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Watts V GJ, Tai R, Joshi G, Garwood E, Saha D. Reinjury Following Return to Play. Semin Musculoskelet Radiol 2024; 28:154-164. [PMID: 38484768 DOI: 10.1055/s-0043-1778022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Radiologists are frequently called on for guidance regarding return to play (RTP) for athletes and active individuals after sustaining a musculoskeletal injury. Avoidance of reinjury is of particular importance throughout the rehabilitative process and following resumption of competitive activity. Understanding reinjury risk estimation, imaging patterns, and correlation of clinical and surgical findings will help prepare the radiologist to identify reinjuries correctly on diagnostic imaging studies and optimize management for a safe RTP.
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Affiliation(s)
- George J Watts V
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, UMass Chan Medical School, Worcester, Massachusetts
| | - Ryan Tai
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, UMass Chan Medical School, Worcester, Massachusetts
| | - Ganesh Joshi
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, UMass Chan Medical School, Worcester, Massachusetts
| | - Elisabeth Garwood
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, UMass Chan Medical School, Worcester, Massachusetts
| | - Debajyoti Saha
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, UMass Chan Medical School, Worcester, Massachusetts
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Kawashima I, Iwahori Y, Ishizuka S, Oba H, Sakaguchi T, Watanabe A, Inoue M, Imagama S. Arthroscopic Bankart repair with peeling osteotomy of the anterior glenoid rim preserves glenoid morphology. J Shoulder Elbow Surg 2023; 32:2445-2452. [PMID: 37327987 DOI: 10.1016/j.jse.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND A decrease in the glenoid size after arthroscopic Bankart repair (ABR) was common in shoulders without osseous fragments compared with those with osseous fragments. For cases of chronic recurrent traumatic anterior glenohumeral instability without osseous fragments, we have performed ABR with peeling osteotomy of the anterior glenoid rim (ABRPO) to make an intentional osseous Bankart lesion. The aim of this study was to compare the glenoid morphology after ABRPO with it after simple ABR. METHODS The medical records of patients who underwent arthroscopic stabilization for chronic recurrent traumatic anterior glenohumeral instability were retrospectively reviewed. Patients with an osseous fragment, with revision surgery and without complete data were excluded. Patients were assigned to 1 of 2 groups: Group A, ABR without peeling osteotomy procedure or Group B, with ABRPO procedure. Computed tomography was performed preoperatively and 1 year after surgery. The size of the glenoid bone loss was investigated by the assumed circle method. The following formula was used to calculate the decreased size of the glenoid: (Δ) = (postoperative size of the glenoid bone loss) - (preoperative size of the glenoid bone loss). The size of the glenoid 1 year after surgery was assessed to determine if it had decreased (Δ > 0%) or not decreased (Δ ≤ 0%) relative to the preoperative size. RESULTS This study evaluated 39 shoulders divided into 2 groups: 27 shoulders in Group A and 12 shoulders in Group B. In Group A, postoperative glenoid bone loss was significantly greater than preoperative glenoid bone loss (7.8 ± 6.2 vs. 5.5 ± 5.3, respectively, P = .02). In Group B, postoperative glenoid bone loss was significantly lower than preoperative glenoid bone loss (5.6 ± 5.4 vs. 8.7 ± 4.0, respectively, P = .02). The P value for the interaction of group (A or B) × time (preoperative or postoperative) was 0.001. The decreased size of the glenoid was significantly larger in Group A than in Group B (2.1 ± 4.2 vs. -3.1 ± 4.5, respectively, P = .001). The rate of shoulders in which the size of the glenoid decreased 1 year after surgery relative to the preoperative size was significantly higher in Group A than in Group B (63% [17/27] vs. 25% [3/2], respectively, P = .04). CONCLUSIONS The study showed that ABRPO preserved the glenoid size better than simple ABR without a peeling osteotomy procedure.
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Affiliation(s)
- Itaru Kawashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yusuke Iwahori
- Sports Medicine and Joint Center, Asahi Hospital, Kasugai, Aichi, Japan
| | - Shinya Ishizuka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
| | - Hiroki Oba
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takefumi Sakaguchi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | - Masaki Inoue
- Department of Radiology, Asahi Hospital, Kasugai, Aichi, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Wu C, Liu B, Xu C, Zhao S, Li Y, Xu J, Zhao J. Native Glenoid Depth and Hill-Sachs Lesion Morphology in Traumatic Anterior Shoulder Instability. Am J Sports Med 2023; 51:3374-3382. [PMID: 37740546 DOI: 10.1177/03635465231200246] [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: 09/24/2023]
Abstract
BACKGROUND Although Hill-Sachs lesions (HSLs) are assumed to be influenced by glenoid characteristics in the context of bipolar bone loss, little is known about how glenoid concavity influences HSL morphology. PURPOSE To investigate the relationship between the native glenoid depth and HSL morphological characteristics. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Computed tomography images of bilateral shoulders from 151 consecutive patients with traumatic unilateral anterior shoulder instability were retrospectively reviewed. Patients were categorized into flat (<1 mm), moderate (1-2 mm), and deep (>2 mm) groups based on the native glenoid depth measured from the contralateral unaffected shoulder. The HSL morphological characteristics included size (depth, width, length, and volume), location (medial, superior, and inferior extent), and orientation (rim and center angle). The glenoid characteristics included diameter, depth, version, and bone loss. The patient, glenoid, and HSL morphological characteristics were compared among the 3 depth groups. Subsequently, the independent predictors of some critical HSL morphological characteristics were determined using multivariate stepwise regression. RESULTS After exclusion of 55 patients, a total of 96 patients were enrolled and classified into the flat group (n = 31), moderate group (n = 35), and deep group (n = 30). Compared with those in the flat group, patients in the deep group were more likely to have dislocation (38.7% vs 93.3%; P = .009) at the primary instability and had a significantly larger number of dislocations (1.1 ± 1.0 vs 2.2 ± 1.8; P = .010); moreover, patients in the deep group had significantly deeper, wider, larger volume, more medialized HSLs and higher incidences of off-track HSLs (all P≤ .025). No significant differences were detected among the 3 groups in HSL length, vertical position, and orientation (all P≥ .064). After adjustment for various radiological and patient factors in the multivariate regression model, native glenoid depth remained the strongest independent predictor for HSL depth (β = 0.346; P < .001), width (β = 0.262; P = .009), volume (β = 0.331; P = .001), and medialization (β = -0.297; P = .003). CONCLUSION The current study sheds light on the association between native glenoid depth and the morphology of HSLs in traumatic anterior shoulder instability. Native glenoid depth was independently and positively associated with HSL depth, width, volume, and medialization. Patients with deeper native glenoids were more likely to have off-track HSLs and thus require more attention in the process of diagnosis and treatment.
