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 Prospective evaluation of glenoid bone loss after first-time and recurrent anterior glenohumeral instability events

2019 ◽  
Vol 28 (6) ◽  
pp. e197
Author(s):  
Jonathan F. Dickens ◽  
Sean E. Slaven ◽  
Kenneth L. Cameron ◽  
Adam M. Pickett ◽  
Matthew Posner ◽  
...  
Keyword(s):  
Bone Loss ◽  
Glenoid Bone Loss ◽  
Prospective Evaluation ◽  
Glenohumeral Instability ◽  
Anterior Glenohumeral Instability ◽  
First Time

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.

scholarly journals A Rare Complication of Tuberculous Meningitis Pediatric Anterior Glenohumeral Instability

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Kerem Bilsel ◽  
Mehmet Erdil ◽  
Mehmet Elmadag ◽  
Hasan H. Ceylan ◽  
Derya Celik ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Tuberculous Meningitis ◽  
Shoulder Instability ◽  
Rare Complication ◽  
Central Nervous System Infection ◽  
Arthroscopic Stabilization ◽  
Anterior Instability ◽  
Glenohumeral Instability ◽  
Rehabilitation Protocols ◽  
Anterior Glenohumeral Instability

Dislocation and instability of the shoulder joint are rare occurrences in childhood. Traumatic, infectious, congenital, and neuromuscular causes of pediatric recurrent shoulder dislocations are reported before. Central nervous system infection in infancy may be a reason for shoulder instability during childhood. This situation, which causes a disability for children, can be treated successfully with arthroscopic stabilization of the shoulder and postoperative effective rehabilitation protocols. Tuberculous meningitis may be a reason for neuromuscular shoulder instability. We describe a 12-year-old child with a recurrent anterior instability of the shoulder, which developed after tuberculous meningitis at 18 months of age. We applied arthroscopic treatment and stabilized the joint.

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.

Recurrent anterior glenohumeral instability: the quantification of glenoid bone loss using magnetic resonance imaging

2014 ◽  
Vol 43 (8) ◽  
pp. 1085-1092 ◽  
Author(s):  
Patrícia Martins e Souza ◽  
Bruno Lobo Brandão ◽  
Eduardo Brown ◽  
Geraldo Motta ◽  
Martim Monteiro ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Bone Loss ◽  
Glenoid Bone Loss ◽  
Resonance Imaging ◽  
Glenohumeral Instability ◽  
Anterior Glenohumeral Instability

scholarly journals Recurrent Shoulder Instability: Do Morbidity and Treatment Differ Based on Insurance?

2019 ◽  
Vol 7 (4) ◽  
pp. 232596711984107
Author(s):  
Ariel A. Williams ◽  
Nickolas S. Mancini ◽  
Cameron Kia ◽  
Megan R. Wolf ◽  
Simran Gupta ◽  
...  
Keyword(s):  
Bone Loss ◽  
Surgical Procedures ◽  
Shoulder Instability ◽  
Private Insurance ◽  
Glenoid Bone Loss ◽  
Preoperative Imaging ◽  
Anterior Shoulder Instability ◽  
Time Of Surgery ◽  
Open Stabilization ◽  
History Of

Background: Patients with public insurance often face barriers to obtaining prompt orthopaedic care. For patients with recurrent traumatic anterior shoulder instability, delayed care may be associated with increasing bone loss and subsequently more extensive surgical procedures. Purpose/Hypothesis: The purpose of this study was to evaluate whether differences exist in patients undergoing treatment for shoulder instability between those with Medicaid versus non-Medicaid insurance. We hypothesized that at the time of surgery, Medicaid patients would have experienced greater delays in care, would have a more extensive history of instability, would have more bone loss, and would require more extensive surgical procedures than other patients. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were identified who underwent surgical stabilization for traumatic anterior shoulder instability between January 1, 2011, and December 1, 2015, at a single sports medicine practice. Clinic, billing, and operative records were reviewed for each patient to determine age, sex, insurance type, total number of instability episodes, time from first instability episode to surgery, intraoperative findings, and procedure performed. Glenoid bone loss was quantified by use of preoperative imaging studies. Results: During this time period, 206 patients (55 Medicaid, 131 private insurance, 11 Tricare, 9 workers’ compensation) underwent surgical stabilization for traumatic anterior shoulder instability. Average wait time from initial injury to surgery was 1640 days (95% CI, 1155-2125 days) for Medicaid patients compared with 1237 days (95% CI, 834-1639 days) for others ( P = .005). Medicaid patients were more likely to have sustained 5 or more instability events at the time of surgery (OR, 3.3; 95% CI, 1.64-6.69; P = .001), had a higher risk of having 15% or more glenoid bone loss on preoperative imaging (OR, 3.5; 95% CI, 1.3-10.0; P = .01), and had a higher risk of requiring Latarjet or other open stabilization procedures as opposed to an arthroscopic repair (OR, 3.0; 95% CI, 1.5-6.2; P = .002) when compared with other patients. Conclusion: Among patients undergoing surgery for traumatic anterior shoulder instability, patients with Medicaid had significantly more delayed care. Correspondingly, they reported a more extensive history of instability, were more likely to have severe bone loss, and required more invasive stabilization procedures.

scholarly journals Return to Sport Following Open Latarjet Procedure for Recurrent Shoulder Instability

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0037
Author(s):  
Joseph Liu ◽  
Anirudh Gowd ◽  
Grant Garcia ◽  
Alexander Beletsky ◽  
Brandon Cabarcas ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Sport Participation ◽  
Return To Sport ◽  
High Rate ◽  
Glenoid Bone Loss ◽  
Latarjet Procedure ◽  
Recurrent Instability ◽  
Post Surgery

Objectives: Shoulder instability is common within athletic populations, particularly in contact sports. The Latarjet procedure is typically reserved for recurrent instability recalcitrant to soft tissue repair. Limited literature exists regarding return-to-sport following Latarjet stabilization. Methods: A single institutional registry was queried between 2012 – 2016 for all open Latarjet stabilization procedures. Patients with no sport history were excluded. Glenoid bone loss was measured using the PICO method. Hill-Sachs defects were categorized as “on-track” or “off-track.” Sport participation was retrospectively surveyed 3-years prior and 3-years following surgery. Factors associated with return-to-sport, throwing, and recurrent instability were assessed using multivariate logistic regressions. Results: A total of 92 surgeries were identified, 67 of which were available for follow-up (72.8%). Average follow-up was 53.8 ± 11.6 months. Mean age and BMI were 27.9 ± 11.6 years and 25.9 ± 8.4 kg/m2, respectively. Mean glenoid bone loss was 16.4 ± 5.1%. There were 13 Hill Sachs lesions (5 off track), with a mean defect size of 145.8 ± 60.4 mm3. The dominant side was involved in 36 patients. Fifty-two patients (77.6%) reported return-to-sport at an average of 8.6 ± 4.6 months. Thirty-six patients (53.7%) reported return-to-sport at the same or higher level than their preoperative state. Only 58.6% of throwing athletes returned to throwing post-surgery. Seven patients (10.4%) reported recurrence of instability following surgery. A higher likelihood of recurrent instability was associated with larger Hill-Sachs volume (p=0.021, OR: 1.06, 95% CI: 1.01-1.16). A reduced likelihood of returning to sport at same or better level was associated with dominant-sided surgery (p=0.010, OR: 0.362, 95% CI: 0.210-0.622). Conclusion: The open Latarjet procedure is associated with high rate of return-to-sport; however, nearly half were unable to return to their pre-injury level. During preoperative assessment, consideration of Hill-Sachs lesion size and laterality are significant factors for improved outcomes.

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