Preoperative Diagnostic Rates and Clinical Outcomes After Arthroscopic Stabilization Procedures for Panlabral Tear of the Glenohumeral Joint

Rhee, Yong Girl; Park, In; Kim, Jung Youn; Hyun, Hwan Sub; Shin, Sang-Jin

doi:10.1016/j.arthro.2019.09.012

Cited by 5 publications

(8 citation statements)

References 23 publications

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“…On the Coleman methodology score, one scored poor, 11 43 studies scored fair, 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 37 scored good, 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 ...…”

Section: Resultsunclassified

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High Variability of the Definition of Recurrent Glenohumeral Instability: An Analysis of the Current Literature by a Systematic Review

Alkaduhimi¹,

Connelly

Deurzen³

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To determine the definitions for recurrence used in the literature, assess the consensus in using these definitions, and determine the impact of these definitions on recurrence rates. Methods: A literature search was performed in PubMed and EMBASE including studies from 2000 to 2020 reporting on recurrence rates after anterior arthroscopic shoulder instability surgery. Dislocation, apprehension, subluxation and recurrence rates were compared. Results: Ninety-one studies were included. In 68% of the eligible studies, recurrence rates are not well defined. Thirty (33%) studies did not report on dislocations, 45 (49%) did not report on subluxations, and 58 (64%) did not report on apprehension. Seventeen different definitions for recurrence of instability, 4 definitions of dislocations, and 8 definitions of subluxation were used. Conclusion: Recurrence rates are poorly specified and likely underreported in the literature, hampering comparison with results of other studies. This highlights the need for a consensus on definition of recurrence across shoulder instability studies. We recommend not using the definition recurrence of instability anymore. We endorse defining dislocations as a radiographically confirmed dislocation or a dislocation that is manually reduced, subluxations as the feeling of a dislocation that can be (spontaneously) reduced without the need for a radiographically confirmed dislocation, and a positive apprehension sign as fear of imminent dislocation when placing the arm in abduction and external rotation during physical examination. Reporting on the events resulting in a dislocation or subluxation aids in making an estimation of the severity of instability. Level of Evidence: Level IV, systematic review.

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Section: Resultsunclassified

“…62 33 170 +/− − RCT + + 1,2,3,4 1,2,3,4 1 81 Rhee et al. 63 48 35 + + Retrospective + + 1,2,3 1,2,3,4 1,2 73 Oh et al. 64 120 28 + + Retrospective + + 1,2,3 2,3,4 1,2 71 Ono et al.…”

Section: Resultsunclassified

High Variability of the Definition of Recurrent Glenohumeral Instability: An Analysis of the Current Literature by a Systematic Review

Alkaduhimi¹,

Connelly

Deurzen³

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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“…In the article, "Preoperative Diagnostic Rates and Clinical Outcomes After Arthroscopic Stabilization Procedures for Panlabral Tear of the Glenohumeral Joint," by Rhee, Park, Kim, Hyun, and Shin, 7 the authors present a retrospective analysis of 48 patients who underwent arthroscopic repair of a panlabral tear, defined as a labral tear involving at least 270 of the 4 and our findings, 6 MR arthrography detected more panlabral tears that noncontrast MRI (22.5% vs 7.1%). 7 This poor sensitivity of preoperative MRI or physical examination findings alone highlights the importance of considering the possibility of a more extensive labral tear than suggested by these tests, and using additional information preoperatively in this patient population, such as the history and intraoperative examination under anesthesia, to help make the diagnosis. If a labral tear is identified on preoperative MRI, surgeons should be prepared for more extensive labral pathology at the time of surgery.…”

Section: See Related Article On Page 411mentioning

confidence: 99%

“…Rhee et al 7 should be commended for the quality and completeness of the data reported in their study. Minimum 2-year follow-up outcomes were obtained in 91% (48/53) of patients that met their well-defined inclusion criteria.…”

