scholarly journals Mean Glenoid Defect Size and Location Associated With Anterior Shoulder Instability

2017 ◽  
Vol 5 (1) ◽  
pp. 232596711667626 ◽  
Author(s):  
Lionel J. Gottschalk ◽  
Aaron J. Bois ◽  
Marcus A. Shelby ◽  
Anthony Miniaci ◽  
Morgan H. Jones
Keyword(s):  
Surface Area ◽  
Shoulder Instability ◽  
Defect Size ◽  
Anterior Shoulder Instability ◽  
Level Of Evidence ◽  
Glenoid Defect ◽  
Percentage Loss ◽  
Prior Surgery ◽  
Glenoid Surface ◽  
Recurrent Anterior Shoulder Instability

Background: There is a strong correlation between glenoid defect size and recurrent anterior shoulder instability. A better understanding of glenoid defects could lead to improved treatments and outcomes. Purpose: To (1) determine the rate of reporting numeric measurements for glenoid defect size, (2) determine the consistency of glenoid defect size and location reported within the literature, (3) define the typical size and location of glenoid defects, and (4) determine whether a correlation exists between defect size and treatment outcome. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed, Ovid, and Cochrane databases were searched for clinical studies measuring glenoid defect size or location. We excluded studies with defect size requirements or pathology other than anterior instability and studies that included patients with known prior surgery. Our search produced 83 studies; 38 studies provided numeric measurements for glenoid defect size and 2 for defect location. Results: From 1981 to 2000, a total of 5.6% (1 of 18) of the studies reported numeric measurements for glenoid defect size; from 2001 to 2014, the rate of reporting glenoid defects increased to 58.7% (37 of 63). Fourteen studies (n = 1363 shoulders) reported defect size ranges for percentage loss of glenoid width, and 9 studies (n = 570 shoulders) reported defect size ranges for percentage loss of glenoid surface area. According to 2 studies, the mean glenoid defect orientation was pointing toward the 3:01 and 3:20 positions on the glenoid clock face. Conclusion: Since 2001, the rate of reporting numeric measurements for glenoid defect size was only 58.7%. Among studies reporting the percentage loss of glenoid width, 23.6% of shoulders had a defect between 10% and 25%, and among studies reporting the percentage loss of glenoid surface area, 44.7% of shoulders had a defect between 5% and 20%. There is significant variability in the way glenoid bone loss is measured, calculated, and reported.

A Clinical Comparison of Linear- and Surface Area–Based Methods of Measuring Glenoid Bone Loss

2018 ◽  
Vol 46 (10) ◽  
pp. 2472-2477 ◽  
Author(s):  
Neil K. Bakshi ◽  
George A. Cibulas ◽  
Jon K. Sekiya ◽  
Asheesh Bedi
Keyword(s):  
Bone Loss ◽  
Surface Area ◽  
Shoulder Instability ◽  
Linear Measurement ◽  
Glenoid Bone Loss ◽  
Area Measurement ◽  
Anterior Shoulder Instability ◽  
3D Ct ◽  
Ct Reconstruction ◽  
Level Of Evidence

Background: The purpose of this study was to determine whether linear-based measurement significantly overestimates glenoid bone loss in comparison with surface area–based measurement in patients with recurrent anterior shoulder instability and glenoid bone loss. Hypothesis: Linear-based measurement will significantly overestimate glenoid bone loss in comparison with surface area–based measurement in patients with anterior shoulder instability and glenoid bone loss. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Thirty patients with anterior shoulder instability underwent preoperative bilateral shoulder computed tomography (CT) scans. Three-dimensional CT (3D-CT) reconstruction with humeral head subtraction was performed to obtain an en face view of the 3D-CT glenoid. Glenoid bone loss was measured with the surface area and linear methods of measurement. Statistical analysis was performed with a paired 2-tailed t test. Results: Twenty-eight patients (5 female and 23 male; mean age, 25.1 years; age range, 15-58 years) were included in the study; 17 patients underwent a glenoid augmentation procedure, and 11 underwent arthroscopic Bankart repair. The mean percentage glenoid bone loss calculated with the surface area and linear methods was 12.8% ± 8.0% and 17.5% ± 9.7% ( P < .0001), respectively. For the 17 patients who underwent glenoid augmentation, mean percentage bone loss with the surface area and linear methods was 16.6% ± 7.9% and 23.0% ± 8.0% ( P < .0001), respectively. Conclusion: Linear measurement of glenoid bone loss significantly overestimates bone loss compared with surface area measurement in patients with anterior glenoid bony defects. These results indicate that these different methods cannot be used interchangeably and cannot be used with the same critical thresholds for glenoid bone loss.

