Rowe Score Research Articles

Arthroscopic reduction internal fixation for glenoid fractures: a systematic review of the outcomes and complications.

With the advanced arthroscopic technique, arthroscopic-assisted reduction and internal fixation (ARIF) is gaining popularity for Glenoid fractures with and without scapular involvement. ARIF offers a complete view of the articular surfaces and diagnoses and treats other associated injuries. ARIF provides less soft tissue trauma than open reduction internal fixation (ORIF). The aim of this systemic review is to look at the functional outcomes and complications of ARIF. A systematic review of the PubMed, Embase, and Scopus databases was performed. The search terms included "glenoid fracture" OR "scapula fracture" AND "arthroscopic fixation" OR "arthroscopy" OR "arthroscopic-assisted reduction and internal fixation". Studies were limited to English publications with reported functional outcome measures and complications. Patient demographic characteristics, clinical outcomes including range of motion, outcome performance scores including ROWE score, visual analogue scale and American shoulder and elbow surgeons score and complications were extracted. Five studies met the inclusion criteria. The participants ranged in age from 41 to 48, and the mean length of follow-up ranged from 12 to 41months postoperatively. The mean ROWE scores for the ARIF group were significantly better postoperatively. ARIF allows accurate diagnosis of the fracture pattern and associated injuries, in addition to representing a safe option to treat glenoid fractures with or without scapular fractures with fewer complications compared to ORIF. Level of Evidence: Level IV, Systematic review.

Surgical management and results of glenohumeral combination fractures of the anterior glenoid rim and the proximal humerus.

The combination of anterior large glenoid rim fractures (GRF) and proximal humerus fractures (PHF) is rare, with limited data available on specific treatments for these glenohumeral combination fractures (GCF). This study aimed to evaluate the treatment approaches for GCF, analyze patient outcomes, and outline surgical management strategies for different fracture types. This retrospective study included patients with GCF, excluding those with fossa glenoidalis fractures, isolated greater tuberosity fractures, or small glenoid rim fractures (< 5mm). Preoperative radiographs, CT scans, and follow-up radiographs were reviewed. Clinical outcomes were assessed using the Constant-Murley Score (CMS), Western Ontario Shoulder Instability Index (WOSI), Rowe Score (RS), and Oxford Shoulder Score (OSS). Sixteen patients with 17 GCFs (mean age 62years) were followed for an average of 39months. PHFs were categorized into three-part (76%), four-part (12%), and two-part fractures (12%). The average medial displacement of GRF was 5mm, with an average dehiscence of 4mm in the sagittal plane. Fourteen patients (88%) underwent surgical treatment; 35% had only the PHF surgically addressed, while 53% had both lesions surgically treated. Two patients (12%) received non-operative treatment. Complications were observed in 29% of cases, primarily involving the humeral side. The average CMS was 68 points, WOSI was 75%, RS was 77 points, and OSS was 41 points. Treating GCF is complex and routinely necessitates surgical intervention, with or without GRF refixation. CT imaging is crucial for precise assessment of fracture morphology. The involvement of the minor tuberosity is critical in selecting the optimal surgical approach and managing the subscapularis muscle.

Preoperative patient-reported outcome measures predict minimal clinically important difference and patient-acceptable symptomatic state following arthroscopic Bankart repair.

The aims of this study were to validate the minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) thresholds for Western Ontario Shoulder Instability Index (WOSI), Rowe score, American Shoulder and Elbow Surgeons (ASES), and visual analogue scale (VAS) scores following arthroscopic Bankart repair, and to identify preoperative threshold values of these scores that could predict the achievement of MCID and PASS. A retrospective review was conducted on 131 consecutive patients with anterior shoulder instability who underwent arthroscopic Bankart repair between January 2020 and January 2023. Inclusion criteria required at least one episode of shoulder instability and a minimum follow-up period of 12 months. Preoperative and one-year postoperative scores were assessed. MCID and PASS were estimated using distribution-based and anchor-based methods, respectively. Receiver operating characteristic curve analysis determined preoperative patient-reported outcome measure thresholds predictive of achieving MCID and PASS. MCID thresholds were determined as 169.6, 6.8, 7.2, and 1.1 for WOSI, Rowe, ASES, and VAS, respectively. PASS thresholds were calculated as ≤ 480, ≥ 80, ≥ 87, and ≤ 1 for WOSI, Rowe, ASES, and VAS, respectively. Preoperative thresholds of ≥ 760 (WOSI) and ≤ 50 (Rowe) predicted achieving MCID for WOSI score (p < 0.001). Preoperative thresholds of ≤ 60 (ASES) and ≥ 2 (VAS) predicted achieving MCID for VAS score (p < 0.001). A preoperative threshold of ≥ 40 (Rowe) predicted achieving PASS for Rowe score (p = 0.005). Preoperative thresholds of ≥ 50 (ASES; p = 0.002) and ≤ 2 (VAS; p < 0.001) predicted achieving PASS for the ASES score. Preoperative thresholds of ≥ 43 (ASES; p = 0.046) and ≤ 4 (VAS; p = 0.024) predicted achieving PASS for the VAS. This study defined MCID and PASS values for WOSI, Rowe, ASES, and VAS scores in patients undergoing arthroscopic Bankart repair. Higher preoperative functional scores may reduce the likelihood of achieving MCID but increase the likelihood of achieving the PASS. These findings provide valuable guidance for surgeons to counsel patients realistically regarding their expectations.

