scholarly journals Does the innate relative size of the humeral head and glenoid affect the risk of anterior shoulder instability?

2018 ◽  
Vol 11 (6) ◽  
pp. 424-429
Author(s):  
NW Willigenburg ◽  
RA Bouma ◽  
VAB Scholtes ◽  
VPM van der Hulst ◽  
DFP van Deurzen ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Humeral Head ◽  
Relative Size ◽  
Ct Scans ◽  
Anterior Shoulder Instability ◽  
Multivariate Logistic Regression ◽  
Recurrent Instability ◽  
Bony Lesions ◽  
Joint Contact ◽  
And Gender

Background Bony lesions after shoulder dislocation reduce the joint contact area and increase the risk of recurrent instability. It is unknown whether the innate relative sizes of the humeral head and glenoid may predispose patients to shoulder instability. This study evaluated whether anterior shoulder instability is associated with a larger innate humeral head/glenoid ratio (IHGR). Methods We evaluated CT scans of 40 shoulders with anterior shoulder instability and 48 controls. We measured axial humeral head diameter and glenoid diameter following native contours, discarding any bony lesions, and calculated IHGR by dividing both diameters. Multivariate logistic regression determined whether the IHGR, corrected for age and gender as potential confounders, was associated with anterior shoulder instability. Results Mean IHGR was 1.48 ± 0.23 in the group with anterior shoulder instability and 1.42 ± 0.20 in the group without anterior shoulder instability. Measurements for axial humeral head and axial glenoid diameters demonstrated excellent intra-rater reliability (ICC range: 0.94–0.95). IHGR was not significantly associated with anterior shoulder instability (OR = 1.105, 95%CI = 0.118–10.339, p = 0.930). Discussion The innate ratio of humeral head and glenoid diameters was not significantly associated with anterior shoulder instability in this retrospective sample of 88 shoulder CT scans.

scholarly journals Outcomes and Return to Sport and Work After Open Bankart Repair for Recurrent Shoulder Instability: A Systematic Review

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110269
Author(s):  
Khalid AlSomali ◽  
Erica Kholinne ◽  
Thanh Van Nguyen ◽  
Chang-Ho Cho ◽  
Jae-Man Kwak ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shoulder Instability ◽  
Return To Sport ◽  
Bankart Repair ◽  
Cochrane Library ◽  
Anterior Shoulder Instability ◽  
Functional Score ◽  
High Demand ◽  
Recurrent Instability ◽  
Instability Rate

Background: Open Bankart repair provides surgeons and patients with an alternative solution for managing recurrent instability in young athletes with or without minimal bone loss. Despite many studies that have reported low recurrence rates and good functional outcomes after open Bankart repair, we have limited knowledge about the return to sport and work for high-demand populations. Purpose: To assess the return to sport and work for high-demand populations after open Bankart repair for recurrent anterior shoulder instability, outcomes of open Bankart repair with regard to recurrence, and development of osteoarthritic (OA) changes. Study Design: Systematic review; Level of evidence, 4. Methods: We searched PubMed, EMBASE, Cochrane Library, Scopus, and Google Scholar databases using keywords as well as Medical Subject Headings terms and Emtree using “(Open Bankart OR Bankart surgery) (NOT arthroscopy NOT revision)” for English-language studies. We conducted a systematic review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: In total, 11 articles (10 with level 4 and 1 with level 3 evidence) including 563 patients (566 shoulders) were identified. The majority of patients were male (82%), the average age at the time of surgery was 27.4 years, and the mean follow-up was 11.5 years (range, 2.5-29 years). The most common functional score used was the Rowe score (95%) for the reported outcome measures, which showed good to excellent results (mean, 88.5 points). The overall recurrent instability rate, including dislocation and subluxation as a postoperative complication, was 8.5%. A total of 87% of patients were able to return to sport and work postoperatively. Overall, OA changes were reported in 33% of the patients, and the overall revision rate was 1%. Conclusion: Open Bankart repair exhibited favorable results, with a low postoperative instability rate. It is a reliable surgical procedure that allows high-demand patients to return to sport and work.

