Traumatic Anterior Instability Research Articles

Managing Bony Defects of the Shoulder Joint that Occur in Association with Dislocation.

Background:Defects to the articular surface of the humeral head have been known to be associated with shoulder dislocation since the 19th century. It wasn't until 1934 that the first description of the ubiquitous compression fracture of the posterolateral humeral head that occurs with traumatic anterior instability appeared. From 1940, this defect became referred to as a Hill-Sachs lesion after the investigators who reported the condition. The significance of, and therefore treatment of, these and other such bony defects around the shoulder joint has been hotly debated.Methods:We reviewed the available current literature to determine and report on the most up to date concepts and treatment techniques being used to manage bony defects of the shoulder.Results:Numerous surgical options have been proposed to manage bony defects of the shoulder, including a variety of defect-filling procedures, with good outcomes. However, the small numbers and diversity of case mix makes for difficult comparisons.Conclusion:We are currently developing a greater appreciation of how both the humeral and glenoid defects interact and therefore should be assessed and addressed simultaneously in order to improve patient outcomes. More research and collaboration is needed to determine the optimal method of assessing and managing these patients.

Indication for Computed Tomography Scan in Shoulder Instability: Sensitivity and Specificity of Standard Radiographs to Predict Bone Defects After Traumatic Anterior Glenohumeral Instability.

Background:Quantifying glenohumeral bone loss is key in preoperative surgical planning for a successful Bankart repair.Hypothesis:Simple radiographs can accurately measure bone defects in cases of recurrent shoulder instability.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:A true anteroposterior (AP) view, alone and in combination with an axillary view, was used to evaluate the diagnostic properties of radiographs compared with computed tomography (CT) scan, the current gold standard, to predict significant bone defects in 70 patients. Sensitivity, specificity, and positive and negative predictive values were evaluated and compared.Results:Detection of glenoid bone loss on plain film radiographs, with and without axillary view, had a sensitivity of 86% for both views and a specificity of 73% and 64% with and without the axillary view, respectively. For detection of humeral bone loss, the sensitivity was 8% and 17% and the specificity was 98% and 91% with and without the axillary view, respectively. Regular radiographs would have missed 1 instance of significant bone loss on the glenoid side and 20 on the humeral side. Interobserver reliabilities were moderate for glenoid detection (κ = 0.473-0.503) and poor for the humeral side (κ = 0.278-0.336).Conclusion:Regular radiographs showed suboptimal sensitivity, specificity, and reliability. Therefore, CT scan should be considered in the treatment algorithm for accurate quantification of bone loss to prevent high rates of recurrent instability.

Traumatic anterior instability of the shoulder

The shoulder is the most unstable joint in the human body. Traumatic anterior instability of the shoulder is a common condition, which, especially in young patients, is associated with high recurrence rates. The effectiveness of non-surgical treatments when compared to surgical ones is still controversial. The purpose of this study was to review the literature for current concepts and updates regarding the treatment of this condition.

Management of Glenoid Defects in Anterior Shoulder Instability: A Review of Current Concepts.

Background:Bone defects of the glenoid are often found in patients with traumatic anterior glenohumeral instability. There is no consensus regarding which glenoid defects need to be treated surgically. The aim of this review is to describe the management of glenoid defects in anterior shoulder instability in patients with traumatic anterior glenohumeral instability.Methods:We conducted a review of the literature through a Pubmed search.Results:The management of glenoid defects in anterior shoulder instability consists of conservative or operative treatment. There is a wide variety in the treatment options. Also, the diagnostics of the presence and size of a glenoid bone defect is still debated on in literature.Conclusion:Based on the current available literature, we advise to begin management of traumatic anterior shoulder instability combined with glenoid defects with conservative treatment. Operative treatment can be used when the bone fragment consists of a large glenoid surface and the patient is active, or in the case of a chronic defect or recurrent instability.

Controversies in the Surgical Management of Shoulder Instability: Open vs Arthroscopic Procedures.

