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Castillo de la Peña J, Ma J, Wong I. Arthroscopic capsular shift from inferior to superior has an exceptional safety profile and short-term outcomes. J ISAKOS 2024; 9:314-318. [PMID: 38403194 DOI: 10.1016/j.jisako.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES Arthroscopic Bankart for anterior shoulder instability has a good safety profile but with a relatively high recurrence index. Open surgery has been used to decrease recurrence rates but with a higher complication rate. Arthroscopic capsular shift from inferior to superior (ACSIS) was designed to decrease the recurrence rates without the added morbidity of open surgery. METHODS An observational retrospective study was conducted to analyze perioperative complications and patient reported outcomes of patients treated with ACSIS to determine the safety profile of the procedure. The patients with anterior traumatic shoulder instability treated with ACSIS between January 2015 and December 2021 were included for the study. The analysis was conducted using SPSS (Version 27). The pre vs. postoperative Western Ontario Shoulder Instability Index scores were compared using a paired sample t-test or Wilcoxon signed ranks test depending on the results of the normality test and Levene's test. The significance level was 0.05 in all analyses. Thirty-six patients were included in this study, the mean age of the population is 30.8 ± 11.4 years, with a male dominance of 86.1% (N = 31), and a mean clinical follow-up of 2.7 ± 1.2 years. RESULTS No intraoperative complications, including bleeding or neurovascular injury, were noted. Additionally, no early postoperative complications, including infection or hospital readmission, were noted. During the follow-up, one patient (3%) had persistent apprehension. The mean Western Ontario Shoulder Instability index decreased from 66.6 ± 13.10% to 27.9 ± 22% postoperatively (P < 0.001). CONCLUSIONS ACSIS procedure is safe and has good short-term outcomes with a low recurrence rate at 1-year minimum follow-up. LEVEL OF EVIDENCE 3 (Observational study).
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Affiliation(s)
- Jose Castillo de la Peña
- Division of Orthopaedics, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, B3H 2E1, Canada
| | - Jie Ma
- Division of Orthopaedics, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, B3H 2E1, Canada
| | - Ivan Wong
- Division of Orthopaedics, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, B3H 2E1, Canada.
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Ahmed NA, Narendran K, Ahmed NA, A P, Holebasu B, Kalawatia M, Dudeja K, Kamble P, Prasad R, Mittal G, Sangoi R. Comparison of the Glenoid Index by Computed Tomography With Magnetic Resonance Imaging. Cureus 2024; 16:e51914. [PMID: 38333443 PMCID: PMC10851955 DOI: 10.7759/cureus.51914] [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: 11/17/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction Anterior shoulder instability results in labral and osseous glenoid injuries. With a large osseous defect, there is a risk of recurrent dislocation of the joint, and therefore the patient has to undergo surgical correction. An MRI evaluation of the patient helps to assess the soft tissue injury. Currently, the volumetric three-dimensional (3D) reconstructed CT image is the standard for measuring glenoid bone loss and the glenoid index. However, it has the disadvantage of exposing the patient to radiation and additional expenses. This study aims to compare the values of the glenoid index using MRI and CT. Methodology The present study was a two-year cross-sectional study of patients with shoulder pain, trauma, and dislocation in a tertiary hospital in Karnataka. The sagittal proton density (PD) section of the glenoid and enface 3D reconstructed images of the scapula were used to calculate glenoid bone loss and the glenoid index. The baseline data were analyzed using descriptive statistics, and the Chi-square test was used to test the association of various complications with selected variables of interest. Results The glenoid index calculated in the current study using 3D volumetric CT images and MR sagittal PD images was 0.95±0.01 and 0.95±0.01, respectively. The CT and MRI glenoid bone loss was 5.41±0.65% and 5.38±0.65%, respectively. When compared, the glenoid index and bone loss calculated by MRI and CT revealed a high correlation and significance with a p-value of <0.001. Conclusions The study concluded that MRI is a reliable method for glenoid measurement. The sagittal PD sequence combined with an enface glenoid makes it possible to identify osseous defects linked to glenohumeral joint damage and dislocation. The values derived from 3D CT are identical to the glenoid index and bone loss determined using the sagittal PD sequence in MRI.
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Affiliation(s)
- Nida A Ahmed
- Trauma and Orthopaedics, Barnsley Hospital NHS foundation Trust, Barnsley, GBR
| | | | - Nishath A Ahmed
- Pediatrics, Dr. B.R. Ambedkar Medical College and Research Institute, Bangalore, IND
| | - Prashanth A
- Physiology, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | - B Holebasu
- Radiodiagnosis, Gadag Institute of Medical Sciences, Gadag, IND
| | | | - Kunal Dudeja
- Physiology, Maharjah's Institute of Medical Sciences, Nellimarla, IND
| | | | - Roshan Prasad
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gaurav Mittal
- Research and Development, Rotract Club Of Indian Medicos, Mumbai, IND
- Research, Students Network Organization, Mumbai, IND
- Internal Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | - Ravi Sangoi
- Internal Medicine, Punyashlok Ahilyadevi Holkar Government Medical College and General Hospital, Baramati, IND
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Bond EC, Florance J, Dickens JF, Taylor DC. Review of Burkhart and DeBeer's (2000) article on traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repair: Where have we taken the concept of glenoid bone loss in 2023? J ISAKOS 2023; 8:467-473. [PMID: 37673126 DOI: 10.1016/j.jisako.2023.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/03/2023] [Accepted: 08/25/2023] [Indexed: 09/08/2023]
Abstract
This classic discusses the original publication by Burkhart and DeBeer "Traumatic Glenohumeral Bone Defects and Their Relationship to Failure of Arthroscopic Bankart Repair" published in 2000 in Arthroscopy. At that time, the authors sought to understand the reasons behind the failure of arthroscopic soft tissue repair. Based on their findings, the authors introduced the concept of the inverted pear glenoid and engaging Hill-Sachs lesion which is now part of the orthopedic lexicon. The importance of bony pathologic changes in anterior glenohumeral instability has become so apparent, that it now forms the basis of clinical understanding and underpins treatment algorithms. Since this publication over 20 years ago, the idea of glenohumeral bone loss has been extensively explored and refined. There is no doubt of the importance of structural bone loss yet there is still uncertainty as to the best management of those with subcritical bone loss. The purpose of revisiting this classic article is to look at where we are in understanding recurrent instability and bony deficiency while appreciating how far we have come. This review begins with a detailed summary of the classic article along with a historic perspective. Next, we look at the current evidence as it pertains to the classic article and how modern technology and innovation has advanced our ability to assess and quantify glenohumeral bone loss. We finish with expert commentary on the topic from two current surgeons with a research interest in shoulder instability to offer an insight into how modern surgeons view and address this issue. One of the original authors also reflects on the topic. The findings of this classic study changed the way we think about shoulder instability and opened the doors to an exciting body of research that is still growing today. Future research offers an opportunity for high quality evidence to guide management in the group of patients with subcritical bone loss and we eagerly await the results.
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Affiliation(s)
- Elizabeth C Bond
- Duke Sports Sciences Institute, Duke Centre for Living Campus, 3475 Erwin Road, Durham, NC 27705, USA.
| | - Jonathon Florance
- Duke Sports Sciences Institute, Duke Centre for Living Campus, 3475 Erwin Road, Durham, NC 27705, USA.
| | - Jonathan F Dickens
- Duke Sports Sciences Institute, Duke Centre for Living Campus, 3475 Erwin Road, Durham, NC 27705, USA.
| | - Dean C Taylor
- Duke Sports Sciences Institute, Duke Centre for Living Campus, 3475 Erwin Road, Durham, NC 27705, USA.
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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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Hu B, Hong J, Zhu H, Yan S, Wu H. Arthroscopic Bankart repair versus conservative treatment for first-time traumatic anterior shoulder dislocation: a systematic review and meta-analysis. Eur J Med Res 2023; 28:260. [PMID: 37501089 PMCID: PMC10373227 DOI: 10.1186/s40001-023-01160-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/10/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Shoulder is vulnerable to dislocation owing to its anatomical structure and the increasing popularity of contact sports in young population. The management of first-time anterior shoulder dislocation in this group is still controversial and the prognosis are varied. This review aimed to compare the results of arthroscopic Bankart repair and conservative management for first-time traumatic anterior shoulder dislocation in young active patients. METHODS Databases were searched till November 2021, and comparative studies between arthroscopic Bankart repair and conservative management for first-time traumatic anterior shoulder dislocation in young population were selected. Methodological quality of the studies was assessed according to the Cochrane Back Review Group 12-item scale. Outcome measures included recurrence of instability, return to play, subsequent instability surgery, and shoulder functional scores. RESULTS The search returned 12 eligible trials with 786 participants. All the trials were of prospective design. After arthroscopic Bankart repair, patients experienced significantly less re-dislocation (7.5% vs. 53.0%, p < 0.00001, I2 = 0%), subluxation (3.1% vs. 24.2%, p < 0.0001, I2 = 0%), positive apprehension test (7.3% vs. 25.8%, p = 0.002, I2 = 11%), and subsequent surgical treatment for instability (5.6% vs. 37.8%, p < 0.00001, I2 = 0%) when compared with those underwent conservative management. And more patients returned to play (83.5% vs. 66.0%, p = 0.03, I2 = 81%) after arthroscopic Bankart repair. Outcomes regarding the functional scores did not reach a significant difference between the two cohorts. CONCLUSIONS Arthroscopic Bankart repair showed superiority over conservative management in terms of recurrence, return to play, and subsequent instability surgery during the follow-up in young active patients that encountered first episode of dislocation. As long-term prognosis is comparable, an immediate surgical stabilization might not be suitable for everyone.
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Affiliation(s)
- Bin Hu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 1511# JiangHong Road, Hangzhou, 310009, China
- Orthopaedics Research Institute of Zhejiang University, Hangzhou, China
| | - Jianqiao Hong
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 1511# JiangHong Road, Hangzhou, 310009, China
- Orthopaedics Research Institute of Zhejiang University, Hangzhou, China
| | - Hanxiao Zhu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 1511# JiangHong Road, Hangzhou, 310009, China
- Orthopaedics Research Institute of Zhejiang University, Hangzhou, China
| | - Shigui Yan
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 1511# JiangHong Road, Hangzhou, 310009, China
- Orthopaedics Research Institute of Zhejiang University, Hangzhou, China
| | - Haobo Wu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 1511# JiangHong Road, Hangzhou, 310009, China.
- Orthopaedics Research Institute of Zhejiang University, Hangzhou, China.