Preoperative Analysis of the Hill-Sachs Lesion in Anterior Shoulder Instability

2011 ◽  
Vol 39 (11) ◽  
pp. 2389-2395 ◽  
Author(s):  
Seung Hyun Cho ◽  
Nam Su Cho ◽  
Yong Girl Rhee
Keyword(s):  
3D Reconstruction ◽  
Shoulder Instability ◽  
Humeral Head ◽  
Postoperative Recurrence ◽  
Anterior Shoulder Instability ◽  
Level Of Evidence ◽  
Preoperative Prediction ◽  
Mean Width ◽  
The Mean ◽  
The Hill

Background: It has been reported that engagement of the Hill-Sachs lesion affects postoperative recurrence of anterior shoulder instability. However, no method has been recognized as an effective preoperative means to predict engagement of the Hill-Sachs lesion. Purpose: This study was undertaken to assess the diagnostic validity of computed tomography (CT) with 3-dimensional (3D) reconstruction to judge engagement of the Hill-Sachs lesion preoperatively. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: One hundred four consecutive patients (107 shoulders) who underwent arthroscopic Bankart repair for traumatic anterior shoulder instability were enrolled for this study. Preoperatively, CT with 3D reconstruction was performed on all patients to evaluate the size (width and depth measured on axial and coronal images), orientation (Hill-Sachs angle), and location (bicipital and vertical angles) of the Hill-Sachs lesion. Dynamic arthroscopic examination was made to confirm engagement of the Hill-Sachs lesion. Then the correlation between the results and measurements on CT images was statistically analyzed. Results: In cases of engaging lesions, the mean width was 52% (range, 27%-66%) and the mean depth was 14% (range, 8%-20%) of the humeral head diameter on axial images. The corresponding measurements on coronal images were 42% (range, 16%-67%) and 13% (range, 5%-24%), respectively. In cases of nonengaging lesions, the corresponding measurements were 40% (range, 0%-71%) and 10% (range, 0%-21%) on axial images and 31% (range, 0%-62%) and 11% (range, 0%-46%) on coronal images. The size of engaging Hill-Sachs lesions was significantly larger than that of nonengaging lesions on both axial and coronal images ( P = .001, < .001, .012, .007). The Hill-Sachs angle was 25.6° ± 7.4° in engaging lesions, which was significantly larger than 13.8° ± 6.2° in nonengaging lesions ( P < .001). The bicipital and vertical angles did not demonstrate significant correlation with engagement of the Hill-Sachs lesion ( P = .850, .584). Conclusion: On CT with 3D reconstruction images, the engaging Hill-Sachs lesions were larger in size and more horizontally oriented to the humeral shaft than nonengaging lesions. The authors concluded that preoperative prediction of the engagement of the Hill-Sachs lesion, based on these findings, would be useful in planning additional procedures to treat a significant bone defect on the humeral head.

scholarly journals Outcomes of arthroscopic capsulolabral reconstruction for anterior instability with greater than 20% glenoid bone defects: are Latarjet procedures absolutely indicated for these patients?

2020 ◽  
Vol 23 (2) ◽  
pp. 62-70 ◽  
Author(s):  
Sae Hoon Kim ◽  
Whanik Jung ◽  
Sung-Min Rhee ◽  
Ji Un Kim ◽  
Joo Han Oh
Keyword(s):  
Bone Defect ◽  
Shoulder Instability ◽  
Bone Defects ◽  
Defect Size ◽  
Anterior Shoulder Instability ◽  
Return To Sports ◽  
Anterior Instability ◽  
Recurrent Instability ◽  
Capsulolabral Reconstruction

Background: Recent studies have reported high rates of recurrence of shoulder instability in patients with glenoid bone defects greater than 20% after capsulolabral reconstruction. The purpose of the present study was to evaluate the failure rate of arthroscopic capsulolabral reconstruction for the treatment of anterior instability in the presence of glenoid bone deficits >20%. Methods: Retrospective analyses were conducted among cases with anterior shoulder instability and glenoid bone defects of >20% that were treated by arthroscopic capsulolabral reconstruction with a minimum 2-year follow-up (30 cases). We included the following variables: age, bone defect size, instability severity index score (ISIS), on-/off-track assessment, incidence recurrent instability, and return to sports. Results: The mean glenoid bone defect size was 25.8% ± 4.2% (range, 20.4%–37.2%), and 18 cases (60%) had defects of >25%. Bony Bankart lesions were identified in 11 cases (36.7%). Eleven cases (36.7%) had ISIS scores >6 points and 21 cases (70%) had off-track lesions. No cases of recurrent instability were identified over a mean follow-up of 39.9 months (range, 24–86 months), but a sense of subluxation was reported by three patients. Return to sports at the preinjury level was possible in 24 cases (80%), and the average satisfaction rating was 92%. Conclusions: Arthroscopic soft tissue reconstruction was successful for treating anterior shoulder instability among patients with glenoid bone defects >20%, even enabling return to sports. Future studies should focus on determining the range of bone defect sizes that can be successfully managed by soft tissue repair.

