Medial Posterior Capsular Plication Reduces Anterior Shoulder Instability Similar to Remplissage Without Restricting Motion in the Setting of an Engaging Hill-Sachs Defect

2017 ◽  
Vol 45 (9) ◽  
pp. 1982-1989 ◽  
Author(s):  
Brian C. Werner ◽  
Xiang Chen ◽  
Christopher L. Camp ◽  
Andreas Kontaxis ◽  
Joshua S. Dines ◽  
...  
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Biomechanical Testing ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Anterior Translation ◽  
Capsular Plication ◽  
Fresh Frozen ◽  
Surgical Options ◽  
Joint Loads

Background: Numerous surgical options for the management of engaging Hill-Sachs lesions exist, of which remplissage has emerged as one of the most popular arthroscopic techniques. Remplissage is not without disadvantages, however, and has been demonstrated to potentially result in a loss of external rotation (ER) due to nonanatomic tethering of the infraspinatus tendon and a potential decrease in infraspinatus strength clinically. Purpose: The efficacy of posterior medial capsular plication in addition to Bankart repair was examined as an arthroscopic management strategy for an engaging Hill-Sachs defect. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen human cadaveric shoulders were utilized for the study. After testing baseline translation and motion, 30% Hill-Sachs lesions were created in each specimen. Three experimental groups were assembled: (1) isolated Bankart repair (HSD), (2) Bankart repair with remplissage (RM), and (3) Bankart repair with posterior medial capsular plication (PL). Biomechanical testing was performed to determine anterior translation, range of motion, and Hill-Sachs engagement. Translation and motion measurements were normalized to the baseline laxity values for each specimen. Results: A significant reduction in anterior translation was noted at 60° of abduction and 60° of ER for both the PL and RM groups compared with the HSD group throughout most of the joint loads tested ( P < .05), but no significant differences were noted between the PL and RM groups at any load. The RM group had significantly less normalized ER at 60° of abduction compared with the HSD and PL groups ( P < .05). There were no differences in internal rotation between the groups. All 8 specimens in the HSD group engaged, while no specimens in the RM and PL groups engaged ( P < .001). Conclusion: In a cadaveric model, medial posterior capsular plication as an adjunct to Bankart repair offers similar resistance to anterior translation and Hill-Sachs engagement as compared with remplissage in the setting of an engaging Hill-Sachs defect. Medial posterior capsular plication results in less restriction of ER compared with remplissage without any significant limitation of internal rotation. Clinical Relevance: Posterior medial capsular plication reduces translation and engagement similarly to remplissage, without any restriction in motion.

scholarly journals Stability Outcomes following Computer-Assisted ACL Reconstruction

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
Melissa A. Christino ◽  
Bryan G. Vopat ◽  
Alexander Mayer ◽  
Andrew P. Matson ◽  
Steven E. Reinert ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Acl Reconstruction ◽  
External Rotation ◽  
Patient Characteristics ◽  
Computer Assisted ◽  
Single Bundle ◽  
Anterior Instability ◽  
Knee Stability ◽  
Anterior Translation ◽  
Stability Measurements

Purpose. The purpose of this study was to determine whether intraoperative prereconstruction stability measurements and/or patient characteristics were associated with final knee stability after computer-assisted ACL reconstruction.Methods. This was a retrospective review of all patients who underwent computer-assisted single-bundle ACL reconstruction by a single surgeon. Prereconstruction intraoperative stability measurements were correlated with patient characteristics and postreconstruction stability measurements. 143 patients were included (87 male and 56 female). Average age was 29.8 years (SD ± 11.8).Results. Females were found to have significantly more pre- and postreconstruction internal rotation than males (P< 0.001 andP= 0.001, resp.). Patients with additional intra-articular injuries demonstrated more prereconstruction anterior instability than patients with isolated ACL tears (P< 0.001). After reconstruction, these patients also had higher residual anterior translation (P= 0.01). Among all patients with ACL reconstructions, the percent of correction of anterior translation was found to be significantly higher than the percent of correction for internal or external rotation (P< 0.001).Conclusion. Anterior translation was corrected the most using a single-bundle ACL reconstruction. Females had higher pre- and postoperative internal rotation. Patients with additional injuries had greater original anterior translation and less operative correction of anterior translation compared to patients with isolated ACL tears.

