Chronic Anterior Shoulder Instability Research Articles

Latarjet procedure: is the coracoid enough to restore the glenoid surface?

The aim of this study was to establish whether anterior glenoid bone loss in patients with large glenoid rim defects can be restored with a coracoid graft (Latarjet procedure). A total of 143 consecutive patients with chronic anterior shoulder instability and glenoid bone deficiency were treated in 2013. A pre-operative computed tomography (CT) scan using the PICO method was obtained to estimate anterior glenoid rim erosion. The 23 patients with anterior glenoid deficiency exceeding 20% were included in the study. A post-operative CT scan was obtained to establish whether coracoid transfer had fully restored the glenoid surface. Mean bone loss was 26 ± 3.9% of the glenoid surface (range 20-34%) compared with the contralateral glenoid. Mean coracoid dimensions were 26.3 ± 2.9mm × 7.6 ± 0.65mm. The graft successfully restored the glenoid surface in all patients (mean filling, 102.4 ± 0.8%). The Latarjet procedure is a valuable approach to treat patients with chronic shoulder instability and glenoid deficiency. Coracoid transfer restored the glenoid surface even in patients with large defects. The Eden-Hybinette technique seems to be more appropriate for revision surgery and for patients with a failed Latarjet procedure.

The intra- and inter-observer reliability of the CT-scan based X index to quantify glenoid bone loss in chronic anterior shoulder instability and its impact on decision making.

The X index is a measure of the antero-inferior glenoid bone loss on unilateral 2D CT-scans in the preoperative analysis of chronic anterior shoulder instability. Recurrence rate was shown to be higher after stabilization surgery if X index is superior or equal to 0.4. The objective of this study was to assess the intra- and inter-observer reliability of the X index. Sixty patients with an X index ≥0.4 were included retrospectively. The X index was measured twice by two independent evaluators, 15 days apart. The measurement was performed on a unilateral 2D CT-scan by dividing the length of the antero-inferior glenoid defect over the maximal antero-posterior diameter of the glenoid. Reliability of X index was assessed with intra-class correlation coefficient (ICC, ρ). Two points were added to the ISIS calculation if its glenoid criterion was "zero" and we compared this modified score to the original one. The intra-observer reliability of the X index measurement was "excellent" (ρ = 0.95 ± 0.01, p < 0.0001) while the inter-observer reliability was "good" (ρ = 0.59 ± 0.08, p < 0.0001). In patients with a glenoid bone loss visualized by the X index, 48.3 % had a negative sclerotic glenoid line sign. This proportion significantly decreased with the augmentation of the X index, p = 0.02. The average original ISIS score was 3.4 ± 1.9 and became 4.3 ± 1.7 (p < 0.00001) when the X index was incorporated. The X index is a reliable and simple unilateral 2D CT-scan measurement. AP shoulder radiographs significantly underestimated glenoid bony lesions.

Arthroscopic treatment of recurrent anterior shoulder instability with augmentation

Chronic anterior shoulder instability was found in cases with little soft tissue on the anterior portion of the joint, especially the anterior bundle of the inferior glenohumeral ligament (AIGHL) complex. Low volume and quality of the AIGHL complex tissue can lead to limitation of external rotation and difficulties to return to activities of daily living and overhead throwing sports. A new approach for the augmentation of chronic Bankart repair was developed for these cases based on a pilot study using polyglycolic acid sheets (PGA sheet). Favorable functional results without recurrence were obtained using the PGA sheet for augmentation of the AIHGL complex without any side effects. A long-term follow-up is necessary.

Reliability and validity assessment of a glenoid bone loss measurement using the Bernageau profile view in chronic anterior shoulder instability

One of the identified risk factors for anterior shoulder instability is bone loss on the anterior-inferior glenoid rim. The aim of our study was to assess intraobserver and interobserver reproducibility of the Bernageau view to estimate glenoid bone loss and validate this radiographic method with computed tomography (CT) scan. The second objective was to find correlation between Bernageau and arthroscopic bone loss measurements. Twenty patients were included retrospectively. Two independent observers evaluated glenoid bone loss with the ratio between glenoid joint surface diameters of the pathologic and healthy shoulders on Bernageau views. Results were compared with CT (gold standard) and arthroscopic measurements. Validity and reliability of Bernageau measurement were assessed with Spearman correlation coefficients (r) and intraclass correlation coefficients (ρ). The interobserver and intraobserver reliability and the validity of Bernageau measurement compared with the reference test, the CT scan, were all excellent, with a Spearman ρ between 0.56 (P=.0002) and 0.95 (P<.00001) and an intraclass correlation coefficient between 0.82 (P=.0007) and 0.97 (P<.10(-5)). There was no correlation with arthroscopic evaluation. The glenoid bone defect measurement on the Bernageau profile view is a valid and reliable method. Furthermore, it is easy to use in current clinical practice. Surgeons can therefore consider it as a tool for preoperative planning, and its use could decrease CT scan indications.

