Arthroscopic Capsulolabral Repair Research Articles

Subscapularis Tendon Augmentation in Patients With Anterior Shoulder Instability Associated With Capsule-Labral Deficit

Shoulder instability is a common problem in young adults. Without surgical treatment, the recurrence rate is unacceptably high. While arthroscopic capsulolabral repair is popular for anterior glenohumeral instability, it still faces limitations. Surgical failures may arise from technical errors, soft tissue insufficiency, bone loss, or rehabilitation challenges. In cases with less than 15% glenoid bone loss and no external rotation deficit, subscapular augmentation provides an option without necessitating bone grafts or additional surgery. An arthroscopic technique is presented that utilizes the subscapularis tendon for tenodesis at the anterior edge of the glenoid ring in patients with the absence of capsulolabral tissue to provide both protection of the anterior glenohumeral aspect and a safer return to functional activities.

Arthroscopic selective approach to dynamic posterior shoulder instability: long-term follow-up insights

AimsEvaluate outcomes of arthroscopic capsulolabral repair in patients with structural dynamic posterior instability (Moroder classification B2), analyzing factors associated with inferior clinical outcomes or recurrence. The primary hypothesis is that this surgical approach in patients without static structural changes such as excessive glenoid retroversion or dysplastic glenoids will result in satisfactory clinical outcomes and low failure rates. MethodsObservational retrospective analysis in patients diagnosed with posterior structural dynamic instability who underwent arthroscopic capsulolabral repair. Demographic, clinical and radiologic characteristics were registered as well as patient reported outcomes, satisfaction, complications and failure with a minimum 2-year follow-up. Association between these outcomes and preoperative factors was investigated. Results21 patients were included, with an average age of 38.1 years (range 27-51) and a mean follow-up of 68.7 months (range 24-127). At final follow-up the degree of instability was 0 in 19 (90.5%) patients. Overall outcome assessment demonstrated a mean SSV of 82.3 (±15.2), mean WOSI score of 460.1 (±471) and a mean 91.5 (±13) ROWE score. Furthermore, a significant portion of patients returned to sport 71.4% at any level and 57.1% at previous level, and 71.4% reported satisfaction with treatment, while 5 patients (23.8%) had criteria for failure. ConclusionArthroscopic capsulolabral repair in selected patients with type B2 posterior shoulder instability without static posterior findings yielded satisfactory clinical outcomes and low failure rates.

Outcomes of primary arthroscopic shoulder stabilization in active patients over 40—results at a mean follow-up of 7 years

PurposeThe purpose of this study is to report clinical outcomes, return to activity, redislocation rate, and rate of conversion to arthroplasty for active patients over age 40 undergoing primary arthroscopic shoulder stabilization. MethodsPatients over 40 years of age who underwent arthroscopic capsulolabral repair for shoulder instability between December 2005 and January 2018 with a minimum of 2-year postoperative follow-up were enrolled in this retrospective, monocentric study. Clinical outcome scores including the 12-Item Short Form Survey (SF-12), American Shoulder and Elbow Surgeons (ASES), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Single Assessment Numeric Evaluation (SANE), and VAS pain were collected. Additionally, it was determined which patients reached the minimal clinically important difference (MCID) and the patient acceptable symptom state (PASS) for the ASES score. Bivariate analysis was utilized to determine if there was any association between baseline demographic and clinical factors with the outcome scores. ResultsOf a total of 814 patients assessed for eligibility, a total of 40 patients were included and 33 patients (8 females) were available for follow-up. Average age was 49.4 ± 7.6 years. At an average follow-up of 7.0 ± 3.6 years, all the outcome scores significantly improved compared to baseline. These include ASES (69.9 ± 19 to 95.8 ± 7.6, p<.001), QuickDASH (29.7 ± 17.7 to 3.9 ± 5.4, p<.002); SANE (53.5 ± 29.3 to 91.6 ± 14.3, p<.003), SF-12 (45.6± 8.8 to 55.2 ± 5.7, p<.001) and VAS (2.1 ± 2.1 to 0.3 ± 1, p<.002). MCID was reached by 72.7% of the patients and 81.8% reached the PASS threshold for the ASES score. Postoperative shoulder stability improved substantially and significantly. Median postoperative satisfaction was 10/10 (range 1-10). 95.6% of the patients returned to sport, with 91.0% of the patients able to return to pre-injury level. One patient (3%) underwent revision surgery for osteoarthritis, in the form of comprehensive arthroscopic management procedure. The presence of cartilage defects cartilage defects Outerbridge grade >2 (p=0.020) and posterior labral lesions (p=0.03) at index surgery were significantly associated with inferior outcomes in the ASES score. ConclusionActive patients aged 40 years and older undergoing arthroscopic shoulder stabilization experienced favorable functional outcomes at a mean follow-up of 7 years, with low rates of revision surgery or of progression to clinically relevant osteoarthritis. However, the presence of high-grade cartilage lesions and the presence of a posterior labral tear were associated with inferior clinical outcomes.

