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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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Cozzolino A, de Giovanni R, Malfi P, Bernasconi A, Scarpa S, Smeraglia F, Russo R, Mariconda M. Arthroscopic Latarjet Versus Arthroscopic Free Bone Block Procedures for Anterior Shoulder Instability: A Proportional Meta-analysis Comparing Recurrence, Complication, and Reoperation Rates. Am J Sports Med 2024; 52:1865-1876. [PMID: 38240595 DOI: 10.1177/03635465231188530] [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: 06/02/2024]
Abstract
BACKGROUND Several arthroscopic glenoid bone augmentation techniques have been introduced to treat patients affected by anterior shoulder instability associated with critical bone loss. The efficacy of the different arthroscopic bony procedures has not been compared yet. PURPOSE To compare the recurrence, complication, and reoperation rates of the arthroscopic Latarjet (AL) and arthroscopic free bone block (ABB) procedures for anterior shoulder instability. STUDY DESIGN Meta-analysis and systematic review; Level of evidence, 4. METHODS A systematic search was conducted in MEDLINE/PubMed, Web of Science, and Embase to identify clinical studies reporting the outcomes of the AL and ABB procedures. The following search phrases were used: "Arthroscopic" AND "Bone Block" OR "Bone Graft," and "Arthroscopic" AND "Glenoid Augmentation" OR "Glenoid Reconstruction," and "Arthroscopic" AND "Latarjet" OR "Coracoid Graft" OR "Coracoid Transfer." Exclusion criteria were <24 months of minimum follow-up, sample size <10 cases, revision after previous glenoid bone grafting, epilepsy, and multidirectional instability. Data regarding the study design, patient characteristics, surgical technique, and outcomes were extracted and analyzed. A proportional meta-analysis was conducted to compare the complication, recurrence, and reoperation rates between the 2 groups. Multiple subgroup analyses were performed to analyze the incidence of each complication and assess the weight of different fixation methods (in the whole cohort) or different graft types (in the ABB group). The modified Coleman Methodology Score was used to assess the risk of bias. RESULTS Of 5010 potentially relevant studies, 18 studies regarding the AL procedure (908 cases) and 15 studies regarding the ABB procedure (469 cases) were included. The 2 groups were comparable in age (P = .07), sex (P = .14), glenoid bone loss (P = .14), number of preoperative dislocations (P = .62), proportion of primary and revision procedures (P = .95), length of follow-up (P = .81), modified Coleman Methodology Score (P = .21), and level of evidence (P = .49). There was no difference in the recurrence (P = .88), reoperation (P = .79), and complication (P = .08) rates. The subgroup analyses showed a higher rate of hardware-related complications for screw fixation compared with flexible fixation (P = .01). CONCLUSION The AL and ABB procedures had similar recurrence, reoperation, and complication rates. Screw fixation of the bone graft was related to an increased risk of complications compared with flexible fixation. REGISTRATION CRD42022368153 (PROSPERO).
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Affiliation(s)
- Andrea Cozzolino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Roberto de Giovanni
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | - Alessio Bernasconi
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Simona Scarpa
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Francesco Smeraglia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Raffaele Russo
- Department of Public Health, University of Naples Federico II, Naples, Italy
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Massimo Mariconda
- Department of Public Health, University of Naples Federico II, Naples, Italy
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Bauer S, Neyton L, Collin P, Zumstein M. The open Latarjet-Patte procedure for the treatment of anterior shoulder instability in professional handball players at a mean follow-up of 6.6 years. J Shoulder Elbow Surg 2024; 33:924-931. [PMID: 37648015 DOI: 10.1016/j.jse.2023.07.029] [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: 01/28/2023] [Revised: 07/12/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND The popularity of team handball is increasing, with >10 million children playing this overhead throwing and collision sport with highest demands on the shoulder joint. Because of the risk of recurrent instability, the Latarjet-Patte (LP) procedure has been recommended to treat young competitive players. This is the first LP outcome study in professional handball players. METHODS We retrospectively included 20 shoulders (18 players [17 male patients]; mean age, 22.9 years [range, 17-35 years]; minimum follow-up period, 2 years; mean follow-up period, 6.6 years) operated on by 3 expert surgeons (2011-2020) with the Walch LP technique. We documented preoperative hyperlaxity (25%, n = 5), affected throwing arm (55%, n = 11), position (backcourt, winger, and goalkeeper, 22% each; full back and pivot, 17% each), >2 dislocations prior (20%, n = 4), >10 dislocations prior (5%, n = 1), previous failed Bankart or humeral avulsion of glenohumeral ligament (HAGL) repair (10%, n = 2), and large Hill-Sachs lesions (HSLs) (20%, n = 4). Clinical and radiographic outcomes, visual analog scale score, Subjective Shoulder Value, Walch-Duplay score, Rowe score, and return-to-sport (RTS) rate were recorded. RESULTS The RTS rate was 85% (17 of 20 shoulders); rate of RTS at the same level, 80% (16 of 20); and rate of RTS with no throwing pain, 73% (8 of 11). The time to training with a ball was 3.2 months, and the time to competition was 4.9 months. The mean Rowe score, Walch-Duplay score, and Subjective Shoulder Value were 90 points, 88 points, and 89%, respectively. Shoulder symptoms led players to give up handball in 2 cases (10%), whereas 1 player (5%) stopped playing handball for other reasons. We recorded 1 recurrent dislocation (5%) (non-throwing arm, winger, no recurrence after rehabilitation). Persistent apprehension occurred in 1 goalkeeper (5%). Residual pain was seen in 4 shoulders (20%); this was relieved by screw removal in 1. Resistant pain (throwing shoulder) was seen in 2 backcourt players (10%, 1 of whom had a large HSL) and 1 goalkeeper (5%; large HSL with >10 dislocations prior), all 3 of whom were aged > 30 years. Bone block positioning was correct (no lateral overhang) in all shoulders. At final follow-up, 1 shoulder (5%) showed mild arthritic changes (>10 dislocations, large HSL). CONCLUSION The open LP procedure is consistent in providing shoulder stability combined with return-to-throwing performance in professional handball players with a short time to RTS and high same-level RTS rate without increasing the risk of arthritic changes. Throwing shoulders of backcourt players, large HSLs, or age > 30 years may have an increased risk of persistent symptoms.
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Affiliation(s)
- Stefan Bauer
- Shoulder Surgery and Upper Limb Center, Ensemble Hospitalier de la Côte, Morges, Switzerland; School of Surgery, University of Western Australia, Perth, Australia.
| | - Lionel Neyton
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Philippe Collin
- Orthopedics and Traumatology, American Hospital of Paris, Neuilly-sur-Seine, France; Shoulder Surgery, Clinique Victor Hugo, Paris, France
| | - Matthias Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopädie Sonnenhof, Bern, Switzerland; Shoulder, Elbow Unit, SportsClinic#1, Bern, Switzerland
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Adolfsson L. What keeps a shoulder stable - Is there an ideal method for anterior stabilisation? Shoulder Elbow 2024; 16:4-7. [PMID: 38435031 PMCID: PMC10902409 DOI: 10.1177/17585732231224699] [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: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 03/05/2024]
Abstract
The gleno-humeral joint is by far the most mobile in the human body but also afflicted by dislocations, predominantly anterior. Surgical stabilisation is often successful but failures not uncommon. The following review describes potential causes of failure and highlights the need of adapting surgical methods to pathomorphology.
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Affiliation(s)
- Lars Adolfsson
- Department of Orthopedics, Linköping and Örebro Universities, Linkoping, Sweden
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Ahmed A, Jassim S, Karkuri A. Readability of Online Information on the Latarjet Procedure. Cureus 2023; 15:e49184. [PMID: 38024088 PMCID: PMC10662536 DOI: 10.7759/cureus.49184] [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: 11/21/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction A common complication of first-time or recurrent shoulder dislocations is bone loss at the humeral head and glenoid. Recurrent shoulder instability is often a result of bony defects in the glenoid following shoulder dislocations. In the setting of glenoid bone loss, surgical interventions are generally required to restore stability. The Latarjet procedure is a challenging operation and, due to its complexity, may be associated with operative complications. It can be difficult to explain the procedure to patients in a manner that is easily comprehensible, which may lead to confusion or being overwhelmed with information. Hence, it is important that the information available to patients is easily accessible and perceivable to allow for adequate health literacy. Health literacy is defined as the ability to make health decisions in the context of everyday life. Methods The search engines Google and Bing were accessed on a single day in the month of July 2023, searching the terms "Latarjet surgery" and "Latarjet procedure." For each term on both search engines, the first three pages were evaluated, resulting in a total of 114 websites for review. Out of these, 25 websites met the inclusion criteria and underwent further in-depth analysis through the online readability software, WEB FX. This software generated a Flesch Reading Ease Score (FRES) and a Reading Grade Level (RGL) for each website. Results In our study, the mean FRES was 50.3 (SD ±12.5), categorizing the data as 'fairly difficult to read.' The mean RGL score was 8.12 (SD ±2.35), which exceeds the recommended target. Conclusion In conclusion, the results of this study have demonstrated that the material available on the Internet about the Latarjet procedure is above the recommended readability levels for the majority of the population. Our findings align with similar studies assessing the readability of online patient information. Based on these findings, physicians should provide patients with vetted information to facilitate a better understanding of the procedure, thereby enabling patients to make more informed decisions regarding their health.
