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Lu W, Liang D, Liu Y, Wu B, Long Z, Su J, Liu H, Luo X, Deng Z. Modified Suture-Button Latarjet Procedure With Coracoacromial Ligament and Pectoralis Minor Preservation Achieves Good Clinical Outcomes at 2-Year Follow-Up: Case Series of Latarjet Technique. Arthroscopy 2024:S0749-8063(24)00343-8. [PMID: 38735417 DOI: 10.1016/j.arthro.2024.04.037] [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: 12/06/2023] [Revised: 03/30/2024] [Accepted: 04/14/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To evaluate whether the modified suture-button Latarjet procedure with coracoacromial ligament (CAL) and pectoralis minor (PM) preservation could achieve excellent outcomes at the 2-year follow-up. METHODS During January 2019 to January 2021, the data of patients who underwent modified suture-button Latarjet with CAL and PM preservation in our department were collected. The glenoid bone loss of these patients was greater than 20% or greater than 10% with high demands for exercise. Partial coracoid osteotomy was based on the results of a preoperative 3-dimensional computed tomography evaluation of the glenoid defect area and corresponding coracoid process morphology. The preoperative and postoperative clinical results were assessed. The minimal clinically important difference (MCID) was used to compare improvement in clinical outcomes. Graft-glenoid union and remodeling were assessed using postoperative 3-dimensional computed tomography, and magnetic resonance imaging was performed to confirm the integrity of the CAL and PM postoperatively. RESULTS In total, 35 patients were included in this study; the mean follow-up time was 26.9 ± 1.9 months. No case of recurrent dislocation or sublaxity. Significant improvements were observed in mean visual analog scale (VAS) scores for pain during motion, American Shoulder and Elbow Surgeons (ASES) score, Rowe score, and Walch-Duplay score (P < .001). The percentage of patients achieving at least an MCID improvement in clinical outcomes was VAS 85.71%, ASES 97.14%, Rowe 100%, and Walch-Duplay 97.14%. Thirty-three patients (94.3% of all cases) were able to return to their preoperative sport levels, 34 grafts (97.1%) achieved bone union (1 soft union) in 6.3 ± 2.2 months, and the coracoid grafts restored 97.1 ± 4.0% of the perfect-fitting circle at the last follow-up. Postoperative computed tomography scan showed that 31 grafts (88.6%) were placed ideally in vertical view. In the axial view, 25 grafts (82.9%) were flushed to the glenoid, whereas 1 and 5 grafts were fixed medially and laterally, respectively. The CAL and PM were visualized postoperatively. No arthropathy was observed in any patient at the last follow-up. CONCLUSIONS The modified suture-button Latarjet procedure with CAL and PM preservation obtained good clinical and radiological results without recurrence or complications. A substantial number of patients (>85%) achieved the MCID for the VAS, ASES, Rowe, and Walch-Duplay scores. In addition, the malpositioned graft (17.1%) did not cause arthropathy of the joints at 2-year follow-up. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Wei Lu
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Daqiang Liang
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Yan Liu
- Department of Infection and Critical Care Medicine, and Department of Nosocomial Infection Prevention and Control, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China; Department of Nosocomial Infection Prevention and Control, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Bing Wu
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Zeling Long
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Jingyue Su
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Haifeng Liu
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Xun Luo
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Zhenhan Deng
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Bond EC, Florance J, Dickens JF, Taylor DC. Review of Burkhart and DeBeer's (2000) article on traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repair: Where have we taken the concept of glenoid bone loss in 2023? J ISAKOS 2023; 8:467-473. [PMID: 37673126 DOI: 10.1016/j.jisako.2023.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/03/2023] [Accepted: 08/25/2023] [Indexed: 09/08/2023]
Abstract
This classic discusses the original publication by Burkhart and DeBeer "Traumatic Glenohumeral Bone Defects and Their Relationship to Failure of Arthroscopic Bankart Repair" published in 2000 in Arthroscopy. At that time, the authors sought to understand the reasons behind the failure of arthroscopic soft tissue repair. Based on their findings, the authors introduced the concept of the inverted pear glenoid and engaging Hill-Sachs lesion which is now part of the orthopedic lexicon. The importance of bony pathologic changes in anterior glenohumeral instability has become so apparent, that it now forms the basis of clinical understanding and underpins treatment algorithms. Since this publication over 20 years ago, the idea of glenohumeral bone loss has been extensively explored and refined. There is no doubt of the importance of structural bone loss yet there is still uncertainty as to the best management of those with subcritical bone loss. The purpose of revisiting this classic article is to look at where we are in understanding recurrent instability and bony deficiency while appreciating how far we have come. This review begins with a detailed summary of the classic article along with a historic perspective. Next, we look at the current evidence as it pertains to the classic article and how modern technology and innovation has advanced our ability to assess and quantify glenohumeral bone loss. We finish with expert commentary on the topic from two current surgeons with a research interest in shoulder instability to offer an insight into how modern surgeons view and address this issue. One of the original authors also reflects on the topic. The findings of this classic study changed the way we think about shoulder instability and opened the doors to an exciting body of research that is still growing today. Future research offers an opportunity for high quality evidence to guide management in the group of patients with subcritical bone loss and we eagerly await the results.
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Affiliation(s)
- Elizabeth C Bond
- Duke Sports Sciences Institute, Duke Centre for Living Campus, 3475 Erwin Road, Durham, NC 27705, USA.
| | - Jonathon Florance
- Duke Sports Sciences Institute, Duke Centre for Living Campus, 3475 Erwin Road, Durham, NC 27705, USA.
| | - Jonathan F Dickens
- Duke Sports Sciences Institute, Duke Centre for Living Campus, 3475 Erwin Road, Durham, NC 27705, USA.
| | - Dean C Taylor
- Duke Sports Sciences Institute, Duke Centre for Living Campus, 3475 Erwin Road, Durham, NC 27705, USA.
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Hemstock R, Sommer M, McRae S, MacDonald P, Woodmass J, Ogborn D. Characterizing the Practices of Canadian Orthopedic Surgeons in the Management of patients With Anterior Glenohumeral Instability. Clin J Sport Med 2023; 33:611-617. [PMID: 37185225 DOI: 10.1097/jsm.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 03/28/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To determine the practice patterns of Canadian orthopedic surgeons in the management of patients with anterior glenohumeral instability (AGHI). DESIGN Cross-sectional survey. SETTING Canada. PATIENTS OR OTHER PARTICIPANTS Canadian orthopedic surgeons with membership in the Canadian Orthopedic Association or Canadian Shoulder and Elbow Surgeon group who had managed at least 1 patient with AGHI in the previous year. INTERVENTIONS A survey including demographics and questions on the management of patients with AGHI was completed. Statistical comparisons (χ 2 ) were completed with responses stratified using the instability severity index score (ISIS) in practice, years of practice, and surgical volumes. MAIN OUTCOME MEASURES Summary statistics were compiled, and response frequencies were considered for consensus (75%). Case series responses were stratified on use of the ISIS in practice, years of experience, and annual procedure volumes (χ 2 , P < 0.05). RESULTS Eighty orthopedic surgeons responded, with consensus on areas of diagnostic workup of AGHI, nonoperative management, and operative techniques. There was no consensus on indications for soft tissue and bony augmentation or postoperative management. There was no difference in practices based on the use of ISIS, years in practice, or surgical volumes. CONCLUSIONS Canadian orthopedic surgeons manage AGHI consistently with consensus achieved in preoperative diagnostics and operative techniques, although debate remains as to the indications for soft tissue and bony augmentation procedures.
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Affiliation(s)
- Riley Hemstock
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
| | - Micah Sommer
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Sheila McRae
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada; and
- Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
| | - Peter MacDonald
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada; and
| | - Jarret Woodmass
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada; and
| | - Dan Ogborn
- Department of Surgery, Orthopedic Section, University of Manitoba, Winnipeg, MB, Canada
- Pan Am Clinic Foundation, Winnipeg, MB, Canada; and
- Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
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Ji X, Ye L, Hua Y, Zhou X. Arthroscopic repair with transosseous sling-suture technique for acute and chronic bony Bankart lesions. Asia Pac J Sports Med Arthrosc Rehabil Technol 2023; 34:9-14. [PMID: 37744966 PMCID: PMC10511304 DOI: 10.1016/j.asmart.2023.08.008] [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: 12/29/2022] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Background Failure to fix the fractured fragment can result in bony fragment resorption and consequent glenoid bone loss. Current arthroscopic repair techniques might lead to insecure fixation and refracture. The purpose of this study was to evaluate the effectiveness of the transosseous sling-suture technique for bony Bankart lesions, and to compare the clinical outcomes for acute and chronic bony Bankart lesions treated with this technique. Methods A retrospective case series consisting of 46 patients with bony fracture of the glenoid rim following traumatic injury was identified from May 2015 to August 2020. The patients were divided into the acute lesion group and the chronic lesion group according to the time from first injury to surgery. The size of bone fragment was used to group the patients into the small and the medium sized fragment groups. All the patients underwent arthroscopic repairs using the transosseous sling-suture technique. Preoperative and postoperative evaluations including Rowe score, West Ontario Shoulder Instability Index (WOSI), Visual Analogue Scale (VAS) for pain scores, ROMs and number of dislocations were recorded. No significant differences were found in the comparisons of postoperative ROMs ang functional outcomes regarding between the small and the medium sized fragment groups. Results No dislocations occurred for both groups postoperatively. At the last follow-up, all the ROMs (including anterior flexion, abduction, external rotation and internal rotation at the side), the Rowe score, the WOSI score and the VAS score for pain in the both groups were significantly improved compared to the preoperative evaluations (all Ps < 0.001). In the comparisons between the acute and the chronic lesion groups, significantly greater anterior flexion (158.9 ± 8.9° vs. 153.0 ± 6.4°, P = 0.037), abduction (167.7 ± 10.1° vs. 161.0 ± 7.0°, P = 0.035) and external rotation at the side (88.3 ± 6.4° vs. 83.5 ± 5.5°, P = 0.024) were found in the acute lesion group. The comparisons of the Rowe score (86.0 ± 7.5 vs. 87.5 ± 10.6, P = 0.319), the WOSI score (223.5 ± 56.3 vs. 185.0 ± 79.9, P = 0.062), the VAS score for pain (0.4 ± 0.2 vs. 0.3 ± 0.2, P = 0.324) and the internal rotation at the side (74.6 ± 13.2° vs. 80.5 ± 11.1°, P = 0.116) between these two groups did not demonstrate significant differences between the two groups. Conclusion This arthroscopic transosseous sling-suture repair technique for shoulder anterior instability with acute and chronic bony Bankart lesion can restore joint stability, improve clinical outcomes and range of motion postoperatively. The acute bony Bankart lesion using the current technique can produce better range of motion compared to the chronic lesion. Study design Retrospective case series; Level of evidence, 4.
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Affiliation(s)
- Xiaoxi Ji
- Sports Medicine Center of Fudan University, Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Shanghai, China
| | - Lingchao Ye
- Department of Sports Medicine, Orthopedics, Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang Province, China
| | - Yinghui Hua
- Sports Medicine Center of Fudan University, Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Shanghai, China
| | - Xiaobo Zhou
- Department of Sports Medicine, Orthopedics, Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang Province, China
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Sudah SY, Menendez ME. Classifications in Brief: The Instability Severity Index Score for Predicting Recurrent Shoulder Instability After Arthroscopic Bankart Repair. Clin Orthop Relat Res 2023; 481:382-386. [PMID: 36006660 PMCID: PMC9831186 DOI: 10.1097/corr.0000000000002386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/09/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Suleiman Y. Sudah
- Department of Orthopedics, Monmouth Medical Center, Long Branch, NJ, USA
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Kuan FC, Hsu KL, Lin FH, Hong CK, Chen Y, Shih CA, Su WR. Morphometric and Biomechanical Comparison of the Scapular Spine and Coracoid Graft in Anterior Shoulder Instability. Am J Sports Med 2022; 50:3625-3634. [PMID: 36190171 DOI: 10.1177/03635465221124277] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND The scapular spine has been described as a relatively new bone graft alternative used in glenoid augmentation. The classic Latarjet procedure, which transfers the coracoid as a graft, is regarded as the gold standard. The comparison of these 2 techniques has not been fully reported. PURPOSE To compare the anatomic and biomechanical properties of glenoid augmentation using scapular spine graft or coracoid graft. STUDY DESIGN Controlled laboratory study. METHODS The study used 20 fresh-frozen human cadaveric shoulders. A 25% anterior glenoid defect was created, and the specimens were divided randomly to receive glenoid augmentation by scapular spine or coracoid grafts. For both procedures, the grafts were secured to the glenoid defect with 2 screws. Morphometric data, including the glenoid articular area, amount of restoration, and graft dimensions, were obtained. A biomechanical test was conducted in a direct-loading scenario. The construct stiffness, cyclic displacement, and ultimate failure of each specimen were collected. RESULTS No significant difference was found in glenoid articular restoration between the scapular spine group and the coracoid group (31% vs 33%, respectively; P = .311). Morphometric analysis indicated that coracoid grafts exhibited significantly greater thickness and height than scapular spine grafts. In biomechanical results, the scapular spine group exhibited significantly greater construct stiffness than the coracoid group (206.3 ± 58.8 vs 148.3 ± 76.0 N/mm, respectively; P = .023). The average failure load in the scapular spine group was not significantly higher than that in the coracoid group. No significant differences in cyclic displacement were found between the 2 techniques. CONCLUSION In a simulated 25% anterior glenoid bony defect, a scapular spine graft was comparable with the classic Latarjet procedure in restoring the glenoid articular dimension and exhibited superior construct stiffness in a cadaveric model. CLINICAL RELEVANCE The scapular spine may serve as an alternative graft choice in glenoid augmentation surgery considering the amount of articular restoration and initial fixation stability.
