Assessment of Capsular Insertion Type and of Capsular Elongation in Patients with Anterior Shoulder Instability and It's Correlation with Surgical Outcome: A Quantitative Assessment with Computed Tomography Arthrography

Abstract BackgroundGenerally, the treatment of recurrent anterior shoulder instability is a challenge in the orthopedics with various treatment methods. There is a high recurrence rate for those patients with high activity and glenoid bone lesion less than 20% after Bankart procedure. The authors present a novel surgical technique using autologous osteochondral transplantation (AOT) method for recurrent anterior shoulder instability.MethodsBetween 2019 to 2021, 7 patients (five man and two women; mean age 35.1 years (range 17–55 years)) with recurrent anterior shoulder instability and glenoid bone lesion of 20% or less were treated with AOT method. All patients were available for follow-up at a mean of 25.4 months (range, 16 to 32 months), including Rowe score, Oxford Shoulder Score (OSS), Simple Shoulder Test (SST), and 3-dimensional computed tomography examination.ResultsThe mean preoperative and postoperative Rowe score were calculated to be 25.7 ± 6.7 (range, 20–35) and 90.6 ± 2.4 (range, 85–95), respectively (p < 0.01). The mean preoperative and postoperative Oxford score were 36.4 ± 5.6 (range, 30–40) and 54.6 ± 2.4 (range, 50–57), respectively (p < 0.01). The mean preoperative and postoperative SST score were 6.9 ± 0.7 (range, 6–8) and 11.5 ± 0.7 (range, 11–12), respectively (p < 0.01). The average final forward flexion was 176° (affected shoulder), compared with 177° on the non-affected shoulder (P = 0.81). The average final abduction in external rotation was 86.6° (affected shoulder), compared with 89° on the non-affected shoulder (P = 0.31). Analysis of Computed Tomography (CT) data at an average 1 years postoperative showed that a mean glenoid bony gain of 16.7% was observed (range, 11.2%-19%, SD 3.6).ConclusionThis technique can be a useful option, particularly in patients with glenoid bone defect less than 20%. In addition, AOT technique may be considered as alternative to the Latarjet procedure. Nonetheless, further biomechanical and clinical studies are needed to determine the effect of this procedure to more commonly utilized techniques.Level of EvidenceLevel IV; Case series

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Evaluation of the Clinical Significance of Classification of Traumatic Anterior Shoulder Instability Using Double-Contrast Computed Tomography Arthrography

Journal of International Medical Research ◽

10.1177/147323001103900210 ◽

2011 ◽

Vol 39 (2) ◽

pp. 424-434 ◽

Cited By ~ 3

Author(s):

YD Hao ◽

F Cui ◽

WH Zhu ◽

LY Lu ◽

YB Wang

Keyword(s):

Computed Tomography ◽

Clinical Significance ◽

Shoulder Instability ◽

Anterior Shoulder Instability ◽

Double Contrast

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Recurrent anterior shoulder instability: accuracy of estimations of glenoid bone loss with computed tomography is insufficient for therapeutic decision-making

Skeletal Radiology ◽

10.1007/s00256-011-1184-5 ◽

2011 ◽

Vol 40 (10) ◽

pp. 1329-1334 ◽

Cited By ~ 25

Author(s):

Polydoor Emile Huijsmans ◽

Pieter Bas de Witte ◽

Richard V. P. de Villiers ◽

Derk Willem Wolterbeek ◽

Piet Warmerdam ◽

...

Keyword(s):

Computed Tomography ◽

Decision Making ◽

Bone Loss ◽

Shoulder Instability ◽

Glenoid Bone Loss ◽

Anterior Shoulder Instability ◽

Therapeutic Decision ◽

Therapeutic Decision Making ◽

Recurrent Anterior Shoulder Instability

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Computed Tomography Features of Glenoid Osteophytes in Traumatic Anterior Shoulder Instability: Comparison Between Younger and Older Patients

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119846908 ◽

2019 ◽

Vol 7 (5) ◽

pp. 232596711984690

Author(s):

Takehito Hirose ◽

Shigeto Nakagawa ◽

Seira Sato ◽

Yuta Tachibana ◽

Tatsuo Mae

Keyword(s):

