Samilson-Prieto Classification Research Articles

Radiographic progression of arthritic changes in shoulders with degenerative rotator cuff tears

Very little longitudinal information has been available regarding the relationship of cuff tears and arthritis. The purpose of this study was to determine the midterm risk of and risk factors for rotator cuff tear arthropathy progression in a cohort of subjects with an asymptomatic rotator cuff tear. Baseline (visit 1), 5-year (visit 2), and most recent follow-up (visit 3) radiographs were reviewed in a cohort of 105 subjects enrolled for longitudinal surveillance of asymptomatic degenerative rotator cuff tears and 33 controls. The radiographs were assessed in a blinded, randomized fashion by 3 observers who graded glenohumeral arthritic changes using the Hamada scores, Samilson-Prieto (SPO) scores, and acromiohumeral interval (AHI). Osteoarthritis (SPO classification), cuff tear arthropathy (Hamada classification), and AHI progressed between visits 1 and 3 (median, 8 years; P < .001 in all cases). SPO progression was not significantly different for partial- vs. full-thickness vs. control baseline tear types (P = .19). Both full-thickness and partial-thickness tears had greater progression in Hamada scores than controls did in the first 5 years of follow-up (P = .02 and P = .03, respectively), but scores did not differ between partial- and full-thickness tears. Tears with and without enlargement did not differ in progression in SPO grade, Hamada grade, or AHI. Glenohumeral arthritic changes progress significantly but remain minimal within an 8-year period in early to moderate degenerative cuff disease. Whereas the presence of a rotator cuff tear influences progression in Hamada grade, the magnitude of radiographic progression is not influenced by tear severity or enlargement at midterm time points.

All-Arthroscopic Revision Eden-Hybinette Procedure for Failed Instability Surgery: Technique and Preliminary Results

To describe the technique of an all-arthroscopic Eden-Hybinette procedure in the revision setting for treatment of a failed instability procedure, particularly after failed Latarjet, as well as to present preliminary results of this technique. Between 2007 and 2011, 18 shoulders with persistent instability after failed instability surgery were treated with an arthroscopic Eden-Hybinette technique using an autologous bicortical iliac crest bone graft. Of 18 patients, 12 (9 men, 3 women) were available for follow-up. The average follow-up was 28.8months (range, 15 to 60months). A Latarjet procedure was performed as an index surgery in 10 patients (83%). Two patients (17%) had a prior arthroscopic Bankart repair. Eight patients (67%) obtained a good or excellent result, whereas 4 patients (33%) reported a fair or poor result. Seven patients (58%) returned to sport activities. A positive apprehension test persisted in 5 patients (42%), including 2 patients (17%) with recurrent subluxations. The Rowe score increased from 30.00 to 78.33 points (P< .0001). The Walch-Duplay score increased from 11.67 to 76.67 points (P < .0001). The Western Ontario Shoulder Instability Index score showed a good result of 28.71% (603 points). The average anterior flexion was 176° (range, 150° to 180°), and the average external rotation was 66° (range, 0° to 90°). Two patients (16.67%) showed a progression of glenohumeral osteoarthritic changes, with each patient increasing by one stage in the Samilson-Prieto classification. All 4 patients (33%) with a fair or poor result had a nonunion identified on postoperative computed tomography scan. An all-arthroscopic Eden-Hybinette procedure in the revision setting for failed instability surgery, although technically demanding, is a safe, effective, and reproducible technique. Although the learning curve is considerable, this procedure offers all the advantages of arthroscopic surgery and allows reconstruction of glenoid defects and restoration of shoulder stability inthis challenging patient population. In our hands, this procedure yields good or excellent results in 67% of patients. Successful outcome is correlated with bony healing of the iliac crest graft to the glenoid. Level IV, therapeutic case series.

