Anterior Stabilization Research Articles

Intraoperative Kinematics in Posterior Cruciate Ligament Retaining Total Knee Arthroplasty Using Different Inserts.

We analyzed the intraoperative kinematics of total knee arthroplasty (TKA) using a navigation system to investigate the influence of different inserts on kinematics. This was a retrospective observational study. The Vanguard individualized design (33 patients, 33 knees) XP and anterior-stabilized (AS) inserts were used in TKA for osteoarthritis. Kinematic data were intraoperatively recorded. The range of motion, tibiofemoral rotational angle, anteroposterior translation of the femur, and varus-valgus laxity were compared between the two inserts (XP vs. AS). There was no significant difference in the range of motion (extension: XP, 3.7° ± 3.3° vs. AS, 3.8° ± 3.3°, p = 0.84; flexion: XP, 138.1° ± 10.2° vs. AS, 139.0° ± 13.3°, p = 0.73). With the AS insert, the tibia was gradually internally rotated as the knee was flexed. At maximum extension, the internal rotation was smallest with AS (XP 6.5° ± 4.0° vs. AS 5.1° ± 3.4°, p = 0.022), which was also associated with smaller anterior femoral translation (maximum extension: XP, 14.1 ± 4.8 mm vs. AS, 11.3 ± 4.7 mm, p = 0.00036; 30°: XP, 23.7 ± 5.6 mm vs. AS, 20.7 ± 5.1 mm, p = 0.000033; 45°: XP, 24.4 ± 4.9 mm vs. AS, 23.2 ± 4.5 mm, p = 0.0038). The AS was associated with a lower varus-valgus laxity (30° XP 4.1° ± 3.4 vs. AS 3.3° ± 2.7°, p = 0.036; 60°: XP, 3.2° ± 3.0° vs. AS, 2.4° ± 3.3°, p = 0.0089). The AS insert facilitated sequential tibiofemoral rotation with varus-valgus stability in mid-flexion without restricting the range of motion.

Secondary Dislocations in Type B and C Injuries of the Subaxial Cervical Spine: Risk Factors and Treatment

Introduction: This study analyzed the incidence of secondary dislocations (sDLs) after surgical stabilization of AO Spine type B and C injuries of the subaxial cervical spine (sCS). Materials and Methods: Patients treated for injuries of the sCS from 2010 to 2020 were retrospectively analyzed for the incidence of sDL within 60 days after first surgery. A univariate analysis of variables potentially influencing the risk of sDL was performed. Patients with solitary anterior stabilization underwent subgroup analysis. The treatment of sDLs was described. Results: A total of 275 patients were included. sDLs occurred in 4.0% of patients (n = 11) in the total sample, most frequently after solitary anterior stabilization with 8.0% (n = 10, p = 0.010). Only one sDL occurred after combined stabilization and no sDLs after posterior stabilization. In the total sample and the anterior subgroup, variables significantly associated with sDL were older age (p = 0.001) and concomitant unstable facet joint injury (p = 0.020). No neurological deterioration occurred due to sDL and most patients were treated with added posterior stabilization. sDL is frequent after solitary anterior stabilization and rare after posterior or combined stabilization. Discussion: Patients of higher age and with unstable facet joint injuries should be followed up diligently to detect sDLs in time. Neurological deterioration does not regularly occur due to sDL, and most patients can be treated with added posterior stabilization.

Dynamic Anterior Stabilization with Hill-Sachs Remplissage Can be Employed in Skeletally Immature Patients-Operative Technique.

Numerous studies indicate that glenoid bony augmentation raises the risk of complications during and after surgery. On the other hand, repairing the labrum alone in cases with subcritical glenoid bone loss results in recurrent instability and persistent apprehension. As a result, recent advancements in shoulder instability surgery prioritize fully restoring the anterior shoulder restraint. A novel method for treating recurrent anterior shoulder instability with subcritical glenoid bone loss and off-track Hill-Sachs lesion in skeletally immature patients is suggested: the use of dynamic anterior stabilization technique incorporating the long head of the biceps tendon onto the anterior glenoid rim via trans-subscapular transfer, in conjunction with Hill-Sachs remplissage. A practical, step-by-step surgical technique for a complete reconstruction of the anterior capsule-labral-ligamentous complex is provided. This involves utilizing a soft-tissue dynamic anterior sling, achieved through the trans-subscapularis transfer of the long head of the biceps tendon at the glenoid level. The procedure concludes with a Hill-Sachs remplissage to further prevent off-track events and alleviate apprehension. Dynamic anterior stabilization is a suitable approach for addressing recurring anterior shoulder instability in skeletally immature patients who have subcritical glenoid bone loss and bipolar bone lesions.

