Analysis of complication after open coracoid transfer as a revision surgery for failed soft tissue stabilization in recurrent anterior shoulder instability

2019 ◽  
Vol 139 (10) ◽  
pp. 1435-1444 ◽  
Author(s):  
Marvin Minkus ◽  
Julia Wolke ◽  
Pit Fischer ◽  
Markus Scheibel
Keyword(s):  
Soft Tissue ◽  
Revision Surgery ◽  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Coracoid Transfer ◽  
Tissue Stabilization ◽  
Recurrent Anterior Shoulder Instability

scholarly journals Revision Arthroscopic Bankart Repair Versus Arthroscopic Latarjet for Failed Primary Arthroscopic Stabilization With Subcritical Bone Loss

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110018
Author(s):  
Emilio Calvo ◽  
Gonzalo Luengo ◽  
Diana Morcillo ◽  
Antonio M. Foruria ◽  
María Valencia
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
Revision Surgery ◽  
Shoulder Instability ◽  
Activity Level ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Arthroscopic Bankart Repair ◽  
Functional Scores ◽  
Arthroscopic Latarjet

Background: Limited evidence is available regarding the recommended technique of revision surgery for recurrent shoulder instability. Only 1 previous study has compared the results of soft tissue repair and the Latarjet technique in patients with persistent shoulder instability after primary surgical stabilization. Purpose/Hypothesis: To evaluate the results of revision surgery in patients with previous surgical stabilization failure and subcritical glenoid bone defects, comparing repeated Bankart repair versus arthroscopic Latarjet technique. The hypothesis was that Latarjet would be superior to soft tissue procedures in terms of objective and subjective functional scores, recurrence rates, and range of movement. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 45 patients (mean age, 29.1 ± 8.9 years) with subcritical bone loss (<15% of articular surface) who had undergone revision anterior shoulder instability repair after failed Bankart repair. Of these, 17 patients had arthroscopic Bankart repair and 28 had arthroscopic Latarjet surgery. Patients were evaluated at a minimum of 2 years postoperatively with the Rowe score, Western Ontario Shoulder Instability Index, and Subjective Shoulder Value. Subluxation or dislocation episodes were considered failures. Results: No statistically significant differences were found between groups in age, sex, sporting activity, preoperative Rowe score, or the presence of hyperlaxity or bony lesions. At revision arthroscopy, 20 shoulders showed a persistent Bankart lesion, 13 a medially healed labrum, and 6 a bony Bankart. In 6 patients, no abnormalities were present that could explain postoperative recurrence. In the Bankart repair group, 7 patients underwent isolated Bankart procedures; in the remaining 10 cases, a capsular shift was added. No significant differences were found between the Bankart and Latarjet groups in outcome scores, recurrence rate (11.8% vs 17.9%, respectively), or postoperative athletic activity level. The mean loss of passive external rotation at 0° and 90° of abduction was similar between groups. Conclusion: Arthroscopic Latarjet did not lead to superior results compared with repeated Bankart repair in patients with subcritical glenoid bone loss and recurrent anterior shoulder instability after Bankart repair.

scholarly journals Arthroscopic Soft Tissue Stabilization for Traumatic Anterior Shoulder Instability in Elite Collision Athletes

2019 ◽  
Vol 7 (3_suppl2) ◽  
pp. 2325967119S0019
Author(s):  
Hoshika Shota ◽  
Hiroyuki Sugaya ◽  
Norimasa Takahashi ◽  
Keisuke Matsuki ◽  
Morihito Tokai ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
Recurrence Rate ◽  
Shoulder Instability ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Bony Bankart ◽  
The Mean ◽  
Tissue Stabilization

