1
|
Wu YM, Xiao YF, Meng JH, Xiong YL, Tang H, Gao SG. All-Arthroscopic Treatment of Combined Off-Track Hill-Sachs Lesions Using Interference Screw and Shoulder Glenoid Bone Defects Using Bone Grafting With Soft Fixation. Arthrosc Tech 2024; 13:103045. [DOI: 10.1016/j.eats.2024.103045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
|
2
|
Kay J, Heyworth BE, Bae DS, Kocher MS, Milewski MD, Kramer DE. Arthroscopic Bankart Repair for Anterior Glenohumeral Instability in 488 Adolescents Between 2000 and 2020: Risk Factors for Subsequent Recurrent Instability Requiring Revision Stabilization. Am J Sports Med 2024; 52:2331-2339. [PMID: 39101737 PMCID: PMC11308280 DOI: 10.1177/03635465241259736] [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: 12/05/2023] [Accepted: 04/16/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND After arthroscopic Bankart repair (ABR) for anterior glenohumeral instability (GHI), adolescent athletes have higher rates of subsequent recurrent GHI than any other subpopulation. Elucidating which adolescents are at highest risk of postoperative recurrent GHI may optimize surgical decision-making. PURPOSE To identify prognostic factors associated with subsequent recurrent GHI requiring revision stabilization surgery (RSS) after ABR. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS The study included patients 12 to 21 years old who had undergone ABR for anterior GHI at a pediatric tertiary care hospital by 1 of 5 sports medicine fellowship-trained surgeons between 2000 and 2020. A multivariate Cox proportional hazards model, with percentage of patients with recurrent GHI undergoing subsequent RSS, was used with a time-to-event outcome analysis. The Cox model effects were expressed as the hazard ratio (HR). All tests were 2-sided, with an alpha of .05. RESULTS Records of 488 adolescent patients with ABR (78% male; mean age, 16.9 ± 1.98 years) were analyzed. Of these, 86 patients (17.6%) underwent subsequent RSS for recurrent GHI, yielding a cumulative risk of 8.8% at 2 years, 16.5% at 5 years, and 20% at 15 years. RSS occurred at a mean of 2.6 ± 2.1 years after ABR. Risk factors for RSS included >1 preoperative dislocation (2 dislocations: HR = 7.4, P = .0003; ≥3 dislocations: HR = 10.9, P < .0001), presence of a Hill-Sachs lesion (small: HR = 2.5, P = .0114; medium-large: HR = 4.2, P = .0004), younger age (1-year decrease: HR = 1.2, P = .0015), and participation in contact sports (HR = 1.8, P = .01). Adolescents with only 1 preoperative dislocation had a cumulative incidence of RSS (3.2%), which was significantly lower than those with 2 (24.2%) or ≥3 preoperative dislocations (33.5%). CONCLUSION The number of dislocations before index ABR was the strongest risk factor for recurrent GHI requiring RSS in adolescents with anterior GHI, with 2 dislocations conferring >7-fold increased risk compared with a single preoperative dislocation. Other significant risk factors included the presence of a Hill-Sachs lesion, younger age, and participation in contact sports.
