Recurrent Anterior Dislocation Research Articles

A case of recurrent anterior shoulder dislocation with massive rotator cuff tear treated with arthroscopic procedure

A case of recurrent anterior shoulder dislocation with massive rotator cuff tear treated with arthroscopic procedure

Clinical outcome following arthroscopic Bankart repair in post-traumatic recurrent anterior shoulder dislocations of shoulder at tertiary health care centre

Clinical outcome following arthroscopic Bankart repair in post-traumatic recurrent anterior shoulder dislocations of shoulder at tertiary health care centre

The critical size of a defect in the glenoid causing anterior instability of the shoulder after a Bankart repair, under physiological joint loading.

Patients with recurrent anterior dislocation of the shoulder commonly have an anterior osseous defect of the glenoid. Once the defect reaches a critical size, stability may be restored by bone grafting. The critical size of this defect under non-physiological loading conditions has previously been identified as 20% of the length of the glenoid. As the stability of the shoulder is load-dependent, with higher joint forces leading to a loss of stability, the aim of this study was to determine the critical size of an osseous defect that leads to further anterior instability of the shoulder under physiological loading despite a Bankart repair. Two finite element (FE) models were used to determine the risk of dislocation of the shoulder during 30 activities of daily living (ADLs) for the intact glenoid and after creating anterior osseous defects of increasing magnitudes. A Bankart repair was simulated for each size of defect, and the shoulder was tested under loading conditions that replicate in vivo forces during these ADLs. The critical size of a defect was defined as the smallest osseous defect that leads to dislocation. The FE models showed a high risk of dislocation during ADLs after a Bankart repair for anterior defects corresponding to 16% of the length of the glenoid. This computational study suggests that bone grafting should be undertaken for an anterior osseous defect in the glenoid of more than 16% of its length rather than a solely soft-tissue procedure, in order to optimize stability by restoring the concavity of the glenoid.

Clinical outcomes of the reverse McLaughlin procedure for Hill-Sachs lesions in anterior shoulder instability.

Engaging Hill-Sachs lesions in recurrent anterior shoulder dislocation have been managed with the remplissage procedure. Clinical and cadaveric studies have reported limitation of rotation after this procedure. We introduce the reverse McLaughlin procedure where the infraspinatus and the underlying capsule are detached and approximated into the Hill-Sachs defect with transosseous sutures. This is a preliminary report using this technique. Seventeen patients with recurrent anterior shoulder dislocations and an engaging Hill-Sachs lesion underwent a Bankart repair and remplissage procedure (n = 9) or the reverse McLaughlin procedure ( n = 8). Patients were evaluated using the SF-36, American Shoulder and Elbow Surgeons (ASES), and Constant scores. Clinical assessment of the shoulders was also performed. At the final follow-up, all patients in both groups achieved comparable clinical outcome scores. No significant differences were reported in the range of motion of the shoulders between the two groups. There was one dislocation of the operated shoulder in each group after an injury. The reverse McLaughlin procedure for engaging Hill-Sachs lesions is simple, easy to perform, and associated with functional outcomes and range of motion at least equivalent to those obtained via the remplissage technique. It may be an alternative to the latter procedure. III, Retrospective Comparative Study.

Long Head of Biceps Tendon Transfer for Anterior Shoulder Instability

Recurrent anterior shoulder dislocation is a common disabling condition that is treated with either arthroscopic Bankart repair or open Bristow-Latarjet procedure. Although multiple studies have reported excellent results for both techniques, there is still a relatively high incidence of complications. We describe a technique variation for the treatment of recurrent anterior shoulder dislocation: the long head of biceps tendon transfer. This technique follows the same crucial “sling effect” of the Bristow-Latarjet without the risk of coracoid bone block complications or scapular dyskinesis due to detachment of the conjoined tendon and pectoralis minor from the scapula. Moreover, it can be used with capsule-labrum repair.

