scholarly journals The role of Hill-Sachs localization on the failure of arthroscopic shoulder stabilization. The results of a prospective cohort study

2021 ◽  
Vol 9 (2_suppl) ◽  
pp. 2325967121S0000
Author(s):  
Patrick Goetti ◽  
Emilie Sandman ◽  
Marie-lyne Nault ◽  
Jonah Hebert Davies ◽  
Dominique Rouleau
Keyword(s):  
Bone Loss ◽  
Prospective Cohort ◽  
External Rotation ◽  
Arthroscopic Stabilization ◽  
Latarjet Procedure ◽  
Shoulder Stabilization ◽  
Recurrent Instability ◽  
Glenoid Track ◽  
The Hill

Objectives: Recurrent glenohumeral instability is frequently associated with glenoid and humeral bone loss. It is predictive of capsulolabral repair failure. However, the best way to quantify these shortcomings remains controversial. The aim of our study is to determine the best predictor of recurrent instability after arthroscopic shoulder stabilization. Methods: Over the past 10 years, all the patients recruited for shoulder stabilization surgery in 4 academic centers have been included in the prospective cohort called "LUXE". The ISIS score is used to stratify patients for surgery (Bankart, Bankart + Remplissage, Latarjet). Only patients with a preoperative CT scan with 3D reconstruction and clinical follow-up ≥1 year were included. Of a total of 262 patients included in the “LUXE” cohort, 103 met the inclusion criteria. The majority of patients were male (79%) with an average age of 28 years. The median number of dislocations before stabilization surgery was six. Bone deficits were measured on the 3D reconstructions using the Glenoid Clock and Ratio, the Humeral Clock and Ratio and the Glenoid Track methods and the angle of engagement of the Hill-Sachs lesion in the axial plane. Results: Seventy patients had arthroscopic stabilization and 33 a Latarjet procedure. The ISIS scores for the two groups were 2.7 and 4.8 (p<0.001) respectively. The average glenoid bone loss was 9+/-10% (0-37%), humeral bone loss was 15+/-6% (0-36%) and the angle of engagement of the Hill-Sachs lesion was 71+/-30° in external rotation. Fifty-three patients (51%) had an off-track lesion. Eighteen patients had recurrent instability after arthroscopic stabilization (23%) versus only 2 patients (6%) for Latarjets (OR= 4.6, p=0.034). Preoperative bone loss was not related to failure after a Latarjet procedure. The risk factors identified after arthroscopic stabilization were a lower engaging Hill-Sachs angle in external rotation (65° vs. 72°; p=0.05), less humeral bone loss (humeral clock of 42° vs. 58°; p=0.034) and an extended follow-up time (p=0.006). Glenoid bone loss, or the combined measurement (glenoid track) was not predictive of failure. Conclusion: Despite a lower ISIS score, arthroscopic management with Bankart +/- Remplissage is correlated with a significantly higher recurrence rate compared to the Latarjet procedure. Failure was related to humeral bone loss and to the morphology/orientation of the Hill-Sachs lesion rather than the volume of bone loss.

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

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

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

scholarly journals Failed Latarjet procedure: a systematic review of surgery revision options

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Matteo Buda ◽  
Riccardo D’Ambrosi ◽  
Enrico Bellato ◽  
Davide Blonna ◽  
Alessandro Cappellari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Case Series ◽  
Review Of The Literature ◽  
Inclusion Criteria ◽  
Latarjet Procedure ◽  
Shoulder Stabilization ◽  
Recurrent Instability ◽  
Level Of Evidence ◽  
Radiographic Outcomes

Abstract Background Revision surgery after the Latarjet procedure is a rare and challenging surgical problem, and various bony or capsular procedures have been proposed. This systematic review examines clinical and radiographic outcomes of different procedures for treating persistent pain or recurrent instability after a Latarjet procedure. Methods A systematic review of the literature was performed using the Medline, Cochrane, EMBASE, Google Scholar and Ovid databases with the combined keywords “failed”, “failure”, “revision”, “Latarjet”, “shoulder stabilization” and “shoulder instability” to identify articles published in English that deal with failed Latarjet procedures. Results A total of 11 studies (five retrospective and six case series investigations), all published between 2008 and 2020, fulfilled our inclusion criteria. For the study, 253 patients (254 shoulders, 79.8% male) with a mean age of 29.6 years (range: 16–54 years) were reviewed at an average follow-up of 51.5 months (range: 24–208 months). Conclusions Eden–Hybinette and arthroscopic capsuloplasty are the most popular and safe procedures to treat recurrent instability after a failed Latarjet procedure, and yield reasonable clinical outcomes. A bone graft procedure and capsuloplasty were proposed but there was no clear consensus on their efficacy and indication. Level of evidence Level IV Trial registration PROSPERO 2020 CRD42020185090—www.crd.york.ac.uk/prospero/

