Shoulder Instability
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2021 ◽  
pp. 036354652110423
Author(s):  
Chul-Hyun Cho ◽  
Sang Soo Na ◽  
Byung-Chan Choi ◽  
Du-Han Kim

Background: In cases of recurrent anterior shoulder instability with a glenoid defect, Latarjet procedures are widely used for stabilization. Although complications with this procedure have been reported, few studies have comprehensively analyzed issues related to the Latarjet procedure. Purpose: To identify the overall complication rate of the Latarjet procedure used for anterior shoulder instability and to compare the rate of complications between arthroscopic and open approaches. Study Design: Systematic review; Level of evidence, 4. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed by using the PubMed, EMBASE, Scopus, and Cochrane Library databases. Data on complications were extracted and classified as intraoperative, postoperative, or instability-related for further analysis. Quality assessments were performed with criteria from the Methodological Index for Nonrandomized Studies (MINORS). A quantitative synthesis of data was conducted to compare the complication rates between arthroscopic and open approaches. Results: A total of 35 articles were included in this analysis. The MINORS score was 11.89. A total 2560 Latarjet procedures (2532 patients) were included. The overall complication rate was 16.1% (n = 412). The intraoperative complication rate was 3.4% (n = 87) and included a 1.9% (n = 48) incidence of nerve injuries and a 1.0% (n = 25) incidence of iatrogenic fractures. Screw problems, vascular injuries, and conversion arthroscopic to open surgery each occurred at a rate of <1%. The postoperative complication rate was 6.5% (n = 166), and the most common complication was nonunion (1.3%; n = 33). The instability-related complication rate was 6.2% (n = 159) and included a 1.5% (n = 38) rate of redislocation, a 2.9% (n = 75) rate of positive apprehension test, and a 1.0% (n = 26) rate of instability. Overall, 2.6% (n = 66) of patients required an unplanned secondary operation after the initial surgery. The arthroscopic approach was associated with a higher rate of intraoperative complications compared with the open approach (5.0% vs 2.9%; P =.020) and a lower rate of instability-related complications (3.1% vs 7.2%; P < .001). Conclusion: The Latarjet procedure for anterior shoulder instability results in an overall complication rate of 16.1% and a reoperation rate of 2.6%. However, serious complications at short-term follow-up appear rare. When the arthroscopic approach was used, the rate of intraoperative complications was higher, although instability-related complications were lower when compared with the open approach.


2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110269
Author(s):  
Khalid AlSomali ◽  
Erica Kholinne ◽  
Thanh Van Nguyen ◽  
Chang-Ho Cho ◽  
Jae-Man Kwak ◽  
...  

Background: Open Bankart repair provides surgeons and patients with an alternative solution for managing recurrent instability in young athletes with or without minimal bone loss. Despite many studies that have reported low recurrence rates and good functional outcomes after open Bankart repair, we have limited knowledge about the return to sport and work for high-demand populations. Purpose: To assess the return to sport and work for high-demand populations after open Bankart repair for recurrent anterior shoulder instability, outcomes of open Bankart repair with regard to recurrence, and development of osteoarthritic (OA) changes. Study Design: Systematic review; Level of evidence, 4. Methods: We searched PubMed, EMBASE, Cochrane Library, Scopus, and Google Scholar databases using keywords as well as Medical Subject Headings terms and Emtree using “(Open Bankart OR Bankart surgery) (NOT arthroscopy NOT revision)” for English-language studies. We conducted a systematic review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: In total, 11 articles (10 with level 4 and 1 with level 3 evidence) including 563 patients (566 shoulders) were identified. The majority of patients were male (82%), the average age at the time of surgery was 27.4 years, and the mean follow-up was 11.5 years (range, 2.5-29 years). The most common functional score used was the Rowe score (95%) for the reported outcome measures, which showed good to excellent results (mean, 88.5 points). The overall recurrent instability rate, including dislocation and subluxation as a postoperative complication, was 8.5%. A total of 87% of patients were able to return to sport and work postoperatively. Overall, OA changes were reported in 33% of the patients, and the overall revision rate was 1%. Conclusion: Open Bankart repair exhibited favorable results, with a low postoperative instability rate. It is a reliable surgical procedure that allows high-demand patients to return to sport and work.


