Recurrent Shoulder Dislocation Research Articles

Increased nerve growth factor expression in the synovial tissues of patients with rotator cuff tears.

BackgroundRotator cuff tears (RCTs) are often associated with severe shoulder pain. Non-steroidal anti-inflammatory drugs, not recommended for long-term use, do not effectively manage RCT-induced pain, resulting in reduced quality of life. To improve management, a better understanding of the fundamental properties of RCT pain is needed. Here, we aimed to compare the expression levels of nerve growth factor (NGF) and cyclooxygenase-2 (COX-2) mRNA in the synovial tissues of patients with RCT-induced pain and patients with non-painful recurrent shoulder dislocation (RSD).MethodsThe study included 32 patients with RCT who underwent arthroscopic rotator cuff repair and 28 patients with non-painful RSD who underwent arthroscopic Bankart repair. Synovial tissue samples were harvested from subacromial bursa and rotator interval of RCT patients and from the rotator interval of RSD patients. Samples were analyzed quantitatively expression levels for NGF and COX2 mRNA and NGF protein.ResultsNGF mRNA and protein levels were significantly higher in the rotator interval of RCT patients than in the rotator interval of RSD patients (p = 0.0017, p = 0.012, respectively), while COX2 mRNA levels did not differ significantly between the two patient groups. In RCT patients, COX2 mRNA was more highly expressed in the rotator interval than in the subacromial bursa (p = 0.038), whereas the mRNA and protein levels of NGF did not differ between the two tissues. The expression of NGF mRNA in the synovium of the rotator interval was significantly correlated with the numeric rating scale of pain (ρ = 0.38, p = 0.004).ConclusionNGF mRNA and protein levels were elevated in patients with painful RCT compared with those in patients with non-painful RSD, whereas COX-2 levels were comparable in the two patient groups. These findings provide insights into novel potential strategies for clinical management of RCT.

Recurrent dislocation of the shoulder managed with bristow latarjet procedure

Aim: To evaluate the functional outcomes of the Bristow-Latarjet procedure in patients with recurrent shoulder dislocations. Objective: “Recurrent dislocation of the shoulder”, is a common problem in youngsters. Basically, the ball of the shoulder joint slips out of it’s socket. First time it is caused by significant injury, fall while playing in the playground or an accident. It becomes “recurrent”, if repeated dislocation (slipping of ball out of the socket) happens with trivial injury or in sleep too. Such patients need an MRI and Surgical treatment like Arthroscopic Bankart Repair (Key Hole surgery). But, sometimes the socket gets partly eroded by repeated dislocation, (Bony Bankart lesion) in which case, keyhole surgery cannot be performed, rather a open surgery called as Bristow latarjet procedure, is required, which prevents further recurrent dislocations.

Congruent Arc Latarjet with Subscapularis Split in Patients with Shoulder Instability and Hill Sachs Lesions: Functional Outcome at 2-Year Follow-Up

Introduction: Shoulder dislocations are the most frequent of all dislocations in the body. Recurrence of shoulder dislocations is common in the younger age group with associated Bankart or Hill Sach’s lesions. Over 200 procedures have been described in the literature for the treatment of recurrent anterior dislocation of shoulder.

TREATMENT OF RECURRENT ANTERIOR SHOULDER DISLOCATION WITH BRISTOW-LATARJET PROCEDURE.