All-Suture Anchor vs. Knotless Suture Anchor for the Treatment of Anterior Shoulder Instability-A Prospective Cohort Study.

All-suture or soft-anchors (SA) represent a new generation of suture anchor technology with a completely suture-based system. This study's objective was to assess Juggerknot® SA, for arthroscopic Bankart repair in recurrent shoulder instability (RSI), and to compare it to a commonly performed knotless anchor (KA) technique (Pushlock®). In a prospective cohort study, 30 consecutive patients scheduled for reconstruction of the capsulolabral complex without substantial glenoid bone loss were included and operated on using the SA technique. A historical control group was operated on using the KA technique for the same indication. Clinical examinations were performed preoperatively and 12 and 24 months postoperatively. RSI and WOSI at 24 months were the co-primary endpoints, evaluated with logistic and linear regression. A total of 5 out of 30 (16.7%) patients suffered from RSI in the SA group, one out of 31 (3.2%) in the KA group (adjusted odds ratio = 10.12, 95% CI: 0.89-115.35), and 13.3% in the SA group and 3.2% in the KAgroup had a revision. The median WOSI in the SA group was lower than in the KA group (81% vs. 95%) (adjusted regression coefficient = 10.12, 95% CI: 0.89-115.35). Arthroscopic capsulolabral repair for RSI using either the SA or KA technique led to satisfying clinical outcomes. However, there is a tendency for higher RSI and lower WOSI following the SA technique.

Arthroscopic Posterior Glenoid Reconstruction With Distal Clavicle Bone-Block

Posterior glenoid bone loss is a potential cause for failure in arthroscopic capsulolabral repair. Although multiple techniques have been described to reconstruct posterior bone defects, they do not reliably yield improved patient outcomes and have high complication rates. We present a technique to reconstruct posterior glenoid bone loss using a distal clavicle autologous bone graft harvested by a mini-open approach and secured arthroscopically with suture buttons. The graft is positioned extra-articularly by repairing the posterior labral complex with a knotless fixation using labral tape.

A study on Subscapularis augmented Bankart repair (SB) vs capsulo-labral Bankart repair (CB) for recurrent anterior shoulder dislocation with moderate glenoid bone loss (< 20 %) in non-athletepopulation

Introduction- Subscapularis augmented Bankart repair (SB) is a novel arthroscopic technique of tenodesis of upper 1/3rd fibers of subscapularis tendon to capsulo-labral repair of Bankart lesion. Treatment of Bony Bankart lesion with glenoid bone loss % (GBL%) 10%–20 % is still a grey zone where bone augmentation procedures are an overtreatment and capsulo-labral repair is associated with high recurrence. MethodologyA retrospective study of 30 patients with h/o anterior instability with GBL%<20 % were classified into two groups. SB group included patients managed with arthroscopic subscapularis augmentation while CB group included patients managed with arthroscopic capsulo-labral repair. These patients were followed up after a minimum of 24 months post-surgery and functional outcomes evaluated using WOSI, ASES and ROWE scores. ResultsPatients in the SB group showed superior functional outcomes for WOSI and ROWE scores. Considering postoperative shoulder pain, the median ROWE-P (pain) score was better for SB group (10/10) when compared to CB group (5/10). Patients under SB group were more comfortable with physical symptoms of their shoulder (WOSI-P average 60/1000) and were more likely to continue their recreational sports activity (WOSI- sports for SB 63.7 and CB 119.5. In our study, none of the 15 SB patients had any restriction in range of shoulder movements [ROWE-M score of 10]. Subscapularis augmented Bankart repair is associated with minimal restriction of shoulder range, better pain relief, better acceptability and smoother return to daily living and occupation and can be considered as a routine for every patient with GBL<20 %.

Correlation of Acromial Morphology With Risk and Direction of Shoulder Instability: An MRI Study