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Affiliation(s)
- Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
| | - Fang-Hsien Lin
- Department of Physical Medicine and Rehabilitation, Tainan Municipal An-Nan Hospital, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
| | - Yueh Chen
- Department of Orthopaedic Surgery, Sin Lau Christian Hospital, Tainan, Taiwan
| | - Chien-An Shih
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
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Hurley ET, Davey MS, Montgomery C, Moore DM, Mojica ES, Gaafar M, Pauzenberger L, Jazrawi LM, Mullett H. Analysis of Athletes Who Did Not Return to Play After Open Latarjet. Orthop J Sports Med 2022; 10:23259671211071082. [PMID: 35187183 PMCID: PMC8851950 DOI: 10.1177/23259671211071082] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/08/2021] [Indexed: 02/03/2023] Open
Abstract
Background: The Latarjet procedure is indicated in patients with risk factors for postoperative recurrence, including collision and competitive athletes. However, the factors that prevent athletes from being able return to play (RTP) after the open Latarjet procedure are still unclear and have not been fully elucidated in the literature. Purpose: To evaluate patient-reported outcomes and psychological and psychosocial factors associated with athletes who did not RTP after the open Latarjet procedure compared with patients who did RTP. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a retrospective review of athletes who underwent the open Latarjet procedure and subsequently did not RTP after a minimum of 12 months. These patients were pair matched in a 2:1 ratio for age, sex, sport, and level of preoperative play with a control group who returned to play. Patients were evaluated for their psychological readiness to return to sport using the Shoulder Instability–Return to Sport after Injury (SIRSI); other measures included the visual analog scale (VAS) for pain and Subjective Shoulder Value (SSV). Multivariate regression models were used to evaluate factors affecting RTP. Results: Included were 35 patients in the no-RTP group and 70 patients in the RTP group. In the no-RTP group, 7 patients (20%) passed the SIRSI benchmark of 56, with a mean overall score of 41.5 ± 21.9; in the RTP group, 57 patients (81.4%) passed the SIRSI benchmark, with a mean overall score of 74.5 ± 19.8 (P < .0001 for both). Patients in the RTP group had better SSV (88.0 vs 75.7; P <.0001) and VAS pain (1.7 vs 2.9; P = .0046) scores. Of the athletes who did not return, 18 felt persistent pain/apprehension and 17 felt that it was a natural end to their career or that their lifestyle had changed. Multiple logistic regression revealed that thoughts of having to go through surgery and rehabilitation again was significantly associated with lower RTP (P < .05). Conclusion: Patients who did not RTP after open Latarjet exhibited poor psychological readiness to RTP and worse pain VAS and SSV scores compared with patients who did RTP.
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Affiliation(s)
- Eoghan T. Hurley
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- National University of Ireland, Galway, Ireland
- NYU Langone Health, New York, New York, USA
| | - Martin S. Davey
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- National University of Ireland, Galway, Ireland
| | | | - David M. Moore
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Lu Y, Pareek A, Wilbur RR, Leland DP, Krych AJ, Camp CL. Understanding Anterior Shoulder Instability Through Machine Learning: New Models That Predict Recurrence, Progression to Surgery, and Development of Arthritis. Orthop J Sports Med 2021; 9:23259671211053326. [PMID: 34888391 PMCID: PMC8649098 DOI: 10.1177/23259671211053326] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/02/2021] [Indexed: 01/06/2023] Open
Abstract
Background Management of anterior shoulder instability (ASI) aims to reduce risk of future recurrence and prevent complications via nonoperative and surgical management. Machine learning may be able to reliably provide predictions to improve decision making for this condition. Purpose To develop and internally validate a machine-learning model to predict the following outcomes after ASI: (1) recurrent instability, (2) progression to surgery, and (3) the development of symptomatic osteoarthritis (OA) over long-term follow-up. Study Design Cohort study (prognosis); Level of evidence, 2. Methods An established geographic database of >500,000 patients was used to identify 654 patients aged <40 years with an initial diagnosis of ASI between 1994 and 2016; the mean follow-up was 11.1 years. Medical records were reviewed to obtain patient information, and models were generated to predict the outcomes of interest. Five candidate algorithms were trained in the development of each of the models, as well as an additional ensemble of the algorithms. Performance of the algorithms was assessed using discrimination, calibration, and decision curve analysis. Results Of the 654 included patients, 443 (67.7%) experienced multiple instability events, 228 (34.9%) underwent surgery, and 39 (5.9%) developed symptomatic OA. The ensemble gradient-boosted machines achieved the best performances based on discrimination (via area under the receiver operating characteristic curve [AUC]: AUCrecurrence = 0.86), AUCsurgery = 0.76, AUCOA = 0.78), calibration, decision curve analysis, and Brier score (Brierrecurrence = 0.138, Briersurgery = 0.185, BrierOA = 0.05). For demonstration purposes, models were integrated into a single web-based open-access application able to provide predictions and explanations for practitioners and researchers. Conclusion After identification of key features, including time from initial instability, age at initial instability, sports involvement, and radiographic findings, machine-learning models were developed that effectively and reliably predicted recurrent instability, progression to surgery, and the development of OA in patients with ASI. After careful external validation, these models can be incorporated into open-access digital applications to inform patients, clinicians, and researchers regarding quantifiable risks of relevant outcomes in the clinic.
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Affiliation(s)
- Yining Lu
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ayoosh Pareek
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan R Wilbur
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Devin P Leland
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Gowd AK, Liu JN, Polce EM, Agarwalla A, Garcia GH, Nicholson GP, Cole BJ, Romeo AA, Verma NN. Return to sport following Latarjet glenoid reconstruction for anterior shoulder instability. J Shoulder Elbow Surg 2021; 30:2549-2559. [PMID: 33930559 DOI: 10.1016/j.jse.2021.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/01/2021] [Accepted: 04/04/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Latarjet coracoid transfer reconstruction is the gold standard for the treatment of recurrent shoulder instability with anterior-inferior glenoid bone loss, and return to sport is often a primary outcome of interest in this patient population. The purpose of this study was to determine the rate of return to sport in patients undergoing the Latarjet procedure and variables that are associated with a higher likelihood of a successful return to sport. METHODS A prospectively maintained institutional registry was retrospectively queried between August 2012 and August 2016 for all patients who underwent the Latarjet procedure. Patients were contacted electronically and via telephone to administer a previously validated and standardized return-to-sport survey. Patients self-reported return to sport, varying sports participation, recurrence of instability, and time to return to sport. Multivariate analysis was performed to determine variables associated with each outcome. RESULTS Of 83 patients, 66 (75.3%) were available for final follow-up, of whom 60 participated in sports prior to surgery and were eligible for inclusion. The average follow-up period was 53.8 ± 11.8 months. The average age at surgery was 26.7 ± 11.3 years, and the average body mass index was 26.2 ± 4.0 kg/m2. There were 54 patients (90%) who were able to return to sport at an average of 8.6 ± 4.1 months following surgery. In total, 36 patients (60%) were able to return to sport at the same level or a better level of intensity, 19 of 28 patients (67.9%) were able to return to throwing sports without difficulty, and 31 of 60 patients (51.7%) reported that their shoulder was a hindrance to some activity. An increased likelihood of returning to sport was associated with increased body mass index (P = .016), male sex (P = .028), and decreased humeral bone loss volume (P = .034). An increased likelihood of returning to sport at the same level or a better level of intensity was associated with reduced humeral bone loss volume (P = .026). Recurrent instability was associated with humeral bone loss (P = .038). CONCLUSION Although a large majority of patients were able to return to sport following the Latarjet procedure, some patients experienced limitation with throwing and return to sport at the preinjury level. Greater humeral bone loss was associated with inferior outcomes. These findings should be discussed with patients in the preoperative setting to manage expectations appropriately.
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Affiliation(s)
- Anirudh K Gowd
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Joseph N Liu
- Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Evan M Polce
- Rush University Medical Center, Chicago, IL, USA
| | | | | | | | - Brian J Cole
- Rush University Medical Center, Chicago, IL, USA
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Editorial Commentary: Should We Condemn the Shoulder Instability Severity Index Scoring System? Not at All!... Can We Improve Its Radiographic Component? Yes, We Can! Arthroscopy 2021; 37:1392-1396. [PMID: 33896494 DOI: 10.1016/j.arthro.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 02/02/2023]
Abstract
Is patient selection necessary in shoulder instability surgery? Absolutely. The risk-benefit discussion that the surgeon must have with the patient before proposing an arthroscopic Bankart repair remains crucial to provide informed consent. The most important preoperative risk factors are incorporated in the instability severity index (ISI) score to assist surgeons in the decision-making process. This 10-point score is based on factors derived from a preoperative questionnaire, physical examination, and simple plain radiographs. Using this score at the first visit, the surgeon can explain to the patient and family why a Bankart repair may be contraindicated and why other surgical options may be more suitable. A recent study found that the ISI score has no limited predictive value when applied in a preselected population of military patients without severe bone loss or hyperlaxity. This is not surprising because the authors analyzed a preselected patient population with lower risk than the general population. The value of the ISI scoring system relies on the fact that this tool has been developed after evaluation of arthroscopic Bankart repair in an unselected patient population and that there is no need for sophisticated imaging studies to make the decision. This scoring system should not be condemned but complemented with preoperative advanced imaging studies (computed tomography [CT] scanning or magnetic resonance imaging) to assess the severity of the bone lesions more accurately. Today, the choice of the surgical procedure depends not only on the clinical risk factors included in the ISI score (age, type of sports, level of practice, hyperlaxity) but also on the presence, location and size of bony lesions, as identified and measured on advanced CT scanning images.
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Dekker TJ, Peebles LA, Bernhardson AS, Golijanin P, Di Giacomo G, Hackett TR, Provencher MT. Limited Predictive Value of the Instability Severity Index Score: Evaluation of 217 Consecutive Cases of Recurrent Anterior Shoulder Instability. Arthroscopy 2021; 37:1381-1391. [PMID: 33340676 DOI: 10.1016/j.arthro.2020.12.185] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To review the existing variables and their ability to predict recurrence of shoulder instability as it relates to the Instability Severity Index Score (ISIS), as well as evaluate any other pertinent imaging and patient history variables that may impact risk of recurrent anterior instability after arthroscopic Bankart repair. METHODS All consecutive patients with recurrent anterior shoulder instability and who had arthroscopic instability repair were identified. Exclusion criteria were prior surgery on the shoulder, posterior or multidirectional instability, instability caused by seizure disorder, or a rotator cuff tear. All ISIS variables were recorded (age <20 years, sport type and level, hyperlaxity, Hill-Sachs on anteroposterior external rotation radiograph, loss of glenoid contour on anteroposterior radiograph), as well as additional variables: (1) number of instability events; (2) total time of instability; (3) glenoid bone loss (GBL) percent; and (4) Hill-Sachs measures (H/L/W/D/Volume). Postoperative outcomes were assessed based on the Western Ontario Shoulder Instability Index (WOSI), Single Assessment Numeric Evaluation (SANE) scores, and American Shoulder and Elbow Surgeons (ASES) scores, and recurrent anterior instability. Regression analysis was used to determine preoperative variables that predicted outcomes and failures. RESULTS There were 217 consecutive patients (209 male patients [96.5%], 8 female patients [3.5%]) who met the inclusion criteria and were all treated with a primary arthroscopic shoulder stabilization during a 3.5-year period (2007-2011), with a mean follow-up time of 42 months (range, 26-58). The mean age at first instability event was 23.9 years (range, 16-48 years) and the mean cumulative ISIS score for the overall group was 3.6 (range, 1-6). Outcomes were improved from mean preoperative (WOSI = 1,050/2,100; ASES = 61.0; SANE = 52.5) to postoperative (WOSI = 305/2,100; ASES = 93.5; SANE = 95.5). A total of 11.5% (25/217) of patients had evidence of recurrent instability (subluxation or dislocation). Additionally, all 25 patients who failed postoperatively also had consistently inferior ASES, SANE, and WOSI outcome scores when compared with successfully treated patients. Factors associated with failure were GBL greater than 14.5% (P < .001), total time of instability symptoms greater than 3 months (P = .03), Hill-Sachs volume greater than 1.3 cm3 (P = .02), contact sports participation (P = .05), and age 20 years or younger (P < .01). There was no correlation in outcomes with Hill-Sachs on presence of glenoid contour loss on radiograph (P = .07), participation sports, or ISIS (mean = 3.4 success vs 3.9 failure, P > .05). CONCLUSIONS At a mean follow-up of 42 months was an 11.5% failure rate after arthroscopic Bankart stabilization surgery. This study shows no correlation between treatment outcome and the ISIS measure, given a mean score of 3.4 for the overall cohort with little difference identified in those who failed. However, several important parameters previously unidentified were detected including, GBL greater than 14.5%, Hill-Sachs volume greater than 1.3 cm3, and duration of instability symptoms (>3 months). The ISIS may need to be redesigned to incorporate variables that more accurately portray the actual risk of failure after arthroscopic stabilization, including quantification of both glenoid and humeral head bone loss. LEVEL OF EVIDENCE III (Retrospective Case Series).