ABSTRACTObjectives: To describe the clinical and radiographic results of patients with traumatic recurrent anterior shoulder dislocation treated with the Bristow-Latarjet procedure. Methods: Retrospective case series including 44 patients (45 shoulders) who underwent the Bristow-Latarjet procedure. The graft was fixed “standing” in 84% of the shoulders, and “lying” in 16%. Results: The follow-up was 19.25 ± 10.24 months. We obtained 96% of good results, with 2 recurrences presented as subluxation. Graft healing occurred in 62% of cases. The graft was positioned below the glenoid equator in 84% of the cases, and less than 10 mm from its edge in 98%. The external rotation had a limitation of 20.7º ± 15.9º, while the internal rotation was limited in 4.0º ± 9.6º. The limitation of rotation and the position of the graft (“standing” or “lying”) did not correlate with graft healing (p>0.05). Bicortical fixation was positively correlated with healing (p <0.001). Conclusion: The Bristow-Latarjet technique is indicated for the treatment of recurrent anterior dislocations and subluxations of the shoulder. It is a safe treatment method, which can be used in people with intense physical activity. Limiting shoulder mobility does not prevent patients from returning to their usual occupations. Level of Evidence IV, Case series.

Integrative management of recurrent anterior shoulder dislocation

Introduction: Shoulder joint is the most mobile ball and socket joint. It allows movement along three planes due to its bony configuration and loose joint capsule. Stability of shoulder joint mainly depends on muscle strength supporting the joint. Shoulder dislocation is common injury; anterior dislocation being most common. Main Clinical Findings and Diagnosis: 38 year male patient with a history of fourth recurrent anterior shoulder dislocation (RASD) reduced under anaesthesia was immobilized in sling for 6 weeks. After immobilization, active assisted flexion and abduction was restricted to 90° associated with pain and feeling of instability. Interventions: Integrative treatments of Ayurveda and Physiotherapy were given in three divided sessions, 7 days in each session for a total of 21 treatment days. Ayurveda treatments included Sthanika abhyanga (SA) and Shashtika shali pinda sweda (SSPS). Physiotherapy treatments included interferential therapy (IFT) and exercises. Outcome: Nourishing external treatments enhanced muscle strength and joint mobility. Conclusion: There was appreciable improvement in shoulder muscle strength, active range of motion (AROM) and no incidence of recurrence since past 2 years. The patient is able to carry out unhindered daily activities with full and free AROM.

Midterm clinical results of bankart repair, bankart remplissage, and latarjet procedures for treating recurrent anterior shoulder dislocation

Introduction: This study compared the midterm outcomes of pain, apprehension and range of motion in the shoulder after three arthroscopic procedures including Bankart repair, Bankart repair plus remplissage, and Latarjet surgeries, in patients with recurrent anterior shoulder dislocation. Materials and Methods: We evaluated 128 patients who had undergone anterior shoulder instability surgery at least 4 years ago in our centre based on pain, apprehension and range of motion of both shoulders. Pain was assessed with visual analogue scale, apprehension by physical examination and range of motion with goniometer. We divided them into three groups based on their treatment: (1) Bankart repair, (2) Bankart remplissage and (3) Laterjet procedure. Results: There were 34 patients with Bankart repair, 68 with Bankart remplissage and 26 with Latarjet procedure. The mean of follow-up time was 6.2 years. There was only one re-dislocation. Apprehension was positive in two patients of Bankart repair, eight patients of Bankart remplissage and none of Latarjet procedure groups. The movement limitation average of the external rotation was 9.12° in Bankart repair, 7° in Bankart rempilssage and 18.53° in Latarjet procedure groups. The means of visual analogue scales were 0.29, 0.76, and 0.38 in Bankart repair, Bankart remplissage and Latarjet procedure groups. Conclusion: All operations had had satisfactory results. Remplissage does not induce more restriction on the range of motion. However, in case of more bone loss in the humeral head, apprehension seems to be more positive in those who do remplissage. Latarjet procedure seems to be very effective but causes more range of motion restrictions.

