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Castillo de la Peña J, Ma J, Wong I. Arthroscopic capsular shift from inferior to superior has an exceptional safety profile and short-term outcomes. J ISAKOS 2024; 9:314-318. [PMID: 38403194 DOI: 10.1016/j.jisako.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES Arthroscopic Bankart for anterior shoulder instability has a good safety profile but with a relatively high recurrence index. Open surgery has been used to decrease recurrence rates but with a higher complication rate. Arthroscopic capsular shift from inferior to superior (ACSIS) was designed to decrease the recurrence rates without the added morbidity of open surgery. METHODS An observational retrospective study was conducted to analyze perioperative complications and patient reported outcomes of patients treated with ACSIS to determine the safety profile of the procedure. The patients with anterior traumatic shoulder instability treated with ACSIS between January 2015 and December 2021 were included for the study. The analysis was conducted using SPSS (Version 27). The pre vs. postoperative Western Ontario Shoulder Instability Index scores were compared using a paired sample t-test or Wilcoxon signed ranks test depending on the results of the normality test and Levene's test. The significance level was 0.05 in all analyses. Thirty-six patients were included in this study, the mean age of the population is 30.8 ± 11.4 years, with a male dominance of 86.1% (N = 31), and a mean clinical follow-up of 2.7 ± 1.2 years. RESULTS No intraoperative complications, including bleeding or neurovascular injury, were noted. Additionally, no early postoperative complications, including infection or hospital readmission, were noted. During the follow-up, one patient (3%) had persistent apprehension. The mean Western Ontario Shoulder Instability index decreased from 66.6 ± 13.10% to 27.9 ± 22% postoperatively (P < 0.001). CONCLUSIONS ACSIS procedure is safe and has good short-term outcomes with a low recurrence rate at 1-year minimum follow-up. LEVEL OF EVIDENCE 3 (Observational study).
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Affiliation(s)
- Jose Castillo de la Peña
- Division of Orthopaedics, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, B3H 2E1, Canada
| | - Jie Ma
- Division of Orthopaedics, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, B3H 2E1, Canada
| | - Ivan Wong
- Division of Orthopaedics, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, B3H 2E1, Canada.
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2
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Hachem AI, Diaz-Apablaza E, Molina-Creixell A, Ruis X, Videla S, Luis Agulló J. Clinical Outcomes and Graft Resorption After Metal-Free Bone Block Suture Tape Cerclage Fixation for Recurrent Anterior Shoulder Instability: A Computed Tomography Analysis. Am J Sports Med 2024; 52:1472-1482. [PMID: 38590203 DOI: 10.1177/03635465241236179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Glenoid reconstruction with a bone block for anterior glenoid bone loss (GBL) has shown excellent outcomes. However, fixation techniques that require metal implants are associated with metal-related complications and bone graft resorption. HYPOTHESIS Arthroscopic glenoid reconstruction using a tricortical iliac crest bone graft (ICBG) and metal-free suture tape cerclage fixation can safely and effectively restore the glenoid surface area in patients with recurrent anterior shoulder instability and anterior GBL. STUDY DESIGN Case series; Level of evidence, 4. METHODS Adult patients (≥18 years) of both sexes with recurrent anterior shoulder instability and anterior GBL ≥15% were enrolled. These patients underwent arthroscopic glenoid reconstruction with ICBGs and metal-free suture tape cerclage fixation. The effectiveness and clinical outcomes with this technique were evaluated at 24 months using functional scores. Resorption of the graft articular surface was assessed by computed tomography, with the graft surface divided into 6 square areas aligned in 2 columns. Descriptive analysis was conducted. RESULTS A total of 23 consecutive patients met inclusion criteria (22 male, 1 female; mean age, 30.5 ± 7.9 years). The mean preoperative GBL was 19.7% ± 3.4%, and there were 15 allograft and 8 autograft ICBGs. All patients exhibited graft union at 3 months. The median follow-up was 38.5 months (interquartile range, 24-45 months). The Western Ontario Shoulder Instability Index, Rowe, Constant-Murley, and Subjective Shoulder Value scores improved from preoperatively (35.1%, 24.8, 83.1, and 30.9, respectively) to postoperatively (84.7%, 91.1, 96.0, and 90.9, respectively) (P < .001). No differences in clinical scores were observed between the graft types. One surgical wound infection was reported, and 2 patients (8.7% [95% CI, 2.4%-26.8%]) required a reoperation. The mean overall glenoid surface area increased from 80.3% ± 3.5% to 117.0% ± 8.3% immediately after surgery before subsequently reducing to 98.7% ± 6.2% and 95.0% ± 5.7% at 12 and 24 months, respectively (P < .001). The mean graft resorption rate was 18.1% ± 7.9% in the inner column and 80.3% ± 22.4% in the outer column. Additionally, 3 patients treated with an allograft (20.0% [95% CI, 7.1%-45.2%]), including the 2 with clinical failures, exhibited complete graft resorption at the last follow-up. CONCLUSION Arthroscopic glenoid reconstruction using an ICBG and metal-free suture tape cerclage fixation was safe and effective, yielding excellent clinical outcomes. Resorption of the graft articular surface predominantly affected the nonloaded areas beyond the best-fit circle perimeter.
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Affiliation(s)
- Abdul-Ilah Hachem
- Department of Orthopaedic Surgery and Traumatology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | | | | | - Xavi Ruis
- Department of Orthopaedic Surgery and Traumatology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sebastian Videla
- Clinical Research Support Unit, Department of Clinical Pharmacology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Jose Luis Agulló
- Department of Orthopaedic Surgery and Traumatology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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Stambaugh JR, Bryan TP, Edmonds EW, Pennock AT. Arthroscopic Shoulder Stabilization in High School Football Players. Orthop J Sports Med 2024; 12:23259671241239334. [PMID: 38584991 PMCID: PMC10998486 DOI: 10.1177/23259671241239334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 04/09/2024] Open
Abstract
Background Destabilizing shoulder injuries are common in high school American football players; however, the rate of recurrent glenohumeral instability and return to play after arthroscopic labral stabilization surgery remains unknown. Purpose/Hypothesis The purpose of this study was to determine the rate of recurrent instability on return to competitive high school football after arthroscopic shoulder labral stabilization and capsulorrhaphy procedures. It was hypothesized that the instability rate would be greater in players with more years of eligibility remaining (YER) to play at the high school level. Study Design Case series; Level of evidence, 4. Methods Consecutive male high school football players with at least 1 YER who sustained at least 1 anterior traumatic inseason shoulder instability episode and underwent arthroscopic stabilization between 2012 and 2017 were identified. Patients and/or families were contacted by phone to discuss (1) recurrent instability episodes and (2) return to competitive sport and/or recreational athletic activity. Statistical analysis was conducted using chi-square tests to compare recurrent shoulder instability with return to play and YER. Results A total of 45 football players aged 14 to 17 years were included, with a mean follow-up of 4.1 years. Most patients (60%) chose not to return to competitive football, due mainly to fear of recurrent injury. Overall, the recurrent instability rate was 15.6% (7/45). The instability rate in players who returned to football was 16.7%, with 66.7% requiring revision surgery. The instability rate in patients who did not return to football was 14.8%, with no revision procedures required. In players who returned to football, the instability rate in YER group 4 was significantly higher than that in YER groups 1 to 3 (42% vs 10.5%, respectively, P = .03), with each year of play conferring an additional 10% risk of reinjury. There was a significant difference in the type of recurrent instability in players who returned to any sport versus those who did not (P = .029). Conclusion High school football players who returned to competitive play after arthroscopic shoulder stabilization surgery experienced a higher rate of recurrent instability that was dependent on their YER. Over half of the players chose not to return to football, with fear of reinjury being the most common reason.
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Affiliation(s)
- Jessica R. Stambaugh
- Department of Orthopedic Surgery, Naval Medical Center, San Diego, California, USA
| | - Tracey P. Bryan
- Department of Orthopedic Surgery, Rady Children’s Hospital, San Diego, California, USA
| | - Eric W. Edmonds
- Department of Orthopedic Surgery, Rady Children’s Hospital, San Diego, California, USA
| | - Andrew T. Pennock
- Department of Orthopedic Surgery, Rady Children’s Hospital, San Diego, California, USA
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Gao A, Song Q, Shao Z, Pan H, Cui G. Inlay structure can improve bone graft stability in the Bristow procedure. J Shoulder Elbow Surg 2024; 33:781-791. [PMID: 37778656 DOI: 10.1016/j.jse.2023.08.023] [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: 05/19/2023] [Revised: 08/09/2023] [Accepted: 08/27/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Compared with the Latarjet procedure, the Bristow procedure has a lower screw-related complication rate but poor bone healing. A modified Inlay Bristow procedure has been reported to significantly improve the bone healing rate, but the biomechanical mechanism is unclear. The aim of this study was to evaluate the biomechanical stability of the bone graft between a modified Inlay Bristow procedure and the classic Bristow procedure. METHODS Sixteen left scapula models (Sawbones, Composite Scapula, and fourth generation) were randomly divided into 2 groups (8:8). The bone graft in the first group was fixed with a 3.5 mm screw using the Inlay structure. The bone graft in the second group was fixed with a 3.5 mm screw via the traditional method. The maximum cyclic displacement, ultimate failure load and stiffness were evaluated biomechanically. The failure type was recorded for each model. RESULTS Cyclic loading tests demonstrated that the maximum cyclic displacement of the Inlay procedure was significantly smaller (P = .001) than that of the classic procedure. The Inlay Bristow technique resulted in a significantly higher (P = .024) ultimate failure load than the classic Bristow technique. The stiffness of the classic group was 19.17 ± 4.01 N/mm and that of the inlay group was 22.34 ± 5.35 N/mm (P = .232). Failure was mainly due to bone graft fractures through the drill hole or glenoid bone fractures. CONCLUSION Inlay Bristow fixation of the bone graft in a Sawbones model provides significantly stronger fixation and better time point zero stability than classic Bristow fixation, suggesting a higher likelihood of graft union.