Outcomes of Arthroscopic Cortical-Button Latarjet Procedure with Minimum Five Year Follow-Up

IntroductionThe surgical treatment of anterior shoulder instability with arthroscopic cortical-button Latarjet procedure has been the subject of very few medium and long-term studies. The aim of this study was to analyze the clinical and radiological results of arthroscopic cortical-button Latarjet procedure with minimum 5 years follow-up. MethodThis is a monocentric retrospective study including 40 patients who have undergone shoulder stabilization with primary arthroscopic cortical-button Latarjet procedure and been reviewed with minimum 5 years follow-up. The average age at the time of surgery was 26.6 years (16 – 59; ± 10) and 92.5% were sporty individuals. The average ISI score was 6 points (2- 9; ± 1,6). The clinical evaluation involved active range of motion measurement, apprehension test, Rowe and Walch-Duplay scores, SSV and Net Promoter Score. Radiologically, evolution of the bone graft and degenerative arthritis of the shoulder joint were analyzed at the last follow-up. ResultsAt an average follow-up of 71 months (60 – 97; ± 12), 3 patients (7.5%) experienced recurrence as a dislocation or subluxation, which was responsible for revision in 1 case. Moreover, apprehension persisted in 6 (16%) patients. There were no significant restrictions in recovery of active ranges of motion, including external rotation. Return to sports was effective in 94.6% of cases. The average Rowe and Walch-Duplay scores were 87 points (15 - 100; ± 20) and 88 points (15 - 100; ± 19) respectively. SSV was 91% (10 – 100; ± 16) and NET Promoter Score was 9.3 points (5 – 10; ± 1,3). Radiologically, degenerative arthritis occurred in 18.7% of patients, mainly asymptomatic stage 1 (9.4%). Bone healing was acquired in 72% of cases and partial lysis of the bone block in 41%. ConclusionAt an average follow-up of 6 years, arthroscopic cortical-button Latarjet procedure effective, enabling return to sport in 95% of cases. Onset of asymptomatic arthritis seems similar to conventional techniques but justifies a more long-term follow-up.

Arthroscopic Trillat technique for chronic anterior shoulder instability: outcomes at 2 years follow-up in 74 at risk sport-patient

BackgroundChronic anterior shoulder instability affects a young and athletic population, with a high demand for functional recovery and return to sport. Arthroscopic Trillat dynamic stabilization technique has shown great results at 2 years in terms of stabilization and functional outcomes on general population. The hypothesis is that it could do so in at-risk for dislocation athletic population for stabilization and return to sport, with results comparable to the reference techniques. MethodsMulticenter retrospective study of Walch-Duplay type 2, 3 and 4 at risk sports patients treated by arthroscopic Trillat for chronic anterior shoulder instability between January 2012 and January 2021, at a two years follow-up. Primary endpoint: occurrence of dislocation recurrence. Secondary endpoints: subluxation recurrence, functional outcomes, time and level of return to sport, functional scores, bony fusion and complications. Results74 patients were analyzed, with a mean age of 24.4 years (15-50). Sports level was, moderate risk of dislocation Walch-Duplay type 2 for n=34 (46%), medium risk Walch- Duplay type 3 for n=19 (26%) and high-risk Walch-Duplay type 4 for n=21 (28%). Recurrence of dislocation occurred in 3 patients (4.1%). 100% of patients returned to sport, with an average delay of 4.6 months, with n=56 (76%) returning to the same previous level. The mean Constant score was 94.5 (79-100), the Rowe score 94.7 (70-100), the Walch-Duplay score 90.2 (50-100) and the SSV score 90.5 (65-100). Subgroup analysis of athletes at moderate risk of dislocation recurrence (Walch-Duplay type 2) vs. medium and high risk of dislocation recurrence (Walch-Duplay type 3 and 4) revealed no statistically significant difference. One patient presented with asymptomatic pseudarthrosis. ConclusionArthroscopic Trillat offers highly satisfactory results in the treatment of chronic anterior shoulder instability for athletes regardless of the type of sport practised and type of risk according to Walch-Duplay. This simple and quick technique enables a rapid return to sport and at the previous level in the majority of cases. After showing its effectiveness in the general population at two years, arthroscopic Trillat offers a reliable alternative to the reference procedures in young athletic patients.

Additional Scapular Spine Bone Grafting Combined with Bankart and Remplissage for Off-Track Hill-Sachs Lesions with Subcritical Glenoid Bone Loss: Provides Better Stability.

