Does surgery for instability of the shoulder truly stabilize the glenohumeral joint?

Abstract

Despite the fact that surgery is commonly used to treat glenohumeral instability, there is no evidence that such treatment effectively corrects glenohumeral translation. The purpose of this prospective clinical study was to analyze the effect of surgical stabilization on glenohumeral translation.Glenohumeral translation was assessed in 11 patients preoperatively and 1 year postoperatively following surgical stabilization for anterior shoulder instability. Translation was measured using optical motion capture and computed tomography.Preoperatively, anterior translation of the affected shoulder was bigger in comparison to the normal contralateral side. Differences were significant for flexion and abduction movements (P < 0.001). Postoperatively, no patients demonstrated apprehension and all functional scores were improved. Despite absence of apprehension, postoperative anterior translation for the surgically stabilized shoulders was not significantly different from the preoperative values.While surgical treatment for anterior instability limits the chance of dislocation, it does not seem to restore glenohumeral translation during functional range of motion. Such persistent microinstability may explain residual pain, apprehension, inability to return to activity and even emergence of dislocation arthropathy that is seen in some patients. Further research is necessary to better understand the causes, effects, and treatment of residual microinstability following surgical stabilization of the shoulder.

Treatment type may influence degree of post-dislocation shoulder osteoarthritis: a systematic review and meta-analysis

“…Furthermore, the difference between the subgroups is determined. OA proportion was calculated by merging all categories describing signs of OA (categories I, II, and III) instability and development of OA in the long term [7,36]. However, the Bankart repair, showing a wide range of 14% to 86% OA, may have a wider indication range compared to the bony augmentation procedures.…”

Surgical Repair of Bankart lesion in Recurrent Shoulder Dislocation: a Comparative and Retrospective Study between Open and Arthroscopic Technique

“…Chalmers P et al [13] through a systematic metaanalysis review concluded that there is no difference between the two techniques in relation to failure rates. Lädermann et al [14] in a prospective study, concluded that regardless of the surgical technique used, there is no evidence that such treatments effectively correct glenohumeral translation, leaving a residual microinstability that may be the cause of residual pain, persistent apprehension and arthrosis, but further studies are needed to better understand residual microinstability. Antunes JP et al [15] observed good results in patients with arthroscopic Bankart repair and recurrence rate of 7%, with a higher risk in young patients with ligament laxity, concluding that arthroscopic repair is a reliable method.…”

Dynamic Anterior Stabilization Using the Long Head of the Biceps for Anteroinferior Glenohumeral Instability

“…Nevertheless, if persistent apprehension is observed, 34 , 35 , 36 a multidisciplinary approach can be recommended. This can include (1) a “reafferentation” of the shoulder based on a neuromuscular and proprioceptive work, 37 (2) a neurofeedback therapy, 38 (3) a cognitive behavioral approach to decondition the pathological residual apprehension by highlighting to the patients that residual micromotion does not necessarily lead to recurrent instability, 39 and finally with (4) a rotator cuff reinforcement to avoid further dysfunction due to muscle fatigue.…”