Management of Glenoid Bone Loss with Anterior Shoulder Instability: Indications and Outcomes

Rabinowitz, Justin; Friedman, Richard J.; Eichinger, Josef K.

doi:10.1007/s12178-017-9439-y

Cited by 55 publications

(33 citation statements)

References 66 publications

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“…Glenoid bone loss (GBL) is often present in patients with glenohumeral instability. 10,15,16,21 Osseous glenoid abnormalities have been reported in 87% of shoulders with chronic anterior instability and in 22% of shoulders after first-time dislocations. 10,21 Many authors have noted significant GBL as a contraindication for soft tissue repair alone, with 1 study finding GBL to be the most common risk factor causing recurrent instability after surgical repair.…”

mentioning

confidence: 99%

Risk Factors for Recurrence After Arthroscopic Instability Repair—The Importance of Glenoid Bone Loss >15%, Patient Age, and Duration of Symptoms: A Matched Cohort Analysis

et al. 2020

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Background: Glenoid bone loss (GBL) has been implicated as a risk factor for failure of arthroscopic anterior glenohumeral instability repair. Although certain amounts of GBL are associated with higher recurrence rates, there are limited studies on successes versus failures in these cohorts. Purpose: To compare the outcomes of arthroscopic Bankart repair in patients with and without GBL to determine a threshold percentage of GBL that predicts success. Study Design: Cohort study; Level of evidence, 2. Methods: All consecutive patients who underwent arthroscopic Bankart repair for anterior shoulder instability between 2004 and 2013 were prospectively enrolled. Patients with ≤25% GBL were included. Patients with no GBL were grouped and compared with those having 5% to 25% GBL. Outcomes included Single Assessment Numerical Evaluation, Western Ontario Shoulder Index, and American Shoulder and Elbow Surgeons scores, with evidence of recurrent instability. Patients with and without GBL were statistically compared with respect to outcomes and recurrence rates. Results: Of 434 eligible patients, the cases of 405 (45 female, 360 male; mean age, 27.5 years [range, 18-47 years]) were followed for a mean 61 months (range, 48-96 months). There were 189 (46.6%) with no GBL and 216 (53.3%) with GBL; the mean GBL of the latter cohort was 15% (range, 5%-25%). The mean duration of instability symptoms was 7.9 months (range, 1-21 months) and was significantly longer in the GBL group ( P < .05). The mean recurrence rate was 14.8%, which was significantly greater in patients presenting with GBL versus those with none (48/216 [22.2%] vs 12/189 [6.3%]; P < .01). Within the GBL group, GBL ≥15%, duration of symptoms >5 months, and younger age (<20 years) were independent risk factors for failure ( P < .01). Patients with any GBL had >4-times greater odds of recurrence after arthroscopic stabilization (odds ratio, 4.21; 95% CI, 2.16-8.21). Moreover, patients presenting for arthroscopic Bankart repair with GBL ≥15% had nearly 3-times greater odds of recurrent instability. Conclusion: GBL ≥15% in an active patient population portends to increased odds of recurrent instability events and inferior clinical outcomes after arthroscopic Bankart repair. Furthermore, nonmodifiable risk factors, such as age (<20 years) and duration of symptoms before presentation (>5 months), significantly affect risk of recurrence and should be key factors when counseling patients on risk of failure and determining the ideal procedure for the individual patient.

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confidence: 99%

Risk Factors for Recurrence After Arthroscopic Instability Repair—The Importance of Glenoid Bone Loss >15%, Patient Age, and Duration of Symptoms: A Matched Cohort Analysis

et al. 2020

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“…6,7 It is widely accepted that this structural damage alters glenoid biomechanics by impairing its function as a static stabilizer. 8 Defects greater than 20 to 25% deserve special attention because of their worse prognosis with arthroscopic repair. 6,9 In an anterior dislocation, the shoulder may suffer an impaction fracture at the posterosuperior and lateral portion of the humeral head.…”

Section: Discussionmentioning

confidence: 99%

A avaliação do método tomográfico glenoid track na ressonância magnética/artro RM

