Shoulder Instability Research Articles

Does scapular dyskinesia affect upper extremity performance, proprioception, and body image in kickboxers? Case-control study

BackgroundScapular Dyskinesia (SD) is detected more frequently in athletes who do overhead activity sports. SD is more common in kickboxers who actively use their upper extremities. This study was conducted to compare upper extremity stabilization, proprioception and body image in kickboxers with and without SD.MethodsKickboxing athletes participating in the study were divided into two groups according to whether they had SD or not. Presence of SD with Lateral Scapular Slide Test; Shoulder proprioception sense with digital inclinometer (Dualer IQ Pro, JTECH Medical Industries) at 40, 70, 90 and 135 degrees; Shoulder joint stabilization was evaluated with the Closed Kinetic Chain Upper Extremity Stabilization Test, and body image was evaluated with the Body Assessment Scale.ResultsA total of 56 male kickboxing athletes with (n:27) and without (n:29) SD between the ages of 18–35 were included in the study. There was no difference between the groups regarding age, height, weight, body mass index, and 40° with 135° shoulder abduction proprioception sense (p > 0.05). There were differences between the groups in terms of sports history, 70° and 90° shoulder abduction proprioception sense, shoulder stabilization and body image (p: 0.001; p: 0.003; p: 0.003; p: 0.012, respectively).ConclusionShoulder proprioception, shoulder joint stabilization, and body image in kickboxers with SD were better than kickboxers without SD. In addition, Kickboxers with SD performed in this sport for a longer time than kickboxers without SD.

Effect of a multicomponent exercise program focused on multivariable fatigue improvement versus standard care for glenohumeral instability: MoveUS study protocol

BackgroundGlenohumeral instability is a highly prevalent pathology; however, there are problems in defining it. Traditionally, structural problems such as labral injury or bone loss in the glenoid cavity and/or humeral side were considered the main causes; but recently, it has been seen that motor control plays a very relevant role. This means that currently, there is a disparity of action protocols, and the treatment of this pathology is a great challenge.AimThe primary aim of this study is to evaluate the effectiveness of a supervised multicomponent therapeutic exercise program in reducing multivariable fatigue in patients with instability of the glenohumeral joint.MethodsA single-blind randomized controlled trial will be carried out, in which 108 adult patients who have suffered at least one episode of glenohumeral instability in the last year will be recruited by the Department of Traumatology and Rehabilitation of Axarquia Hospital (Málaga). Patients will be randomized to the intervention group, which will carry out a multicomponent therapeutic exercise program supervised by physiotherapists (MoveUS Program); or to the control group, which will receive the usual care. All subjects will be evaluated at baseline, mid-treatment, after the intervention, and three months later at the follow-up. In these evaluations, range of movement, maximum peak of isometric force, kinematic, physiological, and psychometric fatigue, return to activity, motor control, and number of recurrences will be assessed; as well as the quality of life measured through the Western Ontario Shoulder Instability Index, which will be the main outcome variable. A multivariate analysis will be performed through a statistical program to better determine the factors that could influence the results.DiscussionThis study aims to determine if therapeutic exercise supervised by physiotherapists is capable of reducing multivariable fatigue, reducing the number of recurrences, and improving quality of life; to be able to implement it in the future in public and private clinics since materials are available and physiotherapist have enough skills in the field of therapeutic exercise, so it is expected to be a quality tool in the approach to glenohumeral instability.RegistrationRegistry: ClinicalTrials.gov. Number: NCT05443295. Date: 01/07/2022.