Risk of arthropathy after the Bristow-Latarjet repair: a radiologic and clinical thirty-three to thirty-five years of follow-up of thirty-one shoulders

Transfer of the coracoid (Bristow-Latarjet [B-L]) is used to stabilize anterior shoulder instability. We report the long-term results of our first 31 operations with this method. Thirty-six patients (mean age, 26.7 years) had a B-L repair from 1977 to 1979. Five patients died, and during 2012 to 2013, the remaining 31 shoulders had a follow-up with questionnaire, physical examination, Western Ontario Shoulder Instability Index, Subjective Shoulder Value, Subjective Assessment of Shoulder Function, subjective assessment of loss of motion, and radiologic imaging. One patient required revision surgery because of recurrence and another because of repeat dislocation. Six patients reported subluxations. Eighteen patients (58%) were very satisfied, and 13 (42%) were satisfied. The mean Western Ontario Shoulder Instability Index score (100 possible) was 85, and the median score was 93. According to Samilson-Prieto classification of arthropathy of the shoulder, 39% were classified as normal, 27% as mild, 23% as moderate, and 11% as severe. The classification of arthropathy varied with observers and radiologic views. Age younger than 22 years at the primary dislocation meant less arthropathy at follow-up (P = .045). The degree of arthropathy 33 to 35 years after the B-L repair seems to follow the natural history of shoulder dislocation with respect to arthropathic joint degeneration. Postoperative restriction of external rotation does not increase later arthropathy.

Arthrosis of glenohumeral joint after arthroscopic Bankart repair: a long-term follow-up of 13 years

The purpose of the study was to establish radiologic and clinical occurrence of glenohumeral arthrosis after arthroscopic Bankart repair. Between January 1994 and December 1998, an arthroscopic Bankart repair was performed in 187 patients at our institution. We were able to assess clinical and radiologic glenohumeral arthrosis in 72 of the 101 patients who met the inclusion criteria (74 shoulders) (71%) after a 13-year follow-up. An additional 9 patients were interviewed by telephone. Radiologic arthrosis was evaluated with the Samilson-Prieto classification and clinical arthrosis with an arthrosis-specific quality-of-life questionnaire (Western Ontario Osteoarthritis of the Shoulder test). In addition, functional impairment was assessed with the Constant score and subjective satisfaction with a questionnaire. Radiologic arthrosis was diagnosed in 50 of 74 shoulders (68%), with 40 (80%) of them classified as mild. The mean score on the Western Ontario Osteoarthritis of the Shoulder questionnaire was 280 points (85% of the best possible score), which is considered relatively good. The mean Constant score was 78 points, and 75% of the patients were extremely satisfied or satisfied with the final results of operative treatment. The radiologic evaluation and self-assessment of the patients imply that the incidence of glenohumeral arthrosis after arthroscopic Bankart repair is quite common but the symptoms are generally mild and comparable to nonoperative treatment. Arthrosis rarely causes more than minor subjective symptoms or a minor objectively perceived disadvantage during 13 years' follow-up.

Efficacy of Hylan G-F 20 versus 6-methylprednisolone acetate in painful shoulder osteoarthritis: a retrospective controlled trial

Shoulder osteoarthritis affect about 32% of patients over 60years. Conservative treatment are recommended to restore shoulder function while shoulder arthroplasty remains the standard treatment for severe osteoarthritis. When conservative therapies fail and surgical approach is precluded, viscosupplementation with HA may be the treatment of choice. Currently, there is minimal information available comparing the results of Hylan G-F 20 and corticosteroid injections for the treatment of shoulder osteoarthritis. Therefore, the purpose of this study was to examine the results of these two treatments at specific time points with validated outcome measurements. Retrospective comparative cohort study. The study population included 84 patients, 51 of whom treated with Hylan G-F 20 and 33 with a corticosteroid. Gleno-humeral osteoarthritis was graded according to Samilson-Prieto classification and rotator cuff was assessed with MRI. Both groups received three injections 1week apart and were evaluated using a Visual Analog Scale (VAS) for pain and satisfaction, the Shoulder Pain and Disability Index (SPADI) and the Constant-Murley scale. Outcomes were registered at 1, 3, and 6months. The Hylan G-F 20 group showed a significant pain reduction (P<0.05), improvement in the Constant-Murley, SPADI scores (P<0.05), and satisfaction (P<0.01) at all three follow-up times. Pain, clinical scores, and subjective satisfaction in the corticosteroid group improved in the first post treatment month only (P<0.05) compared with the baseline. Overall, lower clinical advantages were found in patients with greater degree of osteoarthritis and rotator cuff tears. Intra-articular injections with Hylan G-F 20 are effective in reducing pain for up to 6months in gleno-humeral osteoarthritis whereas corticosteroids injections resulte in improvement at 1month only. In patients with severe osteoarthritis and/or full-thickness, RC tears results tended to be worse.