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Affiliation(s)
| | - Liam A Peebles
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Petar Golijanin
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, U.S.A
| | | | - Thomas R Hackett
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A..
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Yellin JL, Fabricant PD, Anari JB, Neuwirth AL, Ganley TJ, Chauvin NA, Lawrence JT. Increased Glenoid Index as a Risk Factor for Pediatric and Adolescent Anterior Glenohumeral Dislocation: An MRI-Based, Case-Control Study. Orthop J Sports Med 2021; 9:2325967120986139. [PMID: 34250154 PMCID: PMC8239337 DOI: 10.1177/2325967120986139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/10/2020] [Indexed: 12/03/2022] Open
Abstract
Background: In adults, anterior glenohumeral instability has been associated with a tall
and narrow glenoid morphology, assessed using the glenoid index (GI; glenoid
height-to-width ratio) on magnetic resonance imaging (MRI). This
morphological association has not been assessed in children and
adolescents. Purpose/Hypothesis: To examine the association of GI and other MRI measurements of interest
supported in studies on adults with anterior glenohumeral dislocation in
patients aged ≤19 years. We hypothesized that these patients would have a
significantly greater GI (relatively taller and narrower glenoid morphology)
compared with healthy controls. Study Design: Case-control study; Level of evidence, 3. Methods: An institutional radiology database was queried over a 10-year period to
identify patients aged ≤19 years who had been diagnosed with
radiographically confirmed anterior shoulder dislocation and who underwent
glenohumeral magnetic resonance arthrography as well as those without
dislocation with normal shoulder arthrogram studies (controls). Patients
with bony Bankart lesions were excluded. The following glenohumeral
dimensions were measured on shoulder arthrogram: GI, glenoid version,
coracohumeral interval, and rotator interval width/depth. Comparative
analysis between the 2 groups was performed using the Student
t test for each variable, followed by receiver
operating characteristic (ROC) analysis to determine discriminative ability
when statistically significant. Results: Overall, 55 participants (33 male and 22 female patients; mean age, 15.4 ±
2.1 years) were enrolled; 22 patients were in included in the dislocator
group and 33 patients comprised the control group. The mean GI in the
dislocator group was significantly greater than the control group (1.55 ±
0.14 vs. 1.38 ± 0.08; P < .001). ROC analysis revealed
adequate discrimination of GI in predicting glenohumeral dislocation (area
under the curve = 0.88). A GI ≥1.45 was 83% sensitive and 79% specific for
predicting dislocation in the study cohort. Conclusion: Patients with anterior glenohumeral dislocation had increased GI (taller and
narrower glenoid morphology) than controls. This useful MRI measurement may
help identify patients at risk for primary or recurrent anterior
glenohumeral instability events and may therefore help with guiding
treatment and prevention.
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Affiliation(s)
- Joseph L Yellin
- Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Harvard Combined Orthopaedic Residency Program, Boston Children's Hospital/Massachusetts General Hospital/Brigham and Women's Hospital/Beth Israel Lahey Health, Boston, Massachusetts, USA
| | - Peter D Fabricant
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, and Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Jason B Anari
- Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexander L Neuwirth
- Columbia University Irving Medical Center, Department of Orthopaedic Surgery, New York, New York, USA
| | - Theodore J Ganley
- Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nancy A Chauvin
- Department of Radiology, Hershey Children's Hospital and Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Philadelphia, PA, USA
| | - John T Lawrence
- Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Editorial Commentary: The Shoulder Transpectoralis Portal for Arthroscopic Latarjet: Medial to the Coracoid Can Also Be a Safe Side! Arthroscopy 2021; 37:477-479. [PMID: 33546786 DOI: 10.1016/j.arthro.2020.12.177] [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: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 02/02/2023]
Abstract
The all-arthroscopic Latarjet is gaining popularity among shoulder surgeons, although the procedure is technically demanding and potentially dangerous, placing the brachial plexus and axillary vessels at risk when using screws for fixation of the bone block from the front. Matsen once wrote that "lateral to the coracoid is the safe side, while medial to the coracoid is the suicide." However, creation of a portal medial to the coracoid during arthroscopic reconstruction of the glenoid is needed to permit accurate positioning of the screws (parallel to the glenoid surface) and coracoid bone block (flush to the glenoid surface). Our own clinical experience with the arthroscopic Latarjet over the last decade has shown us that the safety of the arthroscopic medial transpectoralis portal depends on 3 technical considerations: (1) the portal should always be established in an outside-in fashion from anterior to posterior; (2) passing through the pectoralis major muscle with a relatively superficial trajectory, using a switching stick oriented with a 45° orientation toward the tip of the coracoid; and (3) under visual control of the anterior extra-articular subdeltoid space to end up lateral to the coracoid process. If these conditions are respected, surgeons should not worry: medial to the coracoid can also be a safe side! An inside-out technique (introducing a switching stick from posterior to anterior) is forbidden, as this would end up piercing the neurovascular structures. Once the coracoid has been osteotomized and the conjoint tendon retracted distally, all instruments passing though the transpectoral portal are directly in contact with the neurovascular structures. This is why working through the medial transpectoralis portal should be done only with the help of a cannula or half-pipe. Ideally, the transpectoral portal should not be used as a "working portal" but as a "protecting portal" instead, placing a stick or spreader to protect the neurovascular structures. To avoid working through the anterior medial portal, we have proposed a much safer alternative that consists of drilling the glenoid from posterior to anterior (using a guide and remaining inside the glenohumeral joint) and using cortical-buttons (instead of screws) for coracoid fixation. In this modern technique, the transpectoral portal makes the arthroscopic safe as it allows the introduction of a spreader to retract the subscapularis muscle and protect the neurovascular structures during transfer and fixation of the coracoid bone block.
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Verweij LPE, van Spanning SH, Grillo A, Kerkhoffs GMMJ, Priester-Vink S, van Deurzen DFP, van den Bekerom MPJ. Age, participation in competitive sports, bony lesions, ALPSA lesions, > 1 preoperative dislocations, surgical delay and ISIS score > 3 are risk factors for recurrence following arthroscopic Bankart repair: a systematic review and meta-analysis of 4584 shoulders. Knee Surg Sports Traumatol Arthrosc 2021; 29:4004-4014. [PMID: 34420117 PMCID: PMC8595227 DOI: 10.1007/s00167-021-06704-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/13/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Determining the risk of recurrent instability following an arthroscopic Bankart repair can be challenging, as numerous risk factors have been identified that might predispose recurrent instability. However, an overview with quantitative analysis of all available risk factors is lacking. Therefore, the aim of this systematic review is to identify risk factors that are associated with recurrence following an arthroscopic Bankart repair. METHODS Relevant studies were identified by searching PubMed, Embase/Ovid, Cochrane Database of Systematic Reviews/Wiley, Cochrane Central Register of Controlled Trials/Wiley, CINAHL/Ebsco, and Web of Science/Clarivate Analytics from inception up to November 12th 2020. Studies evaluating risk factors for recurrence following an arthroscopic Bankart repair with a minimal follow-up of 2 years were included. RESULTS Twenty-nine studies met the inclusion criteria and comprised a total of 4582 shoulders (4578 patients). Meta-analyses were feasible for 22 risk factors and demonstrated that age ≤ 20 years (RR = 2.02; P < 0.00001), age ≤ 30 years (RR = 2.62; P = 0.005), participation in competitive sports (RR = 2.40; P = 0.02), Hill-Sachs lesion (RR = 1.77; P = 0.0005), off-track Hill-Sachs lesion (RR = 3.24; P = 0.002), glenoid bone loss (RR = 2.38; P = 0.0001), ALPSA lesion (RR = 1.90; P = 0.03), > 1 preoperative dislocations (RR = 2.02; P = 0.03), > 6 months surgical delay (RR = 2.86; P < 0.0001), ISIS > 3 (RR = 3.28; P = 0.0007) and ISIS > 6 (RR = 4.88; P < 0.00001) were risk factors for recurrence. Male gender, an affected dominant arm, hyperlaxity, participation in contact and/or overhead sports, glenoid fracture, SLAP lesion with/without repair, rotator cuff tear, > 5 preoperative dislocations and using ≤ 2 anchors could not be confirmed as risk factors. In addition, no difference was observed between the age groups ≤ 20 and 21-30 years. CONCLUSION Meta-analyses demonstrated that age ≤ 20 years, age ≤ 30 years, participation in competitive sports, Hill-Sachs lesion, off-track Hill-Sachs lesion, glenoid bone loss, ALPSA lesion, > 1 preoperative dislocations, > 6 months surgical delay from first-time dislocation to surgery, ISIS > 3 and ISIS > 6 were risk factors for recurrence following an arthroscopic Bankart repair. These factors can assist clinicians in giving a proper advice regarding treatment. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Lukas P. E. Verweij
- Amsterdam UMC, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, Netherlands
| | - Sanne H. van Spanning
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands
| | - Adriano Grillo
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands
| | - Gino M. M. J. Kerkhoffs
- Amsterdam UMC, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, Netherlands
| | | | | | - Michel P. J. van den Bekerom
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands ,Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Chen KH, Yang TC, Chiang ER, Wang HY, Ma HL. The Hill-Sachs interval to glenoid track width ratio is comparable to the instability severity index score for predicting risk of recurrent instability after arthroscopic Bankart repair. Knee Surg Sports Traumatol Arthrosc 2021; 29:250-256. [PMID: 32253482 DOI: 10.1007/s00167-020-05955-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 03/23/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to clinically validate the Hill-Sachs interval to glenoid track width ratio (H/G ratio) compared with the instability severity index (ISI) score for predicting an increased risk of recurrent instability after arthroscopic Bankart repair. METHODS A retrospective evaluation was performed using data from patients with anteroinferior shoulder instability who underwent arthroscopic Bankart repair with a follow-up period of at least 24 months. A receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values for the H/G ratio and the ISI score to predict an increased risk of recurrent instability. The area under the ROC curve (AUC) of the two methods and the sensitivity and specificity of their optimal cut-off values were compared. RESULTS A total of 222 patients were included, among whom 31 (14.0%) experienced recurrent instability during the follow-up period. The optimal cut-off values for predicting an increased risk of recurrent instability were an H/G ratio of ≥ 0.7 and ISI score of ≥ 4. There were no significant differences between the AUC of the two methods (H/G ratio AUC = 0.821, standard error = 0.035 and ISI score AUC = 0.792, standard error = 0.04; n.s.) nor between the sensitivity and specificity of the optimal cut-off values (n.s. and n.s., respectively). CONCLUSIONS The H/G ratio is comparable to the ISI score for predicting an increased risk of recurrent instability after arthroscopic Bankart repair. Surgeons are recommended to consider other strategies to treat anterior shoulder instability if H/G ratio is ≥ 0.7. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kun-Hui Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzu-Cheng Yang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - En-Rung Chiang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Yi Wang
- Department of Anaesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiao-Li Ma
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Stefaniak J, Lubiatowski P, Kubicka AM, Wawrzyniak A, Wałecka J, Romanowski L. Clinical and radiological examination of bony-mediated shoulder instability. EFORT Open Rev 2020; 5:815-827. [PMID: 33312708 PMCID: PMC7722946 DOI: 10.1302/2058-5241.5.200049] [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] [Indexed: 12/19/2022] Open
Abstract
The coexistence of glenoid and humeral head bone defects may increase the risk of recurrence of instability after soft tissue repair. Revealed factors in medical history such as male gender, younger age of dislocation, an increasing number of dislocations, contact sports, and manual work or epilepsy may increase the recurrence rate of instability. In physical examination, positive bony apprehension test, catching and crepitations in shoulder movement may suggest osseous deficiency. Anteroposterior and axial views allow for the detection of particular bony lesions in patients with recurrent anterior shoulder instability. Computed Tomography (CT) with multiplanar reconstruction (MPR) and various types of 3D rendering in 2D (quasi-3D-CT) and 3D (true-3D-CT) space allows not only detection of glenoid and humeral bone defects but most of all their quantification and relations (engaging/not-engaging and on-track/off-track) in the context of bipolar lesion. Magnetic resonance imaging (MRI) is increasingly developing and can provide an equally accurate measurement tool for bone assessment, avoiding radiation exposure for the patient.
