Glenoid Bone Loss in Posterior Shoulder Instability: Prevalence and Outcomes in Arthroscopic Treatment

2018 ◽  
Vol 46 (5) ◽  
pp. 1053-1057 ◽  
Author(s):  
Adam Hines ◽  
Jay B. Cook ◽  
James S. Shaha ◽  
Kevin Krul ◽  
Steve H. Shaha ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Patient Reported Outcomes ◽  
Glenoid Bone Loss ◽  
Labral Repair ◽  
Arthroscopic Stabilization ◽  
Posterior Instability ◽  
Glenohumeral Instability ◽  
Patient Reported ◽  
Return To Duty

Background: Glenoid bone loss is a well-accepted risk factor for failure after arthroscopic stabilization of anterior glenohumeral instability. Glenoid bone loss in posterior instability has been noted relative to its existence in posterior instability surgery. Its effect on outcomes after arthroscopic stabilization has not been specifically evaluated and reported. Purpose: The purpose was to evaluate the presence of posterior glenoid bone loss in a series of patients who had undergone arthroscopic isolated stabilization of the posterior labrum. Bone loss was then correlated to return-to-duty rates, complications, and validated patient-reported outcomes. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective review was conducted at a single military treatment facility over a 4-year period (2010-2013). Patients with primary posterior instability who underwent arthroscopic isolated posterior labral repair were included. Preoperative magnetic resonance imaging was used to calculate posterior glenoid bone loss using a standardized “perfect circle” technique. Demographics, return to duty, complications, and reoperations, as well as outcomes scores including the Single Assessment Numeric Evaluation and the Western Ontario Shoulder Instability Index (WOSI) scores, were obtained. Outcomes were analyzed across all patients based on percentage of posterior glenoid bone loss. Bone loss was then categorized as below or above the subcritical threshold of 13.5% to determine if bone loss effected outcomes similar to what has been shown in anterior instability. Results: There were 43 consecutive patients with primary, isolated posterior instability, and 32 (74.4%) completed WOSI scoring. Mean follow-up was 53.7 months (range, 25-82 months) The mean posterior glenoid bone loss was 7.3% (0%-21.5%). Ten of 32 patients (31%) had no appreciable bone loss. Bone loss exceeded 13.5% in 7 of 32 patients (22%), and 2 patients (6%) exceeded 20% bone loss. Return to full duty or activity was nearly 90% overall. However, those with >13.5%, subcritical glenoid bone loss, were statistically less likely to return to full duty (relative risk = 1.8), but outcomes scores, complications, and revision rates were otherwise not different in those with no or minimal bone loss versus those with more significant amounts. Conclusion: Posterior glenoid bone loss has not previously been evaluated independently relative to patients with shoulder instability repairs. Sixty-nine percent of our patients had measurable bone loss, and 22% had greater than 13.5%, or above subcritical bone loss. While these patients were statistically less likely to return to full duty, the reoperation rate, complications, and patient-reported outcomes between groups were not different.

scholarly journals WHAT ARE THE PREDICTORS OF POOR PATIENT-REPORTED OUTCOMES FOLLOWING SHOULDER INSTABILITY SURGERY?

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0017
Author(s):  
Ahmad F. Bayomy ◽  
Isaac Briskin ◽  
Lauren E. Grobaty ◽  
Elizabeth Sosic ◽  
Greg J. Strnad ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Bone Loss ◽  
Revision Surgery ◽  
Shoulder Instability ◽  
Patient Reported Outcomes ◽  
Glenoid Bone Loss ◽  
Smoking History ◽  
Labral Tears ◽  
Patient Reported ◽  
One Year

