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Arenas-Miquelez A, Barco R, Cabo Cabo FJ, Hachem AI. Management of bone loss in anterior shoulder instability. Bone Joint J 2024; 106-B:1100-1110. [PMID: 39348897 DOI: 10.1302/0301-620x.106b10.bjj-2024-0501.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
Bone defects are frequently observed in anterior shoulder instability. Over the last decade, knowledge of the association of bone loss with increased failure rates of soft-tissue repair has shifted the surgical management of chronic shoulder instability. On the glenoid side, there is no controversy about the critical glenoid bone loss being 20%. However, poor outcomes have been described even with a subcritical glenoid bone defect as low as 13.5%. On the humeral side, the Hill-Sachs lesion should be evaluated concomitantly with the glenoid defect as the two sides of the same bipolar lesion which interact in the instability process, as described by the glenoid track concept. We advocate adding remplissage to every Bankart repair in patients with a Hill-Sachs lesion, regardless of the glenoid bone loss. When critical or subcritical glenoid bone loss occurs in active patients (> 15%) or bipolar off-track lesions, we should consider anterior glenoid bone reconstructions. The techniques have evolved significantly over the last two decades, moving from open procedures to arthroscopic, and from screw fixation to metal-free fixation. The new arthroscopic techniques of glenoid bone reconstruction procedures allow precise positioning of the graft, identification, and treatment of concomitant injuries with low morbidity and faster recovery. Given the problems associated with bone resorption and metal hardware protrusion, the new metal-free techniques for Latarjet or free bone block procedures seem a good solution to avoid these complications, although no long-term data are yet available.
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Affiliation(s)
| | - Raul Barco
- La Paz University Hospital, Madrid, Spain
| | - Francisco J Cabo Cabo
- Orthopaedics and Traumatolgy, Hospital Universitario de Bellvitge, Hospitalet de llobregat, Barcelona, Spain
| | - Abdul-Ilah Hachem
- Orthopaedics and Traumatolgy, Hospital Universitario de Bellvitge, Hospitalet de llobregat, Barcelona, Spain
- Shoulder unit, Centro Medico Teknon, Barcelona, Spain
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Hamitouche S, Boubaker F, Hossu G, Sirveaux F, Gillet R, Blum A, Gondim Teixeira PA. Glenoid morphology variation between patients with hypermobile shoulder joints and controls: Identification of hyperlaxity-related morphologic bone changes. RESEARCH IN DIAGNOSTIC AND INTERVENTIONAL IMAGING 2024; 11:100052. [PMID: 39263272 PMCID: PMC11387896 DOI: 10.1016/j.redii.2024.100052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/04/2024] [Indexed: 09/13/2024]
Abstract
Objective Our study aims to quantitatively determine the concavity of the glenoid articular surface in patients with hypermobile shoulders compared to those without. Method We examined medical records of shoulder CTs from 2017 to 2022, selecting 50 patients with clinical signs of joint hypermobility for our case group and 54 for our control group. Two blinded readers independently assessed the glenoid morphology, calculating the glenoid concavity angle (GCA) and evaluating the articular surface shape as concave, flat, or convex. They also recorded the presence and severity of glenoid dysplasia. We compared these assessments between groups. Results The mean GCA was significantly lower in the hypermobile group (2.3 ± 3.7° and 2.3 ± 3.8°) versus controls (6.6 ± 3.3° and 5.3 ± 3.8°) (P < 0.05). Interobserver reproducibility was high (ICC=0.76). A stark difference in glenoid morphology was noted between groups (P < 0.001), with a majority of hypermobile patients having a flat or convex glenoid. GCAs decreased with increasing shoulder laxity and dysplasia. GCA showed 77-81 % sensitivity and 55-82 % specificity for detecting shoulder hyperlaxity with a 4° cutoff. Conclusion There is a significant association between GCA and shoulder hyperlaxity, demonstrating diagnostic efficacy and substantial interobserver agreement. Clinical Relevance GCA values lower than 4° warrant further clinical investigation for shoulder hyperlaxity and associated conditions, which is crucial for patient treatment planning.
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Affiliation(s)
- Sirine Hamitouche
- Guilloz Imaging Department, Hôpital Central, Centre Hospitalier Universitaire de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy Cedex, France
| | - Fatma Boubaker
- Guilloz Imaging Department, Hôpital Central, Centre Hospitalier Universitaire de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy Cedex, France
| | - Gabriela Hossu
- Université de Lorraine, Inserm, Iadi, 54000 Nancy, France
| | - François Sirveaux
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Émile-Gallé, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Romain Gillet
- Guilloz Imaging Department, Hôpital Central, Centre Hospitalier Universitaire de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy Cedex, France
| | - Alain Blum
- Guilloz Imaging Department, Hôpital Central, Centre Hospitalier Universitaire de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy Cedex, France
| | - Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, Hôpital Central, Centre Hospitalier Universitaire de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy Cedex, France
- Université de Lorraine, Inserm, Iadi, 54000 Nancy, France
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Wu C, Ye Z, Lu S, Fang Z, Xu J, Zhao J. Biomechanical Analysis Reveals Shoulder Instability With Bipolar Bone Loss Is Best Treated With Dynamic Anterior Stabilization for On-Track Lesions and With Remplissage for Off-Track Lesions. Arthroscopy 2024; 40:1982-1993. [PMID: 38311260 DOI: 10.1016/j.arthro.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To compare the biomechanical effects of augmenting Bankart repair (BR) with either remplissage or dynamic anterior stabilization (DAS) in the treatment of anterior shoulder instability with on-track or off-track bipolar bone loss. METHODS Eight fresh-frozen cadaveric shoulders were tested at 60° of glenohumeral abduction in the intact, injury, and repair conditions. Injury conditions included 15% glenoid bone loss with an on-track or off-track Hill-Sachs lesion as previously recommended. Repair conditions included isolated BR, BR with remplissage, and BR with DAS (long head of biceps transfer). The glenohumeral stability was assessed by measuring the anterior translation under 0, 10, 20, 30, 40, 50 N load and maximum load without causing instability at mid-range (60°) and end-range (90°) external rotation (ER). Maximum range of motion (ROM) was measured by applying a 2.2-N·m torque in passive ER and internal rotation. RESULTS Isolated BR failed to restore native glenohumeral stability in both on-track and off-track bipolar bone loss models. Both remplissage and DAS significantly decreased the anterior instability in the bipolar bone loss models, showing better restoration than the isolated BR. In the on-track lesions, DAS successfully restored native glenohumeral stability and mobility, whereas remplissage significantly decreased anterior translation without load (-2.12 ± 1.07 mm at 90° ER, P = .003; -1.98 ± 1.23 mm at 60° ER, P = .015). In the off-track lesions, remplissage restored native glenohumeral stability but led to significant ROM limitation (-8.6° ± 2.3° for internal rotation, P < .001; -13.9° ± 6.2° for ER, P = .003), whereas DAS failed to restore native stability at 90° ER regarding the increased anterior translation under 50 N (4.10 ± 1.53 mm, P < .001) and decreased maximum load (-13.8 ± 9.2 N, P = .021). CONCLUSIONS At time-zero, both remplissage and DAS significantly reduced residual anterior instability compared with isolated BR in the bipolar bone loss models and restored the native glenohumeral stability under most translational loads. However, remplissage could decrease the anterior translation without load for on-track lesions and may restrict ROM for off-track lesions, whereas DAS failed to restore native stability under high translational loads for off-track lesions. CLINICAL RELEVANCE DAS could be recommended to treat on-track bipolar bone loss with less biomechanical adverse effects, whereas remplissage might be the preferred procedure to address off-track bipolar bone loss for better stability.