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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
| | - Beibei Liu
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuehua Li
- Institute of Diagnostic and Interventional Radiology, 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
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Delgado C, Luengo-Alonso G, Valencia M, Martínez-Catalán N, Calvo E. Association of Instability History and Off-Track Hill-Sachs Lesions in Anterior Shoulder Instability. Orthop J Sports Med 2023; 11:23259671231213858. [PMID: 38035218 PMCID: PMC10686021 DOI: 10.1177/23259671231213858] [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: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 12/02/2023] Open
Abstract
Background The glenoid track concept is now widely accepted, and its evaluation is considered essential for making decisions about surgery. Purpose To define preoperative descriptive data and clinical and functional features in patients with anterior glenohumeral instability according to glenoid track status and to analyze the influence of off-track Hill-Sachs (HS) lesions on preoperative shoulder function. Study Design Case-control study; Level of evidence, 3. Methods Preoperative magnetic resonance imaging or computed tomography scans were used to measure the glenoid track. Descriptive data and preoperative objective and subjective clinical and functional features were compared between patients with on-track HS lesions versus off-track HS lesions. Multivariate regression analysis was conducted to identify potential risk factors for off-track HS lesion development. Results A total of 235 patients (201 men, 34 women; mean age, 29.6 ± 8.6 years) were included- 134 shoulders (57%) with on-track HS lesions and 101 shoulders (43%) with off-track HS lesions. Age <20 years at first dislocation, number of dislocations, and ≥2 years between first dislocation and surgery were significantly different between the study groups (P = .005, P = .0001, and P = .01, respectively). Regarding these characteristics, the odds ratios for the risk of developing an off-track lesion were 2.67 (95% CI, 1.2-5.99)-1.2 times higher for each additional instability episode (95% CI, 1.025-1.14) and 2.42 times higher (95% CI, 1.176-4.608) for patients whose first dislocation was ≥2 years before surgery, respectively. Patients with off-track HS lesions had a significantly greater degree of instability (P = .04), worse Rowe scores (48.8 ± 15.3 vs 54.8 ± 28.3 for on-track HS lesions; P = .04), and lower Western Ontario Shoulder Instability scores (975 ± 454 vs 1179 ± 428 for on-track HS lesions; P = .01). Conclusion Characteristics related to a history of instability (age <20 years at first instability episode, larger number of dislocations, ≥2 years between first dislocation and surgery) were found to be risk factors for the development of an off-track HS lesion in this study. Off-track lesions led to a higher degree of instability and worse objective and subjective preoperative shoulder function versus on-track HS lesions.
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Affiliation(s)
- Cristina Delgado
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Gonzalo Luengo-Alonso
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Maria Valencia
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Natalia Martínez-Catalán
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Nakagawa S, Hiramatsu K, Yamada Y, Yoneda K, Tanaka Y, Toritsuka Y, Mae T. Glenoid rim morphology in young athletes with unstable painful shoulders: primarily painful vs. frankly unstable. JSES Int 2023; 7:720-729. [PMID: 37719811 PMCID: PMC10499651 DOI: 10.1016/j.jseint.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background To investigate the characteristics of glenoid rim morphology in young athletes (<40 yr) with unstable painful shoulder. Methods This was a retrospective case series. The inclusion criteria were as follows: (1) shoulder pain during sports activity, (2) traumatic onset, (3) no complaint of shoulder instability, and (4) soft tissue or bony lesions confirmed on imaging examinations (computed tomography and magnetic resonance imaging). The above-mentioned painful cohort was then compared (in a 2:1 ratio) to a match-paired control group of patients with similar demographics but with frank anterior glenohumeral instability as defined by imaging and physical findings. The pain (not apprehension) was reproduced during the anterior apprehension test in supine position and relieved by relocation test in all patients. Glenoid rim morphology, bone union in shoulders with a fragment-type glenoid, glenoid defect size, bone fragment size, medial displacement of bone fragments (MDBF), and medial distance of erosion (MDE) were compared between painful shoulders and unstable shoulders. Results There were 79 painful shoulders and 165 unstable shoulders. The glenoid rim morphology was normal in 33 shoulders, erosion-type in 15 shoulders, and fragment-type in 31 shoulders among painful shoulders, whereas the respective shoulders were 19, 33, and 113 among unstable shoulders (P < .001). Bone union was complete in 15 shoulders, partial in 14 shoulders, and nonunion in 2 shoulders among painful shoulders, whereas the respective shoulders were 43, 31, and 39 among unstable shoulders (P = .001). The mean glenoid defect size was 6.0 ± 7.2% and 12.7 ± 7.4%, respectively (P < .001), and the mean bone fragment size was 5.8 ± 6.4% and 5.4 ± 4.6%, respectively, (P = .591). The mean MDBF was 1.4 ± 1.5 mm and 3.0 ± 2.2 mm, respectively (P < .001), and the mean MDE was 2.3 ± 1.2 mm and 5.2 ± 2.4 mm, respectively (P < .001). In shoulders with a smaller glenoid defect (<13.5%), the prevalence of shoulders with MDBF (<2 mm) and shoulders with MDE (<2 mm) was more frequent in painful shoulders. On the other hand, in shoulders with a larger glenoid defect (≥13.5%), erosion-type glenoid, nonunion in fragment-type glenoid and bone fragment smaller than 7.5% was not recognized in painful shoulders. Shoulders with MDBF (<2 mm) were significantly more frequent in painful shoulders (P = .009). Conclusions In painful shoulders normal or erosion-type glenoid was predominant, and glenoid defect size was significantly smaller than unstable shoulders. On the other hand, a large bone fragment (≥7.5%) remained and united completely or partially in all shoulders with a larger glenoid defect (≥13.5%). Bone union was obtained within 2 mm from the articular surface in most of them.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Osaka, Japan
| | | | - Yuzo Yamada
- Department of Orthopaedic Surgery, Yao Municipal Hospital, Yao, Osaka, Japan
| | | | - Yoshinari Tanaka
- Osaka Metropolitan University, Graduate School of Human Life and Ecology, Habikino, Osaka, Japan
| | | | - Tatsuo Mae
- Yukioka Medical University, Ibaraki, Osaka, Japan
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Nakagawa S, Take Y, Mizuno N, Ozaki R, Hanai H, Iuchi R, Kinugasa K. The prevalence of shoulders with a large glenoid defect and small bone fragment increases after several instability events during conservative treatment for traumatic anterior instability. JSES Int 2023; 7:538-543. [PMID: 37426910 PMCID: PMC10328779 DOI: 10.1016/j.jseint.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Background Unstable shoulders with a large glenoid defect and small bone fragment are at higher risk for postoperative recurrence after arthroscopic Bankart repair. The purpose of the present study was to clarify the changes in the prevalence of such shoulders during conservative treatment for traumatic anterior instability. Methods We retrospectively investigated 114 shoulders that underwent conservative treatment and computed tomography (CT) examination at least twice after an instability event in the period from July 2004 to December 2021. We investigated the changes in glenoid rim morphology, glenoid defect size, and bone fragment size from the first to the final CT. Results At first CT, 51 shoulders showed no glenoid bone defect, 12 showed glenoid erosion, and 51 showed a glenoid bone fragment [33 small bone fragment (<7.5%) and 18 large bone fragment (≥7.5%); mean size: 4.9 ± 4.2% (0-17.9%)]. Among patients with glenoid defect (fragment and erosion), the mean glenoid defect was 5.4 ± 6.6% (0-26.6%); 49 were considered a small glenoid defect (<13.5%) and 14 were a large glenoid defect (≥13.5%). While all 14 shoulders with large glenoid defect had a bone fragment, small fragment was solely seen in 4 shoulders. At final CT, 23 of the 51 shoulders persisted without glenoid defect. The number of shoulders presenting glenoid erosion increased from 12 to 24, and the number of shoulders with bone fragment increased from 51 to 67 [36 small bone fragment and 31 large bone fragment; mean size: 5.1 ± 4.9% (0-21.1%)]. The prevalence of shoulders with no or a small bone fragment did not increase from first CT (71.4%) to final CT (65.9%; P = .488), and the bone fragment size did not decrease (P = .753). The number of shoulders with glenoid defect increased from 63 to 91 and the mean glenoid defect significantly increased to 9.9 ± 6.6% (0-28.4%) (P < .001). The number of shoulders with large glenoid defect increased from 14 to 42 (P < .001). Of these 42 shoulders, 19 had no or a small bone fragment. Accordingly, among a total of 114 shoulders, the increase from first to final CT in the prevalence of a large glenoid defect accompanied by no or a small bone fragment was significant [4 shoulders (3.5%) vs. 19 shoulders (16.7%); P = .002]. Conclusions The prevalence of shoulders with a large glenoid defect and small bone fragment increases significantly after several instability events.