A cadaveric study of the posterior band of the inferior glenohumeral ligament of the shoulder and its dynamic behaviour in different arm positions.

The inferior glenohumeral ligament (IGHL) is composed of three parts: the anterior branch or band (AB), the axillary pouch and the posterior band (PB). The latter has rarely been studied. We aim to describe the PB of the IGHL and its dynamic behaviour in different arm positions. Twelve fresh cadaveric shoulders were used and the two bands (AB and PB) of the IGHL were dissected and isolated, taking away all muscle, ligaments and capsule. Characteristics of the bands were studied in five positions: maximum external rotation (ER1), abduction (ABD), internal rotation (IR), ABD external rotation (ER2) and anterior elevation-adduction-IR (Hawkins-Kennedy test position). Progressive and randomized sectioning of the bands and capsule with a scalpel was performed to study its impact on mobility and translation of the glenohumeral joint. The bands that tensioned first werein ER1, the AB at 97 ± 9° (80-110); in ER2, the AB at 81 ± 19° (30-100); in IR, the PB at 64 ± 9° (50-80); and in ABD, the PB at 87 ± 10° (70-105). Isolated sectioning of the AB had no effect on ABD, whilst isolated sectioning of the PB allowed greater ABD. In ER2, the AB limited anterior translation. After sectioning the AB, anterior translation remained limited by the PB, which wrapped around the humeral head and locked the joint by pressing the two joint surfaces tightly together. In Hawkins-Kennedy position anterior elevation-adduction-IR, the AB is the first constraint and the posterior translation was limited by the PB alone only in four cases. When the IGHL is isolated, ligament limitation of glenohumeral ABD seems to be uniquely dependent on the PB. In the Hawkins and Kennedy position, the AB is the first constraint. In the case of an isolated lesion to the AB, the PB participates in anterior stabilization of the shoulder by wrapping around the humeral head that cannot dislocate. These findings confirm the role of the PB in glenohumeral joint stability. Level IV.

Anchorless Onlay Dynamic Anterior Stabilization of the Shoulder Using a Guided Posterior Double Endobutton Fixation

The treatment of shoulder instability in the presence of a subcritical glenoid defect poses challenges, as simple Bankart seems insufficient, and the Latarjet procedure may be excessive. Recently, a dynamic anterior stabilization technique involving anterior transposition of the long head of the biceps (LHB) through a subscapularis split was described for that purpose. Previously published results demonstrated good short-term results, but several technical pitfalls have also been mentioned. We describe an onlay, anchorless, and intra-articular knotless method of fixing the LHB into the anterior glenoid that provides the important stabilizing “sling effect” of the dynamic anterior stabilization while avoiding some of the pitfalls described by other techniques.

Physeal-Sparing, All-Inside Anterior Cruciate Ligament Reconstruction Using Quadrupled Semitendinosus Autograft and Suture Tape Augmentation for Skeletally Immature Patients

The anterior cruciate ligament (ACL) is the primary soft-tissue structure for anterior stabilization of the knee and is one of the most frequently injured structures. The incidence of ACL injuries in children and adolescents ranges from 92 to 151 per 100,000 person-years. The choice of surgical treatment for this population group is controversial, with a widespread concern that adult reconstruction techniques may damage the epiphyseal plate, compromise growth, or cause deformity. In this article, we describe a physeal-sparing, all-inside ACL reconstruction technique for skeletally immature patients. This technique is supported by retrograde drilling of the femoral tunnel and retrograde drilling of the tibial tunnel, both of which are able to avoid the epiphyseal growth line. Fixation of the quadrupled semitendinosus autograft and suture tape augmentation are achieved by soft-tissue buttons on the femur and tibia. The surgical details of this reproducible reconstruction technique are elaborated.

Cross-education effects on shoulder rotator muscle strength and function after shoulder stabilization surgery: a randomized controlled trial