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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
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Simin Lu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaoyi Fang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Milano G, Colosio A, Agosti M, Bergomi A, Saccomanno MF. Arthroscopic humeral head defect filling with osteochondral autografts transplantation for near-track Hill-Sachs lesions. JSES Int 2024; 8:686-691. [PMID: 39035648 PMCID: PMC11258713 DOI: 10.1016/j.jseint.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Affiliation(s)
- Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Alessandro Colosio
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Monica Agosti
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Bergomi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Maristella F. Saccomanno
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
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Zhang C, Yang S, Wang J, Shao W, Huang Y, Tang X. Prognostic factors for recurrent instability in recreational athletes following arthroscopic Bankart repair: a retrospective study with an average 4.1-year follow-up. BMC Sports Sci Med Rehabil 2024; 16:140. [PMID: 38915076 PMCID: PMC11194893 DOI: 10.1186/s13102-024-00925-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 06/12/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Extensive research has been conducted to investigate the short-term and long-term outcomes of arthroscopic Bankart repair, yielding varying results across different populations. However, there remains a dearth of studies specifically focused on evaluating outcomes in recreational athletes. METHODS A retrospective case series study was conducted on recreational athletes who underwent isolated arthroscopic Bankart repair between 2013 and 2021. The primary outcome assessed was recurrent instability, defined as dislocation or subluxation. Secondary outcomes included patient satisfaction, rates of returning to the same sports (RTS) and RTS at preinjury level, and patient-reported outcomes. Evaluation of the Rowe score, Constant score, American Shoulder and Elbow Surgeons score, and VAS pain score were performed. Prognostic factors for recurrent instability, including demographic and clinical characteristics, as well as postoperative magnetic resonance imaging (MRI) appearance of the labrum were analyzed. RESULTS A total of 191 patients met the selection criteria, with 150 (78.5%) available for the final follow-up. Recurrent instability occurred in 10.7% of patients, with a mean follow-up duration of 4.1 years. Younger age at surgery and more critical glenoid bone loss were significantly associated with recurrent instability (p = .038 and p = .011, respectively). The satisfaction rate regarding surgery was 90.0%. Rates of return to the same sports (RTS) and RTS at preinjury level were 82.0% and 49.3%, respectively. Clinical outcomes measured at the final follow-up were as follows: Rowe score - 92.8; Constant score - 98.0; ASES score - 98.3; VAS pain score - 0.2. Patients with recurrent instability had significantly inferior outcomes in terms of satisfaction rate, RTS at preinjury level rate, Rowe score, and Constant score (p = .000, p = .039, p = .000, and p = .015, respectively). A total of thirty-seven patients underwent MRI examination six months after surgery in our institution. The T2-weighted anterior labrum morphology was found to be poorer in patients with recurrent instability. No significant difference was observed between patients with or without recurrent instability in terms of anterior Slope, anterior labral glenoid height index (LGHI), inferior Slope, inferior LGHI, and T2-weighted inferior labrum morphology. CONCLUSION Arthroscopic Bankart repair can yield satisfactory medium-term outcomes for recreational athletes. Younger age at surgery, more critical glenoid bone loss, and poorer T2-weighted anterior labrum morphology assessed six months postoperatively were significantly associated with recurrent instability.
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Affiliation(s)
- Chunsen Zhang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Songyun Yang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Santai county people's hospital, Mianyang, 621199, China
| | - Jiapeng Wang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wenze Shao
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yizhou Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China hospital, Sichuan University, Chengdu, 610041, China.