Cite this article: EFORT Open Rev 2020;5:815-827. DOI: 10.1302/2058-5241.5.200049
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Affiliation(s)
- Jakub Stefaniak
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, Poznan, Poland.,Sport Traumatology and Biomechanics Unit, Rehasport Clinic, Poznan University of Medical Sciences, Poznan, Poland
| | - Przemyslaw Lubiatowski
- Sport Traumatology and Biomechanics Unit, Rehasport Clinic, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Maria Kubicka
- Institute of Zoology, Poznan University of Life Sciences, Poznan, Poland
| | - Anna Wawrzyniak
- Sport Traumatology and Biomechanics Unit, Rehasport Clinic, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Wałecka
- Sport Traumatology and Biomechanics Unit, Rehasport Clinic, Poznan University of Medical Sciences, Poznan, Poland
| | - Leszek Romanowski
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, Poznan, Poland
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First-time Glenohumeral Dislocations: Current Evidence and Considerations in Clinical Decision Making. Sports Med Arthrosc Rev 2020; 28:122-131. [PMID: 33156225 DOI: 10.1097/jsa.0000000000000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The decision to manage first-time shoulder dislocations conservatively or operatively has become increasingly complex because of conflicting literature. Although shoulder dislocations have traditionally been managed with reduction and immobilization, recent evidence has suggested high rates of subsequent recurrence. Surgical intervention is thought to better restore stability and decrease recurrence rates; however, it also has the potential for additional morbidity and financial cost. As such, recent literature has sought to better define patient risk profiles to identify optimal candidates for both conservative and operative management. The purpose of the current review is to provide a comprehensive and evidence-based assessment of the most recent literature to better delineate an appropriate treatment algorithm for this challenging clinical scenario.
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The Arthroscopic Bankart Repair: State of the Art in 2020: Decision-making and Operative Technique. Sports Med Arthrosc Rev 2020; 28:e25-e34. [PMID: 33156227 DOI: 10.1097/jsa.0000000000000290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Traumatic anterior shoulder instability is prevalent among young athletes, and recurrent dislocations can result in compromised upper extremity function, increasing glenohumeral bone loss, and ultimately, posttraumatic arthritis. Although management algorithms have evolved in response to contemporary data and technical innovation, the arthroscopic Bankart repair continues to be a mainstay for the primary surgical management of first-time or recurrent anterior shoulder instability with marginal attritional glenoid bone loss (ie, <10% to 15%) and/or "on track" Hill-Sachs defects. The advantages of arthroscopic stabilization include its minimally invasive technique, high cost effectiveness, and relatively low recurrence rates and propensity for perioperative complications. The current article reviews contemporary indications/contraindications, management of the first-time dislocator, critical glenoid bone loss, surgical technique, and reported clinical outcomes of the arthroscopic Bankart repair.
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Rosenberg N, Hamoud K. Management of Failed Surgery for Anterior Glenohumeral Instability: Synopsis of Clinical Evidence. Rambam Maimonides Med J 2020; 11:RMMJ.10408. [PMID: 32516110 PMCID: PMC7571438 DOI: 10.5041/rmmj.10408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Failed surgical treatment of anterior shoulder instability should be treated according to clinical principles similar to primary stabilization by addressing risk factors related to the damaged static glenohumeral stabilizers (labrum, capsule and its components, and bony damage to the humeral head and scapular glenoid). In relatively rare conditions when failed primary surgery involves patients with functionally low demands, conservative treatment by strengthening dynamic muscular stabilizers might be considered; otherwise, surgical revision should be strongly considered aimed at improving quality of life. Although the overall failure rate following primary and revision surgery is expected to be below 4%, it is clear that revision surgery is technically demanding. Therefore, the initial recognition and correction of the exact pathology causing glenohumeral instability is crucial to avoid failure of primary surgery and to facilitate the success of the revision procedure, if necessary.
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Affiliation(s)
- Nahum Rosenberg
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- Muscle and Skeleton Laboratory, Orthopedic Surgery Section, Rambam Health Care Campus, Haifa, Israel
| | - Kamal Hamoud
- Back Unit, Orthopedic Surgery Section, Rambam Health Care Campus, Haifa, Israel
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Stefaniak J, Kubicka AM, Wawrzyniak A, Romanowski L, Lubiatowski P. Reliability of humeral head measurements performed using two- and three-dimensional computed tomography in patients with shoulder instability. INTERNATIONAL ORTHOPAEDICS 2020; 44:2049-2056. [PMID: 32712787 PMCID: PMC7584559 DOI: 10.1007/s00264-020-04710-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 07/06/2020] [Indexed: 11/30/2022]
Abstract
Purpose The aim of the study was to compare two measurement methods of humeral head defects in patients with shoulder instability. Intra- and inter-observer reliability of humeral head parameters were performed with the use of 2D and 3D computed tomography. Methods The study group was composed of one hundred humeral heads measured with the use of preoperative 2D and 3D computed tomography by three independent observers (two experienced and one inexperienced). All observers repeated measurements after 1 week. The intra-class correlation coefficient (ICC) and the minimal detectable change with 95% confidence (MDC95%) were used for statistical analysis of diagnostic agreement. Results For 3D inter-observer reliability, ICC values were “excellent” for all parameters and MDC95% values were “excellent” or “reasonable.” All intra-observer ICC and MDC95% values for 3D were “excellent” for experienced and inexperienced observers. For 2D-CT, ICC values were usually “good” or “moderate” with MDC95% values higher than 10 or 30%. Conclusions Three-dimensional CT measurements are more reliable than 2D for humeral head and Hill-Sachs lesion assessment. This study showed that 2D measurements, even performed by experienced observers (orthopaedic surgeons), are burdened with errors. The 3D reconstruction decreased the risk of error by eliminating inaccuracy in setting the plane of the measurements.
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Affiliation(s)
- Jakub Stefaniak
- Sport Trauma and Biomechanics Unit, Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland. .,Rehasport Clinic, Poznań, Poland.
| | - A M Kubicka
- Institute of Zoology, Poznań University of Life Sciences, Poznań, Poland
| | | | - L Romanowski
- Sport Trauma and Biomechanics Unit, Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - P Lubiatowski
- Sport Trauma and Biomechanics Unit, Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland.,Rehasport Clinic, Poznań, Poland
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Lemmex D, Cárdenas G, Ricks M, Woodmass J, Chelli M, Boileau P. Arthroscopic Management of Anterior Glenoid Bone Loss. JBJS Rev 2020; 8:e0049. [DOI: 10.2106/jbjs.rvw.19.00049] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Xu J, Liu H, Lu W, Deng Z, Zhu W, Peng L, Ouyang K, Li H, Wang D. Modified Arthroscopic Latarjet Procedure: Suture-Button Fixation Achieves Excellent Remodeling at 3-Year Follow-up. Am J Sports Med 2020; 48:39-47. [PMID: 31765231 DOI: 10.1177/0363546519887959] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Some studies have advocated the use of suture-button fixation during the Latarjet procedure to reduce complications associated with screw fixation. However, the sample size of these studies is relatively small, and their follow-up period is short. PURPOSE To investigate the efficacy of the suture-button Latarjet procedure with at least 3 years of follow-up and remodeling of the coracoid graft. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 152 patients who underwent the suture-button Latarjet procedure between February 2013 and February 2016 were selected, and 128 patients who met the inclusion criteria were enrolled in this study. Preoperative and postoperative clinical results were assessed. The position and healing condition of the coracoid graft and arthropathy of the glenoid and humeral head were also assessed using radiography and 3-dimensional computed tomography (CT). RESULTS The mean follow-up time was 40.3 ± 5.8 months. There were 102 patients included in this study. The mean visual analog scale score for pain during motion, the American Shoulder and Elbow Surgeons score, the Rowe score, and the Walch-Duplay score were improved considerably. A total of 100 grafts achieved bone union. The overall absorption rate was 12.6% ± 4.3%. Graft absorption mostly occurred on the edge and outside the "best-fit" circle of the glenoid. A vertical position was achieved in 98 grafts (96% of all cases) immediately postoperatively, with the mean graft midline center at the 4 o'clock position. In the axial view, CT showed that 89 grafts were flush to the glenoid, whereas 2 and 11 grafts were fixed medially and laterally, respectively. In all cases, the bone graft and glenoid tended to extend toward each other to form concentric circles during the remodeling process. During follow-up observations, the height of the 11 grafts that were positioned laterally (ie, above the glenoid level) exhibited a wave-curved change. No arthropathy was observed in any patient. CONCLUSION Patient outcomes were satisfactory after the modified arthroscopic suture-button Latarjet technique. Graft absorption mostly occurred on the edge and outside the "best-fit" circle of the glenoid. The graft exhibited the phenomenon of ectatic growing when it fused with the glenoid and finally remodeled to a new concentric circle with the humeral head analogous to the original glenoid. Grafts positioned laterally did not cause arthropathy of the joints within the period of the study.
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Affiliation(s)
- Jian Xu
- Department of Sports Medicine, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Haifeng Liu
- Department of Sports Medicine, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Wei Lu
- Department of Sports Medicine, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Zhenhan Deng
- Department of Sports Medicine, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Weimin Zhu
- Department of Sports Medicine, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Liangquan Peng
- Department of Sports Medicine, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Kan Ouyang
- Department of Sports Medicine, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Hao Li
- Department of Sports Medicine, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Daping Wang
- Department of Sports Medicine, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
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Di Giacomo G, Peebles LA, Pugliese M, Dekker TJ, Golijanin P, Sanchez A, Provencher MT. Glenoid Track Instability Management Score: Radiographic Modification of the Instability Severity Index Score. Arthroscopy 2020; 36:56-67. [PMID: 31864596 DOI: 10.1016/j.arthro.2019.07.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is (1) to test the proposed treatment algorithm, the Glenoid Track Instability Management Score (GTIMS), which incorporates the glenoid track concept into the instability severity index score (ISIS), and (2) to compare treatment decision-making using either GTIMS versus ISIS in 2 cohorts of patients with operatively treated anterior instability. METHODS A multicenter, retrospective review of two consecutive groups consisting of 72 and 189 patients treated according to ISIS and GTIMS, respectively, was conducted. Inclusion criteria for all patients were ≥2 confirmed traumatic anterior shoulder instability events and a physical examination demonstrating a positive anterior apprehension and relocation test. The GTIMS was graded for all 189 patients in the cohort, which uses 3-dimensional computed tomography as the sole radiographic parameter to assess on-track (0 points) versus off-track (4 points) Hill-Sachs lesions. This method differs from ISIS, which uses multiple plain radiographs for the 4-point imaging portion of the score. Outcomes scores were compared within the GTIMS and ISIS groups, as well as between them for overall comparisons based on the Western Ontario Shoulder Instability Index (WOSI), the Single Assessment Numerical Evaluation (SANE) score, and the mean rates of recurrent instability. RESULTS A total of 261 consecutive patients from 2009 to 2014 who presented with recurrent anterior shoulder instability were treated according to either ISIS (n = 72/261, 27.6%) or GTIMS (n = 189/261, 72.4%). At a mean follow-up time of 33.2 months (range 24-49 months), the overall cohort mean ISIS of 2.9 ± 2.2 (range 0-9) was significantly higher than the mean GTIMS of 1.9 ± 1.9 (range = 0-9, P < .001). Of the 72 ISIS treated patients, 50 (69.4%) had an ISIS score of ≥ 4 and underwent a Latarjet, and the 22 patients (30.6%) with an ISIS score of < 4 underwent an arthroscopic Bankart repair. Based on GTIMS in the 189-patient cohort, using the same cutoff of 4 to indicate the need for a Latarjet, 162 patients were treated with arthroscopic Bankart repair (85.7%) and 27 with Latarjet (14.3%). The overall outcomes improved for patients treated with a Latarjet in both groups (GTIMS WOSI from 1099 [47.7% normal] to 395 [81.3% normal]; GTIMS SANE from 48 to 81; ISIS WOSI from 1050 [50% normal] to 345 [83.4% normal]; ISIS SANE from 50 to 84; P < .01). Similar positive outcomes were seen in patients treated with arthroscopic Bankart repair (GTIMS WOSI from 1062 [49.2% normal] to 402 [80.6% normal]; GTIMS SANE from 49 to 82; ISIS WOSI from 1080 [51.8% normal] to 490 [76.7% normal]; ISIS SANE from 48 to 77; P < .01). Of note, the patients with arthroscopically indicated ISIS had significantly worse outcomes scores than those treated arthroscopically according to GTIMS (P < .01). Of the 189 patients graded with GTIMS, there would have been 33 more Latarjet procedures recommended based on ISIS score. Thus the distribution of procedures based on ISIS versus GTIMS was significantly different (χ2 = 45.950; P < .001), indicating a higher rate of recommending Latarjets when using ISIS versus GTIMS. CONCLUSIONS When ISIS scoring and plain radiograph parameters only are used, this predicted a 2-fold increase in recommending a Latarjet versus GTIMS scoring criteria, which uses advanced imaging and the on- and off-track principle to more conservatively delineate anterior instability treatment with promising postoperative patient outcomes. Overall, there were minimal differences in outcomes between GTIMS and ISIS Latarjet patients; however, better outcomes were seen in patients indicated for arthroscopic Bankart repair according to GTIMS and on-off track computed tomography scanning indications. LEVEL OF EVIDENCE II, Prospective Cohort Study.
