, especially the competitive athletes targeting an early return to sports at the same pre-injury level with minimal incidence of recurrence, making the surgeon's choice very challenging.
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12
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Gómez DJ, Veloz Serrano D, Moya D, Crosa JI, Cullari ML, Taleb JP, Quiroga G, Maya XA, Muratore Á. Functional results and return to sports on recurrent anterior glenohumeral instability. Influence of the COVID-19 pandemic; Comparative retrospective study and short-term results. J Orthop Surg (Hong Kong) 2023; 31:10225536231160308. [PMID: 36856055 PMCID: PMC9982427 DOI: 10.1177/10225536231160308] [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] [Indexed: 03/02/2023] Open
Abstract
AIMS Our objective is to compare the functional results in patients that underwent surgery for recurrent anterior shoulder instability (RAGHI) during the COVID-19 pandemic with remotely-based rehabilitation, to those who had surgery before the pandemic and had in-person rehabilitation therapy. METHODS A retrospective case series of 68 patients were included and divided into two groups: In person-group and Home-based group. Western Ontario Shoulder Instability Index (WOSI) and Subjective Shoulder Value (SSV) scores were used to evaluate objective and subjective clinical parameters. Time and level of return to sports was studied by the Subjective Patient Outcome for Return to Sports (SPORTS) score. RESULTS The mean SSV score was 82% (40-100) on the In-Person group compared with 87% (65-100) for the Home-Based group. Results for WOSI score were similar, with an average of 210.42 (90%) for In-Person and 261.45 (88%) for the Home-Based group (p 0.12). Return to sports was carried out in an average of 6.6 (4-16) months for In-Person group, compared to 6.5 (5-8) months for Home-Based. CONCLUSION Follow-up and rehabilitation methods for patients who underwent surgery for RAGHI, during COVID-19 lockdown, were not significantly (p 0.12) affected on functional and athletic return in comparison to traditional methods according to WOSI scale. LEVEL OF EVIDENCE IV Retrospective series of cases.
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Affiliation(s)
- Diego J Gómez
- Orthopedic Surgery, 62870British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Daniel Veloz Serrano
- Orthopedic Surgery, 62870British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Daniel Moya
- Orthopedic Surgery, 62870British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Juan I Crosa
- Orthopedic Surgery, 62870British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Matias L Cullari
- Orthopedic Surgery, 62870British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Juan P Taleb
- Orthopedic Surgery, 62870British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Gonzalo Quiroga
- Orthopedic Surgery, 62870British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Xavier A Maya
- Orthopedic Surgery, 62870British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Álvaro Muratore
- Orthopedic Surgery, 62870British Hospital of Buenos Aires, Buenos Aires, Argentina
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13
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Li L, McGuinness BK, Layer JS, Song Y, Jensen MA, Dai B. Longitudinal assessments of strength and dynamic balance from pre-injury baseline to 3 and 4 months after labrum repairs in collegiate athletes. Physiother Theory Pract 2022; 38:2505-2513. [PMID: 34098835 PMCID: PMC8648851 DOI: 10.1080/09593985.2021.1934925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/26/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is a lack of quantitative assessments of athletes' functional strength and dynamic balance following labrum repairs. PURPOSE To compare the upper extremity strength and dynamic balance among pre-injury baseline and approximately 3 and 4 months after labrum surgeries in collegiate athletes to identify critical values to inform rehabilitation. METHODS Fifteen male and one female collegiate athletes between 18 and 22 years old were tested at pre-injury baseline (n = 14) and 2.7 (n = 16) and 3.8 months (n = 12) after labrum surgeries. Strength was assessed using the peak forces produced in a maximal push-up test. Dynamic balance was assessed using the reaching distances in a reaching test. RESULTS The injured side's peak forces significantly decreased from the baseline to the 3-month post-surgery and then significantly increased between the 3-month and 4-month post-surgery assessments but remained significantly less at the 4-month post-surgery compared to the baseline (p ≤ 0.024; Cohen's dz ≥ 0.75). Peak force asymmetries were greater at the 3-month and 4-month post-surgery assessments than the baseline (p ≤ 0.005; Cohen's dz ≥ 1.02). CONCLUSION With a relatively small sample size, the results support the use of objective functional assessments for rehabilitation and return-to-play decisions among collegiate athletes following labrum repairs.
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Affiliation(s)
- Ling Li
- Division of Kinesiology and Health, University of Wyoming, 1000 E. University Ave. Laramie, WY, USA
| | - Brenna K. McGuinness
- Division of Kinesiology and Health, University of Wyoming, 1000 E. University Ave. Laramie, WY, USA
| | - Jacob S. Layer
- Division of Kinesiology and Health, University of Wyoming, 1000 E. University Ave. Laramie, WY, USA
| | - Yu Song
- Division of Kinesiology and Health, University of Wyoming, 1000 E. University Ave. Laramie, WY, USA
| | - Megan A. Jensen
- Department of Sports Medicine, 1000 E. University Ave.University of Wyoming, Laramie, USA
| | - Boyi Dai
- Division of Kinesiology and Health, University of Wyoming, 1000 E. University Ave. Laramie, WY, USA
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14
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Castricini R, Castioni D, De Benedetto M, Cimino M, Massarini A, Galasso O, Gasparini G. Arthroscopic Latarjet for Primary Shoulder Instability With Off-Track Lesions or Revision Surgery Yields Satisfactory Clinical Results and Reliable Return to Sport and Work at Minimum 3-Year Follow-Up. Arthroscopy 2022; 38:2809-2818.e1. [PMID: 35469994 DOI: 10.1016/j.arthro.2022.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To retrospectively evaluate clinical and radiologic outcomes and return to sport and to work of patients after arthroscopic Latarjet stabilization for primary instability or revision surgery; factors influencing and determining results and potential predictors for clinical outcomes also were evaluated. METHODS This is a retrospective study including patients older than 18 years old who underwent arthroscopic Latarjet stabilization for recurrent anterior glenohumeral instability with off-track lesions, or for cases of recurrence after previous surgery, from 2011 to 2017. Patients were assessed preoperatively and at a minimum 3 years of follow-up using the Rowe score, the University of California at Los Angeles Shoulder Score and Simple Shoulder Test score; the range of motion, satisfaction rate, return to work and sport, perception of discomfort during sporting and daily activities, and complications and recurrence after surgery were also evaluated. The integration of the coracoid graft and the position of the screws were examined by computed tomography scan. RESULTS At a mean follow-up time of 6 ± 2 years, 93 patients (95 shoulders) showed significant improvement of all scale scores (P < .001), 97.8% of the patients had returned to the same working condition as before surgery, and all the patients who practiced sports preoperatively (85; 91.4%) returned to sport after surgery; 97.9% of patients were satisfied with surgery. The complication rate was 5.4%, and 2 cases (2.1%) of recurrence occurred, both after high-energy trauma. At an average of 17 ± 13 months postoperatively, computed tomography scans showed 4 (6.6%) stable nonunions, 9 (14.8%) superior, and 1 (1.6%) inferior lyses of the graft; a correct positioning of the graft was observed in 86.9% of the cases. Greater satisfaction, fewer complications, less pain during daily activities, and a lower number of reoperations were associated with a shorter time between the first dislocation episode and surgery (P = .019, P < .001, P = .014, and P = .005, respectively). Complications were directly associated with older patient age at operation (P = .001). A greater number of nonunions was found in patients with increased angle between the line linking the posterior and anterior glenoid rim and the screw axis (P = .040) and a medial axial position or a lower coronal position of the graft (both P = .010). A lower age at the time of surgery predicted better Rowe scores at follow-up (P < .001), and a lower age at the time of the first episode of dislocation predicted better postoperative Simple Shoulder Test scores (P = .026). CONCLUSIONS At a mean 6-year follow-up time, excellent clinical outcomes, and radiological results, with few complications, high rates of satisfaction and return to work and sport and low sports anxiety can be expected after arthroscopic Latarjet procedure. A shorter time between the first dislocation episode and surgery was associated with higher satisfaction, fewer complications, less pain during daily activities and lower reoperations; a lower age at the operation was associated with lower complications.
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Affiliation(s)
- Roberto Castricini
- Division of Orthopaedic and Trauma Surgery, "Villa Verde" Hospital, Fermo, Italy
| | - Davide Castioni
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Massimo De Benedetto
- Division of Orthopaedic and Trauma Surgery, "Villa Verde" Hospital, Fermo, Italy
| | - Monica Cimino
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Alessandro Massarini
- Division of Orthopaedic and Trauma Surgery, "Villa Verde" Hospital, Fermo, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, "Mater Domini" University Hospital, Catanzaro, Italy.
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, "Mater Domini" University Hospital, Catanzaro, Italy
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15
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Single- and Double-Loaded All-Suture Anchor Repairs of Anteroinferior Labral Tears Are Biomechanically Similar in a Cadaveric Shoulder Model. Arthrosc Sports Med Rehabil 2022; 4:e1933-e1939. [PMID: 36579055 PMCID: PMC9791829 DOI: 10.1016/j.asmr.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/19/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose To compare the biomechanical strength of single- versus double-loaded all-suture constructs in an anteroinferior glenoid labral repair. Methods Anteroinferior labral lesions were created on 6 matched pairs of cadaveric shoulder specimens. Each shoulder in a matched pair was randomized to either receive capsulolabral repair with 3 single-loaded all-suture anchors or 3 double-loaded all-suture anchors. Immediately following capsulolabral repair, the specimens underwent mechanical testing, which included cyclic testing (5 N to 50 N for 500 cycles) and load-to-failure testing (rate of 15 mm/min). The gap formation between the repaired labrum and glenoid (measured at 1, 25, 100, and 500 cycles), the load at 2-mm gap formation, the maximum load at failure and the method of failure were recorded. Data were analyzed with paired Student t tests and Bonferroni correction factor. Results The single and double all-suture constructs did not differ significantly in gap formation at any number of cycles, load to 2-mm gap formation (P = .75), or maximum load to failure (P = .46) between the 2 groups. Conclusions In this study, single-loaded and double-loaded all-suture anchor constructs demonstrated comparable biomechanical performance and did not significantly differ in gap formation, load to 2-mm gap formation, or maximum load to failure when used in the capsulolabral repair of anteroinferior glenoid labral tears in human cadaveric specimens. Clinical Relevance Although studies have evaluated the biomechanical properties of various arthroscopic labral stabilization techniques, the biomechanical properties of all-suture anchors with regard to labral stabilization are not well understood.
