Pub Date : 2024-12-01DOI: 10.1016/j.otsm.2024.151137
Christiaan Sonke , Ivan Wong
This chapter explores the use of distal tibia allograft (DTA) for addressing glenoid bone deficiencies in revision surgery for anterior glenohumeral instability. Traditional approaches have often overlooked glenoid bone loss, which can negatively impact functional outcomes of a shoulder instability repair. The DTA offers a promising solution, effectively reconstructing the glenoid vault while minimizing damage to surrounding tissues when performed arthroscopically. This approach not only simplifies the surgical technique but also enhances stability when combined with soft tissue procedures. By allowing for personalized graft sizing, the DTA presents an adaptable option for various patients facing revision surgeries for anterior instability, making it a leading consideration in modern orthopaedic practice for the management of shoulder instability repair.
{"title":"Treatment of Failed Anterior Instability Repair With DTA","authors":"Christiaan Sonke , Ivan Wong","doi":"10.1016/j.otsm.2024.151137","DOIUrl":"10.1016/j.otsm.2024.151137","url":null,"abstract":"<div><div>This chapter explores the use of distal tibia allograft (DTA) for addressing glenoid bone deficiencies in revision surgery for anterior glenohumeral instability. Traditional approaches have often overlooked glenoid bone loss, which can negatively impact functional outcomes of a shoulder instability repair. The DTA offers a promising solution, effectively reconstructing the glenoid vault while minimizing damage to surrounding tissues when performed arthroscopically. This approach not only simplifies the surgical technique but also enhances stability when combined with soft tissue procedures. By allowing for personalized graft sizing, the DTA presents an adaptable option for various patients facing revision surgeries for anterior instability, making it a leading consideration in modern orthopaedic practice for the management of shoulder instability repair.</div></div>","PeriodicalId":54678,"journal":{"name":"Operative Techniques in Sports Medicine","volume":"32 4","pages":"Article 151137"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.otsm.2024.151133
Elizabeth Carpenter , Emily Whicker , Ryan J. Whalen , Nate J. Dickinson , Matthew T. Provencher
This chapter emphasizes the significance of advanced imaging techniques, particularly MRI, in diagnosing the underlying causes of failed stabilization, such as recurrent labral tears, capsular deficiency, and glenoid bone loss. Key criteria for evaluating labral integrity postsurgery are discussed, alongside the importance of assessing the capsule and inferior glenohumeral ligament for signs of laxity or tears. Advanced MRI methodologies enable precise assessment of bony structures, while the interplay of imaging findings with history informs clinical decisions regarding revision surgery. Ultimately, integrating advanced imaging examination and surgical expertise can enhance patient outcomes and contribute to long-term shoulder functionality.
{"title":"Imaging Pearls and Findings After Prior Shoulder Stabilization","authors":"Elizabeth Carpenter , Emily Whicker , Ryan J. Whalen , Nate J. Dickinson , Matthew T. Provencher","doi":"10.1016/j.otsm.2024.151133","DOIUrl":"10.1016/j.otsm.2024.151133","url":null,"abstract":"<div><div>This chapter emphasizes the significance of advanced imaging techniques, particularly MRI, in diagnosing the underlying causes of failed stabilization, such as recurrent labral tears, capsular deficiency, and glenoid bone loss. Key criteria for evaluating labral integrity postsurgery are discussed, alongside the importance of assessing the capsule and inferior glenohumeral ligament for signs of laxity or tears. Advanced MRI methodologies enable precise assessment of bony structures, while the interplay of imaging findings with history informs clinical decisions regarding revision surgery. Ultimately, integrating advanced imaging examination and surgical expertise can enhance patient outcomes and contribute to long-term shoulder functionality.</div></div>","PeriodicalId":54678,"journal":{"name":"Operative Techniques in Sports Medicine","volume":"32 4","pages":"Article 151133"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143099740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1053/S1060-1872(24)00088-1
{"title":"Table of Contents (pick up from previous issue w/updates)","authors":"","doi":"10.1053/S1060-1872(24)00088-1","DOIUrl":"10.1053/S1060-1872(24)00088-1","url":null,"abstract":"","PeriodicalId":54678,"journal":{"name":"Operative Techniques in Sports Medicine","volume":"32 4","pages":"Article 151146"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143099743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.otsm.2024.151140
Patrick Luchini, Thomas Spears, Lance E. LeClere
Multidirectional instability (MDI) of the shoulder presents a unique challenge in orthopedics due to its complex etiology and varied patient profiles. MDI can arise from congenital ligamentous laxity, atraumatic repetitive microtrauma, or traumatic events. The pathophysiology involves an imbalance between shoulder mobility and stability, with significant contributions from both static and dynamic stabilizers. Initial management focuses on conservative treatments, emphasizing physical therapy to strengthen the dynamic stabilizers of the glenohumeral joint. Surgical options, primarily open inferior capsular shift and arthroscopic capsular plication, have shown comparable success rates. However, revision surgery outcomes remain poorly defined, with limited literature indicating low success rates and a need for tailored approaches based on individual pathology. This chapter outlines the treatment of failed MDI surgeries and optimized return-to-sport outcomes for affected individuals.
