DOCSLIB.ORG

Treatment After Traumatic Shoulder Dislocation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Treatment After Traumatic Shoulder Dislocation Review Br J Sports Med: first published as 10.1136/bjsports-2017-098539 on 23 June 2018. Downloaded from Treatment after traumatic shoulder dislocation: a systematic review with a network meta-analysis Lauri Kavaja,1,2 Tuomas Lähdeoja,1,3,4 Antti Malmivaara,5,6 Mika Paavola4 ► Additional material is ABStract Acute treatment of a dislocated shoulder is closed published online only. To view Objective To review and compare treatments (1) reduction, which should be performed as soon as please visit the journal online after primary traumatic shoulder dislocation aimed at possible, either on the field or in an emergency (http:// dx. doi. org/ 10. 1136/ 14 bjsports- 2017- 098539). minimising the risk of chronic shoulder instability and (2) department. Some patients develop recurrent for chronic post-traumatic shoulder instability. dislocations or symptomatic subluxations even in 1Medical Faculty, University of Design Intervention systematic review with random daily activities. This has prompted suggestions that Helsinki, Helsinki, Finland effects network meta-analysis and direct comparison surgical stabilisation may be indicated after the first 2Department of Surgery, South Carelia Central Hospital, meta-analyses. dislocation—a treatment strategy that has been Lappeenranta, Finland Data sources Electronic databases (Ovid MEDLINE, investigated in several randomised controlled trials 3Finnish Center of Evidence- Cochrane Clinical Trials Register, Cochrane Database (RCT), with mixed results.3 4 6 7 15 16 based Orthopaedics (FICEBO), of Systematic Reviews, Embase, Scopus, CINAHL, Ovid There is considerable variation in the manage- University of Helsinki, Helsinki, ment of patients after a primary traumatic shoulder Finland MEDLINE Epub Ahead of Print, In-Process & Other 4Department of Orthopaedics Non-Indexed Citations, Ovid MEDLINE Daily, DARE, dislocation (both between surgeons and disci- and Traumatology, Helsinki HTA, NHSEED, Web of Science) and reference lists were plines).17 18 Most patients with chronic post-trau- University Hospital, Töölö searched from inception to 15 January 2018. matic shoulder instability are offered stabilisation Hospital, Helsinki, Finland Eligibility criteria for selecting surgery, while the surgical methods vary widely.17–20 5Centre for Health and Social Economics, Institute of Health studies Randomised trials comparing any Some evidence suggests that in the management of and Welfare, Helsinki, Finland interventions either after a first-time, traumatic musculoskeletal conditions patients are more likely 6Orton Orthopaedic Hospital shoulder dislocation or chronic post-traumatic shoulder to undergo surgical treatment if the treating physi- and Orton Research Institute, instability, with a shoulder instability, function or cian is a surgeon versus a non-surgical specialty (eg, Orton Foundation, Helsinki, physiotherapy),21 and that surgeons more easily Finland quality of life outcome. Results Twenty-two randomised controlled trials recommend surgical treatment if the evidence Correspondence to were included. There was moderate quality evidence regarding the effectiveness of surgery is inconclu- 19 Dr Lauri Kavaja, Medical Faculty, suggesting that labrum repair reduced the risk of future sive. Thus, to provide the best care, physiothera- University of Helsinki, Helsinki shoulder dislocation (relative risk 0.15; 95% CI 0.03 to pists, physical medicine specialists, sports medicine 00290, Finland; 0.8, p=0.026), and that with non-surgical management specialists and orthopaedic surgeons should know lauri. kavaja@ helsinki. fi 47% of patients did not experience shoulder what is the best quality evidence for treatment of LK and TL contributed equally. redislocation. Very low to low-quality evidence suggested shoulder instability. no benefit of immobilisation in external rotation versus Therefore, we aimed to assess the current http://bjsm.bmj.com/ Received 17 September 2017 internal rotation. There was low-quality evidence that an evidence regarding the effectiveness of interven- Revised 8 May 2018 open procedure was superior to arthroscopic surgery for tions after primary traumatic shoulder dislocation Accepted 16 May 2018 preventing shoulder redislocations. and in chronic post-traumatic shoulder instability. Conclusions There was moderate-quality evidence Our systematic review focused on two clinical that half of the patients managed with physiotherapy