Management of Recurrent Anterior Shoulder Instability With Bipolar Bone Loss: A Systematic Review to Assess Critical Bone Loss Amounts

2018 ◽  
Vol 47 (10) ◽  
pp. 2484-2493 ◽  
Author(s):  
Anirudh K. Gowd ◽  
Joseph N. Liu ◽  
Brandon C. Cabarcas ◽  
Grant H. Garcia ◽  
Gregory L. Cvetanovich ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Loss ◽  
Shoulder Instability ◽  
Operative Management ◽  
Glenoid Bone Loss ◽  
Cochrane Library ◽  
Anterior Shoulder Instability ◽  
Bone Block ◽  
Recurrence Rates ◽  
The Mean

Background: There is increasing evidence to suggest that the amount of glenoid bone loss to indicate bone block procedures may be lower than previously thought, particularly in the presence of a Hill-Sachs defect. Purpose: To better establish treatment recommendations for anterior shoulder instability among patients with bipolar bone lesions. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic review of the literature was performed with PubMed, EMBASE, Cochrane Library, and Scopus databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Studies evaluating outcomes of operative management in anterior shoulder instability that also reported glenoid bone loss in the presence of Hill-Sachs defects were included. Recurrence rates, glenoid bone loss, and humeral bone loss were pooled and analyzed with forest plots stratified by surgical procedure. Methods of quantification were analyzed for each article qualitatively. Results: Thirteen articles were included in the final analysis, with a total of 778 patients. The mean ± SD age was 24.9 ± 8.6 years. The mean follow-up was 30.1 months (range, 11-240 months). Only 13 of 408 (3.2%) reviewed bipolar bone loss articles quantified humeral and/or glenoid bone loss. Latarjet procedures had the greatest glenoid bone loss (21.7%; 95% CI, 14.8%-28.6%), followed by Bankart repairs (13.1%; 95% CI, 9.0%-17.2%), and remplissage (11.7%; 95% CI, 5.5%-18.0%). Humeral bone loss was primarily reported as percentage bone loss (22.2%; 95% CI, 13.1%-31.3% in Bankart repairs and 31.7%; 95% CI, 21.6%-41.1% in Latarjet) or as volumetric defects (439.1 mm3; 95% CI, 336.3-541.9 mm3 in Bankart repairs and 366.0 mm3; 95% CI, 258.4-475.4 mm3 in remplissage). Recurrence rates were as follows: Bankart repairs, 19.5% (95% CI, 14.5%-25.8%); remplissage, 4.4% (95% CI, 1.3%-14.0%); and Latarjet, 8.7% (95% CI, 5.0%-14.7%). Bankart repairs were associated with significantly greater recurrence of instability in included articles ( P = .013). Conclusion: There exists a need for universal and consistent preoperative measurement of humeral-sided bone loss. The presence of concomitant Hill-Sachs defects with glenoid pathology should warrant more aggressive operative management through use of bone block procedures. Previously established values of critical glenoid bone loss are not equally relevant in the presence of bipolar bone loss.

Modified Latarjet Without Capsulolabral Repair in Rugby Players With Recurrent Anterior Glenohumeral Instability and Significant Glenoid Bone Loss

2018 ◽  
Vol 46 (4) ◽  
pp. 795-800 ◽  
Author(s):  
Maximiliano Ranalletta ◽  
Luciano A. Rossi ◽  
Agustin Bertona ◽  
Ignacio Tanoira ◽  
Ignacio Alonso Hidalgo ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Functional Outcomes ◽  
Glenoid Bone Loss ◽  
Anterior Shoulder Instability ◽  
Bone Block ◽  
Latarjet Procedure ◽  
The Mean ◽  
Rugby Players ◽  
Recurrent Anterior Shoulder Instability

