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van der List JP, Waterman BR. Humeral Head Reconstruction of Reverse
Hill-Sachs Lesions. Instr Course Lect 2024; 73:559-571. [PMID: 38090925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Compared with anterior instability, posterior shoulder dislocations are a rare entity and are often missed at presentation. A concomitant anteromedial impression fracture of the humeral head, or a reverse Hill-Sachs lesion, is commonly present with these dislocations and is more pronounced with a longer timeline to reduction. Treatment of these defects ranges from nonsurgical treatment to soft-tissue procedures, bony reconstruction, and arthroplasty. Management may be dictated by various factors, such as patient demands, defect size and location, concomitant injuries, and underlying etiology. Small reverse Hill-Sachs defects without engagement can generally be treated nonsurgically or with benign neglect, whereas larger defects (>20%) often require surgery. The most reported surgical techniques are the (arthroscopic) McLaughlin and modified McLaughlin procedure, disimpaction and bone grafting, or reconstruction of the defect with autograft or with fresh (or fresh-frozen) osteochondral allograft. Finally, arthroplasty is generally required for large defects, where more than 45% to 50% of the articular cartilage is involved. Overall, reported outcomes generally reflect patient satisfaction for most patients, with a low incidence of secondary instability or posttraumatic arthritis, although better results are achieved when recognizing and treating these injuries in the more acute setting.
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Cong T, Charles S, Reddy RP, Fatora G, Fox MA, Barrow AE, Lesniak BP, Rodosky MW, Hughes JD, Popchak AJ, Lin A. Defining Critical Humeral Bone Loss: Inferior Craniocaudal Hill-Sachs Extension as Predictor of Recurrent Instability After Primary Arthroscopic Bankart Repair. Am J Sports Med 2024; 52:181-189. [PMID: 38164666 DOI: 10.1177/03635465231209443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND The glenoid track concept for shoulder instability primarily describes the medial-lateral relationship between a Hill-Sachs lesion and the glenoid. However, the Hill-Sachs position in the craniocaudal dimension has not been thoroughly studied. HYPOTHESIS Hill-Sachs lesions with greater inferior extension are associated with increased risk of recurrent instability after primary arthroscopic Bankart repair. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS The authors performed a retrospective analysis of patients with on-track Hill-Sachs lesions who underwent primary arthroscopic Bankart repair (without remplissage) between 2007 and 2019 and had a minimum 2-year follow-up. Recurrent instability was defined as recurrent dislocation or subluxation after the index procedure. The craniocaudal position of the Hill-Sachs lesion was measured against the midhumeral axis on sagittal magnetic resonance imaging (MRI) using either a Hill-Sachs bisecting line through the humeral head center (sagittal midpoint angle [SMA], a measure of Hill-Sachs craniocaudal position) or a line tangent to the inferior Hill-Sachs edge (lower-edge angle [LEA], a measure of Hill-Sachs caudal extension). Univariate and multivariate regression were used to determine the predictive value of both SMA and LEA for recurrent instability. RESULTS In total, 176 patients were included with a mean age of 20.6 years, mean follow-up of 5.9 years, and contact sport participation of 69.3%. Of these patients, 42 (23.9%) experienced recurrent instability (30 dislocations, 12 subluxations) at a mean time of 1.7 years after surgery. Recurrent instability was found to be significantly associated with LEA >90° (ie, Hill-Sachs lesions extending below the humeral head equator), with an OR of 3.29 (P = .022). SMA predicted recurrent instability to a lesser degree (OR, 2.22; P = .052). Post hoc evaluation demonstrated that LEA >90° predicted recurrent dislocations (subset of recurrent instability) with an OR of 4.80 (P = .003). LEA and SMA were found to be collinear with Hill-Sachs interval and distance to dislocation, suggesting that greater LEA and SMA proportionally reflect lesion severity in both the craniocaudal and medial-lateral dimensions. CONCLUSION Inferior extension of an otherwise on-track Hill-Sachs lesion is a highly predictive risk factor for recurrent instability after primary arthroscopic Bankart repair. Evaluation of Hill-Sachs extension below the humeral equator (inferior equatorial extension) on sagittal MRI is a clinically facile screening tool for higher-risk lesions with subcritical glenoid bone loss. This threshold for critical humeral bone loss may inform surgical stratification for procedures such as remplissage or other approaches for at-risk on-track lesions.
