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Hoffer AJ, Tummala SV, Tokish JM. Arthroscopic Technique for Headless Compression Screw Fixation of Large Bony Bankart Fractures in Anterior Shoulder Instability. Arthrosc Tech 2024; 13:103029. [PMID: 39233807 PMCID: PMC11369937 DOI: 10.1016/j.eats.2024.103029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/30/2024] [Indexed: 09/06/2024] Open
Abstract
A bony Bankart fracture is a common injury pattern in anterior shoulder instability. The fracture fragment size varies and the larger the fragment the more likely recurrent instability will occur. When a large bony Bankart fracture is present, surgical fixation is preferred. Both open and arthroscopic approaches exist with multiple fixation techniques including anterior-to-posterior screw fixation, suture anchor bridge fixation, and suture button fixation. Arthroscopic screw fixation is difficult, as the angle necessary to be parallel to the glenoid surface requires a far medial start point and places the nerve at risk. The use of a variable-pitch, headless compression screw placed from posterior to anterior avoids these risks. We describe an arthroscopic technique for glenoid fixation using a posterior-to-anterior, cannulated, variable-pitch headless compression screw for the treatment of an anterior BBF.
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Affiliation(s)
| | | | - John M. Tokish
- Department of Orthopedic Surgery, Mayo Clinic, Arizona, U.S.A
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Qu D, Fu H, Shen Y, Zhang J, Zhang D, Jiang Q, Qi C. Modified double-pulley fixation provides better reduction of bone fragments and union compared to single-point fixation in bony Bankart lesions. Knee Surg Sports Traumatol Arthrosc 2024; 32:2141-2151. [PMID: 38721628 DOI: 10.1002/ksa.12218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE The purpose of this study was to compare clinical scores and imaging outcomes of bony Bankart lesions that underwent single-point and modified double-pulley fixation after at least 2 years of follow-up. METHODS Patients who underwent surgery to treat bony Bankart injuries were included and divided into groups A and B. A total of 69 patients were included (32 in group A and 37 in group B). Patients in group A underwent arthroscopic modified double-pulley fixation and patients in group B underwent arthroscopic single-point fixation. Three-dimensional computed tomography (3D-CT) was used to assess glenoid reduction one day after surgery. Postoperative bony union was assessed using 3D-CT and multiplanar reconstruction images 6 months after surgery. Constant-Murley, Rowe rating system, visual analogue scale and University of California at Los Angeles and American Shoulder and Elbow Surgeons scores were recorded before and after surgery. RESULTS In terms of imaging measurements, there was no significant group difference in the preoperative size of the glenoid defect, the size of the bony fragment or the expected postoperative size of the glenoid defect. The sizes of the actual postoperative glenoid defects differed significantly between the groups (p = 0.027), as did the absolute difference between the expected and actual glenoid defect sizes (p < 0.001). At 6 months postoperatively, 50.0% of group A patients and 24.3% of group B patients exhibited complete bony union (p = 0.027); the rates of partial union were 37.5% and 56.8%, respectively. At the final follow-up, all clinical scores were significantly better than the preoperative scores (all p < 0.05), with no significant group differences (not significant). CONCLUSIONS The use of the modified double-pulley technique with two anchors to treat bony Bankart injuries provides a better reduction of bone fragments than single-point fixation with two anchors and was associated with a higher rate of early bone union. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Di Qu
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- Medical Department, Qingdao University, Qingdao, Shandong, China
| | - Haitao Fu
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Youliang Shen
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jing Zhang
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- Medical Department, Qingdao University, Qingdao, Shandong, China
| | - Dongfang Zhang
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Qi Jiang
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- Medical Department, Qingdao University, Qingdao, Shandong, China
| | - Chao Qi
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Nakagawa S, Hirose T, Hanai H, Tsunematsu T, Ohori T, Yokoi H, Uchida R. Unrecognized glenoid fracture in opposite shoulders with symptomatic anterior instability. J Orthop Sci 2024; 29:122-127. [PMID: 36402605 DOI: 10.1016/j.jos.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of the present study was to investigate the characteristics of unrecognized glenoid fracture in opposite shoulders with symptomatic anterior instability. METHODS Participants were 38 patients, who had complaints of instability on only one side (symptomatic shoulder) and had no complaints despite of a glenoid fracture on the other shoulder (asymptomatic shoulder) from 2011 to 2020. Factors that could influence the onset of symptoms including glenoid rim morphology were retrospectively investigated. RESULTS Among the asymptomatic shoulders, 16 had a single traumatic event and 22 had no history of trauma. The glenoid morphology was normal in 6, erosion in 12 and bony Bankart in 20 on the symptomatic side, whereas the respective shoulders were 0, 16 and 22 on the asymptomatic side. Bone union of bony Bankart was complete in 9, partial in 3 and non-union in 8 on the symptomatic side, whereas the respective shoulders were 18, 3 and 1 on the asymptomatic side. The mean glenoid defect size was 10.4% and 7.8%, and the mean bone fragment size was 5.0% and 4.5%, respectively. The mean medial displacement of bone fragments was 2.6 mm and 1.0 mm, respectively (p < 0.001). A larger glenoid defect (≥10%) was recognized in 19 symptomatic shoulders and 10 asymptomatic shoulders. Among them, erosion was solely recognized in 5 symptomatic shoulders. In shoulders with bony Bankart, all 10 asymptomatic shoulders had a completely or partially united fragment with less than 2 mm displacement. On the other hand, among 14 symptomatic shoulders, united fragment was solely recognized in 8 shoulders, in which medial displacement was less than 2 mm in 3 shoulders. CONCLUSIONS Even if a glenoid fracture occurred, symptom such as instability or pain was not always recognized by all patients. Regardless of glenoid defect size, shoulders with a completely or partially united bone fragment and with less than 2 mm displacement were found to be asymptomatic.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan.
| | - Takehito Hirose
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Hiroto Hanai
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Toshitaka Tsunematsu
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Hiroyuki Yokoi
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
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Nakagawa S, Hirose T, Ohori T, Yokoi H, Uchida R, Sahara W, Mae T. The process of bone union after arthroscopic bony Bankart repair in younger athletes with a subcritical glenoid defect: An advantage of remained large bone fragment. J Orthop Sci 2024; 29:115-121. [PMID: 36372678 DOI: 10.1016/j.jos.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/13/2022] [Accepted: 10/21/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND The purpose of the present study was to investigate the bone union process after arthroscopic bony Bankart repair (ABBR) in shoulders with a subcritical glenoid defect of 13.5% or larger. METHODS Bone union process after ABBR performed from 2011 to 2018 were retrospectively investigated in 47 athletes younger than 30 years with a subcritical glenoid defect, who underwent CT at least twice postoperatively. The change of bone union between first CT within 6 months and final CT later than 6 months was investigated, especially noticing bone fragment size (≥7.5% versus <7.5%). RESULTS The mean period at first CT and at final CT was 4.1 ± 0.6 months (3-6 months) and 16.8 ± 11.6 months (7-71 months), respectively. From the first to final CT, among 15 shoulders with a small bone fragment (<7.5%), complete union increased from 4 shoulders (26.7%) to 8 shoulders (53.3%), while among 32 shoulders with a large bone fragment (≥7.5%), complete union increased from 15 shoulders (46.9%) to 25 shoulders (78.1%). On the other hand, while non-union or disappeared bone fragment was recognized in 8 shoulders (53.3%) with a small fragment and in 2 shoulders (6.3%) with a large fragment at first CT, it was solely recognized in 4 shoulders (26.7%) with a small fragment and in no shoulders with a large fragment at final CT. While postoperative glenoid fracture at the site of bone union was recognized in 7 shoulders, complete union was finally obtained after conservative treatment in 5 shoulders. So, final complete union was obtained in 9 (60%) of 15 shoulders with a small fragment and in 29 (90.6%) of 32 shoulders with a large fragment (p = 0.021). CONCLUSIONS In shoulders with a subcritical glenoid defect, when a large bone fragment (≥7.5%) was repaired, complete union rate was higher and complete union could be obtained earlier.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan.
| | - Takehito Hirose
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Hiroyuki Yokoi
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Wataru Sahara
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan
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Billaud A, Baverel L, Metais P. Arthroscopic Latarjet yields better union and prevention of instability compared to arthroscopic bony Bankart repair in shoulders with recurrent anterior instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:5994-6005. [PMID: 37980282 DOI: 10.1007/s00167-023-07655-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/24/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE To determine whether arthroscopic Latarjet procedure or arthroscopic bony Bankart repair provide better outcomes in terms of rates of recurrent instability, non-union and complications, as well as clinical scores and range of motion. METHODS An electronic literature search was performed using PubMed, Embase®, and Cochrane databases, applying the following keywords: "Arthroscopic bony Bankart" OR "Arthroscopic osseous Bankart" AND "Arthroscopic Latarjet" OR "Arthroscopic coracoid bone block". RESULTS The systematic search returned 1465 records, of which 29 were included (arthroscopic bony Bankart repair, n = 16; arthroscopic Latarjet, n = 13). 37 datasets were included for data extraction, on 1483 shoulders. Compared to arthroscopic Latarjet, arthroscopic bony Bankart repair had significantly higher instability rates (0.14; CI 0.10-0.18; vs 0.04; CI 0.02-0.06), significantly lower union rates (0.63; CI 0.28-0.91 vs 0.98; CI 0.93-1.00), and significantly lower pain on VAS (0.42; CI 0.17-0.67 vs 1.17; CI 0.96-1.38). There were no significant differences in preoperative glenoid bone loss, follow-up, complication rate, ROWE score, ASES score, external rotation, and anterior forward elevation between arthroscopic Latarjet and arthroscopic bony Bankart repair. CONCLUSION Compared to arthroscopic Latarjet, arthroscopic bony Bankart repair results in significantly (i) higher rates of recurrent instability (14% vs 4%), (ii) lower union rates (63% vs 98%), but (iii) slightly lower pain on VAS (0.45 vs 1.17). There were no differences in complication rates, clinical scores, or postoperative ranges of motion. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Anselme Billaud
- Clinique du Sport, 2 rue Georges Negrevergne, 33700, Mérignac, France
| | | | - Pierre Metais
- Hopital Prive de la Châtaigneraie, ELSAN, Clermont-Ferrand, France
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Kawashima I, Iwahori Y, Ishizuka S, Oba H, Sakaguchi T, Watanabe A, Inoue M, Imagama S. Arthroscopic Bankart repair with peeling osteotomy of the anterior glenoid rim preserves glenoid morphology. J Shoulder Elbow Surg 2023; 32:2445-2452. [PMID: 37327987 DOI: 10.1016/j.jse.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND A decrease in the glenoid size after arthroscopic Bankart repair (ABR) was common in shoulders without osseous fragments compared with those with osseous fragments. For cases of chronic recurrent traumatic anterior glenohumeral instability without osseous fragments, we have performed ABR with peeling osteotomy of the anterior glenoid rim (ABRPO) to make an intentional osseous Bankart lesion. The aim of this study was to compare the glenoid morphology after ABRPO with it after simple ABR. METHODS The medical records of patients who underwent arthroscopic stabilization for chronic recurrent traumatic anterior glenohumeral instability were retrospectively reviewed. Patients with an osseous fragment, with revision surgery and without complete data were excluded. Patients were assigned to 1 of 2 groups: Group A, ABR without peeling osteotomy procedure or Group B, with ABRPO procedure. Computed tomography was performed preoperatively and 1 year after surgery. The size of the glenoid bone loss was investigated by the assumed circle method. The following formula was used to calculate the decreased size of the glenoid: (Δ) = (postoperative size of the glenoid bone loss) - (preoperative size of the glenoid bone loss). The size of the glenoid 1 year after surgery was assessed to determine if it had decreased (Δ > 0%) or not decreased (Δ ≤ 0%) relative to the preoperative size. RESULTS This study evaluated 39 shoulders divided into 2 groups: 27 shoulders in Group A and 12 shoulders in Group B. In Group A, postoperative glenoid bone loss was significantly greater than preoperative glenoid bone loss (7.8 ± 6.2 vs. 5.5 ± 5.3, respectively, P = .02). In Group B, postoperative glenoid bone loss was significantly lower than preoperative glenoid bone loss (5.6 ± 5.4 vs. 8.7 ± 4.0, respectively, P = .02). The P value for the interaction of group (A or B) × time (preoperative or postoperative) was 0.001. The decreased size of the glenoid was significantly larger in Group A than in Group B (2.1 ± 4.2 vs. -3.1 ± 4.5, respectively, P = .001). The rate of shoulders in which the size of the glenoid decreased 1 year after surgery relative to the preoperative size was significantly higher in Group A than in Group B (63% [17/27] vs. 25% [3/2], respectively, P = .04). CONCLUSIONS The study showed that ABRPO preserved the glenoid size better than simple ABR without a peeling osteotomy procedure.