Dynamic Anterior Shoulder Stabilization With the Long Head of the Biceps Tendon: A Biomechanical Study

2019 ◽  
Vol 47 (6) ◽  
pp. 1441-1450 ◽  
Author(s):  
Julian Mehl ◽  
Alexander Otto ◽  
Florian B. Imhoff ◽  
Matthew Murphy ◽  
Felix Dyrna ◽  
...  
Keyword(s):  
External Rotation ◽  
Biceps Tendon ◽  
Surgical Techniques ◽  
Bankart Repair ◽  
Shoulder Stabilization ◽  
Glenoid Defect ◽  
Anterior Translation ◽  
Defect Groups ◽  
Anterior Glenoid ◽  
Long Head

Background: The concept of dynamic anterior shoulder stabilization (DAS) combines a Bankart repair with the additional sling effect of the long head of the biceps (LHB) tendon to treat anterior glenohumeral instability. This surgical technique was created to close the gap between the indications for isolated Bankart repair and those requiring bone transfer techniques. Purpose: To biomechanically investigate the stabilizing effects of the DAS technique in comparison with the standard Bankart repair in different defect models. Study Design: Controlled laboratory study. Methods: Twenty-four fresh-frozen cadaveric shoulders (mean ± SD age, 60.1 ± 8.6 years) were mounted in a 6 degrees of freedom shoulder testing system. With cross-sectional area ratios, the rotator cuff muscles and LHB tendon were loaded with 40 N and 10 N, respectively. Anterior and inferior glenohumeral translation was tested in 60° of abduction and 60° of external rotation (ABER position) while forces of 20 N, 30 N, and 40 N were applied to the scapula in the posterior direction. Total translation and relative translation in relation to the native starting position were measured with a 3-dimensional digitizer. Maximal external rotation and internal rotation after application of 1.5-N·m torque to the humerus were measured. All specimens went through 4 conditions (intact, defect, isolated Bankart repair, DAS) and were randomized to 1 of 3 defect groups (isolated Bankart lesion, 10% anterior glenoid defect, 20% anterior glenoid defect). The DAS was performed by transferring the LHB tendon through a subscapularis split to the anterior glenoid margin, where it was fixed with an interference screw. Results: Both surgical techniques resulted in decreased anterior glenohumeral translation in comparison with the defect conditions in all defect groups. As compared with isolated Bankart repair, DAS showed significantly less relative anterior translation in 10% glenoid defects at translation forces of 20 N (0.3 ± 1.7 mm vs 2.2 ± 1.8 mm, P = .005) and 30 N (2.6 ± 3.4 mm vs 5.3 ± 4.2 mm, P = .044) and in 20% glenoid defects at all translation forces (20 N: –3.2 ± 4.7 mm vs 0.8 ± 4.1 mm, P = .024; 30 N: –0.9 ± 5.3 mm vs 4.0 ± 5.2 mm, P = .005; 40 N: 2.1 ± 6.6 mm vs 6.0 ± 5.7 mm, P = .035). However, in 20% defects, DAS led to a relevant posterior and inferior shift of the humeral head in the ABER position and to a relevant increase in inferior glenohumeral translation. Both surgical techniques did not limit the rotational range of motion. Conclusion: In the context of minor glenoid bone defects, the DAS technique demonstrates less relative anterior translation as compared with an isolated Bankart repair at time zero. Clinical Relevance: The new DAS technique seems capable of closing the gap between the indications for isolated Bankart repair and bone transfer techniques.