Arthroscopic Bankart repair combined with remplissage and autologous scapular spine bone grafting have been described as a treatment for off-track Hill-Sachs lesions with subcritical glenoid bone defects in the anterior shoulder instability. However, whether these two techniques can achieve satisfactory postoperative outcomes is unclear, and there are few comparative studies between them. Therefore, this study compared the postoperative efficacy of the two techniques for off-track Hill-Sachs lesions with subcritical glenoid bone loss. Between June 2017 and December 2020, 62 patients with shoulder instability due to Off-Track Hill-Sachs lesions with subcritical glenoid bone loss underwent surgical treatment and were included in this regression study. Thirty-two patients underwent arthroscopic Bankart repair combined with remplissage (B + R group), and 30 patients underwent additional autologous scapular glenoid bone grafting (additional bone grafting group). The general information of the patients was recorded. The patient's activity before and after surgery was recorded. The DASH score and Constant-Murley (CM) score were used to assess the patient's functional status; the Rowe score was used to evaluate the patient's shoulder stability. The shoulder function and stability before and after surgery were analyzed and compared between the two groups. The final DASH scores of the B + R group and the additional bone grafting group were significantly lower than those before surgery, with a statistically significant difference (9.76 ± 4.32 vs. 27.89 ± 6.63, 8.50 ± 3.32 vs. 28.0 ± 4.27, p = 0.000); the final CM scores of the two groups were significantly higher than those before surgery (88.71 ± 3.74 vs. 73.68 ± 3.74, 87.16 ± 2.29 vs. 71.37 ± 2.68, p = 0.000). There was no statistical difference in the final DASH score and final CM score between the two groups (p > 0.05). In terms of postoperative stability, the final Rowe scores of the two groups were significantly higher than those before surgery, with a statistically significant difference (89.06 ± 9.19 vs. 41.71 ± 4.13; 93.16 ± 4.99 vs. 42.33 ± 2.53, p = 0.000). Compared with the control group, the additional bone graft group achieved higher final Rowe scores (93.16 ± 4.99 vs. 89.06 ± 9.19, p = 0.032). For patients with anterior shoulder instability due to off-track Hill-Sachs lesions with subcritical glenoid bone loss, although Bankart and remplissage can achieve satisfactory clinical results, additional autogenous scapular spine bone grafting can provide better stability of the shoulder, especially for patients with high sports demands.

Promising clinical effect of arthroscopic autologous iliac bone grafting with suture anchor binding fixation for recurrent anterior shoulder instability.

To evaluate the clinical efficacy of arthroscopic autologous iliac bone grafting with suture anchor binding fixation combined with a Bankart repair for recurrent anterior shoulder dislocation with a significant anterior glenoid defect. Patients with recurrent anterior shoulder dislocation with an anterior glenoid defect area greater than 20% admitted to our department from March 2019 to March 2022 were prospectively enrolled. Arthroscopic autologous iliac bone grafting with suture anchor binding fixation combined with a Bankart repair was performed. Computed tomography (CT) images were captured preoperatively, immediately after surgery, and at 3, 6, and 12 months postoperatively to evaluate the glenoid defect area, graft area, and graft healing. Shoulder function was assessed using the Instability Severity Index, Oxford Shoulder Instability, and Rowe scores recorded preoperatively and at the final follow-up. The shoulder range of motion, shoulder stability test, surgery-related complications, subluxation/dislocation, and revision surgery were also evaluated. A total of 32 patients were included in the study, with an average follow-up time of 18.3 ± 6.3 months, when the graft healing rate was shown to be 100%. The area ratio of the graft to the glenoid was 37.6% ± 10.5% (range, 23.5%-44.1%) determined by an enface-view three-dimensional CT performed immediately after surgery, and 29.2 ± 8.2% (range, 19.6%-38.7%) at 12 months postoperatively. At the final follow-up, the glenoid defect had improved from 28.7 ± 6.4% (range, 20.5%-40.6%) before surgery to -10.2 ± 4.7% (range, -13.8% to 6.1%). The preoperative Rowe and Oxford scores were 56.4 ± 8.5 and 34.7 ± 7.1 respectively, which improved to 94.3 ± 6.7 and 15.3 ± 3.2 at the final follow-up (p < .001). All patients had no limited shoulder joint activity, no re-dislocation or revision surgery, and no neurovascular injury. For recurrent anterior shoulder dislocation with an anterior glenoid defect area greater than 20%, arthroscopic autologous iliac bone grafting with suture anchor fixation combined with a Bankart repair produced a promising clinical effect. A significant shoulder function score was achieved, as was a 100% bone healing rate and ideal glenoid reconstruction without major complications. Thus, this technique may be considered an alternative to the classic Latarjet approach to treat recurrent anterior shoulder dislocation with an anterior glenoid defect area greater than 20%. IV.

Association of the Inlay Structure Used in the Modified Bristow Procedure With Accelerated Bone Union: Comparing the Cuistow and Modified Bristow Procedures.

