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Moussa MK, Hariri BE, Lefèvre N, Grimaud O, Bouché PA, Bohu Y, Khalaf Z, Werthel JD, Gerometta A, Hardy A. Isokinetic Strength and Balance Analyses for Predicting Return to Sports After the Latarjet Procedure: A Prospective Cross-sectional Study. Am J Sports Med 2024:3635465241271518. [PMID: 39214077 DOI: 10.1177/03635465241271518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND Isokinetic torque in shoulder internal rotation (IR) and external rotation (ER) can be considered as potential indicators for dynamic stability of the glenohumeral joint. PURPOSE To assess the efficacy of 4-month isokinetic testing in predicting the 6-month return-to-sports (RTS) status after Latarjet surgery, explore its correlations with testing parameters, and identify optimal thresholds to ensure a safe RTS. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS The study assessed athletes who underwent the Latarjet stabilization procedure between January 2022 and June 2023. The primary outcome was RTS at 6 months after surgery. The primary examined predictors were isokinetic testing metrics at 4 months postoperatively. Secondary outcomes comprised the modified Closed Kinetic Chain Upper Extremity Stability Test (mCKCUEST) and several patient-reported outcome measures, including the Walch-Duplay score, the Western Ontario Shoulder Instability Index (WOSI), and the Shoulder Instability-Return to Sports after Injury scale. To assess the predictors, patients were divided into those who returned to any level of sports compared with those who did not return to sports. The correlation between isokinetic testing results and other outcome scores was also analyzed. RESULTS A total of 71 patients (mean age, 27.43 ± 9.09 years) were included in the study. Of these, 23.61% did not return to sports, 38.89% returned at a lower level, and 37.50% returned to the same level. Significant rotational strength disparities were noted. Patients who did not return to sports at 6 months demonstrated inferior strength in concentric ER at 60 deg/s, concentric ER at 240 deg/s, concentric IR at 240 deg/s, and eccentric IR at 30 deg/s (P < .05). Similar trends appeared for all studied patient-reported outcome measures and the mCKCUEST (P < .05). Receiver operating characteristic analysis emphasized the significance of isokinetic testing in concentric ER at 240 deg/s (area under the curve = 0.759; P = .001; cutoff = 0.32 N·m/kg; sensitivity = 100.0%; specificity = 49.1%) and eccentric ER at 30 deg/s (area under the curve = 0.760; P = .001; cutoff = 0.51 N·m/kg; sensitivity = 94.1%; specificity = 49.1%) for RTS prediction. Additionally, ER strength moderately correlated with the Walch-Duplay score across all examined velocities (r = 0.26-0.34; P < .05). The modified WOSI score was weakly linked to ER strength at 240 deg/s and 30 deg/s (r = 0.24-0.25; P < .05) as well as moderately linked to the limb symmetry index in ER at 60 deg/s and 30 deg/s (r = 0.30-0.38; P < .05). CONCLUSION Isokinetic testing can act as an independent predictor of successful RTS after Latarjet surgery, with concentric ER at 240 deg/s, concentric IR at 240 deg/s, eccentric ER at 30 deg/s, and eccentric IR at 30 deg/s showing the most accuracy. Strength recovery in ER was associated with better Walch-Duplay and modified WOSI scores.
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Affiliation(s)
- Mohamad K Moussa
- Clinique du Sport, Paris, France
- Groupe hospitalier Sélestat-Obernai, Sélestat, France
| | - Badr El Hariri
- L'éKipe-Centre d'Expertise de la Performance Sportive et Isocinétique, Paris, France
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Yildiz TI, Turhan E, Huri G, Ocguder DA, Duzgun I. Cross-education effects on shoulder rotator muscle strength and function after shoulder stabilization surgery: a randomized controlled trial. J Shoulder Elbow Surg 2024; 33:804-814. [PMID: 38122890 DOI: 10.1016/j.jse.2023.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023]
Abstract
HYPOTHESIS This study aimed to investigate the effects of cross education (CE) on rotator cuff (RC) muscle strength recovery and shoulder function in patients who underwent arthroscopic anterior shoulder stabilization surgery. METHODS Twenty-eight patients who underwent shoulder stabilization surgery were included in the study (age, 25 ± 6 years; body mass index, 24.8 ± 3.6 kg/m2). The patients were randomly divided into either the CE group (n = 14) or the control group (n = 14). All patients received a standardized rehabilitation program until the end of the 12th postoperative week. The CE group also received isokinetic training of the nonoperative shoulder focusing on the RC muscles (twice a week, 3 sets of 10 repetitions). RC muscle strength was measured preoperatively and at 3 and 6 months postoperatively using an isokinetic dynamometer at 60°/s and 180°/s angular velocities. Shoulder function was assessed with the Closed Kinetic Chain Upper Extremity Stability Test and Y-Balance Test-Upper Quarter. Analyses of covariance were used for the statistical analyses. RESULTS At 6 months postoperatively, at 60°/s angular velocity, there was higher internal rotator strength in the CE group (P = .02) and similar external rotator strength (P = .62) between the groups. At 180°/s angular velocity, both internal rotator strength (P = .04) and external rotator strength (P = .02) were higher in the CE group. The Closed Kinetic Chain Upper Extremity Stability Test (P = .47), Y-Balance Test-Upper Quarter (P = .95), and Western Ontario Shoulder Instability Index (P = .12) scores were similar between the groups at 6 months after surgery. CONCLUSIONS CE in the early period of postoperative rehabilitation following stabilization surgery improves RC strength recovery. However, it has no effect on functional outcomes. Integrating a CE program into the postoperative rehabilitation protocol may help to improve dynamic shoulder stability but not functional capacity.