Reliability of radiologic classification for cuff tear arthropathy

Several classification schemes have been proposed for cuff tear arthropathy and used for scientific and clinical purposes, even though their reliability has not been established and compared as of yet. Two observers (O1 and O2) twice independently classified 52 shoulder radiographs into the cuff arthropathy schemes of Favard, Visotsky-Seebauer, Hamada, and Sirveaux. The schemes of Samilson and Prieto as well as Kellgren and Lawrence, commonly used for osteoarthritis of the shoulder, were also used for comparison. Reliability was tested with the κ coefficient. The intraobserver and interobserver reliabilities were 0.812 for O1, 0.710 for O2, and 0.305 for O1 versus O2 for the Favard classification; 0.868, 0.583, and 0.551, respectively, for the Visotsky-Seebauer classification; 1.000, 0.491, and 0.407, respectively, for the Hamada classification; and 0.852, 0.602, and 0.598, respectively, for the Sirveaux classification. For comparison, the Samilson-Prieto classification reached 0.815, 0.710, and 0.507, respectively, and the Kellgren-Lawrence scheme reached 0.815, 0.713, and 0.430, respectively. Of the classification schemes tested, the Sirveaux classification displayed the best reliability overall. The Sirveaux classification only respects alterations of the glenoid, however. Among the schemes respecting both the glenoid and the humerus, the Hamada and Visotsky-Seebauer schemes showed similar reliability compared with the Samilson-Prieto and Kellgren-Lawrence systems, whereas the Favard classification was not as reliable. We therefore recommend the Visotsky-Seebauer or Hamada classification scheme.

Arthroscopic Bankart Suture-Anchor Repair

Background There are not many reports in the literature about the long-term outcomes in terms of recurrence and degenerative changes after arthroscopic capsulolabral reconstruction for anterior shoulder instability. Purpose The aim of this study was to evaluate long-term follow-up (minimum 10 years) of arthroscopic suture-anchor repair for traumatic unidirectional anterior instability, with special emphasis on the radiological evidence of arthritis and clinical outcome. Study Design Case series; Level of evidence, 4. Methods Forty-two patients (43 shoulders) treated at our institute from 1995 to 1997 were included in the study. Thirty patients (31 shoulders) were available for clinical and radiological examination (71%). The mean follow-up was 10.9 years (range, 9.8-14.3 years). Patients were evaluated preoperatively and after surgery using the University of California, Los Angeles (UCLA), Simple Shoulder Test (SST), and Rowe score. Patient satisfaction was determined by asking the patients if they would do this operation again. Radiological outcome was used to evaluate the incidence and grade of arthritis according to the Samilson-Prieto classification. Results At the final follow-up examination, 5 patients (16%) reported an atraumatic recurrent instability, while 2 recurrences (7%) occurred after a major injury. Three of the 7 recurrences occurred 6 years after surgery. All of the patients in the recurrence group except 1 were contact or overhead athletes. Twenty-six patients were satisfied (84%) with the outcome. The SST showed an improvement of shoulder function in 23 cases, the UCLA score improved from 21.8 to 32.1, and the Rowe score showed excellent or good results in 77.3% of cases. Twenty-two patients (71%) were able to return to their preoperative sports level. Radiographic findings showed 9 cases with mild arthritis (29%) and 3 cases with moderate arthritis (10%). Conclusion The recurrence rate deteriorated with time. Involvement in contact sports and overhead activities appears to be a risk factor for recurrence of instability, although this could not be proved statistically with the numbers available, whereas age, gender, and number of preoperative dislocations did not reveal any correlation with recurrence. Degenerative changes of the glenohumeral joint were noted but had no significant effect on the clinical outcomes.