The Chinese unique inlay Bristow (Cuistow) procedure is a modified Bristow surgery in which an inlay (mortise-and-tenon) structure is added to the contact surface between the coracoid tip and the glenoid. Patients who have undergone the Cuistow procedure have had satisfying clinical performance and excellent postoperative bone healing rates (96.1%). To compare the clinical and radiographic outcomes after the arthroscopic Cuistow procedure and the arthroscopic Bristow procedure. Cohort study; Level of evidence, 3. A total of 91 patients who underwent either the Cuistow or Bristow procedure between January 2017 and March 2018 were selected, and 69 patients (70 shoulders; 35 in the Cuistow group and 35 in the Bristow group) were included. Clinical assessment at minimum 24 months postoperatively, including the visual analog scale for pain and instability, American Shoulder and Elbow Surgeons score, Rowe score, subjective shoulder value score, and active range of motion, was completed by independent observers and compared with values collected preoperatively. Assessment with 3-dimensional computed tomography scans was performed preoperatively; immediately after the operation; at 3, 6, and 12 months postoperatively; and at the final follow-up. A total of 69 patients (70 shoulders) were included, with a mean follow-up duration of 34.41 ± 5.99 months (range, 24-50 months). Both groups saw significant improvement in visual analog scale for pain and instability, American Shoulder and Elbow Surgeons, Rowe, and subjective shoulder value scores at the final follow-up compared with the preoperative values (P < .001 for all), with no significant between-group differences on any clinical outcomes at the final follow-up. The 3-month postoperative graft union rate on computed tomography was significantly higher in the Cuistow group compared with the Bristow group (82.9% vs 51.4%, respectively, P = .003), although the graft union rate at the final follow-up was not significantly different (94.3% vs 85.7%, respectively; P = .449). Patients receiving the Cuistow procedure had equivalent clinical outcomes and a significantly higher bone union rate at 3 months postoperatively than those in the Bristow group. The inlay structure used in the Cuistow procedure was found to be associated with accelerated bone union.

Arthroscopic repair of anteroinferior glenoid rim fractures: mean 10-year clinical and radiologic results

BackgroundTo date, long-term results of the arthroscopic repair of glenoid rim fractures are missing. The aim of this study was, to evaluate clinical and radiographic results following arthroscopic repair of anteroinferior glenoid fractures using anchors or bioabsorbable compression screws after a mean follow-up period of ten years. MethodsClinical outcome measures included evaluation of recurrent instability, the Constant Score (CS), Subjective Shoulder Value (SSV), Rowe Score (RS), Western Ontario Shoulder Instability Score (WOSI) and Melbourne Instability Shoulder Score (MISS). X-ray images were obtained for assessment of an instability arthropathy (IA). Results23 patients (7 female and 16 male, mean (± SD) age 48 ± 15 years) who underwent arthroscopic repair of an acute substantial solitary or multifragmented anteroinferior glenoid rim fracture were enrolled. After a mean follow-up period of 10 ± 2 years, patients reached a mean CS of 92 ± 10 points, SSV of 93 ± 11%, RS of 84 ± 20 points, WOSI of 98 ±2% and MISS of 91 ± 11 points. No patient suffered recurrent dislocation. Radiographic results were obtained of 18 patients. Signs of IA were noted in nine patients (50%) with progression of IA in all cases in comparison to the preoperative status. Patients with IA were significantly older (52 versus 38 years, p = 0.04). Clinical score results did not show a significant difference in patients with versus without IA except for the RS (74 versus 94 points, p = 0.02). No intra- or postoperative complications were observed, and no patient required revision endoprosthetic surgery. ConclusionArthroscopic repair of acute anteroinferior glenoid rim fractures shows good clinical long-term results. High rates of IA were observed especially in older patients. However, the presence of IA did not seem to influence the subjective shoulder score outcomes.

Clinical and radiographic outcomes using standard length of cannulated screws for traditional Latarjet procedure

PurposeThe purpose of this study was to evaluate the clinical and radiographic outcomes of open traditional Latarjet stabilization using 32mm and 30mm long cannulated screws in males and females respectively with a minimum of 2 years’ follow-up. MethodsWe retrospectively reviewed open Latarjet procedures using cannulated screws of standard length with a minimum of 2 years follow-up. Functional evaluation was performed with postoperative Rowe and Walch score, visual analogue scale for pain (VAS) and return to sport. Graft healing was assessed with CT scans at 4 to 6 months postoperatively. Patients were divided into 2 groups according to postoperative radiographic measurements: a bicortical or unicortical screw groups. The α angle between the shaft of the screw and the glenoid subchondral bone was measured for superior and inferior screws. Level of significance was 0.05. The post hoc power analysis was 0.89. ResultsA total of 69 patients met the criteria for inclusion. Of these patients, 60 (87%) were available for final follow-up (n =62 shoulders), with a mean age of 28.4 ±9.5 years (range, 16-55 years) at time of surgery. 56 males (93.3%) and 4 females (6.7%) were included. The mean final follow-up period was a mean of 38 months after the procedure (range, 25-48 months). 8 out 60 patients (13.3%) had persistent apprehension in abduction–external rotation position. One patient (1.7%) had a recurrence of shoulder subluxation. The mean Walch-Duplay score was 90±11.6 points (range, 40-100 points), and the mean Rowe score was 93.4±11 points (range, 50-100 points). The mean VAS score for the evaluation of pain was 0.9±1.3 (range, 0-4). The coracoid healed the glenoid neck in 87.1% (54/62) of the shoulders on the postoperative CT scan. Lower alpha angle for inferior and superior screws had more rate of unicortical fixation (P=0.05 and P=0.04, respectively). 14 out 62 (22.6%) shoulders were found unicortical screws. Six bicortical cases and 2 cases unicortical screws (25%) showed nonunion (p=0.86). There were 2 complications, one patient had hematoma that required drainage, one case had transient axillary nerve palsy which resolved spontaneously. No complications associated with the hardware were found. ConclusionOpen traditional Latarjet procedure using 32 mm and 30mm long cannulated screws in male and females respectively, provided good outcomes with acceptable complication rates. Unicortical screws fixation does not have a higher rate of non-union than bicortical screws.