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Affiliation(s)
- Taha Ibrahim Yildiz
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Egemen Turhan
- Department of Orthopedy and Traumatology, Hacettepe University, Ankara, Turkey
| | - Gazi Huri
- Department of Orthopedy and Traumatology, Hacettepe University, Ankara, Turkey
| | - Durmus Ali Ocguder
- Department of Orthopedy and Traumatology, Ankara Sehir Hastanesi, Ankara, Turkey
| | - Irem Duzgun
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Chiddarwar V, de Zoete RMJ, Dickson C, Lathlean T. Effectiveness of combined surgical and exercise-based interventions following primary traumatic anterior shoulder dislocation: a systematic review and meta-analysis. Br J Sports Med 2023; 57:1498-1508. [PMID: 37451706 DOI: 10.1136/bjsports-2022-106422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To investigate the effectiveness, risk of recurrence and return to activity (RTA) of surgery combined with exercise-based interventions (EBI) versus EBI alone after traumatic anterior shoulder dislocation (ASD). DESIGN Systematic review and meta-analysis. DATA SOURCES Systematic literature search (MEDLINE, Web of Science, Scopus, Google Scholar). ELIGIBILITY Studies focused on EBI or EBI as a part of postoperative care for adults with an ASD, written in English, and published after 1990. We excluded diagnostic, assessment-based studies on individuals experiencing recurrent shoulder dislocations, concomitant shoulder injury, animal or cadaveric studies. Primary outcomes were dislocation RTA. Secondary outcomes were self-reported outcome measures, strength and range of motion. Random-effects meta-analysis was used to estimate the effect of EBI (SMD; Hedges' g, RR). The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the certainty of evidence. RESULTS Sixty studies were included (n=3598); seven were meta-analysed (n=345). The mean age of participants in the included studies was 26.71±9.19 and 56% of those included were male. Of the 60 studies included in the systematic review, 29 were fair quality (48.3%), 15 studies were good quality (25%) and 16 studies were poor quality (26.7%), (k=0.66). Individuals who underwent EBI alone were 2.03 times more likely to experience recurrent instability than individuals who underwent EBI in conjunction with surgery (RR 2.03, 95% CI 1.03 to 3.97). Individuals who underwent EBI with surgery appeared 1.81 times more likely to RTA than those who underwent EBI alone, although results were not statistically significant (RR 1.81, 95% CI 0.96 to 3.43). CONCLUSIONS Surgery combined with EBI is more effective in reducing the risk of recurrence and possibly increasing RTA than EBI alone after traumatic ASD.
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Affiliation(s)
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Cameron Dickson
- School of Allied Health Science and Practice, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Timothy Lathlean
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
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Yildiz TI, Turhan E, Ocguder DA, Yaman F, Huri G, Duzgun I. Functional Performance Tests Reveal Promising Results at 6 Months After Shoulder Stabilization Surgery. Sports Health 2023; 15:878-885. [PMID: 36539969 PMCID: PMC10606971 DOI: 10.1177/19417381221141075] [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: 10/27/2023] Open
Abstract
BACKGROUND Although athletes are mostly allowed to return to play 6 months after shoulder stabilization surgery, there are inadequate data about their functional status during this period. HYPOTHESES Performance tests would reveal insufficiency in the functional capacity of shoulder 6 months after stabilization surgery. STUDY DESIGN Prospective cohort study. LEVEL OF EVIDENCE Level 3. METHODS A total of 32 male athletes with arthroscopic anterior capsulolabral repair (AACR) were included in the study. Shoulder internal and external rotator (IR-ER) strength was assessed using isokinetic dynamometer at 60°/s and 180°/s angular velocities preoperatively and 6 months postoperatively. Shoulder function was assessed with closed kinetic chain upper extremity stability (CKCUES) test, Y balance test-upper quarter (YBT-UQ), and unilateral seated shot-put test (USSPT) at 6 months postoperation. Western Ontario shoulder instability index (WOSI) and Tampa scale of kinesiophobia (TSK) were used for the self-assessment of the shoulder. Mixed-model ANOVA was used to analyze the changes in the IR-ER strength on both shoulders. Limb symmetry index (LSI) was calculated for the IR-ER strength, YBT-UQ, and USSPT scores. RESULTS Shoulder IR strength was higher at 6 months postoperatively compared with preoperatively. The LSI was 76.4% and 76.6% for ER strength, and 94.2% and 94% for IR strength at 60°/s and 180°/s angular velocities, respectively, at the postoperative 6 month timepoint. The mean CKCUES test score was 21.8 ± 2.6 touches and the LSI was 94.7% for the YBT-UQ and 102.5% for the USSPT. WOSI (P < 0.001) and TSK (P = 0.001) scores were significantly lower at 6 months postoperatively. CONCLUSION Functional status of the patients with shoulder stabilization surgery improved considerably 6 months after surgery, yet they did not fully recover function. CLINICAL RELEVANCE Exercise programs focusing on shoulder ER strength and shoulder performance should be emphasized after stabilization surgery.
