Is it time to get ‘on-track’ with 3D printing for recurrent shoulder instability?

2021 ◽  
Author(s):  
Zachary S Aman ◽  
Travis J Dekker ◽  
Filippo Familiari ◽  
Robert F LaPrade ◽  
Nicholas N DePhillipo
Keyword(s):  
3D Printing ◽  
Shoulder Instability ◽  
Recurrent Shoulder Instability

scholarly journals Open Capsulorrhaphy for Recurrent Multidirectional Instability of the Shoulder

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542110071
Author(s):  
Ioanna K. Bolia ◽  
Rebecca Griffith ◽  
Nickolas Fretes ◽  
Frank A. Petrigliano
Keyword(s):  
Shoulder Instability ◽  
Return To Sport ◽  
Young Female ◽  
Subscapularis Tendon ◽  
Shoulder Stabilization ◽  
Ehlers Danlos Syndrome ◽  
Physically Active ◽  
Recurrent Shoulder Instability ◽  
Multidirectional Instability

Background: The management of multidirectional instability (MDI) of the shoulder remains challenging, especially in athletes who participate in sports and may require multiple surgical procedures to achieve shoulder stabilization. Open or arthroscopic procedures can be performed to address shoulder MDI. Indications: Open capsulorrhaphy is preferred in patients with underlying tissue hyperlaxity and who had 1 or more, previously failed, arthroscopic shoulder stabilization procedures. Technique Description: With the patient in the beach-chair position (45°), tissue dissection is performed to the level of subscapularis tendon via the deltopectoral approach. The subscapularis tenotomy is performed in an L-shaped fashion, and the subscapularis tendon is tagged with multiple sutures and mobilized. Careful separation of the subscapularis tendon from the underlying capsular tissue is critical. Capsulotomy is performed, consisting of a vertical limb and an inferior limb that extends to the 5 o’clock position on the humeral neck (right shoulder). After evaluating the integrity of the labrum, the capsule is shifted superiorly and laterally, and repaired using 4 to 5 suture anchors. The redundant capsule is excised, and the subscapularis tendon is repaired in a side-to-side fashion, augmented by transosseous equivalent repair using the capsular sutures. Results: Adequate shoulder stabilization was achieved following open capsulorrhaphy in a young female athlete with tissue hyperlaxity and history of a previously failed arthroscopic soft tissue stabilization surgery of the shoulder. The athlete returned to sport at 6 months postoperatively and did not experience recurrent shoulder instability episodes at midterm follow-up. Discussion/Conclusion: Based on the existing literature, 82% to 97% of patients who underwent open capsulorrhaphy for MDI had no recurrent shoulder instability episodes at midterm follow-up. One study reported 64% return-to-sport rate following open capsulorrhaphy in 15 adolescent athletes with Ehlers-Danlos syndrome, but more research is necessary to better define the indications and outcomes of this procedure in physically active patients.

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

2021 ◽  
Vol 37 (1) ◽  
pp. e23
Author(s):  
Nikhil N. Verma ◽  
Joseph Liu ◽  
Ani Gowd ◽  
Grant Garcia ◽  
Alexander Beletsky ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Return To Sport ◽  
Latarjet Procedure ◽  
Recurrent Shoulder Instability

Recurrent Shoulder Instability: Current Concepts for Evaluation and Management of Glenoid Bone Loss

2010 ◽  
Vol 92 (Suppl 2) ◽  
pp. 133-151 ◽  
Author(s):  
CDR Matthew T Provencher ◽  
Sanjeev Bhatia ◽  
Neil S Ghodadra ◽  
Robert C Grumet ◽  
Bernard R Bach ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Glenoid Bone Loss ◽  
Recurrent Shoulder Instability

scholarly journals Recurrence Rates Following Arthroscopic Shoulder Stabilization are Improved Following a Criteria Based Return to Sport Testing Protocol

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0038
Author(s):  
Adam Popchak ◽  
Kevin Wilson ◽  
Gillian Kane ◽  
Albert Lin ◽  
Mauricio Drummond
Keyword(s):  
Shoulder Instability ◽  
Return To Sport ◽  
Return To Play ◽  
Return To Sports ◽  
Recurrence Rates ◽  
Shoulder Stabilization ◽  
Recurrent Instability ◽  
Testing Protocol ◽  
Recurrent Shoulder Instability ◽  
Arthroscopic Shoulder Stabilization

Objectives: Recurrent shoulder instability after arthroscopic shoulder stabilization is a challenging complication that often manifests after return to sports. Many physicians use an arbitrary minimum of 5 months from surgery for clearance, although there is little data to support the use of temporal based criteria. Prior literature on ACL reconstruction has demonstrated overwhelming evidence for improved failure rates following return to sport after criteria based testing compared to time based clearance, but no such studies to date have evaluated the use of objective return to play testing protocols on recurrence rates following arthroscopic shoulder stabilization. We have prior presented on a return to sport criteria-based protocol that has demonstrated that a majority of athletes have residual strength and functional limitations which would preclude them from full clearance and return to play at 6 months postoperatively. The purpose of this study is to analyze the impact of a return to play criteria-based testing protocol on recurrent instability following arthroscopic shoulder stabilization. We hypothesized that patients who meet return to play criteria would have less recurrent instability compared to those who did not undergo the testing and were cleared to return based on time from surgery. Methods: Forty eight patients (group I) who underwent arthroscopic shoulder stabilization surgery from 2016 to 2018 with minimum 1 year follow up and were referred during postoperative rehabilitation for functional testing to evaluate readiness for return to sport were included in this retrospective case controlled study. These patients were compared to a control group of forty-eight historical consecutive cases (group II) who did not undergo return to sports testing and were cleared for sports after a minimum of 5 months following surgery. Patients with critical glenoid bone loss or off-track Hill-Sach’s lesions necessitating a remplissage or bone augmentation procedure were excluded from the study. ANOVA and independent t test were performed to analyze recurrence shoulder instability rates defined as dislocations or subluxation symptoms. Results: There was no difference between groups with regard to age ( p=0.64), sex (p=0.24), hand dominance (p=0.84), or participation in contact sports (p=0.66). Patients who underwent return to play criteria based testing protocol had a statistically significant difference in the rate of recurrent shoulder instability (10% vs. 31%, odds ratio=3.9, p<0.001). Conclusion: Athletes who undergo an objective return to play criteria based testing protocol have lower rates of recurrent instability following arthroscopic shoulder stabilization surgery than those cleared by time from surgery. Based on our findings, we strongly recommend the utilization of a criteria based testing protocol for return to play following arthroscopic shoulder stabilization, particularly for sports that have known higher risks of recurrence.

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