Glenoid vault and humeral head alignment in relation to the scapular blade axis in young patients with pre-osteoarthritic static posterior subluxation of the humeral head

Akgün, Doruk; Siegert, Paul; Danzinger, Victor; Plachel, Fabian; Minkus, Marvin; Thiele, Kathi; Moroder, Philipp

doi:10.1016/j.jse.2020.08.004

Cited by 13 publications

(14 citation statements)

References 18 publications

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“…According to the results of this study, surgery should be considered in cases with posterior humeral subluxation as it is associated with a worse WOSI score at follow-up and a persisting static posterior glenohumeral head subluxation, which might lead to early-onset posterior decentring osteoarthritis[ 1 , 31 ]. In addition, posttraumatic posterior glenohumeral subluxation was much higher in the redislocation group compared to the no redislocation group without reaching statistical significance, thus warranting further studies (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Glenohumeral centring was measured as previously published by Walch et al and illustrated in Fig. 1 A [ 1 , 32 ]. Scapulohumeral centring was measured according to Kidder et al [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

“…A tangential line was drawn on the bony glenoid width, with two perpendicular lines starting from the anterior and posterior glenoid rims (dashed lines). Distances from the centre of the circle to the anterior dashed line was measured in relation to the distance from the anterior to the posterior dashed line and expressed as a percentage according to a previously published technique [ 1 , 32 ]. Therefore, values > 50% represent a posterior glenohumeral decentring and values < 50% an anterior decentring, respectively.…”

Section: Methodsmentioning

confidence: 99%

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Conservative treatment of acute traumatic posterior shoulder dislocations (Type A) is a viable option especially in patients with centred joint, low gamma angle, and middle or old age

Festbaum

Minkus

Akgün

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Purpose of this study was to evaluate the mid- to long-term outcome after conservatively treated first-time posterior shoulder dislocations and to determine structural defects associated with failure. Methods In this multi-centric retrospective study, 29 shoulders in 28 patients with first-time acute posterior shoulder dislocation (Type A1 or A2 according to the ABC classification) and available cross-sectional imaging were included. Outcome scores as well as radiological and magnetic resonance imaging were obtained at a mean follow-up of 8.3 ± 2.7 years (minimum: 5 years). The association of structural defects with redislocation, need for secondary surgery, and inferior clinical outcomes were analysed. Results Redislocation occurred in six (21%) shoulders and nine shoulders (31%) underwent secondary surgery due to persistent symptoms. The posttraumatic posterior glenohumeral subluxation was higher in the redislocation group compared to the no redislocation group; however, statistical significance was not reached (61.9 ± 12.5% vs. 50.6 ± 6.4%). Furthermore, a higher adapted gamma angle was observed in the failed conservative treatment group versus the conservative treatment group, similarly without statistically significant difference (97.8° ± 7.2°, vs. 93.3° ± 9.7°). The adapted gamma angle was higher than 90° in all patients of failed conservative therapy and the redislocation group. An older age at the time of dislocation showed a significant correlation with better clinical outcomes (SSV: r = 0.543, p = 0.02; ROWE: r = 0.418, p = 0.035 and WOSI: r = 0.478, p = 0.045). Posterior glenohumeral subluxation after trauma correlated with a worse WOSI (r = − 0.59, p = 0.02) and follow-up posterior glenohumeral decentring (r = 0.68, p = 0.007). The gamma angle (r = 0.396, p = 0.039) and depth of the reverse Hill–Sachs lesion (r = 0.437, p = 0.023) correlated significantly with the grade of osteoarthritis at follow-up. Conclusion Conservative treatment is a viable option in patients with an acute traumatic posterior shoulder dislocation with good outcome after mid- and long-term follow-up especially in patients with centred joint, low gamma angle, and middle or old age. Level of evidence IV.

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Section: Discussionmentioning

confidence: 99%

“…Glenohumeral centring was measured as previously published by Walch et al and illustrated in Fig. 1 A [ 1 , 32 ]. Scapulohumeral centring was measured according to Kidder et al [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Conservative treatment of acute traumatic posterior shoulder dislocations (Type A) is a viable option especially in patients with centred joint, low gamma angle, and middle or old age

Festbaum

Minkus

Akgün

et al. 2022

Knee Surg Sports Traumatol Arthrosc

Self Cite

View full text Add to dashboard Cite

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“…In cases with excessive glenoid retroversion corrective osteotomy of the glenoid can be performed, however, the correction of glenoid retroversion does not necessarily correct the PSHH [20]. This can be due to significant differences of scapula morphology in terms of an increased anterior glenoid offset, which is not addressed with retroversion corrective osteotomy [21]. Surgical treatment of young patients with advanced osteoarthritis and B-type glenoids remains a challenge.…”

Section: Discussionmentioning

confidence: 99%

Patient-specific risk profile associated with early-onset primary osteoarthritis of the shoulder: is it really primary?