| | - Xin Tang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Badavath RR, Kumar TS, Chodavarapu L. Arthroscopic Management of Anterior Shoulder Instability: A Study of Functional Outcome and Analysis. Cureus 2024; 16:e61870. [PMID: 38975477 PMCID: PMC11227652 DOI: 10.7759/cureus.61870] [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] [Accepted: 06/07/2024] [Indexed: 07/09/2024] Open
Abstract
Background The remarkable range of motion of the shoulder comes at the cost of increased instability, especially anterior instability. Arthroscopic Bankart repair with or without remplissage, which is a minimally invasive surgery, is the preferred treatment for recurrent anterior instability. This study investigated the effectiveness of Bankart repair, with or without remplissage, in restoring function, preventing redislocation, and improving patient satisfaction. Methods A prospective observational study examined 40 patients (19-50 years old) with recurrent anterior instability and MRI-confirmed Bankart or Bankart with Hill-Sachs lesions. Patients underwent arthroscopic Bankart repair with or without remplissage based on the inclusion criteria of this study. Preoperative assessments included demographics, history, physical examination, American Shoulder and Elbow Surgeons (ASES) score, Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score, ROWE score, and plain MRI of the shoulder joint. Post-operative radiographs and rehabilitation were advised. Functional recovery was evaluated at three months and six months after surgery. Results All patients underwent Bankart repair. Among them, 22 with engaging Hill-Sachs lesions received an additional remplissage procedure. Both groups showed significant improvements in their functional scores (p<0.05) and returned to their prior activities. However, the additional remplissage group had a slightly reduced mean external rotation (86.59°) compared with the Bankart repair-only group (90°). Notably, the recurrence rate was very low, with only one patient (2.5%) experiencing instability. Conclusion Our study emphasizes the importance of proper capsulolabral tissue elevation to achieve a sufficient labral bump during Bankart repair. This technique allowed us to efficiently use only two suture anchors in 35 cases (87.5%). Additionally, remplissage was performed on all identified engaging Hill-Sachs lesions. We found that proper anchor placement and suturing techniques were crucial for successful Bankart repair. The emphasis on the potential cost benefits of a two-anchor approach is a valuable contribution to the field.
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Affiliation(s)
- Raja Ramesh Badavath
- Department of Orthopedics, Nizam's Institute of Medical Sciences, Hyderabad, IND
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Baur A, Raghuwanshi J, Gwathmey FW. Is Revision Arthroscopic Bankart Repair a Viable Option? A Systematic Review of Recurrent Instability following Bankart Repair. J Clin Med 2024; 13:3067. [PMID: 38892778 PMCID: PMC11172870 DOI: 10.3390/jcm13113067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/10/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: Recurrent shoulder instability following Bankart lesion repair often necessitates surgical revision. This systematic review aims to understand the failure rates of arthroscopic revision Bankart repair. Methods: Following the PRISMA guidelines and registered on PROSPERO, this systematic review examined twenty-five articles written between 2000 and 2024. Two independent reviewers assessed eligibility across three databases, focusing on recurrent instability as the primary endpoint, while also noting functional measures, adverse events, revision operations, and return-to-sport rates when available. Results: The key surgical techniques for recurrent instability post-Bankart repair were identified, with revision arthroscopic Bankart being the most common (685/1032). A comparative analysis revealed a significantly lower recurrence for open coracoid transfer compared to arthroscopic revision Bankart repair (9.67% vs. 17.14%; p < 0.001), while no significant difference was observed between remplissage plus Bankart repair and Bankart repair alone (23.75% vs. 17.14%; p = 0.24). The majority of studies did not include supracritical glenoid bone loss or engaging Hill-Sachs lesions, and neither subcritical nor non-engaging lesions significantly influenced recurrence rates (p = 0.85 and p = 0.80, respectively). Conclusions: Revision arthroscopic Bankart repair remains a viable option in the absence of bipolar bone loss; however, open coracoid transfer appears to have lower recurrence rates than arthroscopic Bankart repair, consistent with prior evidence. Further studies should define cutoffs and investigate the roles of critical glenoid bone loss and off-track Hill-Sachs lesions. Preoperative measurements of GBL on three-dimensional computed tomography and characterizing lesions based on glenoid track will help surgeons to choose ideal candidates for arthroscopic revision Bankart repair.
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Affiliation(s)
- Alexander Baur
- Liberty University College of Osteopathic Medicine, Lynchburg, VA 24502, USA
| | - Jasraj Raghuwanshi
- University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - F. Winston Gwathmey
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA 22903, USA
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Pasqualini I, Rossi LA, Hurley ET, Turan O, Tanoira I, Ranalletta M. Shoulder Instability-Return to Sports After Injury (SIRSI) Scale Shows That Lack of Psychological Readiness Predicts Outcomes and Recurrence Following Surgical Stabilization. Arthroscopy 2024:S0749-8063(24)00336-0. [PMID: 38735414 DOI: 10.1016/j.arthro.2024.04.030] [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: 11/01/2023] [Revised: 04/17/2024] [Accepted: 04/20/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE This study aimed to evaluate the predictive ability of psychological readiness to return to sports on clinical outcomes and recurrences in athletes who return to sports following shoulder instability surgery. METHODS A retrospective analysis was performed of patients who underwent shoulder instability surgery between September 2020 and October 2021 (arthroscopic Bankart repair or Latarjet procedure) with a minimum follow-up of 2 years. Patients were grouped according to the achievement of psychological readiness to return to play using the SIRSI scale (≥ 55 points) measured at 6 months following surgery. Recurrences were measured and functional outcomes were evaluated by the Visual Analogue Scale (VAS), Rowe, and Athletic Shoulder Outcome Scoring System (ASOSS). The minimal clinically important difference (MCID) for the VAS and Rowe scores was calculated using the distribution-based method of ½ standard deviation of the delta (difference between postoperative and preoperative scores). The patient acceptable symptomatic state (PASS) for the VAS scale was set at 2.5 based on previous literature. To evaluate the predictive ability of SIRSI a regression model analysis and a receiver operating characteristic (ROC) curve were used. RESULTS A total of 108 who achieved psychological readiness (PSR) and 41 who did not (NPSR) met the study criteria. PSR achieved significantly higher percentages of MCID and PASS thresholds for VAS than NPSR (MCID: 68.5% vs 48.7%, p=0.026; PASS: 92.5% vs 58.5%, p<0.001). However, there were no differences in the percentage of patients achieving MCID for the Rowe score between groups (98.1% vs 100%, p=0.999). The only strongest independent predictor of postoperative outcomes was being psychologically ready to return to sports. The SIRSI scale had an excellent predictive ability for recurrences (area under curve 0.745, 95% CI 0.5-0.8). Of those who sustained a recurrence, 20% were not psychologically ready compared to 4.3% who were (p= 0.002). A power analysis was not conducted for this study. CONCLUSION The SIRSI scale is associated with postoperative clinical outcomes and recurrences in patients who returned to sports following shoulder instability surgery. Patients who were not psychologically ready following shoulder instability surgery had worse clinical outcomes with fewer patients achieving clinically significant outcomes (PASS and MCID) for pain, and a higher risk of recurrence. LEVEL OF EVIDENCE Level IV, Retrospective cohort study.
