scholarly journals Failure Rates After Revision Arthroscopic Stabilization for Recurrent Anterior Shoulder Instability Based on Anterior Capsulolabral Complex Conditions

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199589
Author(s):  
In Park ◽  
Jae-Hyung Lee ◽  
Jin-Young Park ◽  
Sang-Jin Shin
Keyword(s):  
Revision Surgery ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Arthroscopic Stabilization ◽  
Anterior Capsule ◽  
Surgical Failure ◽  
Group 2 ◽  
Tissue Stabilization ◽  
Recurrent Anterior Shoulder Instability ◽  
Group 1

Background: A labral retear is an important contributing factor to surgical failure after arthroscopic soft tissue stabilization for recurrent anterior shoulder instability. However, surgeons frequently encounter poor tissue conditions in the anterior capsule, such as capsular tears, during revision surgery. Purpose: To analyze the clinical outcomes and failure rates of revision arthroscopic stabilization after failed Bankart repair based on the tissue conditions of the anterior capsule and the labrum. Outcomes were compared for revision after failed Bankart repair because of a labral retear versus a healed labrum but with capsular tears. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 55 patients who underwent revision arthroscopic stabilization after failed Bankart repair were included. Revision surgery was indicated if patients had a history of recurrent instability with positive apprehension test results, regardless of magnetic resonance imaging (MRI) findings of a labral retear. Patients were allocated into 2 groups based on arthroscopic findings at the time of revision surgery: group 1 consisted of patients who had a healed labrum with definite anterior capsular tears, and group 2 comprised patients who had labral retears without capsular tears. Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons score, Rowe score, and surgical failure rate. Results: Overall, 10 patients were included in group 1, and 45 patients were included in group 2. No capsular tears were detected on preoperative MRI or magnetic resonance arthrography scans in either group, whereas all patients in group 2 had evidence of anterior labral retears on imaging scans. After revision surgery, 9 patients (16.4%) showed surgical failure by 25.6 months postoperatively. Patients in group 1 had a significantly higher surgical failure rate than did those in group 2 (4 patients [40.0%] vs 5 patients [11.1%], respectively; P = .04). The incidence of capsular tears was significantly higher in patients with surgical failure versus those without surgical failure (44.4% vs 13.0%, respectively; P = .04). Conclusion: A capsular tear of the anterior capsulolabral complex was an important indicator for surgical failure after revision arthroscopic stabilization. If patients demonstrate symptomatic instability after arthroscopic soft tissue stabilization without evidence of labral retears on imaging scans, an anterior capsular tear should be considered as a possible factor for recurrence.

scholarly journals Outcomes of the Latarjet Procedure for the Treatment of Chronic Anterior Shoulder Instability: Patients With Prior Arthroscopic Bankart Repair Versus Primary Cases

2019 ◽  
Vol 48 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Jean-David Werthel ◽  
Vincent Sabatier ◽  
Bradley Schoch ◽  
Lior Amsallem ◽  
Geoffroy Nourissat ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Recurrent Instability ◽  
Simple Shoulder Test ◽  
Arthroscopic Bankart Repair ◽  
Group 2 ◽  
Group 1

Background: It remains unclear whether results differ between a Latarjet procedure performed after a failed arthroscopic Bankart repair and one performed as the primary operation. Purpose: To compare the postoperative outcomes of the Latarjet procedure when performed as primary surgery and as revision for a failed arthroscopic Bankart repair. Study Design: Cohort study; Level of evidence, 3. Methods: A multicenter retrospective comparative case-cohort analysis was performed for all patients undergoing a Latarjet procedure for recurrent anterior shoulder instability. Patients were separated into 2 groups depending on if the Latarjet procedure was performed after a failed arthroscopic Bankart repair (group 1) or as the first operation (group 2). Outcome measures included recurrent instability, reoperation rates, complications, pain, Walch-Duplay scores, and Simple Shoulder Test. Results: A total of 308 patients were eligible for participation in the study; 72 (23.4%) did not answer and were considered lost to follow-up, leaving 236 patients available for analysis. Mean follow-up was 3.4 ± 0.8 years. There were 20 patients in group 1 and 216 in group 2. Despite similar rates of recurrent instability (5.0% in group 1 vs 2.3% in group 2; P = .5) and revision surgery (0% in group 1 vs 6.5% in group 2; P = .3), group 1 demonstrated significantly worse pain scores (2.56 ± 2.7 vs 1.2 ± 1.7; P = .01) and patient-reported outcomes (Walch-Duplay: 52 ± 25.1 vs 72.2 ± 25.0; P = .0007; Simple Shoulder Test: 9.3 ± 2.4 vs 10.7 ± 1.9; P = .001) when compared with those patients undergoing primary Latarjet procedures. Conclusion: Functional outcome scores and postoperative pain are significantly worse in patients undergoing a Latarjet procedure after a failed arthroscopic Bankart repair when compared with patients undergoing primary Latarjet. The assumption that a failed a Bankart repair can be revised by a Latarjet with a similar result to a primary Latarjet appears to be incorrect. Surgeons should consider these findings when deciding on the optimal surgical procedure for recurrent shoulder instability.

