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J Am Acad Orthop Surg Glob Res Rev 2022 04 12;6(4). Epub 2022 Apr 12.

From the Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI (Dr. Zhou); the Department of Orthopaedic Surgery, Fort Belvoir Community Hospital, Fort Belvoir, VA (Dr. Gee); and the John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Community Hospital, West Point, NY (Dr. Posner, and Dr. Cameron).

Introduction: Concomitant rotator cuff tear and glenohumeral instability in a large cohort of young and active patients has not been examined. The purpose of this study was to investigate the incidence, associated variables, and outcomes in military cadets undergoing shoulder stabilization procedures with these concomitant pathologies.

Methods: A retrospective cohort study of a consecutive series of collegiate patients who underwent shoulder stabilization from 2014 to 2018 at a single service academy was conducted. Read More

Orthop J Sports Med 2022 Apr 4;10(4):23259671221086615. Epub 2022 Apr 4.

Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA.

Background: Glenoid cartilage defects may contribute to anterior shoulder instability recurrence and progression to osteoarthritis, but their morphology remains unknown.

Purpose/hypothesis: The purpose was to determine the shape, size, and location of glenoid cartilage defects and the prevalence and risk factors for cartilage defects in the setting of anterior glenohumeral instability. It was hypothesized that glenoid cartilage defects would be common, would be associated with recurrence of dislocation, and would share similar morphology with glenoid osseous defects. Read More

Arthroscopy 2021 Dec 7. Epub 2021 Dec 7.

Division of Orthopaedics and Trauma Surgery; Faculty of Medicine, University of Geneva; Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland. Electronic address:

Purpose: To evaluate the short-term outcomes of the arthroscopic dynamic anterior stabilization (DAS), which is a transfer of the intra-articular portion of the long head biceps through the subscapularis split and fixation on the anterior glenoid, combined with a Bankart repair.

Methods: A retrospective evaluation was performed of DAS and a minimum of 2-year follow-up. Inclusion criteria were the presence of anteroinferior instability, a positive apprehension test at 90° of abduction and external rotation, and subcritical glenoid bone loss (less than 20%). Read More

Braz J Phys Ther 2021 Nov-Dec;25(6):883-890. Epub 2021 Nov 12.

Divisions of Rehabilitation Science and Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, United States.

Background: Clinical laxity tests are commonly used together to identify individuals with multidirectional instability (MDI). However, their biomechanical validity in distinguishing distinct biomechanical characteristics consistent with MDI has not been demonstrated.

Objective: To determine if differences in glenohumeral (GH) joint laxity exist between individuals diagnosed with multidirectional instability (MDI) and asymptomatic matched controls without MDI. Read More

Am J Sports Med 2021 11 15;49(13):3620-3627. Epub 2021 Sep 15.

Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.

Background: The Latarjet is a successful procedure but can be associated with significant complications, including failure. Iliac crest bone grafting (ICBG) is one of the salvage options for such failure.

Purpose: To analyze factors associated with failure or success to restore shoulder stability with ICBG after Latarjet failure. Read More

Clin Sports Med 2021 Oct;40(4):585-599

Department of Radiology & Imaging Sciences, Indiana University School of Medicine, 1701 N. Senate Boulevard, Indianapolis, IN 46202, USA.

The glenohumeral joint is intrinsically predisposed to instability because of the bony anatomy but maintained in alignment by many important structures, including the glenoid labrum, glenohumeral ligaments (GHLs), and muscles and tendons. Trauma and overuse can damage these stabilizers, which may then lead to subluxation or dislocation and eventually recurrent instability. This is most common in the anterior direction, which has several recognizable patterns of injury on advanced imaging, including humeral Hill Sachs deformities, bony Bankart lesion of the anteroinferior glenoid, soft tissue Bankart lesions, Bankart variant lesions (Perthes and ALPSA lesions), and HAGL/GAGL lesions. Read More

Sports Med Arthrosc Rev 2021 Jun;29(2):110-118

Medstar Montgomery Medical Center, Olney, MD.