Diagnostic performance of magnetic resonance arthrography of the shoulder in the evaluation of anteroinferior labrum abnormalities: a prospective study

ObjectiveTo evaluate the diagnostic performance of magnetic resonance (MR) arthrography of the shoulder in the diagnosis of anteroinferior labrum lesions, using arthroscopy as the reference standard and to classify these lesions.MethodsInstitutional review board approval was obtained. The study population included 59 consecutive patients with history and clinical diagnosis of acute or chronic anterior shoulder instability. A total of 62 MR arthrograms were performed, since three patients had undergone a bilateral procedure. Arthroscopy, which was performed within a mean of 3 months (range 2–5 months) after MR arthrography, was used as the reference standard. Sensitivity, specificity, accuracy, positive and negative predictive values were then calculated.ResultsMR arthrography showed a sensitivity of 96 % and a specificity of 80 % for the overall detection of anteroinferior labrum abnormalities. The diagnostic accuracy was 95 % and the positive and negative predictive values were 98 % and 66 % respectively. Ten lesions were non-classifiable on surgery, of which eight were non classifiable on MR arthrography also.ConclusionsMR arthrography is highly accurate for the detection and classification of shoulder anteroinferior labrum lesions. Shoulder surgeons can confidently rely on this method to determine which patients will benefit from arthroscopy.Main Messages • MR arthrography is accurate for the detection and classification of shoulder labrum lesions. • MR arthrography is a valuable tool for the preoperative planning in acute or chronic instability. • Shoulder surgeons can rely on this method to determine which patients will benefit from arthroscopy.

Clinical results of shoulder arthroscopy combined with an open modified Latarjet procedure for chronic anterior shoulder instability with glenoid bony loss

The purpose of this study was to follow up the clinical results of the modified Latarjet procedure combined with shoulder arthroscopy for chronic anterior shoulder dislocation with glenoid bony defect. From 1999 to 2004, we evaluated 28 patients with 28 shoulders receiving shoulder arthroscopy combined with an open modified Latarjet procedure. The average age of the patients was 28.5 years. The average length of follow-up in this series was 108.2 months (range 86–126 months). At the final follow-up, the Rowe score was excellent in 21 patients (75%), and good in seven patients (25%). No patient reported subluxation or recurrent instability. The average American Shoulder and Elbow Surgeons score was 93.4, and the average total Western Ontario Shoulder Instability score was 72.74%. Shoulder arthroscopy before the Latarjet procedure is recommended because of the higher incidence of intra-articular lesions affecting satisfactory functional outcomes.

Recurrent anterior shoulder dislocation due to a partial-thickness articular surface supraspinatus tendon tear without capsulolabral lesion

Different patterns of intra-articular lesions are found in patients with chronic posttraumatic anterior shoulder instability.3,5,15 Besides bony lesions like Hill-Sachs lesion or glenoid bone deficiency, these include predominantly soft tissue injuries of the ligament-labrum complex, as well as rotator cuff tears.3,5,14,15

Prediction of coracoid thickness using a glenoid width–based model: implications for bone reconstruction procedures in chronic anterior shoulder instability