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Affiliation(s)
- Itaru Kawashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yusuke Iwahori
- Sports Medicine and Joint Center, Asahi Hospital, Kasugai, Aichi, Japan
| | - Shinya Ishizuka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
| | - Hiroki Oba
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takefumi Sakaguchi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | - Masaki Inoue
- Department of Radiology, Asahi Hospital, Kasugai, Aichi, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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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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Moroder P, Paksoy A, Siegert P, Thiele K, Lacheta L, Akgün D. The Independent Double-Row (IDR) Bony Bankart Repair Technique. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:538-543. [PMID: 35196739 DOI: 10.1055/a-1753-9883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A displaced anterior glenoid rim fracture, the so-called bony Bankart lesion, occurs after a traumatic shoulder dislocation resulting from a high energy trauma and is associated with recurrent shoulder instability. Different surgical techniques have been described in the literature to address this pathology, including open reduction and fixation, as well as arthroscopic transosseous, and single-row or double-row approaches with the use of suture anchors. However, there is currently no gold standard of treatment and the stability of fixation and the healing of the bony fragment are still a concern. The purpose of this report was to introduce an arthroscopic independent double-row (IDR) bony Bankart repair technique for fixation of large glenoid fractures.
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Affiliation(s)
- Philipp Moroder
- Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Alp Paksoy
- Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Paul Siegert
- Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Kathi Thiele
- Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Lucca Lacheta
- Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
| | - Doruk Akgün
- Department for Shoulder and Elbow Surgery, Charité - Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
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Nakagawa S, Hiramatsu K, Yamada Y, Yoneda K, Tanaka Y, Toritsuka Y, Mae T. Glenoid rim morphology in young athletes with unstable painful shoulders: primarily painful vs. frankly unstable. JSES Int 2023; 7:720-729. [PMID: 37719811 PMCID: PMC10499651 DOI: 10.1016/j.jseint.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background To investigate the characteristics of glenoid rim morphology in young athletes (<40 yr) with unstable painful shoulder. Methods This was a retrospective case series. The inclusion criteria were as follows: (1) shoulder pain during sports activity, (2) traumatic onset, (3) no complaint of shoulder instability, and (4) soft tissue or bony lesions confirmed on imaging examinations (computed tomography and magnetic resonance imaging). The above-mentioned painful cohort was then compared (in a 2:1 ratio) to a match-paired control group of patients with similar demographics but with frank anterior glenohumeral instability as defined by imaging and physical findings. The pain (not apprehension) was reproduced during the anterior apprehension test in supine position and relieved by relocation test in all patients. Glenoid rim morphology, bone union in shoulders with a fragment-type glenoid, glenoid defect size, bone fragment size, medial displacement of bone fragments (MDBF), and medial distance of erosion (MDE) were compared between painful shoulders and unstable shoulders. Results There were 79 painful shoulders and 165 unstable shoulders. The glenoid rim morphology was normal in 33 shoulders, erosion-type in 15 shoulders, and fragment-type in 31 shoulders among painful shoulders, whereas the respective shoulders were 19, 33, and 113 among unstable shoulders (P < .001). Bone union was complete in 15 shoulders, partial in 14 shoulders, and nonunion in 2 shoulders among painful shoulders, whereas the respective shoulders were 43, 31, and 39 among unstable shoulders (P = .001). The mean glenoid defect size was 6.0 ± 7.2% and 12.7 ± 7.4%, respectively (P < .001), and the mean bone fragment size was 5.8 ± 6.4% and 5.4 ± 4.6%, respectively, (P = .591). The mean MDBF was 1.4 ± 1.5 mm and 3.0 ± 2.2 mm, respectively (P < .001), and the mean MDE was 2.3 ± 1.2 mm and 5.2 ± 2.4 mm, respectively (P < .001). In shoulders with a smaller glenoid defect (<13.5%), the prevalence of shoulders with MDBF (<2 mm) and shoulders with MDE (<2 mm) was more frequent in painful shoulders. On the other hand, in shoulders with a larger glenoid defect (≥13.5%), erosion-type glenoid, nonunion in fragment-type glenoid and bone fragment smaller than 7.5% was not recognized in painful shoulders. Shoulders with MDBF (<2 mm) were significantly more frequent in painful shoulders (P = .009). Conclusions In painful shoulders normal or erosion-type glenoid was predominant, and glenoid defect size was significantly smaller than unstable shoulders. On the other hand, a large bone fragment (≥7.5%) remained and united completely or partially in all shoulders with a larger glenoid defect (≥13.5%). Bone union was obtained within 2 mm from the articular surface in most of them.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Osaka, Japan
| | | | - Yuzo Yamada
- Department of Orthopaedic Surgery, Yao Municipal Hospital, Yao, Osaka, Japan
| | | | - Yoshinari Tanaka
- Osaka Metropolitan University, Graduate School of Human Life and Ecology, Habikino, Osaka, Japan
| | | | - Tatsuo Mae
- Yukioka Medical University, Ibaraki, Osaka, Japan
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10
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Nakagawa S, Take Y, Mizuno N, Ozaki R, Hanai H, Iuchi R, Kinugasa K. The prevalence of shoulders with a large glenoid defect and small bone fragment increases after several instability events during conservative treatment for traumatic anterior instability. JSES Int 2023; 7:538-543. [PMID: 37426910 PMCID: PMC10328779 DOI: 10.1016/j.jseint.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Background Unstable shoulders with a large glenoid defect and small bone fragment are at higher risk for postoperative recurrence after arthroscopic Bankart repair. The purpose of the present study was to clarify the changes in the prevalence of such shoulders during conservative treatment for traumatic anterior instability. Methods We retrospectively investigated 114 shoulders that underwent conservative treatment and computed tomography (CT) examination at least twice after an instability event in the period from July 2004 to December 2021. We investigated the changes in glenoid rim morphology, glenoid defect size, and bone fragment size from the first to the final CT. Results At first CT, 51 shoulders showed no glenoid bone defect, 12 showed glenoid erosion, and 51 showed a glenoid bone fragment [33 small bone fragment (<7.5%) and 18 large bone fragment (≥7.5%); mean size: 4.9 ± 4.2% (0-17.9%)]. Among patients with glenoid defect (fragment and erosion), the mean glenoid defect was 5.4 ± 6.6% (0-26.6%); 49 were considered a small glenoid defect (<13.5%) and 14 were a large glenoid defect (≥13.5%). While all 14 shoulders with large glenoid defect had a bone fragment, small fragment was solely seen in 4 shoulders. At final CT, 23 of the 51 shoulders persisted without glenoid defect. The number of shoulders presenting glenoid erosion increased from 12 to 24, and the number of shoulders with bone fragment increased from 51 to 67 [36 small bone fragment and 31 large bone fragment; mean size: 5.1 ± 4.9% (0-21.1%)]. The prevalence of shoulders with no or a small bone fragment did not increase from first CT (71.4%) to final CT (65.9%; P = .488), and the bone fragment size did not decrease (P = .753). The number of shoulders with glenoid defect increased from 63 to 91 and the mean glenoid defect significantly increased to 9.9 ± 6.6% (0-28.4%) (P < .001). The number of shoulders with large glenoid defect increased from 14 to 42 (P < .001). Of these 42 shoulders, 19 had no or a small bone fragment. Accordingly, among a total of 114 shoulders, the increase from first to final CT in the prevalence of a large glenoid defect accompanied by no or a small bone fragment was significant [4 shoulders (3.5%) vs. 19 shoulders (16.7%); P = .002]. Conclusions The prevalence of shoulders with a large glenoid defect and small bone fragment increases significantly after several instability events.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Osaka, Japan
| | - Yasuhiro Take
- Department of Orthopaedic Surgery, Daini Police Hospital, Osaka, Osaka, Japan
| | - Naoko Mizuno
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | | | - Hiroto Hanai
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Ryo Iuchi
- Department of Orthopaedic Surgery, Seihu Hospital, Sakai, Osaka, Japan
| | - Kazutaka Kinugasa
- Department of Orthopaedic Sports Medicine, Osaka Rosai Hospital, Sakai, Osaka, Japan
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11
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Hoyt BW, Dickens JF, Kilcoyne KG. Transosseous Equivalent Technique for Bony Bankart Repair. Arthrosc Tech 2023; 12:e889-e896. [PMID: 37424651 PMCID: PMC10323730 DOI: 10.1016/j.eats.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/11/2023] [Indexed: 07/11/2023] Open
Abstract
Bony Bankart lesions of the anterior glenoid arise from traumatic glenohumeral instability events and can predispose persons to recurrent instability if not surgically stabilized. Large osseous fragments, when repaired anatomically, have excellent stability and functional outcomes; however, techniques to achieve this repair are often either tenuous or overcomplicated. In this technique guide, we describe a repair technique based on established biomechanical principles that achieves a reliable, anatomic glenoid articular surface. This technique can be readily applied in most bony Bankart settings using standard anterior labral repair instrumentation and implants.
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Affiliation(s)
- Benjamin W. Hoyt
- Department of Orthopaedic Surgery, James A Lovell Federal Health Care Center, North Chicago, Illinois, U.S.A
- Department of Surgery, USU-WRNMMC, Bethesda, Maryland, U.S.A
| | - Jon F. Dickens
- Department of Surgery, USU-WRNMMC, Bethesda, Maryland, U.S.A
- Department of Orthopaedics, Duke University, Durham, North Carolina, U.S.A
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12
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Park I, Shin SJ. Arthroscopic double-row bridge fixation provided satisfactory shoulder functional restoration with high union rate for acute anterior glenoid fracture. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07389-w. [PMID: 36995378 DOI: 10.1007/s00167-023-07389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE To introduce a novel surgical technique for arthroscopic reduction and double-row bridge fixation using trans-subscapularis tendon portal for anterior glenoid fracture and to evaluate the clinical and radiological outcomes. METHODS A total of 22 patients who underwent arthroscopic reduction and double-row bridge fixation for an acute anterior glenoid fracture were retrospectively evaluated. Arthroscopic surgery was performed using four portals including a trans-subscapularis tendon portal. All patients underwent 3D-CT preoperatively and one day and one year postoperatively to evaluate the fracture fragment size, reduction status, and presence of fracture union. To evaluate the degree of fragment displacement, articular step-off and medial fracture gap were measured using 3D-CT. Clinical outcomes were assessed based on the ASES and Constant scores. Postoperative glenohumeral joint arthritis was evaluated using plain radiographs with the Samilson and Prieto classification. RESULTS The average preoperative fracture fragment size was 25.9 ± 5.6%. Articular step-off (preoperative: 6.0 ± 3.3 mm, postoperative one day: 1.1 ± 1.6 mm, P < 0.001) and medial fracture gap (preoperative: 5.2 ± 2.6 mm, postoperative one day: 1.9 ± 2.3 mm, P < 0.001) were improved after surgery. On the postoperative one year 3D-CT, 20 patients achieved complete fracture union, and two patients showed partial union. Postoperative glenohumeral joint arthritis was observed in four patients. At the last visit, the ASES score was 91.8 ± 7.0 and the Constant score was 91.6 ± 7.0. CONCLUSION Arthroscopic reduction and double-row bridge fixation using a trans-subscapularis tendon portal for acute anterior glenoid fracture achieved satisfactory clinical outcomes and anatomical reduction as demonstrated by a low degree of articular step-off and medial fracture gap. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- In Park
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, 260 Gonghang-daero, Gangseo-Gu, Seoul, 07804, Republic of Korea
| | - Sang-Jin Shin
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, 260 Gonghang-daero, Gangseo-Gu, Seoul, 07804, Republic of Korea.