effectiveness questions regarding post-traumatic after a first-time traumatic shoulder dislocation did not shoulder instability: (1) What are the best treat- experience recurrent shoulder dislocations. If chronic ments to reduce the incidence of chronic shoulder on September 29, 2021 by guest. Protected copyright. instability develops, surgery could be considered. There instability after a first-time traumatic shoulder was no evidence regarding the effectiveness of surgical dislocation? and (2) How can the clinician best management for post-traumatic chronic shoulder treat a patient with chronic post-traumatic shoulder instability. instability? METHODS We followed the Preferred Reporting Items for INTRODUCTION Systematic Reviews and Meta-Analyses statement22 The shoulder is the most commonly dislocated large when conducting and reporting this prospectively joint.1 A traumatic shoulder dislocation is often registered systematic review (PROSPERO registra- accompanied by a labral lesion,2–7 which predis- tion ID: CRD42015020303). We use dislocation to poses the patient to developing chronic shoulder refer to a true dislocation of the joint and insta- instability.8–11 The incidence of primary shoulder bility to refer to dislocations, subluxations or other dislocation varies between 15.31 and 56.312 per symptoms of instability either alone or together. 100 000 person-years. Most patients are men aged By recurrent dislocation(s) and redislocation(s) we To cite: Kavaja L, Lähdeoja T, under 40 years and most dislocations are sports mean one or more dislocations after the primary Malmivaara A, et al. Br J Sports Med Epub ahead injuries. Both these facts make shoulder disloca- episode, and by chronic post-traumatic instability of print: [please include Day tion and possible subsequent chronic instability an we mean recurrent dislocation(s), subluxations or Month Year]. doi:10.1136/ important health issue for young, active patients other symptoms of instability occurring after a first- bjsports-2017-098539 and their treating clinicians.13 time traumatic shoulder dislocation. Kavaja L, et al. Br J Sports Med 2018;0:1–11. doi:10.1136/bjsports-2017-098539 1 Review Br J Sports Med: first published as 10.1136/bjsports-2017-098539 on 23 June 2018. Downloaded from Data sources and searches criteria; with a judgement of ‘yes’, ‘unclear’ or ‘no’. If at least six We searched Ovid MEDLINE, Cochrane Central Register of of the 12 criteria were judged to be at low risk of bias (‘yes’), the Controlled Trials, Cochrane Database of Systematic Reviews, risk of bias in the publication was considered low.23 Embase, Scopus, CINAHL, Ovid MEDLINE Epub Ahead of Print, To assess possible selective reporting of results, we compared In-Process & Other Non-Indexed Citations, Ovid MEDLINE the outcome measures specified in the methods section of the Daily, Database of Abstracts of Reviews of Effect (DARE), Health publication and in the trial registry (if available) to what was Technology Assessment Database, NHS Economic Evaluation reported in the results section of the publication. For the analysis Database and Web of Science on 15 January 2018. There were of the timing of the outcome assessment, we deemed a deviation no restrictions on language or publication date. We adjusted the of 3 months (in a 2-year follow-up) to be an acceptable range. search strategies to meet the specifications of the individual data- Disagreements between the two reviewers on the retrieved bases (online supplementary appendix 1). We reviewed the refer- data were resolved by consensus. If any item was unclear, we ence lists of included publications and earlier reviews to identify contacted the authors by email to clarify the issue. any additional studies that were missed in the electronic data- Researcher conflict of interest and industry sponsorship have base search. We also searched the WHO International Clinical been identified as potential sources of bias.24–26 We evaluated Trials Registry Platform (WHO ICTRP) (www.who. int/ ictrp) on and noted the existence of these potential sources of bias in the 23 January 2018 for registrations of the included RCTs, possible studies. completed but unpublished RCTs and ongoing RCTs. Data synthesis and analysis Study selection We performed meta-analyses of clinically homogenous studies We included RCTs that compared any interventions after a (patient populations, indications of treatment, intervention pairs first-time, traumatic shoulder dislocation or chronic post-trau- and outcomes). If studies with same intervention-control pairs matic shoulder instability with a follow-up of at least 1 year. We were not sufficiently homogenous, we performed multiple pair- required an outcome measure related to shoulder instability, wise meta-analyses of the trials with poolable patients and data. shoulder function or quality of life. We excluded studies of treat- In the analysis of surgical treatment after first-time shoulder ment of non-traumatic shoulder instability, cadaveric or biome- dislocation, we performed a frequentist network meta-analysis chanical studies and studies on secondary