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Affiliation(s)
- Aofei Gao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China; The 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Qingfa Song
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Zhenxing Shao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
| | - Haile Pan
- The 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.
| | - Guoqing Cui
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
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Bauer S, Neyton L, Collin P, Zumstein M. The open Latarjet-Patte procedure for the treatment of anterior shoulder instability in professional handball players at a mean follow-up of 6.6 years. J Shoulder Elbow Surg 2024; 33:924-931. [PMID: 37648015 DOI: 10.1016/j.jse.2023.07.029] [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: 01/28/2023] [Revised: 07/12/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND The popularity of team handball is increasing, with >10 million children playing this overhead throwing and collision sport with highest demands on the shoulder joint. Because of the risk of recurrent instability, the Latarjet-Patte (LP) procedure has been recommended to treat young competitive players. This is the first LP outcome study in professional handball players. METHODS We retrospectively included 20 shoulders (18 players [17 male patients]; mean age, 22.9 years [range, 17-35 years]; minimum follow-up period, 2 years; mean follow-up period, 6.6 years) operated on by 3 expert surgeons (2011-2020) with the Walch LP technique. We documented preoperative hyperlaxity (25%, n = 5), affected throwing arm (55%, n = 11), position (backcourt, winger, and goalkeeper, 22% each; full back and pivot, 17% each), >2 dislocations prior (20%, n = 4), >10 dislocations prior (5%, n = 1), previous failed Bankart or humeral avulsion of glenohumeral ligament (HAGL) repair (10%, n = 2), and large Hill-Sachs lesions (HSLs) (20%, n = 4). Clinical and radiographic outcomes, visual analog scale score, Subjective Shoulder Value, Walch-Duplay score, Rowe score, and return-to-sport (RTS) rate were recorded. RESULTS The RTS rate was 85% (17 of 20 shoulders); rate of RTS at the same level, 80% (16 of 20); and rate of RTS with no throwing pain, 73% (8 of 11). The time to training with a ball was 3.2 months, and the time to competition was 4.9 months. The mean Rowe score, Walch-Duplay score, and Subjective Shoulder Value were 90 points, 88 points, and 89%, respectively. Shoulder symptoms led players to give up handball in 2 cases (10%), whereas 1 player (5%) stopped playing handball for other reasons. We recorded 1 recurrent dislocation (5%) (non-throwing arm, winger, no recurrence after rehabilitation). Persistent apprehension occurred in 1 goalkeeper (5%). Residual pain was seen in 4 shoulders (20%); this was relieved by screw removal in 1. Resistant pain (throwing shoulder) was seen in 2 backcourt players (10%, 1 of whom had a large HSL) and 1 goalkeeper (5%; large HSL with >10 dislocations prior), all 3 of whom were aged > 30 years. Bone block positioning was correct (no lateral overhang) in all shoulders. At final follow-up, 1 shoulder (5%) showed mild arthritic changes (>10 dislocations, large HSL). CONCLUSION The open LP procedure is consistent in providing shoulder stability combined with return-to-throwing performance in professional handball players with a short time to RTS and high same-level RTS rate without increasing the risk of arthritic changes. Throwing shoulders of backcourt players, large HSLs, or age > 30 years may have an increased risk of persistent symptoms.
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Affiliation(s)
- Stefan Bauer
- Shoulder Surgery and Upper Limb Center, Ensemble Hospitalier de la Côte, Morges, Switzerland; School of Surgery, University of Western Australia, Perth, Australia.
| | - Lionel Neyton
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Philippe Collin
- Orthopedics and Traumatology, American Hospital of Paris, Neuilly-sur-Seine, France; Shoulder Surgery, Clinique Victor Hugo, Paris, France
| | - Matthias Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopädie Sonnenhof, Bern, Switzerland; Shoulder, Elbow Unit, SportsClinic#1, Bern, Switzerland
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Wang L, He S, Wu X, Lv X, Wang T, Tan H. Efficacy and safety of the Latarjet procedure for the treatment of athletes with glenoid bone defects ≥ 20%: a single-arm meta-analysis. J Orthop Surg Res 2024; 19:159. [PMID: 38429849 PMCID: PMC10908040 DOI: 10.1186/s13018-024-04641-y] [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: 12/27/2023] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND The shoulder joint is the most commonly dislocated joint in the human body, and the recurrence rate exceeds 50% after nonsurgical treatment. Although surgical treatment reduces the recurrence rate, there is controversy regarding the optimal surgical approach. Previous studies suggest that the Latarjet procedure yields favourable outcomes for specific populations at risk of recurrence, such as competitive athletes with significant glenoid defects. However, most of the existing related research consists of nonrandomized controlled trials with small sample sizes, and there is a lack of strong evidence regarding the efficacy and safety of the Latarjet procedure. METHODS The PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched. Athletes with ≥ 20% glenoid defects were selected for inclusion. The following data were extracted: general patient information, instability rates, return to sports (RTS) rates, imaging features (graft positioning rate and graft healing rate), functional assessments [Rowe score, Athletic Shoulder Outcome Scoring System(ASOSS), visual analogue scale (VAS), forward flexion function, and external rotation function], and complications. RESULTS After excluding suspected duplicate cases, a total of 5 studies were included in this meta-analysis. The studies involved a total of 255 patients, including 237 males (93%) and 18 females (7%). The average age at the time of surgery was 25.4 ± 8.5 years. All the studies had a minimum follow-up period of 2 years, with an average follow-up time of 48.7 ± 18.9 months. The pooled rate of return to sport (RTS) was 94.3% (95% CI: 87.3%, 98.8%), and 86.1% (95% CI: 78.2%, 92.5%) of patients returned to their preoperative level of activity. The pooled redislocation rate was 1.1% (95% CI: 0%, 3.8%). Regarding the imaging results, the combined graft retention rate was 92.1% (95% CI: 88.1%, 95.5%), and the graft healing rate was 92.1% (95% CI: 88%, 95.4%). Postoperative functional evaluation revealed that the combined Rowe score, ASOSS score, and VAS score were 93.7 ± 6.5 points, 88.5 ± 4.4 points, and 1.1 ± 10 points, respectively. The forward flexion and external rotation angles were 170.9 ± 6.9 degrees and 65.6 ± 4.5 degrees, respectively. After excluding one study with unclear complications, the combined complication rate was 9.4% (95% CI: 1.0%, 23.6%). CONCLUSION For athletes with shoulder instability and a total of ≥ 20% glenoid bone defects, the Latarjet procedure can achieve excellent functional outcomes, with the majority of patients returning to preoperative levels of sports activity. This procedure also leads to a low recurrence rate. Therefore, the Latarjet procedure has been proven to be a safe and effective treatment.
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Affiliation(s)
- Ling Wang
- People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming, 650100, China
| | - ShengRong He
- The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital/Yunnan Cancer Center), Kunming, 650100, China
| | - Xia Wu
- The Third People's Hospital of Kunming, Kunming, 650041, China
| | - XiaoYu Lv
- People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming, 650100, China
| | - Tao Wang
- People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming, 650100, China
| | - HongBo Tan
- People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming, 650100, China.
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Pasqualini I, Rossi LA, Franco JVA, Denard PJ, Fieiras C, Escobar Liquitay C, Tanoira I, Ranalletta M. Results After Arthroscopic Bankart Repair in Contact Athletes Should Not Be Reported Globally Because of the High Variability in Recurrences Among the Different Contact or Collision Sports: A Systematic Review. Arthroscopy 2024; 40:523-539.e2. [PMID: 37394151 DOI: 10.1016/j.arthro.2023.06.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 06/07/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To describe and compare the recurrence rates in contact or collision (CC) sports after arthroscopic Bankart repair (ABR) and to compare the recurrence rates in CC versus non-collision athletes after ABR. METHODS We followed a prespecified protocol registered with PROSPERO (registration No. CRD42022299853). In January 2022, a literature search was performed using the electronic databases MEDLINE, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials), as well as clinical trials records. Clinical studies (Level I-IV evidence) that evaluated recurrence after ABR in CC athletes with a minimum follow-up period of 2 years postoperatively were included. We assessed the quality of the studies using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool, and we described the range of effects using synthesis without meta-analysis and described the certainty of the evidence using GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). RESULTS We identified 35 studies, which included 2,591 athletes. The studies had heterogeneous definitions of recurrence and classifications of sports. The recurrence rates after ABR varied significantly among studies between 3% and 51% (I2 = 84.9%, 35 studies and 2,591 participants). The range was at the higher end for participants younger than 20 years (range, 11%-51%; I2 = 81.7%) compared with older participants (range, 3%-30%; I2 = 54.7%). The recurrence rates also varied by recurrence definition (I2 = 83.3%) and within and across categories of CC sports (I2 = 83.8%). CC athletes had higher recurrence rates than did non-collision athletes (7%-29% vs 0%-14%; I2 = 29.2%; 12 studies with 612 participants). Overall, the risk of bias of all the included studies was determined to be moderate. The certainty of the evidence was low owing to study design (Level III-IV evidence), study limitations, and inconsistency. CONCLUSIONS There was high variability in the recurrence rates reported after ABR according to the different types of CC sports, ranging from 3% to 51%. Moreover, variations in recurrence among CC sports were observed, with ice hockey players being in the upper range but field hockey players being in the lower range. Finally, CC athletes showed higher recurrence rates when compared with non-collision athletes. LEVEL OF EVIDENCE Level IV, systematic review of Level II, III, and IV studies.