Objectives: Surgical options for shoulder instability in collision athletes remain controversial. Although arthroscopic soft tissue stabilization is widely accepted treatment for traumatic anterior shoulder instability, many surgeons prefer coracoid transfer such as Latarjet procedure for collision athletes with or without glenoid defect due to potential high recurrence rate after arthroscopic soft tissue Bankart repair (ABR). In the meantime, Hill-Sachs remplissage (HSR) has been gaining popularity as an effective arthroscopic augmentation procedure. Since 2002, we performed rotator interval closure (RIC) as an augmentation in addition to ABR or arthroscopic bony Bankart repair (ABBR) for collision athletes and obtained satisfactory outcome. However, teen players demonstrated higher recurrence rate compared to twenties and thirties. Therefore, from 2012, we performed HSR as an additional augmentation for teen players besides ABR/ABBR and RIC. The purpose of this study was to assess the outcomes after arthroscopic stabilization in collision athletes who underwent shoulder stabilization under our treatment strategy. Methods: Between 2012 through 2015, 95 consecutive collision athletes underwent shoulder stabilization. Among those, only 2 patients (2%) underwent arthroscopic bony procedure for poor capsular integrity. Among the remaining 93 patients who underwent soft tissue stabilization, 65 were available for minimum 2-year follow-up (70%). Therefore, subjects consisted of 65 players including 54 rugby and 11 American football players (Table 1). There were 13 national top league, 24 collegiate, 21 junior or senior high school, and 7 recreational players. The mean age at surgery was 20 years (range, 16-36). The mean follow-up was 37 months (range, 24-64). We retrospectively reviewed intraoperative findings and surgical procedures using patient records including surgical reports and videos. We also investigated functional outcome and recurrence rate. Pre- and postoperative Rowe scores were compared using paired t test. Results: Preoperative 3DCT of the glenoid demonstrated bony Bankart (fragment type) in 43 players (66%), attritional type in 16 (25%), and normal glenoid in 6 (9%). Mean glenoid bone loss was 15% (range, 0-25) and all of the glenoid with more than 10% bone loss retained bony fragment. All 65 players demonstrated Bankart lesion and 15 had concomitant SLAP lesion (23%) which required to be repaired. In addition, 5 players demonstrated capsule tear (8%), which were also repaired. Twenty-four players (36%) underwent ABR or ABBR with RIC and forty one players (64%) underwent ABR or ABBR combined with HSR (Table 1). The mean Rowe score significantly improved after surgery from 65 (range, 55-75) to 92 (range, 65-100) (P < .001). Recurrence appeared in 2 cases (3%), both of which were junior or senior high school players who underwent ABR with HSR. Ten national top league players who underwent ABR with RIC had no recurrence. Conclusion: Soft tissue stabilization combined with selective augmentation procedures for traumatic shoulder instability in collision athletes demonstrated satisfactory outcomes with extremely low recurrence rate. Since the incidence of having bony Bankart lesion in collision athletes was very high, arthroscopic bony Bankart repair worked in many patients even with significant glenoid bone loss. Further, Hill-Sachs remplissage seemed to be effective additional augmentation especially in young collision athletes. [Table: see text]

scholarly journals Management of The Failed Latarjet Procedure: Outcomes of Revision Surgery With Fresh Distal Tibial Allograft

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0031
Author(s):  
Andrew S. Bernhardson ◽  
Liam A. Peebles ◽  
Colin P. Murphy ◽  
Anthony Sanchez ◽  
Robert F. LaPrade ◽  
...  
Keyword(s):  
Ct Scan ◽  
Revision Surgery ◽  
Shoulder Instability ◽  
Distal Tibia ◽  
Substantial Improvement ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Recurrent Shoulder Instability ◽  
Hardware Complications ◽  
Recurrent Anterior Shoulder Instability

Objectives: A patient with recurrent instability after a failed Latarjet procedure remains a challenge to address. The vast majority of these result in large amounts of bone loss, resorption, and issues with retained hardware, and there is minimal literature that assesses outcomes of revision surgery following a failed Latarjet. The objective of this study was to determine the outcomes of patients who underwent revision surgery for a recurrent shoulder instability after a failed Latarjet procedure. Methods: All consecutive patients who presented with recurrent anterior shoulder instability after a Latarjet procedure were prospectively enrolled. Patients were included if they had a prior Latarjet, and a history and physical examination findings consistent with recurrent anterior shoulder instability. Patients were excluded if they had prior neurologic injury, a seizure disorder, bone graft requirements to the humeral head, or findings of multidirectional or posterior instability. History of shoulder instability was documented, including initial dislocation history, time of instability, number of prior procedures, and examination findings, as well as plain radiographic data and computed tomography (CT) scan obtained on all patients, and arthritis graded with Samilson and Prieto (SP) grade. All patients were treated with hardware removal, capsulo-labral release with subsequent repair and bony reconstruction via fresh distal tibial allograft to the glenoid. Outcomes pre- and post-revision were assessed with ASES (American Shoulder and Elbow Score), Single Assessment Numerical Evaluation (SANE), and Western Ontario Shoulder Index (WOSI), and statistically compared. All patients underwent a CT scan of the distal tibial allograft at a minimum time point 4 months after surgery. Results: There were 31 patients enrolled (all males), with mean age 25.5 (range, 19 to 38), and with a mean follow-up of 47 months (range, 36 to 60) after the revision with distal tibial allograft. All patients after their Latarjet presented with recurrent shoulder dislocation (11/31) or recurrent subluxation (20/31) and all patients had recurrent shoulder instability on examination. Radiographs demonstrated two fixation screws in all cases, mean SP grade of 0.5 (range, I to III), and CT scan demonstrated that mean 78% of the Latarjet coracoid graft had resorbed (range, 50% to 100%). Preoperative outcomes improved for ASES (40 to 92, p=0.001), SANE (44 to 91, p=0.001), and WOSI (1300 to 310, p=0.001). There were no recurrences, and a final CT scan of the distal tibia revision demonstrated a mean 92% of DTA remained, but 98% union at the glenoid-DTA interface. Conclusion: Although the failed Latarjet with subsequent instability remains a challenge, treatment with fresh a distal tibial allograft provided substantial improvement in terms of stability and function. The vast majority of the failed Latarjet procedures had near complete resorption of the coracoid graft and many had hardware complications. Additional long-term studies are necessary to determine the efficacy of this challenging revision population.