Background: The influence of bony morphology on the development of posterior shoulder instability is not well known. Purpose: To determine if acromial morphology, as measured on magnetic resonance imaging (MRI), is associated with posterior or anterior shoulder instability. Design: Cross-sectional study; Level of evidence, 3. Methods: MRI measurements of posterior acromial coverage (PAC), posterior acromial height (PAH), posterior acromial tilt (PAT), and anterior acromial coverage (AAC) were completed for 3 separate matched groups who underwent surgical intervention: posterior instability, anterior instability, and a comparison group of patients who underwent arthroscopic surgery for snapping scapula. Inclusion criteria were patients with recurrent instability <40 years of age without multidirectional instability, glenoid bone loss >13.5%, or glenoid retroversion >10%. Results: Overall, 37 patients were included in each group. PAC was significantly less in the posterior instability group than in the anterior instability and comparison groups (68.3° vs 88.7° vs 81.7°; P < .001). PAH was significantly greater in the posterior group than in the anterior instability group (11.0 mm vs −0.1 mm; P < .001) and comparison group (0.7 mm; P < .001). There was no difference between the posterior and anterior groups in terms of PAT or AAC (P = .45 and P = .05, respectively). PAT was significantly smaller in the posterior instability group than the comparison group (55.2° vs 62.2°; P = .026). The anterior and comparison groups were not significantly different in PAH or PAT (P = .874 and P = .067, respectively) but were significantly different in AAC (P = .026). Conclusion: A higher and flatter posterior acromion, as measured on preoperative MRI, appears to be associated with patients who require arthroscopic capsulolabral repair due to posterior shoulder instability. This information may help clinicians to both diagnose and predict the need for operative intervention for patients with posterior labral tears.

Trends and projections in surgical stabilization of glenohumeral instability in the United States from 2009 to 2030: rise of the Latarjet procedure and fall of open Bankart repair.

Advances in surgical techniques have improved the ability to address recurrent glenohumeral instability via arthroscopic capsulolabral repair and bone-restoring procedures such as the Latarjet procedure. Given the paucity of studies analyzing temporal trends in the surgical management of glenohumeral instability, the purpose of this study was to assess trends in the treatment of anterior, posterior, and multidirectional instability over a 10-year period and model projections to 2030. Using the IBM Watson MarketScan national database, we identified all patients who underwent glenohumeral instability procedures from 2009 to 2018. Procedures were identified using Current Procedural Terminology codes for open Bankart, Latarjet, anterior bone block, posterior bone block, multidirectional capsular shift, and arthroscopic Bankart procedures. Sample weights provided by the database were used to calculate national estimates. US Census Bureau annual population data were used to calculate incidence. Future projections to 2030 were modeled using Poisson and linear regression. There were an estimated 446,072 glenohumeral instability cases from 2009 to 2018. The per capita incidence (per 100,000) remained constant, from 14.8 in 2009 to 14.5 in 2018. Arthroscopic Bankart procedures comprised the highest number of procedures throughout the study period, accounting for 89% of all procedures in 2009 and 93% in 2018. The number of open Bankart procedures decreased by 65% from 2009 to 2018, whereas the number of Latarjet procedures showed a 250% increase over the same period. Patient demographics did not change over the study period, and male patients aged 18-25 years comprised the largest demographic group undergoing anterior instability procedures. Multidirectional instability procedures exhibited the least pronounced sex differences. Future modeling from 2018 to 2030 projected a continued steady rise in arthroscopic Bankart procedures (from 40,000 to 49,000 cases/yr), rapid growth in Latarjet procedures (from 1370 to 4300 cases/yr), and continued decline in open Bankart procedures (from 1000 to 250 cases/yr). Arthroscopic Bankart repair continues to be the most common glenohumeral instability procedure in the United States. From 2009 to 2018, the incidence of open Bankart procedures declined whereas the incidence of Latarjet procedures markedly increased. Future projections to 2030 mirrored these findings. These data may provide an enhanced understanding of the evolution of surgical treatment of glenohumeral instability within the United States, laying the foundation for continued prospective studies into the appropriate indications and advancements in surgical techniques.

Outcomes After Revision Posterior Shoulder Capsulolabral Repair in Adolescent Athletes.

Few studies have evaluated the outcomes of posterior arthroscopic capsulolabral repair in adolescents, especially with regard to outcomes after revision repair. Adolescent athletes who undergo revision arthroscopic posterior unidirectional capsulolabral repair will have similar outcomes and return to play when compared with adolescent athletes who underwent primary arthroscopic posterior unidirectional capsulolabral repair. Cohort study; Level of evidence, 3. Data were reviewed from patients who underwent posterior shoulder stabilization between 2000 and 2019 and had a minimum follow-up of 2 years. Patients <11 and >19 years of age and those with multidirectional instability were excluded. Revision surgery was defined as repeat arthroscopic posterior capsular repair. The ability to return to sport (and level of sport), clinical outcomes scores (American Shoulder and Elbow Surgeons [ASES] and visual analog scale for pain), and patient-reported perception of range of motion, strength, and satisfaction were recorded. Comparisons between the primary and revision cohorts were made using the chi-square or the Mann-Whitney U test. Included were 180 adolescent patients (182 shoulders) who underwent a primary unidirectional posterior stabilization, with an average follow-up of 6.1 years. Of these patients, 17 patients required revision surgery (9.3% revision rate). At the final follow-up, patients who underwent revision surgery returned to sport at similar rates to those who did not (70.6% vs 85.9%; P = .095) and were similarly likely to return to their presurgery level of play (41.1% vs 23.7%; P = .10). The no-revision patients had higher ASES scores (76.1 vs 87.1; P = .007) as well as less pain and improved subjective range of motion scores. However, both groups had similar subjective strength scores, and both reported that surgical repair was satisfactory (no revision, 93.2% vs revision, 88.2%; P = .45). Adolescent athletes had a low risk of revision surgery and frequently returned to play after arthroscopic posterior capsulolabral repair, often at a lower level of play. Those who required revision surgery had poorer outcome scores but still reported a high rate of satisfaction.