Background:Traumatic anterior instability of the shoulder is a common condition associated with a high recurrence rate in young adults. Operative treatment reduces the risk of recurrence. Several studies have compared arthroscopic and open shoulder instability repair. The purpose of this paper is to perform a review of the literature where both techniques are compared in the repair of the anterior shoulder instability without bone loss.Methods:Prior to arthroscopy, recurrent dislocations were managed by open repair. There have been many studies documenting low recurrence rates after open Bankart stabilization.Initially, arthroscopic fixation reported high failure rates.Results:In the last 20 years, the development of arthroscopic stabilization for recurrent anterior instability has improved failure rates. In comparison with open techniques, arthroscopic procedures have the advantages of decreased morbidity rate, early functional rehabilitation and improved range of motion.Conclusion:The available evidence does not show a statistically significant difference in outcome measures between arthroscopic and open repair for the treatment of recurrent anterior shoulder instability. Given the similar results between the 2 groups, differences in length of hospital stay and cost to the patient and society point to arthroscopic repair as the more judicious treatment approach.

Instabilidade anterior traumática do ombro

The shoulder is the most unstable joint in the human body. Traumatic anterior instability of the shoulder is a common condition, which, especially in young patients, is associated with high recurrence rates. The effectiveness of non‐surgical treatments when compared to surgical ones is still controversial. The purpose of this study was to review the literature for current concepts and updates regarding the treatment of this condition.

Arthroscopic repair of bony Bankart lesions in collision athletes.

The present study aimed to report the outcomes of acute and subacute arthroscopic bony Bankart repairs in collision athletes. We reviewed 22 consecutive rugby players with traumatic anterior glenohumeral instability who underwent arthroscopic bony Bankart repair within 4 months of injury over a 2-year period. All lesions were less than 25% of the glenoid bony area. A significant improvement was noted at three months and was maintained at 28 months postoperatively. The mean Constant score improved from 61.5 to 84.1, the mean Oxford shoulder score decreased from 26.3 to 13.6 and the mean Oxford instability score decreased from 42.9 to 13.5. The mean satisfaction score was 8.3 out of 10 at final follow-up. All patients returned to their pre-injury sporting level. Twenty patients (91%) remained stable and asymptomatic, although two (9%) had recurrent instability after further traumatic sports injuries. One required a modified Latarjet procedure, whereas the other patient sustained a soft tissue Bankart lesion and had a revision arthroscopic repair. Acute and sub-acute bony Bankart lesions in collision athletes can be addressed through arthroscopic repair with a satisfactory outcome and return to pre-injury level of sport.

Operação de Bristow‐Latarjet modificada no tratamento na luxação glenoumeral anterior traumática recidivante

ObjectiveRetrospective case‐control study of authors experience in the modified Bristow‐Latarjet procedure for treatment of recurrent traumatic anterior glenohumeral dislocation with glenoid bone injury. MethodsSample with 102 recurrent glenohumeral dislocation cases submitted to modified Bristow‐Latarjet procedure. Indications included situations of recurrent traumatic anterior glenohumeral instability with more than two dislocation episodes and with glenoid bone attritional or fragmentary injuries, without possibility of reconstruction. Mean follow‐up time was 5.33±2.74 years (minimum 1; range 1‐13). ResultsThe mean Walch‐Duplay Score at the last evaluation was 91.23±11.46 (range 15‐100). The functional score of patients with glenoid bone loss greater than 20% did not show a significant difference in comparison with patients with glenoid bone loss lower than 20% (90 vs. 92, respectively). The functional score also did not show a significant difference between sports practice categories and between recreational and competitive practice, being excellent (greater than 90) in every category. There were no dislocation recurrences and the only complications were a case of persistent instability and a screw revision. Mild glenohumeral osteoarthrosis imaging signs were identified in 7.84% of the patients; however, their functional scores were not significantly different in comparison to other patients. ConclusionThe modified Bristow‐Latarjet procedure is a very effective procedure with few complications in the medium‐term, showing very satisfactory functional outcomes in the treatment of recurrent traumatic anterior glenohumeral dislocation associated with glenoid bone injury.