scholarly journals A Multicenter Retrospective Study With a Minimum 5-Year Follow-up Comparing Arthroscopic Bankart Repair and the Latarjet Procedure

2020 ◽  
Vol 8 (8) ◽  
pp. 232596712094136
Author(s):  
Eran Maman ◽  
Oleg Dolkart ◽  
Rafael Krespi ◽  
Assaf Kadar ◽  
Gabriel Mozes ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Published Data ◽  
Return To Sports ◽  
Latarjet Procedure ◽  
Recurrent Instability ◽  
Arthroscopic Bankart Repair ◽  
Functional Scores

Background: Arthroscopic Bankart repair (ABR) and the Latarjet procedure are surgical techniques commonly used to treat anterior shoulder instability. There is no consensus among shoulder surgeons regarding the indications for choosing one over the other. Purpose: To compare the results of the Latarjet procedure with those of ABR for the treatment of anterior shoulder instability. Study Design: Cohort study; Level of evidence, 3. Methods: Data on all patients who were treated surgically for recurrent anterior shoulder instability between 2006 and 2011 were retrospectively collected at 4 medical centers. The minimum follow-up was 5 years. Data were retrieved from medical charts, and patients were interviewed to assess their level of satisfaction (range, 0-100), functional outcomes (using the American Shoulder and Elbow Surgeons shoulder score; the Subjective Shoulder Value; and the Disabilities of the Arm, Shoulder and Hand score), and quality of life (using the 12-Item Short Form Health Survey [SF-12]). Information on return to sports activities and postoperative level of activity compared with that of the preinjury state, complications, reoperations, and recurrent instability were recorded and evaluated. Results: A total of 242 patients were included. The Latarjet procedure was performed in 27 shoulders, and ABR was performed in 215 shoulders. Patients in the ABR group had significantly higher rates of redislocation (18.5%; P = .05) and subluxation (21.4%; P = .43) but a lower rate of self-reported apprehension (43.0%; P = .05) compared with patients in the Latarjet group (3.7%, 14.8%, and 63.0%, respectively). There were 5 patients in the ABR group who underwent reoperation with the Latarjet procedure because of recurrent instability. The functional scores in the Latarjet group were better than those in the ABR group. The SF-12 physical score was significantly better in the Latarjet group than in the ABR group (98.1 vs 93.9, respectively; P = .01). Patient satisfaction and subjective scores were similar in both groups. Conclusion: These results support recently published data on the Latarjet procedure that showed its superiority over ABR in midterm stability (dislocations or subluxations). The contribution of self-reported apprehension to the broad definition of stability is not clear, and apprehension rates were not correlated with satisfaction scores or the recurrence of dislocation or subluxation.

A lower Instability Severity Index score threshold may better predict recurrent anterior shoulder instability after arthroscopic Bankart repair: a systematic review

2021 ◽  
pp. jisakos-2020-000584
Author(s):  
Samuel I Rosenberg ◽  
Simon J Padanilam ◽  
Brandon Alec Pagni ◽  
Vehniah K Tjong ◽  
Ujash Sheth
Keyword(s):  
Shoulder Instability ◽  
Severity Index ◽  
Postoperative Recurrence ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Recurrence Rates ◽  
Recurrent Instability ◽  
Arthroscopic Bankart Repair ◽  
Score Threshold ◽  
Recurrent Anterior Shoulder Instability