Collapse
Affiliation(s)
- Jeffrey Kay
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston Massachusetts, USA
- Division of Sports Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Benton E. Heyworth
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston Massachusetts, USA
- Division of Sports Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Donald S. Bae
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston Massachusetts, USA
- Division of Sports Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Mininder S. Kocher
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston Massachusetts, USA
- Division of Sports Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew D. Milewski
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston Massachusetts, USA
- Division of Sports Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Dennis E. Kramer
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston Massachusetts, USA
- Division of Sports Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Wu C, Ye Z, Lu S, Fang Z, Xu J, Zhao J. Biomechanical Analysis Reveals Shoulder Instability With Bipolar Bone Loss Is Best Treated With Dynamic Anterior Stabilization for On-Track Lesions and With Remplissage for Off-Track Lesions. Arthroscopy 2024; 40:1982-1993. [PMID: 38311260 DOI: 10.1016/j.arthro.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To compare the biomechanical effects of augmenting Bankart repair (BR) with either remplissage or dynamic anterior stabilization (DAS) in the treatment of anterior shoulder instability with on-track or off-track bipolar bone loss. METHODS Eight fresh-frozen cadaveric shoulders were tested at 60° of glenohumeral abduction in the intact, injury, and repair conditions. Injury conditions included 15% glenoid bone loss with an on-track or off-track Hill-Sachs lesion as previously recommended. Repair conditions included isolated BR, BR with remplissage, and BR with DAS (long head of biceps transfer). The glenohumeral stability was assessed by measuring the anterior translation under 0, 10, 20, 30, 40, 50 N load and maximum load without causing instability at mid-range (60°) and end-range (90°) external rotation (ER). Maximum range of motion (ROM) was measured by applying a 2.2-N·m torque in passive ER and internal rotation. RESULTS Isolated BR failed to restore native glenohumeral stability in both on-track and off-track bipolar bone loss models. Both remplissage and DAS significantly decreased the anterior instability in the bipolar bone loss models, showing better restoration than the isolated BR. In the on-track lesions, DAS successfully restored native glenohumeral stability and mobility, whereas remplissage significantly decreased anterior translation without load (-2.12 ± 1.07 mm at 90° ER, P = .003; -1.98 ± 1.23 mm at 60° ER, P = .015). In the off-track lesions, remplissage restored native glenohumeral stability but led to significant ROM limitation (-8.6° ± 2.3° for internal rotation, P < .001; -13.9° ± 6.2° for ER, P = .003), whereas DAS failed to restore native stability at 90° ER regarding the increased anterior translation under 50 N (4.10 ± 1.53 mm, P < .001) and decreased maximum load (-13.8 ± 9.2 N, P = .021). CONCLUSIONS At time-zero, both remplissage and DAS significantly reduced residual anterior instability compared with isolated BR in the bipolar bone loss models and restored the native glenohumeral stability under most translational loads. However, remplissage could decrease the anterior translation without load for on-track lesions and may restrict ROM for off-track lesions, whereas DAS failed to restore native stability under high translational loads for off-track lesions. CLINICAL RELEVANCE DAS could be recommended to treat on-track bipolar bone loss with less biomechanical adverse effects, whereas remplissage might be the preferred procedure to address off-track bipolar bone loss for better stability.
Collapse
Affiliation(s)
- Chenliang Wu
- 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
| | - Simin Lu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaoyi Fang
- 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.
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
4
|
Bulleit CH, Hurley ET, Jing C, Hinton ZW, Doyle TR, Anakwenze OA, Klifto CS, Dickens JF, Lau BC. Risk factors for recurrence following arthroscopic Bankart repair: a systematic review. J Shoulder Elbow Surg 2024:S1058-2746(24)00407-5. [PMID: 38852707 DOI: 10.1016/j.jse.2024.04.017] [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: 01/31/2024] [Revised: 04/05/2024] [Accepted: 04/15/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Recurrent instability remains a major source of morbidity following arthroscopic Bankart repair. Many risk factors and predictive tools have been described, but there remains a lack of consensus surrounding individual risk factors and their contribution to outcomes. The purpose of this study is to systematically review the literature to identify and quantify risk factors for recurrence following arthroscopic Bankart repair. METHODS A literature search was performed using the PubMed/MEDLINE databases based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were included if they evaluated risk factors for recurrent instability following arthroscopic Bankart repair. RESULTS Overall, 111 studies were included in the analysis, including a total of 19,307 patients and 2750 episodes of recurrent instability with 45 risk factors described. Age at operation was reported by 60 studies, with 35 finding increased risk at younger ages. Meta-analysis showed a 2-fold recurrence rate of 27.0% (171 of 634) for patients <20 years old compared with 13.3% (197 of 1485) for older patients (P < .001). Seventeen studies completed multivariable analysis, 13 of which were significant (odds ratio 1.3-14.0). Glenoid bone loss was evaluated by 39 studies, with 20 finding an increased risk. Multivariable analysis in 9 studies found odds ratios ranging from 0.7 to 35.1; 6 were significant. Off-track Hill-Sachs lesions were evaluated in 21 studies (13 significant), with 3 of 4 studies that conducted multivariable analysis finding a significant association with odds ratio of 2.9-8.9 of recurrence. The number of anchors used in repair was reported by 25 studies, with 4 finding increased risk with fewer anchors. Pooled analysis demonstrated a 25.0% (29 of 156) risk of recurrence with 2 anchors, compared with 18.1% (89 of 491) with 3 or more anchors (P = .06). Other frequently described risk factors included glenohumeral joint hyperlaxity (46% of studies reporting a significant association), number of preoperative dislocations (31%), contact sport participation (20%), competitive sport participation (46%), patient sex (7%), and concomitant superior labral anterior-posterior tear (0%). CONCLUSION Younger age, glenoid bone loss, and off-track Hill-Sachs lesions are established risk factors for recurrence following arthroscopic Bankart repair. Other commonly reported risk factors included contact and competitive sports participation, number of fixation devices, and patient sex.
