Recurrent Shoulder Dislocation Research Articles

Modified arthroscopic remplissage for Hill-Sachs lesions with high-strength sutures

The aim is to present amodified arthroscopic remplissage for shoulder Hill-Sachs lesions with high-strength sutures instead of suture anchors, to achieve better tendon-bone healing and avoid failure of remplissage due to anchor detachment. A total of seven patients with recurrent anterior shoulder dislocation combined with a Hill-Sachs lesion were included in this study. Firstly, anteroinferior glenoid labrum complex damage was treated then 2-3bone tunnels were punched with asighting device from the bony defect of the humeral head to the inside of lesser tubercles of the humerus. The bony defect was filled by stitching the infraspinatus tendon through the bony tunnels with high-strength sutures. After the operation, the filling and healing of the infraspinatus tendon in the Hill-Sachs lesion were assessed using magnetic resonance imaging (MRI). Patients were followed up for 12months. The results of MRI showed that all of the filled tendons healed well. Postoperative external rotation of the shoulder joint increased on average from 67° to 87°. Compared with the preoperative level, the Oxford Shoulder Instability Score (OSIS) was 18.50 ± 1.04 points higher and the Rowe score was increased by 66.755 ± 0.914 points. Arthroscopic remplissage of ashoulder Hill-Sachs lesion with high-strength sutures carries the benefits of secure fixing and good tendon-bone healing without the risk of anchor detachment.

Management of The Failed Latarjet Procedure: Outcomes of Revision Surgery With Fresh Distal Tibial Allograft

Objectives: A patient with recurrent instability after a failed Latarjet procedure remains a challenge to address. The vast majority of these result in large amounts of bone loss, resorption, and issues with retained hardware, and there is minimal literature that assesses outcomes of revision surgery following a failed Latarjet. The objective of this study was to determine the outcomes of patients who underwent revision surgery for a recurrent shoulder instability after a failed Latarjet procedure. Methods: All consecutive patients who presented with recurrent anterior shoulder instability after a Latarjet procedure were prospectively enrolled. Patients were included if they had a prior Latarjet, and a history and physical examination findings consistent with recurrent anterior shoulder instability. Patients were excluded if they had prior neurologic injury, a seizure disorder, bone graft requirements to the humeral head, or findings of multidirectional or posterior instability. History of shoulder instability was documented, including initial dislocation history, time of instability, number of prior procedures, and examination findings, as well as plain radiographic data and computed tomography (CT) scan obtained on all patients, and arthritis graded with Samilson and Prieto (SP) grade. All patients were treated with hardware removal, capsulo-labral release with subsequent repair and bony reconstruction via fresh distal tibial allograft to the glenoid. Outcomes pre- and post-revision were assessed with ASES (American Shoulder and Elbow Score), Single Assessment Numerical Evaluation (SANE), and Western Ontario Shoulder Index (WOSI), and statistically compared. All patients underwent a CT scan of the distal tibial allograft at a minimum time point 4 months after surgery. Results: There were 31 patients enrolled (all males), with mean age 25.5 (range, 19 to 38), and with a mean follow-up of 47 months (range, 36 to 60) after the revision with distal tibial allograft. All patients after their Latarjet presented with recurrent shoulder dislocation (11/31) or recurrent subluxation (20/31) and all patients had recurrent shoulder instability on examination. Radiographs demonstrated two fixation screws in all cases, mean SP grade of 0.5 (range, I to III), and CT scan demonstrated that mean 78% of the Latarjet coracoid graft had resorbed (range, 50% to 100%). Preoperative outcomes improved for ASES (40 to 92, p=0.001), SANE (44 to 91, p=0.001), and WOSI (1300 to 310, p=0.001). There were no recurrences, and a final CT scan of the distal tibia revision demonstrated a mean 92% of DTA remained, but 98% union at the glenoid-DTA interface. Conclusion: Although the failed Latarjet with subsequent instability remains a challenge, treatment with fresh a distal tibial allograft provided substantial improvement in terms of stability and function. The vast majority of the failed Latarjet procedures had near complete resorption of the coracoid graft and many had hardware complications. Additional long-term studies are necessary to determine the efficacy of this challenging revision population.

