Recurrent Shoulder Dislocation Research Articles

Latarjet operation carries three times the risk of failure in seizure versus non-seizure recurrent anterior dislocation of the shoulder joint: outcome of a systematic review with meta-analysis.

Recurrent anterior shoulder dislocation (RASD) in cases of seizure disorders (SDs) total 50%-80% of all SD-associated shoulder instabilities. Based on the extent of bone loss, treatment options include bony and soft-tissue reconstructions, arthroplasty, and arthrodesis. The primary objective of this paper was to review the treatment options for RASD in SDs. Several bibliographic databases were searched for RASD treatment options in SD patients. The demographic outcome measures, the failure rate (defined as the relative risk of recurrence of dislocation postoperation), and the postoperative seizure recurrence rate were recorded. We pooled 171 cases (187 shoulders) from 11 studies. Of these, one, five, two, two, and one reports studied Bankart's operation with remplissage (27 cases/29 shoulders), the Latarjet procedure (106/118), bone block operation (21/23), arthroplasty (11/11), and arthrodesis (6/6), respectively, in treating SD-associated RASD. The relative risk of failure between SD and non-SD patients was 3.76 (1.36-10.38) after the Latarjet operation. The failure rates were 17% and 13% for Bankart's operation with remplissage and the Latarjet procedure in SD patients, respectively, but 0% each for bone block operation, arthroplasty, and arthrodesis. The total rate of seizure recurrence after operation was 33% of the pooled cases. SD recurrence in the postoperative period, the size of the bone block, and the muscular attachments to a small coracoid autograft are the determinants of failure among various reconstructive operations in SD-associated RASD.

Location and Size of the Reverse Hill-Sachs Lesion in Patients with Traumatic Posterior Shoulder Instability

BackgroundIn patients with traumatic posterior shoulder instability, little is known about the precise location and size of the reverse Hill-Sachs lesion. MethodsForty-nine shoulders of 47 patients with traumatic posterior instability were included in this study based on the following inclusion criteria: 1) a primary or recurrent traumatic posterior shoulder dislocation, and 2) the initial event was caused by trauma. Patients were excluded if they had: 1) no history of trauma, 2) prior shoulder surgery, 3) no CT examination, or 4) seizure cases. Three-dimensional images of the humerus reconstructed from CT images were reviewed using an image analysis software. The location and size of the reverse Hill-Sachs lesion were measured and described on a clock face on the humeral head. ResultsThe reverse Hill-Sachs lesion was observed in 25 of 49 shoulders (51%). The reverse Hill-Sachs lesions were located between 1:37 and 2:48. The depth of the reverse Hill-Sachs lesion (mean ± SD) was 5.8 ± 2.2 mm. The extent of the reverse Hill-Sachs lesion was 35° ± 12°. The average orientation of the reverse Hill-Sachs lesion, represented by an angle measured from the 12 o'clock position, was 64° ± 12° and pointing towards 2:09 on a clock face. Length and width of reverse Hill-Sachs lesions were 9.7 ± 4.7 mm, 11.1 ± 3.6 mm, respectively. ConclusionThe reverse Hill-Sachs lesion was a semicircular compression fracture located on the anteromedial aspect of the humeral head. Compared with shoulders with anterior shoulder instability, the humeral defect was smaller and located more inferiorly in shoulders with posterior instability.

Brittle cornea syndrome—A rare genetic disease

To report a case of an 8-year-old girl who presented with bluish discoloration of sclera, keratoconus, and progressive high myopia. She had a history of recurrent shoulder dislocation. A general physical examination showed a midfacial hypoplasia, upturned nares, thick and tented upper lip, and hyperextensible joints. The genetic analysis showed ZNF469 mutation suggestive of Brittle cornea syndrome 1 (BCS-1). We aim to highlight the importance of timely diagnosis and early provision of protective glasses seems to be the most important step in treating BCS.