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13
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Nakagawa S, Hirose T, Uchida R, Nakamura H, Mae T, Hayashida K, Yoneda M. Glenoid defect size increases but the bone fragment rarely resorbs in shoulders with recurrent anterior instability. JSES Int 2023; 7:218-224. [PMID: 36911769 PMCID: PMC9998875 DOI: 10.1016/j.jseint.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background With recurrent anterior instability the bone fragment of a bony Bankart lesion is often small compared to the glenoid defect. The purpose of the present study was to clarify the changes to both the bone fragment and glenoid defect over time in a single subject. Methods Participants were patients who underwent computed tomography (CT) at least twice after an instability event between 2004 and 2021 and had a fragment-type glenoid at first CT. The glenoid rim width (A), glenoid defect width (B), and bone fragment width (C) were measured in millimeters. If B or C increased by 1 mm or more from the first to final CT, the change was judged as "enlarged," and if B or C decreased by 1 mm or more, it was judged as "reduced"; all other cases were judged as "similar." Then, glenoid defect size and bone fragment size were calculated as B/A×100% and C/A×100%, respectively, and the changes from the first to final CT were compared. Results From the first to final CT, the glenoid defect was enlarged in 30 shoulders, similar in 13 shoulders, and reduced in 4 shoulders, and the bone fragment was enlarged in 18 shoulders, similar in 24 shoulders, and reduced in 5 shoulders. The mean glenoid defect size significantly increased from 10.9% to 15.3% (P < .001), and the mean bone fragment size increased from 6.4% to 7.8%, respectively (P = .005). At the final CT, in 6 shoulders a new glenoid fracture was observed at a different site from the original fracture. When they were excluded from the analyses, the mean glenoid defect size still significantly increased (from 11.2% to 15.2%; P < .001), but the mean bone fragment size did not (6.5% vs. 7.3%, respectively; P = .088). Conclusions In shoulders with recurrent anterior instability, glenoid defect size appears to increase significantly over time, whereas the bone fragment size remains unchanged or increases only slightly. Bone fragment resorption is quite rare, and a bone fragment appears to be small because of an enlarged glenoid defect.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Osaka, Japan
| | - Takehito Hirose
- Department of Orthopaedic Surgery, Daini Osaka Police Hospital, Osaka, Osaka, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | | | - Tatsuo Mae
- Osaka Yukioka Medical University, Ibaraki, Osaka, Japan
| | - Kenji Hayashida
- Department of Orthopaedic Surgery, Osaka Central Hospital, Osaka, Osaka, Japan
| | - Minoru Yoneda
- Department of Orthopaedic Surgery, Kashiwa Tanaka Hospital, Kashiwa, Chiba, Japan
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14
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Hill JR, Motley J, Keener JD. Rehabilitation after Shoulder Instability Surgery. Phys Med Rehabil Clin N Am 2023; 34:409-425. [PMID: 37003661 DOI: 10.1016/j.pmr.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Shoulder instability can occur in any direction and presents across a broad spectrum including traumatic dislocations, repetitive microinstability events or subluxations, and global joint laxity. The development of pain, functional decline, and articular pathologic condition is a multifaceted process that is influenced by the underlying bony morphology, biology of the surrounding soft tissue structures, dynamic coordination of the periscapular musculature, and patient factors such as age, activity level, and associated injuries. This article will focus on the younger, active patient with instability due to deficiencies in the capsulolabral complex and dynamic stabilizers.
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15
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New bone formation after arthroscopic Bankart repair for unstable shoulders with an erosion-type glenoid defect. J Shoulder Elbow Surg 2023; 32:9-16. [PMID: 35931333 DOI: 10.1016/j.jse.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of the present study was to retrospectively evaluate new bone formation after arthroscopic Bankart repair (ABR) and the influence of new bone formation on recurrence in shoulders with an erosion-type glenoid defect. METHODS We analyzed data on shoulders with an erosion-type glenoid defect. Participants were patients who underwent computed tomography to evaluate new bone formation after ABR performed from 2004 to 2021 and were followed for a minimum of 2 years. We investigated the factors influencing new bone formation, in particular the presence of an intraoperative bone fragment, and the influence of new bone formation and its size on postoperative recurrence. RESULTS A total of 100 shoulders were included. The mean glenoid defect size was 10.1% ± 6.3% (range, 1.2%-31.5%). New bone formed postoperatively in 15 shoulders (15.0%) and was seen in significantly more shoulders with an intraoperative bone fragment (11 of 18, 61.1%) than in those without a fragment (4 of 82, 4.9%; P < .001). Recurrence occurred in 22 shoulders (22.0%), and the rate of recurrence was not different between shoulders with new bone formation (3 of 15, 20.0%) and without new bone formation (19 of 85, 22.4%; P = .999). Among the 15 shoulders with new bone formation, the size of the new bone fragments relative to glenoid width was <5% in 2 shoulders, 5%-<7.5% in 8 shoulders, 7.5%-<10% in 3 shoulders, and ≥10% in 2 shoulders; in all 3 shoulders with postoperative recurrence, the relative size was <7.5%. CONCLUSIONS Even in shoulders with an erosion-type glenoid defect, new bone may form after ABR, especially in shoulders with an intraoperative bone fragment. However, new bone formation does not decrease the rate of postoperative recurrence.
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16
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Nakagawa S, Hirose T, Tsunematsu T, Ohori T, Yokoi H, Mae T, Yoneda M. Is preoperative glenoid defect size a reliable indicator of postoperative recurrence after arthroscopic Bankart repair in teenage competitive athletes? J Shoulder Elbow Surg 2022; 32:1165-1173. [PMID: 36584869 DOI: 10.1016/j.jse.2022.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/14/2022] [Accepted: 11/20/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Being younger than 20 years of age at the time of arthroscopic Bankart repair (ABR) is known to be one of the most important risk factors for postoperative recurrence of instability. When deciding on the appropriate surgical approach, surgeons generally consider only the size of a critical glenoid defect, and most of them do not take into account factors such as the size of bone fragments and possible bone union after arthroscopic bony Bankart repair (ABBR). Therefore, this retrospective study aimed to clarify the risk factors for postoperative recurrence after ABR in teenage competitive athletes by focusing on glenoid rim morphologies and bone union. METHODS Participants were 115 teenage competitive athletes without a capsular injury who underwent primary ABR for chronic traumatic anterior instability and were followed up for a minimum of 2 years. Possible risk factors for postoperative recurrence were investigated by univariate and multivariate analysis. In shoulders with a glenoid defect and bone fragment, the influence of glenoid defect size and bone fragment size on bone union after ABBR was also investigated. RESULTS Postoperative recurrence was seen in 16 patients (13.9%). Regarding glenoid defect size, recurrence was seen in 1 (3.2%) of 31 shoulders with a glenoid defect smaller than 5% (including those with a normal glenoid), 15 (22.1%) of 68 shoulders with a glenoid defect of 5%-20%, and 0 (0%) of 16 shoulders with a glenoid defect of 20% or larger (P = .009). Regarding bone union, recurrence was seen in 4 (6.9%) of 58 shoulders with complete or partial bone union after ABBR and 8 (40%) of 20 shoulders with nonunion or disappearance of the bone fragment (P = .001). Regarding bone fragment size, recurrence was seen in 12 (20.7%) of 58 shoulders with a small or no bone fragment (<7.5%) and in 3 (8.6%) of 35 shoulders with a large bone fragment (≥7.5%; P = .154). Multivariate analysis identified non-union or disappearance of the bone fragment after ABBR as a significant risk factor for recurrence. Complete or partial bone union was seen in 25 (58.1%) of 43 shoulders with a small bone fragment (<7.5%) and 33 (94.3%) of 35 shoulders with a large bone fragment (≥7.5%; P < .001). CONCLUSIONS In teenage competitive athletes, bone union after ABBR affects postoperative recurrence after ABR, regardless of the preoperative glenoid defect size, and bone union rate after ABBR is significantly influenced by bone fragment size.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Osaka, Japan.
| | - Takehito Hirose
- Department of Orthopaedic Surgery, Daini Osaka Police Hospital, Osaka, Osaka, Japan
| | - Toshitaka Tsunematsu
- Department of Orthopaedic Surgery, Moriguchi Keijinkai Hospital, Moriguchi, Osaka, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroyuki Yokoi
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Osaka, Japan
| | - Tatsuo Mae
- Osaka Yukioka Medical University, Ibaraki, Osaka, Japan
| | - Minoru Yoneda
- Department of Orthopaedic Surgery, Kashiwa Tanaka Hospital, Kashiwa, Chiba, Japan
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17
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Hirose T, Nakagawa S, Hanai H, Nishimoto R, Mizuno N, Tanaka M. Anterior glenoid rim erosion in the early stage after arthroscopic Bankart repair affects postoperative recurrence. JSES Int 2022; 7:121-125. [PMID: 36820429 PMCID: PMC9937838 DOI: 10.1016/j.jseint.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Recent studies reported that anterior glenoid rim erosion can occur in the early period after arthroscopic Bankart repair (ABR) for traumatic anterior shoulder instability. However, it is unknown whether such erosion is a risk factor for postoperative recurrence. This study evaluated risk factors for postoperative recurrence after ABR, specifically aiming to elucidate whether reduction of postoperative glenoid width due to anterior glenoid rim erosion is one of such factors. Methods A total of 220 shoulders that underwent ABR alone between 2013 and 2020 were retrospectively investigated. Patient age at surgery, whether the patient was a collision/contact athlete, anchor placement, preoperative glenoid bone defect (%), localization of the Hill-Sachs lesion, and change of glenoid width (%) in the 6 months after surgery were investigated for their statistical relation to recurrence by univariate and multiple logistic regression analysis. Results Postoperative recurrence occurred in 32 of 220 shoulders (14.5%). In univariate analysis, being a collision/contact athlete was the only variable with a significant effect on recurrence (odds ratio [OR], 2.555; 95% confidence interval [CI], 1.123-5.814; P = .03). Change of glenoid width reduction was larger in those with recurrence than without recurrence, but the difference was not statistically significant (-7.0 ± 6.6% vs. -5.0 ± 9.3%; P = .14). However, in multivariate logistic analysis, preoperative glenoid bone defect (%) (adjusted unit OR, 1.076; 95% CI, 1.018-1.137; P = .010) and postoperative change of glenoid width (%) (adjusted unit OR, 0.946; 95% CI, 0.900-0.994; P = .028) had a significant influence on postoperative recurrence. Conclusion Glenoid width reduction due to anterior glenoid rim erosion after ABR is a risk factor for recurrence.
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Affiliation(s)
- Takehito Hirose
- Department of Orthopaedic Surgery, Daini Osaka Police Hospital, Osaka, Osaka, Japan,Corresponding author: Takehito Hirose, MD, PhD, Department of Orthopaedic Surgery, Daini Osaka Police Hospital, 2-6-40 Karasugatsuji, Tennoji-ku, Osaka-shi, Osaka 543-8922, Japan.
| | - Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Osaka, Japan
| | - Hiroto Hanai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Ryuji Nishimoto
- Department of Orthopaedic Surgery, JCHO Osaka Hospital, Osaka, Osaka, Japan
| | - Naoko Mizuno
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Makoto Tanaka
- Center for Sports Medicine, Daini Osaka Police Hospital, Osaka, Osaka, Japan
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18
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Chen AZ, Greaves KM, deMeireles AJ, Fortney TA, Saltzman BM, Trofa DP. Clinical Outcomes of Arthroscopic Bony Bankart Repair for Anterior Instability of the Shoulder: A Systematic Review. Am J Sports Med 2022:3635465221094832. [PMID: 35749344 DOI: 10.1177/03635465221094832] [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 Individual studies reporting the clinical outcomes of arthroscopic bony Bankart repair for anterior shoulder instability have reported excellent results but have been limited by their small sample sizes. No systematic review of the literature has been performed examining the clinical outcomes of arthroscopic bony Bankart repair. PURPOSE To provide a systematic review of the literature to examine the functional outcomes, recurrence rate, and return to sports rate after arthroscopic bony Bankart repair for anterior instability of the shoulder. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of the literature based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted using the Cochrane Database of Systematic Reviews, Ovid/Embase, PubMed, and Web of Science. Studies that examined clinical outcomes after arthroscopic bony Bankart repair for anterior shoulder instability were included. Data pertaining to study characteristics and design, patient demographic characteristics, and clinical results, including functional outcomes, recurrence rate, and return to sports, were collected. The results from the studies were pooled, and weighted means and overall rates were calculated. RESULTS In total, 21 studies with 769 patients were included for analysis. Most patients were male (91.7%), the mean age was 26.7 years (range, 12-71 years), and the mean follow-up was 42.7 months (range, 6-120 months). The most commonly reported functional outcome score was the Rowe score (12 studies), which improved on average from 41.9 preoperatively to 90.8 postoperatively. The rate of recurrent instability was reported by all 21 studies, and the overall recurrence rate was 11.9% (88/738). Return to sports after arthroscopic bony Bankart repair was reported by 11 studies, with a pooled return to sports rate of 91.0% (264/290). CONCLUSION Arthroscopic bony Bankart repair for anterior shoulder instability resulted in improvements in functional outcomes, a low rate of recurrent instability, and a high rate of return to sports. Although these findings are extremely promising, future prospective studies with larger sample sizes are needed to further evaluate the clinical outcomes of arthroscopic bony Bankart repair.