Arthroscopic Bankart repair: modified transglenoid sutures versus suture anchors more than 5 years: a retrospective study

Introduction Arthroscopic Bankart repair is a common procedure for treatment of recurrent traumatic anterior shoulder dislocation all over the world. Different studies compared the outcome of transglenoid sutures after different modifications with the outcome of suture anchors and they found no significant difference between the two procedures. Objective The aim of this study was to compare the long-term results of the modified transglenoid sutures through two holes and the use of suture anchors . Patients and methods Seventy patients were included in this study (42 for the transglenoid group and 28 for the second group). The mean follow-up period for the first (transglenoid) group was 7.19 years (range 5–11) and for the second (anchor) group 6.93 years (range 5–12). Results There is a significant difference in both groups between the preoperative and postoperative Rowe scores (P=0.000), while there is insignificance when comparing the two groups. Six patients (14.3%) in the transglenoid group suffered from recurrence of instability (two dislocations and four subluxations). Two of them needed second operation (open Laterjet procedure). In the anchor group, four (14.2%) patients suffered recurrence of symptoms of instability (two dislocations and two subluxations). Two of them required second operation. One patient of the first group suffered infection related to the sutures and the knot that required removal of the suture material. Conclusion Modified transglenoid suture technique is quietly equal to the repair with suture anchors for treatment of recurrent traumatic anterior shoulder instability.

Management of Recurrent Anterior Shoulder Dislocation by Modified Boytchev Procedure- Our Experience

Background: Recurrent anterior shoulder dislocation is not uncommon. Although the etiology for recurrent anterior shoulder dislocation is not very clear, there are 3 lesions usually responsible for its occurrence: Bankart lesion, Hill-Sachs lesion and laxity of subscapularis muscle. Several operations have been described for the treatment of recurrent anterior dislocation of shoulder but only a few of them have good result in terms of recurrence and loss of shoulder movement in follow-up period. Modified Boytchev procedure is an effective, technically simple procedure for the management of recurrent anterior dislocation of shoulder. Methods: Ten patients with recurrent anterior dislocation of the shoulder were treated from September 2017 to August 2019 by the modified Boytchev procedure. The age of the patients varied from 20 to 38 years (average 25.6 years). Outcome was evaluated using the Burkhead and Rockwood criteria, a score of 90 to 100 was considered excellent, 70 to 89 good, 40 to 69 fair and ?39 was considered poor. Results: The mean follow-up period was 15.4 (SD=3.2; range=6-29) months. Outcome was excellent in 7 patients, good in 2, and fair in 1. None had poor outcome. The shoulders were stable with increased ROM in all directions. Mean external rotation deficit at 0o and 90o of improved from 18o to 7o and 21o to 10o respectively (student's paired t-test). Conclusions: This is an effective, technically simple procedure with minimum restriction of movements around the shoulder joint and does not require expert skills.

Serial Changes in Perianchor Cysts Following Arthroscopic Labral Repair Using All-Suture Anchors.

BackgroudChanges in perianchor cysts around the all-suture anchors, which demonstrate distinguished features from the biocomposite anchors, have not been revealed sufficiently. The purpose of this study was to investigate serial changes of perianchor cysts according to the location of the inserted anchor in the glenoid in arthroscopic labral repair using all-suture anchors.MethodsWe enrolled 43 patients who underwent computed tomography (CT) immediately postoperatively and CT arthrogram (CTA) at 1 year or 2 years after arthroscopic labral repair using a 1.3-mm all-suture anchor for recurrent anterior shoulder dislocation with or without a superior labral tear from anterior to posterior and a posterior labral tear. The mean diameter and tissue density (HU) of perianchor cysts were measured depending on the location in the glenoid. Clinical outcomes, labral healing, and redislocation rate were evaluated at 2 years after surgery.ResultsOn functional assessment, the mean American Shoulder and Elbow Surgeons score and Rowe score improved statistically significantly after surgery (from 47.9 ± 14.3 preoperatively to 90.1 ± 9.6 postoperatively and from 45.3 ± 12.4 preoperatively to 92.2 ± 10.1 postoperatively, respectively; p < 0.01). Postoperative redislocations were found in 2 patients (4.7%). In radiological evaluation, the mean diameter of perianchor cysts at postoperative 1 year (3.24 ± 0.65 mm) was significantly larger than the immediate postoperative diameter; however, there was no significant difference between postoperative 1 year and 2 years (3.23 ± 0.57 mm). Tissue density at the center of cysts demonstrated no significant difference between 1 and 2 year postoperatively (107.7 ± 29.8 HU [superior], 99.7 ± 31.7 HU [anteroinferior], and 105.1 ± 25.0 HU [posterior] vs. 109.1 ± 26.1 HU [superior], 106.4 ± 30.3 HU [anteroinferior], and 111.0 ± 32.9 HU [posterior]). The mean diameter of perianchor cysts in the anteroinferior position was largest compared with that in superior or posterior positions.ConclusionsPerianchor cysts associated with all-suture anchors enlarged significantly within 1 year after arthroscopic labral repair regardless of the insertion location in the glenoid. However, the size and tissue density of perianchor cysts were similar at postoperative 1 and 2 years, and satisfactory stability and clinical outcomes were obtained.