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16
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Haase L, Wise K, Kelly B, Harris J, Macalena J. No Difference Between Anchorless and Traditional Suture Anchors in Arthroscopic Bankart Repair: A Clinical Comparison. Cureus 2022; 14:e26988. [PMID: 35989839 PMCID: PMC9385306 DOI: 10.7759/cureus.26988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background Shoulder instability and recurrent dislocations are common problems encountered by orthopedic surgeons and are frequently associated with a Bankart lesion. These are classically treated with either open or arthroscopic repair utilizing traditional suture anchors, though anchorless fixation techniques have recently been developed as an alternate fixation method that reduces native bone loss and has comparable pull-out strength. Methods A retrospective review was performed at a single institution for patients who underwent Bankart repair from January 2008 through February 2014. American Shoulder and Elbow Surgeons (ASES) questionnaires were mailed to 35 patients with anchorless fixation and 35 age-, gender-, and surgeon-matched patients with traditional suture anchors. Statistical analysis was performed comparing re-dislocation, additional surgery, and ASES scores with statistical significance set at p < 0.05. Results Eleven patients in the anchorless implant group and 15 patients in the anchor group completed the questionnaire. The mean follow-up was 4.1 years in the anchorless group and 5.6 years in the anchor group (p=0.04). The number of implants was 4.82 in the anchorless group and 3.87 in the anchor group (p = 0.04). No difference was found in re-dislocation rates (p = 0.80) or additional surgery on the affected shoulder (p = 0.75). ASES scores were found to have no statistical difference (89.89 for the anchorless group versus 85.37 for the anchor group; p = 0.78). Conclusion In patients undergoing arthroscopic Bankart lesion repair with traditional anchors compared to anchorless fixation, there appears to be no difference in shoulder re-dislocation rates, recurrent ipsilateral shoulder surgery, or ASES scores.
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17
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Monk AP, Crua E, Gatenby GC, Walsh AJ, Stanley JC, Rosenfeldt MP, Twaddle BC, Walsh SJ. Clinical outcomes following open anterior shoulder stabilization for glenohumeral instability in the young collision athlete. J Shoulder Elbow Surg 2022; 31:1474-1478. [PMID: 35051538 DOI: 10.1016/j.jse.2021.12.013] [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: 07/18/2021] [Revised: 12/07/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior glenohumeral instability occurs most commonly in those aged 15-29, with 72% of individuals younger than 22 years suffering recurrent episodes; collision athletes are at particular risk. In the setting of subcritical glenoid bone loss, arthroscopic Bankart repair is widely used despite concerns of recurrent dislocations when compared with open techniques. Furthermore, indications for bone-block procedures are evolving with the Latarjet procedure being favored amongst recent authors as a primary stabilization method in elite and contact athletes. OBJECTIVE To determine the efficacy of open modified Bankart stabilization in treating anterior glenohumeral instability in young collision athletes. METHODS This was a retrospective review of outcomes of consecutive patients aged 15-20 years who underwent unilateral or bilateral open stabilization for recurrent anterior glenohumeral instability over a 7-year period (2007-2015). The cohort was selected as recent literature suggests that this is the group with the highest redislocation rate and poorest outcomes. Outcome assessments included redislocation rate, return to sport, pain score, patient-related satisfaction scores, and the Western Ontario Shoulder Instability Index. RESULTS A total of 60 patients (55 male: 5 female) of mean age 18 years (range: 15-20 years) were available for follow-up at 7 years. All but 3 were competitive athletes with 18 competing regionally and 9 internationally; rugby union and rugby league represent the most common sports. Fifty-five of 60 (92%) have returned to their desired level of sport with 62% of athletes returning to their previous level of competition sport and 1 retuning at a higher level. The mean postoperative pain score was 2.5/10. The mean time to return to play was 14 months (range: 5-48 months). Eight of 60 shoulders reported redislocation (13%), 7 of these being traumatic dislocations after return to high-impact sporting activities. At 7 years of follow-up, 4 of 60 shoulders (7%) had undergone revision surgery. CONCLUSION Young collision athletes represent a challenging cohort of instability patients. This study of open modified Bankart in young collision sport athletes revealed excellent outcomes with 92% return to sport and a low revision rate. The results from this cohort rival those of arthroscopic repair. The open procedure described here in this 7-year series represents a robust, reliable technique that could be considered as an alternative to arthroscopic Bankart due to concern for recurrence, while avoiding potential morbidity and complication of bone-block procedures. There is still a role for the open modified Bankart procedure in treating traumatic anterior instability.
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Affiliation(s)
- A Paul Monk
- Unisports Orthopaedics, Auckland, New Zealand
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18
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Jenkins AS, Pollock JR, Moore ML, Makovicka JL, Brinkman JC, Chhabra A. The 100 Most-Cited and Influential Articles in Collegiate Athletics. Orthop J Sports Med 2022; 10:23259671221108401. [PMID: 35837444 PMCID: PMC9274432 DOI: 10.1177/23259671221108401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/11/2022] [Indexed: 12/26/2022] Open
Abstract
Background Bibliometric citation analyses have been widely used in medicine to help researchers gain foundational knowledge about a topic and identify subtopics of popular interest for further investigations. There is a lack of similar research in collegiate athletics. Purpose To identify the 100 most-cited research publications related to collegiate athletics. Study Design Cross-sectional study. Methods The Clarivate Analytics Web of Knowledge database was used to generate a list of articles relating to collegiate athletics on January 24, 2022. Articles were filtered by the total number of citations, and the 100 most-cited articles were selected. For each article, we identified and analyzed the following: author name, publication year, country of origin, journal name, article type, main research topic area, competitive level, sex of study population, and level of evidence. Results Of the top 100 most-cited articles, 63 were related to medicine. In total, 96% of articles were published in the United States, and 80% were published in the year 2000 or later. Of the top 100 articles, 85 were observational; only 5 were experimental. The sport most represented was soccer, followed by football, baseball, and basketball. Of the top 100 articles, 21 were published in a single journal, the American Journal of Sports Medicine. Ten authors published ≥5 of the top 100 most-cited studies. Conclusion The majority of top 100 articles were published in the United States after 1999 and primarily focused on medicine-related topics. Soccer was studied by more articles than football, baseball, and basketball. An author's prestige may have influenced the likelihood of citation. The top 100 most-cited studies provide researchers, medical students, residents, and fellows with a foundational list of the most important and influential academic contributions to the literature on collegiate athletics.
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Affiliation(s)
- Anna S Jenkins
- Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - M Lane Moore
- Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Joseph C Brinkman
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA
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19
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Consigliere P, Bernasconi A, Dimock R, Narvani AA. Clinical outcomes and structural integrity rate of arthroscopic augmented rotator cuff repairs using extracellular porcine matrix patch. Shoulder Elbow 2022; 14:38-51. [PMID: 35845616 PMCID: PMC9284254 DOI: 10.1177/1758573220982607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Structural failure rate in rotator cuff repairs is still high. The purpose of the study is to assess the structural integrity of a series of augmented rotator cuff repairs with porcine matrix patch and report the functional outcomes. METHODS Between 2014 and 2017, 44 consecutive patients underwent arthroscopic double-row repair of medium to massive rotator cuff tears with extracellular porcine dermal matrix augmentation. At one-year follow-up, magnetic resonance imaging scan was performed to assess the integrity of the repair. Oxford Shoulder Score (OSS), Constant Score (CS) and Visual Analogue Scale pain score, together with range of motion were used to assess patients. RESULTS Patients mean age was 68 (53-82); mean follow-up was 17.2 (12-24) months. On magnetic resonance imaging scans, seven rotator cuff repair failures (15.9%) were observed: tear size was an independent predictor of re-rupture at one-year follow-up. Clinical scores showed a statistically significant improvement at three months and until final follow-up (p< 0.001). No complications occurred. CONCLUSION Observed structural failure rate of 15.9% is lower than those reported in the literature for standard rotator cuff repair of medium to massive tears in similar cohorts to ours. Extracellular matrix augmentation for rotator cuff repair was shown to be a safe and reliable support to the repairs and patients recovered good shoulder function.Level of Evidence: Level IV.
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Affiliation(s)
- Paolo Consigliere
- Wythenshawe Hospital, Manchester
University NHS FT, Manchester UK,Reading Shoulder Unit, Reading, UK,Paolo Consigliere, Wythenshawe Hospital,
Roundthorn Industrial Estate, Wythenshawe, Manchester M23 9LT, UK.
| | | | - Richard Dimock
- Department of Trauma and Orthopaedics,
Ashford & St Peters NHS FT, Chertsey, UK
| | - A Ali Narvani
- Department of Trauma and Orthopaedics,
Ashford & St Peters NHS FT, Chertsey, UK,Fortius Clinic London, London, UK
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20
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Pasqualini I, Rossi LA, Tanoira I, Ranalletta M. Return to sports, functional outcomes, and recurrences after arthroscopic Bankart repair in soccer players. Shoulder Elbow 2022; 14:16-20. [PMID: 35845617 PMCID: PMC9284261 DOI: 10.1177/1758573220928926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a shortage of relevant reports about the results obtained after shoulder stabilization in soccer players. Therefore, this retrospective study aims to report return to sports, functional outcomes, and recurrences after arthroscopic Bankart repair in soccer players. METHODS A total of 156 soccer players were treated for anterior shoulder instability at a single institution between 2008 and 2017. The Rowe score and Athletic Shoulder Outcome Scoring System were used to assess functional outcomes. Return to sport and recurrence rates were also evaluated. RESULTS The Rowe and Athletic Shoulder Outcome Scoring System scores showed statistical improvement after surgery (P < .001). Overall, 148 soccer players (94.8%) returned to sports, and 122 (78.2%) returned to the same level. The mean time to return to sport was 4.8 months. The recurrence rate was 5.2%. DISCUSSION Soccer players who underwent an arthroscopic isolated Bankart repair for anterior glenohumeral instability have shown remarkable outcomes, with most of the patients returning to sports, and at the same level they had before surgery with a low rate of recurrence.
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Affiliation(s)
| | - Luciano A Rossi
- Luciano A Rossi, Peron 4190 (C1199ABB),
Buenos Aires, Argentina.
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21
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No Clinical or Radiographic Difference Seen in Arthroscopic Bankart Repair With Knotted Versus Knotless Suture Anchors: A Randomized Controlled Trial at Short-Term Follow-Up. Arthroscopy 2022; 38:1812-1823. [PMID: 34952187 DOI: 10.1016/j.arthro.2021.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 12/06/2021] [Accepted: 12/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of this study was to compare the clinical and radiographic results of patients undergoing arthroscopic repair of labral lesions using knotted and knotless anchors. METHODS Sixty-four patients with anterior labral lesions (bone defects of the glenoid up to 13.5% or up to 20% if the instability severity index score was less than 4) and without other shoulder pathologies were randomly assigned to 2 groups, with 32 patients in each group. Clinical outcomes were assessed 6, 12, and 24 months after surgery by the Rowe score, Western Ontario shoulder instability index (WOSI), single assessment numeric evaluation (SANE), visual analog scale for pain (VASp), range of motion, and rate of postoperative recurrence. Postoperative magnetic resonance imaging (MRI) was performed, and the anterior and inferior labrum glenoid height indexes and anterior and inferior labral slopes were measured. The primary endpoint was the Rowe score at 24 months postoperatively. RESULTS Fifty-one patients, 24 in the knotted group and 27 in the knotless group, completed 24 months of follow-up. At 24 months, the Rowe scores were 81.7 ± 19.9 points and 85.9 ± 14 points, respectively (P = .623); the WOSI scores were 509.2 ± 480.1 points and 555.9 ± 393.6 points, respectively (P = .533); the SANE scores were 90.7 ± 18.7 points and 89.2 ± 14.8 points, respectively (P = .427); and the VASp scores were 1.7 ± 2.5 points and 2.5 ± 2.7 points, respectively (P = .275). There was no significant difference in range of motion, postoperative recurrence, or MRI parameters between the groups. All subjects (100%) in both groups exceeded the minimal clinically important difference of 9.7 for the Rowe score (P > .999). CONCLUSION Repair of Bankart's lesion through the use of knotted and knotless suture anchors yielded similar clinical and radiographic results on analysis at 24 months after operation. LEVEL OF EVIDENCE Level I. Randomized controlled clinical trial.
