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.

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.

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 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 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.

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 Treatment type may influence degree of post-dislocation shoulder osteoarthritis: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Lukas P. E. Verweij ◽  
Erik C. Pruijssen ◽  
Gino M. M. J. Kerkhoffs ◽  
Leendert Blankevoort ◽  
Inger N. Sierevelt ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Shoulder Instability ◽  
Operative Procedures ◽  
Lower Degree ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Eligibility Criteria ◽  
Level Of Evidence ◽  
Treatment Type

Abstract Purpose Age at primary dislocation, recurrence, and glenoid bone loss are associated with development of osteoarthritis (OA). However, an overview of OA following traumatic anterior shoulder instability is lacking and it is unclear to what degree type of surgery is associated with development of OA in comparison to non-operative treatment. The aim of this study was to determine the degree of OA at long-term follow-up after non-operative and operative treatments for patients with anterior shoulder instability. Surgery is indicated when patients experience recurrence and this is associated with OA; therefore, it was hypothesized that shoulders show a higher proportion or degree of OA following operative treatment compared to non-operative treatment. Methods A literature search was performed in the PubMed/Medline, EMBASE, and Cochrane databases. Articles reporting the degree of OA that was assessed with the Samilson–Prieto or Buscayret OA classification method after non-operative and operative treatment for anterior shoulder instability with a minimum of 5 years follow-up were included. Results Thirty-six articles met the eligibility criteria of which 1 reported the degree of OA for non-operative treatment and 35 reported the degree of OA for 9 different operative procedures. A total of 1832 patients (1854 shoulders) were included. OA proportions of non-operative and operative treatments are similar at any point of follow-up. The Latarjet procedure showed a lower degree of OA compared to non-operative treatment and the other operative procedures, except for the Bristow procedure and Rockwood capsular shift. The meta-analyses showed comparable development of OA over time among the treatment options. An increase in OA proportion was observed when comparing the injured to the contralateral shoulder. However, a difference between the operative subgroups was observed in neither analysis. Conclusion Non-operative and operative treatments show similar OA proportions at any point of follow-up. The hypothesis that shoulders showed a higher proportion or degree of OA following operative treatment compared to non-operative treatment is not supported by the data. Operative treatment according to the Latarjet procedure results in a lower degree of OA compared to other treatments, including non-operative treatment. Level of evidence IV.

Trends in Bone-Block Augmentation Among Recently Trained Orthopaedic Surgeons Treating Anterior Shoulder Instability

2016 ◽  
Vol 98 (13) ◽  
pp. e56 ◽  
Author(s):  
Ryan M. Degen ◽  
Christopher L. Camp ◽  
Brian C. Werner ◽  
David M. Dines ◽  
Joshua S. Dines
Keyword(s):  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Bone Block ◽  
Orthopaedic Surgeons

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.

Clinical Outcomes of Patients With Anterior Shoulder Instability and Glenolabral Articular Disruption Lesions: A Retrospective Comparative Study

2020 ◽  
Vol 48 (14) ◽  
pp. 3472-3477
Author(s):  
Martin S. Davey ◽  
Eoghan T. Hurley ◽  
Christopher A. Colasanti ◽  
John P. Scanlon ◽  
Mohamed Gaafar ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Shoulder Instability ◽  
Return To Sport ◽  
Return To Play ◽  
Anterior Shoulder Instability ◽  
Control Group ◽  
Control Groups ◽  
Level Of Evidence ◽  
Significant Difference ◽  
And Control

Background: Anterior shoulder instability is a common clinical condition that often requires surgical stabilization. Glenoid labral tears are often associated with instability, with glenolabral articular disruption (GLAD) lesions occasionally being identified arthroscopically during repair, particularly in collision athletes. Purpose: To evaluate the clinical outcomes and recurrence rates in patients who had GLAD lesions and underwent arthroscopic Bankart repair (ABR) and compare them with a control group without GLAD lesions. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of patients who underwent ABR with GLAD lesions, by a single surgeon between July 2012 and March 2017, was performed. Additionally, these were pair matched in a 2:1 ratio for age, sex, sport, and level of play with a control group who underwent ABR without GLAD lesions. Return to sport, the level of return, and the timing of return were assessed. The visual analog scale (VAS) for pain score, Rowe score, Shoulder Instability–Return to Sport after Injury (SIRSI) score, and Subjective Shoulder Value (SSV) were evaluated. Results: The study included a total of 66 patients (22 and 44 patients for the GLAD and control groups, respectively), with a mean age of 25.8 years and a mean follow-up of 66 months. Overall, there was no significant difference in any of the clinical outcome scores (VAS, Rowe, SIRSI, and SSV) utilized for the GLAD and control groups ( P > .05 for all). Similarly, there was no significant difference in the total rate of return to play (90.9% vs 88.6%; P > .99) or return at the same/higher level (68.2% vs 72.7%; P = .78). There was no significant difference in timing of return to play (6.3 ± 6.6 months vs 6.4 ± 2.5 months; P = .98). There were 3 cases (13.6%) requiring further surgery (1 revision stabilization, 1 arthroscopic release, and 1 rotator cuff repair) in the GLAD group and 2 cases (4.5%) requiring further surgery (both revision stabilization) in the control group; the difference was not statistically significant ( P = .32). Conclusion: After arthroscopic repair, patients with GLAD lesions had similar midterm outcomes when compared with a control group without GLAD lesions.

scholarly journals Return to Sport After Coracoid Transfer in Athletes With Anterior Shoulder Instability: A Systematic Review

2019 ◽  
Vol 11 (5) ◽  
pp. 402-408
Author(s):  
Georgina Glogovac ◽  
Adam P. Schumaier ◽  
Brian M. Grawe
Keyword(s):  
Systematic Review ◽  
Shoulder Instability ◽  
Return To Sport ◽  
Patient Reported Outcome ◽  
Rate Of Return ◽  
Anterior Shoulder Instability ◽  
Level Of Evidence ◽  
Coracoid Transfer ◽  
Patient Reported

Context: Recurrent shoulder instability in young athletes can lead to a spectrum of soft tissue and bony lesions that can be bothersome and/or disabling. Coracoid transfer is a treatment option for athletes with recurrent instability. Objective: To report the rate of return to sport for athletes after coracoid transfer. Data Sources: An electronic search of the literature was performed using the PubMed (MEDLINE) and Cochrane Databases (1966-2018). Study Selection: Studies were included if they evaluated return to sport after treatment with coracoid transfer at a minimum 1-year follow-up. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Data were extracted by 2 authors and included study design, level of evidence, patient demographics (number, age, sex), procedure performed, duration of clinical follow-up, rate of return to sport, patient-reported outcome measures, reoperations, and complications. Results: Fourteen studies met the inclusion criteria. The rate of return to sport at any level ranged from 80% to 100% in all but 1 study (38%), and the rate of return to the previous level of play ranged from 56% to 95% in all but 1 study (16%). Patients returned to sport at an average of 3.2 to 8.1 months. The average patient-reported outcome scores ranged from 78% to 94% (Rowe), 223.6 to 534.3 (Western Ontario Shoulder Instability Index), and 75% to 90% (subjective shoulder value). The rate of postoperative dislocation ranged from 0% to 14%, and the reoperation rate ranged from 1.4% to 13%. Conclusion: There was a high early rate of return to sport in patients who underwent coracoid transfer for anterior shoulder instability, although patients did not reliably return to the same level of play. The procedure had very favorable outcomes for treatment of instability, with low rates of recurrent dislocation and reoperation.

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