To investigate the effects of cross-education on RC muscle strength recovery and shoulder function in patients with arthroscopic anterior shoulder stabilization surgery. Twenty-eight patients with shoulder stabilization surgery were included in the study (age: 25±6 years and body-mass index: 24.8±3.6 kg/m2). The patients were randomly divided into either cross-education (n=14) or control (n=14) groups. All patients received a standardized rehabilitation program until the end of the postoperative 12th week. The cross-education group also received an isokinetic training with the non-operated shoulder focusing on the RC muscles (twice a week, 3 sets of 10 repetitions). RC muscle strength was measured preoperatively and three, and six months postoperatively using an isokinetic dynamometer at 60°/sec and 180°/sec angular velocities. Shoulder function was assessed with Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) and Y-balance Test for Upper Quarter (YBT-UQ). Analyses of covariance were used for the statistical analyses. At the postoperative six months and at 60°/sec angular velocity, there was higher IR strength in the cross-education group (p=0.02) and similar ER strength (p=0.62) between the groups. At 180°/sec angular velocity, both IR (p=0.04) and ER (p=0.02) strength were higher in the cross-education group. The CKCUEST (p=0.47), YBT-UQ (p=0.95) and WOSI (p=0.12) scores were similar between the groups at six months after the surgery. Cross-education in the early periods of the postoperative rehabilitation following the stabilization surgery improves the RC strength recovery. However, it has no effects on the functional outcomes. Integrating the cross-education program to the postoperative rehabilitation may help to improve dynamic shoulder stability but not the functional capacity.

Analysis of treatment outcomes in patients with combat spinal column and spinal cord injuries

Introduction. Spinal column and spinal cord injuries are one of the most severe types of trauma. The paper presents the results of examination and treatment of 80 patients with combat spinal column and spinal cord injuries treated in the neurosurgical department of the FSBI National Medical Research Center for High Medical Technologies — A. A. Vishnevsky Central Military Clinical Hospital. Purpose. To analyze the structure of incoming wounded patients and the results of treatment of patients with combat spinal injury in the conditions of a multidisciplinary medical center. Materials and methods. The paper analyzes the results of treatment of 80 patients with combat spinal column and spinal cord injuries treated in the Neurosurgery Center, FSBI National Medical Research Center for High Medical Technologies — A. A. Vishnevsky Central Military Clinical Hospital. The inclusion criteria were the radiological signs of combat spinal injury upon admission to the hospital. Upon admission, all patients underwent pan CT scan, their somatic and neurological status was assessed, and laboratory parameters were evaluated. Gunshot wounds were found in 66.25 % (n=53) of the patients, and blunt combat injuries to the spine were found in 33.75 % (n=17). Concomitant injuries were sustained by 81.25 % (n=65) of the studied patients. Prior to admission to the Neurosurgery Center, neurosurgical care was provided to some of the wounded. Spinal surgery was performed in 30.0 % (n=24) of the cases, and 56.25 % (n=45) were operated on for injuries to other anatomical regions and organ systems. Results. 69 % (n=55) of the patients underwent neurosurgical treatment. The indication for surgery in 56.4 % (n=31) of the patients was instability in the spinal motion segment (SMS). Both one-stage (anterior or posterior stabilization) and two-stage operations consisting of posterior and anterior approaches, including with the use of minimally invasive techniques (8 cases), were performed. In 23 patients, foreign body removal was performed, including by means of videoimage endoscopy (in 5 cases). On average, the wounded had an operation on the 5th day after the injury. At discharge, motor neurological improvement or complete recovery was seen in 21.1 % (n=16) of the patients, while motor disorders remained at the initial level in 78.9 % (n=60). Sensory disorders decreased in 13.1 % (n=10), while 84.2 % (n=64) showed no improvement in sensory level. There was a significant decrease in the intensity of the pain syndrome. However, the number of patients with neuropathic pain decreased slightly (41 patients among all the examined at discharge versus 42 at admission). The functions of the pelvic organs were restored in 8.25 % (n=7) of the patients. At the stage of treatment in the specialized center, 49 % (n=39) of the patients had complications in different organ systems. The mortality rate was 2.5 % (n=2).

Concomitant Biceps Tenodesis Does Not Portend Inferior Outcomes After Anterior Glenohumeral Stabilization