Arthroscopic selective approach to dynamic posterior shoulder instability: long-term follow-up insights

AimsEvaluate outcomes of arthroscopic capsulolabral repair in patients with structural dynamic posterior instability (Moroder classification B2), analyzing factors associated with inferior clinical outcomes or recurrence. The primary hypothesis is that this surgical approach in patients without static structural changes such as excessive glenoid retroversion or dysplastic glenoids will result in satisfactory clinical outcomes and low failure rates. MethodsObservational retrospective analysis in patients diagnosed with posterior structural dynamic instability who underwent arthroscopic capsulolabral repair. Demographic, clinical and radiologic characteristics were registered as well as patient reported outcomes, satisfaction, complications and failure with a minimum 2-year follow-up. Association between these outcomes and preoperative factors was investigated. Results21 patients were included, with an average age of 38.1 years (range 27-51) and a mean follow-up of 68.7 months (range 24-127). At final follow-up the degree of instability was 0 in 19 (90.5%) patients. Overall outcome assessment demonstrated a mean SSV of 82.3 (±15.2), mean WOSI score of 460.1 (±471) and a mean 91.5 (±13) ROWE score. Furthermore, a significant portion of patients returned to sport 71.4% at any level and 57.1% at previous level, and 71.4% reported satisfaction with treatment, while 5 patients (23.8%) had criteria for failure. ConclusionArthroscopic capsulolabral repair in selected patients with type B2 posterior shoulder instability without static posterior findings yielded satisfactory clinical outcomes and low failure rates.

Arthroscopic Bankart repair using a single anterior working portal technique: a systematic review and meta-analysis.

To evaluate the efficacy and outcomes of arthroscopic Bankart repair using a single anterior working portal and determine whether they are comparable to the standard two-portal technique. A search following PRISMA guidelines was performed in July 2024 in the PubMed, Embase, Scopus, and Cochrane Library databases. Studies evaluating outcomes of patients undergoing arthroscopic Bankart repair using a single anterior portal technique were included. A meta-analysis comparing outcomes was performed using a random-effects model. A P-value < 0.05 was considered statistically significant. Seven studies in patients undergoing Bankart repair with a single anterior portal were included (311 patients, 84.6% male, mean age 27.8 years, mean follow-up 37.4 months). Five of seven studies compared outcomes of a single anterior portal versus the standard two-portal technique. The duration of surgery was significantly shorter in the single anterior portal group (P < 0.00001). The postoperative Oxford Instability Score (P = 0.84), Rowe score (P = 0.26), American Shoulder and Elbow Surgeons score (P = 0.73), Constant-Murley score (P = 0.92), and Visual Analog Scale Pain score (P = 0.07) were similar between both groups. The postoperative degree of shoulder abduction (P = 0.84) and external rotation (P = 0.64) were similar between both groups. The risk of redislocation (P = 0.98) was similar between both groups. Patients undergoing arthroscopic Bankart repair with a single anterior portal had significantly lower operative times and comparable PROs, ROM, and risk of redislocation relative to patients undergoing repair with a standard two-portal technique.

Chronic shoulder instability using the Latarjet technique: About 20 cases

This retrospective study included 20 patients operated on in the Traumatology and Orthopedics Surgery Department (A) of the HASSAN II University Hospital in Fez, treated with a LATARJET · between January 2016 and December 2023, a 5-year period · In our series, the mean age at surgery was 27 years. · Male predominance was evident, with a traumatic context found in 90% of cases. · The apprehension test was positive in 65% of cases. · Our patients underwent a systematic standard preoperative radiological work-up. · We opted for the LATARJET technique · Elbow-to-body immobilization for 21 days post-operatively. · They were followed up in consultation with a 5-year follow-up. The results of our series are very satisfactory according to the ROWE score: · -85% of patients complained of no pain. Stability was perfect in 18 cases (90%). · -Unrestricted mobility was restored in 80% of cases. · -Only one case of recurrence (5%) · One patient with postoperative osteoarthritis, corresponding to 5%. In all, we had 85% good and excellent results, versus 15% fair and poor results. The results of this study are similar to those found in the literature, confirming that the LATARJET technique is the most reliable in the treatment of anterior shoulder instability, with good functional results and the fewest complications.