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Affiliation(s)
- Ignacio Pasqualini
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | | | - Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Oguz Turan
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
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Hachem AI, Diaz-Apablaza E, Molina-Creixell A, Ruis X, Videla S, Luis Agulló J. Clinical Outcomes and Graft Resorption After Metal-Free Bone Block Suture Tape Cerclage Fixation for Recurrent Anterior Shoulder Instability: A Computed Tomography Analysis. Am J Sports Med 2024; 52:1472-1482. [PMID: 38590203 DOI: 10.1177/03635465241236179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Glenoid reconstruction with a bone block for anterior glenoid bone loss (GBL) has shown excellent outcomes. However, fixation techniques that require metal implants are associated with metal-related complications and bone graft resorption. HYPOTHESIS Arthroscopic glenoid reconstruction using a tricortical iliac crest bone graft (ICBG) and metal-free suture tape cerclage fixation can safely and effectively restore the glenoid surface area in patients with recurrent anterior shoulder instability and anterior GBL. STUDY DESIGN Case series; Level of evidence, 4. METHODS Adult patients (≥18 years) of both sexes with recurrent anterior shoulder instability and anterior GBL ≥15% were enrolled. These patients underwent arthroscopic glenoid reconstruction with ICBGs and metal-free suture tape cerclage fixation. The effectiveness and clinical outcomes with this technique were evaluated at 24 months using functional scores. Resorption of the graft articular surface was assessed by computed tomography, with the graft surface divided into 6 square areas aligned in 2 columns. Descriptive analysis was conducted. RESULTS A total of 23 consecutive patients met inclusion criteria (22 male, 1 female; mean age, 30.5 ± 7.9 years). The mean preoperative GBL was 19.7% ± 3.4%, and there were 15 allograft and 8 autograft ICBGs. All patients exhibited graft union at 3 months. The median follow-up was 38.5 months (interquartile range, 24-45 months). The Western Ontario Shoulder Instability Index, Rowe, Constant-Murley, and Subjective Shoulder Value scores improved from preoperatively (35.1%, 24.8, 83.1, and 30.9, respectively) to postoperatively (84.7%, 91.1, 96.0, and 90.9, respectively) (P < .001). No differences in clinical scores were observed between the graft types. One surgical wound infection was reported, and 2 patients (8.7% [95% CI, 2.4%-26.8%]) required a reoperation. The mean overall glenoid surface area increased from 80.3% ± 3.5% to 117.0% ± 8.3% immediately after surgery before subsequently reducing to 98.7% ± 6.2% and 95.0% ± 5.7% at 12 and 24 months, respectively (P < .001). The mean graft resorption rate was 18.1% ± 7.9% in the inner column and 80.3% ± 22.4% in the outer column. Additionally, 3 patients treated with an allograft (20.0% [95% CI, 7.1%-45.2%]), including the 2 with clinical failures, exhibited complete graft resorption at the last follow-up. CONCLUSION Arthroscopic glenoid reconstruction using an ICBG and metal-free suture tape cerclage fixation was safe and effective, yielding excellent clinical outcomes. Resorption of the graft articular surface predominantly affected the nonloaded areas beyond the best-fit circle perimeter.
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Affiliation(s)
- Abdul-Ilah Hachem
- Department of Orthopaedic Surgery and Traumatology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | | | | | - Xavi Ruis
- Department of Orthopaedic Surgery and Traumatology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sebastian Videla
- Clinical Research Support Unit, Department of Clinical Pharmacology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Jose Luis Agulló
- Department of Orthopaedic Surgery and Traumatology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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Hohmann E. Editorial Commentary: Recurrence Rates Following Arthroscopic Bankart Repair Differ Among Contact and Collision Sports and Are Higher in Collision Sports. Arthroscopy 2024; 40:540-542. [PMID: 38296450 DOI: 10.1016/j.arthro.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 02/08/2024]
Abstract
Collision and contact sports athletes are at higher risk of shoulder dislocations. In collision sports such as boxing, ice hockey, rugby, football, and various martial arts, the athlete purposely hits or collides with other athletes or objects with substantial force, whereas in contact sports such as basketball, field hockey, wrestling, and soccer, the athlete makes regular contact with other athletes but with substantially less force. Return-to-sports rates following arthroscopic shoulder stabilization are above 90%. Risk factors for a recurrent shoulder dislocation include younger age, previous dislocations, generalized hyperlaxity, an instability severity index score above 3, off-track lesions, glenoid bone loss, and participation in contact and collision sports. However, data from a recent study have shown that the rate of recurrence varies among different contact sports as both kinematics and kinetics are clearly different. Ice hockey (ES, 0.72) has been identified as the collision sport with the highest recurrence rate. Wrestling (ES, 0.33), rugby (ES, 0.23), martial arts (ES, 0.20), and boxing (ES, 0.18) had similar recurrence rates, but the effect sizes were 3 times lower when compared to ice hockey. The lowest recurrence rates were observed in field hockey (ES, 0.04), football (ES, 0.06), and soccer (ES, 0.06). The sample size was sufficient, but the moderate risk of bias and study quality suggest that the true effect will most likely be markedly different from the estimated effect. Although common sense dictates that recurrence rates should be different, scientific evidence is not supporting this motion, and the findings should be viewed with some caution.
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Müller PE, Konvalin LJ. [Shoulder-clinical introduction]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:93-100. [PMID: 37816804 DOI: 10.1007/s00117-023-01219-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Radiological imaging plays a significant role in the diagnostics of shoulder pathologies. Based on a patient's medical history, physical examination and radiological imaging, it is possible to plan the further conservative or surgical treatment. OBJECTIVES Common pathologies of the shoulder and the correct radiological imaging are presented. CONCLUSIONS A rational and targeted use of radiological imaging, together with the medical history and physical examination allows correct diagnosis of pathologies of the shoulder joint.
