Recurrent Anterior Dislocation Research Articles

Total hip arthroplasty dislocation rate following isolated cup revision using Hueter's direct anterior approach on a fracture table

Instability is a major complication after revision total hip arthroplasty. Studies in the literature have shown that the dislocation rate after primary arthroplasties by anterior approach on a fracture table is satisfactory, but the rate of instability following revision surgery is not known. We hypothesized that the Hueter direct anterior approach would result in a lower rate of postoperative dislocation following revision surgery. This hypothesis was tested in a series of isolated acetabular component replacements. Seventy-three consecutive isolated acetabular component replacements were performed between January 2000 and December 2007. Twelve revisions using constrained liners or dual mobility cups were excluded, thus 61 revisions in 59 patients, mean age 65.8-year-old (range 27-86) were included. The indications for revision arthroplasty were: 51 (83.6%) cases of aseptic loosening, five (8.2%) non-integration of cementless cups, three (4.9%) cases of instability, one (1.6%) case of impingement with the psoas and one (1.6%) case of excessive (3cm) lengthening. Acetabular bone defects were moderate, with 12 stage I, 26 stage II, 19 stage III, and only four stage IV defects on the SOFCOT bone stock deficiency score. There was no acetabular reconstruction in 18 cases, while there were four isolated reconstruction cages and 39 cages with a graft. The replacement cup was cemented in 52 cases and cementless in nine. Inclination and anteversion were measured by the Pradhan method on standard X-rays. Results were evaluated after a mean follow-up of 2.4 years±1.7 years (1-7 years). Four dislocations were observed (6.6%) all anterior and early in the postoperative period (less than 2 months): three patients had a single episode of dislocation and one patient again underwent revision cup replacement by Hueter anterior approach for recurrent anterior dislocation. The only factor associated with a risk of dislocation was a high body mass index: 29.7±0.8 in the group with dislocation compared to 25.6±3.2 in the group without (P=0.008). A high number of prior interventions was also a significant risk factor (P=0.045). On the other hand, there was no difference in cup inclination or femoral offset between the group with dislocation and that without. Although the rate of dislocation is higher than after primary THA by anterior approach, it remains acceptable for revision THA and is similar to rates observed with other approaches. The literature does not clearly establish that one surgical approach is better than another in terms of instability. This study was limited by the absence of CT-scan measurements of component orientation both preoperatively to evaluate the femoral component which is preserved, as well as during follow-up to evaluate cup angle and compare the groups with and without dislocation. The Hueter direct anterior approach is a viable option for isolated cup revision, as long as femoral loosening has been excluded, and the orientation of the preserved femoral component is known. Level IV; retrospective study.

Arthroscopic Bankart repair with suture anchors: results and risk factors of recurrence of instability

To evaluate retrospectively the results of arthroscopic Bankart repair using suture anchors for recurrent anterior shoulder dislocation with a minimum 1-year follow-up and to assess risk factors for recurrence. From March 2002 to March 2010, 259 patients with recurrent anterior shoulder dislocation underwent arthroscopic Bankart repair with suture anchors. And 188 patients (50 athletes, 138 nonathletes) were available for follow-up. The mean age at the time of surgery was 25.3 years (range, 13 - 58 years). The mean follow-up was 38.6 months (range, 12 - 110 months). All of the 188 patients were evaluated preoperatively and postoperatively with the American Shoulder and Elbow Society (ASES) shoulder score and Rowe score system. The rate of recurrent instability, range of motion, and risk factors for postoperative recurrence were evaluated. The ASES score was 72.6 preoperatively, and Rowe score was 33.4. The ASES scores improved significantly to 91.9 postoperatively (P < 0.001). The Rowe scores improved to 81.9 postoperatively (P < 0.001). And 152 patients were greatly satisfied with the results, 16 satisfied and 20 unsatisfied. The satisfactory rate was 89.4%. 24 patients (12.8%) suffered a recurrence after surgery, 14 athletes and 10 nonathletes. The recurrence rates were 28.0% in the athlete group and 7.2% in the nonathlete group. On average there was no significant loss of external rotation postoperatively (average, 75.2° preoperatively and 67.2° postoperatively). Patients under age 20, and athlete patients were associated with recurrence (P < 0.05). Other factors including length of time until surgery, type of anchors, number of anchors, presence of bony Bankart lesion, presence of a superior labrum, anterior and posterior tear, presence of posterior or inferior labrum lesion, presence of rotator cuff tear, ligamentous laxity and rotator interval closure did not influence the recurrence rate (P > 0.05). Arthroscopic Bankart repair is a good option for the treatment of recurrent anterior shoulder dislocation. Identification of risk factors for recurrence allows for consideration of open stabilization. In the series, patients under age 20 and athlete patients are the most important risk factors for recurrence.