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

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

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

Outcomes of the Latarjet Procedure Versus Free Bone Block Procedures for Anterior Shoulder Instability: A Systematic Review and Meta-analysis

2020 ◽  
pp. 036354652092583
Author(s):  
Ron Gilat ◽  
Eric D. Haunschild ◽  
Ophelie Z. Lavoie-Gagne ◽  
Tracy M. Tauro ◽  
Derrick M. Knapik ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shoulder Instability ◽  
Meta Analysis ◽  
Anterior Shoulder Instability ◽  
Bone Block ◽  
Return To Sports ◽  
Latarjet Procedure ◽  
Shoulder Stabilization ◽  
Recurrent Instability

Background: Free bone block (FBB) procedures for anterior shoulder instability have been proposed as an alternative to or bail-out for the Latarjet procedure. However, studies comparing the outcomes of these treatment modalities are limited. Purpose: To systematically review and perform a meta-analysis comparing the clinical outcomes of patients undergoing anterior shoulder stabilization with a Latarjet or FBB procedure. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: PubMed, Embase, and the Cochrane Library databases were systematically searched from inception to 2019 for human-participants studies published in the English language. The search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement including studies reporting clinical outcomes of patients undergoing Latarjet or FBB procedures for anterior shoulder instability with minimum 2-year follow-up. Case reports and technique articles were excluded. Data were synthesized, and a random effects meta-analysis was performed to determine the proportions of recurrent instability, other complications, progression of osteoarthritis, return to sports, and patient-reported outcome (PRO) improvement. Results: A total of 2007 studies were screened; of these, 70 studies met the inclusion criteria and were included in the meta-analysis. These studies reported outcomes on a total of 4540 shoulders, of which 3917 were treated with a Latarjet procedure and 623 were treated with an FBB stabilization procedure. Weighted mean follow-up was 75.8 months (range, 24-420 months) for the Latarjet group and 92.3 months (range, 24-444 months) for the FBB group. No significant differences were found between the Latarjet and the FBB groups in the overall random pooled summary estimate of the rate of recurrent instability (5% vs 3%, respectively; P = .09), other complications (4% vs 5%, respectively; P = .892), progression of osteoarthritis (12% vs 4%, respectively; P = .077), and return to sports (73% vs 88%; respectively, P = .066). American Shoulder and Elbow Surgeons scores improved after both Latarjet and FBB, with a significantly greater increase after FBB procedures (10.44 for Latarjet vs 32.86 for FBB; P = .006). Other recorded PRO scores improved in all studies, with no significant difference between groups. Conclusion: Current evidence supports the safety and efficacy of both the Latarjet and FBB procedures for anterior shoulder stabilization in the presence of glenoid bone loss. We found no significant differences between the procedures in rates of recurrent instability, other complications, osteoarthritis progression, and return to sports. Significant improvement in PROs was demonstrated for both groups. Significant heterogeneity existed between studies on outcomes of the Latarjet and FBB procedures, warranting future high-quality, comparative studies.

scholarly journals Return to Sport Following Open Latarjet Procedure for Recurrent Shoulder Instability

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0037
Author(s):  
Joseph Liu ◽  
Anirudh Gowd ◽  
Grant Garcia ◽  
Alexander Beletsky ◽  
Brandon Cabarcas ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Sport Participation ◽  
Return To Sport ◽  
High Rate ◽  
Glenoid Bone Loss ◽  
Latarjet Procedure ◽  
Recurrent Instability ◽  
Post Surgery