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Affiliation(s)
- Aathir Ahmed
- Orthopaedics, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Sarmed Jassim
- Surgery, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Ahmed Karkuri
- Orthopaedic Surgery, Sligo University Hospital, Sligo, IRL
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Fares MY, Boufadel P, Daher M, Koa J, Khanna A, Abboud JA. Anterior Shoulder Instability and Open Procedures: History, Indications, and Clinical Outcomes. Clin Orthop Surg 2023; 15:521-533. [PMID: 37529197 PMCID: PMC10375816 DOI: 10.4055/cios23018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/15/2023] [Accepted: 04/16/2023] [Indexed: 08/03/2023] Open
Abstract
The shoulder, being the most mobile joint in the human body, is often susceptible to dislocations and subluxations more so than other joints. As such, shoulder instability constitutes a common complaint among patients worldwide, especially those who are young, participate in contact sports, and have increased innate flexibility in their joints. Management options in the setting of instability vary between conservative and surgical options that aim to mitigate symptoms and allow return of function. Surgical options can be arthroscopic and open, with a general shift among surgeons towards utilizing arthroscopic surgery in the past several decades. Nevertheless, open procedures still play a role in managing shoulder instability patients, especially those with significant bone loss, recurrent instability, coexisting shoulder pathologies, and high risk of failure with arthroscopic surgery. In these clinical settings, open procedures, like the Latarjet procedure, open Bankart repair, glenoid bone augmentation using iliac crest autograft or distal tibial allograft, and salvage options like glenohumeral arthrodesis and arthroplasty may show good clinical outcomes and low recurrence rates. Each of these open procedures possesses its own set of advantages and disadvantages and entails a specific set of indications based on published literature. It is important to cater treatment options to the individual patient in order to optimize outcomes and reduce the risk of complications. Future research on open shoulder stabilization procedures should focus on the long-term outcomes of recently utilized procedures, investigate different graft options for procedures involving bone augmentation, and conduct additional comparative analyses in order to establish concrete surgical management guidelines.
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Affiliation(s)
- Mohamad Y. Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Peter Boufadel
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Mohammad Daher
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Jonathan Koa
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Akshay Khanna
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph A. Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
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Lavaill M, Martelli S, Cutbush K, Gupta A, Kerr GK, Pivonka P. Latarjet's muscular alterations increase glenohumeral joint stability: A theoretical study. J Biomech 2023; 155:111639. [PMID: 37245383 DOI: 10.1016/j.jbiomech.2023.111639] [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: 01/10/2023] [Revised: 03/20/2023] [Accepted: 05/10/2023] [Indexed: 05/30/2023]
Abstract
The surgical Latarjet procedure aims to stabilise the glenohumeral joint following anterior dislocations. Despite restoring joint stability, the procedure introduces alterations of muscle paths which likely modify the shoulder dynamics. Currently, these altered muscular functions and their implications are unclear. Hence, this work aims to predict changes in muscle lever arms, muscle and joint forces following a Latarjet procedure by using a computational approach. Planar shoulder movements of ten participants were experimentally assessed. A validated upper-limb musculoskeletal model was utilised in two configurations, i.e., a baseline model, simulating normal joint, and a Latarjet model simulating its related muscular alterations. Muscle lever arms and differences in muscle and joint forces between models were derived from the experimental marker data and static optimisation technique. Lever arms of most altered muscles, hence their role, were substantially changed after Latarjet. Altered muscle forces varied by up to 15% of the body weight. Total glenohumeral joint force increased by up to 14% of the body weight after Latarjet, mostly due to increase in compression force. Our simulation indicated that the Latarjet muscular alterations lead to changes in the muscular recruitment and contribute to the stability of the glenohumeral joint by increasing compression force during planar motions.
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Affiliation(s)
- Maxence Lavaill
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia; Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia.
| | - Saulo Martelli
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia; Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia; Medical Device Research Institute, College of Science and Engineering, Flinders University, Tonsley, SA, Australia
| | - Kenneth Cutbush
- Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia; St Andrew's War Memorial Hospital, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Ashish Gupta
- Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia; Greenslopes Private Hospital, Brisbane, Australia
| | - Graham K Kerr
- Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia; Movement Neuroscience Group, School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Peter Pivonka
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia; Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia
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郑 武, 郑 佳, 林 达, 谢 逸, 徐 慰, 吴 清, 肖 棋, 邓 辉, 江 惠, 冯 国. [Clinical application of Fastpass Scorpion suture passer for arthroscopic Bankart repair]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:538-544. [PMID: 37190828 PMCID: PMC10196981 DOI: 10.7507/1002-1892.202301046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 05/17/2023]
Abstract
Objective To explore the effectiveness and advantages of using Fastpass Scorpion suture passer to stitch the inferior capsulolabral complex in arthroscopic Bankart repair compared with traditional arthroscopic suture shuttle. Methods The clinical data of 41 patients with Bankart lesion, who met the selection criteria and were admitted between August 2019 and October 2021, was retrospectively analyzed. Under arthroscopy, the inferior capsulolabral complex was stitched with Fastpass Scorpion suture passer in 27 patients (FS group) and with arthroscopic suture shuttle in 14 patients (ASS group). There was no significant difference between the two groups ( P>0.05) in gender, age, injured side, frequency of shoulder dislocation, time from first dislocation to operation, and preoperative Rowe score of shoulder. Taking successful suture and pull-tightening as the criteria for completion of repair, the number of patients that were repaired at 5∶00 to 6∶00 (<6:00) and 6∶00 to 7∶00 positions of the glenoid in the two groups was compared. The operation time, and the difference of Rowe shoulder score betwee pre- and post-operation, the occurrence of shoulder joint dislocation, the results of apprehension test, and the constituent ratio of recovery to the pre-injury movement level between the two groups at 1 year after operation. Results Both groups completed the repair at 5∶00 to 6∶00 (<6∶00), and the constituent ratio of patients completed at 6∶00 to 7∶00 was significantly greater in the FS group than in the ASS group ( P<0.05). The operation time was significantly shorter in the FS group than in the ASS group ( P<0.05). All incisions in the two groups healed by first intention. All patients were followed up 12-36 months (mean, 19.1 months). No anchor displacement or neurovascular injury occurred during follow-up. Rowe score of shoulder in the two groups significantly improved at 1 year after operation than preoperative scores ( P<0.05), and there was no significant difference in the difference of Rowe shoulder score between pre- and post-operation between the two groups ( P>0.05). At 1 year after operation, no re-dislocation occurred, and there was no significant difference in the apprehension test and the constituent ratio of recovery to the pre-injury movement level between the two groups ( P>0.05). Conclusion Compared with the arthroscopic suture shuttle, using Fastpass Scorpion suture passer to stitch the inferior capsulolabral complex in arthroscopic Bankart repair is more convenient, saves operation time, and has good effectiveness.