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Osaka, Japan
| | - Yasuhiro Take
- Department of Orthopaedic Surgery, Daini Police Hospital, Osaka, Osaka, Japan
| | - Naoko Mizuno
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | | | - Hiroto Hanai
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Ryo Iuchi
- Department of Orthopaedic Surgery, Seihu Hospital, Sakai, Osaka, Japan
| | - Kazutaka Kinugasa
- Department of Orthopaedic Sports Medicine, Osaka Rosai Hospital, Sakai, Osaka, Japan
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Nakagawa S, Hirose T, Uchida R, Nakamura H, Mae T, Hayashida K, Yoneda M. Glenoid defect size increases but the bone fragment rarely resorbs in shoulders with recurrent anterior instability. JSES Int 2023; 7:218-224. [PMID: 36911769 PMCID: PMC9998875 DOI: 10.1016/j.jseint.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background With recurrent anterior instability the bone fragment of a bony Bankart lesion is often small compared to the glenoid defect. The purpose of the present study was to clarify the changes to both the bone fragment and glenoid defect over time in a single subject. Methods Participants were patients who underwent computed tomography (CT) at least twice after an instability event between 2004 and 2021 and had a fragment-type glenoid at first CT. The glenoid rim width (A), glenoid defect width (B), and bone fragment width (C) were measured in millimeters. If B or C increased by 1 mm or more from the first to final CT, the change was judged as "enlarged," and if B or C decreased by 1 mm or more, it was judged as "reduced"; all other cases were judged as "similar." Then, glenoid defect size and bone fragment size were calculated as B/A×100% and C/A×100%, respectively, and the changes from the first to final CT were compared. Results From the first to final CT, the glenoid defect was enlarged in 30 shoulders, similar in 13 shoulders, and reduced in 4 shoulders, and the bone fragment was enlarged in 18 shoulders, similar in 24 shoulders, and reduced in 5 shoulders. The mean glenoid defect size significantly increased from 10.9% to 15.3% (P < .001), and the mean bone fragment size increased from 6.4% to 7.8%, respectively (P = .005). At the final CT, in 6 shoulders a new glenoid fracture was observed at a different site from the original fracture. When they were excluded from the analyses, the mean glenoid defect size still significantly increased (from 11.2% to 15.2%; P < .001), but the mean bone fragment size did not (6.5% vs. 7.3%, respectively; P = .088). Conclusions In shoulders with recurrent anterior instability, glenoid defect size appears to increase significantly over time, whereas the bone fragment size remains unchanged or increases only slightly. Bone fragment resorption is quite rare, and a bone fragment appears to be small because of an enlarged glenoid defect.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Osaka, Japan
| | - Takehito Hirose
- Department of Orthopaedic Surgery, Daini Osaka Police Hospital, Osaka, Osaka, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | | | - Tatsuo Mae
- Osaka Yukioka Medical University, Ibaraki, Osaka, Japan
| | - Kenji Hayashida
- Department of Orthopaedic Surgery, Osaka Central Hospital, Osaka, Osaka, Japan
| | - Minoru Yoneda
- Department of Orthopaedic Surgery, Kashiwa Tanaka Hospital, Kashiwa, Chiba, Japan
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Evaluation and Management of the Contact Athlete's Shoulder. J Am Acad Orthop Surg 2022; 30:e584-e594. [PMID: 35171860 DOI: 10.5435/jaaos-d-20-01374] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 12/10/2021] [Indexed: 02/01/2023] Open
Abstract
Shoulder injuries are common in contact athletes and vary in severity because of the required complex interplay of shoulder stability and range of motion for proper function. Pathology varies based on sport but most commonly includes shoulder instability, acromioclavicular injuries, traumatic rotator cuff tears, and brachial plexus injuries. Acute management ranges from reduction of shoulder dislocations to physical examination to determine the severity of injury. Appropriate radiographs should be obtained to evaluate for alignment and fracture, with magnetic resonance imaging commonly being necessary for accurate diagnosis and management. Treatments range from surgical stabilization in shoulder instability to repeat examinations and physical therapy. Return-to-play decision making can be complex with avoidance of reinjury and player safety being of utmost concern. Appropriate evaluation and treatment are vital because repeat injury can lead to long-term effects due to the relatively high effectsometimes seen in contact sports.
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Nakagawa S, Hirose T, Uchida R, Yokoi H, Ohori T, Sahara W, Mae T. A Glenoid Defect of 13.5% or Larger Is Not Always Critical in Male Competitive Rugby and American Football Players Undergoing Arthroscopic Bony Bankart Repair: Contribution of Resultant Large Bone Fragment. Arthroscopy 2022; 38:673-681. [PMID: 34389413 DOI: 10.1016/j.arthro.2021.07.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate bone union and postoperative recurrence after arthroscopic bony Bankart repair (ABBR) in male competitive rugby and American football players with a subcritical glenoid defect of ≥13.5% and to compare findings with those in players with a glenoid defect of <13.5%. METHODS Participants were male competitive rugby or American football players with a glenoid defect and bone fragment who underwent ABBR from July 2011 to December 2018 and were followed for a minimum of 2 years. We investigated the influence of glenoid defect and bone fragment size on bone union and postoperative recurrence after ABBR. RESULTS We included 45 rugby players and 35 American football players. A total of 38 shoulders were assigned to the small defect group (<13.5%) and 42 to the large defect group (≥13.5%). The complete bone union rate was 47.4% in the small defect group and 71.4% in the large defect group (P = .040), and postoperative recurrence was seen in 13 (34.2%) and 5 shoulders (11.9%), respectively (P = .030). In the small defect group, the bone fragment size was <7.5% in 30 shoulders and ≥7.5% in 8 shoulders; in comparison, the respective numbers were 12 and 30 shoulders in the large defect group, and large fragments (>7.5%) were significantly more common in this group (P < .001). The complete union rate was significantly higher in shoulders with a large fragment (≥7.5%) than in those with a small fragment (<7.5%; 78.9% versus 42.9%, respectively; P = .001). The recurrence rate was 33.3% in shoulders with a small fragment (<7.5%) and 10.5% in shoulders with a large fragment (≥7.5%; P = .017) and was significantly lower in shoulders with a complete union than in those without a complete union (6.3% versus 46.9%, respectively; P < .001). CONCLUSION The postoperative recurrence rate after ABBR was lower in male competitive rugby and American football players with a large glenoid defect (≥13.5%) than in those with a small glenoid defect (<13.5%) and might be associated with a higher rate of complete bone union of the resultant large bone fragment (≥7.5%). LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan.