Can arthroscopic Bankart repairs using suture anchors restore equivalent stability to open repairs in the management of traumatic anterior shoulder dislocation? A meta-analysis

BackgroundRecently, arthroscopic Bankart repairs have become much more popular than open repairs for the treatment of recurrent anterior shoulder instability. However, it is unclear whether the modern arthroscopic Bankart repairs using suture anchors could restore equivalent stability to open repairs. We conducted a meta-analysis to compare arthroscopic Bankart repairs using suture anchors and open repairs in regard to clinical outcomes. MethodsA literature review was performed according to the PRISMA guidelines. PubMed was searched from January 1966 to January 2017. Studies were identified using the terms ‘anterior shoulder dislocation’ or ‘recurrent anterior shoulder dislocation’ and ‘Bankart repair’. The search yielded 36 publications. After reading the full-text articles, we included four randomized controlled trials and five retrospective studies that compared arthroscopic and open repairs using suture anchors. ResultsNo significant differences were found between the two procedures in frank re-dislocation and revision surgery due to recurrence. However, the overall recurrent instability including not only re-dislocation but also subluxation and apprehension was significantly higher in arthroscopic repairs than in open repairs, while a significantly higher Rowe score and lower loss of external rotation at 90° of abduction were observed following arthroscopic repairs compared to open repairs. ConclusionsModern arthroscopic Bankart repairs using suture anchors provide an equivalent outcome compared to open repairs in terms of apparent re-dislocation, but overall recurrent instability including subluxation or apprehension was still significantly higher in arthroscopic repairs than in open repairs.

Arthroscopic Bankart repair for the acute anterior shoulder dislocation: systematic review and meta-analysis.

The ideal treatment of acute anterior shoulder dislocation remains one of the topics that spark debate over the value of primary repair for the first-time anterior shoulder dislocation. The high rate of complications especially in young adults, such as recurrent instability, residual pain, and inability to return to sports, has led to the quest for an ideal management of such injuries. In this meta-analysis, we compare between the immediate arthroscopic repair and conservative treatment of primary anterior shoulder dislocation as well as arthroscopic reconstruction of recurrent anterior shoulder dislocation. Outcome measures were failure rate (dislocation, subluxation, and instability) and revision rates. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched several database including PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov through August 2017 to identify observational and experimental randomized controlled trials comparing the outcomes of immediate arthroscopic repair and conservative treatment of primary shoulder dislocations as well as arthroscopic reconstruction of recurrent dislocation. The primary outcome was failure rate, whereas, secondary outcomes were revision rate and functional outcomes. Out of the 710 studies identified, 12 were eligible for meta-analysis. The estimated pooled failure rate was 13.7% (7.7%-19.6%), whereas, the pooled revision rate was 7.1% (3.8%-10.4%) in immediate arthroscopic repair of primary shoulder dislocation. The odd ratio (OR) of failure and revision rates were significantly lower in arthroscopic repair of primary shoulder dislocation compared to conservative treatment (OR 0.103, 95% CI [0.052, 0.201]), (OR 0.217, 95% CI [0.078, 0.607]), respectively. The odd ratio (OD) of failure and revision rates were lower in arthroscopic repair of primary shoulder dislocation compared to arthroscopic reconstruction of the recurrent shoulder dislocation; however, the difference was statistically insignificant (OR 0.423, 95% CI [0.117, 1.522]) and (OR 0.358, 95% CI [0.044, 2.920]) respectively. The outcome of immediate arthroscopic repair of primary anterior shoulder dislocation is superior and encouraging with significant reduction in failure and revision rates compared to conservative treatment. Nevertheless, the failure and revision rates are statistically insignificant compared to arthroscopic reconstruction of recurrent dislocation. Hence, there is evidence to support immediate arthroscopic repair option for primary anterior shoulder dislocations over conservative treatment in young active patients, in order to reduce the risk of failure and revision rates. However, the evidence is inconclusive compared to arthroscopic reconstruction of recurrent dislocation.

