scholarly journals Indication and technique for arthroscopic stabilization of anterior shoulder instability with multidirectional laxity

2021 ◽  
Vol 16 (1) ◽  
pp. 41-50
Author(s):  
Marco-Christopher Rupp ◽  
Sebastian Siebenlist ◽  
Bastian Scheiderer ◽  
Andreas B. Imhoff ◽  
Jonas Pogorzelski
Keyword(s):  
Independent Risk Factor ◽  
Clinical Evidence ◽  
Anterior Shoulder Instability ◽  
Clinical Tests ◽  
Posterior Instability ◽  
Shoulder Stabilization ◽  
Labral Lesion ◽  
Current Article ◽  
Clear Differentiation ◽  
Broad Consensus

AbstractAs concomitant hyperlaxity has been identified as an independent risk factor for failure following anterior shoulder stabilization, the treatment of this special pathology remains challenging. There is a broad consensus that a clear differentiation to multidirectional instability and isolated anteroinferior instability should be ensured to avoid unsatisfactory outcomes. Typical features of this patient collective include positive clinical tests for anteroinferior instability and multidirectional shoulder hyperlaxity, findings of an anterior labral lesion and general capsular redundancy in the radiologic assessment, while tests for posterior instability are negative. Surgical treatment should consist of an anteroinferior capsulolabroplasty with concomitant posteroinferior plication to reduce pathological capsular volume. Although there is a lack of clinical evidence, biomechanical investigations suggest that a four-anchor construct with three anterior anchors and one posteroinferior anchor may be sufficient to restore glenohumeral stability. This surgical approach is presented and discussed in the current article.

scholarly journals Differences in Outcomes Between Anterior and Posterior Shoulder Instability After Arthroscopic Bankart Repair: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110064
Author(s):  
Matthew L. Vopat ◽  
Reed G. Coda ◽  
Nick E. Giusti ◽  
Jordan Baker ◽  
Armin Tarakemeh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Posterior Shoulder Instability ◽  
Anterior Instability ◽  
Posterior Instability ◽  
Female Patients ◽  
Posterior Shoulder ◽  
Male Patients ◽  
Postoperative Instability

Background: The glenohumeral joint is one of the most frequently dislocated joints in the body, particularly in young, active adults. Purpose: To conduct a systematic review and meta-analysis to evaluate and compare outcomes between anterior versus posterior shoulder instability. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed using the PubMed, Cochrane Library, and MEDLINE databases (from inception to September 2019) according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they were published in the English language, contained outcomes after anterior or posterior shoulder instability, had at least 1 year of follow-up, and included arthroscopic soft tissue labral repair of either anterior or posterior instability. Outcomes including return-to-sport (RTS) rate, postoperative instability rate, and pre- and postoperative American Shoulder and Elbow Surgeons (ASES) scores were recorded and analyzed. Results: Overall, 39 studies were included (2077 patients; 1716 male patients and 361 female patients). Patients with anterior instability had a mean age of 23.45 ± 5.40 years (range, 11-72 years), while patients with posterior instability had a mean age of 23.08 ± 8.41 years (range, 13-61 years). The percentage of male patients with anterior instability was significantly higher than that of female patients (odds ratio [OR], 1.36; 95% CI, 1.04-1.77; P = .021). Compared with patients with posterior instability, those with anterior instability were significantly more likely to RTS (OR, 2.31; 95% CI, 1.76-3.04; P < .001), and they were significantly more likely to have postoperative instability (OR, 1.53; 95% CI, 1.07-2.23; P = .018). Patients with anterior instability also had significantly higher ASES scores than those with posterior instability (difference in means, 6.74; 95% CI, 4.71-8.77; P < .001). There were no significant differences found in postoperative complications between the anterior group (11 complications; 1.8%) and the posterior group (3 complications; 1.6%) (OR, 1.12; 95% CI, 0.29-6.30; P = .999). Conclusion: Patients with anterior shoulder instability had higher RTS rates but were more likely to have postoperative instability compared with posterior instability patients. Overall, male patients were significantly more likely to have anterior shoulder instability, while female patients were significantly more likely to have posterior shoulder instability.

scholarly journals Clinical Outcomes of Shoulder Stabilization in Females With Glenoid Bone Loss

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110075
Author(s):  
Rachel M. Frank ◽  
Hytham S. Salem ◽  
Catherine Richardson ◽  
Michael O’Brien ◽  
Jon M. Newgren ◽  
...  
Keyword(s):  
Bone Loss ◽  
Clinical Outcomes ◽  
Shoulder Instability ◽  
Glenoid Bone Loss ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Shoulder Stabilization ◽  
Simple Shoulder Test ◽  
Female Patients