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Affiliation(s)
- 武源 郑
- 中国人民解放军海军陆战队医院关节外科(广东潮州 521000)Department of Joint Surgery, the Marine Corps Hospital of Chinese PLA, Chaozhou Guangdong, 521000, P. R. China
| | - 佳鹏 郑
- 中国人民解放军海军陆战队医院关节外科(广东潮州 521000)Department of Joint Surgery, the Marine Corps Hospital of Chinese PLA, Chaozhou Guangdong, 521000, P. R. China
| | - 达生 林
- 中国人民解放军海军陆战队医院关节外科(广东潮州 521000)Department of Joint Surgery, the Marine Corps Hospital of Chinese PLA, Chaozhou Guangdong, 521000, P. R. China
| | - 逸波 谢
- 中国人民解放军海军陆战队医院关节外科(广东潮州 521000)Department of Joint Surgery, the Marine Corps Hospital of Chinese PLA, Chaozhou Guangdong, 521000, P. R. China
| | - 慰凯 徐
- 中国人民解放军海军陆战队医院关节外科(广东潮州 521000)Department of Joint Surgery, the Marine Corps Hospital of Chinese PLA, Chaozhou Guangdong, 521000, P. R. China
| | - 清泉 吴
- 中国人民解放军海军陆战队医院关节外科(广东潮州 521000)Department of Joint Surgery, the Marine Corps Hospital of Chinese PLA, Chaozhou Guangdong, 521000, P. R. China
| | - 棋 肖
- 中国人民解放军海军陆战队医院关节外科(广东潮州 521000)Department of Joint Surgery, the Marine Corps Hospital of Chinese PLA, Chaozhou Guangdong, 521000, P. R. China
| | - 辉云 邓
- 中国人民解放军海军陆战队医院关节外科(广东潮州 521000)Department of Joint Surgery, the Marine Corps Hospital of Chinese PLA, Chaozhou Guangdong, 521000, P. R. China
| | - 惠祥 江
- 中国人民解放军海军陆战队医院关节外科(广东潮州 521000)Department of Joint Surgery, the Marine Corps Hospital of Chinese PLA, Chaozhou Guangdong, 521000, P. R. China
| | - 国栋 冯
- 中国人民解放军海军陆战队医院关节外科(广东潮州 521000)Department of Joint Surgery, the Marine Corps Hospital of Chinese PLA, Chaozhou Guangdong, 521000, P. R. China
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Alfaraidy M, Alraiyes T, Moatshe G, Litchfield R, LeBel ME. Low rates of serious complications after open Latarjet procedure at short-term follow-up. J Shoulder Elbow Surg 2023; 32:41-49. [PMID: 35872172 DOI: 10.1016/j.jse.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/27/2022] [Accepted: 06/05/2022] [Indexed: 02/01/2023]
Abstract
PURPOSE To report on intraoperative and short-term postoperative adverse events after open Latarjet procedure in patients with recurrent anterior shoulder instability. These complications were classified into different grades of severity based on the treatment required and the learning curve of the procedure. METHODS Ninety-six patients (102 shoulders) underwent open Latarjet procedure for recurrent post-traumatic anterior glenohumeral instability between 2012 and 2020. The minimum duration of patients' follow-up was 6 months. Adverse events were classified into 3 classes based on the severity and subsequent treatment. The complications in the first 50% of all cases were compared with the latter 50% to evaluate the role of learning curve on the complication rates. RESULTS The mean follow-up was 7.2 ± 2.8 months. The patients' mean age was 26.7 ± 8.9 years and consisted of 83 (86.4%) male and 13 (13.6%) female patients. The total adverse events rate was 18.6%. Adverse events requiring no additional treatment (class 1) occurred in 6 cases (5.8%) including fibrous union (3.9%) and asymptomatic resorption of the graft (1.9%). Adverse events requiring additional or extended nonoperative management (class 2) occurred in 8 cases (7.8%), including coracoid fracture (2.9%), musculocutaneous nerve palsy (1.9%), axillary nerve palsy (0.9%), suprascapular nerve palsy (0.9%), and stiffness (0.9%). All the nerve palsies recovered without long-term sequelae. Adverse events requiring secondary operative procedures (class 3) occurred in 5 cases (4.9%), including symptomatic hardware (1.9%), medial healing of the graft (0.9%), screw loosening (0.9%), and deep infection (0.9%). The rate of adverse events in revision cases was higher than primary cases in 11.7% and 6.8%, respectively (P = .119). The complication rate was significantly higher in the first half of the surgeons' practice (14.7%) than in the second half (3.9%) (P ≤ .05). CONCLUSIONS The overall complication rate reported in this open Latarjet series is 18.6%; however, the rate of class 3 adverse events that required additional surgery or long-term medical treatment was only 4.9%. Revision cases had a higher rate of complications than primary cases, and the learning curve has had a significant impact on the rate of adverse events.
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Affiliation(s)
- Moaad Alfaraidy
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada; Medical Cities, General Directorate of Medical Services, Ministry of Interior, Riyadh, Saudi Arabia
| | - Thamer Alraiyes
- Roth
- McFarlane Hand and Upper Limb Centre, Western University, London, ON, Canada; Department of Orthopaedics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Gilbert Moatshe
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada; OSTRC, Norwegian School of Sports Sciences, Oslo, Norway; Orthopaedic Division, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Robert Litchfield
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada
| | - Marie-Eve LeBel
- Roth
- McFarlane Hand and Upper Limb Centre, Western University, London, ON, Canada.
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10
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Ohin CA, Guarrella V, Perfetti C, Larghi MM, Messina C, Sconfienza LM, Taverna E. CT-scan Evaluation of Osteointegration and Osteolysis in Different Graft Types and Surgical Techniques for the Treatment of Shoulder Instability. THE ARCHIVES OF BONE AND JOINT SURGERY 2023; 11:117-123. [PMID: 37168828 PMCID: PMC10165674 DOI: 10.22038/abjs.2022.62012.3040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 08/26/2022] [Indexed: 05/13/2023]
Abstract
Background Bone graft is often needed in treating anterior shoulder instability in glenoid bone loss and graft integration is crucial in achieving good results. This study aimed to evaluate bone graft remodeling in different techniques for shoulder anterior-inferior instability. Methods Graft osteointegration and osteolysis were retrospectively evaluated with CT-scan imaging performed 6 to 12 months after surgery to compare the outcome of three procedures: Latarjet, bone block with allograft, and bone block with xenograft. Screw fixation and double endobuttons fixation were also compared. Results CT scans of 130 patients were analyzed. Of these, 30 (23%) were performed after the bone block procedure with xenograft and endobuttons fixation, 55 (42%) after the bone block procedure with allograft and endobuttons fixation, 13 (10%) Latarjet with screw fixation and 32 (25%) Latarjet with endobuttons fixation. The prevalence of osteolysis was significantly inferior (P<.01) in the bone block procedure compared to the Latarjet procedure (11.7 % vs. 28.8 %). Bone integration was higher in bone block procedures (90.5%) than in Latarjet (84.4%), but the difference was not statistically significant. Among the Latarjet procedures, endobuttons fixation resulted in a higher integration rate (87.5% vs. 73.6%) and lower osteolysis rate than screw fixation (24.6% vs. 38.5%), despite these differences did not reach a statistical significance. Among the bone block procedures, using a xenograft resulted in a lower osteolysis rate (6.7%) than an allograft (14.5%), but the result was not statistically significant. Conclusion This study shows a significantly lower rate of graft osteolysis after bone block procedures compared to Latarjet procedure between 6 and 12 months postoperatively. Moreover, our findings suggest good results in osteolysis and graft integration with xenograft compared to allograft and double endobuttons fixation compared to screw fixation, despite these differences being not-significant. Further studies on this topic are needed to confirm our results at a longer follow-up and thoroughly investigate the clinical relevance of these findings.
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Affiliation(s)
- Caterina Albizzini Ohin
- Department of Shoulder Surgery, IRCCS Ospedale Galeazzi Sant Ambrogio, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Vincenzo Guarrella
- Department of Shoulder Surgery, IRCCS Ospedale Galeazzi Sant Ambrogio, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Carlo Perfetti
- Department of Shoulder Surgery, IRCCS Ospedale Galeazzi Sant Ambrogio, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Marco Mattia Larghi
- School of Medicine and Residency Program in Orthopaedics, Università degli studi di Milano Via Festa del Perdono 7, 20122 Milano, Italy
| | - Carmelo Messina
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Ospedale Galeazzi Sant Ambrogio, Via Cristina Belgioioso 173, 20157 Milan, Italy
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Ospedale Galeazzi Sant Ambrogio, Via Cristina Belgioioso 173, 20157 Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy
| | - Ettore Taverna
- Department of Shoulder Surgery, IRCCS Ospedale Galeazzi Sant Ambrogio, Via Cristina Belgioioso 173, 20157 Milan, Italy
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11
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Alkaduhimi H, Willigenburg NW, Wessel RN, Wolterbeek N, Veen EJD, Koorevaar RCT, Willems WJ, Nelissen EM, Sonneveld H, Flikweert PE, Pasma JH, Visser CPJ, Meier ME, van den Borne MPJ, Dijkstra AJ, Kraal T, van Noort A, Alta TDW, Gałek-Aldridge MS, Floor S, van den Bekerom MPJ, Eygendaal D. Ninety-day complication rate based on 532 Latarjet procedures in Dutch hospitals with different operation volumes. J Shoulder Elbow Surg 2022; 32:1207-1213. [PMID: 36586507 DOI: 10.1016/j.jse.2022.11.015] [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: 08/17/2022] [Revised: 10/31/2022] [Accepted: 11/13/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND In this study, we aimed to provide insight into the 90-day complication rates following the Latarjet procedure. Data from 2015 were collected from multiple hospitals in the Netherlands, with different volumes of Latarjet procedures. Our second aim was to examine which patient and surgical factors were associated with complications. METHODS We conducted a retrospective chart review of 13 hospitals between 2015 and 2022. Data regarding complications within 90 days of Latarjet procedures were extracted. The effect of sex, age, body mass index (BMI), smoking, previous shoulder operations, fixation material, hospital volume, screw size, and operation time on the complication rate was assessed by multivariable logistic regression analysis. RESULTS Of the 532 included patients, 58 (10.9%) had complications. The most common complications were material failure (n = 19, 3.6%) and nerve injury (n = 13, 2.4%). The risk of complications was lower for male patients than for female patients (odds ratio, 0.40; 95% confidence interval, 0.21-0.77; P = .006). Age, BMI, smoking, previous shoulder operations, type of fixation material, hospital volume, screw size, and operation time were not associated with complications. CONCLUSION The 90-day complication rate after the Latarjet procedure was 10.9% and was higher in female patients than in male patients. Age, BMI, smoking, previous shoulder operations, type of fixation material, hospital volume, screw size, and operation time did not affect complication rates. We advise setting up a national registry to prevent under-reporting of complications.