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Affiliation(s)
- Taha Ibrahim Yildiz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Turkey
| | - Egemen Turhan
- Department of Orthopedy and Traumatology, Hacettepe University, Turkey
| | - Durmus Ali Ocguder
- Department of Orthopedics and Traumatology, Ankara Şehir Hastanesi, Turkey
| | - Firat Yaman
- Department of Orthopedics and Traumatology, Ankara Şehir Hastanesi, Turkey
| | - Gazi Huri
- Department of Orthopedy and Traumatology, Hacettepe University, Turkey
| | - Irem Duzgun
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Turkey
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Nimse A, Patel N, Pardiwala D. Criterion-Based Rehabilitation and Return to Play in Fast Bowlers Following Arthroscopic Bankart Repair: Recommendations Based on a Detailed Clinical Review. Indian J Orthop 2023; 57:1565-1574. [PMID: 37766945 PMCID: PMC10519911 DOI: 10.1007/s43465-023-00931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/05/2023] [Indexed: 09/29/2023]
Abstract
Background Anterior shoulder instability due to labral tears in the dominant arm of cricket fast bowlers can be particularly disabling and results in significant match time loss. This often follows injuries sustained during fielding and training, although micro-instability following repetitive throwing progressing to overt anterior shoulder instability is also known. To ensure ball release speeds of over 140 km/h with different ball variations, these athletes require not only physical fitness and technical skill, but also a completely stable shoulder. Methods A literature search of "MEDLINE", "SPORT DISCUSS", and "GOOGLE SCHOLAR" was done to identify relevant articles published till the year 2023. Results A treatment approach that involves anatomic restoration of the shoulder via an arthroscopic Bankart capsulo-labral repair, followed by functional and biomechanical restoration via rehabilitation is the most predictable method to ensure a successful return to pre-injury fast-bowling status. A post-operative rehabilitation program that ensures a quick return to fast bowling without disrupting the surgical repair is crucial. Timely integration of exercises to recruit and strengthen the kinetic chain used for bowling and throwing plays a key role in this faster recovery. This current review provides a phase-wise, evidence-based rehabilitation guideline for return to competitive cricket after arthroscopic Bankart repair in a fast bowler. This review also highlights a structured return to bowling, throwing, and fielding program with a clinical decision-making process. Conclusion Exercise selection at an early stage that does not compromise the healing tissue, and timely integration of workouts to recruit and strengthen the kinetic chain used for bowling and throwing is the key strategy to allow faster recovery. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-023-00931-5.
