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Clin Orthop Relat Res 2021 04 30. Epub 2021 Apr 30.

R. M. Greiwe, OrthoCincy Orthopaedics and Sports Medicine, St. Elizabeth Healthcare, Edgewood, KY, USA.

Background: Traditional total shoulder arthroplasty is performed through the deltopectoral approach and includes subscapularis release and repair. Subscapularis nonhealing or dysfunction may leave patients with persistent pain, impairment, and instability. Alternative approaches that spare the subscapularis include rotator interval and posterior shoulder approaches; however, to our knowledge, a cadaveric study describing pertinent surgical anatomy for a posterior shoulder approach regarding shoulder arthroplasty has not been performed. Read More

Orthop Traumatol Surg Res 2021 Apr 28:102949. Epub 2021 Apr 28.

Kansas City University of Medicine and Biosciences, Missouri, USA.

Introduction: Recurrent shoulder instability is frequently associated with glenohumeral bone loss. Recently there has been a surge of interest in arthroscopically performed bone block procedures. The aim of this systematic review was to determine the clinical and radiological outcomes of arthroscopic glenoid bone block stabilisation for recurrent anterior dislocation. Read More

Indian J Orthop 2021 Apr 4;55(2):285-298. Epub 2021 Mar 4.

Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, 1611 W. Harrison Street, Suite 300, Chicago, IL 60612 USA.

Background: Shoulder instability exists on a spectrum ranging from subtle subluxation and pain to dislocation and can be the result of a traumatic event or repetitive microtrauma. Shoulder instability can result in significant disability and often requires surgical intervention, especially amongst younger, active patient populations. The optimal treatment of shoulder instability depends on the degree of instability and concomitant pathology involving the labrum, capsule, and bony anatomy of the glenoid and humeral head. Read More

Arthroscopy 2021 May;37(5):1397-1399

IRCCS Humanitas Research Hospital.

The recurrence of shoulder instability is a challenging complication after anterior open or arthroscopic stabilization in patients with glenohumeral instability. Use of the arthroscopic Bankart procedure has increased over the last decade, because of its less invasiveness and low complication rates compared with the Latarjet procedure. However, arthroscopic repair has the possibility of a greater recurrent instability rate. Read More

Orthop Traumatol Surg Res 2021 Apr 22:102943. Epub 2021 Apr 22.

Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, P.O. Box 1777, 70211 Kuopio, Finland.

Background: This retrospective study investigated 5-year results of primary arthroscopic operation for anterior glenohumeral instability (AI) with special interest in patients aged <25 years and gender.

Hypothesis: Recurrence of AI is higher in male patients aged <25 years than older patients or females.

Patients And Methods: Primary arthroscopic Bankart repair was performed between January 2009 and December 2015 on 156 shoulders [154 patients, 104/156 (67%) males]. Read More

J Shoulder Elbow Surg 2021 Apr 22. Epub 2021 Apr 22.

Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA.

Background: The biomechanical relationship between irreparable rotator cuff tear size and glenohumeral joint stability in the setting of superiorly directed forces has not been characterized. The purpose of this study was to quantify kinematic alterations of the glenohumeral joint in response to superiorly directed forces in a progressive posterosuperior rotator cuff tear model.

Methods: Nine fresh-frozen cadaveric shoulders (mean age; 58 years) were tested with a custom shoulder testing system. Read More

Clin J Sport Med 2021 Mar 1. Epub 2021 Mar 1.

Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; Department of Orthopedic Surgery, Sierra Pacific Orthopedics, Fresno, California; and Department of Orthopedic Surgery, Pan Am Clinic, Winnipeg, MB, Canada.

Objective: To report the injury characteristics, radiographic findings, and long-term outcomes of nonoperative management for posterior shoulder instability (PSI).

Design: A retrospective review of 143 patients with PSI using a large geographic database.

Setting: Single county between January 1994 and July 2012. Read More

J Orthop Surg Res 2021 Apr 13;16(1):255. Epub 2021 Apr 13.

Department of Clinical Biomechanics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.

Background: Significant bone defects are associated with poor clinical results after surgical stabilization in cases of glenohumeral instability. Although multiple factors are thought to adversely affect enlargement of bipolar bone loss and increased shoulder instability, these factors have not been sufficiently evaluated. The purpose of this study was to identify the factors related to greater bone defects and a higher number of instability episodes in patients with glenohumeral instability. Read More

Knee Surg Sports Traumatol Arthrosc 2021 Apr 11. Epub 2021 Apr 11.

Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany.