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Affiliation(s)
| | | | - Ronald N Wessel
- Department of Orthopedic Surgery, St Antonius Ziekenhuis, Utrecht, The Netherlands
| | - Nienke Wolterbeek
- Department of Orthopedic Surgery, St Antonius Ziekenhuis, Utrecht, The Netherlands
| | - Egbert J D Veen
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rinco C T Koorevaar
- Department of Orthopaedic Surgery, Deventer Hospital, Deventer, The Netherlands
| | - W Jaap Willems
- Department of Orthopaedic Surgery, DC Clinics, Amsterdam, The Netherlands
| | - Eelco M Nelissen
- Department Orthopaedic Surgery, Spijkenisse Medical Center, Spijkenisse, The Netherlands
| | - Heleen Sonneveld
- Department of Orthopaedic Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - Petra E Flikweert
- Department of Orthopaedic Surgery, HagaZiekenhuis, The Hague, The Netherlands
| | - Jantsje H Pasma
- Department of Orthopaedic Surgery, HagaZiekenhuis, The Hague, The Netherlands
| | - Cornelis P J Visser
- Department of Orthopaedic Surgery, Alrijne Hospital, Leiden, The Netherlands
| | - Maartje E Meier
- Department of Orthopaedic Surgery, Alrijne Hospital, Leiden, The Netherlands
| | | | - Arien J Dijkstra
- Department of Orthopaedic Surgery, Flevoziekenhuis, Almere, The Netherlands
| | - Tim Kraal
- Department of Orthopaedic Surgery, Flevoziekenhuis, Almere, The Netherlands
| | - Arthur van Noort
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands; Erasmus MC, University Medical Center Rotterdam, Department of Orthopaedics and Sports Medicine, the Netherlands
| | - Tjarco D W Alta
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | | | - Sebastiaan Floor
- Department of Orthopaedic Surgery, Central Military Hospital, Utrecht, The Netherlands
| | - Michel P J van den Bekerom
- Shoulder and Elbow Unit, Joint Research, OLVG, Amsterdam, The Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Denise Eygendaal
- Erasmus MC, University Medical Center Rotterdam, Department of Orthopaedics and Sports Medicine, the Netherlands
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12
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Maiotti M, De Vita A, De Benedetto M, Cerciello S, Massoni C, Di Giunta A, Raffelini F, Lo Cascio R, Pirani P, Castricini R. Clinical outcomes and recurrence rate of 4 procedures for recurrent anterior shoulder instability: ASA, remplissage, open, and arthroscopic Latarjet: a multicenter study. J Shoulder Elbow Surg 2022; 32:931-938. [PMID: 36470517 DOI: 10.1016/j.jse.2022.10.030] [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: 06/21/2022] [Revised: 10/16/2022] [Accepted: 10/20/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of the present study was to compare the clinical outcomes of 4 surgical techniques in patients with recurrent anterior shoulder dislocation, glenoid bone loss (GBL) <15% and Instability Severity Index (ISI) score >3. METHODS A retrospective multicenter study was conducted on 226 patients who underwent 1 of 4 different techniques (Bankart plus arthroscopic subscapularis augmentation (ASA), Bankart plus remplissage, Latarjet, Arthro-Latarjet). The inclusion criteria were: recurrent dislocation, GBL <15%, and ISI score >3. The exclusion criteria were: GBL >15%, voluntary instability, multidirectional instability, preexisting osteoarthritis, throwing athletes' first dislocation, and ISI score<3. Follow-up ranged from 24 months to 6 years. Hyperlaxity was clinically evaluated according to Neer and Coudane-Walch tests. Clinical outcomes were assessed using the Rowe score and the Western Ontario Shoulder Instability Index (WOSI) for each technique. Before surgery, all patients underwent magnetic resonance imaging and computed tomography scanning. The Pico area method was used to assess the percentage of GBL. The operations were performed by 10 experienced surgeons; the functional outcomes were evaluated by 2 independent observers. RESULTS A total of 226 patients who met the inclusion criteria were included in the present series. A total of 89.2% of patients in the ASA group reported an excellent Rowe score at the final follow-up, and their scores on the WOSI scale, improved from 838 to 235 points. A total of 79.9% of patients in remplissage (R) group reported an excellent Rowe score at the final follow-up, and their scores on the WOSI scale improved from 1146 to 465 points. A total of 98.5% of patients in the Latarjet (L) group reported an excellent Rowe score at the final follow-up, and their scores on the WOSI scale improved from 1456 to 319 points. A total of 81.6% of patients in the Arthro-Latarjet (AL) group reported an excellent Rowe score at the final follow-up, and their scores on the WOSI scale improved from 1250 to 221 points. The recurrence rates were as follows: ASA group (7%), remplissage group (6.1%), L group (1.5%), Arthro-Latarjet group (0%). Patients in the open L group had 15.5% (10/66) more complications. CONCLUSION The use of ASA and remplissage to augment the Bankart repair have been demonstrated to be effective for restoring joint stability, yielding good clinical outcomes similar to the L procedure in patients affected by recurrent anterior dislocation with GBL <15% and an ISI score score >3. Soft tissues augmentations of the Bankart repair have been demonstrated to be effective for addressing anterior soft tissue deficiency dysfunction and critical Hill-Sachs lesions.
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Affiliation(s)
- Marco Maiotti
- Villa Stuart Hospital, Rome, Italy; Mediterranea Hospital, Naples, Italy.
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13
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Navigation-Guided Trans-glenoid Flexible Fixation Technique for Arthroscopic Autologous Iliac Crest Grafting Treatment of Recurrent Shoulder Dislocation. Arthrosc Tech 2022; 11:e2003-e2011. [PMID: 36457404 PMCID: PMC9705807 DOI: 10.1016/j.eats.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/28/2022] [Indexed: 11/07/2022] Open
Abstract
Recurrent anterior shoulder dislocations accompanied by severe glenoid bone defects are typically treated with arthroscopy. Until now, autologous iliac grafting has been reported with excellent results, and different techniques of bone fixation have been introduced by numerous scholars. In this article, we introduce a specially designed guide that can achieve accurate positioning of the bone graft and a nonrigid graft fixation technique with a single EndoButton (Smith & Nephew). Using this technique, we greatly simplify the arthroscopic procedure and avoid the use of screws.
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14
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Bodine M, Bishai SK, Ball GR, King CN, Wait L, Brannan GD. Arthroscopic Latarjet Procedure Does Not Lead to Loss of Clinically Significant External Rotation at 0° and 90° of Shoulder Abduction. JSES Int 2022; 6:1023-1028. [PMID: 36353414 PMCID: PMC9637787 DOI: 10.1016/j.jseint.2022.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Several reports have shown that shoulder stabilizing procedures lead to postoperative external rotation (ER) deficits. However, no study on arthroscopic Latarjet procedures has investigated the effect on ER when the arm is abducted at 0° (ER0) and 90° (ER90). This study examined the relationship between the arthroscopic Latarjet procedure and the subsequent effect on ER0 and ER90. Methods Patients who underwent an arthroscopic Latarjet procedure from December 2015 to April 2021 were retrospectively evaluated. Preoperative ER0 and ER90 values were obtained from the contralateral shoulder. ER0 and ER90 values from the operative side were collected at both 3 and 6 months postoperatively. A repeated measures ANOVA was performed to assess the mean preoperative and postoperative values. Results Forty-six patients met the inclusion criteria. Mean ER0 for the 3- and 6-month time frames measured 44.2° and 54.6°, respectively. Mean ER90 for the 3- and 6-month time frames measured 78.4° and 90.4°, respectively. Comparison to the contralateral arm at the 3-month follow-up period showed a deficit of 14.9° (P = .0001) and 17.2° (P = .0001) for ER0 and ER90, respectively. At the 6-month follow-up period, patients demonstrated an average decline in ER0 and ER90 of 4.57° (P = .063) and 5.11° (P = .008), respectively. Conclusion A nominal deficit in ER occurred for both ER0 and ER90 status post arthroscopic Latarjet procedure. Despite loss of ER90 at 6 months achieving statistical significance, the clinical impact is arguably inconsequential. Such limited loss of ER provides more information regarding bony procedures being a more definitive treatment for glenohumeral instability and the ability to restore native motion.