Functional outcome of latarjet’s procedure for recurrent shoulder dislocation

Background: Recurrence of anterior shoulder instability is disabling condition for which treatment options have been insufficiently studied. Our patients don’t seek definitive treatment initially, hence they tend to have engaging hill sacks with or without bony bank arts defect. Coracoid transfer as described by Latar jet and modified by Joe De Beer is one surgery which is suited for recurrent shoulder dislocations. There are various papers mentioning different results. Hence the purpose of this study was to know the functional outcome at two years duration in our set of patients with variable age and occupation.Methods: A cohort formed the basis of retrospective series study was done in tertiary care medical college hospital in Mangalore, Karnataka, India involving twenty-seven patients who underwent Latar jet procedure with congruent ark modification for recurrent anterior glen humeral instability by a single Orthopaedic surgeon in our Institute during July 2015 and Jan 2018. Twenty-four patients were available for follow-up. Clinical outcomes at a mean of three, twelve and twenty-four months postoperatively assessed by the Rowe and SPADI (Shoulder Pain and Disability Index) scores. Standardized anteroposterior and axial radiographs were used to assess the graft position and union.Results: No shoulder dislocations or subluxations observed post-surgery. Unspecified shoulder symptoms of pain were present in two patients. We noticed that there was significant increase in the functional outcome between the 3rd, 12th and the 24th month follow up. At the end of 24months follow up sixteen patients had excellent and remaining eight had good results in terms of Rowe scoring.Conclusions: Later jet procedure with congruent arc modification and adequate rehab can effectively restore anterior glen humeral shoulder stability with good functional results.

Evaluation of arthroscopic Bankart repair in recurrent shoulder dislocation

<p class="abstract"><strong>Background:</strong> Our aim was to study the surgical and functional outcome and postoperative shoulder motion following, arthroscopic repair of the Bankart lesion of the shoulder with suture anchors.</p><p class="abstract"><strong>Methods:</strong> This was a study of arthroscopic Bankart repair in recurrent anterior shoulder dislocation with suture anchors in 20 patients. Most of patients had symptoms for a period ranging from 1 to 2 years and 1- 4 recurrent dislocation episodes preoperatively. Necessary radiological and haematological investigations were done. The post-operative x-rays were evaluated and the post-operative rehabilitation evaluation done at 3 weeks, 6 weeks, 12 weeks, 6 months and 1 year, for any recurrence of symptoms.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study of 20 patients, with the mean follow up period of 12 months, the mean Rowe score post-operatively improved to 94 from a pre-operative mean score of 56.25. Out of 20 patients none had episodes of recurrent dislocation. In 15 patients 3 suture anchors were used and in 5 patients 2 suture anchors used intra operatively. The range of movement – external rotation in 90º of abduction improved in 17 patients (85%).</p><p><strong>Conclusions:</strong> We concluded that arthroscopic Bankart repair in recurrent anterior shoulder dislocation with suture anchors is effective in providing better shoulder function with range of movement and lower rate of recurrence.</p>

A functional Magnetic Resonance Imaging study of patients with Polar Type II/III complex shoulder instability

The pathophysiology of Stanmore Classification Polar type II/III shoulder instability is not well understood. Functional Magnetic Resonance Imaging was used to measure brain activity in response to forward flexion and abduction in 16 patients with Polar Type II/III shoulder instability and 16 age-matched controls. When a cluster level correction was applied patients showed significantly greater brain activity than controls in primary motor cortex (BA4), supramarginal gyrus (BA40), inferior frontal gyrus (BA44), precentral gyrus (BA6) and middle frontal gyrus (BA6): the latter region is considered premotor cortex. Using voxel level correction within these five regions a unique activation was found in the primary motor cortex (BA4) at MNI coordinates -38 -26 56. Activation was greater in controls compared to patients in the parahippocampal gyrus (BA27) and perirhinal cortex (BA36). These findings show, for the first time, neural differences in patients with complex shoulder instability, and suggest that patients are in some sense working harder or differently to maintain shoulder stability, with brain activity similar to early stage motor sequence learning. It will help to understand the condition, design better therapies and improve treatment of this group; avoiding the common clinical misconception that their recurrent shoulder dislocations are a form of attention-seeking.