Background: The optimal management of recurrent anterior shoulder instability with significant glenoid bone loss in high-demand collision athletes remains a challenge. Purpose: To analyze the time to return to sport, clinical outcomes, and recurrences following a modified Latarjet procedure without capsulolabral repair in rugby players with recurrent anterior shoulder instability and significant glenoid bone loss. Study Design: Case series; Level of evidence, 4. Methods: Between June 2008 and June 2015, 50 competitive rugby players (practice >2 times per week and competition during weekends) with recurrent anterior shoulder instability underwent operation with the modified congruent arc Latarjet procedure without capsulolabral repair in our institution. Cases included 18 primary repairs and 32 revisions. Return to sports, range of motion (ROM), the Rowe score, a visual analog scale for pain in sport activity (VAS), and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed with computed tomography. The final analysis included 49 shoulders in 48 patients (31 revision cases). Results: The mean follow-up was 48 months (range, 24-108 months) and the mean age at the time of operation was 22.8 years (range, 17-35 years). Forty-five patients (93.7%) returned to playing rugby, all at their preinjury level of play. No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe, VAS, and ASOSS scores showed statistically significant improvement after operation ( P < .001). The Rowe score increased from a mean of 39.5 points preoperatively to 94 points postoperatively ( P < .01). The VAS score decreased from 3.6 points preoperatively to 1.2 points postoperatively ( P < .01). The ASOSS score improved significantly from a mean of 44 points preoperatively to 89.5 points postoperatively ( P < .01). No recurrence of shoulder dislocation or subluxation was noted. The bone block healed in 43 shoulders (88%). Conclusion: In rugby players with recurrent anterior shoulder instability and significant glenoid bone loss, the modified Latarjet procedure without capsulolabral repair produced excellent functional outcomes, with most athletes returning to rugby at their preinjury level of play without recurrences.

Reporting of glenoid bone loss measurement in clinical studies and the need for standardization

2022 ◽  
Vol 104-B (1) ◽  
pp. 12-18
Author(s):  
Simon Weil ◽  
Magnus Arnander ◽  
Yemi Pearse ◽  
Duncan Tennent
Keyword(s):  
Systematic Review ◽  
Bone Loss ◽  
Shoulder Instability ◽  
Clinical Studies ◽  
Imaging Modality ◽  
Measurement Techniques ◽  
Specific Treatment ◽  
Glenoid Bone Loss ◽  
Anterior Shoulder Instability ◽  
Significant Heterogeneity

Aims The amount of glenoid bone loss is an important factor in deciding between soft-tissue and bony reconstruction when managing anterior shoulder instability. Accurate and reproducible measurement of glenoid bone loss is therefore vital in evaluation of shoulder instability and recommending specific treatment. The aim of this systematic review is to identify the range methods and measurement techniques employed in clinical studies treating glenoid bone loss. Methods A systematic review of the PubMed, MEDLINE, and Embase databases was undertaken to cover a ten-year period from February 2011 to February 2021. We identified clinical studies that incorporated bone loss assessment in the methodology as part of the decision-making in the management of patients with anterior shoulder instability. The Preferred Reporting Items for Systematic Reviews (PRISMA) were used. Results A total of 5,430 articles were identified from the initial search, of which 82 studies met the final inclusion criteria. A variety of imaging methods were used: three studies did not specify which modality was used, and a further 13 used CT or MRI interchangeably. There was considerable heterogeneity among the studies that specified the technique used to quantify glenoid bone loss. A large proportion of the studies did not specify the technique used. Conclusion This systematic review has identified significant heterogeneity in both the imaging modality and method used to measure glenoid bone loss. The recommendation is that as a minimum for publication, authors should be required to reference the specific measurement technique used. Without this simple standardization, it is impossible to determine whether any published paper should influence clinical practice or should be dismissed. Cite this article: Bone Joint J 2022;104-B(1):12–18.

