scholarly journals Distal Tibial Allograft Glenoid Reconstruction for Recurrent Shoulder Instability: Clinical Outcomes and Complications

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0009 ◽  
Author(s):  
Anthony F. De Giacomo ◽  
Hithem Rahmi ◽  
Sevag Bastian ◽  
Christopher Klein ◽  
John Itamura
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Functional Outcomes ◽  
Glenoid Bone Loss ◽  
Dash Score ◽  
Recurrent Instability ◽  
Allograft Reconstruction ◽  
Recurrent Shoulder Instability ◽  
Outcome Scores

Objectives: Treatment options for recurrent shoulder instability, in the setting of significant glenoid bone loss, consists of several iterations of bone stabilization procedures. However, advanced arthritic changes with the Laterjet procedure and rapid resorption changes with the iliac crest bone graft reconstruction has led into the search for more optimal surgical reconstruction options. The purpose of this study is to evaluate the clinical and functional outcomes of patients with recurrent shoulder instability, with significant glenoid bone loss, treated with fresh distal tibial allograft reconstruction with regards to recurrence, revision surgery, and complications. Methods: At a single institution, all consecutive patients with recurrent shoulder instability and at least 15% anterior glenoid bone loss, undergoing distal tibial allograft reconstruction, between 2011 to 2016, were identified by diagnostic and procedural codes. All clinical notes, diagnostic imaging, and operative reports were reviewed in detail. From these sources, demographics, operative techniques, and radiographic parameters were collected and measured. Functional outcome scores were prospectively collected from patients. The primary outcome of the study was the Disability of Arm, Shoulder, Hand (DASH) score. The secondary outcomes of the study were the Visual Analog Scale (VAS) pain score, Single Assessment Numeric Evaluation (SANE) score, recurrent instability, revision surgery, and complications. Results: At 6 years, there were a total of 36 distal tibial allograft reconstructions performed in patients with recurrent shoulder instability in the setting of significant glenoid bone loss. Amongst this cohort, average age was 35 years old with 72% of patients being male. The dominant extremity was involved in 20 (56%) of patients and 24 (67%) of patients had previous surgery to address episodes of shoulder instability. Follow-up, for the entire cohort was on average 15.5 months. In comparison to preoperative range of motion, after surgery there was significantly less abduction (P=0.01). At final follow-up, patients undergoing distial tibial allograft reconstruction showed trend towards significant improvement in the DASH score (preoperative DASH=50.7, postoperative DASH=37.1, P=0.09). In like manner, there was significant improvement in both the VAS score (P=0.001) and the SANE score (P=0.002). There was no significant difference in functional outcome scores between those patients who had failed a previous surgery for instability. Recurrent instability, after distal tibial allograft reconstruction, occurred in 4 (11%) of patients and 8 (22%) of patients underwent an additional surgical procedure. Complications occurred in 31% of patients, with the most common complication being rupture of the subscapularis. Conclusion: This study provides functional outcomes in one of the largest consecutive cohort of patients undergoing distal tibial allograft reconstruction for recurrent shoulder instability due to significant glenoid bone loss. The study suggests that distal tibial allograft reconstruction may provide improved functional outcomes in patients with recurrent shoulder instability. After this procedure, 89% of patients did not experience any additional episodes of shoulder instability. Despite these encouraging results, complications are common after this procedure, with 31% of patients experiencing a complication. [Table: see text][Table: see text]

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.

scholarly journals Clinical Outcomes of Shoulder Stabilization in Females With Glenoid Bone Loss

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110075
Author(s):  
Rachel M. Frank ◽  
Hytham S. Salem ◽  
Catherine Richardson ◽  
Michael O’Brien ◽  
Jon M. Newgren ◽  
...  
Keyword(s):  
Bone Loss ◽  
Clinical Outcomes ◽  
Shoulder Instability ◽  
Glenoid Bone Loss ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Shoulder Stabilization ◽  
Simple Shoulder Test ◽  
Female Patients