Glenolabral Articular Disruption (GLAD) Is Not Associated with Worse Outcomes or Higher Instability Recurrence after Arthroscopic Bankart Repair-A Matched-Pair Analysis.

Background: This study aimed to compare clinical outcomes and recurrence of instability after arthroscopic Bankart repair (ABR) in patients with anterior shoulder instability, with and without a GLAD lesion, while distinguishing between primary and recurrent instability. Methods: Consecutive patients who underwent isolated ABR between January 2012 and December 2021 were included. Patients with a concomitant GLAD lesion were matched in with patients without a GLAD lesion according to the following criteria: age, sex, BMI, follow-up time, and primary versus recurrent instability. At minimum two-year follow-up, the clinical outcome (Rowe score, redislocation rate) and the functional outcome, including the American Shoulder and Elbow Surgeons (ASES) score, Western Ontario Shoulder Instability Index (WOSI), Oxford Shoulder Instability Score (OSIS), satisfaction (1-10 scale, 0 = unsatisfied, 10 = very satisfied), and Visual Analogue Scale (VAS), were compared between groups. Results: In total, 28 patients (14 GLAD vs. 14 Bankart; age: 32.5 ± 13.0 years; sex: 92.9% male; BMI: 24.6 ± 2.2) were included 6.9 ± 2.8 (2-11) years after isolated ABR (follow-up rate 63.6%). Clinical and functional outcome did not differ significantly between patients with versus without GLAD lesions (ASES score: 100 [96.5-100] vs. 97.5 [93.3-100], p = 0.27); WOSI (%): 9.0 [3.7-24.5] vs. 3.8 [0.8-8.9], p = 0.22; Rowe score: 90.0 [75.0-100] vs. 95.0 [78.8-100], p = 0.57; OSIS: 46 [44.7-48] vs. 46 [43.0-48], p = 0.54; satisfaction: 8.9 ± 1.4 vs. 8.0 ± 1.4, p = 0.78; VAS 0 [0-1.3] vs. 0 [0-1.0]. In both groups, two patients (14.3%) reported a redislocation during the observation period. Conclusions: At short- to mid-term follow-up, ABR showed favorable outcomes, low dislocation rates, and high patient satisfaction, regardless of the presence of a GLAD lesion or primary versus recurrent instability. However, follow-up time was heterogeneous, and the follow-up rate was marginal.

Open Latarjet reduces residual apprehension, redislocation and possibility of dislocation arthropathy compared to arthroscopic Bankart repair despite greater bipolar bone loss in anterior glenohumeral instability

BackgroundArthroscopic Bankart repair (ABR) and the open Latarjet (OL) procedure are the most frequently preferred methods in the treatment of anterior glenohumeral instability. The aim of this study was to compare patients who underwent ABR or OL due to anterior glenohumeral instability in terms of functional capacity, glenohumeral bone loss, residual apprehension, redislocation and dislocation arthropathy. MethodsA total of 56 patients who underwent ABR or OL due to anterior glenohumeral instability between January 2018 and December 2021 were evaluated retrospectively. There were 32 patients in the ABR group and 24 patients in the OL group. Patients’ demographic characteristics, number of preoperative dislocations, and return-to-work and follow-up periods were recorded. Glenoid bone loss, Hill-Sachs interval, and Hill-Sachs depth were measured from preoperative computed tomography sections. The ASES score, WOSI score, Rowe score, and joint range of motion were calculated. Patients were also asked about residual apprehension, postoperative redislocations, dislocation arthropathy and surgery satisfaction. ResultsThe mean age of the ABR group was 22.5±3.9 years (28 men, 4 women), while that of the OL group was 25.0±4.8 years (22 men, 2 women). The mean number of dislocations was 2.7±1.3 in the ABR and 10.9±5.5 in the OL (p=0.001). Higher values of glenoid bone loss (%) (ABR: 6±2; OL: 20±4), Hill-Sachs interval (mm) (ABR: 8±3; OL: 21±3), and Hill-Sachs depth (mm) (ABR: 5±2; OL: 8±2) were measured in the OL (p=0.001 for all), reflecting significantly more bone loss. Residual apprehension was detected in 10 patients in the ABR and 2 patients in the OL (p=0.007). While 4 patients in the ABR had a history of redislocation, no redislocation occurred in the OL (p=0.012). Dislocation arthropathy development was observed in 9 patients in the ABR and 4 patients in the OL (p=0.038) according to the modified Samilson and Prieto classification. External rotation in adduction and external rotation in 90° abduction were approximately 5° higher in the OL (p=0.011 and p=0.016, respectively). ConclusionThe ABR and OL methods both provide satisfactory outcomes in the treatment of anterior glenohumeral instability with appropriate indications. The OL procedure is preferred for patients with more dislocations and greater bipolar bone loss. Despite greater bipolar bone loss, the OL procedure provides lower rates of residual apprehension, redislocation and dislocation arthropathy. Additionally, due to the stability it provides, there is less loss in external rotation.