Subregions of the Rotator Cuff Muscles Present Distinct Anatomy, Biomechanics, and Function

Shoulder and elbow injuries are prevalent among baseball players, particularly pitchers, who experience repetitive eccentric loading of the shoulder, leading to muscle damage and increased injury risk. Nearly 40% of shoulder injuries in baseball occur in pitchers, with many facing low rates of return to sport. The rotator cuff (RC) muscles—supraspinatus (SSP), infraspinatus (ISP), subscapularis (SSC), and teres minor (TMin)—are crucial for shoulder stability, movement, and force generation, particularly in overhead sports. Each RC muscle comprises subregions with distinct biomechanical properties, such as strength, moment arm behavior, and activation patterns. These differences allow for a finely tuned balance between joint stability and mobility. For example, the superior subregion of the ISP significantly contributes to external rotation, a function critical in sports like baseball that require precision and power. During pitching, the SSP, ISP, and SSC stabilize the glenohumeral joint through high activation during explosive phases, such as stride, arm cocking, and arm acceleration. Understanding these functional subregional differences is vital for diagnosing and managing shoulder pathologies like RC tears. Despite advancements, clinicians face challenges in predicting re-injury risks and determining return-to-play readiness for athletes with shoulder injuries. Integrating insights into subregional biomechanics with patient care could enhance outcomes. Tailored interventions—whether surgical or rehabilitative—targeting specific subregions could improve recovery times, reduce re-injury risks, and enable more personalized treatment plans. Such approaches are especially beneficial for athletes, older individuals, and those prone to RC injuries, promoting better long-term shoulder health and performance. The present work aims to highlight some of the research on these subregions and their differences, providing insights to enhance treatment approaches for shoulder injuries.

The Radiologic Evaluation and Clinical Significance of Glenohumeral Bone Loss in Anterior Shoulder Instability

Glenoid and humeral bone loss is associated with a high incidence of recurrent shoulder instability and failure of arthroscopic stabilization procedures. However, the radiographic evaluation of bony Bankart and Hill–Sachs injuries continues to pose a diagnostic challenge, and a universally accepted optimal method of measurement is lacking. The purpose of this review is to summarize the advantages and disadvantages of various techniques and imaging modalities available for measuring glenoid bone loss in shoulder instability, including conventional roentgenography, 2-dimensional and 3-dimensional computed tomography (CT), and magnetic resonance imaging (MRI). We also review the concepts of engaging “on-track” and “off-track” Hill–Sachs lesions. Finally, we highlight the clinical importance of obtaining accurate determinations of bone loss by the various methods available, as it can affect surgical decision making and the appropriate procedure required to ensure shoulder stability is adequately restored.

Influence analysis of glenohumeral bone structure on anterior shoulder instability

To investigate the effect of glenohumeral bone structure on anterior shoulder instability by three-dimensional CT reconstruction. The clinical data of 48 patients with unilateral anterior shoulder dislocation (instability group) and 46 patients without shoulder joint disease (control group) admitted between February 2012 and January 2024 were retrospectively analyzed. There was no significant difference in gender and side between the two groups ( P>0.05). The patients were significantly younger in the instability group than in the control group ( P<0.05). The glenoid joint morphological parameters such as glenoid height, glenoid width, ratio of glenoid height to width, glenoid inclination, the humeral containing angle, and glenoid version were measured on three-dimensional CT reconstruction of the glenoid. The differences of the above indexes between the two groups were compared, and the differences of the above indexes between the two groups were compared respectively in the male and the female. Random forest model was used to analyze the influencing factors of anterior shoulder instability. The comparison between the two groups and the comparison between the two groups in the male and the female showed that the ratio of of the instability group glenoid height to width was larger than that of the control group, the glenoid width and humeral containing angle were smaller than those of the control group, and the differences were significant ( P<0.05); there was no significant difference in glenoid height, glenoid inclination, and glenoid version between the two groups ( P>0.05). The accuracy of the random forest model was 0.84. The results showed that the top four influencing factors of anterior shoulder instability were ratio of glenoid height to width, the humeral containing angle, age, and glenoid width. Ratio of glenoid height to width and the humeral containing angle are important influencing factors of anterior shoulder instability.

Does high body mass index increase the risk of shoulder instability surgery? The LUXE prospective cohort study on 227 recurrent anterior shoulder instability

Does high body mass index increase the risk of shoulder instability surgery? The LUXE prospective cohort study on 227 recurrent anterior shoulder instability

The Coraco-Gleno-Scapular Line: A Simple Novel Tool for Assessing Glenoid Bone Defects.

