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de Cabo G, Álvarez-Benito N, Ramos-Murillo P, Poyato-Núñez F, González-Martín D, Leyes M. Modified Dynamic Anterior Stabilization and Labroplasty for Anterior Shoulder Instability With Concomitant SLAP Lesion. Arthrosc Tech 2023; 12:e2153-e2159. [PMID: 38196855 PMCID: PMC10772957 DOI: 10.1016/j.eats.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/20/2023] [Indexed: 01/11/2024] Open
Abstract
Several arthroscopic techniques to treat anterior shoulder instability have been described. Bankart repair may be insufficient in cases with some degree of bone loss, and arthroscopic Latarjet is technically challenging. It is not rare to find at the time of surgery a more extensive labral tear (SLAP lesion) or an insufficient anterior capsulolabral tissue. We describe for those cases a dynamic anterior stabilization where using the long head of the biceps we are treating the SLAP lesion and at the same time it provides the "sling effect" of a Latarjet procedure for the anterior instability.
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Affiliation(s)
- Gonzalo de Cabo
- Department of Orthopedic Surgery and Traumatology, Olympia, Quirón Salud, Madrid, Spain
| | - Nuria Álvarez-Benito
- Department of Orthopedic Surgery and Traumatology, Olympia, Quirón Salud, Madrid, Spain
- Department of Orthopedic Surgery and Traumatology, Hospital Universitario de Canarias, Tenerife, Spain
| | - Pablo Ramos-Murillo
- Department of Orthopedic Surgery and Traumatology, Olympia, Quirón Salud, Madrid, Spain
| | | | - David González-Martín
- Department of Orthopedic Surgery and Traumatology Clínica Origen, Grupo Recoletas, Valladolid, Spain
- Universidad Europea Miguel de Cervantes, Valladolid, Spain
| | - Manuel Leyes
- Department of Orthopedic Surgery and Traumatology, Olympia, Quirón Salud, Madrid, Spain
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2
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Kang Y, Wang L, Wang M, Wei Y, Li Y, Jiang J, Yu S, Zhao J, Xie G. Bankart Repair With Transferred Long Head of the Biceps Provides Better Biomechanical Effect Than Conjoined Tendon Transfer in Anterior Shoulder Instability With 20% Glenoid Defect. Arthroscopy 2022; 38:2628-2635. [PMID: 35364262 DOI: 10.1016/j.arthro.2022.03.022] [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: 10/30/2021] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the biomechanical differences between labral repair with transferred conjoined tendon and transferred long head of the biceps tendon (LHBT) for anterior shoulder instability with 20% bone loss. METHODS Twelve cadaveric shoulders were tested in sequent 5 conditions: intact, 20% glenoid defect, Bankart repair, Bankart repair with transferred conjoined tendon (dynamic conjoined tendon sling, DCS), and with transferred LHBT (dynamic LHBT sling, DLS) at 60° of glenohumeral abduction and 60° of external rotation. The physiological glenohumeral joint load was created by forces applied to the rotator cuff, conjoined tendon, and LHBT. The glenohumeral compression force and range of motion were recorded before anteroinferior force application. The anterior, inferior, and total translations were measured with 20, 30, 40, and 50 N of anteroinferior force, respectively. RESULTS Anteroinferior glenoid defect led to significant increase of humerus translation and decrease of glenohumeral compression force. DLS provided better resistance effect in both anterior-posterior and superior-inferior directions than DCS under high loading condition (40 N, P =.03; 50 N, P <.01). Both DCS and DLS procedures could further restore glenohumeral compression force with Bankart repair (Bankart repair: 32.1 ± 4.0 N; DCS: 36.7 ± 3.2 N, P < .01; DLS: 35.8 ± 3.6 N, P =.03). No range of motion restrictions were observed relative to the normal shoulder. CONCLUSIONS Both the DLS and DCS techniques could reduce the anterior-inferior translation and partially restore the glenohumeral stability in anterior shoulder instability with 20% anteroinferior glenoid defect compared with Bankart repair. Under greater loading conditions, DLS provides better stability than DCS. CLINICAL RELEVANCE Shoulder stability can be restored by DLS and DCS with low load. With greater shoulder stability requirements, DLS might be a better option than DCS for anterior shoulder instability with 20% bone loss.
