Recurrent Shoulder Dislocation Research Articles

The Latarjet procedure for the treatment of recurrent anterior shoulder instability: A case series

Background: Recurrence of glenohumeral instability is common in the presence of osseous defect of glenoid after an arthroscopic Bankart’s repair or open capsulolabral repair. The Latarjet’s procedure that involves transfer of the coracoid to tuck the glenoid bone defect is a popular surgical procedure and this study was undertaken to evaluate the efficacy of Latarjet’s procedure in the management of recurrent shoulder dislocations after a failed index surgical procedure other than Latarjet’s procedure. Materials and Methods: A total of 5 patients were included in the study (3 male; 2 female). All the patients were operated using the Latarjet’s procedure and a follow up was done at regular intervals. The evaluation at follow up included serial radiographs along with outcome assessment parameters such as subjective shoulder score, Constant-Murley score and VAS score. Results: There were no cases of redislocations or subluxations at the end of follow up. No revision surgery was needed. The mean shoulder value improved from 61% to 83% postoperatively at 1 year follow up ((p< 0.001)) and the relative Constant -Murley score improved from 75% preoperatively to 85% postoperatively at the end of 1 year of follow up(>0.05). Conclusion: Coracoid transfer as described by Latarjet can effectively restore anterior glenohumeral shoulder stability if previous operation(s) have failed to do so.

Arthroscopic Bankart repair combined with Reimplissage for the treatment of recurrent anterior dislocation of shoulder in adults with Hill-Sachs defect

To investigate the method and clinical effects of the treatment of recurrent anterior dislocation of shoulder with Hill-Sachs injury by arthroscopic Bankart repair and Remplissage. From March 2016 to March 2019, 106 patients with recurrent anterior dislocation of shoulder with glenoid bone defect less than 20% underwent arthroscopic Bankart repair, including 76 males and 30 females, aged from 18 to 45 (27.3±8.6) years, 59 cases of left shoulder and 47 cases of right shoulder. Range of motion (ROM), American Shoulder and Elbow Surgeons(ASES) score, Constant-Murley score and Rowe score were used to evaluate shoulder functionand stability before and after operation. All patients were followed up, and the duration ranged from 21 to 60 months, with a mean of (41.5± 8.5) months. One patient developed infection after operation, and the infection was controlled after arthroscopic debridement again. The remaining patients did not have clinical complications such as infection, intra articular hematocele and redislocation. Shoulder flexion and lifting increased from (158.33±15.72) ° preoperatively to (169.43±10.04) ° at the latest follow up, and internal rotation changed from T7 (T4 to T10) preoperatively to T8 (T5 to T10) at the latest follow up;the average lateral external rotation and abduction 90 ° external rotation decreased from (58.46±15.51) ° preoperatively and (99.37±14.09) ° to (53.18±14.90) ° and (92.52±13.10) ° at the latest follow up, respectively. The ASES score, Constant -Murley score and Rowe score were significantly improved. The clinical effect of rehabilitation of Bankart repair combined with Remplissageunder arthroscopy in the treatment of recurrent dislocation of shoulder joint in adults with Hill-Sachs defect is satisfactory. Although the external rotation function is weaker than that before operation, it can effectively reconstruct the shoulder function and avoid the occurrence ofdislocation after operation.

Reliability of three dimensional CT measurement of glenoid track in patients with recurrent anterior dislocation of shoulder

To evaluate the reliability and repeatability of three-dimensional (3D)-CT measurement of glenoid track. Glenoid and Hill-Sachs bone defects in 60 patients with recurrent anterior dislocation of the unilateral shoulder were evaluated by 3D-CT and analyzed by three independent observers(shoulder orthopedists) according to the Di Giacomo method. These injuries were classified to formulate a surgical protocol. All the patients were repeatedly measured 1 week later. Intraclass correlation coefficient (ICC) and coefficient of variation (COV) were used for reliability analysis. Interobserver reliability was "very good" for both measurements of glenoid diameter and glenoid bone defects, and "good" for measurements of Hill-Sachs interval. Interobserver agreement was high on the assessment of the extent of the glenoid defect, and poor on track/off track assessment of the Hill-Sachs lesion. Intraobserver reliability for measurements of glenoid diameter, glenoid defect, and Hill-Sachs interval was "very good". The COV was 4.1% for glenoid diameter, 4.4% for glenoid defect, and 21.1% for Hill-Sachs interval. The reliability and reproducibility of 3D-CT measurements of glenoid bone defects are good, but the assessment of humeral head bone defects shows large variability with poor reliability.