Arthroscopic Soft Tissue Stabilization With Selective Augmentations for Traumatic Anterior Shoulder Instability in Competitive Collision Athletes

2021 ◽  
pp. 036354652110030
Author(s):  
Shota Hoshika ◽  
Hiroyuki Sugaya ◽  
Norimasa Takahashi ◽  
Keisuke Matsuki ◽  
Morihito Tokai ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Shoulder Instability ◽  
American Football ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Return To Sports ◽  
Rotator Interval ◽  
Functional Scores ◽  
The Mean ◽  
Tissue Stabilization

Background: Many surgeons prefer bony stabilization including Bristow or Latarjet procedures for shoulder instability in collision athletes, even though several potential complications have been reported. There has been a limited number of studies on the midterm outcomes of arthroscopic soft tissue stabilization for anterior shoulder instability in competitive collision athletes. Purpose: To assess the outcomes of arthroscopic soft tissue stabilization in combination with selective augmentation procedures for collision athletes with traumatic anterior shoulder instability Study Design: Case series; Level of evidence, 4. Methods: We retrospectively assessed rugby or American football players (<40 years old) who underwent arthroscopic Bankart or bony Bankart repair with selective augmentations (rotator interval closure and/or Hill-Sachs remplissage) for traumatic anterior shoulder instability between January 2012 and March 2017. Shoulders that required other bony procedures were excluded. Recurrence, complications, return to sport, and functional scores (Rowe score and Subjective Shoulder Value sports score) were investigated. Results: This study included 113 shoulders in 100 patients with a mean age of 20 years (range, 15-36 years) at surgery. Rotator interval closure was performed on 36 shoulders in addition to Bankart repair, and rotator interval closure and Hill-Sachs remplissage were performed on 77 shoulders. The mean follow-up period was 44 months (range, 24-72 months). Of the 113 shoulders, 4 (3.5%) experienced postoperative dislocation, but there were no complications. A total of 93 athletes (93%) attained complete or near complete preinjury sports activity levels. The mean Rowe score significantly improved from 36 (range, 10-75) at presurgery to 96 (range, 35-100; P = .003) at postsurgery. The mean Subjective Shoulder Value sports score significantly improved after surgery, from a mean preoperative score of 22 (range, 0-50) to a postoperative score of 92 (range, 64-100; P = .002). Conclusion: Our treatment strategy, where arthroscopic soft tissue stabilization was combined with selected augmentations, provided good clinical outcomes for competitive collision athletes in terms of low rates of recurrence and complication, a high rate of return to sports, and good shoulder function.

scholarly journals Failure Rates After Revision Arthroscopic Stabilization for Recurrent Anterior Shoulder Instability Based on Anterior Capsulolabral Complex Conditions

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199589
Author(s):  
In Park ◽  
Jae-Hyung Lee ◽  
Jin-Young Park ◽  
Sang-Jin Shin
Keyword(s):  
Revision Surgery ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Arthroscopic Stabilization ◽  
Anterior Capsule ◽  
Surgical Failure ◽  
Group 2 ◽  
Tissue Stabilization ◽  
Recurrent Anterior Shoulder Instability ◽  
Group 1