Biomechanical Measurements of Torsion-Tension Coupling in Human Cadaveric Femurs

2010 ◽  
Vol 133 (1) ◽  
Author(s):  
Rad Zdero ◽  
Alison J. McConnell ◽  
Christopher Peskun ◽  
Khalid A. Syed ◽  
Emil H. Schemitsch
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Tensile Load ◽  
Strong Relationship ◽  
Strongly Coupled ◽  
Axial Tensile ◽  
Applied Torque ◽  
Two Factors ◽  
Fresh Frozen ◽  
Rotation Groups

The mechanical behavior of human femurs has been described in the literature with regard to torsion and tension but only as independent measurements. However, in this study, human femurs were subjected to torsion to determine if a simultaneous axial tensile load was generated. Fresh frozen human femurs (n=25) were harvested and stripped of soft tissue. Each femur was mounted rigidly in a specially designed test jig and remained at a fixed axial length during all experiments. Femurs were subjected to external and internal rotation applied at a constant angulation rate of 0.1 deg/s to a maximum torque of 12 N m. Applied torque and generated axial tension were monitored simultaneously. Outcome measurements were extracted from torsion-versus-tension graphs. There was a strong relationship between applied torsion and the resulting tension for external rotation tests (torsion/tension ratio=551.7±283.8 mm, R2=0.83±0.20, n=25), internal rotation tests (torsion/tension ratio=495.3±233.1 mm, R2=0.87±0.17, n=24), left femurs (torsion/tension ratio=542.2±262.4 mm, R2=0.88±0.13, n=24), and right femurs (torsion/tension ratio=506.7±260.0 mm, R2=0.82±0.22, n=25). No statistically significant differences were found for external versus internal rotation groups or for left versus right femurs when comparing torsion/tension ratios (p=0.85) or R2 values (p=0.54). A strongly coupled linear relationship between torsion and tension for human femurs was exhibited. This suggests an interplay between these two factors during activities of daily living and injury processes.

ULTRASONIC EVALUATION OF ANTERIOR SHOULDER TRANSLATION IN NORMAL SHOULDERS

2003 ◽  
Vol 07 (02) ◽  
pp. 125-134 ◽  
Author(s):  
Joo Seng Yeap ◽  
Alison H. McGregor ◽  
Keith Humphries ◽  
Andrew L. Wallace
Keyword(s):  
Internal Rotation ◽  
Humeral Head ◽  
External Rotation ◽  
Correlation Coefficients ◽  
Observer Variation ◽  
Present Moment ◽  
Anterior Translation ◽  
Ultrasonic Evaluation ◽  
Displacement Force ◽  
The Right

Anterior translation in the right shoulders of 23 volunteers was evaluated using ultrasound from an anterior approach with a 10 MHz, 6 cm wide linear transducer. A translatory force of 90 N was used to translate the humeral head in the adduction and internal rotation position, while a translatory force of 60 N was used in the more clinically relevant position of 90° abduction and external rotation position. The overall intra-observer coefficients of variation ranged from 0–13.0% (mean 3.8 ± 2.5%) for examiner I and 0.5–20.9% (mean 5.1 ± 3.9%) for examiner II. The overall inter-observer variation ranged from 0–29.8% (mean 9.3 ± 7.3%). The anterior translation of the humeral head in adduction and internal rotation following 90 N displacement force ranged from -2.6 to 12.9 mm (mean 2.1 ± 3.1 mm) for examiner I and from -4.1 to 4.7 mm (mean 1.1 ± 2.2 mm) for examiner II. The anterior translation of the humeral head in abduction and external rotation following 60 N displacement force ranged from -3.3 to 3.7 mm (mean 0.3 ± 1.9 mm) for examiner I and from -8.3 mm to 4.5 mm (mean -0.7 ± 2.6 mm) for examiner II. The intra-class correlation coefficients (r) for the measured anterior translation between the two examiners for the 2 positions were 0.029 and -0.058 respectively. We concluded that the inter-observer coefficient of variation remained excessive and the agreement in the measured anterior translation between the two examiners was poor. The finding of negative values in the measured anterior translation despite the use of 90 N and 60 N translatory force raises further concerns about the prospective clinical use of this technique at the present moment.

scholarly journals Clinical Outcome of Arthroscopic Remplissage as Augmentation During Arthroscopic Bankart Repair for Recurrent Anterior Shoulder Instability