The Functional Outcome Between Arthroscopic and Open Surgery for Recurrent Anterior Shoulder Instability: A Systematic Review

Background: It remains unknown if arthroscopic repair of recurrent anterior shoulder instability is as effective as open repair. The aim of this study was to compare the functional outcome between arthroscopic and open repair for recurrent Anterior Shoulder Instability. Methods: We searched the Cochrane Library, EMBASE, and PubMed extensively for studies comparing open versus arthroscopic repair for recurrent anterior shoulder dislocations until March 1, 2021. The PRISMA guidelines were utilised by two different researchers to assist them in selecting pertinent papers. Because there were few studies, there was no restriction on publication status, open and arthroscopic repair technique, or patient demographics. Results: For recurrent anterior shoulder dislocations, five randomised controlled trials assessed the use of open repair against arthroscopic surgery. According to these investigations, there is no discernible difference between the two operational strategies. At present, there are no known long-term follow-up data that describe the outcomes of either surgical method. Every inquiry had flaws in the way it was designed, which reduced the reliability of the results. Conclusion: There is insufficient data from randomised controlled trials to conclude that there is a statistically significant difference between the groups that underwent open repair and those that underwent arthroscopic surgery in terms of redislocation rates, return to activity, and functional outcomes. After arthroscopic surgery, range of motion is slightly better than after open repair. No recommendations regarding the best course of surgery can be given. Keywords: recurrent anterior shoulder instability; open; arthroscopic; repair.

Comparison of the Latarjet Procedure With the Modified Putti-Platt Surgery for Recurrent Anterior Shoulder Dislocation With Respect to Functional Outcome.

Introduction Shoulder dislocation is the most common injury encountered in orthopedic outpatient department. The choice of procedure depends on the expertise of surgeons.The objective of this study was tocompare the Latarjet procedure with the modified Putti-Platt surgery for recurrent anterior shoulder dislocation in terms of functional outcomes. Materials and methods A quasi-experimental study evaluated 60 patients with recurrent anterior shoulder instability. Patients were assigned to either Latarjet or modifiedPutti-Platt surgery. Functional outcomes were assessed at sixmonths using the Constant-Murley shoulder score. Results This study encompassed 60 patients (mean age:23.93±5.88 years) undergoing shoulder procedures.Functional outcomes exhibited a majority of 55% excellent, 35% good, 6.7% fair, and 3.3% poor outcomes. No significant differences in functional outcomes were found between the procedures. Conclusion Both procedures may be viable options for recurrent shoulder instability. The choice may depend on patient factors and surgeon preference. Further research is needed to refine techniques and identify ideal candidates.

Arthroscopic Bankart versus Open Latarjet; Short-to-Mid-Term Outcomes of Recurrence and Patient-Reported Outcomes in Patients with Recurrent Anterior Shoulder Dislocation

Objectives This retrospective comparative study compared the short to mid-term outcomes of arthroscopic Bankart repair and open Latarjet procedures in patients with recurrent anterior shoulder instability. Methods Patients who underwent either arthroscopic Bankart repair or open Latarjet procedures between 2008 and 2020, with at least one year of follow-up, were included. Arthroscopic Bankart repairs were performed on shoulders with minimal glenoid bone loss (<15%), and the Latarjet procedure was performed if the preoperative computed tomography (CT) scan showed a 15% bone loss on the glenoid side or 30-40% humeral head bone loss. Their surgery results and patient-reported outcome measures (PROMs) were assessed using the Oxford Shoulder Score (OSS) and Shoulder Pain and Disability Index (SPADI). Results 133 patients were analyzed in Latarjet (n = 67) and Bankart groups (n = 66). Before surgery, the two groups of patients were similar regarding surgery side, hand dominance, education level, occupation difficulty level, and smoking (P>0.05). However, Latarjet’s patients were younger (32 vs. 35, P=0.04), had a higher proportion of males (96% vs. 82%, P=0.01), and had a significantly shorter follow-up period (3.2 vs. 6.4 years, P<0.001) than the Bankart group. There was no significant difference between the Latarjet and Bankart groups regarding the follow-up’s OSS score (37 vs. 36; P=0.94) and SPADI score (22 vs. 24, P=0.80). Dislocation was observed in only one patient (1.5%) in the Latarjet group (P=1.0). Subluxation was observed in 5 patients (7.5%) of the Latarjet group and three patients (4.5%) of the Bankart group (P=0.4). The overall instability rate was similar (P>0.05). Conclusion Our findings suggest that both arthroscopic Bankart repair and open Latarjet are reliable techniques in short to mid-term follow-up based on the glenoid bone loss cut-off of 15%. Level of Evidence Therapeutic Level III