scholarly journals Arthroscopic Bankart Repairs With and Without Remplissage in Recurrent Adolescent Anterior Shoulder Instability With Hill-Sachs Deformity

2018 ◽  
Vol 6 (12) ◽  
pp. 232596711881398 ◽  
Author(s):  
Jessica L. Hughes ◽  
Tracey Bastrom ◽  
Andrew T. Pennock ◽  
Eric W. Edmonds
Keyword(s):  
Shoulder Instability ◽  
Adult Population ◽  
Patient Reported Outcome ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Anterior Glenoid ◽  
The Hill ◽  
Recurrent Anterior Shoulder Instability

Background: Recurrent shoulder dislocation after surgical intervention in adolescents with anterior instability is now understood to occur with a relatively high frequency. The remplissage procedure is successfully used in the adult population to mitigate the ability of a Hill-Sachs lesion to engage the anterior glenoid and can be used during an arthroscopic Bankart repair for anterior shoulder instability. Purpose: To compare the clinical outcomes in adolescent patients who underwent a Bankart repair with or without remplissage for treatment of recurrent anterior shoulder instability and associated Hill-Sachs defects. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was conducted on adolescents who underwent a remplissage procedure for recurrent anterior shoulder instability from 2009 to 2017 at a single institution. Controls were identified in a cohort of patients who underwent a Bankart repair only and were matched based on age, sex, and size of Hill-Sachs lesion. All patients were then contacted to determine instability recurrence as well as to complete the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) and the Pediatric Adolescent Shoulder Score (PASS) outcome surveys. Results: Twenty-one adolescents underwent a remplissage procedure, and 20 matched controls underwent only a Bankart procedure. A significantly higher rate of recurrence was noted in the Bankart-only patients (8/17) compared with remplissage patients (2/15) ( P = .04). No statistical difference was found in patient-reported outcome scores between treatment groups or in range of motion measurements ( P > .05). In a subset of patients in the remplissage group with pre- and postoperative surveys available, mean ± SD scores for PASS (77 ± 11) and QuickDASH (19 ± 12) improved when compared with preoperative scores (PASS, 54 ± 16; QuickDASH, 35 ± 28), but only the PASS score was statistically improved (PASS, P = .003; QuickDASH, P = .23). Conclusion: The addition of the remplissage procedure to a Bankart repair is a reasonable surgical option to treat a Hill-Sachs deformity in adolescents with anterior shoulder instability. The success of this additional procedure may be due to filling the Hill-Sachs defect, or perhaps it augments stability through a mechanism of posterior capsulorrhaphy. Either way, this young athletic population appears to have a lower rate of recurrence and improved patient-reported outcomes with a remplissage procedure to address the Hill-Sachs deformity.

Long-term Results of the Arthroscopic Bankart Repair for Recurrent Anterior Shoulder Instability in Patients Older Than 40 Years: A Comparison With the Open Latarjet Procedure

2020 ◽  
Vol 48 (9) ◽  
pp. 2090-2096
Author(s):  
Lukas Ernstbrunner ◽  
Bianca De Nard ◽  
Maurits Olthof ◽  
Silvan Beeler ◽  
Samy Bouaicha ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Constant Score ◽  
Bankart Repair ◽  
Long Term Results ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Level Of Evidence ◽  
Arthroscopic Bankart Repair ◽  
Recurrent Anterior Shoulder Instability