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Affiliation(s)
- Peter E Müller
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Lennart J Konvalin
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
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12
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Pasqualini I, Rossi LA, Franco JVA, Denard PJ, Fieiras C, Escobar Liquitay C, Tanoira I, Ranalletta M. Results After Arthroscopic Bankart Repair in Contact Athletes Should Not Be Reported Globally Because of the High Variability in Recurrences Among the Different Contact or Collision Sports: A Systematic Review. Arthroscopy 2024; 40:523-539.e2. [PMID: 37394151 DOI: 10.1016/j.arthro.2023.06.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 06/07/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To describe and compare the recurrence rates in contact or collision (CC) sports after arthroscopic Bankart repair (ABR) and to compare the recurrence rates in CC versus non-collision athletes after ABR. METHODS We followed a prespecified protocol registered with PROSPERO (registration No. CRD42022299853). In January 2022, a literature search was performed using the electronic databases MEDLINE, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials), as well as clinical trials records. Clinical studies (Level I-IV evidence) that evaluated recurrence after ABR in CC athletes with a minimum follow-up period of 2 years postoperatively were included. We assessed the quality of the studies using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool, and we described the range of effects using synthesis without meta-analysis and described the certainty of the evidence using GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). RESULTS We identified 35 studies, which included 2,591 athletes. The studies had heterogeneous definitions of recurrence and classifications of sports. The recurrence rates after ABR varied significantly among studies between 3% and 51% (I2 = 84.9%, 35 studies and 2,591 participants). The range was at the higher end for participants younger than 20 years (range, 11%-51%; I2 = 81.7%) compared with older participants (range, 3%-30%; I2 = 54.7%). The recurrence rates also varied by recurrence definition (I2 = 83.3%) and within and across categories of CC sports (I2 = 83.8%). CC athletes had higher recurrence rates than did non-collision athletes (7%-29% vs 0%-14%; I2 = 29.2%; 12 studies with 612 participants). Overall, the risk of bias of all the included studies was determined to be moderate. The certainty of the evidence was low owing to study design (Level III-IV evidence), study limitations, and inconsistency. CONCLUSIONS There was high variability in the recurrence rates reported after ABR according to the different types of CC sports, ranging from 3% to 51%. Moreover, variations in recurrence among CC sports were observed, with ice hockey players being in the upper range but field hockey players being in the lower range. Finally, CC athletes showed higher recurrence rates when compared with non-collision athletes. LEVEL OF EVIDENCE Level IV, systematic review of Level II, III, and IV studies.
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Affiliation(s)
- Ignacio Pasqualini
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Luciano Andrés Rossi
- Shoulder Unit, Department of Orthopedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Juan Victor Ariel Franco
- Institute of General Practice, Medical Faculty of the Heinrich-Heine - University Dusseldorf, Dusseldorf, Germany
| | | | - Cecilia Fieiras
- Shoulder Unit, Department of Orthopedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Ignacio Tanoira
- Shoulder Unit, Department of Orthopedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano Ranalletta
- Shoulder Unit, Department of Orthopedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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13
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Herman ZJ, Nazzal EM, Keeling L, Reddy RP, Como M, Hughes JD, Lin A. Bipolar bone loss and distance to dislocation. ANNALS OF JOINT 2024; 9:7. [PMID: 38529290 PMCID: PMC10929361 DOI: 10.21037/aoj-23-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 12/08/2023] [Indexed: 03/27/2024]
Abstract
Studies have shown that glenoid- and humeral-sided bone loss may be present in up to 73-93% of individuals with recurrent anterior shoulder instability. As such, bone loss must be addressed appropriately, as the amount of bone loss drives surgical decision making and influences outcomes. Methods to describe and measure bone loss have changed over time. Originally, glenoid and humeral bone loss were viewed separately. However, the concepts of bipolar bone loss, the glenoid track (GT), and "on/off-track" lesions arose, highlighting the interplay between the two entities in contributing to recurrent instability. Classically, "off-track" lesions have been described as those Hill-Sachs interval (HSI) greater than the GT, and have been shown to result in higher rates of re-instability when addressed nonoperatively or with Bankart repair alone. More recently, further attention has been given to "on-track" lesions (HSI < GT). The new concept of "distance to dislocation" (DTD) has gained popularity. DTD is calculated as the difference between the GT and HSI, and literature evaluating DTD suggests that not all "on-track" lesions should be treated in the same manner. The purpose of this concept review article is twofold: (I) describe glenoid, humeral, and bipolar bone loss in the setting of anterior shoulder instability; and (II) elaborate on the new concept of "DTD" and its use in guidance of management.