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Panagopoulos G, Picca G, Adamczyk A, Leonidou A, Consigliere P, Sforza G, Atoun E, Rath E, Levy O. The "purse string" technique for anterior glenohumeral instability: long-term results 7-13-year follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03426-5. [PMID: 36350404 DOI: 10.1007/s00590-022-03426-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE The "Purse-String Technique" (PST) is an arthroscopic horizontal mattress suture technique for recurrent anterior shoulder instability that uses a single double-loaded suture anchor at the 4-o' clock position, achieving a Bankart labral repair and an infero-superior capsular shift. In this study, we describe the long-term results of the PST. METHODS The study included 69 individuals (70 shoulders), with a mean age of 30 years, who had recurrent post-traumatic anteroinferior instability. A purse-string suture anchor at the 4-o'clock position was used to address the Bankart lesion and capsular laxity, recreating the anterior glenoid bumper. All patients were assessed via telephone interview at a mean of 116 months after surgery (7-13-year follow-up). RESULTS Postoperatively, the mean Constant score was 94, mean Rowe score was 93 and mean Walch-Duplay score was 89. 89% of patients resumed their preinjury sport activities, with 61% of patients achieving preinjury levels and most professional athletes returning to full activity. Seven patients had recurrent dislocation postoperatively (10% failure rate). Of these patients, three had revision arthroscopic stabilization, one patient had revision arthroscopic stabilization with remplissage, two had a Latarjet procedure, whereas one patient decided to seek no further treatment. CONCLUSION The long-term results of PST are promising, with a low failure rate, high patient satisfaction and a high rate of return to sport. LEVEL OF EVIDENCE Level IV; Case series; Treatment study.
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Affiliation(s)
- Georgios Panagopoulos
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK.
| | - Girolamo Picca
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Aleksandra Adamczyk
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Andreas Leonidou
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Paolo Consigliere
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Giuseppe Sforza
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Ehud Atoun
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Levy
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel
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Markes AR, Cevallos N, Lansdown DA, Ma CB, Feeley BT, Zhang AL. Risk for recurrent instability and reoperation following arthroscopic and open shoulder stabilization in a large cross-sectional population. JSES Int 2022; 6:730-735. [PMID: 36081703 PMCID: PMC9446191 DOI: 10.1016/j.jseint.2022.06.004] [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] [Indexed: 11/30/2022] Open
Abstract
Background Recurrent shoulder instability is an orthopedic problem with potentially long-term functional ramifications. Although arthroscopic stabilization has become increasingly utilized over open stabilization, optimal surgical intervention to minimize recurrent instability remains controversial. Methods The PearlDiver Mariner database was queried for all cases of open and arthroscopic shoulder stabilization from 2010 to 2019. Utilization trends were aggregated after identifying cohorts of 107,210 and 13,217 patients who respectively underwent arthroscopic or open stabilization using Current Procedural Terminology codes. Subsets from those cohorts with laterality-specific International Classification of Diseases, Tenth Revision codes for shoulder instability were used to evaluate 2-year rates of recurrent instability (presence of shoulder dislocation or revision open or arthroscopic stabilization). Linear regression and chi-squared analysis were used to analyze utilization trends and to compare recurrent instability. Results Arthroscopic stabilization comprised 90% of all stabilization procedures with annual utilization continuing to increase into 2019. Latarjet utilization increased from 15% to 42% of all open stabilization procedures while open Bankart repair utilization decreased from 56% to 35%. The rate of recurrent instability was 10.2% after arthroscopic stabilization and 12.3% after open stabilization (P = .01). Rates of redislocation (4.0% vs. 2.6%, P < .01), conversion to shoulder arthroplasty (1.2% vs. 0.4%, P < .01), and revision open stabilization (6.8% vs. 2.3%, P < .01) after index open stabilization were significantly higher than after index arthroscopic stabilization. There was no difference in revision stabilization or dislocation rates between open procedures. Conclusion Despite increasing utilization of coracoid transfer, arthroscopic stabilization is still the dominant modality used for surgical treatment of shoulder instability and in our analysis, showed lower 2-year rates of dislocation, revision open stabilization, and conversion to shoulder arthroplasty.
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Affiliation(s)
- Alexander R. Markes
- Corresponding author: Alexander R. Markes, MD, 1500 Owens Street, San Francisco, CA 94158, USA.
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Anterior mid-portion capsular tear with Bankart lesion in recurrent anterior shoulder dislocation: outcome report and bone defect evaluation. Arch Orthop Trauma Surg 2022; 143:2581-2587. [PMID: 35964261 DOI: 10.1007/s00402-022-04580-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/07/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION This study aimed to report the incidence of anterior mid-portion capsular tears identified during arthroscopic Bankart repair (ABR), the clinical outcomes of repairing this combined lesion, and to evaluate the associated bone defects. METHODS We retrospectively reviewed the records of patients undergoing ABR between January 2014 and December 2017. Data from patients with capsular tears identified during ABR were included and analyzed. Age, number of dislocations, repair technique, follow-up results, and X-rays were reviewed. The size of the glenoid defect and Hill-Sachs lesion were reviewed via magnetic resonance imaging or magnetic resonance arthrography (MRA). RESULTS Records of 95 patients undergoing ABR during the study period were reviewed, and nine were included. The overall incidence of capsular tears was 9.5% and the mean age at surgery was 45.3 ± 14.3 years. All cases had > 3 dislocations before treatment. All patients had labral lesions, and one had a glenoid defect. Hill-Sachs lesions were observed in eight patients. Seven patients underwent MRA examination, and all seven showed axillary pouch disruption. Over 3.9 ± 1.1 years of follow-up, there was no instability recurrence, and Rowe scores improved from 42.2 to 96.7 (p < 0.001). CONCLUSIONS There was no recurrent shoulder instability after combined arthroscopic repair of capsular and Bankart lesions. There were Rowe score improvements over at least three years of follow-up. Although our case number was small, we found that mid-portion capsular tear occurred in patients over 30 years with multiple recurrent dislocations, with or without small glenoid bone defects, and with axillary pouch disruption on MRA images.
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Haase L, Wise K, Kelly B, Harris J, Macalena J. No Difference Between Anchorless and Traditional Suture Anchors in Arthroscopic Bankart Repair: A Clinical Comparison. Cureus 2022; 14:e26988. [PMID: 35989839 PMCID: PMC9385306 DOI: 10.7759/cureus.26988] [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: 07/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background Shoulder instability and recurrent dislocations are common problems encountered by orthopedic surgeons and are frequently associated with a Bankart lesion. These are classically treated with either open or arthroscopic repair utilizing traditional suture anchors, though anchorless fixation techniques have recently been developed as an alternate fixation method that reduces native bone loss and has comparable pull-out strength. Methods A retrospective review was performed at a single institution for patients who underwent Bankart repair from January 2008 through February 2014. American Shoulder and Elbow Surgeons (ASES) questionnaires were mailed to 35 patients with anchorless fixation and 35 age-, gender-, and surgeon-matched patients with traditional suture anchors. Statistical analysis was performed comparing re-dislocation, additional surgery, and ASES scores with statistical significance set at p < 0.05. Results Eleven patients in the anchorless implant group and 15 patients in the anchor group completed the questionnaire. The mean follow-up was 4.1 years in the anchorless group and 5.6 years in the anchor group (p=0.04). The number of implants was 4.82 in the anchorless group and 3.87 in the anchor group (p = 0.04). No difference was found in re-dislocation rates (p = 0.80) or additional surgery on the affected shoulder (p = 0.75). ASES scores were found to have no statistical difference (89.89 for the anchorless group versus 85.37 for the anchor group; p = 0.78). Conclusion In patients undergoing arthroscopic Bankart lesion repair with traditional anchors compared to anchorless fixation, there appears to be no difference in shoulder re-dislocation rates, recurrent ipsilateral shoulder surgery, or ASES scores.
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Rodriguez S, Mancini MR, Kakazu R, LeVasseur MR, Trudeau MT, Cote MP, Arciero RA, Denard PJ, Mazzocca AD. Comparison of the Coracoid, Distal Clavicle, and Scapular Spine for Autograft Augmentation of Glenoid Bone Loss: A Radiologic and Cadaveric Assessment. Am J Sports Med 2022; 50:717-724. [PMID: 35048738 DOI: 10.1177/03635465211065446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Glenohumeral instability caused by bone loss requires adequate bony restoration for successful surgical stabilization. Coracoid transfer has been the gold standard bone graft; however, it has high complication rates. Alternative autologous free bone grafts, which include the distal clavicle and scapular spine, have been suggested. STUDY DESIGN Controlled laboratory study. PURPOSE The purpose of this study was to determine the percentage of glenoid bone loss (GBL) restored via coracoid, distal clavicle, and scapular spine bone grafts using a patient cohort and a cadaveric evaluation. METHODS Autologous bone graft dimensions from a traditional Latarjet, congruent arc Latarjet, distal clavicle, and scapular spine were measured in a 2-part study using 52 computed tomography (CT) scans and 10 unmatched cadaveric specimens. The amount of GBL restored using each graft was calculated by comparing the graft thickness with the glenoid diameter. RESULTS Using CT measurements, we found the mean percentage of glenoid restoration for each graft was 49.5% ± 6.7% (traditional Latarjet), 45.1% ± 4.9% (congruent arc Latarjet), 42.2% ± 7.7% (distal clavicle), and 26.2% ± 8.1% (scapular spine). Using cadaveric measurements, we found the mean percentage of glenoid restoration for each graft was 40.2% ± 5.0% (traditional Latarjet), 53.4% ± 4.7% (congruent arc Latarjet), 45.6% ± 8.4% (distal clavicle), and 28.2% ± 7.7% (scapular spine). With 10% GBL, 100% of the coracoid and distal clavicle grafts, as well as 88% of scapular spine grafts, could restore the defect (P < .001). With 20% GBL, 100% of the coracoid and distal clavicle grafts but only 66% of scapular spine grafts could restore the defect (P < .001). With 30% GBL, 100% of coracoid grafts, 98% of distal clavicle grafts, and 28% of scapular spine grafts could restore the defect (P < .001). With 40% GBL, a significant difference was identified (P = .001), as most coracoid grafts still provided adequate restoration (congruent arc Latarjet, 82.7%; traditional Latarjet, 76.9%), but distal clavicle grafts were markedly reduced, with only 51.9% of grafts maintaining sufficient dimensions. CONCLUSIONS The coracoid and distal clavicle grafts reliably restored up to 30% GBL in nearly all patients. The coracoid was the only graft that could reliably restore up to 40% GBL. CLINICAL RELEVANCE With "subcritical" GBL (>13.5%), all autologous bone grafts can be used to adequately restore the bony defect. However, with "critical" GBL (≥20%), only the coracoid and distal clavicle can reliably restore the bony defect.