{"title":"Treatment of Failed Arthroscopic Multidirectional Instability Repair: Next Options?","authors":"Patrick Luchini, Thomas Spears, Lance E. LeClere","doi":"10.1016/j.otsm.2024.151140","DOIUrl":"10.1016/j.otsm.2024.151140","url":null,"abstract":"<div><div>Multidirectional instability (MDI) of the shoulder presents a unique challenge in orthopedics due to its complex etiology and varied patient profiles. MDI can arise from congenital ligamentous laxity, atraumatic repetitive microtrauma, or traumatic events. The pathophysiology involves an imbalance between shoulder mobility and stability, with significant contributions from both static and dynamic stabilizers. Initial management focuses on conservative treatments, emphasizing physical therapy to strengthen the dynamic stabilizers of the glenohumeral joint. Surgical options, primarily open inferior capsular shift and arthroscopic capsular plication, have shown comparable success rates. However, revision surgery outcomes remain poorly defined, with limited literature indicating low success rates and a need for tailored approaches based on individual pathology. This chapter outlines the treatment of failed MDI surgeries and optimized return-to-sport outcomes for affected individuals.</div></div>","PeriodicalId":54678,"journal":{"name":"Operative Techniques in Sports Medicine","volume":"32 4","pages":"Article 151140"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1053/j.otsm.2024.151132
Phob Ganokroj , Marco Adriani , Ryan J. Whalen , Nate J. Dickinson , Eddie Afetse , CAPT Matthew T. Provencher
Shoulder instability, particularly prevalent among athletes and military personnel, poses significant challenges in both diagnosis and treatment. This chapter explores the multifaceted nature of shoulder instability, distinguishing between dislocation and subluxation, and highlights the critical role of careful patient selection in achieving successful surgical outcomes. Risk factors contributing to failed shoulder stabilization, including patient-related factors, pathoanatomical conditions, and technical errors, are analyzed. Furthermore, this chapter reviews clinical outcomes for various revision procedures, such as arthroscopic and open Bankart repairs, Latarjet procedures, and bone block procedures, emphasizing the importance of addressing underlying risk factors to optimize recovery and return-to-play rates. Overall, effective management of failed shoulder instability repairs requires a comprehensive understanding of the factors influencing recurrence and a tailored approach to each patient's unique situation.
{"title":"What Is a Failed Shoulder Instability...It Includes More Than Recurrent Dislocation","authors":"Phob Ganokroj , Marco Adriani , Ryan J. Whalen , Nate J. Dickinson , Eddie Afetse , CAPT Matthew T. Provencher","doi":"10.1053/j.otsm.2024.151132","DOIUrl":"10.1053/j.otsm.2024.151132","url":null,"abstract":"<div><div>Shoulder instability, particularly prevalent among athletes and military personnel, poses significant challenges in both diagnosis and treatment. This chapter explores the multifaceted nature of shoulder instability, distinguishing between dislocation and subluxation, and highlights the critical role of careful patient selection in achieving successful surgical outcomes. Risk factors contributing to failed shoulder stabilization, including patient-related factors, pathoanatomical conditions, and technical errors, are analyzed. Furthermore, this chapter reviews clinical outcomes for various revision procedures, such as arthroscopic and open Bankart repairs, Latarjet procedures, and bone block procedures, emphasizing the importance of addressing underlying risk factors to optimize recovery and return-to-play rates. Overall, effective management of failed shoulder instability repairs requires a comprehensive understanding of the factors influencing recurrence and a tailored approach to each patient's unique situation.</div></div>","PeriodicalId":54678,"journal":{"name":"Operative Techniques in Sports Medicine","volume":"32 4","pages":"Article 151132"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.otsm.2024.151138
Bryant P. Elrick, Daniel J. Stokes, Abdulaziz F. Ahmed, Rachel M. Frank
The Latarjet procedure is commonly performed in patients with recurrent shoulder instability and critical glenoid bone loss. While the success rate of the Latarjet procedure is high, failures do occur. Revision surgery can be challenging, and options are limited. Glenoid reconstruction using a distal tibial allograft (DTA) is a viable option to revise a failed Latarjet. Using a DTA bone block technique provides an osteochondral surface with an articular congruency similar to the native glenoid, which effectively restores glenohumeral joint stability and biomechanics. The bony composition, along with technical execution, allows for excellent graft integration with minimal resorption. In this paper, we describe our preferred surgical technique for glenoid reconstruction using a fresh DTA bone block in the setting of a failed Latarjet.