Background: Military patients are known to suffer disproportionately high rates of glenohumeral instability as well as superior labrum anterior to posterior (SLAP) tears. Additionally, a concomitant SLAP tear is frequently observed in patients with anterior shoulder instability. Even though biceps tenodesis has been demonstrated to produce superior outcomes to SLAP repair in military patients with isolated SLAP lesions, no existing studies have reported on outcomes after simultaneous tenodesis and anterior labral repair in patients with co-existing abnormalities. Purpose: To evaluate outcomes after simultaneous arthroscopic-assisted subpectoral biceps tenodesis and anterior labral repair in military patients younger than 40 years. We also sought to compare these outcomes with those after repair of an isolated anterior labral tear. Study Design: Cohort study; Level of evidence, 3. Methods: This study is a retrospective analysis of all military patients younger than 40 years from a single base who underwent arthroscopic anterior glenohumeral stabilization with or without concomitant biceps tenodesis between January 2010 and December 2019. Patients with glenoid bone loss of >13.5% were not eligible for inclusion. Outcome measures including the visual analog scale (VAS) for pain, the Single Assessment Numeric Evaluation (SANE), the American Shoulder and Elbow Surgeons (ASES) shoulder score, the Rowe instability score, and range of motion were administered preoperatively and postoperatively, and scores were compared between groups. Results: A total of 82 patients met inclusion criteria for the study. All patients were active-duty service members at the time of surgery. The mean follow-up was 87.75 ± 27.05 months in the repair + tenodesis group and 94.07 ± 28.72 months in the isolated repair group (P = .3085). Patients who underwent repair + tenodesis had significantly worse preoperative VAS pain (6.85 ± 1.86 vs 5.02 ± 2.07, respectively; P < .001), ASES (51.78 ± 11.89 vs 62.43 ± 12.35, respectively; P = .0002), and Rowe (26.75 ± 7.81 vs 37.26 ± 14.91, respectively; P = .0002) scores than patients who underwent isolated repair. Both groups experienced significant improvements in outcome scores postoperatively (P < .0001 for all), and there were no statistically significant differences in postoperative outcome scores or range of motion between groups. There were no differences in the percentage of patients who achieved the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state for the VAS pain, SANE, ASES, and Rowe scores between groups. Overall, 37 of the 40 (92.50%) patients in the repair + tenodesis group and 40 of the 42 (95.24%) patients in the isolated repair group returned to unrestricted active-duty military service (P = .6045). In addition, 38 (95.00%) patients in the repair + tenodesis group and 40 (95.24%) patients in the isolated repair group returned to preinjury levels of sporting activity (P = .9600). There were no significant differences in the number of failures, revision surgical procedures, or patients discharged from the military between groups (P = .9421, P = .9400, and P = .6045, respectively). Conclusion: The findings of this study indicate that simultaneous biceps tenodesis and labral repair was a viable treatment option for the management of concomitant SLAP and anterior labral lesions in young, active military patients younger than 40 years.

Modified Dynamic Anterior Stabilization and Labroplasty for Anterior Shoulder Instability With Concomitant SLAP Lesion

Several arthroscopic techniques to treat anterior shoulder instability have been described. Bankart repair may be insufficient in cases with some degree of bone loss, and arthroscopic Latarjet is technically challenging. It is not rare to find at the time of surgery a more extensive labral tear (SLAP lesion) or an insufficient anterior capsulolabral tissue. We describe for those cases a dynamic anterior stabilization where using the long head of the biceps we are treating the SLAP lesion and at the same time it provides the “sling effect” of a Latarjet procedure for the anterior instability.

Anterior Cruciate Ligament Stability in Soft-Embalmed Cadaver vs In vivo Knee: Alternative Approaches to Medical Education.

Soft-embalmed cadavers have been used in medical education with a variety of success in different curriculum objectives. In the United States, the ACL is the most commonly injured ligament. Yet, there has been little focus on the stability of the knee in the sagittal plane provided by the anterior cruciate ligament within the soft-embalmed cadaver model. If the soft-embalmed cadaver ligaments contain similar elastic properties as an in-vivo knees, this will offer yet another means for further advancements in medical education to detect and assess musculoskeletal injuries. Evaluate how similarly the anterior tibial translation of soft-embalmed cadaver anterior cruciate ligaments compares to in-vivo tissue. The KT-1000 arthrometer was used to assess the laxity of the anterior cruciate ligament of thirteen soft-embalmed cadavers consisting of five females and eight males with a mean age of 79.3 years and duration of time since embalming ranging from 250 to 1156 days. Anterior displacement of the tibia in relation to the femur was registered at 67N and 89N. The soft-embalmed cadaver measurements were compared against twenty-one healthy uninjured individuals whose anterior tibial translation was measured using the same process. Data sets were analyzed using a welch two-sample t-test to determine the similarity between the means of the data sets. The t-tests proved a significant difference between live and soft-embalmed cadaver knees. The anterior tibial translation in the set of healthy live knees directly compared to the soft-embalmed cadaver group for 67N depicts an average difference of 1.76mm. The same comparison at 89N depicts an average difference of 2.12mm. While soft-embalmed cadavers may not directly replicate ATT to an exact number to that of in vivo tissue, they still allow the perception of the tibial translation against a stationary femur. The difference is less than 2.5 mm in both data sets when compared to an in-vivo knee, equivalent to one-tenth of an inch. Suggesting the viability of soft-embalmed cadavers ATT and should not exclude their use in medical education.