The Arthroscopic Subscapular Sling Procedure Results in Low Recurrent Anterior Shoulder Instability at 24 Months of Follow-Up

The purpose of this study was to analyze the results of the subscapular sling procedure developed for anterior shoulder instability in patients with less than 10 % anterior glenoid bone loss. The aim was to explore if this procedure would be successful in preventing recurrent shoulder dislocation. Patients were treated surgically with the arthroscopic subscapular sling procedure. A semitendinosus graft was used to reconstruct the anterior labrum and to establish a sling suspension around the upper part of the subscapularis tendon. The patients were followed by x-ray (12 and 24 months). Magnetic resonance imaging (MRI) of the shoulder region and clinical examinations were performed at 3, 12 and 24 months. Recurrent dislocation was the primary endpoint. The Western Ontario Shoulder Instability Index (WOSI) and MRI results were secondary outcome measures. An independent physiotherapist assessed residual instability and ROM. Fifteen patients were included with a dislocation rate of zero % after 24 months follow-up. There was a significant clinical improvement of the WOSI score from 57 % (904) at baseline to 88 % (241) at 24 months (p < 0.001). The proportion of patients with an improvement in the WOSI Total score larger than the estimated Minimal Clinically Important Difference (MCID) was 100% both at 12 and 24 months. MRI showed an intact sling in all patients. External rotation was not significantly reduced (52° at baseline vs 47° at 24 months, p = 0.211). Flexion and abduction were significantly improved from 152° to 174° (p=0.001) and 141° to 170° (p<0.001) after 24 months. The surgical procedures were completed without any intraoperative complications. The subscapular sling procedure resulted in low recurrent shoulder instability and improved patient-reported outcome measures at 24-months follow-up.

Reconstruction of recurrent shoulder dislocation with glenoid bone defect with 3D-printed titanium alloy pad: outcomes at 2-year minimum follow-up

BackgroundTo evaluate the outcome of shoulder arthroscopy-assisted implantation of three-dimensional (3D)-printed titanium pads for recurrent shoulder dislocation with glenoid bone defects.MethodsFrom June 2019 to May 2020, the clinical efficacy of 3D printed titanium pad implantation assisted by shoulder arthroscopy, for the treatment of recurrent shoulder dislocations with shoulder glenoid defects was retrospectively analyzed. The American Shoulder and Elbow Surgeons (ASES) shoulder, Rowe, and Constant scores were recorded before surgery and at 3 months, 6 months, 1 year, and 2 years after surgery. 3D computed tomography (CT) and magnetic resonance imaging were used to evaluate the location of the glenoid pad, bone ingrowth, joint degeneration, and osteochondral damage.ResultsThe mean age of the 12 patients was 21.4 (19–24) years and the mean follow-up time was 27.6 (24–35) months. The Visual Analog Scale score significantly improved from 5.67 ± 1.98 preoperatively to 0.83 ± 0.58 postoperatively (p = 0.012). The postoperative ASES score was significantly increased to 87.91 ± 3.47 compared with preoperative ASES score (46.79 ± 6.45) (p < 0.01). Rowe and Constant scores also improved from 22.5 ± 12.34 and 56.58 ± 7.59 preoperatively to 90.83 ± 4.69 and 90.17 ± 1.89 at 2 years postoperatively, respectively. CT performed 2 years after surgery showed that the pad perfectly replenished the bone-defective part of the shoulder glenoid and restored the articular surface curvature of the shoulder glenoid in the anterior-posterior direction, and the bone around the central riser of the pad was tightly united. Magnetic resonance imaging 2 years after surgery showed that the humeral head osteochondral bone was intact, and there was no obvious osteochondral damage.Conclusions3D printed titanium pads are a reliable, safe, and effective surgical procedure for treating recurrent shoulder dislocations with glenoid bone defects.