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Affiliation(s)
- Giovanni Di Giacomo
- Department of Shoulder Surgery, Concordia Hospital for Special Surgery, Rome, Italy
| | - Liam A Peebles
- Steadman Philippon Research Institute), Vail, Colorado, U.S.A
| | - Mattia Pugliese
- Trauma & Orthopaedics Department, University of Rome "La Sapienza", Rome, Italy
| | | | - Petar Golijanin
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, U.S.A
| | - Anthony Sanchez
- Steadman Philippon Research Institute), Vail, Colorado, U.S.A
| | - Matthew T Provencher
- The Steadman Clinic, Vail, Colorado, U.S.A.; Steadman Philippon Research Institute), Vail, Colorado, U.S.A..
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Ruiz Ibán MA, Asenjo Gismero CV, Moros Marco S, Ruiz Díaz R, Del Olmo Hernández T, Del Monte Bello G, García Navlet M, Ávila Lafuente JL, Díaz Heredia J. Instability severity index score values below 7 do not predict recurrence after arthroscopic Bankart repair. Knee Surg Sports Traumatol Arthrosc 2019; 27:3905-3911. [PMID: 30955072 DOI: 10.1007/s00167-019-05471-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/04/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate the efficacy of the Instability Severity Index Score (ISIS) in predicting an increased recurrence risk after an arthroscopic Bankart repair. METHODS Retrospective review of a cohort of patients operated in three different centres. The inclusion criteria (recurrent anterior instability [dislocation or subluxation] with or without hyperlaxity, arthroscopic Bankart repair) and the exclusion criteria (concomitant rotator cuff lesion, acute first-time dislocation, surgery after a previous anterior stabilization, surgery for an unstable shoulder without true dislocation or subluxation; multidirectional instability) were those used in the study that defined the ISIS score. The medical records and a telephone interview were used to identify the six variables that define the ISIS and identify recurrences. RESULTS One hundred and sixty-three shoulders met the inclusion and exclusion criteria. Of these, 140 subjects (22 females/118 males; mean age 35.5 ± 7.9) with 142 (89.0%) shoulders were available for follow-up after 5.3 (1.1) (range 3.1-7.4) years. There were 20 recurrences (14.1%). The mean (SD) preoperative ISIS was 1.8 (1.6) in the patients without recurrence and 1.8 (1.9) in the patients with recurrence (n.s.). In the 117 subjects with ISIS between 0 and 3 the recurrence rate was 12.8%; in the 25 with ISIS 4 to 6 the rate was 20% (n.s.). CONCLUSION For subjects with anterior shoulder instability in which an arthroscopic Bankart repair is being considered, the use of the ISIS, when the values obtained are ≤ 6 was not useful to predict an increased recurrence risk in the midterm in this retrospectively evaluated case series. The efficacy of the ISIS score in defining a group of subjects with a preoperative increased risk of recurrence after an arthroscopic Bankart instability repair is limited in lower risk populations (with ISIS scores ≤ 6). LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Affiliation(s)
- Miguel Angel Ruiz Ibán
- Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Cta Colmenar Km 9, 100, 28034, Madrid, Spain.
| | | | | | - Raquel Ruiz Díaz
- Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Cta Colmenar Km 9, 100, 28034, Madrid, Spain
| | | | | | | | | | - Jorge Díaz Heredia
- Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Cta Colmenar Km 9, 100, 28034, Madrid, Spain
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Oh JH, Shin SJ, Cho CH, Seo HJ, Park JS, Rhee YG. Reliability of the Instability Severity Index Score as a Predictor of Recurrence after Arthroscopic Anterior Capsulolabral Reconstruction: A Multicenter Retrospective Study. Clin Orthop Surg 2019; 11:445-452. [PMID: 31788168 PMCID: PMC6867924 DOI: 10.4055/cios.2019.11.4.445] [Citation(s) in RCA: 5] [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: 02/18/2019] [Accepted: 05/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background Although the instability severity index score (ISIS) is widely used to predict recurrence after arthroscopic anterior instability surgery, its reliability, especially on the weightings and cutoff values, is questionable. The goal of the current retrospective study was to investigate recurrence after arthroscopic capsulolabral reconstruction to evaluate whether each domain of the ISIS has the appropriate predictive power for recurrence by using logistic regression analyses with odds ratios (ORs). Methods This study included 120 consecutive patients who underwent arthroscopic capsulolabral reconstruction between 2004 and 2016. We retrospectively reviewed patients' preoperative history and radiographs, postoperative recurrence or sensation of instability, and risk factors related to the ISIS. The mean postoperative follow-up was 27.6 months (range, 12 to 96 months; median, 21 months). Twenty-six patients with recurrence or positive apprehension were classified as the recurrence group; 94 patients without any symptoms were classified as the non-recurrence group. Logistic regression analyses with ORs were used to verify the utility of each domain of the ISIS for predicting recurrence. Results The mean ISIS did not differ significantly between the recurrence and non-recurrence groups (4.3 ± 1.8 vs. 3.4 ± 2.1 points; p = 0.063). Among the domains of ISIS, factors related to bone defects, the presence of a Hill-Sachs lesion and glenoid bone loss had the lowest ORs (0.77 and 0.38, respectively). Conclusions Not all ISIS domains accurately predicted recurrence after arthroscopic capsulolabral reconstruction. The ISIS may not be a proper reference for determining Latarjet procedure in patients with anterior shoulder instability.
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Affiliation(s)
- Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Jin Shin
- Department of Orthopaedic Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - Chul-Hyun Cho
- Department of Orthopaedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Hyuk Jun Seo
- Department of Orthopaedic Surgery, Daegu Chamtntn Hospital, Daegu, Korea
| | - Ji Soon Park
- Department of Orthopaedic Surgery, Sheikh Khalifa Specialty Hospital, Ras al Khaimah, United Arab Emirates
| | - Yong Girl Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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Rohman E, Gronbeck K, Tompkins M, Mittelsteadt M, Kirkham JA, Arciero RA. Scapular Spine Dimensions and Suitability as a Glenoid Bone Graft Donor Site. Am J Sports Med 2019; 47:2469-2477. [PMID: 31310727 DOI: 10.1177/0363546519861965] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current structural bone graft options used for glenoid augmentation in glenohumeral instability have known drawbacks. The scapular spine may be a possible alternative graft choice, but its dimensions and anatomy are not fully reported. HYPOTHESIS The scapular spine's harvestable graft dimensions will be similar to harvestable dimensions of the coracoid and iliac crest. STUDY DESIGN Descriptive laboratory study. METHODS The scapular spine, coracoid, and iliac crest dimensions were recorded and compared bilaterally in 50 patients with 3-dimensional computed tomography imaging. The portion of the scapular spine with the largest harvestable dimensions was quantified and its location defined. Measurements were independently taken by 2 investigators and averaged for the final result. RESULTS The scapular spine has 81.5 mm of harvestable length and a "flare" located approximately 49.6 mm lateral to the medial scapular border, where the widest harvestable cross section is located (mean harvestable dimensions: 10.9-mm height, 11.5-mm width). Mean coracoid dimensions were 24-mm length, 14.2-mm height, and 10.6-mm width. Mean iliac crest width was 14.7 mm. In sum, 96% of scapular spines, 85% of coracoids, and 100% of iliac crests exceeded minimum dimensions of 8 mm × 8 mm × 20 mm. The coronal radius of curvature of the glenoid was significantly different from the corresponding plane of all measured structures. CONCLUSION/CLINICAL RELEVANCE The scapular spine has dimensions similar to the coracoid and iliac crest in the majority of patients and is therefore appropriate for further investigation as a potential graft choice in glenohumeral instability. A harvest location 49.6 mm lateral to the medial scapular border will provide the largest cross-sectional graft while avoiding the acromial base.
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Affiliation(s)
- Eric Rohman
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kyle Gronbeck
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marc Tompkins
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA.,TRIA Orthopaedic Center, Bloomington, Minnesota, USA
| | - Marcus Mittelsteadt
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - James A Kirkham
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robert A Arciero
- Department of Orthopedics, University of Connecticut Health Center, Farmington, Connecticut, USA
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Chan AG, Kilcoyne KG, Chan S, Dickens JF, Waterman BR. Evaluation of the Instability Severity Index score in predicting failure following arthroscopic Bankart surgery in an active military population. J Shoulder Elbow Surg 2019; 28:e156-e163. [PMID: 30685274 DOI: 10.1016/j.jse.2018.11.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/02/2018] [Accepted: 11/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Instability Severity Index (ISI) score is a preoperative risk stratification tool used to identify patients at heightened risk of recurrent anterior instability after an arthroscopic Bankart procedure. The primary objective of this study was to validate the utility of the ISI score in predicting failure of primary arthroscopic Bankart surgery in an active-duty military population. METHODS A retrospective study was performed to compare all military service members undergoing primary arthroscopic Bankart repairs at a single military treatment facility between 2007 and 2014. The primary outcome of interest was surgical failure due to recurrent instability. The ISI framework was used to stratify each patient for recurrence, and multivariate analysis was performed to evaluate the composite ISI score and individual domains between patients with and patients without failed Bankart repairs. RESULTS A total of 131 patients were identified, with a mean patient age of 26.8 years (range, 19-47 years), among whom 42 patients (32%) were identified as having a higher-demand military occupation. At a minimum 2-year follow-up, 34 patients (26%) sustained recurrent anterior shoulder instability. The mean ISI score of patients in the failed Bankart repair group was not statistically different than that of patients with a successful repair (3.41 vs 3.5, P = .74), and no individual ISI domains were identified as independent risk factors for subsequent surgical failure or revision stabilization. CONCLUSION Contrary to the findings of previous validation studies, the composite ISI score and its individual risk factors were not predictive of subsequent surgical failure after primary arthroscopic Bankart repair in an active military population.