Collapse
Affiliation(s)
- Clark H Bulleit
- Department of Orthopaedics, Duke University, Durham, NC, USA.
| | - Eoghan T Hurley
- Department of Orthopaedics, Duke University, Durham, NC, USA
| | - Crystal Jing
- Department of Orthopaedics, Duke University, Durham, NC, USA
| | - Zoe W Hinton
- Department of Orthopaedics, Duke University, Durham, NC, USA
| | - Tom R Doyle
- Sports Surgery Clinic, Santry, Dublin, Ireland
| | - Oke A Anakwenze
- Department of Orthopaedics, Duke University, Durham, NC, USA
| | | | | | - Brian C Lau
- Department of Orthopaedics, Duke University, Durham, NC, USA
| |
Collapse
|
5
|
Rosello O, Barret H, Langlais T, Boileau P. Comparison of Return to Sports and Competition After the Arthroscopic Bristow-Latarjet Procedure Versus Arthroscopic Bankart Repair in Adolescents With Recurrent Anterior Shoulder Instability. Am J Sports Med 2024; 52:1457-1463. [PMID: 38616609 DOI: 10.1177/03635465241245608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND The use of isolated soft tissue repair versus bone block stabilization for the treatment of recurrent anterior shoulder instability in adolescents has no scientific evidence. PURPOSE To compare the clinical outcomes of adolescent patients who underwent isolated arthroscopic Bankart (iB) repair with those who underwent the arthroscopic Bristow-Latarjet procedure in addition to Bankart (BLB) repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 60 shoulders in adolescents (aged 13-18 years) were reviewed with a minimum 2 years' follow-up: iB repair (n = 36) and arthroscopic Bankart repair with an additional Bristow-Latarjet procedure (BLB; n = 24). The characteristics of the patients in each group in terms of age at the first instability episode, age at surgery, hyperlaxity, participation in at-risk sports, and Instability Severity Index Score were comparable. The mean follow-up was longer in the iB group (7.7 vs 4.1 years, respectively), whereas the rates of patients engaged in competition and those with glenoid lesions were higher in the BLB group. The primary outcome measures were failure, defined as the recurrence of instability (clinical dislocation or subluxation), and return to sports. The mean follow-up was 6.2 years (range, 2-16 years). RESULTS At the last follow-up, the rate of recurrence was significantly higher in the iB group, with 22% (8/36) failures, than in the BLB group, with 8% (2/24) instability recurrences (P < .05). The rate of return to sports at the same level was significantly higher after the BLB repair than after iB repair (79% vs 47%, respectively; P < .001). No statistical difference was found in patient-reported outcome scores between treatment groups (P > .05). Although failures occurred early after the BLB repair, 88% of failures after iB repair occurred after 2 years. On multivariate analysis, adolescents in the iB group with >3 episodes of preoperative dislocation and shoulder hyperlaxity (external rotation >90°) had a 60% recurrence rate (P < .005). CONCLUSION Adolescent patients undergoing the BLB repair had a lower rate of recurrent instability and higher rates of return to sports and competition than those undergoing iB repair. Patients with shoulder hyperlaxity (external rotation >90°) and >3 dislocations had an unacceptable failure rate of 60% after iB repair.