Background: A labral retear is an important contributing factor to surgical failure after arthroscopic soft tissue stabilization for recurrent anterior shoulder instability. However, surgeons frequently encounter poor tissue conditions in the anterior capsule, such as capsular tears, during revision surgery. Purpose: To analyze the clinical outcomes and failure rates of revision arthroscopic stabilization after failed Bankart repair based on the tissue conditions of the anterior capsule and the labrum. Outcomes were compared for revision after failed Bankart repair because of a labral retear versus a healed labrum but with capsular tears. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 55 patients who underwent revision arthroscopic stabilization after failed Bankart repair were included. Revision surgery was indicated if patients had a history of recurrent instability with positive apprehension test results, regardless of magnetic resonance imaging (MRI) findings of a labral retear. Patients were allocated into 2 groups based on arthroscopic findings at the time of revision surgery: group 1 consisted of patients who had a healed labrum with definite anterior capsular tears, and group 2 comprised patients who had labral retears without capsular tears. Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons score, Rowe score, and surgical failure rate. Results: Overall, 10 patients were included in group 1, and 45 patients were included in group 2. No capsular tears were detected on preoperative MRI or magnetic resonance arthrography scans in either group, whereas all patients in group 2 had evidence of anterior labral retears on imaging scans. After revision surgery, 9 patients (16.4%) showed surgical failure by 25.6 months postoperatively. Patients in group 1 had a significantly higher surgical failure rate than did those in group 2 (4 patients [40.0%] vs 5 patients [11.1%], respectively; P = .04). The incidence of capsular tears was significantly higher in patients with surgical failure versus those without surgical failure (44.4% vs 13.0%, respectively; P = .04). Conclusion: A capsular tear of the anterior capsulolabral complex was an important indicator for surgical failure after revision arthroscopic stabilization. If patients demonstrate symptomatic instability after arthroscopic soft tissue stabilization without evidence of labral retears on imaging scans, an anterior capsular tear should be considered as a possible factor for recurrence.

Management of the Failed Latarjet Procedure: Outcomes of Revision Surgery With Fresh Distal Tibial Allograft

2019 ◽  
Vol 47 (12) ◽  
pp. 2795-2802 ◽  
Author(s):  
Matthew T. Provencher ◽  
Liam A. Peebles ◽  
Zachary S. Aman ◽  
Andrew S. Bernhardson ◽  
Colin P. Murphy ◽  
...  
Keyword(s):  
Bone Loss ◽  
Physical Examination ◽  
Ct Scan ◽  
Revision Surgery ◽  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Recurrent Shoulder Instability ◽  
Recurrent Anterior Shoulder Instability

Background: Patients with recurrent anterior glenohumeral instability after a failed Latarjet procedure remain a challenge to address. Complications related to this procedure include large amounts of bone loss, bone resorption, and issues with retained hardware that necessitate the need for revision surgery. Purpose: To determine the outcomes of patients who underwent revision surgery for a recurrent shoulder instability after a failed Latarjet procedure with fresh distal tibial allograft. Study Design: Case series; Level of evidence, 4. Methods: All consecutive patients who underwent revision of a failed Latarjet procedure with distal tibial allograft were prospectively enrolled. Patients were included if they had physical examination findings consistent with recurrent anterior shoulder instability. Patients were excluded if they had prior neurologic injury, a seizure disorder, bone graft requirements to the humeral head, or findings of multidirectional or posterior instability. History of shoulder instability was documented, including initial dislocation history, duration of instability, number of prior surgeries, examination findings, plain radiographic and computed tomography (CT) data, and arthritis graded with Samilson and Prieto (SP) classification. All patients were treated with hardware removal, capsular release with subsequent repair, and fresh distal tibial allograft to the glenoid. Outcomes before and after revision were assessed according to the American Shoulder and Elbow Score (ASES), Single Assessment Numerical Evaluation (SANE), and Western Ontario Shoulder Index (WOSI) and statistically compared. All patients underwent a CT scan of the distal tibial allograft at a minimum 4 months after surgery. Results: There were 31 patients enrolled (all males), with a mean age of 25.5 years (range, 19-38 years) and a mean follow-up time of 47 months (range, 36-60 months) after revision with distal tibial allograft. Before distal tibial allograft augmentation, the mean percentage glenoid bone loss was 30.3% (range, 25%-49%). All patients after their Latarjet stabilization had recurrent shoulder dislocation (11/31, 35.5%) or subluxation (20/31, 64.5%), and all patients had symptoms consistent with recurrent shoulder instability upon physical examination. Radiographs demonstrated 2 fixation screws in all cases, mean SP grade was 0.5 (range, 0-3), and CT scans revealed that a mean 78% of the Latarjet coracoid graft had resorbed (range, 37%-100%). Patient-reported outcome scores improved significantly pre- to postoperatively for ASES (40 to 92, P = .001), SANE (44 to 91, P = .001), and WOSI (1300 to 310, P = .001). There were no cases of recurrence, and a final CT scan of the distal tibial revision demonstrated a complete union at the glenoid–distal tibial allograft interface in 92% of patients. Conclusion: The majority of the failed Latarjet procedures included in this study had near-complete resorption of the coracoid graft and hardware complications. At a minimum follow-up time of 36 months, patients who underwent revision treatment for a failed Latarjet procedure with a fresh distal tibial allograft demonstrated excellent clinical outcomes and near-complete osseous union at the glenoid-allograft interface. Although patients evaluated with recurrent anterior shoulder instability after a failed Latarjet procedure remain a challenge to address, fresh distal tibial allograft augmentation is a viable and highly effective revision procedure to treat this patient population.

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