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Haidar IM, Werthel JD, Hooke AW, Sanchez-Sotelo J, Hardy A. Latarjet Coracoid Transfer Versus Distal Clavicular Autograft for Anterior Shoulder Instability With Glenoid Bone Loss: A Biomechanical Comparison of 2 Graft Reconstructions in Various Medial Positions. Orthop J Sports Med 2025; 13:23259671251320369. [PMID: 40190688 PMCID: PMC11970044 DOI: 10.1177/23259671251320369] [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: 09/17/2024] [Accepted: 09/19/2024] [Indexed: 04/09/2025] Open
Abstract
Background No biomechanical study has established the effect of different graft positions or bone block options on anterior glenohumeral joint stability. Purpose/Hypothesis The purpose of this study was to compare graft choice (distal clavicular vs coracoid autograft for Latarjet) and position on stability of the bone block for anterior glenohumeral instability. It was hypothesized that both grafts would be comparable if flush with the glenoid but that the sling effect of the Latarjet procedure would lead to greater stability in case of graft medialization. Study Design Controlled laboratory study. Methods Eight cadaveric shoulders were included. Defects stabilized using a distal clavicular graft and a coracoid graft were consecutively positioned at 0, 4, and 8 mm medially. The starting position was determined by the humeral head's being seated at its most medial position on the glenoid surface. Each experiment comprised maximal external rotation and glenohumeral abduction at 60° while applying a constant 50-N medial compressive force to the humerus under all conditions. The conjoint tendon was routed through a split in the subscapularis and loaded with a 5-N weight using a pulley system for all Latarjet trials to simulate the sling effect. Results Regarding the clavicular graft, the stability ratio significantly decreased versus the intact condition at all medial offsets (P = .007 for 0 mm, P < .001 for 4 mm, and P < .001 for 8 mm), and it was significantly lower in the 4-mm versus 0-mm position (P = .008), significantly higher in the 4-mm versus 8-mm position (P < .001), and significantly lower in the 8-mm versus 0-mm position (P < .001). Regarding the coracoid graft, the stability ratio was comparable with intact for the 0-mm position (P = .12), while it was significantly lower in the 4-mm and 8-mm positions (P < .001 for both). The distal clavicular graft at 0-mm offset was comparable with the coracoid graft at 0-mm offset. Conclusion In shoulders with anterior glenoid bone loss, the coracoid and distal clavicular autografts were biomechanically comparable when placed flush with the glenoid. The distal clavicle at 0-mm offset did not restore stability compared with the intact specimen, but the Latarjet at 0-mm offset was not significantly different from the intact condition. Clinical Relevance The Latarjet procedure provides higher stability compared with distal clavicular autograft when medialized.
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Affiliation(s)
| | | | - Alexander W. Hooke
- Materials and Structural Testing Core, Mayo Clinic, Rochester, Minnesota, USA
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Belotti N, Fox AS, Henze J, Page RS, Ernstbrunner L, Ackland DC. The Influence of Subscapularis Muscle Split Location on Subscapularis Function After the Latarjet Procedure. Orthop J Sports Med 2025; 13:23259671251329516. [PMID: 40291629 PMCID: PMC12033652 DOI: 10.1177/23259671251329516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 11/22/2024] [Indexed: 04/30/2025] Open
Abstract
Background Splitting the subscapularis in the Latarjet procedure is known to influence subscapularis muscle mechanics postoperatively; however, the influence of split level on postoperative muscle and joint function remains poorly understood. Purpose To assess the effects of midlevel, lower-third, and upper-third subscapularis split levels in the Latarjet procedure on subscapularis lines of action and moment arms in the shoulder abduction, abduction and external rotation (ABER), and apprehension positions. Study Design Controlled laboratory study. Methods The Latarjet procedure was performed on 8 fresh-frozen human cadaveric upper extremities with a simulated 20% anteroinferior glenoid bone defect. A midwidth subscapularis muscle belly split was first performed on all specimens in which the conjoint tendon was routed. Lines of action and moment arms of 4 subregions of the subscapularis muscle (superior, mid-superior, mid-inferior, and inferior) were quantified radiographically with the conjoint tendon unloaded and loaded and the glenohumeral joint positioned in (1) 0° of abduction, (2) 90° of abduction, (3) 90° of abduction and full external rotation (ABER), and (4) the apprehension position, defined as ABER with 30° of horizontal extension. Testing was then repeated in random order after rerouting the conjoint tendon through both an upper- and then lower-third subscapularis split. Utmost care was taken to ensure that the subscapularis muscle integrity was not disrupted during the rerouting process. Results Subscapularis splitting in Latarjet surgery deformed the muscle fibers below the split level, significantly increasing the inferior inclination of subscapularis muscle lines of action, but only for the midlevel and lower-third subscapularis split levels (P < .001). This increased inferior inclination was significantly greater in the ABER and apprehension positions compared with those at 0° and 90° of abduction (P < .05). In the ABER and apprehension positions, the adduction moment arms of the mid-superior subscapularis muscle subregion were also significantly larger for the midlevel split compared with the lower-third and upper-third split (P < .05), indicating greater depressor capacity. Conclusion Latarjet surgery deforms subscapularis muscle fibers below the level of the split, changing subscapularis leverage and line of force. The midlevel subscapularis muscle split in the Latarjet procedure confers greater mechanical advantage in terms of shoulder depressor function and stabilizing potential than that associated with an upper-third or lower-third split, particularly in the ABER and apprehension positions. Clinical Relevance Subscapularis muscle leverage and force potential are significantly influenced by split location in Latarjet surgery. A midlevel subscapularis split is likely to provide the greatest mechanical stability, particularly in positions of shoulder instability.
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Affiliation(s)
- Natalia Belotti
- University of Melbourne, Melbourne, Australia
- Deakin University, Geelong, Australia
| | | | - Janina Henze
- University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Richard S. Page
- University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Lukas Ernstbrunner
- University of Melbourne, Melbourne, Australia
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Australia
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Arce G, Deimundo M, Previgliano JP. "Bankart Repair and Beyond. Anticipating difficulties and managing complications. Current concepts". J Clin Orthop Trauma 2025; 62:102919. [PMID: 39898293 PMCID: PMC11786085 DOI: 10.1016/j.jcot.2025.102919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 01/04/2025] [Accepted: 01/10/2025] [Indexed: 02/04/2025] Open
Abstract
Anterior shoulder instability is a frequent complaint among young athletes. The Arthroscopic Bankart Repair (ABR) is a highly successful technique for restoring the native anatomy after a capsular and labrum avulsion lesion from the glenoid. The procedure has a low complication rate, and a large proportion of patients return to sports at the same pre-injury level. As a reliable surgical technique, ABR is rarely associated with intraoperative complications, but surgical details are critical to avoid struggling during the procedure. Postoperative complications, such as neurovascular injuries, infections, and stiffness, are significant concerns. In the long term, ABR's most common complications are the recurrence of instability and shoulder arthritis after the procedure. This article focuses on 1) the complications of ABR and the critical measures to prevent them, 2) additional techniques that can enhance primary ABR outcomes or address recurrences and failures, and 3) best practices to prevent shoulder arthritis after ABR.
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Affiliation(s)
- Guillermo Arce
- Instituto Argentino de Diagnóstico y Tratamiento IADT, Marcelo T. de Alvear 2439, 1423, Buenos Aires, Argentina
| | - Marcos Deimundo
- Instituto Argentino de Diagnóstico y Tratamiento IADT, Marcelo T. de Alvear 2439, 1423, Buenos Aires, Argentina
| | - Juan Pablo Previgliano
- Instituto Argentino de Diagnóstico y Tratamiento IADT, Marcelo T. de Alvear 2439, 1423, Buenos Aires, Argentina
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Caron J, Walsh K, Zhang T, AlAhmed R, MacDonald PB, Bassi C, Pollock JW, McIlquham K, Lapner P. Approach to shoulder instability: a randomized, controlled trial. JSES Int 2025; 9:290-295. [PMID: 39898192 PMCID: PMC11784472 DOI: 10.1016/j.jseint.2024.09.015] [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: 02/04/2025] Open
Abstract
Background The significant rate of recurrent instability following arthroscopic stabilization surgery points to a need for an evidence-based treatment approach. The instability severity index Score (ISI score) is a point-based algorithm that may be used to assist clinicians in selecting the optimal treatment approach, but its efficacy compared with a traditional treatment algorithm has not been previously validated. The aim was to compare two surgical treatment algorithms: the ISI score and a conventional treatment algorithm (CTA). Methods This was a prospective, randomized controlled trial involving participants who were randomized to either the ISI score or CTA and were followed for 24 months postrandomization. In the ISI score cohort, patients underwent a Latarjet procedure if they presented with a score >3 points. Those scoring ISI score ≦3 points underwent an arthroscopic Bankart repair. Patients randomized to the CTA group underwent a Latarjet procedure if the glenoid bone loss was > 25%. The primary outcome was the Western Ontario Shoulder Instability Index. Secondary outcomes included the American Shoulder and Elbow Surgeons score as well as recurrence rates between groups. Results Sixty-three patients were randomized to ISI score (n = 31) or CTA (n = 32). At two years, the Western Ontario Shoulder Instability Index score was similar between groups (ISI score: 84.1 ± 16.9, CTA: 85.7 ± 12.5, P = .70). Similarly, no differences were detected in American Shoulder and Elbow Surgeons scores (ISI score: 93.2 ± 16.2, CTA: 92.6 ± 9.9, P = .89). Apprehension was reported in 18.5% for the ISI score group and 20% in the CTA group (P = 1.00). At a 24-month follow-up, there was no difference in redislocations: one in ISI score group and none in the CTA group (P = .48). There were two revision surgeries in the ISI score group and two in the CTA group. Conclusion This study did not demonstrate any differences in functional outcomes, the incidence of apprehension, or failure rates between the two treatment algorithms at 24-month follow-up.
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Affiliation(s)
- Julien Caron
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Kellen Walsh
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Tinghua Zhang
- The Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Rashed AlAhmed
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Peter B. MacDonald
- Section of Orthopaedic Surgery & The Pan Am Clinic, Division of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, MB, Canada
| | - Cristina Bassi
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - J Whitcomb Pollock
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Katie McIlquham
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Peter Lapner
- Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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Arenas-Miquelez A, Barco R, Cabo Cabo FJ, Hachem AI. Management of bone loss in anterior shoulder instability. Bone Joint J 2024; 106-B:1100-1110. [PMID: 39348897 DOI: 10.1302/0301-620x.106b10.bjj-2024-0501.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
Bone defects are frequently observed in anterior shoulder instability. Over the last decade, knowledge of the association of bone loss with increased failure rates of soft-tissue repair has shifted the surgical management of chronic shoulder instability. On the glenoid side, there is no controversy about the critical glenoid bone loss being 20%. However, poor outcomes have been described even with a subcritical glenoid bone defect as low as 13.5%. On the humeral side, the Hill-Sachs lesion should be evaluated concomitantly with the glenoid defect as the two sides of the same bipolar lesion which interact in the instability process, as described by the glenoid track concept. We advocate adding remplissage to every Bankart repair in patients with a Hill-Sachs lesion, regardless of the glenoid bone loss. When critical or subcritical glenoid bone loss occurs in active patients (> 15%) or bipolar off-track lesions, we should consider anterior glenoid bone reconstructions. The techniques have evolved significantly over the last two decades, moving from open procedures to arthroscopic, and from screw fixation to metal-free fixation. The new arthroscopic techniques of glenoid bone reconstruction procedures allow precise positioning of the graft, identification, and treatment of concomitant injuries with low morbidity and faster recovery. Given the problems associated with bone resorption and metal hardware protrusion, the new metal-free techniques for Latarjet or free bone block procedures seem a good solution to avoid these complications, although no long-term data are yet available.