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Affiliation(s)
- Ting Cong
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shaquille Charles
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rajiv P Reddy
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gabrielle Fatora
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael A Fox
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Aaron E Barrow
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bryson P Lesniak
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mark W Rodosky
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jonathan D Hughes
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Adam J Popchak
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Albert Lin
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Barati H, Afzal S. Simultaneous acromioclavicular dislocation, proximal humeral fracture, and reverse Hill-Sachs lesion: a case report. J Med Case Rep 2023; 17:222. [PMID: 37248546 PMCID: PMC10228123 DOI: 10.1186/s13256-023-03966-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND In cases with injuries to the shoulder region, the combination of acromioclavicular joint dislocation, reverse Hill-Sachs lesion, and proximal humeral fracture is a very rare condition. CASE PRESENTATION This study described a 38-year-old male Persian patient with simultaneous acromioclavicular joint dislocation, proximal humeral fracture, and reverse Hill-Sachs lesion due to motor vehicle crash injury who underwent arthroscopic acromioclavicular joint fixation using tight rope technique. In the 7-month follow-up period following the surgical fixation, range of motion was approximately normal. Reduction and hardware were intact, no dislocation or apprehension to dislocation was observed. Patient only had minor shoulder pain at the end of range of motion and a dull pain on the site of incision over the clavicle in deep touch. Our findings showed acceptable arthroscopic outcomes in the management of such complex case. CONCLUSION Our experience on this case showed acceptable outcomes of the arthroscopic treatment of the acromioclavicular joint dislocation in the management of such a complex case with associated injuries to the shoulder region.
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Affiliation(s)
- Hasan Barati
- Department of Orthopedic, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Afzal
- Department of Orthopedic, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Kim SC, Kim KH, Park JH, Bukhary H, Kim IS, Lee SM, Yoo JC. Microinstability characterised by small and easily overlooked anterior labral or Hill-Sachs lesions can be managed with arthroscopic anterior labral repair. Knee Surg Sports Traumatol Arthrosc 2022; 30:3818-3826. [PMID: 35344057 DOI: 10.1007/s00167-022-06941-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Some young individuals present with shoulder pain without a definite history or complaint of instability. However, careful history taking, physical examination, and high-quality magnetic resonance imaging may reveal evidence of instability of which the patient is unaware. Therefore, a clearer definition of these ambiguous patients is needed. This study aimed to report the characteristics and surgical outcomes of patients with microinstability compared to those of patients with classic recurrent anterior shoulder instability. METHODS From 2005 to 2018, 35 patients with microinstability (group M) underwent arthroscopic anterior labral repair (AALR) and were compared to 35 sex- and age-matched patients with classic recurrent anterior shoulder instability (group C) who also underwent AALR. Baseline characteristics, preoperative apprehension test findings, preoperative imaging for the presence of anterior labral and Hill-Sachs lesions, preoperative and postoperative (over 2 years) range of motion (ROM) and functional scores, final complications, and patient satisfaction were analysed. RESULTS The most common chief complaints in groups M and C were pain (29/35) and both pain and instability (27/35), respectively. Only pain during the apprehension test was predominant in group M (M vs. C, 27 vs. 1, p < 0.001). High incidence of chronic repetitive injuries (26/35) and acute trauma (28/35) were observed in groups M and C, respectively. Over half of the patients in group M showed anterior labral lesions on magnetic resonance arthrography (MRA, 18/35), and 21 patients had Hill-Sachs lesions on MRA/three-dimensional computed tomography. Finally, 29 patients showed either anterior labral or Hill-Sachs lesions on preoperative imaging. The lesion severity was higher in group C than that in group M. All patients underwent AALR with/without the remplissage procedure, with no significant differences in final clinical outcomes, complications, and patient satisfaction between the groups. CONCLUSIONS Microinstability is diagnostically challenging and can be diagnosed in young patients with ambiguous shoulder pain during motion, without instability. Pain on anterior apprehension test and subtle labral and/or Hill-Sachs lesion on imaging study could be diagnostic clues. This condition can be managed with arthroscopic anterior labral repair with or without the remplissage procedure. The possibility of microinstability in young patients with shoulder pain should always be considered, and small anterior labral or Hill-Sachs lesions should be closely monitored. