Management of Primary Acute Anterior Shoulder Dislocation: Systematic Review and Quantitative Synthesis of the Literature

Longo, Umile Giuseppe; Loppini, Mattia; Rizzello, Giacomo; Ciuffreda, Mauro; Maffulli, Nicola; Denaro, Vincenzo

doi:10.1016/j.arthro.2014.01.003

Cited by 129 publications

(108 citation statements)

References 42 publications

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“…In particular, after surgery, an expected decrease in shoulder pain (pain VAS) and in parallel an increase in shoulder performance, stability and motility (SSV, SST, ROWE and WOSI) was found. These results are in line with previous studies and demonstrate an improvement in shoulder functions and decrease in pain after surgery [7][8][9] confirming surgery as valid intervention for shoulder dislocation in properly selected patients 10 .…”

Section: Discussionsupporting

confidence: 82%

Brain activity in the right-frontal pole and lateral occipital cortex predicts successful postoperatory outcome after surgery for anterior glenoumeral instability

Lädermann

Tirefort

Zanchi

et al. 2017

Revue de Chirurgie Orthopédique et Traumatologique

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Shoulder apprehension is more complex than a pure mechanical problem of the shoulder, creating a scar at the brain level that prevents the performance of specific movements. Surgery corrects for shoulder instability at the physical level, but a re-dislocation within the first year is rather common. Predicting which patient will be likely to have re-dislocation is therefore crucial. We hypothesized that the assessment of neural activity at baseline and follow-up is the key factor to predict the postoperatory outcome. 13 patients with shoulder apprehension (30.03 ± 7.64 years) underwent clinical and fMRI examination before and one year after surgery for shoulder dislocation contrasting apprehension cue videos and control videos. Data analyses included task-related general linear model (GLM) and correlations imaging results with clinical scores. Clinical examination showed decreased pain and increased shoulder functions for post-op vs. pre-op. Coherently, GLM results show decreased activation of the left pre-motor cortex for post-surgery vs. pre-surgery. Right-frontal pole and right-occipital cortex activity predicts good recovery of shoulder function measured by STT. Our findings demonstrate that beside physical changes, changes at the brain level also occur one year after surgery. In particular, decreased activity in pre-motor and orbito-frontal cortex is key factor for a successful post-operatory outcome.Combining modern advances in functional neuroimaging and shoulder surgery has highlighted and defined the complex neural mechanisms behind shoulder apprehension in patients with glenohumeral instability. Recent works have proven that this previously presumed peripheral pathology induces significant cerebral alterations, the complexity of which cannot be comprehensively measured by clinical scores 1, 2 . However, these results are based on a single observation in a preoperative cohort of unstable patients. The evolution of apprehension with time, and particularly after surgical stabilization, remains to be elucidated.Persistent apprehension following shoulder stabilization is a common finding 3 , affecting up to 16% of postoperative patients 4 . Although various etiologies may be in cause, including local mechanical failure 5 or peripheral neurologic dysfunction 6 , a persistent central neurologic dysfunction remains an unexplored and highly probable explanation.The aim of the present study was thus to compare the cerebral mapping of shoulder apprehension in patients with glenohumeral instability before and one year after surgical stabilization and correlate them with clinical scores. The hypothesis was that assessing neural changes could help to determine the post-operatory outcome.

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Section: Discussionsupporting

confidence: 82%

Brain activity in the right-frontal pole and lateral occipital cortex predicts successful postoperatory outcome after surgery for anterior glenoumeral instability

Lädermann

Tirefort

Zanchi

et al. 2017

Revue de Chirurgie Orthopédique et Traumatologique

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“…39,41,47 Surgical management should be individualized to address the anatomic cause of the instability. [48][49][50][51][52][53] Even if there is no pathognomonic finding, and in 98% of MDI there is no finding at all, capsular redundancy, increased glenohumeral volume and labral abnormalities can sometimes be found. 26,39 Hyperlaxity is common in patients with MDI, often involving findings such as patulous capsular tissue, signs of generalized hyperlaxity, and recurrent subluxation.…”