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Affiliation(s)
- Aaron Z Chen
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Kaylre M Greaves
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Alirio J deMeireles
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Thomas A Fortney
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute (MSKI), Charlotte, North Carolina, USA
| | - David P Trofa
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
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19
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Evaluating Bone Loss in Anterior Shoulder Instability. J Am Acad Orthop Surg 2022; 30:563-572. [PMID: 35653280 DOI: 10.5435/jaaos-d-22-00016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/23/2022] [Indexed: 02/01/2023] Open
Abstract
Anterior shoulder instability is a common orthopaedic condition that often involves damage to the bony architecture of the glenohumeral joint in addition to the capsulolabral complex. Patients with recurrent shoulder dislocations are at increased risk for glenohumeral bone loss, as each instability event leads to the accumulation of additional glenoid and/or humeral head bone defects. Depending on the degree of bone loss, successful treatment may need to address bony lesions in addition to injured soft-tissue structures. As such, a thorough understanding of methods for evaluating bone loss preoperatively, in terms of location, size, and significance, is essential. Although numerous imaging modalities can be used, three-dimensional imaging has proven particularly useful and is now an integral component of preoperative planning.
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20
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Giacomo GD, Pugliese M, Peebles AM, Provencher MT. Bone Fragment Resorption and Clinical Outcomes of Traumatic Bony Bankart Lesion Treated With Arthroscopic Repair Versus Open Latarjet. Am J Sports Med 2022; 50:1336-1343. [PMID: 35244488 DOI: 10.1177/03635465221076841] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bony Bankart lesions can perpetuate chronic anterior glenohumeral instability. When surgical treatment is pursued, several factors need to be considered to obtain optimal outcomes. PURPOSE To (1) quantitatively describe patterns of bone fragment resorption and associated risk factors for developing glenoid bone loss (GBL) and (2) to compare clinical and radiological results of attritional bone loss treated with either the arthroscopic Bankart or the open Latarjet procedure. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective analysis of prospectively collected data was conducted for patients who underwent arthroscopic stabilization (group A1, 10%-20% GBL; group A2, >20% GBL) or open Latarjet (group B, >10% GBL) for recurrent shoulder instability with bony Bankart lesion. Patient characteristics, number of dislocations, and Western Ontario Shoulder Instability Index (WOSI) scores were obtained. Pre- and postoperative computed tomography imaging was used to quantitatively describe patterns of bone fragment resorption. RESULTS A total of 120 consecutive patients (group A1, 40; group A2, 23; group B, 57) were included in the study, with a mean age of 25.6 years (range, 19-35 years). The average follow-up was 5.0 years for all groups (range, 4.83-5.16 years in group A1, 4.58-5.41 years in group A2, and 4.33-5.67 years in group B). The mean times between dislocation event and surgery were 12.8 months (range, 6-32 months) and 13.6 months (range, 6-38 months) for groups A and B, respectively. Redislocation rates were 7.5% in group A1 versus 13.0% in group A2, and only occurred in patients with ≥13.5% GBL. There were no redislocations for group B (0%). Patients had better WOSI scores in group B (234.1 ± 126.9) than in group A (576.1 ± 224.6) (P < .0001). In group A, smaller preoperative bone fragment size displayed a higher percentage of resorption after surgery (r = -0.64; P < .05). CONCLUSION A significant inverse relationship exists between preoperative bone fragment size and percentage of postoperative resorption. Patients treated with arthroscopic bony Bankart repair who had final GBL ≥13.5% had worse outcomes. When planned GBL approaches 13.5% in high-demand patients, a smaller fragment size can result in worse clinical outcomes because of resorption. In these cases, choosing the open Latarjet procedure leads to better clinical results.
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Affiliation(s)
| | | | | | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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21
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On-the-Edge Anchor Placement May Be Protective Against Glenoid Rim Erosion After Arthroscopic Bankart Repair Compared to On-the-Face Anchor Placement. Arthroscopy 2022; 38:1099-1107. [PMID: 34715278 DOI: 10.1016/j.arthro.2021.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE This retrospective study aimed to compare the effects of 2 different anchoring placements on glenoid rim erosion after arthroscopic Bankart repair (ABR). METHODS Shoulders that underwent ABR from January 2013 to July 2020 were divided into 2 groups according to anchor placement (on-the-face, group F; on-the-edge, group E). We retrospectively calculated the percent change of glenoid width (Δ) on the first postoperative computed tomography scan (CT; performed within 6 months) and second postoperative CT (performed at 6 to 12 months) relative to the width on the preoperative CT and compared percent changes between the 2 groups. Also, we investigated the influence of preoperative glenoid structures (normal, erosion, bony Bankart) and the postoperative recurrence rate. RESULTS We examined 225 shoulders in 214 patients (group F, n = 151; group E, n = 74). At first CT, anchoring placement was significantly associated with postoperative decrease of glenoid width (group F, -7.6% ± 7.9%; group E, -0.1% ± 9.7%; P < .0001). The difference between groups F and E was significant in shoulders with a preoperative glenoid defect (bony Bankart, -6.6% ± 8.8% vs 2.5% ± 11.2%, respectively; P < .0001; erosion, -6.6% ± 6.2% vs -2.6% ± 5.3%, respectively; P = .03). In 112 shoulders, CT was performed twice; Δ was -6.9% ± 7.3% in group F (n = 64) and -1.7% ± 10.1% in group E (n = 48; P = .005) at the first CT and -3.2% ± 10.0% and 1.0% ± 10.6% (P = .10), respectively, at the second CT, indicating recovery of glenoid width in both groups. The postoperative recurrence rate in patients with at least 2 years' follow-up was 14.7% in group F and 14.6% in group E. CONCLUSIONS In the early stage after ABR, on-the-edge glenoid anchor placement was associated with less glenoid rim erosion than on-the-face anchor placement. LEVEL OF EVIDENCE Level III, retrospective comparative trial.
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Nakagawa S, Hirose T, Uchida R, Yokoi H, Ohori T, Sahara W, Mae T. A Glenoid Defect of 13.5% or Larger Is Not Always Critical in Male Competitive Rugby and American Football Players Undergoing Arthroscopic Bony Bankart Repair: Contribution of Resultant Large Bone Fragment. Arthroscopy 2022; 38:673-681. [PMID: 34389413 DOI: 10.1016/j.arthro.2021.07.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate bone union and postoperative recurrence after arthroscopic bony Bankart repair (ABBR) in male competitive rugby and American football players with a subcritical glenoid defect of ≥13.5% and to compare findings with those in players with a glenoid defect of <13.5%. METHODS Participants were male competitive rugby or American football players with a glenoid defect and bone fragment who underwent ABBR from July 2011 to December 2018 and were followed for a minimum of 2 years. We investigated the influence of glenoid defect and bone fragment size on bone union and postoperative recurrence after ABBR. RESULTS We included 45 rugby players and 35 American football players. A total of 38 shoulders were assigned to the small defect group (<13.5%) and 42 to the large defect group (≥13.5%). The complete bone union rate was 47.4% in the small defect group and 71.4% in the large defect group (P = .040), and postoperative recurrence was seen in 13 (34.2%) and 5 shoulders (11.9%), respectively (P = .030). In the small defect group, the bone fragment size was <7.5% in 30 shoulders and ≥7.5% in 8 shoulders; in comparison, the respective numbers were 12 and 30 shoulders in the large defect group, and large fragments (>7.5%) were significantly more common in this group (P < .001). The complete union rate was significantly higher in shoulders with a large fragment (≥7.5%) than in those with a small fragment (<7.5%; 78.9% versus 42.9%, respectively; P = .001). The recurrence rate was 33.3% in shoulders with a small fragment (<7.5%) and 10.5% in shoulders with a large fragment (≥7.5%; P = .017) and was significantly lower in shoulders with a complete union than in those without a complete union (6.3% versus 46.9%, respectively; P < .001). CONCLUSION The postoperative recurrence rate after ABBR was lower in male competitive rugby and American football players with a large glenoid defect (≥13.5%) than in those with a small glenoid defect (<13.5%) and might be associated with a higher rate of complete bone union of the resultant large bone fragment (≥7.5%). LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan.
| | - Takehito Hirose
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, Hyogo, Japan
| | - Hiroyuki Yokoi
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Wataru Sahara
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Tatsuo Mae
- Department of Sports Medicine Biomechanics, Osaka University, Graduate School of Medicine, Osaka, Japan
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Simmer Filho J, Kautsky RM. Arthroscopy Limits on Anterior Shoulder Instability. Rev Bras Ortop 2022; 57:14-22. [PMID: 35198104 PMCID: PMC8856842 DOI: 10.1055/s-0041-1731357] [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: 12/07/2020] [Accepted: 04/15/2021] [Indexed: 10/26/2022] Open
Abstract
Much is discussed about the limits of the treatment of anterior shoulder instability by arthroscopy. The advance in understanding the biomechanical repercussions of bipolar lesions on shoulder stability, as well as in the identification of factors related to the higher risk of recurrence have helped us to define, more accurately, the limits of arthroscopic repair. We emphasize the importance of differentiation between glenoid bone loss due to erosion (GBLE) and glenoid edge fractures, because the prognosis of treatment differs between these forms of glenoid bone failure. In this context, we understand that there are three types of bone failure: a) bone Bankart (fracture); b) combined; and c) glenoid bone loss due to anterior erosion (GBLE), and we will address the suggested treatment options in each situation. Until recently, the choice of surgical method was basically made by the degree of bone involvement. With the evolution of knowledge, the biomechanics of bipolar lesions and the concept of glenoid track , the cutoff point of critical injury, has been altered with a downward trend. In addition to bone failures or losses, other variables were added and made the decision more complex, but a little more objective. The present update article aims to make a brief review of the anatomy with the main lesions found in instability; to address important details in arthroscopic surgical technique, especially in complex cases, and to bring current evidence on the issues of greatest divergence, seeking to guide the surgeon in decision making.
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Nakagawa S, Hirose T, Uchida R, Ohori T, Mae T. Remaining Large Bone Fragment of a Bony Bankart Lesion in Shoulders With a Subcritical Glenoid Defect: Association With Recurrent Anterior Instability. Am J Sports Med 2022; 50:189-194. [PMID: 34855520 DOI: 10.1177/03635465211055707] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A preoperative glenoid defect of 13.5% or larger is recognized as a subcritical glenoid defect at arthroscopic Bankart repair (ABR) for collision/contact athletes or military personnel. PURPOSE To clarify the prevalence and size of remaining bone fragments in shoulders with a subcritical glenoid defect at recurrent anterior instability and to investigate the influence on postoperative recurrence after ABR for younger competitive athletes. STUDY DESIGN Cohort study; Level of evidence, 4. METHODS The study included 96 shoulders with recurrent instability that underwent ABR between July 2011 and March 2018 for shoulders with a subcritical glenoid defect. The patients were divided into 2 groups according to the glenoid defect size (13.5%-<20%, medium; ≥20%, large). The bone fragment size in each defect group was retrospectively investigated and classified into 4 groups (no, 0%; small, >0%-<5%; medium, 5%-<10%; large, ≥10%). The postoperative recurrence rate for each combination of glenoid defect size and bone fragment size was investigated for competitive athletes aged <30 years. The fragments, when present, were repaired to the glenoid. RESULTS The glenoid defect size was 13.5%-<20% in 60 shoulders (medium defect group) and ≥20% in 36 shoulders (large defect group). The mean bone fragment size was 6.7% ± 5.1% and 8.9% ± 4.9%, respectively (P = .042). In the medium defect group, there were 15 shoulders (25%) without a bone fragment, 6 shoulders (10%) with a small fragment, 23 shoulders (38.3%) with a medium fragment, and 16 shoulders (26.7%) with a large fragment. In the large defect group, the respective numbers were 2 shoulders (5.6%), 6 shoulders (16.7%), 14 shoulders (38.9%), and 14 shoulders (38.9%). A medium or large bone fragment was more common in the large defect group (P = .252). Among 64 younger competitive athletes who underwent ABR with a minimum of 2 years of follow-up, postoperative recurrence was recognized in 7 of 38 (18.4%) athletes in the medium defect group, but it was not recognized in any of the 26 athletes in the large defect group (P = .036). Postoperative recurrence was recognized in 4 of 12 (33.3%) athletes with a small fragment or no fragment and in 3 of 52 (5.8%) athletes with a medium or large fragment (P = .019). CONCLUSION A larger bone fragment frequently remained in shoulders with a subcritical glenoid defect at recurrent instability. The postoperative recurrence rate after ABR for younger competitive athletes was low when a remaining larger bone fragment was repaired.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Takehito Hirose
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Kansai-Rosai Hospital, Amagasaki, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan
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Tasaki A, Morita W, Nozaki T, Yonekura Y, Saito M, Phillips BB, Kitamura N. Arthroscopic Bankart Repair and Open Bristow Procedure in the Treatment of Anterior Shoulder Instability With Osseous Glenoid Lesions in Collision Athletes. Orthop J Sports Med 2021; 9:23259671211008274. [PMID: 34104661 PMCID: PMC8165538 DOI: 10.1177/23259671211008274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Traumatic anterior shoulder instability in collision sports athletes often involves osseous glenoid lesions, which make surgical treatment challenging. High redislocation rates have been seen in collision sports athletes treated using arthroscopic Bankart repair. Purpose: To investigate the effectiveness of a combined arthroscopic Bankart repair and open Bristow procedure for the treatment of traumatic anterior shoulder instability in collision sports athletes, with a focus on osseous glenoid lesions. Study Design: Case series; Level of evidence, 4. Methods: We reviewed 149 shoulders in 141 competitive collision sports athletes (mean ± standard deviation age, 20.1 ± 4.1 years; 8 bilateral cases) who underwent a combined arthroscopic Bankart repair and open Bristow procedure with minimum 2 years of follow-up. Osseous Bankart lesions were arthroscopically reduced and fixed using a coracoid graft. Results: Clinical outcomes as indicated by mean Rowe score improved significantly from 50.0 preoperatively to 98.9 postoperatively (P < .001) at a median follow-up of 3.4 years (range, 2.5-7 years). There were 2 recurrent dislocations (1.3%), both of which had nonunion of the transferred coracoid. Osseous Bankart lesions were observed in 85 shoulders, and osseous glenoid lesions ≥10% of the diameter of the nonoperative side were found in 58 shoulders, including 24 off-track cases. Clinical outcomes were not significantly different between patients with a glenoid defect ≥10% and <10%. Nonunion of the transferred coracoid was observed in 16 shoulders (10.7%), which had inferior Rowe scores; however, we could not define any risk factors for nonunion, including patient characteristics or bone morphology. Postoperative computed tomography performed in 29 patients >1 year after surgery showed successful repair of the osseous glenoid lesions, with a restored glenoid articular surface in all cases. Significant pre- to postoperative increases were seen in glenoid diameter (mean, 13.1% [95% CI, 9.9%-16.3%]; P < .001) and area (mean, 10.6% [95% CI, 8.5%-12.7%]; P < .001). Conclusion: A combined arthroscopic Bankart repair and open Bristow procedure improved bone morphology and was a reliable surgical method for treating collision sports athletes with traumatic anterior shoulder instability involving osseous glenoid lesions.
