Athletes with Primary Glenohumeral Instability Demonstrate Lower Rates of Bone Loss than those with Recurrent Instability and Failed Prior Stabilisation

2021 ◽  
Author(s):  
David T. Lennon ◽  
Martin S. Davey ◽  
Eoghan T. Hurley ◽  
Mohamed Gaafar ◽  
Leo Pauzenberger ◽  
...  
Keyword(s):  
Bone Loss ◽  
Glenohumeral Instability ◽  
Recurrent Instability

scholarly journals Prospective Evaluation of Glenoid Bone Loss After First-time and Recurrent Anterior Glenohumeral Instability Events

2019 ◽  
Vol 47 (5) ◽  
pp. 1082-1089 ◽  
Author(s):  
Jonathan F. Dickens ◽  
Sean E. Slaven ◽  
Kenneth L. Cameron ◽  
Adam M. Pickett ◽  
Matthew Posner ◽  
...  
Keyword(s):  
Cohort Study ◽  
Bone Loss ◽  
Shoulder Instability ◽  
Glenoid Bone Loss ◽  
Anterior Instability ◽  
Glenohumeral Instability ◽  
Recurrent Instability ◽  
History Of ◽  
Anterior Glenohumeral Instability ◽  
First Time

Background: Determining the amount of glenoid bone loss in patients after anterior glenohumeral instability events is critical to guiding appropriate treatment. One of the challenges in treating the shoulder instability of young athletes is the absence of clear data showing the effect of each event. Purpose: To prospectively determine the amount of bone loss associated with a single instability event in the setting of first-time and recurrent instability. Study Design: Cohort study; Level of evidence, 2. Methods: The authors conducted a prospective cohort study of 714 athletes surveilled for 4 years. Baseline assessment included a subjective history of shoulder instability. Bilateral noncontrast shoulder magnetic resonance imaging (MRI) was obtained for all participants with and without a history of previous shoulder instability. The cohort was prospectively followed during the study period, and those who sustained an anterior glenohumeral instability event were identified. Postinjury MRI with contrast was obtained and compared with the screening MRI. Glenoid width was measured for each patient’s pre- and postinjury MRI. The projected total glenoid bone loss was calculated and compared for patients with a history of shoulder instability. Results: Of the 714 athletes (1428 shoulders) who were prospectively followed during the 4-year period, 22 athletes (23 shoulders) sustained a first-time anterior instability event (5 dislocations, 18 subluxations), and 6 athletes (6 shoulders) with a history of instability sustained a recurrent anterior instability event (1 dislocation, 5 subluxations). On average, there was statistically significant glenoid bone loss (1.84 ± 1.47 mm) after a single instability event ( P < .001), equivalent to 6.8% (95% CI, 4.46%-9.04%; range, 0.71%-17.6%) of the glenoid width. After a first-time instability event, 12 shoulders (52%) demonstrated glenoid bone loss ≥5% and 4 shoulders, ≥13.5%; no shoulders had ≥20% glenoid bone loss. Preexisting glenoid bone loss among patients with a history of instability was 10.2% (95% CI, 1.96%-18.35%; range, 0.6%-21.0%). This bone loss increased to 22.8% (95% CI, 20.53%-25.15%; range, 21.2%-26.0%) after additional instability ( P = .0117). All 6 shoulders with recurrent instability had ≥20% glenoid bone loss. Conclusion: Glenoid bone loss of 6.8% was observed after a first-time anterior instability event. In the setting of recurrent instability, the total calculated glenoid bone loss was 22.8%, with a high prevalence of bony Bankart lesions (5 of 6). The findings of this study support early stabilization of young active patients after a first-time anterior glenohumeral instability event.

scholarly journals Prospective Evaluation of Glenoid Bone Loss After First-Time and Recurrent Anterior Glenohumeral Instability Events

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0009 ◽  
Author(s):  
Jonathan F. Dickens ◽  
Sean E. Slaven ◽  
Kenneth L. Cameron ◽  
Adam M. Pickett ◽  
Matthew A. Posner ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Glenoid Bone Loss ◽  
Anterior Instability ◽  
Glenohumeral Instability ◽  
Post Injury ◽  
Recurrent Instability ◽  
History Of ◽  
Anterior Glenohumeral Instability ◽  
First Time