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Affiliation(s)
| | - Raul Barco
- La Paz University Hospital, Madrid, Spain
| | - Francisco J Cabo Cabo
- Orthopaedics and Traumatolgy, Hospital Universitario de Bellvitge, Hospitalet de llobregat, Barcelona, Spain
| | - Abdul-Ilah Hachem
- Orthopaedics and Traumatolgy, Hospital Universitario de Bellvitge, Hospitalet de llobregat, Barcelona, Spain
- Shoulder unit, Centro Medico Teknon, Barcelona, Spain
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Mouchantaf M, Bastard C, Corsia S, Métais P, Nourissat G. High Rates of Return to Play and Low Recurrence Rate After Arthroscopic Latarjet Procedure for Anterior Shoulder Instability in Rugby Players. Arthrosc Sports Med Rehabil 2024; 6:100912. [PMID: 38590787 PMCID: PMC10999816 DOI: 10.1016/j.asmr.2024.100912] [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: 08/25/2023] [Accepted: 02/09/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose To analyze the rate of return to play, changes in athletic level, and recurrence rate and to report subjective outcomes in a series of rugby players with anterior shoulder instability who underwent an arthroscopic Latarjet procedure. Methods A multicenter retrospective study done in 2 centers on rugby players who were operated on between January 2011 and December 2020 was performed. Rugby players who underwent arthroscopic Latarjet procedure for anterior shoulder stabilization with a minimum follow-up period of 2 years were included. Rugby players were grouped according to their competitive level in their country (recreational, regional, national, and international). Data collected included return to sport after surgery, time to return to rugby, athletic level before and after surgery, patient satisfaction, and subjective scores. Recurrence and apprehension rates were also evaluated. Results A total of 73 subjects were included. Mean age at time of surgery was 23 ± 5 years. Mean duration of follow-up was 5 ± 2.6 years. Eighty-four percent of rugby players returned to rugby within a mean period of 6.6 months. Initial athletic level was a significant factor (P = .012) for not returning to sport, with 67% of patients who initially played at a recreational level not returning to rugby and 33% of patients who initially played at a regional league level not returning. All national and international players returned to play. Of the 12 non-returning rugby players, only 30% did not return because of their shoulder. Mean Subjective Shoulder Value was 90 ± 9%. Recurrence rate was 7%. Conclusions Arthroscopic Latarjet procedure proved its efficacy in managing recurrent anterior shoulder instability in rugby players. Return to play was achieved in almost all cases, with low recurrence rates. Despite high global return to the same level of sport, the higher the level of competition, the harder it is for rugby players to resume sport at the same level. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Mark Mouchantaf
- Clinique de l’épaule–Paris, Clinique Maussins-Nollet, Ramsay Sante, Paris, France
| | - Claire Bastard
- Service de Chirurgie Orthopedique–Hôpital Saint-Antoine, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Simon Corsia
- Service de Chirurgie Orthopédique–Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
| | | | - Geoffroy Nourissat
- Clinique de l’épaule–Paris, Clinique Maussins-Nollet, Ramsay Sante, Paris, France
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Vopat ML, Hanson JA, Fossum BW, Dey Hazra RO, Peebles AM, Horan MP, Foster MJ, Jildeh TR, Provencher MT, Millett PJ. Outcomes of total shoulder arthroplasty in patients with prior anterior shoulder instability: minimum 5-year follow-up. J Shoulder Elbow Surg 2024; 33:657-665. [PMID: 37573930 DOI: 10.1016/j.jse.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Patients with a history of anterior shoulder instability (ASI) commonly progress to glenohumeral arthritis or even dislocation arthropathy and often require total shoulder arthroplasty (TSA). The purposes of this study were to (1) report patient-reported outcomes (PROs) after TSA in patients with a history of ASI, (2) compare TSA outcomes of patients whose ASI was managed operatively vs. nonoperatively, and (3) report PROs of TSA in patients who previously underwent arthroscopic vs. open ASI management. METHODS Patients were included if they had a history of ASI and had undergone TSA ≥5 years earlier, performed by a single surgeon, between October 2005 and January 2017. The exclusion criteria included prior rotator cuff repair, hemiarthroplasty, or glenohumeral joint infection before the index TSA procedure. Patients were separated into 2 groups: those whose ASI was previously operatively managed and those whose ASI was treated nonoperatively. This was a retrospective review of prospective collected data. Data collected was demographic, surgical and subjective. The PROs used were the American Shoulder and Elbow Surgeons score, Single Assessment Numerical Evaluation score, QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand) score, and 12-item Short Form physical component score. Failure was defined as revision TSA surgery, conversion to reverse TSA, or prosthetic joint infection. Kaplan-Meier survivorship analysis was performed. RESULTS This study included 36 patients (27 men and 9 women) with a mean age of 56.4 years (range, 18.8-72.2 years). Patients in the operative ASI group were younger than those in the nonoperative ASI group (50.6 years vs. 64.0 years, P < .001). Operative ASI patients underwent 10 open and 11 arthroscopic anterior stabilization surgical procedures prior to TSA (mean, 2 procedures; range, 1-4 procedures). TSA failure occurred in 6 of 21 patients with operative ASI (28.6%), whereas no failures occurred in the nonoperative ASI group (P = .03). Follow-up was obtained in 28 of 30 eligible patients (93%) at an average of 7.45 years (range, 5.0-13.6 years). In the collective cohort, the American Shoulder and Elbow Surgeons score, Single Assessment Numerical Evaluation score, QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand) score, and 12-item Short Form physical component score significantly improved, with no differences in the postoperative PROs between the 2 groups. We found no significant differences when comparing PROs between prior open and prior arthroscopic ASI procedures or when comparing the number of prior ASI procedures. Kaplan-Meier analysis demonstrated a 79% 5-year survivorship rate in patients with prior ASI surgery and a 100% survivorship rate in nonoperatively managed ASI patients (P = .030). CONCLUSION At mid-term follow-up, patients with a history of ASI undergoing TSA can expect continued improvement in function compared with preoperative values. However, TSA survivorship is decreased in patients with a history of ASI surgery compared with those without prior surgery.
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Affiliation(s)
- Matthew L Vopat
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA; Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health Systems, Kansas City, KS, USA
| | - Jared A Hanson
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bradley W Fossum
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA; University of Minnesota Medical School, Minneapolis, MN, USA
| | - Rony-Orijit Dey Hazra
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA
| | - Annalise M Peebles
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA
| | - Marilee P Horan
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA
| | - Michael J Foster
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | - Toufic R Jildeh
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | - Matthew T Provencher
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | - Peter J Millett
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA.
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Chen C, Ye T, Jiang J, He W, Xia J, Yang Y. Exploring temporal trends and burden of traumatic shoulder dislocation: a global perspective. Front Public Health 2024; 12:1346957. [PMID: 38487187 PMCID: PMC10937414 DOI: 10.3389/fpubh.2024.1346957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
Objective To explore the geographical and temporal trends of traumatic shoulder dislocation, describe the association between the social and demographic factors and the health burden due to traumatic shoulder dislocation, and further investigate its causes. Methods Data on traumatic shoulder dislocation was collected from the Global Burden of Disease 2019, spanning the years 1990 to 2019. The epidemiology and disease burden were examined at global, regional, and national levels. Additionally, the age and gender patterns were analyzed, followed by an investigation into the primary causes. Lastly, the study studied the correlation between age-standardized rates and the socio-demographic index (SDI). Results Over a span of 30 years, both the crude and age-standardized rates of incidence and years lived with disability (YLDs) rates for all genders displayed a slight fluctuating downward trend. The incidence and YLDs rates in males were consistently higher than those in females. The study analyzed both incidence and YLDs rates of the global, regional, and national of traumatic shoulder dislocations from 1990 to 2019, as well as the temporal trends. Among males, the highest incidence rate was observed in young adulthood, while females exhibited the highest incidence rate in old age. This pattern was mirrored in the YLDs rate. Falls were identified as the main cause contributing to the disease burden related to traumatic shoulder dislocations. Moreover, a positive correlation was found between the age-standardized rates and SDI. Conclusion The disease burden of traumatic shoulder dislocation has not significantly decreased from 1990 to 2019. The incidence and YLD rates are associated with age, gender, and SDI. A thorough examination of the disease burden contributes to the efficient allocation and utilization of resources, as well as the development of targeted and effective intervention strategies.
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Affiliation(s)
- Cheng Chen
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tianbao Ye
- Department of Cardiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiantao Jiang
- Department of Orthopedic Surgery, Shaoxing Shangyu Traditional Chinese Medicine Hospital, Zhejiang, China
| | - Wenbao He
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jiang Xia
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yunfeng Yang
- Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Davey MS, Hurley ET, Kilkenny C, Anakwenze OA, Klifto CS, Mullett H. Long-term outcomes of anterior shoulder instability treated with open latarjet procedure - a systematic review of outcomes at a minimum 15-year follow-up. Shoulder Elbow 2024; 16:8-14. [PMID: 38435043 PMCID: PMC10902406 DOI: 10.1177/17585732221141062] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/22/2022] [Accepted: 11/02/2022] [Indexed: 03/05/2024]
Abstract
Background To systematically review the literature to evaluate the outcomes following an open Latarjet (OL) procedure at a minimum 15-year follow-up. Methods Two independent reviewers performed a literature search using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines using 3 databases. Only studies reporting outcomes of OL procedure with a minimum of 15 years of follow-up were included. Results Nine studies composed of 326 shoulders (78.2% males) in 313 patients were included (average age 26.9 ± 3.2 years (15-58)), with a mean follow-up of 271.9 ± 69.2 months (180-420) At a minimum 15-year follow-up, 93.5% (286 of 306) patients reported being satisfied with their OL procedure, whilst 86.8% (177 of 204) reported good/excellent outcomes at final follow-up. All nine of the included studies reported an overall rate of recurrent instability was 7.7%, with re-dislocations and subluxation at 3.4% and 5.8%, respectively. The rate of surgical revision was 5.15%; 3.5% of cases were revised for recurrent instability. Instability arthropathy was reported across all included studies as 41.0%. Conclusion The OL procedure results in satisfactory clinical outcomes, low rates of recurrent instability and surgical revision at a minimum 15-year follow-up. Although high levels of radiological instability arthropathy and residual pain are found over the same period, these appear stable from a minimum of 10-year follow-up data. Level of Evidence IV; a systematic review of all levels of evidence.
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Affiliation(s)
- Martin S Davey
- Sports Surgery Clinic, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan T Hurley
- Sports Surgery Clinic, Dublin, Ireland
- Duke University Medical Center, Durham, NC, USA
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Jackson GR, Brusalis CM, Schundler SF, Sachdev D, Obioha OA, McCormick JR, Mameri ES, Kaplan DJ, Knapik DM, Chahla J, Verma NN. Isolated Primary Latarjet Procedures for Anterior Shoulder Instability Results in High Rates of Graft Resorption and Glenohumeral Degenerative Changes With Low Rates of Failure at a Minimum 2-Year Follow-Up: A Systematic Review. Arthroscopy 2024; 40:581-591.e1. [PMID: 37270111 DOI: 10.1016/j.arthro.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/14/2023] [Accepted: 05/18/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE To evaluate the incidence of postoperative complications after an isolated primary Latarjet procedure for anterior shoulder instability at a minimum 2-year follow-up. METHODS A systematic review was performed in accordance with 2020 PRISMA guidelines. EMBASE, Scopus, and PubMed databases were queried from database inception through September 2022. The literature search was limited to human clinical studies reporting on postoperative complications and adverse events after a primary Latarjet procedure with a minimum 2-year follow-up. Risk of bias was measured using the Newcastle-Ottawa Scale. RESULTS Twenty-two studies, consisting of 1,797 patients (n = 1,816 shoulders), with a mean age of 24 years were identified. The overall postoperative complication rate ranged from 0% to 25.7%, with the most common complication being persistent shoulder pain (range: 0%-25.7%). Radiological changes included graft resorption (range: 7.5%-100%) and glenohumeral degenerative changes (range: 0%-52.5%). Recurrent instability following surgery was documented in 0% to 35% of shoulders, while the incidence of bone block fractures ranged from 0% to 6% of cases. Postoperative nonunion, infection, and hematomas had a reported incidence rate ranging from 0% to 16.7%, 0% to 2.6%, and 0% to 4.4%, respectively. Overall, 0% to 7.5% of surgeries were reported failures, and 0% to 11.1% of shoulders required reoperation, with a revision rate ranging from 0% to 7.7%. CONCLUSIONS The incidence of complications following the primary Latarjet procedure for shoulder instability was variable, ranging from 0% to 25.7%. High rates of graft resorption, degenerative changes, and nonunion were present while failure and revision rates remained low at a minimum 2-year follow-up. LEVEL OF EVIDENCE Level III, systematic review of Level I-III studies.
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Affiliation(s)
- Garrett R Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Christopher M Brusalis
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Sabrina F Schundler
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Divesh Sachdev
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Obianuju A Obioha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Johnathon R McCormick
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Enzo S Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Instituto Brasil de Tecnologia da Saúde, Rio de Janeiro, Brazil; Department of Orthopedics and Traumatology, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Daniel J Kaplan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University and Barnes-Jewish Orthopedic Center, Chesterfield, Missouri, U.S.A
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
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Kawakami EFKI, Godoy GPD, Cohen MT, Yamada AF, Motta Filho GR, Ejnisman B, Belangero PS. Evaluation of Screws Positioning in Latarjet Surgery: Is There a Correlation between Parallelism to Glenoid and Radiographic Complications? Rev Bras Ortop 2023; 58:e876-e884. [PMID: 38077761 PMCID: PMC10708985 DOI: 10.1055/s-0042-1751110] [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: 03/08/2022] [Accepted: 05/19/2022] [Indexed: 10/17/2022] Open
Abstract
Objective To evaluate whether the parallelism of screws with glenoid in Latarjet surgery interferes in the positioning of the graft and to verify the reproducibility of a method of measuring screws positioning. Methods Retrospective, multicenter study, of patients with anterior shoulder instability submitted to modified Latarjet surgery and at least one year of postoperative follow-up. Two radiologists analyzed the postoperative tomographic images, acquired in a database, to evaluate the positioning of screws and radiographic complications. Results We evaluated 34 patients, aged between 21 and 60 years, one of them with bilateral shoulder involvement, totaling 35 shoulders evaluated. The tomographic evaluation of the inclination angles of the screws showed no difference between the observers. There was intra- and interobserver agreement to evaluate the following surgical parameters: graft position, presence or not of radiographic complications. Conclusion The technique described for measuring the parallelism of screws in Latarjet surgery presented a very good and excellent intra-observer agreement, respectively. Screw parallelism with glenoid is recommended; however, it is not a mandatory and unique condition to avoid radiographic complications.