Effectiveness of Latarjet for anterior shoulder instability in patients with seizure disorder.

BackgroundA paucity of literature exists on the outcomes after Latarjet for anterior shoulder instability in patients with seizure disorders (SDs). The purpose of this study was to determine the effectiveness of the Latarjet procedure for anterior shoulder instability in patients with SDs.MethodsA retrospective review of patients undergoing Latarjet from 2013 to 2017 for anterior shoulder instability with minimum 2 years of clinical follow-up was performed. Patients were divided into two groups: patients diagnosed with SD, and patients without a history of seizure (control). Demographics, indications, SD details, and postoperative outcomes were collected. The incidence of complications, recurrent instability, revision surgery, and repeat seizure(s) were also examined.ResultsA total of 53 patients were identified, including 10 shoulders in 9 patients with an SD (88.9% male; mean age, 29.2 years [range, 20-37]), and 44 shoulders in 44 non-SD patients (86.4% male; mean age, 30.3 years [range, 18-52]). The mean follow-up time was 3.4 (range, 2.2-4.8) and 3.8 (range, 2.1-5.6) years in the SD and control group, respectively. During the follow-up period, 4 of 9 (44.4%) patients with an SD (50% shoulders) had a recurrent seizure postoperatively. Of those 4 patients, three sustained a recurrent dislocation of the operative shoulder(s) resulting from a postoperative seizure, including one who dislocated bilateral shoulders from a single seizure event after bilateral Latarjet procedures. There was no recurrent instability in patients who did not sustain a seizure in the postoperative period. Having a seizure in the postoperative period significantly increased the risk of recurrent dislocation (OR = 39.9, P = 0.04).ConclusionsLatarjet is a successful operation for recurrent anterior shoulder instability in patients without an SD. While it can still be successful in patients with SD, adequate control of seizures postoperatively is paramount to prevent recurrent instability episodes. Patients with an SD can be advised that if their seizures can remain controlled, they have a high likelihood of clinical success equal to that of patients without an SD.

Arthroscopic Glenoid Bone Grafting With Soft Fixation for Recurrent Anterior Shoulder Dislocation

Glenoid bone defect is a common structural deficiency in cases of recurrent anterior shoulder dislocation. Glenoid bone grafting is an effective method to address glenoid defect and promote labrum regeneration. In most previous reports, firm fixation of the bone grafts was conducted, but with obvious inconvenience. Thus, we introduce a special glenoid bone-grafting technique in which the bone fragments are placed to the anterior side of the glenoid through the rotator interval, with 1 inferior graft free of fixation and 1 superior graft fixed to the glenoid by suture suspension. This technique is indicated in patients with recurrent anterior shoulder dislocation with glenoid defect or needing osseous stimulation for labrum regeneration. The critical point of this technique is the proper use of special glenoid bone grafting instruments. We believe this technique will provide a special choice in the treatment of recurrent anterior shoulder dislocation.