Load more

Recommended publications
  • Arthroscopic Bankart Repair Is a Function Selection Patient Indication
    CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 390, pp. 31–41 © 2001 Lippincott Williams & Wilkins, Inc. Arthroscopic Bankart Repair Experience With an Absorbable, Transfixing Implant 03/25/2020 on BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3XGJiJSDa6kLdjliRzOOsR+bI3gZWJ99pv/KNUfPjA6Y= by https://journals.lww.com/clinorthop from Downloaded Stephen Fealy, MD; Mark C. Drakos, BA; Downloaded Answorth A. Allen, MD; and Russell F. Warren, MD from https://journals.lww.com/clinorthop by 3 BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3XGJiJSDa6kLdjliRzOOsR+bI3gZWJ99pv/KNUfPjA6Y= The use of arthroscopic means to address shoul- scribed in 1938. The essential lesion of shoul- der instability has provided a technically advan- der instability, as described by Bankart, is tageous way to approach Bankart lesions while thought by many to represent the most com- posing complex questions regarding the specific mon disorder underlying possible causes for indications for such an intervention. A successful shoulder instability.2,19,31 It represents a de- outcome with arthroscopic Bankart repair is a tachment of the labrum and its osseous inser- function of proper surgical indication and pa- tient selection. Several authors have evaluated tion from the anteroinferior glenoid. Reestab- the causes of failure and reasons for success with lishing the structural integrity of the soft tissue the Suretac device. The development of a bioab- to glenoid interface is the paramount objective sorbable repair device at the authors’ institution of the Bankart repair and has an essential role was precipitated by a desire to address and re- in surgery for shoulder stability. Although the pair Bankart lesions arthroscopically while traditional open Bankart repair remains the avoiding the frequent complications associated gold standard in treatment options, continued with the metal staple and the transglenoid suture development of arthroscopic techniques and technique.
    [Show full text]
  • Coracoid Graft Union: a Quantitative Assessment by Computed Tomography in Primary and Revision Latarjet Procedure
    ARTICLE IN PRESS J Shoulder Elbow Surg (2018) ■■, ■■–■■ www.elsevier.com/locate/ymse ORIGINAL ARTICLE Coracoid graft union: a quantitative assessment by computed tomography in primary and revision Latarjet procedure Mohammad Samim, MD, MRCSa, Kirstin M. Small,MDb,*, Laurence D. Higgins, MD, MBAc aDepartment of Radiology, NYU Langone Medical Center, New York, NY, USA bDepartment of Radiology, Brigham and Women’s Hospital, Boston, MA, USA cBoston Shoulder Institute, Boston, MA, USA Background: The goal of the Latarjet procedure is restoration of shoulder stability enabled by accurate graft positioning and union. This study aimed to establish a reproducible method of quantitatively assess- ing coracoid graft osseous union percentage (OUP) using computed tomography (CT) scans and to determine the effect of other factors on the OUP. Materials and methods: Postoperative CT scans of 41 consecutive patients treated with the open Latarjet procedure (37% primary, 63% revision) for anterior glenohumeral instability were analyzed for the OUP, position of the graft, and screw type and angle. Two musculoskeletal radiologists independently exam- ined the images 2 times, and intraobserver and interobserver reliability was calculated using intraclass correlation coefficient (ICC). Results: Mean OUP was 66% (range, 0%-94%) using quantitate methods, with good intraobserver re- liability (ICC = 0.795) and interobserver reliability (ICC = 0.797). Nonunion and significant graft resorption was found in 2 patients. No significant difference was found in the mean OUP in the primary (63%) vs. revision Latarjet procedure (67%). Grafts were flush in 39%, medial in 36%, and lateral in 8%. The medial and neutral graft position was associated with slightly higher OUP (72% and 69%) compared with lateral (65%).