Arthroscopic Suture Anchor Fixation Results in Similar Clinical Outcomes, Less Range of Motion Limitation but Poorer Quality of Reduction compared to Open Screw Fixation for Acute Large Anterior Glenoid Rim Fractures

BackgroundThe purpose of the present study was to retrospectively compare the clinical and radiological outcomes of arthroscopic suture anchor fixation and open screw fixation for acute large anterior glenoid rim fractures. MethodsThis study enrolled patients with acute large anterior glenoid rim fractures treated with arthroscopic suture anchor fixation (group A) or open screw fixation (group O) from January 2013 to June 2020 with a minimum follow-up of＞2 years. The Subjective Shoulder Value (SSV), American Shoulder and Elbow Surgeons (ASES) score, Rowe score, Constant score, range of motion (ROM), recurrent instability rate, and complications were recorded as clinical results. The quality of the postoperative reduction, reconstructed glenoid sizes, rate of fracture healing, and progression of osteoarthritis (OA) were evaluated as radiological outcomes. ResultsThis retrospective study included 66 patients, including 37 in Group A and 29 in Group O with a mean follow-up of 46.9 (range, 24.3-94.2) months and a mean patient age of 46.8 (range, 21-69) years. No significant differences were found in the clinical outcomes between the two groups. A significant ROM limitation in all planes was found in both groups and group O showed more limitations in external rotation at the side (ERs) (18° vs. 10°, P = 0.002). The reduction quality was better in group O (P < 0.001). However, there was no significant difference between the two groups in terms of reconstructed glenoid size (101.6% ± 4.6% vs. 100.6% ± 7.1%, P = 0.460) and the rate of OA progression (26.9% vs. 20%, P = 0.525). ConclusionArthroscopic suture anchor fixation and open screw fixation achieved similar clinical outcomes, reconstructed glenoid sizes, and OA progression in patients with acute large anterior glenoid rim fractures. Arthroscopic suture fixation showed a poorer quality of reduction but less ERs limitations.

High long-term failure rates after arthroscopic Bankart repair in younger patients with recurrent shoulder dislocations: A plea for early treatment.

To determine arthroscopic Bankart repair outcomes and recurrence risk factors at a minimum 5-year follow-up. Retrospective assessment of prospectively collected data, single-cohort study of patients who underwent arthroscopic Bankart repair with a minimum 5-year follow-up. Demographical and preoperative instability features were collected. Primary outcome was recurrent instability set as dislocation or subluxation. Secondary outcomes were revision surgery, postoperative instability degree according to Manta criteria, objective and subjective clinical and functional status, assessed by the Rowe, Western Ontario Shoulder Index (WOSI) and Subjective Shoulder Value (SSV) scores. Return to sport and postoperative sports activity at the final follow-up were also recorded. One-hundred and seventy-two patients, 82% men, average age at surgery 29.5 ± 9.2 years, were included. At a mean follow-up of 8.3 ± 2.6 years, recurrent instability occurred in 53 of 172 patients (30.8%). Revision surgery was required in 23/53 (43.4%) of shoulder with recurrent instability. Recurrence occurred within the first 2 years postoperative in 49% of the shoulders, whereas 51% of recurrences occurred after this period. Recurrence took place after a traumatic event in 25% and 56%, respectively. Recurrence rates were higher in patients who underwent surgery after two or more dislocations (p = 0.029). Patients younger at the time of first dislocation, younger at surgery and those with a higher preoperative degree of instability also showed significantly higher rates of recurrence (p = 0.04, p = 0.02, p = 0.03). Postoperative ROWE, WOSI and SSV scores were significantly worse in patients with recurrent instability (p < 0.001). Return-to-sports rate was also lower in patients with postoperative recurrence (p < 0.001). The arthroscopic Bankart repair was associated with a high long-term recurrence rate, and its effectiveness decreased over time. The lowest recurrence rates in arthroscopic Bankart repair were achieved in older patients with only one prior instability episode and a lower instability degree. Level IV.

Arthroscopic Autologous Iliac Crest Grafting with an Adjustable Loop Suspensory Device Yields Favorable Outcomes for Anterior Shoulder Instability with Glenoid Defects.