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Affiliation(s)
- Yuhao Kang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Group, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liren Wang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Group, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingqi Wang
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Group, Shanghai Jiao Tong University School of Medicine, Shanghai, China; School of Basic Medical Science, Fudan University, Shanghai, China
| | - Yiyao Wei
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Group, Shanghai Jiao Tong University School of Medicine, Shanghai, China; School of Basic Medical Science, Fudan University, Shanghai, China
| | - Yufeng Li
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jia Jiang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Group, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Suiran Yu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Group, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Guoming Xie
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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3
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Krespi R, Maman E, Factor S, Benshabat D, Dolkart O, Ashkenazi I, Beyth S, Chechik O. Combined Bankart and SLAP repair: patient-reported outcome measurements after a minimum 5-year follow-up. Arch Orthop Trauma Surg 2022; 143:2621-2626. [PMID: 36018369 DOI: 10.1007/s00402-022-04599-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anterior shoulder instability is typically characterized by detachment of the anteroinferior labrum (Bankart lesion). Some patients also sustain a superior labrum anterior-to-posterior (SLAP) injury. The purpose of this study was to compare the medium-term clinical results of isolated anterior Bankart repairs (ABR) with those of combined Bankart and SLAP repair (ABR + SLAP). METHODS Data on all patients treated surgically for recurrent anterior shoulder instability between 2006 and 2011 were retrospectively collected from medical charts. The minimum follow-up was 5 years. Patients were interviewed to assess patient-reported outcome measurements (PROM) as determined by the American Shoulder and Elbow Surgeons Score (ASES), the Subjective Shoulder Score (SSV), and the Disabilities of the Arm, Shoulder, and Hand Score (DASH), as well as their quality of life (QOL: SF12 questionnaire). Information on complications, re-operations, and recurrent instability was recorded and evaluated as well. RESULTS A total of 150 patients (88% males) with a mean age 23.7 years (range 15-40) were included. Forty-two patients following ABR + SLAP repair were compared to 108 patients following ABR alone, with a mean follow-up of 7.8 years (range 5-10.7). The rate of re-dislocation was similar in both groups (26% for ABR + SLAP vs 20% for ABR, p = .44). There were no significant differences in functional outcome between the ABR + SLAP and the ABR alone groups (SSV 86.7 vs 86.5, p = .93, ASES 89.6 vs 86.5, p = .11, and DASH 4.9 vs 7, p = .17), or in QOL outcome (SF12 physical 95.6 vs 93.3, p = .27, SF12 mental 84.4 vs 85.7, p = .63). CONCLUSION Surgical repair for anterior shoulder instability and a coexisting SLAP lesion yields clinical results as good as those of isolated ABR, as evidenced by similar PROM and re-dislocation rates after medium-term follow-up. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Raphael Krespi
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weitzman St., 6423906, Tel Aviv, Israel
| | - Eran Maman
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weitzman St., 6423906, Tel Aviv, Israel
| | - Shai Factor
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weitzman St., 6423906, Tel Aviv, Israel.