Background: Nearly all studies describing shoulder stabilization focus on male patients. Little is known regarding the clinical outcomes of female patients undergoing shoulder stabilization, and even less is understood about females with glenoid bone loss. Purpose: To assess the clinical outcomes of female patients with recurrent anterior shoulder instability treated with the Latarjet procedure. Study Design: Case series; Level of evidence, 4. Methods: All cases of female patients who had recurrent anterior shoulder instability with ≥15% anterior glenoid bone loss and underwent the Latarjet procedure were analyzed. Patients were evaluated after a minimum 2-year postoperative period with scores of the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale. Results: Of the 22 patients who met our criteria, 5 (22.7%) were lost to follow-up, leaving 17 (77.2%) available for follow-up with a mean ± SD age of 31.7 ± 12.9 years. Among these patients, 16 (94.1%) underwent 1.6 ± 0.73 ipsilateral shoulder operations (range, 1-3) before undergoing the Latarjet procedure. Preoperative indications for surgery included recurrent instability with bone loss in all cases. After a mean follow-up of 40.2 ± 22.9 months, patients experienced significant score improvements in the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale ( P < .05 for all). There were 2 reoperations (11.8%). There were no cases of neurovascular injuries or other complications. Conclusion: Female patients with recurrent shoulder instability with glenoid bone loss can be successfully treated with the Latarjet procedure, with outcomes similar to those of male patients in the previously published literature. This information can be used to counsel female patients with recurrent instability with significant anterior glenoid bone loss.

Arthroscopic Versus Open Anterior Shoulder Stabilization: A Prospective Randomized Clinical Trial With 15-Year Follow-up With an Assessment of the Glenoid Being “On-Track” and “Off-Track” as a Predictor of Failure

2021 ◽  
pp. 036354652110182
Author(s):  
Craig R. Bottoni ◽  
John D. Johnson ◽  
Liang Zhou ◽  
Sarah G. Raybin ◽  
James S. Shaha ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Shoulder Stabilization ◽  
Mri Studies ◽  
Open Stabilization ◽  
The Mean ◽  
Recurrent Anterior Shoulder Instability

Background: Recent studies have demonstrated equivalent short-term results when comparing arthroscopic versus open anterior shoulder stabilization. However, none have evaluated the long-term clinical outcomes of patients after arthroscopic or open anterior shoulder stabilization, with inclusion of an assessment of preoperative glenoid tracking. Purpose: To compare long-term clinical outcomes of patients with recurrent anterior shoulder instability randomized to open and arthroscopic stabilization groups. Additionally, preoperative magnetic resonance imaging (MRI) studies were used to assess whether the shoulders were “on-track” or “off-track” to ascertain a prediction of increased failure risk. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A consecutive series of 64 patients with recurrent anterior shoulder instability were randomized to receive either arthroscopic or open stabilization by a single surgeon. Follow-up assessments were performed at minimum 15-year follow-up using established postoperative evaluations. Clinical failure was defined as any recurrent dislocation postoperatively or subjective instability. Preoperative MRI scans were obtained to calculate the glenoid track and designate shoulders as on-track or off-track. These results were then correlated with the patients’ clinical results at their latest follow-up. Results: Of 64 patients, 60 (28 arthroscopic and 32 open) were contacted or examined for follow-up (range, 15-17 years). The mean age at the time of surgery was 25 years (range, 19-42 years), while the mean age at the time of this assessment was 40 years (range, 34-57 years). The rates of arthroscopic and open long-term failure were 14.3% (4/28) and 12.5% (4/32), respectively. There were no differences in subjective shoulder outcome scores between the treatment groups. Of the 56 shoulders, with available MRI studies, 8 (14.3%) were determined to be off-track. Of these 8 shoulders, there were 2 surgical failures (25.0%; 1 treated arthroscopically, 1 treated open). In the on-track group, 6 of 48 had failed surgery (12.5%; 3 open, 3 arthroscopic [ P = .280]). Conclusion: Long-term clinical outcomes were comparable at 15 years postoperatively between the arthroscopic and open stabilization groups. The presence of an off-track lesion may be associated with a higher rate of recurrent instability in both cohorts at long-term follow-up; however, this study was underpowered to verify this situation.

Diagnostic value of patient characteristics, history, and six clinical tests for traumatic anterior shoulder instability

2013 ◽  
Vol 22 (10) ◽  
pp. 1310-1319 ◽  
Author(s):  
Derk A. van Kampen ◽  
Tobias van den Berg ◽  
Henk Jan van der Woude ◽  
René M. Castelein ◽  
Caroline B. Terwee ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Patient Characteristics ◽  
Diagnostic Value ◽  
Anterior Shoulder Instability ◽  
Clinical Tests

Proprioception Evaluation of Patients Undergoing Anterior Shoulder Stabilization

2004 ◽  
Author(s):  
Michael Nowak ◽  
Mick Joseph ◽  
Carl Nissen ◽  
Takafumi Asaki
Keyword(s):  
Initial Data ◽  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Shoulder Stabilization ◽  
Passive Motion ◽  
Repair Method ◽  
2Nd Generation ◽  
Post Surgery