Background: Nearly all studies describing shoulder stabilization focus on male patients. Little is known regarding the clinical outcomes of female patients undergoing shoulder stabilization, and even less is understood about females with glenoid bone loss. Purpose: To assess the clinical outcomes of female patients with recurrent anterior shoulder instability treated with the Latarjet procedure. Study Design: Case series; Level of evidence, 4. Methods: All cases of female patients who had recurrent anterior shoulder instability with ≥15% anterior glenoid bone loss and underwent the Latarjet procedure were analyzed. Patients were evaluated after a minimum 2-year postoperative period with scores of the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale. Results: Of the 22 patients who met our criteria, 5 (22.7%) were lost to follow-up, leaving 17 (77.2%) available for follow-up with a mean ± SD age of 31.7 ± 12.9 years. Among these patients, 16 (94.1%) underwent 1.6 ± 0.73 ipsilateral shoulder operations (range, 1-3) before undergoing the Latarjet procedure. Preoperative indications for surgery included recurrent instability with bone loss in all cases. After a mean follow-up of 40.2 ± 22.9 months, patients experienced significant score improvements in the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale ( P < .05 for all). There were 2 reoperations (11.8%). There were no cases of neurovascular injuries or other complications. Conclusion: Female patients with recurrent shoulder instability with glenoid bone loss can be successfully treated with the Latarjet procedure, with outcomes similar to those of male patients in the previously published literature. This information can be used to counsel female patients with recurrent instability with significant anterior glenoid bone loss.

Recurrent Shoulder Instability: Current Concepts for Evaluation and Management of Glenoid Bone Loss

2010 ◽  
Vol 92 (Suppl 2) ◽  
pp. 133-151 ◽  
Author(s):  
CDR Matthew T Provencher ◽  
Sanjeev Bhatia ◽  
Neil S Ghodadra ◽  
Robert C Grumet ◽  
Bernard R Bach ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Glenoid Bone Loss ◽  
Recurrent Shoulder Instability

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 The Instability Severity Index Score Revisited: Evaluation of 217 Consecutive Cases of Recurrent Anterior Shoulder Instability

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0026
Author(s):  
Matthew T. Provencher ◽  
George Sanchez ◽  
Andrew S. Bernhardson ◽  
Liam A. Peebles ◽  
Daniel B. Haber ◽  
...  
Keyword(s):  
Bone Loss ◽  
Severity Index ◽  
Index Score ◽  
Glenoid Bone Loss ◽  
Anterior Shoulder Instability ◽  
Arthroscopic Stabilization ◽  
Recurrent Instability ◽  
Severity Index Score ◽  
Recurrent Anterior Shoulder Instability

Objectives: The instability severity index score (ISIS) was designed to predict the risk of recurrence after arthroscopic instability shoulder surgery and to better predict those who would benefit from an open or bone transfer operation. Although this score has been widely disseminated to predict recurrence, there are certain areas in which preoperative assessment is limited, especially in radiographic workup. The objective of this study was to examine the validity of ISIS based on its existing variables, as well as to evaluate additional imaging and patient history variables pertinent to the potential redevelopment of a new score to assess risk of recurrent anterior instability following an arthroscopic Bankart repair. Methods: All consecutive patients were prospectively enrolled with recurrent anterior shoulder instability who subsequently underwent an arthroscopic stabilization with minimum 24 months follow-up. Exclusion criteria included, prior surgery on the shoulder, posterior or multidirectional instability, or a rotator cuff tear. All instability severity index score variables were recorded (age <20, degree and sport type, hyperlaxity, Hill Sachs on AP xray, glenoid loss of contour on AP xray), as well as additional variables: 1. Position of arm at dislocation; 2. Number of instability events; 3. Total time of instability; 4. Glenoid bone loss percent; 5. Amount of attritional glenoid bone loss; 6. Hill Sachs measures (H/W/D and volume), and outcomes (recurrent instability) and scores (WOSI, ASES and SANE). Regression analysis was utilized to determine preoperative variables that predicted outcomes and failures. Results: There were 217 consecutive patients (209 male-96.5%, 8 female-3.5%) who met criteria and were all treated with a primary arthroscopic shoulder stabilization during a 3.5-year period (2007-2011), with mean follow-up of 42 (range, 26-58 mos). The mean age at first instability event was 23.9 (range, 16-48), with 55% right shoulder affected, 60% dominant shoulder. Outcomes were improved from mean scores preoperative (WOSI=1050/2100, ASES=61.0, SANE=52.5) to postoperative (WOSI=305/2100, ASES=93.5, SANE=95.5), and 11.5% (25/217) had evidence or recurrent instability or subluxation. A total of 51/217 were 20 years or under, hyperlaxity in 5, Hill Sachs on internal rotation XR in 77, glenoid contour on AP XR in 41, with an overall mean ISIS score of 3.6. Factors associated with failure were glenoid bone loss greater than 14.5%(p<0.001), total time of instability symptoms >11.5 months(p<0.03), Hill Sachs volume > 1.3 cm3 with H>1.5 cm, W>1.0 cm and D>5 mm(p<0.01), contact sport (p<0.01) and age 20 or under (p<0.01). There was no correlation in outcomes with Hill Sachs on IR or glenoid contour on XR (p>0.45), sports participation, and Instability Severity Score (mean=3.4 success, vs 3.9 failure, p>0.44). Conclusion: At nearly four years of follow-up, there was an 11.5% failure rate of scope stabilization surgery. However, there was no correlation between treatment outcome and the ISIS measure given a mean score of 3.4 with little difference identified in those that failed. However, several important parameters previously unidentified were detected including, glenoid bone loss >14.5%, Hill Sachs volume >1.3 cm3, and time length of instability symptoms. Therefore, the ISIS measure may need to be redesigned in order to incorporate variables that more accurately portray the actual risk of failure following arthroscopic stabilization.

