Journal of Shoulder and Elbow Surgery最新文献

Background: Glenohumeral instability is a common pathology, particularly in young, active patients.

Methods: A narrative review was performed to describe the history of surgical treatments for anterior shoulder instability.

Results: Open surgical techniques were first described by Bankart in 1923. Techniques include both anatomic soft tissue repairs and nonanatomic procedures to provide constraint to motion and dislocation. Osseous techniques to address glenoid bone loss include both autograft techniques, such as the Latarjet procedure, or the use of various allografts. Technological advances, particularly arthroscopy, have continued to drive the evolution of treatments. The concept of the glenoid track has furthered our understanding of this pathology to guide appropriate treatment to reduce recurrence.

Conclusions: Surgical treatment for anterior shoulder instability continues to evolve in an effort to restore function and prevent additional injury.

Background: The posterosuperior humeral head contacts the glenoid during pitching. While magnetic resonance imaging (MRI) often detects abnormalities in the posterosuperior humeral head of baseball pitchers, ultrasonography may also be effective in identifying these abnormalities. However, studies on such abnormalities in asymptomatic players are limited. Thus, this study aimed to determine the prevalence of abnormal findings in the humeral head using ultrasonography in asymptomatic collegiate baseball pitchers.

Methods: We utilized ultrasonography to assess abnormal findings in the humeral head, defined as a break in continuity or an irregular surface around the infraspinatus insertion, in 33 college baseball pitchers (pitcher group) and 30 college students without experience in overhead sports (control group). For 11 of the 33 pitchers, computed tomography (CT)-like images were used to locate the abnormalities. The location was quantitatively identified in the axial plane using a clock system, with the bicipital groove designated as 12 o'clock, and qualitatively assessed in the sagittal plane. Shoulder internal and external rotation ranges of motion (IR and ER ROMs) and humeral retroversion were measured using an inclinometer. The prevalence of abnormalities among the four subgroups (throwing and non-throwing shoulders of the pitcher group and dominant and non-dominant shoulders of the control group) was compared using the Fisher's exact test. A paired t-test was also performed to compare the IR and ER ROMs, as well as the humeral retroversion between each group's throwing (dominant) and non-throwing (non-dominant) sides.

Results: The prevalence of abnormalities was significantly higher (76%) in the throwing shoulder of the pitcher group than in the other shoulder groups (< .001). The mean position of the humeral head abnormalities in the axial plane was 8:32 ± 0:21 in the clock system, with all abnormalities located at the infraspinatus insertion on the greater tuberosity in the sagittal plane according to CT-like image analysis. While ER ROM and humeral retroversion were greater in the throwing shoulder, IR ROM was less than that in the non-throwing shoulder in the pitcher group (< .001).

Conclusion: Ultrasonographic assessments revealed a higher prevalence of abnormalities in humeral head for asymptomatic collegiate baseball pitchers. Repetitive throwing motions may lead not only to adaptations in the ROM of the shoulder joint but also to abnormalities in the humeral head. Thus, ultrasonography may help identify asymptomatic baseball players with physiological internal impingement.

Background: Arthroscopic Latarjet using suture-button fixation has shown good clinical results and low recurrent instability in patients with significant glenoid bone loss (18). However, the presence of an associated Hill-Sachs lesion (HSL) is a risk factor for recurrent instability after isolated Latarjet (8,35,36). The aim of the study is to report clinical and radiological results following all-arthroscopic Latarjet combined with Hill-Sachs Remplissage (HSR).

Methods: Monocentric prospective study including 41 patients (mean age 28 ± 7 years) who underwent the combined procedure between 2014-2019 with minimum 2 years follow-up (mean 40 ± 13 months). Indications were glenoid bone loss >10% (mean 23.9% ± 7.5%) and large, deep HSL (Calandra 3). Five (13%) patients had signs of osteoarthrosis stage I preoperatively, four (10%) had previous stabilization surgery (3 cases isolated Bankart and 1 case Bankart combined with HSR), and five (13%) were epileptic. The HSR was performed first followed by guided Latarjet procedure. Primary outcome measures included shoulder stability and function represented by Walch-Duplay and Rowe scores, and subjective shoulder value (SSV) for daily life/sports. Secondary outcome measures included coracoid graft position and union, and glenohumeral osteoarthritis using X-rays and computer tomography (CT).

Results: Three patients (7%) had recurrent instability: one due to seizure, one following fall, and one related to graft osteolysis. Two patients were revised because of recurrence with arthroscopic distal clavicle autograft. There were no infections, neurologic complications, or hardware failures. The Walch-Duplay score was 90 (95% CI 76.8-93.2) and the Rowe score 95 (95% CI 77.2-92.2). The Median SSV averaged 96% (95% CI 87.5-97.0) for daily life and 90% (95% CI 75.7-90.2) for sports. Mean external rotation with the arm at side was 60˚ (95%CI 59-70) with a median loss 10° (95%CI 3-17) compared to contralateral side. Among patients playing sport preoperatively, 36 (95%) were able to return to sport: 25 (67%) at same level and 7 (18%) at lower level. The coracoid graft was flush with the glenoid surface in 96% of cases and subequatorial in 89%. The graft developed nonunion in 11% and fractured in 5%. Seven patients (18%) had radiographical signs of grade I osteoarthritis.