Godinho

França³

et al. 2020

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Comparar a avaliação do método glenoid-track (GT) em exames de tomografia computadorizada com reconstrução 3-D (TC-3D) com a avaliação realizada em exames de ressonância magnética (RM) e/ou artro-ressonância magnética (ARM). Métodos Quarenta e quatro ombros com diagnóstico clínico e radiográfico de instabilidade anterior traumática foram avaliados por meio de exames de TC-3D, RM e/ou ARM. As variáveis GT, intervalo de Hill-Sachs (IHS) e a perda óssea da glenoide (POG) foram realizadas por um médico radiologista, utilizando imagens de TC-3D, e classificadas em on-track/off-track. Três cirurgiões cegos à avaliação do radiologista realizaram o mesmo método utilizando RM/ARM. O estudo realizou análise descritiva, de variância, de associação da discordância de resultados, de concordância e curva característica de operação do receptor. Resultados Os resultados dos 4 examinadores foram totalmente concordantes em 61,4%. A RM/ARM diagnosticou lesões off-track com a sensibilidade variando de 35 a 65%, e lesões on-track com a especificidade variando de 91,67 a 95,83%. A acurácia variou de 68,1 a 79,5%. A maior divergência de dados ocorreu para o diagnóstico por RM/ARM de lesões off-track. A maior variabilidade dos dados ocorreu para o cálculo do IHS. Valores maiores de IHS e de POG foram associados a maior discordância entre os examinadores. A RM/ARM apresentou menor medida de valores de IHS quando comparado com a TC-3D. Ocorreu apenas moderada concordância no método GT entre a TC e a RM/ARM (Kappa 0,325–0,579). Conclusão A RM/ARM apresentou baixa acurácia e moderada concordância para o método GT, devendo ser utilizada com cautela por cirurgiões.

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“…The primary factor guiding the choice of reconstruction procedure will be the extent of glenoid bone loss and the presence of humeral bone defects, whereby the Latarjet procedure will be more likely in the presence of greater bone loss and/or defects (ie, >20% anterior glenoid bone loss). 31 All participants in the experimental groups will undergo MRI, and where a bone defect is identified be referred for a CT scan. A sagittal view of the glenoid face will be used to fit a circle to the 3–9 o’clock inferior contour of the glenoid.…”

Section: Methods and Analysismentioning

confidence: 99%

Evaluating the effects of arthroscopic Bankart repair and open Latarjet shoulder stabilisation procedures on shoulder joint neuromechanics and function: a single-centre, parallel-arm trial protocol

Fox

Bonacci

Gill

et al. 2021

BMJ Open Sport Exerc Med

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IntroductionShoulder instability injuries are common in sports involving collisions and overhead movements. Arthroscopic Bankart repair and the open Latarjet are two commonly used surgical stabilisation procedures. There is a lack of knowledge surrounding movement strategies, joint loading and muscle strength after each of these procedures. This study will compare: (1) shoulder joint neuromechanics during activities of daily living and an overhead sporting task; (2) shoulder range of motion; (3) shoulder strength; and (4) self-reported shoulder function and health status, between individuals who have undergone an arthroscopic Bankart repair versus open Latarjet.Methods and analysisThis is a prospective cohort, single-centre, non-randomised parallel arm study of surgical interventions for athletic shoulder instability injuries. Thirty participants will be recruited. Of these, 20 will have experienced one or more traumatic shoulder instability injuries requiring surgical stabilisation—and will undergo an arthroscopic Bankart repair or open Latarjet procedure. The remaining 10 participants will have no history of shoulder instability injury and act as controls. Participants will undergo baseline testing and be followed up at 3, 6 and 12 months. A two-way (group×time) analysis of variance with repeated measures on one factor (ie, time) will compare each outcome measure between groups across time points.Ethics and disseminationThis study was approved by the Barwon Health and Deakin University Human Research Ethics Committees. Outcomes will be disseminated through publications in peer-reviewed journals and presentations at relevant scientific conferences.Trial registration numberAustralian and New Zealand Clinical Trials Registry (ACTRN12620000016932).

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Management of Glenoid Bone Loss with Anterior Shoulder Instability: Indications and Outcomes

Cited by 55 publications

References 66 publications

Risk Factors for Recurrence After Arthroscopic Instability Repair—The Importance of Glenoid Bone Loss >15%, Patient Age, and Duration of Symptoms: A Matched Cohort Analysis

Risk Factors for Recurrence After Arthroscopic Instability Repair—The Importance of Glenoid Bone Loss >15%, Patient Age, and Duration of Symptoms: A Matched Cohort Analysis

A avaliação do método tomográfico glenoid track na ressonância magnética/artro RM

Evaluating the effects of arthroscopic Bankart repair and open Latarjet shoulder stabilisation procedures on shoulder joint neuromechanics and function: a single-centre, parallel-arm trial protocol

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