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Affiliation(s)
- Atsushi Tasaki
- Department of Orthopedic Surgery, St Luke's International Hospital, Tokyo, Japan
| | - Wataru Morita
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Taiki Nozaki
- Department of Radiology, St Luke's International Hospital, Tokyo, Japan
| | - Yuki Yonekura
- Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan
| | - Masayoshi Saito
- Department of Orthopedic Surgery, St Luke's International Hospital, Tokyo, Japan
| | - Barry B Phillips
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee; Campbell Clinic, Memphis, Tennessee, USA
| | - Nobuto Kitamura
- Department of Orthopedic Surgery, St Luke's International Hospital, Tokyo, Japan
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Nakagawa S, Sahara W, Kinugasa K, Uchida R, Mae T. Bipolar Bone Defects in Shoulders With Primary Instability: Dislocation Versus Subluxation. Orthop J Sports Med 2021; 9:23259671211003553. [PMID: 34036111 PMCID: PMC8127765 DOI: 10.1177/23259671211003553] [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: 11/04/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022] Open
Abstract
Background: In shoulders with traumatic anterior instability, a bipolar bone defect has been recognized as an important indicator of the prognosis. Purpose: To investigate bipolar bone defects at primary instability and compare the difference between dislocation and subluxation. Study Design: Cohort study; Level of evidence, 3. Methods: There were 156 shoulders (156 patients) including 91 shoulders with dislocation and 65 shoulders with subluxation. Glenoid defects and Hill-Sachs lesions were classified into 5 size categories on 3-dimensional computed tomography (CT) scans and were allocated scores ranging from 0 (no defect) to 4 points (very large defect). To assess the combined size of the glenoid defect and Hill-Sachs lesion, the scores for both lesions were summed (range, 0-8 points). Patients in the dislocation and subluxation groups were compared regarding the prevalence of a glenoid defect, a bone fragment of bony Bankart lesion, a Hill-Sachs lesion, a bipolar bone defect, and an off-track Hill-Sachs lesion. Then, the combined size of the bipolar bone defects was compared between the dislocation and subluxation groups and among patients stratified by age at the time of CT scanning (<20, 20-29, and ≥30 years). Results: Hill-Sachs lesions were observed more frequently in the dislocation group (75.8%) compared with the subluxation group (27.7%; P < .001), whereas the prevalence of glenoid defects was not significantly different between groups (36.3% vs 29.2%, respectively; P = .393). The combined defect size was significantly larger in the dislocation versus subluxation group (mean ± SD combined defect score, 2.1 ± 1.6 vs 0.8 ± 0.9 points, respectively; P < .001) due to a larger Hill-Sachs lesion at dislocation than subluxation (glenoid defect score, 0.5 ± 0.9 vs 0.3 ± 0.6 points [P = .112]; Hill-Sachs lesion score, 1.6 ± 1.2 vs 0.4 ± 0.7 points [P < .001]). Combined defect size was larger in older patients than younger patients in the setting of dislocation (combined defect score, <20 years, 1.6 ± 1.2 points; 20-29 years, 1.9 ± 1.5 points; ≥30 years, 3.4 ± 1.6 points; P < .001) but was not different in the setting of subluxation (0.8 ± 1.0, 0.7 ± 0.9, and 0.8 ± 0.8 points, respectively; P = .885). An off-track Hill-Sachs lesion was observed in 2 older patients with dislocation but was not observed in shoulders with subluxation. Conclusion: The bipolar bone defect was significantly more frequent, and the combined size was greater in shoulders with primary dislocation and in older patients (≥30 years).
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
- Shigeto Nakagawa, MD, PhD, Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan ()
| | - Wataru Sahara
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan
| | - Kazutaka Kinugasa
- Department of Orthopaedic Sports Medicine, Osaka Rosai Hospital, Sakai, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, Amagasaki, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan
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Abstract
Fractures of the anteroinferior aspect of the glenoid rim, known as a bony Bankart lesions, can occur frequently in the setting of traumatic anterior shoulder dislocation. If these lesions are large and are left untreated in active patients, then recurrent glenohumeral instability due to glenoid bone deficiency may occur. Therefore, the clinician must recognize these lesions when they occur and provide appropriate treatment to restore physiological joint stability. This article aims to provide an overview focusing on clinical and technical considerations in the diagnosis and treatment of bony Bankart lesions.
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28
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Chapter 6: Attritional Glenoid Bone Loss in the Shoulder: Operative Considerations. Sports Med Arthrosc Rev 2021; 28:159-166. [PMID: 33156231 DOI: 10.1097/jsa.0000000000000292] [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
Patients with recurrent anterior shoulder instability often have glenoid bone loss present in addition to soft tissue pathologies. It is known that patients with significant glenoid bone loss are best treated with a boney augmentation procedure as opposed to a soft tissue Bankart repair because of the high rate of recurrent instability that results from a Bankart repair. Although the Latarjet technique has been the gold-standard treatment for patients with glenoid bone loss because of the low incidence of recurrent instability, it has a high complication rate and a steep learning curve. Herein, the authors present the technique and outcomes for arthroscopic anatomic glenoid reconstruction that has a similar complication rate to the Bankart repair but with a low recurrence rate similar to the Latarjet. This procedure is safe, has a short learning curve, low recurrence rate, and positive patient-reported outcomes.
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29
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Lau BC, Hutyra CA, Gonzalez JM, Mather RC, Owens BD, Levine WN, Garrigues GE, Kelly JD, Kovacevic D, Abrams JS, Cuomo F, McMahon PJ, Kaar S, Dines JS, Miniaci A, Nagda S, Braman JP, Harrison AK, MacDonald P, Riboh JC. Surgical treatment for recurrent shoulder instability: factors influencing surgeon decision making. J Shoulder Elbow Surg 2021; 30:e85-e102. [PMID: 32721507 DOI: 10.1016/j.jse.2020.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The optimal surgical approach for recurrent anterior shoulder instability remains controversial, particularly in the face of glenoid and/or humeral bone loss. The purpose of this study was to use a contingent-behavior questionnaire (CBQ) to determine which factors drive surgeons to perform bony procedures over soft tissue procedures to address recurrent anterior shoulder instability. METHODS A CBQ survey presented each respondent with 32 clinical vignettes of recurrent shoulder instability that contained 8 patient factors. The factors included (1) age, (2) sex, (3) hand dominance, (4) number of previous dislocations, (5) activity level, (6) generalized laxity, (7) glenoid bone loss, and (8) glenoid track. The survey was distributed to fellowship-trained surgeons in shoulder/elbow or sports medicine. Respondents were asked to recommend either a soft tissue or bone-based procedure, then specifically recommend a type of procedure. Responses were analyzed using a multinomial-logit regression model that quantified the relative importance of the patient characteristics in choosing bony procedures. RESULTS Seventy orthopedic surgeons completed the survey, 33 were shoulder/elbow fellowship trained and 37 were sports medicine fellowship trained; 52% were in clinical practice ≥10 years and 48% <10 years; and 95% reported that the shoulder surgery made up at least 25% of their practice. There were 53% from private practice, 33% from academic medicine, and 14% in government settings. Amount of glenoid bone loss was the single most important factor driving surgeons to perform bony procedures over soft tissue procedures, followed by the patient age (19-25 years) and the patient activity level. The number of prior dislocations and glenoid track status did not have a strong influence on respondents' decision making. Twenty-one percent glenoid bone loss was the threshold of bone loss that influenced decision toward a bony procedure. If surgeons performed 10 or more open procedures per year, they were more likely to perform a bony procedure. CONCLUSION The factors that drove surgeons to choose bony procedures were the amount of glenoid bone loss with the threshold at 21%, patient age, and their activity demands. Surprisingly, glenoid track status and the number of previous dislocations did not strongly influence surgical treatment decisions. Ten open shoulder procedures a year seems to provide a level of comfort to recommend bony treatment for shoulder instability.
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Affiliation(s)
- Brian C Lau
- Duke Sport Science Institute, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Carolyn A Hutyra
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Juan Marcos Gonzalez
- Duke University School of Medicine, Department of Population Health Sciences, Durham, NC, USA
| | - Richard C Mather
- Duke Sport Science Institute, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brett D Owens
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - William N Levine
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Grant E Garrigues
- Midwest Orthopaedics at RUSH, Rush University Medical Center, Chicago, IL, USA
| | - John D Kelly
- Penn Perelman School of Medicine, Philadelphia, PA, USA
| | - David Kovacevic
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | | | - Frances Cuomo
- Department of Orthopaedic Surgery, Montefiore, New York, NY, USA
| | | | - Scott Kaar
- Department of Orthopaedic Surgery, Saint Louis University, St. Louis, MO, USA
| | | | - Anthony Miniaci
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Jonathan P Braman
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Alicia K Harrison
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Peter MacDonald
- Orthopaedic Surgery, Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada
| | - Jonathan C Riboh
- Duke Sport Science Institute, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Inoue K, Suenaga N, Oizumi N, Yamaguchi H, Miyoshi N, Taniguchi N, Morita S, Kurata S, Tanaka Y. Glenoid bone resorption after Bankart repair: finite element analysis of postoperative stress distribution of the glenoid. J Shoulder Elbow Surg 2021; 30:188-193. [PMID: 32778380 DOI: 10.1016/j.jse.2020.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/02/2020] [Accepted: 04/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are various modifications of the Bankart repair, and postoperative changes to the glenoid morphology after the repair are reported. Among the various procedures performed, a decrease in the lateral glenoid diameter might be related to the surgery that involves removal of the articular cartilage and repair of the labrum-anterior inferior glenohumeral ligament complex on the glenoid surface. This is in contrast to cases without significant bony Bankart lesions that are not on the edge of the glenoid. Thus, this study aimed to compare glenoid rim stress after Bankart repair using 2 methods of finite element analysis: a method of removing the anteroinferior cartilage and repairing the glenohumeral ligament complex on the glenoid and a method of preserving the cartilage and repairing the glenohumeral ligament complex on the glenoid edge. METHODS Five preoperative computed tomography scans of patients with traumatic anterior instability who underwent arthroscopic Bankart repair were used. Two models simulating different surgical procedures were created as follows: in model G, a 5-mm-thick cartilage on the glenoid rim was removed between 2 and 7 o'clock, and the glenohumeral ligament complex was repaired on the medial edge of the glenoid bone where the cartilage was removed. In model E, the cartilage on the glenoid rim was not removed, and the glenohumeral ligament complex was repaired on the glenoid edge. The load stresses on the anteroinferior area of the glenoid after Bankart repair with models G and E were measured using finite element analysis. RESULTS The stress on the glenoid at 3-4 o'clock was 3.16 MPa in model G and 6.42 MPa in model E (P = .043). The stress at 4-5 o'clock was 1.68 MPa in model G and 4.53 MPa in model E (P = .043). The stress at 5-6 o'clock was 2.26 MPa in model G and 3.93 MPa in model E (P = .043). CONCLUSION Significantly lower load stresses were observed at the anteroinferior rim of the glenoid in model G than in model E.