Treatment decisions for shoulder instability often necessitate surgical intervention, with glenoid bone loss being a key factor. Currently, various techniques exist to identify glenoid bone loss, each with its own advantages and disadvantages. This study introduces the Coraco-Gleno-Scapular (CGS) line as a tool for assessing critical glenoid bone defects. The objective is to define the CGS line and evaluate its utility in guiding clinical decisions regarding bone loss, proposing that defects extending posterior to this line indicate critical bone involvement requiring surgical intervention. The study analyzed 50 normal right shoulders from individuals aged 18-40 years. Using 3D en face views of the glenoid, the CGS line was defined from the anteroinferior base of the coracoid process, crossing the anterior glenoid, to the anteroinferior pole of the scapula. The Best fit circle area method and the Glenoid index linear method were used to calculate the percentage of the bone area located anterior to the CGS line. The Best Fit Circle Area Method revealed a mean glenoid surface area anterior to the CGS line of 22.19%, while the Glenoid Index Linear Method indicated a mean area of 27.2% anterior to the CGS line. Of the 50 shoulders, 14 had a glenoid surface area <20% anterior to the CGS line using the Best Fit Circle Method, with no cases below 17.5%, while 36 individuals had a glenoid surface area >20%. The Coraco-Gleno-Scapular line is a reliable and simple tool for assessing glenoid bone loss, providing valuable guidance in managing shoulder instability. Its ease of use makes it a promising candidate for standard application in clinical practice. Prospective observational study, Level III.

Treatment of Initial Anterior Shoulder Instability in National Hockey League Players: A Survey of NHL Team Physicians.

Managing an in-season anterior shoulder instability poses a special challenge for team physicians, as they need to balance the aim of promptly returning the athlete to play while mitigating the chances of recurrence and further injury to the shoulder. To investigate and report on the treatment preferences of National Hockey League (NHL) team physicians when managing in-season first-time anterior shoulder instability in professional hockey players. Cross-sectional study. A survey consisting of 33 sport-specific questions focused on the treatment options and preferences for anterior shoulder instability in hockey players was developed, and 32 NHL team physicians were invited to anonymously complete the survey. Following the collection of the data, the distribution of the responses to each question was documented as counts and percentages. Of the 32 invited team physicians, 31 (97%) completed all (n = 28) or most (n = 3) of the survey. The mean experience of the respondents was 13 ± 11 years. A total of 28 (90%) respondents would attempt nonoperative treatment of an in-season initial anterior shoulder dislocation with an isolated soft tissue injury, while 28 (90%) would recommend operative treatment of the same injury with bony involvement. Of the 31 respondents, 30 (97%) utilized rehabilitation parameters rather than time from injury when determining whether a player could return to play. Of those parameters, clinical strength (100%), range of motion (87%), anterior apprehension (84%), and pain (65%) were the most utilized. For surgical management of an isolated soft tissue lesion, 28 (90%) of the respondents preferred arthroscopic repair, while 2 (7%) preferred open repair. Of the 32 NHL team physicians surveyed, 28 preferred nonoperative management for the treatment of initial anterior shoulder dislocations with isolated soft tissue injuries, while initial operative management was preferred by the same number of team physicians for any injuries with bony involvement.

Suture Button Fixation in Shoulder Instability Surgery to Achieve Bone Healing: A Critical Analysis Review.

» Suture button fixation has emerged as an effective surgical construct in arthroscopic and open Latarjet and anterior glenoid reconstruction with free autograft bone with high rates of bone block healing.» Biomechanical data suggest that screw and suture button mechanical fixation constructs provide similar load to failure and stability for the Latarjet procedure.» Preliminary bone healing models have identified that flexible fixation may exhibit a higher degree of bone callus maturation, whereas rigid fixation results in excessive callus hyperplasia» Mechanical tensioner use provides consistent tensioning of suture button constructs and improves bone-to-bone healing rates when used for anterior glenoid reconstruction surgery.» Evidence is lacking regarding the reliability of bone-to-bone healing of allografts to native bone with use of suture button constructs.» Suture button fixation provides good short- and mid-term clinical outcomes for the arthroscopic Latarjet and anterior glenoid reconstruction with free autograft bone.