Impact of Remplissage on Global Shoulder Outcome: A Long-Term Comparative Study

To evaluate the global function of patients treated by arthroscopic shoulder stabilization with or without remplissage at a minimum of 10years of follow-up. The inclusion criteria were existence of a recurrent anterior shoulder dislocation, with or without a Hill-Sachs lesion. The exclusion criteria were prior shoulder stabilization surgery and patients with a glenoid lesion that had been stabilized using the Latarjet procedure. Included patients with a Hill-Sachs lesion underwent surgical remplissage, and the others had Bankart repair only. The main criterion for failure was recurrence of instability or apprehension. The Rowe score and the Walch-Duplay score were used to assess shoulder function before surgery and 10years afterward, in clinical reviews or telephone interviews. Seventy-nine patients underwent surgical Bankart repair with or without remplissage between November 2004 and January 2008 and were followed up for a mean duration of 128months (range, 120-150); 12 patients were lost to follow-up, and 39 patients had Bankart stabilization only: the mean Instability Severity Index Score was 2.3 (range, 0-6). Three patients had recurrence with new dislocation, and 8 patients had apprehension. The Rowe score progressed from 54.3 (range, 25-65) to 83.8 (range, 70-100; P < .01), and the Walch-Duplay score rose from 46.8 (range, 25-75) to 85.6 (range 70-100; P < .01). Twenty-eight patients had arthroscopic Bankart repair+ remplissage; the mean Instability Severity Index Score was 1.8 (range, 1-4). There was no recurrence, and no patient had apprehension. The Rowe score progressed from 51.8 (range, 20-65) to 92.3 (range, 70-100; P<.01), and the Walch-Duplay score rose from 58.7 (range, 30-75) to 91.4 (range, 70-100; P < .01). Functional scores in the second group were statistically significant better than in the first one. Bankart repair combined with remplissage seems to be an effective method for restoring joint stability in patients with recurrent anterior shoulder dislocation with an associated Hill-Sachs lesion at a minimum of 10years of follow-up. This technique appears to deliver better functional results than Bankart repair only, showing better scores for mobility and stability in the remplissage group. Limitations (pain and restriction of motion) reported in literature at short-term follow-up for this technical procedure do not seem to be anymore an issue at long-term follow-up. Level III, retrospective comparative study.

Comparison of Clinical Outcomes and Computed Tomography Analysis for Tunnel Diameter After Arthroscopic Bankart Repair With the All-Suture Anchor and the Biodegradable Suture Anchor