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Affiliation(s)
- Ashutosh Nimse
- Musculoskeletal Physiotherapy AUT, Auckland, New Zealand
- Centre for Sports Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
- Mumbai Indians Cricket Team, Indian Premier League, Mumbai, India
| | - Nitin Patel
- National Cricket Academy, Board of Control for Cricket in India (BCCI), Bangalore, India
- The Maharaja Sayajirao University of Baroda, Boroda, India
- University of Nottingham, Nottingham, UK
| | - Dinshaw Pardiwala
- Centre for Sports Medicine, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
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Albright JA, Lemme NJ, Meghani O, Owens BD. Public Insurance Is Associated With Decreased Rates of Surgical Management for Glenohumeral Instability: An Analysis of the Rhode Island All-Payers Claims Database. Orthop J Sports Med 2023; 11:23259671221147050. [PMID: 36814768 PMCID: PMC9940189 DOI: 10.1177/23259671221147050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Background Socioeconomic status has been shown to influence patients' ability to access health care. Purpose To evaluate the socioeconomic status and/or insurance provider of patients and to determine whether these differences influence the management of shoulder instability. Study Design Descriptive epidemiology study. Methods The Rhode Island All-Payers Claims Database (APCD) was used to identify all patients between the ages of 5 and 64 years who made an insurance claim related to a shoulder instability event between January 1, 2011, and December 31, 2019. Chi-square analysis and multivariate logistic regression were utilized to determine whether insurance status, social deprivation index (SDI), or median income by zip code were significant predictors of treatment methodology and recurrent instability. Kaplan-Meier failure analysis and Cox regression were used to assess for variation in the cumulative rates of surgical intervention and recurrent instability over 20-year age groups (5-24, 25-44, and 45-64 years). Results There were 3310 patients from the APCD query included in the analysis. Bivariate analysis demonstrated significant variation in the rates of surgical stabilization between patients with public and commercial insurance providers (P < .001). Patients with public insurance received surgery 1.8% of the time compared with 5.8% of the time in patients with commercial insurance. After controlling for recurrent instability, age, instability type (subluxation or dislocation) and directionality, and sex, patients with public insurance were 79% less likely to receive surgery within 30 days (P = .035) and 64% less likely to receive surgery within 1 year (P = .002). This disparity was most notable in the 5- to 24-year (hazard ratio [HR] = 0.28; 95% CI, 0.13-0.61) and 25- to 44-year (HR = 0.26; 95% CI, 0.08-0.89) age groups. Neither SDI quartile nor income quartile based on patient primary zip code had a clinically significant influence on rates of surgery or recurrent instability. Conclusion These data demonstrate that patients with public insurance have a decreased likelihood of undergoing surgical stabilization to address glenohumeral instability compared with patients with commercial insurance.
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Affiliation(s)
- J. Alex Albright
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- J. Alex Albright, BS, Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI 02903, USA () (Twitter: alex_albright20)
| | - Nicholas J. Lemme
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Ozair Meghani
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Brett D. Owens
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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Breborowicz E, Lubiatowski P, Jokiel M, Breborowicz M, Stefaniak J, Zygmunt A, Wojtaszek M, Kaczmarek P, Romanowski L. Isokinetic and functional shoulder outcomes after arthroscopic capsulolabral stabilization. Arch Orthop Trauma Surg 2022; 142:3927-3935. [PMID: 34964916 PMCID: PMC9596548 DOI: 10.1007/s00402-021-04290-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/27/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Shoulder stability is secured by dynamic and static stabilizers. Rotator cuff is responsible for dynamic stabilization. In cases of shoulder instability their activity is disturbed. Capsulolabral repair restores mainly static stabilization. This surgery treatment technique of shoulder instability was first described by Bankart in 1923. His idea, with further modifications, is commonly used up to this day. Evaluation of muscle shoulder recovery after stabilization should be one of the important criteria to allow patient to return to sport and work. However, not much isokinetic assessment after capsulolabral repair was described. The aim of this study were the following: the comparative assessment of the shoulder rotatory strength in patients following arthroscopic capsulolabral repair of unilateral anterior traumatic instability and clinical assessment with comparison of pre and post-operative results. MATERIAL AND METHODS Forty-five patients, 14 women and 31 men, with an average follow-up of 4.4 years were tested bilaterally for internal and external rotation strength at four angular velocities. ASES and UCLA tests were collected before and after surgery. RESULTS The values of peak moment and muscle power parameters were slightly lower for an operated shoulder in comparison to a healthy shoulder for the external rotation. Total work parameter in external rotation was significantly lower for the operated shoulder in comparison to the non-operated side. The internal/external muscle group balance was lower for the operated shoulder in comparison to reference values in the women group. Furthermore, both ASES and UCLA scores were significantly higher after operation. CONCLUSIONS After arthroscopic capsulolabral shoulder stabilization, slight differences in isokinetic evaluation, especially in external shoulder rotation, occur. It affects rotators muscle balance. In functional evaluation significant improvement in shoulder function occurs.
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Affiliation(s)
- Ewa Breborowicz
- Orthopaedics, Traumatology and Hand Surgery Department, Poznan University of Medical Sciences,, 28 Czerwca 1956 no 135/147, 61-545, Poznań, Poland.