Plachel

Akgün

Imiolczyk

et al. 2021

Arch Orthop Trauma Surg

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Introduction Although age is considered to be the major risk factor of primary glenohumeral osteoarthritis (GOA), younger population may suffer from degenerative changes of the shoulder joint without evidence of any leading cause. The purpose of this study was to investigate the risk profile in young patients suffering from presumably primary GOA. Methods A consecutive group of 47 patients undergoing primary shoulder arthroplasty for early-onset GOA below the age of 60 years at time of surgery was retrospectively identified and prospectively evaluated. Patients with identifiable cause for GOA (secondary GOA) were excluded. The resulting 32 patients (mean age 52 ± 7 years; 17 male, 15 female) with primary GOA were matched by age (± 3 years) and gender to 32 healthy controls (mean age 53 ± 7 years; 17 male, 15 female). Demographic data and patient-related risk factors were assessed and compared among both groups to identify extrinsic risk factors for primary GOA. Patients were further subdivided into a group with concentric GOA (group A) and a group with eccentric GOA (group B) to perform a subgroup analysis. Results Patients had a significantly higher BMI (p = 0.017), were more likely to be smokers (p < 0.001) and to have systematic diseases such as hypertension (p = 0.007) and polyarthritis (p < 0.001) and a higher Shoulder Activity Level (SAL) (p < 0.001) when compared to healthy controls. Furthermore, group B had a significantly higher SAL not only compared to healthy controls but also to group A, including activities such as combat sport (p = 0.048) and weightlifting (p = 0.01). Conclusions Several patient-specific risk factors are associated with primary GOA in the young population, as well as highly shoulder demanding activities in the development of eccentric GOA. Consequently, a subset of young patients with eccentric primary GOA could in reality be secondary due to a muscular imbalance between internal and external rotators caused by improper weight training. Level of evidence III, Case–Control study

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“… 23 , 25 The ABC classification separates PSI into 3 groups: first-time (type A), dynamic (type B), and static (type C) and further differentiates type C into the subtypes constitutional static posterior instability (C1) and acquired static posterior instability (C2) 20 ( Figure 1 ). Although the actual cause of type C1 PSI remains controversial, constitutional muscular imbalances and scapular shape alterations, including excessive anterior glenoid offset, glenoid dysplasia, increased glenoid retroversion, and acromial variants, are being debated as potential risk factors contributing to this preosteoarthritic pathology 1 , 2 , 8 , 12 , 18 . Although initially patients are asymptomatic, progressive wear of the posterior articular cartilage and posterior labrum due to the static posterior subluxation of the humeral head ( Figure 2 ) leads to pain and loss of strength during exertion, typically without evident instability symptoms.…”

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confidence: 99%

Arthroscopic Posterior Articular Coverage and Shift (PACS) Procedure for Treatment of Preosteoarthritic Constitutional Static Posterior Shoulder Instability (Type C1)

et al. 2022

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Background: Different joint-preserving techniques for treatment of preosteoarthritic, constitutional static (type C1) posterior shoulder instability (PSI) have been proposed, including posterior glenoid open wedge osteotomy and bone graft augmentation. However, the techniques are demanding, the reported complication and reoperation rates are high, and posterior decentering cannot reliably be reversed. Purpose: To assess the clinical and radiological longitudinal outcomes of patients with type C1 PSI after arthroscopic posterior articular coverage and shift (PACS) surgery. Study Design: Case series; Level of evidence, 4. Methods: We performed a retrospective analysis of a prospective database with longitudinal follow-up including 14 shoulders in 13 patients who underwent an arthroscopic PACS procedure for symptomatic preosteoarthritic constitutional static posterior instability (type C1) with previous failed nonoperative treatment. Patients were clinically evaluated before surgery and at 3, 6, 12, and 24 months postoperatively in terms of satisfaction and pain levels as well as standardized physical examination, Subjective Shoulder Value (SSV), Western Ontario Shoulder Instability Index (WOSI) score, Constant score, and Rowe score. Preoperative, postoperative, and follow-up magnetic resonance imaging scans were obtained in all patients. A paired 2-sample t test was used to compare changes in continuous variable parameters over time. Correlation analyses were performed using the Pearson correlation coefficient. Results: All outcome scores and the pain level improved significantly from preoperatively to postoperatively, and the improvement was sustained over the follow-up period of 2 years (pain level, 6.4 preoperatively vs 3.3 at 2 years, P < .001; SSV, 40 vs 70, P = .001; WOSI, 33 vs 56, P = .001; Constant, 70 vs 79, P = .049; Rowe, 52 vs 76, P < .001). The mean glenohumeral and scapulohumeral subluxation indices were significantly lower in the early postoperative period compared with preoperative measurements (glenohumeral, 52% ± 6% vs 58% ± 10%, P = .02; scapulohumeral, 70% ± 8%; vs 77% ± 9%, P = .002, respectively); however, they returned to baseline values at follow-up (57% ± 7% vs 58% ± 10%, P = .7; 75% ± 6% vs 77% ± 9%, P = .4, respectively). A high scapulohumeral subluxation index, excessive glenoid retroversion, and increased posterior positioning of the humeral head in relation to scapular blade axis and older age were correlated with worse clinical outcomes. Conclusion: Over the follow-up period of 2 years, the PACS procedure significantly improved outcome scores in patients who had preosteoarthritic constitutional static posterior shoulder instability, especially in younger patients with less severe glenoid retroversion and posterior decentering of the humeral head. However, similar to other techniques, the PACS procedure needs to be considered a symptomatic therapy that does not reverse the underlying cause or stop the progressive pathology.

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Glenoid vault and humeral head alignment in relation to the scapular blade axis in young patients with pre-osteoarthritic static posterior subluxation of the humeral head

Cited by 13 publications

References 18 publications

Conservative treatment of acute traumatic posterior shoulder dislocations (Type A) is a viable option especially in patients with centred joint, low gamma angle, and middle or old age

Conservative treatment of acute traumatic posterior shoulder dislocations (Type A) is a viable option especially in patients with centred joint, low gamma angle, and middle or old age

Patient-specific risk profile associated with early-onset primary osteoarthritis of the shoulder: is it really primary?

Arthroscopic Posterior Articular Coverage and Shift (PACS) Procedure for Treatment of Preosteoarthritic Constitutional Static Posterior Shoulder Instability (Type C1)

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