Trends in Surgical Management of Anterior Shoulder Instability: Increased Utilization of Bone Augmentation Techniques†

Galvin, Joseph W.; Eichinger, Josef K.; Cotter, Eric J.; Greenhouse, Alyssa; Parada, Stephen A.; Waterman, Brian R.

doi:10.1093/milmed/usx077

Cited by 17 publications

(12 citation statements)

References 25 publications

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“…3 Epidemiological studies have shown a significant increased use of the Latarjet procedure over recent years. 6 This likely represents the better recognition of bone loss through improved computed tomography with 3-dimensional reconstructions.…”

Section: Surgical Managementmentioning

confidence: 99%

“…Although anterior arthroscopic stabilisation (capsulolabral repair) may have become the gold standard for the first time dislocator, there is a significant trend toward increased bone augmentation surgery with evolving indications. 6 Primary arthroscopic Bankart repair has proven to be a successful operation. 7e10 However more recently 'critical' anteroinferior bone loss, 'off track' Hill-Sachs lesions, contact sports, overhead athletes and inferior shoulder hyperlaxity have been identified as risk factors associated with failure.…”

Section: Anterior Bone Block Proceduresmentioning

confidence: 99%

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Bone block procedures for glenohumeral joint instability

Nzeako

Bakti

Bawale

et al. 2019

Journal of Clinical Orthopaedics and Trauma

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Glenoid bone loss is a well established cause of instability and long term morbidity if not adequadely addressed. Anterior glenohumeral instability due an anterior glenoid defect is significantly more common, and for many years has been well treated with open anterior bone block augmentation procedures, most commonly the latarjet procedure. However, with refinement of this technique and some interest in reducing morbidity associated with iliac crest bone harvest, arthroscopic bone block procedures with allograft has become more popular. In this article we will review some of the key available evidence. We will also review management of the less common and more challenging posterior glenoid defects associated with posterior instability.

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Section: Surgical Managementmentioning

confidence: 99%

Section: Anterior Bone Block Proceduresmentioning

confidence: 99%

Bone block procedures for glenohumeral joint instability

Nzeako

Bakti

Bawale

et al. 2019

Journal of Clinical Orthopaedics and Trauma

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“…From 2004-2013, the overall annual incidence of both arthroscopic stabilization and boneblock procedures increased; however, the proportion of stabilization cases using bone-block augmentation increased significantly, while the proportion of arthroscopic stabilizations decreased significantly. In a recent study of the military population, Galvin et al 49 reported that although arthroscopic Bankart repair remained relatively stable as the dominant surgical procedure for ASI, there was a significant increase in the use of the Latarjet procedure, probably because of the recognition of bone loss through use of preoperative advanced imaging and 3-dimensional reconstructions.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent study of the military population, Galvin et al. 49 reported that although arthroscopic Bankart repair remained relatively stable as the dominant surgical procedure for ASI, there was a significant increase in the use of the Latarjet procedure, probably because of the recognition of bone loss through use of preoperative advanced imaging and 3-dimensional reconstructions.…”

Section: Discussionmentioning

confidence: 99%

Significant Changes in the Diagnosis, Injury Severity and Treatment for Anterior Shoulder Instability Over Time in a U.S. Population