Section: See Related Article On Page 411mentioning

confidence: 99%

“…Although prior systematic reviews have shown possible lower recurrent instability rates for unidirectional labral repairs when performed in the lateral decubitus compared to the beach chair position, [8][9][10] potentially because of better visualization of the entire glenoid rim in this position, a difference was not seen by Rhee et al No significant differences were seen in clinical outcomes or recurrence rates based on surgical position, despite a larger number of suture anchors used per case in group II compared with group I (7.6 AE 1.1 vs 6.2 AE 1.5, P < .001). 7 Although prior studies have not directly compared surgical position in 1 patient population, they have reported good outcomes with panlabral repair in both of the common surgical positions. All patients underwent surgical repair in the lateral decubitus position in the study by Tokish et al, with a mean American Shoulder and Elbow Surgeons score of 89.6 AE 11.1 and 2 patients undergoing revision surgery for recurrent instability at latest follow-up, 4 whereas 80% (35/44) of the patients in our study underwent surgical repair in the beach chair position, with a mean American Shoulder and Elbow Surgeons score of 90.1 AE 17.7 and 1 patient undergoing revision surgery for recurrent instability at latest follow-up.…”

Section: See Related Article On Page 411mentioning

confidence: 99%

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Editorial Commentary: The Surgeon is the Method: Patient Positioning in Arthroscopic Repair of Shoulder Panlabral Tears

Ricchetti¹

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Combined tears of the anterior, posterior, and superior glenoid labrum have not been commonly reported in the literature. These lesions represent a small, but significant portion of labral injuries. Care should be taken in the diagnosis and management of these lesions because preoperative physical examination and imaging may have limited ability to detect the full extent of pathology. Arthroscopic repair of panlabral tears produces good to excellent outcomes and a low rate of recurrent instability at short-term follow-up, both when performed in the beach chair position and in the lateral decubitus position. Surgical positioning, therefore, should be based on surgeon preference.

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Arthroscopic repair of inferior glenoid labrum tears (Down Under lesions) produces similar outcomes to other glenoid tears

Page

Fraser-Moodie

Bayne

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose Inferior glenoid labral tears are an uncommon but distinct shoulder injury. Only a small number of studies have reported outcomes following arthroscopic repair. The aim of the current study was to report minimum 2-year outcomes following inferior labral repair and to compare outcomes and risk factors associated with the injury to non-inferior labral tears. Whether preoperative MRI or MRA identified inferior labral tears was also assessed. Methods A prospective study of 162 consecutive patients undergoing arthroscopic glenoid labral repair, excluding isolated superior labral tears, was conducted. Of the 130 patients available for follow-up, 18 (13.7%) had an inferior labral tear ("Down Under lesion"), the remainder had anterior, posterior or mixed anterior/posterior lesions that did not include the inferior pole. Mean follow-up time for the Down Under group was 44 months (SD 10, range 27-57), and 30 months (SD 14, range 4-60) for the non-Down Under group. Postoperative outcomes included the Oxford Shoulder Instability Score and recurrent instability. Associations between Down Under lesions and injury mechanism, instability at presentation, recurrent instability and family history were assessed with multivariable logistic regression. Preoperative MRI or MRA reports by radiologists were examined to determine if Down Under lesions were identified. Results Oxford Shoulder Instability Scores indicated that most patients in both groups had little pain or shoulder problems postoperatively (average Oxford Score 41; 48 = no symptoms). Oxford Scores were not significantly different between the Down Under and non-Down Under groups. Four patients (22.2%) in the Down Under group had recurring symptoms (pain and instability) compared to 12 (10.6%) in the non-Down Under group; this difference was not statistically significant (adjusted OR 1.09, 95% CI 0.19,4.77). Family history of shoulder instability was positively associated with a Down Under lesion (adjusted OR 5.0, 95%CI 1.51,16.7). MRI or MRA identified 52.9% of Down Under lesions. Conclusion Down Under lesions were an infrequent type of glenoid labral injury, yet postoperative outcomes were similar to other labral tears. Patients with Down Under lesions had a significant risk factor due to family history of shoulder instability. MRI and MRA could not reliably identify Down Under lesions. Level of evidence Level III.

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Preoperative Diagnostic Rates and Clinical Outcomes After Arthroscopic Stabilization Procedures for Panlabral Tear of the Glenohumeral Joint

Cited by 5 publications

References 23 publications

High Variability of the Definition of Recurrent Glenohumeral Instability: An Analysis of the Current Literature by a Systematic Review

High Variability of the Definition of Recurrent Glenohumeral Instability: An Analysis of the Current Literature by a Systematic Review

Editorial Commentary: The Surgeon is the Method: Patient Positioning in Arthroscopic Repair of Shoulder Panlabral Tears

Arthroscopic repair of inferior glenoid labrum tears (Down Under lesions) produces similar outcomes to other glenoid tears

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