Outcomes After Arthroscopic Anterior Shoulder Stabilization in Professional Handball Players

Background: Although numerous studies have reported on the redislocation rate and functional results of arthroscopic treatment for anterior shoulder instability in athletes, they have not disclosed outcomes in the high-risk group of elite handball players. Purpose: To investigate the postoperative outcomes of arthroscopic treatment for anterior shoulder instability as well as the return-to-sport (RTS) rate in professional handball players. Study Design: Case series; Level of evidence, 4. Methods: Involved in this study were 44 competitive handball players (47 shoulders) who underwent arthroscopic anterior capsulolabral reconstruction between 2010 and 2018 and had a minimum follow-up of 24 months. After surgery, patients completed a questionnaire that collected Rowe and American Shoulder and Elbow Surgeons (ASES) scores and RTS data, and we compared these results with their preoperative scores. We also compared results according to the following subgroups: true dislocations versus recurrent subluxations, younger (<20 years) versus older (≥20 years) age, male versus female sex, and shorter versus longer duration of instability. Statistical analysis included the paired-samples t test and nonparametric Fisher exact test. Results: The mean follow-up period was 52.2 ± 21.4 months. There were 4 shoulders (9%) with recurrent instability. There were significant preoperative to postoperative improvements in the mean Rowe score (from 45.2 to 91.8) and mean ASES score (from 70.6 to 95.7) ( P < .001 for both). Overall, the RTS rate was 83%, and 64% (30/47 shoulders) were able to return to their preinjury level. The RTS rate was significantly lower in the younger players than in the older players (46% vs 86%, respectively; P = .005). Conclusion: The study results indicated that handball players with anterior shoulder instability can be treated using arthroscopic labral reconstruction successfully and 83% of the athletes were able to RTS activity. The handball players aged ≥20 years returned to their preinjury level of sport at a higher rate than did those aged <20 years.

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Arthroscopic treatment of subtalar joint injuries

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.889 ◽

2019 ◽

Vol 13 (1) ◽

pp. 22-27

Author(s):

Felipe Ayusso Correa Sossa ◽

Inacio Diogo Asaumi ◽

Alfonso Apostólico Netto ◽

Rafael Da Rocha Macedo ◽

Donato Lo Turco ◽

...

Keyword(s):

Subtalar Joint ◽

Case Series ◽

Arthroscopic Treatment ◽

Level Of Evidence ◽

Before And After ◽

Reduction Of Pain ◽

Vas Scores ◽

The Mean ◽

Status Level

Objective: To evaluate the results of arthroscopic treatment of various subtalar joint pathologies. Methods: Retrospective study of patients undergoing arthroscopy of the subtalar joint from 2005 to 2013, totaling 10 cases over a mean follow-up of 27.1 months, in which the American Orthopedic Foot and Ankle Society (AOFAS) scale and pain visual analogue scale (VAS) scores before and after surgery were compared. Results: The preoperative AOFAS scores ranged from 35 to 74, with a mean score of 50.1 points, and the postoperative scores ranged from 82 to 100 points, with a mean score of 90.8 points. When comparing the scores, we observed an average gain of 40.1 points. The mean VAS score for the initial pain assessment was 6.5 points, and the mean postoperative score was 1.4 points. Conclusion: Arthroscopic treatment of the reported subtalar pathologies led to encouraging results, with a significant reduction of pain and improvement of functional status. Level of Evidence IV; Therapeutic Studies; Case Series.

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Arthroscopic Treatment of Multidirectional Shoulder Instability in Athletes

The American Journal of Sports Medicine ◽

10.1177/0363546509335464 ◽

2009 ◽

Vol 37 (9) ◽

pp. 1712-1720 ◽

Cited By ~ 54

Author(s):

Champ L. Baker ◽

Randy Mascarenhas ◽

Alex J. Kline ◽

Anikar Chhabra ◽

Mathew W. Pombo ◽

...