To compare the clinical outcomes and radiological findings at the anchor site after arthroscopic Bankart repair with all-suture anchors and biodegradable suture anchors in patients with recurrent anterior shoulder dislocation. The patients who underwent arthroscopic Bankart repair were divided into 2 groups depending on the type of the suture anchor used in different periods. Power analysis was designed based on the postoperative Rowe score. Clinical outcomes, including the Rowe score, American Shoulder and Elbow Surgeons score, subjective instability, and redislocation rates were evaluated. In all patients enrolled, the tunnel diameter of the anchor was assessed with computed tomography arthrogram at 1year postoperatively. The Institutional Review Board of Ewha Womans University approved this study (no. EUMC 2017-05-058). A total of 67 patients were enrolled: 33 underwent surgery with a 1.3-mm (single-loaded) or 1.8-mm (double-loaded) all-suture anchor (group A), and 34 underwent surgery with a 3.0-mm biodegradable anchor (10.8mm in length, 30% 1,2,3-trichloropropane/70% poly-lactide-co-glycolic acid) (group B). There were no significant differences in clinical outcomes between groups A and B in the American Shoulder and Elbow Surgeons score (preoperatively, 51.2 ± 13.7 vs 47.7 ± 12.2; 2years postoperatively, 88.5 ± 12.3 vs 89.7 ± 10.9; P= .667) and Rowe score (preoperatively, 41.4 ± 10.5 vs 41.3 ± 9.4; 2years postoperatively, 87.9 ± 14.9 vs 88.5 ± 14.6; P= .857). Postoperative redislocation (6.1% vs 5.9%, P= .682) and subjective instability rate (12.2% vs 17.7%, P= .386) of both groups showed no significant difference. Average tunnel diameter increment was significantly greater with the 1.8-mm all-suture anchor (2.8 ± 0.9mm) than the 1.3-mm all-suture anchor (1.2 ± 0.8mm) and 3.0-mm biodegradable anchor (0.8 ± 1.2mm)(P < .001). Arthroscopic Bankart repair with the all-suture anchor showed comparable clinical outcomes and postoperative stability as the conventional biodegradable suture anchor at 2years after surgery. Tunnel diameter increment of the all-suture anchor was significantly greater than that of the biodegradable suture anchor at the 1-year computed tomography analysis. Although tunnel diameter increment was greater with the all-suture anchor, it did not influence the clinical outcomes. Level III, retrospective comparative study.

Patients with non-operated traumatic primary or recurrent anterior shoulder dislocation have equally poor self-reported and measured shoulder function: a cross-sectional study

BackgroundPatients with non-operated traumatic primary anterior shoulder dislocation (PASD) are assumed to have less shoulder impairment than patients with recurrent anterior shoulder dislocations (RASD). This may impact treatment decision strategy. The aim was to study whether patients with non-operated traumatic PASD have less shoulder impairment than those with RASD.MethodsIn a cross-sectional study baseline data from patients with PASD and RASD in a randomised controlled trial of non-operative shoulder exercise treatment were used. Shoulder function was self-reported (Western Ontario Shoulder Instability (WOSI), Tampa Scale of Kinesiophobia (TSK), General Health (EQ-5D-VAS), Numeric Pain Rating Scale (NPRS)), and measured (Constant-Murley shoulder Score (CMS total), CMS - Range of Motion (CMS-ROM, CMS – strength, proprioception, clinical tests).ResultsIn total, 56 patients (34 (28 men) with PASD and 22 (21 men) with RASD) (mean age 26 years) participated. WOSI total was 1064 and 1048, and TSK above 37 (indicating high re-injury fear) was present in 33 (97%) and 21 (96%) of the groups with PASD and RASD, with no group difference. CMS total (66.4 and 70.4), CMS-ROM (28.7 and 31.5), CMS-strength (injured shoulder: 7.6 kg and 9.1 kg), proprioception and clinical tests were the same. Furthermore, 26 (76%) with PASD and 13 (59%) with RASD reported not to have received non-operative shoulder treatment.ConclusionsNon-operated patients with PASD and self-reported shoulder trouble three-six weeks after initial injury do not have less shoulder impairment (self-reportedly or objectively measured) than non-operated patients RASD and self-reported shoulder trouble three-six weeks after their latest shoulder dislocation event.

Upper extremity conversion disorder in children

Conversion disorder in children presents a challenge to orthopedic surgeons. The condition is frequently associated with unnecessary diagnostic tests, treatments, and cost. The purpose of this study was to report a series of children with upper extremity conversion disorder to raise awareness for this uncommon condition and to assist with its diagnosis and management. A retrospective review was conducted of 4 pediatric patients with upper extremity conversion disorder at a tertiary pediatric hospital from 2015 to 2017. Medical records were reviewed for patient demographics, including psychiatric history, clinical findings, diagnostic studies, treatment, and cost of care. Patients presented with upper extremity muscle stiffness, unremitting dysmorphic muscle spasms, weakness, pain, very limited shoulder range of motion, and complaints of recurrent shoulder dislocations. All patients had been evaluated by multiple specialists and had an extensive prior diagnostic workup that was inconclusive. Two patients had a history of prior psychiatric illness and suicidal ideation, and all patients expressed despair and depression. All patients had normal physical examination findings under anesthesia. Two patients with muscle stiffness were treated with botulism injections and improved their shoulder range of motion. The average total charge for care since presentation was $42,729. Conversion disorder should be considered in patients with an extensive prior diagnostic workup, deficits inconsistent with anatomic patterns or imaging findings, and a history of prior psychiatric illness. Examination under anesthesia is a successful diagnostic approach in children with suspected conversion disorder.