Posterior glenohumeral (GH) joint instability is uncommon compared with anterior and multidirectional instability. A variety of surgical techniques are used to treat posterior GH instability. As a result, there are numerous rehabilitation protocols that vary greatly. Read More

Clin J Sport Med 2022 03;32(2):e116-e120

Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.

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

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):e629-e637. Epub 2021 Feb 2.

Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.

The surgical results of shoulder multidirectional instability are not satisfactory. To address the structural and biological factors that are related to the low success rate of surgical treatment, we developed a whole glenoid reconstruction technique, which includes mainly 270° glenoid bone grafting and capsule labrum reconstruction, and glenohumeral ligament reconstruction. Our clinical experience indicates that the application of this technique can result in optimal shoulder stability. Read More

Orthop J Sports Med 2021 Feb 24;9(2):2325967120982965. Epub 2021 Feb 24.

Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, Hwaseong, Republic of Korea.

Background: Posterior shoulder instability (PSI) is a relatively uncommon condition that occurs in about 10% of patients with shoulder instability. PSI is usually associated with dislocations due to acute trauma and multidirectional instability, but it can also occur with or without recognizable recurrent microtrauma. The infrequency of atraumatic or microtraumatic PSI and the lack of a full understanding of the pathoanatomy and the knowledge of management can lead to misdiagnosis or delayed diagnosis. Read More

Asia Pac J Sports Med Arthrosc Rehabil Technol 2021 Jan 9;23:1-7. Epub 2020 Nov 9.

St Georges University Medical Center, Beirut, Achrafieh, St Georges Street, Lebanon.

Introduction: Anterior labrum periosteal sleeve avulsion (ALPSA) is the avulsion of the labrum and of the non-disrupted periosteum with the subsequent healing of the labrum in a medialized nonfunctional position on the glenoid neck.

Obejctive: In this study, a modified technique for arthroscopic repair of ALPSA lesions is presented, along with post operative clinical results and follow up.

Method: 72 patients who underwent this procedure were included in this study. Read More

Ann Phys Rehabil Med 2021 Jan 28;64(1):101457. Epub 2020 Nov 28.

Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 0k5, 9000 Ghent, Belgium; Centre for Medical Genetics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium. Electronic address:

Background: Several studies reported the importance of glenohumeral and scapular muscle activity and scapular kinematics in multidirectional shoulder instability (MDI), yet a systematic overview is currently lacking.

Objective: This systematic review evaluates and summarizes the evidence regarding muscle activity and shoulder kinematics in individuals with MDI compared to healthy controls.

Method: The electronic databases PubMed and Web of Science were searched in September 2020 with key words regarding MDI (population), muscle activity, and glenohumeral and scapular movement patterns (outcomes). Read More

J Shoulder Elbow Surg 2021 Jun 16;30(6):1356-1361. Epub 2020 Sep 16.

Department of Orthopaedics & Traumatology, Gazi University School of Medicine, Ankara, Turkey.

Background: This study aimed to determine the prevalence of the Buford complex and to investigate its association with labral pathologies (superior labrum anterior-posterior [SLAP] lesion and anterior, posterior, or multidirectional instability) using a very large patient database. Furthermore, the prevalence of the Buford complex in patients without any labral pathology was also determined.

Methods: A total of 3129 consecutive shoulder arthroscopy procedures were retrospectively evaluated for the presence of the Buford complex and coexisting labral pathologies. Read More

Jt Dis Relat Surg 2020 18;31(2):223-229. Epub 2020 Jun 18.

Harran Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, 63300 Şanlıurfa, Türkiye.

Objectives: This study aims to compare the clinical results of patients with traumatic isolated Bankart lesions and type V superior labrum anterior to posterior (SLAP) lesions after arthroscopic repair.