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Affiliation(s)
- Ignacio Pasqualini
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Luciano Andrés Rossi
- Shoulder Unit, Department of Orthopedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Juan Victor Ariel Franco
- Institute of General Practice, Medical Faculty of the Heinrich-Heine - University Dusseldorf, Dusseldorf, Germany
| | | | - Cecilia Fieiras
- Shoulder Unit, Department of Orthopedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Ignacio Tanoira
- Shoulder Unit, Department of Orthopedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano Ranalletta
- Shoulder Unit, Department of Orthopedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Hurley ET, Danilkowicz RM, Paul AV, Myers H, Anakwenze OA, Klifto CS, Lau BC, Taylor DC, Dickens JF. Majority of Studies Show Similar Rates of Return to Play After Arthroscopic Bankart Repair or Latarjet Procedure: A Systematic Review. Arthroscopy 2024; 40:515-522. [PMID: 37146663 DOI: 10.1016/j.arthro.2023.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE To systematically review the current evidence in the literature to compare return to play following arthroscopic Bankart repair versus open Latarjet procedure for the treatment of anterior shoulder instability. METHODS A literature search was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comparative studies reporting return to play following arthroscopic Bankart repair versus open Latarjet procedure were included. Return to play was compared, with all statistical analysis performed using Review Manager, Version 5.3. RESULTS Nine studies with 1,242 patients (mean age: 15-30 years) were included. The rate of return to play was 61% to 94.1% among those undergoing arthroscopic Bankart repair and 72% to 96.8% in those undergoing an open Latarjet procedure. Two studies (Bessiere et al. and Zimmerman et al.) found a significant difference in favor of the Latarjet procedure (P < .05 for both, I2 = 37%). The rate of return to play at preinjury level was 9% to 83.8% among those undergoing arthroscopic Bankart repair and 19.4% to 80.6% in those undergoing an open Latarjet procedure, with no study finding a significant difference (P > .05 for all, I2 = 0%). The mean time of return to play was 5.4 to 7.3 months among those undergoing arthroscopic Bankart repair and 5.5 to 6.2 months in those undergoing an open Latarjet procedure, with no study finding a significant difference (P > .05 for all, I2 = 39%). CONCLUSIONS Overall, the majority of studies showed no significant difference in rates of return to play or timing following arthroscopic Bankart repair or open Latarjet procedure. Furthermore, no study has found a significant difference in rate of return to play at pre-injury level, or rate of return to play among collision athletes. LEVEL OF EVIDENCE Level III, systematic review of Level I-III studies.
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Affiliation(s)
- Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A..
| | | | - Alexandra V Paul
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Heather Myers
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Dean C Taylor
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A
| | - Jonathan F Dickens
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A.; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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9
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Shin SJ, Kim JH, Ahn J. Arthroscopic Latarjet procedure: current concepts and surgical techniques. Clin Shoulder Elb 2023; 26:445-454. [PMID: 37442776 DOI: 10.5397/cise.2022.01396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/25/2023] [Indexed: 07/15/2023] Open
Abstract
The Latarjet procedure is a surgical procedure that can effectively restore glenohumeral stability, especially in patients with anterior shoulder instability and glenoid bone loss. Many studies have shown comparable clinical outcomes between patients undergoing the arthroscopic Latarjet procedure and those undergoing traditional open methods or other glenohumeral joint stabilization procedures. However, the arthroscopic Latarjet procedure is a challenging technique due to the unfamiliar portal placements, proximity of neurovascular structures, and serious postoperative complications. The arthroscopic Latarjet procedure has not yet been widely applied, and a clear understanding of the anatomical structure and the precise methods is required prior to operation performance. Satisfactory clinical outcomes can be achieved by thorough preoperative planning and proper implant fixation methods.
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Affiliation(s)
- Sang-Jin Shin
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jae Hyung Kim
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jonghyun Ahn
- Department of Orthopedic Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
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10
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Min KS, Horng J, Cruz C, Ahn HJ, Patzkowski J. Glenoid Bone Loss in Recurrent Shoulder Instability After Arthroscopic Bankart Repair: A Systematic Review. J Bone Joint Surg Am 2023; 105:1815-1821. [PMID: 37643239 DOI: 10.2106/jbjs.23.00388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Glenoid bone loss has been reported to occur in as many as 86% of patients with recurrent shoulder stability. This systematic review evaluated the amount of glenoid bone loss associated with recurrent shoulder dislocation or subluxation and with worse patient-reported outcomes after arthroscopic Bankart repair. We hypothesized that the percentage of glenoid bone loss associated with recurrent instability after arthroscopic Bankart repair is lower than the previously proposed critical value of 25%. METHODS The systematic review included 528 patients with glenoid bone loss from 3 clinical studies. The percentage of bone loss was the value quantified and reported in each study. Failure was defined as recurrent dislocation or subluxation. The percentage of glenoid bone loss associated with recurrent shoulder dislocation or subluxation after arthroscopic Bankart labral repair was analyzed with receiver operating characteristic (ROC) curve analysis. RESULTS Recurrent dislocation or subluxation occurred in 23.7% (125) of 528 patients in the pooled study cohort. There was a significant difference in age between those in whom the arthroscopic Bankart repair failed and those in whom it did not (22.9 versus 24.3 years; p = 0.009). The ROC curve analysis demonstrated that ≥16.0% glenoid bone loss was predictive of recurrent shoulder dislocation or subluxation (Youden index = 0.59, sensitivity = 80%, specificity = 80%). In patients who did not sustain a recurrent dislocation or subluxation, the ROC curve analysis demonstrated that 20.0% glenoid bone loss was predictive of a Single Assessment Numeric Evaluation (SANE) score of <85% (Youden index = 0.93, sensitivity = 93%, specificity = 100%). CONCLUSIONS The critical amount of glenoid bone loss associated with an increased risk of persistent instability was found to be less than previously reported. Glenoid bone loss of ≥16.0% was found to place patients at higher risk for recurrent shoulder dislocation or subluxation after treatment with arthroscopic Bankart repair alone. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kyong S Min
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii
- Uniformed Services University, Bethesda, Maryland
- John A. Burns School of Medicine, Honolulu, Hawaii
| | | | - Christian Cruz
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii
| | | | - Jeanne Patzkowski
- Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, Texas
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Song Q, Zhang S, Bai J, Cheng X, Luo H, Shao Z, Cui G. Previously failed Bankart repair and the duration from first dislocation to surgery were the risk factors associated with the level of return to sports after coracoid transfer. Knee Surg Sports Traumatol Arthrosc 2023; 31:4052-4059. [PMID: 37212830 DOI: 10.1007/s00167-023-07453-5] [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: 06/25/2022] [Accepted: 05/10/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE This study aims to determine the rate of different levels of return to sports (RTS) in athletes undergoing the modified arthroscopic Bristow procedure and the factors associated with the level of RTS. METHODS The study was performed retrospectively on patients with traumatic anterior shoulder instability who underwent the modified arthroscopic Bristow procedure with a minimum follow-up of 2 years. The RTS rate, the level of return and the timing of return were assessed. Additionally, factors such as preoperative basic information, clinical outcomes, graft position, graft healing and graft absorption were analysed to investigate their correlation with the level of RTS. Multivariate regression models were used to evaluate the factors affecting the level of RTS. RESULTS In total, this study included 182 shoulders of 177 athletes undergoing the modified arthroscopic Bristow procedure. Of these patients, 142 (78.0%) shoulders of 137 athletes were enrolled, with a mean of 3.3-year follow-up. At the final follow-up, 134 (94.4%) shoulders were able to RTS, 123 (86.6%) shoulders were able to RTS to the pre-injury level, 52 (36.6%) shoulders could be completely "forgotten" without any psychological barrier during exercise. The multivariate logistic regression analysis identified the variable associated with RTS at the pre-injury level as previously failed arthroscopic Bankart repair (p < 0.001). As for the "forgetting" operated shoulder, the duration from first dislocation to surgery was a significant independent predictor (p = 0.034). CONCLUSION Although a large majority of athletes were able to RTS at the pre-injury level after the modified arthroscopic Bristow procedure, about two-thirds of the athletes felt difference in shoulders on both sides and could not completely "forget" the operated shoulder during exercise. Previously failed Bankart repair and the duration from first dislocation to surgery were the risk factors associated with the level of RTS after the modified arthroscopic Bristow procedure. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Qingfa Song
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Shuhan Zhang
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Jucheng Bai
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Xu Cheng
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Hao Luo
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Zhenxing Shao
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
| | - Guoqing Cui
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
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Abdel-Mordy Kandeel A. Intra-articular soft arthroscopic Latarjet technique as a Bankart-plus procedure for type V superior labrum anterior-posterior lesion: lower rate of instability recurrence and better functional outcomes of a prospective cohort study. J Shoulder Elbow Surg 2023; 32:1838-1849. [PMID: 36907315 DOI: 10.1016/j.jse.2023.01.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Intra-articular soft arthroscopic Latarjet technique (in-SALT) involves augmentation of arthroscopic Bankart repair (ABR) with soft tissue tenodesis of long head of biceps to upper subscapularis. This study was conducted to investigate superiority of outcomes of in-SALT-augmented ABR over those of concurrent ABR and anterosuperior labral repair (ASL-R) in management of type V superior labrum anterior-posterior (SLAP) lesion. METHODS This prospective cohort study (conducted between January 2015 and January 2022) included 53 patients with arthroscopic diagnosis of type V SLAP lesion. Patients were allocated into 2 consecutive groups: group A of 19 patients managed with concurrent ABR/ASL-R and group B of 34 patients managed with in-SALT-augmented ABR. Outcome measurements included 2-year postoperative pain, range of motion, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and Rowe instability scores. Failure was defined as frank/subtle postoperative recurrence of glenohumeral instability or objective diagnosis of Popeye deformity. RESULTS The statistically matched studied groups showed significant postoperative improvement in outcome measurements. However, group B demonstrated significantly better 3-month postoperative visual analog scale score (3.6 vs. 2.6, P = .006) and 24-month postoperative external rotation at 0° abduction (44° vs. 50°, P = .020) and ASES (84 vs. 92, P < .001) and Rowe (83 vs. 88, P = .032) scores. Rate of postoperative recurrence of glenohumeral instability was relatively lower in group B (10.5% vs. 2.9%, P = .290). No Popeye deformity was reported. CONCLUSION For management of type V SLAP lesion, in-SALT-augmented ABR yielded a relatively lower rate of postoperative recurrence of glenohumeral instability and significantly better functional outcomes compared with concurrent ABR/ASL-R. However, currently reported favorable outcomes of in-SALT should be validated via further biomechanical and clinical studies.