Background: Prospectively-collected patient-reported outcomes (PROs) following shoulder instability surgery are limited. Attention has been drawn to standardizing these outcome measures in the adolescent literature. Hypothesis/Purpose: The purpose of this study was to evaluate which factors predict unfavorable PROs following shoulder instability surgery, including a “No” response to the Patient Acceptable Symptom State (PASS) question. We hypothesized that poor outcomes are associated with adolescent males, bone loss, larger labral tears, and articular cartilage injury. Methods: A cohort of patients age 13 years and older undergoing shoulder instability surgery were prospectively enrolled in point-of-care data collection at a single institution across 12 surgeons from 2015-2017. Demographics, ASES and SANE responses, and surgical findings were obtained at baseline. ASES, SANE, and PASS responses as well as revision surgery were queried at least one year post-operatively. Patients with isolated posterior labral tears and prior ipsilateral shoulder surgery were excluded. Regression analyses were performed. Results: A total 268 patients met inclusion criteria of which 201 completed follow-up responses (75%). Non-responders had a greater BMI, smaller proportion of glenoid bone loss, fewer Hill-Sachs lesions, and lower baseline ASES scores by 7.5 points (p < 0.05). Responders’ mean age was 25.5 years and 23% were female. Revision surgery occurred in 2.5% of these patients, and 81% responded “Yes” to PASS. A “Yes” response correlated to mean 31-point improvement in ASES and 34-point improvement in SANE scores. On univariate analysis, “No” responders were more likely to have a smoking history, a larger proportion of glenoid bone loss, and revision surgery (p < 0.05). However, on multivariate analysis, only combined labral tears (anterior/inferior plus superior or posterior tears) and injured capsules were associated with greater odds of responding “No” to PASS and with lower ASES and SANE scores (p ≤ 0.05) (Table 1). Age, sex, Hill-Sachs lesions, and grade III/IV articular cartilage injuries were not associated with variation in any PROs. Conclusion: In this prospective cohort, patients largely approve of their symptom state at one year or greater following shoulder instability surgery. A PASS “Yes” response occurred in 81% of patients and correlated to a clinically and statistically significant improvement in ASES and SANE scores. Combined labral tears and injured capsules were negative prognosticators across PROs, whereas age, sex, and Hill-Sachs lesions were not. Table: [Table: see text]

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.

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.

scholarly journals The role of structured physiotherapy in treating patients with atraumatic shoulder instability: Medium term results from a case series

2019 ◽  
Vol 12 (1) ◽  
pp. 63-70 ◽  
Author(s):  
Martin Scott ◽  
Nikolaos Platon Sachinis ◽  
Benjamin Gooding
Keyword(s):  
Shoulder Instability ◽  
Patient Reported Outcomes ◽  
Case Series ◽  
Posterior Instability ◽  
Medium Term ◽  
Previous Surgery ◽  
Early Referral ◽  
Improved Outcomes ◽  
Patient Reported

BackgroundConsensus favours conservative treatment for atraumatic shoulder instability, but literature is scarce on the topic. We therefore prospectively assessed the results of structured physiotherapy for these patients.MethodsPatient reported outcomes were recorded prior to physiotherapy and on discharge. Notes review identified patients re-referred for the same condition.ResultsN = 85. Review range was 12–72 months post-treatment. Median Oxford Shoulder Instability Score (OSIS) improved from 21 (range: 2–47) to 39 (11–47). Median Western Ontario Shoulder Instability Index (WOSI) improved from 1117 (range: 306–2028) to 485 (0–1569). Patients with posterior instability demonstrated better results compared with other groups (OSIS change, p = 0.025; WOSI change, p = 0.060). Quicker referral to physiotherapy gave improved outcomes (OSIS change, p = 0.004, rs = −0.4; WOSI change, p = 0.047, rs = 0.24). Twenty-one patients (24.7%) were re-referred, seven of them for repeat physiotherapy and 14 of them for surgery. Previous surgery significantly affected the possibility of a further referral ( p < 0.001), and initial diagnosis was significantly correlated with further surgery ( p = 0.032).DiscussionEarly referral to physiotherapy may produce better results. Patients with posterior instability responded better to physiotherapy. Previous surgery increased the risk of re-referral. Re-referred patients with posterior instability tended to be managed with further physiotherapy.

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 Arthroscopic Distal Tibial Allograft for Posterior Glenoid Reconstruction

2021 ◽  
Vol 1 (4) ◽  
pp. 263502542110067
Author(s):  
Benjamin W. Hoyt ◽  
Cory A. Riccio ◽  
Lance E. LeClere ◽  
Kelly G. Kilcoyne ◽  
Jonathan F. Dickens
Keyword(s):  
Bone Loss ◽  
Distal Tibia ◽  
Glenoid Bone Loss ◽  
Labral Repair ◽  
Anatomic Reconstruction ◽  
Joint Surface ◽  
Bone Block ◽  
Posterior Instability ◽  
Invasive Approach ◽  
Glenoid Reconstruction