Beach-Chair Versus Lateral Decubitus Positioning for Primary Arthroscopic Anterior Shoulder Stabilization: A Consecutive Series of 641 Shoulders

Background: There are limited data comparing the beach-chair (BC) versus lateral decubitus (LD) position for arthroscopic anterior shoulder stabilization. Purpose: To identify predictors of instability recurrence and revision after anterior shoulder stabilization and evaluate surgical position and glenoid bone loss as independent predictors of recurrence and revision at short- and midterm follow-ups. Study Design: Cohort study; Level of evidence, 3. Methods: A consecutive series of 641 arthroscopic anterior stabilization procedures were performed from 2005 to 2019. All shoulders were evaluated for glenohumeral bone loss on magnetic resonance imaging. The primary outcomes of interest were recurrence and revision. Multivariable logistic regression models were used to assess the relationships of outcomes with age, position, glenoid bone loss group, and track. Results: A total of 641 shoulders with a mean age of 22.3 years (SD, 4.45 years) underwent stabilization and were followed for a mean of 6 years. The overall 1-year recurrent instability rate was 3.3% (21/641) and the revision rate was 2.8% (18/641). At 1 year, recurrence was observed in 2.3% (11/487) and 6.5% (10/154) of BC and LD shoulders, respectively. The 5-year recurrence and revision rates were 15.7% (60/383) and 12.8% (49/383), respectively. At 5 years, recurrence was observed in 16.4% (48/293) and 13.3% (12/90) of BC and LD shoulders, respectively. Multivariable modeling demonstrated that surgical position was not associated with a risk of recurrence after 1 year (odds ratio [OR] for LD vs BC, 1.39; P = .56) and 5 years (OR for LD vs BC, 1.32; P = .43), although younger age at index surgery was associated with a higher risk of instability recurrence (OR, 1.73 per SD [4.1 years] decrease in age; P < .03). After 1 and 5 years, surgical position results were similar in a separate multivariable logistic regression model of revision surgery as the dependent variable, when adjusted for age, surgical position, bone loss group, and track. At 5 years, younger age was an independent risk factor for revision: OR 1.68 per SD (4.1 years) decrease in age (P < .05). Conclusion: Among fellowship-trained orthopaedic surgeons, there was no difference in rates of recurrence and revision surgery after performing arthroscopic anterior stabilization in either the BC or the LD position at 1- and 5-year follow-ups. In multivariable analysis, younger age, but not surgical position, was an independent risk factor for recurrence.

Comparing Clinical Outcomes of Early and Elective Reconstruction in Patients with Anterior Cruciate Ligament Tears

Purpose: The optimal time of treatment for anterior cruciate ligament tears remains controversial. Two times are early (&lt; 6 weeks) and elective (≥ 6 weeks) reconstruction. This retrospective study tested the hypothesis that clinical outcomes are similar between the two time groups for anterior cruciate ligament reconstruction. Methods: A total of 61 patients were included in this study. Thirty and 31 patients were in the early and elective reconstruction groups, respectively. The collected patient data included a preoperative and 2-year postoperative range of motion, visual analog scale scores, anterior stability tests, and clinical knee scores. Results: There were no significant differences in the 2-year postoperative range of motion, visual analog scale scores, or anterior stability tests. The Lysholm and International Knee Documentation Committee knee evaluation form scores were significantly higher in the early reconstruction group than in the elective reconstruction group. Conclusions: Early anterior cruciate ligament reconstruction is a more effective clinical knee score than elective reconstruction in treating anterior cruciate ligament tears.

A pelvis-oriented margin of stability is robust against deviations in walking direction

The Margin of Stability (MOS) is often assessed relative to the intended, linear path of walking progression. When an unanticipated or irregular change in direction occurs, such as during a sudden turn or during activities of daily living, distinguishing the lateral from anteroposterior MOS can be challenging. The purpose of this study was to assess an anatomically orientated method of calculating the MOS using the pelvic orientation to define lateral and anteroposterior directions. We hypothesized that when straight walking was disrupted with a curved path, the pelvis-oriented MOS measure would be less variable compared to the global-oriented MOS measure. We recruited 16 unimpaired participants to walk at preferred and fast walking speeds along a straight walking path, as well as a path with an exaggerated, curvilinear deviation. We determined the within-subject mean and standard deviation of the anterior MOS at mid-swing and the posterior and lateral MOS at ipsilateral foot strike. For straight walking and curved walking separately, repeated measures factorial ANOVAs assessed the effects of model (global or pelvis-oriented), limb (left or right), and speed (preferred or fast) on these MOS values. Based on reduced variability during curved walking, the pelvis-oriented MOS was more robust to walking deviations than the globally defined MOS. In straight walking, the pelvis-oriented MOS was characterized by less lateral and more anterior stability with differences exacerbated by faster walking. These results suggest a pelvis-oriented MOS has utility when the path of progression is unknown or unclear.

