Retrospective comparative analysis, Level III.

Purpose The purpose of this study was to analyse the longterm incidence of dislocation arthropathy after a modified Latarjet procedure for glenohumeral instability. Methods Long-term follow-up information was obtained from a consecutive series of patients who had undergone a modified Latarjet procedure by one surgeon between 1986 and 1999. Multivariable regression analysis was performed to examine the relation between the development of a dislocation arthropathy and patients and surgery-related factors. Results There were 117 patients (117 shoulders) for evaluation, (35 women and 82 men) with a mean age 28.4±8.5 (range, 16-55). The mean follow-up was 16.2 years (range, ten to 22.2 years). Signs of dislocation arthropathy were found in 36 % of patients, graded as Samilson 1 in 30 %, Samilson 2 in 3 %, and 3 % Samilson 3 in 3 % of patients. Risk factors for dislocation arthropathy included surgery in patients older than 40 years of age (64.3 vs. 34.4 %; adjusted RR 2.2, 95 % CI 1.7-2.9) and lateral positioning of the transferred coracoid process in relation to the glenoid rim (82.4 vs. 30.4 %; adjusted RR 2.3, 95 % CI 1.7-3.2). Patients with hyperlaxity developed less dislocation arthropathy (15 vs. 42.5 %; adjusted RR 0.4, 95 % CI 0.1-0.95). Conclusion The development of dislocation arthropathy after the Latarjet procedure remains a source of concern in the long term. It correlates with surgery after the age of 40 and lateral coracoid transfer in relation to the glenoid rim. On the other hand, hyperlaxity seems to have a protective effect on the development of dislocation arthropathy.

BACKROUND AND PURPOSE:Shoulder apprehension is defined as anxiety and resistance in patients with a history of anterior glenohumeral instability. It remains unclear whether shoulder apprehension is the result of true recurrent instability or a memorized subjective sensation. We tested whether visual presentation of apprehension videos modifies functional brain networks associated with motor resistance and anxiety. MATERIALS AND METHODS:This prospective study includes 15 consecutive right-handed male patients with shoulder apprehension (9 with right shoulder apprehension, 6 with left shoulder apprehension; 27.5 Ϯ 6.4 years) and 10 healthy male right-handed age-matched control participants (29.0 Ϯ 4.7 years). Multimodal MR imaging included 1) functional connectivity tensorial independent component analysis, 2) taskrelated general linear model analysis during visual stimulation of movies showing typical apprehension movements vs control videos, 3) voxelbased morphometry analysis of GM, and 4) tract-based spatial statistics analysis of WM. RESULTS:Patients with shoulder apprehension had significant (P Ͻ .05 corrected) increase in task-correlated functional connectivity, notably in the bilateral primary sensory-motor area and dorsolateral prefrontal cortex and, to a lesser degree, the bilateral dorsomedial prefrontal cortex, anterior insula, and dorsal anterior cingulate cortex (ϩ148% right, ϩ144% left). Anticorrelated functional connectivity decreased in the higher-level visual and parietal areas (Ϫ185%). There were no potentially confounding structural changes in GM or WM. CONCLUSIONS:Shoulder apprehension induces specific reorganization in apprehension-related functional connectivity of the primary sensory-motor areas (motor resistance), dorsolateral prefrontal cortex (cognitive control of motor behavior), and the dorsal anterior cingulate cortex/dorsomedial prefrontal cortex and anterior insula (anxiety and emotional regulation).ABBREVIATIONS: dACC ϭ dorsal anterior cingulate cortex; dlPFC ϭ dorsolateral prefrontal cortex; dmPFC ϭ dorsomedial prefrontal cortex; GLM ϭ general linear model; IC ϭ independent component; TBSS ϭ tract-based spatial statistics; TICA ϭ tensorial independent component analysis; VBM ϭ voxel-based morphometry S houlder apprehension is defined as anxiety and resistance in patients with a history of anterior glenohumeral instability. The apprehension sign is a physical finding in which placement of the humerus in the position of abduction to 90°and maximal external rotation produces anxiety and resistance in patients with a history of anterior glenohumeral instability.

Overall, Rowe score provides the strongest link between shoulder apprehension and brain level alterations as it correlates with the highest number of independent components involving areas responsible for both motor and cognitive functions, whereas pain VAS and WOSI occupy an intermediately strong link recruiting less brain networks. Finally, Simple Shoulder Test and SSV have the weakest link at the brain level.

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