| | - Takehito Hirose
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, Hyogo, Japan
| | - Hiroyuki Yokoi
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Wataru Sahara
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Tatsuo Mae
- Department of Sports Medicine Biomechanics, Osaka University, Graduate School of Medicine, Osaka, Japan
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Nakagawa S, Hirose T, Uchida R, Ohori T, Mae T. Remaining Large Bone Fragment of a Bony Bankart Lesion in Shoulders With a Subcritical Glenoid Defect: Association With Recurrent Anterior Instability. Am J Sports Med 2022; 50:189-194. [PMID: 34855520 DOI: 10.1177/03635465211055707] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A preoperative glenoid defect of 13.5% or larger is recognized as a subcritical glenoid defect at arthroscopic Bankart repair (ABR) for collision/contact athletes or military personnel. PURPOSE To clarify the prevalence and size of remaining bone fragments in shoulders with a subcritical glenoid defect at recurrent anterior instability and to investigate the influence on postoperative recurrence after ABR for younger competitive athletes. STUDY DESIGN Cohort study; Level of evidence, 4. METHODS The study included 96 shoulders with recurrent instability that underwent ABR between July 2011 and March 2018 for shoulders with a subcritical glenoid defect. The patients were divided into 2 groups according to the glenoid defect size (13.5%-<20%, medium; ≥20%, large). The bone fragment size in each defect group was retrospectively investigated and classified into 4 groups (no, 0%; small, >0%-<5%; medium, 5%-<10%; large, ≥10%). The postoperative recurrence rate for each combination of glenoid defect size and bone fragment size was investigated for competitive athletes aged <30 years. The fragments, when present, were repaired to the glenoid. RESULTS The glenoid defect size was 13.5%-<20% in 60 shoulders (medium defect group) and ≥20% in 36 shoulders (large defect group). The mean bone fragment size was 6.7% ± 5.1% and 8.9% ± 4.9%, respectively (P = .042). In the medium defect group, there were 15 shoulders (25%) without a bone fragment, 6 shoulders (10%) with a small fragment, 23 shoulders (38.3%) with a medium fragment, and 16 shoulders (26.7%) with a large fragment. In the large defect group, the respective numbers were 2 shoulders (5.6%), 6 shoulders (16.7%), 14 shoulders (38.9%), and 14 shoulders (38.9%). A medium or large bone fragment was more common in the large defect group (P = .252). Among 64 younger competitive athletes who underwent ABR with a minimum of 2 years of follow-up, postoperative recurrence was recognized in 7 of 38 (18.4%) athletes in the medium defect group, but it was not recognized in any of the 26 athletes in the large defect group (P = .036). Postoperative recurrence was recognized in 4 of 12 (33.3%) athletes with a small fragment or no fragment and in 3 of 52 (5.8%) athletes with a medium or large fragment (P = .019). CONCLUSION A larger bone fragment frequently remained in shoulders with a subcritical glenoid defect at recurrent instability. The postoperative recurrence rate after ABR for younger competitive athletes was low when a remaining larger bone fragment was repaired.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Takehito Hirose
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Kansai-Rosai Hospital, Amagasaki, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan
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Maier J, Oak SR, Soloff L, Schickendantz M, Frangiamore S. Management of common upper extremity injuries in throwing athletes: a critical review of current outcomes. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:295-300. [PMID: 37588704 PMCID: PMC10426540 DOI: 10.1016/j.xrrt.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Given the rising incidence and prevalence of shoulder injuries in throwing athletes, this review aims to evaluate management options and outcomes of common shoulder injuries in overhead throwers. Laxity of the glenohumeral joint is often adaptive for overhead athletes to achieve the velocity necessary to compete in the professional ranks. Surgical repair of the stabilizers of the humeral head-specifically the labrum and rotator cuff-often causes inflammation, scarring, and overtensioning of the glenohumeral joint which lead to poor postoperative performance. Thus, nonsurgical management should be exhausted in this population before considering surgical intervention.
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Affiliation(s)
- Jacob Maier
- University of Toledo College of Medicine, Toledo, OH, USA
| | | | - Lonnie Soloff
- Cleveland Indians Baseball Organization, Cleveland, OH, USA
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Nakagawa S, Sahara W, Kinugasa K, Uchida R, Mae T. Bipolar Bone Defects in Shoulders With Primary Instability: Dislocation Versus Subluxation. Orthop J Sports Med 2021; 9:23259671211003553. [PMID: 34036111 PMCID: PMC8127765 DOI: 10.1177/23259671211003553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022] Open
Abstract
Background: In shoulders with traumatic anterior instability, a bipolar bone defect has been recognized as an important indicator of the prognosis. Purpose: To investigate bipolar bone defects at primary instability and compare the difference between dislocation and subluxation. Study Design: Cohort study; Level of evidence, 3. Methods: There were 156 shoulders (156 patients) including 91 shoulders with dislocation and 65 shoulders with subluxation. Glenoid defects and Hill-Sachs lesions were classified into 5 size categories on 3-dimensional computed tomography (CT) scans and were allocated scores ranging from 0 (no defect) to 4 points (very large defect). To assess the combined size of the glenoid defect and Hill-Sachs lesion, the scores for both lesions were summed (range, 0-8 points). Patients in the dislocation and subluxation groups were compared regarding the prevalence of a glenoid defect, a bone fragment of bony Bankart lesion, a Hill-Sachs lesion, a bipolar bone defect, and an off-track Hill-Sachs lesion. Then, the combined size of the bipolar bone defects was compared between the dislocation and subluxation groups and among patients stratified by age at the time of CT scanning (<20, 20-29, and ≥30 years). Results: Hill-Sachs lesions were observed more frequently in the dislocation group (75.8%) compared with the subluxation group (27.7%; P < .001), whereas the prevalence of glenoid defects was not significantly different between groups (36.3% vs 29.2%, respectively; P = .393). The combined defect size was significantly larger in the dislocation versus subluxation group (mean ± SD combined defect score, 2.1 ± 1.6 vs 0.8 ± 0.9 points, respectively; P < .001) due to a larger Hill-Sachs lesion at dislocation than subluxation (glenoid defect score, 0.5 ± 0.9 vs 0.3 ± 0.6 points [P = .112]; Hill-Sachs lesion score, 1.6 ± 1.2 vs 0.4 ± 0.7 points [P < .001]). Combined defect size was larger in older patients than younger patients in the setting of dislocation (combined defect score, <20 years, 1.6 ± 1.2 points; 20-29 years, 1.9 ± 1.5 points; ≥30 years, 3.4 ± 1.6 points; P < .001) but was not different in the setting of subluxation (0.8 ± 1.0, 0.7 ± 0.9, and 0.8 ± 0.8 points, respectively; P = .885). An off-track Hill-Sachs lesion was observed in 2 older patients with dislocation but was not observed in shoulders with subluxation. Conclusion: The bipolar bone defect was significantly more frequent, and the combined size was greater in shoulders with primary dislocation and in older patients (≥30 years).