Poster 201: Trends and Projections in Surgical Stabilization of Glenohumeral Instability in the United States from 2009 to 2030: Rise of the Latarjet and Fall of the Open Bankart

Objectives: Advances in surgical techniques have improved the ability to addressrecurrent glenohumeral instability via arthroscopic capsulolabral repair and bonerestoring procedures such as Latarjet. Given the paucity of studies analyzing temporaltrends in surgical management of glenohumeral instability, the purpose of this studywas to assess trends in treatment of anterior, posterior, and multidirectional instabilityover a 10-year period and model projections to 2030. Methods: Using IBM Watson Marketscan national database, all patients thatunderwent glenohumeral instability procedures from 2009 to 2018 were identified.Procedures were identified using common procedural terminology (CPT) codes foropen Bankart Repair, Latarjet, anterior bone block, posterior bone block,multidirectional capsular shift, and arthroscopic Bankart procedures. Sample weightsprovided by the database were utilized to calculate national estimates. The UnitedStates (U.S.) Census Bureau annual population data were utilized for calculatingincidence. Future projections to 2030 were modeled using Poisson and linearregression. Results: There were an estimated 446,072 glenohumeral instability cases from 2009-2018. Per capita (per 100,000) incidence remained constant, from 14.8 in 2009 to 14.5in 2018. Arthroscopic Bankart comprised the highest number of procedures throughoutthe study period, accounting for 89% of all procedures in 2009 and 93% in 2018. OpenBankart procedures decreased by 65% from 2009 to 2018, while there was a 250%increase in Latarjet procedures over the same period. Patient demographics did notchange over the study period, and males aged 18-25 comprised the largestdemographic group undergoing anterior instability procedures. Multidirectionalinstability procedures exhibited the least pronounced gender differences. Futuremodeling from 2018-2030 projected continued steady rise in arthroscopic Bankart(40,000-49,000 case/yr), rapid growth in Latarjet (1370-4300 cases/yr), and continueddecline in open Bankart (1000-250 cases/yr) procedures. Conclusions: Arthroscopic Bankart continues to be the most common glenohumeralinstability procedure in the U.S. From 2009 to 2018, incidence of open Bankartprocedures declined while Latarjet procedures markedly increased. Future projectionsto 2030 mirrored these findings. These data may provide an enhanced understandingof the evolution of surgical treatment of glenohumeral instability within the U.S. layingthe foundation for continued prospective studies into the appropriate indications andadvancements in surgical techniques. [Table: see text][Table: see text]

Poster 182: Acromial Morphology Influences Instability Risk and Direction: An MRI Study

Objectives: To determine if acromial morphology is associated with posterior or anterior shoulder instability as measured on MRI. Methods: MRI measurements of posterior acromial coverage (PAC), posterior acromial height (PAH), posterior acromial tilt (PAT), and anterior acromial coverage (AAC) were completed for three separate matched groups who underwent surgical intervention: posterior instability, anterior instability, and a comparison group of patients with who underwent arthroscopic surgery for snapping scapula. Inclusion criteria were patients with recurrent instability younger than 40 years of age without multidirectional instability, glenoid bone loss greater than 13.5% or glenoid retroversion greater than 10%. Results: Thirty-seven patients were included in each group. PAC was significantly less in the posterior instability group when compared to anterior and the comparison groups (68.3° vs. 88.7° vs. 81.7°, p&lt;.001). PAH was significantly greater in the posterior group than compared to the anterior instability patients (11.0 mm vs -0.1 mm, p&lt;.001) as well as the comparison patients (0.7 mm, p&lt;.001). There was no difference between the posterior and anterior groups in terms of PAT or AAC (p=0.45, p=0.05). PAT was significantly smaller in the posterior instability group than the comparison group (55.2 degrees vs 62.2 degrees, p=0.026). The anterior and comparison groups were not significantly different in PAH or PAT (p=8.74, p=0.067) but were significantly different with AAC (p=0.26). Conclusions: The posterior acromion is significantly higher and flatter in patients with posterior shoulder instability who require arthroscopic capsulolabral repair when measured on pre-operative MRI. This information may help clinicians to both diagnose and predict the need for operative intervention for patients with posterior labral tears.

Outcomes of Revision Arthroscopic Posterior Labral Repair and Capsulorrhaphy: A Systematic Review.