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Affiliation(s)
| | - Shariff K. Bishai
- Corresponding author: Shariff K. Bishai, DO, 24715 Little Mack Avenue Suite 100, Saint Clair Shores, MI 48080, USA.
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15
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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 (B Aires) 2022; 58:medicina58081008. [PMID: 36013475 PMCID: PMC9412539 DOI: 10.3390/medicina58081008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
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
- Correspondence:
| | - 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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16
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Kim M, Haratian A, Fathi A, Kim DR, Patel N, Bolia IK, Hasan LK, Petrigliano FA, Weber AE. Can We Identify Why Athletes Fail to Return to Sports After Arthroscopic Bankart Repair: A Systematic Review and Meta-analysis. Am J Sports Med 2022:3635465221089980. [PMID: 35658631 DOI: 10.1177/03635465221089980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND No previous systematic reviews have reported on athletes who fail to return to sports after arthroscopic Bankart repair. PURPOSE To review the literature on athletes who fail to return to sports after arthroscopic Bankart repair to determine the rate of athletes who did not return to sports and to identify the specific reasons for failure to return to sports by nonreturning athletes. STUDY DESIGN Systematic review and meta-analysis. METHODS A meta-analysis was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Three electronic databases (PubMed, Scopus, Web of Science) were queried for articles meeting the inclusion criteria. Studies were considered eligible only if reporting the rate of failure for return to sports and providing the specific reasons why athletes were unable to return to sports. All records were screened by title, abstract, and full text by 2 authors independently, with any discrepancies resolved by a third senior author. For articles selected for inclusion, data were collected on the number of athletes, average age, average follow-up time, type of sport played, rate of failure to return to sports, and specific reasons for failure to return. A random-effects model was used to conduct the meta-analysis. RESULTS Seventeen studies were selected for inclusion reporting on a total of 813 athletes. The calculated weighted rate of failure to return to sports after arthroscopic Bankart repair was 15.6% (95% CI, 10.9%-21.1%). A significantly higher proportion of athletes cited shoulder-dependent versus shoulder-independent reasons for failure to return to sports (81.7% vs 18.3%; P < .0001). The most cited reasons for failure to return included recurrent or persistent instability (33.3%), fear of reinjury (17.7%), apprehension (9.9%), changes in priorities or personal interest (8.5%), lack of time (7.1%), and discomfort or pain with sports (6.4%). CONCLUSION Our study estimated the rate of failure to return to sports after arthroscopic Bankart repair to be 15.6%, with most athletes citing shoulder-related reasons as the primary factor precluding return. Identifying the potential reasons preventing successful return to sports can guide surgeons in counseling athletes regarding postoperative expectations and addressing hesitations for returning to sports.
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Affiliation(s)
- Michael Kim
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Aryan Haratian
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Amir Fathi
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Daniel R Kim
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Nilay Patel
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Laith K Hasan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
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17
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Hickey IPM, Davey MS, Hurley ET, Gaafar M, Delaney RA, Mullett H. Return to play following open Bankart repair in collision athletes aged 18 years or less. J Shoulder Elbow Surg 2022; 31:S8-S12. [PMID: 34906680 DOI: 10.1016/j.jse.2021.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/07/2021] [Accepted: 11/07/2021] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The purpose of this study was to evaluate clinical outcomes, return to play (RTP), and recurrence rates in patients aged 18 years or less who underwent open Bankart repair (OBR) for anterior shoulder instability. METHODS A retrospective review of collision athletes under 18 years old who underwent OBR by 2 surgeons between the years 2010 and 2019 was carried out. An OBR using a subscapularis split was performed in all patients. Recurrent instability, rate of RTP, and time to RTP were recorded. The Shoulder Instability Return to Sport after Injury score, Subjective Shoulder Value score, and visual analog scale scores were also evaluated. RESULTS The study included 34 male collision athletes with a mean age of 16.5 ± 1.3 years (range, 15-18 years). The mean follow-up for patients was 49.5 ± 30.7 months. A total of 30 patients (88.2%) returned to full sport at a mean time of 5.8 ± 2.2 months, with 27 (90%) managing to return at their preinjury level of participation. The mean Subjective Shoulder Value score for patients at the final follow-up was 86.8 ± 17.5, the mean Shoulder Instability Return to Sport after Injury score was 86.3 ± 22.6, and the mean visual analog scale score was 1.6 ± 1.8. Eight patients (23.5%) re-dislocated their shoulder, with 4 of them requiring a further surgery. Two patients (5.8%) reported having incidents of subluxation that did not require reduction. CONCLUSION This study found high rates of patient-reported satisfaction, excellent functional outcomes, and high rates of RTP in the medium term among young collision athletes aged 18 years or less who underwent OBR for anterior shoulder instability. However, there were high rates of recurrence with moderate rates of revision surgical stabilization in the medium term.
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Affiliation(s)
- Ian P M Hickey
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
| | - Martin S Davey
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
| | - Eoghan T Hurley
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland.
| | - Mohamed Gaafar
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
| | - Ruth A Delaney
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
| | - Hannan Mullett
- Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland
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18
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An algorithm for successfully managing anterior shoulder instability. JAAPA 2022; 35:17-28. [DOI: 10.1097/01.jaa.0000823168.14527.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Eberlin CT, Varady NH, Kucharik MP, Naessig SA, Best MJ, Martin SD. Comparison of Perioperative Complications Following Surgical Treatment of Shoulder Instability. JSES Int 2022; 6:355-361. [PMID: 35572454 PMCID: PMC9091785 DOI: 10.1016/j.jseint.2022.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Surgical repair for shoulder instability includes arthroscopic Bankart, open Bankart, and Latarjet-Bristow. Methods This is a cohort study of patients who underwent arthroscopic Bankart, open Bankart, or Latarjet-Bristow procedures that were identified within the National Surgical Quality Improvement Program database (2007-2019). Unadjusted and adjusted analyses were performed (α = 0.05). Outcomes included 30-day adverse events, readmission, and operative time. Results This study included 10,955 patients (9128 arthroscopic Bankart, 1148 open Bankart, and 679 Latarjet-Bristow). Compared with arthroscopic Bankart, Latarjet-Bristow had longer operative times (129.96 [95% CI: 126.49-133.43] vs. 86.35 [85.51-87.19] minutes), along with a higher percentage of serious adverse events (2.5% vs. 0.4%), reoperation (1.9% vs. 0.1%), readmission (1.8% vs. 0.3%), thromboembolic complications (0.4% vs. 0.1%), and sepsis (0.4% vs. 0.0%) (P < .05 for all). Open Bankart had longer operative times (98.17 [95.52-100.82] vs. 86.35 [85.51-87.19] minutes) and a higher percentage of sepsis (0.2% vs. 0.0%) (P < .05 both). Latarjet-Bristow had increased odds of a serious adverse event (odds ratio [OR]: 7.68 [4.19-14.07]), reoperation (OR: 17.32 [7.58-39.56]), readmission (OR: 5.73 [2.84-11.54]), and deep wound complications (OR: 14.98 [3.92-57.23]) (P < .05 for all). In comparing the relative utilization of arthroscopic versus open Bankart, arthroscopic Bankart increased (83.4% to 91.2%) while open Bankart decreased (16.6% to 8.8%) from the 2011-2013 time period to 2017-2019 (Ptrend < .001). Conclusion In addition to a low complication rate, the relative utilization of arthroscopic Bankart increased compared with open Bankart over the past decade. Furthermore, Latarjet-Bristow was associated with a higher incidence of serious adverse events than arthroscopic Bankart.
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Affiliation(s)
- Christopher T. Eberlin
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
- Corresponding author: Christopher T. Eberlin, BS, Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Mass General Brigham, 175 Cambridge Street, Suite 400, Boston, MA 02114, USA.
| | - Nathan H. Varady
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Michael P. Kucharik
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
| | - Sara A. Naessig
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
| | - Matthew J. Best
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
| | - Scott D. Martin
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Mass General Brigham, Boston, MA, USA
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Rai AK, Bandebuche AR, Bansal D, Gupta D, Naidu A. Chronic Unreduced Anterior Shoulder Dislocation Managed by Latarjet Procedure: A Prospective Study. Cureus 2022; 14:e21769. [PMID: 35251839 PMCID: PMC8890609 DOI: 10.7759/cureus.21769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 11/30/2022] Open
Abstract
The shoulder joint is the most common joint to undergo dislocation, with the anterior subtype being the most common. The most accepted definition of chronic dislocation is a shoulder joint that has remained dislocated for a minimum of three weeks. Due to rare presentation, there is a lack of consensus among surgeons regarding the optimal management option of chronic shoulder dislocation. The goal of this prospective study was to assess the efficacy of open reduction with Latarjet procedure in the management of chronic unreduced shoulder dislocation. A total of seven patients were included in this study. Five patients were males and two were females. The study was conducted in a single tertiary care centre between July 2015 and May 2018. All patients were managed by open reduction with the Latarjet procedure. The capsulolabral structures were repaired in all the cases. The post-operative functional outcome was assessed by shoulder range, Rowe score, and the University of California, Los Angeles (UCLA) score at regular intervals for a period of one year. There was a significant improvement in terms of pain relief and functional status of the patients. The patients were satisfied as they could do their daily routine activities without pain at a one-year follow-up. Early post-operative rehabilitation and physiotherapy are key to improving the functional range.