Direction of Capsular Strain Implies Surgical Repair Following Recurrent Anterior Shoulder Dislocation

Objectives:Capsular plication is often performed in addition to arthroscopic Bankart repair. However, little is known regarding the direction of capsular injury making the direction of plication fairly arbitrary. This study aimed to determine the optimal direction for capsular plication within four sub-regions of the inferior glenohumeral capsule following multiple dislocations.Methods:Seven fresh-frozen cadaveric shoulders (age range 48-66 yrs) were dissected free of all soft tissue except the glenohumeral capsule. A grid of strain markers was affixed to the anterior and posterior band (A/PB) of the inferior glenohumeral ligament (IGHL), and the axillary pouch. The position of the markers while the capsule was inflated with minimal pressure served as the reference state. The humerus and scapula were then mounted in a 6 degree-of-freedom robotic testing system. At 60 degrees of abduction and 60 degrees of external rotation of the glenohumeral joint, an anterior load was applied to reach an anterior translation of one half the maximum AP width of the glenoid plus 10 mm. This definition of dislocation resulted in non-recoverable strain and a reproducible Bankart lesion. Following 1, 2, 3, 4, 5 and 10 dislocations, the positions of the strain markers were again recorded with the capsule inflated. The difference in these positions compared to the reference state defined the non-recoverable strain. The strain map was split into four sub-regions, the anterior band of IGHL (AB), anterior axillary pouch (AA), posterior axillary pouch (PA), and the posterior band of IGHL (PB) (Fig. 1). The angle of deviation between each of the maximum principle strain vectors and the AB-IGHL or PB-IGHL for the anterior and posterior regions of the capsule were determined using ImageJ. Circular statistics were employed to calculate mean direction of each sub-region and a Watson-Williams test was performed to compare mean direction among each dislocation with significance set at p < 0.05. The mean direction of all strain vectors in each sub-region was categorized as parallel or perpendicular to the AB-IGHL or PB-IGHL serving as the clinical reference. Direction ranging from 0 to 45 or 135 to 180 degrees was categorized as parallel. Direction ranging between 45 and 135 degrees was categorized as perpendicular.Results:The direction of 81.8% of the AB sub-regions was categorized as parallel and 18.2% categorized as perpendicular to the AB-IGHL. Direction of 61.3% of the AA sub-region was categorized as parallel (Table 1) and 38.7% categorized as perpendicular to AB-IGHL. The direction of 33.3% of the PA sub-region was categorized as parallel and 66.7% categorized as perpendicular to the PB-IGHL. The direction of 21.4% of PB sub-region was categorized as parallel and 78.6% categorized as perpendicular to PB-IGHL. A Watson-Williams test demonstrated that the direction of 81.3% of the sub-regions were not significantly different (p > 0.05) among dislocations for each specimen (Table 1).Conclusion:The non-recoverable strain in most of the AB and AP sub-regions were categorized as parallel to the AB-IGHL while for the PA and PB sub-regions mostly perpendicular to the PB-IGHL. These findings imply that it may be more optimal to plicate the anteroinferior capsule parallel to the AB-IGHL while posteroinferior capsular plication, which is often not classically considered for plication in the setting of anterior instability, may also be necessary and best performed perpendicular to the PB-IGHL.Figure 1.Fringe plot of non-recoverable strain for anterior half of inferior capsule in a typical shoulder following 5th dislocation. The borderline of AA and posterior axillary pouch sub-regions was the column of markers placed at the 6 o'clock position of the glenoid. AB-IGHL, anterior band of inferior glenohumeral ligament; AA, anterior axillary pouch sub-region; AB, anterior band of IGHL sub-region.Table 1.Direction of non-recoverable strain in the anterior axillary pouch sub-region following 1st to 10th dislocations for a typical shoulder (mean ± SD)Anterior Axillary Pouch sub-regionDirection of non-recoverable strainCategorizationDislocation 1168±5Parallel to AB-IGHLDislocation 2168±8Parallel to AB-IGHLDislocation 3166±5Parallel to AB-IGHLDislocation 4165±5Parallel to AB-IGHLDislocation 5175±13Parallel to AB-IGHLDislocation 10158±20Parallel to AB-IGHLWatson-Williams test showed directions were not significantly different among dislocation (p=0.33). Direction through 6 dislocation states were categorized as parallel (between 135 to 180 degrees) to anterior-band (AB) of IGHL

Outcome analysis of management of recurrent shoulder dislocation by latarjet procedure