Outcome of Modified Open Latarjet Operation in the Treatment of the Recurrent Anterior Shoulder Dislocation: A Cohort Study

Introduction: Shoulder instability is defined as a symptomatic translation of the humeral head about the glenoid fossa during active shoulder motion. Anteroinferior glenoid bone loss or labrum avulsion is most often a consistent finding in recurrent dislocation. The modified open Latarjet procedure is one of the most effective methods of treatment for patients with recurrent shoulder instability with glenoid bone loss. Aim: To determine the functional outcome of the congruent arc modification of the open Latarjet procedure. Materials and Methods: This prospective cohort study was conducted at a tertiary healthcare centre in Bhopal, Madhya Pradesh, India between January 2018 and December 2020. A total of 25 patients with recurrent anterior shoulder dislocation underwent treatment using the modified open Latarjet procedure. Two patients were lost to follow-up, resulting in the evaluation of 23 patients. All patients underwent a 3D Computed Tomography (CT) scan to document glenoid bone loss. The intensity of pain, activity level, strength of abduction, and Range of Motion (ROM) were assessed to calculate the Constant Shoulder Score for pre- and postoperative evaluation of functional outcomes. Follow-ups were conducted at 3 months, 6 months, 1 year, and 2 years after surgery. The data was analysed using the Wilcoxon’s signed-rank test, and Spearman’s correlation coefficient was used to identify associations between various variables. Results: A total of 23 male patients aged between 18 and 63 years were included. The average age of patients was 30.35±11.27 years. Preoperatively, only 3 patients (13.04%) had good to excellent Constant Shoulder Scores. However, no statistically significant variation in Constant Score was observed three months after surgery. Six months post-surgery, 17 patients (73.92%) showed good to excellent scores. Nearly one year after surgery, 21 patients (91.3%) had good to excellent outcomes. At the final follow-up, 22 patients (95.65%) demonstrated good to excellent outcomes. A statistically significant improvement in good to excellent scores was noted six months postoperatively (p-value &lt;0.001). A total of 20 patients (86.96%) achieved full ROM, with only 3 patients (13.04%) reporting mild to moderate limitations in shoulder ROM. None of the patients experienced redislocation, and the apprehension test was positive in only one patient. Conclusion: The modified open Latarjet procedure is a reliable method for providing stability and Self confidence to patients with recurrent shoulder instability and glenoid bone loss.

Arthroscopic Remplissage for Anterior Shoulder Instability

Background: There are several approaches such as the Bankart repair, Latarjet, and Remplissage to treat recurrent glenohumeral instability. Indications: We chose to augment an arthroscopic Bankart repair with a Remplissage in this 26-year-old patient given the presence of a Hill-Sachs lesion, history of recurrent shoulder dislocations, and young age of the patient. Technique Description: We established four portals using previously well-documented techniques. The Hill-Sachs lesion was evaluated using the anterosuperior portal. Two anchors were placed, one on both the superior and inferior aspects of the Hill-Sachs lesion. The sutures were shuttled through the knotless anchor mechanism and tensioned after confirming the cannula was through the deltoid. Then, we completed the Remplissage by repairing the infraspinatus tendon and capsule into the posterior humeral head. Results: The Remplissage procedure is very successful at reducing recurrent instability in young, active patients. Previous studies have reported very low rates, even 0% recurrent instability, after surgery with 80% to 90% of patients returning to sports. Studies have also documented excellent patient-reported outcomes at short- to mid-term follow-up. Complication rates are historically lower when the Remplissage is done with an arthroscopic Bankart repair than the Bankart repair alone. Discussion/Conclusion: The Remplissage procedure is a safe, effective option at reducing future instances of shoulder dislocations in conjunction with Bankart repairs. Patients can expect to return to their active lifestyles, with many patients achieving the same level of activity as before the initial shoulder dislocation. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Functional outcome of arthroscopic labral repair in adults for traumatic shoulder instability: a prospective study