This paper presents the initial data from the first clinical usage of a 2nd generation device to measure proprioception of the shoulder or knee. The device was used to evaluate the surgical stabilization of subjects with anterior shoulder instability. Two types of shoulder proprioception were evaluated: Threshold to Detection of Passive Motion (TTDPM) and Reproduction of Passive Position (RPP). Data is presented for 12 subjects 1 year post-surgery. The data demonstrated that the involved limb TTDPM and RPP approached that of the uninvolved limb, and that the values improved as the shoulder was rotated upwards. Both results point to the efficacy of the repair method and the ability of the device to evaluate proprioception.

scholarly journals Anterior Shoulder Instability in the Professional Athlete: Return to Competition, Time to Return, and Career Length

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712095972
Author(s):  
Travis J. Dekker ◽  
Brandon Goldenberg ◽  
Lucca Lacheta ◽  
Marilee P. Horan ◽  
Peter J. Millett
Keyword(s):  
Surgical Treatment ◽  
Shoulder Instability ◽  
Bankart Repair ◽  
Professional Athletes ◽  
Successful Outcome ◽  
Anterior Shoulder Instability ◽  
Shoulder Stabilization ◽  
Arthroscopic Bankart Repair ◽  
The Mean ◽  
Return To Competition

Background: Anterior shoulder instability is a common condition in professional athletes, yet little is known about the success of surgery. Return to competition (RTC) is a metric indicative of a successful outcome for professional athletes who undergo anterior shoulder stabilization surgery. Purpose: To determine the rate of RTC, time to RTC, recurrence rate, and length of career after surgery in professional athletes who had undergone surgical treatment for anterior shoulder instability. Study Design: Case series; Level of evidence, 4. Methods: We evaluated professional athletes who underwent surgical treatment for anterior shoulder instability by a single surgeon between 2007 and 2018. Data from patients’ medical records, a patient data registry, basic search engines, sports websites, and individual team websites were used to determine length of professional play before injury, duration of career after surgery, and RTC level. Results: Overall, 23 professional athletes (25 shoulders from 12 contact and 13 noncontact athletes) were identified. The mean age at the time of surgery was 24.3 ± 4.9 years (range, 16-35 years). Primary procedures included arthroscopic Bankart repair (76%; 19/25), open Latarjet (20%; 5/25), and bony Bankart repair (4%; 1/25). Of the 23 athletes, 22 returned to their previous level of competition (96%; 95% CI, 78%-100%). The mean time between surgery and RTC was 4.5 months (range, 3-8 months). There was no difference in time to RTC between contact and noncontact athletes (4.1 vs 4.4 months). There was no difference in RTC rates and time to return for players who received a Bankart repair versus a Latarjet procedure (4.6 vs 4.2 months). A total of 12 participants were still actively engaged in their respective sport at an average of 4.3 years since surgery, while 11 athletes went on to retire at an average of 4.8 years. Duration of play after surgery was 3.8 years for contact athletes and 5.8 years for noncontact athletes ( P > .05). Conclusion: In this series, professional athletes who underwent surgical shoulder stabilization for the treatment of anterior glenohumeral instability returned to their presurgical levels of competition at a high rate. No differences in RTC rate or time to RTC were observed for contact versus noncontact athletes or for those who received arthroscopic Bankart repair versus open Latarjet. However, contact athletes had shorter careers after surgery than did noncontact athletes.

Return to Sport After Surgical Treatment for Anterior Shoulder Instability: A Systematic Review

2018 ◽  
Vol 47 (6) ◽  
pp. 1507-1515 ◽  
Author(s):  
Hussein Abdul-Rassoul ◽  
Joseph W. Galvin ◽  
Emily J. Curry ◽  
Jason Simon ◽  
Xinning Li
Keyword(s):  
Systematic Review ◽  
Shoulder Instability ◽  
Return To Sport ◽  
Activity Level ◽  
Rate Of Return ◽  
Anterior Shoulder Instability ◽  
Activity Levels ◽  
Shoulder Stabilization ◽  
Successful Recovery ◽  
Arthroscopic Latarjet