Introduction: With the extreme range of movements, the shoulder joint is prone for dislocations. This could be due to traumatic or atraumatic, though the majority are atraumatic. With each subsequent episode of dislocation, humeral head, the glenoid, capsule, labrum and the ligaments undergoes progressive degeneration which further worsens the situation. Selecting an optimal and efficient surgical procedure for patients with anterior glenohumeral instability and associated glenoid bone loss is a complex problem. Among the coracoid transfer procedures, open laterjet procedure offers good clinical outcomes even with engaging Hill sach’s along with glenoid bone loss. The purpose is to study the clinical outcome of Open Laterjet procedure in anterior glenohumeral instability and even with Hill Sach’s lesion. Materials & Methods: Twenty patients with recurrent dislocation were performed Open Laterjet Procedure. All patients were screened by arthroscopy through standard portals of the shoulder before open procedure. Patients were followed up for mean period of 22 months. The functional outcome was measured with Walch Duplay and Visual analog scores. Results: All twenty patients had solid bone union. 90% of the patients had excellent to good outcomes. 10% of these patients had developed Grade 1 Humeral Arthropathy and this is due to improper instrument selection. One patient had transient axillary nerve weakness which recovered fully within 3 months period. During the first 10 months, there is significant loss of external rotation. But during 18 to 20 months period, there is significant improvement in the range of external rotation. None of the patient developed recurrent dislocation or positive apprehension. All patients have resorted back to routine work after 6 months period. Conclusion: Open latarjet procedure offers a good surgical method of management of recurrent anterior shoulder dislocation with significant bone loss and our study showed good functional outcome as measured by Walch Duplay and VAS scores.

Study of functional outcome after arthroscopic repair in recurrent traumatic anterior dislocation of shoulder

Study of functional outcome after arthroscopic repair in recurrent traumatic anterior dislocation of shoulder

New multidetector computed tomography quantitative technique in evaluation of shoulder instability

AimThis study aimed to assess the role of multidetector computed tomography (MDCT) in detection and evaluation of severity of glenoid and humeral head bone loss in cases of recurrent anterior shoulder joint dislocation. Patients and methodsTwenty four patients were included in the study. MDCT with 3D VR examination was performed to both shoulders of all patients. The area of the missing glenoid was calculated as well as glenoid track and Hill-Sachs interval in cases of humeral head bone loss. The findings were compared with the intra operative arthroscopic results. ResultsMDCT could detect minimal glenoid bone loss in 19 patients (79.2%), moderate glenoid bone loss in 4 patients (16.7%) and severe glenoid bone loss in 1 patient (4.2%), while arthroscope detected minimal loss in 16 patients (66.7%), moderate glenoid bone loss in 7 patients (29.2%) and significant glenoid bone loss in 1 patient (4.2%). Off-track Hill-Sachs lesions were detected by MDCT in 40% of patients and reduced to 35% of patients by arthroscopy. ConclusionMDCT is an optimal imaging modality in preoperative evaluation of glenoid and humeral head bone loss. It is the most accurate radiologic method in evaluating the new concepts of on-track and off- track Hill-Sachs lesions.

Results of Open Bankart Surgery for Recurrent Anterior Shoulder Dislocation with Glenoid Bone Defect and Concomitant Hill-Sachs Lesion.

Open Bankart surgery is the main treatment procedure in patients with recurrent anterior shoulder dislocation, especially in cases with glenoid bone defect. The goal of this study was to determine the outcomes after open Bankart surgery in cases of recurrent anterior shoulder dislocation with glenoid bone defects and concomitant Hill-Sachs lesions. Between 2006 and 2010, 89 patients with recurrent anterior shoulder dislocation and concomitant glenoid bone defects (10-30%) and Hill-Sachs lesions undergoing open Bankart surgery were reviewed. The mean follow-up after surgery was 7 years (5.5-9.5 years). The recurrence rate as well as the degree of shoulder pain and daily activity level was determined subjectively based on the visual analogue scale (VAS) and activity daily living scale (ADLs). Shoulder range of motion (ROM) in abduction and external rotation was compared with contralateral side; and finally, the American shoulder and elbow score (ASES) and constant-Murley score (CMS) were calculated. Over 7 years of follow-up, a total of 15 patients (16.8%) undergoing surgery were found to have instability (3 patients (3.3%) with dislocation and 12 patients with (13.4%) subluxation). Patients with postsurgical instability had significantly larger glenoid bone defects (P=0.0001) and Hill-Sachs lesions (P=0.019) compared to those without instability. The mean loss of forward flexion compared with the normal contralateral side was 4º while the mean loss of external rotation between both sides was 5º. At the final visit, the average VAS was 0.4 (out of 10); ADL was 28.97 (range: 25-30); ASES was 96.1(range: 78.3-100); and the mean CMS value was 93.9(range: 82-100). Open Bankart surgery with anteroinferior capsular shift for recurrent anterior shoulder dislocation with up to 30% glenoid bone defect and Hill-Sachs lesion provided desirable results in terms of shoulder function and recurrence rate. Bankart surgery is a successful and practical option in these patients and can be considered as an alternative to other procedures.