Keyword(s):

Range Of Motion ◽

Shoulder Instability ◽

Case Series ◽

High Rate ◽

Arthroscopic Treatment ◽

Level Of Evidence ◽

Athletic Population ◽

Multidirectional Instability ◽

Patient Reported ◽

The Mean

Background There are few reports in the literature detailing the arthroscopic treatment of multidirectional instability of the shoulder. Hypothesis Arthroscopic management of symptomatic multidirectional instability in an athletic population can successfully return athletes to sports with a high rate of success as determined by patient-reported outcome measures. Study Design Case series; Level of evidence, 4. Methods Forty patients (43 shoulders) with multidirectional instability of the shoulder were treated via arthroscopic means and were evaluated at a mean of 33.5 months postoperatively. The mean patient age was 19.1 years (range, 14-39). There were 24 male patients and 16 female patients. Patients were evaluated with the American Shoulder and Elbow Surgeons and Western Ontario Shoulder Instability scoring systems. Stability, strength, and range of motion were also evaluated with patient-reported scales. Results The mean American Shoulder and Elbow Surgeons score postoperatively was 91.4 of 100 (range, 59.9-100). The mean Western Ontario Shoulder Instability postoperative percentage score was 91.1 of 100 (range, 72.9-100). Ninety-one percent of patients had full or satisfactory range of motion, 98% had normal or slightly decreased strength, and 86% were able to return to their sport with little or no limitation. Conclusion Arthroscopic methods can provide an effective treatment for symptomatic multidirectional instability in an athletic population.

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Arthroscopic Treatment of Osteochondral Lesions of the Talus in a Suspended Position With the Patient in a Prone Position

Foot & Ankle International ◽

10.1177/1071100719839697 ◽

2019 ◽

Vol 40 (7) ◽

pp. 811-817

Author(s):

Chenyu Wang ◽

Min Wook Kang ◽

Hyong Nyun Kim

Keyword(s):

Compartment Syndrome ◽

Prone Position ◽

Case Series ◽

Arthroscopic Treatment ◽

Osteochondral Lesions ◽

Retrospective Case ◽

Level Of Evidence ◽

Arthroscopic Microfracture ◽

The Mean

Background:The purpose of this study was to evaluate the clinical results and the safety of arthroscopic microfracture with the ankle suspended on a shoulder-holding traction frame for simultaneous anterior and posterior ankle arthroscopy in the prone position.Methods:Between May 2010 and January 2016, 31 patients with posterior osteochondral lesions of the talus (OLTs) were treated with arthroscopic microfracture in a suspended position with the patient prone. Ankle distraction was achieved by suspending the affected ankle on a shoulder-holding traction frame. The 100 mm visual analog scale (VAS) and the Foot Function Index (FFI) were checked preoperatively and at final follow-up. Postoperative complications related to the suspended position were analyzed. Lower leg intramuscular compartment pressure was checked after the surgery to determine if there was any risk of compartment syndrome.Results:The mean 100-mm VAS score, and FFI improved from 62.8 ±11.3 and 48.5 ± 12.1, respectively, preoperatively to 15.8 ± 10.4 and 16.4 ± 9.2, respectively, at final follow-up ( P = .025, and P = .005, respectively). The mean anterior, lateral, superficial posterior, and deep posterior compartment pressures were 7.3 ± 1.5, 8.1 ± 1.1, 5.6 ± 1.9, and 9.2 ± 2.4 mmHg, respectively. No compartment syndrome occurred.Conclusion:Arthroscopic treatment of OLT in a prone position with the ankle suspended on a shoulder-holding traction frame allowed the use of simultaneous anterior and posterior portals for viewing and instrumentation without major operative complications, such as compartment syndrome.Level of Evidence:Level IV, retrospective case series.

