Outcomes of Arthroscopic Posterior Shoulder Stabilization in the Beach-Chair Versus Lateral Decubitus Position: A Systematic Review

Moeller, Ellie; Houck, Darby A.; McCarty, Eric C.; Seidl, Adam J.; Bravman, Jonathan T.; Vidal, Armando F.; Frank, Rachel M.

doi:10.1177/2325967118822452

Cited by 13 publications

(19 citation statements)

References 43 publications

(187 reference statements)

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“…Our results show that the rate of return to duty slightly lags behind the rates of return to sport in studies of athletes. A recent systematic review by Moeller et al 17 revealed an 89% to 96% rate of return to sport in athletes after undergoing posterior stabilization surgery at a mean follow-up of 37.6 months. In the largest prospective study to date on arthroscopic posterior stabilization in athletes, Bradley et al 2 showed a 93.5% success rate in return to play after posterior stabilization in 200 NOTE.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, we cannot make true determinations based on our data alone, but we can make comparisons with existing literature. Regarding intraoperative patient positioning, Moeller et al 17 performed a systematic review comparing outcomes in patients who underwent arthroscopic posterior stabilization in either the beachchair or lateral decubitus position. They found no differences in patient outcome scores or rates of recurrent instability or return to sport.…”

Section: Discussionmentioning

confidence: 99%

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Low Risk of Recurrence After Posterior Labral Repair of the Shoulder in a High-Risk United States Military Population

Chan

O’Brien

Waterman

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To examine the results of isolated arthroscopic posterior labral repair of the shoulder in an active military population, looking specifically at the reoperation rate and rate of return to previous military activity with a minimum follow-up period of 2 years. Methods: A retrospective case series was performed in active-duty military service members who underwent isolated, primary arthroscopic posterior labral repair at a single academic military treatment facility between 2009 and 2015 and had at least 2 years of follow-up. Patients were excluded if they were of noneactive-duty status, had insufficient follow-up (<2 years), or had undergone a concurrent procedure. Injury presentation, demographic data, and surgical data (i.e., surgical positioning, number of anchors, and anchor placement location) were compiled manually. Outcomes including the rate of return to active duty, recurrence of symptoms, and need for revision surgery were evaluated. Results: Sixty-five patients were included. After arthroscopic repair, a high rate of return to previous military duties (83%) was noted at short-to mid-term follow-up (mean AE standard deviation, 3.04 AE 1.30 years), with 1 patient (1.5%) requiring revision arthroscopic repair and 10 patients (15.5%) showing activity-limiting shoulder pain preventing a return to active duty. Intraoperative positioning (P ¼ .17), a low anchor position (P ¼ .27), and the number of anchors used (P ¼ .62) were not found to be significant contributors to continued postoperative pain or recurrent instability. Conclusions: Arthroscopic intervention resulted in a reliable rate of glenohumeral stability with a low rate of surgical revision and a high rate of return to military duty at short-to mid-term follow-up. However, 1 in 6 military service members showed significant, activity-limiting shoulder pain postoperatively that did not permit a return to previous military activities after surgical intervention. Level of Evidence: Level IV, therapeutic case series.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Low Risk of Recurrence After Posterior Labral Repair of the Shoulder in a High-Risk United States Military Population

Chan

O’Brien

Waterman

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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“…There was also no difference in the rate of identified posterior pathology when comparing procedures performed in the beachchair and lateral positions, an outcome consistent with prior authors' findings. [13][14][15] Of particular interest, combined anterior and posterior lesions were more likely following two or fewer dislocations rather than in individuals that had suffered multiple prior instability events. One possible explanation for this finding is that the encountered posterior pathology may have occurred prior to traumatic dislocation.…”

Section: Discussionmentioning

confidence: 99%

Posterior Labral Tear Extension Concomitant With Shoulder Bankart Injuries Is not Uncommon