| | - Dvir Benshabat
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weitzman St., 6423906, Tel Aviv, Israel
| | - Oleg Dolkart
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weitzman St., 6423906, Tel Aviv, Israel
| | - Itay Ashkenazi
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weitzman St., 6423906, Tel Aviv, Israel
| | - Shaul Beyth
- Department of Orthopedic Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofir Chechik
- Orthopedic Division, Department of Orthopedic Surgery, Affiliated with the Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, 6 Weitzman St., 6423906, Tel Aviv, Israel
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4
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Baron JE, Duchman KR, Hettrich CM, Glass NA, Ortiz SF, Baumgarten KM, Bishop JY, Bollier MJ, Bravman JT, Brophy RH, Carpenter JE, Cox CL, Feeley BT, Frank RM, Grant JA, Jones GL, Kuhn JE, Lansdown DA, Benjamin Ma C, Marx RG, McCarty EC, Miller BS, Neviaser AS, Seidl AJ, Smith MV, Wright RW, Zhang AL, Wolf BR. Beach Chair Versus Lateral Decubitus Position: Differences in Suture Anchor Position and Number During Arthroscopic Anterior Shoulder Stabilization. Am J Sports Med 2021; 49:2020-2026. [PMID: 34019439 DOI: 10.1177/03635465211013709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic shoulder capsulolabral repair using glenoid-based suture anchor fixation provides consistently favorable outcomes for patients with anterior glenohumeral instability. To optimize outcomes, inferior anchor position, especially at the 6-o'clock position, has been emphasized. Proponents of both the beach-chair (BC) and lateral decubitus (LD) positions advocate that this anchor location can be consistently achieved in both positions. HYPOTHESIS Patient positioning would be associated with the surgeon-reported labral tear length, total number of anchors used, number of anchors in the inferior glenoid, and placement of an anchor at the 6-o'clock position. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS This study was a cross-sectional analysis of a prospective multicenter cohort of patients undergoing primary arthroscopic anterior capsulolabral repair. Patient positioning in the BC versus LD position was determined by the operating surgeon and was not randomized. At the time of operative intervention, surgeon-reported labral tear length, total anchor number, anchor number in the inferior glenoid, and anchor placement at the 6-o'clock position were evaluated between BC and LD cohorts. Descriptive statistics and between-group differences (continuous: t test [normal distributions], Wilcoxon rank sum test [nonnormal distributions], and chi-square test [categorical]) were assessed. RESULTS In total, 714 patients underwent arthroscopic anterior capsulolabral repair (BC vs LD, 406 [56.9%] vs 308 [43.1%]). The surgeon-reported labral tear length was greater for patients having surgery in the LD position (BC vs LD [mean ± SD], 123.5°± 49° vs 132.3°± 44°; P = .012). The LD position was associated with more anchors placed in the inferior glenoid and more frequent placement of anchors at the 6-o'clock (BC vs LD, 22.4% vs 51.6%; P < .001). The LD position was more frequently associated with utilization of ≥4 total anchors (BC vs LD, 33.5% vs 46.1%; P < .001). CONCLUSION Surgeons utilizing the LD position for arthroscopic capsulolabral repair in patients with anterior shoulder instability more frequently placed anchors in the inferior glenoid and at the 6-o'clock position. Additionally, surgeon-reported labral tear length was longer when utilizing the LD position. These results suggest that patient positioning may influence the total number of anchors used, the number of anchors used in the inferior glenoid, and the frequency of anchor placement at the 6 o'clock position during arthroscopic capsulolabral repair for anterior shoulder instability. How these findings affect clinical outcomes warrants further study. REGISTRATION NCT02075775 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Jacqueline E Baron
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Kyle R Duchman
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Carolyn M Hettrich
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Natalie A Glass
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Shannon F Ortiz
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
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- Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, South Dakota, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Julie Y Bishop
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Matthew J Bollier
- University of Iowa, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Jonathan T Bravman
- University of Colorado, Aurora, Colorado, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Robert H Brophy
- Washington University, St. Louis, Missouri, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - James E Carpenter
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Charles L Cox
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Brian T Feeley
- University of California, San Francisco, San Francisco, California, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Rachel M Frank
- University of Colorado, Denver, Denver, Colorado, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - John A Grant
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Grant L Jones
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - John E Kuhn
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Drew A Lansdown
- University of California, San Francisco, San Francisco, California, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - C Benjamin Ma
- University of California, San Francisco, San Francisco, California, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Eric C McCarty
- University of Colorado, Aurora, Colorado, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Bruce S Miller
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Andres S Neviaser
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Adam J Seidl
- University of Colorado, Aurora, Colorado, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Matthew V Smith
- Washington University, St. Louis, Missouri, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Rick W Wright
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Alan L Zhang
- University of California, San Francisco, San Francisco, California, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