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Changes in Shoulder Rotator Strength After Arthroscopic Capsulolabral Reconstruction in Patients With Anterior Shoulder Instability

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120972052 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712097205

Author(s):

Sung-Min Rhee ◽

Piyush Suresh Nashikkar ◽

Joo Hyun Park ◽

Young Dae Jeon ◽

Joo Han Oh

Keyword(s):

Shoulder Instability ◽

External Rotation ◽

Case Series ◽

Peak Torque ◽

Anterior Shoulder Instability ◽

Level Of Evidence ◽

Functional Scores ◽

Strengthening Exercises ◽

Capsulolabral Reconstruction

Background: The correlation between isokinetic internal and external rotation (IR and ER) strength and functional outcomes in patients with anterior shoulder instability treated by arthroscopic capsulolabral reconstruction (ACR) has not been studied. Purpose: To analyze isokinetic IR and ER strength and their correlation with clinical outcomes in patients with anterior shoulder instability treated by ACR. Study Design: Case series; Level of evidence, 4. Methods: Between January 2004 and June 2015, a total of 104 patients who underwent ACR for anterior shoulder instability were analyzed. The mean peak torque (PT) in IR (IRPT) and ER (ERPT), PT deficit (PTD; %) relative to the opposite healthy shoulder, and PT ratio (PTR; ERPT/IRPT) were calculated before and 1 year after surgery. Functional scores were evaluated before surgery and at every follow-up visit. Recurrence and postoperative apprehension during ER at 90° of arm abduction were evaluated at 1 year and the final follow-up (76.6 ± 64.4 months). Results: IR and ER strength were measured for 68 of 104 patients at 1 year after surgery. ERPT and IRPT were less on the involved side than on the uninvolved side before surgery (0.29 ± 0.10 vs 0.33 ± 0.10 N·m/kg, respectively, for ERPT [ P = .002]; 0.36 ± 0.14 vs 0.41 ± 0.16 N·m/kg, respectively; for IRPT [ P = .01]). At 1 year after surgery, IRPT on the involved side recovered (0.40 ± 0.20 N·m/kg), whereas ERPT remained weak (0.30 ± 0.13 N·m/kg) relative to the baseline value. PTD in IR (PTDIR) improved to 2.2% ± 24.4% ( P = .012), whereas PTD in ER (PTDER) showed no improvement (13.5% ± 13.8%; P = .569). PTR on the involved side improved from 1.07 ± 1.71 to 0.86 ± 0.23 at 1 year ( P < .001). All functional scores improved significantly at the final follow-up. At 1 year, 9 of 68 (13.2%) patients showed positive apprehension. PTDIR and PTDER on the involved side were worse in patients with positive apprehension than in those with negative apprehension ( P = .039 and .014, respectively). PTDER was worse than PTDIR in patients with positive apprehension at 1 year ( P = .022). Conclusion: For those with anterior shoulder instability, preoperative IR and ER strength of the involved shoulder were lower than those of the uninvolved shoulder. IRPT recovered, whereas ERPT remained weak after ACR. To prevent positive apprehension after surgery, IR and ER strengthening exercises are important, with more emphasis on exercises for ER.

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Return to Sport After Arthroscopic Treatment of Posterior Shoulder Instability

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120969151 ◽

2020 ◽

Vol 8 (12) ◽

pp. 232596712096915

Author(s):

Attila Pavlik ◽

Miklós Tátrai ◽

Eszter Papp

Keyword(s):

Shoulder Instability ◽

Sport Activity ◽

Case Series ◽

Return To Sport ◽

Arthroscopic Treatment ◽

Rate Of Return ◽

Fisher Exact Test ◽

Posterior Shoulder Instability ◽

Posterior Shoulder

Background: Arthroscopic treatment of posterior shoulder instability has become more popular and effective in recent years, but few data are available concerning the rate of return to sport. Purpose: To present our experiences with arthroscopic posterior labral reconstruction in athletes and review our results, with a particular focus on the rate of return to sport. Study Design: Case series; Level of evidence, 4. Methods: Included in the study were 40 arthroscopic stabilizations performed because of posterior shoulder instability in 37 athletes at a single institution. During follow-up, the athletes’ rate of return to sport was calculated. Shoulder function was evaluated based on a pre- versus postoperative comparison of the Rowe instability score and the American Shoulder and Elbow Surgeons score. Additionally, the return-to-sport rate was compared among different subgroups: traumatic versus atraumatic origin of injury, competitive versus recreational athletes, high-risk versus low-risk sport, and posterior-only versus anterior and posterior stabilization. Data were statistically analyzed using paired-samples t test and nonparametric Fisher exact test. Results: The average follow-up period was 54.4 months (range, 24-112 months). Three shoulders (7.5%) continued to have posterior subluxations postoperatively. There were 34 excellent, 3 good, and 3 fair results based on the Rowe score (average postoperative score, 92.9), and patients achieved an average postoperative American Shoulder and Elbow Surgeons score of 92.7. The pre- to postoperative improvement was statistically significant in both scoring systems ( P < .001). Of the 37 patients, 36 (98.2%) were able to return to sport activity: 27 of them (72.9%) to their original sport and 19 (51.4%) at their preinjury level. A significantly higher rate of return to the same sport occurred in athletes who had traumatic injury compared with a subgroup of athletes without a traumatic event ( P < .02). Conclusion: More than half of the athletes were able to return to their preinjury level of sport after arthroscopic posterior labral reconstruction. In addition, low recurrence rates and good functional outcomes were seen in >90% of the patients, and 98% returned to sport activity. The athletes had a significantly higher rate of return to sport if their posterior shoulder instability had a clear traumatic origin.

