scholarly journals Restoration of the Posterior Glenoid in Recurrent Posterior Shoulder Instability Using an Arthroscopically Placed Iliac Crest Bone Graft: A Computed Tomography–Based Analysis

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097637
Author(s):  
Roland S. Camenzind ◽  
Louis Gossing ◽  
Javier Martin Becerra ◽  
Lukas Ernstbrunner ◽  
Julien Serane-Fresnel ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Ct Scans ◽  
Posterior Shoulder Instability ◽  
Glenoid Version ◽  
Posterior Shoulder ◽  
Outcome Scores ◽  
Arthroscopically Assisted ◽  
Preoperative Ct

Background: Posterior shoulder instability is uncommon, and its treatment is a challenging problem. An arthroscopically assisted technique for posterior iliac crest bone grafting (ICBG) has shown promising short- and long-term clinical results. Changes as shown on imaging scans after posterior ICBG for posterior shoulder instability have not been investigated in the recent literature. Purpose: To evaluate changes on computed tomography (CT) after arthroscopically assisted posterior ICBG and to assess clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: Patients with preoperative CT scans and at least 2 postoperative CT scans with a minimum follow-up of 2 years were included in the evaluation. Of 49 initial patients, 17 (follow-up rate, 35%) met the inclusion criteria and were available for follow-up. We measured the glenoid version angle and the glenohumeral and scapulohumeral indices on the preoperative CT scans and compared them with measurements on the postoperative CT scans. Postoperatively, graft surface, resorption, and defect coverage were measured and compared with those at early follow-up (within 16 months) and final follow-up (mean ± SD, 6.6 ± 2.8 years). Results: The mean preoperative glenoid version was –17° ± 13.5°, which was corrected to –9.9° ± 11.9° at final follow-up ( P < .001). The humeral head was able to be recentered and reached normal values as indicated by the glenohumeral index (51.8% ± 6%; P = .042) and scapulohumeral index (59.6% ± 10.2%; P < .001) at final follow-up. Graft surface area decreased over the follow-up period, from 24% ± 9% of the glenoid surface at early follow-up to 17% ± 10% at final follow-up ( P < .001). All clinical outcome scores had improved significantly. Progression of osteoarthritis was observed in 47% of the shoulders. Conclusion: Arthroscopically assisted posterior ICBG restored reliable parameters as shown on CT scans, especially glenoid version and the posterior subluxation indices. Graft resorption was common and could be observed in all shoulders. Patient-reported clinical outcome scores were improved. Osteoarthritis progression in almost 50% of patients is concerning for the long-term success of this procedure.

scholarly journals Non-operative Management of Posterior Shoulder Instability: An Assessment of Survival and Predictors for Conversion to Surgery at 1 to 13 Years After Diagnosis

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0009
Author(s):  
Jarret Murray Woodmass ◽  
Julia Lee ◽  
Nick R. Johnson ◽  
Christopher L. Camp ◽  
Diane L. Dahm ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Radiographic Progression ◽  
Surgical Intervention ◽  
Cox Proportional Hazards ◽  
Posterior Shoulder Instability ◽  
Late Failure ◽  
Posterior Shoulder ◽  
Increased Risk ◽  
History Of