An arthroscopic bone block procedure is effective in restoring stability, allowing return to sports in cases of glenohumeral instability with glenoid bone deficiency.

A group of patients affected by bone loss in the context of recurrent anterior shoulder instability were treated arthroscopically with a modified Eden-Hybinette technique since 2005. The last modification was made in 2013, consisting of fixation using a pair of specifically designed double round Endobuttons, which secure the bone graft to the glenoid rim placed through a guide. This report describes patients operated on after this last modification. No reports have described the results of this technique, and the purpose of this study was to assess early clinical and radiological results of an arthroscopic bone block procedure with double round Endobutton fixation. We hypothesized that this technique would restore shoulder stability in patients with anteroinferior glenohumeral instability with glenoid bone deficit, with excellent clinical and radiological results. The clinical and radiological efficacy of this procedure was retrospectively evaluated in 26 patients with an average follow-up of 29.6months (range 24-33months). At minimum 2-year follow-up, we had no recurrent anterior dislocations, excellent clinical results [average Walch-Duplay score 93.2, (SD 7.8); average Rowe score, 96.4 (SD 6.5); average SSV, 87.4 (SD 12.1); satisfaction rate, 88.5%; average loss of external rotation, 4.4° (SD 8.7°)] optimal graft positioning, and a healing rate of 92.3% on computed tomography scan. Arthroscopic bone block grafting combined with a standard Bankart repair restored shoulder stability in patients with anteroinferior glenohumeral instability with glenoid bone deficit, with excellent clinical and radiological results. This procedure did not substantially limit external rotation, allowing a high rate of return to sports even among competitive, overhead, and "at risk" athletes.

Modified Bristow-Latarjet procedure for treatment of recurrent traumatic anterior glenohumeral dislocation

ObjectiveRetrospective case–control study of authors experience in the modified Bristow-Latarjet procedure for treatment of recurrent traumatic anterior glenohumeral dislocation with glenoid bone injury. MethodsSample with 102 recurrent glenohumeral dislocation cases submitted to modified Bristow-Latarjet procedure. Indications included situations of recurrent traumatic anterior glenohumeral instability with more than two dislocation episodes and with glenoid bone attritional or fragmentary injuries, without possibility of reconstruction. Mean follow-up time was 5.33±2.74 years (minimum 1; range 1–13). ResultsThe mean Walch-Duplay Score at the last evaluation was 91.23±11.46 (range 15–100). The functional score of patients with glenoid bone loss greater than 20% did not show a significant difference in comparison with patients with glenoid bone loss lower than 20% (90 vs. 92, respectively). The functional score also did not show a significant difference between sports practice categories and between recreational and competitive practice, being excellent (greater than 90) in every category. There were no dislocation recurrences and the only complications were a case of persistent instability and a screw revision. Mild glenohumeral osteoarthrosis imaging signs were identified in 7.84% of the patients; however, their functional scores were not significantly different in comparison to other patients. ConclusionThe modified Bristow-Latarjet procedure is a very effective procedure with few complications in the medium-term, showing very satisfactory functional outcomes in the treatment of recurrent traumatic anterior glenohumeral dislocation associated with glenoid bone injury.