Background: Long-term results of the arthroscopic Bankart repair in patients older than 40 years are unknown and may be favorable in terms of postoperative glenohumeral arthritis as opposed to the long-term results of the open Latarjet procedure in patients older than 40 years. Purpose: To analyze our long-term results of the arthroscopic Bankart repair for recurrent anterior shoulder instability in patients older than 40 years of age and to compare these results with previously published long-term results of the Latarjet procedure in a cohort of similar age. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 35 consecutive patients (36 shoulders) with a mean age of 47 years (range, 40-69) at time of the arthroscopic Bankart repair were studied at a mean 13.2 years (range, 8-18) after surgery. Clinical and radiographic results were then compared with those of our previous study of 39 consecutive patients (40 shoulders) of a same age group who had been treated for the same pathology with an open Latarjet procedure. Results: Six shoulders (17%) sustained a recurrent shoulder dislocation after a mean 5.3 years; subluxation occurred in 3 shoulders (8%); and apprehension persisted in 3 shoulders (8%). Revision surgery was performed in 8 patients (22%): 2 Bankart and 6 open Latarjet. The relative preoperative Constant score and Subjective Shoulder Value were significantly improved ( P < .001) at final follow-up. Arthropathy of stabilization was advanced in the shoulders of 16 patients (47%) and had progressed by at least 2 grades in 21 patients (62%). There were significantly higher rates of redislocation and subluxation when compared with the open Latarjet procedure (9 vs 3; P = .037), and the mean final Subjective Shoulder Value was significantly lower in the Bankart group (86% vs 91%; P = .011). There were no significant differences in final advanced arthropathy (16 vs 14; P = .334) and revision rates (8 vs 7; P = .409) when compared with the Latarjet procedure. Conclusion: Arthroscopic Bankart repair for recurrent anterior shoulder instability in patients older than 40 years was associated with reliable pain relief and patient satisfaction similar to that after the open Latarjet procedure. Restoration of stability was significantly less successful and development of arthropathy no better than the open Latarjet procedure in patients older than 40 years.

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.

scholarly journals Three-Dimensional Quantification of Glenoid Bone Loss in Anterior Shoulder Instability: The Anatomic Concave Surface Area Method

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110110
Author(s):  
Marine Launay ◽  
Muhammad Naghman Choudhry ◽  
Nicholas Green ◽  
Jashint Maharaj ◽  
Kenneth Cutbush ◽  
...  
Keyword(s):  
Bone Loss ◽  
Surface Area ◽  
Shoulder Instability ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Glenoid Bone Loss ◽  
Concave Surface ◽  
Anterior Shoulder Instability ◽  
Level Of Evidence ◽  
Best Fit

Background: Recurrent shoulder instability may be associated with glenoid erosion and bone loss. Accurate quantification of bone loss significantly influences the contemplation of surgical procedure. In addition, assessment of bone loss is crucial for surgical planning and accurate graft placement during surgery. Purpose: To quantify the concave surface area of glenoid bone loss by using 3-dimensional (3D) segmented models of the scapula and to compare this method with the best-fit circle and glenoid height/width methods, which use the glenoid rim for bone loss estimations. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 36 consecutive preoperative bilateral computed tomography scans of patients eligible for a primary Latarjet procedure were selected from our institutional surgical database (mean patient age, 29 ± 9 years; 31 men and 5 women). The 3D models of both scapulae were generated using medical segmentation software and were used to map the anatomic concave surface area (ACSA) of the inferior glenoid using the diameter of the best-fit circle of the healthy glenoid. Bone loss was calculated as a ratio of the difference between surface areas of both glenoids (healthy and pathological) against the anatomic circular surface area of the healthy glenoid (the ACSA method). These results were compared with bone loss calculations using the best-fit circle and glenoid height/width methods. Inter- and intraobserver reliability were also calculated. Results: The mean (± SD) bone loss calculated using the ACSA, the best-fit circle, and glenoid height/width methods was 9.4% ± 6.7%, 14.3% ± 6.8%, and 17.6% ± 7.3%, respectively. The ACSA method showed excellent interobserver reliability, with an intraclass correlation coefficient (ICC) of 0.95 versus those for the best-fit circle (ICC, 0.71) and glenoid height/width (ICC, 0.79) methods. Conclusion: Quantification of instability-related glenoid bone loss is reliable using the 3D ACSA method.

scholarly journals Arthroscopic Anatomic Glenoid Reconstruction: Analysis of the Learning Curve

2018 ◽  
Vol 6 (11) ◽  
pp. 232596711880790 ◽  
Author(s):  
Iustin Moga ◽  
George Konstantinidis ◽  
Catherine Coady ◽  
Swagata Ghosh ◽  
Ivan Ho-Bun Wong
Keyword(s):  
Shoulder Instability ◽  
Operative Time ◽  
Anterior Shoulder Instability ◽  
Surgical Time ◽  
Anterior Glenoid ◽  
Glenoid Surface ◽  
Levene Test ◽  
Recurrent Anterior Shoulder Instability ◽  
Graft Positioning ◽  
Glenoid Reconstruction