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Affiliation(s)
- Kazuya Inoue
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan.
| | - Naoki Suenaga
- Upper Extremity Center of Joint Replacement and Endoscopic Surgery, Orthpaedic Hokushin Hospital, Sapporo, Hokkaido, Japan
| | - Naomi Oizumi
- Upper Extremity Center of Joint Replacement and Endoscopic Surgery, Orthpaedic Hokushin Hospital, Sapporo, Hokkaido, Japan
| | - Hiroshi Yamaguchi
- Department of Orthopedic Surgery, Rehabilitation Clinic Yamaguchi, Naha, Okinawa, Japan
| | - Naoki Miyoshi
- Department of Orthopedic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Noboru Taniguchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima, Japan
| | - Shuzo Morita
- Upper Extremity Center of Joint Replacement and Endoscopic Surgery, Orthpaedic Hokushin Hospital, Sapporo, Hokkaido, Japan
| | - Shimpei Kurata
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan
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31
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Atala NA, Bongiovanni S, Rossi LA, De Cicco F, Bruchmann MG, Tanoira I, Ranalletta M. Arthroscopic Acute Bony Bankart Repair in Lateral Decubitus. Arthrosc Tech 2020; 9:e1907-e1915. [PMID: 33381400 PMCID: PMC7768221 DOI: 10.1016/j.eats.2020.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/16/2020] [Indexed: 02/03/2023] Open
Abstract
The optimal management of anterior shoulder instability continues to be a challenge. The presence of an anterior glenoid rim fracture in the context of a glenohumeral dislocation, also called "bony Bankart lesion," can alter therapeutic behavior. Reduction and fixation of the bone fragment has been shown to greatly reduce the risk of recurrence once bone consolidation is achieved. However, there is no gold standard surgical technique. Stability of fixation and the healing of the bony fragment are still a concern, and there are no clinical studies comparing the different techniques to date. The aim of this report is to describe an arthroscopic double-point fragment fixation technique in lateral decubitus for the treatment of an acute traumatic shoulder dislocation with a bony Bankart lesion.
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Affiliation(s)
- Nicolás A. Atala
- Address correspondence to Nicolás Agustín, Atala Peron 4190 (C1199ABB), Buenos Aires, Argentina.
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Benefits of bone graft augmentation to arthroscopic Bankart repair for recurrent anterior shoulder instability with glenoid bone loss. Knee Surg Sports Traumatol Arthrosc 2020; 28:2325-2333. [PMID: 31667568 DOI: 10.1007/s00167-019-05746-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Glenoid bone loss contributes to recurrent instability after arthroscopic Bankart repair alone. With significant glenoid bone loss, better results have been reported after arthroscopic Bankart repair with glenoid arc reconstruction. However, no reports compare augmentation using bone graft with non-augmentation for glenoid bone loss. The purpose of this study was to assess clinical results of an arthroscopic Bankart repair with or without arthroscopic bone graft augmentation. It was hypothesized that such bone graft augmentation would restore shoulder stability, and lead to excellent outcomes. METHODS Of 552 patients treated for anterior glenohumeral instability with arthroscopic Bankart repair, 68 met this study's inclusion criteria of glenoid bone loss over 20% and follow-up of at least 2 years. Patients were divided into 2 groups based on whether with bone graft augmentation for glenoid bone loss [Group A: n = 35, median age; 21 years (range 13-72 years)], or not (Group B: n = 33, median age; 21 years (range 13-50 years)]. For grafting, either autologous iliac bone or artificial bone made of hydroxyapatite was used. Rowe score, recurrence rate, and return to sport were used to assess the results. RESULTS Mean Rowe score was 95.0 (SD 10.6) in Group A and 69.7 (SD 27.2) in Group B (p < 0.05). The recurrence rate was 2.9% (1/36) in Group A and 48.5% (16/33) in Group B (p < 0.05). Regarding contact/collision athletes, 24 were contained in Group A and 22 in Group B. Of the patients with recurrence in Group B, 13 (59.1%) were contact/collision athletes. Finally, 50% of the contact/collision sports athletes for both groups returned to their sports at the same as pre-injury level. Of the 11 patients who returned to the same level of contact/collision sports in Group B, seven returned with residual instability. Nine athletes in Group A and 3 in Group B quit their sports for personal or social reasons. CONCLUSIONS Bone graft augmentation was beneficial when used with Arthroscopic Bankart repair for recurrent anterior shoulder instability with glenoid bone loss. Especially, for recurrent anterior shoulder instability with glenoid bone loss in contact/collision sports athletes, bone graft augmentation should be strongly considered as beneficial. LEVEL OF EVIDENCE Level IV.
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Progression of Erosive Changes of Glenoid Rim After Arthroscopic Bankart Repair. Arthroscopy 2020; 36:44-53. [PMID: 31708354 DOI: 10.1016/j.arthro.2019.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/02/2019] [Accepted: 07/10/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate changes of the glenoid after arthroscopic Bankart repair (ABR) in patients with different preoperative glenoid structures. METHODS Patients who underwent ABR for traumatic anterior shoulder instability were retrospectively investigated. They were divided into 3 groups on the basis of preoperative glenoid structure by computed tomography (CT): normal glenoid (group N), glenoid erosion (group E), or glenoid defect associated with a bony Bankart lesion (group B). Shoulders in group B were also stratified according to the postoperative status of the bone fragment (union, nonunion, or resorbed). Postoperative changes of glenoid width (Δ) (increase: Δ ≥5%, stable: Δ >-5% to <5%, decrease: Δ ≤-5%) and the extent of glenoid bone loss were investigated by 3-dimensional CT. RESULTS A total of 186 shoulders were divided into 3 groups: group N (n = 61), group E (n = 46), and group B (n = 79). At initial postoperative CT, the glenoid width was decreased in 41 shoulders, stable in 20 shoulders, and increased in no shoulders from group N. The respective numbers were 27, 18, and 1 in group E, and 50, 22, and 7 in group B. The glenoid width was reduced in all groups (mean percent change: -8.8%, -5.9%, and -6.1%, respectively). In group B, glenoid width decreased in most of the shoulders without bone union. The glenoid bone loss on the preoperative and postoperative final CT was, respectively, 0% and 8.6% in group N (P < .0001), 9.9% and 12.4% in group E (P = .03), and 10.4% and 7.2% in group B (P = .01). Final glenoid bone loss >13.5% was recognized in 18.2% of group N, 35.7% of group E, and 21.8% of group B. CONCLUSIONS Glenoid width often decreased after ABR because of anterior glenoid rim erosion, and this change was frequent in patients with preoperative normal glenoid, glenoid erosion, or without postoperative union of a bony Bankart lesion. LEVEL OF EVIDENCE Level 3, Case-control study.
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Nakagawa S, Hirose T, Uchida R, Tanaka M, Mae T. Postoperative Recurrence of Instability After Arthroscopic Bankart Repair for Shoulders With Primary Instability Compared With Recurrent Instability: Influence of Bipolar Bone Defect Size. Am J Sports Med 2020; 48:48-55. [PMID: 31684736 DOI: 10.1177/0363546519880496] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In shoulders with traumatic anterior instability, a bipolar bone defect has recently been recognized as an important indicator of the prognosis. PURPOSE To investigate the influence of bipolar bone defects on postoperative recurrence after arthroscopic Bankart repair performed at primary instability. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The study group consisted of 45 patients (45 shoulders) who underwent arthroscopic Bankart repair at primary instability before recurrence and were followed for at least 2 years. The control group consisted of 95 patients (95 shoulders) with recurrent instability who underwent Bankart repair and were followed for at least 2 years. Glenoid defects and Hill-Sachs lesions were classified into 5 size categories on 3-dimensional computed tomography and were allocated scores ranging from 0 for no defect to 4 for the largest defect. The shoulders were classified according to the total score for both lesions (0-8 points). The postoperative recurrence rate was investigated for each score of bipolar bone defects and was compared between patients with primary instability and patients with recurrent instability. The same analysis was performed for the age at operation (<20 years, 20-29 years, or ≥30 years) and for the presence of an off-track Hill-Sachs lesion. RESULTS Bipolar bone defects were smaller in shoulders with primary instability (mean ± SD defect score, 1.4 ± 1.5 points) than in those with recurrent instability (3.6 ± 1.9 points) and were larger in older patients than in younger patients at the time of primary instability. The postoperative recurrence rate was low (6.7%) in shoulders with primary instability regardless of the size of the bipolar bone defect and the patient's age, whereas the postoperative recurrence rate was high (23.2%) in shoulders with recurrent instability, especially among patients younger than 20 years with bipolar bone defects of 2 points or greater. An off-track Hill-Sachs lesion was found in only 1 patient in the oldest age group (2.2%) at primary instability, but it was found in 19 patients (20%) at recurrent instability, including 14 patients younger than 30 years. Among patients with an off-track lesion, the postoperative recurrence rate was significantly higher in patients younger than 20 years with recurrent instability (recurrence rates: <20 years, 71.4%; 20-29 years, 14.3%; ≥30 years, 0%). CONCLUSION The recurrence rate was consistently low in patients with primary instability and was significantly influenced by bipolar bone defect size and patient age in patients with recurrent instability.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Takehito Hirose
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Makoto Tanaka
- Department of Orthopaedic Surgery, Daini Osaka Police Hospital, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan
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Nakagawa S, Uchida R, Yokoi H, Sahara W, Mae T. Changes of Bipolar Bone Defect Size After Arthroscopic Bankart Repair for Traumatic Anterior Shoulder Instability: Evaluation Using a Scoring System and Influence on Postoperative Recurrence. Orthop J Sports Med 2019; 7:2325967119885345. [PMID: 31807605 PMCID: PMC6880029 DOI: 10.1177/2325967119885345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The combination of a glenoid defect and a Hill-Sachs lesion in shoulders with traumatic anterior instability has been termed bipolar bone loss, and the preoperative size of these lesions has been reported to influence postoperative recurrence of instability after arthroscopic Bankart repair. Purpose To investigate the influence of postoperative bipolar bone defect size on postoperative recurrence of instability. Study Design Cohort study; Level of evidence, 3. Methods A total of 64 male collision/contact athletes (69 shoulders) were evaluated for a minimum of 2 years after surgery, and the pre- and postoperative sizes of both lesions (glenoid defect and Hill-Sachs) were evaluated retrospectively with 3-dimensional computed tomography. The sports played by the athletes included rugby (n = 28 shoulders), American football (n = 24 shoulders), and other collision/contact sports (n = 17 shoulders). Glenoid defects and Hill-Sachs lesions were classified into 5 size categories and assigned scores from 0 (no defect) to 4 (very large defect). Patients were then classified according to the total score (sum of the scores for both lesions). The influence of pre- and postoperative bipolar bone defect sizes on recurrence of instability was investigated by using the total scores for bipolar bone defects. The influence of postoperative glenoid morphology (normal preoperative glenoid, preoperative glenoid erosion, bone union after arthroscopic bony Bankart repair [ABBR], or nonunion after ABBR) was also investigated, as well as changes in shoulders with a preoperative off-track Hill-Sachs lesion. Results Of 69 shoulders, 15 (21.7%) developed recurrent instability after surgery. The postoperative recurrence rate was 0% in shoulders with a total score ≤1, while the recurrence rate was consistently higher in shoulders with a total score ≥2 at both pre- and postoperative evaluation (mean, 28.8% and 32.6%, respectively). Postoperative recurrence was uncommon when there was a normal preoperative glenoid or bone union after ABBR, while it was frequent in shoulders with preoperative glenoid erosion or shoulders with nonunion after ABBR and a total score ≥2. An off-track lesion was recognized in 9 shoulders preoperatively. It was transformed to on-track lesions in 4 of the 5 shoulders showing bone union after ABBR, and there was no recurrence in the 5 shoulders with bone union. In contrast, postoperative recurrence of instability occurred in 3 of the 4 shoulders without bone union. Conclusion Postoperative recurrence was influenced by the pre- and postoperative size of bipolar bone defects. Recurrence was uncommon if bone union was achieved after ABBR, even if there had been an off-track lesion preoperatively.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Hiroyuki Yokoi
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Wataru Sahara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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Gowd AK, Liu JN, Cabarcas BC, Garcia GH, Cvetanovich GL, Provencher MT, Verma NN. Management of Recurrent Anterior Shoulder Instability With Bipolar Bone Loss: A Systematic Review to Assess Critical Bone Loss Amounts. Am J Sports Med 2019; 47:2484-2493. [PMID: 30148653 DOI: 10.1177/0363546518791555] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is increasing evidence to suggest that the amount of glenoid bone loss to indicate bone block procedures may be lower than previously thought, particularly in the presence of a Hill-Sachs defect. PURPOSE To better establish treatment recommendations for anterior shoulder instability among patients with bipolar bone lesions. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS A systematic review of the literature was performed with PubMed, EMBASE, Cochrane Library, and Scopus databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Studies evaluating outcomes of operative management in anterior shoulder instability that also reported glenoid bone loss in the presence of Hill-Sachs defects were included. Recurrence rates, glenoid bone loss, and humeral bone loss were pooled and analyzed with forest plots stratified by surgical procedure. Methods of quantification were analyzed for each article qualitatively. RESULTS Thirteen articles were included in the final analysis, with a total of 778 patients. The mean ± SD age was 24.9 ± 8.6 years. The mean follow-up was 30.1 months (range, 11-240 months). Only 13 of 408 (3.2%) reviewed bipolar bone loss articles quantified humeral and/or glenoid bone loss. Latarjet procedures had the greatest glenoid bone loss (21.7%; 95% CI, 14.8%-28.6%), followed by Bankart repairs (13.1%; 95% CI, 9.0%-17.2%), and remplissage (11.7%; 95% CI, 5.5%-18.0%). Humeral bone loss was primarily reported as percentage bone loss (22.2%; 95% CI, 13.1%-31.3% in Bankart repairs and 31.7%; 95% CI, 21.6%-41.1% in Latarjet) or as volumetric defects (439.1 mm3; 95% CI, 336.3-541.9 mm3 in Bankart repairs and 366.0 mm3; 95% CI, 258.4-475.4 mm3 in remplissage). Recurrence rates were as follows: Bankart repairs, 19.5% (95% CI, 14.5%-25.8%); remplissage, 4.4% (95% CI, 1.3%-14.0%); and Latarjet, 8.7% (95% CI, 5.0%-14.7%). Bankart repairs were associated with significantly greater recurrence of instability in included articles (P = .013). CONCLUSION There exists a need for universal and consistent preoperative measurement of humeral-sided bone loss. The presence of concomitant Hill-Sachs defects with glenoid pathology should warrant more aggressive operative management through use of bone block procedures. Previously established values of critical glenoid bone loss are not equally relevant in the presence of bipolar bone loss.