Clinical Outcome of Arthroscopic Bankart Repair Combined With Simultaneous Capsular Repair

Background: A capsular tear and humeral avulsion of the glenohumeral ligament lesion are not uncommon findings in association with a Bankart lesion. However, there have been few reports regarding the prevalence of such capsular lesions and the postoperative recurrence after capsular repair. Purpose/Hypothesis: This study investigated the prevalence of capsular lesions and clarified their influence on the postoperative recurrence of instability. In addition, factors were identified that were associated with the occurrence of capsular lesions and the postoperative recurrence of instability. We hypothesized that clinical outcomes would be improved by combining arthroscopic Bankart repair with simultaneous capsular repair. Study Design: Cohort study; Level of evidence, 3. Methods: Capsular lesions were retrospectively examined through operative records, still pictures, and videos in 172 shoulders with traumatic anterior instability. First, the prevalence of capsular lesions and their severity were investigated. Then, postoperative recurrence was determined in shoulders observed for a minimum of 2 years. Finally, factors were assessed that were associated with the occurrence of capsular lesions and the postoperative recurrence of instability. Results: A capsular lesion was recognized in 37 shoulders (21.5%), being severe and mild in 20 and 17, respectively. All were repaired simultaneously with the arthroscopic Bankart procedure. After follow-up for at least 2 years, recurrence of instability was detected in 10 of 34 shoulders (29.4%), including 6 (31.6%) with severe capsular lesions and 4 (26.7%) with mild lesions. The recurrence rate was significantly higher in shoulders with a capsular lesion than in shoulders without a capsular lesion (18 of 120, 15%; P = .013), but there was no significant difference between severe and mild lesions. Regardless of the sport played, capsular lesions were significantly more frequent in patients ≥30 years old, patients with complete dislocation, and patients with a coexisting Hill-Sachs lesion. Postoperative recurrence of instability was significantly more frequent in patients <30 years and competitive athletes. Conclusion: In shoulders undergoing arthroscopic Bankart repair, capsular lesions were often present and were associated with higher postoperative recurrence of instability. While these lesions were more frequent in older patients, postoperative recurrence of instability was more likely in young competitive athletes.

Criteria for assessing the effectiveness of arthroscopic access in the treatment of traumatic anterior instability of the shoulder joint

For an objective evaluation of the effectiveness of surgical ap­proach, topographic anatomical criteria are known, which include: the axis of the operating performance, wound depth, angle of surgical performance and operating performance axis tilt, access zone. With the use of technology in arthroscopic treatment of anterior instability of the shoulder joint it was nec­essary to adapt the proposed concepts in open surgery. Objec­tive:to evaluate the performance criteria of arthroscopic ac­cess to treatment of traumatic anterior instability of the shoul­der joint. Methods: We applied Sozon-Yaroshevich method and criteria for evaluating the effectiveness of surgical approach adapted for endoscopy. Results: The authors have changed some concepts that are used for evaluation of the wound in the ab­dominal endoscopic surgery. In particular, the angle of the op­erating performance, the apex of which is the point of setting the endoscopic port and rays — the direction of the instrument determines the possibility of moving the wound instruments and achieve extreme points of accessibility zones. Important for ar­throscopic surgery is the concept of range of motion of the in­strument (extreme possible its position within the port), the ef­fective angle of operational steps (between the extreme positions of the tool by which the execution of the necessary manipula­tions) area accessibility (areas of the bottom of the wound, which can be opened for inspection and manipulation). The concept: an optimal angle of attack, formed a line slope edge instruments and glenoid border when convenient to carry out manipulations to prepare input channel and anchor in articular edge of the blade; the effective accessibility zone (bottom area of the wound where the manipulations performed without restrictions). This scheme calculation of surgical approach. Conclusions: Ar­throscopic method of operation has certain performance stan­dards. Clinical features of pathology determine the different ap­proaches to treatment and improving arthroscopic technique.