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Affiliation(s)
- Zachary J Herman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ehab M Nazzal
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Laura Keeling
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rajiv P Reddy
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Matthew Como
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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14
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Cong T, Charles S, Reddy RP, Fatora G, Fox MA, Barrow AE, Lesniak BP, Rodosky MW, Hughes JD, Popchak AJ, Lin A. Defining Critical Humeral Bone Loss: Inferior Craniocaudal Hill-Sachs Extension as Predictor of Recurrent Instability After Primary Arthroscopic Bankart Repair. Am J Sports Med 2024; 52:181-189. [PMID: 38164666 DOI: 10.1177/03635465231209443] [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: 01/03/2024]
Abstract
BACKGROUND The glenoid track concept for shoulder instability primarily describes the medial-lateral relationship between a Hill-Sachs lesion and the glenoid. However, the Hill-Sachs position in the craniocaudal dimension has not been thoroughly studied. HYPOTHESIS Hill-Sachs lesions with greater inferior extension are associated with increased risk of recurrent instability after primary arthroscopic Bankart repair. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS The authors performed a retrospective analysis of patients with on-track Hill-Sachs lesions who underwent primary arthroscopic Bankart repair (without remplissage) between 2007 and 2019 and had a minimum 2-year follow-up. Recurrent instability was defined as recurrent dislocation or subluxation after the index procedure. The craniocaudal position of the Hill-Sachs lesion was measured against the midhumeral axis on sagittal magnetic resonance imaging (MRI) using either a Hill-Sachs bisecting line through the humeral head center (sagittal midpoint angle [SMA], a measure of Hill-Sachs craniocaudal position) or a line tangent to the inferior Hill-Sachs edge (lower-edge angle [LEA], a measure of Hill-Sachs caudal extension). Univariate and multivariate regression were used to determine the predictive value of both SMA and LEA for recurrent instability. RESULTS In total, 176 patients were included with a mean age of 20.6 years, mean follow-up of 5.9 years, and contact sport participation of 69.3%. Of these patients, 42 (23.9%) experienced recurrent instability (30 dislocations, 12 subluxations) at a mean time of 1.7 years after surgery. Recurrent instability was found to be significantly associated with LEA >90° (ie, Hill-Sachs lesions extending below the humeral head equator), with an OR of 3.29 (P = .022). SMA predicted recurrent instability to a lesser degree (OR, 2.22; P = .052). Post hoc evaluation demonstrated that LEA >90° predicted recurrent dislocations (subset of recurrent instability) with an OR of 4.80 (P = .003). LEA and SMA were found to be collinear with Hill-Sachs interval and distance to dislocation, suggesting that greater LEA and SMA proportionally reflect lesion severity in both the craniocaudal and medial-lateral dimensions. CONCLUSION Inferior extension of an otherwise on-track Hill-Sachs lesion is a highly predictive risk factor for recurrent instability after primary arthroscopic Bankart repair. Evaluation of Hill-Sachs extension below the humeral equator (inferior equatorial extension) on sagittal MRI is a clinically facile screening tool for higher-risk lesions with subcritical glenoid bone loss. This threshold for critical humeral bone loss may inform surgical stratification for procedures such as remplissage or other approaches for at-risk on-track lesions.
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Affiliation(s)
- Ting Cong
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shaquille Charles
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rajiv P Reddy
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gabrielle Fatora
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael A Fox
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Aaron E Barrow
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bryson P Lesniak
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mark W Rodosky
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jonathan D Hughes
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Adam J Popchak
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Albert Lin
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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15
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Youssef Y, Heilemann M, Melcher P, Fischer JP, Schleifenbaum S, Hepp P, Theopold J. Assessment of micromotion at the bone-bone interface after coracoid and scapular-spine bone-block augmentation for the reconstruction of critical anterior glenoid bone loss-a biomechanical cadaver study. BMC Musculoskelet Disord 2023; 24:790. [PMID: 37798626 PMCID: PMC10552292 DOI: 10.1186/s12891-023-06914-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Glenoid bone loss is among the most important risk factors for recurrent anterior shoulder instability, and a bony reconstruction is recommended in cases of critical bone loss (> 15%). The commonly used surgical techniques, including coracoid transfer, are associated with considerable complications. The aim of this study was to assess the motion at the glenoid-bone-block interface after coracoid and spina-scapula bone-block reconstruction of the anterior glenoid. METHODS Twelve cadaveric shoulders were tested. A 20% bone defect of the anterior glenoid was created, and the specimens were randomly assigned for glenoid augmentation using a coracoid bone block (n = 6) or a scapular spine bone block (n = 6). The glenoid-bone interface was cyclically loaded for 5000 cycles with a force of 170 N. The micromotion was tracked using an optical measurement system (GOM ARMIS) and was evaluated with the GOM Correlate Pro software. RESULTS The most dominant motion component was medial irreversible displacement for the spina-scapula (1.87 mm; SD: 1.11 mm) and coracoid bone blocks (0.91 mm; SD: 0.29 mm) (n.s.). The most medial irreversible displacement took place during the first nine cycles. The inferior reversible displacement was significantly greater for spina-scapula bone blocks (0.28 mm, SD: 0.16 mm) compared to coracoid bone blocks (0.06 mm, SD: 0.10 mm) (p = 0.02). CONCLUSIONS The medial irreversible displacement is the dominant motion component in a bone-block reconstruction after a critical bone loss of the anterior glenoid. The spina-scapula and coracoid bone blocks are comparable in terms of primary stability and extent of motion. Thus, spina-scapula bone blocks may serve as alternatives in bony glenoid reconstruction from a biomechanical point of view.
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Affiliation(s)
- Yasmin Youssef
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany.
| | - Martin Heilemann
- ZESBO-Center for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany
| | - Peter Melcher
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - Jean-Pierre Fischer
- ZESBO-Center for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany
| | - Stefan Schleifenbaum
- ZESBO-Center for Research on Musculoskeletal Systems, Leipzig University, Leipzig, Germany
| | - Pierre Hepp
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - Jan Theopold
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany
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16
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Yeo MHX, Lie D, Cheong T, Wonggokusuma E, Mak WK. Anatomic risk factors for arthroscopic Bankart repair failure: A case-control study comparing failure and non-failure groups in an Asian population. J Orthop 2023; 41:73-78. [PMID: 37362959 PMCID: PMC10285502 DOI: 10.1016/j.jor.2023.06.005] [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: 05/02/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Post-arthroscopic Bankart repair failure/re-dislocation rates are influenced by several risk factors, including anatomic defects. There is limited evidence on the role of anatomic defects, especially for Hill-Sachs size in on-track lesions. This study aimed to assess glenoid bone loss, Hill-Sachs lesion and labral tear size and evaluate their contribution to post-operative instability after a primary repair. Material and methods Across 169 patients with on-track Bankart lesions who underwent primary arthroscopic Bankart repair from 2010 to 2015, this study matched 14 failure with 14 non-failure cases based on age/gender. Patient demographics, pre-operative radiological parameters (including size of glenoid bone loss and Hill-Sachs lesion) and labral tear size were compared between the failure and non-failure groups. Result All patients were male with a mean age of 21.01 ± 4.97. Significantly greater glenoid bone loss (p = 0.024) and labral tear size (p = 0.039) were found in the failure group. However, there was no significant difference in mean volume of Hill-Sachs lesion between the two groups (p = 0.739). Conclusion Extensive glenoid bone loss and labral tears are risk factors for post-arthroscopic Bankart failure. However, the size of Hill-Sachs lesion is not a risk factor for failure, in a specific group of on-track Hill-Sachs lesions. Level of evidence Retrospective Study, Level IV.