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Tanaka M, Hanai H, Kotani Y, Kuratani K, Nakai H, Kinoshita S, Hirose T, Hayashida K. Open Bristow Versus Open Latarjet for Anterior Shoulder Instability in Rugby Players: Radiological and Clinical Outcomes. Orthop J Sports Med 2022; 10:23259671221095094. [PMID: 35601734 PMCID: PMC9118436 DOI: 10.1177/23259671221095094] [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: 02/05/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Coracoid transfer is a reliable method for managing anterior shoulder instability in athletes who play contact sports; however, differences between the Bristow and Latarjet procedures are unclear. Purpose: To compare clinical outcomes and rates of bone union and bone resorption of the coracoid process between the open Bristow and open Latarjet procedures in rugby players. Study Design: Cohort study; Level of evidence, 3. Methods: Rugby players who underwent an open Bristow or an open Latarjet procedure were retrospectively reviewed for anterior shoulder instability, and 66 shoulders in the Bristow group and 35 in the Latarjet group were included. Graft union and resorption were evaluated using computed tomography at 3 months to 1 year postoperatively. Patient-reported outcome measures (American Shoulder and Elbow Surgeons score, Rowe score, and satisfaction rate) were obtained at a mean follow-up of 74 months (range, 45-160 months) for Bristow and 64 months (range, 50-76 months) for Latarjet procedures. Recurrence and the rate of return to play (RTP), frequency of pain after RTP, and retirement rate after RTP were also assessed. Results: In 97.1% of the Latarjet procedure cases, bone union of the coracoid was achieved at 3 months postoperatively; however, bone union was achieved in only 72.7% of the Bristow procedure cases at 6 months postoperatively. Bone resorption of the coracoid process occurred in 6.1% of shoulders after the Bristow procedure, whereas 100% of shoulders showed bone resorption after the Latarjet procedure. No statistical differences were found in outcome scores between the 2 procedures. Subluxation and persistent pain after returning to sports were identified at a significantly higher rate in the Latarjet group (5 shoulders [14%] and 9 shoulders [26%], respectively) than in the Bristow group (2 shoulders [3%] and 2 shoulders [3%]) (P = .0471 and P = .001, respectively). Conclusion: The Latarjet procedure had an advantage in the early and high rate of bone union but was at a disadvantage in bone resorption compared with the Bristow procedure. Subluxation and pain after returning to sports were more frequent in patients who underwent the open Latarjet procedure than in those who underwent the open Bristow procedure.
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Affiliation(s)
- Makoto Tanaka
- Center for Sports Medicine, Daini Osaka Police Hospital, Osaka, Japan
- Makoto Tanaka MD, PhD, Center for Sports Medicine, Daini Osaka Police Hospital, 2-4-60 Karasugatsuji, Tennouji-ku, Osaka, 543-8922, Japan (e-mail: )
| | - Hiroto Hanai
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuki Kotani
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kosuke Kuratani
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Hidekazu Nakai
- Department of Orthopaedic Surgery, Daini Osaka Police Hospital, Osaka, Japan
| | - Shuma Kinoshita
- Department of Orthopaedic Surgery, Daini Osaka Police Hospital, Osaka, Japan
| | - Takehito Hirose
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenji Hayashida
- Department of Orthopaedic Surgery, Daini Osaka Police Hospital, Osaka, Japan
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Successful Outcomes and Return to Sport After Arthroscopic Bankart Repair in National Collegiate Athletic Association and National Football League Football Players. Clin J Sport Med 2022; 32:e288-e292. [PMID: 34320568 DOI: 10.1097/jsm.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/19/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To characterize recurrent instability, return to sport (RTS), and patient-reported outcomes (PROs) after arthroscopic Bankart repair for acute traumatic anterior shoulder instability in National Collegiate Athletic Association (NCAA) and National Football League (NFL) football players. DESIGN Case series. SETTING Orthopaedic and sports medicine clinic. PARTICIPANTS National Collegiate Athletic Association and NFL football athletes with traumatic anterior shoulder instability who underwent arthroscopic shoulder stabilization at a single institution with at least 2-year follow-up. INTERVENTIONS OR ASSESSMENT OF RISK FACTORS OR INDEPENDENT VARIABLES Arthroscopic Bankart repair. MAIN OUTCOME MEASURES Recurrent instability, RTS, patient satisfaction, the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score. RESULTS Thirty-three players were included with a mean age of 23.8 years (range, 18-33 years) and a mean follow-up of 6.3 years (range, 4.1-9.3 years). One shoulder (3.0%) had a postoperative subluxation event, and 1 shoulder (3.0%) required revision surgery for issues other than instability; 93.3% of players were able to RTS at the same level or higher for at least 1 season. Mean satisfaction was 8.9 ± 2.3. Mean VAS was 1.0 ± 1.7, and mean ASES and Rowe scores were 90.7 ± 18.5 and 89.7 ± 15.2, respectively. CONCLUSION Arthroscopic Bankart repair is an effective surgical intervention for traumatic anterior shoulder instability in NCAA and NFL football players. At a mean 6-year follow-up, surgery restored stability in 97% of cases and 93.3% returned to their preinjury level of sport.
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Cruz CA, Sy J, Miles R, Bottoni CR, Min KS. Surgical treatment of anterior shoulder instability with glenoid bone loss with the Latarjet procedure in active-duty military service members. J Shoulder Elbow Surg 2022; 31:629-633. [PMID: 34537338 DOI: 10.1016/j.jse.2021.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/08/2021] [Accepted: 08/10/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The arthroscopic Bankart repair in the setting of glenoid bone loss has high rates of failure. In patients with anterior glenoid bone loss, the Latarjet provides glenohumeral stability through restoration of the glenoid bone, the conjoint tendon acting as a sling on the subscapularis, and anterior capsulolabral repair. Active-duty military personnel are at high risk for glenohumeral instability and have been equated to the contact athlete; most are young, male, and engage in contact sports. The purpose of this study is to assess the return to full-duty rates in active-duty military personnel following the Latarjet for anterior glenohumeral instability with glenoid bone loss. METHODS A retrospective review of all glenohumeral instability procedures were reviewed at a tertiary training hospital from June 2014 to June 2019. The patient population consisted of active-duty military personnel with glenoid bone loss and anterior glenohumeral instability, who were treated with a Latarjet. The primary outcome was return to full-duty status. RESULTS There were 50 patients identified for the study. Four patients were lost to follow-up, leaving 46 of 50 patients (92.0%) eligible for this study. The average age at the time of the index procedure was 23.1 years. The average percentage bone loss was 18.4%. Forty-one patients (89.1%) were able to return to full-duty status. Four patients (8.7%) sustained a recurrent dislocation following the Latarjet; all 4 dislocations occurred during a combat deployment. Four patients (8.7%) reported episodes of subluxation without dislocation. Forty-one patients (89.1%) reported that their shoulders felt stable, and we found an average return to full duty at 5.3 months CONCLUSION: In our active-duty military cohort, we found an 8.7% rate of recurrent instability after a Latarjet procedure, and 41 patients (89.1%) were able to return to full-duty status. In conclusion, the Latarjet procedure in the active-duty military population with anterior glenoid bone loss resulted in a high rate of return to duty, excellent functional outcomes, low rate of recurrent instability, and a low overall complication rate.
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Affiliation(s)
- Christian A Cruz
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Joshua Sy
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Rebecca Miles
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Craig R Bottoni
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Kyong S Min
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA.
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Nakagawa S, Hirose T, Uchida R, Yokoi H, Ohori T, Sahara W, Mae T. A Glenoid Defect of 13.5% or Larger Is Not Always Critical in Male Competitive Rugby and American Football Players Undergoing Arthroscopic Bony Bankart Repair: Contribution of Resultant Large Bone Fragment. Arthroscopy 2022; 38:673-681. [PMID: 34389413 DOI: 10.1016/j.arthro.2021.07.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate bone union and postoperative recurrence after arthroscopic bony Bankart repair (ABBR) in male competitive rugby and American football players with a subcritical glenoid defect of ≥13.5% and to compare findings with those in players with a glenoid defect of <13.5%. METHODS Participants were male competitive rugby or American football players with a glenoid defect and bone fragment who underwent ABBR from July 2011 to December 2018 and were followed for a minimum of 2 years. We investigated the influence of glenoid defect and bone fragment size on bone union and postoperative recurrence after ABBR. RESULTS We included 45 rugby players and 35 American football players. A total of 38 shoulders were assigned to the small defect group (<13.5%) and 42 to the large defect group (≥13.5%). The complete bone union rate was 47.4% in the small defect group and 71.4% in the large defect group (P = .040), and postoperative recurrence was seen in 13 (34.2%) and 5 shoulders (11.9%), respectively (P = .030). In the small defect group, the bone fragment size was <7.5% in 30 shoulders and ≥7.5% in 8 shoulders; in comparison, the respective numbers were 12 and 30 shoulders in the large defect group, and large fragments (>7.5%) were significantly more common in this group (P < .001). The complete union rate was significantly higher in shoulders with a large fragment (≥7.5%) than in those with a small fragment (<7.5%; 78.9% versus 42.9%, respectively; P = .001). The recurrence rate was 33.3% in shoulders with a small fragment (<7.5%) and 10.5% in shoulders with a large fragment (≥7.5%; P = .017) and was significantly lower in shoulders with a complete union than in those without a complete union (6.3% versus 46.9%, respectively; P < .001). CONCLUSION The postoperative recurrence rate after ABBR was lower in male competitive rugby and American football players with a large glenoid defect (≥13.5%) than in those with a small glenoid defect (<13.5%) and might be associated with a higher rate of complete bone union of the resultant large bone fragment (≥7.5%). LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan.
| | - Takehito Hirose
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, Hyogo, Japan
| | - Hiroyuki Yokoi
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Wataru Sahara
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Tatsuo Mae
- Department of Sports Medicine Biomechanics, Osaka University, Graduate School of Medicine, Osaka, Japan
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冯 思, 陈 俊, 张 健, 陈 世. [Research progress on the relationship between shoulder instability and superior labrum anterior posterior lesion]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:135-142. [PMID: 35172396 PMCID: PMC8863524 DOI: 10.7507/1002-1892.202108078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/25/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To summarize the relationship between shoulder instability and superior labrum anterior posterior (SLAP) lesion. METHODS The characteristics of shoulder instability and SLAP lesion were analyzed, and the relationship between them in pathogenesis, clinical symptoms, and biomechanics was discussed by referring to relevant domestic and foreign literature. RESULTS Shoulder instability and SLAP lesion can occur both spontaneously and respectively. SLAP lesion destroys the superior labrum integrity and the long head of biceps tendon (LHBT) insertion, causing excessive humeral head displacement against glenoid, and leading to shoulder instability. While chronic repetitive or acute high-energy traumatic shoulder instability can in turn aggravate SLAP lesion, resulting in expansion and increased degree of the original lesion. CONCLUSION SLAP lesion destroys mechanisms of shoulder stability, while shoulder instability causes tears of the upper labrum and the LHBT, showing a connection between shoulder instability and SLAP lesion. However, the existing evidence can only demonstrate that shoulder instability and SLAP lesion induce and promote the development of each other, instead of a necessary and sufficient condition. Therefore, the specific causal relationship between the two remains unknown and needs to be further studied.