Arthroscopic Findings and Clinical Outcomes in Patients 40 Years of Age and Older With Recurrent Shoulder Dislocation

The present study investigates the intra-articular findings and clinical outcomes after arthroscopic surgery in patients after age 40 with chronic anterior shoulder instability. Fifty patients older than 40years who underwent arthroscopic stabilization for recurrent anterior shoulder dislocation were analyzed. The mean age at the time of surgery was 44.8years (range, 40-72years), and the mean duration of follow-up was 45months (range, 28-150months). The mean visual analog scale score for pain with motion significantly improved from 4.1 preoperatively to 1.7 at the last follow-up (P < .001). The range of motion in the affected shoulder revealed limitations of 9.4° in forward flexion and 17.8° in external rotation compared with the unaffected shoulder. Both the Constant and Rowe scores significantly improved (P < .001 and P < .001, respectively). Recurrence, which includes dislocation and subluxation, occurred in 14% postoperatively. Anteroinferior labral lesion was seen in 92% of patients. Associated lesions included superior labrum anterior to posterior lesion (22%), midsubstance capsular tear (10%), and Hill-Sachs lesion (92%). Rotator cuff tears were found in 18%-partial-thickness tear in 10% and full-thickness tear, which was repaired with suture anchor, in 8%. Among the intra-articular lesions, there was no significant relation with recurrent instability or functional outcome as a single factor. In patients with chronic anterior shoulder instability who were older than 40years, the clinical results after arthroscopic surgery showed statistically significant improvement with good muscle strength recovery. The quality of labral lesion, size of the Hill-Sachs lesion, and glenoid defect showed positive correlation with the number of preoperative dislocation. The intra-articular pathologies were varied, however no single articular lesion had significant impact on the recurrence rate. Level IV, case series.

Arthroscopic Bankart Repair with Subscapularis Augmentation in The Treatment of Recurrent Anterior Shoulder Instability with Bone Loss

Background: In this study, we focused on the analysis of new published surgical technique in the management of recurrent anterior shoulder dislocation in presence of glenoid bone defect using traditional Bankart repair augmented with subscapularis tendon. Method: This prospective study was performed on 30 patients having recurrent anterior shoulder dislocation; these patients were managed between January 2016 and December 2018, Thirty-one shoulders in thirty-one patients had arthroscopic Bankart repair and subscapularis augmentation. One patient was lost to follow up; thirty patients with thirty shoulders were evaluated using American shoulder and elbow surgeons score, the percentage of glenoid bone defect was evaluated using PICO method. Results: 30 patients were followed for 22.03 Months range 16 – 24 Months. Only one patient had recurrent dislocation after significant trauma. The American Shoulder and Elbow Surgeon Score (ASES) shows significant improvement in score from Mean ± SD 13.27 ± 3.24 to 23.47 ± 3.14 after, function Mean ± SD from 6.23 ± 2.01 to 8.83 ± 0.75 and pain decrease from Mean ± SD 6.17 ± 1.53 to1.33 ± 0.80, with no significant functional changes in ROM even ER at 90 abduction Mean ± SD changes from 79.00 ± 9.95 to 77.33 ± 7.85 or ER at side Mean ± SD changes from 68.67 ± 18.14to 66.33 ± 15.31. Conclusion: The procedure of Bankart repair with Arthroscopic Subscapularis Augmentation (ASA) is an effective procedure in the management of recurrent anterior shoulder dislocation associated with GBD ≤ 25% with good results.