scholarly journals Pathology and clinical outcomes after arthroscopic stabilization in shoulders with traumatic anterior instability older than 40 years: Comparison between shoulders with the first dislocation before or after 40 years (241)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0034
Author(s):  
Yusuke Ueda PhD ◽  
Hiroyuki Sugaya ◽  
Norimasa Takahashi ◽  
Keisuke Matsuki ◽  
Morihito Tokai ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Instability ◽  
External Rotation ◽  
Bankart Lesion ◽  
Rotator Cuff Tears ◽  
Anterior Shoulder Instability ◽  
Arthroscopic Stabilization ◽  
Group 2 ◽  
Group 1

Objectives: Traumatic anterior shoulder instability is common in young population but sometimes seen in middle-aged and elderly patients. The higher incidence of rotator cuff tears has been reported in middle-aged and elderly patients with anterior shoulder instability than young population. We, however, had an impression through clinical experiences that the pathology, including the incidence of rotator cuff tears, might be different by age at the first dislocation. There have been few articles that reported the pathology of shoulders with anterior shoulder instability in older population. The purpose of this study was to investigate pathology and clinical outcomes in patients who underwent arthroscopic stabilization at 40 years or older and to compare them between shoulders with the first dislocation before or after 40 years. Methods: The inclusion criteria of this study were as follows: 1) shoulders that underwent arthroscopic stabilization between October 2005 and September 2017, 2) traumatic anterior shoulder instability, and 3) 40 year old or older. The exclusion criterion was < 2-year follow-up. Glenoid morphology was evaluated with preoperative 3-dimensional computed tomography, and the size of glenoid bone defect was measured. Intraoperative findings, including rotator cuff tear, Bankart lesion, and humeral avulsion of the glenohumeral ligament (HAGL) lesion, and surgical procedures were investigated with surgical records. Range of motion was assessed preoperatively and at the final follow-up. Postoperative re-dislocation was also investigated. The subjects were divided into two groups according to the age at the first dislocation: Group 1, < 40 years; Group 2, 40 years or older. The findings and outcomes were compared between the two groups. The unpaired t-test was used to compare continuous data between the groups, and the paired t-test was used for pre- and postoperative comparison of continuous data. The chi-square test was used for categorical variables. The level of significance was set at p < 0.05. Results: Between October 2005 and September 2017, 198 shoulders (198 patients) underwent arthroscopic shoulder stabilization for traumatic anterior shoulder instability at 40 years or older. Fifty-six shoulders were excluded due to < 2-year follow-up, and 142 shoulders (142 patients) were included in this study. They consisted of 69 males and 73 females with a mean age of 51 (range, 40-78) years. The mean follow-up was 4 (range, 2-12) years. Group 1 included 105 shoulders (52 males and 53 females] with a mean age of 48 (range, 40-77) years. Group 2 included 37 shoulders (17 male and 20 females) with a mean age of 59 (range, 40-78) years. Group 1 had a longer time from the first dislocation to surgery (P<.001) and larger number of dislocation (P<.001) than Group 2 (Table 1). Bony Bankart lesion was more frequently seen in Group 2 than Group 1 (P=.02), and bone defect was greater in Group 1 than Group 2 (P=.02). The incidence of Bankart lesion or HAGL lesion was not significantly different between the groups. There were 2 full-thickness (1 small and 1 medium) and 16 joint-side partial-thickness rotator cuff tears in Group 1, while 16 full-thickness (4 small, 4 medium, 5 large, and 3 massive) and 8 joint-side partial-thickness tears were found in Group 2. The difference in the incidence of rotator cuff tears was significant between the groups (P<.001). Arthroscopic Bankart repair (ABR) with or without augmentation was performed in 103 shoulders (98 %) in Group 1 and in 35 shoulders (95%) in Group 2 (Table 2). There were 2 isolated HAGL repairs (2 %) in Group 1 and 2 isolated rotator cuff repairs (6 %) in Group 2. Two shoulders (6%) in Group 2 experienced re-dislocation. Forward flexion showed significant improvement from 159 (range, 100-180) to 170 (range, 140-180) degrees in Group 1 and from 148 (range, 40-180) to 163 (range, 70-180) degrees in Group 2 (P<.001 for each). Postoperative forward flexion showed no significant difference between the groups. External rotation showed no postoperative changes in both groups, while Group 1 had significantly better pre- and postoperative external rotation than Group 2. Conclusions: This study demonstrated that the incidence of rotator cuff tears was much higher in shoulders with the first dislocation after 40 years compared to shoulders with the first dislocation before 40 years. Shoulders with the first dislocation before 40 years had larger glenoid bone loss, while 51% of shoulders with the first dislocation after 40 years retained bony fragments. The longer time from the initial injury to surgery might be associated with the larger glenoid bone loss and absorption of bone fragments. Both groups showed satisfactory outcomes with the low rate of complications.