Objectives: Shoulder instability is common within athletic populations, particularly in contact sports. The Latarjet procedure is typically reserved for recurrent instability recalcitrant to soft tissue repair. Limited literature exists regarding return-to-sport following Latarjet stabilization. Methods: A single institutional registry was queried between 2012 – 2016 for all open Latarjet stabilization procedures. Patients with no sport history were excluded. Glenoid bone loss was measured using the PICO method. Hill-Sachs defects were categorized as “on-track” or “off-track.” Sport participation was retrospectively surveyed 3-years prior and 3-years following surgery. Factors associated with return-to-sport, throwing, and recurrent instability were assessed using multivariate logistic regressions. Results: A total of 92 surgeries were identified, 67 of which were available for follow-up (72.8%). Average follow-up was 53.8 ± 11.6 months. Mean age and BMI were 27.9 ± 11.6 years and 25.9 ± 8.4 kg/m2, respectively. Mean glenoid bone loss was 16.4 ± 5.1%. There were 13 Hill Sachs lesions (5 off track), with a mean defect size of 145.8 ± 60.4 mm3. The dominant side was involved in 36 patients. Fifty-two patients (77.6%) reported return-to-sport at an average of 8.6 ± 4.6 months. Thirty-six patients (53.7%) reported return-to-sport at the same or higher level than their preoperative state. Only 58.6% of throwing athletes returned to throwing post-surgery. Seven patients (10.4%) reported recurrence of instability following surgery. A higher likelihood of recurrent instability was associated with larger Hill-Sachs volume (p=0.021, OR: 1.06, 95% CI: 1.01-1.16). A reduced likelihood of returning to sport at same or better level was associated with dominant-sided surgery (p=0.010, OR: 0.362, 95% CI: 0.210-0.622). Conclusion: The open Latarjet procedure is associated with high rate of return-to-sport; however, nearly half were unable to return to their pre-injury level. During preoperative assessment, consideration of Hill-Sachs lesion size and laterality are significant factors for improved outcomes.

Arthroscopic Stabilization in Patients with an Inverted Pear Glenoid

2007 ◽  
Vol 35 (8) ◽  
pp. 1276-1283 ◽  
Author(s):  
Timothy S. Mologne ◽  
Matthew T. Provencher ◽  
Kyle A. Menzel ◽  
Tyler A. Vachon ◽  
Christopher B. Dewing
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Anterior Shoulder Instability ◽  
Bony Defect ◽  
Arthroscopic Stabilization ◽  
Recurrent Instability ◽  
Bone Deficiency ◽  
Bony Fragment ◽  
The Mean

Background Recent literature has demonstrated that the success rates of arthroscopic stabilization of glenohumeral instability deteriorate in patients with an anteroinferior glenoid bone deficiency, also known as the “inverted pear” glenoid. Purpose This study was conducted to assess the outcomes of arthroscopic stabilization for recurrent anterior shoulder instability in patients with a mean anteroinferior glenoid bone deficiency of 25% (range, 20%-30%). Study Design Cohort study; Level of evidence, 3. Methods Twenty-one of 23 patients (91% follow-up) undergoing arthroscopic stabilization surgery and noted to have a bony deficiency of the anteroinferior glenoid of 20% to 30% were reviewed at a mean follow-up of 34 months (range, 26-47). The mean age was 25 years (range, 20-34); 2 patients were female and 19 were male. All patients were treated with a primary anterior arthroscopic stabilization using a mean of 3.2 suture anchors (range, 3-4). Eleven patients had a bony Bankart that was incorporated into the repair; 10 had no bone fragment and were considered attritional bone loss. Outcomes were assessed using the Rowe score, the American Shoulder and Elbow Surgeons (ASES) Score, the Single Assessment Numeric Evaluation (SANE), and the Western Ontario Shoulder Instability (WOSI) Index. Findings of recurrent instability and dislocation events were documented. Results Two patients (9.5%) experienced symptoms of recurrent subluxation, and 1 (4.8%) sustained a recurrent dislocation that required revision open surgery. The mean postoperative outcomes scores were as follows SANE = 88.1 (range, 65-100; standard deviation [SD] 9.0); Rowe = 85.2 (range, 55-100; SD 14.1); ASES Score = 93.1 (range, 78-100; SD 5.3); and WOSI Index = 398 (82% of normal; range, 30-1175; SD 264). No patient with a bony fragment experienced a recurrent subluxation or dislocation, and mean outcomes scores for patients with a bony fragment were better than those with no bony fragment (P = .08). No patient required medical discharge from the military for his or her shoulder condition. Conclusions Arthroscopic stabilization for recurrent instability, even in the presence of a significant bony defect of the glenoid, can yield a stable shoulder; however, outcomes are not as predictable especially in attritional bone loss cases. Longer-term follow-up is needed to see if these results hold up over time.