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Affiliation(s)
- Santiago Rodriguez
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Michael R Mancini
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Rafael Kakazu
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Matthew R LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Maxwell T Trudeau
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Robert A Arciero
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | | | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
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BALDAN ARTHURRODRIGUES, PEREIRA VITORLUIS, LARA PAULOHENRIQUESCHMIDT, EJNISMAN BENNO, BELANGERO PAULOSANTORO. RESULT OF BONE BLOCKING SURGERY IN COMBAT ATHLETES WITH ANTERIOR SHOULDER INSTABILITY: A PROSPECTIVE STUDY. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e244517. [PMID: 35719178 PMCID: PMC9177064 DOI: 10.1590/1413-785220223002244517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/19/2021] [Indexed: 11/22/2022]
Abstract
Objective: This study aims to understand the way fighting athletes respond to bone block
surgery in the treatment for shoulder instability. Methods: Prospective clinical study with competitive fighters with shoulder
instability who underwent bone block surgery from 2013 to 2016, followed by
a postoperative rehabilitation protocol. For the evaluation, eight combat
athletes with anterior shoulder instability were treated, with a total of
nine shoulders, since one athlete underwent bilateral surgery. All patients
signed the Free and Informed Consent Form. The evaluation protocol included
medical consultation, radiography of the operated shoulder, degree of active
and passive lateral rotation; degree of active and passive elevation; visual
analogue scale (VAS) for pain; Athletic Shoulder Outcome Rating Scale (EROE;
acronym in Portuguese) scores; Western Ontario Shoulder Instability Index
(WOSI), and American Shoulder and Elbow Surgeons (ASES). Results: We observed a decrease in the range of passive and active movement in the
recent postoperative period. In later postoperative, values were close to
those in the preoperative period at the end of the follow-up. There was
improvement in pain, and in all ASES, WOSI and EROE scores no complications
were documented. As for returning to sport, two athletes did not return, one
of them due to shoulder pain and the other due to retirement. Conclusion: Bone block surgery has shown good functional results in uncomplicated combat
athletes. Level of Evidence IV, Prospective Case Series.
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Repair integrity and functional outcomes of arthroscopic repair in chronic anterior shoulder instability: single-loaded versus double-loaded single-row repair. Arch Orthop Trauma Surg 2022; 142:131-138. [PMID: 33130935 DOI: 10.1007/s00402-020-03661-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION This study compared the clinical outcome and repair integrity of single-loaded and double-loaded single-row arthroscopic repair of chronic anterior shoulder instability. MATERIALS AND METHODS Fifty consecutive chronic anterior shoulder instability cases treated by arthroscopic labral repair were included. A single-loaded single-row technique was used in the first 25 consecutive shoulders, and a double-loaded single-row technique was used in the next 25 consecutive shoulders. The number of suture anchors was 4 in the shoulders that underwent single-loaded repair and 3 in the shoulders that underwent double-loaded repair. 42 shoulders (84.0%) followed up clinical outcomes were evaluated a minimum 2 years (mean 28.5 months; range 24-46) postoperatively. The postoperative labral repair integrity was evaluated by MDCT-arthrogram at a minimum 6 months postoperatively. RESULTS At the final follow-up, the average UCLA, ASES, Constant, Rowe score, VAS pain score, and VAS for instability scores improved significantly, to 33.05, 92.33, 89.05, 94.86, 0.90 and 0.52, respectively, in the single-loaded group and to 32.19, 90.10, 89.05, 94.52, 0.90, and 0.86, respectively, in the double-loaded group. The clinical scores improved in both groups postoperatively (all P < 0.05); however, there was no significant difference between the two groups at final follow-up (P = 0.414, 0.508, 1.000, 0.917, 1.000, and 0.470, respectively). The re-tear rate was 2 (9.5%) in the shoulders that underwent single-loaded repair and 3 (14.3%) in the shoulders that underwent double-loaded repair; this difference was statistically not significant (P = 0.634). CONCLUSION The double-loaded single-row technique resulted in comparable clinical outcomes, and re-tear rate compared with the single-loaded single-row technique in chronic anterior shoulder instability at short-term follow-up. Number of used suture anchor in double-loaded single-row technique was fewer than that of single-loaded single-row technique. LEVEL OF EVIDENCE Comparative retrospective study, level III.
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Simmer Filho J, Kautsky RM. Limites da artroscopia na instabilidade anterior do ombro. Rev Bras Ortop 2021; 57:14-22. [PMID: 35198104 PMCID: PMC8856842 DOI: 10.1055/s-0041-1731357] [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] [Received: 12/07/2020] [Accepted: 04/15/2021] [Indexed: 10/26/2022] Open
Abstract
ResumoMuito se discute sobre os limites do tratamento da instabilidade anterior do ombro por artroscopia. O avanço no entendimento das repercussões biomecânicas das lesões bipolares sobre a estabilidade do ombro, bem como na identificação de fatores relacionados ao maior risco de recidiva têm nos ajudado a definir, de forma mais apurada, os limites do reparo por via artroscópica.Ressaltamos a importância de diferenciação entre perda óssea por erosão da glenoide (POAG) e fraturas da borda da glenoide, pois o prognóstico do tratamento diverge entre essas formas de falha óssea da glenoide. Neste contexto, entendemos que há três tipos de falha óssea: a) Bankart ósseo (fratura); b) combinada; e c) POAG, e abordaremos as opções de tratamento sugerido em cada situação.Até há pouco tempo, a escolha do método cirúrgico era norteada basicamente pelo grau de acometimento ósseo. Com a evolução do conhecimento, da biomecânica das lesões bipolares e do conceito do glenoid track (trilho da glenoide), o ponto de corte da lesão crítica, vem sendo alterado com tendência de queda. Além das falhas ou perdas ósseas, outras variáveis foram adicionadas e tornaram a decisão mais complexa, porém um pouco mais objetiva.O presente artigo de atualização tem como objetivo fazer uma breve revisão da anatomia com as principais lesões encontradas na instabilidade; abordar detalhes importantes na técnica cirúrgica artroscópica, em especial nos casos complexos, e trazer as evidências atuais sobre os assuntos de maior divergência, buscando guiar o cirurgião na tomada de decisão.
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Abstract
Magnetic resonance imaging provides a comprehensive evaluation of the shoulder including the rotator cuff muscles and tendons, glenoid labrum, long head biceps tendon, and glenohumeral and acromioclavicular joint articulations. Most institutions use two-dimensional sequences acquired in all three imaging planes to accurately evaluate the many important structures of the shoulder. Recently, the addition of three-dimensional (3D) acquisitions with 3D reconstructions has become clinically feasible and helped improve our understanding of several important pathologic conditions, allowing us to provide added value for referring clinicians. This article briefly describes techniques used in 3D imaging of the shoulder and discusses applications of these techniques including measuring glenoid bone loss in anterior glenohumeral instability. We also review the literature on routine 3D imaging for the evaluation of common shoulder abnormalities as 3D imaging will likely become more common as imaging software continues to improve.
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Affiliation(s)
- Steven P Daniels
- Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York
| | - Soterios Gyftopoulos
- Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York
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15
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Moya D, Aydin N, Yamamoto N, Simone JP, Robles PP, Tytherleigh-Strong G, Gobbato B, Kholinne E, Jeon IH. Current concepts in anterior glenohumeral instability: diagnosis and treatment. SICOT J 2021; 7:48. [PMID: 34519639 PMCID: PMC8439181 DOI: 10.1051/sicotj/2021048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/27/2021] [Indexed: 11/14/2022] Open
Abstract
The glenohumeral joint is the most dislocated articulation, accounting for more than 50% of all joint dislocations. The reason behind shoulder instability should be investigated in detail for successful management, and the treatment plan should be individualized for all patients. Several classification systems have been proposed for glenohumeral instability. A physical exam is mandatory no matter what classification system is used. When treating patients with anterior shoulder instability, surgeons need to be aware of the critical size of the bone loss, which is commonly seen. The glenoid track concept was clinically adopted, and the measurement of the glenoid track for surgical decision-making is recommended. Detailed assessment of existing soft tissue injury to the labrum, capsule, glenohumeral ligaments, and rotator cuff is also mandatory as their presence influences the surgical outcome. Rehabilitation, arthroscopic repair techniques, open Bankart procedure, capsular plication, remplissage, Latarjet technique, iliac crest, and other bone grafts offer the surgeon different treatment options according to the type of patient and the lesions to be treated. Three-dimensional (3D) technologies can help to evaluate glenoid and humeral defects. Patient-specific guides are low-cost surgical instruments and can be used in shoulder instability surgery. 3D printing will undoubtedly become an essential tool to achieve the best results in glenohumeral instability surgery.
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Affiliation(s)
- Daniel Moya
- Department of Orthopedic Surgery, Hospital Británico de Buenos Aires, C1280 AEB Buenos Aires, Argentina
| | - Nuri Aydin
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Orthopedics and Traumatology, 34098 Istanbul, Turkey
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 980-8575 Sendai, Japan
| | - Juan Pablo Simone
- Department of Orthopaedic Surgery, Hospital Alemán de Buenos Aires, C1118 AAT Buenos Aires, Argentina
| | | | - Graham Tytherleigh-Strong
- Division of Orthopaedics, Addenbroke's Hospital, Cambridge University Hospitals Trust, CB2 0QQ Cambridge, United Kingdom
| | - Bruno Gobbato
- Department of Orthopaedic Surgery, Hospital Sao Jose, Jaraguá do Sul, SC 89251-830, Brazil
| | - Erica Kholinne
- Faculty of Medicine, Universitas Trisakti, Department of Orthopaedic Surgery, St Carolus Hospital, 10440 Jakarta, Indonesia
| | - In-Ho Jeon
- Department of Orthopaedics, University of Ulsan, College of Medicine, Asan Medical Center, 05505 Seoul, Korea
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Iftikhar N, Stead TS, Ganti L, Aleksandrovskiy I, Fraunfelter F. Anterior Shoulder Dislocation Complicated by Hill-Sachs Lesion. Cureus 2021; 13:e16925. [PMID: 34513496 PMCID: PMC8418586 DOI: 10.7759/cureus.16925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/18/2022] Open
Abstract
We present the case of a 60-year-old woman with a Hill-Sachs lesion caused by an anterior shoulder dislocation (SD) as a result of her falling on her left shoulder at a local restaurant. While the diagnosis of an anterior SD is commonplace, the involvement of a Hill-Sachs lesion can complicate the treatment needed to manage the SD. Crucial aspects of treatment include performing closed reduction followed by acute immobilization in a timely manner and prompt consultation with orthopedic surgery.