Posterior Shoulder Stability Depends on Acromial Anatomy: A Cadaveric, Biomechanical Study

Failure rates in the management of recurrent posterior shoulder instability remain a concern. Cadaveric studies have established that posterior capsulolabral tears, glenoid retroversion, and posterior glenoid bone loss result in increased posterior humeral head translation in the setting of a posteriorly directed force. A high and flat acromion has recently been associated with posterior instability. Therefore, the purpose of this study was to evaluate a potential stabilizing effect of the acromion against posterior humeral head displacement. Eight fresh-frozen human cadaveric shoulders were biomechanically tested in a shoulder simulator in the load-and-shift and Jerk test positions. Prior to testing, CT scans were performed to measure native glenoid width, glenoid retroversion, posterior acromial coverage (PAC), sagittal acromial tilt (SAT) and posterior acromial height (PAH). Each specimen underwent four testing conditions using pre-planned and 3D printed cutting and reduction guides: (1) Intact joint, native acromion; (2) Intact joint, severe acromial malalignment (SAT 69°, PAC 47°, PAH 26mm); (3) Intact joint, moderate acromial malalignment (SAT 59°, PAC 57°, PAH 20mm); (4) Intact joint, corrected acromial alignment (SAT 48°, PAC 70°, PAH 11mm). The degree of acromial malalignment and acromial reorientation was chosen based on a previous study that defined acromial anatomy in patients with posterior instability. The humeral head was translated posteriorly until reaching either (1) a peak force of 150N or (2) a maximum posterior displacement of 50% of the glenoid width. Forces (N), displacement (mm) and acromiohumeral contact pressures (kPA) were simultaneously recorded. The force needed to displace the humeral head by 50% of the glenoid width decreased between 23% and 60% in moderate to severe acromial malalignment (high and flat acromion) and increased up to 122% following surgical correction of acromial alignment (low and steep acromion) when compared to the native condition. Correction of acromial alignment significantly increased stability compared to all other scenarios after ≥5% of displacement (p<0.05 for all comparisons). Furthermore, it increased acromiohumeral contact pressures compared with severe malalignment in 30° flexion and with moderate and severe acromial malalignment in 60° flexion (p<0.05 for all comparisons). The acromion acts as a mechanical buttress to posterior humeral head displacement. Surgical correction of acromial malalignment cannot only effectively restore but increase glenohumeral joint stability. Future studies are needed to define the quantitative relevance of the different factors contributing to posterior shoulder instability and assist in defining the optimal amount of correction needed in an individual situation.

Minimally invasive balloon-reduction of acute Hill-Sachs-lesions and impression fractures after shoulder dislocation – an experimental approach

The shoulder is the joint most often affected by dislocations. It is known that bony defects of the glenoid and/or humerus can lead to recurrent dislocations even after arthroscopic shoulder stabilization. To prevent recurrent instability, it appears reasonable to reduce fresh and larger Hill-Sachs lesions (off-track lesions). In spine surgery, balloon kyphoplasty is widely used for fracture reduction. The aim of this study was to determine whether the balloon dilatation procedure is transferable to the humeral head and under which conditions it can be successful. In this biomechanical proof-of-concept study, a preformed "impression stamp" was used to create standardized Hill-Sachs impressions (Calandra grade III lesion) on 13 human humeral specimens. A kyphoplasty balloon was then placed intraosseously and close to the defect using a special monolateral trocar and the defect was reduced by balloon dilatation. CT imaging was performed on the native specimens, after defect placement and after reduction. Both the defect size and the extent of reduction were measured radiologically, as well as the bone density. Also, the pressure and volume necessary for reduction were measured. 13 proximal humerus specimens were examined. The mean age of the 7 body donors (3 female) was 85 years (SD ±8.1). The average bone density was 49.0 mg/ml (SD ±26.9) and therefore defined as osteoporotic. The average defect depth (difference to native, measured from a best-fit circle) was 4.1 mm (SD ±1.4), corresponding to an average defect volume of 1203 mm³ (SD ±949). After balloon dilatation, the average achieved reduction (difference to the defect) was 4.3 mm (SD ±1.9) or 1223 mm³ (SD ±1059). This results in an average difference from native to reduced of -0,2 mm (SD ±0.5) or 20 mm³ (SD ±212) and represents no significant difference compared to baseline values (p = 0.90 or p = 0,75, respective), but a slight overreduction in the volumetric measurements. In all humeral specimens, a reduction of at least 2.6 mm or 221 mm³ compared to the defect situation was achieved. An average volume of 3.4 ml (SD ±1,1) and pressure of 271 psi (SD ±81) were required for reduction. The present results demonstrate, that minimally invasive balloon reposition of large acute Hill-Sachs lesions appears methodologically feasible. The required pressure for reduction seems to be higher compared to previous studies. Further studies are necessary for the development of this technique and its reproducible translation into clinical practice.