    [Show full text]
  • Clinical Guidelines
    CLINICAL GUIDELINES Joint Services Guidelines Version 1.0.2019 Clinical guidelines for medical necessity review of comprehensive musculoskeletal management services. © 2019 eviCore healthcare. All rights reserved. Regence: Comprehensive Musculoskeletal Management Guidelines V1.0.2019 Large Joint Services CMM-311: Knee Replacement/Arthroplasty 3 CMM-312: Knee Surgery-Arthroscopic and Open Procedures 14 CMM-313: Hip Replacement/Arthroplasty 35 CMM-314: Hip Surgery-Arthroscopic and Open Procedures 46 CMM-315: Shoulder Surgery-Arthroscopic and Open Procedures 47 CMM-318: Shoulder Arthroplasty/ Replacement/ Resurfacing/ Revision/ Arthrodesis 62 ______________________________________________________________________________________________________ © 2019 eviCore healthcare. All Rights Reserved. Page 2 of 69 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www.eviCore.com Regence: Comprehensive Musculoskeletal Management Guidelines V1.0.2019 CMM-311: Knee Replacement/Arthroplasty CMM-311.1: Definition 4 CMM-311.2: General Guidelines 5 CMM-311.3: Indications and Non-Indications 5 CMM-311.4 Experimental, Investigational, or Unproven 9 CMM-311.5: Procedure (CPT®) Codes 10 CMM-311.6: References 10 ______________________________________________________________________________________________________ © 2019 eviCore healthcare. All Rights Reserved. Page 3 of 69 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www.eviCore.com Regence: Comprehensive Musculoskeletal Management Guidelines V1.0.2019 CMM-311.1: Definition
    [Show full text]
  • Epidemiology of Paediatric Shoulder Dislocation: a Nationwide Study in Italy from 2001 to 2014
    International Journal of Environmental Research and Public Health Article Epidemiology of Paediatric Shoulder Dislocation: A Nationwide Study in Italy from 2001 to 2014 Umile Giuseppe Longo 1,* , Giuseppe Salvatore 1, Joel Locher 1, Laura Ruzzini 2, Vincenzo Candela 1, Alessandra Berton 1, Giovanna Stelitano 1, Emiliano Schena 3 and Vincenzo Denaro 1 1 Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy; [email protected] (G.S.); [email protected] (J.L.); [email protected] (V.C.); [email protected] (A.B.); [email protected] (G.S.); [email protected] (V.D.) 2 Department of Orthopedics, Children’s Hospital Bambino Gesù, Via Torre di Palidoro, Palidoro, 00165 Rome, Italy; [email protected] 3 Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy; [email protected] * Correspondence: [email protected]; Tel.: +39-06-225411613; Fax: +39-06-225411638 Received: 10 March 2020; Accepted: 17 April 2020; Published: 20 April 2020 Abstract: Limited knowledge is accessible concerning the tendencies of hospitalization for skeletally immature patients with episodes of shoulder dislocation. Our research aim was to evaluate annual hospitalizations for shoulder dislocation in paediatric patients in Italy from 2001 to 2014, on the basis of the official data source as hospitalization reports. The second purpose was to investigate geographical diversification in hospitalization for shoulder dislocation in regions of Italy. The last aim was to make statistical predictions of the number of shoulder dislocation hospitalization volumes and rates in skeletally immature patients based on data from 2001 to 2014.
    [Show full text]
  • The Only Online Procedures Training and Reference Solution
    Procedures Consult Enhances Patient Safety and Reduces Medical Errors from Elsevier, world’s leading provider of medical information resources. Complete list of procedures Internal Medicine Module Lumbar Epidural Injections Arthrocentesis: Elbow* Abdominal Paracentesis Lumbar Laminectomy Arthrocentesis: Knee* Arterial Blood Gas Sampling Mini incision – total hip Arthrocentesis: MCP* Arterial Cannulation Mini incision – total knee Arthrocentesis: MTP* Arthrocentesis: Ankle Minimally Invasive Plating of Pilon Fractures Arthrocentesis: Shoulder* Arthrocentesis: Elbow Open repair chronic rotator cuff tear Arthrocentesis: Wrist* Arthrocentesis: Knee ORIF distal fibular fracture (lateral malleolus) Balloon Tamponade of Gastroesophageal Varcies Arthrocentesis: MCP ORIF distal radial fracture (Colles or Smith fx) Basic Airway Management* Arthrocentesis: MTP ORIF femoral fracture Basics of Wound Management Arthrocentesis: Shoulder Osteochondral Allograft Cardioversion* Arthrocentesis: Wrist Osteochondral Autograft Coaptation Splint* Basic Airway Management Osteochondral Cartilage Repair Compartment Syndrome Evaluation Cardioversion Osteotomies for Hallux Valgus Correction Cricothyrotomy Percutaneous Fixation of Proximal Slipped Capital Central Venous Catheterization: Femoral Approach Defibrillation* Femoral Epiphysis Central Venous Catheterization: Internal Dental Nerve Blocks Plateing of humeral shaft fractures Jugular Approach Digital Nerve Block Posterior spinal instrumentation – scoliosis Central Venous Catheterization: Subclavian Approach