Failure rates up to 14% have been reported after arthroscopic posterior capsulolabral repair. It is unknown if revision arthroscopic posterior capsulolabral stabilization has inferior restoration of stability and return to sport when compared with primary repair. Optimal management of failed posterior capsulolabral stabilization is unknown. To report outcomes of revision posterior capsulolabral repair and factors that contribute to failure and to determine optimal management of failed posterior stabilization procedures. Systematic review; Level of evidence, 4. A computerized search of the PubMed, EMBASE, and Web of Science databases and manual screening of selected article reference lists were performed in January 2022. Randomized controlled trial, cohort, case-control, and case series studies reporting clinical outcomes of revision arthroscopic posterior capsulolabral repair were eligible. Patient characteristics, indications for revision, intraoperative findings, surgical techniques, and patient-reported outcomes were recorded. Owing to heterogeneity of reported outcomes, data were summarized and presented without pooled statistics. Only 3 of the 990 identified studies met inclusion criteria. The included studies encompassed 26 revision arthroscopic posterior capsulolabral repairs, with follow-up ranging from 2.3 to 5.3 years. The failed index procedure was arthroscopic capsulolabral repair with suture anchors (n = 22) or posterior thermal capsulorrhaphy (n = 4). The primary indications for revision were recurrent instability and pain. Six patients experienced recurrent instability after revision. Patient satisfaction ranged from 15% to 25%. This systematic review of 3 studies demonstrated that the incidence of persistent pain and recurrent instability after revision arthroscopic posterior shoulder stabilization is common, and despite slight improvement in patient-reported outcomes, many patients are dissatisfied with their clinical outcomes. Revision arthroscopic posterior shoulder stabilization appears to have a significant failure rate, and there is need for additional prospective studies to help determine the best intervention for these patients.

Arthroscopic Posterior Capsulolabral Repair With Suture-First Versus Anchor-First Technique in Patients With Posterior Shoulder Instability (Type B2): Clinical Midterm Follow-up.

Isolated soft tissue injuries of the posterior capsulolabral complex can be addressed arthroscopically, with various anchor systems available for repair. To evaluate clinical and patient-reported outcomes after arthroscopic capsulolabral repair in patients with posterior shoulder instability (PSI) and to compare differences in outcomes between patients treated with a suture-first technique (PushLock anchor) and an anchor-first technique (FiberTak all-suture anchor). Cohort study; Level of evidence, 3. Included were 32 patients with dynamic structural PSI (type B2 according to the ABC classification) treated with an arthroscopic posterior capsulolabral repair. After a mean follow-up time of 4.8 ± 3.4 years (range, 2-11) patients were evaluated clinically, and standardized outcome scores were obtained for the Subjective Shoulder Value (SSV), the Western Ontario Shoulder Instability Index (WOSI), Rowe, Kerlan-Jobe Orthopaedic Clinic (KJOC), patient satisfaction (0-5 [best]), and pain on a visual analog scale (VAS; 0-10 [worst]). The overall satisfaction level with the outcome of the surgery was 4.6 ± 0.5 (range, 4-5). No patient suffered from instability events. The mean VAS level for pain was 0.4 ± 0.9 (range, 0-4) at rest and 1.9 ± 2.0 (range, 0-6) during motion. The mean SSV was 80 ± 17 (range, 30-100), the mean postoperative WOSI score 75% ± 19% (range, 18-98), the mean Rowe score 78 ± 20 (range, 10-100), and the mean KJOC score was 81 ± 18 (range, 40-100) for the entire cohort. There was no significant difference between the techniques with regard to range of motion, strength, or clinical outcome scores. Arthroscopic posterior capsulolabral repair was a satisfactory method to treat structural PSI type B2 with regard to stability, pain relief, and functional restoration. The majority of patients had good outcomes. No differences in outcomes were observed between the anchor-first and suture-first techniques.

Minimum 10-Year Clinical Outcomes After Arthroscopic Capsulolabral Repair for Isolated Posterior Shoulder Instability