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Affiliation(s)
- 思嘉 冯
- 复旦大学运动医学研究所(上海 200040)Sports Medicine Institute, Fudan University, Shanghai, 200040, P. R. China
- 复旦大学附属华山医院运动医学科(上海 200040)Department of Sports Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, 200040, P. R. China
| | - 俊 陈
- 复旦大学运动医学研究所(上海 200040)Sports Medicine Institute, Fudan University, Shanghai, 200040, P. R. China
- 复旦大学附属华山医院运动医学科(上海 200040)Department of Sports Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, 200040, P. R. China
| | - 健 张
- 复旦大学运动医学研究所(上海 200040)Sports Medicine Institute, Fudan University, Shanghai, 200040, P. R. China
- 复旦大学附属华山医院运动医学科(上海 200040)Department of Sports Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, 200040, P. R. China
| | - 世益 陈
- 复旦大学运动医学研究所(上海 200040)Sports Medicine Institute, Fudan University, Shanghai, 200040, P. R. China
- 复旦大学附属华山医院运动医学科(上海 200040)Department of Sports Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, 200040, P. R. China
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Ribeiro LM, Lara PHS, Pochini ADC, Andreoli CV, Belangero PS, Ejnisman B. Isokinetic Evaluation of the Shoulder After Bristow/Latarjet Surgical Procedure in Athletes. Rev Bras Ortop 2022; 57:128-135. [PMID: 35198120 PMCID: PMC8856852 DOI: 10.1055/s-0041-1726059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 10/28/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives To evaluate the muscular strength of the internal (IR) and external (ER) rotators of the shoulder after Bristow/Latarjet surgery. Methods Cross-sectional study with 18 patients (36 shoulders). The isokinetic evaluation was performed using the Biodex 3 System Pro dynamometer (Biodex Medical System, Inc., Shirley, NY, USA). The athletic shoulder outcome rating scale (ASORS) and the visual analogue scale (VAS) were applied. Results The values of peak torque and maximum work in concentric and eccentric mode on the non-operated shoulder were higher than on the operated side for both the IR and ER ( p < 0.01). The conventional and functional balance between the ER and IR showed no differences between the operated and the non-operated side. When comparing patients with postoperative time < 1 year or 1 year, no differences were observed in peak torque values at 60°/s and 240°/s and maximum work at 60°/s and 240°/s of the IR to the operated shoulder. However, the peak torque values of 60°/s and 240°/s and maximum work at 60°/s and 240°/s of the ER were higher in subjects with postoperative time ≥ 1 year in all variables ( p < 0.05). Conclusions There was a decrease in the strength of the IR and ER in the operated shoulder compared with the healthy shoulder. However, the conventional and functional balance was maintained.
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Affiliation(s)
- Leandro Masini Ribeiro
- Centro de Traumatologia do Esporte da Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Paulo Henrique Schmidt Lara
- Centro de Traumatologia do Esporte da Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Alberto de Castro Pochini
- Centro de Traumatologia do Esporte da Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Carlos Vicente Andreoli
- Centro de Traumatologia do Esporte da Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Paulo Santoro Belangero
- Centro de Traumatologia do Esporte da Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Benno Ejnisman
- Centro de Traumatologia do Esporte da Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Repair integrity and functional outcomes of arthroscopic repair in chronic anterior shoulder instability: single-loaded versus double-loaded single-row repair. Arch Orthop Trauma Surg 2022; 142:131-138. [PMID: 33130935 DOI: 10.1007/s00402-020-03661-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION This study compared the clinical outcome and repair integrity of single-loaded and double-loaded single-row arthroscopic repair of chronic anterior shoulder instability. MATERIALS AND METHODS Fifty consecutive chronic anterior shoulder instability cases treated by arthroscopic labral repair were included. A single-loaded single-row technique was used in the first 25 consecutive shoulders, and a double-loaded single-row technique was used in the next 25 consecutive shoulders. The number of suture anchors was 4 in the shoulders that underwent single-loaded repair and 3 in the shoulders that underwent double-loaded repair. 42 shoulders (84.0%) followed up clinical outcomes were evaluated a minimum 2 years (mean 28.5 months; range 24-46) postoperatively. The postoperative labral repair integrity was evaluated by MDCT-arthrogram at a minimum 6 months postoperatively. RESULTS At the final follow-up, the average UCLA, ASES, Constant, Rowe score, VAS pain score, and VAS for instability scores improved significantly, to 33.05, 92.33, 89.05, 94.86, 0.90 and 0.52, respectively, in the single-loaded group and to 32.19, 90.10, 89.05, 94.52, 0.90, and 0.86, respectively, in the double-loaded group. The clinical scores improved in both groups postoperatively (all P < 0.05); however, there was no significant difference between the two groups at final follow-up (P = 0.414, 0.508, 1.000, 0.917, 1.000, and 0.470, respectively). The re-tear rate was 2 (9.5%) in the shoulders that underwent single-loaded repair and 3 (14.3%) in the shoulders that underwent double-loaded repair; this difference was statistically not significant (P = 0.634). CONCLUSION The double-loaded single-row technique resulted in comparable clinical outcomes, and re-tear rate compared with the single-loaded single-row technique in chronic anterior shoulder instability at short-term follow-up. Number of used suture anchor in double-loaded single-row technique was fewer than that of single-loaded single-row technique. LEVEL OF EVIDENCE Comparative retrospective study, level III.
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Kelley TD, Clegg S, Rodenhouse P, Hinz J, Busconi BD. Functional Rehabilitation and Return to Play After Arthroscopic Surgical Stabilization for Anterior Shoulder Instability. Sports Health 2021; 14:733-739. [PMID: 34918564 DOI: 10.1177/19417381211062852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND There exists limited objective functional return-to-play criteria after surgical stabilization for anterior shoulder instability in the competitive athlete. HYPOTHESIS The proposed functional rehabilitation program and psychological evaluation after arthroscopic Bankart repair will help athletes return to sport with a decreased redislocation rate on return. STUDY DESIGN Case series. LEVEL OF EVIDENCE Level 4. METHODS Participants were contact or overhead athletes at the high school or collegiate level. Each underwent arthroscopic Bankart repair after a single dislocation event, with less than 10% glenoid bone loss. Western Ontario Shoulder Instability Index (WOSI) scores, Single Assessment Numeric Evaluation (SANE) scores, and American Shoulder and Elbow Surgeons (ASES) scores were evaluated pre- and postoperatively. Athletes were only allowed to return to competition after completing the proposed functional and psychological rehabilitation protocol. RESULTS A total of 62 participants were enrolled (52 male, 10 female; average age, 18.7 years (range 16-24 years); mean Instability Severity Index Score, 5.63 ± 0.55). All returned to sport for 1 full season and completed a minimum of 2 years of follow-up. The average time to pass functional testing was 6.2 ± 0.7 months, psychological testing was 5.2 ± 0.5 months, and return to sport was 6.5 ± 0.7 months. SANE scores improved from 44.3 to 90.0, ASES from 45.5 to 89.3, and WOSI from 1578.0 to 178.9 (all P < 0.001). Redislocation rate was 6.5% (4 of 62). CONCLUSION The proposed functional rehabilitation and psychological assessment protocol is safe and effective in returning athletes to sport after arthroscopic surgical intervention for anterior shoulder instability. This demonstrated a low redislocation rate after 2-year follow-up. CLINICAL RELEVANCE Most return-to-play protocols after arthroscopic Bankart repair are centered on recovery time alone, with limited focus on functional rehabilitation, psychological assessment, and return-to-play testing parameters. To our knowledge, this is the first study to propose a dedicated rehabilitation program incorporating functional testing, psychological readiness, and return-to-play criteria for competitive athletes recovering from arthroscopic shoulder stabilization.
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Affiliation(s)
- Timothy D Kelley
- Department of Orthopaedic Surgery, University of Massachusetts, Worcester, Massachusetts
| | - Stephanie Clegg
- Department of Orthopaedic Surgery, University of Massachusetts, Worcester, Massachusetts
| | - Paul Rodenhouse
- Department of Orthopaedic Surgery, University of Massachusetts, Worcester, Massachusetts
| | - Jon Hinz
- Department of Orthopaedic Surgery, University of Massachusetts, Worcester, Massachusetts
| | - Brian D Busconi
- Department of Orthopaedic Surgery, University of Massachusetts, Worcester, Massachusetts
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Pavlik A, Tátrai M, Tátrai A, Tállay A. Outcomes After Arthroscopic Anterior Shoulder Stabilization in Professional Handball Players. Orthop J Sports Med 2021; 9:23259671211011614. [PMID: 34368376 PMCID: PMC8299888 DOI: 10.1177/23259671211011614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/12/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Although numerous studies have reported on the redislocation rate and functional results of arthroscopic treatment for anterior shoulder instability in athletes, they have not disclosed outcomes in the high-risk group of elite handball players. Purpose: To investigate the postoperative outcomes of arthroscopic treatment for anterior shoulder instability as well as the return-to-sport (RTS) rate in professional handball players. Study Design: Case series; Level of evidence, 4. Methods: Involved in this study were 44 competitive handball players (47 shoulders) who underwent arthroscopic anterior capsulolabral reconstruction between 2010 and 2018 and had a minimum follow-up of 24 months. After surgery, patients completed a questionnaire that collected Rowe and American Shoulder and Elbow Surgeons (ASES) scores and RTS data, and we compared these results with their preoperative scores. We also compared results according to the following subgroups: true dislocations versus recurrent subluxations, younger (<20 years) versus older (≥20 years) age, male versus female sex, and shorter versus longer duration of instability. Statistical analysis included the paired-samples t test and nonparametric Fisher exact test. Results: The mean follow-up period was 52.2 ± 21.4 months. There were 4 shoulders (9%) with recurrent instability. There were significant preoperative to postoperative improvements in the mean Rowe score (from 45.2 to 91.8) and mean ASES score (from 70.6 to 95.7) (P < .001 for both). Overall, the RTS rate was 83%, and 64% (30/47 shoulders) were able to return to their preinjury level. The RTS rate was significantly lower in the younger players than in the older players (46% vs 86%, respectively; P = .005). Conclusion: The study results indicated that handball players with anterior shoulder instability can be treated using arthroscopic labral reconstruction successfully and 83% of the athletes were able to RTS activity. The handball players aged ≥20 years returned to their preinjury level of sport at a higher rate than did those aged <20 years.
