Treatment Of Recurrent Shoulder Dislocation Research Articles

Development and research progress of suture button fixation Latarjet procedure

To review the development and research progress of suture button fixation Latarjet procedure. A comprehensive literature review was conducted to summarize the development and related modified techniques of the suture button fixation Latarjet procedure. Since the Latarjet procedure was first introduced by French scholar Latarjet in 1954, it has undergone three key transformations, resulting in suture button fixation Latarjet procedure, which has shown satisfactory outcomes in treatment of recurrent shoulder dislocation. However, there are still drawbacks such as the risk of impingement of the graft on surrounding tissues, and the surgical disruption of anatomical structures like the coracoclavicular ligament and the pectoralis minor muscle. The scholars have proposed several modified techniques based on the suture button fixation Latarjet procedure to further reduce complications from impingement of the graft, to lower the glenohumeral contact pressure, and to eliminate the impact of surgery on the physiological structures of the shoulder joint. The modified techniques include the arthroscopic suture button fixation Latarjet procedure using FiberTape Cerclage, reconstruction of the coracoacromial ligament during congruent-arc Latarjet procedures, and limit unique coracoid osteotomy suture button Latarjet procedure (LU-tarjet procedure). These modified techniques have also shown good clinical outcomes. Additionally, other related modified techniques for reconstruction of the glenoid, such as Chinese unique Inlay Bristow procedure (Cuistow procedure), arthroscopic glenoid bone grafting with soft fixation, and all-arthroscopic modified Eden-Hybinette procedure, have also demonstrated favorable efficacy. However, there is still a lack of long-term follow-up results for these techniques and comparative studies between them. Suture button fixation Latarjet procedure is an effective method for the treatment of recurrent shoulder dislocation. There are various techniques, but there is no recognized gold standard, and further clinical and basic research is needed.

Surgical accidents and postoperative complications of recurrent shoulder dislocation treated by suture button fixation with bone occlusion

To summarize the surgical accidents and postoperative complications of the treatment of recurrent shoulder dislocation by suture button fixation and bone occlusion, and to provide clinical reference. The clinical data of 16 patients with recurrent shoulder dislocation treated with modified arthroscopic Latarjet suture button fixation and bone occlusion between July 2017 and April 2023 were retrospectively analyzed. Among them, 15 were male and 1 was female. The age ranged from 16 to 45 years, with an average of 26 years. Admission examination showed the range of motion of shoulder joint was normal; the shoulder joint fear test was positive; En-face CT scan measured 10%-20% of the glenoid defects, averaging 13.4%; and MRI examination revealed bone Bankart injury. The disease duration ranged from 2 to 20 years, with an average of 7.1 years. The shoulder joint was dislocated 8- 45 times, with an average of 17.4 times, and the shoulder joint was unstable. The occurrence of surgical accidents and postoperative complications as well as corresponding measures and outcomes were recorded. All the incisions healed by first intention without any complications such as incision infection or vascular injury. All 16 cases were followed up for an average of 3.6 years (range, 1-7 years), and no shoulder redislocation occurred. Four types of intraoperative surgical accidents and two types of postoperative complications occurred in the early stage of implementation of the technique. Intraoperative surgical accidents included 1 case of difficulty in passing subscapular muscle through coracotomy with large size, which was treated with exchange rod or finger through subscapular muscle split; 2 cases of coracoidal process fracture, of which 1 case was treated conservatively, and the other case was sutured to the base of tendon and fixed through tunnel; 1 case of glenoid fracture occurred in the glenoid tunnel, which was fixed with knot-free anchors; the posterior loop plate fixation was abnormal in 2 cases, of which 1 case was re-fixed and the other case was renovated. Postoperative complications included coracoid bone mass displacement in 1 case, conservative biceps rehabilitation was given to avoid premature external rotation; 1 case of radial nerve injury of healthy upper limb and musculocutaneous nerve injury of affected side was given oral medication and physiotherapy. The above conditions recovered well after corresponding treatment. Suture button fixation with bone occlusion is a safe method for the treatment of recurrent shoulder dislocation. Careful operation should be performed during coracoid interception and glenoid tunnel drilling, especially in the fixation process.