2017 ◽  
Vol 11 (1) ◽  
pp. 1268-1276 ◽  
Author(s):  
Ryosuke Miyamoto ◽  
Atsushi Yamamoto ◽  
Hitoshi Shitara ◽  
Tsuyoshi Ichinose ◽  
Daisuke Shimoyama ◽  
...  
Keyword(s):  
Los Angeles ◽  
Bone Defect ◽  
External Rotation ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Control Group ◽  
Arthroscopic Bankart Repair ◽  
Clinical Scores ◽  
Bony Bankart ◽  
One Year

Purpose:We aimed to assess functional outcomes and postoperative recurrence rate associated with the remplissage procedure used for bone augmentation with Bankart repair in patients with Hill-Sachs lesions after shoulder dislocation.Methods:Preoperative computed tomography was performed to check for bony Bankart lesions,calculate the bone defect rate, and estimate the risk for re-dislocation. Functional and clinical scores were assessed preoperatively and at three months, six months, and one year postoperatively.Results:Between 2011 and 2014, 18 patients (17 male; age at surgery, 29.0±10.4 years; 18 affected shoulders) underwent arthroscopic Bankart repair with arthroscopic remplissage (remplissage group), and 18 sex- and age-matched controls underwent arthroscopic Bankart repair alone (control group). The incidence of bony Bankart lesion and glenoid bone defect was significantly higher in the remplissage group. No complications, re-dislocation, or re-subluxation was noted during or after the operation. Postoperatively, the range of motion and muscular weakness alleviated with time, and the clinical scores improved significantly from the preoperative values. However, the remplissage group showed significantly restricted shoulder flexion, abduction, internal rotation and external rotation even at one year postoperatively. Compared to the control group, the remplissage group showed significantly lower Rowe scores preoperatively, and both Rowe scores and University of California-Los Angeles scale scores remained significantly lower throughout the one-year follow-up.Conclusion:Despite some restriction of external rotation, remplissage leads to better clinical scores and no recurrence, providing a valid means of augmentation for Bankart repair in high-risk patients with engaged Hill-Sachs lesion.

Borderline Glenoid Bone Defect in Anterior Shoulder Instability: Latarjet Procedure Versus Bankart Repair

2018 ◽  
Vol 46 (9) ◽  
pp. 2170-2176 ◽  
Author(s):  
Yoon Sang Jeon ◽  
Ho Yeon Jeong ◽  
Dong Ki Lee ◽  
Yong Girl Rhee
Keyword(s):  
Bone Defect ◽  
Shoulder Instability ◽  
External Rotation ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Spinal Segment ◽  
Arthroscopic Bankart Repair ◽  
Recurrent Anterior Shoulder Instability

Background: The optimal procedure for anterior shoulder instability with a borderline (15%-20%) bone defect on the anterior rim of the glenoid is still controversial. Purpose: To compare the clinical outcome and recurrence rate between the arthroscopic Bankart repair and Latarjet procedure among patients with recurrent anterior shoulder instability and a borderline glenoid bone defect. Study Design: Cohort study; Level of evidence, 3. Methods: The authors retrospectively reviewed cases of arthroscopic Bankart repair and the Latarjet procedure for recurrent anterior shoulder instability with a borderline (15%-20%) glenoid bone defect. Enrollment comprised 149 patients (Bankart group, n = 118; Latarjet group, n = 31). The mean follow-up and age at operation were 28.9 ± 7.3 months (range, 24-73 months) and 26 ± 5 years (range, 16-46 years), respectively. Results: Rowe and UCLA (University of California, Los Angeles) shoulder scores significantly improved from 42.0 ± 14.3 and 22.9 ± 3.2 preoperatively to 90.9 ± 15.4 and 32.5 ± 3.3 postoperatively in the Bankart group ( P < .001) and from 41.0 ± 17.9 and 22.3 ± 3.4 to 91.1 ± 16.1 and 32.3 ± 3.4 in the Latarjet group ( P < .001), respectively. There were no significant between-group differences in Rowe ( P = .920) or UCLA ( P = .715) scores at the final follow-up. Mean postoperative loss of motion during forward flexion, external rotation in abduction, and internal rotation to the posterior was 3.0° ± 6.2°, 11.6° ± 10.2°, and 0.6 spinal segment in the Bankart group and 3.7° ± 9.8°, 10.3° ± 12.8°, and 0.9 spinal segment in the Latarjet group, respectively. These differences were not significant. However, the loss of external rotation at the side was significantly greater in the Bankart group (13.3° ± 12.9°) than in the Latarjet group (7.3° ± 18.1°, P = .034). The overall recurrence rate was significantly higher in the Bankart group (22.9%) than in the Latarjet group (6.5%), ( P = .040). Conclusion: The Latarjet procedure and arthroscopic Bankart repair both provided satisfactory clinical outcome scores and pain relief for anterior shoulder instability with a borderline glenoid bone defect. However, the Latarjet procedure resulted in significantly lower recurrences and less external rotation limitation than the arthroscopic Bankart repair. Therefore, the Latarjet procedure could be a more reliable surgical option in anterior recurrent instability with a borderline glenoid bone defect.