| | - Przemyslaw Lubiatowski
- Orthopaedics, Traumatology and Hand Surgery Department, Poznan University of Medical Sciences,, 28 Czerwca 1956 no 135/147, 61-545, Poznań, Poland
- Rehasport Clinic, Gorecka 30, 60-201, Poznań, Poland
| | - Marta Jokiel
- Orthopaedics, Traumatology and Hand Surgery Department, Poznan University of Medical Sciences,, 28 Czerwca 1956 no 135/147, 61-545, Poznań, Poland
- Physiotherapy Department, Poznan University of Medical Sciences, 28 Czerwca 1956 no 135/147, 61-545, Poznań, Poland
| | - Maciej Breborowicz
- Orthopaedics, Traumatology and Hand Surgery Department, Poznan University of Medical Sciences,, 28 Czerwca 1956 no 135/147, 61-545, Poznań, Poland
| | - Jakub Stefaniak
- Orthopaedics, Traumatology and Hand Surgery Department, Poznan University of Medical Sciences,, 28 Czerwca 1956 no 135/147, 61-545, Poznań, Poland
| | - Adam Zygmunt
- Orthopaedics, Traumatology and Hand Surgery Department, Poznan University of Medical Sciences,, 28 Czerwca 1956 no 135/147, 61-545, Poznań, Poland
| | - Marcin Wojtaszek
- Orthopaedics, Traumatology and Hand Surgery Department, Poznan University of Medical Sciences,, 28 Czerwca 1956 no 135/147, 61-545, Poznań, Poland
| | | | - Leszek Romanowski
- Orthopaedics, Traumatology and Hand Surgery Department, Poznan University of Medical Sciences,, 28 Czerwca 1956 no 135/147, 61-545, Poznań, Poland
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Visconti-Lopez FJ, Hernández-Vásquez A, Azañedo D, Sanchez Carbonel JF. Global Research Trends in the Latarjet Procedure: A Bibliometric and Visualized Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1008. [PMID: 36013475 PMCID: PMC9412539 DOI: 10.3390/medicina58081008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Latarjet is among the procedures indicated to treat shoulder instability, producing excellent results, including low instability rates and high patient satisfaction. The aim of this study was to report the characteristics of scientific articles that address the subject of the Latarjet procedure through the use of bibliometric analysis. Materials and Methods: Bibliographic searches were performed for original articles published in journals indexed by the Web of Science database until 2021, with no language restrictions. Results: A total of 668 articles published in 87 journals were included. The first publication was in 1981; the most registered publications were in 2018 and 2021 (89 articles), with an annual percentage growth rate of 11.9. Provencher MT was the author with the most published articles, and the institutional affiliation with the most original articles was the Steadman Philippon Research Institute. The most cited article was a study by Burkhart and Beer, and the scientific journal with the most publications on the subject was the Journal of Shoulder and Elbow Surgery. Most published studies included keywords such as dislocation, instability, and meta-analysis. Conclusion: There has been a sustained increase in original articles on the Latarjet procedure. However, the greatest growth in articles has occurred during the last decade, demonstrating the considerable interest among the world scientific community.
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Affiliation(s)
- Fabriccio J. Visconti-Lopez
- Department of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru; (F.J.V.-L.); (J.F.S.C.)
| | - Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima 15024, Peru
| | - Diego Azañedo
- Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima 15067, Peru;
| | - Jose Fernando Sanchez Carbonel
- Department of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru; (F.J.V.-L.); (J.F.S.C.)
- Department of Sports Orthopaedics, Technical University of Munich, 80333 Munich, Germany
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Sinha S, Kar S, Naik AK, Kumar J, Goyal R, Jain VK, Arya RK. Decreased motion with normal strength after Latarjet procedure has minimal impact on return to activity. Knee Surg Sports Traumatol Arthrosc 2021; 29:2579-2586. [PMID: 33459831 DOI: 10.1007/s00167-020-06414-6] [Citation(s) in RCA: 12] [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: 07/25/2020] [Accepted: 12/10/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE The Latarjet procedure can affect the range of motion (ROM) and strength of the shoulder, which determine the time to return to the preinjury level of activity. This study prospectively assessed whether the Latarjet procedure leads to a decrease in range of motion and muscle strength, affecting the time to return to the previous level of activity. METHODS Fifty-one consecutive patients who underwent the Latarjet procedure for recurrent dislocation of the shoulder were included prospectively. The ROM, strength, Walch-Duplay score, and Rowe score were measured every 3 months for 1 year and then every 6 months for 2 years. Radiological assessments were performed to confirm the graft location, union, and the humeral head position in abduction and external rotation (ER). RESULTS Out of 51 patients, 49 completed all follow-ups. The median age was 27 years (17-45 years), and the dominant side was involved in 36 patients. The median number of dislocations was 11 (5-50). Twelve patients were sleep dislocators. There was a significant loss (p < 0.0001) of abduction, forward flexion (FF), ER, and internal rotation (IR) in the affected shoulder compared to the contralateral shoulder. Recovery plateaued at 12 months. There was near complete recovery of muscle strength after the Latarjet procedure, and the difference between the affected and contralateral shoulders was not significant (n.s.). The modified Rowe score was excellent in 44 (90%) patients, and the Walch-Duplay score was excellent in 43 patients (88%) at 24 months. Suboptimal results were associated with non-compliance with rehabilitation in two (4%) patients and neglected unreduced dislocation in one (2%) patient. The coracoid graft position was below the equator in 44 patients (90%). Forty-six patients (94%) could return to the previous level of activity. CONCLUSION The Latarjet procedure results in a restricted ROM of the shoulder, but there is no loss of muscle strength. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Skand Sinha
- Sports Injury Centre, Safdarjung & VMMC, New Delhi, 110029, India.