Rewiring for Victory: Neuro-Athletic Training Enhances Flexibility, Serve Speed, and Upper Limb Performance in Elite Volleyball Players—A Randomized Controlled Trial

This randomized controlled trial investigated the effects of neuro-athletic training (NAT) on flexibility, spike speed, and upper extremity stability in elite volleyball players. Thirty professional male athletes aged 18–23 years old (mean age of 19.5 ± 1.77 years old in the NAT group and 19.8 ± 1.87 years old in the control group) participated, with 26 completing this study. The participants were randomly assigned into an NAT intervention group or a control group continuing traditional training. Both groups trained three days per week for eight weeks, with the NAT program targeting neuromuscular adaptations while maintaining equal total training durations. Flexibility was assessed using the Sit and Reach Test, spike speed was evaluated using the Pocket Radar Ball Coach, and upper extremity stability was measured using the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). The NAT group demonstrated significant improvements across all performance metrics. Flexibility increased significantly (p = 0.040; Cohen’s d = 0.845), indicating improved range of motion and musculoskeletal adaptability. Spike speed showed a highly significant improvement (p &lt; 0.001; Cohen’s d = 1.503), reflecting enhanced neuromuscular coordination and power. Similarly, upper extremity stability exhibited substantial gains (p = 0.002; Cohen’s d = 1.152), highlighting improved shoulder stability and motor control. In contrast, the control group did not show statistically significant changes in their flexibility (p = 0.236; Cohen’s d = 0.045), spike speed (p = 0.197; Cohen’s d = 0.682), or upper extremity stability (p = 0.193; Cohen’s d = 0.184). Between-group comparisons confirmed the superiority of the NAT intervention, with significant differences across all metrics (p-values ranging from 0.040 to &lt;0.001) and effect sizes spanning from moderate to large (Cohen’s d = 0.845–1.503). These findings demonstrate the effectiveness of NAT in enhancing volleyball-specific performance metrics, emphasizing its potential to target neuromuscular adaptations for improved flexibility, power, and stability. Future studies should explore the long-term effects of NAT and its applicability across various sports disciplines.

Oxford Shoulder Instability Score: cross-cultural adaptation into Spanish and analysis of its methodological quality

BackgroundOxford Shoulder Instability Score (OSIS) is a patient reported outcome measure designed specifically to assess functional difficulties resulting from shoulder instability. The main aim of this study was to cross-culturally adapt the OSIS to Spanish. Secondary, it aimed to analyse its methodological quality.MethodsA cross-cultural adaptation to Spanish has been carried out following the recommendations of COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) with a sample of 167 cases of shoulder instability. Inclusion criteria were: subjects with instability symptoms in at least one shoulder with or without clinical diagnosis; aged between 18 and 60. The following psychometric properties were evaluated: validity (construct, internal and external), reliability (internal consistency, test-retest and measurement error), discriminant ability and feasibility. The methodological quality was addressed with Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and COSMIN Risk of Bias checklist (COSMIN RoB).ResultsThe construct validity obtained an OSIS correlation with the Simple Shoulder Test of r = 0.636 and with the Western Ontario Shoulder Instability of r = 0.80. The unidimensionality of the OSIS was confirmed through second-order factor analysis. Cronbach’s alpha and intraclass correlation coefficient were both 0.93 (IC95%: 0.91–0.94). Standard error of measurement was 0.70, and the percentage of error and smallest detectable change were 1.46% and 1.94, respectively. No floor or ceiling effects were found. Assessing feasibility of OSIS, the participants answered all questions, had no questions and completion time was: mean 2 min 30 s; SD ± 1 min. Regarding methodological quality, the study showed low risk of bias in the areas of patient selection, index test, reference standard and flow and timing, as well as low concern regarding applicability in the domains of patient selection, index test and reference standard according to QUADAS-2. In relation to COSMIN RoB, all psychometric properties, except for content validity, obtained very good results.ConclusionsThe Spanish version of OSIS offers valid, reliable and feasible functional outcome measures for Spanish-speaking subjects with shoulder instability, based on its psychometric properties and its methodological quality.