Objectives: Among patients treated non-operatively for 1 year following a diagnosis of posterior shoulder instability (PSI), little is known about the the incidence of surgery between 1-13 years after injury. The purpose of this study is to define the frequency and evaluate the factors predictive for late surgical intervention of symptomatic PSI. Methods: This study included a population-based cohort of 115 patients (14 females, 101 males) diagnosed with PSI between January 1994 and July 2012 with a minimum 5-years follow-up (mean:13.9 years; range: 5-23 years). Landmark survival analysis was performed to evaluate incidence of surgery after 1 year. Survival was estimated using Kaplan Meier method and predictors of late surgical intervention were analyzed using Cox proportional hazards regression. Results: A total of 61/115 (53%) patients were treated non-operatively for 1 year following diagnosis of PSI. Of these, 24/61 (39%) converted to surgery for symptomatic PSI. The overall survival free of surgery at 1 and 5 years was 53.0% (95% CI 434.7-63.0) and 37.1% (95% CI 29.1-47.1), respectively. BMI >35 (p=0.04, HR 3.3) was predictive for late conversion to surgery. Age, gender, occupation, or history of glenohumeral dislocation were not significant. Assessing surgery as a time dependent covariate, a patient undergoing surgery was at an increased risk for radiographic progression of osteoarthritis (p=0.02, HR=4.0, 95% CI 1.2-13.2). Conclusion: Conservative management was performed for at least one year in over half of patients diagnosed with PSI. However, long-term follow-up demonstrates that nearly 40% of these patients eventually require surgery. Increased BMI was predictive for late failure of while age, gender, history of dislocation and occupation did not show an effect. Patients who underwent surgery were at an increased risk of radiographic progression of arthritis.

A Prospective Analysis of Patients With Anterior Versus Posterior Shoulder Instability: A Matched Cohort Examination and Surgical Outcome Analysis of 200 Patients

2019 ◽  
Vol 47 (3) ◽  
pp. 682-687 ◽  
Author(s):  
Andrew S. Bernhardson ◽  
Colin P. Murphy ◽  
Zachary S. Aman ◽  
Robert F. LaPrade ◽  
Matthew T. Provencher
Keyword(s):  
Shoulder Instability ◽  
Matched Cohort ◽  
Arthroscopic Stabilization ◽  
Mechanism Of Injury ◽  
Posterior Shoulder Instability ◽  
Anterior Instability ◽  
Posterior Instability ◽  
Medical Provider ◽  
Posterior Shoulder

Background: Anterior and posterior shoulder instabilities are entirely different entities. The presenting complaints and symptoms vastly differ between patients with these 2 conditions, and a clear understanding of these differences can help guide effective treatment. Purpose: To compare a matched cohort of patients with anterior and posterior instability to clearly outline the differences in the initial presenting history and overall outcomes after arthroscopic stabilization. Study Design: Cohort study; Level of evidence, 2. Methods: Consecutive patients with either anterior or posterior glenohumeral instability were prospectively enrolled; patients were excluded if they had more than 10% anterior or posterior glenoid bone loss, multidirectional instability, neurologic injury, or prior surgery. Patients were assigned to anterior or posterior shoulder instability groups based on the history and clinical examination documenting the primary direction of instability, with imaging findings to confirm a labral tear associated with the specific direction of instability. Preoperative demographic data, injury history, and overall clinical outcome scores (American Shoulder and Elbow Surgeons [ASES], Single Assessment Numeric Evaluation [SANE], and Western Ontario Shoulder Index [WOSI]) were assessed and compared statistically between the 2 cohorts. Patients were indicated for surgery if they elected to proceed with surgical management or did not respond to a course of nonoperative management. Results: The study included 103 patients who underwent anterior stabilization (mean age, 23.5 years; range, 18-36 years) and 97 patients who underwent posterior stabilization (mean age, 24.5 years; range, 18-36 years). The mean follow-up was 39.7 months (range, 24-65 months), and there were no age or sex differences between the groups. No patients were lost to follow-up. The primary mechanism of injury in the anterior cohort was a formal dislocation event (82.5% [85/103], of which 46% [39/85] required reduction by a medical provider), followed by shoulder subluxation (12%, 12/103), and “other” (6%, 6/103; no forceful injury). No primary identifiable mechanism of injury was found in the posterior cohort for 78% (75/97) of patients; lifting and pressing (11%, 11/97) and contact injuries (10% [all football blocking], 10/97) were the common mechanisms that initiated symptoms. Only 10 patients (10.3%) in the posterior cohort sustained a dislocation. The most common complaints for patients with anterior instability were joint instability (80%) and pain with activities (32%). In the posterior cohort, the most common complaint was pain (90.7%); only 13.4% in this cohort reported instability as the primary complaint. Clinical outcomes after arthroscopic stabilization were significantly improved in both groups, but the anterior cohort had significantly better outcomes in all scores measured: ASES (preoperative: anterior 58.0, posterior 60.0; postoperative: anterior 94.2 vs posterior 87.7, P < .005), SANE (preoperative: anterior 50.0, posterior 60.0; postoperative: anterior 92.9 vs posterior 84.9, P < .005), and WOSI (preoperative: anterior 55.95, posterior 60.95; postoperative: anterior 92% of normal vs posterior 84%, P < .005). Conclusion: This study outlines clear distinctions between anterior and posterior shoulder instability in terms of presentation and clinical findings. Patients with anterior instability present primarily with an identifiable mechanism of injury and complaints of instability, whereas most patients with classic posterior instability have no identifiable mechanism of injury and their primary symptom is pain. Anterior instability outcomes in this matched cohort were superior in all domains versus posterior instability after arthroscopic stabilization, which further highlights the differences between anterior and posterior instability.