scholarly journals Biomechanical Evaluation of a New Suture Button Technique for Reduction and Stabilization of the Distal Tibiofibular Syndesmosis

2020 ◽  
Vol 5 (4) ◽  
pp. 247301142096914
Author(s):  
Andres Eduardo O’Daly ◽  
R. Timothy Kreulen ◽  
Sorawut Thamyongkit ◽  
Alfred Pisano ◽  
Kitchai Luksameearunothai ◽  
...  
Keyword(s):  
Conventional Method ◽  
External Rotation ◽  
Biomechanical Testing ◽  
Biomechanical Properties ◽  
New Technique ◽  
Rotational Stability ◽  
Torsional Resistance ◽  
Fresh Frozen ◽  
Biomechanical Evaluation ◽  
Stabilization Technique

Background: Stabilization methods for distal tibiofibular syndesmotic injuries present risk of malreduction. We compared reduction accuracy and biomechanical properties of a new syndesmotic reduction and stabilization technique using 2 suture buttons placed through a sagittal tunnel in the fibula and across the tibia just proximal to the incisura with those of the conventional method. Methods: Syndesmotic injury was created in 18 fresh-frozen cadaveric lower leg specimens. Nine ankles were repaired with the conventional method and 9 with the new technique. Reduction for the conventional method was performed using thumb pressure under direct visualization and for the new method by tightening both suture buttons passed through the fibular and tibial tunnels. Computed tomography was used to assess reduction accuracy. Torsional resistance, fibular rotation, and fibular translation were evaluated during biomechanical testing. Results: The new technique showed less lateral translation of the fibula on CT measurements after reduction (0.06 ± 0.06 mm) than the conventional method (0.26 ± 0.31 mm), P = .02. The new technique produced less fibular rotation during internal rotation after 0 cycles (new –2.4 ± 1.4 degrees; conventional –5.0 ± 1.2 degrees, P = .001), 100 cycles (new –2.1 ± 1.9 degrees; conventional –4.6 ± 1.4 degrees, P = .01), and 500 cycles (new –2.2 ± 1.6 degrees; conventional –5.3 ± 2.5 degrees, P = .01) and during external rotation after 100 cycles (new 3.9 ± 3.3 degrees; conventional 5.9 ± 3.5 degrees, P = .02) and 500 cycles (new 3.3 ± 3.2 degrees; conventional 6.3 ± 2.6 degrees, P = .03). Fixation failed in 3 specimens. Conclusion: The new syndesmotic reduction and fixation technique resulted in more accurate reduction of the fibula in the tibial incisura in the coronal plane and better rotational stability compared with the conventional method. Clinical Relevance: This new technique of syndesmosis reduction and stabilization may be a reliable alternative to current methods.