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Affiliation(s)
- Nofel Iftikhar
- Emergency Medicine, Trinity Preparatory School, Winter Park, USA
| | - Thor S Stead
- Medicine, Warren Alpert Medical School, Providence, USA
| | - Latha Ganti
- Emergency Medicine, Envision Physician Services, Plantation, USA.,Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA.,Emergency Medicine, Ocala Regional Medical Center, Ocala, USA.,Emergency Medicine, HCA Healthcare Graduate Medical Education Consortium Emergency Medicine Residency Program of Greater Orlando, Olrando, USA
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Wu IT, Desai VS, Mangold DR, Camp CL, Barlow JD, Sanchez-Sotelo J, Dahm DL, Krych AJ. Comparable clinical outcomes using knotless and knot-tying anchors for arthroscopic capsulolabral repair in recurrent anterior glenohumeral instability at mean 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 2021; 29:2077-2084. [PMID: 32462270 DOI: 10.1007/s00167-020-06057-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/10/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare rates of recurrent instability, revision surgery and functional outcomes following arthroscopic anterior capsulolabral repair for recurrent anterior instability using knot-tying versus knotless suture anchor techniques. METHODS Patients who had undergone arthroscopic anterior labrum and capsular repair for recurrent anterior glenohumeral instability using knotless anchors were identified. Those with minimum 2-year follow-up were matched (1:2) to knot-tying anchor repair patients. Rates of failure and recurrent instability were compared, as well as Visual Analog Scale (VAS), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), University of California Los Angeles (UCLA) and Rowe scores. RESULTS One hundred and two patients (89 males, 13 females) with a mean age of 24.3 ± 9.6 were included. Repair was performed with knotless anchors in 34 and knot-tying anchors in 68 shoulders. At mean follow-up of 4.8 ± 2.5 years, re-dislocation rates between groups were not significantly different (knotless anchor: 9% versus knot-tying group: 15%, n.s.), but the knot-tying group showed a higher re-subluxation rate (p = 0.039). 12 (18%) revisions were performed in the knot-tying group at a mean 2.9 years after surgery and 1 (3%) revision in the knotless anchors group at 1.4 years (n.s.). There was no difference in mean VAS with use (1.3 ± 1.9 versus 0.8 ± 1.5, n.s.), SANE scores (91.8 ± 12.7 versus 92.0 ± 11.0, n.s.), QuickDASH scores (4.1 ± 5.5 versus 3.0 ± 6.5, n.s.), UCLA Shoulder Score (32.5 ± 3.6 versus 33.2 ± 3.1, n.s.), or Rowe scores (90.5 ± 18.5 versus 92.2 ± 16.6, n.s.) between knotless and knot-tying groups, respectively. VAS at rest was higher in the knotless group (0.7 ± 1.5 vs 0.1 ± 0.4, p = 0.021). CONCLUSIONS Knotless anchors demonstrated similar rates of re-dislocation and revision surgery, and lower rates of recurrent subluxation, compared to knot-tying anchors. Patients achieved good-to-excellent functional outcomes. This supports the efficacy of knotless anchors as an alternative to knot-tying anchors for arthroscopic anterior labral repair of recurrent anterior shoulder dislocation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Isabella T Wu
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Vishal S Desai
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Devin R Mangold
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Jonathan D Barlow
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Joaquin Sanchez-Sotelo
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Diane L Dahm
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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Housset V, Chevallier R, Nourissat G. Open Trillat Procedure for Recurrent Anterior Instability of the Shoulder in Elderly Patients. Arthrosc Tech 2021; 10:e1211-e1216. [PMID: 34141533 PMCID: PMC8185572 DOI: 10.1016/j.eats.2021.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/22/2021] [Indexed: 02/03/2023] Open
Abstract
Among the many different procedures available in the treatment of shoulder instability, the Trillat procedure remains indicated in case of recurrent shoulder instability in elderly patient with an irreparable cuff tear or in case of hyperlaxity. Despite the constantly increasing number of arthroscopic assisted techniques, the open procedure remains a simple, reliable and fast surgical procedure with a shorter learning curve than the arthroscopic techniques. It consists in a partial osteotomy of the anterior cortical of the coracoid process which is then tilted and fixed with a screw into the anterior part of the scapula downwards and medially to obtain a re-centering effect due to the conjoint tendon on the humeral head when rotational movement are applied. This article aims to present a stepwise approach for the open surgical technique.
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Affiliation(s)
- Victor Housset
- Address correspondence to Victor Housset, M.D., Clinique Maussins-Nollet, Sorbonne Université, Paris, France.
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19
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Connaughton AJ, Kluczynski MA, Marzo JM. Simple versus horizontal mattress suture configuration in bankart repair. J Orthop 2021; 23:225-226. [PMID: 33642819 DOI: 10.1016/j.jor.2021.01.012] [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: 12/14/2020] [Accepted: 01/31/2021] [Indexed: 11/25/2022] Open
Abstract
The purpose of this article was to compare the anatomy and biomechanics of different suture repair configurations for arthroscopic Bankart lesion repair. The horizontal mattress technique improves the restoration of labral height and decreases capsular strain in comparison to simple suture repairs. Further research examining the clinical outcomes of horizontal mattress suture technique is required for comparison with simple suture arthroscopic Bankart repairs.
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Affiliation(s)
- Alexander J Connaughton
- Jacobs School of Medicine and Biomedical Sciences, Department of Orthopaedics and Sports Medicine, University at Buffalo, Room 7156, 955 Main St., Buffalo, NY, 14214, USA
| | - Melissa A Kluczynski
- Jacobs School of Medicine and Biomedical Sciences, Department of Orthopaedics and Sports Medicine, University at Buffalo, Room 7156, 955 Main St., Buffalo, NY, 14214, USA
| | - John M Marzo
- Jacobs School of Medicine and Biomedical Sciences, Department of Orthopaedics and Sports Medicine, University at Buffalo, Room 7156, 955 Main St., Buffalo, NY, 14214, USA
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Perceived vs. true glenoid anchor placement: a cadaveric comparison of the beach chair and lateral position. JSES Int 2021; 5:66-71. [PMID: 33554167 PMCID: PMC7846687 DOI: 10.1016/j.jseint.2020.09.012] [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] [Indexed: 11/23/2022] Open
Abstract
Purpose To explore whether patient position influences a surgeon’s ability to accurately judge anchor position on the glenoid. Materials and Methods Two anchors were inserted into the glenoid of 8 shoulders. Arthroscopic videos were taken from 3 views (posterior beach chair [pBC], posterior lateral decubitus [pLD], and anterosuperolateral decubitus [asLD]). The shoulders were disarticulated to identify “true” anchor position. Seventeen shoulder surgeons reviewed the videos and indicated anchor positions using the “clock face” method. Accuracy was measured within tolerances, ranging from zero (exact), 0.5 (half-hour), 1.0, and 1.5 hours of “true” position. Intra- and inter-rater agreement was calculated. Post hoc analyses explored for bias dependent on surgical side. Results The overall accuracy was 34.0%. At tolerances of 0.5, 1.0, and 1.5 hours, accuracy increased to 82.4%, 95.4%, and 98.0%. With a 30° scope, identification of exact position was more accurate in pBC than pLD (odds ratio [OR] = 1.397; P = .029) but not asLD (OR =1.341; P = .197). At a tolerance of 0.5 hour, the 30° scope was more accurate in pBC than both pLD (OR = 1.444; P = .011) and asLD (OR = 1.728; P = .009). In left shoulders, anchors were perceived as more inferior than true position in asLD and pLD. In right shoulders, anchors were perceived as more superior than true position from pBC and pLD. Inter- and intrarater agreement were highest in pBC with a 30° scope (30° scope weighted kappa = 0.783 and 70° scope weighted kappa = 0.853, respectively). Conclusion Judgment of anchor position on video is most accurate in a pBC view. Inter- and intrarater reliability were also highest from a pBC view.
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21
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Arthroscopic Anatomic Glenoid Repair Using Distal Tibial Allograft and an Inferior-to-Superior Capsular Shift. Arthrosc Tech 2021; 10:e221-e228. [PMID: 33532232 PMCID: PMC7823141 DOI: 10.1016/j.eats.2020.09.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/23/2020] [Indexed: 02/03/2023] Open
Abstract
Traumatic anterior dislocation of the shoulder accounts for the vast majority of shoulder dislocations. Recurrence following initial traumatic dislocation is common, and the risk is increased by the presence of both bony and soft-tissue damage. Arthroscopic procedures have been described to address each of these etiologies individually but have not provided a technique to address bony and soft tissue pathology concurrently. This paper describes an all-arthroscopic, anatomic glenoid repair using distal tibial allograft with an inferior-to-superior capsular shift, addressing significant glenoid bone loss and capsular laxity with a single operation.
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Buckley A, Wong I. Arthroscopic Bankart Repair With Inferior to Superior Capsular Shift in Lateral Decubitus Position. Arthrosc Tech 2021; 10:e145-e150. [PMID: 33532221 PMCID: PMC7823104 DOI: 10.1016/j.eats.2020.09.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/20/2020] [Indexed: 02/03/2023] Open
Abstract
Traditional Bankart repairs for anterior labral tears of the shoulder use suture anchors to repair the anterior shoulder labrum and capsule to the glenoid. The technique described here involves releasing the anterior capsule of the glenoid and shifting it superiorly along with the labrum before anchoring. The intention of this extra step is to replicate the open technique, where the entire capsule is shifted superiorly on the glenoid.
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Affiliation(s)
- Andrew Buckley
- Dalhousie University Medical School, Halifax, Nova Scotia, Canada
| | - Ivan Wong
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada,Address correspondence to Dr. Ivan Wong, Department of Surgery, Faculty of Medicine, Dalhousie University, 5955 Veteran's Memorial Lane, Room 2106 VMB, Halifax, Nova Scotia, Canada, B3H 2E1.
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Cortical suture button fixation vs. bicortical screw fixation in the Latarjet procedure: a biomechanical comparison. J Shoulder Elbow Surg 2020; 29:1470-1478. [PMID: 32147337 DOI: 10.1016/j.jse.2019.11.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/08/2019] [Accepted: 11/16/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Latarjet procedure traditionally has been performed with 2 screws in an open manner. Recently, cortical suture button fixation for coracoid transfer has been used in hopes of mitigating complications seen with screw placement. The aim of this study was to evaluate a cortical suture button and technique currently available in the United States compared with screw fixation in the Latarjet procedure in a cadaveric model. METHODS We randomly assigned 9 matched pairs of fresh-frozen cadaveric shoulders (N = 18) to undergo the Latarjet procedure with either screw fixation or cortical suture button fixation. After fixation, all shoulders underwent biomechanical testing with direct loading on the graft vas a material testing system. Cyclic testing was performed for 100 cycles to determine axial displacement with time; each graft was then monotonically loaded to failure. RESULTS The maximum cycle displacement was significantly less for screw fixation vs. cortical suture button fixation (3.1 ± 1.3 mm vs. 8.9 ± 2.1 mm, P < .0001). The total load at failure was 481.1 ± 88.8 N for screws and 175.5 ± 95.8 N for cortical suture buttons (P < .0001). Bony damage to the surrounding anatomy was more extensive at failure in the screw-fixation group. CONCLUSION At time zero, the cortical button fixation and technique did not resist direct loads to the graft as much as traditional screw fixation, although bony damage to the surrounding anatomy was more extensive in screw fixation than button fixation. In the event of unanticipated loading, this could place a patient at higher risk of graft migration, which could lead to unintended early outcomes. These results support the need for implants and techniques specifically tailored to the Latarjet procedure and should bring into question the adoption of a cortical button and technique not specific to the procedure.