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13
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Billaud A, Garcia-Maya B, Pesquer L, Pillot S. Outcomes After Open Latarjet in Patients With or Without SLAP Lesions. Orthop J Sports Med 2023; 11:23259671231185199. [PMID: 37533499 PMCID: PMC10392464 DOI: 10.1177/23259671231185199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/13/2023] [Indexed: 08/04/2023] Open
Abstract
Background Up to 20% of shoulders with anterior instability are associated with superior labrum anterior-posterior (SLAP) lesions, and they remain untreated after an open Latarjet procedure. SLAP lesions can be responsible for pain and feelings of instability in high-demand patients. Purpose/Hypothesis The aim of this study was to compare the early functional outcomes and return to sport rates in athletes after the Latarjet procedure with versus without associated SLAP lesions. It was hypothesized that untreated SLAP lesions would not influence clinical results. Study Design Cohort study; Level of evidence, 3. Methods Inclusion criteria were athletes with anterior shoulder instability treated with Latarjet procedure, a minimum follow-up of 1 year, and an available preoperative computed tomography arthrogram. We recorded patient characteristics; type of sport; bone loss; Rowe, Single Assessment Numeric Evaluation (SANE), and 11-item Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores; 5-point pain and satisfaction scores; reported apprehension; and return to sport. Patients with and without a preoperative type 5 SLAP lesion on imaging were compared. Results Fifty patients were included (mean age, 22 ± 5 years [range, 16-36 years]; mean follow-up, 27 ± 9 months [range, 12-42 months]). Thirty-four patients practiced contact sports, including 20 rugby players. Twelve patients (24%) had a preoperative SLAP lesion. Groups with (+) and without (-) a SLAP lesion were comparable in terms of age, sex, number of instability episodes, type of sport, and glenoid and humeral bone loss. The SLAP+ group had significantly worse outcomes with a lower Rowe score (79 ± 23 vs 91 ± 15; P = .018) and painless rate (50% vs 77%; P = .04). There were no significant differences between the groups in SANE score (SLAP+ vs SLAP-: 80% vs 87%), QuickDASH score (8% vs 8%), return to sport (83% vs 91%), apprehension (79% vs 50%), and reported satisfaction. There was 1 episode of postoperative subluxation in each group. Conclusion Patients who underwent an open Latarjet procedure with an associated SLAP tear more frequently reported postoperative pain than those without a SLAP lesion. Patients with untreated SLAP tears had significantly lower Rowe scores, although SANE score and return to sport were not significantly different between the groups.
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14
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Genena A, Hashem M, Waly A, Hegazy MO. Open Latarjet Versus Arthroscopic Bankart Repair for the Treatment of Traumatic Anterior Shoulder Instability in High-Demand Patients With Minimal Glenoid Bone Loss. Cureus 2023; 15:e37127. [PMID: 37168209 PMCID: PMC10166300 DOI: 10.7759/cureus.37127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND This study compared the clinical outcomes and return to sports/work between open Latarjet and arthroscopic Bankart repair in high-demand patients with traumatic anterior shoulder instability with minimal glenoid bone loss. METHODS We prospectively recruited 30 patients and randomised them to either open Latarjet or arthroscopic Bankart. The mean duration of follow-up in our study was 13.27 months±2.70. All patients were males with a mean age at surgery of 28.6 years (range, 18-41 years). RESULTS The overall mean for the Rowe score in the 30 patients increased from 33.5±14 points preoperatively to 79.6±18 points. However, there was no statistically significant difference in the postoperative ROM (range of motion) and Rowe score among the Bankart and Latarjet groups. The main finding in our study was the time to return to sports/work which was significantly lower in the Latarjet group (5.2 months) compared to the Bankart group (seven months). CONCLUSIONS Open Latarjet is considered a more invasive and non-anatomical procedure, however, it is less costly with a shorter time to return to sports/work compared to the Bankart procedure, which is very crucial for high-demand patients, especially the competitive athletes targeting an early return to sports at the same pre-injury level with minimal incidence of recurrence, making the surgeon's choice very challenging.
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15
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Kim D, Lee DW, Lee J, Jang Y. Latarjet procedure without capsular repair produces favorable clinical results and avoids limitation in external rotation. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07393-0. [PMID: 36951982 DOI: 10.1007/s00167-023-07393-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE This study aimed at analyzing the range of motion (ROM) and other clinical outcomes in patients with > 20% glenoid bone loss who underwent the Latarjet procedure with or without anterior capsule repair. METHODS This retrospective study included 47 patients with > 20% glenoid bone loss who underwent the classic Latarjet procedure from 2016 to 2021. Of these, 25 did not undergo capsular repair (no-capsular-repair group; group I) whereas 22 patients did (capsular-repair group; group II). The Rowe score, American Shoulder and Elbow Surgeons score, Visual Analogue Scale, ROM, recurrence, and complications were evaluated before and 3, 6, and 12 months after the surgery. A goniometer was used to measure the forward flexion and external rotation (arm adducted, 90° abducted) of both shoulders. The ROM deficit was measured as the difference from the contralateral healthy shoulder. RESULTS The external rotation in arm adduction at 3 and 6 months after surgery showed significantly better results in group I than group II(p = 0.002 at 3 months; p = 0.005 at 6 months). The deficit in external rotation with arm adduction was also significantly lower in group I at 3 months (p = 0.001) and 6 months (p = 0.001) after surgery. However, external rotation with arm adduction at 12 months after surgery did not significantly differ between the groups. Moreover, the ROM in external rotation with 90° arm abduction was significantly better in group I than that in group II at 3, 6, and 12 months postoperatively (p = 0.002, p = 0.001, and p = 0.005, respectively). The deficit in external rotation with 90° arm abduction gradually decreased with time after surgery and differed significantly between the groups. However, the difference in deficit between the two groups at 12 months after surgery did not exceed the measurement error. All clinical scores significantly improved after surgery compared to before surgery; however, the improvement did not significantly differ between the two groups. CONCLUSION The Latarjet procedure without capsular repair showed good laxity restoration and clinical results with less early postoperative external rotation limitation than that achieved by the same procedure with capsular repair. However, external rotation deficit at 1 year after surgery did not show a clinically relevant difference difference between the two groups. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- DooSup Kim
- Department of and Orthopedic Surgery, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, 20 Ilsan-Ro, Wonju, 26426, Republic of Korea
- Yonsei Institute of Sports Science and Exercise Medicine, Wonju, Korea
| | - Dong-Woo Lee
- Department of and Orthopedics, Hanil General Hospital, Seoul, Republic of Korea
| | - JaeMin Lee
- Department of and Orthopedic Surgery, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, 20 Ilsan-Ro, Wonju, 26426, Republic of Korea
| | - YoungHwan Jang
- Department of and Orthopedic Surgery, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, 20 Ilsan-Ro, Wonju, 26426, Republic of Korea.
- Yonsei Institute of Sports Science and Exercise Medicine, Wonju, Korea.