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Affiliation(s)
- Attila Pavlik
- Department of Sport Surgery, National Institute for Sports Medicine, Budapest, Hungary.,Department of Sport Surgery, National Institute for Sports Medicine, Budapest, Hungary.,Department of Sport Surgery, National Institute for Sports Medicine, Budapest, Hungary
| | - Miklós Tátrai
- Department of Sport Surgery, National Institute for Sports Medicine, Budapest, Hungary.,Kastélypark Clinic, Tata, Hungary
| | | | - András Tállay
- Department of Sport Surgery, National Institute for Sports Medicine, Budapest, Hungary.,Faculty of Sport Medicine, Semmelweis University, Budapest, Hungary.,Kastélypark Clinic, Tata, Hungary
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Teske LG, Arvesen J, Kissenberth MJ, Pill SG, Lutz A, Adams KJ, Thigpen CA, Tokish JM, Momaya A, Shanley E. Athletes diagnosed with anterior and posterior shoulder instability display different chief complaints and disability. J Shoulder Elbow Surg 2021; 30:S21-S26. [PMID: 33895304 DOI: 10.1016/j.jse.2021.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior shoulder instability is a common complaint of young athletes. Posterior instability in this population is less well understood, and the standard of care has not been defined. The purpose of the study is to compare index frequency, treatment choice, and athlete disability following an incident of anterior or posterior shoulder instability in high school and collegiate athletes. METHODS A total of 58 high school and collegiate athletes (n=30 athletes with anterior instability; n=28 athletes with posterior instability) were included. Athletes suffering from a traumatic sport-related shoulder instability episode during a team-sponsored practice or game were identified by their school athletic trainer. Athletes were referred to the sports medicine physician or orthopedic surgeon for diagnosis and initial treatment choice (operative vs. nonoperative). Athletes diagnosed with traumatic anterior or posterior instability who completed the full course of treatment and provided pre- and post-treatment patient-reported outcome measures were included in the study. The frequency of shoulder instability was compared by direction, mechanism of injury (MOI), and treatment choice through χ2 analyses. A repeated measures analysis of variance was used to compare the functional outcomes by treatment type and direction of instability (α = 0.05). RESULTS Athletes diagnosed with anterior instability were more likely to report a chief complaint of instability (70%), whereas those diagnosed with posterior instability reported a primary complaint of pain interfering with function (96%) (P = .001). The primary MOI classified as a contact event was similar between anterior and posterior instability groups (77% vs. 54%, P = .06) as well as the decision to proceed with surgery (60% vs. 72%, P = .31). In patients with nonoperative care, athletes with anterior instability had significantly more initial disability than those with posterior instability (32±6.1 vs. 58±8.1, P = .001). Pre- and post-treatment Penn Shoulder Scores for athletes treated with early surgery were similar (P > .05). There were no differences in functional outcomes at discharge in those treated nonoperatively regardless of direction of instability (P = .24); however, change in Penn score was significantly greater in those with anterior (61±18.7) than those with posterior (27 ± 25.2) instability (P = .002). CONCLUSION Athletes with anterior instability appear to have different mechanisms and complaints than those with posterior instability. Among those that receive nonoperative treatment, athletes with anterior instability have significantly greater initial disability and change in disability than those with posterior disability during course of care.
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Affiliation(s)
- Lucas G Teske
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA
| | - John Arvesen
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA
| | - Michael J Kissenberth
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA
| | - Stephan G Pill
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA
| | - Adam Lutz
- ATI Physical Therapy, Greenville, SC, USA
| | | | | | | | - Amit Momaya
- University of Alabama at Birmingham, Birmingham, AL, USA
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Maiotti M, Russo R, Zanini A, Castricini R, Castellarin G, Schröter S, Massoni C, Savoie FH. Bankart Repair With Subscapularis Augmentation in Athletes With Shoulder Hyperlaxity. Arthroscopy 2021; 37:2055-2062. [PMID: 33581299 DOI: 10.1016/j.arthro.2021.01.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to demonstrate that arthroscopic Bankart repair with associated arthroscopic subscapularis augmentation (ASA) could be a valid surgical option in the treatment of anterior shoulder instability, in collision and contact sports athletes, affected by shoulder hyperlaxity. METHODS In total, 591 arthroscopic Bankart repairs plus ASA were performed in 6 shoulder centers from 2009 to 2017. Inclusion criteria were the following: collision and contact sports activities, recurrent anterior instability associated with hyperlaxity and glenoid bone loss (GBL) < 15%. Exclusion criteria were GBL > 15%, voluntary instability, multidirectional instability, pre-existing osteoarthritis and throwing athletes. The minimum follow-up was 24 months. Hyperlaxity was clinically evaluated according to Neer and Coudane-Walch tests. Before surgery, all patients underwent magnetic resonance imaging and computed tomography scanning. Pico area method was used to assess the percentage of GBL. Patients were operated on by 6 surgeons, and their functional outcomes were evaluated by 2 independent observers. The Western Ontario Shoulder Instability Index (WOSI), Rowe, American Shoulder and Elbow Surgeons (ASES) scores were used to assess results. RESULTS Overall, 397 patients with evidence of shoulder hyperlaxity (positive sulcus sign in ER1 position and Coudane-Walch test > 85°) met all inclusion criteria. The mean WOSI score was 321; the mean Rowe score rose from 68.5 to 92.5 (P = .037), and the ASES score rose from 71.5 to 97.4 (P = .041). Seven patients (1.6%) had atraumatic redislocation, and 9 patients (2.2%) had post-traumatic redislocation. At final follow-up the mean functional deficit of external rotation was 15° with the arm in adduction (ER1 position) and 10° in abduction (ER2 position). CONCLUSIONS The Bankart repair plus ASA has been demonstrated to be safe and effective for restoring joint stability in patients practicing collision and contact sports or affected by chronic anterior shoulder instability associated with GBL (<15%) and hyperlaxity, without compromising external rotation. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Raffaele Russo
- Orthopedics and Traumatology Unit, Pineta Grande Hospital, Castelvolturno, Italy
| | - Antonio Zanini
- Orthopedics and Traumatology Unit, San Clemente Hospital, Mantua, Italy
| | | | | | - Steffen Schröter
- Department of Orthopedics, Eberhard Karls University, Tübingen, Germany
| | - Carlo Massoni
- Orthopedics and Traumatology Unit, Pio XI Hospital, Rome
| | - Felix Henry Savoie
- Tulane Institute of Sports Medicine, Tulane University, New Orleans, LA, USA
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Tasaki A, Morita W, Nozaki T, Yonekura Y, Saito M, Phillips BB, Kitamura N. Arthroscopic Bankart Repair and Open Bristow Procedure in the Treatment of Anterior Shoulder Instability With Osseous Glenoid Lesions in Collision Athletes. Orthop J Sports Med 2021; 9:23259671211008274. [PMID: 34104661 PMCID: PMC8165538 DOI: 10.1177/23259671211008274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Traumatic anterior shoulder instability in collision sports athletes often involves osseous glenoid lesions, which make surgical treatment challenging. High redislocation rates have been seen in collision sports athletes treated using arthroscopic Bankart repair. Purpose: To investigate the effectiveness of a combined arthroscopic Bankart repair and open Bristow procedure for the treatment of traumatic anterior shoulder instability in collision sports athletes, with a focus on osseous glenoid lesions. Study Design: Case series; Level of evidence, 4. Methods: We reviewed 149 shoulders in 141 competitive collision sports athletes (mean ± standard deviation age, 20.1 ± 4.1 years; 8 bilateral cases) who underwent a combined arthroscopic Bankart repair and open Bristow procedure with minimum 2 years of follow-up. Osseous Bankart lesions were arthroscopically reduced and fixed using a coracoid graft. Results: Clinical outcomes as indicated by mean Rowe score improved significantly from 50.0 preoperatively to 98.9 postoperatively (P < .001) at a median follow-up of 3.4 years (range, 2.5-7 years). There were 2 recurrent dislocations (1.3%), both of which had nonunion of the transferred coracoid. Osseous Bankart lesions were observed in 85 shoulders, and osseous glenoid lesions ≥10% of the diameter of the nonoperative side were found in 58 shoulders, including 24 off-track cases. Clinical outcomes were not significantly different between patients with a glenoid defect ≥10% and <10%. Nonunion of the transferred coracoid was observed in 16 shoulders (10.7%), which had inferior Rowe scores; however, we could not define any risk factors for nonunion, including patient characteristics or bone morphology. Postoperative computed tomography performed in 29 patients >1 year after surgery showed successful repair of the osseous glenoid lesions, with a restored glenoid articular surface in all cases. Significant pre- to postoperative increases were seen in glenoid diameter (mean, 13.1% [95% CI, 9.9%-16.3%]; P < .001) and area (mean, 10.6% [95% CI, 8.5%-12.7%]; P < .001). Conclusion: A combined arthroscopic Bankart repair and open Bristow procedure improved bone morphology and was a reliable surgical method for treating collision sports athletes with traumatic anterior shoulder instability involving osseous glenoid lesions.
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Affiliation(s)
- Atsushi Tasaki
- Department of Orthopedic Surgery, St Luke's International Hospital, Tokyo, Japan
| | - Wataru Morita
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Taiki Nozaki
- Department of Radiology, St Luke's International Hospital, Tokyo, Japan
| | - Yuki Yonekura
- Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan
| | - Masayoshi Saito
- Department of Orthopedic Surgery, St Luke's International Hospital, Tokyo, Japan
| | - Barry B Phillips
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee; Campbell Clinic, Memphis, Tennessee, USA
| | - Nobuto Kitamura
- Department of Orthopedic Surgery, St Luke's International Hospital, Tokyo, Japan
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Career Longevity and Performance After Shoulder Instability in National Football League Athletes. Arthroscopy 2021; 37:1437-1445. [PMID: 33422614 DOI: 10.1016/j.arthro.2020.12.225] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 12/15/2020] [Accepted: 12/20/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the career longevity, game utilization, and performance of National Football League (NFL) athletes after glenohumeral instability events treated operatively versus nonoperatively. METHODS Using public resources, we identified NFL players who sustained a shoulder instability event from September 2000 to February 2019. Players with prior shoulder instability, without NFL experience before injury, or who did not return to play (RTP) after injury were excluded. Demographic information, utilization (games and seasons), and season approximate value (SAV) statistics were recorded 1 year prior to injury and 3 years after RTP. Statistical analysis compared utilization and the SAV after RTP for athletes managed operatively versus nonoperatively. RESULTS We identified 97 NFL players who sustained their first instability event while playing in the NFL, 91 of whom returned to play (93.8%). Quarterbacks were significantly more likely to undergo immediate surgical management compared with players in other positions (P = .023). The final analysis included 58 players managed operatively and 33 managed nonoperatively by the end of the index season. Players treated operatively played in significantly more seasons after RTP during their remaining careers (4.1 ± 2.7 seasons vs 2.8 ± 2.5 seasons, P = .015). There were no differences in games played or started, offensive or defensive snap count percentage, or performance (SAV) before and after injury when compared between cohorts (P > .05). After surgical stabilization, time to RTP (36.62 ± 10.32 weeks vs 5.43 ± 12.33 weeks, P < .05) and time interval before recurrent instability (105.7 ± 100.1 weeks vs 24.7 ± 40.6 weeks, P < .001) were significantly longer than with nonoperative treatment. Additionally, the operative cohort experienced less recurrent instability (27% vs 50%, P = .035). CONCLUSIONS Athletes who RTP in the NFL after a shoulder instability injury do so with a similar workload and performance irrespective of surgical or nonsurgical management. Whereas nonoperative treatment is associated with faster RTP, operative management is associated with fewer recurrent instability events, greater time between recurrent instability events, and greater career longevity. LEVEL OF EVIDENCE Level III, retrospective case-control study.