Objectives: Determining the amount of glenoid bone loss in patients following anterior glenohumeral instability events is critical to guiding appropriate treatment. One of the challenges in managing shoulder instability in young athletes is the absence of clear data showing the impact of each event. The purpose of this study was to prospectively determine the amount of bone loss associated with a single instability event, in the setting of both first-time and recurrent instability. Methods: We conducted a prospective cohort study of 714 athletes followed for four years. Baseline assessment included a subjective history of shoulder instability. Bilateral shoulder MRIs were obtained in all participants with and without a history of previous shoulder instability. The cohort was prospectively followed during the study period and those who sustained an anterior glenohumeral instability event were identified. A post-injury MRI was obtained and compared to the screening MRI. Glenoid width was measured for each patient’s pre- and post-injury MRI. The projected total glenoid bone loss was calculated and compared for patients with a prior history of shoulder instability. Results: Of the 714 athletes that were prospectively followed during the four-year period, 23 shoulders in 22 subjects sustained a first-time anterior instability event (5 dislocations, 18 subluxations), and six subjects with a previous history of instability sustained a recurrent anterior instability event (1 dislocation, 5 subluxations). On average, there was statistically significant glenoid bone loss (1.84 ± 1.47 mm) following a single instability event (p<0.001), equivalent to 6.8% (95% CI: 4.46%, 9.04%, range 0.71%-17.6%) of the glenoid width. Twelve shoulders (52%) demonstrated glenoid bone loss ≥ 5%, 4 shoulders demonstrated glenoid bone loss ≥13.5% and no shoulders had ≥20% glenoid bone loss after a first-time instability event. Pre-existing glenoid bone loss in subjects with a history of instability was 10.2% (95% CI: 1.96%, 18.35%, range 0.6% - 21.0%). This bone loss increased to 22.8% (95% CI: 20.53%, 25.15%, range 21.2% to 26.0%) following an additional instability event (P=0.0117). All six shoulders with recurrent instability had >20% glenoid bone loss. Conclusion: Glenoid bone loss of 6.8% was observed after a first-time anterior instability event. In the setting of recurrent instability, the total calculated glenoid bone loss was 22.8% with a high prevalence of bony Bankart lesions (5/6). The findings of this study support early stabilization of young, active subjects following a first-time anterior glenohumeral instability event. [Figure: see text][Table: see text]

scholarly journals Risk Factors for Recurrent Anterior Glenohumeral Instability Following a Primary Latarjet Procedure: A Prospective Analysis of 358 Patients

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0037
Author(s):  
Matthew Provencher ◽  
Liam Peebles ◽  
Nicola de Gasperis ◽  
Petar Golijanin ◽  
Paolo Scarso ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Loss ◽  
Clinical Outcomes ◽  
Anterior Instability ◽  
Latarjet Procedure ◽  
Glenohumeral Instability ◽  
Recurrent Instability ◽  
The Mean ◽  
Anterior Glenohumeral Instability