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16
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Makaram NS, Nicholson JA, Yapp LZ, Gillespie M, Shah CP, Robinson CM. Factors affecting a patient's experience following the open Latarjet procedure to treat recurrent anterior shoulder instability. Bone Joint J 2023; 105-B:389-399. [PMID: 36924182 DOI: 10.1302/0301-620x.105b4.bjj-2022-1049.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
The open Latarjet procedure is a widely used treatment for recurrent anterior instability of the shoulder. Although satisfactory outcomes are reported, factors which influence a patient's experience are poorly quantified. The aim of this study was to evaluate the effect of a range of demographic factors and measures of the severity of instability on patient-reported outcome measures in patients who underwent an open Latarjet procedure at a minimum follow-up of two years. A total of 350 patients with anterior instability of the shoulder who underwent an open Latarjet procedure between 2005 and 2018 were reviewed prospectively, with the collection of demographic and psychosocial data, preoperative CT, and complications during follow-up of two years. The primary outcome measure was the Western Ontario Shoulder Instability Index (WOSI), assessed preoperatively, at two years postoperatively, and at mid-term follow-up at a mean of 50.6 months (SD 24.8) postoperatively. The secondary outcome measure was the abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. The influence of the demographic details of the patients, measurements of the severity of instability, and the complications of surgery were assessed in a multivariate analysis. The mean age of the patients was 25.5 years (22 to 32) and 27 (7.7%) were female. The median time to surgery after injury was 19 months (interquartile range (IQR) 13 to 39). Seven patients developed clinically significant complications requiring further intervention within two years of surgery. The median percentage WOSI deficiency was 8.0% (IQR 4 to 20) and median QuickDASH was 3.0 (IQR 0 to 9) at mid-term assessment. A minority of patients reported a poorer experience, and 22 (6.3%) had a > 50% deficiency in WOSI score. Multivariate analysis revealed that consumption of ≥ 20 units of alcohol/week, a pre-existing affective disorder or epilepsy, medicolegal litigation, increasing time to surgery, and residing in a more socioeconomically deprived area were independently predictive of a poorer WOSI score. Although most patients treated by an open Latarjet procedure have excellent outcomes at mid-term follow-up, a minority have poorer outcomes, which are mainly predictable from pre-existing demographic factors, rather than measures of the severity of instability.
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Affiliation(s)
- Navnit S Makaram
- Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
| | - Jamie A Nicholson
- Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
| | - Liam Z Yapp
- Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Matthew Gillespie
- Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - C M Robinson
- Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Edinburgh, UK
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17
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Rogowski I, Nové-Josserand L, Godenèche A, Colotte P, Franger G, Vigne G, Vieira TD, Blache Y, Neyton L. Functional Deficits After Open Latarjet Procedure and Dominance of the Operated Shoulder: An Analysis of 133 Patients. Am J Sports Med 2023; 51:1277-1285. [PMID: 36847281 DOI: 10.1177/03635465231156181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Return to sport after stabilization surgery using the open Latarjet procedure remains challenging. Additional knowledge is needed about postoperative shoulder functional deficits in order to better design return-to-sport programs. PURPOSE To investigate the effects of the dominance status of the operated shoulder on the shoulder functional profile recovery at 4.5 months after open Latarjet procedure. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A retrospective analysis of prospectively collected data was performed. All patients who underwent the open Latarjet procedure between December 2017 and February 2021 were eligible for the study. Functional assessment at 4.5 months after the surgery was performed using the following tests: maximal voluntary isometric contractions in glenohumeral internal and external rotation, upper-quarter Y balance test, unilateral seated shot-put test, and modified closed kinetic chain upper extremity stability test, leading to 10 outcome measures. Patients whose dominant side had undergone surgery and those whose nondominant side had undergone surgery were compared with a group of 68 healthy control participants. RESULTS A total of 72 patients who underwent an open Latarjet procedure on the dominant side and 61 patients who underwent open Latarjet on the nondominant side were compared with 68 healthy control athletes. In patients whose dominant shoulder had undergone surgery, significant deficits for the dominant side (P < .001) and for the nondominant side (P < .001) were found in 9 of 10 functional outcome measures. Among patients whose operations were on the nondominant shoulder, significant deficits for the nondominant side (P < .001) and for the dominant side (P < .001) were found in 9 and 5 of the 10 functional outcome measures, respectively. CONCLUSION Regardless of dominance of the stabilized shoulder, persistent deficits in strength, stability, mobility, power, and stroke frequency were observed at 4.5 months postoperatively. Stabilization of the dominant shoulder resulted in residual surgery-related functional impairments on both sides. However, stabilization of the nondominant shoulder resulted in impairments primarily noted in the nondominant, operative shoulder. REGISTRATION NCT05150379 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Isabelle Rogowski
- Université de Lyon, Université Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité-EA 7424, Villeurbanne Cedex, France
| | - Laurent Nové-Josserand
- Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Centre orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
| | - Arnaud Godenèche
- Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Centre orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
| | - Philippe Colotte
- Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Centre orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
| | - Gabriel Franger
- Centre orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
| | | | - Thais Dutra Vieira
- Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Centre orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
| | - Yoann Blache
- Université de Lyon, Université Lyon 1, Laboratoire Interuniversitaire de Biologie de la Motricité-EA 7424, Villeurbanne Cedex, France
| | - Lionel Neyton
- Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Centre orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
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Goetti P, Martinho T, Seurot A, Bothorel H, Lädermann A. Is sling immobilization necessary after open Latarjet surgery for anterior shoulder instability? A randomized control trial. Trials 2023; 24:148. [PMID: 36850012 PMCID: PMC9969622 DOI: 10.1186/s13063-023-07180-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 02/17/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND There is a current lack of knowledge regarding optimal rehabilitation and duration of sling immobilization after an open Latarjet procedure. A shift towards immediate self-rehabilitation protocols in shoulder surgery is observed to avoid postoperative stiffness and fasten return to sport. Avoiding sling immobilization could further simplify rehabilitation and provide an even faster return to activities of daily living and enhance patient satisfaction. METHODS This study is a single-center, randomized control trial. Sixty-eight patients will be instructed with the same standardized immediate postoperative self-rehabilitation protocol. Patients will be allocated 1:1 between a sling immobilization group for the first three postoperative weeks and no sling group without postoperative immobilization. The primary endpoint will be functional outcome at 6 months postoperative evaluated by the disease-specific Rowe score. Secondary endpoints will include baseline, 1.5-, 6-, and 12-month single assessment numeric evaluation (SANE) of instability score and visual analog pain scale (VAS). At the 6-month time point, graft bony union and position will be assessed by computed tomography. Motion capture technology will evaluate the baseline and 6-month postoperative range of motion. Finally, time to return to work and sport during the first postoperative year, along with patient satisfaction at one postoperative year, will also be recorded. DISCUSSION This study will allow further insights into the optimal rehabilitation protocol after open Latarjet surgery and enhance patient care by helping identify rehabilitation and coracoid graft-related factors influencing functional outcomes, bony union, range of motion, and patient satisfaction. TRIAL REGISTRATION The protocol was approved by the ethical committee board (CCER 2019-02,469) in April 2020 and by ClinicalTrials.gov (Identifier: NCT04479397 ) in July 2020.
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Affiliation(s)
- Patrick Goetti
- grid.8515.90000 0001 0423 4662Department of Orthopedic Surgery and Traumatology, Lausanne University Hospital and University of Lausanne, Avenue Pierre Decker 4, 1005 Lausanne, Switzerland
| | - Tiago Martinho
- grid.413934.80000 0004 0512 0589Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Rue J.-D. Maillard 3, CH-1217 Meyrin, Switzerland
| | - Antoine Seurot
- grid.413934.80000 0004 0512 0589Department of Physiotherapy, La Tour Hospital, 1217 Meyrin, Switzerland
| | - Hugo Bothorel
- grid.413934.80000 0004 0512 0589Research Department, La Tour Hospital, 1217 Meyrin, Switzerland
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Rue J.-D. Maillard 3, CH-1217, Meyrin, Switzerland. .,Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland. .,Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.
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19
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Rossi LA, Pasqualini I, Huespe I, Brandariz R, Fieiras C, Tanoira I, Ranalletta M. A 2-Year Follow-up May Not be Enough to Accurately Evaluate Recurrences After Arthroscopic Bankart Repair: A Long-term Assessment of 272 Patients With a Mean Follow-up of 10.5 Years. Am J Sports Med 2023; 51:316-322. [PMID: 36594485 DOI: 10.1177/03635465221139290] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is a great discrepancy between the rates of recurrent instability reported after arthroscopic Bankart repair in relation to the follow-up time. PURPOSE To analyze the rate of recurrences after arthroscopic Bankart repair in the long term, emphasizing whether a minimum follow-up of 2 years is adequate to assess this outcome. STUDY DESIGN Case series; Level of evidence, 4. METHODS Between January 2008 and April 2013, a total of 356 athletes underwent arthroscopic Bankart repair for anterior glenohumeral instability at our institution. Return to sports, the Rowe score, the Subjective Shoulder Value (SSV), and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. We analyzed the proportion of recurrences before and after 4 years of follow-up. Additionally, we performed a Kaplan-Meier analysis to evaluate recurrence-free time in patients with a recurrence. RESULTS The mean follow-up was 10.5 ± 1.6 years, and the mean age was 20.8 ± 3.9 years. In total, 90% of patients were able to return to sports; of these, 91% returned to their preinjury level of play. The Rowe, SSV, and ASOSS scores showed a statistical improvement after surgery (P < .01). The proportion of patients with a recurrence during the follow-up period was 25% (95% CI, 20%-31%; n = 70), and the mean time until a recurrence was 3.8 ± 2.6 years. Only 39% of the recurrences (95% CI, 30%-48%) occurred in the first 2 years after surgery, while 61% (95% CI, 50%-73%) occurred in the first 4 years after surgery. CONCLUSION In our study, the effectiveness of Bankart repair to stabilize the shoulder decreased significantly over time. Indeed, less than half of the recurrences occurred after 2 years of follow-up. Therefore, we propose that the recommended minimum follow-up should be 4 years; otherwise, it is very likely that the actual rate of recurrences will be significantly underestimated.