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
- Shigeto Nakagawa, MD, PhD, Department of Orthopaedic Sports Medicine, Yukioka Hospital, 2-2-3 Ukita, Kita-ku, Osaka, Osaka 530-0021, Japan ()
| | - Wataru Sahara
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan
| | - Kazutaka Kinugasa
- Department of Orthopaedic Sports Medicine, Osaka Rosai Hospital, Sakai, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, Amagasaki, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan
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Matsumura N, Kaneda K, Oki S, Kimura H, Suzuki T, Iwamoto T, Matsumoto M, Nakamura M, Nagura T. Factors related to large bone defects of bipolar lesions and a high number of instability episodes with anterior glenohumeral instability. J Orthop Surg Res 2021; 16:255. [PMID: 33849594 PMCID: PMC8045245 DOI: 10.1186/s13018-021-02395-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background Significant bone defects are associated with poor clinical results after surgical stabilization in cases of glenohumeral instability. Although multiple factors are thought to adversely affect enlargement of bipolar bone loss and increased shoulder instability, these factors have not been sufficiently evaluated. The purpose of this study was to identify the factors related to greater bone defects and a higher number of instability episodes in patients with glenohumeral instability. Methods A total of 120 consecutive patients with symptomatic unilateral instability of the glenohumeral joint were retrospectively reviewed. Three-dimensional surface-rendered/registered models of bilateral glenoids and proximal humeri from computed tomography data were matched by software, and the volumes of bone defects identified in the glenoid and humeral head were assessed. After relationships between objective variables and explanatory variables were evaluated using bivariate analyses, factors related to large bone defects in the glenoid and humeral head and a high number of total instability episodes and self-irreducible dislocations greater than the respective 75th percentiles were evaluated using logistic regression analyses with significant variables on bivariate analyses. Results Larger humeral head defects (P < .001) and a higher number of total instability episodes (P = .032) were found to be factors related to large glenoid defects. On the other hand, male sex (P = .014), larger glenoid defects (P = .015), and larger number of self-irreducible dislocations (P = .027) were related to large humeral head bone defects. An increased number of total instability episodes was related to longer symptom duration (P = .001) and larger glenoid defects (P = .002), and an increased number of self-irreducible dislocations was related to larger humeral head defects (P = .007). Conclusions Whereas this study showed that bipolar lesions affect the amount of bone defects reciprocally, factors related to greater bone defects differed between the glenoid and the humeral head. Glenoid defects were related to the number of total instability episodes, whereas humeral head defects were related to the number of self-irreducible dislocations.
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Affiliation(s)
- Noboru Matsumura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Kazuya Kaneda
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Satoshi Oki
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroo Kimura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Taku Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takuji Iwamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takeo Nagura
- Department of Clinical Biomechanics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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14
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Bixby EC, Ahmad CS. Anterior Shoulder Instability in the Throwing Athlete. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Yoshida M, Takenaga T, Chan CK, Musahl V, Lin A, Debski RE. Altered shoulder kinematics using a new model for multiple dislocations-induced Bankart lesions. Clin Biomech (Bristol, Avon) 2019; 70:131-136. [PMID: 31491738 DOI: 10.1016/j.clinbiomech.2019.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many active individuals undergo multiple dislocations during the course of a season before surgical treatment without considering the implications of each successive injury. Therefore, the purpose of this study was to develop a multiple dislocation model for the glenohumeral joint and evaluate the resulting changes in joint function. METHODS Eight cadaveric shoulders were evaluated using a robotic testing system. A simulated clinical exam was performed by applying a 50 N anterior load to the humerus at 60° of glenohumeral abduction and external rotation. Each joint was then dislocated. The same loads were applied again and the resulting kinematics were recorded following each of 10 dislocations. The force required to achieve dislocation was recorded and capsulolabral status was assessed. FINDINGS A reproducible Bankart lesion was repeatedly created following the dislocation protocol. The force required for all dislocations significantly decreased following the 1st dislocation. In addition, even lower forces were required to achieve the 5th and subsequent dislocations (p < 0.05). Anterior translation in response to an anterior load during the simulated clinical exam increased between the intact and injured joints (p < 0.05). However, anterior translation reached a plateau following the 3rd to 10th dislocations and was increased compared with the 1st dislocation (p < 0.05). INTERPRETATION A repeatable Bankart lesion was not surgically made, but created by our new dislocation model. Joint function appeared to reach a constant level after the 3rd to 5th dislocations. Thus, multiple dislocations result in a deleterious dose dependent effect suggesting additional damage is not sustained after the fifth dislocation. LEVEL OF EVIDENCE Controlled laboratory study.
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Affiliation(s)
- Masahito Yoshida
- Orthopaedic Robotic Laboratory, University of Pittsburgh, Pittsburgh, USA; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Tetsuya Takenaga
- Orthopaedic Robotic Laboratory, University of Pittsburgh, Pittsburgh, USA; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Calvin K Chan
- Orthopaedic Robotic Laboratory, University of Pittsburgh, Pittsburgh, USA; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA.
| | - Volker Musahl
- Orthopaedic Robotic Laboratory, University of Pittsburgh, Pittsburgh, USA; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA.
| | - Albert Lin
- Orthopaedic Robotic Laboratory, University of Pittsburgh, Pittsburgh, USA; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA.
| | - Richard E Debski
- Orthopaedic Robotic Laboratory, University of Pittsburgh, Pittsburgh, USA; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA.
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16
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Matsumura N, Oki S, Fukasawa N, Matsumoto M, Nakamura M, Nagura T, Yamada Y, Jinzaki M. Glenohumeral translation during active external rotation with the shoulder abducted in cases with glenohumeral instability: a 4-dimensional computed tomography analysis. J Shoulder Elbow Surg 2019; 28:1903-1910. [PMID: 31204064 DOI: 10.1016/j.jse.2019.03.008] [Citation(s) in RCA: 10] [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: 11/25/2018] [Revised: 03/16/2019] [Accepted: 03/19/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although glenohumeral instability is common, the mechanism of instability remains unclear. The purpose of this study was to quantitatively evaluate humeral head translation during active external rotation with abduction in patients with glenohumeral instability by use of 4-dimensional computed tomography scans. METHODS Ten patients with unilateral glenohumeral instability with a positive fulcrum test were prospectively included in this study. Sequential computed tomography of bilateral shoulders during active external rotation at 90° of shoulder abduction was performed for 6 seconds at 5 frames per second. The 3-dimensional positions of the humeral head center in the anteroposterior, superoinferior, and mediolateral directions were calculated at 0°, 20°, 40°, 60°, and maximum shoulder abduction-external rotation from the starting position. Translation of the humeral head center from the starting position was evaluated using Dunnett multiple-comparison tests, and the differences between the affected and intact shoulders were assessed using Wilcoxon signed rank tests. RESULTS The humeral head center translated posteriorly, inferiorly, and medially during glenohumeral external rotation with the shoulder in the abducted position on the intact side. However, the affected humeral head showed significantly less posterior translation (P = .028), greater inferior translation (P = .047), and less medial translation (P = .037) than the contralateral side. CONCLUSIONS This study indicated that dysfunction of the anterior band of the inferior glenohumeral ligament causes decreased posterior, increased inferior, and decreased medial translation of the humeral head during active shoulder abduction-external rotation.