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21
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Vilela JCS, Franco N, Campos G, Deligne LDM, Machado TLA. Prognostic Factors of the Latarjet Procedure. Rev Bras Ortop 2021; 57:975-983. [PMID: 36540740 PMCID: PMC9757978 DOI: 10.1055/s-0041-1736513] [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: 12/15/2020] [Accepted: 07/08/2021] [Indexed: 10/19/2022] Open
Abstract
Objective To investigate the factors that influence the functional results of patients submitted to the Latarjet procedure. Methods Evaluation of 26 patients submitted to surgical treatment following the Latarjet technique due to traumatic recurrent anterior dislocation of the glenohumeral joint, with glenoidal bone loss greater than 20% and/or off-track injury. The minimum follow-up time was of 12 months. The Visual Analogue Scale (VAS), The Western Ontario Shoulder Instability Index (WOSI), and the Subjective Shoulder Value (SSV) scales, as well as objective data from the participants, were evaluated. Results Most patients (84.62%) did not present recurrence of the dislocation, and 92.31% were satisfied. Regarding the functional analysis, the physical component score (PCS) and the mental component score (MCS) found were within the mean quality of life of the population. The physical symptoms, according to the WOSI, presented the best percentage (8.5%), while the worst result was observed regarding lifestyle (20%). On the VAS, pain was classified as moderate (3/10) by 15.38% of the patients (4/26). In relation to sports, patients who practice sports showed improvement in SSV parameters, which had an inverse relationship with the number of relapses. It was also observed that the shorter the time between the first dislocation and the surgery, the greater the patient's satisfaction. Conclusion Early indication of surgical treatment of anterior glenohumeral instability may provide better subjective functional results to the patient.
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Affiliation(s)
| | | | - Gustavo Campos
- Ortopedia e Traumatologia, Instituto de Previdência dos Servidores do Estado de Minas Gerais (Ipsemg), Belo Horizonte, MG, Brasil
| | | | - Thalles Leandro Abreu Machado
- Hospital Unimed BH, Belo Horizonte, MG, Brasil,Ortopedia e Traumatologia, Instituto de Previdência dos Servidores do Estado de Minas Gerais (Ipsemg), Belo Horizonte, MG, Brasil,Endereço para correspondência Thalles Leandro Abreu Machado, MD Rua Grão Pará, 658, 2° andar, Santa Efigênia, Belo Horizonte, MG, 30150-341Brasilwww.imotbh.com.br
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22
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Yan H, Dai L, Wang J. Modified Arthroscopic Latarjet Procedure: Button Fixation Without Splitting of the Subscapularis. Arthrosc Tech 2021; 10:e2365-e2373. [PMID: 34754746 PMCID: PMC8556670 DOI: 10.1016/j.eats.2021.07.014] [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: 04/28/2021] [Accepted: 07/02/2021] [Indexed: 02/03/2023] Open
Abstract
The Latarjet procedure is used for the treatment of anterior glenohumeral instability in the presence of bone loss. One decade after a fully arthroscopic Latarjet procedure was described, this technique has been modified to reduce the risk of complications and improve the fixation method. We aimed to simplify the components of this surgical procedure.
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Affiliation(s)
| | | | - Jianquan Wang
- Address correspondence to Jianquan Wang, M.D., Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, and Beijing Key Laboratory of Sports Injuries, Beijing, China.
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23
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Perret M, Warby S, Brais G, Hinse S, Hoy S, Hoy G. Return to Professional Australian Rules Football After Surgery for Traumatic Anterior Shoulder Instability. Am J Sports Med 2021; 49:3066-3075. [PMID: 34398642 DOI: 10.1177/03635465211029022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The treatment of traumatic anterior shoulder instability in professional Australian Football League (AFL) players is challenging, with an emphasis on early return to play and avoidance of instability recurrence. PURPOSE To investigate return-to-sport (RTS) outcomes and complications after 2 different procedures for traumatic anterior shoulder instability in professional AFL players. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We retrospectively reviewed our surgical database for professional AFL players who underwent capsulolabral stabilization or open Latarjet procedure by a single surgeon between 2006 and 2017. Outcomes included RTS, on-field performance, and complications. Between-group analyses for RTS and complications were estimated using Kaplan-Meier survival analyses. Within-group analyses for on-field performance data were performed using paired t tests with significance set at .05. RESULTS A total of 58 capsulolabral stabilization procedures in 54 players and 32 Latarjet procedures in 29 players were included in the analysis; 93.1% of capsulolabral patients and 96.9% of Latarjet patients returned to professional AFL. The median RTS time was 6.8 months for the capsulolabral group and 7.3 months for the Latarjet group. There was no significant difference in RTS rates between the 2 groups (P = .270). Of those undergoing surgery early in the season, 75% of the capsulolabral and 71% of Latarjet group were able to RTS within the same season, at a mean time of 16.9 weeks and 18.8 weeks, respectively. There was a significant difference in instability recurrence, with 19% for the capsulolabral group and no recurrence in the Latarjet group (P = .017). There was no significant reduction in player on-field performance in either group (P < .05). CONCLUSION In this study, the median RTS in AFL players was approximately 7 months after capsulolabral and Latarjet surgery with no compromise to on-field performance. Instability-related complications occurred only in the capsulolabral group, and the incidence increased with time.
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Affiliation(s)
- Michael Perret
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.,Perth Shoulder Clinic, Bethesda Hospital, Orthopaedic Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Sarah Warby
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.,Melbourne Shoulder Group, Prahran, Victoria, Australia.,Department of Rehabilitation, Nutrition and Sport, La Trobe University, Victoria, Australia
| | - Godefroy Brais
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
| | | | - Sophie Hoy
- Royal Children's Hospital, Parkville, Victoria, Australia
| | - Gregory Hoy
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.,Melbourne Shoulder Group, Prahran, Victoria, Australia.,Department of Surgery, Monash University, Victoria, Australia
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24
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Miettinen SSA, Kiljunen T, Joukainen A. Anterior glenohumeral instability treated with arthroscopic Bankart operation - a retrospective 5-year follow-up study. Orthop Traumatol Surg Res 2021; 107:102943. [PMID: 33895383 DOI: 10.1016/j.otsr.2021.102943] [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: 08/03/2020] [Revised: 12/31/2020] [Accepted: 01/06/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND This retrospective study investigated 5-year results of primary arthroscopic operation for anterior glenohumeral instability (AI) with special interest in patients aged<25 years and gender. HYPOTHESIS Recurrence of AI is higher in male patients aged<25 years than older patients or females. PATIENTS AND METHODS Primary arthroscopic Bankart repair was performed between January 2009 and December 2015 on 156 shoulders [154 patients, 104/156 (67%) males]. The mean follow-up was 5.6 (SD 2.1, range 0.4-8.9) years. Outcome measures, including re-dislocation, fear of dislocation, Western Ontario instability index, Subjective shoulder value and pain Numerical rating scale scores, the number of revision surgeries and satisfaction with the result of surgical treatment, were assessed for 130 shoulders [82/130 (63%) males]. AI recurrence was defined as a dislocation or a fear of such. RESULTS The Kaplan-Meier analysis estimates for the cumulative survival of stable shoulders were 28% at 8.8 years for patients aged<25 years (SE 0.4, CI 95% 5.5-7.2) and 53% at 8.9 years for patients aged ≥25 years (SE 0.2, CI 95% 7.2-8.0; p=0.005). The Kaplan-Meier estimates for the cumulative survival of stable shoulders were 50% at 8.9 years for males (SE 0.3, CI 95% 6.8-7.8) and 37% at 8.6 years for females (SE 0.3, CI 95% 6.5-7.7; p=0.8). Mean time to revision was 2.4 (SD 1.7, range 0.4-5.3) years. DISCUSSION Recurrence of AI was higher in the patients aged<25 years (p=0.005), but gender was not a risk factor. Re-operation rate due to recurrent AI was 10% in this 5-year follow-up. LEVEL OF EVIDENCE III; case-control study.