Keát quaû phaãu thuaät noäi soi ñieàu trò traät khôùp vai taùi dieãn taïi Beänh vieän Höõu Nghò Vieät Ñöùc

Abstract Introduction: This study aims to assess the results of patients with recurrent shoulder dislocation treated with arthroscopic Bankart repair. Patients and Method: 31 patients (26 males and 5 females, with an average age of 28.7) were treated with arthroscopic Bankart repair from 2017 to 2018. Those with multidirectional instability, posterior shoulder instability and more-than-25% Hill-Sachs defects, along with those who had prior shoulder surgeries were excluded. Average follow-up time after surgery is 15.13 months. Frequency of pre-operative dislocation, post-operative dislocation, functional status and daily activity performance were evaluated. The results were assessed using CONSTANT score. Results: One patient had post-operative dislocation (3.23%). One patient had post-operative joint adhesion (3.23%). Assessment using CONSTANT score showed an excellent result in 67.4%, good in 12.9%, moderate in 12.9% and average in 6.46%. There was no case with poor result. One patient had post-operative dislocation due to a sport injury. Conclusions: Arthroscopic repair is a modern technology, and is being used widely in diagnosing and treating shoulder lesions. This study shows that arthroscopic repair for recurrent shoulder dislocation may bring good result for patients. Keywords: Shoulder instability, arthroscopy, Bankart.

Progress on arthroscopic surgery for recurrent anterior shoulder dislocation

The surgical treatment of recurrent anterior shoulder dislocation is a difficult problem in the field of sports injury medicine. The main reason focus on dynamic and osseous constraints of shoulder joint could not recover well. At present, arthroscopic surgery is used at home and abroad, and could receive statisfied postoperative effect, but the choice of specific surgical methods is still controversial. According to presence and size of glenoid and humeral skull defects, different treatments should be selected in clinic. The author recommends that no articular glenoid defect or glenoid defect <20%, choose Bankart surgery;articular glenoid defect <20% with Hill-Sachs bone defect <40%, choose Bankart surgery combined with remplissage surgery or ASA surgery;Glenoid defect 20% to 25%, choose "Sling";Glenoid defect 25% to 40%, choose Bristow-Latarjet; Glenoid or Hill-Sachs bone defect>40% or Bristow-Latarjet if the surgical repair fails, bone grafting is used. In addition, if (humeral avulsion of glenohumeral ligaments, HAGL) injury existed, HAGL injury repair should be used. In addition to considering the important factor of bone defects, it is necessary to combine patient's age, exercise level and surgeon's technique to comprehensively select the bestsurgical method.

Using Biceps Autograft in Reconstruction of Labral Defect in Recurrent Shoulder Dislocation

Recurrent anterior shoulder dislocation is a very common problem that face the orthopedic surgeon, which affect young people in their life, specially the professional workers or athletes and military persons. They may need either arthroscopic or open procedure to obtain a stable shoulder

Evaluation of Recurrence Rate and Risk Factors Affecting Recurrence of Recurrent Shoulder Dislocation in Kashani Hospital in 2017-2018

Background: In this article, the prevalence of recurrent anterior dislocation of the shoulder and the effect of factors such as age, occupation, primary cause and gender on it have been investigated. Objectives: This study aimed to investigate the factors related to the frequency of recurrent anterior shoulder dislocation in clients of the Orthopedic Ward of Kashani Hospital, Isfahan City, Iran, in 2017-2018. Methods: The present research is a cross-sectional study. The study population comprised all patients with traumatic and anterior shoulder dislocation referred to Kashani Hospital during 2017-2018. The sampling method in the present study was census. The patients were asked by phone or in person after their presence about the recurrences of dislocations between the beginning of 2017 and the end of 2018. The obtained data were analyzed in SPSS version 25. Results: Out of 256 patients, 22% had a recurrence of dislocation. The recurrence rate of dislocation in less than 20 years patients was 40%, and in 20 to 40 years was 63%. The highest recurrence rate of dislocation was reported in the age group of 20 to 40 years in the present study. Based on the present study results, the recurrence rate of dislocation in the age-group of 20-40 years was significantly higher than in other groups. There was no significant relationship between gender and recurrence of dislocation in the subjects (P&gt;0.05). Significance was observed in the primary cause and type of occupation in recurrence of dislocation (P&lt;0.05). Conclusion: The recurrence rate of dislocation in the patients who suffered from dislocations for the first time was 22%. Based on the results, the rate of recurrence of dislocation in the present study was lower than the rate of recurrence of dislocation in similar studies.