Reversed arthroscopic subacromial decompression for symptomatic irreparable rotator cuff tears: Mid-term follow-up results in 34 shoulders

In the elderly, there is no guideline for the treatment of irreparable rotator cuff lesions. The results of open or arthroscopic repair are variable. We hypothesized that the use of a reversed arthroscopic subacromial decompression (RASD) would yield comparable results. Between January 2004 and December 2006, thirty-eight patients underwent a RASD for irreparable cuff tears in 39 shoulders. The surgical procedure consisted of a tenotomy of the long head of the biceps tendon, a debridement of the torn rotator cuff and a tuberoplasty, without violation of the coracoacromial arch and the acromion. Thirty-three patients (age 69.9 +/- 7.3 years) were available for clinical and radiological evaluation of 34 shoulders (male/female ratio: 11/22), at a mean follow-up of 38 months (range: 21 months-52 months). Two of 33 patients had required revision surgery, and were excluded from further statistical analysis. In the remaining 31 patients (32 shoulders), the modified Constant-Murley score (CMS) improved from 34.9% +/- 11.6 to 84.0% +/- 11.6 (p < 0.0001). The preoperative mobility did not correlate with the final result. Preoperative pain was found to correlate negatively to the modified CMS at follow-up (p= 0.0038). Although the acromiohumeral height decreased with 2.58 mm +/- 1.68 and the severity of glenohumeral osteoarthritis increased with one grade (Samilson-Prieto classification), there was no correlation with the functional outcome. We conclude that for irreparable rotator cuff tears in the elderly, excellent mid-term results can be achieved with a RASD.

Documentation of dislocation arthropathy of the shoulder “area index”: A better method to objectify the humeral osteophyte?

We suggest a method to validate the Samilson-Prieto classification system of dislocation arthropathy of the shoulder. Based on a mean standard sagital measure of the humeral head, we calculate an area index for the humeral osteophyte. The application of this method is done on a previous published series of 56 shoulders with a follow-up time of 15 years minimum after surgery with the Bankart or Bristow repairs. This technique of evaluation showed that the Bristow shoulders had a higher mean area index value on all radiological projections compared to the Bankart shoulders. The highest index was found on AP radiogrammes angulated 45 degrees from above with the arm in neutral rotation (subcoracoid view) followed by the AP view in inward rotation. Our observations indicate that the humeral osteophyte mostly has its largest size at 4 to 5 o'clock position, as visualized with its greatest index on the subcoracoid view. Mild arthropathy, according to Samilson-Prieto, had a mean osteophyte area index of 3.7 (standard deviation, 3.4) on the AP inward rotation view. The corresponding figures for moderate arthropathy were 10.6 (standard deviation, 13.3) and 30.3 for severe (standard deviation, 24.1), respectively. The use of this index, based on the AP view in inward and outward rotation, will make future comparisons between different series of patients more reliable than using just the Samilson-Prieto classification. The radiological change over time should also be more appropriately described. Furthermore, this paper emphasizes the importance of using the same radiological views when dislocation arthropathy of the shoulder is documented.

Radiographic classification of glenohumeral arthrosis

We studied the interobserver agreement of two radiographic classification systems for evaluation of glenohumeral arthrosis in 40 patients at long-term follow-up after the Eden Hybbinette operation for habitual dislocation of the anterior shoulder. Both observers agreed that none of the patients had severe arthrosis. The Samilson-Prieto system showed agreement using the classification in 35 of 40 operated shoulders (kappa 0.76). The Kellgren-Lawrence system showed agreement using the classification in 23 of 40 operated shoulders (kappa 0.36). The rate of arthrosis in the operated shoulder ranged from 0.2 to 0.6, depending on the classification system and the observer. None of the patients without arthrosis, but one fifth of those with arthrosis reported pain. The Samilson-Prieto classification is preferable because it is simple to use and has excellent interobserver agreement.