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Affiliation(s)
- Eduardo Felipe Kin Ito Kawakami
- Médico radiologista do Departamento de Diagnóstico por Imagem, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Gabriel Paris de Godoy
- Médico ortopedista e traumatologista da Disciplina de Medicina Esportiva - Grupo de Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Marcio T. Cohen
- Médico ortopedista e traumatologista do Grupo de Ombro e Cotovelo do Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | - Andre Fukunishi Yamada
- Médico radiologista do Departamento de Diagnóstico por Imagem, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
- Médico radiologista do Hospital do Coração (HCOR), São Paulo, SP, Brasil
| | - Geraldo R. Motta Filho
- Médico ortopedista e traumatologista do Grupo de Ombro e Cotovelo do Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | - Benno Ejnisman
- Chefe da Disciplina de Medicina Esportiva - Grupo de Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Paulo Santoro Belangero
- Chefe da Disciplina de Medicina Esportiva - Grupo de Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
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12
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Min KS, Horng J, Cruz C, Ahn HJ, Patzkowski J. Glenoid Bone Loss in Recurrent Shoulder Instability After Arthroscopic Bankart Repair: A Systematic Review. J Bone Joint Surg Am 2023; 105:1815-1821. [PMID: 37643239 DOI: 10.2106/jbjs.23.00388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Glenoid bone loss has been reported to occur in as many as 86% of patients with recurrent shoulder stability. This systematic review evaluated the amount of glenoid bone loss associated with recurrent shoulder dislocation or subluxation and with worse patient-reported outcomes after arthroscopic Bankart repair. We hypothesized that the percentage of glenoid bone loss associated with recurrent instability after arthroscopic Bankart repair is lower than the previously proposed critical value of 25%. METHODS The systematic review included 528 patients with glenoid bone loss from 3 clinical studies. The percentage of bone loss was the value quantified and reported in each study. Failure was defined as recurrent dislocation or subluxation. The percentage of glenoid bone loss associated with recurrent shoulder dislocation or subluxation after arthroscopic Bankart labral repair was analyzed with receiver operating characteristic (ROC) curve analysis. RESULTS Recurrent dislocation or subluxation occurred in 23.7% (125) of 528 patients in the pooled study cohort. There was a significant difference in age between those in whom the arthroscopic Bankart repair failed and those in whom it did not (22.9 versus 24.3 years; p = 0.009). The ROC curve analysis demonstrated that ≥16.0% glenoid bone loss was predictive of recurrent shoulder dislocation or subluxation (Youden index = 0.59, sensitivity = 80%, specificity = 80%). In patients who did not sustain a recurrent dislocation or subluxation, the ROC curve analysis demonstrated that 20.0% glenoid bone loss was predictive of a Single Assessment Numeric Evaluation (SANE) score of <85% (Youden index = 0.93, sensitivity = 93%, specificity = 100%). CONCLUSIONS The critical amount of glenoid bone loss associated with an increased risk of persistent instability was found to be less than previously reported. Glenoid bone loss of ≥16.0% was found to place patients at higher risk for recurrent shoulder dislocation or subluxation after treatment with arthroscopic Bankart repair alone. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kyong S Min
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii
- Uniformed Services University, Bethesda, Maryland
- John A. Burns School of Medicine, Honolulu, Hawaii
| | | | - Christian Cruz
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii
| | | | - Jeanne Patzkowski
- Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, Texas
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13
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Masud S, Momtaz D, Betsch M, Migliorini F, Ghali A, Popa A, Gouveia K, Leroux T, Degen R, Khan M. A comprehensive comparison and evaluation of surgical techniques for anterior shoulder instability: a Bayesian network meta-analysis. J Shoulder Elbow Surg 2023; 32:e531-e547. [PMID: 37541334 DOI: 10.1016/j.jse.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/27/2023] [Accepted: 07/02/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Anterior shoulder instability is a common clinical problem; however, conflicting evidence exists regarding optimal treatment algorithms. We perform a comparative analysis of stabilization techniques used for recurrent anterior shoulder instability to identify the one associated with the lowest rate of recurrent instability. We additionally explore how glenoid bone loss and osseus lesions affect recurrence rates. METHODS PubMed, MEDLINE, Embase, and Cochrane databases were searched for clinical studies comparing surgical techniques for anterior shoulder instability. Two team members independently assessed all potential studies for eligibility and extracted data. Each included study underwent a risk of bias assessment using the Cochrane risk of bias summary tool. The primary outcome of interest was the rate of recurrent instability, which underwent a Bayesian network meta-analysis. Additional analyses were performed relating to the degree of glenoid bone loss and the presence of osseous lesions. RESULTS Of 2699 studies screened, 52 studies with 4209 patients were included. Patients who underwent open Latarjet demonstrated the overall lowest rate of recurrent instability [log odds ratio (LOR) 1.93], whereas patients who underwent arthroscopic Bankart repair demonstrated the highest (LOR 2.87). When glenoid bone loss was 10% to 20%, open Latarjet had significantly lower recurrent instability (P = .0016) compared to arthroscopic Bankart repair. When glenoid bone loss increased from 0%-10% to 10%-20%, arthroscopic Bankart repair had a significantly increased rate of recurrence (P = .021). In the presence of an engaging Hill-Sachs lesion, both open Latarjet (P = .01) and arthroscopic Bankart with remplissage (P = .029) had significantly reduced recurrence rates compared to arthroscopic Bankart repair. Finally, regardless of procedure, the presence of a Hill-Sachs or bony Bankart lesion was associated with an increased risk of recurrent instability (r = 0.44, P = .0003, and r = 0.40, P = .006, respectively). CONCLUSION The open Latarjet has the overall lowest recurrent instability and significantly lower compared to arthroscopic Bankart repair in the setting of increasing glenoid bone loss. Bone loss between 0% and 10% results in similar outcomes across all procedures.
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Affiliation(s)
- Saad Masud
- Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Hospital Mannheim, Medical Faculty of the University Heidelberg, Mannheim, BW, Germany
| | - Filippo Migliorini
- Department of Orthopaedics and Trauma Surgery, University Hospital RWTH Aachen, Aachen, NW, Germany
| | - Abdullah Ghali
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, USA
| | | | - Kyle Gouveia
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Timothy Leroux
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Ryan Degen
- Division of Orthopaedic Surgery, University of Western Ontario, London, ON, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada.
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14
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Griswold BG, Barker EP, Steflik MJ, Kowalski BL, Parada SA, Galvin JW, Boileau P. The Radius of Curvature of the Inferior Distal Clavicle Is Similar to That of the Glenoid in Both the Axial and Coronal Planes and Similar to the Inferior Coracoid. Arthrosc Sports Med Rehabil 2023; 5:100777. [PMID: 37520505 PMCID: PMC10382879 DOI: 10.1016/j.asmr.2023.100777] [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: 03/13/2023] [Accepted: 06/15/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose The purposes of this study were to use computed tomography (CT) scans to compare the radius of curvature (ROC) of the inferior concave surface of the distal clavicle to the glenoid, determine graft dimensions, and compare the ROC of the congruent-arc distal clavicle autograft (DCA) to the congruent-arc Latarjet graft. Methods Patients who underwent bony glenoid reconstruction via a Laterjet procedure between January 2018 and January 2023 at a single institution were retrospectively identified. CT scans were used to measure the ROC of the glenoid on the axial and coronal sequences, measure the ROC of the distal clavicle on the sagittal oblique sequences, and determine the dimensions of the distal clavicle and coracoid graft. Results A total of 42 patients were included (Latarjet, n = 22; control, n = 20). The mean ROC of the inferior surface of the distal clavicle was not significantly different from the ROC of the glenoid in the coronal (P = .15) or axial planes (P = .65). The ROC of the coracoid when measured in the sagittal plane was not significantly different from the ROC of the distal clavicle (P = .25). The length, depth, and surface area of the coracoid in the congruent arc orientation were significantly larger than the distal clavicle (P < .005). Patients in the control group tended to have both a larger inferior clavicle ROC and a larger coracoid ROC compared to the Latarjet group (32.8 mm vs 29.6 mm, P < .0001; 31.8 mm vs 30.9 mm, P = .02). Conclusions The ROC of the inferior distal clavicle is similar to that of the glenoid in both the axial and coronal planes and similar to the inferior coracoid. Clinical Relevance CT analysis reveals that the congruent-arc DCA technique provides a robust graft with dimensions that are suitable for reconstruction of the anterior glenoid.
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Affiliation(s)
- B. Gage Griswold
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, U.S.A
| | - Elizabeth P. Barker
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, U.S.A
| | - Michael J. Steflik
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, U.S.A
| | - Brooke L. Kowalski
- Department of Orthopaedic Surgery, Madigan Army Community Hospital Orthopedic Clinic Tacoma, Tacoma, Washington, U.S.A
| | - Stephen A. Parada
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, U.S.A
| | - Joseph W. Galvin
- Department of Orthopaedic Surgery, Madigan Army Community Hospital Orthopedic Clinic Tacoma, Tacoma, Washington, U.S.A
| | - Pascal Boileau
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, University of Nice Sophia-Antipolis, Nice, France
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15
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Best MJ, Wang KY, Nayar SK, Agarwal AR, Kreulen RT, Sharma S, McFarland EG, Srikumaran U. Epidemiology of shoulder instability procedures: A comprehensive analysis of complications and costs. Shoulder Elbow 2023; 15:398-404. [PMID: 37538528 PMCID: PMC10395401 DOI: 10.1177/17585732221116814] [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: 04/07/2022] [Revised: 06/24/2022] [Accepted: 07/12/2022] [Indexed: 08/05/2023]
Abstract
Background Recurrent shoulder instability is a debilitating condition that can lead to chronic pain, decreased function, and inability to return to activities or sport. This retrospective epidemiology study was performed to report 90-day postoperative complications and costs of Latarjet, anterior bone block reconstruction, arthroscopic, and open Bankart repair for shoulder instability. Methods Patients 18 years and older who underwent four primary shoulder surgeries from 2010 to 2019 were identified using national claims data. Patient demographics, comorbidities, and 90-day postoperative complications were analyzed using univariate analysis and multivariable logistic regression. Total and itemized 90-day reimbursements were determined for each procedure. Results The 90-day medical and surgery-specific complication rates were highest for anterior bone block reconstruction, followed by Latarjet. Arthroscopic Bankart repair had the highest 90-day costs and primary procedure costs compared to other procedures. Conclusion Anterior bone block reconstruction and Latarjet procedures were associated with the highest rates of 90-day medical and surgery-specific complications, while arthroscopic Bankart repair was associated with the highest costs.
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Affiliation(s)
- Matthew J Best
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Suresh K Nayar
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Amil R Agarwal
- George Washington University School of Medicine, Washington DC, USA
| | - R Timothy Kreulen
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sribava Sharma
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edward G McFarland
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Ernstbrunner L, Robinson DL, Huang Y, Wieser K, Hoy G, Ek ET, Ackland DC. The Influence of Glenoid Bone Loss and Graft Positioning on Graft and Cartilage Contact Pressures After the Latarjet Procedure. Am J Sports Med 2023; 51:2454-2464. [PMID: 37724693 DOI: 10.1177/03635465231179711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Glenohumeral joint contact loading before and after glenoid bone grafting for recurrent anterior instability remains poorly understood. PURPOSE To develop a computational model to evaluate the influence of glenoid bone loss and graft positioning on graft and cartilage contact pressures after the Latarjet procedure. STUDY DESIGN Controlled laboratory study. METHODS A finite element model of the shoulder was developed using kinematics, muscle and glenohumeral joint loading of 6 male participants. Muscle and joint forces at 90° of abduction and external rotation were calculated and employed in simulations of the native shoulder, as well as the shoulder with a Bankart lesion, 10% and 25% glenoid bone loss, and after the Latarjet procedure. RESULTS A Bankart lesion as well as glenoid bone loss of 10% and 25% significantly increased glenoid and humeral cartilage contact pressures compared with the native shoulder (P < .05). The Latarjet procedure did not significantly increase glenoid cartilage contact pressure. With 25% glenoid bone loss, the Latarjet procedure with a graft flush with the glenoid and the humerus positioned at the glenoid half-width resulted in significantly increased humeral cartilage contact pressure compared with that preoperatively (P = .023). Under the same condition, medializing the graft by 1 mm resulted in humeral cartilage contact pressure comparable with that preoperatively (P = .097). Graft lateralization by 1 mm resulted in significantly increased humeral cartilage contact pressure in both glenoid bone loss conditions (P < .05). CONCLUSION This modeling study showed that labral damage and greater glenoid bone loss significantly increased glenoid and humeral cartilage contact pressures in the shoulder. The Latarjet procedure may mitigate this to an extent, although glenoid and humeral contact loading was sensitive to graft placement. CLINICAL RELEVANCE The Latarjet procedure with a correctly positioned graft should not lead to increased glenohumeral joint contact loading. The present study suggests that lateral graft overhang should be avoided, and in the situation of large glenoid bone defects, slight medialization (ie, 1 mm) of the graft may help to mitigate glenohumeral joint contact overloading.