Quadriceps Tendon With Bone Autograft Has Better Stability and Magnetic Resonance Imaging Maturation Than Hamstring Tendon Autograft After Anterior Cruciate Ligament Reconstruction in Patients With Knee Hyperextension

To compare the clinical outcomes of anterior cruciate ligament (ACL) reconstruction between methods using quadriceps tendon with bone (QTB) and hamstring tendon (HT) in patients with hyperextension of the knee. The medical records of patients with knee hyperextension greater than 8° who underwent arthroscopic ACL reconstruction between October 2010 and October 2020 with follow-up for at least 2 years (median, 3 years; interquartile range [IQR], 2.0-4.6 years) were retrospectively reviewed. Side-to-side difference in anterior translation, pivot-shift test grade, Lysholm score, and graft intensity using the Howell grade on magnetic resonance imaging at final follow-up were compared between the QTB and HT groups. The HT and QTB groups consisted of 42 patients and 21 patients, respectively. The overall mean age was 21.5 years (range, 14-48 years), and the median Tegner Activity Scale score was 6 (range, 3-9). Postoperatively, the median side-to-side difference in anterior translation was 1.75 mm (IQR, 1-3 mm) in the HT group and 1.0 mm (IQR, 0-1.75 mm) in the QTB group (P= .01). Pivot-shift testing showed grade 0 in 74.7%, grade 1 in 18.7%, and grade 2 in 6.6% of patients in the HT group and grade 0 in 85.7% and grade 1 in 14.3% of those in the QTB group (P= .03). The median postoperative Lysholm score was 99 in both groups. Graft signal intensity showed a significant between-group difference: grade I in 52%, grade II in 36%, and grade III in 12% of patients in the HT group versus grade I in 85.7%, grade II in 9.5%, and grade III in 4.8% of those in the QTB group (P= .03). In patients who underwent ACL reconstruction for hyperextension of the knee, QTB yielded better clinical outcomes than HT with respect to anterior stability, rotational stability, and graft signal intensity on median 2-year follow-up magnetic resonance imaging. Level III, retrospective case-control study.

Outcomes of total shoulder arthroplasty in patients with prior anterior shoulder instability: minimum 5-year follow-up

Patients with a history of anterior shoulder instability (ASI) commonly progress to glenohumeral arthritis or even "dislocation arthropathy" and often require total shoulder arthroplasty (TSA). The purposes of this study were to 1) report patient reported outcomes (PROs) after TSA in patients with a history of ASI, 2) compare TSA outcomes of those whose ASI was managed operatively versus those managed nonoperatively, and 3) report PROs of TSA in patients who previously underwent arthroscopic versus open ASI management. Patients were included if they had a history of ASI and were at least 5 years out from TSA performed by a single surgeon between 10/2005 and 01/2017. Exclusion criteria included prior rotator cuff repair, hemi-arthroplasty, or glenohumeral joint infection prior to index TSA. Patients were separated into two groups, those with previous operatively managed ASI and those whose ASI was treated nonoperatively. Prospectively collected demographic, surgical, and subjective data were retrospectively reviewed. PROs utilized were the ASES score, SANE, QuickDASH, SF-12 PCS. Failure was defined as revision TSA surgery, conversion to reverse TSA, or prosthetic joint infection. Kaplan-Meier survivorship analysis was performed. 36 patients (27 male, 9 female) with a mean age of 56.4 years (range, 18.8-72.2) were included. Patients in the operative ASI group were younger than those in the nonoperative ASI group (50.6 vs 64.0 years, p<.001). Operative ASI patients underwent 10 open and 11 arthroscopic anterior stabilization surgeries prior to their TSA (mean, 2; range, 1-4). 6 of 21 (28.6%) TSAs failed in patients with operative ASI while there were no failures in the nonoperative ASI group (p=0.03). Follow-up was obtained in 28 of 30 (93%) eligible patients at an average of 7.45 years (range, 5.0-13.6). In the collective cohort, ASES, SANE, QuickDASH, and SF-12 PCS scores significantly improved with no differences in the postoperative PROs between the two groups. No significant differences were found when comparing PROs between prior open and prior arthroscopic ASI procedures or when comparing the number of prior ASI procedures. Kaplan-Meier analysis demonstrated 79% 5-year survivorship in patients with prior ASI surgery and 100% survivorship in nonoperatively managed ASI patients (p=.030). At mid-term follow-up, patients with a history of prior ASI undergoing TSA can expect continued improvement in function compared to preoperative values. However, TSA survivorship is decreased in patients with a history of ASI surgery compared to those without prior surgery.