Chronic anterior shoulder instability with glenoid bone loss can be a very challenging clinical problem. Significant bone loss is commonly managed with the Latarjet procedure. However, in some cases with severe glenoid bone loss, iliac crest bone grafting is required to obtain a graft of adequate size. Iliac crest bone graft is associated with high rates of donor-site complications. Whereas glenoid dimensions can be determined by use of 3-dimensional computed tomography reconstructions, the thickness of the coracoid cannot be easily measured. This study aims to define a ratio between glenoid width and coracoid thickness that can be used in preoperative planning to determine whether coracoid transfer will yield adequate bone graft to restore glenoid contour or whether iliac crest bone graft must be taken. We studied 100 paired cadaveric scapulae (50 male and 50 female scapulae). The bony dimensions of the coracoid and glenoid were measured for each specimen. Coracoid and glenoid dimensions are provided. The mean thickness of the male coracoid was 35.4% of the width of the glenoid. The mean female coracoid thickness was 34.4% of the glenoid width. A new biomorphologic model is presented to predict coracoid thickness and the ability of the Latarjet procedure to restore stability to a given bone-deficient glenoid. This model may aid the shoulder surgeon in preoperative planning and help promote successful outcomes in glenoid reconstruction surgery by determining whether a Latarjet procedure or iliac crest bone graft is the most appropriate procedure given the predicted amount of coracoid bone graft available.

Can we improve radiological analysis of osseous lesions in chronic anterior shoulder instability?

Osseous lesions of the glenoid cavity and humeral head are predictive of recurrence after Bankart arthroscopic procedures. The objective of this study was to analyze, for each glenoid and humeral defect plain x-ray criteria of the Instability Severity Index Score (ISIS), two aspects: inter- and intraobserver reliability of their qualitative and quantitative assessment and correlations between positive criteria and their quantitative measurement. Thirty-one medical files were retained for evaluation of the glenoid and 26 for humeral notch assessment. The yes or no response for the ISIS criterion was completed by its quantitative measurement using the Griffiths and Sugaya CT methods for the glenoid and the P/R index calculation on plain x-rays with internal rotation for the Hill-Sachs lesion. Three observers provided two consecutive readings for each criterion. The analysis of the glenoid radiological criterion of the ISIS seems sufficiently reproducible for daily practice. When the evaluation is positive, bone loss is greater than 15%, without a maximum value established. In this study, the analysis of the ISIS humeral notch criterion was not reproducible. It can be improved using the P/R index and should be completed by CT imaging.

Can we improve the indication for Bankart arthroscopic repair? A preliminary clinical study using the ISIS score

The objectives of this study on arthroscopic treatment of chronic anterior shoulder instability were the collection of the current practices for this indication, their development as reported in the literature, and the analysis of preliminary results on a multicenter prospective series of Bankart arthroscopic procedures undertaken using a common technique on patients selected based on the Instability Severity Index Score (ISIS). This procedure predominates in the English-speaking world, whereas the Latarjet protocol is preferred in France. The choice between the two seems to be cultural since neither technique could be demonstrated to be superior in an analysis of 171 responses to an Internet questionnaire in this study. The literature reports disappointing results in the Bankart arthroscopic procedure and recent articles have researched the predictive factors for its failure. Eleven centers prospectively included 125 patients from 1 December 2007 to 30 November 2008. The inclusion criteria were recurrence of anterior instability and an ISIS less than or equal to four points out of 10. All the selected patients underwent capsuloligamentous reinsertion with a common minimal technique of at least three anchors and four sutures with the same postoperative protocol. At a mean follow-up of 18 months, four patients (3.2%) had experienced recurrence. For the 84 patients reexamined at 1 year, the Walch-Duplay and Rowe scores were, respectively, 88.4 and 87.8 points out of 100. Subjectively, 88.1% of the patients declared they were satisfied and would undergo the intervention again. This study confirmed the use of the ISIS as a consultation tool. Only continuation of the study with a minimum follow-up of 3 years will allow us to validate the lower limit of the ISIS below which this technique could be proposed provided that it respects the technical prerequisite of at least four capsuloligamentous sutures.

Arthroscopic Repair for Chronic Anterior Shoulder Instability

Background Although labrum lesions in patients with chronic anterior shoulder instability may not only involve detachment of the anteroinferior labrum but a lesion of the superior glenoid labrum as well, no studies have compared the clinical outcome between patients with a lesion of the anteroinferior labrum and patients with a combined lesion of the anterior and superior labrum after arthroscopic shoulder stabilization. Hypothesis Arthroscopic repair of a combined lesion of the anterior and superior labrum may have inferior clinical outcome to repair of an anterior lesion only in patients with anterior shoulder instability. Study Design Cohort study; Level of evidence, 2. Methods Sixty-three patients operated on for anterior shoulder instability between April 2002 and June 2006 were included in this study. Patients with bone deficiency were excluded. Fixation of the detached labrum was performed using suture anchors. Thirty-eight patients had a lesion of the anterior labrum (group A), and 25 had a combined lesion of the anterior and superior labrum (group B). Patients were evaluated after a 2-year minimum follow-up with Constant and Rowe scores. Failure was defined as a redislocation or a subluxation episode. Results Patients in group B experienced a significantly higher number of dislocations preoperatively (P < .05). However, there was no difference between the 2 groups regarding the failure rate postoperatively. One patient from each group had a failed result. A mean loss of 5° and 8° of external rotation at 90° of abduction was noted in patients in groups A and B, respectively (P = .113). The Constant score was 94 in group A and 93 in group B (P = .435). The Rowe score was 91 in group A and 90 in group B (P = .338). Conclusion There are no differences in shoulder stability and function in patients with anterior shoulder instability and a lesion of the anteroinferior labrum and patients with an extended lesion of the anterior and superior labrum after arthroscopic shoulder stabilization.