Background: Posterior glenoid bone loss occurs in more than two-thirds of patients with posterior glenohumeral instability, with 14% to 22% having greater than subcritical bone loss (13.5%), a marker for potential need for bony augmentation versus soft tissue-only procedures. Several techniques are described to augment either the version or volume of the glenoid surface including osteotomies, autograft transfers, and allograft tibia transfers. Indications: Arthroscopic-assisted allograft distal tibia bone block augmentation to the posterior glenoid is indicated for revision posterior instability procedures with posterior bone loss and in primary cases of posterior instability with critical bone loss. Technique Description: Arthroscopic posterior glenoid reconstruction with allograft distal tibia and posterior labral repair in the lateral position is presented. This technique uses standard instrument sets and requires no patient repositioning. The preplanned tibial bone block is prepared on a back table either prior to, or concurrently with, arthroscopic procedure. After creation of high posterior portal and standard anterior portal, a sucker-shaver and burr are used to create a perpendicular edge for apposition of the allograft tibia. The bone block is introduced through a longitudinal incision and underdelivered to the prepared surface under the liberated labrum. The articular surface of the graft and glenoid are aligned and cannulated screws are used to compress the bone block against the native glenoid. The posterior labral tissue is then mobilized over the graft and repaired to the native glenoid. Results: Arthroscopic distal tibial allograft augmentation for posterior bone loss restored stability and function in a small cohort of patients. Patients reported improved stability in the immediate postoperative course, with restoration of motion by 2 months. Push-ups, pull-ups, and return to full active duty without restrictions is allowed at 6 months postoperatively. Imaging at 3 months postoperatively has shown excellent graft healing. Discussion: The benefits of allograft tibia augmentation for posterior instability with glenoid bone loss include an anatomic joint surface restoration including articular cartilage, lack of donor site morbidity, and a minimally invasive approach. When performed arthroscopically, this technique permits concurrent posterior labral repair and anatomic reconstruction.

scholarly journals Revision Arthroscopic Bankart Repair in the Military

2020 ◽  
Vol 8 (3_suppl2) ◽  
pp. 2325967120S0011
Author(s):  
Sean E. Slaven ◽  
Robert Tardif ◽  
Kevin Foley ◽  
Kenneth L. Cameron ◽  
Matthew A. Posner ◽  
...  
Keyword(s):  
Bone Loss ◽  
Active Duty ◽  
Glenoid Bone Loss ◽  
Bankart Repair ◽  
Arthroscopic Stabilization ◽  
Recurrent Instability ◽  
Active Duty Military ◽  
Arthroscopic Bankart Repair ◽  
Successful Group ◽  
Return To Duty

Objectives: There is no consensus on the optimal method of stabilization (arthroscopic or open) for revision anterior shoulder stabilization. The purpose of this study was to determine the success of revision arthroscopic stabilization at preventing further recurrence in active duty military patients. Methods: 53 revision arthroscopic stabilizations were performed at our institution between 2005-2016 for recurrent anterior shoulder instability after an arthroscopic Bankart index procedure. Shoulders with glenoid bone loss >20% were excluded from the study. The primary outcome of interest was the ability to return to activity/duty without subsequent instability. Patients were followed for time to a subsequent instability event and repeat revision arthroscopic stabilization following return to duty/activity. Results: Patient age at revision surgery averaged 22.9 ± 4.3 years. Mean follow up was 6.1 years (range 0.4-12.9). 34 out of 53 patients (64%) returned to duty without recurrent instability following revision arthroscopic anterior stabilization. 19 patients (36%) experienced recurrent instability following return to duty after revision arthroscopic stabilization. Glenoid bone loss averaged 7.8% ± 8.0% in the successful group and 6.5 % ± 6.5% in the failure group (p=0.573). Durability of the index surgery was significantly longer in the successful group (38.1 ± 31.3 months vs. 20.5 ± 17.8 months, p=.029). There was no difference between groups in patient age or number of anchors used in the index or revision stabilization procedures. Conclusion: Revision arthroscopic stabilization of failed primary arthroscopic Bankart repair has a failure rate of 36% in a young active duty military population, which is substantially higher than primary arthroscopic Bankart repair in this population and higher than revision arthroscopic Bankart repair in other patient populations. The similar amounts of bone loss between groups indicates that bone loss is not the primary determinant of failure in revision arthroscopic stabilization.