Systematic review of arthroscopic versus open repair for recurrent anterior shoulder dislocations.

Context:It remains unknown if arthroscopic repair of recurrent anterior shoulder instability is as effective as open repair.Objective:The purpose of this study is to analyze the literature to provide clinical recommendations regarding the most appropriate therapeutic intervention for recurrent anterior shoulder instability.Study Design:Systematic review of level I and II studies.Data Sources:PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and secondary references from 1967 to March 2010 were appraised for studies that met the inclusion criteria.Study Selection:Inclusion criteria were English-language level I or level II trials involving the treatment of recurrent anterior shoulder instability. Exclusion criteria included non-English-language studies; level III, IV, or V studies; and trials examining treatment of first-time shoulder dislocation, posterior shoulder dislocation, or diagnoses other than recurrent anterior shoulder dislocations.Data Extraction:Included studies underwent quality appraisal independently by each author identifying strengths, weaknesses, and biases.Results:Four randomized controlled trials compared the use of arthroscopic and open repair for recurrent anterior shoulder dislocations. These studies show no statistically significant difference between the 2 operative approaches. No long-term follow-up data describing the effects of either surgical approach are available at this time. Each investigation had weaknesses in study design that decreased the validity of its findings.Conclusions:While limited, the available evidence from randomized controlled trials does not show a statistically significant difference in redislocation rates, return to activity, and functional outcomes between the arthroscopic and open repair groups. Range of motion is marginally better following arthroscopic treatment when compared with open repair. Recommendations on the optimal surgical intervention cannot be provided.

Rotator Cuff Strength in Recurrent Anterior Shoulder Instability

Although rotator-cuff muscle contraction plays an important role in stabilizing the glenohumeral joint, little is known about the role of these muscles in the pathophysiology of recurrent anterior instability. We intended to analyze the association between isokinetic internal rotator and external rotator muscle strength and glenohumeral joint instability in patients with recurrent anterior instability that was not previously treated surgically. We enrolled thirty-seven patients with unilateral recurrent anterior posttraumatic shoulder dislocation and eleven healthy nonathletic subjects in this controlled study. The association between internal rotator and external rotator strength and shoulder instability was analyzed by side-to-side comparisons and comparisons with a control group. Isokinetic internal rotator and external rotator strength was evaluated with a Con-Trex dynamometer, with the subject seated and the shoulder abducted 45° in the scapular plane. Tests were performed at 180°/s, 120°/s, and 60°/s in concentric mode for both sides. Peak torque normalized to body weight and external rotator to internal rotator ratio were calculated for each angular velocity. Clinical and isokinetic evaluation was done by the same rehabilitation physician. The association between shoulder instability and internal rotator and external rotator strength was associated with side-to-side differences (p < 0.05). Compared with a control group, strength values were lower on the pathological shoulder side of the patients with shoulder instability than on the healthy contralateral shoulder of control subjects at 180°/s and 120°/s (p < 0.05). The side-to-side differences were increased when the nondominant upper-extremity side was involved and were decreased when the dominant side was involved. There was no association between glenohumeral joint instability and external rotator to internal rotator ratio. Internal rotator and external rotator weakness was associated with recurrent anterior instability, and side-to-side differences depended on the side of hand dominance. Use of a control group may help in the analysis of the influence of constraints on shoulder strength. Further prospective studies are necessary to determine whether the weakness is a cause or an effect of the instability.

Rotator cuff strength weakness in recurrent anterior shoulder instability physiopathology

BackgroundAlthough rotator cuff contractions play an important role in stabilizing the glenohumeral joint, little is known about the role of these muscles in physiopathological recurrent anterior instability.ObjectiveTo analyze the association...