Outcome of Arthroscopic Bankart’s Repair Using Trans- Glenoid Suture Technique in Recurrent Post-Traumatic Anterior Shoulder Dislocation Without Bony Defect

Glenohumeral dislocation is a common entity and represents more than 50% of all joint dislocations with anterior dislocation being most common with overall incidence of 2%strategies

Radiographic study of effect of lateral placement of bone graft on shoulder joint degeneration after modified arthroscopic Latarjet surgery with elastic fixation

To investigate the mid-term effect of lateral placement of bone graft on shoulder joint degeneration after modified arthroscopic Latarjet surgery with elastic fixation for recurrent anterior shoulder dislocation with an anterior glenoid bone defect. According to the inclusion and exclusion criteria, 18 patients with recurrent anterior shoulder dislocation and anterior glenoid bone defect who received the modified arthroscopic Latarjet surgery with elastic fixation between January 2015 and November 2016 were enrolled in this study. There were 12 males and 6 females with an average age of 26.2 years (range, 19-37 years). The number of shoulder dislocation ranged from 4 to 30 times (mean, 8.8 times). The disease duration was 8-49 months (mean, 23.8 months). The mean anterior glenoid bone defect was 25.2% of the glenoid surface (range, 20%-29%). The mean preoperative Instability Severity Index Score (ISIS) was 7.6 (range, 7-10). According to Samilson-Prieto classification, the shoulder joint degeneration was rated as grade 0 in 13 cases, grade Ⅰ in 3 cases, and grade Ⅱ in 2 cases. Before and after operation, the visual analogue scale (VAS) score, American Society of Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, Rowe score, and shoulder mobility were used to evaluate the effectiveness. Imaging examination was performed to observe the shoulder joint degeneration, the position of the bone graft, and the postoperative shaping of the scapular glenoid. All patients were followed up 55-62 months, with an average of 59.6 months. There was no neurovascular injuries, infections, fixation-related and bone graft-related complications. No re-dislocation and revision occurred. All patients returned to normal life, 17 of whom returned to sport. The VAS score was significantly decreased and ASES, Walch-Duplay, and Rowe scores were significantly improved at last follow-up ( P<0.05). No significant difference was found in range of motion of forward flexion, abduction, lateral rotation at 90° abduction, internal rotation at 90° abduction, or lateral rotation at 0° between pre- and post-operation ( P>0.05). Three-dimensional CT showed that the centers of all bone grafts were between 3∶30 and 4∶30 (right shoulder) or between 7∶40 and 8∶20 (left shoulder) and no bone grafts were positioned superiorly or inferiorly in the glenoid En-face view. All bone grafts were positioned lateral to the scapular glenoid with an average distance of 3.5 mm (range, 2.3-4.6 mm) in cross-sectional imaging by CT. Compared with the preoperative Samilson-Prieto classification results, all cases showed no progression of shoulder joint degeneration at 36, 48 months and last follow-up. All bone grafts remodeled to a steady state within 24 months after operation. The bone graft and glenoid finally remodeled analogous to the shape of the intact glenoid in the En-face view and became flush with the glenoid rim, remodeling to a curved shape congruent to the humeral head in cross-sectional imaging by CT. The shape of the remodeled glenoid at last follow-up was not significantly different from that at 24 months after operation. The lateral placement of the bone graft during modified arthroscopic Latarjet surgery with elastic fixation do not accelerate the imaging changes of shoulder joint degeneration.