scholarly journals Donor-Specific Human Leukocyte Antigen Antibody Formation After Allograft Glenoid Reconstruction Occurs But Does Not Impact Clinicoradiographic Outcomes

2021 ◽  
pp. 036354652199670
Author(s):  
Daniel R. Liwski ◽  
Robert S. Liwski ◽  
Ivan Wong
Keyword(s):  
Bone Loss ◽  
Human Leukocyte Antigen ◽  
Shoulder Instability ◽  
Human Leukocyte ◽  
Hla Typing ◽  
Glenoid Bone Loss ◽  
Fisher Exact Test ◽  
Leukocyte Antigen ◽  
Patient Reported ◽  
Small Bone

Background: Recurrent shoulder instability is a prevalent condition, with glenoid bone loss as a common cause. Arthroscopic repair using distal tibial allografts provides long-lasting treatment by restoring glenoid surface area and presumably avoids risks of sensitization against donor human leukocyte antigen (HLA). Two case studies have challenged this assumption, suggesting that small bone allografts are able to induce host adaptive immune responses to donor HLA. The incidence of small bone allograft HLA sensitization and its effects on resorption and patient outcomes are unclear. Purpose/Hypothesis: The purpose was to assess the rate of sensitization against donor HLA after distal tibial allograft procedures for shoulder instability due to glenoid bone loss and to find whether HLA sensitization negatively affects patient-reported and radiographic outcomes. We hypothesized that sensitized patients would have worse radiographic and self-reported outcomes compared with nonsensitized patients. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 71 patients with a mean age of 28.85 years (range, 13.58-61.31 years) were enrolled, with 58 patients submitting sufficient pre- and postoperative blood samples for HLA antibody testing. In patients who developed HLA antibodies postoperatively, donor HLA typing was used to confirm donor-specific sensitization. Pre- and postoperative computerized tomography scans (0.9 ± 0.8 years follow-up) were used to grade resorption based on the modified Zhu resorption grade classification (ie, grade 0 = no resorption; grade 1 = less than 25% resorption; grade 2 = between 25% and 50% resorption; and grade 3 = larger than 50% resorption). The Western Ontario Shoulder Instability Index outcome scores were obtained preoperatively and at regular postoperative appointments. Resorption and outcome data were compared between sensitized and nonsensitized patients using the Fisher exact test, independent 2-tailed Student t tests, and the Wilcoxon rank-sum test to determine the effect of HLA sensitization on radiographic and patient-reported outcomes. Results: A total of 7 (12.1%) patients with sufficient HLA samples were sensitized against donor HLA postoperatively. Sensitized patients did not have significantly higher rates of resorption (21.9% vs 14.3%, 21.9% vs 28.6%, 43.8% vs 28.6%, and 12.5% vs 28.6% for respective resorption grades 0-3; P = .67; α = .05). Self-reported outcomes were not statistically significant between sensitized and nonsensitized patients (24.9 ± 27.61 vs 40.16 ± 18.99; P = .37; α = .05) and did not differ significantly based on resorption grade (47.4 ± 0.0 vs 55.2 ± 18.8, 30.4 ± 15.8 vs 39.9 ± 20.9, 41.2 ± 0.0 vs 39.1 ± 13.1, and -24.9 ± 0 vs 24.4 ± 19.6 for resorption grades 0-3; P > .05; α = .05). Conclusion: Sensitization against donor HLA after small bone graft allografting was not previously considered but has been brought to light as a possibility. Aside from potential complications for future organ transplants, HLA sensitization does not introduce a risk for adverse outcomes or higher grades of resorption compared with nonsensitized patients after small bone allografting for shoulder instability.

scholarly journals What Are the Predictors of Poor Patient-Reported Outcomes After Shoulder Instability Surgery?