Conclusion: Combined arthroscopic Latarjet and HSR is an efficient solution for dealing with significant bipolar glenohumeral bone loss. The combined procedure deserves consideration in high-risk patients including combined bone loss, recurrent anterior instability after failed stabilization procedures and/or seizure.

Background: Shoulder proprioception, in which the anterior glenohumeral capsule plays a major role, is critical to the functioning of the shoulder. Consequently, most surgeons either do not resect or reinsert the anterior capsule in shoulder stabilization surgery. In the original Open Latarjet Procedure (OLP), the anterior capsule is preserved. However, in the all-Arthroscopic Latarjet Procedure (ALP), complete anterior capsule resection is recommended for better view and access to the coracoid. This raises the question if there is a postoperative difference in proprioception between these two procedures. Therefore, the aims of this study are (1) to assess the difference in postoperative proprioception between the operated and healthy sides after the OLP and ALP, and (2) to compare the difference in postoperative proprioception on the operated side between the OLP and ALP.

Methods: We conducted a retrospective analysis including all patients who underwent a proprioception test after an OLP or ALP at our center. Collected baseline characteristics included sex, age at surgery, operated side, hand dominance, presence of a Hill-sachs lesion, and time between surgery and the proprioception test. For the test, patients were positioned 1 meter from a wall. They were blindfolded and had to point at a target with a laser pointer taped to their index finger. The laser point was marked and the errors were measured horizontally and vertically and categorized as < 4 centimeters, 4-8 centimeters, 8-16 centimeters, and >16 centimeters.

Results: Between April 2022 and April 2024, 91 cases were identified, of which 24 underwent an OLP and 67 underwent an ALP. No significant difference was found in error distribution between the healthy and operated side after both the OLP (p = 0.30 horizontally, p = 0.67 vertically) and ALP (p = 0.20 horizontally, p = 0.34 vertically). Moreover, there was no significant difference in error distribution between the operated sides after the OLP versus ALP (p= 0.52 horizontally, p = 0.61 vertically).

Conclusion: Our data suggests that postoperative proprioception is not significantly different between the operated and healthy sides after both the OLP and ALP, nor between the operated sides after the OLP versus after the ALP. This might imply that completely resecting the anterior glenohumeral capsule does not have a detrimental effect on shoulder proprioception. However, these results are multifactorial and prospective studies are needed to better understand the regeneration potential of glenohumeral capsule mechanoreceptors and the importance of the anterior capsule for shoulder proprioception.

Background: A failed prior Latarjet procedure can be a challenging situation for both patients and surgeons. The purpose of this study was to report on the techniques and outcomes of patients undergoing revision surgery for the treatment of recurrent anterior shoulder instability after a failed Latarjet procedure.

Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify clinical studies which reported on surgical techniques for a failed Latarjet procedure with reporting of clinical outcomes. The search terms used were: Latarjet failed. Patients were evaluated based on revision method, patient-reported outcome measures (PROMs), reoperation rates, recurrent instability, overall satisfaction, and return to sports and work.

Results: Thirteen studies (all Level IV evidence) met inclusion criteria, including a total of 293 shoulders with a mean age of 28.3 years (range, 16-55 years) at the time of surgery. The mean follow-up time was 50.4 months (range, 14.0-208.0 months) and males accounted for 78.6% of all patients. Revision procedures included open and arthroscopic Eden-Hybinette, distal tibial allograft, iliac crest autograft, osteochondral glenoid allograft, and Bankart repair and/or capsular plication. These may all be viable techniques for revision surgery for a failed Latarjet procedure. All revision procedures showed improvements in PROMs including the VAS (Visual analogue scale), Constant score, subjective shoulder value (SSV), Walch-Duplay, and Rowe scores. Return to sports ranged from 46.1% to 94%. Recurrent instability rates ranged from 0% to 43.8%. Reoperation rates ranged from 0% to 31.3%. Overall satisfaction following a revision procedure ranged from 80% to 100%.

Conclusion: A failed Latarjet procedure can be treated with various revision procedures such as open and arthroscopic Eden-Hybinette, distal tibial allograft, iliac crest autograft, osteochondral glenoid allograft, and Bankart repair and/or capsular plication. Overall, surgical management of the failed Latarjet results in improvements in PROMs, pain, return to sports, and decreased recurrent instability with a moderate complication rate.

Background: To date, long-term results of the arthroscopic repair of glenoid rim fractures are missing. The aim of this study was, to evaluate clinical and radiographic results following arthroscopic repair of anteroinferior glenoid fractures using anchors or bioabsorbable compression screws after a mean follow-up period of ten years.