Objectives: The purpose of this study was to identify historical and demographic risk factors influencing failure rates and inferior clinical outcomes in patients reporting recurrent anterior glenohumeral instability following a primary Latarjet procedure. It was hypothesized that patients who have a greater risk of recurrent instability and worse clinical outcomes following a primary Latarjet procedure can be preoperatively identified on the basis of clinical, demographic, and radiological criteria. Methods: Between 2004 and 2014, patients who were treated with a primary Latarjet by the senior author (GDG) for unidirectional anterior shoulder instability were reviewed. Further inclusion criteria were ≥ 2 traumatic or atraumatic anterior instability events and physical examination and imaging findings consistent with anterior instability. Patients were excluded if they underwent previous ipsilateral shoulder surgery, had a rotator cuff tear, or had voluntary and/or multidirectional instability. Gender, age at first dislocation, duration of instability symptoms, number of dislocation events, age at surgery, bilateral instability, mechanism of dislocation, and quantification of glenoid and humeral head bone loss were recorded. Western Ontario Score Index (WOSI) and Single Assessment Numeric Evaluation (SANE) outcomes scores were collected at minimum five-year follow-up, along with clinical outcomes parameters including evidence of recurrent instability. Results: 358 consecutive patients (372 shoulders) with a mean age of 29.2 years (range = 16 to 68 years) met inclusion criteria at a mean follow-up of 75 months (range = 61 to 89 months). There were 299 men (83.5%) and 59 women (16.5%), of which 86 had bilateral dislocations (24%). Bilateral Latarjet procedures were performed on 14 patients (4.1%). There was a total of 173 patients (48.3%) with an on-track lesion and glenoid bone loss ≤ 13.5%, 154 patients (43%) with on-track lesion but glenoid bone loss >13.5%, and 31 patients (8.7%) with off-track lesions. 17 patients (4.9%) experienced an instability episode following treatment with primary Latarjet. The mean WOSI was 818.2 ± 156.9 for recurrent instability patients while it was 296.4 ± 207.3 for patients with no postoperative instability (F1,356 = 104.6, p < 0.05). SANE scores were also lower in cases of recurrence (65.9 ± 9.0) when compared to patients that did not report postoperative recurrence (85.8 ± 8.1) (F1,356 = 98.4 p < 0.05). The mean WOSI score of bilateral instability subjects (438.6 ± 205.8) was higher than those with unilateral instability (256.3 ± 189.6) (F2,339 = 427.0; p < 0.05), while SANE was similarly worse for bilateral subjects (79.7 ± 8.4) compared to unilateral subjects (87.6 ± 7.1) (F2,339=23168.9; p < 0.05). The patients with atraumatic dislocations reported WOSI scores that were, on average, higher than those reported for patients with traumatic ones (396.3 ± 216.3 versus 270.6 ± 197.2, respectively; F2,339 = 380.7; p < 0.05) and mean SANE scores that were lower than the others (81.7 ± 9.4 versus 86.9 ± 7.3, respectively; F2,339 = 20,722.3; p < 0.05). The mean postoperative WOSI for female patients in this cohort was higher than that of males (397.3±227.9 and 276.5±197.4 respectively; F2,339 = 372.9; p < 0.05), while SANE was lower (82.6 ± 8.4 for females and 86.5±7.8 for males; F2,339 = 19959.6; p < 0.05). The mean postoperative WOSI for subjects who were between 31 and 40 years old at the first instability episode was higher (366.5 ± 236.6) than who were less than 30 years old (F4,337 = 181.1; p < 0.05). There was no significant difference across age groups with respect to postoperative SANE scores. The mean WOSI score for patients over 40 years old at the time of the surgery was higher (347.2 ± 269.0) than for those under 22 years old (233.3 ± 217.7) and those between 23 and 30 years old (272.0 ± 182.5; (F4,337 = 181.9; p < 0.05)). SANE scores were not significantly different with respect to patient age at the time of treatment. There was found to be no correlation between the pattern of bone loss (OFF-track, ON-track < 13.5%, ON -track > 13.5%) recurrent instability and clinical outcomes. Conclusion: 4.9% of patients treated with primary Latarjet experienced recurrent anterior instability postoperatively. Preoperative risk factors included history of bilateral shoulder instability and atraumatic mechanism of dislocation. Poorer postoperative outcome scores independent of recurrent instability included age > 31 years, female gender, having more than seven instability events prior to surgery, bilateral instability, and atraumatic mechanism of first-time dislocation. This is the first clinical study to provide evidence behind specific demographic and historical factors that predispose patients to a greater risk of recurrent instability and inferior clinical outcomes following a Latarjet. This has implications on both clinical treatment and patient education to more accurately evaluate Latarjet candidates.

Diagnosis and Management of Humeral Head Bone Loss in Shoulder Instability

2012 ◽  
Vol 40 (11) ◽  
pp. 2633-2644 ◽  
Author(s):  
Jack G. Skendzel ◽  
Jon K. Sekiya
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
Humeral Head ◽  
Treatment Options ◽  
Glenohumeral Instability ◽  
Recurrent Instability ◽  
Soft Tissue Repair ◽  
Anterior Glenoid ◽  
Bony Lesions ◽  
Persistent Instability

Humeral head bone defects (Hill-Sachs lesions) are caused by anterior shoulder dislocation with impaction of the posterosuperior humeral head onto the anterior glenoid rim. Frequently, these bony lesions are associated with glenohumeral instability, and large lesions may contribute to recurrent instability after failure of a soft tissue repair. To improve outcomes and minimize the risk of persistent instability, a thorough understanding of the biomechanics of humeral bone loss is required. Detection and quantification of clinically relevant humeral head bone loss are performed through an accurate history, physical examination, and interpretation of imaging studies. The diagnosis and treatment options for reverse Hill-Sachs lesions are discussed, and the various treatment options for Hill-Sachs lesions are reviewed, including operative techniques to limit engagement of the deformity by soft tissue transfer, rotational osteotomy, bone grafting, or osteochondral transplantation.