Inclusion of Glenoid Anteversion Provides a More Accurate Assessment of Glenoid Stability Using a Measuring Protocol for Modified Bony Shoulder Stability Ratio

PurposeThe objectives are to clarify whether there is a disparity between the conventional bony shoulder stability ratio (cBSSR) calculated using Moroder's method and satbility ratio (SR) obtained biomechanically, and whether the modified BSSR (mBSSR) calculated using the new method adjusted for glenoid anteversion shows good consistency with the biomechanically determined SR. MethodsForty-two glenoid models were successively constructed from seven cadaveric scapula bones, each with varying degrees of bone defects (intact/2 mm/4 mm/6 mm/8 mm/10 mm). The cBSSR and mBSSR were calculated by using the conventional and the modified radiological protocols, respectively. A biomechanical experiment was conducted to measure the biomechanical SR of the glenoid model for accuracy validation. Linear regression, ICC, Bland‒Altman plots, and repeated ANOVA were performed to compare these methods to ascertain the impact of including glenoid anteversion on the accuracy of the BSSR. ResultsThe mBSSR, which includes glenoid anteversion, showed a stronger correlation with biomechanical SRs compared to the cBSSR. Linear regression analysis showed R2 = 0.7727 and ICC = 0.726 for mBSSR vs. biomechanical SR, while R2 = 0.5507 and ICC = 0.363 for cBSSR vs. biomechanical SR. Bland‒Altman analysis revealed less bias between the mBSSR and biomechanical SR (bias = 0.0854, 95% CI [-0.0762, 0.2470]) than between the cBSSR and biomechanical SR (bias = 0.1899, 95% CI [0.0039, 0.3759]). Repeated measures ANOVA confirmed a significant difference between the cBSSR and biomechanical SR (p = 0.002). ConclusionThe inclusion of glenoid anteversion in the mBSSR calculations provides a more accurate assessment of glenoid stability. Our findings indicate the need to consider anteversion adjustments in BSSR estimation. Clinical RelevanceOur present research identified that conventional methods did not take glenoid anteversion into account. Through comprehensive biomechanical experiment, we have demonstrated that incorporating glenoid anteversion in the BSSR calculation yields a more precise assessment of glenoid stability, which can provide a crucial methodological foundation for clinical assessments.

Arthroscopic Bankart repair versus arthroscopic Latarjet for anterior shoulder instability in adolescents.