A systematic review and meta-analysis of clinical and patient-reported outcomes following two procedures for recurrent traumatic anterior instability of the shoulder: Latarjet procedure vs. Bankart repair

The Bankart repair and Latarjet procedure are both viable surgical options for recurrent traumatic anterior instability of the shoulder joint. The anatomic repair is the more popular option, with 90% of surgeons internationally choosing the Bankart repair as the initial treatment. There has been no previous review directly comparing the 2 techniques. Hence, we aimed to systematically review studies to compare the outcomes of Bankart repairs vs. the Latarjet procedure for recurrent instability of the shoulder. Six electronic databases were searched for original, English-language studies comparing the Bankart and Latarjet procedures. Studies were critically appraised using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Data were extracted from the text, tables, and figures of the selected studies. Eight comparative studies were identified with 795 shoulders; 416 of them underwent open or arthroscopic Bankart repairs, and 379 were repaired by the open Latarjet procedure. Primary and revision procedures were studied. The Latarjet procedure conferred significantly lower risk of recurrence and redislocation. There was no significant difference in the rates of complication requiring reoperation between the two procedures. Rowe scores were higher and loss of external rotation lower in the Latarjet group compared with the Bankart repair group. Our studies demonstrate that the Latarjet procedure is a viable and possibly superior alternative to the Bankart repair, offering greater stability with no significant increase in complication rate. However, the studies identified were retrospective and of limited quality, and therefore randomized controlled trials with large populations of patients or prospective assessment of national orthopedic registries should be employed to confirm our findings.

Tissue regeneration for the traumatic anterior instability with bony defect

10 LONGITUDINAL STUDY FOR ROTATOR CUFF TEARS IN THE GENERAL POPULATION Atsushi Yamamoto, Kenji Takagishi, Hitoshi Shitara, Tsuyoshi Ichinose, Tsuyoshi Sasaki, Noritaka Hamano, Tsutomu Kobayashi, Daisuke Shimoyama, Toshihisa Osawa, Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Department of Physical Therapy, Takasaki University of Health and Welfare, Department of Orthopaedic Surgery, Takasaki General Medical Center The purpose of this study was to elucidate the natural history of rotator cuff tears (RCTs) in the general population. We have performed annual medical check-ups since 2006. The subjects of this study consisted of 568 people, with 1,136 shoulders, who were investigated longitudinally more than two times between 2009 and 2015, which comprised 400 men and 736 women, with a mean age of 67.2 years (range; 30-85), and a mean follow-up period of 3.5 years (range; 1-6). We performed ultrasonography to diagnose RCTs. At the beginning of the survey, 957 shoulders were diagnosed as non-tear. As time passed, 45 and 29 of these shoulders progressed to partial-thickness tear (PTT) and full-thickness tear (FTT), respectively. At the same time, 32 shoulders were diagnosed as PTT, and 53.1% of them progressed to FTTas time passed. Additionally, 147 shoulders were diagnosed as FTTat the beginning of the survey, and 33.3% of them enlarged the size of tears by more than 5 mm during the survey. In 147 of FTTs, 43 shoulders were symptomatic tears and 104 shoulders were asymptomatic tears. The development of symptoms in both symptomatic and asymptomatic tears was associated with the enlargement of the size of tear. In conclusion, RCTs might become asymptomatic if the size of tear the remains the same, while they seem to be symptomatic when a new tear or enlargement of the size of the existing tear occurs.