Section: Recurrent Instabilitymentioning

confidence: 92%

Multidirectional Instability of the Shoulder: A Systematic Review

Longo

Rizzello

Loppini

et al. 2015

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…1 Although most individuals elect nonoperative management after a first-time dislocation, significant delays in return to sport and poorer functional outcomes are frequent. 2 Further, nonoperative management has led to recurrence rates as high as 55%, and the pathoanatomy of recurrent dislocations was associated with more severe Bankart lesions and bony defects. 3,4 Therefore, surgical stabilization is typically recommended for individuals such as young adult athletes to address soft tissue insufficiency and bony lesions.…”

Section: Commentarymentioning

confidence: 99%

Outcomes of the Latarjet Procedure Compared With Bankart Repair for Recurrent Traumatic Anterior Shoulder Instability

Bliven

Parr

2018

Journal of Athletic Training

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Study Selection: Criteria used to include studies that (1) were written in English; (2) compared the outcomes of any Latarjet procedure (Bristow-Latarjet, coracoid transfer, or modified Bristow) with Bankart repair (anatomic); (3) reported a minimum of 1 outcome of recurrence, redislocation, revision, or patient-reported outcome measure; and (4) reported original data.Data Extraction: Data presented in any format (text, table, figure) were extracted from all included studies. The quality of each study was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Summary statistics were reported as relative risks and weighted mean differences. Fixed-effects (the assumed treatment effect was the same across studies) and random-effects (variations in treatment effect were assumed among studies) models were tested. Heterogeneity between trials was assessed using the v 2 statistic, and the amount (percentage) of variation across studies due to heterogeneity was calculated using the I 2 statistic. Forest plots were used to present pooled results.Main Results: After the initial search, 245 articles were identified. After we applied the inclusion criteria, a total of 8 studies reporting on 795 patients (Latarjet ¼ 379, Bankart ¼ 416)were included in this review. Using the National Health and Medical Research Council's level of evidence, the authors scored 7 of the studies at level III and 1 study at level II. All Latarjet procedures were performed using an open technique, whereas the Bankart procedure was performed open in 6 studies and arthroscopically in 2 studies. The demographics of the patients (age, proportion of males to females, proportion with surgery on the dominant side, and proportion of revisions) were similar between the 2 surgical procedures. Four groups reported that patients who underwent the Latarjet procedure had fewer recurrences than patients in the Bankart repair group (11.6% versus 21.1%, respectively), irrespective of whether the Bankart was performed open or arthroscopically. Similarly, 4 groups observed that the Latarjet procedure resulted in fewer postsurgical redislocations (5.0%) than the Bankart (9.5%) procedure, irrespective of whether the repair was open or arthroscopic. The authors of 7 studies noted no differences between the 2 procedures in revision rates (Latarjet: 3.4%, Bankart: 4.5%), and 8 studies demonstrated no differences in complications requiring reoperation (Latarjet: 5.0%, Bankart: 3.1%). Investigators in 7 studies used the Rowe score to measure patientreported satisfaction and function; patients who underwent the Latarjet procedure reported better Rowe scores postsurgically than patients who underwent the Bankart repair (scores: 79.0 and 85.4, respectively). Researchers in 4 studies reported a loss of external-rotation range of motion, which was less in the Latarjet (11.58) compared with the Bankart (20.98) procedure. Of the 5 groups that reported return to function, a trend suggested that a greater proportion of patients wh...

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Management of Primary Acute Anterior Shoulder Dislocation: Systematic Review and Quantitative Synthesis of the Literature

Cited by 129 publications

References 42 publications

Brain activity in the right-frontal pole and lateral occipital cortex predicts successful postoperatory outcome after surgery for anterior glenoumeral instability

Brain activity in the right-frontal pole and lateral occipital cortex predicts successful postoperatory outcome after surgery for anterior glenoumeral instability

Multidirectional Instability of the Shoulder: A Systematic Review

Outcomes of the Latarjet Procedure Compared With Bankart Repair for Recurrent Traumatic Anterior Shoulder Instability

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