Operative Techniques in Sports Medicine最新文献

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Treatment of Failed Arthroscopic Multidirectional Instability Repair: Next Options? 关节镜多向不稳定性修复失败的治疗：下一步选择？

IF 0.4 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2024-12-01 DOI: 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.

肩部多向不稳定性（MDI）由于其复杂的病因和不同的患者概况，在骨科中提出了独特的挑战。MDI可由先天性韧带松弛、非外伤性重复性微创伤或外伤性事件引起。病理生理学涉及肩部活动和稳定性之间的不平衡，静态和动态稳定剂都有重要贡献。最初的治疗侧重于保守治疗，强调物理治疗以加强盂肱关节的动态稳定。手术选择，主要是开放下囊移位和关节镜下囊应用，已经显示出相当的成功率。然而，翻修手术的结果仍然不明确，有限的文献表明低成功率和需要根据个体病理量身定制的方法。本章概述了MDI手术失败的治疗方法，并为受影响的个体优化了恢复运动的结果。

引用次数: 0

Imaging Pearls and Findings After Prior Shoulder Stabilization 先前肩部稳定后的成像珍珠和结果

IF 0.4 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2024-12-01 DOI: 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.

本章强调了先进的成像技术的重要性，特别是MRI，在诊断稳定失败的潜在原因，如复发性唇撕裂，囊膜缺失和盂骨丢失。本文讨论了评估术后唇部完整性的关键标准，以及评估关节囊和下盂肱韧带松弛或撕裂迹象的重要性。先进的MRI方法能够精确评估骨结构，同时影像学发现与病史的相互作用为翻修手术的临床决策提供信息。最终，整合先进的影像学检查和外科专业知识可以提高患者的预后，并有助于长期的肩部功能。

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Table of Contents (pick up from previous issue w/updates) 目录（选自上一期的内容和更新）

IF 0.4 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2024-12-01 DOI: 10.1053/S1060-1872(24)00088-1

引用次数: 0

What Is a Failed Shoulder Instability...It Includes More Than Recurrent Dislocation 什么是失败的肩部不稳定…它不仅包括复发性脱位

IF 0.4 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2024-12-01 DOI: 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.

肩关节不稳，尤其在运动员和军人中普遍存在，在诊断和治疗方面都提出了重大挑战。本章探讨了肩部不稳定的多面性，区分脱位和半脱位，并强调了谨慎选择患者在获得成功手术结果中的关键作用。分析导致肩关节稳定失败的危险因素，包括患者相关因素、病理解剖条件和技术错误。此外，本章回顾了各种翻修手术的临床结果，如关节镜和开放式Bankart修复、Latarjet手术和骨块手术，强调了解决潜在风险因素以优化恢复和恢复率的重要性。总的来说，有效处理肩部不稳定修复失败需要全面了解影响复发的因素，并根据每位患者的独特情况量身定制方法。

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Treatment of the Failed Latarjet With Distal Tibia Allograft 胫骨远端同种异体移植治疗椎弓形缺损失败

IF 0.4 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2024-12-01 DOI: 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.

Latarjet手术通常用于复发性肩关节不稳定和严重肩关节骨丢失的患者。虽然Latarjet的成功率很高，但也会出现故障。翻修手术具有挑战性，而且选择有限。使用胫骨远端同种异体移植（DTA）重建关节盂是修复失败的Latarjet的可行选择。DTA骨块技术提供了与天然关节盂相似的关节一致性的骨软骨表面，有效地恢复了盂肱关节的稳定性和生物力学。骨组成，连同技术执行，允许良好的移植物整合和最小的吸收。在本文中，我们描述了在Latarjet失败的情况下使用新鲜DTA骨块进行关节盂重建的首选手术技术。

引用次数: 0

Anchor, Implant, and Post-Traumatic Arthropathy After Instability Repair: How to Diagnose and Manage 不稳定修复后的锚定、植入物和创伤后关节病变：如何诊断和处理

IF 0.4 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2024-12-01 DOI: 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.