Outcomes at Long-term Follow-up After Open Latarjet Versus Open Bankart Repair in Rugby Players.

Because rugby is a collision sport, it exposes players to a high risk of recurrence after anterior shoulder stabilization. Therefore, the choice of surgical procedure warrants close attention in order to optimize the time to return to sport and the stability of the shoulder throughout the player's career. The open Latarjet procedure would allow for a faster return to play and provide a lower rate of recurrence than the open Bankart repair at long-term follow-up. Cohort study; Level of evidence, 3. The study retrospectively enrolled 62 competitive rugby players who had undergone an anterior shoulder instability procedure and had at least 5 years of follow-up data. A total of 32 players treated with an open Bankart repair (BK group) were compared with 30 players (31 shoulders) treated with an open Latarjet procedure (LT group). Outcomes between groups were compared with the Rowe score, Walch-Duplay score, recurrence rate, and osteoarthritis evaluation on plain radiograph (Samilson classification). The recurrence rate was significantly higher at 18.8% for the BK group (mean follow-up, 6.9 ± 1.7 years) compared with 3.3% for the LT group (mean follow-up, 6.2 ± 1.4 years) (P = .04). No postoperative complications occurred in the BK group, whereas 1 infection and 1 hematoma required a second surgery in the LT group (P = .14). In the BK and LT groups, 97% and 90% of players, respectively, were able to return to rugby at the same level or higher (P = .27), at a mean time of 8 and 6.3 months, respectively (P = .03). The mean Rowe and Walch-Duplay scores were not significantly different between the groups; however, the osteoarthritis rate was significantly higher in the BK versus the LT group (68% vs 38%, respectively; P = .03); 23% of patients, all in the BK group, had Samilson grade 2 osteoarthritis. The open Latarjet procedure outperformed the open Bankart procedure in terms of stability, time to return to play, and radiological outcomes at long-term follow-up in competitive rugby players.

A High Rate of Return to Running Is Seen After Both Arthroscopic and Open Shoulder Surgery

To determine the percentage of patients who report the ability to run 1 mile at various time points after arthroscopic and open shoulder surgery. We performed a retrospective review of prospectively collected data for all active-duty military patients aged 18 to 45 years who underwent shoulder surgery at a single institution over a 2-year period. The rehabilitation protocol discouraged running before 3 months, but all patients were able to return to unrestricted running at 3 months postoperatively. Patients were excluded if they lacked 1-year follow-up data. Parameters collected included demographic information and validated patient-reported outcome measures at the preoperative and short-term postoperative visits, as well as patients' ability to run at least 1 mile postoperatively. A total of 126patients were identified who underwent shoulder surgery with return-to-running data. Compared with baseline, significant improvements in patient-reported outcomes were shown at 1 and 2 years postoperatively (P= .001). The percentage of patients reporting the ability to run 1 mile postoperatively was 59% at 3 months, 74% at 4.5 months, 79% at 6 months, 83% at 12 months, and 91% at 24 months. There was no significant difference in patients undergoing shoulder surgery for instability versus non-instability diagnoses or in patients undergoing open versus arthroscopic anterior stabilization. All 11 patients unable to return to running at final follow-up had chronic lower-extremity diagnoses limiting their running ability. Young military athletes undergoing arthroscopic and open shoulder surgery have a high rate of early return to running. Approximately 60% of patients report the ability to run 1 mile at 3 months postoperatively, and three-quarters of patients do so at 4.5 months. Age, sex, military occupation, underlying diagnosis or type of surgery did not influence the rate of return to running after shoulder surgery. Level IV, therapeutic case series.

Poster 107: Biomechanical Effect of “AIGHL Reconstruction” for Bankart Lesion in Thrower’s Shoulder: A Novel Surgical Treatment to Maintain Maximum Shoulder External Rotation Angle after Surgery