Background: Anterior shoulder instability is often treated either by open procedure or arthroscopic method. present study to assess the functional outcome of the patients with recurrent dislocation of shoulder with Bankart lesion, treated with arthroscopic stabilization to evaluate shoulder function with labral tear and after repair of labral tear, to study epidemiology of labral tear and to study epidemiology of associated lesions. Methods: Prospective study in the 25 consented patients admitted in the orthopaedics department in new civil hospital Surat with different shoulder injury after IEC approval. Statistical analyses done in MS excel. Results: Mean age at time of first dislocation was 30 year and most (50%) were of 20-30 years. Most patients were males (92%). 84% of the cases, the dominant side is involved, right shoulder. Number of episodes of recurrent dislocation prior to surgery averaged 5 times. most common mechanism was Accidental fall (48%) followed by sports (32%), RTA (20%). Association of Hill-Sachs lesions was 80% with labral-tear secured with extra suture anchor. Preoperative parameters; number of dislocations, chronicity, reduction method do not have any significance on outcome. Rowe-score improved from 40.2% Preoperatively to 89.8% postoperatively at 12 weeks. 80% of patients is having excellent outcome. Conclusions: Arthroscopic Bankart’s repair is gold standard for labral tear due to recurrent shoulder dislocation which led to short surgery time, less intraoperative and postoperative complications, increased shoulder function among patients. Associated Hill Sach’s lesion should be repaired for better functional outcome.

Readability of Online Information on the Latarjet Procedure.

Introduction A common complication of first-time or recurrent shoulder dislocations is bone loss at the humeral head and glenoid. Recurrent shoulder instability is often a result of bony defects in the glenoid following shoulder dislocations. In the setting of glenoid bone loss, surgical interventions are generally required to restore stability. The Latarjet procedure is a challenging operation and, due to its complexity, may be associated with operative complications. It can be difficult to explain the procedure to patients in a manner that is easily comprehensible, which may lead to confusion or being overwhelmed with information. Hence, it is important that the information available to patients is easily accessible and perceivable to allow for adequate health literacy. Health literacy is defined as the ability to make health decisions in the context of everyday life. Methods The search engines Google and Bing were accessed on a single day in the month of July 2023, searching the terms "Latarjet surgery" and "Latarjet procedure." For each term on both search engines, the first three pages were evaluated, resulting in a total of 114 websites for review. Out of these, 25 websites met the inclusion criteria and underwent further in-depth analysis through the online readability software, WEB FX. This software generated a Flesch Reading Ease Score (FRES) and a Reading Grade Level (RGL) for each website. Results In our study, the mean FRES was 50.3 (SD ±12.5), categorizing the data as 'fairly difficult to read.' The mean RGL score was 8.12 (SD ±2.35), which exceeds the recommended target. Conclusion In conclusion, the results of this study have demonstrated that the material available on the Internet about the Latarjet procedure is above the recommended readability levels for the majority of the population. Our findings align with similar studies assessing the readability of online patient information. Based on these findings, physicians should provide patients with vetted information to facilitate a better understanding of the procedure, thereby enabling patients to make more informed decisions regarding their health.

IODA-shoulder®, a 3-dimensional automated software for glenoid bone loss quantification in shoulder instability. A validation study