Background: For athletes, a return to preinjury activity levels with minimal time away is a metric indicative of successful recovery. The knowledge of this metric would be helpful for the sports medicine specialist to advise patients on appropriate expectations after surgery. Purpose: To evaluate the rate and amount of time needed for athletes to return to sport (RTS) after different surgical treatments for anterior shoulder instability. Study Design: Systematic review and meta-analysis. Methods: The MEDLINE, EMBASE, and Cochrane databases were searched for articles relevant to athletes’ RTS after surgical anterior shoulder stabilization with variants of the Latarjet and Bankart procedures. Article selection was based on relevant inclusion and exclusion criteria. After the articles were reviewed, the data pertinent to rates of and time to RTS were extracted, compiled, and analyzed. Results: Sixteen articles met the inclusion criteria. Based on these articles, the rate of RTS was 97.5% after arthroscopic Bankart, 86.1% after open Bankart, 83.6% after open Latarjet, 94.0% after arthroscopic Latarjet, and 95.5% after arthroscopic Bankart with remplissage. Among the athletes who did RTS, arthroscopic Bankart had the highest rate of return to preinjury levels (91.5%), while arthroscopic Latarjet had the lowest rate (69.0%). The time to RTS was 5.9 months after arthroscopic Bankart, 8.2 months after open Bankart, 5.07 months after open Latarjet, 5.86 months after arthroscopic Latarjet, and 7 months after arthroscopic Bankart with remplissage. Conclusion: Of the pooled data, patients who underwent arthroscopic Bankart showed the highest rate of RTS, while patients who underwent open Latarjet showed the shortest time to RTS. Return to preinjury level was highest in the arthroscopic Bankart group and lowest in the arthroscopic Latarjet group. Physicians can utilize these data to set expectations for their patient-athletes regarding RTS after anterior shoulder stabilization procedures. Clinical Relevance: When treating an athlete, many factors must be taken into account to weigh treatment options. Two important factors to consider with the patient-athlete are the rate of return to the previous activity level and the timeline for this to occur. This study provides a guide for physicians and a time frame for athletes with respect to the mean percentage and time for return to sport after different surgical procedures for anterior shoulder instability.

scholarly journals Glycemic disorders and coronary collateral circulation

2013 ◽  
Vol 16 (1) ◽  
pp. 19-26 ◽  
Author(s):  
Ivan Vasil'evich Starostin ◽  
K A Talitskiy ◽  
O S Bulkina ◽  
Yury Alexandrovich Karpov
Keyword(s):  
Collateral Circulation ◽  
Clinical Evidence ◽  
Metabolic Disturbances ◽  
Coronary Collateral Circulation ◽  
Coronary Collateral ◽  
Circulation Current ◽  
Lateral Circulation ◽  
Current Article

Although collateral circulation is the essential means of perfusion for ischemized myocardium, its efficiency varies substantially within and between the species. There is both experimental and clinical evidence for association of glycemic disorders with inadequate col- lateral circulation. Current article reviews general mechanisms of collateral circulation failure due to such metabolic disturbances with regard for stages of arteriogenesis. We also highlight horizons of further studies in this field.

scholarly journals Evidence-Based Review of Clinical Diagnostic Tests and Predictive Clinical Tests That Evaluate Response to Conservative Rehabilitation for Posterior Glenohumeral Instability: A Systematic Review

2018 ◽  
Vol 10 (2) ◽  
pp. 141-145 ◽  
Author(s):  
Jasdeep Dhir ◽  
Myles Willis ◽  
Lyn Watson ◽  
Lyndsay Somerville ◽  
Jackie Sadi
Keyword(s):  
Systematic Review ◽  
Diagnostic Tests ◽  
Glenohumeral Joint ◽  
Evidence Based ◽  
Clinical Tests ◽  
Posterior Instability ◽  
Glenohumeral Instability ◽  
Predictive Tests ◽  
Clinical Diagnostic ◽  
Weak Evidence

Context: Posterior glenohumeral instability is poorly understood and can be challenging to recognize and evaluate. Using evidence-based clinical and predictive tests can assist clinicians in appropriate assessment and management. Objective: To review evidence-based clinical diagnostic tests for posterior glenohumeral instability and predictive tests that identify responders to conservative management. Data Sources: A comprehensive electronic bibliographic search was conducted using Embase, Ovid MEDLINE, PEDro, and CINAHL databases from their date of inception to February 2017. Study Selection: Studies were included for further review if they (1) reported on clinical diagnostic tests for posterior or posteroinferior instability of the glenohumeral joint, (2) assessed predictive clinical tests for posterior instability of the glenohumeral joint, and (3) were in English. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Data were extracted from the studies by 2 independent reviewers and included patient demographics and characteristics, index/reference test details (name and description of test), findings, and data available to calculate psychometric properties. Results: Five diagnostic and 2 predictive studies were selected for review. There was weak evidence for the use of the jerk test, Kim test, posterior impingement sign, and O’Brien test as stand-alone clinical tests for identifying posterior instability. Additionally, there was weak evidence to support the use of the painless jerk test and the hand squeeze sign as predictive tests for responders to conservative management. These findings are attributed to study design limitations, including small and/or nonrepresentative samples. Conclusion: Clustering of thorough history and physical examination findings, including the aforementioned tests, may identify those with posterior glenohumeral instability and assist in developing management strategies.

Sign in / Sign up

Export Citation Format

Share Document