Arthroscopic nomenclature of capsulolabral appearances in anterior shoulder dislocation

ObjectivesTo study the intraoperative morphology of the glenoid labrum and capsule in recurrent shoulder dislocation and to study the relationship between the number of dislocations and the changes in the glenoid and labrum. MethodsOver a period of 18 months, 108 patients with traumatic anterior dislocations were included in the study, of which 102 men and 6 women with mean age of 33.4yrs range from 18 to 45. The patients with bony bankart, other labral lesions, ligamentous laxity, SLAP tear were excluded from the study. All the patients underwent arthroscopic bankart repair. We have classified the morphology of labrum and capsule on their appearance intraoperatively. Labrum is named as Normal, Desiccated or Shredded and Capsule as Normal or Damaged. ResultsSix varieties of appearances were observed. Namely, Normal capsule and Normal labrum (NN), Normal capsule and Desiccated labrum (ND), Normal capsule and Shredded labrum (NS), Damaged capsule and Normal labrum (DN), Damaged capsule and Desiccated labrum(DD), Damaged capsule and Shredded labrum(DS). Among them, DD (33.3%) and DS (29.6%) variety had highest number of dislocations suggesting the labrum and capsule lose normal anatomy with more recurrence of dislocations. ConclusionThese findings support that reproducing normal anatomy after surgical repair is possible when the intervention is done sooner than later. Level of evidenceIII.

Eden-Hybinette Procedure for Revision Surgery in Recurrent Anterior Shoulder Instability in Epilepsy.

The purpose of this study was to analyze the clinical outcomes after Eden-Hybinette procedure for revision surgery in recurrent anterior shoulder instability in patients with epilepsy. We retrospectively evaluated eight such patients between 2015 and 2018. Four patients had failed Latarjet/Bristow procedure and two had failed arthroscopic Bankart procedure, while two had history of both the procedures. After medical control of epilepsy, Eden-Hybinette procedure was performed in all patients. WOSI score and Rowe shoulder score was recorded preoperatively and in subsequent post-operative follow-up. A paired t test was used to analyze and compare preoperative and postoperative outcomes and was considered significant if p value was < 0.05. The average follow-up was 30months (range 24-48months). There was no recurrence of shoulder instability. The mean WOSI score before surgery was 77.3 (range 70-83), which improved to 24.2 (range 19-30) at 24-month follow-up. The mean Rowe score before surgery was 11.3 (range 5-15), which improved to 81.8(range 65-90) at 24-month follow-up. The improvement in WOSI and Rowe score was found to be statistically significant [p value < 0.05]. We conclude that Eden-Hybinette is a useful revision procedure to manage recurrent anterior shoulder dislocation in patients with epilepsy. Optimum medical control of seizure is also an important factor in preventing recurrent shoulder instability.

Comparative study of arthroscopic Bankart repair versus open Latarjet procedure for recurrent shoulder dislocation.

ObjectivesThe primary aim of this study was to compare the clinical outcomes of patients undergoing arthroscopic Bankart repair and the open Latarjet procedure for recurrent dislocation of the shoulder. The secondary aims were to assess and compare the surgical cost, patient satisfaction, and complications, including recurrence and infection.MethodsWe retrospectively compared the clinical outcomes of all consecutive patients undergoing either arthroscopic Bankart repair or the open Latarjet procedure from May 2015 to May 2018 with a minimum 2-year follow-up. Forty-one patients (32 men, 9 women) in the Bankart group and 40 patients (34 men, 6 women) in the Latarjet group were available for the final follow-up.ResultsThere were no statistically significant differences in the demographic parameters or clinical outcomes between the two groups. Functional satisfaction was higher with the Latarjet procedure. Bankart repair had a significantly higher operating cost than the Latarjet procedure. Three patients in the Bankart group and no patients in the Latarjet group developed recurrence.ConclusionBoth procedures provided satisfactory clinical outcomes. However, the Latarjet group had a higher rate of functional satisfaction and lower operating cost, and there was a trend toward higher recurrence in the arthroscopic Bankart group.