| | - Santanu Kar
- Department of Orthopaedics, PGIMER & Dr RML Hospital, New Delhi, 110001, India
| | - Ananta K Naik
- Department of Orthopaedics, PGIMER & Dr RML Hospital, New Delhi, 110001, India
| | - Jaswant Kumar
- Sports Injury Centre, Safdarjung & VMMC, New Delhi, 110029, India
| | - Rakesh Goyal
- Sports Injury Centre, Safdarjung & VMMC, New Delhi, 110029, India
| | - Vijay K Jain
- Department of Orthopaedics, PGIMER & Dr RML Hospital, New Delhi, 110001, India
| | - Rajendra K Arya
- Sports Injury Centre, Safdarjung & VMMC, New Delhi, 110029, India
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McIsaac W, Lalani A, Silveira A, Chepeha J, Luciak-Corea C, Beaupre L. Rehabilitation after arthroscopic Bankart repair: a systematic scoping review identifying important evidence gaps. Physiotherapy 2021; 114:68-76. [PMID: 34598773 DOI: 10.1016/j.physio.2021.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND Evidence to develop best rehabilitation practices after Arthroscopic Bankart Repair (ABR) is lacking, leading to heterogeneity in rehabilitation approaches. OBJECTIVES This systematic scoping review investigated current evidence for rehabilitation and associated outcomes following ABR, including rehabilitation parameters, evaluative approaches (outcomes/outcome measures, follow-up timing/duration). DATA SOURCES A systematic search was performed of CINAHL, MEDLINE, and Embase databases in May 2019. STUDY SELECTION Prospective studies detailing rehabilitation protocols following ABR reporting at least one postoperative assessment within 1 year of surgery (to measure impact of rehabilitation) were included. DATA EXTRACTION AND SYNTHESIS Two blinded reviewers independently selected studies using standardized criteria and extracted study characteristics and outcomes of interest. Quality of evidence was assessed using Joanna Brigg's quality assessment tool. A narrative analysis was conducted and evidence gaps were identified. RESULTS Nine studies evaluating 11 rehabilitation protocols with a total of 384 participants were included. Considerable variability was seen in rehabilitation protocols and evaluation parameters. Return to sports/activity was frequently measured, but not well-defined. Strengthening was an important component of rehabilitation protocols, but rarely reported as an outcome. Follow-up was variable, with 4 studies ending follow-up before 24-months postoperatively. Overall, patient outcomes improved postoperatively. CONCLUSIONS There is a paucity of evidence investigating the impact of rehabilitation approaches following ABR. Although patient outcomes improve after ABR, selected outcomes/measures are highly variable with limited evidence on those important to measure rehabilitation success, particularly strength and return to activity. Identified evidence gaps should be addressed in future research.
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Affiliation(s)
- Willem McIsaac
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Canada
| | - Amaan Lalani
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton Alberta, Canada T6G 2B4
| | - Anelise Silveira
- Department of Surgery, Alberta Health Services, 6-110 Clinical Sciences Building, 8224-112St, Edmonton, AB, Canada T6G 2G3; Shoulder and Upper Extremity Research Group of Edmonton, 6-110 Clinical Sciences Building, 8224-112St, Edmonton, AB, Canada T6G 2G3
| | - Judy Chepeha
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton Alberta, Canada T6G 2B4; Shoulder and Upper Extremity Research Group of Edmonton, 6-110 Clinical Sciences Building, 8224-112St, Edmonton, AB, Canada T6G 2G3
| | - Charlene Luciak-Corea
- Shoulder and Upper Extremity Research Group of Edmonton, 6-110 Clinical Sciences Building, 8224-112St, Edmonton, AB, Canada T6G 2G3
| | - Lauren Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton Alberta, Canada T6G 2B4; Shoulder and Upper Extremity Research Group of Edmonton, 6-110 Clinical Sciences Building, 8224-112St, Edmonton, AB, Canada T6G 2G3.