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Affiliation(s)
- Noboru Matsumura
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Satoshi Oki
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
| | - Naoto Fukasawa
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Takeo Nagura
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Yoshitake Yamada
- Department of Radiology, School of Medicine, Keio University, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, School of Medicine, Keio University, Tokyo, Japan
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17
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Hasegawa Y, Kawasaki T, Nojiri S, Sobue S, Kaketa T, Gonda Y, Itoigawa Y, Kaneko K. The Number of Injury Events Associated With the Critical Size of Bipolar Bone Defects in Rugby Players With Traumatic Anterior Shoulder Instability. Am J Sports Med 2019; 47:2803-2808. [PMID: 31425666 DOI: 10.1177/0363546519869673] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The size of a glenoid bone defect is responsible for reduction in shoulder stability and is correlated with the number of instability events. Biomechanical studies have suggested that it should be considered concomitantly with the Hill-Sachs lesion as "bipolar" bone defects for assessing structural degradation, but the definitive number of instability events associated with the critical size has not been investigated. PURPOSE To (1) confirm that the number of instability events is the predictor of a critical size of bipolar bone defects and (2) demonstrate the cutoff value of the number of instability events for these defects in rugby players with traumatic anterior shoulder instability. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS One-hundred forty-four rugby players with anterior shoulder instability underwent morphologic evaluation for glenoid and Hill-Sachs lesions by computed tomography and determination of the critical (a glenoid bone defect of ≥25% or an off-track Hill-Sachs lesion) and subcritical (a glenoid bone defect of ≥13.5%) size of bipolar bone defects. In the primary analysis, the prevalence of the critical and subcritical size of bipolar bone defects was investigated. In the secondary analysis, the authors explored the predictors for these bone defects and determined the cutoff value correlating with the critical and subcritical size of bipolar bone defects by applying receiver operating characteristic curves. RESULTS The primary analysis revealed that the prevalence of critical and subcritical size of bipolar bone defects was 20.8% and 61.8% of 144 shoulders, respectively. In the secondary analysis, multiple logistic regression analysis demonstrated that the total number of shoulder instability events and dominant shoulder were the significant factors associated with the critical and subcritical size of bipolar bone defects. The cutoff value for the number of instability events that correlated with critical bipolar bone defects was 6 for the dominant and 9 for the nondominant shoulder, whereas it was 4 for the dominant and 5 for the nondominant shoulder for subcritical bipolar bone defects. CONCLUSION The number of shoulder instability events and the dominant shoulder were the predictors for the critical and subcritical size of bipolar bone defects for a shoulder with traumatic instability. Four injury events should herald caution when treating rugby players with shoulder instability.
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Affiliation(s)
- Yoshinori Hasegawa
- Department of Orthopaedics and Sports Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Takayuki Kawasaki
- Department of Orthopaedics and Sports Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Shuko Nojiri
- Department of Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Shogo Sobue
- Department of Orthopaedics and Sports Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Takefumi Kaketa
- Department of Orthopaedics and Sports Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yoshinori Gonda
- Department of Orthopaedics and Sports Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yoshiaki Itoigawa
- Department of Orthopaedics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics and Sports Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
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18
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Nakagawa S. Editorial Commentary: Is Arthroscopic Bankart Repair Using Suture Anchors on the Glenoid Appropriate Treatment for Traumatic Anterior Shoulder Instability? Arthroscopy 2019; 35:2509-2511. [PMID: 31395193 DOI: 10.1016/j.arthro.2019.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 02/02/2023]
Abstract
Fracture of the anterior glenoid rim along the sites of suture anchor insertion is not rare after arthroscopic Bankart repair for traumatic anterior shoulder instability. In addition to the influence of the number, type, and size of the suture anchors, placing multiple anchors in a linear arrangement might impose excessive stress on the surrounding bone, leading to critical loss of osseous integrity and glenoid fracture. Although highly active young male collision or contact athletes are most at risk, such fractures sometimes occur after relatively minor trauma at a long interval after surgery, suggesting persistent impairment of bone quality. In patients with postoperative recurrence of instability, detailed examination using computed tomography is recommended.
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19
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Shijith KP, Sood M, Sud AD, Ghai A. Is CT scan a predictor of instability in recurrent dislocation shoulder? Chin J Traumatol 2019; 22:177-181. [PMID: 31056471 PMCID: PMC6543279 DOI: 10.1016/j.cjtee.2019.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 01/15/2019] [Accepted: 03/31/2019] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Glenoid bone defect and the defect on the posterior-superior surface of the humerus "Hill-Sachs lesion" are the commonly seen bony lesions in patients with recurrent dislocation shoulder. Computed tomography (CT) scan is considered as the best option in assessing the bony defects in the recurrent dislocation shoulder. The aim of this study was to assess the clinical and radiological co-relation in the patients with recurrent dislocation shoulder. METHODS Forty-four patients of recurrent dislocation shoulder who were evaluated between January 2015 and December 2017 at a tertiary care center, clinically and radiologically using CT scan and meeting the inclusion criteria, were included. The correlation between the clinical history of the number of dislocations and the bone loss using CT scan was evaluated. Two sided statistical tests were performed at a significance level of α = 0.05. The analysis was conducted using IBM SPSS STATISTICS (version 22.0). RESULTS All the patients were male with mean age of 25.95 (SD ± 4.2) years were evaluated. Twenty-four patients sustained injury in sporting activities while 20 patients sustained injury in training. There were an average of 4.68 (SD ± 3.1, range 2-15, median 3) episodes of dislocation. Forty-one patients had the glenoid bone loss while 40 had the Hill-Sachs lesions. The mean glenoid width defect was 10.80% (range 0-27%) while the mean Hill-Sachs defect was 14.27 mm (range 0-26.6 mm). The mean area of bone loss of the glenoid surface was 10.81% (range 0-22.4%). The lesions were on track in 34 patients and off track in 10 patients. CONCLUSIONS CT scan of the shoulder joint is an effective method for assessing the amount of bone loss. The number of dislocations are correlated significantly with off-track lesions and the amount of bone loss on the glenoid and Hill-Sachs lesion. The glenoid width bone loss of more than 9.80% or Hill-Sachs defect of more than 14.80 mm are the critical defects after which the frequency of dislocations increases.
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Affiliation(s)
- K P Shijith
- Department of Radiology, Army Hospital (R & R), Delhi Cantt, 110010, India
| | - Munish Sood
- Department of Orthopaedics, Command Hospital Chandimandir, Haryana, 134107, India.