Recurrence and Revision Rates With Arthroscopic Bankart Repair Compared With the Latarjet Procedure in Competitive Rugby Players With Glenohumeral Instability and a Glenoid Bone Loss <20%

2021 ◽  
Vol 49 (4) ◽  
pp. 866-872
Author(s):  
Luciano A. Rossi ◽  
Ignacio Tanoira ◽  
Tomás Gorodischer ◽  
Ignacio Pasqualini ◽  
Maximiliano Ranalletta
Keyword(s):  
Bone Loss ◽  
Functional Outcomes ◽  
Return To Sport ◽  
Glenoid Bone Loss ◽  
Bankart Repair ◽  
Latarjet Procedure ◽  
Glenohumeral Instability ◽  
Arthroscopic Bankart Repair ◽  
Significant Difference ◽  
Rugby Players

Background: There is a lack of evidence in the literature comparing outcomes between the arthroscopic Bankart repair and the Latarjet procedure in competitive rugby players with glenohumeral instability and a glenoid bone loss <20%. Purpose: To compare return to sport, functional outcomes, and complications between the arthroscopic Bankart repair and the Latarjet procedure in competitive rugby players with glenohumeral instability and a glenoid bone loss <20%. Study Design: Cohort study; Level of evidence, 3. Methods: Between June 2010 and February 2018, 130 competitive rugby players with anterior shoulder instability were operated on in our institution. The first 80 patients were operated on with the arthroscopic Bankart procedure and the other 50 with the open Latarjet procedure. Return to sport, range of motion (ROM), the Rowe score, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences, reoperations, and complications were also evaluated. Results: In the total population, the mean follow-up was 40 months (range, 24-90 months) and the mean age was 24.2 years (range, 16-33 years). Ninety-two percent of patients were able to return to rugby, 88% at their preinjury level of play. Eighty-nine percent of patients in the Bankart group and 87% in the Latarjet group returned to compete at the same level ( P = .788). No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe and ASOSS scores showed statistical improvement after operation ( P < .01). No significant difference in functional scores was found between the groups The Rowe score in the Bankart group increased from a preoperative mean (± SD) of 41 ± 13 points to 89.7 points postoperatively, and in the Latarjet group, from a preoperative mean of 42.5 ± 14 points to 88.4 points postoperatively ( P = .95). The ASOSS score in the Bankart group increased from a preoperative mean of 53.3 ± 3 points to 93.3 ± 6 points postoperatively, and in the Latarjet group, from a preoperative mean of 53.1 ± 3 points to 93.7 ± 4 points postoperatively ( P = .95). There were 18 recurrences (14%). The rate of recurrence was 20% in the Bankart group and 4% in the Latarjet group ( P = .01). There were 15 reoperations (12%). The rate of reoperation was 16% in the Bankart group and 4% in the Latarjet group ( P = .03). There were 6 complications (5%). The rate of complications was 4% in the Bankart group and 6% in the Latarjet group ( P = .55). The proportion of postoperative osteoarthritis was 10% in the Bankart group (8/80 patients) and 12% (6/50 patients) in the Latarjet group ( P = .55). Conclusion: In competitive rugby players with glenohumeral instability and a glenoid bone loss <20%, both the arthroscopic Bankart repair and the Latarjet procedure produced excellent functional outcomes, with most athletes returning to sport at the same level they had before the injury. However, the Bankart procedure was associated with a significantly higher rate of recurrence (20% vs 4%) and reoperation (16% vs 4%) than the Latarjet procedure.