Background: Arthroscopic capsulolabral repair for posterior shoulder instability has been shown to improve patient-reported outcomes and return to sport at short-term and midterm follow-up, but long-term outcomes are unknown. Purpose: To determine the objective and subjective clinical outcomes of shoulder function after arthroscopic posterior shoulder stabilization at a minimum 10-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: A total of 53 patients (55 shoulders) with unidirectional recurrent posterior shoulder instability who underwent arthroscopic capsulolabral repair were evaluated at a mean follow-up of 15.4 years. Outcomes such as the American Shoulder and Elbow Surgeons (ASES) shoulder score, Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score, and subjective strength, stability, range of motion, and pain were evaluated preoperatively and postoperatively at a minimum 10-year follow-up. Outcomes from the same patient cohort were previously collected at 3.0-year follow-up and were evaluated for longitudinal analysis. Subgroup analyses for sport type (contact vs noncontact), position (thrower vs nonthrower), and revision versus nonrevision were performed. Risk factors for revision surgery based on magnetic resonance imaging findings, patient characteristics, and surgical findings were investigated. Results: Arthroscopic capsulolabral repair for posterior shoulder instability led to a statistically significant improvement on all outcome measures, with similar values at short-term (3.0-year) and long-term (15.4-year) follow-up. Across the total population, patients with 19 of 55 shoulders (35%) returned to sport at the same preinjury level, and patients with 33 of 55 shoulders (60%) returned to sport at some level. At long-term follow-up, patients with only 22% of shoulders were involved in the primary sport in which the injury was sustained, with patients with 28% of shoulders discontinuing sporting participation because of ongoing shoulder issues. Throwers trended toward lower Kerlan-Jobe Orthopaedic Clinic scores than nonthrowers both preoperatively (36.5 ± 22.8 vs 48.7 ± 22.9, respectively; P = .10) and postoperatively (57.4 ± 27.0 vs 73.5 ± 26.8, respectively; P = .09) but had similar improvements. Contact and noncontact athletes had similar preoperative and postoperative values, with equal improvements after surgery. With failure defined as revision surgery, an ASES score <60, or a stability value >5, 19 of 55 shoulders (35%) met failure criteria at final follow-up. Overall, 7 of 55 shoulders (13%) underwent revision surgery. At long-term follow-up, patients who underwent revision surgery had worse outcomes than those who did not undergo revision (ASES score: 53.1 ± 25.9 vs 81.8 ± 19.4, respectively; P < .001). An acute injury in the postoperative period (P < .001) and a smaller glenoid bone width on magnetic resonance imaging (P = .02) were the only identified risk factors for revision surgery. Conclusion: Arthroscopic capsulolabral repair for posterior shoulder instability was a durable treatment option that improved long-term shoulder pain and function and facilitated return to sport in the majority of patients at a mean follow-up of 15.4 years, although a notable proportion of patients met various criteria for failure.

Arthroscopic Capsulolabral Repair for Posterior Shoulder Instability with Suture Anchors Using a Beach Chair Approach

Background: Posterior shoulder instability is a relatively rare cause of recurrent instability with its incidence at 2 to 10%. It is often associated with a posterior capsulolabral tear for which Arthroscopic repair has shown good outcome. In terms of approach, there is a lack of consensus among surgeons regarding the most optimal position to perform the Arthroscopy with earlier studies favoring the use of the Lateral Decubitus (LD) over the Beach Chair (BC) position. Aim: This study is a mini-case series describing a surgical technique using the BC position in Arthroscopic posterior capsulolabral reconstruction. The authors of this study hypothesize that the use of the BC position is adequate in Arthroscopic posterior capsulolabral reconstruction so long as the surgeon is cognizant of its limitations. Methods: A retrospective analysis of the prospectively collected data was performed for 9 shoulders with posterior capsulolabral injury in 8 patients. At a tertiary hospital, the patients underwent an Arthroscopic posterior capsulolabral reconstruction using the BC position by a fellowship trained shoulder Orthopaedic surgeon. Patients were assessed preoperatively and prospectively followed up for two years and at 2 years postoperatively for isometric strength, range of motion (ROM), and various outcome measures. These included the visual analogue scale (VAS), Oxford Shoulder Score (OSS), UCLA Shoulder Score (UCLASS), and Constant Shoulder Score (CSS) and for pain assessment. Results: All the patients were male with a mean age was 25.1 (Range 20-33). 4 out of 9 (44.4%) patients suffered from a traumatic event. The mechanism of injury varied among these patients. All patients had a posterior labral tear with 7 out of 9 having concomitant capsular laxity. There was significant improvement in UCLA scores (18.4 vs 29.8) (P=0.001), Oxford Shoulder Score (37.8 vs 16.1) (P&lt;0.001) and VAS score (3.9 vs 1.3) (P=0.017) at 2 years postoperatively. There was no significant improvement in Isometric strength, Constant Shoulder Scores and Range of motion (Abduction and Forward flexion). Conclusion: The study hypothesized that the use of the BC position is adequate in posterior capsulolabral reconstruction so long as the surgeon is familiar and comfortable with the technique. Level of evidence: 2

Arthroscopic-Assisted Anterior Glenoid Reconstruction Using Nonrigid Fixation With Distal Tibia Osteochondral Allograft