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Updegrove GF, Buckley PS, Cox RM, Selverian S, Patel MS, Abboud JA. Latarjet Procedure for Anterior Glenohumeral Instability: Early Postsurgical Complications for Primary Coracoid Transfer Versus Revision Coracoid Transfer After Failed Prior Stabilization. Orthop J Sports Med 2020; 8:2325967120924628. [PMID: 32587873 PMCID: PMC7294484 DOI: 10.1177/2325967120924628] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 02/15/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The Latarjet procedure (coracoid transfer) is often used to successfully treat failed instability procedures. However, given the reported increased complication rates in primary Latarjet surgery, there is a heightened concern for complications in performing the Latarjet procedure as revision surgery. PURPOSE To evaluate the early outcomes and complications of the Latarjet procedure as primary surgery compared with revision surgery. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 157 patients were included and retrospectively reviewed: 103 patients in the revision group and 54 patients in the primary group. Patients were evaluated by physical examination findings as well as by documentation of complications and reoperations extracted from their electronic medical records. RESULTS The mean follow-up was 7.8 ± 11.0 months for the primary group and 7.0 ± 13.2 months for the revision group. There were no significant differences in overall complication rates between the primary and revision groups (16.7% vs 8.7%, respectively; P = .139). The complication rate was significantly higher in patients in the revision group who had undergone a prior open procedure compared with those who had undergone only arthroscopic procedures (30.0% vs 4.1%, respectively; P < .001). Of those patients who sustained a complication, 7 of the 9 underwent a reoperation in the primary group (13.0%), and 7 of the 9 did so in the revision group (6.8%); the risk of reoperations was not different between groups (P = .198). There were 4 patients in the primary group (7.4%) and 5 patients in the revision group (4.9%) who experienced recurrent dislocations during the follow-up period (P = .513). There was no difference in postoperative range of motion. CONCLUSION The Latarjet procedure is a reasonable option for the treatment of failed arthroscopic instability repair with an early complication rate similar to that found in primary Latarjet surgery.
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Affiliation(s)
- Gary F. Updegrove
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Patrick S. Buckley
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ryan M. Cox
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Stephen Selverian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Manan S. Patel
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph A. Abboud
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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O'Reilly OC, Andrews KA, Siparsky PN. Understanding the Glenoid Avulsion of the Glenohumeral Ligaments as a Cause of Shoulder Instability: Surgical and Postsurgical Management. Arthrosc Tech 2019; 8:e1153-e1158. [PMID: 31921589 PMCID: PMC6948128 DOI: 10.1016/j.eats.2019.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/08/2019] [Indexed: 02/03/2023] Open
Abstract
In adolescents and young adults, instability is a common shoulder pathology with a myriad of coexisting soft tissue and bony lesions. When evaluating a patient for the cause of instability, care must be given to assess for the infrequent lesions, including glenoid avulsion of the glenohumeral ligaments. This case example illustrates key points in the diagnosis, surgical, and postsurgical management of this less common cause of anterior shoulder instability.
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Affiliation(s)
- Olivia C. O'Reilly
- Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa,Address correspondence to Olivia C. O'Reilly, M.D., The University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01019 JPP, Iowa City, IA 52242, U.S.A.
| | - Kyle A. Andrews
- Department of Orthopedic Surgery, The University of Toledo, Toledo, Ohio, U.S.A
| | - Patrick N. Siparsky
- Department of Orthopedic Surgery, The University of Toledo, Toledo, Ohio, U.S.A
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Grieshober JA, Palmer JE, Kim H, Jaffe JT, Paryavi E, Hasan SA, Henn RF. Comparison of Curved and Straight Anchor Insertion for Bankart Repair. Orthopedics 2019; 42:e242-e246. [PMID: 30707238 DOI: 10.3928/01477447-20190125-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/10/2018] [Indexed: 02/03/2023]
Abstract
The quality of Bankart repair may be compromised by the presence of glenoid perforation during suture anchor placement. The purpose of this study was to compare the rate of glenoid perforation and biomechanical strength of antero-inferior suture anchors placed with a curved vs a traditional straight technique through an anteroinferior portal. Ten bilateral pairs of fresh human cadaveric shoulders were randomized to either a curved or a straight suture anchor insertion technique. An anteroinferior portal was used to place a 1.5-mm soft anchor in the anteroinferior glenoid (5:30 position for right shoulders). Anatomic dissection was performed, and the maximum load of each anchor was measured using a materials testing system. The overall rate of glenoid perforation by the anteroinferior anchor was 50%. The rate of glenoid perforation was 40% in the straight group and 60% in the curved group (P=.41). The median maximum load was 86 N in the straight group and 137 N in the curved group (P=.23). The median maximum load of the anchors that did perforate the glenoid was 102 N and of those that did not was 118 N (P=.72). The mode of failure was suture anchor pullout in all except one specimen. The curved guide was not superior to the traditional straight guide in terms of the rate of glenoid perforation or the maximum load of the suture anchors. Anterior cortical perforation of the glenoid during anteroinferior suture anchor placement is common with both techniques. [Orthopedics. 2019; 42(2):e242-e246.].
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Arthroscopic Anatomic Glenoid Reconstruction in Lateral Decubitus Position Using Allograft With Nonrigid Fixation. Arthrosc Tech 2018; 7:e1115-e1121. [PMID: 30533357 PMCID: PMC6261065 DOI: 10.1016/j.eats.2018.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/20/2018] [Indexed: 02/03/2023] Open
Abstract
Recurrent shoulder instability is highly associated with glenoid bone loss. Traditionally, bony procedures to address this bone loss have described nonanatomic, coracoid transfer procedures. More recently, anatomic glenoid reconstruction procedures have been described. These were first described as open procedures, and subsequently there have been several arthroscopic procedures described. We provide a description of an arthroscopic anatomic glenoid reconstruction approach with allograft.
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Min K, Fedorka C, Solberg MJ, Shaha SH, Higgins LD. The cost-effectiveness of the arthroscopic Bankart versus open Latarjet in the treatment of primary shoulder instability. J Shoulder Elbow Surg 2018; 27:S2-S9. [PMID: 29307674 DOI: 10.1016/j.jse.2017.11.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 11/06/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to conduct a cost-effectiveness analysis of the arthroscopic Bankart and the open Latarjet in the treatment of primary shoulder instability. METHODS This cost-effectiveness study used a Markov decision chain and Monte-Carlo simulation. Existing literature was reviewed to determine the survivorship and complication rates of these procedures. Health utility states (EQ-5D and quality-adjusted life-years) of the Bankart and Latarjet were prospectively collected. Using these variables, the Monte-Carlo simulation was modeled 100,000 times. RESULTS In reviewing the literature, the overall recurrence rate is 14% after the arthroscopic Bankart and 8% after the open Latarjet. Postoperative health utility states were equal between the 2 procedures (mean EQ-5D, 0.930; P = .775). The Monte-Carlo simulation showed that the Bankart had an incremental cost-effectiveness ratio of $4214 and the Latarjet had an incremental cost-effectiveness ratio of $4681 (P < .001). CONCLUSION Both the arthroscopic Bankart and open Latarjet are highly cost-effective; however, the Bankart is more cost-effective than the Latarjet, primarily because of a lower health utility state after a failed Latarjet. Ultimately, the clinical scenario may favor Latarjet (ie, critical glenoid bone loss) in certain circumstances, and decisions should be made on a case by case basis.
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Affiliation(s)
- Kyong Min
- Boston Shoulder Institute, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Muriel J Solberg
- Boston Shoulder Institute, Brigham and Women's Hospital, Boston, MA, USA
| | - Steven H Shaha
- Center for Public Policy & Administration, Institute for Integrated Outcomes, Salt Lake City, UT, USA
| | - Laurence D Higgins
- Boston Shoulder Institute, Brigham and Women's Hospital, Boston, MA, USA.
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Abdelshahed MM, Shamah SD, Mahure SA, Mollon B, Kwon YW. Cryopreserved bone allograft for the treatment of shoulder instability with glenoid defect. J Orthop 2018; 15:248-252. [PMID: 29657478 DOI: 10.1016/j.jor.2018.01.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 01/13/2018] [Indexed: 01/26/2023] Open
Abstract
The purpose of this study was to examine outcomes after cryopreserved tri-cortical iliac crest allograft reconstruction for glenoid bone loss in patients with shoulder instability. 10 patients completed the required assessments at a mean follow up of 4.5 years. At final follow up, mean ASES was 92 ± 12, mean WOSI was 315 ± 319, with good range of motion. None of the final radiographs demonstrated graft resorption or failure of hardware. The data demonstrated that patients who were treated with glenoid bone grafting with cryopreserved tri-cortical iliac crest allograft can expect good range of motion and functional capacity.