Golan

Atte

Drummond

et al. 2022

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To identify the rate and risk factors of posterior labral involvement in operatively managed Bankart lesions and assess the effectiveness of MRI arthrogram for preoperative identification of such injury patterns. Methods: A consecutive cohort of patients undergoing arthroscopic Bankart repair were retrospectively reviewed. All subjects underwent a prearthroscopy MRI arthrogram. Operative findings were used as the gold standard for posterior labral tear extension. Patient demographic and surgical data were then analyzed to identify independent factors associated with the presence of concomitant posterior labral injury. Results: Of 124 patients undergoing arthroscopic Bankart stabilization, 23 (19%) were noted to demonstrate posterior labral injury on arthroscopic evaluation. Factors associated with injury to the posterior labrum included those sustaining two or fewer dislocations events (P ¼.001), an earlier average presentation (P ¼ .001), and a reported "contact" mechanism of dislocation (P ¼ .02). Posterior labral involvement did not correlate with surgical positioning (beach-chair versus lateral) or the need for revision surgery. On the basis of review of preoperative imaging, MRI arthrogram demonstrated a sensitivity of 83% and a specificity of 95% for detection of posterior labral injury. Conclusion: Posterior propagation of Bankart lesions is relatively common following shoulder dislocations, with a rate of 18.5%. Risk factors for posterior labral extension include two or fewer dislocations, early presentation from the time of injury, and contact sports. On the basis of these findings, careful assessment of the posterior labrum on MRI arthrogram may reveal the majority, but not all, of these lesions.

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“…Other technical factors may include patient positioning, 39 arthroscope orientation, 51 bone-tendon contact pressure, 17 anchor type, 43 or suture type and strength, 22 all of which have been studied as independent factors with the potential to affect the outcome of a procedure. Additionally, wet conditions within the joint can lead to increased friction of the suture material, 9 and knot security may ultimately be reduced compared with hand-tied knots by the requisite use of instrumentation.…”

Section: Discussionmentioning

confidence: 99%

Sliding or Nonsliding Arthroscopic Knots for Shoulder Surgery: A Systematic Review

Morrissey

Houck

Jang

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Knot tying is a crucial component of successful arthroscopic shoulder surgery. It is currently unknown whether sliding or nonsliding techniques result in superior clinical outcomes. Purpose: To assess the clinical outcomes of arthroscopic sliding knot (SK)– versus nonsliding knot (NSK)–tying techniques during arthroscopic shoulder surgery, including rotator cuff repair, Bankart repair, and superior labral anterior-posterior (SLAP) repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of the PubMed, Embase, and Cochrane Library databases was performed using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. All English-language literature published between 2000 and 2018 reporting clinical outcomes utilizing SK- or NSK-tying techniques during rotator cuff repair, Bankart repair, and SLAP repair with a minimum 24-month follow-up was reviewed by 2 independent reviewers. Information on type of surgery, knot used, failure rate, patient satisfaction, and patient-reported outcomes was collected. Patient-reported outcome measures included the Constant-Murley score, Rowe score, and visual analog scale for pain. Study quality was evaluated using the modified Coleman Methodology Score. Results: Overall, 9 studies (6 level 3 and 3 level 4) with a total of 671 patients (mean age, 52.8 years [range, 16-86 years]; 65.7% male; 206 SK and 465 NSK) were included. There were 4 studies that reported on Bankart repair in 148 patients (63 SK and 85 NSK), 3 on SLAP repair in 59 patients (59 SK), and 2 on rotator cuff repair in 464 patients (84 SK and 380 NSK). Also, 6 studies compared knot-tying with knotless techniques (3 Bankart repair studies and 3 SLAP repair studies), while the studies reporting the outcomes of SLAP repair evaluated SK-tying techniques only. The failure rate for Bankart repair was 3.2% (2/63) for SKs and 4.7% (4/85) for NSKs. The failure rate for rotator cuff repair was 2.4% (2/84) for SKs and 6.3% (24/380) for NSKs. The failure rate for SLAP repair was 11.9% (7/59). Because of inconsistencies in outcomes and procedures, no quantitative analysis was possible. The mean modified Coleman Methodology Score for all studies was 65.1 ± 8.77, indicating adequate methodology. Conclusion: The literature on clinical outcomes using SKs or NSKs for shoulder procedures is limited to level 4 evidence. Future studies should be prospective and focus on comparing the use of SKs and NSKs for shoulder procedures to elucidate which arthroscopic knot results in superior clinical outcomes.

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Outcomes of Arthroscopic Posterior Shoulder Stabilization in the Beach-Chair Versus Lateral Decubitus Position: A Systematic Review

Cited by 13 publications

References 43 publications

Low Risk of Recurrence After Posterior Labral Repair of the Shoulder in a High-Risk United States Military Population

Low Risk of Recurrence After Posterior Labral Repair of the Shoulder in a High-Risk United States Military Population

Posterior Labral Tear Extension Concomitant With Shoulder Bankart Injuries Is not Uncommon

Sliding or Nonsliding Arthroscopic Knots for Shoulder Surgery: A Systematic Review

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