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Affiliation(s)
- Mark HX Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Denny Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Teddy Cheong
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang E Way, 544886, Singapore
| | - Erick Wonggokusuma
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Wai Keong Mak
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang E Way, 544886, Singapore
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17
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Lho T, Lee J, Oh KS, Chung SW. Latarjet procedure for failed Bankart repair provides better stability and return to sports, but worse postoperative pain and external rotation limitations with more complications, compared to revision Bankart repair: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07410-2. [PMID: 37038019 DOI: 10.1007/s00167-023-07410-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/30/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE This study aimed to compare the clinical results of revision Bankart repair versus the Latarjet procedure for failed Bankart repair. METHODS A literature search was performed in databases, such as Pubmed, Embase, and Scopus Library. The studies were appraised using the Methodological Index for Non-randomized Studies tool. Studies for failed Bankart repair with revision Bankart repair or Latarjet procedure were included. The pain VAS, ROWE score, rate of return to sports and preinjury level of sports, recurrent instability, range of motion, and complications were compared. Additionally, the pain VAS, ROWE score, forward flexion, and external rotation at side were subjected to a meta-analysis. RESULTS Twenty-four articles were included in the systematic review. The functional outcomes in terms of the ROWE score, recurrent instability, return to sports, and the preinjury level of sports was better in the Latarjet procedure group than those in the revision Bankart repair group (ROWE score, 91 vs. 86.7; recurrent instability rate, 3.5% vs. 14.4%; return to sports rate, 100% vs. 87.9%; return to preinjury level of sports rate, 89.9% vs. 74.9%; all P < 0.001). However, the results of postoperative pain and the postoperative limitation of external rotation at side were worse in the Latarjet procedure group than those in the revision Bankart repair group (pain VAS, 1.4 vs. 0.8; postoperative external rotation at side, 38° vs. 60°; all P < 0.001). In addition, the majority of the complications occurred in the Latarjet procedure group. In the meta-analysis, the postoperative ROWE score was significantly higher in the Latarjet procedure group than that in the revision Bankart group (revision Bankart repair: 95% CI 88.9-80.9, I2 = 65.70; Latarjet procedure: 95% CI 95.8-88.1, I2 = 93.37; P = 0.014). However, the pain VAS, forward flexion, and external rotation at side did not reach the significant level in the meta-analysis. CONCLUSION Compared with revision Bankart repair, the Latarjet procedure for failed Bankart repair showed better ROWE scores, stability, and return to sports or preinjury level of sports; however, the postoperative pain and the limitation of external rotation at side were worse with more complications. IRB NO KUMC 2022-01-024. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Taewoo Lho
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, School of Medicine, Konkuk University, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea
| | - JiHwan Lee
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, School of Medicine, Konkuk University, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, School of Medicine, Konkuk University, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, School of Medicine, Konkuk University, 120-1 Neungdong-Ro (Hwayang-Dong), Gwangjin-Gu, Seoul, 143-729, Korea.
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18
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Müller PE, Niethammer TR. [Sports injuries : What type of imaging is required?]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:235-240. [PMID: 36757482 DOI: 10.1007/s00117-023-01121-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Imaging is of great importance in sports injuries, since the indication for conservative and surgical therapy depends on precise knowledge of the extent of the damage. OBJECTIVES Typical sports injuries and their imaging requirements are to be presented as examples. CONCLUSIONS In order to detect the often subtle pathologies, imaging must be adapted to the clinical diagnosis that is specifically suspected.
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Affiliation(s)
- Peter E Müller
- Schwerpunkt Knie & Sport, Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Thomas R Niethammer
- Schwerpunkt Knie & Sport, Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland
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19
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Sudah SY, Menendez ME. Classifications in Brief: The Instability Severity Index Score for Predicting Recurrent Shoulder Instability After Arthroscopic Bankart Repair. Clin Orthop Relat Res 2023; 481:382-386. [PMID: 36006660 PMCID: PMC9831186 DOI: 10.1097/corr.0000000000002386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/09/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Suleiman Y. Sudah
- Department of Orthopedics, Monmouth Medical Center, Long Branch, NJ, USA
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20
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High correlation between inner and outer glenoid circle diameters and its clinical relevance. Knee Surg Sports Traumatol Arthrosc 2023; 31:199-205. [PMID: 35809103 DOI: 10.1007/s00167-022-07050-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 06/09/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The majority of methods for measuring glenoid bone loss in shoulder instability use the best-fit circle following the inferior glenoid rim. However, there is no precise method on how to draw this circle, particularly in case of a missing rim segment. Defining the radius is a source of substantial error. It was hypothesized that there is a relationship between the best-fit inferior circle (inner circle), defined by Sugaya, and the circle tangent to the supra- and infra-glenoid tubercles (outer circle), defined by Itoi, thus allowing a more consistent appreciation of the paleo-glenoid. METHODS Ninety-five normal dry scapulae were examined. The specimens were digitally photographed obtaining perpendicular images of the glenoid cavity. Using HOROS® imaging software, a best-fit inferior circle (inner circle) and a second circle fitting the most inferior and superior points of the glenoid (outer circle) were drawn by two investigators. The diameters and areas of the circles were recorded. Two-way random-effects intra-class correlation coefficients (ICC) were used to measure intra- and inter-observer agreement. A Bayesian measurement-error regression model was used to determine the relationship between outer and inner circle measurements. RESULTS The mean glenoid height was 35.1 mm and the glenoid width 25.6 mm. The mean diameter of the outer circle was 35.7 ± 4.2 mm and the mean diameter of the inner circle was 26.8 ± 3.2 mm. ICC showed excellent inter- and intra-observer agreement for both the outer circle diameter (ICC ≥ 0.95) and inner circle diameter (ICC ≥ 0.93). The two diameters demonstrated a very strong significant Pearson correlation (0.92, p < 0.001) and the regression showed excellent model fit R2 = 0.87. The areas of the two circles were also highly and significantly correlated (r = 0.94; p < 0.001). The ratio of inner circle to outer diameters was 0.74. CONCLUSION There is a strong correlation between the inner and outer glenoid circle diameters. This study sets the base for the use the combined outer and inner circle and its ratio to better appreciate the paleo-glenoid morphology and thus obtain a more reliable bone loss estimation. Application of this method aids in a more reliable estimation bone loss with potential benefit in surgical decision-making.