Four-Layer Structural Reconstruction for Recurrent Anterior Shoulder Dislocation

Recurrent anterior shoulder dislocation is always combined with glenoid and capsule-labrum deficiency. To address all these deficiency in a single operation, we developed a 4-layer structural reconstruction technique at the anterior side of the shoulder, which includes capsule-labrum repair, glenoid bone grafting, and transfer of the long head of the biceps brachii (LHB). This procedure is indicated in patients who need both sling and bone fragment augmentation. The critical steps of this technique are LHB transfer and 2-layer glenoid bone grafting. We believe that this technique will enhance the field of anterior shoulder reconstruction for complicated anterior shoulder dislocation.

Arthroscopic Bankart Repair With and Without Curettage of the Glenoid Edge: A Prospective, Randomized, Controlled Study

PurposeTo determine whether curettage of the cartilage on the glenoid edge in arthroscopic Bankart repair reduces the postoperative recurrence rate compared with noncuretted glenoid. MethodsBetween January 2010 and December 2013, 134 patients underwent arthroscopy and stabilization for recurrent anterior dislocation of shoulder; 42 patients were excluded. Alternate glenoid edge was curetted in 92 patients undergoing arthroscopic Bankart repair. Twelve patients were lost to follow-up. The remaining 80 patients were divided into 2 groups of 40 patients each, curettage and noncurettage. In both groups, the Bankart lesion was repaired using ≥3 bioanchors loaded with nonabsorbable braided sutures. Postoperative rehabilitation was the same for the 2 groups. We recorded recurrence of instability, pain, and Constant and Rowe shoulder scores. Statistical analysis of data was performed using unpaired t test (significance level P < .05). ResultsThe 2 groups were comparable in terms of age, number of dislocations, and bone loss. The average follow-up was 7 years and 9 months (range 6 to 10 years). Of the total 40 patients in the curettage group, 6 (15%) had recurrence of dislocation and none had subluxations, whereas in the noncurettage group, 13 (32.5%) had recurrence of dislocation and 3 (7.5%) had subluxations. The difference in postoperative recurrence of instability was statistically significant (P = .012). The average (standard deviation) Rowe score was 83.75 (23.28) in the curettage group and 70.13 (31.29) in the noncurettage group (P = .030). ConclusionsDuring arthroscopic Bankart repair, curettage of the cartilage on the anterior glenoid edge reduces the incidence of postoperative recurrence of instability. Level of EvidenceII, therapeutic; prospective, randomized, controlled study.

COMPARISON OF FUNCTIONAL OUTCOME OF SURGICAL TREATMENT OF RECURRENT ANTERIOR SHOULDER DISLOCATION

Abstract&#x0D; Background &#x0D; Shoulder joint is the most mobile joint of the body. Shoulder joint dislocation accounts for the 50% of all the dislocations. Its incidence is 2 % among general population. In most of the cases it is recurrent shoulder dislocation and in 97% cases of recurrent dislocation it is anterior dislocation. Mechanism for recurrent anterior dislocation is abduction, external rotation and extension. There is persistent inability of tissues to keep the humeral head in glenoid cavity. It may result from sudden injury to glenoid cavity (Bankart lesion), proximal humerus (Hillsachs lesion), repetitive micro trauma or and a result of generalized ligamentous laxity. Once the shoulder is dislocated it is vulnerable to repetitive episodes.&#x0D; Objective:&#x0D; To compare the functional outcome of two different treatment modalities (latarjet &amp;Bristow procedure and Bankart Repair) in recurrent anterior shoulder dislocation&#x0D; Subjects and methods &#x0D; Study design: randomized clinical trial&#x0D; Settings and duration: department of orthopaedic surgery services hospital Lahore from December 2017 to December 2018.&#x0D; Sample collection: A total no of 40 patients with age 18-30 years both male and female having recurrent anterior dislocation of shoulder were included in the study. Patients with ligamentous laxity, psychological ailment and global instability were excluded from the study.&#x0D; Data collection and analysis: Patients were divided in two groups having 20 patients in each group. Detailed history, clinical examination, radiographs, CT scan and MRI was completed to establish the diagnosis of recurrent anterior shoulder dislocation. We performed Bristow latarjet procedure in group a and Bankart repair in group B. All patients were followed at 1st , 2nd , 3rd , 4th,6th week and then at 4th , 6th and 9 months clinically and radiologically to assess the Instability and mobility by using Rowe score.&#x0D; Results: there were 16 males and 4 females while in group B were 17 males and 3 females. Mean age in group A was 26.7 years (18-30) while in group B was 27 years (18-29) which was statistically insignificant (p&gt;0.05). Right shoulder was involved in 13 (65%) patients in group A and 15 (75%) in group B. left shoulder was involved in 7 (35%) patients of Group A and 5 (25%) of group B. In group A 18 patients had excellent results, one patient was having grade I subluxation and one patient had positive apprehension test. In group B four patients had recurrence and three patients had subluxation of grade II.&#x0D; Conclusion&#x0D; Results of latarjet and Bristow procedure were excellent than Banckart repair. Patients satisfaction was also better in group A than group B.&#x0D; &#x0D;