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Surgical treatment results for dupuytren's disease

Acta Ortopédica Brasileira ◽

10.1590/1413-785220172503164827 ◽

2017 ◽

Vol 25 (3) ◽

pp. 71-73 ◽

Cited By ~ 1

Author(s):

Serkan Aykut ◽

Mehmet Baydar ◽

Abdul Fettah Büyük ◽

İbrahim Avşin Öztürk ◽

Erdem Özden ◽

...

Keyword(s):

Gold Standard ◽

Case Series ◽

Dupuytren’S Disease ◽

Treatment Results ◽

Level Of Evidence ◽

Dupuytren's Disease ◽

Study Results ◽

Standard Level ◽

The Mean

ABSTRACT OBJECTIVE: To present the results of our cases of Dupuytren's disease treated with regional selective fasciectomy in light of the literature. METHODS: Patients diagnosed with Dupuytren's contracture and surgically treated with regional selective fasciectomy at our institution with adequate follow-up data were included in the study. All patients were routinely followed after surgery to assess results and complications. QuickDASH scoring was used to evaluate the patients and recurrences and complications were recorded. RESULTS: Twenty-one hands of 19 patients (13 males, 6 females) who underwent surgery and received adequate follow-up were retrospectively evaluated. Mean patient age was 65.8 (range: 41 to 86) and the mean follow-up period was 48.2 months (range: 24 to 86). Fourteen (66.6%) hands had excellent results, five (23%) hands had good results and two (9.4%) had fair results. The mean QuickDASH score for the patients at the final follow-up was 6.58 (range: 0 to 20.4). CONCLUSION: Our study results demonstrated that regional selective fasciectomy is a reliable and efficient method to treat Dupuytren's disease with low rates of complications and recurrence and the technique can be considered the gold standard. Level of Evidence IV, Case Series.

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Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121994550 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712199455

Author(s):

Nicola Maffulli ◽

Francesco Oliva ◽

Gayle D. Maffulli ◽

Filippo Migliorini

Keyword(s):

Surgical Management ◽

Revision Surgery ◽

Case Series ◽

Sports Participation ◽

Patellar Tendinopathy ◽

Symptom Duration ◽

Level Of Evidence ◽

Training Time ◽

The Mean

Background: Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms. Purpose: To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded. Results: The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points ( P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure. Conclusion: Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.

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A Novel Retensioning Technique for Arthroscopic Repair of PASTA Lesions: A Clinical and Radiologic Outcome Study of 24 Shoulders

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120986884 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712098688

Author(s):

Su Cheol Kim ◽

Jong Ho Jung ◽

Sang Min Lee ◽

Jae Chul Yoo

Keyword(s):