Computed Tomography ◽

Shoulder Instability ◽

Early Onset ◽

Older Patients ◽

Late Onset ◽

Anterior Shoulder Instability ◽

Level Of Evidence ◽

Cross Sectional ◽

Younger Patients ◽

Dislocation Arthropathy

Background: Osteoarthritis that develops after traumatic anterior shoulder instability is known as dislocation arthropathy, but its frequency and characteristics are still unclear. Purpose: To evaluate glenoid osteophytes in shoulders with traumatic anterior instability by using computed tomography (CT) and to elucidate the influence of instability on the progression of dislocation arthropathy in different age groups. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study involved 214 unoperated patients with unilateral instability who underwent CT of both shoulders. The patients were divided into 2 groups according to age at the time of CT: ≤30 years (younger group; n = 172) and ≥31 years (older group; n = 42). Patient demographics as well as the presence, size, and location of glenoid osteophytes were compared between the 2 groups and also between patients with and without osteophytes. Furthermore, patients with osteophytes in the older group were divided into 2 subgroups according to age at the time of the initial injury: as a teenager (early-onset subgroup; n = 9) or at ≥31 years (late-onset subgroup; n = 14), and the same assessments were conducted. Results: Osteophytes were significantly more frequent on the affected side of the older group compared with the younger group (71.4% vs 13.9%, respectively; P < .001). In the younger group, patients with osteophytes had more multiple-instability events ( P = .002) and a longer interval from injury to CT ( P < .001) than those without osteophytes. Although there was no difference in osteophyte size between the 2 groups, most osteophytes were located at the anteroinferior part of the glenoid in the younger group, while osteophytes were usually circumferential around the glenoid in the older group. A comparison between the early- and late-onset subgroups in older patients with osteophytes revealed that the osteophytes were more frequently located at the anteroinferior glenoid region in the early-onset subgroup. Conclusion: CT allowed a detailed evaluation of glenoid osteophytes, revealing that osteophytes were not uncommon in younger patients. Instability itself might influence the progression of osteoarthritic changes in younger patients, while aging seems to have a greater effect in older patients.

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Arthroscopic Anatomic Glenoid Reconstruction Using Distal Tibial Allograft for Recurrent Anterior Shoulder Instability: Clinical and Radiographic Outcomes

The American Journal of Sports Medicine ◽

10.1177/0363546520960119 ◽

2020 ◽

Vol 48 (13) ◽

pp. 3316-3321

Author(s):

Ivan Wong ◽

Rakesh John ◽

Jie Ma ◽

Catherine M. Coady

Keyword(s):

Computed Tomography ◽

Bone Loss ◽

Shoulder Instability ◽

Anterior Shoulder Instability ◽

Reconstruction Technique ◽

Arthroscopic Stabilization ◽

Computed Tomography Scans ◽

The Mean ◽

Glenoid Reconstruction

Background: The all-arthroscopic anatomic glenoid reconstruction technique using a distal tibial allograft avoids damage to the subscapularis muscle and allows repair of the capsulolabral tissue. Purpose: To analyze the clinicoradiologic outcomes of patients who underwent this procedure to treat anterior shoulder instability with glenoid bone loss with a minimum 2-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: Over 6 years, 73 patients (52 male and 21 female; mean age, 28.8 years) under the care of the same surgeon underwent arthroscopic stabilization with capsulolabral Bankart repair and bony allograft augmentation of the glenoid for recurrent shoulder instability with significant bone loss. Pre- and postoperative patient-reported functional assessment was performed using 2 questionnaires, the Western Ontario Shoulder Instability Index (WOSI) and the Disabilities of the Arm, Shoulder and Hand, and radiological assessment was performed using radiographs and computed tomography scans obtained preoperatively and approximately 1 year later (mean ± SD, 0.9 ± 1.1 years). Results: The mean follow-up was 4.7 ± 1.1 years. The mean pre- and postoperative WOSI scores were 71.1 ± 17.5 and 25.6 ± 21.9, respectively ( P < .001). There were no recurrences of dislocation, although 1 patient had symptoms of subluxation; however, 5 patients had hardware complications that required screw removal. There were no cases of nerve injury. Postoperative computed tomography scans were available for 66 patients. Seven patients were lost to follow-up. The graft union rate was 100%. Overall, graft resorption was <50% in 86% of patients (57/66). Eighteen patients (27%) had no resorption (grade 0), 39 (59%) had <50% (grades 1 and 2), and 9 (14%) had ≥50% (grade 3); however, none had symptoms of instability. The mean alpha angle of the screw between the screw shaft axis and the native glenoid axis was 18.3°± 5.7°. Graft positioning was flush with the glenoid in 61 of 66 patients (92.4%), and vertical positioning was excellent in 64 of 66 patients (97.0%) (3- to 5-o’clock position). Conclusion: Arthroscopic stabilization using distal tibial allograft augmentation resulted in excellent clinicoradiologic outcomes at a 2-year follow-up. This procedure has the advantages of being an anatomic reconstruction that addresses bony and soft tissue instability. However, long-term follow-up studies are necessary for better assessment of outcomes.

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