Effect of Increased Scapular Internal Rotation on Glenohumeral External Rotation and Elbow Valgus Load in the Late Cocking Phase of Throwing Motion

2018 ◽  
Vol 46 (13) ◽  
pp. 3182-3188 ◽  
Author(s):  
Yasuo Itami ◽  
Teruhisa Mihata ◽  
Michelle H. McGarry ◽  
Charles C. Lin ◽  
Nilay A. Patel ◽  
...  
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Ulnar Collateral Ligament ◽  
Testing System ◽  
Scapular Dyskinesis ◽  
Kinetic Chain ◽  
Valgus Angle ◽  
Joint Gap ◽  
Intact Condition ◽  
Fresh Frozen

Background: Scapular dyskinesis among throwers is thought to affect kinetic chain function and increase the load demands on the shoulder and/or elbow. However, the biomechanical relationship between scapular orientation and elbow valgus load, which is associated with ulnar collateral ligament (UCL) injury, has not been determined. Purpose: To evaluate the effect of increased scapular internal rotation (IR) and glenohumeral external rotation (GHER) on elbow valgus load in a static simulation of the late cocking phase of throwing. Study Design: Controlled laboratory study. Methods: Seven fresh-frozen male cadaveric upper extremities were used with a custom testing system to simulate the late cocking phase. First, the authors evaluated the effect of increasing scapular IR on maximum GHER and forearm angle (forearm axis relative to the ground). Each parameter was evaluated at 20° to 40° (5° increments) of scapular IR by applying 2.2-N·m external rotation torque to the humerus and 0.75-N·m valgus torque to the forearm. Next, to evaluate elbow valgus stability, the humerus was locked in maximal GHER at 40° of scapular IR, and sequentially increasing torque (0.75-7.5 N·m by 0.75-N·m increments) was applied to the forearm. Valgus angle and joint gap were evaluated at each torque. Results: Increases in scapular IR ≥5° significantly decreased GHER ( P < .01). With increasing valgus torque, forearm angle also increased linearly ( R2 = 0.85, P < .001). To compensate for the GHER deficit at 40° of scapular IR, a linear regression model showed that 25.3 N·m of valgus torque would be necessary to reach the original forearm position. In the intact condition, applying elbow valgus torque ≥5.25 N·m significantly increased valgus angle and the joint gap ( P < .01). Conclusion: Increased scapular IR significantly decreased GHER. Compensation for the GHER deficit significantly increased the elbow valgus load required to reach the same forearm position. Clinical Relevance: Increased scapular IR may increase the risk of elbow UCL injury among throwing athletes.

scholarly journals Meta-Analysis of Randomized Controlled Trials Involving Anterior Shoulder Instability

2018 ◽  
Vol 12 (1) ◽  
pp. 411-418 ◽  
Author(s):  
Kavin Khatri ◽  
Hobinder Arora ◽  
Sanjay Chaudhary ◽  
Darsh Goyal
Keyword(s):  
Open Repair ◽  
External Rotation ◽  
Meta Analysis ◽  
Arthroscopic Repair ◽  
Bankart Repair ◽  
Cochrane Library ◽  
Anterior Shoulder Instability ◽  
Controlled Trials ◽  
Effect Analysis ◽  
Randomised Controlled

Background:Arthroscopic repair is gaining popularity over open repair for the treatment of bankart lesions. The study aims to evaluate the outcome of arthroscopic repair with open repair in randomised controlled trials conducted comparing the two techniques.Methods:We searched the Cochrane library, PubMed and EMBASE up to December 2017 for clinical trials comparing the outcomes of arthroscopic bankart repair with open bankart repair. We used fixed or random effects model depending upon heterogenicity. Dichotomous variables were presented as Risk Ratios (RRs) with 95% Confidence Intervals (CIs), and continuous data were measured as measured differences with 95% CIs.Result:Five studies were included, with sample size ranging from 42 to 196. Fixed effect analysis showed that the shoulder was more stable in open repair (RR=0.897, 95% CI: 0.821 to 0.980, P= 0.94) but the loss of external rotation at shoulder joint was also higher in those had open repair (RR=0.325, SMD=-0.411, 95% CI: -1.229 to 0.407). The functional outcome assessed by Rowe score was better in open repair (P=0.325). The operative time was lesser in arthroscopic repair but was not statistically significant (P=0.085).Conclusion:Our meta-analysis showed that the use of arthroscopic repair though offers better shoulder movement but the open repair is superior in terms of shoulder stability.