Risk of Engagement of Bipolar Bone Defects in Posterior Shoulder Instability

2017 ◽  
Vol 45 (12) ◽  
pp. 2835-2839 ◽  
Author(s):  
Philipp Moroder ◽  
Fabian Plachel ◽  
Mark Tauber ◽  
Peter Habermeyer ◽  
Andreas Imhoff ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Relative Size ◽  
Bone Defects ◽  
Ct Scans ◽  
Posterior Shoulder Instability ◽  
Glenoid Defect ◽  
Angle Measure ◽  
Posterior Shoulder ◽  
Cumulative Change ◽  
Retrospective Multicenter Study

Background: The risk of re-engagement of bipolar bone defects in posterior shoulder instability has not yet been investigated. Hypothesis: Posterior glenoid defects can lead to the engagement of supposedly noncritical reverse Hill-Sachs lesions (RHSLs). Study Design: Descriptive laboratory study. Methods: In a retrospective multicenter study, 102 cases of posterior shoulder dislocations and resulting RHSLs were collected. Of these cases, all patients with available computed tomography (CT) scans, with a reduced shoulder joint, and without bony posterior glenoid rim defects or concomitant dislocated fractures of the humeral head were included. The gamma angle (measure of the critical size and localization of RHSLs) and the delta angle (measure of the degree of internal rotation necessary for engagement to occur) of the RHSLs were determined on standardized CT scans. Virtual posterior glenoid defects were created, and the effect of increasing defect size on the delta angle was determined. Results: The mean gamma angle of the 19 patients included in this study was 94.5° (range, 69.7°-124.8°). After creation of the virtual posterior glenoid defects, a mean reduction of the delta angle by 2.3° ± 0.2° (range, 1.9°-2.9°) per millimeter defect was observed. The cumulative change in the delta angle showed a highly significant correlation with the absolute and relative size of the glenoid defect ( R = 0.982, P < .001 and R = 0.974, P < .001, respectively). Conclusion: Concomitant posterior glenoid defects might lead to the engagement of noncritical RHSLs. When measuring the gamma angle to identify critical RHSLs, posterior glenoid bone loss should be accounted for.