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Tasaki A. Clinical Characteristics and Surgical Outcomes for Collision Athletes with Traumatic Posterior Instability. J NIPPON MED SCH 2021; 88:133-137. [PMID: 33980758 DOI: 10.1272/jnms.jnms.2020_88-207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Diagnosis and treatment of traumatic posterior instability of the shoulder have not been described in detail. The author investigated surgical outcomes for traumatic posterior shoulder joint instability in collision athletes. METHODS The author surgically treated patients with a diagnosis of traumatic shoulder joint instability and investigated those that had been followed up for >2 years after surgery. RESULTS Seven shoulders in six collision athletes with a history of traumatic injury were examined. All cases were negative for the general laxity sign and positive for the posterior jerk test; five shoulders showed positive anterior apprehension. Posterior glenoid osseous defects were found in three shoulders, and one shoulder injury involved anterior and posterior osseous lesions. As surgical treatment, one posterior capsulolabral lesion, two posterior osseous lesions, and three combined anterior and posterior capsulolabral lesions were repaired arthroscopically. In a patient with a combined anterior and posterior osseous lesion, the Bristow procedure was perfromed after arthroscopic osseous repair. Patients returned to competition at an average of 6.8 months after surgery. One patient developed anterior subluxation at 7 months, and another exhibited posterior re-dislocation at 8 months after returning to competition. CONCLUSION Traumatic posterior instability in collision athletes often involves glenoid osseous lesions and is frequently accompanied by anterior apprehension and lesions. Although collision athletes can return to play after arthroscopic repair, such activity is associated with a risk of re-dislocation.
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Affiliation(s)
- Atsushi Tasaki
- Department of Orthopedics Surgery, St. Luke's International Hospital
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Bondar KJ, Damodar D, Schiller NC, McCormick JR, Condron NB, Verma NN, Cole BJ. The 50 Most-Cited Papers on Bankart Lesions. Arthrosc Sports Med Rehabil 2021; 3:e881-e891. [PMID: 34195658 PMCID: PMC8220616 DOI: 10.1016/j.asmr.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/02/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To analyze the 50 most-cited articles pertaining to “Bankart lesions,” also known as anteroinferior labral tears, by means of citation analysis as well as to provide analysis and summary of the origins and trends of research on Bankart lesions. Methods Scopus was used to query the literature on Bankart lesions. Included articles were related to Bankart lesions and the indications, risk factors, techniques, and outcomes of arthroscopic and open Bankart repair. The 50 most-cited articles were analyzed in the following areas: year of publication, citations in the most recent year, total citation count, contributing authors, institutions, countries, and journals, article classifications, and level of evidence. Results Years of publication ranged from 1938 to 2013. There were 608 total citations in the most recent year. Total citation count was 12,441. Regarding country, journal, and authorship, United States, R. A. Arciero, and Arthroscopy were the highest respective contributors. Rush University had the greatest number of publications. The most common article classification was clinical outcomes. Of 49 clinical articles, the most frequent Level of Evidence was IV. The majority of the top 50 Bankart literature consisted of case series and retrospective studies performed in the United States. Conclusions Our findings are consistent with the hypothesis that the 50 most-cited articles about Bankart lesions are predominantly U.S.-based, produced by academic orthopaedic groups, clinical outcomes articles, and of Level IV and V evidence. This list of articles should serve as a reference tool for any orthopaedist looking to review Bankart literature.
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Affiliation(s)
- Kevin J Bondar
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Dhanur Damodar
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nicholas C Schiller
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Johnathon R McCormick
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nolan B Condron
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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DeFroda SF, Perry AK, Bodendorfer BM, Verma NN. Evolving Concepts in the Management of Shoulder Instability. Indian J Orthop 2021; 55:285-298. [PMID: 33927807 PMCID: PMC8046877 DOI: 10.1007/s43465-020-00348-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/31/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Shoulder instability exists on a spectrum ranging from subtle subluxation and pain to dislocation and can be the result of a traumatic event or repetitive microtrauma. Shoulder instability can result in significant disability and often requires surgical intervention, especially amongst younger, active patient populations. The optimal treatment of shoulder instability depends on the degree of instability and concomitant pathology involving the labrum, capsule, and bony anatomy of the glenoid and humeral head. Even with surgical intervention, recurrent instability remains a relatively common and difficult problem to address. PURPOSE With a focus on anterior instability, the purpose of this review article is to discuss the current assessment and treatment of shoulder instability, and highlight current and future treatment modalities, as well as to identify current trends and deficiencies in our current management. We also provide an algorithm for the surgical treatment of anterior shoulder instability. METHODS Literature databases were extensively searched for recent articles related to the mechanism, diagnosis, and treatment of shoulder instability to comprise a comprehensive review. CONCLUSION Although there are multiple treatment modalities available for shoulder instability, such as nonoperative management, open and arthroscopic Bankart repair, Latarjet procedures, and remplissage, orthopaedic surgeons continue to learn about the most appropriate method of management as increasing long-term outcomes become available.
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Affiliation(s)
- Steven F. DeFroda
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, 1611 W. Harrison Street, Suite 300, Chicago, IL 60612 USA
| | - Allison K. Perry
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, 1611 W. Harrison Street, Suite 300, Chicago, IL 60612 USA
| | - Blake M. Bodendorfer
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, 1611 W. Harrison Street, Suite 300, Chicago, IL 60612 USA
| | - Nikhil N. Verma
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, 1611 W. Harrison Street, Suite 300, Chicago, IL 60612 USA
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Moore ML, Pollock JR, McQuivey KS, Bingham JS. The Top 50 Most-Cited Shoulder Arthroscopy Studies. Arthrosc Sports Med Rehabil 2021; 3:e277-e287. [PMID: 33615275 PMCID: PMC7879187 DOI: 10.1016/j.asmr.2020.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/04/2020] [Indexed: 01/02/2023] Open
Abstract
Purpose To determine the 50 most frequently cited studies in the orthopaedic shoulder arthroscopy literature and to conduct a bibliometric analysis of these studies. Methods The Clarivate Analytics Web of Knowledge database was used to gather data and metrics using Boolean queries to capture all possible iterations of shoulder arthroscopy research. The search list was sorted so that articles were organized in descending order based on the number of citations and included or excluded based on relevance to shoulder arthroscopy. The information extracted for each article included author name, publication year, country of origin, journal name, article type, and the level of evidence. Results For these 50 studies, the total number of citations was calculated to be 13,910, with an average of 278.2 citations per paper. The most-cited article was cited 1134 times, whereas the second- and third-most cited articles were cited 920 and 745 times, respectively. All 50 articles were published in English and came from 7 different orthopaedic journals. The United States was responsible for most of the included articles (31), followed by France (9) and Japan (3). Conclusions The majority of the most-cited articles in shoulder arthroscopy are case series and descriptive studies originating from the United States. In addition, more than one half of the top 50 most-cited studies were published after 2004, which suggests that article age may be less important in the accumulation of citations for a rapidly growing field like shoulder arthroscopy. Clinical Relevance The top 50 most-cited studies list will provide researchers, medical students, residents, and fellows with a foundational list of the most important and influential academic contributions to shoulder arthroscopy.
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Affiliation(s)
- M Lane Moore
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, U.S.A
| | | | - Kade S McQuivey
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Joshua S Bingham
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, U.S.A.,Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
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Shanmugaraj A, Chai D, Sarraj M, Gohal C, Horner NS, Simunovic N, Athwal GS, Ayeni OR. Surgical stabilization of pediatric anterior shoulder instability yields high recurrence rates: a systematic review. Knee Surg Sports Traumatol Arthrosc 2021; 29:192-201. [PMID: 32112125 DOI: 10.1007/s00167-020-05913-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/17/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE The purpose of this systematic review was to assess the surgical techniques, indications outcomes and complications for pediatric patients (≤ 19 years old) undergoing shoulder stabilization procedures for anterior shoulder instability. METHODS The electronic databases MEDLINE, EMBASE, CINAHL, and Web of Science were searched from data inception to March 14, 2019 for articles addressing surgery for pediatric patients with anterior shoulder instability. The Methodological Index for Non-randomized Studies (MINORS) tool was used to assess the quality of included studies. RESULTS Overall 24 studies, with a total of 688 patients (696 shoulders) and a mean age of 16.6 ± 2.5 years met inclusion criteria. Mean follow-up was 49 ± 26 months. The majority (59%) of studies only offered shoulder stabilization procedures to patients with more than one shoulder dislocation, however, three studies reported operating on pediatric patients after first time dislocations. Of the included patients 525 had arthroscopic Bankart repair (78%), 75 had open Bankart repair (11%), 34 had modified Bristow (5%), and 26 had Latarjet (4%) procedures. The overall complication rate was 26%. Patients undergoing arthroscopic Bankart repair experienced the highest recurrence rate of 24%. There were no significant differences in recurrent instability (n.s.) or loss of external rotation (n.s.) in pediatric patients treated with arthroscopic Bankart repair compared to open Latarjet. Patients had a 95% rate of return to sport at any level (i.e. preinjury level or any level of play) postoperatively (95%). CONCLUSIONS Pediatric patients are at high risk of recurrent instability after surgical stabilization. The majority of pediatric patients with anterior shoulder instability were treated with arthroscopic Bankart repair. Most studies recommend surgical stabilization only after more than one dislocation. However, given the high rates of recurrence with non-operative management, it may be reasonable to perform surgery at a first-time dislocation, particularly in those with other risk factors for recurrence. With the current evidence and limited sample sizes, it is difficult to directly compare the surgical interventions and their post-operative efficacy (i.e. re-dislocation rates or range of motion). There was an overall high rate of return to sport after surgical stabilization at final follow-up. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ajaykumar Shanmugaraj
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Darren Chai
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mohamed Sarraj
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Chetan Gohal
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Nolan S Horner
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Nicole Simunovic
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - George S Athwal
- Roth McFarlane Hand and Upper Limb Center, St Joseph's Health Care, London, ON, Canada
| | - Olufemi R Ayeni
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
- McMaster University Medical Centre, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada.