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Affiliation(s)
- Anirudh K Gowd
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Brandon C Cabarcas
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Grant H Garcia
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Gregory L Cvetanovich
- Department of Orthopaedics, the Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | | | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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Burns JP, Vellinga RM. Acute Bony Bankarts: Tips and Tricks for Success. OPER TECHN SPORT MED 2019. [DOI: 10.1053/j.otsm.2019.01.005] [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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Nakagawa S, Iuchi R, Hanai H, Hirose T, Mae T. The Development Process of Bipolar Bone Defects From Primary to Recurrent Instability in Shoulders With Traumatic Anterior Instability. Am J Sports Med 2019; 47:695-703. [PMID: 30673556 DOI: 10.1177/0363546518819471] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recurrence of glenohumeral joint instability after primary traumatic anterior instability is not rare, and bipolar bone loss is one of the most critical factors for recurrent instability, but the development process of bipolar bone defects is still unclear. PURPOSE To investigate the development process of bipolar bone defects from primary to recurrent instability among shoulders with traumatic anterior instability evaluated at least twice by computed tomography (CT). STUDY DESIGN Case series; Level of evidence, 4. METHODS There were 44 patients (47 shoulders) with recurrence after primary instability in which bone morphology was evaluated by 3-dimensional reconstructed CT at primary instability (initial CT) and after recurrence. As CT was performed 3 times for 3 shoulders including primary injury and the second episode of instability (first recurrence), there were 50 CT evaluations. Morphological changes between the initial CT evaluation at primary instability and the second CT evaluation at first recurrence were investigated for 25 shoulders, with the mean interval since initial CT being 9.8 months (range, 2-23 months). Changes between initial CT evaluation and final CT evaluation after ≥2 recurrences were also investigated for 25 shoulders, while the mean number of instability episodes including primary instability was 8.0 (range, 3-40) and the mean interval since initial CT was 18.5 months (range, 5-56 months). RESULTS At primary instability, the prevalence of Hill-Sachs lesions (66.0%) was almost double that of glenoid defects (34.0%), but their prevalence was different between shoulders with primary subluxation (42.3% and 23.8%, respectively) and those with primary dislocation (84.7% and 42.3%, respectively). After recurrence, glenoid defects became significantly more frequent (at first recurrence, 72%; after ≥2 recurrences, 76%), while Hill-Sachs lesions showed a smaller increase (88% and 80%, respectively), so there was no difference between the prevalence of the 2 lesions. The sizes of glenoid defects and Hill-Sachs lesions also enlarged after recurrence, and large bone defects were frequently recognized after recurrence. While bipolar bone loss was not so frequent at primary instability (29.8%), bipolar bone loss increased significantly after recurrence (at first recurrence, 72%; after ≥2 recurrences, 72%). All Hill-Sachs lesions were on track at primary instability, but off-track lesions were recognized in 3 of 47 shoulders (6.4%) after recurrence. CONCLUSION In most shoulders with recurrent instability, a Hill-Sachs lesion developed first, followed by a glenoid defect, leading to bipolar bone loss. Off-track Hill-Sachs lesions were detected only after recurrence.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Ryo Iuchi
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Hiroto Hanai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Takehito Hirose
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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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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Bonnevialle N, Clavert P, Arboucalot M, Bahlau D, Bauer T, Ehlinger M. Contribution of arthroscopy in the treatment of anterior glenoid rim fractures: a comparison with open surgery. J Shoulder Elbow Surg 2019; 28:42-47. [PMID: 30262253 DOI: 10.1016/j.jse.2018.07.008] [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] [Received: 02/17/2018] [Revised: 06/26/2018] [Accepted: 07/03/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study assessed the clinical and radiologic outcomes of Ideberg type IA glenoid fractures treated using conventional open surgery compared with those treated with arthroscopic surgery. MATERIALS AND METHODS This was a retrospective, multicenter study of anterior glenoid rim fractures (Ideberg IA) treated with conventional open surgery (group O) or arthroscopic surgery (group A). Included were 56 patients: 10 in group O and 46 in group A. The patients were reviewed after a minimum of 12 months of follow-up. The Constant score was used as an objective clinical outcome. Radiographs were reviewed to assess the quality of the postoperative reduction, fracture healing, complications, and whether osteoarthritis was present at the last follow-up. RESULTS At a mean follow-up of 30 months (range, 12-115 months), there was no significant difference between the groups based on the Constant Score (group O: 74 points; group A: 84 points, P = .07). None of the shoulders showed signs of instability. Conversely, the rate of postoperative complications was higher in group O than in group A (30% vs. 4%; P = .03). Glenohumeral osteoarthritis was found in 10% of group O patients and 18% of group A patients (P = .65). CONCLUSIONS This study shows that anterior glenoid rim fractures have similar functional outcomes, whether treated using conventional open surgery or arthroscopic surgery. Arthroscopic surgery appears to reduce the complication and reoperation rate.
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Affiliation(s)
- Nicolas Bonnevialle
- Département d'Orthopédie Traumatologie du Centre Hospitalier Universitaire de Toulouse, Hôpital Riquet, Toulouse, France; Laboratoire de Biomécanique, Institut de Mécanique des Fluides de Toulouse- Unité Mixte de Recherche-Centre National de la Recherche Scientifique, 5502, Hôpital Riquet, Toulouse, France.
| | - Philipe Clavert
- Service de Chirurgie du Membre Supérieur, Centre de Chirurgie Orthopédique et de la Main, Illkirch, France; Laboratoire ICube, Centre National de la Recherche Scientifique Unité Mixte de Recherche 7357, Ilkirch, France
| | - Marine Arboucalot
- Département d'Orthopédie Traumatologie du Centre Hospitalier Universitaire de Toulouse, Hôpital Riquet, Toulouse, France
| | - David Bahlau
- Service de Chirurgie du Membre Supérieur, Centre de Chirurgie Orthopédique et de la Main, Illkirch, France
| | - Thomas Bauer
- Service d'Orthopédie, Ambroise Paré Hospital, Boulogne Billancourt, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital de Hautepierre, Strasbourg, France
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- Société Française de Chirurgie Orthopédique et Traumatologique (SOFCOT), Paris, France
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Nakagawa S, Hanai H, Mae T, Hayashida K, Yoneda M. Bipolar Bone Loss in Male Athletes With Traumatic Anterior Shoulder Instability: An Evaluation Using a New Scoring System. Orthop J Sports Med 2018; 6:2325967118782420. [PMID: 30046627 PMCID: PMC6055304 DOI: 10.1177/2325967118782420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: The combination of a glenoid defect and a Hill-Sachs lesion in a shoulder with anterior instability has recently been termed “bipolar bone loss,” but the prevalence and influence of this condition on postoperative recurrence after arthroscopic Bankart repair are still unclear. Purpose: To investigate bipolar bone loss in male athletes using a new scoring system and to evaluate its efficacy by comparing it with the glenoid track concept. Study Design: Case-control study; Level of evidence, 3. Methods: The sizes of both lesions were evaluated retrospectively in 80 male athletes (85 shoulders) using computed tomography. The glenoid defects and the length, width, and depth of the Hill-Sachs lesions were classified into 5 size categories and were allocated scores from “0” for no defect to “4” for the largest defect. Patients were then classified into 5 classes according to the total score for both lesions: class 1, 0-1 point; class 2, 2 points; class 3, 3 points; class 4, 4 points; and class 5, ≥5 points. The prevalence of bipolar bone loss and postoperative recurrence rates for patients with at least 2 years of follow-up were compared among the classes. The recurrence rate for each class was also compared between shoulders with an off-track lesion and shoulders with an on-track lesion as well as among 3 sporting categories: rugby, American football, and other sports. Results: Based on the combination of glenoid defect size and Hill-Sachs lesion length, the postoperative recurrence rate was 0% for shoulders in class 1, 12.5% for class 2, 33.3% for class 3, 28.6% for class 4, and 31.3% for class 5, while the recurrence rates were 0%, 16.7%, 28.6%, 27.3%, and 31.6%, respectively, for the combination of glenoid defect size and Hill-Sachs lesion width and 0%, 8.3%, 26.7%, 28.6%, and 35.3%, respectively, for the combination of glenoid defect size and Hill-Sachs lesion depth. Postoperative recurrence was frequently recognized regardless of the presence of off-track Hill-Sachs lesions. No recurrence was recognized in class 1 shoulders among rugby players, in classes 1 and 2 among American football players, and in classes 1 through 3 among other athletes based on the combination of glenoid defect size and Hill-Sachs lesion size. Conclusion: Our scoring system for bipolar bone loss was useful to evaluate the influence on postoperative recurrence in male athletes. The postoperative recurrence rate was influenced by the extent of bipolar bone loss and the sporting category regardless of the presence of off-track lesions.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Hiroto Hanai
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kenji Hayashida
- Department of Orthopaedic Surgery, Osaka Police Hospital, Osaka, Japan
| | - Minoru Yoneda
- Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
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Park I, Lee JH, Hyun HS, Oh MJ, Shin SJ. Effects of Bone Incorporation After Arthroscopic Stabilization Surgery for Bony Bankart Lesion Based on Preoperative Glenoid Defect Size. Am J Sports Med 2018; 46:2177-2184. [PMID: 29791191 DOI: 10.1177/0363546518773317] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recurrent shoulder instability occurs more frequently after soft tissue surgery when the glenoid defect is greater than 20%. However, for lesions less than 20%, no scientific guidance is available regarding what size of bone fragments may affect shoulder functional restoration after bone incorporation. Purpose/Hypothesis: The purpose was to analyze how preoperative glenoid defect size and bone fragment incorporation alter postoperative clinical outcomes, we compared the functional outcomes of shoulders with and without bony Bankart lesion. It was hypothesized that differences in postoperative clinical outcomes between patients with and without bony fragments would be found only in patients with a larger glenoid defect. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 223 patients who underwent arthroscopic stabilization surgery for recurrent anterior shoulder instability were divided into two groups based on the presence of anterior glenoid bone fragments. In each group, postoperative shoulder functional outcomes, sports activity level, and recurrence rates were evaluated according to preoperative glenoid defect size (small, <10%; medium, 10%-15% and 15%-20%; large, >20%). RESULTS In patients with small or medium defects, no significant differences were found in postoperative clinical outcomes and sports activity levels between the two groups. However, in patients with a large defect, the patients with bone fragments (mean ± SD American Shoulder and Elbow Surgeons [ASES] score, 92.3 ± 2.7; Rowe score, 90.9 ± 5.4) showed significantly superior clinical outcomes compared with patients who did not have fragments (ASES score, 87.3 ± 6.2, P = .02; Rowe score, 84.8 ± 7.3, P = .04). Among patients without bone fragments, recurrence increased significantly with increasing preoperative glenoid defect size (recurrence rates: 0% in small defects, 7.4% in medium defects, 22.2% in large defects), whereas patients with bone fragments showed no tendency for increasing or decreasing recurrence rates (0% in small defects, 7.9% in medium defects, 5.9% in large defects). CONCLUSION In the treatment of bony Bankart lesion, the effect of bone fragment incorporation was different according to preoperative glenoid defect size. In patients with preoperative glenoid defects less than 20% of the glenoid width, bone fragment incorporation after arthroscopic bony Bankart repair did not alter clinical outcomes, sports activity levels, or recurrence rates, whereas in patients with defects greater than 20% of the glenoid width, bone fragment incorporation improved clinical outcomes and recurrence rates.