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Affiliation(s)
| | | | - Iván Huespe
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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[Chronic posttraumatic shoulder instability]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:145-154. [PMID: 36729203 PMCID: PMC9898333 DOI: 10.1007/s00113-022-01283-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 02/03/2023]
Abstract
Chronic posttraumatic shoulder instability is characterized by trauma-associated, recurrent dislocations. Surgical treatment is indicated in most cases but it remains controversial how risk factors should be weighted to decide between arthroscopic Bankart repair (ABR), Latarjet or alternative procedures. Known risk factors for recurrence are patient age, hyperlaxity, sports profile and bone loss. Surgical techniques are discussed in detail. The ABR leads to high patient satisfaction and return to sports; however, in association with risk factors, recurrent dislocations are seen even several years later. Latarjet or bone block procedures lead to high patient satisfaction, sustainable stability as a revision procedure, but can also be primarily indicated for chronic instability depending on risk factors. Early complications are more frequent but of a minor nature in most cases. All techniques are known for a serious learning curve. If performed well, they do not seem to increase the risk of arthritis, which is most affected by the number of lifetime dislocations and higher energy trauma.
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21
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Wu C, Wang Y, Wang C, Chen J, Xu J, Yu W, Huang K, Ye Z, Jiang J, Tsai TY, Zhao J, Xie G. Glenoid Track Width Is Smaller Under Dynamic Conditions: An In Vivo Dual-Fluoroscopy Imaging Study. Am J Sports Med 2022; 50:3881-3888. [PMID: 36300554 DOI: 10.1177/03635465221126650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The glenoid track concept has been widely used to assess the risk of instability due to bipolar bone loss. The glenoid track width was commonly used as 83% of the glenoid width to determine if a lesion was on-track or off-track. However, the value was obtained under static conditions, and it may not be able to reflect the actual mechanism of traumatic dislocation during motion. PURPOSE To compare the glenoid track width under dynamic and static conditions using a dual-fluoroscopic imaging system. STUDY DESIGN Controlled laboratory study. METHODS In total, 40 shoulders of 20 healthy volunteers were examined for both dynamic and static tests within a dual-fluoroscopic imaging system at 5 different arm positions: 30°, 60°, 90°, 120°, and 150° of abduction, keeping the shoulder at 90° of external rotation. The participants performed a fast horizontal arm backswing for dynamic tests while keeping their arm in maximum horizontal extension for static tests. Computed tomography scans were used to create 3-dimensional models of the humerus and scapula for 2-dimensional to 3-dimensional image registration. Magnetic resonance imaging scans were obtained to delineate the medial margin of the rotator cuff insertion. The glenoid track width was measured as the distance from the anterior rim of the glenoid to the medial margin of the rotator cuff insertion and compared between static and dynamic conditions. RESULTS The mean glenoid track widths at 30°, 60°, 90°, 120°, and 150° of abduction were significantly smaller under dynamic conditions (88%, 81%, 72%, 69%, and 68% of the glenoid width) than those under static conditions (101%, 92%, 84%, 78%, and 77% of the glenoid width) (all P < .001). The glenoid track width significantly decreased with the increasing abduction angles in the range of 30° to 120° under static conditions (all P < .003) and 30° to 90° under dynamic conditions (all P < .001). CONCLUSION A smaller dynamic-based value should be considered for the glenoid track width when distinguishing on-track/off-track lesions. Clinical evidence is needed to establish the superiority of the dynamic-based value over the static-based value as an indicator for augmentation procedures. CLINICAL RELEVANCE Some off-track lesions might be misclassified as on-track lesions when the original commonly used static-based value of 83% is used as the glenoid track width.
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Affiliation(s)
- Chenliang Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yufan Wang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cong Wang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiebo Chen
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wanxin Yu
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kai Huang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Jiang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,TaoImage Medical Technologies Corporation, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoming Xie
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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22
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van Iersel TP, van Spanning SH, Verweij LPE, Priester-Vink S, van Deurzen DFP, van den Bekerom MPJ. Bony reconstruction after failed labral repair is associated with higher recurrence rates compared to primary bony reconstruction: a systematic review and meta-analysis of 1319 shoulders in studies with a minimum of 2-year follow-up. J Shoulder Elbow Surg 2022; 31:1982-1991. [PMID: 35430365 DOI: 10.1016/j.jse.2022.02.044] [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] [Received: 12/21/2021] [Revised: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is uncertainty with regard to the optimal revision procedure after failed labral repair for anterior shoulder instability. An overview of outcomes of these procedures with quantitative analysis is not available in literature. The aim of this review is (1) to compare recurrence rates after revision labral repair (RLR) and revision bony reconstruction (RBR), both following failed labral repair. In addition, (2) recurrence rates after RBR following failed labral repair and primary bony reconstruction (PBR) are compared to determine if a previous failed labral repair influences the outcomes of the bony reconstruction. METHODS Randomized controlled trials and cohort studies with a minimum follow-up of 2 years and reporting recurrence rates of (1) RBR following failed labral repair and PBR and/or (2) RLR following failed labral repair and RBR following failed labral repair were identified by searching PubMed, Embase/Ovid, Cochrane Database of Systematic Reviews/Wiley, Cochrane Central Register of Controlled Trials/Wiley, and Web of Science/Clarivate Analytics. RESULTS Thirteen studies met the inclusion criteria and comprised 1319 shoulders. Meta-analyses showed that RBR has a significantly higher recurrence rate than PBR (risk ratio [RR] 0.51, P < .008) but found no significant difference in the recurrence rates for RLR and RBR (RR 1.40, P < .49). Also, no significant differences were found between PBR and RBR in return to sport (RR 1.07, P < .41), revision surgery (RR 0.8, P < .44), and complications (RR 0.84, P < .53). Lastly, no significant differences between RLR and RBR for revision surgery (RR 3.33, P < .19) were found. CONCLUSION The findings of this meta-analyses show that (1) RBR does not demonstrate a significant difference in recurrence rates compared with RLR and that (2) RBR has a significantly higher recurrence rate than PBR.
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Affiliation(s)
- Theodore P van Iersel
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands.
| | - Sanne H van Spanning
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Lukas P E Verweij
- Amsterdam UMC, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, the Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | | | - Derek F P van Deurzen
- Trauma Unit & Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Michel P J van den Bekerom
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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23
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Menendez ME, Sudah SY, Cohn MR, Narbona P, Lädermann A, Barth J, Denard PJ. Defining Minimal Clinically Important Difference and Patient Acceptable Symptom State After the Latarjet Procedure. Am J Sports Med 2022; 50:2761-2766. [PMID: 35850119 DOI: 10.1177/03635465221107939] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Latarjet procedure is one of the most well-established treatment options for anterior shoulder instability. However, meaningful clinical outcomes after this surgery have not been defined. PURPOSE This study aimed to establish the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) for commonly used outcome measures in patients undergoing the Latarjet procedure and determine correlations between preoperative patient characteristics and achievement of MCID or PASS. STUDY DESIGN Case series; Level of evidence, 4. METHODS A multicenter retrospective review at 4 institutions was performed to identify patients undergoing primary open Latarjet procedure with minimum 2-year follow-up. Data collected included patient characteristics (age, sex, sports participation), radiological parameters (glenoid bone loss, off-track Hill-Sachs lesion), and 4 patient-reported outcome measures (collected preoperatively and 2 years postoperatively): the American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), the visual analog scale (VAS) for pain, and the Western Ontario Shoulder Instability Index (WOSI). The MCID and PASS for each outcome measure were calculated, and Pearson and Spearman coefficient analyses were used to identify correlations between MCID or PASS and preoperative variables (age, sex, sports participation, glenoid bone loss, off-track Hill-Sachs lesion). RESULTS A total of 156 patients were included in the study. The MCID values for ASES, SANE, VAS pain, and WOSI were calculated to be 9.6, 12.4, 1.7, and 254.9, respectively. The PASS values for ASES, SANE, VAS pain, and WOSI were 86.0, 82.5, 2.5, and 571.0, respectively. The rates of patients achieving MCID were 61.1% for VAS pain, 71.6% for ASES, 74.1% for SANE, and 84.2% for WOSI. The rates of achieving PASS ranged from 78.4% for WOSI to 84.0% for VAS pain. There was no correlation between any of the studied preoperative variables and the likelihood of achieving MCID or PASS. CONCLUSION This study defined MCID and PASS values for 4 commonly used outcome measures in patients undergoing the Latarjet procedure. These findings are essential for incorporating patient perspectives into the clinical effectiveness of the Latarjet procedure and provide valuable parameters for the design and interpretation of future clinical trials.