ImportanceThe Instability Severity Index (ISI) score was developed to evaluate a patient’s risk of recurrent shoulder instability following arthroscopic Bankart repair. While patients with an ISI score of >6 were originally recommended to undergo an open procedure (ie, Latarjet) to minimise the risk of recurrence, recent literature has called into question the utility of the ISI score.ObjectiveThe purpose of this systematic review was to evaluate the efficacy of the ISI score as a tool to predict postoperative recurrence among patients undergoing arthroscopic Bankart procedures.Evidence reviewArticles were included if study participants underwent arthroscopic Bankart repair for anterior shoulder instability and reported postoperative recurrence by ISI score at a minimum of 2 years of follow-up. Methodological study quality was assessed using the Methodological Index for Non-Randomized Studies criteria. Pearson’s χ2 test was used to compare recurrence rates among patients above and below an ISI score of 4. Sensitivity, specificity, mean ISI scores and predictive value of individual factors of the ISI score were qualitatively reviewed.FindingsFour studies concluded the ISI score was effective in predicting postoperative recurrence following arthroscopic Bankart repair; however, these studies found threshold values lower than the previously proposed score of >6 may be more predictive of recurrent instability. A pooled analysis of these studies found patients with an ISI score <4 to experience significantly lower recurrence rates when compared with patients with a score ≥4 (6.3% vs 26.0%, p<0.0001). The mean ISI score among patients who experienced recurrent instability was also significantly higher than those who did not.Conclusions and relevanceThe ISI score as constructed by Balg and Boileau may have clinical utility to help predict recurrent anterior shoulder instability following arthroscopic Bankart repair. However, this review found the threshold values published in their seminal article to be insufficient predictors of recurrent instability. Instead, a lower score threshold may provide as a better predictor of failure. The paucity of level I and II investigations limits the strength of these conclusions, suggesting a need for further large, prospective studies evaluating the predictive ability of the ISI score.Level of evidenceIV.

scholarly journals Surgeon Agreement on the Presence of Pathologic Anterior Instability on Shoulder Imaging Studies

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986250 ◽  
Author(s):  
Austin M. Beason ◽  
Ryan J. Koehler ◽  
Rosemary A. Sanders ◽  
Brooke E. Rode ◽  
Travis J. Menge ◽  
...  
Keyword(s):  
Surface Area ◽  
Shoulder Instability ◽  
Humeral Head ◽  
Interrater Agreement ◽  
Anterior Shoulder Instability ◽  
Imaging Studies ◽  
Level Of Evidence ◽  
Plain Radiographs ◽  
Orthopaedic Surgeons ◽  
Shoulder Mri

Background: In the setting of anterior shoulder instability, it is important to assess the reliability of orthopaedic surgeons to diagnose pathologic characteristics on the 2 most common imaging modalities used in clinical practice: standard plain radiographs and magnetic resonance imaging (MRI). Purpose: To assess the intra- and interrater reliability of diagnosing pathologic characteristics associated with anterior shoulder instability using standard plain radiographs and MRI. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patient charts at a single academic institution were reviewed for anterior shoulder instability injuries. The study included 40 sets of images (20 radiograph sets, 20 MRI series). The images, along with standardized evaluation forms, were distributed to 22 shoulder/sports medicine fellowship–trained orthopaedic surgeons over 2 points in time. Kappa values for inter- and intrarater reliability were calculated. Results: The overall response rate was 91%. For shoulder radiographs, interrater agreement was fair to moderate for the presence of glenoid lesions (κ = 0.49), estimate of glenoid lesion surface area (κ = 0.59), presence of a Hill-Sachs lesion (κ = 0.35), and estimate of Hill-Sachs surface area (κ = 0.50). Intrarater agreement was moderate for radiographs (κ = 0.48-0.57). For shoulder MRI, interrater agreement was fair to moderate for the presence of glenoid lesions (κ = 0.44), glenoid lesion surface area (κ = 0.35), Hill-Sachs lesion (κ = 0.33), Hill-Sachs surface area (κ = 0.28), humeral head edema (κ = 0.41), and presence of a capsulolabral injury (κ = 0.36). Fair agreement was found for specific type of capsulolabral injury (κ = 0.21). Intrarater agreement for shoulder MRI was moderate for the presence of glenoid lesion (κ = 0.59), presence of a Hill-Sachs lesion (κ = 0.52), estimate of Hill-Sachs surface area (κ = 0.50), humeral head edema (κ = 0.51), and presence of a capsulolabral injury (κ = 0.53), and agreement was substantial for glenoid lesion surface area (κ = 0.63). Intrarater agreement was fair for determining the specific type of capsulolabral injury (κ = 0.38). Conclusion: Fair to moderate agreement by surgeons was found when evaluating imaging studies for anterior shoulder instability. Agreement was similar for identifying pathologic characteristics on radiographs and MRI. There was a trend toward better agreement for the presence of glenoid-sided injury. The lowest agreement was observed for specific capsulolabral injuries.

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