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Su Cheol Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Kyoung Ho Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jong Hun Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Hashem Bukhary
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Il Su Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Sang Min Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jae Chul Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
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Nie JB, Jin MC, Fang TS, Li JY. [Bilateral posterior shoulder dislocation with associated reverse Hill-Sachs lesions after electrical injury]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2022; 40:527-529. [PMID: 35915945 DOI: 10.3760/cma.j.cn121094-20210311-00137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
After workers suffer electric shock, the ankylosis and contraction of muscle groups around the shoulder joint are more likely to lead to posterior dislocation and fracture, of which 80% are complicated with reverse Hill-Sachs injury of humeral head. This paper reports a case of bilateral posterior dislocation of shoulder joint combined with Hill-Sachs injury caused by electric shock in the Department of Orthopedics, Affiliated Huzhou Hospital, Zhejiang University School of Medicine in August 2020. The diagnosis of left posterior shoulder dislocation was clear, and the diagnosis of right posterior shoulder dislocation was missed. The patient successfully reconstructed the stability of the shoulder joint by actively performing shoulder arthroscopic surgery to repair the joint capsule. After 6 months of follow-up, there was no further dislocation and the function was good.
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Affiliation(s)
- J B Nie
- Department of Orthopedics, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou 313000, China
| | - M C Jin
- Department of Orthopedics, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou 313000, China
| | - T S Fang
- Department of Orthopedics, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou 313000, China
| | - J Y Li
- Department of Orthopedics, Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou 313000, China
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Saito M, Tasaki A, Nozaki T, Mochizuki T. Two-year follow-up after operative treatment of an osseous Bankart lesion with a flap-detached cartilage lesion of the glenoid: A case report. Acta Orthop Traumatol Turc 2022; 56:152-156. [PMID: 35416169 PMCID: PMC9612653 DOI: 10.5152/j.aott.2022.21271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Glenoid articular cartilage lesion is a rare complication following traumatic anterior dislocation of the shoulder. We report the case of a 14-year-old male rugby player with traumatic anterior shoulder instability, an extensively flapped lesion on the glenoid articular cartilage, and an osseous Bankart lesion. Arthroscopic findings revealed that the glenoid cartilage was flap-detached, extending from the anteroinferior to the center. Repair of the osseous Bankart lesion using suture anchors and resection of the unstable peripheral part of the cartilage was performed arthroscopically. The main region of the injured articular surface was left untouched. During postoperative follow-up, absorption of the glenoid articular surface near the suture anchor holes was identified. Arthroscopic examination three months post-surgery showed that the flap detached lesion of the residual cartilage was stable and appeared adapted on the glenoid surface. The resected area was covered by fibrous tissue. A follow-up computed tomography scan revealed that the osseous lesion was united. The patient returned to his previous sports capacity eight months following the operation. At the 2-year-follow-up, magnetic resonance imaging revealed that the glenoid surface was remodeled to a flattened round shape with no signs of osteoarthritis, exhibiting proper conformity of the joint surfaces to the humeral head. Arthroscopic Bankart repair using suture anchors may cause bone resorption at the glenoid surface, leading to remodeling of the glenoid surface from the damaged glenoid cartilage lesion in young patients.
