scholarly journals Open Stabilization Procedures of the Shoulder in the Athlete: Indications, Techniques, and Outcomes

2021 ◽  
Vol Volume 12 ◽  
pp. 159-169
Author(s):  
Aryan Haratian ◽  
Katie Yensen ◽  
Jennifer A Bell ◽  
Laith K Hasan ◽  
Tara Shelby ◽  
...  
Keyword(s):  
Open Stabilization

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

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.

scholarly journals Instrumentation Removal following Minimally Invasive Posterior Percutaneous Pedicle Screw-Rod Stabilization (PercStab) of Thoracolumbar Fractures Is Not Always Required

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Neil Manson ◽  
Dana El-Mughayyar ◽  
Erin Bigney ◽  
Eden Richardson ◽  
Edward Abraham
Keyword(s):  
Patient Satisfaction ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Pedicle Screw ◽  
Rating Scales ◽  
Case Series ◽  
Leg Pain ◽  
Mild Pain ◽  
Open Stabilization ◽  
Percutaneous Pedicle Screw

Study Design. Clinical case series. Background. Percutaneous stabilization for spinal trauma confers less blood loss, reduces postoperative pain, and is less invasive than open stabilization and fusion. The current standard of care includes instrumentation removal. Objective. 1. Reporting patient outcomes following minimally invasive posterior percutaneous pedicle screw-rod stabilization (PercStab). 2. Evaluating the results of instrumentation retention. Methods. A prospective observational study of 32 consecutive patients receiving PercStab without direct decompression or fusion. Baseline data demographics were collected. Operative outcomes of interest were operative room (OR) time, blood loss, and length of hospital stay. Follow-up variables of interest included patient satisfaction, Numeric Rating Scales for Back and Leg (NRS-B/L) pain, Oswestry Disability Index (ODI), and return to work. Clinical outcome data (ODI and NRS-B/L) were collected at 3, 12, 24 months and continued at a 24-month interval up to a maximum of 8 years postoperatively. Results. 81.25% of patients (n = 26) retained their instrumentation and reported minimal disability, mild pain, and satisfaction with their surgery and returned to work (mean = 6 months). Six patients required instrumentation removal due to prominence of the instrumentation or screw loosening, causing discomfort/pain. Instrumentation removal patients reported moderate back and leg pain until removal occurred; after removal, they reported minimal disability and mild pain. Neither instrumentation removal nor retention resulted in complications or further surgical intervention. Conclusions. PercStab without instrumentation removal provided high patient satisfaction, mild pain, and minimal disability and relieved the patient from the burden of finances and resources allocation of a second surgery.

Glenoid osteotomy for atraumatic posteroinferior shoulder instability associated with glenoid dysplasia

2018 ◽  
Vol 100-B (3) ◽  
pp. 331-337 ◽  
Author(s):  
H. Inui ◽  
K. Nobuhara
Keyword(s):  
Shoulder Instability ◽  
Clinical Results ◽  
Anterior Instability ◽  
Previous Surgery ◽  
Osteoarthritic Change ◽  
Joint Congruency ◽  
Open Stabilization ◽  
Glenoid Surface ◽  
Arm Elevation ◽  
Glenoid Dysplasia

Aims We report the clinical results of glenoid osteotomy in patients with atraumatic posteroinferior instability associated with glenoid dysplasia. Patients and Methods The study reports results in 211 patients (249 shoulders) with atraumatic posteroinferior instability. The patients comprised 63 men and 148 women with a mean age of 20 years. The posteroinferior glenoid surface was elevated by osteotomy at the scapular neck. A body spica was applied to maintain the arm perpendicular to the glenoid for two weeks postoperatively. Clinical results were evaluated using the Rowe score and Japan Shoulder Society Shoulder Instability Score (JSS-SIS); bone union, osteoarthrosis, and articular congruity were examined on plain radiographs. Results The Rowe score improved from 36 to 88 points, and the JSS-SIS improved from 47 to 81 points. All shoulders exhibited union without progression of osteoarthritis except one shoulder, which showed osteoarthritic change due to a previous surgery before the glenoid osteotomy. All but three shoulders showed improvement in joint congruency. Eight patients developed disordered scapulohumeral rhythm during arm elevation, and 12 patients required additional open stabilization for anterior instability. Conclusion Good results can be expected from glenoid osteotomy in patients with atraumatic posteroinferior instability associated with glenoid dysplasia. Cite this article: Bone Joint J 2018;100-B:331–7.

scholarly journals Arthroscopic Versus Open Stabilization for Anterior Shoulder Subluxations

2015 ◽  
Vol 3 (1) ◽  
pp. 232596711557108 ◽  
Author(s):  
Brett D. Owens ◽  
Kenneth L. Cameron ◽  
Karen Y. Peck ◽  
Thomas M. DeBerardino ◽  
Bradley J. Nelson ◽  
...  
Keyword(s):  
Open Stabilization

scholarly journals Recurrent Shoulder Instability: Do Morbidity and Treatment Differ Based on Insurance?