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 Clinical Outcomes of Primary versus Revision Surgery using Arthroscopic Anatomic Glenoid Reconstruction for Anterior Shoulder Instability. (244)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0035
Author(s):  
Ivan Wong ◽  
Ryland Murphy ◽  
Sara Sparavalo ◽  
Jie Ma
Keyword(s):  
Bone Loss ◽  
Clinical Outcomes ◽  
Revision Surgery ◽  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Primary Group ◽  
Recurrent Instability ◽  
Exclusion Criteria ◽  
Glenoid Reconstruction

Objectives: Revision surgeries after prior shoulder stabilization are known to have worse outcomes as compared to their primary counterparts. To date, no studies have looked at the utility of arthroscopic anatomic glenoid reconstruction (AAGR) as a revision surgery. The purpose of this study was to assess the clinical outcomes of primary versus revision AAGR for anterior shoulder instability with bone loss. Methods: We performed a retrospective review on consecutive patients with prospectively collected data who underwent AAGR from 2012 to 2018. Patients who received AAGR for anterior shoulder instability with bone loss and had a minimum follow-up of two years were included. Exclusion criteria included patients with rotator cuff pathology, multidirectional instability and glenoid fractures. There were 68 patients (48 primary and 20 revision) who met inclusion/exclusion criteria. Our primary outcome was measured using the Western Ontario Shoulder Instability Index (WOSI) and Disabilities of Arm, Shoulder, Hand (DASH) scores. Secondary outcomes included post-operative complications and post-operative recurrent instability. Results: The primary group showed a significant improvement in most-recent post-operative WOSI from 62.7 to 20.7 (P<0.001, α=0.05) and in DASH from 26.89 to 6.7 (p<0.001, α=0.05). The revision group also showed a significant improvement in WOSI from 71.5 to 34.6 (p<0.001, α=0.05) and in DASH from 39.5 to 17.0 (p<0.05, α=0.05). When comparing between groups, the revision group had worse WOSI scores (34.6) at most recent follow-up compared to the primary group (20.7); p<0.05. The most-recent DASH scores also showed the revision group (17.0) having worse outcomes than the primary group (6.7); p<0.05. Important to note that the minimal clinically important difference (MCID) was met for WOSI (MCID=10.4) but not DASH (MCID=10.83). There were no post-operative reports of instability in either group. For complications, one hardware failure (suture anchor) was seen in the primary group, and two hardware removals were seen in the revision group. Conclusions: While patient reported scores indicated worse outcomes in the revision group, the significant clinical improvement in DASH and WOSI, along with the lack of recurrent instability provides evidence that AAGR is a suitable option for revision patients.

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