BackgroundGlenoid bone loss (GBL) calculation in patients with shoulder instability has a wide variability in methods and their reliability. The purpose of this study was to describe and validate a new semi-automated software developed to improve GBL calculation using a 3D imaging modeling (IODA-shoulder) and to compare the method to the PICO area method. Patients and methodsA semi-automated software to assess GBL was preliminarily developed and validated on 7 fresh frozen specimens (scapulae with artificially created glenoid defect), using water displacement method. Afterwards, the software was retrospectively used on CT images of 20 patients affected by recurrent shoulder dislocation. Inclusion criteria were: unilateral dislocation, minimum 2 dislocation episodes. Exclusion criteria were bone reconstruction of the glenoid, failed shoulder stabilization, bilateral dislocation, shoulder arthritis. Three-dimensional computed tomography images of bilateral shoulder were retrieved for each patient. Two methods to determine GBL were compared. The PICO surface area method and the new IODA method. We assessed the intra- and inter-rater reliability of the two methods with the Intraclass Correlation Coefficient (ICC), the Bland-Alman analysis, and Lin's concordance correlation coefficient (CCC). ResultsWe did not find a statistically significant difference between the mean volumes calculated with PICO and IODA methods, respectively 914 vs. 815 mm3, p=0.155. The analysis carried out by using the traditional PICO method showed a lower concordance rate among four observers than the higher concordance found using IODA method, regardless of the size and the location of the defect. The ICC agreement with PICO was significantly lower than with IODA (0.76 vs. 0.97). We found a poor CCC with PICO (from 0.65 to 0.81) and a substantial one with IODA (from 0.96 to 0.98). DiscussionThe intra- and inter-rater reliability using IODA method is significantly better than PICO method. The assessment of GBL using IODA method is time saving, avoiding significant inter- and intra-observer variation, mainly due to individual skill and experience in the method. Level of evidenceIV, experimental study.

Clinical and Functional Outcomes of Arthroscopic Bankart Repair among Patients with Recurrent Anterior Shoulder Dislocation

OBJECTIVE: To note the functional outcome of recurrent anterior shoulder dislocation with Bankart repair (BR) treated with arthroscopic stabilisation with suture anchors. METHODOLOGY: This prospective cohort study was conducted at the Department of Orthopedic Surgery, Lahore General Hospital, Lahore, from January 2021 to June 2022. Patients undergoing arthroscopic BR with anterior instability of the glenohumeral joint with at least &gt;6 episodes of dislocation/subluxation in the last six months were analysed. Functional outcomes were assessed at one-month, three-month and six month intervals post-surgery using "Modified University of California Los Angeles (UCLA)" and "Simple Shoulder Test (SST)". RESULTS: Of 25 patients, 24 (96.0%) were male. The mean age was 27.20±4.0 years. The mean duration of symptoms was 9.1±6.2 months. In 16 (64.0%) patients, 2-suture anchors were utilised, while 3-suture anchors were used in the remaining 9 (36.0%) patients. Pre-surgery, the mean UCLA score was 16.4±5.6 and improved to 1-month, 3-month and 6-month as 16.6±5.1, 22.8±6.2 and 28.4±6.6 respectively (p&lt;0.001). Pre-surgery, the mean SST score was 4.7±2.4 which improved to 1-month, 3-month and 6-month as 5.4±2.6, 8.1±3.3 and 11.2±3.1 respectively (p&lt;0.001). All patients (100%) had full range of motion after six months post-surgery. CONCLUSION: Arthroscopic BR in recurrent anterior shoulder dislocation was a reliable procedure regarding functional outcomes and range of motion after six months of follow-up. KEYWORDS: Arthroscopy, Bankart repair, shoulder dislocation, suture anchors, range of motion

A study of the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations

To investigate the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations. Eighty-nine patients (89 sides) with recurrent shoulder dislocation admitted between June 2022 and June 2023 and met the selection criteria were included as study subjects. There were 36 males and 53 females with an average age of 44 years (range, 20-79 years). There were 40 cases of left shoulder and 49 cases of right shoulder. The shoulder joints dislocated 2-6 times, with an average of 3 times. The three-dimensional models of the humeral head and scapular glenoid were reconstructed using Mimics 20.0 software based on CT scanning images. The glenoid track (GT), inclusion index, chimerism index, fit index, and Hill-Sachs interval (HSI) were measured, and the degree of on/off track was judged (K value, the difference between HSI and GT). Multiple linear regression was used to analyze the correlation between the degree of on/off track (K value) and inclusion index, chimerism index, and fit index. Multiple linear regression analysis showed that the K value had no correlation with the inclusion index ( P>0.05), and was positively correlated with the chimerism index and the fit index ( P<0.05). Regression equation was K=-24.898+35.982×inclusion index+8.280×fit index, R 2=0.084. Humeral head and scapular glenoid bony area and curvature are associated with shoulder joint stability in recurrent shoulder dislocations. Increased humeral head bony area, decreased scapular glenoid bony area, increased humeral head curvature, and decreased scapular glenoid curvature are risk factors for glenohumeral joint stability.