Comparison of Glenoid Version and Posterior Humeral Subluxation in Patients With and Without Posterior Shoulder Instability

2017 ◽  
Vol 33 (2) ◽  
pp. 254-260 ◽  
Author(s):  
Stephen A. Parada ◽  
Josef K. Eichinger ◽  
Guillaume D. Dumont ◽  
Lauren E. Burton ◽  
Maggie S. Coats-Thomas ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Posterior Shoulder Instability ◽  
Glenoid Version ◽  
Posterior Shoulder

scholarly journals Glenoid Orientation and Profile in Atraumatic or Microtraumatic Posterior Shoulder Instability: Morphological Analysis Using Computed Tomography Arthrogram

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098296
Author(s):  
Yon-Sik Yoo ◽  
Jeehyoung Kim ◽  
Wooyoung Im ◽  
Jeung Yeol Jeong
Keyword(s):  
Computed Tomography ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Shoulder Instability ◽  
Multivariate Logistic Regression Analysis ◽  
Control Group ◽  
Posterior Shoulder Instability ◽  
Multivariate Logistic Regression ◽  
Glenoid Version ◽  
Posterior Shoulder

Background: Posterior shoulder instability (PSI) is a relatively uncommon condition that occurs in about 10% of patients with shoulder instability. PSI is usually associated with dislocations due to acute trauma and multidirectional instability, but it can also occur with or without recognizable recurrent microtrauma. The infrequency of atraumatic or microtraumatic PSI and the lack of a full understanding of the pathoanatomy and the knowledge of management can lead to misdiagnosis or delayed diagnosis. Purpose: To evaluate the morphologic factors of the glenoid that are associated with atraumatic or microtraumatic PSI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Enrolled in this study were patients who underwent arthroscopic posterior labral repair between January 2013 and March 2017 and were diagnosed with posterior glenohumeral instability by means of preoperative computed tomography arthrography (CTA) (n = 39; PSI group). These patients did not have any significant dislocation or subluxation episodes. The morphologic factors of the glenoid as revealed using CTA were compared with the CTA images from a sex-matched control group (n = 117) of patients without PSI who had been diagnosed with adhesive capsulitis in an outpatient clinic. The glenoid version and shape were evaluated between the 2 groups using the CTA findings, and the degree of centricity of the humeral head to the glenoid was assessed in the PSI group. Multivariate logistic regression analysis was performed to identify factors associated with PSI. Results: The results of the multivariate logistic regression analysis indicated no statistically significant difference between the PSI and control groups regarding glenoid version or a flat-shaped glenoid. However, statistically significant between-group differences were found regarding convex glenoid shape, with an odds ratio of 5.39 (95% CI, 1.31-23.35; P = .0207). The proportion of eccentricity was significantly higher in the PSI group (21/39; 54%) versus the control group (47/117; 40%) ( P = .031). Conclusion: The presence of convex glenoid shape was significantly associated with atraumatic or microtraumatic PSI. Humeral head eccentricity accounted for a high percentage of convex glenoid shape. However, there was no significant correlation between PSI and glenoid retroversion.

Posterior Shoulder Instability: Surgical Outcomes and Risk of Failure in Adolescence

2020 ◽  
Vol 48 (5) ◽  
pp. 1200-1206
Author(s):  
Alicia M. Asturias ◽  
Tracey P. Bastrom ◽  
Andrew T. Pennock ◽  
Eric W. Edmonds
Keyword(s):  
Risk Factors ◽  
Shoulder Instability ◽  
Case Series ◽  
Short Version ◽  
Posterior Shoulder Instability ◽  
Level Of Evidence ◽  
Ehlers Danlos Syndrome ◽  
Posterior Shoulder ◽  
Younger Age