2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110302
Author(s):  
Sunita R.P. Mengers ◽  
Derrick M. Knapik ◽  
Matthew W. Kaufman ◽  
Gary Edwards ◽  
James E. Voos ◽  
...  

Background: Few studies have compared clinical outcomes between the traditional Latarjet procedure for anterior shoulder instability and the congruent arc modification to the Latarjet procedure. Purpose: To systematically evaluate the literature for the incidence of recurrent instability, clinical outcomes, radiographic findings, and complications for the traditional Latarjet procedure and the congruent arc modification and to compare results of each search. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review and meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included studies published between January 1990 and October 2020 that described clinical outcomes of the traditional Latarjet and the congruent arc modification with a follow-up range of 2 to 10 years. The difference in surgical technique was analyzed using a chi-square test for categorical variables, while continuous variables were evaluated using a Student t test. Results: In total, 26 studies met the inclusion criteria: 20 studies describing the traditional Latarjet procedure in 1412 shoulders, and 6 studies describing the congruent arc modification in 289 shoulders. No difference between procedures was found regarding patient age at surgery, follow-up time, Rowe or postoperative visual analog scores, early or late complications, return-to-sport timing, or incidence of improper graft placement or graft fracture. A significantly greater proportion of male patients underwent glenoid augmentation using the congruent arc modification versus traditional Latarjet ( P < .001). When comparing outcomes, the traditional Latarjet procedure demonstrated a lower incidence of fibrous union or nonunion ( P = .047) and broken, loose, or improperly placed screws ( P < .001), and the congruent arc modification demonstrated improved outcomes with regard to overall return to sport ( P < .001), return to sport at the same level ( P < .001), incidence of subluxation ( P = .003) or positive apprehension ( P = .002), and revision surgery for recurrent instability ( P = .027). Conclusion: Outcomes after the congruent arc modification proved at least equivalent to the traditional Latarjet procedure in terms of recurrent instability and return to sport, although early and late complications were equivalent. The congruent arc procedure may be an acceptable alternative to traditional Latarjet for the treatment of anterior shoulder instability with glenoid bone loss; however, long-term outcomes of this procedure are needed.


2021 ◽  
pp. bjsports-2021-104028
Author(s):  
Juha Kukkonen ◽  
Sami Elamo ◽  
Tapio Flinkkilä ◽  
Juha Paloneva ◽  
Miia Mäntysaari ◽  
...  

ObjectivesTo compare the success rates of arthroscopic Bankart and open Latarjet procedure in the treatment of traumatic shoulder instability in young males.DesignMulticentre randomised controlled trial.SettingOrthopaedic departments in eight public hospitals in Finland.Participants122 young males, mean age 21 years (range 16–25 years) with traumatic shoulder anteroinferior instability were randomised.InterventionsArthroscopic Bankart (group B) or open Latarjet (group L) procedure.Main outcome measuresThe primary outcome measure was the reported recurrence of instability, that is, dislocation at 2-year follow-up. The secondary outcome measures included clinical apprehension, sports activity level, the Western Ontario Shoulder Instability Index, the pain Visual Analogue Scale, the Oxford Shoulder Instability Score, the Constant Score and the Subjective Shoulder Value scores and the progression of osteoarthritic changes in plain films and MRI.Results91 patients were available for analyses at 2-year follow-up (drop-out rate 25%). There were 10 (21%) patients with redislocations in group B and 1 (2%) in group L, p=0.006. One (9%) patient in group B and five (56%) patients in group L returned to their previous top level of competitive sports (p=0.004) at follow-up. There was no statistically significant between group differences in any of the other secondary outcome measures.ConclusionsArthroscopic Bankart operation carries a significant risk for short-term postoperative redislocations compared with open Latarjet operation, in the treatment of traumatic anteroinferior instability in young males. Patients should be counselled accordingly before deciding the surgical treatment.Trial registration numberNCT01998048.