Mild inflammation persists in the glenohumeral joint of patients with recurrent shoulder dislocation

Approximately two-thirds of patients with a history of shoulder dislocation have the potential to develop OA in the future; however, the cause is unclear. The purpose of this study was to evaluate the expression of inflammatory mediators in the glenohumeral joint of patients with recurrent shoulder dislocation (RSD). We hypothesized that the high prevalence of OA in RSD is due to persistent mild inflammation.

LATARJET PROCEDURE FOR RECURRENT SHOULDER ANTERIOR INSTABILITY WITH LESS THAN 25% GLENOID BONE LOSS- ITS FUNCTIONAL OUTCOME: A PROSPECTIVE STUDY

Background: Latarjet procedure for a recurrent anterior shoulder dislocation with more than 25% of bone loss is a standard treatment with good functional outcome. In glenoid bone loss &lt; than25%, there is no concurrence in the surgery of choice between Bankart repair, Remplissage procedure and Latarjet procedure. This study is aimed to study the functional outcome following Latarjet procedure in recurrent shoulder instability in patients with &lt; than 25% glenoid bone loss and also to assess the instability symptoms and complications following this procedure. Methods: It is a Clinical, Prospective and Observational study on thirty patients with recurrent anterior dislocation of shoulder, with less than 25% glenoid bone loss treated with Open Latarjet Procedure, at Chettinad Hospital and Research Institute, Kelambakkam, done between Jan 2017 to Dec 2020, with a minimum follow-up of atleast 1year duration. Patients were post-operatively assessed functionally using Constant shoulder score, Rowe scoring system and the Walch- Duplay index score. Clinical instability was also assessed using the Anterior Apprehension and Anterior Drawer Test. Results: In our study with thirty patients, who underwent Latarjet procedure, Functional outcome of the patients were assessed using the Constant shoulder score, Rowe scoring system and the Walch- Duplay index score. The combined average percentage of Score of Scores of the three scoring systems were 74.46% had Excellent results, 14.42% had Good and 11.12% of patients had Average or Fair results. None of the patients had any instability symptoms post-operatively at the 1year post-op follow-up. Four patients had supercial Surgical Site Infections and 2 patients had developed mild to moderate shoulder stiffness. Conclusion: The Latarjet gives conrmationally Excellent to Good functional outcome and aid in the early return to activities of daily living and a fewer failure rate. In patients with Recurrent Anterior Shoulder Dislocation, with even less than 25% Glenoid bone loss, it may be pertinent to primarily consider the osseous option of a coracoid transfer (Latarjet) rather than opt for simpler Open Bankart, Arthroscopic Bankart or an Arthroscopic Remplissage procedure alone. Thus, as a yardstick the bone loss concept, either on the Glenoidal or on the Humeral aspect, alone, need to be the deciding factor. The fact remains that in the athletic or otherwise Recurrent Anterior Shoulder Dislocators, there is also a concomitant humeral component, apart from the apparent and demonstrable Glenoid defect with the “Circle concept”.