| | - Brian R Wolf
- University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.,Investigation performed at University of Iowa, Iowa City, Iowa, USA
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5
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Eren TK, Aktaş E, Kaptan AY, Ayanoğlu T, Ulucaköy C, Kanatlı U. Recurrent anterior shoulder instability in patients 40-60 years old. Accompanying injuries and patient outcomes of arthroscopic repair. J Orthop Sci 2021; 26:584-588. [PMID: 32600903 DOI: 10.1016/j.jos.2020.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Accompanying injuries are frequently seen in middle aged patients with recurrent instability. The aim of this study was to elucidate the associated injuries, report patient outcomes of the following arthroscopic instability surgery regarding 40-60 years old patients with recurrent shoulder instability. METHODS Patients that underwent arthroscopic instability surgery due to recurrent shoulder instability between February 2008 and November 2015, and which were 40-60 years old were included and evaluated retrospectively. Minimum follow-up duration was 24 months. Anterior-inferior labral injuries and accompanying pathologies such as rotator cuff tears and SLAP lesions were documented. Postoperative patient-reported outcome evaluation was made using Oxford Shoulder Instability Score. RESULTS Among 355 patients that underwent arthroscopic instability surgery, 88 patients which had pathology of recurrent instability were in the range of 40-60 years old. Patients who had previous shoulder surgery or fracture (n = 8) epileptic seizure history (n = 3), neurologic deficit (n = 2) were excluded from the study. 75 patients were included with a mean follow-up 69 ± 23 months (32-125). The percentage of middle-aged and elderly (40-60 years old) was 24.8% among recurrent shoulder instability patients. 44% had isolated Bankart lesion whereas 56% revealed multiple pathologies. Bankart + SLAP lesions were found in 32%, whereas Bankart + Rotator Cuff tears in 26.7% (13 isolated supraspinatus, 4 supraspinatus + subscapularis, 1 isolated subscapularis full-thickness and 2 partial-thickness supraspinatus tears). The mean Oxford Shoulder Instability Score was 38.4 ± 5.2 (26-48). The scores of patients which were treated with labrum and rotator cuff repair (median 42, range 30-48) were significantly better than the patients who were treated with isolated labrum repair (median 39, range 20-46) (p = 0.015). There was no difference regarding patients with or without SLAP repair (median 39 vs 39 and range 30-48 vs 20-48, respectively) (p = 0.702). CONCLUSIONS Arthroscopic repair of capsulolabral lesions is a safe and successful technique in 40-60 years old patients. Furthermore, the presence of repaired rotator cuff tears led to even superior results. Accompanying SLAP lesions did not affect the results. STUDY DESIGN Retrospective Case Series. LEVEL OF EVIDENCE 4, Retrospective Case Series.
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Affiliation(s)
- Toygun Kağan Eren
- Department of Orthopedics and Traumatology, Ankara Training and Research Hospital, Ankara, Turkey.
| | - Erdem Aktaş
- Department of Orthopedics and Traumatology, TOBB ETU Faculty of Medicine, Ankara, Turkey
| | - Ahmet Yiğit Kaptan
- Department of Orthopedics and Traumatology, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Tacettin Ayanoğlu
- Department of Orthopedics and Traumatology, Bolu Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Coşkun Ulucaköy
- Department of Orthopedics and Traumatology, Dr. Abdurrahman Yurtaslan Ankara Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Ulunay Kanatlı
- Department of Orthopedics and Traumatology, Gazi University Faculty of Medicine, Ankara, Turkey
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6
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Jildeh TR, Taylor KA, Tramer JS, Khalil LS, Hasan L, Okoroha KR, Moutzouros V. Risk Factors for Postoperative Opioid Use in Arthroscopic Shoulder Labral Surgery. Arthroscopy 2020; 36:1813-1820. [PMID: 32200066 DOI: 10.1016/j.arthro.2020.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 02/26/2020] [Accepted: 03/01/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the correlation between preoperative and postoperative opioid use in patients undergoing arthroscopic shoulder labral repair, as well as patient risk factors associated with increased postoperative opioid use after the procedure. METHODS A retrospective review of all patients undergoing arthroscopic shoulder labral surgery at a single institution between August 2013 and November 2017 was performed. Patients were stratified as opioid nonusers, acute users, or chronic users based on preoperative consumption. Patient demographic characteristics, injury characteristics, surgical interventions, and postoperative opioid use for the first 12 months after surgery were then analyzed. RESULTS A total of 340 patients were included in this study. The average age was 26.3 years (range, 13-68 years), and the average body mass index was 27.5 (range, 18.4-45.0). Preoperative opioid users (acute and chronic) were found to continue to receive opioid medications at extended time points beyond 2 months postoperatively compared with nonusers (P < .001). Patients with intraoperatively identified SLAP tears experienced more preoperative pain and required more postoperative opioid prescriptions (P = .018). On stratification for other common shoulder instability injury patterns, no differences were found between the number of postoperative opioid prescriptions filled and the presence of Bankart lesion, Hill-Sachs lesion, reverse Hill-Sachs lesion, anterior labroligamentous periosteal sleeve avulsion, glenolabral articular disruption, or humeral avulsion of the glenohumeral ligament (P > .05). CONCLUSIONS In patients undergoing arthroscopic labral surgery, the chronicity of preoperative opioid use, number of concomitant procedures at the time of initial surgery, and presence of biceps tenodesis were found to significantly increase postoperative opioid demand. Orthopaedic surgeons should recognize risk factors for increased opioid use postoperatively and adapt treatment strategies and patient counseling accordingly. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Toufic R Jildeh
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A..