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Affiliation(s)
- Mina M Abdelshahed
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - Steven D Shamah
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - Siddharth A Mahure
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - Brent Mollon
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - Young W Kwon
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
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Variability of Outcome Reporting Following Arthroscopic Bankart Repair in Adolescent Athletes: A Systematic Review. Arthroscopy 2018; 34:1288-1294. [PMID: 29373288 DOI: 10.1016/j.arthro.2017.10.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/15/2017] [Accepted: 10/15/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To conduct a systematic review of the literature to assess the variability of the reporting of outcome measures after arthroscopic Bankart repair for traumatic anterior shoulder instability in the adolescent population. METHODS A systematic review was conducted investigating all studies reporting outcomes after arthroscopic Bankart repair in the adolescent population. Four databases (Medline, EMBASE, Ovid, and Google Scholar) were screened for clinical studies involving the arthroscopic management of anterior shoulder instability in adolescents. A full-text review of eligible studies was conducted. Inclusion and exclusion criteria were applied to the searched studies. A quality assessment was completed for each included study using the Methodological Index for Nonrandomized Studies instrument and the Center for Evidence-Based Medicine's Levels of Evidence Scale. RESULTS We identified 8 eligible studies involving 274 patients (282 shoulders). There was considerable variation with regard to reported outcomes after arthroscopic Bankart repair for anterior shoulder instability in the adolescent population. The most common patient-reported outcomes included the Rowe Score (50%), Single Assessment Numeric Evaluation (37.5%), American Shoulder and Elbow Surgeons Shoulder Outcome Score (25%), and the Constant Score (25%). Clinical outcomes reported included recurrence (100%), return to sport (62.5%), patient satisfaction (37.5%), stability (37.5%), pain scores (37.5%), and range of motion (12.5%). CONCLUSIONS There is considerable variation in reported clinical outcome measurements after arthroscopic Bankart repair for traumatic shoulder instability in the adolescent population. This study supports the need for standardized outcome reporting after arthroscopic anterior shoulder instability surgery in adolescents. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Mahure SA, Mollon B, Capogna BM, Zuckerman JD, Kwon YW, Rokito AS. Risk factors for recurrent instability or revision surgery following arthroscopic Bankart repair. Bone Joint J 2018; 100-B:324-330. [DOI: 10.1302/0301-620x.100b3.bjj-2017-0557.r1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aims The factors that predispose to recurrent instability and revision stabilization procedures after arthroscopic Bankart repair for anterior glenohumeral instability remain unclear. We sought to determine the rate and risk factors associated with ongoing instability in patients undergoing arthroscopic Bankart repair for instability of the shoulder. Materials and Methods We used the Statewide Planning and Research Cooperative System (SPARCS) database to identify patients with a diagnosis of anterior instability of the shoulder undergoing arthroscopic Bankart repair between 2003 and 2011. Patients were followed for a minimum of three years. Baseline demographics and subsequent further surgery to the ipsilateral shoulder were analyzed. Multivariate analysis was used to identify independent risk factors for recurrent instability. Results A total of 5719 patients were analyzed. Their mean age was 24.9 years (sd 9.3); 4013 (70.2%) were male. A total of 461 (8.1%) underwent a further procedure involving the ipsilateral shoulder at a mean of 31.5 months (sd 23.8) postoperatively; 117 (2.1%) had a closed reduction and 344 (6.0%) had further surgery. Revision arthroscopic Bankart repair was the most common subsequent surgical procedure (223; 65.4%). Independent risk factors for recurrent instability were: age < 19 years (odds ratio 1.86), Caucasian ethnicity (hazard ratio 1.42), bilateral instability of the shoulder (hazard ratio 2.17), and a history of closed reduction(s) prior to the initial repair (hazard ratio 2.45). Revision arthroscopic Bankart repair was associated with significantly higher rates of ongoing persistent instability than revision open stabilization (12.4% vs 5.1%, p = 0.041). Conclusion The incidence of a further procedure being required in patients undergoing arthroscopic Bankart repair for anterior glenohumeral instability was 8.1%. Younger age, Caucasian race, bilateral instability, and closed reduction prior to the initial repair were independent risk factors for recurrent instability, while subsequent revision arthroscopic Bankart repair had significantly higher rates of persistent instability than subsequent open revision procedures. Cite this article: Bone Joint J 2018;100-B:324–30.
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Affiliation(s)
- S. A. Mahure
- NYU Langone Medical Center, Hospital
for Joint Diseases, 333 East 38th Street, New
York, NY 10016, USA
| | | | - B. M. Capogna
- NYU Langone Medical Center, Hospital
for Joint Diseases, 333 East 38th Street, New
York, NY 10016, USA
| | - J. D. Zuckerman
- NYU Langone Medical Center, Hospital
for Joint Diseases, 333 East 38th Street, New
York, NY 10016, USA
| | - Y. W. Kwon
- NYU Langone Medical Center, Hospital
for Joint Diseases, 333 East 38th Street, New
York, NY 10016, USA
| | - A. S. Rokito
- NYU Langone Medical Center, Hospital
for Joint Diseases, 333 East 38th Street, New
York, NY 10016, USA
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Somford MP, Van der Linde JA, Wiegerinck JI, Hoornenborg D, Van den Bekerom MPJ, Van Deurzen DFP. Eponymous terms in anterior shoulder stabilization surgery. Orthop Traumatol Surg Res 2017; 103:1257-1263. [PMID: 28942024 DOI: 10.1016/j.otsr.2017.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 05/21/2017] [Accepted: 07/10/2017] [Indexed: 02/02/2023]
Abstract
UNLABELLED Shoulder dislocation and its treatment are probably as old as time. Surgical treatment has gained acceptance recently, especially in recurrent cases. Within roughly the last 100years, numerous treatment strategies have been developed and questions elucidated regarding the entity of shoulder instability. Shoulder instability holds many eponymous terms. By means of literature and historical research, we present the biographical background of some common eponymous terms and the original publication on which those terms are based. We describe the Perthes lesion, Bankart lesion and repair, Hill-Sachs lesion, Bristow-Latarjet procedure and Eden-Hybbinette procedure. Shoulder instability has been recognized and treated for many centuries. Before the invention of X-rays and the ability to intervene surgically, empirical reduction and time were the only feasible treatment options. Understanding of the pathophysiology of this problem and its corresponding treatment has kept increasing since the 19th century. The originators involved still have their name attached to the different signs and procedures. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- M P Somford
- Department of Orthopedic Surgery, Rijnstate Hospital Arnhem, Wagnerlaan 55, 6814AD Arnhem, Netherlands.
| | - J A Van der Linde
- Department of Orthopedic Surgery, OLVG Hospital Amsterdam, Netherlands
| | - J I Wiegerinck
- Department of Orthopedic Surgery, AMC Hospital Amsterdam, Netherlands
| | - D Hoornenborg
- Department of Orthopedic Surgery, Slotervaart Hospital Amsterdam, Netherlands
| | | | - D F P Van Deurzen
- Department of Orthopedic Surgery, OLVG Hospital Amsterdam, Netherlands
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33
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Valencia Mora M, Ibán MÁR, Heredia JD, Gutiérrez-Gómez JC, Diaz RR, Aramberri M, Cobiella C. Physical Exam and Evaluation of the Unstable Shoulder. Open Orthop J 2017; 11:946-956. [PMID: 29114336 PMCID: PMC5646139 DOI: 10.2174/1874325001711010946] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/09/2016] [Accepted: 10/28/2016] [Indexed: 01/03/2023] Open
Abstract
Background: The clinical evaluation of the patient with shoulder instability can be challenging. The pathological spectrum ranges from the straightforward “recurrent anterior dislocation” patient to the overhead athlete with a painful shoulder but not clear instability episodes. Advances in shoulder arthroscopy and imaging have helped in understanding the anatomy and physiopathology of the symptoms. The aim of this general article is to summarize the main examination manoeuvres that could be included in an overall approach to a patient with a suspicion of instability. Material and Methods: In order to achieve the above-mentioned objective, a thorough review of the literature has been performed. Data regarding sensibility and specificity of each test have been included as well as a detailed description of the indications to perform them. Also, the most frequent and recent variations of these diagnostic tests are included. Results: Laxity and instability should be considered separately. For anterior instability, a combination of apprehension, relocation and release tests provide great specificity. On the other hand, multidirectional or posterior instability can be difficult to diagnose especially when the main complain is pain. Conclusion: A detailed interview and clinical examination of the patient are mandatory in order to identify a shoulder instability problem. Range of motion of both shoulders, clicking of catching sensations as well as pain, should be considered together with dislocation and subluxation episodes. Specific instability and hyperlaxity tests should be also performed to obtain an accurate diagnosis.
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Knapik DM, Gillespie RJ, Salata MJ, Voos JE. Prevalence and Impact of Glenoid Augmentation in American Football Athletes Participating in the National Football League Scouting Combine. Orthop J Sports Med 2017; 5:2325967117722945. [PMID: 28840148 PMCID: PMC5555500 DOI: 10.1177/2325967117722945] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Bony augmentation of the anterior glenoid is used in athletes with recurrent shoulder instability and bone loss; however, the prevalence and impact of repair in elite American football athletes are unknown. Purpose: To evaluate the prevalence and impact of glenoid augmentation in athletes invited to the National Football League (NFL) Scouting Combine from 2012 to 2015. Study Design: Case series; Level of evidence, 4. Methods: A total of 1311 athletes invited to the NFL Combine from 2012 to 2015 were evaluated for history of either Bristow or Latarjet surgery for recurrent anterior shoulder instability. Athlete demographics, surgical history, imaging, and physical examination results were recorded using the NFL Combine database. Prospective participation data with regard to draft status, games played, games started, and status after the athletes’ first season in the NFL were gathered using publicly available databases. Results: Surgical repair was performed on 10 shoulders in 10 athletes (0.76%), with the highest prevalence in defensive backs (30%; n = 3). Deficits in shoulder motion were exhibited in 70% (n = 7) of athletes, while 40% (n = 4) had evidence of mild glenohumeral arthritis and 80% demonstrated imaging findings consistent with a prior instability episode (8 labral tears, 2 Hill-Sachs lesions). Prospectively, 40% (n = 4) of athletes were drafted into the NFL. In the first season after the combine, athletes with a history of glenoid augmentation were not found to be at significant risk for diminished participation with regard to games played or started when compared with athletes with no history of glenoid augmentation or athletes undergoing isolated shoulder soft tissue repair. After the conclusion of the first NFL season, 60% (n = 6 athletes) were on an active NFL roster. Conclusion: Despite being drafted at a lower rate than their peers, there were no significant limitations in NFL participation for athletes with a history of glenoid augmentation when compared with athletes without a history of shoulder surgery or those with isolated soft tissue shoulder repair. Glenohumeral arthritis and advanced imaging findings of labral tearing and Hill-Sachs lesions in elite American football players with a history of glenoid augmentation did not significantly affect NFL participation 1 year after the combine.
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Affiliation(s)
- Derrick M Knapik
- University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA
| | | | - Michael J Salata
- University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA
| | - James E Voos
- University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA
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Karataglis D, Agathangelidis F. Long Term Outcomes of Arthroscopic Shoulder Instability Surgery. Open Orthop J 2017; 11:133-139. [PMID: 28400881 PMCID: PMC5366388 DOI: 10.2174/1874325001711010133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/13/2016] [Accepted: 04/20/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Anterior shoulder instability has been successfully managed arthroscopically over the past two decades with refined "anatomic" reconstruction procedures involving the use of anchors for the repositioning and re-tensioning of the antero-inferior capsuloligamentous complex, in an effort to recreate its "bumper effect". METHODS Research and online content related to arthroscopic treatment of shoulder instability was reviewed and their results compared. RESULTS The short- and mid-term results of this technique have been very satisfactory. The greatest number of recent reports suggests that long-term results (>5 years follow-up) remain rather satisfactory, especially in the absence of significant glenoid bone loss (>20-25%). In these studies recurrent instability, in the form of either dislocation or subluxation, ranges from 5.1 to over 20%, clinical scores, more than 5 years after the index procedure, remain good or excellent in >80% of patient population as do patient satisfaction and return to previous level of activities. As regards arthroscopic non-anatomic bony procedures (Latarjet or Bristow procedures) performed in revision cases or in the presence of >20-25% bone loss of the anteroinferior aspect of the glenoid, recent reports suggest that their long-term results are very satisfactory both in terms of re-dislocation rates and patient satisfaction. CONCLUSION It appears that even "lege artis" performance of arthroscopic reconstruction decelerates but does not obliterate the degenerative procedure of dislocation arthropathy. The presence and grade of arthritic changes correlate with the number of dislocations sustained prior to the arthroscopic intervention, the number of anchors used and the age at initial dislocation and surgery. However, the clinical significance of radiologically evident dislocation arthropathy is debatable.