Relationship Between Glenoid Defects and Hill-Sachs Lesions in Shoulders With Traumatic Anterior Instability

Background: While the combination of a glenoid defect and a Hill-Sachs lesion in a shoulder with anterior instability has recently been termed a bipolar lesion, their relationship is unclear. Purpose: To investigate the relationship of the glenoid defect and Hill-Sachs lesion and the factors that influence the occurrence of these lesions as well as the recurrence of instability. Study Design: Case-control study; Level of evidence, 3. Methods: The prevalence and size of both lesions were evaluated retrospectively by computed tomography scanning in 153 shoulders before arthroscopic Bankart repair. First, the relationship of lesion prevalence and size was investigated. Then, factors influencing the occurrence of bipolar lesions were assessed. Finally, the influence of these lesions on recurrence of instability was investigated in 103 shoulders followed for a minimum of 2 years. Results: Bipolar lesions, isolated glenoid defects/isolated Hill-Sachs lesions, and no lesion were detected in 86, 45, and 22 shoulders (56.2%, 29.4%, and 14.4%), respectively. As the glenoid defect became larger, the Hill-Sachs lesion also increased in size. However, the size of these lesions showed a weak correlation, and large Hill-Sachs lesions did not always coexist with large glenoid defects. The prevalence of bipolar lesions was 33.3% in shoulders with primary instability and 61.8% in shoulders with recurrent instability. In relation to the total events of dislocations/subluxations, the prevalence was 44.2% in shoulders with 1 to 5 events, 69.0% in shoulders with 6 to 10 events, and 82.8% in shoulders with ≥11 events. Regarding the type of sport, the prevalence was 58.9% in athletes playing collision sports, 53.3% in athletes playing contact sports, and 29.4% in athletes playing overhead sports. Postoperative recurrence of instability was 0% in shoulders without lesions, 0% with isolated Hill-Sachs lesions, 8.3% with isolated glenoid defects, and 29.4% with bipolar lesions. The presence of a bipolar lesion significantly influenced the recurrence rate, but lesion size did not. Conclusion: The prevalence of bipolar lesions was approximately 60%. As glenoid defects became larger, Hill-Sachs lesions also enlarged, but there was no strong correlation. Bipolar lesions were frequent in patients with recurrent instability, patients with repetitive dislocation/subluxation, and those playing collision/contact sports. Instability showed a high recurrence rate in shoulders with bipolar lesions.

Glenoid Morphology after Arthroscopic Osseous Bankart Repair for Chronic Traumatic Anterior Glenohumeral Instability: A 5 to 8 Year Follow-Up

Glenoid Morphology after Arthroscopic Osseous Bankart Repair for Chronic Traumatic Anterior Glenohumeral Instability: A 5 to 8 Year Follow-Up

Combined Arthroscopic Bankart Repair and Coracoid Process Transfer to Anterior Glenoid for Shoulder Dislocation in Rugby Players: Evaluation Based on Ability to Perform Sport-Specific Movements Effectively

To evaluate the outcomes of a combination of an arthroscopic Bankart repair and an open Bristow procedure in relation to the subjective quality of performance in movements that are typical in rugby. Forty shoulders in 38 players who underwent surgery for traumatic anterior instability of the shoulder were reviewed. In all cases, arthroscopic Bankart repair was followed by a Bristow procedure, with preservation of the repaired capsular ligaments, during the same operation. The mean age at the time of surgery was 21 years. Patients were asked to describe common rugby maneuvers (tackle, hand-off, jackal, and saving) preoperatively and postoperatively as "no problem," "insufficient," or "impossible." There were no recurrent dislocations at a mean follow-up of 30.5 months. The mean Rowe score improved significantly from 65.0 (range, 55 to 75) to 97.5 (range, 95 to 100) (P < .001) after surgery. Preoperatively, regarding the tackling motion, none of the patients reported having no problem, whereas the ability was described as insufficient for 23 shoulders and impossible for 17 shoulders. Postoperatively, no problem with tackling was reported for 36 shoulders, whereas insufficiency was reported for 4. The results for the hand-off, jackal, and saving maneuvers were similar (P < .001). No patient rated any of the motions as impossible postoperatively. This combined surgical procedure clearly is effective in preventing recurrent dislocation in rugby players; however, some players complained of insufficiency in the quality of their play when they were tackling or performing other rugby-specific movements. Level IV, case series.