Purpose: Surgical treatment of shoulder instability caused by anterior glenoid bone loss is based on a critical threshold of the defect size. Recent studies indicate that the glenoid concavity is essential for glenohumeral stability. However, biomechanical proof of this principle is lacking. Read More

Arthroscopy 2021 Mar 31. Epub 2021 Mar 31.

Department of Trauma and Orthopaedics, "Carlos E. Ottolenghi" Institute, Hospital Italiano de Buenos Aires, Juan D. Perón 4190 (C1181ACH) Buenos Aires, Argentina.

Purpose: There were two main purposes in this study: (1) To report on clinical outcomes of the Latarjet procedure without remplissage in athletes with a glenoid bone defects > 25% and off-track hill sachs lesions and (2) To determine if the isolated Latarjet procedure converted off-track Hill Sachs lesions to on-track Hill Sachs lesions as measured on CT.

Methods: During the study period, a total of 29 athletes with anterior glenohumeral instability with a glenoid bone defect> 25% and Off-Track Hill Sachs lesions who underwent a Latarjet surgery, with a minimum follow-up of 24 months were included in this study. Glenoid tracking was analyzed before and at 3 months after the procedure using a three dimensional computed tomography (3DCT) . Read More

Rev Esp Cir Ortop Traumatol 2021 Mar 24. Epub 2021 Mar 24.

Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.

Introduction: Arthroscopic stabilization is a well-recognized surgical technique with a variable rate of failure reported between 0-35%. The aim of this study was to evaluate the outcome of this technique and our second aim was to identify risk factors that could be associated to recurrence rate.

Material And Methods: 41 patients that underwent arthroscopic shoulder stabilization for glenohumeral instability between 2001-2015 were included. Read More

Arthrosc Tech 2021 Mar 15;10(3):e781-e787. Epub 2021 Feb 15.

The Steadman Clinic, Vail, Colorado, U.S.A.

Traumatic posterior dislocations of the shoulder can result in bony defects, labral tears, and cartilage injuries of the glenohumeral joint. Although traditional Hill-Sachs lesions from anterior dislocations are more commonly identified, reverse Hill-Sachs lesions caused by posterior dislocation often leads to recurrent engagement of the humeral head with the glenoid and significantly greater damage to the humeral chondral surface. In severe traumatic cases, concomitant damage of the capsulolabral soft tissues, such as circumferential labral lesions, can lead to chronic shoulder instability and residual glenoid bone loss. Read More

Arthrosc Tech 2021 Mar 2;10(3):e653-e658. Epub 2021 Feb 2.

Department of Surgery, Faculty of Medicine, Dalhousie University, Nova Scotia, Canada.

Humeral avulsion of the glenohumeral ligament (HAGL) is a rare cause of anterior shoulder instability. Recurrent instability and anterior shoulder pain could be caused by an unrepaired HAGL; therefore, making the diagnosis is crucial. Only a few articles describe arthroscopic HAGL repair. Read More

Clin Orthop Relat Res 2021 04;479(4):694-700

D. J. Tennent, K. L. Cameron, M. A. Posner, J. F. Dickens, John A. Feagin Jr. Orthopaedic Sports Medicine Fellowship at West Point, West Point, NY, USA.

Background: In-season return to play after anterior glenohumeral instability is associated with high rates of recurrent instability and the need for surgical stabilization. We are not aware of previous studies that have investigated in-season return to play after posterior glenohumeral instability; furthermore, as posterior shoulder instability in collision athletes occurs frequently, understanding the expected outcome of in-season athletes may improve the ability of physicians to provide athletes with a better understanding of the expected outcome of their injury and their ability to return to sport.

Questions/purposes: (1) What proportion of athletes returned to play during the season after posterior instability in collegiate football players? (2) How much time did athletes lose to injury, what proportion of athletes opted to undergo surgery, and what proportion of athletes experienced recurrent instability after a posterior instability episode during a collegiate football season?

Methods: A multicenter, prospective, observational study of National Collegiate Athletic Association (NCAA) Division 1 Football Bowl Subdivision athletes was performed at three US Military Service Academies. Read More

Cureus 2021 Feb 10;13(2):e13254. Epub 2021 Feb 10.

Orthopaedics and Traumatology, Department of Orthopaedics, Memorial Ankara Hospital, Ankara, TUR.

Arthroscopic capsulolabral repair is a well-established surgical treatment for traumatic anterior shoulder instability. When there is insufficient labral tissue during arthroscopic primary or revision Bankart repairs, various soft tissue procedures have been recommended. All these procedures aim to reattach glenohumeral ligaments to the glenoid rim and regain the tight anterior structures to prevent re-dislocation or subluxation. Read More

J Shoulder Elbow Surg 2021 Mar 9. Epub 2021 Mar 9.