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Affiliation(s)
| | - F Agathangelidis
- First Orthopaedic Department, Aristotle University of Thessaloniki, Greece
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Management of an engaging Hill-Sachs lesion: arthroscopic remplissage with Bankart repair versus Latarjet procedure. Knee Surg Sports Traumatol Arthrosc 2016; 24:3793-3800. [PMID: 26044354 DOI: 10.1007/s00167-015-3666-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 05/29/2015] [Indexed: 01/22/2023]
Abstract
PURPOSE This study compared the clinical outcomes of arthroscopic remplissage with Bankart repair and Latarjet operation in patients with a large engaging Hill-Sachs lesion. METHODS Thirty-seven shoulders subjected to arthroscopic remplissage with a Bankart repair (group A) and 35 shoulders subjected to a Latarjet operation (group B), for a large engaging Hill-Sachs lesion without significant glenoid bone loss, were retrospectively evaluated. Each group was followed up for a mean more than 2-year period. RESULTS At the last follow-up, postoperative pain, shoulder mobility, muscle strength, Rowe score, and UCLA score revealed no significant difference between the two groups. The postoperative mean deficit in external rotation at the side (ERs) was 8° ± 23° in group A (P = 0.044). In group B, the mean deficits in ERs, external rotation at 90° of abduction, and internal rotation to the posterior were 10° ± 20°, 7° ± 16°, and 1.9° ± 4°, respectively (P = 0.004, 0.022, and 0.009, respectively). The recurrence rate was 5.4 % (two shoulders) in group A and 5.7 % (two shoulders) in group B (n.s.). The overall complication rate was significantly higher in group B (14.3 %) than in group A (0 %) (P = 0.017). CONCLUSIONS For recurrent anterior shoulder instability with a large engaging Hill-Sachs lesion, both arthroscopic remplissage with Bankart repair and the Latarjet procedure were safe and reliable techniques with a low recurrence rate. However, the Latarjet group had a significantly higher postoperative complication rate than the remplissage group. LEVEL OF EVIDENCE Case-control study, Level III.
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37
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Donohue MA, Brelin AM, LeClere LE. Management of First-Time Shoulder Dislocation in the Contact Athlete. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Radiography remains pivotal to the workup of instability lesions of the shoulder, both in the acute as well as the chronic settings. The goal of radiography is to detect osseous abnormalities and locate them in order to determine the direction of instability. In antero-inferior instability, Hill-Sachs lesions are often visible at radiography and should not be confused with various differential diagnoses, which are usually more laterally located. Bankart lesions are more difficult to detect on conventional radiography, but there are less false positives than for Hill-Sachs lesions. The Garth view represents an excellent radiographic view to detect antero-inferior instability impaction fractures at both the humeral and glenoid sides. Accurate quantification of bony abnormalities and detection of lesions to the soft-tissue stabilizers of the shoulder however require advanced cross-sectional imaging techniques.
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39
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Abstract
Glenohumeral joint instability is usually an intimidating topic for most radiologists due to both the complexity of related anatomical and biomechanical considerations and the increasing number of classifications and acronyms reported in the literature in association with this condition. In this short review, we aim to demystify glenohumeral instability by first focusing on the relevant anatomy and pathophysiology. Second, we will review what the important imaging findings are and how to describe them for the clinician in the most relevant yet simple way. The role of the radiologist in assessing glenohumeral instability lesions is to properly describe the stabilizing structures involved (bone, soft-tissue stabilizers, and their periosteal insertion) to localize them and to attempt to characterize them as acute or chronic. Impaction fractures on the glenoid and humeral sides are important to specify, locate, and quantify. In particular, the description of soft-tissue stabilizers should include the status of the periosteal insertion of the capsulo-labro-ligamentous complex. Finally, any associated cartilaginous or rotator cuff tendon lesion should be reported to the clinician.
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40
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Burns DM, Chahal J, Shahrokhi S, Henry P, Wasserstein D, Whyne C, Theodoropoulos J, Ogilvie-Harris D, Dwyer T. Diagnosis of Engaging Bipolar Bone Defects in the Shoulder Using 2-Dimensional Computed Tomography: A Cadaveric Study. Am J Sports Med 2016; 44:2771-2777. [PMID: 27496905 DOI: 10.1177/0363546516655797] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anatomic studies have demonstrated that bipolar glenoid and humeral bone loss have a cumulative effect on shoulder instability and that these defects may engage in functional positions depending on their size and location, potentially resulting in failure of stabilization procedures. Determining which lesions pose a risk for engagement remains challenging, with arthroscopic assessments and a 3-dimensional computed tomography (CT)-based glenoid track method being accepted approaches at this time. PURPOSE The purpose was to investigate the interaction of humeral and glenoid bone defects on shoulder engagement in a cadaveric model. Two alternative approaches to predicting engagement were evaluated: (1) CT of the shoulder in abduction and external rotation (ABER) and (2) measurement of the glenoid lesion width and measurement of a novel parameter, the intact anterior articular angle (IAAA), on conventional 2-dimensional multiplane reformats. STUDY DESIGN Controlled laboratory study. METHODS Hill-Sachs and glenoid defects of varying sizes were created in 12 cadaveric upper limbs, producing 45 bipolar defect combinations. The defect characteristics were assessed using CT with the shoulder in a neutral position. ABER CT was performed with the shoulder positioned in 60° of glenohumeral abduction (corresponding to 90° of abduction relative to the trunk) and 90° of external rotation. The IAAA was measured as the cartilage arc angle anterior to the Hill-Sachs defect on the axial slice bisecting the humeral head. The performance of the ABER CT and IAAA approaches to predicting engagement were compared with the glenoid track method. RESULTS Of the 45 defect combinations, 24 (53%) were classified as engaging using the glenoid track method. ABER CT predicted engagement accurately in 43 of 45 (96%), with a sensitivity and specificity of 92% and 100%, respectively. A logistic model based on the glenoid defect width and IAAA provided a prediction accuracy of 87%, with a sensitivity and specificity of 92% and 81%, respectively. CONCLUSION/CLINICAL RELEVANCE Bipolar lesions at risk for engagement can be identified accurately using an ABER CT scan or by performing 2-dimensional measurements of the glenoid defect width and IAAA on conventional CT multiplane reformats. This information will be useful for surgical planning in the setting of bipolar bone defects before shoulder stabilization.
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Affiliation(s)
- David M Burns
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jaskarndip Chahal
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Orthopedic Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - Shahram Shahrokhi
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Orthopedic Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Henry
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Orthopedic Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - David Wasserstein
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Orthopedic Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Cari Whyne
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - John Theodoropoulos
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Orthopedic Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - Darrell Ogilvie-Harris
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Orthopedic Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - Tim Dwyer
- Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Orthopedic Sports Medicine Program, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
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41
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Luo TD, Poehling GG, Freehill MT. Review of Arciero's article (1994) on arthroscopic Bankart repair versus non-operative treatment for acute, initial anterior shoulder dislocations: does the same hold true in 2016? J ISAKOS 2016. [DOI: 10.1136/jisakos-2016-000091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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42
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Cvetanovich GL, Hamamoto JT, Campbell KJ, McCarthy M, Higgins JD, Verma NN. The Use of Accessory Portals in Bankart Repair With Posterior Extension in the Lateral Decubitus Position. Arthrosc Tech 2016; 5:e1121-e1128. [PMID: 28224066 PMCID: PMC5310186 DOI: 10.1016/j.eats.2016.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/09/2016] [Indexed: 02/03/2023] Open
Abstract
The Bankart lesion, in which the anteroinferior labrum is detached from the glenoid, is the critical anatomic lesion in the majority of patients with anterior glenohumeral instability. Some patients with anterior glenohumeral instability will have Bankart lesions with posterior extension beyond the 6-o'clock position, and achieving anatomic labral repair in these cases can present a technical challenge. In our experience, the lateral decubitus position and use of accessory portals allow superior visualization of the inferior half of the glenohumeral joint for glenoid and labral preparation, anchor placement, and suture management. The use of double-loaded suture anchors at the inferior glenoid provides multiple points of fixation at this challenging location while limiting the number of anchors required. The purpose of this article is to present a simple and reproducible technique for arthroscopic repair of Bankart lesions with posterior extension, emphasizing the use of accessory 5-o'clock trans-subscapularis and 7-o'clock portals.
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Affiliation(s)
| | | | | | | | | | - Nikhil N. Verma
- Address correspondence to Nikhil N. Verma, M.D., Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Midwest Orthopaedics at Rush, 1611 W. Harrison St., Suite 300, Chicago, IL 60612, U.S.A.Department of Orthopaedic SurgeryDivision of Sports MedicineRush University Medical CenterMidwest Orthopaedics at Rush1611 W. Harrison St.Suite 300ChicagoIL60612U.S.A.
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43
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Somford MP, Nieuwe Weme RA, van Dijk CN, IJpma FFA, Eygendaal D. Are eponyms used correctly or not? A literature review with a focus on shoulder and elbow surgery. ACTA ACUST UNITED AC 2016; 21:163-71. [DOI: 10.1136/ebmed-2016-110453] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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44
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Bakshi NK, Jameel OF, Merrill ZF, Debski RE, Sekiya JK. The Influence of Surgical Stabilization on Glenohumeral Abduction Using 3-Dimensional Computed Tomography in Patients With Shoulder Instability. Arthroscopy 2016; 32:1495-501. [PMID: 27020394 DOI: 10.1016/j.arthro.2016.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 12/01/2015] [Accepted: 01/13/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE This study compared the amount of glenohumeral abduction during arm abduction in the affected and unaffected shoulders of 3 groups of patients with shoulder instability: failed surgical stabilization, successful surgical stabilization, and unstable shoulder with no prior surgical intervention. METHODS All patients underwent bilateral shoulder computed tomography scans in 3 positions: 0° of abduction and 0° of external rotation (0-0 position), 30° of abduction and 30° of external rotation (30-30 position), and arms maximally abducted (overhead position). Three-dimensional computed tomography reconstruction was performed for both shoulders in all 3 positions. A specialized coordinate system marked specific points and directions on the humerus and glenoid of each model. These coordinates were used to calculate the glenohumeral abduction for the normal and affected sides in the 0-0, 30-30, and overhead positions. RESULTS Thirty-nine patients with shoulder instability were included, of whom 14 had failed surgical repairs, 10 had successful surgical repairs, and 15 had unstable shoulders with no prior surgical intervention. In the overhead position, patients with failed surgical intervention had significantly less glenohumeral abduction in the failed shoulder (95.6° ± 12.7°) compared with the normal shoulder (101.5° ± 12.4°, P = .02). Patients with successfully stabilized shoulders had significantly less glenohumeral abduction in the successfully stabilized shoulder (93.6° ± 10.8°) compared with the normal shoulder (102.1° ± 12.5°, P = .03). Unstable shoulders with no prior surgical intervention (102.1° ± 10.3°) did not differ when compared with the normal shoulders (101.9° ± 10.9°, P = .95). CONCLUSIONS Surgical intervention, regardless of its success, limits the amount of abduction at the glenohumeral joint. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Neil K Bakshi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Omar F Jameel
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Zachary F Merrill
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Richard E Debski
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Jon K Sekiya
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A..