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11
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Crowell MS, Brindle RA, Mason JS, Pitt W, Miller EM, Posner MA, Cameron KL, Goss DL. The effectiveness of battlefield acupuncture in addition to standard physical therapy treatment after shoulder surgery: a protocol for a randomized clinical trial. Trials 2020; 21:995. [PMID: 33272311 PMCID: PMC7713004 DOI: 10.1186/s13063-020-04909-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/16/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION There is a large incidence of shoulder instability among active young athletes and military personnel. Shoulder stabilization surgery is the commonly employed intervention for treating individuals with instability. Following surgery, a substantial proportion of individuals experience acute post-operative pain, which is usually managed with opioid pain medications. Unfortunately, the extended use of opioid medications can have adverse effects that impair function and reduce military operational readiness, but there are currently few alternatives. However, battlefield acupuncture (BFA) is a minimally invasive therapy demonstrating promise as a non-pharmaceutical intervention for managing acute post-operative pain. METHODS This is a parallel, two-arm, single-blind randomized clinical trial. The two independent variables are intervention (2 levels, standard physical therapy and standard physical therapy plus battlefield acupuncture) and time (5 levels, 24 h, 48 h, 72 h, 1 week, and 4 weeks post shoulder stabilization surgery). The primary dependent variables are worst and average pain as measured on the visual analog scale. Secondary outcomes include medication usage, Profile of Mood States, and Global Rating of Change. DISCUSSION The magnitude of the effect of BFA is uncertain; current studies report confidence intervals of between-group differences that include minimal clinically important differences between intervention and control groups. The results of this study may help determine if BFA is an effective adjunct to physical therapy in reducing pain and opioid usage in acute pain conditions. TRIAL REGISTRATION ClinicalTrials.gov NCT04094246 . Registered on 16 September 2019.
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Affiliation(s)
- Michael S Crowell
- Baylor University - Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, NY, USA.
| | - Richard A Brindle
- Baylor University - Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, NY, USA
| | - John S Mason
- Baylor University - Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, NY, USA
| | - Will Pitt
- Baylor University - Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, NY, USA
| | - Erin M Miller
- Baylor University - Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, NY, USA
| | - Matthew A Posner
- John A Feagin, Jr. Sports Medicine Fellowship, Keller Army Community Hospital, West Point, NY, USA
| | - Kenneth L Cameron
- John A Feagin, Jr. Sports Medicine Fellowship, Keller Army Community Hospital, West Point, NY, USA
| | - Donald L Goss
- Baylor University - Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, West Point, NY, USA
- Department of Physical Therapy, High Point University, High Point, NC, USA
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12
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Lee JH, Park JS, Jeong WK. Which muscle performance can be improved after arthroscopic Bankart repair? J Shoulder Elbow Surg 2020; 29:1681-1688. [PMID: 32147338 DOI: 10.1016/j.jse.2019.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/28/2019] [Accepted: 12/10/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are no published reports available regarding neuromuscular control recovery in nonathletic patients after arthroscopic (A/S) Bankart repair. This study aimed to compare neuromuscular control and performance of the rotator cuff muscles between patients who underwent A/S Bankart repair and normal controls. METHODS In total, 32 nonathletic patients who underwent A/S Bankart repair were compared with 32 asymptomatic nonathletic volunteers. Neuromuscular control index (time to peak torque and acceleration time), muscle strength ratio, muscle strength, and muscle endurance of the internal rotators (IRs) and external rotators (ERs) were measured using an isokinetic device at an angular velocity of 180°/s, with 90° shoulder abduction. RESULTS The neuromuscular control indices of both IRs and ERs were significantly lower in patients who underwent A/S Bankart repair than in normal controls (time to peak torque, IRs: 1059 ± 143 ms vs. 679 ± 226 ms, P = .011; ERs: 595 ± 286 ms vs. 379 ± 123 ms, P = .044; acceleration time, IRs: 75 ± 16 ms vs. 62 ± 15 ms, P = .039, ERs: 70 ± 19 ms vs. 54 ± 18 ms, P = .047). Muscle endurance was significantly lower in patients who underwent A/S Bankart repair than in normal controls (IRs: 670 ± 1 J vs. 718 ± 2 J, P = .002, ERs: 422 ± 6 J vs. 501 ± 2 J, P = .044). The neuromuscular control index showed a significant negative correlation with muscle endurance for both IRs and ERs after the operation (IRs: r = -0.737, P = .003, ERs: r = -0.617, P = .019). CONCLUSION Compared with normal controls, patients who underwent A/S Bankart repair did not show complete recovery of neuromuscular control of IRs and ERs, although their muscle strength ratio and muscle strength had fully recovered.
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Affiliation(s)
- Jin Hyuck Lee
- Department of Sports Medical Center, Korea University College of Medicine Anam Hospital, Seoul, Republic of Korea
| | - Ji Soon Park
- Department of Orthopaedic Surgery, Healthpoint Hospital, Abu Dhabi, UAE
| | - Woong Kyo Jeong
- Department of Sports Medical Center, Korea University College of Medicine Anam Hospital, Seoul, Republic of Korea; Department of Orthopaedic Surgery, College of Medicine, Korea University, Seoul, Republic of Korea.