Management of Recurrent Shoulder Dislocation by Arthroscopic Repair

Management of Recurrent Shoulder Dislocation by Arthroscopic Repair

Functional outcome of arthroscopic Bankart repair in post-traumatic recurrent shoulder dislocation in a private tertiary care teaching hospital in eastern India

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Recurrent anterior shoulder dislocations are quite common in young patients with Bankart lesions. The open Bankart repair was the gold standard for years, however arthroscopic Bankart repair has gained popularity. The aim of the study was to evaluate the functional results of arthroscopic Bankart repair in patients with post-traumatic recurrent anterior glenohumeral instability.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients who underwent arthroscopic Bankart repair for post-traumatic recurrent anterior shoulder dislocation were included in the study. This was a prospective study conducted at a tertiary care Hospital in Kolkata, India between August 2017 to May 2019. All patients were followed up at an interval of 2 weeks, 6 weeks, 12 weeks, 6 months, 9 months and 1 year. Rowe score was used to assess the functional outcomes of the patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 34 (91.9%) patients reported good to excellent results, whereas only 2 (5.4%) patients had fair outcome and 1 (2.7%) patient demonstrated poor surgical result. The total rowe score improved from 46.62 pre-operatively to 94.20 post-operatively after 1 year (p&amp;lt;0.01). By the end of 1-year follow-up, 35 (94.6%) patients had full range of motion in all the planes. Majority of (89.2%) patients did not have any complications. Only 1 patient out of 37 had a recurrence (2.7%).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Arthroscopic Bankart repair is an effective, cosmetic and safe surgical procedure with good clinical outcomes and excellent post-operative shoulder range of motion. This surgical intervention also has low recurrence rate and minimum surgical complications.&lt;/p&gt;

Early Follow-Up of Arthroscopic Latarjet Procedure with Screw or Suture-Button Fixation for Recurrent Anterior Shoulder Instability.