Arthroscopic repair for combined Bankart and superior labral anterior posterior lesions: a comparative study between primary and recurrent anterior dislocation in the shoulder

The purpose of this study was to compare clinical outcomes between a primary dislocation group (group P) and a recurrent dislocation group (group R) with combined lesion of Bankart and type II SLAP lesions (type V SLAP lesion) and to evaluate incidence of type V SLAP lesion. In addition, the authors evaluated clinical outcomes of these patients by dividing two groups according to the sequence for Bankart and SLAP lesion suture. From May 2000 to May 2005, 310 patients who gave informed consent, underwent the diagnostic arthroscopy and magnetic resonance arthrography (MRA). One hundred and ten patients met the following criteria: (1) post-traumatic primary or recurrent anterior shoulder instability, (2) a normal contralateral shoulder, (3) a type V SLAP lesion, and (4) minimum follow-up of two years. Group P included 42 patients, and group R, 68 patients. Among all patients, 58 patients who had Bankart lesions sutured first were included in group B, and 52 who had their SLAP lesions sutured beforehand, group S. Visual analogue scale, range of motion, Rowe and Constant score were used to compare results between group P and group R, also group B and group S. The incidence rates of type V SLAP lesion were 42.8% in group P and 32.0% in group R. The overall treatment results in our study were good. Even if the difference between the two groups was statistically insignificant, group P showed greater recovery of range of motion than group R in external rotation. No significant difference was found between the two different operative methods according to suture sequence. The incidence rates of type V SLAP lesion were 42.8% in the primary dislocation group and 32.0% in the recurrent dislocation group. The overall treatment results in our study were good. Although there was no statistical significance in surgical time between the two groups, when both SLAP and Bankart lesions are present, the Bankart lesion must be sutured first to reduce surgical time.

Resultados do procedimento artroscópico de "remplissage" na luxação anterior recidivante do ombro

OBJETIVO: Avaliar o resultado clínico da técnica de "remplissage" associada ao reparo da lesão de Bankart (BK) para o tratamento da luxação anterior recidivante do ombro. MÉTODOS: Nove pacientes (10 ombros), com seguimento médio de 13,7 meses, apresentaram luxação traumática anterior recidivante do ombro. Todos tinham lesão de BK associada à lesão de Hill e Sachs (HS), com sinal do "encaixe". O defeito das lesões de HS foi medido e apresentava em média 17,3% (7,7% a 26,7%) de perda óssea em relação ao diâmetro da cabeça do úmero. Todos foram submetidos ao reparo artroscópico da lesão de BK associado ao preenchimento ("remplissage") da lesão de HS pela tenodese do infraespinal. RESULTADOS: O escore de Rowe variou de 22,5 (10 a 45) no período pré-operatório para 80,5 (5 a 100) no período pós operatório (p < 0,001). O escore da UCLA variou de 18,0 (8 a 29) para 31,1 (21 a 31) (p < 0,001). As medidas das rotações externa e interna, em 90º de abdução no período pós-operatório, foram 63,5º (45º a 90º) e 73º (50º a 92º), respectivamente. Dois pacientes apresentaram recidiva (um com luxação e outro com subluxações). Nenhum paciente apresentou dor na topografia do tendão infraespinal no período pós-operatório. CONCLUSÃO: A técnica de "remplissage" por artroscopia demonstrou, a curto prazo, melhora dos escores funcionais e baixo índice de complicações no tratamento da instabilidade glenoumeral associada às lesões de Hill-Sachs.

The Change of Anterior Shoulder Translation at 90&deg; Abduction Accompanied by Various Angles of External and Internal Rotation in Patients with Recurrent Anterior Shoulder Dislocation

The Change of Anterior Shoulder Translation at 90&deg; Abduction Accompanied by Various Angles of External and Internal Rotation in Patients with Recurrent Anterior Shoulder Dislocation

Infraspinatus Muscle Transfer for Recurrent Anterior Shoulder Dislocation with Massive Irreparable Rotator Cuff Tears

Infraspinatus Muscle Transfer for Recurrent Anterior Shoulder Dislocation with Massive Irreparable Rotator Cuff Tears

Arthroscopic Bankart Repair for Recurrent Anterior Shoulder Dislocation in the Patient with Deltoid Contracture: A Case Report

Arthroscopic Bankart Repair for Recurrent Anterior Shoulder Dislocation in the Patient with Deltoid Contracture: A Case Report