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Affiliation(s)
- Andrew G Chan
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA.
| | - Kelly G Kilcoyne
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Stephen Chan
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Jonathan F Dickens
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Brian R Waterman
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Thomazeau H, Langlais T, Hardy A, Curado J, Herisson O, Mouton J, Charousset C, Courage O, Nourissat G. Long-term, Prospective, Multicenter Study of Isolated Bankart Repair for a Patient Selection Method Based on the Instability Severity Index Score. Am J Sports Med 2019; 47:1057-1061. [PMID: 30883182 DOI: 10.1177/0363546519833920] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND An isolated arthroscopic Bankart repair carries a high mid- and long-term risk of recurring instability. Preoperative patient selection based on the Instability Severity Index Score should improve outcomes. PURPOSE To report the overall long-term recurrence rate for isolated Bankart repair, investigate the predictive factors for recurrence, analyze time to recurrence, and determine a quantitative cutoff point for recurrence in terms of Instability Severity Index Score. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS This was a prospective multicenter study. Inclusion criteria were recurring anterior instability and an Instability Severity Index Score of 4 or less. Of the 125 patients included, 20 patients had a score of 0, 31 patients scored 1, 29 patients scored 2, 34 patients scored 3, and 11 patients scored 4. All centers used the same arthroscopic technique and rehabilitation protocol. Follow-up data were collected at 3, 6, 12, and 24 months and 3 and 9 years. The primary endpoint was recurrence of instability (total or partial dislocation). The statistical analysis was performed by use of the software package SAS 9.4. RESULTS We initially identified 328 patients, of whom 125 patients were prospectively included. The main reason for excluding the 202 patients was the presence of bony lesions, which carry 2 points each in the Instability Severity Index Score (humeral head notch and/or glenoid lesion visible on standard radiographs). Of the 125 eligible patients, 73% were athletes and 22.5% competitors; 16% were lost at the last follow-up. At the endpoint, 23% had experienced a recurrence after a mean interval of 35 months (range, 5.5-103 months). No statistical differences were found between patients with and without bony lesions in the overall group of 125 patients or in the subgroup with an Instability Severity Index Score of 3 or 4 points ( P = .4). According to univariate analysis, the only predictive factor for recurrence was age less than 20 years at the time of surgery, with a 42% rate of recurrence in this group ( P = .03). Multivariate analysis showed that the Instability Severity Index Score was the only predictive factor with a quantitative cutoff point (namely, a score of ≤2 points) that was statistically associated with a decreased long term recurrence rate ( P = .02). The recurrence rate was 10% for a preoperative Instability Severity Index Score of 2 or less compared with 35.6% for a score of 3 or 4. The survival curves demonstrated no new dislocations after year 4 for patients with an Instability Severity Index Score of up to 2 points. CONCLUSION In a preselected population, mainly without bony lesions, the Instability Severity Index Score cutoff value that provides an acceptable recurrence rate at 9 years after isolated Bankart repair is 2 out of 10.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Geoffroy Nourissat
- Groupe Ramsay Generale de Santé, Clinique Maussins Nollet, Paris, France
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Ryu JH, Kang JR, Ryu RK. Arthroscopic Bankart Reconstruction with Minimal Bone Loss. OPER TECHN SPORT MED 2019. [DOI: 10.1053/j.otsm.2019.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Loppini M, Delle Rose G, Borroni M, Morenghi E, Pitino D, Domínguez Zamora C, Castagna A. Is the Instability Severity Index Score a Valid Tool for Predicting Failure After Primary Arthroscopic Stabilization for Anterior Glenohumeral Instability? Arthroscopy 2019; 35:361-366. [PMID: 30611589 DOI: 10.1016/j.arthro.2018.09.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/08/2018] [Accepted: 09/08/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the validity of the Instability Severity Index Score in predicting the rate of recurrence of dislocation in patients undergoing arthroscopic Bankart repair. METHODS The inclusion criteria were recurrent anterior traumatic glenohumeral instability and a minimum follow-up of 5 years. According to the preoperative Instability Severity Index Score, patients were divided into the following groups: ≤3 points (A), 4 to 6 points (B), and >6 points (C). The recurrence rate was determined by telephone interviews. The estimated overall rate of success at 5 years was defined as the estimated overall percentage of patients free of recurrence at 5 years. RESULTS Six hundred seventy patients (572 men and 98 women) were included. The average age was 27 years (range, 18 to 39 years) at the time of surgery. One hundred fourteen of 670 patients had a recurrence of instability, with an overall recurrence rate of 17% (95% confidence interval [CI] 14.2%-19.9%). The Instability Severity Index Score had a significant association with recurrence. Compared with patients in group A, those in group B had double the risk of recurrence (hazard ratio [HR] = 2.43, 95% CI 1.38-4.28, P = .002), and patients in group C a 9 times greater risk of recurrence (HR = 9.42, 95% CI 5.20-17.7, P < .001). The estimated overall rate of success at 5 years was 84.8% (95% CI 81.8-87.3). The rate of success with an Instability Severity Index Score ≤3 points was 93.7% (95% CI 89.6-96.2), but it dropped to 85.7% (95% CI 81.7-88.9) in those with an Instability Severity Index Score of 4 to 6 points and became 54.6% (95% CI 42.8-64.9) in those with an Instability Severity Index Score >6 points. On multivariable analysis, the Instability Severity Index Score was found to significantly affect the risk of recurrence, corrected by type of sport and glenoid bone loss. CONCLUSIONS The Instability Severity Index Score is a validated tool with which to assess the recurrence rate of dislocation after arthroscopic surgery in patients with shoulder instability. Arthroscopic stabilization in patients with an Instability Severity Index Score ≤3 is associated with a significantly lower risk of recurrence of glenohumeral instability compared with that in patients with an Instability Severity Index Score >3 points. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
| | - Giacomo Delle Rose
- Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Mario Borroni
- Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Emanuela Morenghi
- Biostatistic Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Dario Pitino
- Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | | | - Alessandro Castagna
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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Boileau P, Lemmex DB. Editorial Commentary: Which Patients Are Likely to Undergo Redislocation After an Arthroscopic Bankart Repair? Preoperative Instability Severity Index Scoring Over 3 Points-The Game Is Over! Arthroscopy 2019; 35:367-371. [PMID: 30712616 DOI: 10.1016/j.arthro.2018.11.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 11/27/2018] [Indexed: 02/02/2023]
Abstract
Risk factors for recurrent instability are present and identifiable preoperatively and can be incorporated into a severity scoring system to help with patient selection. The Instability Severity Index (ISI) Score is a tool used to preoperatively identify patients at risk of failure after an arthroscopic Bankart procedure for recurrent anterior shoulder instability. This 10-point score is also designed to help guide the treating surgeon's decision on whether a soft-tissue stabilization or bone block augmentation procedure is indicated. The ISI scoring system has been criticized for its lack of generalizability outside of the French health care system. However, evidence has emerged establishing the ISI Score as a valuable tool with excellent external validity. The ISI scoring system, based on factors derived from a preoperative questionnaire, physical examination, and imaging studies, is helpful to distinguish between patients who will benefit from an arthroscopic Bankart procedure and those who will not. The higher the score, the higher the risk of recurrence of instability. Patients with an ISI Score of 3 points or less may attain very good results with an arthroscopic Bankart procedure compared with patients with an ISI Score of more than 3 points. Performing this procedure in patients with an ISI Score of more than 6 points leads to an increased risk of recurrence (≥50%) within 5 years and is totally inacceptable. We believe that the information gained from this scoring system will help surgeons in their daily practice to not only decide the right procedure for the right patient but also inform their patients preoperatively of the risks and benefits of an arthroscopic Bankart procedure. As such, the ISI Score is an important strategic tool for shoulder surgeons.
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Godin JA, Altintas B, Horan MP, Hussain ZB, Pogorzelski J, Fritz EM, Millett PJ. Midterm Results of the Bony Bankart Bridge Technique for the Treatment of Bony Bankart Lesions. Am J Sports Med 2019; 47:158-164. [PMID: 30485124 DOI: 10.1177/0363546518808495] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The arthroscopic "bony Bankart bridge" (BBB) repair technique was recently shown to successfully restore shoulder stability at short-term follow-up, but longer-term outcomes have not yet been described. PURPOSE To report the outcomes at minimum 5-year follow-up after BBB repair for anterior shoulder instability with a bony Bankart lesion. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients were included if they sustained a bony Bankart lesion, were treated with a BBB technique, and were at least 5 years postoperative. Patients were excluded if they underwent concomitant rotator cuff repair or an open bone fragment reduction. All patients were assessed with the following measures preoperatively and at final evaluation: QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand), American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, and 12-Item Short Form Health Survey (SF-12) Physical Component Summary. RESULTS From 2008 to 2012, 13 patients who underwent BBB met the inclusion criteria with a mean age of 39.6 years (range, 19.1-68.8 years) and a mean follow-up of 6.7 years (range, 5.1-9.0 years). Mean time from most recent injury to surgery was 6.3 months (range, 1 day-36 months). The mean glenoid bone loss was 22.5% (range, 9.1%-38.6%). Mean SF-12 scores demonstrated significant improvement from 45.8 (SD, 9.7) preoperatively to 55.1 (SD, 5.9) at a mean follow-up of 6.7 years. At final follow-up, the mean American Shoulder and Elbow Surgeons score was 93.1 (range, 68.3-100); the mean QuickDASH score, 6.2 (range, 0-25); and the mean Single Assessment Numeric Evaluation score, 92.8 (range, 69-99). None of the patients progressed to further shoulder surgery. Three of 13 patients (23%) reported subjective recurrent instability. At final follow-up, 9 of 12 (75%) patients indicated that their sports participation levels were equal to their preinjury levels. Median patient satisfaction at final follow-up was 10 of 10 points (range, 3-10). CONCLUSION The arthroscopic BBB technique for patients with anterior bony Bankart lesions can restore shoulder stability, yield durable improvements in clinical outcomes, and provide a high return-to-sport rate at a minimum 5-year follow-up. Three of 13 patients experienced postoperative symptoms of instability but did not undergo further stabilization surgery.
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Affiliation(s)
- Jonathan A Godin
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Burak Altintas
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | - Jonas Pogorzelski
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Department of Orthopaedic Sports Medicine, Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Erik M Fritz
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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Privitera DM, Sinz NJ, Miller LR, Siegel EJ, Solberg MJ, Daniels SD, Higgins LD. Clinical Outcomes Following the Latarjet Procedure in Contact and Collision Athletes. J Bone Joint Surg Am 2018; 100:459-465. [PMID: 29557861 DOI: 10.2106/jbjs.17.00566] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have evaluated the success of the Latarjet procedure for recurrent anterior glenohumeral instability in the contact or collision athlete. The purpose of this study was to evaluate the return-to-sport and functional results of the Latarjet procedure in this select group. METHODS One hundred and nine consecutive contact or collision athletes (112 shoulders) treated with an open Latarjet procedure for recurrent anterior glenohumeral instability were retrospectively identified. Seventy-three shoulders in 73 patients (67%) were evaluated at a mean follow-up of 52 months (range, 24 to 120 months). The average age at surgery was 25.8 years (range, 15 to 54 years). The primary outcomes were the scores on the Western Ontario Shoulder Instability Index (WOSI), the American Shoulder and Elbow Surgeons (ASES) questionnaire, a visual analog scale (VAS) for pain, and return to sport. Predictors of return to sport were analyzed. RESULTS Six (8%) of the 73 patients experienced ≥1 postoperative dislocations. Ten additional patients (14%) experienced a perception of instability without a dislocation. The median postoperative WOSI and ASES scores were 382 (range, 0 to 2,016) and 93.3 (range, 21.7 to 100), respectively. The median postoperative VAS pain score was 0 (range, 0 to 10). Forty-nine percent (36) of the 73 patients returned to their preoperative sports level, 14% (10) decreased their activity level in the same sport, 12% (9) changed sports, and 25% (18) decreased their level of activity and changed sports or stopped participating in sports altogether. Patients with ≥2 stabilization procedures prior to the Latarjet procedure demonstrated a lower likelihood of returning to their original sport (p = 0.019; relative risk = 2.84; 95% confidence interval = 1.34 to 6.06). The percentage of glenoid bone loss showed no association with the return-to-sport rate (p = 0.507). CONCLUSIONS The outcome of the Latarjet procedure in high-risk contact or collision athletes is variable. Patients who have fewer prior stabilization surgical procedures are more likely to successfully return to their original sport. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- David M Privitera
- Department of Orthopaedic Surgery, Rochester Regional Health System, Rochester, New York
| | - Nathan J Sinz
- Tufts University School of Medicine, Boston, Massachusetts
| | - Lindsay R Miller
- The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, Vermont
| | - Elana J Siegel
- Department of Pediatrics, The Mount Sinai Hospital, New York, NY
| | - Muriel J Solberg
- Boston Shoulder Institute, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephen D Daniels
- The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, Vermont
| | - Laurence D Higgins
- Boston Shoulder Institute, Brigham and Women's Hospital, Boston, Massachusetts
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Pogorzelski J, Fritz EM, Godin JA, Imhoff AB, Millett PJ. Nonoperative treatment of five common shoulder injuries: A critical analysis. ACTA ACUST UNITED AC 2018; 13:89-97. [PMID: 29887915 PMCID: PMC5976697 DOI: 10.1007/s11678-018-0449-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/29/2018] [Indexed: 12/31/2022]
Abstract
Economic pressure highlights the critical need for appropriate diagnosis and treatment of various shoulder pathologies since under-diagnosis and under-treatment can result in increased costs to society in the form of disability and lost production. On the other hand, aggressive over-treatment can further inflate already burgeoning health-care costs and potentially harm the patient. Therefore, it is crucial to distinguish the indications between operative and nonoperative management, especially in common shoulder pathologies such as rotator cuff tears, anterior shoulder instability, biceps tendinitis, lesions to the acromioclavicular joint, and proximal humeral fractures. As a result, a detailed analysis of individual risk factors for potential failures should be performed and treatment should be based on individualized care with consideration given to each patient’s particular injury pattern, functional demands, and long-term goals.
