Abstract
PurposeRecurrent anterior shoulder instability after surgical treatment can be caused by bony defects. Several diagnostic tools have been designed to measure the extent of these bony lesions. Currently, there is no consensus which measurement tool to use and decide which type of surgery is most appropriate. We therefore performed an evaluation of agreement in surgeons’ preference of diagnostic work-up and surgical treatment of anterior shoulder instability.MethodsAn international survey was conducted amongst orthopaedic shoulder surgeons. The survey contained questions about surgeons’ experience, clinical and radiological examination and the subsequent treatment for anterior shoulder instability. Descriptive statistics were used to present the data, and percentages of responding surgeons were calculated.ResultsThe questionnaire was completed by 197 delegates from 46 countries. 55 % of the respondents think evidence in current literature is sufficient on diagnostic work-up for anterior shoulder instability. Anamnestic, number of dislocations was most frequently asked (by 95 % of respondents), the most frequently used test is the apprehension test (91 %). For imaging, conventional X-ray in various directions was most performed, followed by MR arthrography and plane CT scan respectively. The responding surgeons perform surgery (labrum repair or Latarjet) in 51 % of the patients. A median of 25 % glenoid bone loss was given by the respondents, as cut-off from when to perform a bony repair.ConclusionMany different diagnostic examinations for assessing shoulder instability are used and a high variety is seen in the use of diagnostic tools. Also no consensus is seen in the use of different surgical options (arthroscopic and open procedures). This implies the need for more research on diagnostic imaging and the correlation with specific subsequent surgical treatment.Level of evidenceSurvey, level of evidence IV.
Highlights
Post-traumatic anterior glenohumeral instability is the most common type of shoulder instability with a reported prevalence of 2 % [10]
The questionnaire was completed by 197 delegates from 46 countries. 55 % of the respondents think evidence in current literature is sufficient on diagnostic work-up for anterior shoulder instability
Many different diagnostic examinations for assessing shoulder instability are used and a high variety is seen in the use of diagnostic tools
Summary
Post-traumatic anterior glenohumeral instability is the most common type of shoulder instability with a reported prevalence of 2 % [10]. Several methods have been developed to quantify the position and size of bony defects [22, 28] to predict the risk of recurrence [2]. Depending on this preoperative (or intraoperative) quantification the type of surgical treatment is chosen. The traditional bony procedures such as these according to Latarjet have been reported to have lower recurrence rates [9, 12]. These procedures might have higher complication risks and are not without failures [6]. Current literature is still inconclusive when, with what amount of bone loss, to perform a soft tissue repair or a bony procedure
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