scholarly journals Revision Arthroscopic Bankart Repair Versus Arthroscopic Latarjet for Failed Primary Arthroscopic Stabilization With Subcritical Bone Loss

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110018
Author(s):  
Emilio Calvo ◽  
Gonzalo Luengo ◽  
Diana Morcillo ◽  
Antonio M. Foruria ◽  
María Valencia
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
Revision Surgery ◽  
Shoulder Instability ◽  
Activity Level ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Arthroscopic Bankart Repair ◽  
Functional Scores ◽  
Arthroscopic Latarjet

Background: Limited evidence is available regarding the recommended technique of revision surgery for recurrent shoulder instability. Only 1 previous study has compared the results of soft tissue repair and the Latarjet technique in patients with persistent shoulder instability after primary surgical stabilization. Purpose/Hypothesis: To evaluate the results of revision surgery in patients with previous surgical stabilization failure and subcritical glenoid bone defects, comparing repeated Bankart repair versus arthroscopic Latarjet technique. The hypothesis was that Latarjet would be superior to soft tissue procedures in terms of objective and subjective functional scores, recurrence rates, and range of movement. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 45 patients (mean age, 29.1 ± 8.9 years) with subcritical bone loss (<15% of articular surface) who had undergone revision anterior shoulder instability repair after failed Bankart repair. Of these, 17 patients had arthroscopic Bankart repair and 28 had arthroscopic Latarjet surgery. Patients were evaluated at a minimum of 2 years postoperatively with the Rowe score, Western Ontario Shoulder Instability Index, and Subjective Shoulder Value. Subluxation or dislocation episodes were considered failures. Results: No statistically significant differences were found between groups in age, sex, sporting activity, preoperative Rowe score, or the presence of hyperlaxity or bony lesions. At revision arthroscopy, 20 shoulders showed a persistent Bankart lesion, 13 a medially healed labrum, and 6 a bony Bankart. In 6 patients, no abnormalities were present that could explain postoperative recurrence. In the Bankart repair group, 7 patients underwent isolated Bankart procedures; in the remaining 10 cases, a capsular shift was added. No significant differences were found between the Bankart and Latarjet groups in outcome scores, recurrence rate (11.8% vs 17.9%, respectively), or postoperative athletic activity level. The mean loss of passive external rotation at 0° and 90° of abduction was similar between groups. Conclusion: Arthroscopic Latarjet did not lead to superior results compared with repeated Bankart repair in patients with subcritical glenoid bone loss and recurrent anterior shoulder instability after Bankart repair.

scholarly journals Arthroscopic revision surgery in the arthrofibrotic knee: who benefits?

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0002
Author(s):  
Christian Weber ◽  
Jochen Müller-Stromberg ◽  
Nicola Weber
Keyword(s):  
Quality Of Life ◽  
Revision Surgery ◽  
Oxford Knee Score ◽  
Consecutive Series ◽  
Knee Score ◽  
Sports Activity ◽  
Activity Scale ◽  
Group 2 ◽  
Group 1

Arthrofibrotic stiffness of the knee joint has been recognized as a highly debilitating complication after complex knee reconstruction. The clinical impact of arthroscopic revision surgery was evaluated for patients with knee arthrofibrosis following total knee arthroplasty (TKA) and after joint preserving procedures. Hypothesis: Arthroscopic revision surgery is associated with functional benefits in both groups. We retrospectively reviewed a consecutive series of adult patients (#CHR: greaterlike#18 years) at a single institution who underwent arthroscopic revision for knee stiffness. Minimum follow-up: 24 months. The analysis included demographic, surgical and histological data. The following outcome parameters were evaluated: pain (Visual Analog Scale, VAS); objective score systems (Oxford Knee Score) and patient activity (Tegner Activity Scale (TAS), Univ. of California Activity Scale (UCLA)). Furthermore, range of motion (ROM) was compared pre-, intra- and postoperatively. Finally, we compared body mass index (BMI) and quality of life (EQ-5D) changes. We identified a total of 57 patients who underwent arthroscopic adhesiolysis for knee arthrofibrosis: 45 after TKA (Group 1) and 12 patients with ligament reconstruction (Group 2). The patient cohort included thirty (43.5%) males and thirty-six (56.5%) females. Mean age was 69 (SD 10.6) years in the TKA group and 41 (SD 12.7) years in group 2 (p=0.01). Mean length of stay (LOS) was 4.6 days in Group 1 and 2.8 days in Group 2. Pain levels (VAS) were reduced significantly in both groups (p=0.004); from 7.5 to 4.8 in Group 1 and from 7.8 to 2.9 (Group 2). In terms of sports activity, 26 patients (37.7%) reported an improved sports activity (UCLA score). The TAS improved from 2.58 to 4.08 in Group 2. The Oxford Knee Score improved from 23.5 to 27.2 in Group 1 and from 16.5 to 36.3 in Group 2. No reduction in BMI was observed. However, quality of life (EQ-5D) improved from 47.6 to 51.9 Group 1; and from 52.9 to 71.7 in Group 2. Arthroscopic revision of the stiff knee may offer clinical benefits in terms of significant pain reduction, an improved level of activity and quality of life in stiffness following both TKA and joint preserving surgical reconstruction.