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Affiliation(s)
- Mariano E Menendez
- Oregon Shoulder Institute at Southern Oregon Orthopedics, Medford, Oregon, USA.,Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Suleiman Y Sudah
- Department of Orthopedics, Monmouth Medical Center, Long Branch, New Jersey, USA
| | - Matthew R Cohn
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Pablo Narbona
- Department of Shoulder Surgery, Sanatorio Allende, Córdoba, Argentina
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Johannes Barth
- Centre Ostéo-Articulaire des Cèdres, Parc Sud Galaxie, Echirolles, France
| | - Patrick J Denard
- Oregon Shoulder Institute at Southern Oregon Orthopedics, Medford, Oregon, USA
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24
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Monk AP, Crua E, Gatenby GC, Walsh AJ, Stanley JC, Rosenfeldt MP, Twaddle BC, Walsh SJ. Clinical outcomes following open anterior shoulder stabilization for glenohumeral instability in the young collision athlete. J Shoulder Elbow Surg 2022; 31:1474-1478. [PMID: 35051538 DOI: 10.1016/j.jse.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 12/07/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior glenohumeral instability occurs most commonly in those aged 15-29, with 72% of individuals younger than 22 years suffering recurrent episodes; collision athletes are at particular risk. In the setting of subcritical glenoid bone loss, arthroscopic Bankart repair is widely used despite concerns of recurrent dislocations when compared with open techniques. Furthermore, indications for bone-block procedures are evolving with the Latarjet procedure being favored amongst recent authors as a primary stabilization method in elite and contact athletes. OBJECTIVE To determine the efficacy of open modified Bankart stabilization in treating anterior glenohumeral instability in young collision athletes. METHODS This was a retrospective review of outcomes of consecutive patients aged 15-20 years who underwent unilateral or bilateral open stabilization for recurrent anterior glenohumeral instability over a 7-year period (2007-2015). The cohort was selected as recent literature suggests that this is the group with the highest redislocation rate and poorest outcomes. Outcome assessments included redislocation rate, return to sport, pain score, patient-related satisfaction scores, and the Western Ontario Shoulder Instability Index. RESULTS A total of 60 patients (55 male: 5 female) of mean age 18 years (range: 15-20 years) were available for follow-up at 7 years. All but 3 were competitive athletes with 18 competing regionally and 9 internationally; rugby union and rugby league represent the most common sports. Fifty-five of 60 (92%) have returned to their desired level of sport with 62% of athletes returning to their previous level of competition sport and 1 retuning at a higher level. The mean postoperative pain score was 2.5/10. The mean time to return to play was 14 months (range: 5-48 months). Eight of 60 shoulders reported redislocation (13%), 7 of these being traumatic dislocations after return to high-impact sporting activities. At 7 years of follow-up, 4 of 60 shoulders (7%) had undergone revision surgery. CONCLUSION Young collision athletes represent a challenging cohort of instability patients. This study of open modified Bankart in young collision sport athletes revealed excellent outcomes with 92% return to sport and a low revision rate. The results from this cohort rival those of arthroscopic repair. The open procedure described here in this 7-year series represents a robust, reliable technique that could be considered as an alternative to arthroscopic Bankart due to concern for recurrence, while avoiding potential morbidity and complication of bone-block procedures. There is still a role for the open modified Bankart procedure in treating traumatic anterior instability.
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Affiliation(s)
- A Paul Monk
- Unisports Orthopaedics, Auckland, New Zealand
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25
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Kim M, Haratian A, Fathi A, Kim DR, Patel N, Bolia IK, Hasan LK, Petrigliano FA, Weber AE. Can We Identify Why Athletes Fail to Return to Sports After Arthroscopic Bankart Repair: A Systematic Review and Meta-analysis. Am J Sports Med 2022:3635465221089980. [PMID: 35658631 DOI: 10.1177/03635465221089980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND No previous systematic reviews have reported on athletes who fail to return to sports after arthroscopic Bankart repair. PURPOSE To review the literature on athletes who fail to return to sports after arthroscopic Bankart repair to determine the rate of athletes who did not return to sports and to identify the specific reasons for failure to return to sports by nonreturning athletes. STUDY DESIGN Systematic review and meta-analysis. METHODS A meta-analysis was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Three electronic databases (PubMed, Scopus, Web of Science) were queried for articles meeting the inclusion criteria. Studies were considered eligible only if reporting the rate of failure for return to sports and providing the specific reasons why athletes were unable to return to sports. All records were screened by title, abstract, and full text by 2 authors independently, with any discrepancies resolved by a third senior author. For articles selected for inclusion, data were collected on the number of athletes, average age, average follow-up time, type of sport played, rate of failure to return to sports, and specific reasons for failure to return. A random-effects model was used to conduct the meta-analysis. RESULTS Seventeen studies were selected for inclusion reporting on a total of 813 athletes. The calculated weighted rate of failure to return to sports after arthroscopic Bankart repair was 15.6% (95% CI, 10.9%-21.1%). A significantly higher proportion of athletes cited shoulder-dependent versus shoulder-independent reasons for failure to return to sports (81.7% vs 18.3%; P < .0001). The most cited reasons for failure to return included recurrent or persistent instability (33.3%), fear of reinjury (17.7%), apprehension (9.9%), changes in priorities or personal interest (8.5%), lack of time (7.1%), and discomfort or pain with sports (6.4%). CONCLUSION Our study estimated the rate of failure to return to sports after arthroscopic Bankart repair to be 15.6%, with most athletes citing shoulder-related reasons as the primary factor precluding return. Identifying the potential reasons preventing successful return to sports can guide surgeons in counseling athletes regarding postoperative expectations and addressing hesitations for returning to sports.
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Affiliation(s)
- Michael Kim
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Aryan Haratian
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Amir Fathi
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Daniel R Kim
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Nilay Patel
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Laith K Hasan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
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26
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Arthroscopic Biceps Transfer to the Glenoid With Bankart Repair Grants Satisfactory 2-Year Results for Recurrent Anteroinferior Glenohumeral Instability in Subcritical Bone Loss. Arthroscopy 2022; 38:1766-1771. [PMID: 34883198 DOI: 10.1016/j.arthro.2021.11.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 11/14/2021] [Accepted: 11/22/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the short-term outcomes of the arthroscopic dynamic anterior stabilization (DAS), which is a transfer of the intra-articular portion of the long head biceps through the subscapularis split and fixation on the anterior glenoid, combined with a Bankart repair. METHODS A retrospective evaluation was performed of DAS and a minimum of 2-year follow-up. Inclusion criteria were the presence of anteroinferior instability, a positive apprehension test at 90° of abduction and external rotation, and subcritical glenoid bone loss (less than 20%). Exclusion criteria were severe (≥20%) glenoid bone loss, presence of biceps lesions or rupture (spontaneous or biceps tenotomy), pre-existing glenohumeral osteoarthritis, multidirectional or voluntary instability, previous arthroscopic stabilization procedure, and epilepsy. Outcomes included the Rowe score, range of motion (ROM), and recurrence. RESULTS Twenty-three patients were treated with DAS and arthroscopic Bankart repair during the study period. One person was lost to follow-up, leaving 22 patients available at last follow-up. Those 22 patients had an average age of 31.9 ± 12.3 years (range, 18-68) and were evaluated at an average follow-up of 3.2 ± 0.7 years (range, 1.2-4.2). The Rowe score increased from 36.1 ± 16.2 (range, 10-70) preoperatively to 89.8 ± 20.1 (range, 30-100) postoperatively (P < .001) with almost all patients (90.9%) improving their score beyond the minimal clinically important difference of 9.7 points. Postoperatively, ROM was maintained. Three patients (13.6%) analyzed at final follow-up demonstrated recurrence, one was successfully treated conservatively, but two revised with a Latarjet. No postoperative Popeye deformity, biceps cramping, or other complication were reported. CONCLUSIONS The DAS procedure may be an option for augmentation of a Bankart repair in patients with anterior shoulder instability and subcritical bone loss. ROM is maintained without evidence of postoperative Popeye deformity or biceps cramping. LEVEL OF EVIDENCE Level IV, retrospective study.
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Wang L, Kang Y, Li Y, Wu C, Jiang J, Yu S, Zhao J, Xie G. Dynamic Double-Sling Augmentation Prevents Anteroinferior Translation for Recurrent Anteroinferior Shoulder Dislocation With 20% Glenoid Bone Loss: A Cadaveric Biomechanical Study. Arthroscopy 2022; 38:1433-1440. [PMID: 34838644 DOI: 10.1016/j.arthro.2021.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To biomechanically compare the dynamic double-sling with single-sling augmentation using the conjoined tendon (CT) with 20% of an anteroinferior glenoid bone defect under the high loads in shoulders. METHODS With the shoulder in 60° of glenohumeral abduction and 60° of external rotation, the 12 shoulders stability was tested sequentially in 5 conditions: intact, 20% glenoid bone loss, Bankart repair, single-sling augmentation with the CT, and double-sling augmentation with both the CT and long head of the biceps tendon (LHBT). The anteroinferior humeral head (HH) translation force of 20N, 30N, 40N, 50N, or 60N was applied to determine the shoulder stability in each condition. RESULTS The total HH translation over 8.77 mm represented the anteroinferior shoulder instability (95% confidence interval of bone defect: 7.76-8.77 mm). A significant increase in anteroinferior HH translation was demonstrated after the creation of 20% glenoid bone defect under the 20N translational force (10.52 ± 0.71 mm). Structural failure after the Bankart repair and the single-sling augmentation under the 30N (9.84 ± 1.25 mm) and 40N (9.59 ± 0.66 mm) translational forces, respectively, were observed. The double-sling augmentation effectively prevented the anteroinferior HH translation under the translational force of less than 40N, and only half of the augmentation structure (8.25 ± 1.66 mm) had failed under the 50N translational forces. CONCLUSION In the absence of any Hill-Sachs lesion and when tested at 60° abduction and external rotation in shoulders with 20% glenoid bone defects, at time-zero, the double-sling augmentation strategy could effectively prevent anteroinferior translation when compared with the Bankart repair or the single-sling augmentation technique under all magnitudes of the translational force in biomechanical simulation. Nevertheless, none of the constructs restored the HH translation to the normal intact state. CLINICAL RELEVANCE Double-sling augmentation technique may represent a reliable option for preventing anteroinferior translation.