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Kim K, Saper MG. Postoperative Management Following Arthroscopic Bankart Repair in Adolescents and Young Adults: A Systematic Review. Arthrosc Sports Med Rehabil 2020; 2:e839-e845. [PMID: 33364615 PMCID: PMC7754521 DOI: 10.1016/j.asmr.2020.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/24/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The purpose of this study was to review systematically the literature concerning postoperative management following arthroscopic Bankart repair for traumatic anterior shoulder instability in adolescent and young adult (≤ 25 years) athletes. METHODS The Pubmed, Medline, EMBASE, EBSCO (CINAHL), and Google Scholar databases were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify all studies reporting postoperative rehabilitation guidelines following arthroscopic Bankart repair in the adolescent and young adult population. The Methodological Index for Nonrandomized Studies instrument and Modified Coleman Methodology Score were used for quality assessment of the included studies. All aspects of rehabilitation were extracted and analyzed, including type/duration of immobilization, range of motion, strength, and return to sport (RTS) criteria. RESULTS Screening yielded 17 eligible studies with a total of 675 patients and an average age of 18.3 years. There was considerable variation with regard to reported postoperative rehabilitation guidelines. Of the 17 studies, 15 reported the duration of immobilization; there was a mean of 4 weeks (range, 2-6 weeks). Range of motion and strength restrictions were reported in 15 (88.2%) and 13 (76.4%) studies, respectively. All of the 17 studies included an expected timeframe for RTS, but only 5 of the studies (29.4%) included either subjective or objective criteria to determine safe RTS. Differences in outcomes were unable to be assessed due to large study heterogeneity. CONCLUSION Considerable variation is reported in postoperative rehabilitation guidelines following arthroscopic Bankart repair for traumatic shoulder instability in the adolescent and young adult population. All studies used time-based criteria for determining RTS, but subjective and/or objective criteria were lacking in the majority of studies. The current literature lacks data to generate evidence-based rehabilitation protocols in this young athletic population. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Katie Kim
- Pacific Northwest University of Health Sciences, College of Osteopathic Medicine, Yakima, Washington, U.S.A
| | - Michael G Saper
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, U.S.A.,Seattle Children's Department of Orthopedics and Sports Medicine, Seattle, Washington, U.S.A
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Dekker TJ, Goldenberg B, Lacheta L, P Horan M, Millett PJ. Anterior Shoulder Instability in the Professional Athlete: Return to Competition, Time to Return, and Career Length. Orthop J Sports Med 2020; 8:2325967120959728. [PMID: 33209943 PMCID: PMC7645762 DOI: 10.1177/2325967120959728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/16/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Anterior shoulder instability is a common condition in professional athletes,
yet little is known about the success of surgery. Return to competition
(RTC) is a metric indicative of a successful outcome for professional
athletes who undergo anterior shoulder stabilization surgery. Purpose: To determine the rate of RTC, time to RTC, recurrence rate, and length of
career after surgery in professional athletes who had undergone surgical
treatment for anterior shoulder instability. Study Design: Case series; Level of evidence, 4. Methods: We evaluated professional athletes who underwent surgical treatment for
anterior shoulder instability by a single surgeon between 2007 and 2018.
Data from patients’ medical records, a patient data registry, basic search
engines, sports websites, and individual team websites were used to
determine length of professional play before injury, duration of career
after surgery, and RTC level. Results: Overall, 23 professional athletes (25 shoulders from 12 contact and 13
noncontact athletes) were identified. The mean age at the time of surgery
was 24.3 ± 4.9 years (range, 16-35 years). Primary procedures included
arthroscopic Bankart repair (76%; 19/25), open Latarjet (20%; 5/25), and
bony Bankart repair (4%; 1/25). Of the 23 athletes, 22 returned to their
previous level of competition (96%; 95% CI, 78%-100%). The mean time between
surgery and RTC was 4.5 months (range, 3-8 months). There was no difference
in time to RTC between contact and noncontact athletes (4.1 vs 4.4 months).
There was no difference in RTC rates and time to return for players who
received a Bankart repair versus a Latarjet procedure (4.6 vs 4.2 months). A
total of 12 participants were still actively engaged in their respective
sport at an average of 4.3 years since surgery, while 11 athletes went on to
retire at an average of 4.8 years. Duration of play after surgery was 3.8
years for contact athletes and 5.8 years for noncontact athletes
(P > .05). Conclusion: In this series, professional athletes who underwent surgical shoulder
stabilization for the treatment of anterior glenohumeral instability
returned to their presurgical levels of competition at a high rate. No
differences in RTC rate or time to RTC were observed for contact versus
noncontact athletes or for those who received arthroscopic Bankart repair
versus open Latarjet. However, contact athletes had shorter careers after
surgery than did noncontact athletes.
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Affiliation(s)
| | | | - Lucca Lacheta
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Peter J Millett
- United States Air Force, Eglin Air Force Base, Florida, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
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Yon CJ, Cho CH, Kim DH. Revision Arthroscopic Bankart Repair: A Systematic Review of Clinical Outcomes. J Clin Med 2020; 9:E3418. [PMID: 33113855 PMCID: PMC7693917 DOI: 10.3390/jcm9113418] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 12/19/2022] Open
Abstract
Although the frequency of arthroscopic revision surgery is increasing in patients with recurrent dislocation after a primary shoulder stabilization, the literature describing arthroscopic revision Bankart repair has been limited. Preferred reporting items for systematic meta-analyses guidelines were followed by utilizing PubMed, EMBASE, Scopus, and Cochrane Library databases. Keywords included shoulder dislocation, anterior shoulder instability, revision surgery, stabilization, and arthroscopic Bankart repair. Quality assessments were performed with criteria from the methodological index for nonrandomized studies (MINORS). A total of 14 articles were included in this analysis. The mean MINORS score was 12.43. A total of 339 shoulders (337 patients) were included (281 males and 56 females). The mean follow-up period was 36.7 months. Primary surgeries were as follows: arthroscopic procedures (n = 172, 50.7%), open procedure (n = 87, 25.7%), and unknown (n = 80, 23.6%). The mean rate of recurrent instability after revision arthroscopic Bankart repair was 15.3% (n = 52), and an additional re-revision procedure was needed in 6.5% of cases (n = 22). Overall, there were 18.0% (n = 61) of complications reported. This systematic review suggests that arthroscopic revision Bankart repair can lead to an improvement in functional outcomes and reasonable patient satisfaction with proper patient selection.
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Affiliation(s)
| | | | - Du-Han Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea; (C.-J.Y.); (C.-H.C.)
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Functional outcome and return to sports after the arthroscopic latarjet procedure in young and physically active patients. Arch Orthop Trauma Surg 2020; 140:1487-1494. [PMID: 32524229 DOI: 10.1007/s00402-020-03513-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The ideal treatment strategy for traumatic anterior shoulder instability with glenoid bone loss in young, physically active patients is still controversial. This study examines sporting activity, the ability to practice sports and the ability to return to sports after the arthroscopic Latarjet procedure. METHODS A total of 47 physically active patients with an average age of 24.5 ± 5.9 years were included in the study and evaluated at a minimum of two years after surgical treatment using shoulder and sport-specific scores. The shoulder sport activity score, Brophy marx activity score, Athletic shoulder outcome scoring system and the SPORTS score were used to assess the ability to practice sports, the sporting activity and the ability to return to sports. To assess functional outcome and shoulder stability, the evaluation was conducted using the Western Ontario shoulder instability index, the Constant score, the American shoulder and elbow surgeon score, and the Subjective shoulder value. RESULTS 89.4% of the patients examined were able to perform the sport they had previously practiced after an average of 4.6 ± 2.0 months. Overhead athletes and martial arts athletes demonstrated a significantly lower return to sports rate than non-collision/non-overhead athletes (p = 0.01). With regard to sport-, instability-, or function-specific scores, no significant difference was found between patients after primary Latarjet procedure and patients after Latarjet procedure following a failed open or arthroscopic Bankart repair. All scores showed good to very good functional results on average. Two patients suffered a traumatic recurrent instability (4.1%) during the follow-up period and were therefore excluded from this study. CONCLUSION Arthroscopic Latarjet procedure presents a good surgical option, especially for young, physically active patients; it has very good clinical outcome, a high return to sports rate and a low probability of recurrent dislocation.
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Chalmers PN, Hillyard B, Kawakami J, Christensen G, O'Neill D, Childress V, Tashjian RZ. Double-loaded suture anchors in the treatment of anteroinferior glenohumeral instability. JSES Int 2020; 4:587-591. [PMID: 32939491 PMCID: PMC7479039 DOI: 10.1016/j.jseint.2020.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Hypothesis The purpose of this study was to determine the clinical outcomes of arthroscopic labral repair for anteroinferior glenohumeral instability with the use of double-loaded suture anchors. Methods This study evaluated a series of consecutive patients treated after the senior author changed from single- to double-loaded suture anchors for the treatment of anteroinferior glenohumeral instability with a minimum follow-up period of 2 years. We collected the following outcomes at final follow-up: visual analog scale pain score, Simple Shoulder Test score, American Shoulder and Elbow Surgeons score, and instability recurrence data. Results A total of 41 consecutive patients underwent arthroscopic labral repair with double-loaded anchors, of whom 30 (71%) were able to be contacted at a minimum of 2 years postoperatively. These patients included 4 contact or collision athletes (13%). The patients had an average of 12 ± 13 prior dislocations over an average period of 56 ± 57 months preoperatively. Mean glenoid bone loss measured 16% ± 10%, and 67% (18 of 27 patients) had glenoid bone loss ≥ 13.5%. Intraoperatively, 3.2 ± 0.4 anchors were used. No posterior repairs or remplissage procedures were performed. At an average of 6.7 ± 2.7 years' follow-up, the visual analog scale pain score was 0.8 ± 1.4; Simple Shoulder Test score, 11 ± 2; and American Shoulder and Elbow Surgeons score, 90 ± 14. Patients with bone loss < 13.5% had a 0% redislocation rate and 11% subluxation rate, whereas those with bone loss ≥ 13.5% had a 6% reoperation rate, 22% redislocation rate, and 22% subluxation rate. Conclusion Arthroscopic labral repair with double-loaded anchors provides satisfactory clinical results at early to mid-term outcome assessment when glenoid bone loss is <13.5%.
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Affiliation(s)
- Peter N. Chalmers
- Corresponding author: Peter N. Chalmers, MD, Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84105, USA.