scholarly journals Effect of anterior capsular polishing on the incidence of YAG capsulotomy

2016 ◽  
Vol 11 (3) ◽  
Author(s):  
Muhammad A Ahad ◽  
Mohammad Rashad Qamar ◽  
Sameh K Hindi ◽  
Martin N Kid
Keyword(s):  
Outcome Measure ◽  
Early Postoperative Period ◽  
Controlled Study ◽  
Control Group ◽  
Anterior Capsule ◽  
Main Outcome Measure ◽  
Group I ◽  
Group 2 ◽  
One Year ◽  
Group 1

Purpose: To study the effect of anterior capsule polishing during phacoemulsification on the incidence of post operative YAG laser capsulotomy. Method: A retrospective controlled study of 159 patients who underwent uncomplicated phacoemulsification with anterior capsular polishing between October 1998 and March 2000. 169 age matched patients who underwent phacoemulsification but without anterior capsule polishing served as controls. Main outcome measure: Incidence of visually significant YAG capsulotomy, which improved the Snellen acuity for more than 1 line or at least 1 line with subjective improvements in symptoms. Results: 2.51 % of patients with anterior capsular polishing (Group 1) had YAG capsulotomy compared to 7.1% of patients in control group at one year. However, after two years, 11.3% of patients in Group I had YAG capsulotomy compared to 12.4% in Group 2. Conclusion: Anterior capsular polishing during cataract surgery may delay the opacification of posterior capsule during the early postoperative period. But does not decrease the incidence of YAG capsulotomy after two years.

scholarly journals Comparison of clinical and patient-reported outcomes of three procedures for recurrent anterior shoulder instability: arthroscopic Bankart repair, capsular shift, and open Latarjet

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Yingjie Xu ◽  
Kailun Wu ◽  
Qianli Ma ◽  
Lei Zhang ◽  
Yong Zhang ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Subjective Perception ◽  
Capsular Shift ◽  
Shift Group ◽  
Arthroscopic Bankart Repair ◽  
Significant Difference ◽  
Patient Reported ◽  
Recurrent Anterior Shoulder Instability

Abstract Background Best surgical of recurrent anterior shoulder instability remained controversial. We knew little about the superiority and choice between traditional open and modern arthroscopic techniques. We hypothesized that outcomes of all patients will be similar regardless of surgical technique. Methods A retrospective case-cohort analysis of 168 patients who had recurrent anterior shoulder instability was conducted from September 2010 to December 2013. All cases (mean age 30.8 [range 18–50] years) were performed with arthroscopic Bankart repair (33 males/20 females), open Latarjet (34 males/18 females), and capsular shift (31 males/14 females). The average follow-up was 67.6 months (range 60–72). The shoulder instability index score (ISIS) was more than 3 with an average of 6.4. Results All treatments proved to be effective in improving shoulder functional status and reducing symptoms, while Latarjet had an advantage over subjective perception. The Rowe scores in arthroscopic Bankart, open Latarjet, and capsular shift group were 92.3 ± 1.5, 96.2 ± 2.1, and 93.2 ± 2.3, respectively, with significant difference. There was no significant difference in other functional outcomes. However, the Latarjet group in subjective results (subjective shoulder value (SSV) and subjective shoulder value for sport practice (SSV Sport)) was superior to the others (P < 0.05). There were two relapsed cases in arthroscopic Bankart and capsular shift group, respectively, and no recurrence in open Latarjet group. Conclusion Arthroscopic Bankart repair has the advantage of mini-invasion and rapid recovery. Capsular shift offers stabilizing of inferior or multidirectional type, especially for little bone defect. Latarjet was more effective in reducing recurrence with higher stability. Level of evidence Therapeutic level III

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