    [Show full text]
  • History of Surgical Intervention of Anterior Shoulder Instability
    J Shoulder Elbow Surg (2016) 25, e139–e150 www.elsevier.com/locate/ymse History of surgical intervention of anterior shoulder instability David M. Levy,MD*, Brian J. Cole, MD, MBA, Bernard R. Bach Jr, MD Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA Background: Anterior glenohumeral instability most commonly affects younger patients and has shown high recurrence rates with nonoperative management. The treatment of anterior glenohumeral instability has undergone significant evolution over the 20th and 21 centuries. Methods: This article presents a retrospective comprehensive review of the history of different operative techniques for shoulder stabilization. Results: Bankart first described an anatomic suture repair of the inferior glenohumeral ligament and anteroinferior labrum in 1923. Multiple surgeons have since described anatomic and nonanatomic repairs, and many of the early principles of shoulder stabilization have remained even as the techniques have changed. Some methods, such as the Magnusson-Stack procedure, Putti-Platt procedure, arthroscopic stapling, and transosseous suture fixation, have been almost completely abandoned. Other strategies, such as the Bankart repair, capsular shift, and remplissage, have persisted for decades and have been adapted for arthroscopic use. Discussion: The future of anterior shoulder stabilization will continue to evolve with even newer prac- tices, such as the arthroscopic Latarjet transfer. Further research and clinical experience will dictate which future innovations are ultimately embraced. Level of evidence: Review Article © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Keywords: Anterior glenohumeral instability; dislocation; subluxation; shoulder stabilization; arthroscopic; Bankart Because of its relative lack of bony limitations and ex- Hovelius et al60 in a prospective study of 229 primary dis- tensive range of motion, the shoulder is the most commonly locations treated nonoperatively.
    [Show full text]
  • The Open Modified Bankart Procedure 1065
    Upper limb The open modified Bankart procedure OUTCOME AT FOLLOW-UP OF 10 TO 15 YEARS T. D. Berendes, We report the outcome of a modified Bankart procedure using suture anchors in 31 patients R. Wolterbeek, (31 shoulders) with a mean follow-up of 11 years (10 to 15). The mean age of the patients P. Pilot, was 28 years (16 to 39). At follow-up, the mean Rowe score was 90 points (66 to 98) and the H. Verburg, Constant score was 96 points (85 to 100). A total of 26 shoulders (84%) had a good or R. L. te Slaa excellent result. The rate of recurrence varied between 6.7% and 9.7% and depended on how recurrence was defined. Two patients had a significant new injury at one and nine From The Reinier de years, respectively after operation. The overall rate of instability (including subluxations) Graaf Groep, Delft, varied between 12.9% and 22.6%. All patients returned to work, with 29 (94%) resuming The Netherlands their pre-operative occupation and level of activity. Mild radiological osteoarthritis was seen in nine shoulders (29%) and severe osteoarthritis in one. We conclude that the open modified Bankart procedure is a reliable surgical technique with good long-term results. The common form of instability of the shoulder lisation of the shoulder between November is traumatic anterior dislocation,1 and operative 1989 and December 1993 were reviewed at a treatment is classified as anatomical or non-ana- mean follow-up of 11 years (10 to 15). None tomical. The former was first described by had multi-directional instability or previous Bankart2 in 1938 and involves reconstruction of operative procedures on the shoulder.