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Affiliation(s)
- Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - Dale L Robinson
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Yichen Huang
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Greg Hoy
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - Eugene T Ek
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
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Lalanne C, Vervoort T, Cassagnaud X, Szymanski C, Bourgault C, Pougès C, Maynou C. Long-term prevalence and impact of glenohumeral osteoarthritis after Latarjet-Patte procedure for anterior instability. Orthop Traumatol Surg Res 2023; 109:103050. [PMID: 34506990 DOI: 10.1016/j.otsr.2021.103050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 02/11/2021] [Accepted: 02/22/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The Latarjet procedure provides satisfactory functional results, with low rates of recurrence. It is, however, sometimes claimed to induce osteoarthritis due to the positioning of the bone-block and hardware. The aims of the present study were to assess the long-term prevalence of osteoarthritis following the procedure, to determine risk factors and assess clinical impact. The study hypothesis was that osteoarthritis risk can be reduced by good bone-block positioning. The secondary objective was to assess long-term recurrence of instability. MATERIALS AND METHODS Out of a cohort of 102 patients (106 shoulders) operated on between 1984 and 1998, 77 had complete radiology files for analysis in a previous study published in 2003. Forty-four of these patients were seen again for clinical and radiological assessment at a mean 22 years' follow-up, to be compared to results previously reported at 8 years. Clinical assessment comprised range of motion and Constant and Walch-Duplay scores. X-rays were taken systematically to determine Samilson osteoarthritis stage; 31 patients also underwent CT. RESULTS In the 44 patients, the rate of osteoarthritis was 34.1%. 90.9% of patients were satisfied. Mean Constant score was 83.5±14 and mean Walch-Duplay score was 71.6±23.4. Advanced age at surgery and at assessment, length of follow-up and age >30 years at first episode of instability were the main factors for onset of osteoarthritis, independently of surgery. Lateral bone-block overhang correlated with onset of osteoarthritis: 71.4%, versus 16.7% in medial or flush bone-block (p=0.0004). Humeral notch, glenoid bone defect and number of preoperative episodes of instability were unrelated to onset of osteoarthritis. Lateral bone-block overhang was the only risk factor related to surgery. The clinical impact of the osteoarthritis was significant only in advanced stages (Samilson 3 and 4). CONCLUSION Lateral bone-block overhang was the only surgical risk factor for osteoarthritis in the long-term. Strict coracoid positioning is therefore essential, and could be facilitated by specific instrumentation and by arthroscopy. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Clément Lalanne
- Orthopédie A, université Lille 2, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France.
| | | | | | - Christophe Szymanski
- Orthopédie A, université Lille 2, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France
| | - Caroline Bourgault
- Orthopédie A, université Lille 2, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France
| | - Cecile Pougès
- Orthopédie A, université Lille 2, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France
| | - Carlos Maynou
- Orthopédie A, université Lille 2, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France
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Lavaill M, Martelli S, Cutbush K, Gupta A, Kerr GK, Pivonka P. Latarjet's muscular alterations increase glenohumeral joint stability: A theoretical study. J Biomech 2023; 155:111639. [PMID: 37245383 DOI: 10.1016/j.jbiomech.2023.111639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/20/2023] [Accepted: 05/10/2023] [Indexed: 05/30/2023]
Abstract
The surgical Latarjet procedure aims to stabilise the glenohumeral joint following anterior dislocations. Despite restoring joint stability, the procedure introduces alterations of muscle paths which likely modify the shoulder dynamics. Currently, these altered muscular functions and their implications are unclear. Hence, this work aims to predict changes in muscle lever arms, muscle and joint forces following a Latarjet procedure by using a computational approach. Planar shoulder movements of ten participants were experimentally assessed. A validated upper-limb musculoskeletal model was utilised in two configurations, i.e., a baseline model, simulating normal joint, and a Latarjet model simulating its related muscular alterations. Muscle lever arms and differences in muscle and joint forces between models were derived from the experimental marker data and static optimisation technique. Lever arms of most altered muscles, hence their role, were substantially changed after Latarjet. Altered muscle forces varied by up to 15% of the body weight. Total glenohumeral joint force increased by up to 14% of the body weight after Latarjet, mostly due to increase in compression force. Our simulation indicated that the Latarjet muscular alterations lead to changes in the muscular recruitment and contribute to the stability of the glenohumeral joint by increasing compression force during planar motions.
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Affiliation(s)
- Maxence Lavaill
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia; Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia.
| | - Saulo Martelli
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia; Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia; Medical Device Research Institute, College of Science and Engineering, Flinders University, Tonsley, SA, Australia
| | - Kenneth Cutbush
- Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia; St Andrew's War Memorial Hospital, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Ashish Gupta
- Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia; Greenslopes Private Hospital, Brisbane, Australia
| | - Graham K Kerr
- Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia; Movement Neuroscience Group, School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Peter Pivonka
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia; Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, Australia
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19
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Kim D, Lee DW, Lee J, Jang Y. Latarjet procedure without capsular repair produces favorable clinical results and avoids limitation in external rotation. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07393-0. [PMID: 36951982 DOI: 10.1007/s00167-023-07393-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE This study aimed at analyzing the range of motion (ROM) and other clinical outcomes in patients with > 20% glenoid bone loss who underwent the Latarjet procedure with or without anterior capsule repair. METHODS This retrospective study included 47 patients with > 20% glenoid bone loss who underwent the classic Latarjet procedure from 2016 to 2021. Of these, 25 did not undergo capsular repair (no-capsular-repair group; group I) whereas 22 patients did (capsular-repair group; group II). The Rowe score, American Shoulder and Elbow Surgeons score, Visual Analogue Scale, ROM, recurrence, and complications were evaluated before and 3, 6, and 12 months after the surgery. A goniometer was used to measure the forward flexion and external rotation (arm adducted, 90° abducted) of both shoulders. The ROM deficit was measured as the difference from the contralateral healthy shoulder. RESULTS The external rotation in arm adduction at 3 and 6 months after surgery showed significantly better results in group I than group II(p = 0.002 at 3 months; p = 0.005 at 6 months). The deficit in external rotation with arm adduction was also significantly lower in group I at 3 months (p = 0.001) and 6 months (p = 0.001) after surgery. However, external rotation with arm adduction at 12 months after surgery did not significantly differ between the groups. Moreover, the ROM in external rotation with 90° arm abduction was significantly better in group I than that in group II at 3, 6, and 12 months postoperatively (p = 0.002, p = 0.001, and p = 0.005, respectively). The deficit in external rotation with 90° arm abduction gradually decreased with time after surgery and differed significantly between the groups. However, the difference in deficit between the two groups at 12 months after surgery did not exceed the measurement error. All clinical scores significantly improved after surgery compared to before surgery; however, the improvement did not significantly differ between the two groups. CONCLUSION The Latarjet procedure without capsular repair showed good laxity restoration and clinical results with less early postoperative external rotation limitation than that achieved by the same procedure with capsular repair. However, external rotation deficit at 1 year after surgery did not show a clinically relevant difference difference between the two groups. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- DooSup Kim
- Department of and Orthopedic Surgery, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, 20 Ilsan-Ro, Wonju, 26426, Republic of Korea
- Yonsei Institute of Sports Science and Exercise Medicine, Wonju, Korea
| | - Dong-Woo Lee
- Department of and Orthopedics, Hanil General Hospital, Seoul, Republic of Korea
| | - JaeMin Lee
- Department of and Orthopedic Surgery, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, 20 Ilsan-Ro, Wonju, 26426, Republic of Korea
| | - YoungHwan Jang
- Department of and Orthopedic Surgery, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University of Korea, 20 Ilsan-Ro, Wonju, 26426, Republic of Korea.
- Yonsei Institute of Sports Science and Exercise Medicine, Wonju, Korea.
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Functional biomechanical comparison of Latarjet vs. distal tibial osteochondral allograft for anterior glenoid defect reconstruction. J Shoulder Elbow Surg 2023; 32:374-382. [PMID: 36206982 DOI: 10.1016/j.jse.2022.08.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/25/2022] [Accepted: 08/28/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Glenoid reconstruction is indicated for recurrent glenohumeral instability with significant glenoid bone deficiency. Coracoid autograft (Latarjet) and distal tibial osteochondral allograft (DTA) reconstructions have been used to successfully restore glenohumeral stability. Relative advantages and disadvantages associated with each reconstruction technique have been described. However, direct comparisons of functional glenohumeral biomechanics associated with Latarjet vs. DTA reconstruction are lacking. This study was designed to compare these 2 glenoid reconstruction techniques with respect to joint kinematics and cartilage pressure mapping using a robotic testing system. METHODS In accordance with institutional review board policies, human cadaveric shoulders (n = 8) were cyclically tested in the neutral position and 90° of external rotation with 60° and 90° of abduction under a 45-N joint-compression load to measure clinically relevant translations, loads, and torques. Joint contact pressure maps were obtained under a 120-N joint-compression load using pressure mapping sensors. After confirming that a 25% anterior glenoid defect resulted in glenohumeral dislocation, testing was performed to compare 3 conditions: native intact glenoid, 25% anterior glenoid defect with Latarjet reconstruction, and 25% anterior glenoid defect with DTA reconstruction. Analyses of variance and t tests were used to analyze data with statistical significance set at P < .05. RESULTS Significant differences in anterior translation, inferior drawer, anterior drawer, compression loads, horizontal abduction, negative elevation (adduction), and external rotation torques during cyclical testing in 90° of external rotation with 60° and/or 90° of abduction were noted when comparing the 2 different glenoid bone reconstruction techniques to native, intact shoulders. The only significant difference between Latarjet and DTA reconstructions for measured translations, loads, and torques was a significantly higher absolute maximum compressive load for Latarjet compared to DTA at 60° of abduction. CONCLUSION Latarjet coracoid osseous autograft and distal tibial osteochondral allograft reconstructions of large (25%) glenoid bone defects prevent failure (dislocation) and are associated with significant glenohumeral kinematic differences that largely confer less translation, load, and torque on the joint in abduction when compared to the native state. These findings suggest that these 2 surgical techniques exhibit similar glenohumeral kinematics such that each provides adequate functional stability following anterior glenoid bone reconstruction. Joint compression load and articular contact pressure distribution may favor distal tibial osteochondral allograft reconstruction for treatment of large (25%) anterior glenoid bone defects associated with shoulder instability.
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Sudah SY, Menendez ME, Moverman MA, Puzzitiello RN, Little D, Nicholson AD, Garrigues GE. The role of the anterior shoulder joint capsule in primary glenohumeral osteoarthritis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:21-27. [PMID: 37588061 PMCID: PMC10426523 DOI: 10.1016/j.xrrt.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The pathogenesis of primary glenohumeral arthritis (GHOA) is mediated by a complex interaction between osseous anatomy and the surrounding soft tissues. Recently, there has been growing interest in characterizing the association between the anterior shoulder joint capsule and primary GHOA because of the potential for targeted treatment interventions. Emerging evidence has shown substantial synovitis, fibrosis, and mixed inflammatory cell infiltrate in the anterior capsule of osteoarthritic shoulders. In addition, increased thickening of the anterior shoulder joint capsule has been associated with greater posterior glenoid wear and humeral head subluxation. While these findings suggest that anterior capsular disease may play a causative role in the etiology and progression of eccentric GHOA, further studies are needed to support this association. The purpose of this article is to review the pathogenesis of primary GHOA, contextualize current hypotheses regarding the role of the anterior capsule in the disease process, and provide directions for future research.
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Affiliation(s)
- Suleiman Y. Sudah
- Department of Orthopedics, Monmouth Medical Center, Long Branch, NJ, USA
| | | | - Michael A. Moverman
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University, Boston, MA, USA
| | - Richard N. Puzzitiello
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University, Boston, MA, USA
| | - Dianne Little
- Department of Basic Medical Sciences and the Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
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Kao JT, Yang CP, Sheu H, Tang HC, Chan YS, Chen ACY, Hsu KY, Weng CJ, Cheng YH, Chiu CH. Recurrent Shoulder Instability after Arthroscopic Bankart Repair in an Elite Baseball Pitcher-A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1635. [PMID: 36422174 PMCID: PMC9694900 DOI: 10.3390/medicina58111635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 01/23/2025]
Abstract
A 16-year-old right-handed male pitcher had a first-time right anterior shoulder dislocation during a baseball game. X-ray and MRI revealed no apparent glenoid bone loss or Hill-Sachs lesion, but an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion with mild posterolateral decompression of the humerus head. His instability severity index score (ISIS score) was 5 with an on-track lesion. He had an arthroscopic Bankart repair using two all-suture anchors and returned to pitching 6 months after the index surgery. However, he had an unstable sensation after 50 pitches during a game one year postoperatively. This time, he presented with a significant Hill-Sachs lesion and a recurrent APLSA lesion. His ISIS score was 6 with an on-tract lesion. During the arthroscopic examination, the previous suture was stable, while anterior capsuloligament tissues were dislodged from sutures, and a Hill-Sachs lesion was observed. This time, a revision arthroscopic Bankart repair and Remplissage procedure were done on him with four double-loaded soft tissue anchors. Pitchers often develop more external rotation in their throwing arm because of a repetitive stretch of the anterior shoulder capsule and ligaments during pitching. The decrease in external rotation after surgery may limit the pitching speed of the pitcher, making a return to play (RTP) more difficult. There is still a paucity of best evidence to revise a failed arthroscopic Bankart repair in the dominant arm of a pitcher. Arthroscopic Bankart repair and Remplissage procedure have gained increasing popularity because they can provide a stable shoulder without harvesting the coracoid. The Latarjet procedure provides a high RTP rate; however, we did not perform it in the revision surgery and decided to revise the Bankart lesion again on its own with a Remplissage procedure, even with his ISIS score being 6 before the revision surgery. A salvage Latarjet procedure is left as a bailout procedure.