Department of Orthopaedic Surgery, Akaishi Hospital, Shiogama, Japan.

Background: Although coracoid transfers including the modified Bristow and Latarjet procedures are widely used to treat anterior shoulder instability, the influence of the choice of procedure on the biomechanical outcomes is not well characterized. We aimed to clarify the intraarticular stress distribution following these two procedures using three-dimensional finite element analysis and to investigate the role of stress distribution in the pathophysiology of postoperative complications.

Methods: Overall, 6 male patients aged 17-47 years with unilateral anterior shoulder instability were recruited. Read More

Musculoskelet Surg 2021 Mar 8. Epub 2021 Mar 8.

Orthopaedic and Traumatology Department, University of Modena and Reggio Emilia Policlinico Di ModenaVia del Pozzo 71, 41124, Modena, Italy.

Purpose: Chronic anterior shoulder dislocation represents a rare condition, and there is still lack of consensus in its treatment. Purpose of this study is to evaluate the clinical and radiological outcome of painful locked dislocation underwent shoulder replacement, with a minimum follow-up of two years. Second endpoint is to assess the glenoid bone graft, harvested from the humeral head. Read More

Asia Pac J Sports Med Arthrosc Rehabil Technol 2021 Apr 18;24:41-48. Epub 2021 Feb 18.

Senior Consultant, Department of Orthopedic Surgery, Sports Service, Singapore General Hospital, Singapore.

Introduction: Significant glenoid bone loss contributes to recurrent anterior shoulder instability. Reconstruction using an iliac crest bone graft provides an anatomic restoration of the glenohumeral arc. We present a case series of an all-arthroscopic glenoid bone reconstruction using iliac crest bone graft (ICBG) with a double cannulated screw fixation technique. Read More

Arthrosc Tech 2021 Feb 24;10(2):e341-e351. Epub 2021 Feb 24.

Department of Orthopaedic Surgery, Boston University Medical School and Medical Center, Boston, Massachusetts.

Posterior glenohumeral instability is a relatively uncommon cause of shoulder instability. Recurrent posterior instability with static posterior humeral head subluxation is often associated with critical glenoid bone loss. Unlike anterior instability, the amount of bone loss for posterior instability that requires surgical reconstruction remains a topic of debate. Read More

Arthroscopy 2021 03;37(3):843-844

Anaconda, Montana.

Over the past 3 decades, arthroscopic Bankart repair has become the gold standard for anterior shoulder instability in the absence of significant bone loss. Glenoid curettage may seem unusual in the setting of Bankart repair, but the advantage of a bleeding bony surface in reconstructive procedures is nearly universal in sports medicine, from cartilage restoration in the knee to rotator cuff repair. Intuitively, maximizing the surface of bleeding bone should improve healing, but is it really necessary to remove undamaged cartilage to create a healing response? Perhaps not in general, but in high-risk patients with subcritical bone loss curettage it could make sense. Read More

Arthrosc Sports Med Rehabil 2021 Feb 26;3(1):e163-e170. Epub 2020 Dec 26.

Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.

Purpose: To compare the differences in preoperative pathology, surgical technique, and overall outcomes between patients treated surgically after a single anterior glenohumeral joint dislocation and those undergoing surgery after multiple dislocations.

Methods: An epidemiologic database was used to identify all patients younger than 40 years undergoing surgery for anterior shoulder instability between January 1, 1994, and July 31, 2016, in a defined geographic area. Patient medical records were reviewed to obtain demographic information, patient history, physical examination findings, imaging findings, clinical progression, surgical details, and outcomes. Read More

Am J Sports Med 2021 03 19;49(4):866-872. Epub 2021 Feb 19.

Department of Orthopedics and Traumatology, Prof. Dr. Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina.

Background: There is a lack of evidence in the literature comparing outcomes between the arthroscopic Bankart repair and the Latarjet procedure in competitive rugby players with glenohumeral instability and a glenoid bone loss <20%.

Purpose: To compare return to sport, functional outcomes, and complications between the arthroscopic Bankart repair and the Latarjet procedure in competitive rugby players with glenohumeral instability and a glenoid bone loss <20%.

Study Design: Cohort study; Level of evidence, 3. Read More

Int J Sports Phys Ther 2021 Feb 1;16(1):259-269. Epub 2021 Feb 1.

Steadman Philippon Research Institute; The Steadman Clinic.