Functional and Sport-Specific Outcome Following Traumatic First-Time Shoulder Dislocation and Arthroscopic Surgical Repair in Rock Climbers.

Traumatic shoulder dislocations rank among the most common shoulder injuries in climbers, with rising numbers over the last years. The objective of this study was to analyze the outcome following traumatic first-time shoulder dislocation and subsequent surgical treatment in this population. In a retrospective study, climbers who experienced a traumatic shoulder dislocation were treated with an arthroscopic repair of the labrum-ligament complex (LLC). The functional outcome was assessed with a standardized questionnaire and clinical examination, including the Constant Murley and Single Assessment Numeric Evaluation scores. The sport-specific outcome was analyzed using the Union Internationale des Associations d'Alpinisme (UIAA) scale of difficulty and a sport-specific outcome score. The functional and sport-specific outcome for 27 climbers (20 men; 7 women; 3 with bilateral injuries; age, 34±11 [17-61] y; data presented as mean±SD [range]) was assessed 53±29 (12-103) mo after surgery. The postoperative Constant Murley score was 95±8 (67-100) points. At follow-up, 93% (n=25) of patients had started climbing again. Twenty-one climbers (78%) reached a climbing level within the range of ±0.33 UIAA grades of their initial capability or even exceeded their preinjury grade. Only 7% (n=2) of the patients had a recurrent shoulder dislocation, leading to a secondary surgery, and, therefore, required ongoing postoperative treatment at the time of follow-up. Arthroscopic repair of the LLC following first-time traumatic shoulder dislocation in climbers shows a good outcome and a low recurrence rate. After surgery, most patients are able to regain a high level of rock-climbing ability.

Correlation between glenoid bone structure and recurrent anterior dislocation of the shoulder joint.

The aim of the study was to investigate the anatomical characteristics and symmetry of the bilateral glenoid structures of Chinese people and to explore the relationship between the glenoid bone structure and recurrent anterior dislocation. The control group included 131 individuals with no history of shoulder dislocation. The dislocation group consisted of 131 patients with a history of unilateral shoulder dislocation. All subjects underwent computed tomography scans. Glenoid shape (pear-shaped, inverted comma-shaped, oval-shaped), width, height, depth, version angle, area, maximum fitting circle area and volume were measured. There was no significant difference in normal bilateral glenoid of Chinese people (p > 0.05). There were statistically significant differences in depth, height to width ratio, maximum fitting circle area and shape between the dislocation and control groups (p < 0.05). Regression analyses showed that the glenoid depth (odds ratio [OR] 0.48; p < 0.01), the glenoid height to width ratio (OR 28.61; p < 0.01), the glenoid maximum fitting circle area (OR 1.01; p < 0.01) and the glenoid shape (p <0.05; pear-shaped OR 0.432; inverted comma-shaped OR 0.954) were associated with anterior shoulder instability. Pear-shaped and inverted comma-shaped glenoid had lower risk of recurrent anterior shoulder dislocation compared to oval glenoid. Receiver operating characteristic curve analysis showed that individuals with anterior shoulder instability had smaller glenoid depth and larger height to width ratio and the glenoid maximum fitting circle area compared with the control group. The normal bilateral glenoids of Chinese people are basically symmetrical. The glenoid shape, depth, height to width ratio and maximum fitting circle area are risk factors for recurrent anterior shoulder dislocation. Evaluation of the glenoid bone structure enables more accurate prediction of the risk of recurrent shoulder dislocation.

Expression of Apelin in Rotator Cuff Tears and Examination of Its Regulatory Mechanism: A Translational Study.