FUNCTIONAL OUTCOME OF MODIFIED PUTTI PLATT PROCEDURE IN RECURRENT DISLOCATION OF SHOULDER – A RETROSPECTIVE ANALYSIS

Hand, which is considered to be an extension of brain and a tool for the execution of human intellect and will, owes much to the versatility of the movement of the shoulder for its placement on the desired spot of action. The shoulder, by virtue of its anatomy and biomechanics, is one of the most unstable and frequently dislocated joints, accounting for nearly 50% of all dislocations. Most of the recurrent dislocations of shoulder (96%) follow an initial signicant traumatic dislocation. There are two basic types of surgical approaches for shoulders with anterior instability: "anatomic" and "non-anatomic" repairs. With anatomic repairs, the goals are to restore the labrum toits normal position and to reestablish the appropriate tension in the shoulder capsule and ligaments. The goal of non-anatomic surgical procedures is to stabilize the shoulder by compensating for the capsulolabral and osseous injury with an osseous or soft-tissue checkrein that blocks excessive translation and restores stability. In Modied Putti Platt procedure, as done in our institute, after proper positioning and adequate exposure, the subscapularis muscle and capsule is incised at the musculotendinous junction. Aquadrangular unicortical graft, harvested from the iliac crest, is inserted fully into the trough made in the anterior glenoid, resulting in deepening of the glenoid articular surface. Subscapularis and the capsule are closed by double breasting, keeping the arm in external rotation. We did a retrospective analysis to assess the outcome of this procedure done in our institute. 102 patients were assessed and the required data were collected using hospital medical records, telephonic interview and direct clinicoradiological assessment. All the patients had positive apprehension test, pre- operatively. The mean Rowe score was 30.98 (standard deviation 5.846). The mean follow up duration was 44.52 months. 91 patients (89.2%) had no pain at last follow up duration and the rest had slight and occasional pain. All the patients were able to work above shoulder. The mean external rotation at 6 months follow up was 37.89° (SD 9.239), which increased to 65.88° (SD 8.967) at last follow up. The mean internal rotation at 6 months follow up was 61.18° (SD 4.623), which increased to 77.16° (SD 6.234) at last follow up. There was signicant improvement of Rowe's score post-operatively when compared to pre-operative Rowe's score. There was a signicant mean increase of 49.216 points post operatively with a correlation coefcient of +0.513. (p&lt;0.05). All patients, at last follow up had a UCLA score of more than 27, with 96 patients (94.1%) had good clinical outcome (according to UCLA grading system). 6 patients had fair clinical outcome. 77 patients (75.5 %), according to Rowe score had good clinical outcome.12 patients (11.8%) had excellent outcome. 13 patients had fair clinical outcome. None of the patients who were operated in our institute had recurrence of dislocation. None of them were reoperated. 91 patients (89.2%) had negative apprehension with no evidence of subluxation. 10 patients (9.8%) had negative apprehension, but slight discomfort in abduction and external rotation. One person had positive apprehension test, but he was able to continue his activities of daily living and continued to engage in professional non contact sports, though at one level below; and he did not choose to undergo a reoperation. 6 patients, all aged more than 45 years, had clinicoradiological evidence of mild arthrosis of the shoulder joint. They are being treated conservatively with physical therapy and analgesics Mild donor site pain was there in 6 patients in the rst yr of surgery. This subsided with time with analgesics. None had evidence of donor site infection, and none had evidence of visceral injuries.

Arthroscopic remplissage: a valuable adjunct to arthroscopic Bankart’s repair in shoulder instability

&lt;p class="abstract"&gt;Current study present results of arthroscopic shoulder stabilisation surgery. 46 consecutive patients with recurrent anterior shoulder dislocations and less than 25% Glenoid bone loss were treated with arthroscopic surgery in 2017-2020. Arthroscopic repair of Bankart’s lesion with capsular shift was performed in each. In 8 patients, where the Hill sach’s lesion was “off track” or “engaging”, arthroscopic remplissage was performed along with arthroscopic Bankart’s repair. There was no recurrence of shoulder instability after a mean follow up of 1 year. This included the non-engaging Hill sach’s group (treated with Bankart’s repair) as well as the engaging or off track Hill sach’s group (treated with Bankart’s repair and remplissage). All patients went on to obtain full forward flexion, full abduction and internal rotation. The Bankart’s and remplissage group had a mean of 8 degrees restriction of external rotation. SST scores and oxford scores had improved considerably on follow up in both groups Arthroscopic shoulder surgery provides a safe and reliable option in the management of recurrent shoulder dislocations. Arthroscopic remplissage is a useful adjunct to Bankart’s repair when treating the difficult problem of a large engaging Hill Sachs lesion.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

The causes of Latarjet surgery failure and the revision surgeries

To review the causes of Latarjet surgery failure and various revision surgeries, in order to provide the reference for the revision of treatment options for Latarjet surgery failure. Literature on the causes of Latarjet surgery failure and revision surgeries was extensively reviewed and analyzed. Latarjet surgery is widely used in clinical practice for recurrent anterior dislocation of shoulder with glenoid defects, especially for the defects of more than 25%. The main reasons for its failure are ununion, bone resorption, graft dislocation, trauma, and graft fracture, etc. The revision surgeries are diverse, the standard treatment has not yet been formed. The revision surgeries include open iliac bone grafting, microscopic Eden-Hybinette surgery, soft tissue reconstruction, open or arthroscopic bone grafting, etc. The differences among the revisions are mainly reflected in grafts, complications, and their costs. Latarjet surgery is difficult to operate and requires high technical requirements for the surgeons. It is necessary to continuously improve the surgical technology to reduce the complications related to Latarjet surgery and its revision surgery.