Methods: Clinical outcome measures included evaluation of recurrent instability, the Constant Score (CS), Subjective Shoulder Value (SSV), Rowe Score (RS), Western Ontario Shoulder Instability Score (WOSI) and Melbourne Instability Shoulder Score (MISS). X-ray images were obtained for assessment of an instability arthropathy (IA).

Results: 23 patients (7 female and 16 male, mean (± SD) age 48 ± 15 years) who underwent arthroscopic repair of an acute substantial solitary or multifragmented anteroinferior glenoid rim fracture were enrolled. After a mean follow-up period of 10 ± 2 years, patients reached a mean CS of 92 ± 10 points, SSV of 93 ± 11%, RS of 84 ± 20 points, WOSI of 98 ±2% and MISS of 91 ± 11 points. No patient suffered recurrent dislocation. Radiographic results were obtained of 18 patients. Signs of IA were noted in nine patients (50%) with progression of IA in all cases in comparison to the preoperative status. Patients with IA were significantly older (52 versus 38 years, p = 0.04). Clinical score results did not show a significant difference in patients with versus without IA except for the RS (74 versus 94 points, p = 0.02). No intra- or postoperative complications were observed, and no patient required revision endoprosthetic surgery.

Conclusion: Arthroscopic repair of acute anteroinferior glenoid rim fractures shows good clinical long-term results. High rates of IA were observed especially in older patients. However, the presence of IA did not seem to influence the subjective shoulder score outcomes.

Background: Posterior shoulder dislocation frequently results in a centrally located impression fracture of the anterior humeral head, known as reverse Hill-Sachs lesion (RHSL). Depending on size and location of RHSL the RHSL can lead to engagement with the posterior glenoid rim and subsequently re-dislocation of the shoulder joint. The objective of this study was to present the clinical and radiological outcomes of anatomical reconstruction of the humeral articular surface using arthroscopically assisted disimpaction in patients with acute posterior shoulder dislocation and an engaging RHSL.

Methods: As part of a retrospective analysis, nine shoulders in nine patients (1 female, 8 males) with engaging RHSL following acute posterior shoulder dislocation (Type A2 according to the ABC classification) who underwent arthroscopically assisted disimpaction of the RHSL between 2016 and 2023 were identified. Eight patients were included, as one patient refused to participate. In all patients a radiological analysis of the RHSL was accomplished on preoperative and postoperative cross-sectional imaging including alpha, beta and gamma angle as well as depth measurements. The clinical examination included an assessment of active range of motion, instability tests, and patient-reported outcome measures (PROMs), such as the Western Ontario Shoulder Instability (WOSI) Index, the Constant Score (CS), and the Subjective Shoulder Value (SSV).

Results: The mean follow-up period for all eight patients was 34.4 ± 38 months (range: 6-102 months). The mechanisms of injury included falls (n=6), traffic accident (n=1), and convulsive episode (n=1). The average time from injury to surgery was 6.8 ± 4.7 days (range: 2-16). Patient-reported outcomes at the final follow-up indicated an average WOSI Index of 77.8 ± 17 %, a mean Constant Score of 88.3 ± 11 points, and a mean Subjective Shoulder Value (SSV) of 87 ± 16 %. None of the patients experienced recurrent dislocations during the follow-up period. Post-traumatically, the mean absolute defect depth was 8.4 ± 2.2 mm and mean gamma angle was 115.8 ± 13 °. In the radiological follow-up, the RHSL depth measurements showed a significant reduction in the mean defect depth from 8.4 ± 2 mm to 1.2 ± 1 mm resulting in an average reduction of the RHSL by 7.1 mm (p<0.001). In three of the eight patients (37.5%) the RHSL was not identifiable anymore at follow-up and in 5 patients barely identifiable.

Conclusion: Arthroscopically assisted disimpaction of acute RHSLs leads to close to anatomic reduction of RHSL, achieving a stable shoulder and good clinical outcomes.

Level of evidence: Level IV; Case Series; Treatment Study.

Objective: This retrospective, observational study aimed to assess the revision rates and survival curves in total shoulder arthroplasty (TSA) and hemi-shoulder arthroplasty (HSA) patients, including a sub analysis to investigate the impact of pyrocarbon humeral head in revision rates.

Methods: Data from 92 primary HSA and 508 primary TSA patients performed by seven surgeons at a large private clinic, were analyzed. The study focused on revision rates and identified factors leading to revisions, including rotator cuff insufficiency, dislocation, aseptic loosening, implant material, and glenoid erosion.

Results: The overall revision rate for HSA was found to be significantly higher at 7.6% compared to TSA at 1.2% with a maximum follow-up of seven years. Sub-analysis within the HSA group revealed a notably higher revision rate in cases involving a metal head (cobalt-chrome or titanium) at 12.8% compared to those with a pyrocarbon head (2.3%).

Conclusion: This study underscores the importance of distinguishing between TSA and HSA when evaluating shoulder arthroplasty outcomes. The significantly higher revision rate in HSA, particularly with metal heads, suggests the need for careful consideration of implant selection to optimize long-term success in shoulder arthroplasty procedures.