Arthroscopic Bankart repair following traumatic recurrent shoulder dislocation: A prospective review of 30 cases.

Literature on outcomes of arthroscopic Bankart repair at the intervening time intervals in traumatic recurrent dislocation of shoulder joint is limited. Case series. A prospective review of 30 shoulders, aged 20-40 years with clinically and magnetic resonance imaging established findings that were treated with primary arthroscopic Bankart repair and followed up for a minimum of 2 years. Outcomes were evaluated using Rowe score and University of California at Los Angeles (UCLA) scoring system. The mean age was 26.40 years. All patients had definite trauma history. Average number of dislocation was 13.77 + 18.435 (range: 3-100). Time duration from first dislocation to surgery was an average of 4.80 + 3.576 years. The average size of the lesion was approximately 31% of the glenoid circumference. The number of suture anchors used for fixation did not correlate significantly with any of the scores. The mean Rowe and UCLA scores were 94.16 ± 9.7 and 33.83 ± 3.32, respectively, at final follow-up. The average duration of hospital stay was 7 days. Of the 30 patients, 2 (6.66%) had dislocation events post-operatively. Returns to pre-injury level were available for 27 (90%) of 30 patients. Multivariate analysis of independent Variables: age; side and number of dislocations, time to surgery, duration of surgery, size of lesion, number of anchors, and concurrent Hill-Sachs lesion, shown to have no significant relationship to outcomes. Arthroscopic Bankart repair is an effective and safe technique for treating anterior glenohumeral instability in patients with recurrent traumatic shoulder dislocation.

Outcome of the influence of remplissage repair on shoulder range of motion after arthroscopic bankart repair

Recurrent shoulder dislocation can predispose to Hill-Sach’s lesion. Failure to address humeral osseous defects during arthroscopic stabilization surgery leads to an increased rate of recurrence. This procedure is not much studied in terms of Range of Motion. To further study it we have done a prospective study of 2 patient populations (arthroscopic Bankart repair alone vs Bankart and remplissage). Main clinical outcome was the range of motion within Minimum follow-up was 2 years while Total Patients in each Group taken was 50. In arthroscopic remplissage, the posterior capsule and infraspinatus are sutured into the humeral head. The rate of recurrence was identical in both groups (6.25%) while the range of movement were significantly more in patients where remplissage repair was done along with bankart repair. When compared with Walch-Duplay score we got excellent result in 45 patients where remplissage repair was done out of 50 patients whereas with remplissage excellent range of movement was only 42 patients out of 50 patients. Our study to have some limitation like Sample size was small. All procedures were performed by the same surgeon. Study included postoperative care and follow-up assessments; therefore, the results of this study may not reflect general surgical outcomes of the procedure. The same operative indications and consistent surgical technique were applied in all patients. The conclusion of the study was its always better to do remlissage along with bankart repair for better result in term of range of movement.

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

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

Analysis of the functional outcome in patients following mini-open latarjet procedure for the treatment of anterior instability of shoulder

More than 200 different operations have been described for the treatment of recurrent anterior dislocation of shoulder. The Latarjet procedure employs re-routing of the osteotomised coracoid process with its attached conjoined tendon through a split in the substance of sub scapularis and fixed to the antero inferior aspect of glenoid rim. The present study is done to analyse the functional outcome of Latarjet procedure by mini-open technique in recurrent anterior shoulder dislocations with or without bony Bankart lesion/ Hillsachs lesion. A total of 25 (23 men and 2 women). patients managed by mini open Latarjet technique with a 4-5 cms long incision(3cm in young females) and splitting the subscapularis tendon were followed up for a minimum of one year. Patients were evaluated using ROWE instability score, Oxford Shoulder Instability index Score at the last follow up. The mean external rotation achieved was 60 degrees (45-70 degrees). Mean abduction was 160 deg (150-180 deg).There was no single episode of recurrence of dislocation or subluxation, all the patients regained preoperative range of motion. Mean ROWE score is 90(excellent) & mean oxford shoulder instability index is 38.1(good). One patient has developed fibrous union (4%). None has developed osteoarthritic changes. The classic Open Latarjet procedure results in a large scar and decreased external rotation. Adequate exposure can be obtained by a mini open incision with splitting of the subscapularis. In our technique we split subscapularis at its distal edge in order to place the bone block in right position only splitting of the subscapularis tendon leads to better outcomes with a smaller scar. Latarjet procedure is an excellent surgical option for recurrent shoulder instability associated with glenoid bone deficiency with or without engaging hill Sachs lesion.