Constant Score ◽

Case Series ◽

Tendon Healing ◽

Shoulder Abduction ◽

Level Of Evidence ◽

Simple Shoulder Test ◽

Shoulder Range Of Motion ◽

Functional Scores ◽

The Mean

Background: There is no consensus on the ideal treatment for partial articular supraspinatus tendon avulsion (PASTA) lesions without tendon damage. Purpose: To introduce a novel “retensioning technique” for arthroscopic PASTA repair and to assess the clinical and radiologic outcomes of this technique. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was performed on 24 patients whose PASTA lesion was treated using the retensioning technique between January 2011 and December 2015. The mean ± SD patient age was 57.6 ± 7.0 years (range, 43-71 years), and the mean follow-up period was 57.6 ± 23.4 months (range, 24.0-93.7 months). Sutures were placed at the edge of the PASTA lesion, tensioned, and fixed to lateral-row anchors. After surgery, shoulder range of motion (ROM) and functional scores (visual analog scale [VAS] for pain, VAS for function, American Shoulder and Elbow Surgeons [ASES] score, Constant score, Simple Shoulder Test, and Korean Shoulder Score) were evaluated at regular outpatient visits; at 6 months postoperatively, repair integrity was evaluated using magnetic resonance imaging (MRI). Results: At 12 months postoperatively, all ROM variables were improved compared with preoperative values, and shoulder abduction was improved significantly (136.00° vs 107.08°; P = .009). At final follow-up (>24 months), the VAS pain, VAS function, and ASES scores improved, from 6.39, 4.26, and 40.09 to 1.00, 8.26, and 85.96, respectively (all P < .001). At 6 months postoperatively, 21 of the 24 patients (87.5%) underwent follow-up MRI; the postoperative repair integrity was Sugaya type 1 or 2 for all of these patients, and 13 patients showed complete improvement of the lesion compared with preoperatively. Conclusion: The retensioning technique showed improved ROM and pain and functional scores as well as good tendon healing on MRI scans at 6-month follow-up in the majority of patients. Thus, the retensioning technique appears to be reliable procedure for the PASTA lesion.

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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

The American Journal of Sports Medicine ◽

10.1177/03635465211018212 ◽

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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Postarthroscopy Imaging in Femoroacetabular Impingement: Persistent Pain May Be Due to an Insufficient Correction of Preoperative Abnormalities

Joints ◽

10.1055/s-0037-1601411 ◽

2017 ◽

Vol 05 (01) ◽

pp. 021-026 ◽

Cited By ~ 1

Author(s):

Cosimo Tudisco ◽

Salvatore Bisicchia ◽

Sandro Tormenta ◽

Amedeo Taglieri ◽

Ezio Fanucci

Keyword(s):

Case Series ◽

Persistent Pain ◽

Retrospective Case ◽

Level Of Evidence ◽

Mean Values ◽

Center Edge ◽

Patient Groups ◽

The Mean ◽

Magnetic Resonance Imaging Mri

Purpose The purpose of this study was to evaluate the effect of correction of abnormal radiographic parameters on postoperative pain in a group of patients treated arthroscopically for femoracetabular impingement (FAI). Methods A retrospective study was performed on 23 patients affected by mixed-type FAI and treated arthroscopically. There were 11 males and 12 females with a mean age of 46.5 (range: 28–67) years. Center-edge (CE) and α angles were measured on preoperative and postoperative radiographic and magnetic resonance imaging (MRI) studies and were correlated with persistent pain at follow-up. Results The mean preoperative CE and α angles were 38.6 ± 5.2 and 67.3 ± 7.2 degrees, respectively. At follow-up, in the 17 pain-free patients, the mean pre- and postoperative CE angle were 38.1 ± 5.6 and 32.6 ± 4.8 degrees, respectively, whereas the mean pre- and postoperative α angles at MRI were 66.3 ± 7.9 and 47.9 ± 8.9 degrees, respectively. In six patients with persistent hip pain, the mean pre- and postoperative CE angles were 39.8 ± 3.6 and 35.8 ± 3.1 degrees, respectively, whereas the mean pre- and postoperative α angles were 70.0 ± 3.9 and 58.8 ± 2.6 degrees, respectively. Mean values of all the analyzed radiological parameters, except CE angle in patients with pain, improved significantly after surgery. On comparing patient groups, significantly lower postoperative α angles and lower CE angle were observed in patients without pain. Conclusion In case of persistent pain after arthroscopic treatment of FAI, a new set of imaging studies must be performed because pain may be related to an insufficient correction of preoperative radiographic abnormalities. Level of Evidence Level IV, retrospective case series.

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