2019 ◽  
Vol 7 (4) ◽  
pp. 232596711984107
Author(s):  
Ariel A. Williams ◽  
Nickolas S. Mancini ◽  
Cameron Kia ◽  
Megan R. Wolf ◽  
Simran Gupta ◽  
...  
Keyword(s):  
Bone Loss ◽  
Surgical Procedures ◽  
Shoulder Instability ◽  
Private Insurance ◽  
Glenoid Bone Loss ◽  
Preoperative Imaging ◽  
Anterior Shoulder Instability ◽  
Time Of Surgery ◽  
Open Stabilization ◽  
History Of

Background: Patients with public insurance often face barriers to obtaining prompt orthopaedic care. For patients with recurrent traumatic anterior shoulder instability, delayed care may be associated with increasing bone loss and subsequently more extensive surgical procedures. Purpose/Hypothesis: The purpose of this study was to evaluate whether differences exist in patients undergoing treatment for shoulder instability between those with Medicaid versus non-Medicaid insurance. We hypothesized that at the time of surgery, Medicaid patients would have experienced greater delays in care, would have a more extensive history of instability, would have more bone loss, and would require more extensive surgical procedures than other patients. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were identified who underwent surgical stabilization for traumatic anterior shoulder instability between January 1, 2011, and December 1, 2015, at a single sports medicine practice. Clinic, billing, and operative records were reviewed for each patient to determine age, sex, insurance type, total number of instability episodes, time from first instability episode to surgery, intraoperative findings, and procedure performed. Glenoid bone loss was quantified by use of preoperative imaging studies. Results: During this time period, 206 patients (55 Medicaid, 131 private insurance, 11 Tricare, 9 workers’ compensation) underwent surgical stabilization for traumatic anterior shoulder instability. Average wait time from initial injury to surgery was 1640 days (95% CI, 1155-2125 days) for Medicaid patients compared with 1237 days (95% CI, 834-1639 days) for others ( P = .005). Medicaid patients were more likely to have sustained 5 or more instability events at the time of surgery (OR, 3.3; 95% CI, 1.64-6.69; P = .001), had a higher risk of having 15% or more glenoid bone loss on preoperative imaging (OR, 3.5; 95% CI, 1.3-10.0; P = .01), and had a higher risk of requiring Latarjet or other open stabilization procedures as opposed to an arthroscopic repair (OR, 3.0; 95% CI, 1.5-6.2; P = .002) when compared with other patients. Conclusion: Among patients undergoing surgery for traumatic anterior shoulder instability, patients with Medicaid had significantly more delayed care. Correspondingly, they reported a more extensive history of instability, were more likely to have severe bone loss, and required more invasive stabilization procedures.

scholarly journals Return to Play After Revision Anterior Shoulder Stabilization: A Systematic Review

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712098205
Author(s):  
Brian C. Lau ◽  
Lorena Bejarano Pineda ◽  
Tyler R. Johnston ◽  
Bonnie P. Gregory ◽  
Mark Wu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Return To Play ◽  
Rate Of Return ◽  
Bone Block ◽  
Complication Rates ◽  
Weighted Mean ◽  
Shoulder Stabilization ◽  
Level Of Evidence ◽  
Patient Goals ◽  
Open Stabilization