Background: Anatomic glenoid reconstruction involves the use of distal tibial allograft for bony augmentation of the glenoid surface. An all-arthroscopic approach was recently described to avoid damage to the subscapularis tendon and preserve the capsule and labrum. Purpose: To explore and compare change in surgical time between 2 proposed methods used for the treatment of anterior shoulder instability—arthroscopic anatomic glenoid reconstruction (AAGR) and arthroscopic Latarjet (AL)—over successive procedures. We also compared graft positioning on the anterior glenoid surface between the 2 methods. Study Design: Cohort study; Level of evidence, 3. Methods: This was a single-surgeon retrospective review of 54 cases of surgically treated recurrent anterior shoulder instability: 27 had AAGR with distal tibial allograft, while the other 27 had AL. AAGR with the distal tibial allograft was the primary choice for the treatment of anterior shoulder instability; however, AL was performed when tibial allograft was not available from the bone bank. Thus, there was an overlapping period for those 2 procedures. Procedure start and end times were recorded, and duration was calculated. Postoperative 3-dimensional computed tomography scans were reviewed, and graft position was judged to be in the lower third (desired position), middle third, or upper third of the anterior glenoid surface. To assess learning, these data were organized in chronological order of surgery, and each surgical cohort was divided into 3 chronological clusters of 9 patients each. Learning was assessed through change in operative time over successive clusters, change in variability of operative time among clusters, and change in graft positioning among clusters. Statistical analysis comprised a 2-tailed independent-sample t test and the Levene test for equality of variance. Results: Our study found that AAGR was significantly faster to perform than AL in the early ( P = .001), middle ( P = .001), and late ( P = .05) clusters of each cohort. Duration of surgery did not significantly improve across clusters within each cohort ( P = .15-.79). There were no significant changes in the variability of surgical time in the AAGR group ( P = .09) or the AL group ( P = .13). Desired positioning of the bone graft on the anterior glenoid surface (lower third) was identified more commonly in the AAGR cohort. Conclusion: AAGR is faster to learn and perform than AL for the treatment of recurrent anterior shoulder instability with significant glenoid bone loss. The current study found higher rates of desired graft positioning for AAGR clusters.

The Effects of Thermal Capsular Shrinkage on the Outcomes of Arthroscopic Stabilization for Primary Anterior Shoulder Instability

2005 ◽  
Vol 33 (5) ◽  
pp. 705-711 ◽  
Author(s):  
Shiyi Chen ◽  
Pieter Stijn Haen ◽  
Judie Walton ◽  
George A. C. Murrell
Keyword(s):  
Outcome Measures ◽  
Shoulder Instability ◽  
Labral Repair ◽  
Anterior Shoulder Instability ◽  
Shoulder Stabilization ◽  
Recurrent Instability ◽  
Level Of Evidence ◽  
Kaplan Meier ◽  
Recurrent Anterior Shoulder Instability

Background The effectiveness of arthroscopic thermal capsulorrhaphy in the prevention of recurrent instability in primary anterior stabilization is undetermined. Purpose To determine if patients with recurrent anterior shoulder instability who have labral repair plus arthroscopic thermal capsulorrhaphy have better outcomes than those with labral repair alone. Study Design Cohort study; Level of evidence, 3. Method There were 72 patients who underwent arthroscopic anterior shoulder stabilization with Suretac II tacks (n = 32) during 1996 to 1999 or with Suretac II tacks plus arthroscopic radiofrequency capsular shrinkage (n = 40) from 1999 to 2002. Standardized patient-determined and examiner-determined outcome measures were obtained preoperatively and at 3, 6, 12, and 24 months postoperatively. Statistical analyses included a Kaplan-Meier analysis of time to recurrent instability. Results Of the 72 patients, 66 had complete follow-up, including 28 patients treated with the Suretac stabilization and 38 patients with the Suretac plus radiofrequency shrinkage, for a mean follow-up of 58 and 30 months, respectively. All patients had a Bankart lesion. Both groups had similar results with respect to patient-determined and examiner-determined outcome measures. The only adverse outcome was postoperative recurrent instability in 6 of 28 cases in the Suretac group alone and 8 of 38 cases in the Suretac-plus-shrinkage group. Most recurrent instability occurred between 6 and 24 months. Kaplan-Meier analysis for time to recurrent instability showed no differences in the rate of instability recurrence between the 2 groups. Conclusion Arthroscopic thermal capsulorrhaphy neither enhanced nor impaired the outcomes of arthroscopic labral repair with biodegradable tacks in patients with primary recurrent anterior shoulder instability.