The Bankart and Latarjet procedures are two of the most common surgical techniques to treat anterior shoulder instability with satisfactory clinical and functional outcomes. However, the outcomes in the adolescent population remain unclear, and there is no information regarding the arthroscopic Latarjet in this population. The purpose of this study was to evaluate the outcomes of the arthroscopic Bankart and arthroscopic Latarjet procedures in the management of anterior shoulder instability in adolescents. We present a retrospective, matched-pair study of teenagers with anterior glenohumeral instability treated with an arthroscopic Bankart repair (ABR) or an arthroscopic Latarjet (AL) procedure with a minimum two-year follow-up. Preoperative demographic and clinical features, factors associated with dislocation, and complications were collected. Recurrence, defined as dislocation or subluxation, was established as the primary outcome. Clinical and functional outcomes were analyzed using objective (Rowe), and subjective (Western Ontario Shoulder Instability Index (WOSI) and Single Assessment Numeric Evaluation (SANE)) scores. Additionally, the rate of return to sport was assessed. A total of 51 adolescents were included, of whom 46 (92%) were male, with 17 (33%) in the Latarjet group and 34 (66%) in the Bankart group. The mean age at time of surgery was 18 years (15 to 19). There were no intraoperative complications. At a median follow-up of nine years (IQR 2 to 18), recurrence was observed in 12 patients in the Bankart group (35.3%) and one patient in the Latarjet group (5.9%) (p = 0.023). Satisfactory postoperative outcomes were obtained, with mean Rowe, WOSI, and SANE scores noted at 95 (10 to 100), 325 (25 to 1,975), and 87.5 (10 to 100), respectively. Most patients (29 in the Bankart group (85.3%) and 16 in the Latarjet group (94.1%)) were able to return to sport (p = 0.452). The ABR and AL procedures both obtain satisfactory clinical and functional outcomes in the treatment of anterior glenohumeral instability in adolescents with a low complication rate. However, the ABR is associated with a significantly higher recurrence rate.

Placing Knotless Suture Anchor Through Mid-Glenoid Portal

Optimal portal placement for arthroscopic shoulder stabilization procedures can significantly aid a surgeon’s visualization during the repair as well as suture anchor placement. A percutaneous knotless anchor insertion kit used through a mid-glenoid portal allows the surgeon to access positions on the glenoid rim that are commonly difficult to reach. Moreover, the knotless kit has the ability to save valuable time during arthroscopic stabilization procedures and also eliminates the risk of postoperative knot impingement. The mid-glenoid portal should be made approximately 1 cm lateral from the joint line of the humeral head and 2 to 3 cm inferior and 1 to 2 cm medial from the posterolateral acromial angle. This portal placement avoids injury to the labrum and should be determined after assessing both the thickness of the local soft tissues and the size of the relevant bony architecture. A hole for the knotless anchor should be drilled approximately 1-2 mm onto the face of the glenoid, and the labral tape is then passed a short distance through the eyelet of the knotless fixation device before the construct is inserted into the glenoid. A hemostat is used to hold the tape as it is placed into the drill hole, and a mallet is used to drive the interference portion of the plastic implant to a marked depth. Finally, once the suture anchor is securely affixed, the insertion device is unloaded and pulled out of the portal with 6 counter-clockwise turns.

Evaluation of Preoperative Factors That Affect the Alpha Angle of Screw Insertion After the Open Latarjet Procedure.

The open Latarjet procedure yields excellent results as a treatment for anterior shoulder instability. The position of the bony fragment and the insertion angle of the screw (the alpha angle) are critical factors for a successful procedure. The alpha angle is considered overangulated at >25°, which is associated with poor bone fixation and healing. To assess preoperative patient anatomic factors that affect the alpha angle in the Latarjet procedure for anterior shoulder instability. Case-control study; Level of evidence, 3. In this retrospective study, 76 patients who underwent the open Latarjet procedure between October 2009 and December 2023 were included. Postoperative computed tomography scans were reviewed for the alpha angle, and patients were classified into 2 groups: group 1 (alpha angle ≥25°) and group 2 (alpha angle <25°). Preoperative patient characteristics and radiological parameters obtained from preoperative computed tomography scans were analyzed and compared between groups 1 and 2. We developed a novel method to measure the depth of the chest and the angle between the deltopectoral interval and the plane of screw insertion. We also measured the thickness of the pectoralis major and subscapularis muscles. Of the 76 patients in this study, 41 and 35 patients were included in groups 1 and 2, respectively. The mean alpha angles of groups 1 and 2 were 36° and 12°, respectively, and the body mass index was significantly higher in group 1 (P < .001). In addition, group 1 had a significantly longer distance from the anterior edge of the glenoid to the skin margin of the deltopectoral interval (P < .001). The angle between the deltopectoral interval and the plane of screw insertion (traction angle) was significantly larger in group 1 (P < .001), and the pectoralis major and subscapularis muscles were thicker in group 1 (P = .017 and P = .032, respectively). The alpha angle after the Latarjet procedure was strongly related to the patient's weight, body mass index, depth of the chest, and the angle between the deltopectoral interval and the plane of screw insertion. To our knowledge, this is the first study in which the preoperative factors that facilitate proper screw fixation in the Latarjet procedure are reported.