Return to Play After the Latarjet Procedure for Anterior Shoulder Instability: A Systematic Review

2019 ◽  
Vol 47 (12) ◽  
pp. 3002-3008 ◽  
Author(s):  
Eoghan T. Hurley ◽  
Connor Montgomery ◽  
M. Shazil Jamal ◽  
Yoshiharu Shimozono ◽  
Zakariya Ali ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shoulder Instability ◽  
Return To Play ◽  
Rate Of Return ◽  
Cochrane Library ◽  
Anterior Shoulder Instability ◽  
Return To Sports ◽  
Latarjet Procedure ◽  
Recurrence Rates ◽  
Overhead Athletes

Background: Traumatic anterior shoulder instability is a common clinical problem among athletic populations. The Latarjet procedure is a widely used treatment option to address shoulder instability in high-demand athletes at high risk of recurrence. However, rates and timing of full return to sports have not been systematically analyzed. Purpose: To systematically review the evidence in the literature to ascertain the rate and timing of return to play and the availability of specific criteria for safe return to play after the Latarjet procedure. Study Design: Systematic review. Methods: A systematic literature search was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using the EMBASE, MEDLINE, and Cochrane Library databases. Eligible for inclusion were clinical studies reporting on return to play after the Latarjet procedure. Statistical analysis was performed by use of SPSS. Results: Our review found 36 studies including 2134 cases meeting our inclusion criteria. The majority of patients were male (86.9%), with a mean age of 25.4 years (range, 15-59 years) and a mean follow-up of 83.5 months. The overall rate of return to play was 88.8%, with 72.6% returning to the same level of play. Among collision athletes, the overall rate of return to play was 88.2%, with 69.5% returning to the same level of play. In overhead athletes, the overall rate of return to play was 90.3%, with 80.6% returning to the same level of play. The mean time to return to play was 5.8 months (range, 3.2-8 months). Specific return to play criteria were reported in the majority of the studies (69.4%); time to return to sport was the most commonly reported item (66.7%). Conclusion: The overall rate of return to play was reportedly high after the Latarjet procedure. However, almost a fifth of athletes returning to sports were not able to return at the same level. Further development of validated criteria for safe return to sports could potentially improve clinical outcomes and reduce recurrence rates.

scholarly journals Clinical and Radiographic Outcomes After Arthroscopic Iliac Bone Grafting for Traumatic Anterior Shoulder Instability with Significant Glenoid Bone Loss – A Minimum of Five-year Follow-up

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0040
Author(s):  
Hiroyuki Sugaya ◽  
Norimasa Takahashi ◽  
Keisuke Matsuki ◽  
Morihito Tokai ◽  
Yasutaka Takeuchi ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Bone Grafting ◽  
Iliac Bone ◽  
Glenoid Bone Loss ◽  
Anterior Shoulder Instability ◽  
Bony Defect ◽  
Capsulolabral Reconstruction ◽  
The Mean

Objectives: The choice of surgical options for traumatic anterior shoulder instability with severe glenoid bony defect remains controversial. The purpose of this study was to evaluate the outcomes after arthroscopic (AS) iliac grafting with capsulolabral reconstruction with a minimum of five-year follow-up. Methods: Subjects consisted of 24 patients (24 shoulders), including 22 males and 2 females, who underwent AS iliac bone grafting and were followed for more than five years. Eighteen shoulders were primary surgery, and 6 were revision surgery. The mean age at surgery was 30 years (range, 18-52), and the mean follow-up was 8 years (range, 5-11). The mean glenoid bony defect measured on preoperative 3D-CT was 22% (range, 20-28). All surgeries were performed under general anesthesia. Free bone graft with approximately 2.0 cm length and 0.8 cm height was harvested from the iliac crest with the patients in the supine position, (Figure 1) and then the patient was placed in the beach chair position. The bone graft was inserted in the glenohumeral joint and arthroscopically fixed to the anterior glenoid using 2 cannulated screws followed by soft tissue Bankart repair using four anchors. (Figure 2 Gr: graft GL: glenoid) Functional outcomes including Rowe score, sports return, and ROM were evaluated. Radiographic findings including Samilson osteoarthritis (OA) grade and graft evaluation using 3D-CT at the final follow-up were also evaluated. Results: No patients experienced re-dislocation after surgery except one patient. All patients returned to their sports after surgery except for one patient who was not engaged in any sports. The mean Rowe score improved significantly from 19 (range, 5-40) to 95 (range, 70-100) (p<.0001). Postoperative forward flexion showed significant improvement: 157 (range, 110-180) to 170 (range, 150-180) degrees (p=.006), but no improvement in external rotation: 56 (range, 30- 85) to 56 (range, 30-70) degrees, and internal rotation: T8 (range, T5-L5) to T10 (range, T7-L5) level. OA change progressed in 8 shoulders (40%). 3DCT at the final follow-up demonstrated remodeling of the graft in 20 shoulders (88%) and absorption in 3 shoulders (12%).Failure case: A 23-year-old male experienced re-dislocation of the left shoulder during snowboarding five-year after the index surgery. Healed graft fracture and screw breakage were confirmed on 3DCT images (Figure 3). Conclusion: AS iliac bone grafting for traumatic anterior shoulder instability with significant glenoid bone loss yielded a satisfactory outcome with a minimum of five-year follow-up. Although this is technically demanding procedure, AS iliac bone grafting with capsulolabral reconstruction for shoulders with severe glenoid bone loss is an effective and practical procedure. [Figure: see text][Figure: see text][Figure: see text]