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21
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Dai F, Yang J, Zhang Q, Li Y, Xiang M. Arthroscopic Autologous Scapular Spine Bone Graft for Recurrent Anterior Shoulder Dislocation With Subcritical (10%-15%) Glenoid Bone Loss. Arthrosc Tech 2022; 11:e1871-e1878. [PMID: 36457382 PMCID: PMC9705272 DOI: 10.1016/j.eats.2022.06.027] [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: 03/14/2022] [Accepted: 06/27/2022] [Indexed: 11/06/2022] Open
Abstract
For anterior shoulder instability with subcritical glenoid bone loss (10%-15%), there is no consensus on the optimal treatment. Now, we describe the technique of using autogenous scapular spine bone graft for recurrent anterior shoulder dislocation. This procedure can effectively increase the anterior bone barrier and strengthen the effect of Bankart repair. In addition, this procedure not only avoids coracoid or iliac crest transfer, but also adopts nonrigid fixation, which makes it safer and more convenient. We believe that this technique will provide a promising alternative to the surgical treatment of recurrent anterior shoulder dislocation in subcritical glenoid bone loss (10%-15%).
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Affiliation(s)
| | | | | | | | - Ming Xiang
- Address correspondence to Ming Xiang, Ph.D., Department of Upper Limb, Sichuan Provincial Orthopaedic Hospital, Chengdu, 610041, China.
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22
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Gomez-Espejo V, Olmedilla A, Abenza-Cano L, Garcia-Mas A, Ortega E. Psychological readiness to return to sports practice and risk of recurrence: Case studies. Front Psychol 2022; 13:905816. [PMID: 36211933 PMCID: PMC9540195 DOI: 10.3389/fpsyg.2022.905816] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Abstract
Returning to sport after the sports injury is a difficult decision because it's multicausal and the fact that a rash decision can result in numerous negative consequences. Given the importance of psychological variables for the correct rehabilitation of the injured athlete and his or her optimal return to sports practice, there seems to be little information on this subject. In this sense, the objective is to determine the relationship between the subjective psychological disposition of the athlete in the process of Return to Play (RTP) with the type of mood profile and his mental health. This is based on the fact that each athlete evaluates his or her recovery differently and has different levels of anxiety, depression, and stress. For this purpose, four athletes participated in the study. Two males and two females from the sports of indoor soccer and soccer, who had just returned to sports after a moderate or severe injury. The average age was 24.25 years. Various measurements were taken after practices and after matches, to assess mood, psychological readiness, anxiety, stress, and depression. The results confirm Morgan's iceberg profile and the influence that subjective psychological perceptions and assessed emotional states have on athletes' incorporation into their sports practice with a guarantee of success.
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Affiliation(s)
| | - Aurelio Olmedilla
- Department of Personality, Evaluation and Psychological Treatment, University of Murcia, Murcia, Spain
| | | | - Alejandro Garcia-Mas
- Grupo de Investigación en Ciencias de la Actividad Fisica (GICAFE) (Research Group of Sports Sciences), University of the Balearic Islands, Palma de Mallorca, Spain
| | - Enrique Ortega
- Department of Physical Activity and Sport, Campus of Excellence Mare Nostrum, University of Murcia, Murcia, Spain
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Callegari JJ, McGarry M, Crook L, Adamson NA, Fraipont GM, Provencher M, Lee TQ, Denard PJ. The Addition of Remplissage to Free Bone Block Restores Translation and Stiffness Compared to Bone Block Alone or Latarjet in a Bipolar Bone Loss Model. Arthroscopy 2022; 38:2609-2617. [PMID: 35346773 DOI: 10.1016/j.arthro.2022.03.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/28/2022] [Accepted: 03/16/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare glenohumeral stability following a Latarjet, a free bone block (FBB), and a FBB with remplissage for bipolar bone loss. METHODS Nine matched pairs of fresh frozen cadavers were tested in a custom biomechanical apparatus with rotation and progressive translational loading. The free bone block group consisted of a distal tibial allograft with an all-suture tape construct. The Latarjet group was performed with the native coracoid and two partially threaded cannulated screws. A bipolar bone loss model was created with 20% glenoid bone loss and an off-track Hill-Sachs lesion. Testing conditions included the 1) native state, 2) bipolar bone loss model, 3) Latarjet, 4) FBB with distal tibial allograft secured with cerclage sutures, and 5) FBB with remplissage. Each condition was tested for translation, humeral head apex shift, stiffness, and dislocation force. RESULTS There were no differences in translation, stiffness, or dislocation forced between the FBB alone and Latarjet groups. The FBB with remplissage group demonstrated the lowest anterior-inferior translation at 90° of ER, which was statistically significant compared to Latarjet 20N (P = .013) and compared to the FBB alone at 40N (P = .024) and 50N (P = .011). The FBB with remplissage group was significantly stiffer compared to FBB alone at 90° ER with approximately 60% change in stiffness (P = .028). The force required to dislocate the humeral head after treatment was highest in the FBB with remplissage group, which was statistically significant compared to the FBB alone (P = .003) and Latarjet groups (P = .018). CONCLUSION The addition of remplissage to a FBB restores translation and stiffness closer to the intact state compared to a FBB alone or Latarjet in a bipolar bone loss model with an off-track Hill-Sachs lesion. In this model, dislocation force significantly increased with the addition of remplissage to the FBB. CLINICAL RELEVANCE This biomechanical study provides evidence that Latarjet and FBB are both acceptable forms of treatment for bipolar bone loss, but stability can be enhanced with the addition of remplissage following glenoid reconstruction.
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Affiliation(s)
| | - Michelle McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | | | - Nicholas A Adamson
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Genevieve M Fraipont
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | | | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
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