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Affiliation(s)
- Liren Wang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai
| | - Yuhao Kang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai
| | - Yufeng Li
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai
| | - Chenliang Wu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai
| | - Jia Jiang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai
| | - Suiran Yu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai.
| | - Guoming Xie
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai.
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Song Q, Zhang S, Cheng X, Xiao J, Lin L, Liu Q, Shao Z, Cui G. Clinical and Radiographic Outcomes After Arthroscopic Inlay Bristow Surgery With Screw Versus Suture Button Fixation: A Comparative Study of 117 Patients With 3.3-Year Follow-up. Orthop J Sports Med 2022; 10:23259671221076048. [PMID: 35284584 PMCID: PMC8908399 DOI: 10.1177/23259671221076048] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Some studies have advocated the use of suture button fixation during Bristow-Latarjet surgery to reduce complications associated with screw fixation. However, data comparing these fixation methods are relatively incomplete. Purpose: To investigate the efficacy of modified arthroscopic Bristow-Latarjet surgery and compare the clinical and radiographic outcomes using screw versus suture button fixation. Study Design: Cohort study; Level of evidence, 3. Methods: We evaluated 136 patients with traumatic anterior shoulder instability who underwent the modified arthroscopic Bristow-Latarjet surgery between June 2015 and February 2018. Of these patients, 117 who met the inclusion criteria were enrolled at a mean follow-up of 3.3 ± 0.7 years. Shoulders were separated into 2 groups based on fixation technique: screw fixation (group A; n = 63) or suture button fixation (group B; n = 54). Computed tomography imaging findings and clinical results were assessed preoperatively; immediately after operation; and postoperatively at 3 months, 6 months, 1 year, and final follow-up. Results: There were no significant differences between the groups in terms of postoperative clinical scores, the level of return to sports, range of motion, graft position, or reoperation rates. Bone healing was observed in 97.4% of the cases overall (114/117), with 98.4% bone union in group A and 96.3% in group B at final follow-up. Bone absorption was more common in group A (n = 30; 47.6%) compared with group B (n = 10; 18.5%) (P = .003). There were no hardware-related complications in group B, compared with 7.9% of patients in group A (P = .034). One patient in group B had a recurrent dislocation due to an unexpected event, and there were no recurrent dislocations in group A. Conclusion: After the modified arthroscopic Bristow-Latarjet procedure, both suture button and screw fixation methods demonstrated high bony healing rates and low risk of recurrence. Less coracoid graft resorption and no hardware-related complications were seen with suture button fixation.
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Affiliation(s)
- Qingfa Song
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Shuhan Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Xu Cheng
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Jian Xiao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Lin Lin
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Qiang Liu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Zhenxing Shao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Guoqing Cui
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
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Menon A, Fossati C, Magnani M, Boveri S, Compagnoni R, Randelli PS. Low grade of osteoarthritis development after Latarjet procedure with a minimum 5 years of follow-up: a systematic review and pooled analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2074-2083. [PMID: 34677621 PMCID: PMC9165270 DOI: 10.1007/s00167-021-06771-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/07/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this systematic review and pooled analysis was to evaluate incidence and risk factors for glenohumeral osteoarthritis (OA) in patients who underwent Latarjet procedure with a minimum of 5-year follow-up. METHODS The PRISMA guidelines were followed to perform this systematic review. PubMed and EMBASE were searched up to February 29, 2020 for English, human in vivo studies that evaluated glenohumeral OA in patients undergoing Latarjet procedure at least 5 years after surgery. A pooled analysis on the included databases sent by authors was performed to evaluate the risk factors influencing the development or progression of dislocation arthropathy after the Latarjet procedure. RESULTS Four studies, including a total of 280 patients (213 males and 67 females), were analysed. In our study population, the median age at surgery was 25.0 years (range 20.8-32.6 years). and 92.1% were athletes. In 90% of the cases, the number of dislocations before surgery were fewer than 5. The recurrence of instability after Latarjet procedure was observed only in seven patients (2.5%). The position of the bone graft resulted flush to the anterior glenoid rim in 238 cases (85.3%), medial in 8 (2.9%) and overhanging in 33 (11.8%). Radiological signs of development or progression of shoulder OA were observed in 25.8% of the patients, of which 88.6% presented a grade 1 of OA according to Samilson and Prieto classification. The overhanging position of the bone graft resulted statistically significant for onset or worsening of OA. The age at surgery, the number of dislocations before surgery and the Hill-Sachs lesion were not significantly associated with joint degeneration. Instead, hyperlaxity showed a prevention role in the development of OA after open Latarjet procedure. CONCLUSION The Latarjet procedure is a valid and safe surgical treatment in recurrent anterior shoulder instability with a low risk of developing moderate or severe OA also at long-term follow-up. The overhanging position of the bone graft represents the principal risk factor of joint degeneration, whereas the hyperlaxity seems to be protective. Finally, age, gender, time between first dislocation and surgery, and number of dislocations do not seem to affect the onset of OA after Latarjet procedure. Therefore, an accurate execution of the Latarjet procedure can be considered a valid treatment even in young and athletes thanks to the low recurrence rates and the low development of major long-term complications. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alessandra Menon
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy ,U.O.C. 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Chiara Fossati
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy ,U.O.C. 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Mauro Magnani
- U.O.C. 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.
| | - Sara Boveri
- Scientific Directorate, IRCCS Policlinico San Donato, Piazza Malan 1, 20097 Milan, Italy
| | - Riccardo Compagnoni
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy ,U.O.C. 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Pietro Simone Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy ,U.O.C. 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy ,Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
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Prada C, Al-Mohrej OA, Patel A, Flood B, Leroux T, Khan M. Managing Bone Loss in Shoulder Instability-Techniques and Outcomes: a Scoping Review. Curr Rev Musculoskelet Med 2021; 14:447-461. [PMID: 34961906 DOI: 10.1007/s12178-021-09727-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW The aim of this scoping review is to provide an overview of the literature published over the past 5 years related to the management of bone loss in anterior shoulder instability. RECENT FINDINGS During recent years, there has been a focus on patients at high risk for failure following soft tissue anterior stabilization (Bankart repair). A growing body of evidence suggests that anterior capsulolabral repair is insufficient in the setting of subcritical glenoid bone loss with an off-track Hill Sachs lesion. In such cases, the addition of a remplissage procedure to a Bankart repair or a bone-block augmentation to the glenoid (Latarjet, for example) is often advocated to decrease the risk of recurrent instability. Recent studies have also evaluated the role of alternative bone-block procedures in comparison to the Latarjet, outcomes with arthroscopic and open techniques as well as various fixation methods and radiological outcomes (bone graft resorption, glenohumeral osteoarthritis). Advances in our understanding of subcritical glenoid bone loss and the glenoid track concept have significantly impacted clinical decision making and treatment selection. The development of arthroscopic techniques has allowed for minimally invasive and safe arthroscopic bone-block procedures as an alternative to open procedures. Further research related to free bone-block procedures will inform long-term outcomes between these procedures and the gold standard Latarjet. Additionally, high-quality evidence is lacking to identify the ideal treatment for patients with glenoid subcritical glenoid bone defect. Variability in outcome reporting suggests the need to standardize outcome measures for future instability trials.
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Affiliation(s)
- Carlos Prada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.,Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Omar A Al-Mohrej
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.,Section of Orthopedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Ashaka Patel
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Breanne Flood
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Timothy Leroux
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada. .,Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
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Dorweiler MA, Bishop JY. Editorial Commentary: Lower Return to Play After Failed Prior Instability Surgery: Should the Open Latarjet Be the Gold Standard for Anterior Shoulder Instability? Arthroscopy 2021; 37:2418-2419. [PMID: 34353553 DOI: 10.1016/j.arthro.2021.04.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 02/02/2023]
Abstract
Anterior shoulder instability is common in contact athletes. Arthroscopic Bankart repair can result in good clinical outcomes, but high recurrence rates have been reported. The open Latarjet procedure can result in excellent functional outcomes with low rates of recurrent instability. Despite these encouraging results, there may be a lower return to play rate in athletes undergoing this procedure for a prior failed instability surgery. Due to the complexity of the procedure and high complication rate, the open Latarjet should continue to be reserved for cases of significant glenoid bone loss or revision settings.
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