Resultados clínicos e de imagem da abordagem da lesão de Hill‐Sachs pela técnica de remplissage na instabilidade anterior do ombro

ObjectiveTo evaluate the functional outcome of the remplissage technique, the healing of the capsulotenodesis of infraspinatus tendon on Hill‐Sachs lesion, and the degree of fatty infiltration of infraspinatus muscle and its postoperative strength. MethodsTwenty‐five patients with recurrent anterior dislocation of the shoulder and Hill‐Sachs lesion with a Hardy index greater than 20% who underwent the remplissage arthroscopic technique were evaluated with a minimum follow‐up of one year. Patients underwent clinical evaluation (functional scores of Carter‐Rowe and Walch‐Duplay, measurement of range of motion and strength) and magnetic resonance imaging on the operated shoulder. Results88% and 92% of the patients had good or excellent scores on functional assessments for the Carter‐Rowe and Walch‐Duplay scores, respectively. A mean difference of 1kg less in operated limb strength was observed when compared with the contralateral limb (p<0.001), as well as a mean difference of 10° in external rotation 1 and 2 (p<0.001), again using the contralateral side. All the patients who underwent magnetic resonance imaging presented high‐grade filling of the Hill‐Sachs lesion by capsulotenodesis, as well as absence or minimal fatty infiltration in infraspinatus muscle. ConclusionThe remplissage technique had good/excellent functional score results, despite the discrete, albeit statistically significant, loss of strength and external rotation amplitude. Successful capsulotenodesis healing and filling of the Hill‐Sachs defect were demonstrated.

The effect of subscapularis tenotomy in athletes operated on for recurrent anterior shoulder dislocation.

Some authors consider preservation of the subscapularis tendon as one of the most important elements for a successful long-term outcome in patients operated on with open capsulorrhaphy for recurrent anterior shoulder dislocation. The purpose of this study was to evaluate whether vertical tenotomy of the subscapularis tendon might affect internal rotation strength recovery in patients operated on with open capsulorrhaphy for recurrent anterior shoulder dislocation. Ninety-six patients were retrospectively followed up at a mean of 72.5months. They underwent clinical evaluation, Rowe and Walch-Duplay scoring scales, the Visual Analog Scale (VAS), and dynamometric measurements (side-to-side) of internal and external rotation, forward elevation, and abduction. All patients were athletes: 25% were practising risk-free sports, 44% contact sports, 14.5% sports with cocking of the arm, and 14.5% high-risk sports activities. Five (5.2%) recurrences were registered, and all patients returned to pre-operative sports activity. The Rowe score was 98.12, the Walch-Duplay score 92.25, and the VAS score 0.1. Dynamometric assessment showed no significant differences (side-to-side) in internal rotation (p=0.34), external rotation (p=0.9), flexion (p=0.7), and abduction (p=0.7). Dominant arms showed better results than non-dominant arms (p<0.01). Complete tenotomy of the subscapularis tendon does not seem to negatively affect internal rotation strength recovery or external rotation movement in athletes.

Cartilage Morphological and Histological Findings After Reconstruction of the Glenoid With an Iliac Crest Bone Graft

Background: The J-bone graft is presumably representative of iliac crest bone grafts in general and allows anatomic glenoid reconstruction in cases of bone defects due to recurrent traumatic anterior shoulder dislocations. As a side effect, these grafts have been observed to be covered by some soft, cartilage-like tissue when arthroscopy has been indicated after such procedures. Purpose: To evaluate the soft tissue covering of J-bone grafts by use of magnetic resonance imaging (MRI) and histological analysis. Study Design: Case series; Level of evidence, 4. Methods: Patients underwent MRI at 1 year after the J-bone graft procedures. Radiological data were digitally processed and evaluated by segmentation of axial images. Independent from the MRI analysis, 2 biopsy specimens of J-bone grafts were harvested for descriptive histological analysis. Results: Segmentation of the images revealed that all grafts were covered by soft tissue. This layer had an average thickness of 0.87 mm compared with 1.96 mm at the adjacent native glenoid. Of the 2 biopsy specimens, one exhibited evident hyaline-like cartilage and the other presented patches of chondrocytes embedded in a glycosaminoglycan-rich extracellular matrix. Conclusion: J-bone grafts are covered by soft tissue that can differentiate into fibrous and potentially hyaline cartilage. This feature may prove beneficial for delaying the onset of dislocation arthropathy of the shoulder.