Latarjet Cerclage: The All-Arthroscopic Metal-Free Fixation

The Bristow–Latarjet procedure has been one of the most recognized procedures for the treatment of recurrent shoulder dislocation with anterior glenoid bone loss, revision surgery after failed Bankart repair, contact and collision sport injuries, and patients with a high risk of recurrence. Open and arthroscopic approaches have recently shown similar outcomes by several authors. However, complications related to metal implants, despite being low, are still a matter of concern. We describe an all-arthroscopic Latarjet technique with a metal-free fixation method using 2 ultra-high-strength sutures, creating a cerclage construct through 2.4mm glenoid and coracoid tunnels with a final capsulolabral complex reconstruction.

Implant-free iliac crest bone graft procedure shows anatomic remodelling without redislocation in recurrent anterior shoulder instability after short-term follow-up.

With the help of a J-shaped bicortical iliac crest bone graft, the morphology of the glenoid can be augmented without having to use screws to achieve glenohumeral stability. The aim of this retrospective clinical study was to evaluate the clinical stability and function of the shoulder joint as well as the radiological remodelling process and arthropathic outcomes following the J-bone graft technique. 34 patients with recurrent shoulder dislocations and bony glenoid defects were treated with the J-bone graft technique between 2010 and 2018 at our level-I trauma centre. 15 patients (18 shoulders) could be recruited for the study. Pain levels, ASES, UCLA, SST, DASH, Rowe and WOSI Scores were collected using questionnaires. In 13 patients (16 shoulders) the Constant Score, ROM, CT with 3D reconstruction of the glenoid to assess the graft remodelling and X-rays were performed additionally. None of the patients suffered subluxations or recurrent dislocations during the follow-up period. The overall complication rate was 11%. The evaluation using objective and subjective shoulder function scores yielded good-to-excellent results. Radiological assessment at follow-up showed a low rate of moderate-to-severe arthritis (12%) and a high rate of shoulders without any signs of arthritic degeneration (53%). The CT scans all revealed an almost complete restoration of the glenoid with none of the grafts being resorbed. A rise in the average glenoid circumference and glenoid area could be demonstrated between preoperative measurements (81.6 and 82.4%, respectively) and follow-up measurements (104 and 102.5%, respectively). The results of this study show a successful stabilisation of the shoulder joint and a low complication rate following the J-bone graft technique. Remodelling of the bone graft could be demonstrated, which in turn led to an almost perfect glenoid surface area of 100%.

The clinical and functional outcome of arthroscopic bankart repair in recurrent shoulder dislocation

Background: Study aimed to assess the functional and clinical outcome of arthroscopic bankart’s repair in recurrent shoulder dislocation using UCLA & SST scoring system.Methods: It is a prospective cohort study conducted on the 28 patients undergoing arthroscopic bankart’s repair for recurrent shoulder dislocation in the department of orthopaedics at vydehi institute of medical sciences and research centre, bengaluru from September 2017 to October 2019. Patients aged between 18-50 years of both genders undergoing arthroscopic bankart repair with anterior instability of glenohumeral joint with at least ≥2 episode of dislocation/subluxation, a positive clinical apprehension test and radiological evidence of glenohumeral instability and glenoid bone loss < 25% were included in the study and patients with glenoid bone loss >25%, contact sports athletes, previously failed arthroscopy or open surgery, seizure disorder, multidirectional instability/habitual dislocation were exclueded. Each case was followed post operatively for atleast 1 year.Results: This series consisted of 28 patients, with the mean follow up period of 12 months, the mean pre-operative UCLA score of 18 improved to 31.75 post operatively, the mean pre-operative SST score of 4.89 improved to 10.96 post operatively. Out of 28 patients none had episodes of recurrent dislocation and anterior translation or apprehension. External rotation in 90º of abduction improved in 25 patients (89%).Conclusion: we conclude that arthroscopic bankart’s repair in recurrent shoulder dislocation with suture anchors is a reliable procedure with respect to shoulder function, recurrence rate and range of movement.