Patients And Methods: Patients who underwent arthroscopic repair for traumatic anterior glenohumeral instability were evaluated retrospectively between December 2014 and January 2019. Fifty-one patients (49 males, 2 females; mean age 25 years; range, 18 to 36 years) without bone defects affecting >20% of the glenoid fossa, off-track engaging Hills-Sachs lesions, multidirectional instability, or ligamentous laxity were included in the study. Read More

JSES Int 2020 Jun 16;4(2):297-301. Epub 2020 Mar 16.

Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, UT, USA.

Background: Although surgical shoulder stabilization is a substantial cost nationally within the United States, little information exists to analyze this cost. The purpose of this study was to identify factors associated with variation in direct costs with the arthroscopic treatment of glenohumeral instability.

Methods: This was a retrospective study of all patients who underwent arthroscopic treatment of glenohumeral instability between January 12, 2012 and July 11, 2017. Read More

Arthrosc Tech 2020 May 25;9(5):e657-e662. Epub 2020 Apr 25.

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

Recurrent multidirectional shoulder instability is a common clinical presentation in certain demographics and sporting groups. One such demographic is patients with connective tissue disorders (CTD) such as Ehlers-Danlos syndrome (EDS), in whom shoulder pathologies are exacerbated owing to ligamentous laxity. Features of this laxity can present as both anterior and posterior shoulder instability, which are problematic sources of shoulder pain. Read More

Orthop Clin North Am 2020 Apr 31;51(2):241-258. Epub 2020 Jan 31.

Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 West Harrison Street, Chicago, IL 60612, USA. Electronic address: https://twitter.com/Grant_Garrigues.

The glenohumeral joint is prone to instability. Patients with instability should have a physical examination. Imaging studies can provide additional information. Read More

Physiotherapy 2020 06 28;107:11-18. Epub 2019 Jun 28.

Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.

Objectives: To examine whether patients, diagnosed with the hypermobility type of the Ehlers-Danlos syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD), with multidirectional shoulder instability (MDI) have increased humeral head translations compared to healthy controls and to describe the direction of the humeral translations during five exercises.

Design: Observational study.

Setting: Ghent University Hospital. Read More

Orthop J Sports Med 2019 Dec 27;7(12):2325967119890103. Epub 2019 Dec 27.

Department of Orthopedic Surgery, Tufts University School of Medicine, Boston, Massachusetts, USA.

Background: Circumferential tears of the glenohumeral labrum are an uncommon injury, comprising 2.4% of all labral lesions. Currently, the clinical outcomes of arthroscopic circumferential labral repair for patients with instability and combined anterior, posterior, and superior labral tears are not well-known. Read More

J Shoulder Elbow Surg 2020 Mar 16;29(3):600-608. Epub 2019 Oct 16.

Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.

Objective: The objective of the study was to compare the acromiohumeral distance (AHD) between patients diagnosed with hypermobility type of the Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorder (HSD) and healthy controls by evaluating the relative amount the tendon occupies in the subacromial area. Furthermore, the aim was to evaluate if there was a change in AHD with arm elevation within and between groups.

Methods: Twenty-nine female patients with hEDS/HSD (aged 34 ± 12. Read More

Am J Sports Med 2019 10 9;47(12):2795-2802. Epub 2019 Sep 9.

Department of Shoulder Surgery, Concordia Hospital for Special Surgery, Rome, Italy.

Background: Patients with recurrent anterior glenohumeral instability after a failed Latarjet procedure remain a challenge to address. Complications related to this procedure include large amounts of bone loss, bone resorption, and issues with retained hardware that necessitate the need for revision surgery.

Purpose: To determine the outcomes of patients who underwent revision surgery for a recurrent shoulder instability after a failed Latarjet procedure with fresh distal tibial allograft. Read More

Arthrosc Tech 2019 Jun 16;8(6):e561-e565. Epub 2019 May 16.