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Wilson KW, Popchak A, Li RT, Kane G, Lin A. Return to sport testing at 6 months after arthroscopic shoulder stabilization reveals residual strength and functional deficits. J Shoulder Elbow Surg 2020; 29:S107-S114. [PMID: 32643605 DOI: 10.1016/j.jse.2020.04.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES A good outcome after arthroscopic stabilization for recurrent shoulder instability is often characterized by a successful return to sport while minimizing complications. There is currently no consensus regarding timing or objective criteria for return to sport. The objective of this study is to evaluate the ability of postoperative patients to meet expected goals by using standardized objective evaluations of strength and physical function. METHODS Forty-three (10 females, 76.7% male) subjects (mean age, 18.1 ± 3.7 years) who underwent arthroscopic shoulder stabilization surgery (anterior or posterior) from 2016 until 2018 were referred during their postoperative rehabilitation for functional testing at 6 months postoperatively to evaluate their readiness for return to sport. The Closed Kinetic Chain Upper Extremity Stability test and Unilateral Seated Shot Put test were used to assess shoulder function. Posterior rotator cuff activation was evaluated using a repetition to failure technique with 5% body weight at 0° and 90° of abduction with the goal of 90% of nonoperative extremity. Isokinetic strength testing of external rotation (ER) and internal rotation (IR) was evaluated using a Biodex isokinetic dynamometer at angular velocities of 60° and 180° per second, and a passing score was considered achieving 90% of nonoperative shoulder strength at both 60° and 180° per second. RESULTS All subjects were competitive athletes (20 collegiate, 23 high school). The dominant extremity was the surgical extremity in 22 subjects. Only 5 subjects were able to successfully pass the battery of tests for strength and function. Strength testing revealed that 7 patients achieved 90% of the strength of the nonoperative extremity in both repetitions to failure (23 of 43) and comparative isokinetic testing (7 of 43). More subjects were able to meet IR strength (20 of 43) than ER strength (12 of 43) goals. Functional test goals were more frequently achieved, with 26 of 43 subjects meeting both functional test goals (33 Closed Kinetic Chain Upper Extremity Stability, 34 Unilateral Seated Shot Put). Only 2 subjects were able to achieve strength goals but did not pass functional tests, whereas 21 subjects passed functional tests without meeting strength goals. CONCLUSION A substantial number of athletes in our cohort do not meet the expected goals for their operative shoulder in achieving appropriate function and strength, compared with the contralateral shoulder. Functional goals were more often met than strength. IR strength goals were more frequently achieved than ER strength. Strength and functional testing could provide more reliable criteria than arbitrary passage of time for return to play after shoulder stabilization surgery.
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Affiliation(s)
- Kevin W Wilson
- Orthopedic Surgery, Mount Nittany Health, State College, PA, USA.
| | - Adam Popchak
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ryan T Li
- Wake Orthopaedics, WakeMed Health and Hospitals, Raleigh, NC, USA
| | - Gillian Kane
- Department of Orthopaedic Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Albert Lin
- Department of Orthopaedic Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Ro K, Kim MS, Kim JD, Rhee YG. Arthroscopic Findings and Clinical Outcomes in Patients 40 Years of Age and Older With Recurrent Shoulder Dislocation. Arthroscopy 2019; 35:314-322. [PMID: 30611590 DOI: 10.1016/j.arthro.2018.08.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/12/2018] [Accepted: 08/12/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The present study investigates the intra-articular findings and clinical outcomes after arthroscopic surgery in patients after age 40 with chronic anterior shoulder instability. METHODS Fifty patients older than 40 years who underwent arthroscopic stabilization for recurrent anterior shoulder dislocation were analyzed. RESULTS The mean age at the time of surgery was 44.8 years (range, 40-72 years), and the mean duration of follow-up was 45 months (range, 28-150 months). The mean visual analog scale score for pain with motion significantly improved from 4.1 preoperatively to 1.7 at the last follow-up (P < .001). The range of motion in the affected shoulder revealed limitations of 9.4° in forward flexion and 17.8° in external rotation compared with the unaffected shoulder. Both the Constant and Rowe scores significantly improved (P < .001 and P < .001, respectively). Recurrence, which includes dislocation and subluxation, occurred in 14% postoperatively. Anteroinferior labral lesion was seen in 92% of patients. Associated lesions included superior labrum anterior to posterior lesion (22%), midsubstance capsular tear (10%), and Hill-Sachs lesion (92%). Rotator cuff tears were found in 18%-partial-thickness tear in 10% and full-thickness tear, which was repaired with suture anchor, in 8%. Among the intra-articular lesions, there was no significant relation with recurrent instability or functional outcome as a single factor. CONCLUSIONS In patients with chronic anterior shoulder instability who were older than 40 years, the clinical results after arthroscopic surgery showed statistically significant improvement with good muscle strength recovery. The quality of labral lesion, size of the Hill-Sachs lesion, and glenoid defect showed positive correlation with the number of preoperative dislocation. The intra-articular pathologies were varied, however no single articular lesion had significant impact on the recurrence rate. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Kyunghan Ro
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Myung Seo Kim
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jong Dae Kim
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
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