Introduction: Traumatic anterior glenohumeral instability events result in a capsulolabral (Bankart lesion) and/or osseous injury with subsequent attritional bone loss, particularly with recurrence. Up to 88% of patients with recurrent instability experience glenoid bone loss, which predisposes to future dislocations and subluxations, even with arthroscopic capsulolabral repair. The surgical management of glenoid bone loss includes a number of different techniques such as the Latarjet or coracoid transfer as well as other osseous and osteoarticular autografts and allografts. However, operative management of shoulder instability has increasingly shifted toward arthroscopic approaches with preservation of anatomy when possible. Indications: Arthroscopic-assisted allograft distal tibia bone block augmentation to the anterior glenoid is indicated for revision anterior glenohumeral instability procedures with anterior bone loss and in primary cases of anterior instability with critical bone loss. Technique: Our technique for nonrigid arthroscopic anterior glenoid reconstruction with allograft distal tibia and anterior labral repair is performed preferentially in the lateral position without necessitating patient repositioning. The preplanned tibial bone block is prepared on a back table prior to the arthroscopic procedure. After creation of portals and elevation of labral tissue, a guide and drill are used to introduce a retrograde reamer which is deployed to create a perpendicular edge for apposition of the allograft tibia. The bone block is then introduced through a rotator interval portal by pulling sutures retrograde through glenoid bone tunnels and is secured to the prepared surface medial to the liberated labrum. The articular surface of the graft and glenoid are aligned and suture-based fixation is used to compress the bone block against the native glenoid. The anterior labral tissue is then mobilized over the graft and repaired to the native glenoid when possible. Description/Conclusion: The benefits of allograft tibia augmentation for anterior instability with glenoid bone loss include an anatomic joint surface restoration including articular cartilage, lack of donor site morbidity, and a minimally invasive arthroscopic approach. When performed arthroscopically and with nonrigid fixation, this technique permits concurrent anterior labral repair and anatomic reconstruction, safe graft passage without necessity of a far medial portal, and expeditious return to function.

Poster 160: Outcomes of Revision Posterior Shoulder Capsulolabral Repair in Adolescents

Objectives:Posterior arthroscopic capsulolabral repair has been shown to be successful in the athletic population. Adolescents provide a unique set of challenges to the surgeon due to their young age and potential length of time remaining in competitive athletics. Small studies have identified risk factors for failure, but there a paucity of literature evaluating adolescent specifically. The purpose of this study was to determine failure rates of adolescents who underwent arthroscopic posterior capsulolabral repair and to compare clinical outcomes and return to play between adolescents who required revision versus those who did not. It was hypothesized that adolescent athletes who require revision arthroscopic posterior unidirectional capsulolabral repair will have poorer outcomes and return to play and will undergo revision surgery at a higher rate than adults.Methods:A total of 718 patients who underwent posterior shoulder stabilization between 2000-19 with a minimum of 2-year follow-up were reviewed. Patients <11 years and >19 years of age and those with multidirectional instability were excluded. Revision surgery was defined as repeat arthroscopic posterior capsular repair. The ability to return to play, clinical outcomes scores (American Shoulder and Elbow Surgeons scoring system (ASES) and Visual Analog Scale (VAS)), and patient reported perception of range of motion, strength, and whether the surgery was worthwhile were recorded. Comparisons were made using the Chi-square or the Mann-Whitney U tests with P <0.05.Results:184 patients met inclusion criteria, with an average follow-up of 6.1 years. Nineteen patients required revision surgery, for an overall revision rate of 10.3%. At final follow-up, patients who underwent revision surgery returned to sport less frequently (86.7% vs 68.4%, p=0.04) and less likely to return to their pre-surgery level of play (Table 1). Non-revision patient had higher ASES score, as well as greater strength and range of motion. However, both groups had similar pain scores and reported that surgical repair was worthwhile (93.2% vs. 89.5%, p=0.55).Conclusions:Adolescent patients underwent revision posterior capsulolabral repair at a slightly higher rate (10.3%) when compared with athletes of all ages. Patients requiring revision had poorer outcomes scores when compared to those who did not undergo revision surgery but were able to return to sport at a high level and had a high level of satisfaction. Adolescent athletes return to play at high levels following arthroscopic posterior capsulolabral repair with a low rate of revision; however, those that require revision have poorer outcomes but high satisfaction.Table 1.Comparison of postoperative outcomes between non-revision and revision posterior shoulder arthroscopic capsulolabral repair

Comparison of suture anchor penetration rate between navigation-assisted and traditional shoulder arthroscopic capsulolabral repair.