A Case Report of Recurrent Anterior Dislocation of the Shoulder Secondary to an Epileptic Seizure

A Case Report of Recurrent Anterior Dislocation of the Shoulder Secondary to an Epileptic Seizure

肩甲下筋断裂を伴い受傷後短期間に反復性となった肩関節前方脱臼の 1 例

肩甲下筋断裂を伴い受傷後短期間に反復性となった肩関節前方脱臼の 1 例

Les instabilités antérieures de l’épaule. Á propos de 50 cas

We performed 54 consecutive Latarjet procedures for the treatment of recurrent anterior instability of the shoulder between 1996 and 2005. We retrospectively reviewed the clinical and radiographic results of the procedure. The procedure was performed for the treatment of recurrent anterior dislocation in 51 shoulders, painful recurrent anterior subluxation in two cases and painful shoulder in one case. All patients had a radiographic evaluation before the operation and at the latest follow-up examination. At the time of the latest follow-up, none of the patients had recurrent dislocation. According to the system of Rowe, 51 (94 %) of the 54 shoulders had an excellent or good result. Fifty-one shoulders had no glenohumeral osteoarthrosis.

Prevalence Comparison of Accompanying Lesions between Primary and Recurrent Anterior Dislocation in the Shoulder

Background Many authors have reported the presence of intra-articular lesions after primary dislocation of the shoulder joint. However, few studies have focused on their prevalence or the differences in accompanying lesions between primary and recurrent dislocations of the shoulder joint. Purpose This study was undertaken to investigate and analyze accompanying lesions, including types of anteroinferior labrum injuries, using diagnostic arthroscopy and magnetic resonance arthrography (MRA) in 144 patients with traumatic anterior dislocation of the shoulder joint. Study Design Cohort study; Level of evidence, 3. Methods There were 33 patients with 33 dislocations in the primary dislocation group and 111 patients with 111 dislocations in the recurrent dislocation group. Preoperative magnetic resonance arthrography and diagnostic arthroscopy were performed on all patients. Results In the primary dislocation group, 8 Bankart lesions, 9 free anterior labrum periosteal sleeve avulsion (ALPSA) lesions, 4 bony Bankart lesions, and 1 adhesive ALPSA lesion were observed. In the recurrent dislocation group, 68 Bankart lesions, 11 free ALPSA lesions, 13 bony Bankart lesions, 16 adhesive ALPSA lesions, and 1 glenoid articular rim disruption lesion were found. There were 22 (66.6%) and 109 (98.1%) patients with lesions in the anteroinferior labrum in the primary and recurrent groups, respectively. There was a statistically significant difference between the 2 groups (P = .002). Also, there was a significant difference between the 2 groups in the prevalence of the Hill-Sachs lesion and inverted pear-shaped glenoid lesion (P = .008/P = .047). Inverted pear-shaped glenoids were observed in 15 patients in the recurrent group. In 139 of 144 patients, surgical findings of accompanying lesions coincided with magnetic resonance arthrography findings (96.5%). Conclusion Various forms of anteroinferior labral lesions were seen in patients with traumatic anterior dislocation of shoulder. The recurrent dislocation group showed a significantly higher prevalence of anteroinferior labral lesions and bony lesions in comparison with the primary group. In our study, magnetic resonance arthrography was an accurate method to assess accompanying lesions in first-time and recurrent anterior dislocation of the shoulder, suggesting that this may be a useful tool for determining a treatment method.

Combined arthroscopic-open procedure for the recurrent shoulder dislocation in a 74-year-old man with an irreparable massive rotator cuff tear and a large Hill-Sachs lesion

Large, engaging Hill-Sachs lesions can be one of causes for recurrent glenohumeral instability after initial anterior shoulder dislocation or Bankart repair for the torn anteroinferior labrum. However, there have been relatively few articles describing specific treatments for the humeral head defects. This article described a case of an alternative treatment for large Hill-Sachs lesion using the corticocancellous iliac autograft. The authors present a case of recurrent anterior shoulder dislocation, with a large humeral head defects, and an irreparable massive rotator cuff tear in a 74-year-old man. The size of this Hill-Sachs lesion was 2.7 × 2 cm with a depth of 1.2 cm. After arthroscopic anterior capsulolabral repair, a 3 × 2 cm semicircular graft was harvested from the inner table of anterior iliac crest, trimmed, and transplanted to the humeral defect by cancellous screw fixation. At his 2-year follow-up, the patient remained free of dislocation and apprehension. We recommend this technique as an alternative method for symptomatic patients with engaging Hill-Sachs lesion.