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Affiliation(s)
- Jo-Ting Kao
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Cheng-Pang Yang
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Huan Sheu
- Department of Orthopedic Surgery, Taoyuan Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Hao-Che Tang
- Department of Orthopedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Yi-Sheng Chan
- Department of Orthopedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Alvin Chao-Yu Chen
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Kuo-Yao Hsu
- Department of Orthopedic Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan
| | - Chun-Jui Weng
- Department of Orthopedic Surgery, Kaohsiung Municipal Feng-Shan Hospital, Kaohsiung 833, Taiwan
| | - You-Hung Cheng
- Department of Orthopedic Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan
| | - Chih-Hao Chiu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
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Izquierdo-Fernández A, García-Carmona M, Urbano-Luque M, Márquez-Ruiz J, Quevedo-Reinoso R, Minarro JC. Glenohumeral Arthropathy After Arthroscopic Surgery for Shoulder Instability: Outcomes at 16-Year Follow-up. Orthop J Sports Med 2022; 10:23259671221130710. [PMID: 36329951 PMCID: PMC9623374 DOI: 10.1177/23259671221130710] [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: 05/01/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background Glenohumeral arthropathy after surgery for traumatic shoulder instability is a condition whose etiology and long-term course are still unknown. Purpose To evaluate the risk factors for the onset of arthropathy and to assess the relationship between the degree of arthropathy and final outcomes. Study Design Case series; Level of evidence, 4. Methods We included patients who underwent surgery for a shoulder instability at a single institution between 2000 and 2004. The following variables were studied for relationship with functional outcomes: sex, age, body mass index, smoking at the time of surgery, number of episodes of shoulder dislocation, and time from first dislocation to surgery. The number of anchors used and their position were also evaluated. Functional outcomes were assessed using the Constant-Murley, Western Ontario Shoulder Instability Index, and Rowe scores, and results were compared with the onset of arthropathy according to Buscayret classification. Spearman and Pearson correlations were performed for the association between glenohumeral arthritis (Buscayret grade) and the study variables, the Mann-Whitney U test and Student t test were used to compare outcome scores with the study variables, and the Kruskal-Wallis test was used to compare Buscayret grade and outcome scores. Results A total of 26 shoulders in 25 patients were analyzed, finding a high rate (54%) of arthropathy at a minimum follow-up of 16 years. Patients with Buscayret grade 4 had the worst functional results (P = .007). However, 80% of patients with Buscayret grade ≤3 had excellent Constant-Murley scores. A significant relationship was found between degree of arthropathy and patients who were smokers before surgery (P < .01). No relationship was found between the onset of arthropathy and the other variables analyzed. Conclusion Postinstability glenohumeral arthropathy was not correlated with functional outcomes except in those patients with advanced arthroplasty (Buscayret grade 4). A direct relationship was found between smoking before surgery and the onset of glenohumeral arthropathy.
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Affiliation(s)
| | - Manuel García-Carmona
- Orthopaedics and Traumatology Department, University Hospital Reina
Sofía, Córdoba, Spain
| | - Maite Urbano-Luque
- Centro de Experimentación Animal (SAEX), Campus de Rabanales,
University of Cordoba, Córdoba, Spain
| | - Javier Márquez-Ruiz
- Orthopaedics and Traumatology Department, University Hospital Reina
Sofía, Córdoba, Spain
| | - Rafael Quevedo-Reinoso
- Orthopaedics and Traumatology Department, University Hospital Reina
Sofía, Córdoba, Spain
| | - José Carlos Minarro
- Orthopaedics and Traumatology Department, University Hospital Reina
Sofía, Córdoba, Spain.,José Carlos Minarro, MD, PhD, Orthopaedics and Traumatology
Department, University Hospital Reina Sofía, Calle Buenos Aires 5B, 14006,
Córdoba, Spain ()
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Falbo R, Moore A, Singleton A, Steffenson A, Levine J, Miller R. Glenoid bone augmentation: a contemporary and comprehensive systematic review of open procedures. Orthop Rev (Pavia) 2022; 14:37834. [PMID: 36045697 DOI: 10.52965/001c.37834] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction There is a trend towards arthroscopically treating shoulder instability with glenoid deficiency. Despite this, there remains the option for treatment through an open technique. Multiple bone augmentation options are available for recurrent anterior shoulder instability. Objective To provide a systematic review of recent studies for recurrent anterior shoulder instability necessitating glenoid bone augmentation specifically through open procedures using coracoid bone or free bone blocks [iliac crest bone autograft/allograft or distal tibia allograft (DTA)]. Methods PubMed, Cochrane, EMBASE, and Google Scholar were searched for studies reporting open glenoid bone augmentation procedures with iliac crest, tibia, or coracoid bones within 10 years. Extracted data included study/patient characteristics, techniques, prior surgeries, prior dislocations, radiographic findings, range of motion (ROM), recurrent instability, patient-reported outcomes, and complications. Results 92 met inclusion criteria (5693 total patients). Six were studies of iliac crest bone, four of DTA, and 84 using the coracoid bone. 29 studies measured postoperative arthritis showing no development or mild arthritis. 26 studies reported postoperative graft position. 62 studies reported ROM noting decline in internal/external rotation. 87 studies measured postoperative instability with low rates. Rowe Scores with noted improvement across 31/59 (52.5%) studies were seen. Common post operative complications included infection, hematoma, graft fracture, nerve injury, pain, and screw-related irritation. Conclusion Despite a trend towards arthroscopic management of recurrent anterior shoulder instability with glenoid deficiency, open procedures continue to provide satisfactory outcomes. Additionally, studies have demonstrated safe and efficacious use of free bone block graft options in the primary and revision setting.
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Affiliation(s)
- Ryan Falbo
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
| | - Austin Moore
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
| | - Amy Singleton
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
| | | | - Jason Levine
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
| | - Richard Miller
- Orthopedic Surgery, Mercy Health St. Vincent Medical Center
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Vopat ML, Peebles AM, Hanson JA, Powell SN, Mologne MS, Jildeh TR, Foster MJ, Eble SK, Millett PJ, Provencher CAPTMT. Impact of Prior Anterior Instability on Shoulder Arthroplasty Outcomes: A Systematic Review. JSES Int 2022; 6:874-883. [PMID: 36353431 PMCID: PMC9637700 DOI: 10.1016/j.jseint.2022.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Anterior shoulder instability (ASI) is a frequently encountered pathology. Patients with a history of ASI have an increased rate of developing glenohumeral osteoarthritis and becoming candidates for shoulder arthroplasty. This systematic review aims to synthesize outcomes for patients undergoing shoulder arthroplasty with a history of ASI. Methods A comprehensive literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PubMed, Embase, OVID Medline, Scopus, CINAHL, Web of Science, and Cochrane databases for studies evaluating the impact of prior ASI on total shoulder arthroplasty (TSA), reverse TSA, and/or hemiarthroplasty outcomes, with a minimum follow-up of 12 months. Studies were graded by level of evidence and data concerning patient demographics and outcomes were extracted. Results Sixteen articles met the inclusion criteria, including 596 patients (413 male, 181 female). The average age of the control and prior ASI groups were 57.5 and 57.0 years, respectively. Overall, 251 patients were treated operatively, 132 nonoperatively, and 213 were controls without a history of prior ASI. Shoulder arthroplasty techniques included TSA (436 shoulders), reverse TSA (130 shoulders), and hemiarthroplasty (14 shoulders). Prior anterior stabilization management included soft tissue repair, bony augmentation, and nonoperative treatment. Almost all studies reported no significant difference in subjective and functional arthroplasty outcomes between control and prior ASI groups, or between patients with prior ASI treated nonoperatively vs. surgically. Conclusion Shoulder arthroplasty in the setting of prior ASI results in improved subjective and functional outcome scores that are comparable to patients without a history of instability.
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Menon A, Fossati C, Magnani M, Boveri S, Compagnoni R, Randelli PS. Low grade of osteoarthritis development after Latarjet procedure with a minimum 5 years of follow-up: a systematic review and pooled analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2074-2083. [PMID: 34677621 PMCID: PMC9165270 DOI: 10.1007/s00167-021-06771-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/07/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this systematic review and pooled analysis was to evaluate incidence and risk factors for glenohumeral osteoarthritis (OA) in patients who underwent Latarjet procedure with a minimum of 5-year follow-up. METHODS The PRISMA guidelines were followed to perform this systematic review. PubMed and EMBASE were searched up to February 29, 2020 for English, human in vivo studies that evaluated glenohumeral OA in patients undergoing Latarjet procedure at least 5 years after surgery. A pooled analysis on the included databases sent by authors was performed to evaluate the risk factors influencing the development or progression of dislocation arthropathy after the Latarjet procedure. RESULTS Four studies, including a total of 280 patients (213 males and 67 females), were analysed. In our study population, the median age at surgery was 25.0 years (range 20.8-32.6 years). and 92.1% were athletes. In 90% of the cases, the number of dislocations before surgery were fewer than 5. The recurrence of instability after Latarjet procedure was observed only in seven patients (2.5%). The position of the bone graft resulted flush to the anterior glenoid rim in 238 cases (85.3%), medial in 8 (2.9%) and overhanging in 33 (11.8%). Radiological signs of development or progression of shoulder OA were observed in 25.8% of the patients, of which 88.6% presented a grade 1 of OA according to Samilson and Prieto classification. The overhanging position of the bone graft resulted statistically significant for onset or worsening of OA. The age at surgery, the number of dislocations before surgery and the Hill-Sachs lesion were not significantly associated with joint degeneration. Instead, hyperlaxity showed a prevention role in the development of OA after open Latarjet procedure. CONCLUSION The Latarjet procedure is a valid and safe surgical treatment in recurrent anterior shoulder instability with a low risk of developing moderate or severe OA also at long-term follow-up. The overhanging position of the bone graft represents the principal risk factor of joint degeneration, whereas the hyperlaxity seems to be protective. Finally, age, gender, time between first dislocation and surgery, and number of dislocations do not seem to affect the onset of OA after Latarjet procedure. Therefore, an accurate execution of the Latarjet procedure can be considered a valid treatment even in young and athletes thanks to the low recurrence rates and the low development of major long-term complications. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alessandra Menon
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- U.O.C. 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Chiara Fossati
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- U.O.C. 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Mauro Magnani
- U.O.C. 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.
| | - Sara Boveri
- Scientific Directorate, IRCCS Policlinico San Donato, Piazza Malan 1, 20097, Milan, Italy
| | - Riccardo Compagnoni
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- U.O.C. 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Pietro Simone Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- U.O.C. 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
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Jassim SS, Amaranath J, Taylor DM, Warby SA, Hoy G. Unicortical Fixation Does Not Compromise Bony Union in the Latarjet Procedure. JSES Int 2022; 6:555-562. [PMID: 35813149 PMCID: PMC9264013 DOI: 10.1016/j.jseint.2022.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - David McD. Taylor
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
- The Austin Hospital, Melbourne, VIC, Australia
| | - Sarah Ann Warby
- Melbourne Shoulder Group, Melbourne, VIC, Australia
- La Trobe University, Department of Rehabilitation, Nutrition and Sport, Corner of Kingsbury Drive and Plenty Road Bundoora, Melbourne, VIC, Australia
- Corresponding author: Sarah Ann Warby, PhD, B.Physio (Hon), Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
| | - Gregory Hoy
- Melbourne Orthopaedic Group, Melbourne, VIC, Australia
- Monash University, Department of Surgery, Melbourne, VIC, Australia
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Dislocation Arthropathy of the Shoulder. J Clin Med 2022; 11:jcm11072019. [PMID: 35407627 PMCID: PMC8999818 DOI: 10.3390/jcm11072019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 12/04/2022] Open
Abstract
Glenohumeral osteoarthrosis (OA) may develop after primary, recurrent shoulder dislocation or instability surgery. The incidence is reported from 12 to 62%, depending on different risk factors. The risk of severe OA of the shoulder following dislocation is 10 to 20 times greater than the average population. Risk factors include the patient’s age at the first episode of instability or instability surgery, bony lesions, and rotator cuff tears. For mild stages of OA, arthroscopic removal of intraarticular material, arthroscopic debridement, or arthroscopic arthrolysis of an internal rotation contracture might be sufficient. For severe stages, mobilization of the internal rotation contracture and arthroplasty is indicated. With an intact rotator cuff and without a bone graft, results for anatomical shoulder arthroplasty are comparable to those following primary OA. With a bone graft at the glenoidal side, the risk for implant loosening is ten times greater. For the functional outcome, the quality of the rotator cuff is more predictive than the type of the previous surgery or the preoperative external rotation contracture. Reverse shoulder arthroplasty could be justified due to the higher rate of complications and revisions of non-constrained anatomic shoulder arthroplasties reported. Satisfactory clinical and radiological results have been published with mid to long term data now available.