Proper placement of suture anchors is an important step in Bankart repair as improper placement can lead to failure. Concern surrounding suture anchor placement inspired the use navigation systems in shoulder arthroscopy. We aimed to demonstrate the technological advantage of using the O-arm (Medtronic Navigation, Denver, CO, USA) image guidance system to provide real-time images during portal and anchor placements in shoulder arthroscopy. Consecutive patients (from July to October 2014) who were admitted for arthroscopic capsulolabral repair surgeries were included. Ten patients were randomly enrolled in the navigation group and 10 in the traditional group. The glenoid was divided into four zones, and the penetration rates in each zone were compared between the two groups. In zone III, the most inferior region of the glenoid, the penetration rate was 40.9% in the traditional group and 15.7% in the navigation group (P = 0.077), demonstrating a trend toward improved accuracy of anchor placement with the aid of the navigation system; however, this was not statistically significant. Average surgical time in the navigation and traditional groups was 177.6±40.2 and 117.7±17.6 mins, respectively. American Shoulder and Elbow Surgeons Shoulder Scores showed no difference before and 6 months after surgery. This pilot study showed a trend toward decreased penetration rate in O-arm-navigated capsulolabral repair surgeries and decreased risks of implant misplacement; however, possibly due to the small sample size, the difference was not statistically significant. Further large-scale studies are needed to confirm the possible benefit of the navigation system. Even with the use of navigation systems, there were still some penetrations in zone III of the glenoid. This penetration may be attributed to the micro-motion of the acromioclavicular joint. Although the navigation group showed a significant increase in surgical time, with improvements in instrument design, O-arm-navigated arthroscopy will gain popularity in clinical practice.

Knotless PEEK and double-loaded biodegradable suture anchors ensure comparable clinical outcomes in the arthroscopic treatment of traumatic anterior shoulder instability: a prospective randomized study

PurposeTo compare the clinical outcome of arthroscopic capsulolabral repair for traumatic anterior shoulder instability with PEEK knotless and knotted biodegradable suture anchors.MethodsArthroscopic stabilization was performed in 78 patients with recurrent traumatic anterior shoulder instability. They were divided into 2 groups of 39 patients each, according to suture anchors used: knotless PEEK anchors in group 1, and biodegradable anchors in group 2. Exclusion criteria were: instability without dislocation, posterior or multidirectional instability, glenoid bone loss > 20%, off-track lesions, concomitant rotator cuff tears and previous surgery. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) self-administered questionnaire. Secondary outcomes were: Work-DASH, Sport-DASH, Rowe score, recurrent instability and subsequent surgery. The following independent variables were considered: age, gender, dominance, generalized ligamentous hyperlaxity, duration of symptoms, age at first dislocation, number of dislocations, type of work, type of sport, sports activity level, capsule-labral injury pattern, SLAP lesion and number of anchors. Differences between groups for numerical variables were analyzed by use of the Student’s t-test or Mann–Whitney U-test. Fisher’s exact test was used for analysis of categorical variables. Significance was set at p < 0.05.ResultsSeven patients (9%) were lost at follow-up, 5 from group 1 and 2 from group 2. Follow-up ranged from 36 to 60 months (median: 44; IQR: 13). Comparison between groups did not show significant differences for each independent variable considered. No differences could be found either for DASH (n.s.) or Rowe (p = n.s.) scores between the two groups. Overall recurrence rate was 7%. Three re-dislocations were reported in group 1 and two in group 2 (n.s.). Only one patient in each group underwent re-operation.ConclusionsThe study showed no significant differences in clinical outcomes after arthroscopic treatment of traumatic anterior shoulder instability using PEEK knotless or biodegradable knotted anchors at mid-term follow-up.Level of evidenceI.

Isokinetic and functional shoulder outcomes after arthroscopic capsulolabral stabilization

IntroductionShoulder stability is secured by dynamic and static stabilizers. Rotator cuff is responsible for dynamic stabilization. In cases of shoulder instability their activity is disturbed. Capsulolabral repair restores mainly static stabilization. This surgery treatment technique of shoulder instability was first described by Bankart in 1923. His idea, with further modifications, is commonly used up to this day. Evaluation of muscle shoulder recovery after stabilization should be one of the important criteria to allow patient to return to sport and work. However, not much isokinetic assessment after capsulolabral repair was described. The aim of this study were the following: the comparative assessment of the shoulder rotatory strength in patients following arthroscopic capsulolabral repair of unilateral anterior traumatic instability and clinical assessment with comparison of pre and post-operative results.Material and methodsForty-five patients, 14 women and 31 men, with an average follow-up of 4.4 years were tested bilaterally for internal and external rotation strength at four angular velocities. ASES and UCLA tests were collected before and after surgery.ResultsThe values of peak moment and muscle power parameters were slightly lower for an operated shoulder in comparison to a healthy shoulder for the external rotation. Total work parameter in external rotation was significantly lower for the operated shoulder in comparison to the non-operated side. The internal/external muscle group balance was lower for the operated shoulder in comparison to reference values in the women group. Furthermore, both ASES and UCLA scores were significantly higher after operation.ConclusionsAfter arthroscopic capsulolabral shoulder stabilization, slight differences in isokinetic evaluation, especially in external shoulder rotation, occur. It affects rotators muscle balance. In functional evaluation significant improvement in shoulder function occurs.