scholarly journals Risk Factors for Recurrent Anterior Glenohumeral Instability Following a Primary Latarjet Procedure: A Prospective Analysis of 358 Patients

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0037
Author(s):  
Matthew Provencher ◽  
Liam Peebles ◽  
Nicola de Gasperis ◽  
Petar Golijanin ◽  
Paolo Scarso ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Loss ◽  
Clinical Outcomes ◽  
Anterior Instability ◽  
Latarjet Procedure ◽  
Glenohumeral Instability ◽  
Recurrent Instability ◽  
The Mean ◽  
Anterior Glenohumeral Instability

Objectives: The purpose of this study was to identify historical and demographic risk factors influencing failure rates and inferior clinical outcomes in patients reporting recurrent anterior glenohumeral instability following a primary Latarjet procedure. It was hypothesized that patients who have a greater risk of recurrent instability and worse clinical outcomes following a primary Latarjet procedure can be preoperatively identified on the basis of clinical, demographic, and radiological criteria. Methods: Between 2004 and 2014, patients who were treated with a primary Latarjet by the senior author (GDG) for unidirectional anterior shoulder instability were reviewed. Further inclusion criteria were ≥ 2 traumatic or atraumatic anterior instability events and physical examination and imaging findings consistent with anterior instability. Patients were excluded if they underwent previous ipsilateral shoulder surgery, had a rotator cuff tear, or had voluntary and/or multidirectional instability. Gender, age at first dislocation, duration of instability symptoms, number of dislocation events, age at surgery, bilateral instability, mechanism of dislocation, and quantification of glenoid and humeral head bone loss were recorded. Western Ontario Score Index (WOSI) and Single Assessment Numeric Evaluation (SANE) outcomes scores were collected at minimum five-year follow-up, along with clinical outcomes parameters including evidence of recurrent instability. Results: 358 consecutive patients (372 shoulders) with a mean age of 29.2 years (range = 16 to 68 years) met inclusion criteria at a mean follow-up of 75 months (range = 61 to 89 months). There were 299 men (83.5%) and 59 women (16.5%), of which 86 had bilateral dislocations (24%). Bilateral Latarjet procedures were performed on 14 patients (4.1%). There was a total of 173 patients (48.3%) with an on-track lesion and glenoid bone loss ≤ 13.5%, 154 patients (43%) with on-track lesion but glenoid bone loss >13.5%, and 31 patients (8.7%) with off-track lesions. 17 patients (4.9%) experienced an instability episode following treatment with primary Latarjet. The mean WOSI was 818.2 ± 156.9 for recurrent instability patients while it was 296.4 ± 207.3 for patients with no postoperative instability (F1,356 = 104.6, p < 0.05). SANE scores were also lower in cases of recurrence (65.9 ± 9.0) when compared to patients that did not report postoperative recurrence (85.8 ± 8.1) (F1,356 = 98.4 p < 0.05). The mean WOSI score of bilateral instability subjects (438.6 ± 205.8) was higher than those with unilateral instability (256.3 ± 189.6) (F2,339 = 427.0; p < 0.05), while SANE was similarly worse for bilateral subjects (79.7 ± 8.4) compared to unilateral subjects (87.6 ± 7.1) (F2,339=23168.9; p < 0.05). The patients with atraumatic dislocations reported WOSI scores that were, on average, higher than those reported for patients with traumatic ones (396.3 ± 216.3 versus 270.6 ± 197.2, respectively; F2,339 = 380.7; p < 0.05) and mean SANE scores that were lower than the others (81.7 ± 9.4 versus 86.9 ± 7.3, respectively; F2,339 = 20,722.3; p < 0.05). The mean postoperative WOSI for female patients in this cohort was higher than that of males (397.3±227.9 and 276.5±197.4 respectively; F2,339 = 372.9; p < 0.05), while SANE was lower (82.6 ± 8.4 for females and 86.5±7.8 for males; F2,339 = 19959.6; p < 0.05). The mean postoperative WOSI for subjects who were between 31 and 40 years old at the first instability episode was higher (366.5 ± 236.6) than who were less than 30 years old (F4,337 = 181.1; p < 0.05). There was no significant difference across age groups with respect to postoperative SANE scores. The mean WOSI score for patients over 40 years old at the time of the surgery was higher (347.2 ± 269.0) than for those under 22 years old (233.3 ± 217.7) and those between 23 and 30 years old (272.0 ± 182.5; (F4,337 = 181.9; p < 0.05)). SANE scores were not significantly different with respect to patient age at the time of treatment. There was found to be no correlation between the pattern of bone loss (OFF-track, ON-track < 13.5%, ON -track > 13.5%) recurrent instability and clinical outcomes. Conclusion: 4.9% of patients treated with primary Latarjet experienced recurrent anterior instability postoperatively. Preoperative risk factors included history of bilateral shoulder instability and atraumatic mechanism of dislocation. Poorer postoperative outcome scores independent of recurrent instability included age > 31 years, female gender, having more than seven instability events prior to surgery, bilateral instability, and atraumatic mechanism of first-time dislocation. This is the first clinical study to provide evidence behind specific demographic and historical factors that predispose patients to a greater risk of recurrent instability and inferior clinical outcomes following a Latarjet. This has implications on both clinical treatment and patient education to more accurately evaluate Latarjet candidates.