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Affiliation(s)
- In Park
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Jae-Hoo Lee
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Hwan-Sub Hyun
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Min-Joon Oh
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Sang-Jin Shin
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
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Nakagawa S, Hirose T, Tachibana Y, Iuchi R, Mae T. Postoperative Recurrence of Instability Due to New Anterior Glenoid Rim Fractures After Arthroscopic Bankart Repair. Am J Sports Med 2017; 45:2840-2848. [PMID: 28728432 DOI: 10.1177/0363546517714476] [Citation(s) in RCA: 24] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Computed tomography (CT) sometimes reveals a new fracture of the anterior glenoid rim in patients with postoperative recurrence of instability after arthroscopic Bankart repair using suture anchors, but there have been few previous reports about such fractures. HYPOTHESIS The placement of a large number of suture anchors during arthroscopic Bankart repair might be associated with a new glenoid rim fracture. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Screw-in metal suture anchors were used until June 2011 and suture-based soft anchors from July 2011. A follow-up of at least 2 years was conducted for 128 shoulders treated using metal anchors (metal anchor group) and 129 shoulders treated using soft anchors (soft anchor group). The frequency and features of new glenoid rim fractures were investigated, and the influence of the number of suture anchors and other factors on fractures was also assessed. RESULTS There were 19 shoulders (14.8%) with postoperative recurrence in the metal anchor group and 23 shoulders (17.8%) in the soft anchor group. Among 37 shoulders evaluated by CT at recurrence, a new glenoid rim fracture was detected in 13 shoulders (35.1%; 5 shoulders in the metal anchor group and 8 shoulders in the soft anchor group). A fracture at the anchor insertion site was recognized in 4 shoulders from the metal anchor group and 6 shoulders from the soft anchor group, although linear fractures connecting several anchor holes were only seen in the soft anchor group. While new glenoid fractures occurred regardless of the number of suture anchors used, new fractures were significantly more frequent in teenagers at surgery and in junior high school or high school athletes. Such fractures did not only occur in contact athletes but were also found in overhead athletes. CONCLUSION Postoperative recurrence of instability associated with a new glenoid rim fracture along the suture anchor insertion site was frequent after arthroscopic Bankart repair. These fractures might be related to placing multiple soft suture anchors in a linear arrangement.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Takehito Hirose
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Yuta Tachibana
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Ryo Iuchi
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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Nakagawa S, Mae T, Sato S, Okimura S, Kuroda M. Risk Factors for the Postoperative Recurrence of Instability After Arthroscopic Bankart Repair in Athletes. Orthop J Sports Med 2017; 5:2325967117726494. [PMID: 28959698 PMCID: PMC5593221 DOI: 10.1177/2325967117726494] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Several risk factors for the postoperative recurrence of instability after arthroscopic Bankart repair have been reported, but there have been few detailed investigations of the specific risk factors in relation to the type of sport. Purpose: This study investigated the postoperative recurrence of instability after arthroscopic Bankart repair without additional reinforcement procedures in competitive athletes, including athletes with a large glenoid defect. The purpose of this study was to investigate risk factors related to the postoperative recurrence of instability in athletes. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 115 athletes (123 shoulders) were classified into 5 groups according to type of sport: rugby (41 shoulders), American football (32 shoulders), other collision sports (18 shoulders), contact sports (15 shoulders), and overhead sports (17 shoulders). First, the recurrence rate in each sporting category was investigated, with 113 shoulders followed up for a minimum of 2 years. Then, factors related to postoperative recurrence were investigated in relation to the type of sport. Results: Postoperative recurrence of instability was noted in 23 of 113 shoulders (20.4%). The recurrence rate was 33.3% in rugby, 17.2% in American football, 11.1% in other collision sports, 14.3% in contact sports, and 12.5% in overhead sports. The most frequent cause of recurrence was tackling, and recurrence occurred with tackling in 12 of 16 athletes playing rugby or American football. Reoperation was completed in 11 shoulders. By univariate analysis, significant risk factors for postoperative recurrence of instability included playing rugby, age between 10 and 19 years at surgery, preoperative glenoid defect, small bone fragment of bony Bankart lesion, and capsular tear. However, by multivariate analysis, the most significant factor was not the type of sport but younger age at operation and a preoperative glenoid defect with small or no bone fragment. Compared with the other sports, there was a significantly greater recurrence rate among rugby players without the aforementioned significant risk factors (small glenoid defect, ≤10%; medium or large bone fragment, >5%; and no capsular tear). Conclusion: Younger age at operation and preoperative glenoid defect with small or no bone fragment significantly influenced recurrent instability among competitive athletes.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Seira Sato
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Shinichiro Okimura
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
| | - Miki Kuroda
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
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45
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Simpfendorfer CS, Schickendantz MS, Polster JM. The Shoulder: What is New and Evidence-Based in Orthopedic Sports Medicine. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0228-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Shoulder stability depends on the position of the arm as well as activities of the muscles around the shoulder. The capsulo-ligamentous structures are the main stabilisers with the arm at the end-range of movement, whereas negative intra-articular pressure and concavity-compression effect are the main stabilisers with the arm in the mid-range of movement. There are two types of glenoid bone loss: fragment type and erosion type. A bone loss of the humeral head, known as a Hill-Sachs lesion (HSL), is a compression fracture of the humeral head caused by the anterior rim of the glenoid when the humeral head is dislocated anteriorly in front of the glenoid. Four out of five patients with anterior instability have both Hill-Sachs and glenoid bone lesions, which is called a ‘bipolar lesion’. With the arm moving along the posterior end-range of movement, or with the arm in various degrees of abduction, maximum external rotation and maximum horizontal extension, the glenoid moves along the posterior articular margin of the humeral head. This contact zone of the glenoid with the humeral head is called the ‘glenoid track’. A HSL, which stays on the glenoid track (on-track lesion), cannot engage with the glenoid and cannot cause dislocation. On the other hand, a HSL, which is out of the glenoid track (off-track lesion), has a risk of engagement and dislocation. Clinical validation studies show that the ‘on-track/off-track’ concept is able to predict reliably the risk of a HSL being engaged with the glenoid. For off-track lesions, either remplissage or Latarjet procedure is indicated, depending upon the glenoid defect size and the risk of recurrence.
Cite this article: EFORT Open Rev 2017;2:343-351.
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Affiliation(s)
- E Itoi
- E. Itoi, Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
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47
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Nakagawa S, Mae T, Yoneda K, Kinugasa K, Nakamura H. Influence of Glenoid Defect Size and Bone Fragment Size on the Clinical Outcome After Arthroscopic Bankart Repair in Male Collision/Contact Athletes. Am J Sports Med 2017; 45:1967-1974. [PMID: 28426240 DOI: 10.1177/0363546517700864] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The usefulness of arthroscopic Bankart repair for collision/contact athletes has varied in previous reports. PURPOSE To investigate the influence of glenoid rim morphologic characteristics on the clinical outcome after arthroscopic Bankart repair without additional reinforcement procedures in male collision/contact athletes, including athletes with a large glenoid defect. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Eighty-six athletes (93 shoulders) followed for a minimum of 2 years were retrospectively investigated. The sports were rugby (36 shoulders), American football (29 shoulders), and other collision/contact sports (28 shoulders). Preoperative glenoid defect size, bone fragment size, and bone union after bony Bankart repair were investigated regarding factors influencing postoperative recurrence. Postoperative changes in glenoid defect size and bone fragment size were investigated as well as their influence on the clinical outcome. RESULTS Postoperative recurrence of instability was noted in 22 shoulders (23.7%). The recurrence rate was 33.3% in rugby, 17.2% in American football, and 17.9% in other collision/contact sports. The recurrence rate was only 7.1% in 28 shoulders without a preoperative glenoid defect, but it increased to 43.8% in 16 shoulders that did not have a bone fragment even though there was a preoperative glenoid defect. Additionally, the recurrence rate was 7.7% in 26 shoulders with bone union after arthroscopic bony Bankart repair but rose to 45% in 20 shoulders without bone union. In the shoulders with bone union, the mean bone fragment size increased from 8.2% preoperatively to 15.2% postoperatively, while the mean glenoid defect size decreased from 18.0% to 2.8%, respectively. The recurrence rate was 8.3% in shoulders with a final glenoid defect 5% or less versus 38.1% in shoulders with a defect greater than 5%. While the recurrence rate was low among athletes other than rugby players with a final defect of 10% or less, it was low in only the rugby players with a defect of 0%. CONCLUSION In male collision/contact athletes, while the overall clinical outcome was unsatisfactory, a favorable outcome was achieved in athletes without a preoperative glenoid defect and athletes with bone union. The glenoid defect decreased in size postoperatively due to remodeling of the united bone fragment, and the recurrence rate was low when the final glenoid defect size was 5% or less.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Kenji Yoneda
- Department of Orthopaedic Surgery, Moriguchi Keijinkai Hospital, Moriguchi, Osaka, Japan
| | - Kazutaka Kinugasa
- Department of Orthopaedic Surgery, Hoshigaoka Medical Center, Hirakata, Osaka, Japan
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Nakagawa S, Ozaki R, Take Y, Iuchi R, Mae T. Relationship Between Glenoid Defects and Hill-Sachs Lesions in Shoulders With Traumatic Anterior Instability. Am J Sports Med 2015; 43:2763-73. [PMID: 26316609 DOI: 10.1177/0363546515597668] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While the combination of a glenoid defect and a Hill-Sachs lesion in a shoulder with anterior instability has recently been termed a bipolar lesion, their relationship is unclear. PURPOSE To investigate the relationship of the glenoid defect and Hill-Sachs lesion and the factors that influence the occurrence of these lesions as well as the recurrence of instability. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS The prevalence and size of both lesions were evaluated retrospectively by computed tomography scanning in 153 shoulders before arthroscopic Bankart repair. First, the relationship of lesion prevalence and size was investigated. Then, factors influencing the occurrence of bipolar lesions were assessed. Finally, the influence of these lesions on recurrence of instability was investigated in 103 shoulders followed for a minimum of 2 years. RESULTS Bipolar lesions, isolated glenoid defects/isolated Hill-Sachs lesions, and no lesion were detected in 86, 45, and 22 shoulders (56.2%, 29.4%, and 14.4%), respectively. As the glenoid defect became larger, the Hill-Sachs lesion also increased in size. However, the size of these lesions showed a weak correlation, and large Hill-Sachs lesions did not always coexist with large glenoid defects. The prevalence of bipolar lesions was 33.3% in shoulders with primary instability and 61.8% in shoulders with recurrent instability. In relation to the total events of dislocations/subluxations, the prevalence was 44.2% in shoulders with 1 to 5 events, 69.0% in shoulders with 6 to 10 events, and 82.8% in shoulders with ≥11 events. Regarding the type of sport, the prevalence was 58.9% in athletes playing collision sports, 53.3% in athletes playing contact sports, and 29.4% in athletes playing overhead sports. Postoperative recurrence of instability was 0% in shoulders without lesions, 0% with isolated Hill-Sachs lesions, 8.3% with isolated glenoid defects, and 29.4% with bipolar lesions. The presence of a bipolar lesion significantly influenced the recurrence rate, but lesion size did not. CONCLUSION The prevalence of bipolar lesions was approximately 60%. As glenoid defects became larger, Hill-Sachs lesions also enlarged, but there was no strong correlation. Bipolar lesions were frequent in patients with recurrent instability, patients with repetitive dislocation/subluxation, and those playing collision/contact sports. Instability showed a high recurrence rate in shoulders with bipolar lesions.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Ritsuro Ozaki
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Yasuhiro Take
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ryo Iuchi
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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