A Comparison of the Spectrum of Intra-articular Lesions in Acute and Chronic Anterior Shoulder Instability

The purpose of the study was to compare the incidence of secondary intra-articular shoulder lesions in patients with acute and chronic anterior shoulder instability. The occurrence of glenoid shape alterations (inverted pear glenoid) in recurrent instability was especially examined. Data for all arthroscopically ascertained intra-articular shoulder lesions in a series of 127 patients with acute and chronic traumatic anterior instability were recorded. Hemarthrosis was evident in all patients with acute dislocation and in 7 patients with chronic laxity who underwent surgery shortly after a dislocation episode. In both groups the presence of a chondral or osteochondral Hill-Sachs lesion was noted in 112 patients (88.1%), a Bankart lesion was noted in 106 patients (83.46%), an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion was noted in 13 patients (10.23%), a SLAP lesion was noted in 26 patients (20.47%), a humeral avulsion of the glenohumeral ligament (HAGL) lesion was noted in 2 acutely dislocated shoulders (1.57%), and capsular laxity was noted in 33 patients (25.98%). All ALPSA lesions were noted in patients with chronic instability (P = .044), and both HAGL lesions were found in patients with acute dislocations (P = .002). In patients with acute dislocations the incidence of Bankart lesions was 78.2% (18/23), whereas in chronic cases the incidence of Bankart or ALPSA lesions was 97.11% (101/104) (P = .002). In the group with acute dislocations there was a Hill-Sachs lesion in 15 cases (65.21%) and chronic recurrent instability accounted for 97 cases (93.26%) (P = .001). The capsule was considered lax in 2 patients with acute instability and 31 patients with chronic instability (8.69% v 29.8%, P = .037). The overall frequency of SLAP lesions was not statistically significant between acute and chronic cases (P = .868), unlike their distribution. In acute cases there were 3 type I and 2 type II SLAP lesions, whereas in chronic cases there were 4 type I, 13 type II, 3 type III, and 1 type IV SLAP lesions. Loose bodies were found and removed in 17 chronic and 4 acute cases (16.34% v 13.04%, P = .903). A partial-thickness articular rotator cuff tear was found in 14 patients: 12 with chronic dislocations and 2 with acute dislocations (11.53% v 8.69%, P = .694). The cuff tears were partial articular surface tears, involving less than 25% of the cuff thickness, and were treated with debridement, and cuff repair was not necessary in any case. The inverted pear configuration of the glenoid was found in 16 cases with chronic instability (15.38%), whereas no patient with an acutely dislocated shoulder had an inverted pear-shaped glenoid (P = .044). Associated, secondary intra-articular lesions are more frequent in patients with chronic compared with acute shoulder instability, probably as a result of the repeated dislocation or subluxation episodes. Level IV, prognostic case series.

Is arthroscopic surgery for stabilisation of chronic shoulder instability as effective as open surgery?

A systematic search of the literature published between January 1985 and February 2006 identified 62 studies which reported the results of arthroscopic procedures for chronic anterior shoulder instability or comparisons between arthroscopic and open surgery. These studies were classified by surgical technique and research methodology, and when appropriate, were included in a meta-analysis. The failure rate of arthroscopic shoulder stabilisation using staples or transglenoid suture techniques appeared to be significantly higher than that of either open surgery or arthroscopic stabilisation using suture anchors or bio-absorbable tacks. Arthroscopic anterior stabilisation using the most effective techniques has a similar rate of failure to open stabilisation after two years.