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Affiliation(s)
- Masayoshi Saito
- Department of Orthopedic Surgery, St. Luke’s International Hospital, Tokyo, Japan
| | - Atsushi Tasaki
- Department of Orthopedic Surgery, St. Luke’s International Hospital, Tokyo, Japan
- Corresponding Author: Atsushi
| | - Taiki Nozaki
- Department of Radiology, St. Luke’s International Hospital, Tokyo, Japan
| | - Tomoyuki Mochizuki
- Department of Orthopaedic Surgery, Tokyo North Medical Center, Tokyo, Japan
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Eberbach H, Jaeger M, Bode L, Izadpanah K, Hupperich A, Ogon P, Südkamp NP, Maier D. Arthroscopic Bankart repair with an individualized capsular shift restores physiological capsular volume in patients with anterior shoulder instability. Knee Surg Sports Traumatol Arthrosc 2021; 29:230-239. [PMID: 32240344 PMCID: PMC8324623 DOI: 10.1007/s00167-020-05952-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 03/23/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Capsular volume reduction in the context of anterior arthroscopic shoulder stabilization represents an important but uncontrolled parameter. The aim of this study was to analyse capsular volume reduction by arthroscopic Bankart repair with an individualized capsular shift in patients with and without ligamentous hyperlaxity compared to a control group. METHODS In the context of a prospective controlled study, intraoperative capsular volume measurements were performed in 32 patients with anterior shoulder instability before and after arthroscopic Bankart repair with an individualized capsular shift. The results were compared to those of a control group of 50 patients without instability. Physiological shoulder joint volumes were calculated and correlated with biometric parameters (sex, age, height, weight and BMI). RESULTS Patients with anterior shoulder instability showed a mean preinterventional capsular volume of 35.6 ± 10.6 mL, which was found to be significantly reduced to 19.3 ± 5.4 mL following arthroscopic Bankart repair with an individualized capsular shift (relative capsular volume reduction: 45.9 ± 21.9%; P < 0.01). Pre-interventional volumes were significantly greater in hyperlax than in non-hyperlax patients, while post-interventional volumes did not differ significantly. The average shoulder joint volume of the control group was 21.1 ± 7.0 mL, which was significantly correlated with sex, height and weight (P < 0.01). Postinterventional capsular volumes did not significantly differ from those of the controls (n.s.). CONCLUSION Arthroscopic Bankart repair with an individualized capsular shift enabled the restoration of physiological capsular volume conditions in hyperlax and non-hyperlax patients with anterior shoulder instability. Current findings allow for individual adjustment and intraoperative control of capsular volume reduction to avoid over- or under correction of the shoulder joint volume. Future clinical studies should evaluate, whether individualized approaches to arthroscopic shoulder stabilization are associated with superior clinical outcome.
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Affiliation(s)
- Helge Eberbach
- Department of Orthopaedic and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - Martin Jaeger
- Department of Orthopaedic and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Lisa Bode
- Department of Orthopaedic and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Kaywan Izadpanah
- Department of Orthopaedic and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Andreas Hupperich
- Department of Orthopaedic and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Peter Ogon
- Center of Orthopaedic Sports Medicine, Breisacher Str. 84, 79110, Freiburg, Germany
| | - Norbert P Südkamp
- Department of Orthopaedic and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Dirk Maier
- Department of Orthopaedic and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
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Sochacki KR, Dillingham MF, Abrams GD, Sherman SL, Donahue J. Humeral Head Osteochondral Allograft Reconstruction with Arthroscopic Anterior Shoulder Stabilization at a Long-Term Follow-Up: A Case Report. JBJS Case Connect 2020; 10:e0555. [PMID: 32649125 DOI: 10.2106/jbjs.cc.19.00555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CASE The authors report a case of recurrent anterior shoulder instability in a 19-year-old man. Intraoperative arthroscopic examination identified Bankart and engaging Hill-Sachs lesions. The patient was treated with humeral head osteochondral allograft reconstruction and concomitant arthroscopic anterior stabilization. At the 14-year follow-up, there was no recurrent instability. CONCLUSION Humeral head osteochondral allograft reconstruction combined with an arthroscopic anterior stabilization procedure can be successful for recurrent shoulder instability and engaging Hill-Sachs lesion.