肩关节不稳定手术后的肩关节关节炎可由多种因素引起。其中一种，被称为锚定关节病，在治疗中提出了重大挑战。研究表明，肩关节病的发病率各不相同，其危险因素包括首次脱位的年龄、脱位的次数和手术入路的类型。诊断是复杂的，通常依赖于患者病史、体格检查和影像学检查的结合，对于不稳定修复后的盂肱关节病的早期识别需要高度的怀疑指数。治疗通常包括早期关节镜评估和移除任何潜在的、有问题的植入物，在翻修手术中报告了有希望的结果。这篇文章强调了早期识别肩关节病变对预防长期并发症和改善患者预后的重要性。

引用次数: 0

Editorial Board (pick up from previous issue) 编辑委员会（选自上一期）

IF 0.4 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2024-12-01 DOI: 10.1053/S1060-1872(24)00089-3

引用次数: 0

Bone Loss of The Glenoid and Humerus: A concern for Failure in the Setting of Glenohumeral Instability 关节盂和肱骨的骨丢失：关节盂和肱骨不稳定的失败

IF 0.4 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2024-12-01 DOI: 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.

肩关节不稳定通常以进行性双极骨丢失为特征，这一临床现象不仅使复发性肩关节脱位的治疗复杂化，而且预示着软组织稳定手术失败的风险增加。这篇综述综合了肱骨和肱骨盂骨丢失的历史和病理生理学，描述了临界和亚临界阈值，并强调了在评估和治疗肱骨盂和/或肱骨骨丢失患者时综合诊断和手术方法的必要性。肩关节不稳定中骨损伤的动态特性突出了针对性干预的重要性，以解决双相骨丢失和恢复肩关节的稳定性和功能。通过对当代治疗盂肱部不稳定策略的深入研究，包括采用先进的成像技术和精细的手术方法，本章提供了最佳临床方法的指导。通过关注改善手术结果和患者功能，本综述旨在引导肩部不稳定的复杂性，强调综合方法对患者护理的重要性。

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引用次数: 0

Return to Play After Shoulder Stabilization –What If This Isn't Going Well? 肩部稳定后重返赛场-如果进展不顺利怎么办？

IF 0.4 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2024-12-01 DOI: 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.

外伤性肩部不稳定在运动员中很普遍，经常导致手术干预和具有挑战性的康复结果。本章探讨了肩部稳定手术后恢复比赛（RTP）的复杂性，强调了RTP率的显著差异和恢复到受伤前表现水平的常见滞后，特别是在投掷运动员中。影响成功结果的因素包括不稳定性的性质、手术方式和运动员的个人特征。关于RTP标准的共识仍然难以捉摸，主要依赖于基于时间的恢复，但有证据表明，必须考虑其他生理和心理变量。强调共同的决策过程和对运动范围、力量和本体感觉的持续评估，本章旨在确定关键缺陷和干预措施，这些缺陷和干预措施可以提高运动员努力恢复比赛的康复成功率。运动医学团队和运动员之间的有效沟通对于优化康复方案的依从性和改善总体结果至关重要。

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引用次数: 0

Treatment of Failed Anterior Instability With Latarjet Latarjet治疗前路失稳失败

IF 0.4 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2024-12-01 DOI: 10.1016/j.otsm.2024.151136

Giovanni Di Giacomo , Andrea Vespasiani , Riccardo Mazzaferro

This chapter examines the factors contributing to the failure of arthroscopic Bankart repair and evaluates the Latarjet procedure as a potential salvage option. While arthroscopic Bankart repair is the preferred treatment for Bankart lesions without significant glenoid bone loss, its higher failure rates compared to traditional open techniques pose challenges, particularly in active patients. Factors influencing failure include inadequate tissue healing, insufficient surgical technique, and patient-specific factors among others. The chapter highlights the importance of assessing glenoid and humeral bone loss, utilizing the Instability Severity Index Score (ISIS) to guide surgical decisions. The Latarjet procedure demonstrates promising results, offering a low recurrence rate and additional stability benefits, making it a viable option for managing a prior failed anterior shoulder stabilization procedure.

本章探讨了导致关节镜下Bankart修复失败的因素，并评估了Latarjet手术作为一种潜在的挽救选择。虽然关节镜下Bankart修复是没有明显盂骨丢失的Bankart病变的首选治疗方法，但与传统的开放式技术相比，其较高的失败率带来了挑战，特别是在活动患者中。影响失败的因素包括组织愈合不足、手术技术不足和患者特异性因素等。本章强调了评估肩关节和肱骨骨丢失的重要性，利用不稳定严重程度指数评分（ISIS）来指导手术决策。Latarjet手术显示出良好的效果，复发率低，并且具有额外的稳定性优势，使其成为治疗先前失败的前路肩关节稳定手术的可行选择。

引用次数: 0

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