Short-Term Bone Fusion With Arthroscopic Double-Button Latarjet Versus Open-Screw Latarjet

2021 ◽  
pp. 036354652110010
Author(s):  
Nicolas Bonnevialle ◽  
Mathieu Girard ◽  
Yoann Dalmas ◽  
Vincent Martinel ◽  
Marie Faruch ◽  
...  
Keyword(s):  
Bone Loss ◽  
Ct Scan ◽  
Contact Area ◽  
Shoulder Instability ◽  
Glenoid Bone Loss ◽  
Anterior Shoulder Instability ◽  
Bone Block ◽  
Return To Sports ◽  
Bone Contact ◽  
Bone Fusion

Background: Recently, arthroscopic double-button Latarjet (AL) has provided an alternative to conventional open Latarjet (OL) in the treatment of anterior shoulder instability with glenoid bone loss. Therefore, theoretically, the faster fusion is obtained, the sooner return to sports under safe conditions can occur. The emerging flexible fixation of the bone block has clearly offered a new approach to achieve bone fusion. However, the period required to achieve this goal remains controversial. Purpose/Hypothesis: The purpose was to compare computed tomography (CT) scan results of AL and OL in the early postoperative period. It was hypothesized that the bone block fusion with AL would require a longer time than that with OL. Study Design: Cohort study; Level of evidence, 3. Methods: In a retrospective 1-year study, the authors compared 17 primary double-button AL to 22 primary 2-screw OL procedures indicated for anterior shoulder instability in patients with an Index Severity Instability Score >3 points. These patients were reviewed with a CT scan at 1 day, 3 months, and 6 months postoperatively. The characteristics for the 2 groups were comparable. CT scans aimed to analyze graft position, bone contact area with the scapula, and fusion at 3 and 6 months. Clinical assessment was based on the Walch-Duplay and Rowe scores. Results: The mean preoperative Index Severity Instability Score was 5.3 ± 1.9 points, with a mean anterior glenoid bone loss of 9.1% ± 4.6%. At 3 months, the rates of fusion were 41% and 100% for the AL and OL groups, respectively ( P < .001). This rate increased to 70% in the AL group at 6 months ( P = .006). In the axial and sagittal planes, there was no difference in graft position between the AL group and the OL group. The bone block was longer and there was a more extensive bone contact area in the OL group (AL, 131 mm2 vs OL, 223 mm2; P < .001). At 6 months of follow-up, no significant difference in clinical scores was noted between the groups: Walch-Duplay score, 93.0 ± 10.9 points versus 91.8 ± 12.5 points ( P = .867); and Rowe score, 99.0 ± 2.2 points versus 95.0 ± 8.4 points ( P = .307) for the AL and OL groups, respectively. Conclusion: AL required more time to achieve bone block fusion than OL. This finding should be taken into account when considering this procedure for patients in a hurry to return to sports involving the shoulder.

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