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Affiliation(s)
- Jonas Pogorzelski
- 1Steadman Philippon Research Institute, 181 West Meadow Drive suite 1000, 81657 Vail, CO USA.,Department of Orthopedic Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
| | - Erik M Fritz
- 1Steadman Philippon Research Institute, 181 West Meadow Drive suite 1000, 81657 Vail, CO USA
| | - Jonathan A Godin
- 1Steadman Philippon Research Institute, 181 West Meadow Drive suite 1000, 81657 Vail, CO USA.,3The Steadman Clinic, 181 West Meadow Drive suite 400, 81657 Vail, CO USA
| | - Andreas B Imhoff
- Department of Orthopedic Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
| | - Peter J Millett
- 1Steadman Philippon Research Institute, 181 West Meadow Drive suite 1000, 81657 Vail, CO USA.,3The Steadman Clinic, 181 West Meadow Drive suite 400, 81657 Vail, CO USA
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van der Linde JA, Wessel RN, Trantalis JN, van den Bekerom MPJ. Review of Latarjet (1954) on the treatment of recurrent shoulder dislocations. J ISAKOS 2018. [DOI: 10.1136/jisakos-2017-000153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This classic discusses the original publication ‘Treatment of recurrent dislocation of the shoulder’ on the Latarjet procedure. This surgical technique that has become one of the basics in shoulder-stabilising surgery, introduced by Latarjet in 1954 in the journal Lyon Chirurgical. Inspired by publications of colleagues in the field of shoulder surgery, Latarjet introduced a technique that transfers the coracoid process to the anterior glenoid rim in patients with anterior shoulder instability. Although being outrun in popularity by the Bankart repair for several decades, improved knowledge regarding long-term outcomes, surgical techniques and patient characteristics such as bone loss and participation in contact sports has led to renewed interest in the Latarjet procedure. This especially accounts for patients with significant glenohumeral bone loss or patients with a previously failed soft tissue repairs. Whereas the increase in popularity has led to many studies focussing on various aspects, the 15 basics of the initial procedure have virtually remained unchanged.
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Younan Y, Wong PK, Karas S, Umpierrez M, Gonzalez F, Jose J, Singer AD. The glenoid track: a review of the clinical relevance, method of calculation and current evidence behind this method. Skeletal Radiol 2017; 46:1625-1634. [PMID: 28593363 DOI: 10.1007/s00256-017-2687-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/12/2017] [Accepted: 05/24/2017] [Indexed: 02/02/2023]
Abstract
In the setting of bipolar bone injury, orthopedic surgeons are currently making use of the glenoid track method to guide surgical management. Using preoperative CT or MR imaging, this method allows the identification of patients who are more likely to fail a primary capsuloligamentous Bankart repair. As the glenoid track method becomes increasingly used in preoperative planning, it is important for the radiologist to become familiar with its concept and method of calculation. This review article aims to concisely summarize the current literature and the clinical implications of the glenoid track method.
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Affiliation(s)
- Yara Younan
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA, 30329, USA.
| | - Philip K Wong
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA, 30329, USA
| | - Spero Karas
- Department of Orthopedic Surgery, Emory University Hospital, Atlanta, GA, USA
| | - Monica Umpierrez
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA, 30329, USA
| | - Felix Gonzalez
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA, 30329, USA
| | - Jean Jose
- Department of Radiology, University of Miami, Miami, FL, USA
| | - Adam Daniel Singer
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA, 30329, USA
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Rosa JRP, Checchia CS, Miyazaki AN. Traumatic anterior instability of the shoulder. Rev Bras Ortop 2017; 52:513-520. [PMID: 29062813 PMCID: PMC5643896 DOI: 10.1016/j.rboe.2017.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 09/01/2016] [Indexed: 01/10/2023] Open
Abstract
The shoulder is the most unstable joint in the human body. Traumatic anterior instability of the shoulder is a common condition, which, especially in young patients, is associated with high recurrence rates. The effectiveness of non-surgical treatments when compared to surgical ones is still controversial. The purpose of this study was to review the literature for current concepts and updates regarding the treatment of this condition.
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Affiliation(s)
- João Roberto Polydoro Rosa
- Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCM-SCSP), Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Caio Santos Checchia
- Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCM-SCSP), Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Alberto Naoki Miyazaki
- Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCM-SCSP), Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
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39
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Diagnosis and treatment of anteroinferior capsular redundancy associated with anterior shoulder instability using an open Latarjet procedure and capsulorrhaphy. Knee Surg Sports Traumatol Arthrosc 2016; 24:3756-3764. [PMID: 26003480 DOI: 10.1007/s00167-015-3621-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE There is a paucity of data detailing management of anterior capsular redundancy (ACR) when using the Latarjet procedure for unidirectional instability. This study aimed to describe the surgical management and to assess the clinical profile of patients presenting with anterior capsular redundancy [ACR(+)] with anterior shoulder instability. METHODS Seventy-seven patients who had a Latarjet procedure were followed for a 55-month period. Per-operative ACR was assessed during surgery. ACR was considered present if the inferior capsular flap of a Neer T-shaft capsulorrhaphy was able to cover the superior capsular flap with the arm in the neutral position. Patients with ACR(+) received an additional Neer capsulorrhaphy, while patients with ACR(-) did not. This per-operative finding was correlated with demographics, clinical, radiological pre-operative data and surgical outcome. RESULTS Patients presenting with a per-operative ACR(+) were significantly associated with a sulcus sign (P < 0.001), a Beighton score >4 (P < 0.01), a low-energy instability history (P < 0.05), a predominant history of subluxations (P < 0.05), fewer Hill-Sachs lesion (P < 0.05) and a female gender (P < 0.05), but not significantly with external rotation >85°. Open standard Latarjet procedures with Neer capsulorrhaphy in ACR(+) patients showed excellent or good results and stability rate of 95 %. All patients except four who presented with a new dislocation after surgery were satisfied with their outcome. Thirteen patients (16 %) had a persistent apprehension sign at the last follow-up. ACR(+) and ACR(-) groups did not show significant difference in the mean values of Rowe, Walch-Duplay and Constant-Murley scores. CONCLUSION ACR correlated with a sulcus sign, Beighton score and instability history. In anterior shoulder instability associated with ACR, the Latarjet procedure with a Neer capsulorrhaphy appears a satisfactory treatment alternative to arthroscopic or open capsular shift. It decreased apprehension in comparison with Latarjet procedures without capsular repair. LEVEL OF EVIDENCE Cases series, treatment study, Level IV.
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Degen RM, Camp CL, Werner BC, Dines DM, Dines JS. Trends in Bone-Block Augmentation Among Recently Trained Orthopaedic Surgeons Treating Anterior Shoulder Instability. J Bone Joint Surg Am 2016; 98:e56. [PMID: 27385690 DOI: 10.2106/jbjs.15.01478] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder instability is a common entity requiring surgical stabilization. Although arthroscopic soft-tissue stabilization has been the most common surgical treatment, increased attention is now being paid to Latarjet coracoid transfers and bone-block augmentation, particularly with glenoid bone loss. The purpose of this work was to evaluate the current status of arthroscopic soft-tissue stabilization and bone-block augmentation stabilization techniques among newly trained orthopaedic surgeons in the United States. METHODS The American Board of Orthopaedic Surgery (ABOS) database was utilized to identify shoulder instability cases submitted by ABOS Part-II Board Certification examination candidates. Cases were dichotomized into two groups: isolated soft-tissue stabilizations and bone-block augmentation procedures, including coracoid transfer. The two groups were then analyzed to determine trends in annual incidence, complication rates, types of complications, concomitant procedures, surgeon fellowship training, and geographic region of practice. RESULTS From 2004 to 2013, 6,854 surgeons submitted 7,587 shoulder instability surgical cases that met all inclusion criteria. Of these, 7,515 (99.1%) were isolated soft-tissue stabilizations, and 72 (0.95%) were bone-block glenoid augmentations. Surgeons with sports medicine fellowship training performed 61.85% of isolated soft-tissue stabilization procedures and 58.33% of bone-block stabilization procedures. The percentage of stabilization cases that utilized bone-block augmentation increased tenfold from 0.14% to 1.4% (p = 0.029) during the study period. The overall annual incidence of isolated soft-tissue stabilizations (p = 0.037) and bone-block procedures (p = 0.016) increased from 2004 to 2013. Although the complication rate of the bone-block procedures remained steady (mean rate, 20.8%; p = 0.932), the isolated soft-tissue stabilization complication rate rose from 4.9% to 9.0% (mean rate, 5.4%; p = 0.003). CONCLUSIONS A trend exists toward increased utilization of bone-block stabilization for the treatment of shoulder instability among recently trained orthopaedic surgeons. Complication rates remained relatively high (20.8%) for these procedures, but did not increase as was seen with the isolated soft-tissue stabilizations. Residency and fellowship programs should continue to focus on methods to optimize training for these procedures. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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An VVG, Sivakumar BS, Phan K, Trantalis J. A systematic review and meta-analysis of clinical and patient-reported outcomes following two procedures for recurrent traumatic anterior instability of the shoulder: Latarjet procedure vs. Bankart repair. J Shoulder Elbow Surg 2016; 25:853-63. [PMID: 26809355 DOI: 10.1016/j.jse.2015.11.001] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 11/09/2015] [Accepted: 11/10/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Bankart repair and Latarjet procedure are both viable surgical options for recurrent traumatic anterior instability of the shoulder joint. The anatomic repair is the more popular option, with 90% of surgeons internationally choosing the Bankart repair as the initial treatment. There has been no previous review directly comparing the 2 techniques. Hence, we aimed to systematically review studies to compare the outcomes of Bankart repairs vs. the Latarjet procedure for recurrent instability of the shoulder. METHODS Six electronic databases were searched for original, English-language studies comparing the Bankart and Latarjet procedures. Studies were critically appraised using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Data were extracted from the text, tables, and figures of the selected studies. RESULTS Eight comparative studies were identified with 795 shoulders; 416 of them underwent open or arthroscopic Bankart repairs, and 379 were repaired by the open Latarjet procedure. Primary and revision procedures were studied. The Latarjet procedure conferred significantly lower risk of recurrence and redislocation. There was no significant difference in the rates of complication requiring reoperation between the two procedures. Rowe scores were higher and loss of external rotation lower in the Latarjet group compared with the Bankart repair group. CONCLUSIONS Our studies demonstrate that the Latarjet procedure is a viable and possibly superior alternative to the Bankart repair, offering greater stability with no significant increase in complication rate. However, the studies identified were retrospective and of limited quality, and therefore randomized controlled trials with large populations of patients or prospective assessment of national orthopedic registries should be employed to confirm our findings.
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Affiliation(s)
- Vincent Vinh Gia An
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| | | | - Kevin Phan
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - John Trantalis
- Department of Orthopaedic Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
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Castagna A, Garofalo R, Conti M, Flanagin B. Arthroscopic Bankart repair: Have we finally reached a gold standard? Knee Surg Sports Traumatol Arthrosc 2016; 24:398-405. [PMID: 26714819 DOI: 10.1007/s00167-015-3952-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/15/2015] [Indexed: 11/26/2022]
Abstract
Traditionally, surgical stabilization of the unstable shoulder has been performed through an open incision. Arthroscopic Bankart repair with suture anchors is now widely considered the treatment of choice for anterior shoulder instability in patients who have failed conservative management. Many different factors have now been elucidated for adequate treatment of glenohumeral instability. Because of technical advances in instability repair combined with an increased understanding of factors that lead to recurrent instability, the outcomes following arthroscopic Bankart repair have significantly improved and approach those of open techniques.
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Affiliation(s)
| | - Raffaele Garofalo
- Shoulder and Elbow Unit, IRCCS Humanitas Institute, Milan, Italy
- Upper Limb Surgery Unit, F. Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Marco Conti
- Shoulder and Elbow Unit, IRCCS Humanitas Institute, Milan, Italy
| | - Brody Flanagin
- The Shoulder Center at Baylor University, Dallas, TX, USA
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Abstract
Rugby is a high-impact collision sport, with impact forces. Shoulder injuries are common and result in the longest time off sport for any joint injury in rugby. The most common injuries are to the glenohumeral joint with varying degrees of instability. The degree of instability can guide management. The three main types of instability presentations are: (1) frank dislocation, (2) subluxations and (3) subclinical instability with pain and clicking. Understanding the exact mechanism of injury can guide diagnosis with classical patterns of structural injuries. The standard clinical examination in a large, muscular athlete may be normal, so specific tests and techniques are needed to unearth signs of pathology. Taking these factors into consideration, along with the imaging, allows a treatment strategy. However, patient and sport factors need to be also considered, particularly the time of the season and stage of sporting career. Surgery to repair the structural damage should include all lesions found. In chronic, recurrent dislocations with major structural lesions, reconstruction procedures such as the Latarjet procedure yields better outcomes. Rehabilitation should be safe, goal-driven and athlete-specific. Return to sport is dependent on a number of factors, driven by the healing process, sport requirements and extrinsic pressures. Level of evidence V.