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Cruz CA, Sy J, Miles R, Bottoni CR, Min KS. Surgical treatment of anterior shoulder instability with glenoid bone loss with the Latarjet procedure in active-duty military service members. J Shoulder Elbow Surg 2022; 31:629-633. [PMID: 34537338 DOI: 10.1016/j.jse.2021.08.015] [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: 05/05/2021] [Revised: 08/08/2021] [Accepted: 08/10/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The arthroscopic Bankart repair in the setting of glenoid bone loss has high rates of failure. In patients with anterior glenoid bone loss, the Latarjet provides glenohumeral stability through restoration of the glenoid bone, the conjoint tendon acting as a sling on the subscapularis, and anterior capsulolabral repair. Active-duty military personnel are at high risk for glenohumeral instability and have been equated to the contact athlete; most are young, male, and engage in contact sports. The purpose of this study is to assess the return to full-duty rates in active-duty military personnel following the Latarjet for anterior glenohumeral instability with glenoid bone loss. METHODS A retrospective review of all glenohumeral instability procedures were reviewed at a tertiary training hospital from June 2014 to June 2019. The patient population consisted of active-duty military personnel with glenoid bone loss and anterior glenohumeral instability, who were treated with a Latarjet. The primary outcome was return to full-duty status. RESULTS There were 50 patients identified for the study. Four patients were lost to follow-up, leaving 46 of 50 patients (92.0%) eligible for this study. The average age at the time of the index procedure was 23.1 years. The average percentage bone loss was 18.4%. Forty-one patients (89.1%) were able to return to full-duty status. Four patients (8.7%) sustained a recurrent dislocation following the Latarjet; all 4 dislocations occurred during a combat deployment. Four patients (8.7%) reported episodes of subluxation without dislocation. Forty-one patients (89.1%) reported that their shoulders felt stable, and we found an average return to full duty at 5.3 months CONCLUSION: In our active-duty military cohort, we found an 8.7% rate of recurrent instability after a Latarjet procedure, and 41 patients (89.1%) were able to return to full-duty status. In conclusion, the Latarjet procedure in the active-duty military population with anterior glenoid bone loss resulted in a high rate of return to duty, excellent functional outcomes, low rate of recurrent instability, and a low overall complication rate.
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Affiliation(s)
- Christian A Cruz
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Joshua Sy
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Rebecca Miles
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Craig R Bottoni
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA
| | - Kyong S Min
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI, USA.
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MacDonell RT, Wright L, King JJ. Anterior capsular reconstruction for recurrent anterior shoulder instability: a case report using dermal allograft. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:52-55. [PMID: 37588287 PMCID: PMC10426538 DOI: 10.1016/j.xrrt.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Robert T. MacDonell
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Logan Wright
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Joseph J. King
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
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Haskel JD, Wang KH, Hurley ET, Markus DH, Campbell KA, Alaia MJ, Millett PJ, Jazrawi LM. Clinical outcomes of revision arthroscopic Bankart repair for anterior shoulder instability: a systematic review of studies. J Shoulder Elbow Surg 2022; 31:209-216. [PMID: 34358668 DOI: 10.1016/j.jse.2021.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/12/2021] [Accepted: 06/28/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to review the literature to ascertain the functional outcomes, recurrence rates, and subsequent revision rates following revision arthroscopic Bankart repair. METHODS Two independent reviewers performed a literature search based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using the Embase, MEDLINE, and Cochrane Library databases. Studies in which arthroscopic Bankart repair was performed as a revision procedure were included. The clinical outcomes extracted and analyzed were functional outcomes, return to play, and recurrent instability. RESULTS Fourteen studies with 433 patients met the inclusion criteria. The majority of patients were male patients (63.7%); the average age was 26.1 years (range, 14-58 years), and the mean follow-up period was 37.6 months (range, 10-144 months). The mean Rowe score was 84.2, and 79.7% of patients had good to excellent outcomes. The rate of return to play was 78.5%, with 47.5% of patients returning to their preinjury level of play across 10 studies. The rate of recurrent instability was reported in 12 studies, with 328 shoulders demonstrating 86 instability events (26.2%). The rate of recurrent instability due to dislocation was reported in 7 studies (n = 176), with 19 events (10.8%), whereas the rate of subluxation was reported in 4 studies (n = 76), with 6 events (7.9%). CONCLUSIONS Revision arthroscopic Bankart repair for anterior shoulder instability was shown to result in a high rate of recurrent shoulder instability. There was a relatively poor rate of return to sport among athletes, and only about half of the patients were able to return at or above their preoperative level of ability.
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Affiliation(s)
- Jonathan D Haskel
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.
| | - Karina H Wang
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Eoghan T Hurley
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Danielle H Markus
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Kirk A Campbell
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Michael J Alaia
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | | | - Laith M Jazrawi
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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32
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Oldfield M, Burns J, Wong I. Arthroscopic Glenoid Bone Augmentation Using Iliac Crest Autograft Is Safe and Effective for Anterior Shoulder Instability With Bone Loss. Arthrosc Sports Med Rehabil 2021; 3:e1671-e1677. [PMID: 34977619 PMCID: PMC8689205 DOI: 10.1016/j.asmr.2021.07.023] [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: 02/01/2021] [Accepted: 07/23/2021] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To establish a safety profile for an arthroscopic anatomic glenoid reconstruction using autologous iliac crest bone graft to treat shoulder instability with significant bone loss and to evaluate short-term clinical and radiological outcomes. METHODS A retrospective analysis of prospectively collected data was conducted for the patients who were treated for shoulder instability with bone loss using arthroscopic autologous iliac crest bone graft between November 2014 and June 2018. The safety profile was established by detective intraoperative or postoperative complications such as neurovascular injuries, infections, major bleeding, and subluxations. Short-term clinical and radiologic outcomes also were evaluated. RESULTS Thirteen patients were included in the study. A safety profile was observed, with no occurrence of intraoperative complications, neurovascular injuries, infection, or major bleeding. There were no dislocations or positive apprehension tests on clinical examination postoperatively. Postoperative Western Ontario Shoulder Instability (WOSI) scores were significantly greater than preoperative WOSI scores, with a mean improvement of 35.0 ± 20.2 (P < .001). Twelve patients (92.3%) received postoperative computed tomography scans, with 11 of 12 patients (91.7%) displaying complete graft union. CONCLUSIONS Arthroscopic treatment of shoulder instability with bone loss via autologous iliac crest bone graft is shown to be a safe operative procedure that results in favourable short-term clinical and radiologic outcomes, with a significant improvement in WOSI scores and high rates of graft union. Although graft resorption was seen in most patients who had postoperative computed tomography imaging, there were no instances of clinical graft failure. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Matthew Oldfield
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia Canada
| | - Joseph Burns
- Department of Orthopedics and Shoulder Surgery, Wellstar Medical Group, Alpharetta, Georgia, U.S.A
| | - Ivan Wong
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia Canada
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Mojica ES, Schwartz LB, Hurley ET, Gonzalez-Lomas G, Campbell KA, Jazrawi LM. Posterior glenoid bone block transfer for posterior shoulder instability: a systematic review. J Shoulder Elbow Surg 2021; 30:2904-2909. [PMID: 34298145 DOI: 10.1016/j.jse.2021.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/08/2021] [Accepted: 06/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study is to systematically review the literature and evaluate patient-reported outcomes and complication/revision rates of bone block augmentation in the treatment of posterior shoulder instability (PSI). METHODS PubMed was searched according to PRIMSA guidelines to find clinical studies evaluating patient-reported outcomes, revision, and complication rates in posterior bone block for PSI. A literature search of MEDLINE, EMBASE, and the Cochrane Library was performed based on the PRISMA guidelines. Clinical studies reporting on the complications following posterior bone block were included. RESULTS Overall, 11 studies (level of evidence [LOE] III: 2, LOE IV: 9) met inclusion criteria, with 225 shoulders. Recurrent instability after the posterior bone block was found to be 9.8%. The overall complication rate was 13.8%, with 0.89% having graft complications, 11.1% having hardware complications, 0.4% having wound complications, 0.4% having nerve complications, and 0.89% having other complications. Residual pain was found in 11.6% of shoulders operated on. Patient-reported outcomes were evaluated most commonly by Rowe (81.4%), Constant (84.6%), and Walch-Duplay scores (81.6%). CONCLUSION There is a moderate rate of recurrence following posterior bone block for PSI. However, the patient-reported outcomes are high despite there being commonly reported persistent shoulder pain postoperatively.
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Affiliation(s)
- Edward S Mojica
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA.
| | - Luke B Schwartz
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Eoghan T Hurley
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Guillem Gonzalez-Lomas
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Kirk A Campbell
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Laith M Jazrawi
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
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Ernstbrunner L, Pastor T, Waltenspül M, Gerber C, Wieser K. Salvage Iliac Crest Bone Grafting for a Failed Latarjet Procedure: Analysis of Failed and Successful Procedures. Am J Sports Med 2021; 49:3620-3627. [PMID: 34523379 DOI: 10.1177/03635465211040468] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Latarjet is a successful procedure but can be associated with significant complications, including failure. Iliac crest bone grafting (ICBG) is one of the salvage options for such failure. PURPOSE To analyze factors associated with failure or success to restore shoulder stability with ICBG after Latarjet failure. STUDY DESIGN Case series; Level of evidence, 4. METHODS Twenty consecutive patients with recurrence of instability after a Latarjet procedure underwent revision using ICBG. Sixteen patients (80%) with a mean age of 35.0 years (range, 25-55) could be personally reexamined clinically and radiographically (including computed tomography scan) after a mean follow-up of 4.5 years (range, 2-8). Twelve patients had redislocation and 4 had recurrent subluxation after the Latarjet. RESULTS Salvage ICBG failed in 7 patients because of recurrent dislocations, with 5 necessitating reoperations: 2 arthrodeses, 1 reverse total shoulder arthroplasty, 1 repeat ICBG, and 1 Hill-Sachs allograft reconstruction and Bankart repair. Factors associated with ICBG failure were multidirectional instability (n = 2), subscapularis insufficiency (n = 1), uncontrolled seizures (n = 1), static inferior glenohumeral subluxation (n = 1), total graft resorption (n = 1), and voluntary dislocation attributed to schizoaffective disorder (n = 1). The initial Latarjet graft was malpositioned (too medial) in 3 of these patients. In patients without recurrent instability (n = 9), reasons for Latarjet failure were graft related: 6 graft avulsions, 2 graft resorptions, and 1 medial graft malpositioning. The mean absolute Constant score (62 to 87 points, P = .012) and relative Constant score (66% to 91%, P = .012), pain (10 to 15 points, P < .001), and Subjective Shoulder Value (31% to 85%, P = .011) in the group with a successful procedure were significantly improved over the preoperative state, and the total Western Ontario Shoulder Instability Index averaged 64% at final follow-up. Except in 1 case of major resorption, mild graft resorption or none was observed in successful procedures. Axial and sagittal graft positioning was good in all 9 patients. CONCLUSIONS Salvage ICBG for failed Latarjet procedures failed in 7 of 16 patients. It was successful in patients with clearly graft-related factors of the initial Latarjet procedure. However, patients with unclear instability symptoms, subscapularis insufficiency, inferior subluxation, uncontrolled seizures, or psychological disorders were poor candidates for salvage ICBG, underlining the importance of careful patient selection for the initial Latarjet procedure and for salvage ICBG.
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Affiliation(s)
- Lukas Ernstbrunner
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Torsten Pastor
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Manuel Waltenspül
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christian Gerber
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Tauro TM, Condron NB, Quigley RJ, Bodendorfer BM, Cole BJ. Open Posterior Glenoid Reconstruction Using a Distal Tibial Allograft. VIDEO JOURNAL OF SPORTS MEDICINE 2021; 1:26350254211047999. [PMID: 40309278 PMCID: PMC11894427 DOI: 10.1177/26350254211047999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/23/2021] [Indexed: 05/02/2025]
Abstract
Background Posterior instability is less common than anterior instability but can be seen in contact athletes and posttraumatically. Distal tibial allograft reconstruction for glenoid bone loss was first described by Provencher and colleagues in 2009 and an arthroscopic technique for posterior glenoid reconstruction using a distal tibial allograft was later described by Gupta et al in 2013. Indications The primary indications for posterior distal tibial allograft include the failure of conservative management, recurrent instability after an arthroscopic stabilization, or glenoid bone loss > 20% to 25%. Technique Description The patient is positioned in lateral decubitus, and examination under anesthesia is performed. Following arthroscopic evaluation, an incision is made medial to the posterolateral aspect of the acromion at the glenohumeral joint level. Electrocautery is carried to the deltoid, which is split in line with its fibers. A split between the infraspinatus and teres minor is performed. Vertical capsulotomy is performed, and deep retractors are placed. Attention is turned to the back table for graft preparation. The graft is measured, marked on the lateral aspect of the articular surface, and cut accordingly. Two 3.5-mm holes are drilled 1 cm apart, and the graft is thoroughly irrigated before being placed into the wound. A 2.5-mm drill is used in the 3.5-mm holes, and two 3.5-mm solid fully threaded screws are placed under power and tightened by hand. The wound is closed in the traditional fashion. Results Graft nonunion and/or resorption are the primary concerns following posterior distal tibial allograft. Amar et al found no cases of nonunion or partial unions on 6-month computerized tomography (CT) scan, most patients having no or <50% resorption. Millet et al also found bony union by CT scan and improved patient-reported outcome measures. A case series by Gilat et al found 90% of patients reported restoration of stability. Discussion/Conclusion Posterior distal tibial allograft is a successful surgical intervention for patients with recurrent posterior shoulder instability with glenoid bone loss.