| | - Ajay Deep Sud
- Department of Orthopaedics, AFMC, Pune, 410040, India
| | - Amresh Ghai
- Department of Orthopaedics, Base Hospital Delhi Cantt, New Delhi, 110010, India
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20
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Nakagawa S, Iuchi R, Hanai H, Hirose T, Mae T. The Development Process of Bipolar Bone Defects From Primary to Recurrent Instability in Shoulders With Traumatic Anterior Instability. Am J Sports Med 2019; 47:695-703. [PMID: 30673556 DOI: 10.1177/0363546518819471] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recurrence of glenohumeral joint instability after primary traumatic anterior instability is not rare, and bipolar bone loss is one of the most critical factors for recurrent instability, but the development process of bipolar bone defects is still unclear. PURPOSE To investigate the development process of bipolar bone defects from primary to recurrent instability among shoulders with traumatic anterior instability evaluated at least twice by computed tomography (CT). STUDY DESIGN Case series; Level of evidence, 4. METHODS There were 44 patients (47 shoulders) with recurrence after primary instability in which bone morphology was evaluated by 3-dimensional reconstructed CT at primary instability (initial CT) and after recurrence. As CT was performed 3 times for 3 shoulders including primary injury and the second episode of instability (first recurrence), there were 50 CT evaluations. Morphological changes between the initial CT evaluation at primary instability and the second CT evaluation at first recurrence were investigated for 25 shoulders, with the mean interval since initial CT being 9.8 months (range, 2-23 months). Changes between initial CT evaluation and final CT evaluation after ≥2 recurrences were also investigated for 25 shoulders, while the mean number of instability episodes including primary instability was 8.0 (range, 3-40) and the mean interval since initial CT was 18.5 months (range, 5-56 months). RESULTS At primary instability, the prevalence of Hill-Sachs lesions (66.0%) was almost double that of glenoid defects (34.0%), but their prevalence was different between shoulders with primary subluxation (42.3% and 23.8%, respectively) and those with primary dislocation (84.7% and 42.3%, respectively). After recurrence, glenoid defects became significantly more frequent (at first recurrence, 72%; after ≥2 recurrences, 76%), while Hill-Sachs lesions showed a smaller increase (88% and 80%, respectively), so there was no difference between the prevalence of the 2 lesions. The sizes of glenoid defects and Hill-Sachs lesions also enlarged after recurrence, and large bone defects were frequently recognized after recurrence. While bipolar bone loss was not so frequent at primary instability (29.8%), bipolar bone loss increased significantly after recurrence (at first recurrence, 72%; after ≥2 recurrences, 72%). All Hill-Sachs lesions were on track at primary instability, but off-track lesions were recognized in 3 of 47 shoulders (6.4%) after recurrence. CONCLUSION In most shoulders with recurrent instability, a Hill-Sachs lesion developed first, followed by a glenoid defect, leading to bipolar bone loss. Off-track Hill-Sachs lesions were detected only after recurrence.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Ryo Iuchi
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Hiroto Hanai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Takehito Hirose
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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Traumatic Instability: Treatment Options and Considerations for Recurrent Posttraumatic Instability. Sports Med Arthrosc Rev 2018; 26:102-112. [PMID: 30059444 DOI: 10.1097/jsa.0000000000000204] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Recurrent traumatic glenohumeral instability is a complex problem with multiple variables to consider, but patient demographics, activities, as well as clinical and radiographic findings provide significant information to help choose the best treatment option. Although nonoperative treatment is a viable option for primary glenohumeral instability and in-season instability, recurrent instability exhibits anatomic factors which render nonsurgical treatment limited in scope. A proper patient history, clinical examination, and standard and advanced imaging are necessary in the assessment of patients with recurrent traumatic instability. Age, activity, hypermobility, tissue quality, glenoid and humeral head bone stock, and any prior surgical treatment are factors that must be considered for surgical planning. Open and arthroscopic Bankart repairs are good surgical options when bone loss is not an issue but increasing glenoid or humeral osseous deficiency in this setting frequently warrants additional procedures which address bony insufficiency. Controversy remains concerning the threshold value for glenoid bony deficiency and combined, bipolar defects, but this critical number may be less than previously suspected. Despite this controversy, successful surgical treatment of recurrent glenohumeral instability is possible when properly assessed and the correct surgery applied.
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Nakagawa S, Hanai H, Mae T, Hayashida K, Yoneda M. Bipolar Bone Loss in Male Athletes With Traumatic Anterior Shoulder Instability: An Evaluation Using a New Scoring System. Orthop J Sports Med 2018; 6:2325967118782420. [PMID: 30046627 PMCID: PMC6055304 DOI: 10.1177/2325967118782420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: The combination of a glenoid defect and a Hill-Sachs lesion in a shoulder with anterior instability has recently been termed “bipolar bone loss,” but the prevalence and influence of this condition on postoperative recurrence after arthroscopic Bankart repair are still unclear. Purpose: To investigate bipolar bone loss in male athletes using a new scoring system and to evaluate its efficacy by comparing it with the glenoid track concept. Study Design: Case-control study; Level of evidence, 3. Methods: The sizes of both lesions were evaluated retrospectively in 80 male athletes (85 shoulders) using computed tomography. The glenoid defects and the length, width, and depth of the Hill-Sachs lesions were classified into 5 size categories and were allocated scores from “0” for no defect to “4” for the largest defect. Patients were then classified into 5 classes according to the total score for both lesions: class 1, 0-1 point; class 2, 2 points; class 3, 3 points; class 4, 4 points; and class 5, ≥5 points. The prevalence of bipolar bone loss and postoperative recurrence rates for patients with at least 2 years of follow-up were compared among the classes. The recurrence rate for each class was also compared between shoulders with an off-track lesion and shoulders with an on-track lesion as well as among 3 sporting categories: rugby, American football, and other sports. Results: Based on the combination of glenoid defect size and Hill-Sachs lesion length, the postoperative recurrence rate was 0% for shoulders in class 1, 12.5% for class 2, 33.3% for class 3, 28.6% for class 4, and 31.3% for class 5, while the recurrence rates were 0%, 16.7%, 28.6%, 27.3%, and 31.6%, respectively, for the combination of glenoid defect size and Hill-Sachs lesion width and 0%, 8.3%, 26.7%, 28.6%, and 35.3%, respectively, for the combination of glenoid defect size and Hill-Sachs lesion depth. Postoperative recurrence was frequently recognized regardless of the presence of off-track Hill-Sachs lesions. No recurrence was recognized in class 1 shoulders among rugby players, in classes 1 and 2 among American football players, and in classes 1 through 3 among other athletes based on the combination of glenoid defect size and Hill-Sachs lesion size. Conclusion: Our scoring system for bipolar bone loss was useful to evaluate the influence on postoperative recurrence in male athletes. The postoperative recurrence rate was influenced by the extent of bipolar bone loss and the sporting category regardless of the presence of off-track lesions.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Hiroto Hanai
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kenji Hayashida
- Department of Orthopaedic Surgery, Osaka Police Hospital, Osaka, Japan
| | - Minoru Yoneda
- Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
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Abstract
PURPOSE OF REVIEW The purpose of this review is to outline the natural history and best clinical practices for nonoperative management of anterior shoulder instability. RECENT FINDINGS Recent studies continue to demonstrate a role for nonoperative treatment in the successful long-term management of anterior glenohumeral instability. The success of different positions of shoulder immobilization is reviewed as well. There are specific patients who may be best treated with nonoperative means after anterior glenohumeral instability. There are also patients who are not good nonoperative candidates based on a number of factors that are outlined in this review. There continues to be no definitive literature regarding the return to play of in-season athletes. Successful management requires a thorough understanding of the epidemiology, pathoanatomy, history, physical examination, diagnostic imaging modalities, and natural history of operative and nonoperative treatment.