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Affiliation(s)
- Kyle R Sochacki
- 1Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California
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Elganainy AE, El-Nour MA. Latarjet reconstruction in patients with anterior shoulder instability and significant Hill-Sachs lesion. Acta Orthop Belg 2017; 83:421-427. [PMID: 30423643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Management of glenohumeral instability with large Hill-Sachs lesions remains controversial either to address or just grafting the glenoid rim defects. This study was done to investigate if open Latarjet is sufficient to prevent recurrent instability in patients with significant Hill-Sachs defects without addressing these lesions. In the period between October 2009 and November 2014 twenty three patients with shoulder instability and significant bone loss were treated by open Latarjet. All patients were followed up for a period ranged from 17 to 58 months (median ± SD : 30 ± 13.9).The mean preoperative Rowe score was significantly increased from 45.4 to 91.5 (p value <0,001). At the final follow up there was 17 patients with excellent result, 5 patients with good result and 2 patients with fair result. In conclusion, Latarjet provides a reliable and effective stabilization for anteroinferior glenohumeral instability with significant bone loss and engaging Hill-Sachs lesion.
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Shams A, El-Sayed M, Gamal O, ElSawy M, Azzam W. Modified technique for reconstructing reverse Hill-Sachs lesion in locked chronic posterior shoulder dislocation. Eur J Orthop Surg Traumatol 2016; 26:843-849. [PMID: 27541313 DOI: 10.1007/s00590-016-1825-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Among the uncommon and frequently missed orthopedics injuries is the posterior shoulder dislocation, accounting for about 2-4 % of all shoulder dislocations. Commonly, it is associated with the well-known reverse Hill-Sachs lesion. Several surgical treatment modalities such as transfer of subscapularis tendon or lesser tuberosity, humeral rotational osteotomy, osteochondral grafts were used to repair this defect. Hemiarthroplasty or total shoulder arthroplasty was used as salvage procedure in non-constructable defect or neglected old dislocation. PATIENTS AND METHODS This study included 11 patients with locked chronic posterior shoulder dislocation and reverse Hill-Sachs defects falling in the target range (25-50 % of the head size). The mean age of the patients was 39 (range 31-49) years. Mean time from injury to surgery was 9 (range 3-18) weeks. Open reduction in the dislocated head with the transfer of subscapularis tendon and the attached lesser tuberosity was done to reconstruct the reverse Hill-Sachs defect. The transferred tuberosity was fixed with size 5 Ethibond sutures. RESULTS The mean follow-up period was 29 (range 24-39) months. The median of the scores was much improved, reaching 30 (range 20-34) (satisfactory) compared with preoperative median of 24 (range 20-25) (unsatisfactory). This was statistically highly significant (P = 0.002). Postoperatively, 9 patients had no pain or restricted daily living activities. No patient had symptoms of shoulder instability. According to the modified UCLA shoulder rating scale, there were 4 patients rated excellent, 5 patients rated good, one patient rated fair and one patient rated poor. CONCLUSION Reconstructing the reverse Hill-Sachs defect provides adequate stability, pain relief and function in patients with locked chronic posterior shoulder dislocation and a defect involving 25-50 % of the humeral head. The used technique is simple and cost effective with no need for subsequent hardware removal. LEVEL OF EVIDENCE II.
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Affiliation(s)
| | - Mohamed El-Sayed
- Tanta University, 13 Omar Zafan St., 6th Floor, Tanta, Gharbia, 3111, Egypt.
| | | | | | - Wael Azzam
- Tanta University, 13 Omar Zafan St., 6th Floor, Tanta, Gharbia, 3111, Egypt
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