Management of Bone Loss in Glenohumeral Instability

2014 ◽  
Vol 45 (4) ◽  
pp. 523-539 ◽  
Author(s):  
Ronak M. Patel ◽  
Nirav H. Amin ◽  
T. Sean Lynch ◽  
Anthony Miniaci
Keyword(s):  
Bone Loss ◽  
Glenohumeral Instability

scholarly journals How to measure a Hill–Sachs lesion: a systematic review

2019 ◽  
Vol 4 (4) ◽  
pp. 151-157 ◽  
Author(s):  
Marta Maio ◽  
Marco Sarmento ◽  
Nuno Moura ◽  
António Cartucho
Keyword(s):  
Bone Loss ◽  
Three Dimensional ◽  
Correlation Coefficients ◽  
Glenohumeral Instability ◽  
Search Terms ◽  
Simultaneous Evaluation ◽  
Length Width ◽  
Anterior Glenohumeral Instability ◽  
The Hill ◽  
Mri Measurements

Quantifying bone loss is important to decide the best treatment for patients with recurrent anterior glenohumeral instability. Currently, there is no standard method available to make a precise evaluation of the Hill–Sachs lesion and predict its engagement before the surgical procedure. This literature review was performed in order to identify existing published imaging methods quantifying humeral head bone loss in Hill–Sachs lesions. Searches were undertaken in Scopus and PubMed databases from January 2008 until February 2018. The search terms were “Hill-Sachs” and “measurement” for the initial search and “Hill–Sachs bone loss” for the second, to be present in the keywords, abstracts and title. All articles that presented a method for quantifying measurement of Hill–Sachs lesions were analysed. Several methods are currently available to evaluate Hill–Sachs lesions. The length, width and depth measurements on CT scans show strong inter and intra-observer correlation coefficients. Three-dimensional CT is helpful for evaluation of bony injuries; however, there were no significant differences between 3D CT and 3D MRI measurements. The on-track off-track method using MRI allows a simultaneous evaluation of the Hill–Sachs and glenoid bone loss and also predicts the engaging lesions with good accuracy. Cite this article: EFORT Open Rev 2019;4:151-157. DOI: 10.1302/2058-5241.4.180031

Effect of Posterior Glenoid Bone Loss and Retroversion on Arthroscopic Posterior Glenohumeral Stabilization

2020 ◽  
Vol 48 (11) ◽  
pp. 2621-2627
Author(s):  
Jared A. Wolfe ◽  
Michael Elsenbeck ◽  
Kyle Nappo ◽  
Daniel Christensen ◽  
Robert Waltz ◽  
...  
Keyword(s):  
Bone Loss ◽  
Circle Method ◽  
Glenoid Bone Loss ◽  
Labral Repair ◽  
Glenohumeral Instability ◽  
Level Of Evidence ◽  
Bone Deficiency ◽  
Posterior Shoulder ◽  
Deficiency Group ◽  
Glenoid Retroversion

Background: Posterior glenohumeral instability is an increasingly recognized cause of shoulder instability, but little is known about the incidence or effect of posterior glenoid bone loss. Purpose: To determine the incidence, characteristics, and failure rate of posterior glenoid deficiency in shoulders undergoing isolated arthroscopic posterior shoulder stabilization. Study Design: Cohort study; Level of evidence, 3. Methods: All patients undergoing isolated posterior labral repair and glenoid-based capsulorrhaphy with suture anchors between 2008 and 2016 at a single institution were identified. Posterior bone deficiency was calculated per the best-fit circle method along the inferior two-thirds of the glenoid by 2 independent observers. Patients were divided into 2 groups: minimal (0%-13.5%) and moderate (>13.5%) posterior bone loss. The primary outcome was reoperation for any reason. The secondary outcomes were military separation and placement on permanent restricted duty attributed to the operative shoulder. Results: A total of 66 shoulders met the inclusion criteria, with 10 going on to reoperation after a median follow-up of 16 months (range, 14-144 months). Of the total shoulders, 86% (57/66) had ≤13.5% bone loss and 14% (9/66) had >13.5%. Patients with moderate posterior glenoid bone loss had significantly greater retroversion (−11.5° vs −4.3°; P = .01). Clinical failure requiring reoperation was seen in 10.5% of patients in the minimal bone deficiency group and 44.4% in the moderate group ( P = .024). There was no difference between groups in rate of military separation or restricted duty. Patients with moderate posterior glenoid bone deficiency were more likely to be experiencing instability instead of pain on initial presentation ( P < .001), were more likely to have a positive Jerk test result ( P = .05), and had increased glenoid retroversion ( P = .01). Conclusion: In shoulders with moderate glenoid bone deficiency (>13.5%) and increased glenoid retroversion, posterior capsulolabral repair alone may result in higher reoperation rates than in shoulders without bone deficiency.

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