Author(s):  
Zachary S Aman ◽  
Travis J Dekker ◽  
Filippo Familiari ◽  
Robert F LaPrade ◽  
Nicholas N DePhillipo

2021 ◽  
Author(s):  
Mingtao Zhang ◽  
Zhitao Yang ◽  
Jiaxin Liu ◽  
Yaofei Jia ◽  
Guangrui Zhang ◽  
...  

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


2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110238
Author(s):  
Eoghan T. Hurley ◽  
Martin S. Davey ◽  
Connor Montgomery ◽  
Ross O’Doherty ◽  
Mohamed Gaafar ◽  
...  

Background: In athletes with recurrent shoulder instability, arthroscopic Bankart repair (ABR) and the open Latarjet procedure (OL) are commonly indicated to restore stability and allow them to return to play (RTP). Purpose: To compare the outcomes of ABR and OL in athletes with recurrent shoulder instability. Study Design: Cohort study; Level of evidence, 3. Methods: We performed a retrospective review of patients with recurrent shoulder instability who underwent ABR and OL and had a minimum 24-month follow-up. Indications for OL over ABR in this population were those considered at high risk for recurrence, including patients with glenohumeral bone loss. The patients were pair-matched in a 1:1 ratio (OL and ABR) by age, sex, sport, and level of preoperative play. We evaluated the rate, level, and timing of RTP, and the Shoulder Instability–Return to Sport after Injury (SIRSI) score between procedures. Additionally we compared the recurrence rate, visual analog scale (VAS) pain score, Subjective Shoulder Value (SSV), Rowe score, satisfaction, and whether patients would undergo the same surgery again. Results: Participants included 62 athletes who underwent ABR and 62 who underwent OL, with a mean follow-up of 47.7 months. There was no significant difference between ABR and OL in rate of RTP, return to preinjury level, time to return, SIRSI score, VAS score, SSV, or patient satisfaction. OL resulted in a significantly lower recurrence rate (1.6% vs 16.1% for ABR; P = .009) and a significantly higher Rowe score (mean ± SD, 90.5 ± 12.2 vs 82.2 ± 20.8 for ABR; P = .008). In collision athletes, there was no significant difference between ABR and OL regarding RTP rate (89.1% vs 94.5%; P = .489) or SIRSI score (70.4 ± 24.8 vs 73.8 ± 19.6; P = .426), but OL resulted in a lower recurrence rate (14.5% vs 1.8%; P = .031). Conclusion: ABR and OL resulted in excellent clinical outcomes, with high rates of RTP in athletes. However, lower recurrence rates were seen with OL.


Author(s):  
Moritz Lebe ◽  
Sophia A. Burns ◽  
Mark Falworth ◽  
Deborah S. Higgs ◽  
Will BJ. Rudge. ◽  
...  

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Varasteh ◽  
Z Hakim

Abstract Background Traumatic anterior shoulder dislocation is associated with a high risk of shoulder instability, reduced functional outcome, and recurrence. We conducted an audit to assess the direct management, review in fracture clinic, and definitive imaging of patients with anterior shoulder instability in Southport and Formby Hospital. Aim To identify compliance with the 2015 BOA Traumatic anterior shoulder instability guidelines. Method Identified all patients from 01/01/2019 to 31/12/2019 who had shoulder dislocation coded for their diagnosis. We used imaging, scanned notes, and clinic letters where available to identify the clinical information. We excluded patients with a false diagnosis code, and those with non-local post codes from the analysis. Results We identified 67 patients who had an anterior dislocation. 88% of patients had x-rays in both AP and Lateral. We identified that 8.9% of patients had pre-reduction x-rays in AP only, 11.9% had no pre-reduction x-rays, and 1.5 % had no post reduction imaging. 79% of patients were seen in clinic within 6 weeks but only 40.3% were seen by a shoulder specialist and only 43.3% had appropriate imaging. 16.4% of patients were not given fracture clinic follow up. Conclusions Although most patients were managed acutely according to the guidelines, the follow up and subsequent investigations of these patients can be improved. One method we suggest is renaming fracture clinic days from consultant names to sub-specialty clinic names. In addition, a dedicated session to review the guideline with senior orthopedic surgeons cold improve the compliance as well.


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