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

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

The Notch Types of the Glenoid Cavity in Adult Dry Human Scapulae

Purpose: The glenoid cavity is a shallow pear shaped articular fossa which is located on the lateral angle of the scapula. To clarify normal glenoid cavity morphometry is important for restoration of normal anatomy which is the goal in orthopedic surgery. The purpose of the present study is to explore the presence or absence of the glenoid notch and the distribution of the type variations of glenoid cavity in dry scapulae bones.Methods: 63 adult dried human scapulae with unknown ages and gender belonging to the Anatomy Department Laboratory of Dokuz Eylül University, School of Medicine were examined macroscopically. The presence or absence of notch and notch types were evaluated.Results: The number % of notch types of glenoid cavity of 63 scapulae, in descending order, were as follows: type 1a 24 38.10% , type 2a 17 26.98% , type 0 13 20.63% , type 2b 6 9.53% , type 1b 3 4.76% . We determined that the most observed type of notch of glenoid cavity was type 1a and the least observed type was type 1b.Conclusion: In the treatment of the recurrent shoulder subluxations or dislocations, orthopedic surgeons need to pay attention to the presence or absence and the types of the notches at the glenoid cavity

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

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

Long Head of Biceps Tendon Transfer for Anterior Shoulder Instability

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

Arthroscopic Bankart Repairs With and Without Remplissage in Recurrent Adolescent Anterior Shoulder Instability With Hill-Sachs Deformity.

Background:Recurrent shoulder dislocation after surgical intervention in adolescents with anterior instability is now understood to occur with a relatively high frequency. The remplissage procedure is successfully used in the adult population to mitigate the ability of a Hill-Sachs lesion to engage the anterior glenoid and can be used during an arthroscopic Bankart repair for anterior shoulder instability.Purpose:To compare the clinical outcomes in adolescent patients who underwent a Bankart repair with or without remplissage for treatment of recurrent anterior shoulder instability and associated Hill-Sachs defects.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective review was conducted on adolescents who underwent a remplissage procedure for recurrent anterior shoulder instability from 2009 to 2017 at a single institution. Controls were identified in a cohort of patients who underwent a Bankart repair only and were matched based on age, sex, and size of Hill-Sachs lesion. All patients were then contacted to determine instability recurrence as well as to complete the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) and the Pediatric Adolescent Shoulder Score (PASS) outcome surveys.Results:Twenty-one adolescents underwent a remplissage procedure, and 20 matched controls underwent only a Bankart procedure. A significantly higher rate of recurrence was noted in the Bankart-only patients (8/17) compared with remplissage patients (2/15) (P = .04). No statistical difference was found in patient-reported outcome scores between treatment groups or in range of motion measurements (P > .05). In a subset of patients in the remplissage group with pre- and postoperative surveys available, mean ± SD scores for PASS (77 ± 11) and QuickDASH (19 ± 12) improved when compared with preoperative scores (PASS, 54 ± 16; QuickDASH, 35 ± 28), but only the PASS score was statistically improved (PASS, P = .003; QuickDASH, P = .23).Conclusion:The addition of the remplissage procedure to a Bankart repair is a reasonable surgical option to treat a Hill-Sachs deformity in adolescents with anterior shoulder instability. The success of this additional procedure may be due to filling the Hill-Sachs defect, or perhaps it augments stability through a mechanism of posterior capsulorrhaphy. Either way, this young athletic population appears to have a lower rate of recurrence and improved patient-reported outcomes with a remplissage procedure to address the Hill-Sachs deformity.