scholarly journals Outcomes of the Latarjet Procedure Compared With Bankart Repair for Recurrent Traumatic Anterior Shoulder Instability

2018 ◽  
Vol 53 (2) ◽  
pp. 181-183 ◽  
Author(s):  
Kellie C. Huxel Bliven ◽  
Gail P. Parr
Keyword(s):  
Treatment Effect ◽  
Shoulder Instability ◽  
Fixed Effects ◽  
Patient Reported Outcomes ◽  
External Rotation ◽  
Journal Club ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Patient Reported

Reference/Citation:  An VV, Sivakumar BS, Phan K, Trantalis J. A systematic review and meta-analysis of clinical and patient-reported outcomes following two procedures for recurrent traumatic anterior instability of the shoulder: Latarjet procedure vs. Bankart repair. J Shoulder Elbow Surg. 2016;25(5):853−863. Clinical Question:  Are clinical and patient-reported outcomes different between the Latarjet and Bankart repair stabilization procedures when performed for recurrent traumatic anterior shoulder instability? Data Sources:  Ovid MEDLINE, PubMed, Cochrane databases, American College of Physicians Journal Club, and Database of Abstracts of Review of Effectiveness were searched up to June 2015. The search terms used were Bankart AND Latarjet OR Bristow. Study Selection:  Criteria used to include studies that (1) were written in English; (2) compared the outcomes of any Latarjet procedure (Bristow-Latarjet, coracoid transfer, or modified Bristow) with Bankart repair (anatomic); (3) reported a minimum of 1 outcome of recurrence, redislocation, revision, or patient-reported outcome measure; and (4) reported original data. Data Extraction:  Data presented in any format (text, table, figure) were extracted from all included studies. The quality of each study was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Summary statistics were reported as relative risks and weighted mean differences. Fixed-effects (the assumed treatment effect was the same across studies) and random-effects (variations in treatment effect were assumed among studies) models were tested. Heterogeneity between trials was assessed using the χ2 statistic, and the amount (percentage) of variation across studies due to heterogeneity was calculated using the I2 statistic. Forest plots were used to present pooled results. Main Results:  After the initial search, 245 articles were identified. After we applied the inclusion criteria, a total of 8 studies reporting on 795 patients (Latarjet = 379, Bankart = 416) were included in this review. Using the National Health and Medical Research Council's level of evidence, the authors scored 7 of the studies at level III and 1 study at level II. All Latarjet procedures were performed using an open technique, whereas the Bankart procedure was performed open in 6 studies and arthroscopically in 2 studies. The demographics of the patients (age, proportion of males to females, proportion with surgery on the dominant side, and proportion of revisions) were similar between the 2 surgical procedures. Four groups reported that patients who underwent the Latarjet procedure had fewer recurrences than patients in the Bankart repair group (11.6% versus 21.1%, respectively), irrespective of whether the Bankart was performed open or arthroscopically. Similarly, 4 groups observed that the Latarjet procedure resulted in fewer postsurgical redislocations (5.0%) than the Bankart (9.5%) procedure, irrespective of whether the repair was open or arthroscopic. The authors of 7 studies noted no differences between the 2 procedures in revision rates (Latarjet: 3.4%, Bankart: 4.5%), and 8 studies demonstrated no differences in complications requiring reoperation (Latarjet: 5.0%, Bankart: 3.1%). Investigators in 7 studies used the Rowe score to measure patient-reported satisfaction and function; patients who underwent the Latarjet procedure reported better Rowe scores postsurgically than patients who underwent the Bankart repair (scores: 79.0 and 85.4, respectively). Researchers in 4 studies reported a loss of external-rotation range of motion, which was less in the Latarjet (11.5°) compared with the Bankart (20.9°) procedure. Of the 5 groups that reported return to function, a trend suggested that a greater proportion of patients who underwent the Latarjet procedure returned to work, sport, and throwing activities compared with those who underwent the Bankart repair. Conclusions:  The Latarjet procedure produced fewer recurrences, better patient-reported outcomes, and less restricted external-rotation motion than the Bankart repair.

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