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Affiliation(s)
- Simo S A Miettinen
- Department of orthopedics, traumatology and hand surgery, Kuopio University Hospital, P.O. box 1777, 70211 Kuopio, Finland; Faculty of health sciences, University of Eastern Finland, Yliopistonranta 1, 70210 Kuopio, Finland.
| | - Tatu Kiljunen
- Department of orthopedics, traumatology and hand surgery, Kuopio University Hospital, P.O. box 1777, 70211 Kuopio, Finland
| | - Antti Joukainen
- Department of orthopedics, traumatology and hand surgery, Kuopio University Hospital, P.O. box 1777, 70211 Kuopio, Finland
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25
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Davey MS, Hurley ET, O'Doherty R, Stafford P, Delahunt E, Gaafar M, Pauzenberger L, Mullett H. Open Latarjet Procedure in Athletes Following Failed Prior Instability Surgery Results in Lower Rates of Return to Play. Arthroscopy 2021; 37:2412-2417. [PMID: 33872743 DOI: 10.1016/j.arthro.2021.03.062] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/04/2020] [Accepted: 03/22/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare the outcomes of open Latarjet (OL) in competitive athletes with primary shoulder instability versus those with recurrent instability versus those undergoing OL for failed prior instability surgery. METHODS A retrospective review of patients who underwent OL with a minimum of 24-month follow-up was performed. Additionally, these were pair-matched in a 1:2:1 ratio for age, gender, sport, level of preoperative play, and follow-up length for primary instability, recurrent instability and failed prior instability surgery. Return to sport, the level of return and the timing of return were assessed. Additionally, recurrence, Visual Analogue Scale for pain (VAS), Subjective Shoulder Value (SSV), Rowe score, Shoulder Instability-Return to Sport after Injury (SIRSI) score, satisfaction, and whether they would undergo the same surgery again were compared. RESULTS After pair-matching, a total of 200 patients were included, with a mean age of 22.7 years and a mean follow-up of 38.8 months. Overall, there was no significant difference in any of the clinical outcome scores (VAS, Rowe, SIRSI, SSV) used for the 3 groups (P > 0.05 for all). However, there was a significantly lower rate of return to play for those undergoing OL because of failed prior instability surgery (88% vs 91% vs 64%, P < 0.0001) and for return at the same or a higher level (66% vs 78% vs 56%, P = 0.02). There was no significant difference in the rate of recurrent instability among the 3 groups (6% vs 5% vs 6%, P = 0.95). CONCLUSION OL results in excellent clinical outcomes and low recurrence rates for those with primary shoulder instability, those with recurrent instability and those undergoing OL for failed prior instability surgery. However, in those undergoing OL for failed prior stabilization surgery, there was a lower rate of return to play. LEVEL OF EVIDENCE Level III: Retrospective Comparative Study.
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Affiliation(s)
- Martin S Davey
- Sports Surgery Clinic, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan T Hurley
- Sports Surgery Clinic, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland; National University of Ireland Galway, Galway, Ireland.
| | - Ross O'Doherty
- Sports Surgery Clinic, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Padraic Stafford
- Sports Surgery Clinic, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ethan Delahunt
- Sports Surgery Clinic, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
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26
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Mu Z, Hua H, Dong X. Comparison of efficacy between montgomery and Jobe technique and arthroscopic bankart repair in treating traumatic recurrent anterior shoulder dislocation. Am J Transl Res 2021; 13:8505-8513. [PMID: 34377348 PMCID: PMC8340174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To compare the clinical efficacy of Montgomery and Jobe technique versus arthroscopic Bankart repair in treating traumatic recurrent anterior shoulder dislocation (ASD). METHODS A total of 113 patients with traumatic recurrent ASD admitted to our hospital from June 2016 to January 2019 were selected as study subjects, and were divided into Group A and B in accordance with surgical options. The clinical data of the subjects were collected retrospectively. Group A was treated by the Montgomery and Jobe technique, while Group B was treated with arthroscopic Bankart repair. The arthroscopic manifestations were analyzed before and after arthroscopic Bankart repair. Scores of visual analogue scale (VAS) for shoulder joint and American Shoulder and Elbow Surgeons (ASES), Constant-Murley Score (CMS), Rowe Score, and complications were compared between the two groups before and after surgery. RESULTS Compared with Group A, Group B had a lower score of VAS for the shoulder joint, and higher scores of the range of motion (ROM), functional activities, myodynamia, pain, CMS, vital functions, ASES, and shoulder joint function, and a higher Rowe score after surgery (P < 0.05). The incidence rate (1.75%) of complications in Group B was lower than that (14.29%) in Group A (P < 0.05). CONCLUSION Arthroscopic Bankart repair is superior to the Montgomery and Jobe technique in treating traumatic recurrent ASD. Arthroscopic Bankart repair, exhibiting a high safety profile, is conducive to improving shoulder joint function and pain.
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Affiliation(s)
- Zhongjie Mu
- Department of Orthopaedic Surgery, Fuyang Orthopaedics and Traumatology Affiliated Hospital of Zhejiang Chinese Medical University Hangzhou 311400, Zhejiang, China
| | - Hui Hua
- Department of Orthopaedic Surgery, Fuyang Orthopaedics and Traumatology Affiliated Hospital of Zhejiang Chinese Medical University Hangzhou 311400, Zhejiang, China
| | - Xinhua Dong
- Department of Orthopaedic Surgery, Fuyang Orthopaedics and Traumatology Affiliated Hospital of Zhejiang Chinese Medical University Hangzhou 311400, Zhejiang, China
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27
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García-Vega M, De La Cuadra-Virgil P, Jiménez-Cristobal J, Occhi-Gómez B, Boserman-Pérez-de Villaamil M. Arthroscopic bankart repair for the management of anterior shoulder instability: Mid- and long-term results. ACTA ACUST UNITED AC 2021. [PMID: 34112445 DOI: 10.1016/j.recote.2021.04.005] [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: 10/21/2022]
Abstract
INTRODUCTION Arthroscopic stabilisation is a well-recognised surgical technique with a variable rate of failure reported between 0-35%. The aim of this study was to evaluate the outcome of this technique and our second aim was to identify risk factors that could be associated to recurrence rate. MATERIAL AND METHODS 41 patients that underwent arthroscopic shoulder stabilisation for glenohumeral instability between 2001-2015 were included. Different items such as epidemiologic, recurrence, age at first dislocation, preoperative sport practice, and number of fixation devices used were collected. The results were evaluated using functional scales (WOSI, Rowe y Walch-Duplay) and radiological study was assessed using the Samilson-Prieto score. Data from the medical history were recognised in order to assess possible risk factors. RESULTS The overall redislocation rate was 9.4%. The average follow-up was 83 months. The 54.3% of the patients achieved excellent/good results in the functional assessment scales. The range of motion was complete in 90% of the cases. On the radiographs, only 4.88% of the patients present advanced osteoarthritis. It was not possible to identify risk factors related to a worse outcome after surgery. CONCLUSION The arthroscopic Bankart repair with suture anchors is considered the gold standard for treatment of anterior glenohumeral instability. The long-term follow-up shows a favourable outcome, with a redislocation rate of 9% and low complication rate.
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Affiliation(s)
- M García-Vega
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | | | | | - B Occhi-Gómez
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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28
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Vascellari A, Ramponi C, Venturin D, Ben G, Coletti N. The Relationship between Kinesiophobia and Return to Sport after Shoulder Surgery for Recurrent Anterior Instability. JOINTS 2021; 7:148-154. [PMID: 34235378 PMCID: PMC8253619 DOI: 10.1055/s-0041-1730975] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 04/18/2021] [Indexed: 11/22/2022]
Abstract
Purpose
To evaluate the relationship between kinesiophobia and patient's return to sport after shoulder stabilization surgery. The hypothesis was that kinesiophobia represents an independent factor correlated to the difference between preinjury and postoperative level of sport.
Methods
This study retrospectively evaluated 66 patients (mean age: 35.5, standard deviation [SD] = 9.9 years) and at a mean follow-up of 61.1 (SD = 37.5) months after arthroscopic Bankart's repair or open Bristow–Latarjet procedure. Kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK); return to the preinjury sport was assessed by the difference between baseline and postoperative degree of shoulder involvement in sport (D-DOSIS) scale. The Western Ontario Shoulder Instability index (WOSI) was used to evaluate participants' perceptions of shoulder function.
Results
TSK showed correlation with D-DOSIS (
ρ
= 0.505,
p <
0.001) and the WOSI score (
ρ
= 0.589,
p
< 0.001). There was significant difference in TSK and WOSI scores between participants who had and had not returned to their previous level of sport participation (
p
= 0.006, and 0.0001, respectively).
Conclusion
This study demonstrated that kinesiophobia is correlated to the return to sport after shoulder stabilization surgery.
Level of Evidence
Level IV, retrospective case series.