Leland

Parkes

Bernard

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To report the annual incidence of anterior shoulder instability (ASI) diagnosis, injury severity, and surgical stabilization in a U.S. population. Methods An established U.S. geographic database was used to identify patients < 40 years old with diagnoses of ASI from 1994-2016. Medical records were reviewed to obtain patient demographics, histories, imaging results, and surgical details. Age- and sex-specific incidence rates were calculated and adjusted to the 2010 U.S. population. Poisson regression was performed to examine trends by timeline, sex and age. Results The study population consisted of 652 patients with ASI and a mean age of 21.5 years (range, 3.6-39.5). Comparing 2015-2016 to 1994-1999, we found an increase in the number of dislocations (from 1.0-1.9; P = 0.016) and total instability events (from 2.3-3.4; P = 0.041) per patient prior to presentation to a physician. There was a trend in increased diagnosis of bony Bankart and/or Hill-Sachs on MRI over time, with these lesions documented in 96% of patients undergoing MRI in 2015-2018 compared to 52.9% in 1994-1999 ( P < .001). The use of arthroscopic procedures increased and peaked in 2005-2009 (90% of surgical cases performed). The proportion of open Latarjet procedures increased from 2010-2014 (14%) and 2015-2018 (31%). Conclusions The age- and sex- adjusted incidence of ASI diagnosis in a U.S. population from 1994-2016 is comparable to that demonstrated in Canadian and European populations. This study demonstrates an increasing number of instability events prior to surgical evaluation, which may correlate with patients’ more commonly presenting with bone loss and requiring more aggressive surgical treatment or that ASI is being more frequently cared for and documented by present-day orthopedic surgeons. Level of Evidence Level III, cross-sectional study.

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“…2,7,13 With increasing knowledge and recognition of bone loss in treating anterior shoulder instability, there has been a noted increase in the number of bone-block stabilization procedures being performed for the treatment of shoulder instability in the United States. 6,9 Regardless of the technique or strategy used to treat anterior shoulder instability, the role of postoperative rehabilitation is critical in achieving functional stability and appropriate return to activity. 4,5,8 Nonetheless, there is a paucity of high-quality evidence investigating the effect of rehabilitation programs on functional outcomes after both arthroscopic and open stabilization procedures.…”

mentioning

confidence: 99%

A Comparison of Physical Therapy Protocols Between Open Latarjet Coracoid Transfer and Arthroscopic Bankart Repair

Beletsky

Cancienne²,

Manderle

et al. 2020

Sports Health

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Context: Recent studies examining return to sport after traumatic shoulder instability suggest faster return-to-sport time lines after bony stabilization when compared with soft tissue stabilization. The purpose of the current study was to define variability across online Latarjet rehabilitation protocols and to compare Latarjet with Bankart repair rehabilitation time lines. Evidence Acquisition: Online searches were utilized to identify publicly available rehabilitation protocols from Accreditation Council for Graduate Medical Education (ACGME)–accredited academic orthopaedic surgery programs. Study Design: Descriptive epidemiology study. Level of Evidence: Level 3. Results: Of the 183 ACGME-accredited orthopaedic programs reviewed, 14 institutions (7.65%) had publicly available rehabilitation protocols. A web-based search yielded 17 additional protocols from private sports medicine practices. Of the 31 protocols included, 31 (100%) recommended postoperative sling use and 26 (84%) recommended elbow, wrist, and hand range of motion exercises. Full passive forward flexion goals averaged 3.22 ± 2.38 weeks postoperatively, active range of motion began on average at 5.22 ± 1.28 weeks, and normal scapulothoracic motion by 9.26 ± 4.8 weeks postoperatively. Twenty (65%) protocols provided specific recommendations for return to nonoverhead sport–specific activities, beginning at an average of 17 ± 2.8 weeks postoperatively. This was compared with overhead sports or throwing activities, for which 18 (58%) of protocols recommended beginning at a similar average of 17.1 ± 3.3 weeks. Conclusion: Similar to Bankart repair protocols, Latarjet rehabilitation protocols contain a high degree of variability with regard to exercises and motion goal recommendations. However, many milestones and start dates occur earlier in Latarjet protocols when compared with Bankart-specific protocols. Consequently, variability in the timing of rehabilitation goals may contribute to earlier return to play metrics identified in the broader literature for the Latarjet procedure when compared with arthroscopic Bankart repair. Strength of Recommendation Taxonomy (SORT): Level C.

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Trends in Surgical Management of Anterior Shoulder Instability: Increased Utilization of Bone Augmentation Techniques†

Cited by 17 publications

References 25 publications

Bone block procedures for glenohumeral joint instability

Bone block procedures for glenohumeral joint instability

Significant Changes in the Diagnosis, Injury Severity and Treatment for Anterior Shoulder Instability Over Time in a U.S. Population

A Comparison of Physical Therapy Protocols Between Open Latarjet Coracoid Transfer and Arthroscopic Bankart Repair

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