Learning curve for the open Latarjet procedure: a single-surgeon study.

The popularity of the Latarjet procedure (LP) for the treatment of anterior shoulder instability continues to rise. However, LP is technically demanding and associated with complications. This study aims to determine the learning curve for the open LP (oLP) and the threshold for proficiency. This was a retrospective study of all oLPs performed by a single surgeon in a single institution from 2016 to 2021. Operative time, defined as time from incision to closure, was the primary outcome of this study, and 1-year postoperative complications were the secondary outcome. After listing oLP cases in chronological order, they were classified into groups of 15, and the average operative time for each group was determined. Demographics, operative duration, and postoperative complications were compared across groups. Seventy-five oLPs were included in this study, and operative times decreased after the first 15 procedures. While operative times continued to decrease with increasing case number, the learning curve began to plateau after 30 procedures. After 75 procedures, there was a total decrease in average operative time of 31.5 minutes relative to that of the first 15 cases. There were no differences in complication or revision rates among procedure groups. Establishing learning curves provides important insight into the complexity of surgical procedures. Our study demonstrates that the oLP has a steep learning curve with significant improvement in operative time after the first 15 cases. Operative time plateaus after 30 cases, indicating proficiency in this procedure. Level of evidence: IV.

Multicentre randomised controlled trial comparing Bankart repair with remplissage and Latarjet procedure in shoulder instability with subcritical bone loss (STABLE): study protocol

IntroductionRecurrent shoulder dislocations often cause attrition of the labrum and progressive loss of the anterior bony contour of the glenoid. Treatment options for this pathology involve either soft tissue repair...

Subscapularis Muscle Radiographic Integrity and Patient-Reported Outcomes Following Arthroscopic Anatomic Glenoid Reconstruction With Distal Tibial Allograft

Background: Shoulder stabilization surgery has evolved over time, and bony augmentation procedures on the glenoid side are being performed more often. The Latarjet procedure modifies subscapularis anatomy because the conjoined tendon divides the subscapularis muscle fibers through a split/takedown, which has structural and functional implications. Arthroscopic anatomic glenoid reconstruction (AAGR) re-creates anatomy. This technique uses the Halifax portal to deploy and fix a distal tibial allograft (DTA) through the rotator interval, thus preserving the subscapularis anatomy. Purpose/Hypothesis: The purpose was to analyze the radiographic properties of the subscapularis muscle after AAGR. It was hypothesized that the subscapularis muscle structure remains preserved postoperatively. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was performed comprising a consecutive series of patients treated with AAGR with DTA between November 2012 and April 2021 for traumatic anterior shoulder instability with glenoid bone loss. Patients were excluded if they had posterior instability, glenoid fracture, missing pre- or postoperative computed tomography (CT) scans, or only CT arthrogram available. Radiographic variables measured on CT scans included estimates of subscapularis muscle volume, subscapularis/infraspinatus muscle ratio, and fatty infiltration according to the Goutallier classification. Pre- and postoperative Western Ontario Shoulder Instability index scores were collected as a secondary outcome of this study. Results: Ninety-three patients were included in the study with a clinical follow-up of 2.3 ± 1.5 years (mean ± SD). The subscapularis volume increased from 185.91 ± 45.85 mL preoperatively to 194.1 ± 49.0 mL postoperatively (P = .006). The subscapularis to infraspinatus muscle ratio showed a significant increase from 0.96 ± 0.27 to 1.05 ± 0.30 after surgery (P = .002). All patients had a Goutallier stage of 0 before and after surgery. The Western Ontario Shoulder Instability scores showed a significant improvement from 64.8 ± 15.5 preoperatively to 28.2 ± 24.0 postoperatively (P < .001). Conclusion: Patients who undergo AAGR with DTA for traumatic shoulder instability with glenoid bone loss have a preserved subscapularis muscle volume with no fatty infiltration, while showing a significant improvement in clinical outcomes.