Peripheral-Track and Central-Track Hill-Sachs Lesions: A New Concept of Assessing an On-Track Lesion

2019 ◽  
Vol 48 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Nobuyuki Yamamoto ◽  
Kiyotsugu Shinagawa ◽  
Taku Hatta ◽  
Eiji Itoi
Keyword(s):  
Quality Of Life ◽  
Bone Loss ◽  
Anterior Dislocation ◽  
Life Questionnaire ◽  
Track Width ◽  
Computed Tomography Images ◽  
Glenoid Track ◽  
The Hill

Background: It has been demonstrated biomechanically that 25% is a critical size defect of the glenoid. However, a recent clinical study reported that a bone loss between 13.5% and 20% (subcritical bone loss) led to impairment of quality of life but not a recurrence of instability. Purpose: To clarify whether a subcritical bone loss exists in assessing a Hill-Sachs lesion via a disease-specific quality of life questionnaire. Study Design: Cohort study; Level of evidence, 3. Methods: Fifty patients (mean age, 27 years) with <25% glenoid defect who were treated with arthroscopic Bankart repair for recurrent anterior dislocation were assessed at a mean follow-up of 28 months. All had an on-track Hill-Sachs lesion. The Western Ontario Shoulder Instability Index (WOSI) and Rowe scores were used for the clinical evaluation. The Hill-Sachs interval was measured on 3-dimensional computed tomography images and divided by the glenoid track width, defined as the Hill-Sachs occupancy (in percentages). The glenoid track was divided into 4 zones based on the percentage of the Hill-Sachs occupancy: zone 1, <25%; zone 2, 25% to <50%; zone 3, 50% to <75%; and zone 4, ≥75%. Results: The recurrence rate was 6% (3 of 50 shoulders). The Rowe score significantly improved from 45.2 ± 4.7 (mean ± SD) preoperatively to 92.3 ± 6.5 at the final follow-up ( P < .05). The WOSI score also significantly increased from 46.6% ± 19.3% preoperatively to 72.3% ± 21.0% at the final follow-up ( P < .001). The WOSI score of patients in zone 4 (peripheral-track lesion) (n = 10) was significantly lower than those in the other zones (central-track lesion) ( P = .0379). Of the 10 patients with the peripheral-track lesion, 5 had a <40% WOSI score, similar to the preoperative WOSI score (46.6%). Conclusion: Patients with on-track lesions can be divided into 2 subgroups: those with the Hill-Sachs occupancy ≥75% (peripheral-track lesion) showed significantly worse WOSI score without recurrent instability events than those with the Hill-Sacks occupancy <75% (central-track lesion).

scholarly journals Back to Sports After Arthroscopic Revision Bankart Repair

2018 ◽  
Vol 6 (2) ◽  
pp. 232596711875545 ◽  
Author(s):  
Johannes Buckup ◽  
Frederic Welsch ◽  
Yves Gramlich ◽  
Reinhard Hoffmann ◽  
Philip P. Roessler ◽  
...  
Keyword(s):  
External Rotation ◽  
Bankart Repair ◽  
Return To Sports ◽  
Arthroscopic Stabilization ◽  
Recurrent Instability ◽  
Arthroscopic Bankart Repair ◽  
Sporting Activity ◽  
The Mean ◽  
Sporting Activities