Background: Arthroscopic capsulolabral reconstruction has proven to be effective in treating posterior shoulder instability. Few studies have examined the risk factors that may contribute to poor outcomes in the adolescent population. Purpose: To identify risk factors for surgical failure by comparing anatomic and subjective variations in children who underwent surgical intervention for posterior shoulder instability. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing arthroscopic shoulder surgery at one institution between 2011 and 2018 were reviewed. Patients >18 years old at presentation and those with Ehlers-Danlos syndrome were excluded. Posterior instability was defined as unidirectional subluxation on posterior drawer testing while under anesthesia. Two-year minimum follow-up was required, but those whose treatment failed earlier were included for calculation purposes. Demographics and intraoperative findings were recorded, as were Single Assessment Numeric Evaluation (SANE) scoring, Pediatric and Adolescent Shoulder Survey (PASS), and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) results. Major complication was defined as revision arthroscopy or redislocation, and minor complications included self-reporting a poor outcome score (eg, SANE score <65). Results: A total of 48 children (23 girls and 25 boys) met criteria, with a mean age of 16.5 years (range, 12.4-17.9 years) and a mean follow-up of 3.75 years. Fifteen (31.3%) patients had a complication by our criteria, including 12.5% with surgical failures; regarding major complications, boys were treated successfully 96% of the time and girls 78% of the time ( P = .049). Of the anatomic and subjective variables tested, only younger age ( P≤ .001) and presentation type ( P < .05) were correlated with complications. SANE scores differed significantly ( P < .002) by presentation type, with mean scores of 52 (trauma), 94 (recurrent instability), and 81 (pain). QuickDASH scores demonstrated patients with a history of trauma (mean, 37), instability (mean, 9), and pain (mean, 11). Conclusion: Adolescents treated surgically for posterior shoulder instability are at risk of treatment failure (when including outcome scores), and it appears that patients of female sex, younger age, and traumatic presentation are at the highest risk to require revision surgery or experience continued limitations secondary to their shoulder.

scholarly journals Glenoid Cartilage Lesions Compromise Outcomes of Surgical Treatment for Posterior Shoulder Instability

2020 ◽  
Vol 8 (1) ◽  
pp. 232596711989812
Author(s):  
Geoffroy Nourissat ◽  
Marie Beatrice Hardy ◽  
Jerome Garret ◽  
Pierre Mansat ◽  
Arnaud Godenèche ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Functional Outcomes ◽  
Constant Score ◽  
Bone Block ◽  
Posterior Shoulder Instability ◽  
Level Of Evidence ◽  
Cartilage Lesions ◽  
Posterior Shoulder ◽  
Traumatic Origin

Background: Posterior shoulder instability is associated with nonspecific symptoms, including pain, subluxation, and functional impairment, which complicate its diagnosis and management. Owing to the rarity of the condition, there are no present decision tools for its diagnosis and treatment. Purpose: To investigate demographic, lesional, and surgical factors that influence functional outcomes in patients treated for posterior shoulder instability. Study Design: Case-control study; Level of evidence, 3. Methods: We analyzed the clinical and radiographic records of 150 patients treated surgically for isolated posterior shoulder instability at 10 centers between 2000 and 2015, of which 144 were eligible for inclusion: 114 men (79%) and 30 women (21%) (mean ± SD age, 28.7 ± 9.6 years). The mean time between onset of symptoms and surgery was 66 ± 75 months. Shoulder instability was of traumatic origin in 115 patients (80%). The primary treatment was bone-block procedures for 65 patients (45%), posterior Bankart repair for 67 (47%), and capsular plication for 12 (8%). Patients were assessed with the Constant and Walch-Duplay scores at a mean follow-up of 51 ± 32 months (range, 12-159 months). Uni- and multivariable regression analyses were performed to determine associations between clinical scores and sex, age, traumatic origin, type of lesion, type of procedure, and follow-up. Results: At final follow-up, subluxations or dislocations recurred in 24 patients (17%). The overall Constant score was 86.2 ± 14.5, with a pain component of 12.6 ± 3.5. The Walch-Duplay score was 79.8 ± 24.2. Multivariable regressions revealed that the presence of a glenoid cartilage lesion was the only factor associated with worse Constant score (beta = –10; P = .013) and Walch-Duplay score (beta = –16.7; P = .024) across all subcomponents. Conclusion: The only factor that jeopardized functional outcomes of posterior instability surgery was the presence of glenoid cartilage lesions. Knowing that shoulders with glenoid cartilage lesions are at greater risk of residual pain or instability could help manage patient expectation and justify faster intervention before lesions deteriorate.

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