Rockwood Adults CH34

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CHAPTER 34 • Glenohumeral Instability

Annotated References Reference

Annotation

Arciero RA, Wheeler JH, Ryan JB, et al. Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med. 1994;22(5):589–594.

This was one of the original clinical prospective studies comparing the outcome of arthroscopic Bankart repair with nonoperative treatment for the acute, initial anterior shoulder dislocation in an active military population. A total of 36 athletes were included and separated into two groups; group 1 was immobilized for 1 month followed by rehabilitation, group 2 had arthroscopic Bankart repair. There was 80% recurrence rate in group 1 and 7 of the 12 patients had surgery for shoulder stabilization. In group 2, the recurrence rate was 14%. The authors concluded that arthroscopic Bankart repair significantly reduced the recurrence rate in young athletes who sustained an acute, initial anterior dislocation of the shoulder. There are few reports of outcomes after arthroscopic treatment for multidirectional shoulder instability in athletes. This is one of the largest studies in the literature reporting the 2- and 5-year outcomes in 43 shoulders with MDI and arthroscopic fixation. The mean postoperative ASES scores was 91 out of 100, the mean Western Ontario Shoulder Instability percentage was 91 out of 100, and 86% were able to return to their sports with little or no limitation. The authors concluded that arthroscopic treatment can provide an effective method for symptomatic MDI in an athletic patient population. The largest prospective study on the outcome after arthroscopic posterior labral repair for posterior instability. The authors followed 200 shoulders prospectively with a mean of 36 months of follow- up. They found the ASES scores increased from 45.9 to 85.1 and significant improvements in stability, pain, and function. There was no difference in the outcome comparing contact athletes with noncontact athletes. Patients who had repair with anchors did significantly better than the patients who had anchorless fixation. The authors concluded that arthroscopic capsulolabral reconstruction is an effective, reliable treatment for symptomatic unidirectional recurrent posterior glenohumeral instability in an athletic population. This review article reported the pathophysiology, diagnosis, and management of patients who present with posterior shoulder instability in the setting of glenoid dysplasia. A comprehensive literature review on the outcomes of arthroscopic, open, and posterior bone block procedure is reported in the article. Indications for arthroscopic versus open procedure is also discussed based on the available evidence in the literature. The authors aimed to identify the prevalence and severity of associated radiographic parameters found on magnetic resonance arthrograms in patients with arthroscopically confirmed isolated posterior labral tears and symptomatic recurrent posterior shoulder instability compared with an age-matched cohort of patients without posterior instability. The authors found that the presence of glenoid retroversion, glenoid dysplasia, and increased axial posterior capsular cross-sectional area were significantly associated with patients with posterior labral tears and symptomatic posterior instability. The objective of this cadaveric study was to validate the glenoid track concept in a cadaveric bipolar bone loss model and to test whether “on- track” and “off-track” lesions can be stabilized with Bankart repair (BR) with or without Hill–Sachs remplissage (HSR). The authors found that, for on- track lesions, engagement occurred with translation testing in one shoulder (12.5%) at end-range rotation. After BR, engagement was prevented for this shoulder. For off-track lesions, engagement with translation testing occurred in 8 shoulders (100%) at end-range rotation and in 6 (75%) at mid-range rotation. After BR, engagement was only prevented in 4 of 6 engaging shoulders (67%) at mid-range rotation but was prevented in zero of 8 (0%) at end-range rotation. Adding remplissage prevented engagement in all 14 engaging shoulders with off-track lesions (100%).

Baker CL, Mascarenhas R, Kline AJ, et al. Arthroscopic treatment of multidirectional shoulder instability in athletes: a retrospective analysis of 2- to 5-year clinical outcomes. Am J Sports Med. 2009:37(9):1712– 1720.

Bradeley JP, McClincy MP, Arner JW, et al. Arthroscopic casulolabral reconstruction for posterior instability of the shoulder: a prospective study of 200 shoulders. Am J Sports Med. 2013;41(9):2005–2014.

Eichinger JK, Galvin JW, Grassbaugh JA, et al. Glenoid dysplasia: pathophysiology, diagnosis, and management. J Bone Joint Surg Am . 2016;98(11):958–968.

Galvin JW, Parada SA, Li X, et al. Critical findings of magnetic resonance arthrograms in posterior shoulder instability compared with an age- matched controlled cohort. Am J Sports Med. 2016;44(12):3222–3229.

Hartzler RU, Bui CN, Jeong WK, et al. Remplissage of an off-track Hill- Sachs lesion is necessary to restore biomechanical glenohumeral joint stability in a bipolar bone loss model. Arthroscopy. 2016;32(12):2466– 2476.