ObjectiveTo evaluate the early clinical and radiographic results of arthroscopic Latarjet procedure using screw or suture‐button fixation in patients with recurrent anterior shoulder dislocation.MethodsTwelve patients who underwent arthroscopic Latarjet procedure between January 2015 and December 2018 at our institution were retrospectively studied. Data of the patients' history, including age, gender, side of affected arm, body mass index (BMI), and the number of dislocations since fist dislocation were collected. Preoperative and postoperative clinical follow‐up data were evaluated using Walch–Duplay score, American Shoulder and Elbow Society (ASES) score, and modified Rowe score. Active external rotation and active internal rotation at 90° of abduction as well as active elevation were evaluated preoperatively and postoperatively. The position and healing condition of the transferred coracoid bony graft were also assessed using computed tomography (CT) and Mimics 19.0 software.ResultsMean follow‐up was 24.9 months (range, 13 to 53 months) of all patients. At final follow‐up, the average ASES score (preoperative vs postoperative values) had improved from 68.9 ± 7.9 to 91.1 ± 6.1 in screw fixation group and 68.9 ± 8.9 to 87.5 ± 6.7 in suture‐button fixation group; the average Rowe score (preoperative vs postoperative values) had improved from 25.0 ± 8.4 to 92.5 ± 4.2 in screw fixation group and 21.7 ± 13.7 to 93.3 ± 4.1 in suture‐button fixation group; the average of Walch–Duplay score (preoperative vs postoperative values) had improved from 12.5 ± 15.1 to 91.7 ± 4.1 in screw fixation group and 18.3 ± 20.7 to 88.3 ± 7.5 in button fixation group. The forward flexion was 175.0° ± 8.4° preoperatively and 178.3° ± 4.1° postoperatively in screw fixation group while 174.8° ± 10.2° preoperatively and 175.0° ± 5.5° postoperatively in suture‐button fixation group. The active external rotation was 77.5° ± 5.2° preoperatively and 71.7° ± 4.1° postoperatively in screw fixation group while 72.5° ± 6.9° preoperatively and 68.3° ± 7.5° postoperatively in suture‐button fixation group. The average of active internal rotation was 66.7° ± 6.1° preoperatively and 67.5° ± 6.1° postoperatively in screw fixation group while 68.3° ± 11.3° preoperatively and 66.7° ± 7.5° postoperatively in suture‐button fixation group. In postoperative CT scan, 91.7% grafts midline center were located at or under the equator in the en face view; 75% of the bone blocks were flush to the glenoid face in the axial view, with only two grafts exhibiting slight medial placement in screw fixation group (33.3%) and one graft exhibiting slight lateral placement in suture‐button fixation group (16.7%). All grafts achieved bone union. Graft absorption mostly occurred outside of the “best‐fit” circle. The average bony absorption rates of the coracoid grafts were 25.2% and 10.18% in screw fixation group and suture‐button fixation group, respectively, at 6 months postoperative follow‐up.ConclusionBoth suture‐button fixation and screw fixation techniques in arthroscopic Latarjet procedure revealed excellent clinical outcomes with low complication rates in the early follow‐up. The suture‐button fixation exhibited a flexible fixation pattern that allowed for self‐correction to some extent, even slight lateralization could finally remodel over time.

Congenital Absence of the Long Head of Biceps and Posterior Radial Head Dislocation

Congenital absence of long head of biceps is an uncommon condition. We report the first case of bilateral congenital absence of long head of biceps tendon in a young male presenting with recurrent anterior right shoulder dislocation associated with an ipsilateral congenital radial head dislocation. This association has not hitherto been described. We present the clinical, imaging and arthroscopic findings, as well as a review of literature to promote awareness of this rare pathology and discuss its role in joint instability and associated congenital abnormalities.

An Arthroscopic “Inlay” Bristow Procedure With Suture Button Fixation for the Treatment of Recurrent Anterior Glenohumeral Instability: 3-Year Follow-up