Objectives: For anterior shoulder instability, antero-inferior labral repair (Bankart repair) is a reliable surgery to prevent shoulder dislocation. However, in biomechanical and clinical studies, maximum shoulder external rotation angle is reported to be decreased by about 10 degrees due to shortening of the anterior band of the inferior glenohumeral ligament (AIGHL) length after Bankart repair. For overhead throwing athletes, the 10 degrees reduction in shoulder external rotation makes it difficult to return to the previous performance level, although it does not affect daily activity. To prevent shortening of the AIGHL length, an AIGHL reconstruction was developed using fascia lata graft. Preliminary clinical results in overhead throwing athletes showed that a throwing program could start with complete restoration of maximum shoulder external rotation angle 3 months after AIGHL reconstruction. In this study the effect of AIGHL reconstruction on shoulder external rotation and anterior stability for simulated Bankart lesion in a cadaveric model of a thrower’s shoulder was evaluated (Fig. 1). Methods: Eight cadaveric shoulders were tested at 60° of glenohumeral abduction (90° of shoulder abduction) to simulate throwing motion. Glenohumeral translations at 60° and 90° of external rotation, maximum humeral rotational range of motion, and humeral head shift were measured using goniometer and MicroScribe 3D-digitizer. Each specimen was subjected to five experimental stages: (1) intact condition; (2) simulation of thrower’s shoulder by anterior capsular stretching based on previously reported method; (3) creation of Bankart lesion (AIGHL and the labrum were detached at glenoid side); (4) Bankart repair using three suture anchors; and (5) AIGHL reconstruction using allograft of fascia lata. In the AIGHL reconstruction, allograft was patched between the detached AIGHL and glenoid at maximum shoulder external rotation position to restore the original AIGHL length (Fig. 2). For statistical analysis, linear mixed-effects model and Tukey’s post-hoc analysis were used. Results: After 20% stretching, shoulder external rotation and anterior translation were significantly increased (intact 128.3° and 2.8mm, thrower’s shoulder 141.9° and 7.3mm, p&lt;0.001). Creation of Bankart lesion significantly increased anterior translation (8.3mm) compared with intact condition (p=0.021). Bankart repair completely restored anterior translation (3.0mm) to intact level; however, maximum shoulder external rotation angle after Bankart repair (134.8°) was significantly less than that in thrower’s shoulder (p=0.009). AIGHL reconstruction completely restored anterior translation (6.5mm) to thrower’s shoulder without decreasing maximum shoulder external rotation angle (144.4°) compared with thrower’s shoulder (Fig. 3 &amp; 4). At maximum humeral external rotation, the humeral head was significantly shifted superiorly after creation of Bankart lesion compared with intact condition(p=0.005). After Bankart repair, the humeral head was significantly shifted inferiorly from the Bankart lesion (p=0.003) and was significantly inferior relative to the position after AIGHL reconstruction (p=0.007). Conclusions: While Bankart repair completely restored anterior translation to the intact level (tighter than thrower’s shoulder), AIGHL reconstruction completely restored to the thrower’s level. Furthermore, maximum shoulder external rotation angle was maintained after AIGHL reconstruction although Bankart repair decreased external rotation significantly. Therefore, AIGHL reconstruction can be a useful surgical option for Bankart lesion in overhead throwing athletes to restore anterior stability while maintaining maximum shoulder external rotation angle after surgery.

Bony Sacral Volume after Sacro-Iliac Screw Fixation of Pelvic Fractures Is Dependent on Reduction of the Anterior Pelvic Ring.

Pelvic ring injuries are uncommon but serious injuries. Percutaneous sacro-iliac screw fixation (SSF) is the standard treatment for posterior stabilization of pelvic fractures. Compression forces of the SSF might cause deformity of the sacrum and the pelvic ring. The aim of this radio-volumetric study is to evaluate the morphometry of the sacrum and pelvic ring in SSF for posterior pelvic fractures. (1) Methods: We conducted a radio-volumetric study measuring the bony sacral volume before and after SSF for a pelvic fracture based on a three-dimensional reconstruction of the pre- and postoperative computed tomography scan of 19 patients with a C-type pelvic fracture. In addition to the bony sacral volume, we assessed the pelvic deformity and the load bearing axis. We compared the results of patients without anterior stabilization (Group A) to patients who had additional ORIF of the anterior pelvic ring. (2) Results: Median age of the patients was 41.2 years (±17.8). All patients received percutaneous SSF with partially threaded 7.3 mm screws. The sacral volume decreased from 202.9 to 194.3 cm3 in group A (non-operative treatment anterior, n = 10) and an increase of sacral volume from 229.8 to 250.4 cm3 in group B (anterior ORIF; n = 9). Evaluation of the pelvic deformity also reflected this trend by a decrease of the ipsilateral load-bearing angle in group A (37.0° to 36.4°) and an increase of this angle in group B (36.3 to 39.9°). (3) Conclusions: Bony sacral volume and pelvic deformity after sacro-iliac screw fixation in pelvic fractures depend on treatment of the anterior pelvic ring. Reduction and fixation of the anterior fracture shows an increase of the bony sacral volume and the load bearing angle leading to a closer to normal reconstruction of the pelvic anatomy.