Randomized controlled trial of arthroscopic electrothermal capsulorrhaphy with Bankart repair and isolated arthroscopic Bankart repair.

Electrothermal arthroscopic capsulorrhaphy (ETAC) was introduced as an adjunct to shoulder stabilization surgery to address capsular laxity in the treatment of traumatic anterior dislocation. No previous RCT has compared arthroscopic Bankart repair with ETAC of the medial glenohumeral ligament and anterior band of the inferior glenohumeral ligament versus undergoing arthroscopic Bankart repair alone. Our hypothesis was that there would be no difference in quality of life between these two groups. Complication/failure rates were also compared. Eighty-eight patients were randomly assigned to receive arthroscopic Bankart repair with (n = 44) or without ETAC (n = 44). Post-operative visits occurred at 3, 6, 12, and 24 months with WOSI, ASES, and Constant scores completed, and rates of dislocation/subluxation were determined. Data on 74 patients were analysed, with the rest lost to follow-up. There were no differences between groups at any post-surgery time points for WOSI, ASES, or Constant scores (n.s.). Eight patients in the no-ETAC group and 7 in the ETAC group were considered failures (n.s.). No benefits in patient-reported outcome or recurrence rates using ETAC were found. Mean WOSI scores 2 years post-surgery were virtually identical for the two groups. ETAC could not be shown to provide benefit or detriment when combined with arthroscopic labral repair for traumatic anterior instability of the shoulder. II.

Traumatic anterior instability of the pediatric shoulder: a comparison of arthroscopic and open bankart repairs.

Arthroscopic and open Bankart repairs have proven efficacy in adults with recurrent anterior shoulder instability. Although studies have included children in their analysis, none have previously compared functional outcomes or redislocation rates between these 2 methodologies for anteroinferior glenoid labrum repair in this young population. We hypothesize that open and arthroscopic Bankart repair in children will have similar functional outcomes and redislocation rates, but differing results from adults treated in a similar manner. A retrospective chart review was performed on all Bankart repairs performed between 2006 and 2010 at a tertiary care children's hospital. A shift in treatment modalities occurred in 2008 creating 2 cohorts, open and arthroscopic. Brachial plexus injury, congenital soft-tissue disorder, or incomplete charts were excluded. Demographics, age at surgery, follow-up length, and sport were recorded. Telephone interviews were then performed obtaining the most current QuickDASH (Disability Arm, Shoulder, or Hand), WOSI (Western Ontario Shoulder Instability Index), SF-12 (Short Form 12), SANE (Single Assessment Numeric Evaluation), and verbal pain scores; as well as, inquiring about recurrent dislocation and further surgery. Ninety-nine children (16.9±1.5 y) were included (28 open, 71 arthroscopic). There were no differences in preoperative demographics. Fifty-one patients completed the questionnaires (11 open, 40 arthroscopic). No significant differences in the outcomes scores were seen between the 2 groups. Of the 99 patients, 21 (21%) had redislocation or secondary surgery; there was no significant difference in failure rate between groups (4 open, 17 arthroscopic). A plotted survival curve demonstrated that the adolescent shoulder undergoing Bankart repair for recurrent traumatic anterior instability has a 2-year survival of 86% and a 5-year survival of only 49%, regardless of technique. In adolescents, there is no significant difference in functional outcomes or redislocation rates between open and arthroscopic Bankart repair, yet both demonstrate a very high risk of failure in this young, athletic population which contrasts the results in the historic adult population. Level III-retrospective comparative study.