{"title":"Treatment of the Failed Latarjet With Distal Tibia Allograft","authors":"Bryant P. Elrick, Daniel J. Stokes, Abdulaziz F. Ahmed, Rachel M. Frank","doi":"10.1016/j.otsm.2024.151138","DOIUrl":"10.1016/j.otsm.2024.151138","url":null,"abstract":"<div><div>The Latarjet procedure is commonly performed in patients with recurrent shoulder instability and critical glenoid bone loss. While the success rate of the Latarjet procedure is high, failures do occur. Revision surgery can be challenging, and options are limited. Glenoid reconstruction using a distal tibial allograft (DTA) is a viable option to revise a failed Latarjet. Using a DTA bone block technique provides an osteochondral surface with an articular congruency similar to the native glenoid, which effectively restores glenohumeral joint stability and biomechanics. The bony composition, along with technical execution, allows for excellent graft integration with minimal resorption. In this paper, we describe our preferred surgical technique for glenoid reconstruction using a fresh DTA bone block in the setting of a failed Latarjet.</div></div>","PeriodicalId":54678,"journal":{"name":"Operative Techniques in Sports Medicine","volume":"32 4","pages":"Article 151138"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.otsm.2024.151141
Abigail N. Boduch, Stephen E. Marcaccio, Albert Lin, Justin W. Arner
Glenohumeral arthritis following shoulder instability surgery can be due to a variety of factors. One of these, termed anchor arthropathy, presents a significant challenge in management. Studies indicate a varied incidence of glenohumeral arthropathy, with risk factors including age at first dislocation, number of dislocations, and the type of surgical approach. Diagnosis is complex, often relying on a combination of patient history, physical examination, and imaging, with a high index of suspicion necessary for early identification of glenohumeral arthropathy after instability repair. Management typically involves early arthroscopic evaluation and removal of any potential, problematic implants, with promising outcomes reported in revision surgeries. This article underscores the importance of early recognition of glenohumeral arthropathy to prevent long-term complications and improve patient outcomes.
{"title":"Anchor, Implant, and Post-Traumatic Arthropathy After Instability Repair: How to Diagnose and Manage","authors":"Abigail N. Boduch, Stephen E. Marcaccio, Albert Lin, Justin W. Arner","doi":"10.1016/j.otsm.2024.151141","DOIUrl":"10.1016/j.otsm.2024.151141","url":null,"abstract":"<div><div>Glenohumeral arthritis following shoulder instability surgery can be due to a variety of factors. One of these, termed anchor arthropathy, presents a significant challenge in management. Studies indicate a varied incidence of glenohumeral arthropathy, with risk factors including age at first dislocation, number of dislocations, and the type of surgical approach. Diagnosis is complex, often relying on a combination of patient history, physical examination, and imaging, with a high index of suspicion necessary for early identification of glenohumeral arthropathy after instability repair. Management typically involves early arthroscopic evaluation and removal of any potential, problematic implants, with promising outcomes reported in revision surgeries. This article underscores the importance of early recognition of glenohumeral arthropathy to prevent long-term complications and improve patient outcomes.</div></div>","PeriodicalId":54678,"journal":{"name":"Operative Techniques in Sports Medicine","volume":"32 4","pages":"Article 151141"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1053/S1060-1872(24)00089-3
{"title":"Editorial Board (pick up from previous issue)","authors":"","doi":"10.1053/S1060-1872(24)00089-3","DOIUrl":"10.1053/S1060-1872(24)00089-3","url":null,"abstract":"","PeriodicalId":54678,"journal":{"name":"Operative Techniques in Sports Medicine","volume":"32 4","pages":"Article 151147"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143099742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.otsm.2024.151135
Alexander C. Weissman, Allen A. Yazdi, Jared M. Rubin, Sarah A. Muth, Fatima A. Bouftas, Jared P. Sachs, Andrew S. Bi, John P. Scanaliato, Nikhil N. Verma, Brian J. Cole
Glenohumeral instability is often characterized by progressive bipolar bone loss, a clinical phenomenon that not only complicates the management of recurrent shoulder dislocations but portends an increased risk for failure following soft-tissue stabilization procedures. This review synthesizes the history and pathophysiology of humeral and glenoid bone loss, delineates critical and subcritical thresholds, and emphasizes the necessity of a comprehensive diagnostic and surgical approach in the evaluation and treatment of patients with glenoid and/or humeral bone loss. The dynamic nature of bony injury in shoulder instability highlights the importance of tailored interventions to address bipolar bone loss and restore shoulder stability and function. Through an in-depth examination of contemporary strategies for managing glenohumeral instability, including the employment of advanced imaging techniques and refined surgical methods, this chapter offers guidance on an optimal clinical approach. By focusing on improving surgical outcomes and patient function, this review aims to navigate the complexities of shoulder instability, underscoring the importance of an integrated approach to patient care.