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

Coracohumeral ligament pathology arises from acute trauma, capsular thickening, or congenital connective tissue disorders within the glenohumeral joint. Recent studies have highlighted the significance of this pathology in multidirectional shoulder instability because insufficiency of the rotator interval has become increasingly recognized and attributed to failed shoulder stabilization procedures. The diagnosis and subsequent treatment of coracohumeral ligament pathology can be challenging, however, because patients usually present with a history of failed surgical stabilization and persistent laxity. Read More

Am J Sports Med 2019 07 31;47(8):1909-1914. Epub 2019 May 31.

Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.

Background: Shoulder instability has been well described in young men; however, few studies have specifically evaluated the pathoanatomy and unique spectrum of injuries in women with shoulder instability.

Purpose: To describe the pathoanatomy of operative shoulder instability in a collegiate female cohort.

Study Design: Case series; Level of evidence, 4. Read More

Am J Sports Med 2019 03 30;47(3):682-687. Epub 2019 Jan 30.

The Steadman Clinic, Vail, Colorado, USA.

Background: Anterior and posterior shoulder instabilities are entirely different entities. The presenting complaints and symptoms vastly differ between patients with these 2 conditions, and a clear understanding of these differences can help guide effective treatment.

Purpose: To compare a matched cohort of patients with anterior and posterior instability to clearly outline the differences in the initial presenting history and overall outcomes after arthroscopic stabilization. Read More

J Shoulder Elbow Surg 2019 Jan 19;28(1):95-101. Epub 2018 Oct 19.

Vanderbilt Sports Medicine, Nashville, TN, USA.

Hypothesis: The purpose of this multicenter epidemiologic study was to determine the distribution of patients within the Frequency, Etiology, Direction, and Severity (FEDS) classification system to determine which categories are of clinical importance.

Methods: Shoulder instability patients were identified using International Classification of Diseases, Ninth Revision coding data from 3 separate institutions from 2005-2010. Data were collected retrospectively. Read More

Biomed Res Int 2018 18;2018:8961805. Epub 2018 Jul 18.

Shoulder and Elbow Unit, "D. Cervesi" Hospital, Cattolica-AUSL della Romagna, Ambito Rimini, Italy.

Background: Recurrent shoulder dislocations occur much more frequently in adolescents than in the older population but a clear explanation of this incidence does not exist. The aim of the present study was to define the age-related distribution of the elastic fibers (EFs) in the shoulder capsule's extracellular matrix as a factor influencing shoulder instability.

Materials And Methods: Biopsy specimens were obtained from the shoulder capsule of patients divided preoperatively into three groups: Group 1 consisted of 10 male patients undergoing surgery for unidirectional traumatic anterior instability (TUBS); Group 2 consisted of 10 male patients undergoing surgery for multidirectional instability (MDI); Group 3 represents the control, including 10 patients with no history of instability. Read More

J Orthop Trauma 2018 Aug;32 Suppl 1:S4-S5

Cooper University Hospital, Camden, NJ.

Purpose: The purpose of this video is to demonstrate the surgical technique of a shoulder arthrodesis for a patient with multidirectional instability and multiple failed previous surgeries.

Methods: A 25-year-old woman with a long history of left shoulder multidirectional instability in the setting of Ehlers-Danlos syndrome is shown undergoing a shoulder arthrodesis. The video demonstrates intraoperative patient positioning, approach, shoulder osseous and articular preparation, implant placement (narrow 4. Read More

Am J Sports Med 2018 08 9;46(10):2449-2456. Epub 2018 Jul 9.

Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

Background: Intra-articular glenohumeral joint changes frequently occur after shoulder instability events.

Purpose: (1) To compare demographic characteristics, baseline patient-reported outcomes, and intraoperative findings for patients undergoing primary or revision shoulder stabilization surgery and (2) to determine the incidence of glenohumeral bone and cartilage lesions in this population while identifying factors independently associated with these lesions.

Study Design: Cross-sectional study; Level of evidence, 3. Read More