Résultat de la butée coracoïdienne type Latarjet pour instabilité antérieure chronique de l’épaule: À propos de 74 cas

Purpose of the study Results of the Latarjet procedure for chronic anterior shoulder instability using a coracoid block are known in terms of recurrence, but not in terms of apprehension. We studied a prospective consecutive series of shoulders treated with the Latarjet method in order to determine whether patients forget their shoulder or whether they are still bothered, particularly during sports activities. Material and methods The series included 74 patients with chronic anterior shoulder instability treated with a coracoid block according to the Latarjet procedure. Sixty-nine were available for review and 66 had complete radiographic explorations (93.2%). The Duplay score was used to classify sports activities. Mean age was 26.5 years; 90% of the patients practiced sports. The surgical procedure was performed by the same operator for 78% of patients. The Duplay score and the Constant score were determined and standard x-rays (four views) were obtained. Statistical analysis was performed with the chi-square test. Multivariate analysis was then applied to the subpopulation presenting persistent apprehension. Results Follow-up was at least 24 months, average follow-up 50 months. Four patients presented secondary dislocation and two subluxation; 85% of patients were satisfied, 6% were hesitant and 9% were dissatisfied. The Duplay score was: excellent (18.8%), good (49.9%), fair (20.2%) and poor (10.1%). External elbow rotation (RE1) was limited by 17.69̊ compared with the other side. Eighty-seven percent of patients resumed their sports activity five months postoperatively on average; 34% presented persistent apprehension. This subpopulation was examined separately. Multivariate analysis demonstrated two significantly independent factors of persistent apprehension: recovery of RE1 at 30 days postop, and total recovery of R1 at last follow-up. The radiographies demonstrated degenerative lesions in 10.6% of patients. Discussion The satisfaction rate of 85% and the 9% failure rate are similar to earlier reports. Our series was however exceptional in terms of an unusually high rate of persistent apprehension. Statistical analysis did not demonstrate a significant link between the presence of hyperlaxity and persistent apprehension. Nevertheless, in patients with hyperlaxity associated with chronic anterior shoulder instability, we associate Latarjet coracoid block with Neer capsuloplasty.

Proprioception and EMG pattern after capsulolabral reconstruction in shoulder instability: a clinical and experimental study

The anterior capsulolabral reconstruction according to JOBE [13] is a modification of the Bankart operation. The capsular shift is performed via a subscapularis-split approach avoiding any incision into the musculature. A total of 43 patients with posttraumatic, chronic anterior shoulder instability underwent surgery. All patients had at least four dislocations preoperatively. Thirty-five patients were examined after an average of 3.7 +/- 1.4 years. Twenty-nine (82.9%) of these patients were free of pain, with functional assessment showing a mean external rotation deficit of 4.1 degrees +/- 2.9 degrees without any further movement restrictions. On average, a Rowe-Score of 86.1 +/- 12.4 points and an ASES-Score of 93.3 +/- 8.4 were achieved. The reluxation rate was 7.7%. The study demonstrated that despite the good clinical results, only 69% of patients were able to return to their previous sports activity level. This special problem is in agreement with other similar studies [4, 18] so that this relevant fact was further addressed by determination of proprioception and electromyographic muscle activity. Postoperatively, in contrast to other studies [1, 21, 24], a persisting proprioceptive deficit as well as an altered EMG pattern was found together with a significant reduction in activity of the deltoideus muscle on the operated side. These results may explain the problem to achieve complete restitution of the function of the shoulder joint after capsulolabral reconstruction.

Comparison of outcomes of two different surgeries in regarding to complications for chronic anterior shoulder instability

The purpose of this study is to compare the early clinical results of two techniques in regarding to complications in the patients who suffered from chronic anterior traumatic isolated shoulder instability. Eighty-five patients underwent reconstructive procedures due to chronic isolated traumatic shoulder instability in our clinic between 1990 and 2002. Sixty-four patients in whom preoperatively Bankart lesion were detected with MRI and who participated in the regular follow-up were included in the study. Thirty-four patients were treated with Bankart repair (Group I) and 30 patients were treated with Modified Bristow procedure (Group II). Mean follow-up period was 25 (24-39) months for group I and 28 (24-96) months for group II. All cases were evaluated preoperatively and postoperatively according to Rowe scoring system. Mean Rowe scores were 90 and 88.1 for group I and II, respectively. Due to recurrent dislocation, four revision surgeries (one in group I, three in group II) were performed. Surgical complications were encountered in group II, just as fracture at the bone block in four cases, nonunion in five cases and removal of loose screw in one case. According to clinical outcomes, both the techniques are useful and feasible for the treatment of the chronic traumatic isolated anterior shoulder instability; however, complication rate is higher in the Modified Bristow technique and, Bankart repair is directed to the anatomic repair of the original pathology.