관절와의 심한 골결손을 동반한 견관절 전방 불안정성에서 장골 이식술을 이용한 관절와 재건술 - 2예 보고 -

Purpose: The purpose of this report was to assess a surgical technique-using an autogenous tricortical iliac crest bone graft in patients with epilepsy-for anatomical glenoid reconstruction for recurrent anterior glenohumeral instability with severe glenoid deficiency. Materials and Methods: We studied two cases of recurrent anterior dislocation of the shoulder due to epilepsy. These cases were treated with anatomical glenoid reconstruction using an autogenous tricortical iliac crest bone graft. Results: Both cases achieved bone union in 5 months. There was no recurrence of instability and pain. Both cases had normal range of motion. Conclusion: Anatomical glenoid reconstruction for recurrent anterior glenohumeral instability with severe glenoid deficiency using an autogenous tricortical iliac crest bone graft is a successful surgical technique for achieving shoulder stability.

Arthroscopic rotator interval closure in shoulder instability repair: A retrospective study

Arthroscopic Bankart repair (ABR) is a standard treatment for recurrent anterior shoulder instability. Young age, hyperlaxity, loss of bone stock and multidirectional or voluntary type of instability are all associated with failure of this procedure. Rotator interval laxity is associated with shoulder instability, whereas rotator interval closure increases humeral head stability and reduces shoulder range of motion. The records of patients with recurrent anterior shoulder dislocations who underwent ABR with or without arthroscopic rotator interval closure (ARIC) in our department between 1999 and 2007 were reviewed. Rates of recurrent dislocation or symptomatic subluxation as well as functional outcome were evaluated using Walch-Dupley score. Three (8.1%) of the 37 ABR+ARIC patients (age 19-44 years, 32 males) had re-dislocated their shoulder at 42±16 months following the procedure, all of which had systemic joint hyperlaxity. Six (13%) of the 46 ABR patients (age 19-39 years, 42 males) had re-dislocated their shoulder at 13±14 months, three of which had systemic joint hyperlaxity and dislocated their shoulder within 1 year following the operation. Systemic joint hyperlaxity (28% of ABR and 41% of ABR+ARIC patients) was significantly associated with recurrent dislocation and poor functional outcome. ABR+ARIC patients had slightly more limited range of motion with similar good and excellent functional results (75%) at final follow up time. Systemic joint hyperlaxity is a risk factor for failure of ABR. When ARIC is performed in combination with ABR, it may have an additive effect on shoulder stability.

Arthroscopic Management of Recurrent Low-Energy Anterior Hip Dislocation in a Dancer

Arthroscopic Management of Recurrent Low-Energy Anterior Hip Dislocation in a Dancer

Bankart-Bristow 変法の術後合併症について

Bankart-Bristow 変法の術後合併症について

Shoulder dislocation in patients older than 60 years of age

Purpose:Recurrent anterior shoulder dislocation in elderly patients is a little studied condition. The goal of this paper is to clarify the role of associated injuries with respect to loss of function and recurrence of dislocation.Materials and Methods:We have conducted a retrospective, descriptive study on 29 patients older than 60 years at the moment they suffered their first dislocation episode. All patients were assessed clinically (Constant test) and by imaging testing (X-ray, MRI).Results:Nine (31.03%) out of 29 patients had a recurrent dislocation. Four of them required reconstructive surgery to maintain joint stability. Injury to the anterior support (anterior labrum, anterior glenoid rim) showed a statistically significant relation to the recurrence of dislocations. The occurrence or non-occurrence of a rotator cuff tear does have an impact on the shoulder function. The degree of rotator cuff involvement on the coronal plane does not significantly affect the shoulder’s functional outcome. The tear extension on the sagittal plane does cause impairment on the Constant test.Conclusions:Labrum and/or anterior glenoid involvement should be suspected in elderly patients presenting with recurrent shoulder dislocation. Recurrence is due to an injury in the anterior support or both (anterior and posterior), even though shoulder function gets impaired when a rotation cuff tear occurs with anterior extension on the sagittal plane. Evidence level: IV Case series.