Background: Coracoid graft positioning, fixation, and bone union are key factors affecting the clinical outcomes of Bristow and Latarjet procedures. We developed an arthroscopic “inlay” Bristow procedure based on the “mortise-tenon” joint structure concept using suture button fixation to achieve more stable fixation and better bone union of the graft. Purpose: To evaluate the positioning of the coracoid graft, bone union rate, and clinical outcomes of this arthroscopic inlay Bristow procedure with suture button fixation. Study Design: Case series; Level of evidence, 4. Methods: A total of 62 patients who received the arthroscopic inlay Bristow procedure with suture button fixation between June 2015 to June 2016 were eligible for inclusion, and 56 patients who met the inclusion criteria were enrolled in this study. Radiological assessment on 3-dimensional computed tomography scan was performed preoperatively, immediately after the operation, and postoperatively at 3 months, 6 months, 1 year, and the final follow-up. Pre- and postoperative clinical results were also assessed. Results: A total of 56 patients were included in this study. The mean ± SD follow-up time was 36.1 ± 3.7 months. Coracoid grafts (middle point) were positioned at 4 o’clock (range, 123.8°± 12.3°) in the sagittal view. In the axial view, 94.6% (53/56) of the graft positioning was measured as flush and 5.4% (3/56) as medial. Neither lateral nor too medial positioning was noted. The bone union rate was 96.4% at final follow-up. The mean visual analog scale score for pain during motion, American Shoulder and Elbow Surgeons score, and Rowe score all improved significantly after surgery—from 4.8 ± 2.6 to 1.1 ± 1.0, 69.2 ± 12.5 to 92.5 ± 7.0, and 33.5 ± 12.1 to 96.0 ± 4.9 at last follow-up, respectively. Almost all patients (98%; 55/56) returned to sports within 1 year after surgery at the same or higher level as compared with their preinjury performance. The mean subjective value for sports participation was 90.3% ± 7.1% (range, 70%-100%) as compared with the normal shoulder. The overall complication rate was 3.6%. No degenerative changes were noted in any patients. Conclusion: This study reported the first series of an inlay Bristow procedure with suture button fixation for recurrent shoulder dislocation, providing a satisfactory union rate and excellent graft positioning with a low complication rate. The mortise-tenon joint structure can provide excellent graft fixation and healing, while using suture button fixation instead of screw fixation could reduce osteolysis and complications related to hardware implantation.

Arthroscopic Bankart repair: A matched cohort comparison of the modified Mason Allen method and the simple stitch method

IntroductionArthroscopic Bankart repair (ABR) has become a standard treatment for recurrent anterior shoulder dislocation in cases with minimal bone loss. Using the standard Bankart repair technique, the failure rate has been reported to be approximately between 4 and 35%. In addition to the original injury, multiple pathologies can occur after a dislocation including a Bankart lesion, capsular redundancy and bone defects. In cases with no significant bone loss, soft tissue plays a major role in stabilizing the shoulder joint. We hypothesized that effective repair of soft tissue with good inferior capsular shifting and proper capsulolabral restoration can create a proper level of soft tissue tension so the horizontal mattress suture method should improve outcomes. Materials and methodsA retrospective cohort study was conducted by reviewing the records of patients with recurrent anterior instability who underwent ABR at a single institution between January 2009 and December 2017. Demographic information, preoperative radiographic data including glenoid bone loss, Hill-Sachs width, glenoid track and other surgical details were retrieved from the medical records. The patients identified were divided into 2 groups. Group 1 had one modified Mason Allen stitch plus simple stitches, while Group 2 had only simple stitches. Data obtained from the patient included failure rate, patient satisfaction, the ROWE score and Walch-Duplay score at a minimum of 2 years after surgery. Risk factors for failure were also identified. ResultsGroup 1 included 50 patients (mean age 27.2 ± 9.4 years) who underwent modified Mason Allen stitch ABR (median follow-up, 59.2 months; range, 26.2–128.6 months). Group 2 included 30 patients (mean age 26.9 ± 8.5 years) who underwent simple stitch repair ABR (median follow-up, 68.0 months; range, 24.0–127.9 months). All patients met the inclusion criteria. Evaluation at the final follow-up compared Group 1 and Group 2: ROWE score (86.8 vs 76.3, P = 0.001), Walch-Duplay score (87.2 vs 82.0, P = 0.035), respectively. Failure rates were 6% in group 1 compared to 10% in group 2 (P = 0.511). ConclusionsThe modified Mason Allen stitch technique and the simple stitches technique ABR both result in excellent patient satisfaction at a minimum 2-year follow-up. Both techniques successfully restore shoulder stability, but the modified Mason Allen stitch technique results in better functional outcomes. Study designCohort study; level of evidence, 3.