Background: Revision shoulder stabilizations are becoming increasingly common. Returning to play after revision shoulder stabilizations is important to patients. Purpose: To evaluate the return-to-play rate after revision anterior shoulder stabilization using arthroscopic, open, coracoid transfer, or free bone block procedures. Study Design: Systematic review; Level of evidence, 4. Methods: All English-language studies published between 2000 and 2020 that reported on return to play after revision anterior shoulder stabilization were reviewed. Clinical outcomes that were evaluated included rate of overall return to play, level of return to play, and time to return to play. Study quality was evaluated using the Downs and Black quality assessment score. Results: Eighteen studies (1 level 2; 17 level 4; mean Downs and Black score, 10.1/31) on revision anterior shoulder stabilization reported on return to play and met inclusion criteria (7 arthroscopic, 5 open, 3 Latarjet, and 3 bony augmentation), with a total of 564 revision cases (mean age, 27.9 years; 84.1% male). The weighted mean length of follow-up was 52.5 months. The overall weighted rate of return to play was 80.1%. The weighted mean rate of return to play was 84.0% (n = 153) after arthroscopic revision, 91.5% (n = 153) after open revision, 88.1% (n = 149) after Latarjet, and 73.8% (n = 65) after bone augmentation. The weighted mean rate of return to same level of play was 69.7% for arthroscopic revision, 70.0% for open revision, 67.1% for Latarjet revision, and 61.8% after bone block revision. There were 5 studies that reported on time to return to play, with a weighted mean of 7.75 months (4 arthroscopic) and 5.2 months (1 Latarjet). The weighted mean rates of complication (for studies that provided it) were 3.3% after arthroscopic revision (n = 174), 3.5% after open revision (n = 110), 9.3% after Latarjet revision (n = 108), and 45.8% after bone block revision (n = 72). Conclusion: Revision using open stabilization demonstrated the highest return-to-play rate. Revision using Latarjet had the quickest time to return to play but had higher complication rates. When evaluated for return to same level of play, arthroscopic, open, and Latarjet had similar rates, and bone block had lower rates. The choice of an optimal revision shoulder stabilization technique, however, depends on patient goals. Higher-quality studies are needed to compare treatments regarding return to play after revision shoulder stabilization.

scholarly journals Cost Analysis of Failed Shoulder Stabilization

2015 ◽  
Vol 5 (1) ◽  
pp. 14-19
Author(s):  
Jonathan A Godin ◽  
Jack G Skendzel ◽  
Jon K Sekiya
Keyword(s):  
Cost Analysis ◽  
Failure Rate ◽  
Shoulder Instability ◽  
Open Repair ◽  
Surgical Techniques ◽  
Arthroscopic Repair ◽  
High Rate ◽  
Return To Play ◽  
Shoulder Stabilization ◽  
Open Stabilization

ABSTRACT Background Shoulder instability is a common problem, especially in the young, active population. Revision stabilization has a high rate of recurrent instability, low rates of return to play, and low clinical outcome scores. The challenge for surgeons is identifying the best surgery for each patient. To our knowledge, no studies have been published examining the cost of failed shoulder stabilization. Hypothesis The high cost of index and revision stabilization procedures in a cohort of patients with recurrent shoulder instability can be reduced through judicious preoperative planning and the use of more aggressive surgical techniques during the index operation. Methods We retrospectively reviewed the medical records and billing information of 18 consecutive patients treated at our institution for failed shoulder instability repairs during a 36-month period. Using the billing records for each case, a cost analysis was conducted from a societal perspective. Results The actual costs of index stabilization and revision stabilization procedures for our cohort of 18 patients amounted to $1,447,690. The costs of revision surgeries conducted for this cohort by a single surgeon at our institution amounted to $673,248. The hypothetical costs of primary arthroscopic stabilization and open stabilization for a cohort of 18 patients leading to permanent repair was $395,415 and $585,639 respectively. The incremental difference between actual costs and hypothetical costs of primary osteoarticular (OA) allograft stabilization for patients with bony defects is $278,394. For patients with significant bone defects, an open repair with failure rate of 44.9%, or an arthroscopic repair with failure rate of 62.8%, is cost neutral to a primary open repair with OA allograft. In addition, an open repair with failure rate of 13.0%, or an arthroscopic repair with failure rate of 41.3%, is cost neutral to a primary definitive repair. Conclusion Failed shoulder stabilization bears high costs to society, even without considering the psychological costs to patients. We must identify and refine diagnostic and prognostic factors to better determine the appropriate treatment modality for patients with primary shoulder instability. Godin JA, Skendzel JG, Sekiya JK. Cost Analysis of Failed Shoulder Stabilization. The Duke Orthop J 2015;5(1):14-19.

Arthroscopic and Open Stabilization Techniques for Anterior Instability in the Contact Athlete

2016 ◽  
Vol 24 (4) ◽  
pp. 278-285
Author(s):  
Ariel A. Williams ◽  
Robert A. Arciero
Keyword(s):  
Anterior Instability ◽  
Open Stabilization
Sign in / Sign up

Export Citation Format

Share Document