{"title":"Bone Loss of The Glenoid and Humerus: A concern for Failure in the Setting of Glenohumeral Instability","authors":"Alexander C. Weissman, Allen A. Yazdi, Jared M. Rubin, Sarah A. Muth, Fatima A. Bouftas, Jared P. Sachs, Andrew S. Bi, John P. Scanaliato, Nikhil N. Verma, Brian J. Cole","doi":"10.1016/j.otsm.2024.151135","DOIUrl":"10.1016/j.otsm.2024.151135","url":null,"abstract":"<div><div>Glenohumeral instability is often characterized by progressive bipolar bone loss, a clinical phenomenon that not only complicates the management of recurrent shoulder dislocations but portends an increased risk for failure following soft-tissue stabilization procedures. This review synthesizes the history and pathophysiology of humeral and glenoid bone loss, delineates critical and subcritical thresholds, and emphasizes the necessity of a comprehensive diagnostic and surgical approach in the evaluation and treatment of patients with glenoid and/or humeral bone loss. The dynamic nature of bony injury in shoulder instability highlights the importance of tailored interventions to address bipolar bone loss and restore shoulder stability and function. Through an in-depth examination of contemporary strategies for managing glenohumeral instability, including the employment of advanced imaging techniques and refined surgical methods, this chapter offers guidance on an optimal clinical approach. By focusing on improving surgical outcomes and patient function, this review aims to navigate the complexities of shoulder instability, underscoring the importance of an integrated approach to patient care.</div></div>","PeriodicalId":54678,"journal":{"name":"Operative Techniques in Sports Medicine","volume":"32 4","pages":"Article 151135"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.otsm.2024.151134
Michael D. Rosenthal , Mike Wellsandt , Zachary Specht
Traumatic shoulder instability is prevalent among athletes, often leading to surgical intervention and challenging rehabilitation outcomes. This chapter explores the complexities surrounding return to play (RTP) following shoulder stabilization procedures, highlighting the significant variance in RTP rates and the common lag in returning to preinjury performance levels, particularly in throwing athletes. Factors influencing successful outcomes include the nature of the instability, surgical approach, and individual athlete characteristics. A consensus on RTP criteria remains elusive, with a predominant reliance on time-based recovery, yet evidence suggests that other physical and psychological variables must be considered. Emphasizing a shared decision-making process and ongoing assessment of range of motion, strength, and proprioception, this chapter aims to identify key deficits and interventions that can enhance rehabilitation success for athletes struggling to return to play. Effective communication among the sports medicine team and the athlete is essential to optimize adherence to rehabilitation protocols and improve overall outcomes.
{"title":"Return to Play After Shoulder Stabilization –What If This Isn't Going Well?","authors":"Michael D. Rosenthal , Mike Wellsandt , Zachary Specht","doi":"10.1016/j.otsm.2024.151134","DOIUrl":"10.1016/j.otsm.2024.151134","url":null,"abstract":"<div><div>Traumatic shoulder instability is prevalent among athletes, often leading to surgical intervention and challenging rehabilitation outcomes. This chapter explores the complexities surrounding return to play (RTP) following shoulder stabilization procedures, highlighting the significant variance in RTP rates and the common lag in returning to preinjury performance levels, particularly in throwing athletes. Factors influencing successful outcomes include the nature of the instability, surgical approach, and individual athlete characteristics. A consensus on RTP criteria remains elusive, with a predominant reliance on time-based recovery, yet evidence suggests that other physical and psychological variables must be considered. Emphasizing a shared decision-making process and ongoing assessment of range of motion, strength, and proprioception, this chapter aims to identify key deficits and interventions that can enhance rehabilitation success for athletes struggling to return to play. Effective communication among the sports medicine team and the athlete is essential to optimize adherence to rehabilitation protocols and improve overall outcomes.</div></div>","PeriodicalId":54678,"journal":{"name":"Operative Techniques in Sports Medicine","volume":"32 4","pages":"Article 151134"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143099739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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