Challenging the Current Concept of Critical Glenoid Bone Loss in Shoulder Instability: Does the Size Measurement Really Tell It All?

2019 ◽  
Vol 47 (3) ◽  
pp. 688-694 ◽  
Author(s):  
Philipp Moroder ◽  
Philipp Damm ◽  
Guido Wierer ◽  
Elisabeth Böhm ◽  
Marvin Minkus ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Measurement Techniques ◽  
Defect Size ◽  
Glenoid Bone Loss ◽  
Anterior Shoulder Instability ◽  
Glenoid Defect ◽  
Element Analysis ◽  
Anterior Glenoid ◽  
Biomechanical Effect

Background: Bone loss at the anterior glenoid rim is a main reason for failure of soft-tissue based surgical stabilization procedures in patients with anterior shoulder instability. Purpose: To evaluate the capability of conventional glenoid bone loss measurement techniques to provide an adequate estimation of the actual biomechanical effect of glenoid defects. Study Design: Descriptive laboratory study. Methods: Thirty consecutive patients with unilateral anterior shoulder instability and varying degrees of glenoid defect were included. Patient-specific computer tomography–based 3-dimensional shoulder models of the affected and unaffected sides were created. The bony shoulder stability ratio (SR) was determined in various potential dislocation directions with finite element analysis. Values obtained from conventional glenoid defect size measurement techniques (Pico and Sugaya) were correlated with the finite element analysis results. Additionally, a mathematical model was developed to theoretically analyze the correlation between glenoid defect size measurements and the SR. Results: The authors found substantial interindividual differences of the SR of the unaffected shoulders in all directions of measurement. Bone loss at the anterior glenoid rim significantly reduced the SR in the 2-o’clock ( P = .011), 3-o’clock ( P < .001), and 4-o’clock ( P < .001) directions referring to a right shoulder. The correlation between the defect size measurements and the SR for the 2-o’clock (rho = −0.522 and −0.580), 3-o’clock (rho = −0.597 and −0.580), and 4-o’clock (rho = −0.527 and −0.522) directions was statistically significant. However, it showed only moderate strength and was nonlinear as well as dependent on the inherent shape of the concavity. As shown by the mathematical model, bone loss has the most considerable effect at the edge of the glenoid rim, and an increasingly concave-shaped glenoid leads to an increase in loss of SR provoked by the same extent of bone loss. Conclusion: Current glenoid bone loss measurements are unable to provide an adequate estimation on the actual biomechanical effect of glenoid defects because (1) the relation between the glenoid defect size and its biomechanical effect is nonlinear and (2) patients with shoulder instability have constitutional biomechanically relevant glenoid concavity shape differences. Clinical Relevance: These findings challenge the current concept of setting a general threshold for critical glenoid bone loss, which requires bony reconstruction surgery.

scholarly journals Bipolar Bone Defects in Shoulders With Primary Instability: Dislocation Versus Subluxation

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110035
Author(s):  
Shigeto Nakagawa ◽  
Wataru Sahara ◽  
Kazutaka Kinugasa ◽  
Ryohei Uchida ◽  
Tatsuo Mae
Keyword(s):  
Bone Defect ◽  
Older Patients ◽  
Bone Defects ◽  
Defect Size ◽  
Level Of Evidence ◽  
Glenoid Defect ◽  
Large Defect ◽  
Important Indicator ◽  
Defect Score ◽  
Primary Instability