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Fanning E, Maher N, Cools A, Falvey EC. Outcome Measures After Shoulder Stabilization in the Athletic Population: A Systematic Review of Clinical and Patient-Reported Metrics. Orthop J Sports Med 2020; 8:2325967120950040. [PMID: 32984424 PMCID: PMC7498977 DOI: 10.1177/2325967120950040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/07/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Athletic endeavor can require the “athletic shoulder” to tolerate significant
load through supraphysiological range and often under considerable
repetition. Outcome measures are valuable when determining an athlete’s safe
return to sport. Few data are available to guide a clinician’s choice from
the variety of measures available. Purpose: To describe the use of quantifiable objective outcome measures and
patient-reported outcome tools after glenohumeral joint stabilization,
specifically in an athletic population. The secondary aim of our study was
to assess whether the method of measurement used was clearly described and
standardized to aid clinical interpretation. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of MEDLINE, Scopus, SPORTDiscus, and Web of Science
databases was performed in December 2018 based on the PRISMA (Preferred
Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. After
the application of selection criteria, a full review of identified papers,
and screening of reference lists, a total of 62 studies were included in the
review. All studies were independently appraised for quality, predefined
data fields were populated and cross-checked for accuracy, and results were
then summarized from these data fields. Results: Of the 62 included studies, 94% used a quantifiable objective clinical
outcome. A majority (85%) of the studies measured range of motion, 21%
recorded muscle strength, 5% measured electromyographic activity, 5%
examined shoulder kinematics, and 3% assessed joint proprioception after
surgery. However, only 18% of the studies clearly described a standardized
method of measuring the outcome. Nearly all (95%) of the studies used at
least 1 patient-reported outcome measure. The Rowe score was most commonly
used (35%). Conclusion: We must standardize and clearly describe the use of quantifiable objective
outcome measures to aid clinical interpretation. A concerted effort should
also be made to standardize the use of patient-reported outcome tools after
shoulder stabilization in the athletic population.
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Affiliation(s)
- Edel Fanning
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland.,University College Cork, Cork, Ireland
| | - Natasha Maher
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, West Yorkshire, UK
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Gent, Belgium
| | - Eanna C Falvey
- Sports Surgery Clinic, Sports Medicine, Dublin, Ireland.,University College Cork, Cork, Ireland
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Domos P, Chelli M, Lunini E, Ascione F, Bercik MJ, Neyton L, Godeneche A, Walch G. Clinical and radiographic outcomes of the open Latarjet procedure in skeletally immature patients. J Shoulder Elbow Surg 2020; 29:1206-1213. [PMID: 31812583 DOI: 10.1016/j.jse.2019.09.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 09/06/2019] [Accepted: 09/12/2019] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Recurrent anterior glenohumeral instability has been studied in the young population and limited evidence is available for adolescent patients. Our study is a retrospective review of patients aged <17 years who underwent open Latarjet procedure. METHODS Forty-five patients were available for review. Clinical outcomes were assessed by range of movements, stability, Walch-Duplay score (WDS), Rowe score (RS), Constant-Murley score (CMS), Subjective Shoulder Value (SSV), and return to sport. Radiographs were reviewed for osteoarthritis and complications. RESULTS The median age of patients was 15.7 years (13-17), and 56% had hyperlaxity. The median follow-up time was 6.6 years (3-26). The median postoperative movements showed recovered elevation (175°), external rotation (60°), and internal rotation (T9 level). Seventy-five percent of patients returned to the same level of sport, and 98% were satisfied. Clinical outcomes showed WDS, RS, and CMS scores of 85, 95, and 84 points, respectively, and an SSV of 95%. Twenty percent of patients described mild postoperative pain, and 1 had persistent stiffness. Other complications included 24% subjective apprehension, 4% redislocation, 4% wound problems, and 2% infection. Nine percent of cases had postoperative arthritis. The overall reoperation rate was 11%: 1 open washout for infection and 4 arthroscopic screw removal due to persistent pain. We found that hyperlaxity, female sex, and large or deep Hill-Sachs lesions were frequently associated with persistent apprehension at the last follow-up. CONCLUSIONS The open Latarjet procedure provides a low rate of recurrent instability with acceptable complication rates in the long term for skeletally immature patients. It is an effective, safe treatment option without any significant glenoid growth disturbance.
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Affiliation(s)
- Peter Domos
- Royal Free London NHS Foundation Trust, Barnet and Chase Farm Hospital, London, UK.
| | - Mikaël Chelli
- Institut Universitaire Locomoteur & Sport, Hôpital Pasteur 2, Nice, France
| | | | | | | | - Lionel Neyton
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz Ramsay GDS, Lyon, France
| | - Arnaud Godeneche
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz Ramsay GDS, Lyon, France
| | - Gilles Walch
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz Ramsay GDS, Lyon, France
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Pounder EJ, Hurley ET, Ali ZS, Pauzenberger L, Mullett H. Return to Sport Following Arthroscopic Repair of 270° Labral Tears. Arthrosc Sports Med Rehabil 2020; 2:e237-e240. [PMID: 32548589 PMCID: PMC7283938 DOI: 10.1016/j.asmr.2020.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 02/19/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To evaluate the rate of return to sport following arthroscopic repair of 270° labral tears. Methods We performed a retrospective review of patients with 270° labral tears treated arthroscopically between 2013 and 2017 by a single surgeon. Patients were followed-up to assess whether they were able to return to sport, the level to which they returned and the timing of return. Complications, the Visual Analogue Scale for pain (VAS), the Rowe score, the Shoulder Instability-Return to Sport after Injury (SIRSI) score, and the Subjective Shoulder Value (SSV) were recorded. Results The study included 25 patients, with a mean follow-up of 42.2 ± 16.5 months. Of the 25 patients, 19 (76.0%) returned to sport at a mean of 6.8 ± 2.6 months, while 15 (60%) returned at the same or a higher level. At final follow-up, the mean Rowe score was 80.6 ± 14.2; the mean SIRSI score was 61.8 ± 25.4; the mean SSV was 86.4 ± 15.2; and the mean VAS score was 2.2 ± 2.0. One patient reported recurrent subluxation, but no patients suffered a recurrent dislocation during the study period. No revision surgeries were performed within the study period. Conclusion Patients with 270° labral tears who were treated with arthroscopic repair showed an overall high rate of return to sport. Despite a low rate of recurring instability, not all patients were able to return to their previous levels of sports. Level of evidence Level IV, therapeutic case series.
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Affiliation(s)
- Emma J Pounder
- Sports Surgery Clinic, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan T Hurley
- Sports Surgery Clinic, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Zakariya S Ali
- Sports Surgery Clinic, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
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48
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Anchor placement to glenoid rim during Bankart repair recreates contact area of anterior capsulolabral complex on glenoid better than onto articular surface. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1257-1262. [PMID: 32418057 DOI: 10.1007/s00590-020-02694-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study aimed to compare the contact areas of Bankart repair with suture anchors placed on the articular surface of the glenoid versus at the rim of the glenoid because it is unclear which technique most effectively restores the footprint after Bankart repair. METHODS Ten fresh frozen cadaveric shoulders (mean age 70.7 years) were dissected. The attachment site of the capsulolabral complex from the 1 o' clock position to the 6 o'clock position was marked with ink, and the contact area of the anterior-inferior capsulolabral complex on the glenoid neck was measured using imageJ. Bankart lesions were created, and two types of Bankart repair were performed on each specimen. The suture anchors were inserted at the glenoid rim (Rim group) and onto the glenoid articular surface 2 mm from the rim (Surface group). Using pressure-sensitive films, we examined the interface contact area. RESULTS The Rim group recreated 64.9% of the native surface area, while the Surface group recreated 47.3% of the area. The Rim group recreated significantly greater contact area compared to the Surface group (P = 0.0008). CONCLUSION The anchor placement to the glenoid rim recreates the footprint of the capsulolabral complex on the anterior inferior glenoid better than the anchor placement onto the articular surface.
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49
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Abstract
Most first-time anterior glenohumeral dislocations occur as the result of trauma. Many patients suffer recurrent episodes of anterior shoulder instability (ASI). The anatomy and biomechanics of ASI is addressed, as is the pathophysiology of capsulolabral injury. The roles of imaging modalities are described, including computed tomography (CT) and MR imaging with the additional value of arthrography and specialized imaging positions. Advances in 3D CT and MR imaging particularly with respect to the quantification of humeral and glenoid bone loss is discussed. The concepts of engaging and nonengaging lesions as well as on-track and off-track lesions are examined.
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Affiliation(s)
- Christopher J Burke
- Department of Radiology, NYU Langone Health, NYU Langone Orthopedic Center, 333 East 38th Street, New York, NY 10016, USA.
| | - Tatiane Cantarelli Rodrigues
- Department of Radiology, NYU Langone Health, NYU Langone Orthopedic Center, 333 East 38th Street, New York, NY 10016, USA
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50
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Trojan JD, Meyer LE, Edgar CM, Brown SM, Mulcahey MK. Epidemiology of Shoulder Instability Injuries in Collision Collegiate Sports From 2009 to 2014. Arthroscopy 2020; 36:36-43. [PMID: 31864594 DOI: 10.1016/j.arthro.2019.07.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/27/2019] [Accepted: 07/03/2019] [Indexed: 02/09/2023]
Abstract
PURPOSE To describe the types, mechanisms, and severity of shoulder instability injuries in collegiate collision athletes during the 2009-2010 through 2013-2014 academic years using the National Collegiate Athletic Association Injury Surveillance Program; to compare the injury incidence between men's collision sports and their women's non-collision counterparts, when possible; and to compare injury outcomes between Divisions I, II, and III. METHODS Data regarding men's football, wrestling, ice hockey, and lacrosse, as well as women's ice hockey and lacrosse, were obtained. Injuries requiring attention from a health care provider were reported. Incidence rates per 100,000 athlete-exposures (AEs) were calculated with 95% confidence intervals (CIs). Analysis of variance was used to compare time loss (TL), and χ2 analysis was used to compare surgery rates between divisions. RESULTS A total of 445 shoulder instability injuries occurred in 1,421,561 AEs from 2009-2010 to 2013-2014 (incidence rate, 31.30 injuries/100,000 AEs; 95% CI, 28.4-34.21 injuries/100,000 AEs). Subluxation accounted for 59.1% of injuries, with anterior subluxation (35.3%) being the most common injury. Dislocation resulted in the most TL per injury (17.58 days). Mean TL for all injuries was 8.17 days (standard deviation, 7.21 days). When non-time-loss injuries were excluded from analysis, players experienced a mean TL of 18.34 days (standard deviation, 8.44 days). Divisions I (4.77 days), II (20.52 days), and III (11.23 days) differed significantly in mean TL (P = .01). Of the injuries, 29.3% required surgery. The surgery rates for Divisions I (32.9%), II (38.1%), and III (19.4%) also differed significantly (P = .04). Men's ice hockey and lacrosse players sustained a 2.17-fold (95% CI, 1.04-4.50) higher incidence of shoulder instability than their female counterparts. CONCLUSIONS Anterior subluxation and dislocation accounted for 52.1% of all shoulder instability injuries. Injured athletes missed 8 days on average, and nearly 30% of injuries required surgery. Surgery rates and TL were significantly different between Divisions I, II, and III. Female athletes playing non-collision ice hockey and lacrosse experienced significantly lower shoulder instability rates than their male counterparts. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Jeffrey D Trojan
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Lucy E Meyer
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Cory M Edgar
- Department of Orthopaedic Surgery, University of Connecticut School of Medicine, Storrs, Connecticut, U.S.A
| | - Symone M Brown
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A..
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