Inflammatory mediators play important roles in the pain associated with rotator cuff tears (RCTs), but their underlying mechanisms are unclear. Apelin, a neuropeptide, is upregulated under inflammatory conditions and possibly contributes to pain induced by rotator cuff tears. This translational study aimed to examine apelin expression and regulation by tumor necrosis factor alpha (TNF-α) in patients with RCT and in rat RCT models. Synovial tissues were harvested from the glenohumeral joints of the shoulders in 46 patients who underwent arthroscopic Bankart repair for recurrent shoulder dislocations (RSDs) or arthroscopic rotator cuff repair for RCTs. The harvested tissues were extracted and processed by reverse transcriptase-polymerase chain reaction (RT-PCR). Rats underwent sham or RCT surgery; the rotator cuff tissues were extracted 1, 7, 14, 28, and 56 days after surgery and analyzed for mRNA expression levels of the TNF-α and apelin using RT-PCR. The cultured rotator cuff cells (RCCs) were stimulated with TNF-α to examine their role in the regulation of apelin expression. Apelin expression was higher in the RCT group than in the RSD group and significantly correlated with pain intensity. In rats, the expression was also higher in RCT. Apelin expression significantly increased during the acute and chronic phases in rats. In cultured RCCs, apelin mRNA levels significantly increased after TNF-α stimulation. Apelin levels were regulated by TNF-α and were highly expressed in patients with RCT and rats in RCT models. Thus, apelin may be a new pain management target for RCTs.

Effectiveness of combined surgical and exercise-based interventions following primary traumatic anterior shoulder dislocation: a systematic review and meta-analysis

ObjectiveTo investigate the effectiveness, risk of recurrence and return to activity (RTA) of surgery combined with exercise-based interventions (EBI) versus EBI alone after traumatic anterior shoulder dislocation (ASD).DesignSystematic review and...

Results of arthroscopic treatment for anteroinferior shoulder instability using a single anterior working portal using birdbeak

BackgroundThe shoulder joint is the joint with the most dislocations in all joints. The arthroscopic surgery method is considered the gold standard because it creates less soft tissue damage, shorter hospitalization and surgery time, and less restriction of movement after surgery in shoulder instability. Anterior single portal technique has become popular recently. In this study, it was aimed to evaluate the results of the anterior single portal repair technique using “birdbeak”. We try to evaluate if this technique is a reliable technique and has the same or more advantages of two portal arthroscopic surgery and make the surgery easier for surgeons.MethodsIn the total of 40 patients who underwent arthroscopic surgery for traumatic recurrent anterior shoulder dislocation between January 2017 and February 2020, this study included 19 patients with the surgical technique of arthroscopic isolated anterior labrum tear repair using a birdbeak from the anterior single working portal. Clinical results were evaluated with the Simple Shoulder Test (SST), Rowe Score for Instability (RWS) and Oxford Shoulder Instability Score (OSIS) tests before and after surgery. The relationship between the time to surgery after the first dislocation and clinical outcomes was also examined in the study. Kolmogorov-Smirnov and Shapiro-Wilk tests were used to control the assumption of normality. In addition, Pearson correlation and Spearman correlation analyzes were used to test the relationship between the variables.ResultsThe mean follow-up period of the 19 patients included in this study was 33.1 months. The mean time to surgery after the first dislocation was 18.4 months. The mean preoperative number of dislocations was 5.3. The mean number of anchors used in the repair was 2.1. No recurrent dislocations were observed after surgery. A significant difference was observed between preoperative and postoperative SST, RWS and OSIS scores (respectively, p = 0.000 < 0.001, p = 0.000 < 0.001, p = 0.000 < 0.001). There was no statistically significant relationship between the time elapsed after the first dislocation and the postoperative SST, RWS, OSIS scores (respectively, p = 0.43 > 0.05, p = 0.39 > 0.05, p = 0.31 > 0.05).ConclusionIt has been observed that the repair technique applied using the “birdbeak” from the anterior single working portal is a successful treatment, and further studies are required due to the limited literature.