    [Show full text]
  • CPG Shoulder Instability 2019 Handouts
    CSM 2019 Shoulder Instability Clinical 1/24/19 Practice Guidelines Shoulder Stability and Movement Coordination Impairments: Shoulder Instability Clinical Shoulder Instability Guideline Leaders Practice Guideline Amee Seitz and Tim Uhl Co-Leaders Amee L Seitz, PT, PhD, DPT, OCS & Timothy Uhl, PT, ATC PhD Lori Michener, PT, ATC, PhD, SCS* Support by Orthopedic Section Office (Brenda Johnson, Christine McDonouGh) and APTA and Michael Shaffer, PT, MS, ATC Linda O'Dwyer Certified Science Librarian Martin Kelley, PT, DPT Diagnosis Intervention Angela Tate, PT, PhD Clinical Course/ Prognosis Examination Section Leaders Section Leaders Section Leaders Section Leaders 2600 articles, 260 full-text 6500 titles and abstracts, Margie Olds, PT MHSC, BPHty 5000 titles/abstracts 12,300 titles /abstracts reviews 120 full text reviews Aaron Sciascia, PhD, ATC, PES Tim Uhl PhD, PT, ATC Kyle Matsel, PT, DPT, SCS, CSCS Eric HeGedus PT, DPT, PhD, OCS, Lori Michener PhD, PT, ATC, Amee Seitz PhD PT, DPT, OCS Kyle Matsel DPT, SCS, CSCS CSCS SCS, FAPTA Mike Shaffer PT, MSPT, OCS, Eric Hegedus, PT, PhD, DPT, OCS, CSCS Carolyn Hettrich MD, MPH Aaron Scisascia PhD, ATC, PES AnGela Tate PhD, PT, Cert ATC Marty Kelley PT, DPT, OCS Nitin Jain, MD, MPH MDT MarGie Olds MHSC, BPHty Carolyn Hettrich, MD, MPH DPT Students at DPT Students/ Research Orthopaedic DPT Residents Northwestern Assistants Non-authors; Nitin Jain, MD (Non-authors; acknowledGed (Non-auhtors; acknowledGed acknowledGed contributors) contributors) contributors) Disclosures Objectives of Session • All Authors have no conflicts related to 1. Explain the shoulder pain classification and methods used to categorize development of the CPG patients into shoulder CPG categories, specifically shoulder instability • Funded by the Academy of Orthopaedic Physical 2.
    [Show full text]
  • Open Latarjet Anterior Shoulder Stabilization
    UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for Open Latarjet Anterior Shoulder Stabilization The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on a tee. This analogy is used because the articular surface of the round humeral head (upper most part of the arm) is approximately four times greater than that of the relatively flat shoulder blade face (glenoid fossa). The stability and movement of the shoulder is controlled by Figure 1 L to R: Lateral view of glenoid post laterjay with humerous removed. Anterior view of the rotator cuff muscles, ligaments shoulder post laterjay. Two screws are fixing a bony piece of the coracoid to the front of the bony and the capsulolabral complex glenoid fossa. This increases the surface area of the “golf tee” portion of the shoulder joint and of the shoulder. The labrum is a increases its stability. fibrocartilaginous ring which attaches or the arm is stretched straight out years after the initial dislocation, to the bony rim of the glenoid fossa. from the body, such as falling on 66% of patients who were less than The labrum doubles the depth of an outstretched hand. When the 20 years old suffered a second the glenoid fossa to help provide shoulder dislocates anteriorly the dislocation while 40% of patients stability. An analogy would be a capsule, ligaments and labrum are who were between 20 and 40 years parked car on a hillside with a chop often torn. The anterior inferior part old suffered a second dislocation. block under the tire – the round tire of the labrum (located between the None of the patients older than 40 being the humeral head, the road 3 o’clock to 6 o’clock positions on years old had suffered subsequent being the glenoid fossa and the the glenoid) is the area torn with this dislocations.
    [Show full text]
  • Arthroscopic Bankart Repair with Suture Anchors: Tips for Success Kevin D
    Arthroscopic Bankart Repair With Suture Anchors: Tips for Success Kevin D. Plancher, MD,* and Stephanie C. Petterson, PhD† Anterior instability treated by arthroscopic surgery is a viable option to return the athlete and nonathlete back to activities. The use of suture-loaded anchors has become a standard method with reliable fixation. Arthroscopic Bankart repair can successfully restore range of motion and stability and yield successful outcomes with a low recurrence rate. This article describes arthroscopic Bankart repair with a modified inferior capsular shift in the lateral decubitus position. Oper Tech Sports Med 21:192-200 C 2013 Elsevier Inc. All rights reserved. KEYWORDS shoulder, anterior instability, arthroscopic Bankart, inferior capsular shift nterior instability is the most common form of shoulder A Bankart lesion is the avulsion of the glenoid labrum, with Ainstability.1 The incidence of traumatic anterior gleno- or without a bony lesion, with the anterior band of the inferior humeral instability in the general population is 1.7%,2 with the glenohumeral ligament (IGHL) from the anterior inferior incidence of Bankart lesions in first-time traumatic dislocators glenoid. The anterior band of the IGHL is the primary restraint as high as 97%.3 A patient account of a traumatic fall with a to anterior translation of the humeral head, particularly when resultant anterior dislocation documented by radiography and the shoulder is in 901 abduction and placed in an externally positive physical findings is a good indication of a Bankart rotated position.7,8 A second restraint to anterior humeral lesion. Although changes in the capsule and the glenohumeral translation is the muscular contribution of the subscapularis.