Collapse
Affiliation(s)
- Olivier Rosello
- Institut de Chirurgie Réparatrice Locomoteur et Sports, Nice, France
| | - Hugo Barret
- Institut de Chirurgie Réparatrice Locomoteur et Sports, Nice, France
| | - Tristan Langlais
- Institut de Chirurgie Réparatrice Locomoteur et Sports, Nice, France
| | - Pascal Boileau
- Institut de Chirurgie Réparatrice Locomoteur et Sports, Nice, France
| |
Collapse
|
6
|
Riemann BL, Davies GJ. Reliability of Upper Extremity Functional Performance Tests for the Non-overhead Athlete. Int J Sports Phys Ther 2023; 18:1166-1175. [PMID: 37795324 PMCID: PMC10547086 DOI: 10.26603/001c.87924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/31/2023] [Indexed: 10/06/2023] Open
Abstract
Background While there have been reliability studies conducted on several upper extremity functional performance tests (UEFPT), there are several complicating factors that inhibit the ability to draw definitive consensus about the reliability of the tests in both females and males. Having reliability estimates for UEFPT in the same cohort facilitates direct comparison of their relative and absolute reliability. Purpose To establish the test-retest reliability of the closed kinetic chain upper extremity stability test (CKCUEST), seated medicine ball chest pass test (SMBCPT) and hands-release push-up test (HRPUT) in a cohort of males and females with a history of non-overhead sport participation. A secondary purpose was to examine the associations between the three UEFPT. Study Design Test-retest reliability, single cohort study. Methods Forty adults (20 females, 20 males) with a history of non-overhead sport participation completed three UEFPT during two data collection sessions three to seven days apart. Measures of systematic bias, absolute reliability and relative reliability were computed between the sessions. Additionally, correlational analyses were conducted between the three UEFPT. Results Only the UECKCST (both sexes) demonstrated significant (p≤ 0.003) second session performance improvements. All three tests exhibited excellent relative reliability (intraclass correlational coefficients ≥ 0.823) and except for the HRPUT in males, coefficients of variation were all below 8.8%. Except for a significant relationship (r=.691, p=0.001) between the UECKCST and SMBCPT for the females there were no other associations between the three UEFPT. Conclusion All three UEFPT demonstrated sufficient reliability. Thus, all three assessments can be used for serial assessments to progress a patient through rehabilitation as well as contribute to the criteria used in making return to sport decisions. Level of Evidence 3.
Collapse
Affiliation(s)
- Bryan L Riemann
- Biodynamics and Human Performance Center Georgia Southern University-Armstrong Campus
| | - George J Davies
- Biodynamics and Human Performance Center Georgia Southern University-Armstrong Campus
| |
Collapse
|
7
|
Reider B. That Awkward Age. Am J Sports Med 2023; 51:1389-1391. [PMID: 37125476 DOI: 10.1177/03635465231167163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
|
8
|
Kay J, Heyworth BE, Milewski MD, Kramer DE. Pediatric and Adolescent Shoulder Instability. Curr Rev Musculoskelet Med 2023:10.1007/s12178-023-09837-z. [PMID: 37067690 DOI: 10.1007/s12178-023-09837-z] [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: 04/04/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE OF REVIEW Traumatic and atraumatic shoulder instability is common in pediatric and adolescent patients. It is well-established that young patients with anterior shoulder dislocation are at high risk of recurrent instability. This review assesses the current literature pertaining to management of both anterior instability and MDI in the pediatric and adolescent populations. RECENT FINDINGS Current research suggests that pediatric and adolescent patients with shoulder instability have excellent outcomes following arthroscopic Bankart repair; however, higher rates of recurrent instability requiring revision surgical management have been identified in patients with more than one dislocation episode pre-operatively, those with Hill-Sachs lesions and those under age 16. The addition of the remplissage procedure to an arthroscopic Bankart repair may be useful in preventing recurrent instability for patients with large Hill-Sachs lesions. Open procedures with bony glenoid augmentation may be indicated in patients with significant glenoid bone loss, or those who have failed primary surgical management, with promising outcomes reported following the Latarjet coracoid process transfer procedure in the adolescent population. Pediatric and adolescent patients with hyperlaxity, and those participating in swimming or gymnastics are more likely to have multidirectional instability (MDI). Non-surgical management with physical therapy is the mainstay of treatment for MDI with positive outcomes reported overall. In young patients with MDI who continue to have symptoms of instability and pain that effects daily activities or sports despite an adequate and appropriate course of rehabilitation, surgical management with capsulorrhaphy may be considered, with promising outcomes reported for both open and arthroscopic techniques. Attentive selection of timing and surgical procedure for pediatric and adolescent patients with anterior shoulder instability may help to prevent recurrent instability following shoulder stabilization. Although most pediatric and adolescent patients with MDI do well following non-surgical management alone, those that fail conservative management have good outcomes following arthroscopic or open capsulorrhaphy.
Collapse
Affiliation(s)
- Jeffrey Kay
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA.
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
| | - Benton E Heyworth
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Matthew D Milewski
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Dennis E Kramer
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
- Division of Sports Medicine, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|