Joint Position Awareness and Sports Activity After Capsulolabral Reconstruction in the Overhead Athlete

A total of 24 overhead athletes with posttraumatic, chronic anterior shoulder instability underwent surgery. Twenty-two patients were examined after an average follow-up of 2.8 +/- 0.7 years. On average, a Constant-Score and Constant-Murley-Score of 93.7 +/- 5.3 points and an ASES-Score of 95.0 +/- 5.1 points were achieved. The redislocation rate was 9 %. The study demonstrated, that despite the good clinical results, only 12 out of 22 (55 %) of patients were able to return to their previous sports activity level. This relevant problem is in agreement with other similar studies [ ], so it was further addressed by determination of joint position awareness (JPA) and electromyographic muscle activity. Postoperatively, a persisting deficit of JPA, as well as an altered EMG pattern, was found with a significant reduction in activity of the deltoideus muscle on the operated side. The analysis of the data of each patient showed that there was a significant relation between the restitution of JPA and ability to return to the previous sports activity level. In contrast, the relation between EMG pattern and full recovery to completely unrestricted shoulder function was not significant. The anterior capsulolabral reconstruction enables a reliable restoration of shoulder stability and a low rate of complications. The problem that a relatively high percentage of overhead athletes can not return to their previous performance level is based on an impaired joint position awareness.

Sportfähigkeit und Sensomotorik nach Schulterstabilisierung beim Überkopfathleten

The anterior capsulolaboral reconstruction according to Jobe is a modification of the Bankart operation, performing the capsular shift via a subscapularis-split approach avoiding any incision into the musculature. A total of 24 overhead athletes with posttraumatic, chronic anterior shoulder instability underwent surgery. Twenty-two patients were examined after an average follow-up of 2.8 +/- 0.7 years. On average, a Constant-Murley-Score of 93.7 +/- 5.3 points and an ASES-Score of 95.0 +/- 5.1 points were achieved. The relaxation rate was 9 %. The study demonstrated, that despite the good clinical results, only 12 out of 22 (55 %) of patients were able to return to their previous sports activity level. This relevant problem is in agreement with other similar studies so that it was further addressed by determination of proprioception and electromyographic muscle activity. Postoperatively, a persisting proprioceptive deficit as well as an altered EMG pattern was found with a significant reduction in activity of the deltoideus muscle on the operated side. The analysis of the data of each patient showed that there was a significant relation between the restitution of proprioception and ability to return to the previous sports activity level. In contrast, the relation between EMG pattern and full recovery to completely unrestricted shoulder function was not significant.

Radiographic analysis of bone defects in chronic anterior shoulder instability

Purpose: To describe the incidence of bony lesions accompanying chronic anterior shoulder instability using fluoroscopically controlled radiography. Type of Study: Case series of radiographic findings of patients with chronic anterior shoulder instability. Methods: Radiographs of 160 shoulders in 156 patients with recurrent anterior shoulder instability were retrospectively evaluated; 132 shoulders had experienced recurrent dislocations, 18 shoulders had experienced recurrent subluxations, and 10 shoulders showed evidence of anterior instability at arthroscopy despite no reported history of instability. Fluoroscopically controlled radiographic views included an anteroposterior view with the humeral head in 3 rotations and a glenoid profile view with a comparison view of the contralateral shoulder. Results: A humeral impaction fracture was identified on the anteroposterior radiographs in 117 of 160 shoulders (73.1%). The glenoid profile view showed an osseous lesion of the glenoid in 126 of 160 shoulders (78.8%). The anteroposterior radiograph showed an osseous lesion of the glenoid in an additional 13 shoulders (8.2%). Overall, an osseous lesion, either humeral or glenoid, was identified in 152 of 160 shoulders (95.0%). Conclusions: This study shows the frequent presence of bony lesions in patients with anterior shoulder instability.

Chronic Anterior Shoulder Instability - Long-Term Results after Open Reconstruction

Chronic Anterior Shoulder Instability - Long-Term Results after Open Reconstruction