Arthroscopic evaluation and management of instability of shoulder joint

Background: Shoulder joint instability results in great disability and it is possible to get good results of treatment in selected patients in whom intraarticular pathologies are diagnosed and treated appropriately. Aims: To investigate the pathology of unstable shoulder joint and study the effect of arthroscopic stabilization for the management of traumatic anterior glenohumeral instability and success rate of all arthroscopic Bankart repair. Materials and Methods: This prospective study was conducted in a tertiary care hospital of West Bengal in a time span of 1 year, after getting the approval of the Institutional Ethical Committee and informed consent of the patients. Patients aged between 20 and 40 years with post-traumatic recurrent anterior dislocation of the shoulder were included. Patients were operated arthroscopically and followed up. Results were analyzed per the assessment criteria of Rowe scale. Results: Ten percent had fair and 90% had poor Rowe score during preoperative period. Bankart lesion was present in 16 patients out of 20 patients in whom we performed arthroscopic Bankart repair with suture anchors. At last follow up, 13 patients were able to work above shoulder level normally; two patients had mild limitation of work. One patient had moderate type of restriction of activities. This patient had a history of trauma 3 months after operation. Conclusions: Overall 93.75% patients had excellent to good result in the present study. Based on this short series and minimum follow-up we recommended, this method of management for shoulder instability due to Bankart lesion.

"8 plate": an alternative device to fix highly recurrent traumatic anterior gleno-humeral instability in patients with severe impairment of the anterior capsule.

Background: There is still debate about the best treatment option for highly recurrent anterior shoulder dislocation in patients with severe impairment of the anterior capsule and/or recurrence after either arthroscopic or open capsulorrhaphy. Materials and Methods: The clinical and radiological findings of 7 patients treated with an open capsulorrhaphy stabilized with an “8 plate” for a highly recurrent traumatic anterior shoulder dislocation with severe impairment of the anterior capsule and a large Bankart lesion were retrospectively reviewed. Follow-up evaluation included VAS for pain, Constant-Murley, Simple Shoulder Test, ASES, UCLA, Quick DASH, Rowe, Walsch-Duplay scores, as well as X-rays of the operated shoulder. Results: At follow-up none of the patients reported subsequent dislocations. Range of motion of the shoulder was complete in all cases, but one. Results of the functional scoring systems were satisfactory. X-rays showed no osteolysis and good position of the plate. Conclusion: To our knowledge, this is the first report in the literature about an open capsular tensioning and Bankart lesion repair performed with an “8 plate”. We believe that this is a reliable and effective procedure to address traumatic anterior re-dislocation of the gleno-humeral joint when the capsule is extensively torn and frayed or in revision cases. Moreover the “8 plate” is ideal to be applied in such a narrow space on the slant surface of the scapular neck close to the glenoid rim.

Profile of collagen gene expression in the glenohumeral capsule of patients with traumatic anterior instability of the shoulder

ObjectiveTo evaluate the expression of the genes COL1A1, COL1A2, COL3A1 and COL5A1 in the glenohumeral capsule of patients with traumatic anterior instability of the shoulder. MethodsSamples from the glenohumeral capsule of 18 patients with traumatic anterior instability of the shoulder were evaluated. Male patients with a positive grip test and a Bankart lesion seen on magnetic resonance imaging were included. All the patients had suffered more than one episode of shoulder dislocation. Samples were collected from the injured glenohumeral capsule (anteroinferior region) and from the macroscopically unaffected region (anterosuperior region) of each patient. The expression of collagen genes was evaluated using the polymerase chain reaction after reverse transcription with quantitative analysis (qRT-PCR). ResultsThe expression of COL1A1, COL1A2 and COL3A1 did not differ between the two regions of the shoulder capsule. However, it was observed that the expression of COL5A1 was significantly lower in the anteroinferior region than in the anterosuperior region (median±interquartile range: 0.057±0.052 vs. 0.155±0.398; p=0.028) of the glenohumeral capsule. ConclusionThe affected region of the glenohumeral capsule in patients with shoulder instability presented reduced expression of COL5A1.