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45
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Antunes JP, Mendes A, Prado MH, Moro OP, Miró RL. Arthroscopic Bankart repair for recurrent shoulder instability: A retrospective study of 86 cases. J Orthop 2016; 13:95-9. [PMID: 27053840 DOI: 10.1016/j.jor.2016.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 02/08/2016] [Indexed: 11/18/2022] Open
Abstract
The purpose of our study was to retrospectively evaluate the outcomes of arthroscopic Bankart repair in 86 patients, who met the inclusion criteria of at least one episode of shoulder dislocation, with a minimum follow-up of one year. Outcome was measured by the use of Western Ontario Shoulder Instability (WOSI) score. At the end of our study, the recurrence rate was 7%. Young age (p = 0.016) and ligamentous laxity (p = 0.003) were associated with recurrence. Arthroscopic Bankart repair is a reliable treatment method, with good clinical outcomes. Patients with younger age or with ligamentous laxity were at the greatest risk of recurrence.
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Affiliation(s)
- João P Antunes
- Department of Orthopaedic Surgery, Santa Cristina University Hospital, Madrid, Spain
| | - António Mendes
- Department of Orthopaedic Surgery, Santa Cristina University Hospital, Madrid, Spain
| | - Miguel H Prado
- Department of Orthopaedic Surgery, Santa Cristina University Hospital, Madrid, Spain
| | - Olga P Moro
- Department of Orthopaedic Surgery, Santa Cristina University Hospital, Madrid, Spain
| | - Rafael L Miró
- Department of Orthopaedic Surgery, Santa Cristina University Hospital, Madrid, Spain
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46
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Taverna E, Garavaglia G, Ufenast H, D'Ambrosi R. Arthroscopic treatment of glenoid bone loss. Knee Surg Sports Traumatol Arthrosc 2016; 24:546-56. [PMID: 26658567 DOI: 10.1007/s00167-015-3893-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/19/2015] [Indexed: 01/19/2023]
Abstract
Recurrent anterior instability of the glenohumeral joint has long been an arduous problem to solve surgically, owing to its difficulty to the need to restore both osseous and dynamic constraints in the unstable shoulder. Biomechanical studies have indicated that glenoid bone loss shortens the safe arc through which the glenoid can resist axial forces; in these cases, a soft tissue repair alone may be insufficient to maintain stability. Clinical studies have confirmed that major bone loss is associated with an unfavourable outcome. The benefits of using arthroscopic procedures for surgical stabilization of the shoulder include smaller incisions and less soft tissue dissection, better access for repair and, potentially, the maximum respect for the undamaged anatomical structures. The biggest disadvantage of arthroscopic procedures until recently was the inability to successfully treat a significant bone defect. Over the last 10 years, several new arthroscopic techniques have been developed, providing new surgical options for successfully treating soft tissues and bony lesions in anterior-inferior glenohumeral instability. Level of evidence V.
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Affiliation(s)
- Ettore Taverna
- U.O. Chirurgia della Spalla II, Istituto Ortopedico Galeazzi, Milan, Italy
| | - Guido Garavaglia
- Upper Limb Unit, Department of Surgery, OBV, Mendrisio, Switzerland
| | - Henri Ufenast
- Upper Limb Unit, Department of Surgery, OBV, Mendrisio, Switzerland
| | - Riccardo D'Ambrosi
- U.O. Chirurgia della Spalla II, Istituto Ortopedico Galeazzi, Milan, Italy. .,Universtià degli Studi di Milano, Milan, Italy.
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Dauzère F, Faraud A, Lebon J, Faruch M, Mansat P, Bonnevialle N. Is the Latarjet procedure risky? Analysis of complications and learning curve. Knee Surg Sports Traumatol Arthrosc 2016; 24:557-63. [PMID: 26792565 DOI: 10.1007/s00167-015-3900-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 11/23/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this study was to analyse the learning curve and complication rate of the open Latarjet procedure. METHODS The first 68 Latarjet procedures performed by a single surgeon for chronic anterior shoulder instability were reviewed retrospectively. The standard open surgical technique was followed faithfully during each procedure. Post-operative complications were taken from patient medical records. Post-operative evaluation consisted of clinical and radiological assessments. RESULTS The rate of early (<3 months) clinical complications was 7.4 % (5.9 % haematoma, 1.5 % neurological deficit), and the delayed complication rate was 7.3 %. Early complication rate, duration of surgery (mean 65 min; 35-135) and hospital stay (mean 3 days; 1-4) were significantly reduced as experience increased (respectively; P = 0.03, ρ = - 0.3; P = 0.009, ρ = - 0.3; P < 0.0001, ρ = - 0.6). On the radiographs, the bone block was healed and in perfect position in 87 % of cases, with no effect of surgical experience (P = 0.3, ρ = 0.1). The rate of complications on radiographs was 17 %: 11 % partial lysis, 2 % complete lysis and 4 % non-union. No recurrence of instability was found after an average follow-up of 21 months. CONCLUSION Despite a high rate of post-operative complications, the morbidity of Latarjet procedure remains low. A surgeon's experience significantly affects the surgery duration and the occurrence of early complications. The main radiological complication is partial lysis of the bone block. After a short learning curve, the clinical outcomes of the Latarjet procedure appear to be satisfactory and reproducible. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Florence Dauzère
- Département de chirurgie Orthopédique, Hôpital Riquet, CHU de Toulouse, Place Baylac, 31059, Toulouse, France
| | - Amélie Faraud
- Département de chirurgie Orthopédique, Hôpital Riquet, CHU de Toulouse, Place Baylac, 31059, Toulouse, France
| | - Julie Lebon
- Département de chirurgie Orthopédique, Hôpital Riquet, CHU de Toulouse, Place Baylac, 31059, Toulouse, France
| | - Marie Faruch
- Service de Radiologie, Hôpital Riquet, CHU de Toulouse, Place Baylac, 31059, Toulouse, France
| | - Pierre Mansat
- Département de chirurgie Orthopédique, Hôpital Riquet, CHU de Toulouse, Place Baylac, 31059, Toulouse, France
| | - Nicolas Bonnevialle
- Département de chirurgie Orthopédique, Hôpital Riquet, CHU de Toulouse, Place Baylac, 31059, Toulouse, France. .,Laboratoire de Biomécanique, IMFT CNRS UMR 5502, Hôpital Riquet, Place Baylac, 31059, Toulouse, France.
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48
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Abstract
PURPOSE The surgical management of shoulder instability is an expanding and increasingly complex area of study within orthopaedics. This article describes the history and evolution of shoulder instability surgery, examining the development of its key principles, the currently accepted concepts and available surgical interventions. METHODS A comprehensive review of the available literature was performed using PubMed. The reference lists of reviewed articles were also scrutinised to ensure relevant information was included. RESULTS The various types of shoulder instability including anterior, posterior and multidirectional instability are discussed, focussing on the history of surgical management of these topics, the current concepts and the results of available surgical interventions. CONCLUSIONS The last century has seen important advancements in the understanding and treatment of shoulder instability. The transition from open to arthroscopic surgery has allowed the discovery of previously unrecognised pathologic entities and facilitated techniques to treat these. Nevertheless, open surgery still produces comparable results in the treatment of many instability-related conditions and is often required in complex or revision cases, particularly in the presence of bone loss. More high-quality research is required to better understand and characterise this spectrum of conditions so that successful evidence-based management algorithms can be developed. LEVEL OF EVIDENCE IV.
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49
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Arthroscopic Repair of a Glenoid Avulsion of the Glenohumeral Ligament. Arthrosc Tech 2015; 4:e795-9. [PMID: 27284513 PMCID: PMC4886453 DOI: 10.1016/j.eats.2015.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/31/2015] [Indexed: 02/03/2023] Open
Abstract
Injury to the glenohumeral capsulolabral complex is the critical lesion in anterior shoulder instability. Various injury patterns have been described including the classic Bankart lesion, the bony Bankart lesion, and humeral avulsion of the glenohumeral ligament. A rare injury variant is a glenoid avulsion of the glenohumeral ligament (GAGL lesion). Careful patient setup and surgical technique are required to identify and arthroscopically repair these lesions. We describe a suture anchor-based arthroscopic GAGL repair performed with the patient in the lateral decubitus position through standard anterior and posterior portals and an accessory posterolateral 7-o'clock portal.
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50
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The Bankart Performance Metrics Combined With a Cadaveric Shoulder Create a Precise and Accurate Assessment Tool for Measuring Surgeon Skill. Arthroscopy 2015; 31:1655-70. [PMID: 26238730 DOI: 10.1016/j.arthro.2015.05.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 05/11/2015] [Accepted: 05/13/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if previously validated performance metrics for an arthroscopic Bankart repair (ABR) coupled with a cadaveric shoulder are a valid assessment tool with the ability to discriminate between the performances of experienced and novice surgeons and to establish a proficiency benchmark for an ABR using a cadaveric shoulder. METHODS Ten master/associate master faculty from an Arthroscopy Association of North America Resident Course (experienced group) were compared with 12 postgraduate year 4 and postgraduate year 5 orthopaedic residents (novice group). Each group was instructed to perform a diagnostic arthroscopy and a 3 suture anchor Bankart repair on a cadaveric shoulder. The procedure was videotaped in its entirety and independently scored in blinded fashion by a pair of trained reviewers. Scoring was based on defined and previously validated metrics for an ABR and included steps, errors, "sentinel" (more serious) errors, and time. RESULTS The inter-rater reliability was 0.92. Novice surgeons made 50% more errors (5.86 v 2.95, P = .013), showed more performance variability (SD, 1.86 v 0.55), and took longer to perform the procedure (45.5 minutes v 25.9 minutes, P < .001). The greatest difference in errors related to suture delivery and management (exclusive of knot tying) (1.95 v 0.45, P = .024). CONCLUSIONS The assessment tool composed of validated arthroscopic Bankart metrics coupled with a cadaveric shoulder accurately distinguishes the performance of experienced from novice orthopaedic surgeons. A benchmark based on the mean performance of the experienced group includes completion of a 3-anchor Bankart repair, and enacting no more than 3 total errors and 1 sentinel error. CLINICAL RELEVANCE Validated procedural metrics combined with the use of a cadaveric shoulder can be used to assess the performance of an ABR. The methodology used may serve as a template for outcomes-based procedural skills training in general.
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