| | - Kevin A Taylor
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Joseph S Tramer
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Lafi S Khalil
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Laith Hasan
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Vasilios Moutzouros
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A
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7
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Kandeel AAM. Type V superior labral anterior-posterior (SLAP) lesion in recurrent anterior glenohumeral instability. J Shoulder Elbow Surg 2020; 29:95-103. [PMID: 31471245 DOI: 10.1016/j.jse.2019.05.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/21/2019] [Accepted: 05/28/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The literature has reported debatable diagnostic accuracy of clinical provocative tests for a type II superior labral anteroposterior (SLAP) lesion, especially in the context of a type V SLAP (concurrent Bankart and type II SLAP) lesion. This study was conducted to determine whether the investigated provocative tests offer reliable predictive values in the diagnosis of type II SLAP lesions in patients with recurrent anterior glenohumeral (GH) instability. METHODS This prospective case-control study carried out between September 2014 and September 2018 included 51 patients with post-traumatic recurrent anterior GH instability. Patients were prospectively evaluated for type II SLAP lesions by 9 provocative tests: Jobe relocation test, abduction-external rotation test, anterior slide test, biceps load test I, biceps load test II, pain provocation test, labral tension test, crank test, and the O'Driscoll dynamic labral shear test. The results of these tests were compared with findings of diagnostic arthroscopic GH examinations (control). RESULTS Statistical analysis revealed the mean age of the studied group to be 26.1 ± 7.56 years, with male predominance (50 patients; 98.04%). Arthroscopic examination revealed a Bankart lesion in isolation and in association with a type II SLAP lesion (ie, a type V SLAP lesion) in 15 (29.4%) and 36 (70.6%) patients, respectively. The anterior slide test yielded the highest positive and lowest negative likelihood ratios (2.91 and 0.52, respectively). CONCLUSION Except for the anterior slide test, which can be validated for the clinical diagnosis of type II SLAP lesions in patients with traumatic recurrent anterior GH instability, the investigated tests offer poor predictive values and should be cautiously used in clinical practice.
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Affiliation(s)
- Amr Abdel-Mordy Kandeel
- Department of Orthopedics and Traumatology, Faculty of Medicine, Menoufia University, Menoufia Governorate, Egypt.