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096634
Author(s):  
◽  
Ahmad F. Bayomy ◽  
Mark S. Schickendantz ◽  
Isaac N. Briskin ◽  
Lutul D. Farrow ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Bone Loss ◽  
Shoulder Instability ◽  
Patient Reported Outcomes ◽  
Patient Reported Outcome ◽  
Early Revision ◽  
Labral Tears ◽  
Patient Reported ◽  
Cartilage Injuries ◽  
Articular Cartilage Injuries

Background: Prospectively collected responses to Patient Acceptable Symptom State (PASS) questions after shoulder instability surgery are limited. Responses to these outcome measures are imperative to understanding their clinical utility. Purpose/Hypothesis: The purpose of this study was to evaluate which factors predict unfavorable patient-reported outcomes after shoulder instability surgery, including “no” to the PASS question. We hypothesized that poor outcomes would be associated with male adolescents, bone loss, combined labral tears, and articular cartilage injuries. Study Design: Cohort study; Level of evidence, 2. Methods: Patients aged ≥13 years undergoing shoulder instability surgery were included in point-of-care data collection at a single institution across 12 surgeons between 2015 and 2017. Patients with anterior-inferior labral tears were included, and those with previous ipsilateral shoulder surgery were excluded. Demographics, American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores, and surgical findings were obtained at baseline. ASES and SANE scores, PASS responses, and early revision surgery rates were obtained at a minimum of 1 year after the surgical intervention. Regression analyses were performed. Results: A total of 234 patients met inclusion criteria, of which 176 completed follow-up responses (75.2%). Nonresponders had a younger age, greater frequency of glenoid bone loss, fewer combined tears, and more articular cartilage injuries ( P < .05). Responders’ mean age was 25.1 years, and 22.2% were female. Early revision surgery occurred in 3.4% of these patients, and 76.1% responded yes to the PASS question. A yes response correlated with a mean 25-point improvement in the ASES score and a 40-point improvement in the SANE score. On multivariate analysis, combined labral tears (anterior-inferior plus superior or posterior tears) were associated with greater odds of responding no to the PASS question, while both combined tears and injured capsules were associated with lower ASES and SANE scores ( P < .05). Sex, bone loss, and grade 3 to 4 articular cartilage injuries were not associated with variations on any patient-reported outcome measure. Conclusion: Patients largely approved of their symptom state at ≥1 year after shoulder instability surgery. A response of yes to the PASS question was given by 76.1% of patients and was correlated with clinically and statistically significant improvements in ASES and SANE scores. Combined labral tears and injured capsules were negative prognosticators across patient-reported outcome measures, whereas sex, bone loss, and cartilage injuries were not.

scholarly journals Arthroscopic Treatment for Shoulder Instability with Glenoid Bone Loss Using Distal Tibia Allograft Augmentation: Two Year Outcomes

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0034
Author(s):  
Rakesh Ebnezar ◽  
Ivan H. Wong
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Intraoperative Complications ◽  
Distal Tibia ◽  
Glenoid Bone Loss ◽  
Arthroscopic Stabilization ◽  
Excellent Outcome ◽  
Post Surgery ◽  
The Mean

Objectives: To analyse the clinico-radiologic outcomes of patients who underwent an all arthroscopic procedure to treat shoulder instability with glenoid bone loss using a distal tibial allograft; with a minimum 2 year follow-up. Methods: A retrospective chart review of prospectively collected data was completed for patients who underwent arthroscopic stabilization with Bankart repair and allograft bony augmentation of the glenoid; by the same surgeon. Western Ontario Shoulder Instability Index (WOSI), Disability of the Arm Shoulder and Hand (DASH), Veterans Rand - 12 and MARX questionnaires were completed pre and post-operatively. Radiological assessment was performed with radiographs and CT scans obtained pre-operatively and at approximately one year post surgery. Results: A total of 41 patients (29 males, 12 females) with a mean age of 26 ± 9 years were included. An excellent safety profile was observed, with no intraoperative complications, neurovascular injuries, adverse events, bleeding, or infections. At 2- year follow-up, there was statistically significant improvement of the WOSI score when compared preoperatively (preoperative=62.6 ± 17.06; at 2-year=22.96± 12.92; p<0.001). The mean pre-operative bone loss was 30.32% (SD ± 7.90). There were no cases of non- union or partial union. No resorption of the graft (grade 0) was seen in 42% patients, whereas 42% and 16% of patients had grade 1 and grade 2 resorption; respectively. There was 100% healing at the interface between allograft and native glenoid. The mean sagittal dimension of the remaining allograft post-operatively was 5.10 ± 2.27 mm in the patients with ≥50% resorption which indicates there was still bone graft present and there was no complete resorption. Mean post-operative external rotation for the population was also observed to near full. Conclusion: Arthroscopic stabilization with DTA augmentation has an excellent outcome at 2-year follow-up; long-term follow-up studies are necessary for better assessment of outcomes.

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