The Latarjet procedure with transfer of the coracoid process and its attached conjoint tendon is a well-established surgical technique for the treatment of anterior glenohumeral instability in patients with anteroinferior bone loss and/or high risk for recurrence. Biomechanical and clinical studies have shown excellent results and high rates of return to sports. However, there is an absence of standardized, objective criteria to accurately assess an athlete's ability to progress through each phase of rehabilitation. Read More

JBJS Case Connect 2021 02 17;11(1). Epub 2021 Feb 17.

Department of Orthopaedic Surgery, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.

Cases: Three patients (age, 15-34 years) who had a history of chronic traumatic anteroinferior glenohumeral instability (2-10 dislocations) and preoperatively documented Bankart and Hill-Sachs lesions underwent all-arthroscopic trans-subscapular transposition of the long head of the biceps that was fixed on the anteroinferior glenoid using a novel double double-pulley all-suture anchor method that has not been reported previously.

Conclusion: Excellent 12-month clinical and imaging outcomes, with substantial improvements in the Western Ontario Shoulder Index and the Rowe score in the first consecutive patients who underwent this original technical variant of dynamic anterior stabilization and the surgical pearls and pitfalls are described in detail. Read More

Acta Orthop Belg 2020 Sep;86(3):497-501

The Latarjet procedure alters scapulothoracic motion by releasing the pectoralis minor insertion to the coracoid process and by changing the vector of the conjoint tendon. The purpose of this study is to evaluate the feasibility of retaining the pectoralis minor insertion and a part of the conjoint tendon on to the remainder of the coracoid, and to evaluate the efficiency of the procedure in avoiding scapular dyskinesis, without concessions to glenohumeral stability. Since June 2017, a modification to the Latarjet procedure has been used in the treatment of posttraumatic anterior shoulder instability. Read More

Arthrosc Tech 2021 Jan 20;10(1):e103-e116. Epub 2021 Jan 20.

Shoulder Unit, Department of Orthopedic and Trauma Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain.

Posterior shoulder dislocations are an uncommon cause of glenohumeral instability; they are frequently missed and are associated with humeral head defects and capsulolabral lesions. Despite surgical treatment often being mandatory, there is still no standardized treatment for anterior impaction fractures of the humeral head (reverse Hill-Sachs lesions). Arthroscopic surgery is typically indicated, with a tendency toward resorting to knotless techniques in recent years. Read More

Mil Med 2021 Feb 1. Epub 2021 Feb 1.

Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, GA, 30912, USA.

Anterior glenohumeral instability is an increasingly common injury among young military servicemen. First-time dislocations occurring in combination with anterior labral tears and humeral avulsion of glenohumeral ligament lesions, although rare, significantly contribute to further shoulder dysfunction with recurrent instability and pain. Tears of the pectoralis major are also a type of injury more common in the military population, with operative management resulting in decreased strength. Read More

World J Orthop 2021 Jan 18;12(1):1-13. Epub 2021 Jan 18.

Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY 10021, United States.

The glenohumeral joint (GHJ) allows for a wide range of motion, but is also particularly vulnerable to episodes of instability. Anterior GHJ instability is especially frequent among young, athletic populations during contact sporting events. Many first time dislocators can be managed non-operatively with a period of immobilization and rehabilitation, however certain patient populations are at higher risk for recurrent instability and may require surgical intervention for adequate stabilization. Read More

Arch Orthop Trauma Surg 2021 Jan 24. Epub 2021 Jan 24.

AUVA Trauma Centre Vienna Meidling, Kundratstraße 37, A-1120, Vienna, Austria.

Introduction: With the help of a J-shaped bicortical iliac crest bone graft, the morphology of the glenoid can be augmented without having to use screws to achieve glenohumeral stability. The aim of this retrospective clinical study was to evaluate the clinical stability and function of the shoulder joint as well as the radiological remodelling process and arthropathic outcomes following the J-bone graft technique.

Materials And Methods: 34 patients with recurrent shoulder dislocations and bony glenoid defects were treated with the J-bone graft technique between 2010 and 2018 at our level-I trauma centre. Read More

Musculoskelet Surg 2021 Jan 20. Epub 2021 Jan 20.

Orthopaedic Hospital of Valdoltra, Jadranska cesta 31, 6280, Ankaran, Slovenia.

Purpose: Evaluate complications in correlation with radiological findings after an open Latarjet procedure performed on 140 shoulders with recurrent anterior instability with follow-up from 8 to 174 months.

Methods: Retrospectively, 140 shoulders, diagnosed with recurrent anterior glenohumeral instability, which were surgically treated with the open Latarjet procedure in our hospital, between January 2004 and November 2017, had been analysed. Mean age of operated patients was 29. Read More