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Affiliation(s)
- Alberto Vascellari
- Kinè Physiotherapic and Orthopedic Center, San Vendemiano, Treviso, Italy
| | - Carlo Ramponi
- Kinè Physiotherapic and Orthopedic Center, San Vendemiano, Treviso, Italy
| | - Davide Venturin
- Kinè Physiotherapic and Orthopedic Center, San Vendemiano, Treviso, Italy
| | - Giulia Ben
- High Altitude Pediatric Asthma Center, Misurina Pio XII Institute, Belluno, Italy
| | - Nicolò Coletti
- Department of Orthopaedic and Traumatology, Oderzo Hospital, Oderzo, Treviso, Italy
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29
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Laboute E, Hoffmann R, Bealu A, Ucay O, Verhaeghe E. Recurrence and return to sport after surgery for shoulder instability: arthroscopic Bankart versus Latarjet procedure. JSES Int 2021; 5:609-615. [PMID: 34223404 PMCID: PMC8245985 DOI: 10.1016/j.jseint.2021.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Surgeons differ in their preferences concerning the best surgical technique for treating shoulder instability in sportspeople. The purpose was to evaluate the risk of recurrence and the likelihood of return to sport for the 2 principal shoulder stabilization techniques used to treat shoulder instability in sportspeople. Methods We screened sportspeople who had undergone shoulder stabilization for inclusion in this cohort study. For eligibility, patients had to have undergone surgery by one of the 2 techniques: Latarjet or arthroscopic Bankart between 2005 and 2011, and aged from 18 to 35 years. We excluded acromioclavicular dislocation, tendinous lesion, global or posterior instability, bone fracture or severe glenoid bone loss, neurological lesion, other surgical technique, and orthopedic treatment. Patients were contacted by telephone between 2009 and 2012 and asked to participate in follow-up after surgery. The primary endpoint was recurrence, evaluated by determining frequency and time to recurrence (or censoring) with Cox models. The secondary endpoint was the return to sport (training and competition). Results Follow-up telephone interviews were conducted with 120 sportspeople (response rate of 61.5%), one of whom was excluded due to the occurrence of a new contralateral dislocation before returning to sport after surgery (Latarjet n = 80, Bankart n = 39). The risk of recurrence was significantly higher (P < .001) for Bankart (n = 7, 17.9%) than for Latarjet (n = 2, 2.5%) interventions. Being under the age of 20 years was a significant risk factor for recurrence (P = .007). Return to sport was significantly more frequent among sportspeople undergoing Latarjet procedures, for both training (P = .031) and competition (P = .038), and was also significantly more rapid for training (P = .034) with a mean time to return to training of 5.1 months for Latarjet procedures, versus 6.4 months for Bankart procedures. Conclusion The Latarjet surgical technique results in fewer recurrences than the Bankart technique, with a higher rate of return to sport (training, competition) and a faster return to training for sportspeople practicing potentially risky sports in competition. Age was also identified as an additional risk factor for recurrence. It is important to take these factors into account when considering the indications for surgery.
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Affiliation(s)
- Eric Laboute
- C.E.R.S., Groupe Ramsay Santé, Capbreton, France
| | | | - Alexia Bealu
- C.E.R.S., Groupe Ramsay Santé, Capbreton, France
| | - Olivier Ucay
- C.E.R.S., Groupe Ramsay Santé, Capbreton, France
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30
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García-Vega M, De La Cuadra-Virgil P, Jiménez-Cristobal J, Occhi-Gómez B, Boserman-Pérez-de Villaamil M. Arthroscopic bankart repair for the management of anterior shoulder instability: Mid- and long- term results. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [PMID: 33773949 DOI: 10.1016/j.recot.2020.10.004] [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] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Arthroscopic stabilization is a well-recognized surgical technique with a variable rate of failure reported between 0-35%. The aim of this study was to evaluate the outcome of this technique and our second aim was to identify risk factors that could be associated to recurrence rate. MATERIAL AND METHODS 41 patients that underwent arthroscopic shoulder stabilization for glenohumeral instability between 2001-2015 were included. Different items such as epidemiologic, recurrence, age at first dislocation, preoperative sport practice, and number of fixation devices used were collected. The results were evaluated using functional scales (WOSI, Rowe y Walch-Duplay) and radiological study was assessed using the Samilson-Prieto score. Data from the medical history were recognized in order to assess possible risk factors. RESULTS The overall redislocation rate was 9.4%. The average follow-up was 83 months. The 54.3% of the patients achieved excellent / good results in the functional assessment scales. The range of motion was complete in 90% of the cases. On the radiographs, only 4.88% of the patients present advanced osteoarthritis. It was not possible to identify risk factors related to a worse outcome after surgery. CONCLUSION The arthroscopic Bankart repair with suture anchors is considered the gold standard for treatment of anterior glenohumeral instability. The long-term follow-up shows a favorable outcome, with a redislocation rate of 9% and low complication rate.
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Affiliation(s)
- M García-Vega
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
| | | | | | - B Occhi-Gómez
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
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31
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Bixby EC, Ahmad CS. Anterior Shoulder Instability in the Throwing Athlete. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Patel BH, Lu Y, Agarwalla A, Puzzitiello RN, Nwachukwu BU, Cvetanovich GL, Chahla J, Forsythe B. Maximal Medical Improvement Following Shoulder Stabilization Surgery May Require up to 1 Year: A Systematic Review. HSS J 2020; 16:534-543. [PMID: 33380993 PMCID: PMC7749924 DOI: 10.1007/s11420-020-09773-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is increased emphasis on properly allocating healthcare resources to optimize value within orthopedic surgery. Establishing time to maximal medical improvement (MMI) can inform clinical decision-making and practice guidelines. PURPOSE We sought (1) to evaluate the time to MMI as predicted by commonly used patient-reported outcome measures (PROMs) for evaluation of shoulder stabilization and (2) to evaluate typical time to return to sports and employment following surgery. METHODS A systematic review of the Medline database was conducted to identify outcome studies reporting sequential follow-up at multiple time points, up to a minimum of 2 years after shoulder stabilization surgery. The included studies examined the outcomes of arthroscopic or open surgical techniques on anterior instability. Clinically significant improvements were evaluated utilizing the minimal clinically important difference specific to each PROM. Secondary outcomes included range of motion, return to sport/work, and recurrent instability. RESULTS Ten studies comprising 590 surgically managed cases of anterior shoulder instability were included (78% arthroscopic, 22% open). Clinically significant improvements in PROMs were achieved up to 1 year post-operatively for Rowe, Western Ontario Instability Index (WOSI), American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) scores. For the three most utilized tools (Rowe, WOSI, ASES), the majority of improvement occurred in the first 6 post-operative months. Clinically significant improvements in Constant Score and Oxford Shoulder Instability Score (OSIS) were achieved up to 6 months and 2 years after surgery, respectively. No clinically significant improvements were achieved on the Disabilities of the Arm, Shoulder, and Hand (DASH) tool. CONCLUSION Maximal medical improvement as determined by commonly utilized PROMs occurs by 1 year after operative management of anterior shoulder instability. The DASH tool does not appear to demonstrate a reliable time frame for clinically significant outcome improvement.
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Affiliation(s)
- Bhavik H. Patel
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL USA
| | - Yining Lu
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN USA
| | - Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY USA
| | | | | | - Gregory L. Cvetanovich
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL USA
| | - Brian Forsythe
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL USA
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Labral Repair Augmentation by Labroplasty and Simultaneous Trans-Subscapular Transposition of the Long Head of the Biceps. Arthrosc Tech 2019; 8:e507-e512. [PMID: 31194141 PMCID: PMC6552014 DOI: 10.1016/j.eats.2019.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/20/2019] [Indexed: 02/03/2023] Open
Abstract
Chronic traumatic anteroinferior instability is a common pathology of the shoulder joint. In case of glenoid bone defects, the Latarjet or bone block technique is the method of choice. The arthroscopic Bankart procedure and its modifications remain the preferred methods of treating patients without substantial bone damage of the glenoid and humeral head; however, there is a high recurrence of instability after the Bankart procedure, even for optimal indications. One of the main causes of recurrence is poor quality and weakness of the glenohumeral ligaments and labrum. We describe an alternative technique that provides triple mechanisms of stabilization like the Latarjet procedure. In our procedure, the long head of the biceps tendon is used for a sling effect, dynamic stabilization is achieved by trans-subscapular tenodesis with simultaneous plasty of the anterior segment of the labrum, and subsequent resuspension of the glenohumeral ligaments is performed using the same anchors. In patients without substantial bone loss, this procedure has numerous advantages over the arthroscopic Latarjet procedure. By creating triple mechanisms of stability like the Latarjet procedure (the bumper effect, reinforcement of ligaments, and sling effect), our procedure can significantly reinforce the Bankart procedure in cases of poor-quality glenohumeral ligaments.
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Nelson FRT. Managing Bony Defects of the Shoulder Joint that Occur in Association with Dislocation. Open Orthop J 2019. [DOI: 10.2174/1874325001913010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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