Analysis of Bristow-Later jet procedure in the treatment of recurrent traumatic anterior dislocation of shoulder

The shoulder by virtue of its anatomy and biomechanics is one of the most unstable and frequently dislocated joints in the body, accounting for nearly 50% of all dislocations. Since the beginning of century more than 150 surgical procedures were described in treating recurrent dislocation of the shoulder with varying results and success. Most of the operative techniques described for the treatment of recurrent anterior dislocation or subluxation of the shoulder have 2 distinct disadvantages; need to immobilize the shoulder for several weeks and Loss of external rotation. These can be overcome by Bristow-Laterjet procedure. We analysed Bristow-Laterjet procedure in the treatment of recurrent traumatic anterior dislocation of shoulder at the Department of Orthopaedics, Chengalpattu Medical College Hospital, Chengalpattu, Tamilnadu, India. We came across 20 patients (1 patient had bilateral dislocation) during February 2015 to February 2017. All the patients were followed up periodically both clinically and radiologically till their shoulder regained full range of movements and radiological bony union of the coracoid graft. All the patients were thoroughly examined and evaluated subjectively and objectively and outcome was assessed by Rowe’s scoring system. We found all the patients were satisfied with surgery and were able to return to their pre dislocation level activity and none had further episodes of shoulder instability. Radiologically there was good bony union of the coracoid graft and there was no screw loosening.

Functional outcome of modified Boytchev procedure in recurrent shoulder dislocation

Objective: To evaluate functional outcome of recurrent anterior shoulder dislocation by modified Boytchev procedure. Materials and Method: This prospective study was done in 30 patients with recurrent dislocation of the shoulder, treated in the department of Orthopaedics Rajah Muthiah Medical Hospital and Sri Ramachandra Medical centre. The inclusion criteria were patients with recurrent anterior shoulder dislocation with minimum 5 to 8 episodes and age more than 18 years and less than 50 years. The exclusion criteria were fresh dislocation, dislocations with fracture of Coracoid process and patients with ligamentous laxity. The functional statuses of the patients were assessed using the Modified Rowe’s Scale. Results: out of thirty patients treated by modified Boytchev procedure 93% of patients had excellent/good outcome. Two patients, who had fair outcome in our study, were due to traumatic dislocation one year following the procedure, which leads to periarthritis of the affected shoulder and restricting abduction and external rotation movements. Conclusion: Modified Boytchev procedure is cost effective and has an easy learning curve. Therefore it is the ideal management in rural area.

Individualized coracoid osteotomy and 3D congruent arc reconstruction of glenoid for the treatment of recurrent anterior shoulder dislocation

BackgroundThe present study investigated individualized coracoid osteotomy for 3D congruent arc glenoid reconstruction and evaluated the clinical outcomes in recurrent anterior shoulder dislocation.MethodsFrom January 2005 to July 2015, 78 patients with glenoid defect underwent coracoid and conjoint tendon transposition. The patients were divided into the individualized group (n = 34) and the non-individualized group (n = 44). All patients had CT data to reconstruct the shoulder model using Mimics software. In the individualized group, the individual coracoid osteotomy and bone fixation position parameters were measured from preoperative planification through simulating a 3D congruent arc glenoid reconstruction model. The non-individualized group underwent classic Bristow-Latarjet (B-L) procedure. The postoperative evaluation parameters included 3D congruent arc index, coracoid bone position, shoulder osteoarthritis index (Samilson-Prieto) and shoulder function score (Rowe, Constant-Murley score).ResultsThe mean follow-up time was 51.0 months (ranging from 24 to 146). The individualized group got 3D congruent arc reconstruction of the glenoid by postoperative CT scanning. Bone position was more precise in the individual group than that in the B-L group. There was a lower incidence of shoulder osteoarthritis (Samilson-Prieto) in the individual group compared with that in the B-L group: 0 vs 13.6% (mild 6/44, P = 0.027), respectively. No significant difference was observed between the individual and B-L groups in rate of re-dislocation: 0 vs 4.5% (2/44, P = 0.315), respectively. The postoperative Rowe and Constant score was significantly improved but was not significantly different between the two groups.ConclusionThe individual procedure achieved 3D congruent arc glenoid reconstruction. The clinical effects in patients with medium glenoid defect were good, especially the low incidence of shoulder osteoarthritis in middle-term follow-up.