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Affiliation(s)
- Tracy M. Tauro
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Nolan B. Condron
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Ryan J. Quigley
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | | | - Brian J. Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
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Goodrich E, Wolf M, Vopat M, Mok A, Baker J, Bernard C, Tarakemeh A, Vopat B. Sex-specific differences in outcomes after anterior shoulder surgical stabilization: a meta-analysis and systematic review of literature. JSES Int 2021; 6:123-131. [PMID: 35141686 PMCID: PMC8811409 DOI: 10.1016/j.jseint.2021.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Ezra Goodrich
- Corresponding author: Ezra Goodrich, BA, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
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37
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Perret M, Warby S, Brais G, Hinse S, Hoy S, Hoy G. Return to Professional Australian Rules Football After Surgery for Traumatic Anterior Shoulder Instability. Am J Sports Med 2021; 49:3066-3075. [PMID: 34398642 DOI: 10.1177/03635465211029022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The treatment of traumatic anterior shoulder instability in professional Australian Football League (AFL) players is challenging, with an emphasis on early return to play and avoidance of instability recurrence. PURPOSE To investigate return-to-sport (RTS) outcomes and complications after 2 different procedures for traumatic anterior shoulder instability in professional AFL players. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We retrospectively reviewed our surgical database for professional AFL players who underwent capsulolabral stabilization or open Latarjet procedure by a single surgeon between 2006 and 2017. Outcomes included RTS, on-field performance, and complications. Between-group analyses for RTS and complications were estimated using Kaplan-Meier survival analyses. Within-group analyses for on-field performance data were performed using paired t tests with significance set at .05. RESULTS A total of 58 capsulolabral stabilization procedures in 54 players and 32 Latarjet procedures in 29 players were included in the analysis; 93.1% of capsulolabral patients and 96.9% of Latarjet patients returned to professional AFL. The median RTS time was 6.8 months for the capsulolabral group and 7.3 months for the Latarjet group. There was no significant difference in RTS rates between the 2 groups (P = .270). Of those undergoing surgery early in the season, 75% of the capsulolabral and 71% of Latarjet group were able to RTS within the same season, at a mean time of 16.9 weeks and 18.8 weeks, respectively. There was a significant difference in instability recurrence, with 19% for the capsulolabral group and no recurrence in the Latarjet group (P = .017). There was no significant reduction in player on-field performance in either group (P < .05). CONCLUSION In this study, the median RTS in AFL players was approximately 7 months after capsulolabral and Latarjet surgery with no compromise to on-field performance. Instability-related complications occurred only in the capsulolabral group, and the incidence increased with time.
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Affiliation(s)
- Michael Perret
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.,Perth Shoulder Clinic, Bethesda Hospital, Orthopaedic Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Sarah Warby
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.,Melbourne Shoulder Group, Prahran, Victoria, Australia.,Department of Rehabilitation, Nutrition and Sport, La Trobe University, Victoria, Australia
| | - Godefroy Brais
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
| | | | - Sophie Hoy
- Royal Children's Hospital, Parkville, Victoria, Australia
| | - Gregory Hoy
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.,Melbourne Shoulder Group, Prahran, Victoria, Australia.,Department of Surgery, Monash University, Victoria, Australia
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Greenstein AS, Chen RE, Brown AM, Knapp E, Roberts A, Awad HA, Voloshin I. Chondral Damage After Arthroscopic Repair Techniques for Acute Bony Bankart Lesions: A Biomechanical Study. Am J Sports Med 2021; 49:2743-2750. [PMID: 34236920 DOI: 10.1177/03635465211023758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bony Bankart lesions can be encountered during treatment of shoulder instability. Current arthroscopic bony Bankart repair techniques involve intra-articular suture placement, but the effect of these repair techniques on the integrity of the humeral head articular surface warrants further investigation. PURPOSE To quantify the degree of humeral head articular cartilage damage secondary to current arthroscopic bony Bankart repair techniques in a cadaveric model. STUDY DESIGN Controlled laboratory study. METHODS Testing was performed in 13 matched pairs of cadaveric glenoids with simulated bony Bankart fractures, with a defect width of 25% of the glenoid diameter. Half of the fractures were repaired with a double-row technique, while the contralateral glenoids were repaired with a single-row technique. Samples were subjected to 20,000 cycles of internal-external rotation across a 90° arc at 2 Hz after a compressive load of 750 N, or 90% body weight (whichever was less) was applied to simulate wear. Cartilage defects on the humeral head were quantified through a custom MATLAB script. Mean cartilage cutout differences were analyzed by the Wilcoxon rank-sum test. RESULTS Both single- and double-row repairs showed macroscopic damage. The histomorphometric analysis demonstrated that the double-row technique resulted in a significantly (P = .036) more chondral damage (mean, 57,489.1 µm2; SD, 61,262.2 µm2) than the single-row repair (mean, 28,763.5 µm2; SD, 24,4990.2 µm2). CONCLUSION Both single-row and double-row arthroscopic bony Bankart fixation techniques resulted in damage to the humeral head articular cartilage in the concavity-compression model utilized in this study. The double-row fixation technique resulted in a significantly increased cutout to the humeral head cartilage after simulated wear in this cadaveric model. CLINICAL RELEVANCE This study provides data demonstrating that placement of intra-articular suture during arthroscopic bony Bankart repair techniques may harm the humeral head cartilage. While the double-row repair of bony Bankart lesions is more stable, it results in increased cartilage damage. These findings suggest that alternative, cartilage-sparing arthroscopic techniques for bony Bankart repair should be investigated.
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Affiliation(s)
- Alexander S Greenstein
- Department of Orthopaedic Surgery and Rehabilitation, University of Rochester, Rochester, New York, USA
| | - Raymond E Chen
- Department of Orthopaedic Surgery and Rehabilitation, University of Rochester, Rochester, New York, USA
| | - Alexander M Brown
- Department of Orthopaedic Surgery and Rehabilitation, University of Rochester, Rochester, New York, USA
| | - Emma Knapp
- Department of Orthopaedic Surgery and Rehabilitation, University of Rochester, Rochester, New York, USA
| | - Aaron Roberts
- Department of Orthopaedic Surgery and Rehabilitation, University of Rochester, Rochester, New York, USA
| | - Hani A Awad
- Department of Orthopaedic Surgery and Rehabilitation, University of Rochester, Rochester, New York, USA
| | - Ilya Voloshin
- Department of Orthopaedic Surgery and Rehabilitation, University of Rochester, Rochester, New York, USA
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39
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Ali ZS, Hurley ET, Jamal MS, Horan MP, Montgomery C, Pauzenberger L, Millett PJ, Mullett H. Low rate of recurrent instability following the open Latarjet procedure as a revision procedure for failed prior stabilization surgery. Knee Surg Sports Traumatol Arthrosc 2021; 29:2110-2117. [PMID: 32710144 DOI: 10.1007/s00167-020-06155-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/14/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study is to systematically review the literature to ascertain functional outcomes, recurrence rates and subsequent revision rates following the open Latarjet procedure when performed as a revision procedure. METHODS Two independent reviewers performed the literature search based on PRISMA guidelines, utilizing the EMBASE, MEDLINE, and The Cochrane Library Databases. Studies where the Latarjet procedure was performed as a revision procedure were included. Clinical outcomes analyzed were: (1) functional outcomes, (2) recurrent instability, (3) revisions, and (4) complications. RESULTS The review found 16 studies with 713 shoulders that met the inclusion criteria. 605 of the patients were male (84.9%), with an average age of 28.2 years (15-62) and follow-up of 47.7 months. The most commonly reported functional outcome measure was the Rowe score, with a weighted mean of 92.7. 86/95 patients had good-excellent outcomes (90.4%). 136/143 patients reported return to play (95.1%). 141/161 patients returned to the same level of competition (87.6%). 50 patients experienced recurrence (8.4%). Five patients experienced redislocation (0.9%) and 37 patients experienced subluxation (6.7%). There were 29 revisions (5.1%), with 12 revisions due to recurrence (2.1%). There were 68 total complications, not including recurrence (11%). The most common complications were 13 cases of nerve damage and infection respectively (2.1%). There was 17 cases of new instability arthropathy (6.5%), and 31 cases of residual pain (6.7%). CONCLUSION This review shows that the revision Latarjet provides excellent functional outcomes, low rates of recurrence and complications, and a high rate of return to sport among athletes. This results from study can be used to explain the expected outcomes associated with the Latarjet procedure performed as a revision. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Zakariya S Ali
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan T Hurley
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, Ireland. .,Royal College of Surgeons in Ireland, Dublin, Ireland. .,National University of Ireland Galway, Galway, Ireland.
| | - M Shazil Jamal
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Connor Montgomery
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, Ireland
| | - Leo Pauzenberger
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, Ireland
| | | | - Hannan Mullett
- Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
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40
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Rai S, Tamang N, Sharma LK, Marasini RP, Singh JL, Khanal K, Ghimire KC M, Sherchan B. Comparative study of arthroscopic Bankart repair versus open Latarjet procedure for recurrent shoulder dislocation. J Int Med Res 2021; 49:3000605211007328. [PMID: 33845604 PMCID: PMC8047861 DOI: 10.1177/03000605211007328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The primary aim of this study was to compare the clinical outcomes of patients undergoing arthroscopic Bankart repair and the open Latarjet procedure for recurrent dislocation of the shoulder. The secondary aims were to assess and compare the surgical cost, patient satisfaction, and complications, including recurrence and infection. METHODS We retrospectively compared the clinical outcomes of all consecutive patients undergoing either arthroscopic Bankart repair or the open Latarjet procedure from May 2015 to May 2018 with a minimum 2-year follow-up. Forty-one patients (32 men, 9 women) in the Bankart group and 40 patients (34 men, 6 women) in the Latarjet group were available for the final follow-up. RESULTS There were no statistically significant differences in the demographic parameters or clinical outcomes between the two groups. Functional satisfaction was higher with the Latarjet procedure. Bankart repair had a significantly higher operating cost than the Latarjet procedure. Three patients in the Bankart group and no patients in the Latarjet group developed recurrence. CONCLUSION Both procedures provided satisfactory clinical outcomes. However, the Latarjet group had a higher rate of functional satisfaction and lower operating cost, and there was a trend toward higher recurrence in the arthroscopic Bankart group.
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Affiliation(s)
- Saroj Rai
- Department of Orthopedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Nira Tamang
- Department of Nursing, Norvic International Hospital, Kathmandu, Nepal
| | - Laxmi Kanta Sharma
- Department of Orthopedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Rudra Prasad Marasini
- Department of Orthopedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Janith Lal Singh
- Department of Orthopedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Kiran Khanal
- Department of Orthopedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Milan Ghimire KC
- Department of Orthopedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Binod Sherchan
- Department of Orthopedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
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41
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The Influence of Exposure in Training to the Open Bankart on the Declining Current Use of the Procedure. J Am Acad Orthop Surg 2021; 29:e287-e296. [PMID: 33677458 DOI: 10.5435/jaaos-d-20-00368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/03/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE The purpose of this study was to assess the influence of exposure to the open Bankart during residency and fellowship on the trend toward obsolescence of the procedure. Our hypothesis was that the open Bankart would be used with decreasing frequency and that this would be related to lack of exposure to the procedure during training. METHODS A survey consisting of 10 questions about their experience with the open Bankart procedure in residency, fellowship, and practice, as well as their current usage of it and other operations, was sent to members of the American Shoulder and Elbow Surgeons. Respondents were divided into groups based on the year of completion of training. RESULTS Statistical analysis of the responses revealed a notable trend of progressively diminished use of the open Bankart by those trained before 2000 compared with those completing training between 2001 and 2017. Ancillary findings included more surgeons using the open Bankart for revision cases than as a primary procedure and many using the Latarjet for patients with less than 15% or even no glenoid bone loss. CONCLUSION We concluded that a statistically notable trend of the decreasing use of the open Bankart was observed despite excellent reported outcomes and that its current role is most likely as a revision procedure. Lack of exposure to the operation in training is a major factor in its decline, and this decreasing exposure is self-perpetuating. LEVEL OF EVIDENCE Survey.
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Parvaresh KC, Vargas-Vila M, Bomar JD, Pennock AT. Anterior Glenohumeral Instability in the Adolescent Athlete. JBJS Rev 2021; 8:e0080. [PMID: 32015270 DOI: 10.2106/jbjs.rvw.19.00080] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Glenohumeral instability is multifactorial and has both static and dynamic elements. The initial management of first-time dislocations has become increasingly controversial, although recent evidence supports operative treatment for adolescents who participate in contact sports. Risk factors for recurrent glenohumeral instability include adolescent age, hyperlaxity, glenoid bone loss, off-track Hill-Sachs lesions, and fixation with <=3 anchors. High rates of return to sport can be expected when the surgical plan is tailored to individual pathology.
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Affiliation(s)
| | | | | | - Andrew T Pennock
- University of California, San Diego, San Diego, California.,Rady Children's Hospital, San Diego, California
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Achraf O, Abderrazzek R, Talel Z, Saber S, Lotfi N. [The Latarjet procedure in patients with anterior shoulder instability, with outcome depending on coracoid abutment location on radiography]. Pan Afr Med J 2021; 38:215. [PMID: 34046121 PMCID: PMC8140731 DOI: 10.11604/pamj.2021.38.215.21339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/02/2020] [Indexed: 11/11/2022] Open
Abstract
Anterior shoulder instability following traumatic dislocation in young adults is a common complication. The Latarjet procedure is the most widely used technique for treating this instability. It is based on coracoid abutment repair of the anterior edge of the glenoid. However, joint exposure during this surgical technique is often limited and makes it difficult to position the abutment. The purpose of this study was to evaluate the result of coracoid abutment procedure on functional outcome in the short and medium term. We assessed the positioning of the coracoid abutment on standard postoperative X-rays and the functional outcome according to Duplay score as well as the satisfaction rate in 70 patients. The average age of patients was 25 and a half years, the sex-ratio was nine, and the mean follow-up period was 6.5 years. Radiological examination showed that coracoid abutment was in subequatorial or non-flush position with respect to the anterior glenoid rim (too internal or protruding in intra-articular position) in 20% of cases. This group showed a drop in mean stability score by 7.68 points, in pain by 10.04 points and in Duplay's overall score by 13.3 points as well as a significant increase in the level of glenohumeral arthrosis. This study highlights that coracoid abutment in subequatorial or non-flush position has deleterious effect on the functional outcome of the Latarjet procedure.