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Nakagawa S, Mae T, Sato S, Okimura S, Kuroda M. Risk Factors for the Postoperative Recurrence of Instability After Arthroscopic Bankart Repair in Athletes. Orthop J Sports Med 2017; 5:2325967117726494. [PMID: 28959698 PMCID: PMC5593221 DOI: 10.1177/2325967117726494] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Several risk factors for the postoperative recurrence of instability after arthroscopic Bankart repair have been reported, but there have been few detailed investigations of the specific risk factors in relation to the type of sport. Purpose: This study investigated the postoperative recurrence of instability after arthroscopic Bankart repair without additional reinforcement procedures in competitive athletes, including athletes with a large glenoid defect. The purpose of this study was to investigate risk factors related to the postoperative recurrence of instability in athletes. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 115 athletes (123 shoulders) were classified into 5 groups according to type of sport: rugby (41 shoulders), American football (32 shoulders), other collision sports (18 shoulders), contact sports (15 shoulders), and overhead sports (17 shoulders). First, the recurrence rate in each sporting category was investigated, with 113 shoulders followed up for a minimum of 2 years. Then, factors related to postoperative recurrence were investigated in relation to the type of sport. Results: Postoperative recurrence of instability was noted in 23 of 113 shoulders (20.4%). The recurrence rate was 33.3% in rugby, 17.2% in American football, 11.1% in other collision sports, 14.3% in contact sports, and 12.5% in overhead sports. The most frequent cause of recurrence was tackling, and recurrence occurred with tackling in 12 of 16 athletes playing rugby or American football. Reoperation was completed in 11 shoulders. By univariate analysis, significant risk factors for postoperative recurrence of instability included playing rugby, age between 10 and 19 years at surgery, preoperative glenoid defect, small bone fragment of bony Bankart lesion, and capsular tear. However, by multivariate analysis, the most significant factor was not the type of sport but younger age at operation and a preoperative glenoid defect with small or no bone fragment. Compared with the other sports, there was a significantly greater recurrence rate among rugby players without the aforementioned significant risk factors (small glenoid defect, ≤10%; medium or large bone fragment, >5%; and no capsular tear). Conclusion: Younger age at operation and preoperative glenoid defect with small or no bone fragment significantly influenced recurrent instability among competitive athletes.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Seira Sato
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Shinichiro Okimura
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
| | - Miki Kuroda
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan
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Three-dimensional quantitative analysis of humeral head and glenoid bone defects with recurrent glenohumeral instability. J Shoulder Elbow Surg 2017; 26:1662-1669. [PMID: 28478901 DOI: 10.1016/j.jse.2017.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 02/22/2017] [Accepted: 03/07/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although bone defects of the humeral head and glenoid could affect glenohumeral instability, bone loss has not been sufficiently evaluated. The purpose of this study was to quantify bone defects 3-dimensionally in cases with glenohumeral instability. METHODS Three-dimensional surface models of bilateral proximal humeri and glenoids were reconstructed from computed tomography scans of 90 patients with symptomatic, unilateral, recurrent glenohumeral instability. The left-side models were mirrored, and intact bone areas were matched to those of the right-side models. The volume, length, width, and depth of identified bone defects were assessed. After the values were corrected by patient height, the characteristics of the bone defects were evaluated. RESULTS Bone defects were present in 97.8% of the humeral heads and 96.7% of the glenoids, and women had significantly smaller bone defects than men did. The volume of humeral head defects had a mild correlation with that of glenoid defects. The number of traumatic episodes was not correlated with humeral head bone defects, but it was positively correlated with glenoid bone defects. Patients with recurrent dislocations had significantly deeper and larger Hill-Sachs lesions than the other cases. CONCLUSION Bone defects of the humeral head and the glenoid in cases with symptomatic traumatic glenohumeral instability were quantified 3-dimensionally using a computed tomography surface-matching technique. Almost all cases showed bone defects in the humeral head and glenoid compared with the intact shoulder, and such bone defects may be more common than previously reported. This study suggested that bipolar bone lesions are not always created by the same mechanism.
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Nakagawa S, Ozaki R, Take Y, Iuchi R, Mae T. Relationship Between Glenoid Defects and Hill-Sachs Lesions in Shoulders With Traumatic Anterior Instability. Am J Sports Med 2015; 43:2763-73. [PMID: 26316609 DOI: 10.1177/0363546515597668] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While the combination of a glenoid defect and a Hill-Sachs lesion in a shoulder with anterior instability has recently been termed a bipolar lesion, their relationship is unclear. PURPOSE To investigate the relationship of the glenoid defect and Hill-Sachs lesion and the factors that influence the occurrence of these lesions as well as the recurrence of instability. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS The prevalence and size of both lesions were evaluated retrospectively by computed tomography scanning in 153 shoulders before arthroscopic Bankart repair. First, the relationship of lesion prevalence and size was investigated. Then, factors influencing the occurrence of bipolar lesions were assessed. Finally, the influence of these lesions on recurrence of instability was investigated in 103 shoulders followed for a minimum of 2 years. RESULTS Bipolar lesions, isolated glenoid defects/isolated Hill-Sachs lesions, and no lesion were detected in 86, 45, and 22 shoulders (56.2%, 29.4%, and 14.4%), respectively. As the glenoid defect became larger, the Hill-Sachs lesion also increased in size. However, the size of these lesions showed a weak correlation, and large Hill-Sachs lesions did not always coexist with large glenoid defects. The prevalence of bipolar lesions was 33.3% in shoulders with primary instability and 61.8% in shoulders with recurrent instability. In relation to the total events of dislocations/subluxations, the prevalence was 44.2% in shoulders with 1 to 5 events, 69.0% in shoulders with 6 to 10 events, and 82.8% in shoulders with ≥11 events. Regarding the type of sport, the prevalence was 58.9% in athletes playing collision sports, 53.3% in athletes playing contact sports, and 29.4% in athletes playing overhead sports. Postoperative recurrence of instability was 0% in shoulders without lesions, 0% with isolated Hill-Sachs lesions, 8.3% with isolated glenoid defects, and 29.4% with bipolar lesions. The presence of a bipolar lesion significantly influenced the recurrence rate, but lesion size did not. CONCLUSION The prevalence of bipolar lesions was approximately 60%. As glenoid defects became larger, Hill-Sachs lesions also enlarged, but there was no strong correlation. Bipolar lesions were frequent in patients with recurrent instability, patients with repetitive dislocation/subluxation, and those playing collision/contact sports. Instability showed a high recurrence rate in shoulders with bipolar lesions.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Ritsuro Ozaki
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Yasuhiro Take
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ryo Iuchi
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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Nakagawa S, Ozaki R, Take Y, Mae T, Hayashida K. Bone fragment union and remodeling after arthroscopic bony bankart repair for traumatic anterior shoulder instability with a glenoid defect: influence on postoperative recurrence of instability. Am J Sports Med 2015; 43:1438-47. [PMID: 25748472 DOI: 10.1177/0363546515571555] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although good clinical outcomes have been reported after arthroscopic bony Bankart repair, the extent of bone union is still unclear. PURPOSE To investigate bone union after arthroscopic bony Bankart repair and its influence on postoperative recurrence of instability. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Among 113 consecutive shoulders that underwent arthroscopic bony Bankart repair, postoperative evaluation of bone union by computed tomography (CT) was performed at various times in 81 shoulders. Bone union was investigated during 3 periods: 3 to 6 months postoperatively (first period), 7 to 12 months postoperatively (second period), and 13 months or more postoperatively (third period). The influence of the size of the preoperative glenoid defect and the size of the bone fragment on bone union was investigated, as well as the influence of bone union on postoperative recurrence of instability. In shoulders with bone union, bone fragment remodeling and changes in the glenoid defect size were also investigated. RESULTS The bone union rate was 30.5% in the first period, 55.3% in the second period, and 84.6% in the third period. Among 53 shoulders with CT evaluation in the second period or later and follow-up for a minimum of 1 year, there was complete union in 33 shoulders (62.3%), partial union in 3 (5.7%), nonunion in 8 (15.1%), and no fragment on CT in 9 (17.0%). The complete union rate was 50% for 22 shoulders with small bone fragments (<5% of the glenoid diameter), 56.3% for 16 shoulders with medium fragments (5%-10%), and 86.7% for 15 shoulders with large fragments (>10%). The recurrence rate for postoperative instability was only 6.1% for shoulders with complete union, while it was 50% for shoulders with partial union, nonunion, no fragment, and no fragment on CT. The recurrence rate was significantly higher (36.4%) in shoulders with small fragments, but it was significantly lower in shoulders with bone union. In shoulders with bone union, the bone fragment frequently became larger over time, while the size of the glenoid defect decreased significantly from 18.6% preoperatively to 4.7% postoperatively. CONCLUSION Bone union was not always achieved after arthroscopic bony Bankart repair, and union was often delayed. Recurrence of instability was significantly more frequent when bone union failed. The size of the glenoid defect decreased significantly in shoulders with bone union.
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Affiliation(s)
- Shigeto Nakagawa
- Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
| | - Ritsuro Ozaki
- Department of Orthopaedic Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Yasuhiro Take
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kenji Hayashida
- Department of Orthopaedic Surgery, Osaka Police Hospital, Osaka, Japan
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