Background: Recurrent instability following primary arthroscopic stabilization of the shoulder is a common complication. Young, athletic patients are at the greatest risk of recurring instability. To date, the literature contains insufficient description regarding whether return to sports is possible after revision arthroscopic Bankart repair. Hypothesis: Patients presenting with recurrent instability after primary arthroscopic stabilization should expect limitations in terms of their ability to partake in sporting activities after revision surgery. Study Design: Case series; Level of evidence, 4. Methods: Twenty athletes who underwent arthroscopic revision stabilization of the shoulder after failed primary arthroscopic Bankart repair were included in the study after completing inclusion and exclusion criteria surveys. Athletic Shoulder Outcome Scoring System (ASOSS), Shoulder Sport Activity Score (SSAS), and the Subjective Patient Outcome for Return to Sports (SPORTS) scores were determined to assess the participants’ ability to partake in sporting activities. Furthermore, sport type and sport level were classified and recorded. To assess function and stability, Rowe, American Shoulder and Elbow Surgeons, Constant-Murley, and Walch-Duplay scores were measured and recorded. Results: Follow-up consultations were carried out after a mean of 28.7 months. The mean age at follow-up examination was 27.75 years. At the time of follow-up, 70% of the patients were able to return to their original sporting activities at the same level. However, 90% of patients described a limitation in their shoulder when participating in their sports. At 28.7 months after surgery, the mean ASOSS score was 76.8; the SSAS score decreased from 7.85 before first-time dislocation to 5.35 at follow-up ( P < .005). The SPORTS score was 5.2 out of 10 at the follow-up consultation. Function- and instability-specific scores showed good to excellent results. The mean external rotational deficit for high external rotation was 9.25°, and for low external rotation it was 12°. Conclusion: Patients can return to their original type and level of sport after arthroscopic revision Bankart repair, but they must expect persistent deficits and limitations to the shoulder when put under the strains of sporting activity. Patients with shoulder injuries who partake in sports that put greater demand on the shoulder show the smallest probabilities of returning to sporting activity.

scholarly journals Combined subcritical thresholds of glenoid and humeral sided bone loss are predictive of failure after arthroscopic Bankart repair

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0038
Author(s):  
Gillian Kane ◽  
Elan Golan ◽  
Kevin Wilson ◽  
Bryson Lesniak ◽  
Ryan Li Albert Lin
Keyword(s):  
Bone Loss ◽  
Roc Analysis ◽  
Bankart Repair ◽  
Older Individuals ◽  
Index Procedure ◽  
Arthroscopic Bankart Repair ◽  
Risk Of Failure ◽  
Glenoid Track ◽  
Independent Risk Factors

Objectives: Glenoid and humeral sided bone loss are both independent risk factors for failure after arthroscopic Bankart repair. The purpose of this study was to determine the combined effect of subcritical levels of humeral and glenoid sided bone loss on failure after arthroscopic Bankart repair. Methods: 171 individuals with minimum 2 years follow up who underwent primary arthroscopic Bankart repair between 2007-2015 were included in this study. Glenoid and humeral sided bone loss were measured using the glenoid track model. Cases were defined as individuals who sustained a subluxation or dislocation event after the index procedure, while controls were defined as individuals who did not. Subjects were stratified by age (20+ versus < 20 years). Receiver operating curves (ROC) were generated to determine the threshold of glenoid and humeral sided bone loss that could best predict failure. Results: There were 53 cases and 118 controls. Increased glenoid (p < .001) and humeral-sided (p = .013) bone loss independently predicted failure. ROC analysis demonstrated that threshold values of 12% glenoid (AUC = 0.62) and 13 mm humeral (AUC = 0.60) bone loss were predictive of failure. Combined subcritical thresholds of 10% glenoid and 10 mm humeral sided bone loss successfully predicted outcomes of 49/56 (87.5%) individuals over age 20 and 79/117 (67.5%) individuals under age 20. Humeral and glenoid sided bone loss had an additive effect on risk of failure in older individuals while glenoid sided bone loss was primarily responsible for failure in younger individuals. Conclusion: Both glenoid and humeral sided bone loss are predictive of failure after arthroscopic Bankart repair. Combined subcritical thresholds of glenoid and humeral sided bone loss accurately predict failure, particularly in individuals over the age of 20. These results suggest that individuals with subcritical bipolar lesions may be at higher risk of failure after arthroscopic Bankart repair than previously thought. [Table: see text]

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