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Affiliation(s)
- Oueslati Achraf
- Service d´Orthopédie et de Traumatologie, Hôpital Militaire Principale d´Instruction de Tunis, Montfleury, Tunis, Tunisie
| | - Rafrafi Abderrazzek
- Service d´Orthopédie et de Traumatologie, Hôpital Militaire Principale d´Instruction de Tunis, Montfleury, Tunis, Tunisie
| | - Znagui Talel
- Service d´Orthopédie et de Traumatologie, Hôpital Militaire Principale d´Instruction de Tunis, Montfleury, Tunis, Tunisie
| | - Saadi Saber
- Service d´Orthopédie et de Traumatologie, Hôpital Militaire Principale d´Instruction de Tunis, Montfleury, Tunis, Tunisie
| | - Nouisri Lotfi
- Service d´Orthopédie et de Traumatologie, Hôpital Militaire Principale d´Instruction de Tunis, Montfleury, Tunis, Tunisie
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Abstract
The Latarjet procedure is a commonly used treatment for recurrent shoulder instability. However, its neurological complication rate has been reported to be as high as 10%. During the Latarjet procedure, the neurovascular structures are relocated inferiorly and medially. I hypothesized that the risk of nerve injury would be reduced by assisting the inferior-medial relocation of the neurovascular structures intraoperatively. Methods Seventeen consecutive patients with shoulder instability accompanied by glenoid bone loss were treated with an all-arthroscopic Latarjet procedure assisted by the novel low-profile SaSumata (SS) guide. The SS guide is inserted through a portal made above the coracoid process and is attached to the coracoid process by 2 pre-fix screws (i.e., temporary pre-fixation screws). Unlike previous techniques, the SS guide is not shuttled from 1 portal to the other to redirect the bone graft from the donor site to the recipient site; instead, it remains attached to the graft throughout the procedure. The SS guide brings the coracoid graft along an inferior-medial trajectory, pushing aside the neurovascular structures with the help of a switching stick. Owing to its semicircular pronged head, the SS guide holds the graft until the pre-fix screws are exchanged with permanent screws. All patients were clinically assessed and underwent computed tomography (CT) scans. Results This maneuver was performed arthroscopically in 17 patients, with no conversion to open surgery and no neurological injuries. No patient had recurrence of dislocation after follow-up for a minimum of 24 months. The mean Subjective Shoulder Value was 87.5% ± 11.7%. The mean Rowe score was 88 ± 15.7. The bone block was optimally positioned between 3 o'clock and 5 o'clock and was flush with the glenoid facet in 16 of the 17 patients. There was 1 fracture of the bone block. The mean operation time after the first 5 patients was 125 ± 23 minutes. Conclusions The SS guide was a useful tool for performing the arthroscopically assisted Latarjet procedure for recurrent anterior shoulder instability, with good functional results. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Shinji Imai
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan
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11% complications rate after Latarjet procedure at up to 14 years follow-up. Musculoskelet Surg 2021; 106:227-237. [PMID: 33469890 DOI: 10.1007/s12306-021-00697-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Evaluate complications in correlation with radiological findings after an open Latarjet procedure performed on 140 shoulders with recurrent anterior instability with follow-up from 8 to 174 months. METHODS Retrospectively, 140 shoulders, diagnosed with recurrent anterior glenohumeral instability, which were surgically treated with the open Latarjet procedure in our hospital, between January 2004 and November 2017, had been analysed. Mean age of operated patients was 29.5 years. One hundred and twenty-three patients were male (88.5%) and 16 were female (11.5%). Average length of follow-up was 110 months. Radiographs and CT scans of 16 patients with complications had been evaluated and correlations between radiological findings and observed complications had been analysed. RESULTS Complications occurred in 16 shoulders (11%). Rates of individual complications were: 1. persistent pain (9%), 2. limited ROM (7%), 3. recurrent instability (6%), 4. neurologic injury (2%), 5. persistent apprehension (2%), 6. reduced strength (2%), 7. hematoma (1%) and 8. intraoperative coracoid graft fracture (0.8%). Mean postoperative ASES score and ROWE score were statistically significantly lower in the group with complications, compared to the group without complications. Good or excellent results were reported by 87.9% patients. CONCLUSION Open Latarjet procedure is an effective and safe method for the treatment of recurrent shoulder instability, resulting in good to excellent outcomes in 87.9% of our cases. However, it is related to a higher postoperative complication rate compared to some other treatment options. Overall, very good results with high level of patient satisfaction have been demonstrated.
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Verweij LPE, Pruijssen EC, Kerkhoffs GMMJ, Blankevoort L, Sierevelt IN, van Deurzen DFP, van den Bekerom MPJ. Treatment type may influence degree of post-dislocation shoulder osteoarthritis: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:2312-2324. [PMID: 32936334 PMCID: PMC8225537 DOI: 10.1007/s00167-020-06263-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/28/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Age at primary dislocation, recurrence, and glenoid bone loss are associated with development of osteoarthritis (OA). However, an overview of OA following traumatic anterior shoulder instability is lacking and it is unclear to what degree type of surgery is associated with development of OA in comparison to non-operative treatment. The aim of this study was to determine the degree of OA at long-term follow-up after non-operative and operative treatments for patients with anterior shoulder instability. Surgery is indicated when patients experience recurrence and this is associated with OA; therefore, it was hypothesized that shoulders show a higher proportion or degree of OA following operative treatment compared to non-operative treatment. METHODS A literature search was performed in the PubMed/Medline, EMBASE, and Cochrane databases. Articles reporting the degree of OA that was assessed with the Samilson-Prieto or Buscayret OA classification method after non-operative and operative treatment for anterior shoulder instability with a minimum of 5 years follow-up were included. RESULTS Thirty-six articles met the eligibility criteria of which 1 reported the degree of OA for non-operative treatment and 35 reported the degree of OA for 9 different operative procedures. A total of 1832 patients (1854 shoulders) were included. OA proportions of non-operative and operative treatments are similar at any point of follow-up. The Latarjet procedure showed a lower degree of OA compared to non-operative treatment and the other operative procedures, except for the Bristow procedure and Rockwood capsular shift. The meta-analyses showed comparable development of OA over time among the treatment options. An increase in OA proportion was observed when comparing the injured to the contralateral shoulder. However, a difference between the operative subgroups was observed in neither analysis. CONCLUSION Non-operative and operative treatments show similar OA proportions at any point of follow-up. The hypothesis that shoulders showed a higher proportion or degree of OA following operative treatment compared to non-operative treatment is not supported by the data. Operative treatment according to the Latarjet procedure results in a lower degree of OA compared to other treatments, including non-operative treatment. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Lukas P E Verweij
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands.
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Erik C Pruijssen
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
- Specialized Center of Orthopedic Research and Education (SCORE), Xpert Orthopedics, Amsterdam, The Netherlands
| | - Derek F P van Deurzen
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Lowenstein NA, Ostergaard PJ, Haber DB, Garvey KD, Matzkin EG. Sex differences in outcomes after arthroscopic bankart repair. BMJ Open Sport Exerc Med 2020; 6:e000965. [PMID: 33437497 PMCID: PMC7780536 DOI: 10.1136/bmjsem-2020-000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 11/06/2022] Open
Abstract
Objectives Risk factors for anterior shoulder dislocation include young age, contact activities and male sex. The influence of sex on patient-reported outcomes of arthroscopic Bankart repair (ABR) is unclear, with few studies reporting potential differences. This study’s purpose was to compare patient-reported outcomes of males and females following ABR. Methods Prospectively collected data was analysed for 281 patients (males: 206, females: 75) after ABR with preoperative, 1-year and 2-year follow-up responses. The Wilcoxon signed-rank and χ2 tests, preoperative, 1 year and 2 year follow-up results were examined to determine differences of scores in males versus females. Results No statistically significant sex differences were observed in Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), Visual Analogue Scale (VAS) or Single Assessment Numerical Evaluation (SANE) Scores at 1-year or 2-year follow-up. Females had lower Veterans RAND 12-item health survey (VR-12) mental health subscores at 2-year follow-up (females: 52.3±9.0, males: 55.8±7.6, p=0.0016). Females were more likely to report that treatment had ‘exceeded expectations’ at 2-year follow-up regarding motion, strength, function and normal sports activities. Conclusion Results of study demonstrate that ABR has similar outcomes for both males and females. There were no statistically significant sex-related differences in SST, ASES, VAS or SANE scores following ABR. VR-12 mental health subscores showed a minimal difference at 2-year follow-up, with lower scores in females. Level of evidence Retrospective cohort study; level II.
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Affiliation(s)
- Natalie A Lowenstein
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Peter J Ostergaard
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Daniel B Haber
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kirsten D Garvey
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elizabeth G Matzkin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Weick JW, Kalia V, Pacheco E, Jacobson JA, Freehill MT. Osseous Healing With Nonrigid Suture Fixation in the Arthroscopic Latarjet Procedure. Orthop J Sports Med 2020; 8:2325967120964489. [PMID: 33244477 PMCID: PMC7678400 DOI: 10.1177/2325967120964489] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/11/2020] [Indexed: 11/16/2022] Open
Abstract
Background: The Latarjet procedure is a popular means to surgically address anterior glenohumeral joint instability. Although the Latarjet procedure is becoming increasingly common, challenges persist and include postoperative complications secondary to use of the conventional 2 bicortical fixation screws. Recently, a novel surgical technique using a guided surgical approach for graft positioning with nonrigid fixation via a suture suspensory system has been described. Purpose: To evaluate healing rates and stability of the grafts in patients who underwent this new Latarjet technique. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively gathered anonymized computed tomography (CT) data sets from a total of 107 patients who underwent nonrigid suture fixation using a cortical button fixation for anterior glenohumeral instability. Of the 107 patients, 45 had CT scans performed at 2 different time periods. The CT scans of each patient were compared by 2 fellowship-trained musculoskeletal radiologists. Data recorded included age, sex, date of scan, initial graft position on the glenoid, presence and degree of graft migration relative to the equator on follow-up scan, and percentage of osseous healing (as assessed by osseous bridging) on the follow-up scan. Descriptive statistics were calculated to evaluate the average migration and average percentage of healing at both time points. Results: Our population (n = 45) consisted of 38 men (84.4%) and 7 women (15.6%). The mean age was 27.1 ± 1.1 years. The mean time between initial CT scan (2 weeks postoperatively) and follow-up CT scan was 26 ± 2 weeks. On follow-up scan, reviewer 1 found 75.6% of patients had greater than 75% healing, and reviewer 2 found 70.2% of patients had greater than 75% healing. The center of the graft was measured at or below the equator on follow-up examination in 43 of 45 (95.6%) patients by reviewer 1 and 44 of 45 (97.8%) patients by reviewer 2. Conclusion: Based on these findings, nonrigid suture fixation using a cortical button device offers an effective alternative to traditional screw fixation for the Latarjet procedure with a high level of osseous healing and minimal graft migration.
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Affiliation(s)
- Jack W Weick
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Vivek Kalia
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily Pacheco
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jon A Jacobson
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael T Freehill
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
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Gilat R, Lavoie-Gagne O, Haunschild ED, Knapik DM, Parvaresh KC, Fu MC, Forsythe B, Verma N, Cole BJ. Outcomes of the Latarjet procedure with minimum 5- and 10-year follow-up: A systematic review. Shoulder Elbow 2020; 12:315-329. [PMID: 33123221 PMCID: PMC7545530 DOI: 10.1177/1758573220945318] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/13/2020] [Accepted: 07/07/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate mid- and long-term outcomes following the Latarjet procedure for anterior shoulder instability. METHODS PubMed, MEDLINE, Embase, and Cochrane libraries were systematically searched, in line with PRISMA guidelines, for studies reporting on outcomes following the Latarjet procedure with minimum five-year follow-up. Outcomes of studies with follow-up between 5 and 10 years were compared to those with minimum follow-up of 10 years. RESULTS Fifteen studies reporting on 1052 Latarjet procedures were included. Recurrent instability occurred in 127 patients, with an overall random summary estimates in studies with a minimum five-year follow-up of 0-18% (I2 = 90%) compared to 5-26% (I2 = 59%) for studies with a minimum 10-year follow-up. Overall rates for return to sports, non-instability related complications, and progression of arthritis estimated at 65-100% (I2 = 87%), 0-20% (I2 = 85%), and 8-42% (I2 = 89%) for the minimum five-year follow-up studies and 62-93% (I2 = 86%), 0-9% (I2 = 28%), and 9-71% (I2 = 91%) for the minimum 10-year follow-up studies, respectively. All studies reported good-to-excellent mean PRO scores at final follow-up. CONCLUSIONS The Latarjet is a safe and effective procedure for patients with shoulder instability. The majority of patients return to sport, though at long-term follow-up, a trend towards an increased incidence of recurrent instability is appreciated, while a significant number may demonstrate arthritis progression.
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Affiliation(s)
- Ron Gilat
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA,Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel,Ron Gilat, 1611 W Harrison St, Chicago, IL 60612, USA.
| | | | - Eric D Haunschild
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kevin C Parvaresh
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA
| | - Michael C Fu
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil Verma
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Midwest Orthopaedics, Rush University Medical Center, Chicago, IL, USA
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