    [Show full text]
  • Open Bankart Repair: Is It Still Relevant?????
    Chicago Sports Medicine Symposium 2016 Open Bankart Repair: Is it Still Relevant????? Brian R. Wolf MD MS Congdon Professor and Vice-Chair of Orthopaedic Surgery Director of Sports Medicine Head Team Physician, University of Iowa, Iowa City, IA Photos B. Wolf personal file Disclosures . No Disclosures relevant to this presentation . Grant support: OREF, Arthrex, Smith and Nephew . Consultant: ConMed . Editorial Board: Orthopaedic Journal of Sports Medicine . Committees: Program Committee: ASES, AOSSM, MAOA Corporate Relations Committee: AOSSM BOS Fellowship Match Committee Chair: AAOS (chair) DISCLAIMER . I do the vast majority of my Scope instability surgery repair DTA arthroscopically . I also do a fair amount of glenoid bone restoration (Latarjet) procedures Open . I absolutely think there is a Bankart role for Open Bankart Repair surgery 1 Open Repair – where did it go? . Limited exposures in training . Less frequently done . New trend in shoulder instability Option A: scope repair Option B: latarjet or bone procedure WE ARE FORGETTING GOOD INTERMEDIATE OPTION – OPEN REPAIR The reality . The majority of primary instability surgery today is done arthroscopically MOON shoulder data 94 % done arthroscopic (604/640) 2/3 of revision surgery done open Latarjet > open Bankart / shift Anterior instability surgery Proper Preoperative Planning – Evaluate Glenoid Bone Loss X-ray, CT with 3D recons, +/- MRI arthrogram; +/- Arthroscopy 0 to 15% 15% to 25% > 25% Primary Repair Primary Repair OPEN bone (Scope or open) (Open or Scope) Augmentation •Incorporate Any Bony •Incorporate bony procedures Fragments if possible fragments if possible •Liberal use of anchors •± bone augmentation •+/- address Hill Sachs What was the prior procedure? Consider different technique for revision 6 2 Glenoid Track – Yamamoto 2007 .
    [Show full text]
  • Glenoid Bone Loss Management CDR Provencher MT AOSSM Specialty Day 2013 Naval Med Center San Diego
    Glenoid Bone Loss Management CDR Provencher MT AOSSM Specialty Day 2013 Naval Med Center San Diego Glenoid Bone Loss Management: Alllograft Matthew T. Provencher, MD CDR MC USN Professor of Surgery & Orthopaedics, USUHS Director Orthopaedic Shoulder, Knee and Sports Surgery Department of Orthopaedic Surgery, Naval Medical Center San Diego 34800 Bob Wilson Dr. Ste 112 San Diego, CA 92134 1. Potential Pitfalls in Any Shoulder Instability Repair Glenoid bone loss – Lots of attention in recent literature Significant Hill-Sachs lesion Revision situation – post thermal cases Revision situation with prior capsular insufficiency Prior anchor placement Error in diagnosis Rehabilitation issues and compliance Technical errors o Correct anchor placement o Proper capsular mobilization (HAGL) o RI Closure? o Prior thermal cases? o Adequate capsular tensioning – 1cm? o HAGL injuries Associated injuries o SLAP, HAGL, bony deficiencies o Neurologic injury (winging!) Boileau (JBJS 2006)4 – “Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair” o 91 patients followed prospectively o 15.3% recurrence (36 months f/u), at 17 months post-surgery o Recurrence higher in hyperlaxity, bone loss, and number of anchors (4 or more was good prognostic sign) Tauber32 – “Reasons for failure after surgical repair of anterior shoulder instability” o 41 patients followed 49 months o At revision surgery – 56% with persistent bony defect, patulous capsule 22%, laterally torn capsule 5% Glenoid Bone Loss Management CDR Provencher
    [Show full text]