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8
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Feng S, Song Y, Li H, Chen J, Chen J, Chen S. Outcomes for Arthroscopic Repair of Combined Bankart/SLAP Lesions in the Treatment of Anterior Shoulder Instability: A Systematic Review and Meta-analysis. Orthop J Sports Med 2019; 7:2325967119877804. [PMID: 31700937 PMCID: PMC6823984 DOI: 10.1177/2325967119877804] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Arthroscopic repair of combined Bankart/superior labral anteroposterior (SLAP) lesions is commonly performed to treat anterior shoulder instability, the clinical outcomes of which have not been widely studied. Purpose To compare the clinical outcomes for arthroscopic repair of combined Bankart/SLAP lesions in the treatment of anterior shoulder instability and to ascertain whether it is inferior to isolated Bankart repair. Study Design Systematic review; Level of evidence, 3. Methods A systematic review of the literature was performed through use of the MEDLINE, EMBASE, and Cochrane Library databases according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Study bias was assessed using the MINORS (Methodological Index for Non-Randomized Studies) scoring system. Randomized controlled trials, prospective or retrospective cohort studies, and case-control studies were included, whereas systematic reviews, literature reviews, conference abstracts, case reports, case series, and non-peer-reviewed studies were excluded to guarantee the quality of the study. Data on outcomes including recurrence rate, functional scores, and range of motion (ROM) were pooled, with statistical analysis performed. A P value of <.05 was considered statistically significant. Results The review included 7 studies with a total of 520 patients. The pooled recurrence rate after combined Bankart/SLAP repair was 6.47% (9/139). Significant improvements of postoperative versus preoperative functional scores were observed, including a reduction in the visual analog scale score for pain (mean ± SD: 0.99 ± 1.36 vs 4.13 ± 2.26; P < .00001) and an increase in mean Rowe score (89.56 ± 11.46 vs 43.16 ± 8.87; P < .00001) and mean Constant score (91.41 ± 7.57 vs 59.70 ± 5.63; P < .00001). In terms of ROM, no reduction was found in external rotation (66.56° ± 13.33° vs 67.22° ± 14.27°; P = .21), and a significant increase in abduction was found (157.67° ± 4.11° vs 144.18° ± 8.28°; P < .00001). No statistically significant difference was found between arthroscopic repair of combined Bankart/SLAP lesions and isolated Bankart repair regarding recurrence rate, functional scores, or ROM. Conclusion Of the pooled data, patients who underwent arthroscopic repair of combined Bankart/SLAP lesions in treatment of anterior shoulder instability showed a low recurrence rate, favorable functional scores, and no significant restriction on ROM, all of which were not significantly worse than outcomes of isolated Bankart repair. Therefore, combined repair was proven to be a viable option for extensive labral lesions.
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Affiliation(s)
- Sijia Feng
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yujie Song
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hong Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiwu Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Park I, Kang JS, Jo YG, Shin SJ. Factors Related to Patient Dissatisfaction Versus Objective Failure After Arthroscopic Shoulder Stabilization for Instability. J Bone Joint Surg Am 2019; 101:1070-1076. [PMID: 31220023 DOI: 10.2106/jbjs.18.01243] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND After arthroscopic stabilization procedures for recurrent anterior shoulder instability, patients are not always satisfied with their shoulder, even when the operation successfully restored stability. The aim of this study was to evaluate the factors associated with subjective patient dissatisfaction after arthroscopic stabilization procedures for recurrent anterior shoulder instability and to compare these factors with those associated with objective surgical failure. METHODS A total of 195 patients who underwent an arthroscopic stabilization procedure for recurrent anterior shoulder instability were included in this study. At the 2-year postoperative visit, subjective patient dissatisfaction was assessed with a 15-point scale. Objective surgical failure was defined as postoperative dislocation or subluxation events requiring revision surgery. Several factors, including age at the first dislocation, age at the time of the operation, presence of an off-track Hill-Sachs lesion, width of the Hill-Sachs lesion, size of the glenoid bone defect, and number of instability events, were recorded. Multivariable linear regression analysis and multivariable logistic regression analysis were performed using a backward stepwise procedure as the variable selection method. RESULTS Fifteen patients (7.7%) had recurrent instability requiring revision surgery. In the group of 180 patients without surgical failure, the width of the Hill-Sachs lesion (regression coefficient: 0.052, p = 0.011) and number of instability events (regression coefficient: 0.103, p = 0.029) were positively correlated with subjective patient dissatisfaction, whereas concomitant repair of a SLAP (superior labrum anterior-posterior) lesion showed negative correlation (regression coefficient: -0.926, p = 0.004). In the total cohort of patients, objective surgical failure was correlated with the age at the time of the operation (odds ratio [OR]: 0.851, p = 0.042), size of the glenoid bone defect (OR: 1.172, p < 0.001), and number of instability events (OR: 1.147, p = 0.048). Other variables, including an off-track Hill-Sachs lesion or a concomitant remplissage procedure, were not correlated with subjective patient dissatisfaction or objective surgical failure. CONCLUSIONS Factors related to subjective patient dissatisfaction differed from those related to objective surgical failure. For a better understanding of the clinical outcomes after surgery, surgeons should assess the factors that correlate with subjective patient dissatisfaction and objective surgical failure. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- In Park
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
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Tang J, Zhao J. Arthroscopic Transfer of the Long Head of the Biceps Brachii for Anterior Shoulder Instability. Arthrosc Tech 2017; 6:e1911-e1917. [PMID: 29416978 PMCID: PMC5797298 DOI: 10.1016/j.eats.2017.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/11/2017] [Indexed: 02/03/2023] Open
Abstract
In the treatment of anterior shoulder instability, there are various conditions in which a sling effect is needed to enhance anterior stability. The traditional Latarjet procedure provides a sling effect but destroys the coracoacromial arch, which may result in superior instability. To preserve the coracoacromial arch and create a sling to enhance the anterior-inferior side of the shoulder, we introduce an arthroscopic technique to transfer the long head of the biceps (LHB) brachii. Indications of LHB transfer are patients younger than 45 years of age who participate in competitive sports, require forceful external rotation and abduction movement of the shoulder, and/or have capsule-ligament insufficiency, as well as patients 45 years o or older who have combined SLAP lesions (type II or IV). The main steps of this procedure include detaching the LHB, retrieving and braiding the LHB, creating a glenoid tunnel, placing a guide suture through the subscapularis and glenoid tunnel, passing the LHB through the subscapularis and into the glenoid tunnel, and suspension fixation of the LHB.
