Arthroscopic Treatment of Posterior Shoulder Instability: A Systematic Review

Leivadiotou, Dimitra; Ahrens, Philip

doi:10.1016/j.arthro.2014.11.009

Cited by 41 publications

(15 citation statements)

References 20 publications

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“… 10 A systematic review by Leivadiotou and Ahrens of almost 400 shoulders reported a 92.5% return to sport and a 5.37% rate of recurrent instability. 14 A systematic review by Delong et al. showed that patients treated arthroscopically have superior outcomes compared with patients who undergo open procedures with respect to stability, recurrence of instability, patient satisfaction, return to sport, and return to previous level of play.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Labral Repair in the Setting of Recurrent Posterior Shoulder Instability

Sánchez

Kennedy

Ferrari

et al. 2017

Arthroscopy Techniques

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Posterior shoulder instability, although relatively rare in the general population, is more commonly seen in athletes, especially those in contact sports. Although nonoperative treatment has been associated with satisfactory results in the setting of posterior shoulder instability, conservative management may ultimately fail and lead to recurrence particularly in young, male patients. Both arthroscopic and open repair techniques to address posterior instability have been described, with each showing positive patient-reported outcomes, low risk of recurrence, and considerably high return-to-sport rates. In particular, arthroscopic treatment includes the following: capsular plication and knotted and/or knotless suture anchor fixation. The purpose of this technique is to describe our preferred technique to treat recurrent posterior shoulder instability through arthroscopic labral repair using knotless suture anchor fixation.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic Labral Repair in the Setting of Recurrent Posterior Shoulder Instability

Sánchez

Kennedy

Ferrari

et al. 2017

Arthroscopy Techniques

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“…In our practice, after a failure of extensive nonoperative management or in the setting of recurrent dislocations, arthroscopic capsulorrhaphy and labral repair appear to comprise a reasonable and efficacious treatment, as supported by prior literature. 5,[7][8][9][10][11] Over 90% of patients in these studies returned to sport after this arthroscopic treatment, with recurrent instability rates between 5% and 8%. This first step is not apparently controversial and appears to be a well-accepted aspect of the treatment algorithm for posterior shoulder instability.…”

mentioning

confidence: 87%

Editorial Commentary: Open Posterior Shoulder Stabilization—When Is It Needed? Glenoid Bone Loss Patterns Are Not Created Equal

Wagner

Gottschalk

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Posterior shoulder instability remains a poorly understood pathologic entity. Our current treatment algorithm of simple posterior shoulder instability is fairly straightforward, with most patients receiving arthroscopic capsulorrhaphy with labral repair. However, in those with a failed arthroscopic intervention and/or with bony pathology, the optimal treatment is much less clear. As we move forward to evaluate how to optimally treat these patients, it will be critical to better understand the bony pathologies, including those with true posterior glenoid bone loss versus glenoid retroversion. Using novel methods to identify, measure, and quantify the different glenoid morphologies will be the foundation for improving the treatment of these complex and poorly understood pathologies.

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“…In the last decade, arthroscopic techniques for the treatment of posterior glenohumeral instability have increased [ 7 ]. Numerous published studies show high rates of good results with arthroscopic treatment [ 15 - 18 ].…”

Section: Surgical Treatmentmentioning

confidence: 99%

Treatment of The Posterior Unstable Shoulder

Alepuz¹,

Pérez-Barquero²,

Jorge³

et al. 2017

TOORTHJ

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Background:It is estimated that approximately 5% of glenohumeral instabilities are posterior. There are a number of controversies regarding therapeutic approaches for these patients.Methods:We analyse the main surgery alternatives for the treatment of the posterior shoulder instability. We did a research of the publications related with posterior glenohumeral instability.Results:There are conservative and surgical treatment options. Conservative treatment has positive results in most patients, with around 65 to 80% of cases showing recurrent posterior dislocation.There are multiple surgical techniques, both open and arthroscopic, for the treatment of posterior glenohumeral instability. There are procedures that aim to repair bone defects and others that aim to repair soft tissues and capsulolabral injuries. The treatment should be planned according to each case on an individual basis according to the patient characteristics and the injury type.Surgical treatment is indicated in patients with functional limitations arising from instability and/or pain that have not improved with rehabilitation treatment.The indications for arthroscopic treatment are recurrent posterior subluxation caused by injury of the labrum or the capsulolabral complex; recurrent posterior subluxation caused by capsuloligamentous laxity or capsular redundancy; and multidirectional instability with posterior instability as a primary component. Arthroscopic assessment will help identify potential injuries associated with posterior instability such as bone lesions or defects and lesions or defects of soft tissues.The main indications for open surgery would be in cases of Hill Sachs lesions or broad reverse Bankart lesions not accessible by arthroscopy.We indicated non-anatomical techniques (McLaughlin or its modifications) for reverse Hill-Sachs lesions with impairment of the articular surface between 20% and 50%. Disimpaction of the fracture and placement of bone graft (allograft or autograft) is a suitable treatment for acute lesions that do not exceed 50% of the articular surface and with articular cartilage in good condition. Reconstruction with allograft may be useful in lesions affecting up to 50% of the humeral surface and should be considered when there is a situation of non-viable cartilage at the fracture site. For defects greater than 50% of the articular surface or in the case of dislocations over 6 months in duration where there is poor bone quality, some authors advocate substitution techniques as a treatment of choice. The main techniques for treating glenoid bone defects are posterior bone block and posterior opening osteotomy of the glenoid.Conclusions:The treatment of the posterior glenohumeral instability has to be individualized based on the patient´s injuries, medical history, clinical exam and goals. The most important complications in the treatment of posterior glenohumeral instability are recurrent instability, avascular necrosis and osteoarthritis.

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Arthroscopic Treatment of Posterior Shoulder Instability: A Systematic Review

Cited by 41 publications

References 20 publications

Arthroscopic Labral Repair in the Setting of Recurrent Posterior Shoulder Instability

Arthroscopic Labral Repair in the Setting of Recurrent Posterior Shoulder Instability

Editorial Commentary: Open Posterior Shoulder Stabilization—When Is It Needed? Glenoid Bone Loss Patterns Are Not Created Equal

Treatment of The Posterior Unstable Shoulder

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