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Phadnis J, Arnold C, Elmorsy A, Flannery M. Utility of the Instability Severity Index Score in Predicting Failure After Arthroscopic Anterior Stabilization of the Shoulder. Am J Sports Med 2015; 43:1983-8. [PMID: 26122385 DOI: 10.1177/0363546515587083] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The redislocation rate after arthroscopic stabilization for anterior glenohumeral instability is up to 30%. The Instability Severity Index Score (ISIS) was developed to preoperatively rationalize the risk of failure, but it has not yet been validated by an independent group. PURPOSE To assess the utility of the ISIS in predicting failure of arthroscopic anterior shoulder stabilization and to identify other preoperative factors for failure. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A case-control study was performed on 141 consecutive patients, comparing those who suffered failure of arthroscopic stabilization with those who had successful arthroscopic stabilization. The mean follow-up time was 47 months (range, 24-132 months). The ISIS was applied retrospectively, and an analysis was performed to establish independent risk factors for failure. A receiver operator coefficient curve was constructed to set a threshold ISIS for considering alternative surgery. RESULTS Of 141 patients, 19 (13.5%) suffered recurrent instability. The mean ISIS of the failed stabilization group was higher than that of the successful stabilization group (5.1 vs 1.7; P < .001). Independent risk factors for failure were Hill-Sachs lesion (P < .001), glenoid bone loss (P < .001), age <21 years at the time of surgery (P < .001), age at first dislocation (P = .01), competitive-level participation in sports (P < .001), and participation in contact or overhead sports (P = .03). The presence of glenoid bone loss carried the highest risk of failure (70%). There was a 70% risk of failure if the ISIS was ≥4, as opposed to a 4% risk of failure if the ISIS was <4. CONCLUSION This is the first completely independent study to confirm that the ISIS is a useful preoperative tool. It is recommended that surgeons consider alternative forms of stabilization if the ISIS is ≥4.
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Ropars M, Cretual A, Thomazeau H, Kaila R, Bonan I. Volumetric definition of shoulder range of motion and its correlation with clinical signs of shoulder hyperlaxity. A motion capture study. J Shoulder Elbow Surg 2015; 24:310-6. [PMID: 25193487 DOI: 10.1016/j.jse.2014.06.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/10/2014] [Accepted: 06/19/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder hyperlaxity (SHL) is assessed with clinical signs. Quantification of SHL remains difficult, however, because no quantitative definition has yet been described. With use of a motion capture system (MCS), the aim of this study was to categorize SHL through a volumetric MCS-based definition and to compare this volume with clinical signs used for SHL diagnosis. METHOD Twenty-three subjects were examined with passive and active measurement of their shoulder range of motion (SROM) and then with an MCS protocol, allowing computation of the shoulder configuration space volume (SCSV). Clinical data of SHL were assessed by the sulcus sign, external rotation with the arm at the side (ER1) >85° in a standing position, external rotation >90° in a lying position, and Beighton score for general joint laxity. Active and passive ER1, EIR2 (sum of external and internal rotation at 90° of abduction), flexion-extension, and abduction were also measured and correlated to SCSV. RESULTS Except for the sulcus sign, SCSV was significantly correlated with all clinical signs used for SHL. Passive examination of the different SROMs was better correlated to SCSV than active examination. In passive examination, the worst SROM was ER1 (R = 0.36; P = .09), whereas EIR2, flexion, and abduction were highly correlated to SCSV (P < .01). CONCLUSION SCSV appears to be an appealing tool for evaluation of SHL regarding its correlation with clinical signs used for SHL diagnosis. The sulcus sign and ER1 >85° in a standing position appear less discriminating and should be replaced by EIR2 measurement for SHL diagnosis.
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Affiliation(s)
- Mickaël Ropars
- Orthopedics Department, Pontchaillou University Hospital, Rennes, France; M2S (Mouvement Sport Santé) Laboratory, University Rennes 2, ENS Bretagne, UEB, Campus de Ker Lann, Bruz, France.
| | - Armel Cretual
- M2S (Mouvement Sport Santé) Laboratory, University Rennes 2, ENS Bretagne, UEB, Campus de Ker Lann, Bruz, France
| | - Hervé Thomazeau
- Orthopedics Department, Pontchaillou University Hospital, Rennes, France
| | - Rajiv Kaila
- Orthopedics Department, Pontchaillou University Hospital, Rennes, France
| | - Isabelle Bonan
- M2S (Mouvement Sport Santé) Laboratory, University Rennes 2, ENS Bretagne, UEB, Campus de Ker Lann, Bruz, France
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Kane P, Bifano SM, Dodson CC, Freedman KB. Approach to the treatment of primary anterior shoulder dislocation: A review. PHYSICIAN SPORTSMED 2015; 43:54-64. [PMID: 25559018 DOI: 10.1080/00913847.2015.1001713] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Glenohumeral joint dislocation is common among younger, active patients. Anterior dislocation is the most common direction of instability following a traumatic event. Due to a high rate of recurrence following primary traumatic anterior shoulder dislocation, an evidence-based approach is necessary to determine the best treatment regime for a patient presenting with this problem. A history, physical examination, and radiographic imaging can help guide treatment recommendations by determining the extent of soft tissue damage following dislocation. Controversies in the treatment of the first-time dislocator include the length and position of immobilization following dislocation, and the role of initial surgical stabilization. This article outlines the treatment options for the first-time glenohumeral dislocator, with an emphasis on the available evidence in the literature. Where applicable, the criteria known as the Strength of Recommendation Taxonomy were used to summarize the strength of evidence available for recommendations.
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Bouliane M, Saliken D, Beaupre LA, Silveira A, Saraswat MK, Sheps DM. Evaluation of the Instability Severity Index Score and the Western Ontario Shoulder Instability Index as predictors of failure following arthroscopic Bankart repair. Bone Joint J 2014; 96-B:1688-92. [DOI: 10.1302/0301-620x.96b12.34468] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this study we evaluated whether the Instability Severity Index Score (ISIS) and the Western Ontario Shoulder Instability Index (WOSI) could detect those patients at risk of failure following arthroscopic Bankart repair. Between April 2008 and June 2010, the ISIS and WOSI were recorded pre-operatively in 110 patients (87 male, 79%) with a mean age of 25.1 years (16 to 61) who underwent this procedure for recurrent anterior glenohumeral instability. A telephone interview was performed two-years post-operatively to determine whether patients had experienced a recurrent dislocation and whether they had returned to pre-injury activity levels. In all, six (5%) patients had an ISIS > 6 points (0 to 9). Of 100 (91%) patients available two years post-operatively, six (6%) had a recurrent dislocation, and 28 (28%) did not return to pre-injury activity. No patient who dislocated had an ISIS > 6 (p = 1.0). There was no difference in the mean pre-operative WOSI in those who had a re-dislocation and those who did not (p = 0.99). The pre-operative WOSI was significantly lower (p = 0.02) in those who did not return to pre-injury activity, whereas the ISIS was not associated with return to pre-injury activity (p = 0.13). In conclusion, neither the pre-operative ISIS nor WOSI predicted recurrent dislocation within two years of arthroscopic Bankart repair. Patients with a lower pre-operative WOSI were less likely to return to pre-injury activity. Cite this article: Bone Joint J 2014; 96-B:1688–92.
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Affiliation(s)
- M. Bouliane
- Department of Surgery, University
of Alberta, 6-110 CSB, 8440-112
Street, Edmonton, Alberta, T6G
2B7, Canada
| | - D. Saliken
- Department of Surgery, University
of Alberta, 6-110 CSB, 8440-112
Street, Edmonton, Alberta, T6G
2B7, Canada
| | - L. A. Beaupre
- Department of Physical Therapy, University
of Alberta, 2-50 Corbett Hall, Edmonton, Alberta, T6G
2G4, Canada
| | - A. Silveira
- Alberta Health Services, 6-110
CSB, 8440-112 Street, Edmonton, Alberta, T6G
2B7, Canada
| | - M. K. Saraswat
- Alberta Health Services, 6-110
CSB, 8440-112 Street, Edmonton, Alberta, T6G
2B7, Canada
| | - D. M. Sheps
- Department of Surgery, University
of Alberta, 6-110 CSB, 8440-112
Street, Edmonton, Alberta, T6G
2B7, Canada
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Gaudelli C, Hébert-Davies J, Balg F, Pelet S, Djahangiri A, Godbout V, Rouleau DM. The Impact of Superior Labral Anterior to Posterior Lesions on Functional Status in Shoulder Instability: A Multicenter Cohort Study. Orthop J Sports Med 2014; 2:2325967114554195. [PMID: 26535278 PMCID: PMC4555552 DOI: 10.1177/2325967114554195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Type IV superior labral anterior to posterior (SLAP) lesions, which are superior labral detachments associated with Bankart tears, are reported to occur in up to 25% of recurrent shoulder instability patients. However, the clinical implications of this finding are debatable. PURPOSE To determine whether there are any functional differences between anterior instability patients with and without type IV SLAP lesions at the time of presentation and at short-term follow-up after surgical intervention. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A prospective, multicenter database was established to follow the clinical evolution of patients with shoulder instability. Patients were diagnosed as having a type IV SLAP lesion at the time of arthroscopic Bankart surgery (SLAP+). These patients were compared with a group of patients who simply had a Bankart lesion (SLAP-). The 2 groups had their functional outcomes (Western Ontario Shoulder Instability Index [WOSI]; Disability of the Arm, Shoulder, and Hand [QuickDASH]; and Walch-Duplay) compared prior to surgery and 1 year postoperatively. RESULTS A total of 103 subjects were included in the study; of these, 56 (43 men, 13 women) completed 1-year follow-up. Twenty-three subjects had a type IV SLAP tear, and most had this repaired along with their Bankart lesion. At baseline, SLAP+ subjects had inferior QuickDASH scores compared with SLAP- subjects (37.8 vs 29.0) as well as poorer pain subscores on both the WOSI and QuickDASH. At 1-year follow-up, however, there were no significant differences in any of the outcome measures. CONCLUSION A type IV SLAP lesion can be expected in 22% of patients with recurrent shoulder instability. This finding implies that at baseline, the patient will have slightly worse functional scores related to pain. However, following surgical management of the labral pathology, these patients will have equivalent functional outcomes at short-term follow-up. CLINICAL RELEVANCE With surgical management of the superior and anteroinferior labrum, patients with type IV SLAP lesions will do as well as those with only Bankart tears. Thus, the presence of SLAP lesions should not alter the decision to provide surgical management and should not change the prognosis for a specific patient.
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Affiliation(s)
- Cinzia Gaudelli
- Université de Montréal and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | | | - Frédéric Balg
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Stéphane Pelet
- Centre Hospitalier Affilié Universitaire de Québec, Québec, Canada
| | - Ali Djahangiri
- Centre Hospitalier Universitaire de Vaudois, Lausanne, Switzerland
| | - Véronique Godbout
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Dominique M Rouleau
- Université de Montréal and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
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Bouliane M, Beaupre L, Sheps D. Regarding the Instability Severity Index Score (ISIS). Shoulder Elbow 2014; 6:64. [PMID: 27582914 PMCID: PMC4986654 DOI: 10.1111/sae.12042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 08/15/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Martin Bouliane
- Division of Orthopaedics, University of Alberta, Edmonton, Canada,
Correspondence: Martin Bouliane, Division of Orthopaedics, University of Alberta, Edmonton T6G2B7, Canada. E-mail:
| | - Lauren Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - David Sheps
- Division of Orthopaedics, University of Alberta, Edmonton, Canada
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Houghton-Clemmey R, Boileau P. Regarding the Instability Severity Index Score (ISIS). Shoulder Elbow 2014; 6:63. [PMID: 27582913 PMCID: PMC4986650 DOI: 10.1111/sae.12038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 07/12/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Robert Houghton-Clemmey
- Department of Orthopaedic Surgery and Sports Traumatology, Hopital de l'Archet 2, Nice, France
| | - Pascal Boileau
- Department of Orthopaedic Surgery and Sports Traumatology, Hopital de l'Archet 2, Nice, France,
>Correspondence: Pascal Boileau, Department of Orthopaedic Surgery and Sports Traumatology, Hopital de l'Archet 2, Nice, France. E-mail:
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