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Affiliation(s)
- Jin Tang
- Operating Theater, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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11
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Razmjou H, Lincoln S, Macritchie I, Richards RR, Medeiros D, Elmaraghy A. Sex and gender disparity in pathology, disability, referral pattern, and wait time for surgery in workers with shoulder injury. BMC Musculoskelet Disord 2016; 17:401. [PMID: 27653159 PMCID: PMC5031344 DOI: 10.1186/s12891-016-1257-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 09/14/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The role of sex as an important biological determinant of vulnerability to sustaining injury and gender as a social determinate of access to resources, referral for medical care and perceived disability remains conflicted in injured workers. The purpose of this study was to examine sex and gender disparity following a compensable work-related shoulder injury. METHODS This study involved cross-sectional analyses of data of two independent samples of workers with shoulder injury. Measures of disability and pain were the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Numerical Pain Rating Scale (NPRS) for patients seen at an Early Shoulder Physician Assessment (ESPA) program and the American Shoulder and Elbow Surgeons (ASES) assessment form and Visual Analogue Scale (VAS) for the sample who underwent surgery. RESULTS The files of 1000 (443 females, 557 men) consecutive patients seen at an ESPA program and 150 (44 females, and 106 men) consecutive patients who underwent rotator cuff surgery (repair or decompression) were reviewed. Significant gender disparity was observed in the referral pattern of injured workers seen at the ESPA program who were referred for surgical consultation (22 vs. 78 % for females and males respectively, p < 0.0001). The independent rotator cuff surgical group had a similar gender discrepancy (29 % vs. 71 %, p < 0.0001). The timeframe from injury to surgery was longer in women in the surgical group (p = 0.01). As well, women waited longer from the date of consent to date of surgery (p = 0.04). Women had higher incidence of repetitive injuries (p = 0.01) with men reporting higher incidence of falls (p = 0.01). Women seen at the ESPA program were more disabled than men (p = 0.02). Women in both samples had a higher rate of medication consumption than men (p = 0.01 to <0.0001). Men seen at the ESPA program had a higher prevalence of full thickness rotator cuff tears (p < 0.0001) and labral pathology (p = 0.01). However, these pathologies did not explain gender disparity in the subsample of ESPA who were referred for surgical consultation or those who had surgery. CONCLUSIONS Sex and gender disparity exists in workers with shoulder injuries and is evident in the mechanism of injury, perceived disability, medication consumption, referral pattern, and wait time for surgery.
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Affiliation(s)
- Helen Razmjou
- Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada. .,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada. .,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.
| | - Sandra Lincoln
- Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Iona Macritchie
- Toronto Rehabilitation Institute, Lyndhurst Centre, Brain & Spinal Cord Rehabilitation Program, Toronto, Canada
| | - Robin R Richards
- Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Orthopedic Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Danielle Medeiros
- Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Amr Elmaraghy
- Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Orthopedic Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Orthopaedic Surgery, St. Joseph's Health Centre, Toronto, Canada
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