Background: In shoulders with traumatic anterior instability, a bipolar bone defect has been recognized as an important indicator of the prognosis. Purpose: To investigate bipolar bone defects at primary instability and compare the difference between dislocation and subluxation. Study Design: Cohort study; Level of evidence, 3. Methods: There were 156 shoulders (156 patients) including 91 shoulders with dislocation and 65 shoulders with subluxation. Glenoid defects and Hill-Sachs lesions were classified into 5 size categories on 3-dimensional computed tomography (CT) scans and were allocated scores ranging from 0 (no defect) to 4 points (very large defect). To assess the combined size of the glenoid defect and Hill-Sachs lesion, the scores for both lesions were summed (range, 0-8 points). Patients in the dislocation and subluxation groups were compared regarding the prevalence of a glenoid defect, a bone fragment of bony Bankart lesion, a Hill-Sachs lesion, a bipolar bone defect, and an off-track Hill-Sachs lesion. Then, the combined size of the bipolar bone defects was compared between the dislocation and subluxation groups and among patients stratified by age at the time of CT scanning (<20, 20-29, and ≥30 years). Results: Hill-Sachs lesions were observed more frequently in the dislocation group (75.8%) compared with the subluxation group (27.7%; P < .001), whereas the prevalence of glenoid defects was not significantly different between groups (36.3% vs 29.2%, respectively; P = .393). The combined defect size was significantly larger in the dislocation versus subluxation group (mean ± SD combined defect score, 2.1 ± 1.6 vs 0.8 ± 0.9 points, respectively; P < .001) due to a larger Hill-Sachs lesion at dislocation than subluxation (glenoid defect score, 0.5 ± 0.9 vs 0.3 ± 0.6 points [ P = .112]; Hill-Sachs lesion score, 1.6 ± 1.2 vs 0.4 ± 0.7 points [ P < .001]). Combined defect size was larger in older patients than younger patients in the setting of dislocation (combined defect score, <20 years, 1.6 ± 1.2 points; 20-29 years, 1.9 ± 1.5 points; ≥30 years, 3.4 ± 1.6 points; P < .001) but was not different in the setting of subluxation (0.8 ± 1.0, 0.7 ± 0.9, and 0.8 ± 0.8 points, respectively; P = .885). An off-track Hill-Sachs lesion was observed in 2 older patients with dislocation but was not observed in shoulders with subluxation. Conclusion: The bipolar bone defect was significantly more frequent, and the combined size was greater in shoulders with primary dislocation and in older patients (≥30 years).

Arthroscopic Versus Open Anterior Shoulder Stabilization: A Prospective Randomized Clinical Trial With 15-Year Follow-up With an Assessment of the Glenoid Being “On-Track” and “Off-Track” as a Predictor of Failure

2021 ◽  
pp. 036354652110182
Author(s):  
Craig R. Bottoni ◽  
John D. Johnson ◽  
Liang Zhou ◽  
Sarah G. Raybin ◽  
James S. Shaha ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Shoulder Stabilization ◽  
Mri Studies ◽  
Open Stabilization ◽  
The Mean ◽  
Recurrent Anterior Shoulder Instability

Background: Recent studies have demonstrated equivalent short-term results when comparing arthroscopic versus open anterior shoulder stabilization. However, none have evaluated the long-term clinical outcomes of patients after arthroscopic or open anterior shoulder stabilization, with inclusion of an assessment of preoperative glenoid tracking. Purpose: To compare long-term clinical outcomes of patients with recurrent anterior shoulder instability randomized to open and arthroscopic stabilization groups. Additionally, preoperative magnetic resonance imaging (MRI) studies were used to assess whether the shoulders were “on-track” or “off-track” to ascertain a prediction of increased failure risk. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A consecutive series of 64 patients with recurrent anterior shoulder instability were randomized to receive either arthroscopic or open stabilization by a single surgeon. Follow-up assessments were performed at minimum 15-year follow-up using established postoperative evaluations. Clinical failure was defined as any recurrent dislocation postoperatively or subjective instability. Preoperative MRI scans were obtained to calculate the glenoid track and designate shoulders as on-track or off-track. These results were then correlated with the patients’ clinical results at their latest follow-up. Results: Of 64 patients, 60 (28 arthroscopic and 32 open) were contacted or examined for follow-up (range, 15-17 years). The mean age at the time of surgery was 25 years (range, 19-42 years), while the mean age at the time of this assessment was 40 years (range, 34-57 years). The rates of arthroscopic and open long-term failure were 14.3% (4/28) and 12.5% (4/32), respectively. There were no differences in subjective shoulder outcome scores between the treatment groups. Of the 56 shoulders, with available MRI studies, 8 (14.3%) were determined to be off-track. Of these 8 shoulders, there were 2 surgical failures (25.0%; 1 treated arthroscopically, 1 treated open). In the on-track group, 6 of 48 had failed surgery (12.5%; 3 open, 3 arthroscopic [ P = .280]). Conclusion: Long-term clinical outcomes were comparable at 15 years postoperatively between the arthroscopic and open stabilization groups. The presence of an off-track lesion may be associated with a higher rate of recurrent instability in both cohorts at long-term follow-up; however, this study was underpowered to verify this situation.

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