This study aims to evaluate the clinical and radiological outcomes of the arthroscopic autologous iliac crest grafting (AICG) procedure with an adjustable-loop suspensory fixation device in the treatment of anterior shoulder instability (ASI) with glenoid bone defects. A retrospective review was conducted on the patients who underwent arthroscopic AICG with an adjustable-loop suspensory fixation device from January 2017 to December 2020. Patients with traumatic ASI, significant glenoid bone defects, and a minimum follow-up of 24 months were included. Patient-reported outcomes (PROs), including the Oxford Shoulder Instability Score (OSIS), the Rowe score, the Walch-Duplay score, the Constant score, and the Visual Analogue Score (VAS), were compared preoperatively and postoperatively. Radiological assessments using computed tomography (CT) were performed before and after the procedure. Additional data on active range of motion, recurrence events, and complications were recorded. A total of 42 patients were included in the study, with a mean follow-up time of 35.2 months ranging from 25.1 to 55.9 months. Mean preoperative OSIS, Rowe score, Walch-Duplay score, and Constant score significantly improved from 24.4±7.2, 25.0±9.0, 25.2±9.8, 87.5±7.1 to 42.4±4.9, 92.4±8.1, 87.9±8.3, 93.6±4.5 at the last follow-up, respectively. All patients exceeded the minimal clinically important difference (MCID) for OSIS, Rowe, and Walch-Duplay scores. The graft union rate was 100%, and the glenoid area increased significantly from 82.5% preoperatively to 100.1% at the final follow-up. No patient experienced a recurrence of instability. Two recorded complications included one case of dysesthesia around the donor site and one case of postoperative shoulder stiffness. The outcomes of the arthroscopic AICG procedure, which utilizes an adjustable-loop suspensory fixation device, demonstrated stable bone graft fixation, high rates of graft integration, favorable clinical results, and a low incidence of complications. Moreover, the remodeling of the graft during the follow-up period significantly restored the width and concavity of the inferior glenoid, contributing to the overall recovery. Level IV, retrospective case series.

Impact of size and fragmentation of the anteroinferior glenoid rim on clinical and functional outcomes of non-operatively treated Bony Bankart lesions in middle-aged population

IntroductionThe optimal treatment approach for Bony Bankart remains a subject of considerable debate among shoulder surgeons. Existing literature highlights low recurrence rates and high patient satisfaction with nonoperative treatment, particularly in the middle-aged population. This study aimed to evaluate the recurrence rate of dislocation, as well as the clinical and functional outcomes in middle-aged individuals treated nonoperatively following an acute bony Bankart fracture. Additionally, the impact of glenoid rim size and fragmentation on the treatment outcome was investigated.Material and methodsA prospective analysis was conducted on 20 patients aged over 50 with nonoperatively treated bony Bankart fractures, ensuring a minimum follow-up of 24 months. The study population was categorized based on fragment size (small and medium) according to Kim classification and glenoid rim fragmentation (type 1b and 1c) according to Scheibel classification. Data including UCLA score, Rowe score, recurrence rate, clinical instability, and range of motion (ROM) were collected and analyzed.ResultsThe average UCLA and Rowe scores were 32.15 ± 2.85 and 93.85 ± 2.19, respectively, with no instances of dislocation recurrence. The affected shoulder exhibited no significant reductions in ROM compared to the contralateral side, except for a loss of external rotation (ER) (13.08° ± 7.51; p = 0.005). No differences were observed based on fragment size, although patients with multifragmented glenoid rims showed a greater loss of ER compared to those with a solitary fragment, albeit not reaching statistical significance.ConclusionNonoperative treatment appears to be a viable and effective option for middle-aged individuals with bony Bankart fractures, resulting in favorable functional outcomes and a low risk of recurrence. Additionally, a notable loss of external rotation was observed in fractures with glenoid rim fragmentation.Level of evidenceIV.

Return to sport after arthroscopic xenograft bone block associated with Bankart repair and subscapularis augmentation in competitive contact athletes with recurrent anterior shoulder instability

BackgroundOpen Bankart repair and Latarjet stabilization are two of surgical procedures used in the treatment of shoulder instability in contact athletes. The aim of this study is to evaluate the outcomes of bone block arthroscopic procedure, performed with xenograft, in combination with Bankart repair and selective subscapularis augmentation (ASA) for contact athletes with recurrent anterior shoulder instability. MethodsWe retrospectively assessed contact athletes who underwent arthroscopic bone block with xenograft and Bankart repair with selective augmentation of subscapularis for recurrent anterior shoulder instability between January 2017 and December 2021. Shoulders with posterior instability or multidirectional instability were excluded. Recurrence, complications, return to sport, and functional scores (Rowe score, WOSI score, ASES score) were assessed. A CT scan at 2-year follow-up was performed to assess the status of Bone block integration, its displacement and restoration of glenoid surface. Results16 patients were included in the study with a mean age of 24. None of the patients treated with arthroscopic bone block and ASA presented new dislocation episodes. An increase in preoperative scores was observed at the last follow-up, in particular the ASES, Rowe, and WOSI scores increased from 69±7, 31±9 , 1235±46 respectively to 96.1±3.2, 94±6, 119±51. All athletes returned to sporting activity at or near the same level as pre-surgery. The glenoid bone surface increase from 83% to 116% at last follow-up. ConclusionBone block treatment with Xenograft combined with Bankart repair and ASA procedures has been shown to be effective in treating instability in contact athletes with significant glenoid deficit. All athletes returned to athletic activity at a level similar to the pre-intervention period.