Application of LU-tarjet congruent-arc technique in treatment of recurrent shoulder dislocation with huge glenoid defect

To investigate the early effectiveness of the limited unique coracoid osteotomy suture button fixation Latarjet (LU-tarjet)-congruent-arc (CA) technique (LU-tarjet-CA) in treating recurrent shoulder dislocations with huge glenoid defect. The clinical data of 12 patients with recurrent shoulder dislocation and huge glenoid defect who met the selection criteria and treated with arthroscopic LU-tarjet-CA between January 2021 and December 2023 were retrospectively analyzed. The cohort included 8 males and 4 females, aged 20-40 years with an average age of 30.4 years. The range of glenoid bone loss was 30%-40%, with an average of 35.5%. The time from symptom onset to hospital admission ranged from 1 to 36 months, with an average of 18.5 months. The University of California Los Angeles (UCLA) score, American Association for Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, and Rowe score were used to evaluate shoulder function preoperatively and at 3, 6, and 12 months postoperatively. CT three-dimensional (3D) reconstruction was used to assess coracoid healing and plasticity at 3, 6, and 12 months postoperatively. Subjective satisfaction of patient was recorded at last follow-up. All incisions healed by first intention, with no incision infection or nerve injury. All 12 patients were followed up 12 months. One patient developed Propionibacterium acnes infection within the joint postoperatively and recovered after initial arthroscopic debridement and anti-inflammatory treatment. At 3 months after operation, CT 3D-reconstruction showed 1 case of complete coracoid absorption; neither of these two patients experienced redislocation. The remaining patients exhibited partial coracoid absorption but displayed local reshaping, filling the preoperative defect area, and bony fusion between the coracoid and the glenoid. At last follow-up, 9 patients (75%) were very satisfied with the outcome, and 3 patients (25%) were satisfied; the satisfied patients experienced postoperative shoulder stiffness caused by suboptimal functional exercise but did not have impaired daily life activities. The UCLA score, ASES score, Walch-Duplay score, and Rowe score at 3, 6, and 12 months postoperatively were significantly better than preoperative scores, and each score improved further over time postoperatively, with significant differences between different time points ( P<0.05). The arthroscopic LU-tarjet-CA technique for treating recurrent shoulder dislocations with huge glenoid defect can achieve the surgical objective of bony blockade and filling bone defects to prevent shoulder dislocation, thereby improving patients' quality of life and shoulder joint function and stability.

The congruent arc latarjet procedure – Its functional outcomes in recurrent anterior shoulder dislocation with critical glenoid bone loss

Background: Recurrent shoulder dislocation leading to shoulder instability is a cumbersome clinical problem for patients and orthopedicians. Due to a lack of knowledge in young patients of developing countries, there is a delay in presentation from the first time of dislocation. The aim of this retrospective study was to evaluate the functional and radiographic outcomes of patients with shoulder instability after the Congruent Arc Latarjet procedure. Methods: From January 2018 to November 2021, 20 patients with history of recurrent shoulder dislocation having glenohumeral instability were treated surgically in our institute. Open Congruent Arc Latarjet procedure was performed in 20 patients. Functional outcomes were assessed preoperatively and postoperatively based on American Shoulder and Elbow Surgeons (ASES) score, the visual analog scale (VAS) for pain, ROWE score, and Active range of motion in the diseased shoulder. Results: Twenty shoulders of 20 patients were evaluated for a mean period of 24 months postoperatively. At the time of the latest consultation, the range of motion and the shoulder functional evaluations based on ROWE score which was 89.64 ± 5.71 (range 80–95) improved from 20.36 ± 8.87 (range 10–30), p = 0.001. The mean preoperative ASES score was 22.60 ± 1.09 (range 20.6–25) which improved to 72.50 ± 7.33 (range 52.8–77.2), p = 0.001, which is definitely improved. The overall re-dislocation rate was 0% (0 of 20). In our study, 60% had excellent outcomes, 30% had good outcomes, and 10% had fair outcomes. Conclusion: The Congruent Arc Latarjet procedure for the treatment of recurrent shoulder dislocation with glenoid bone loss of &gt;20% is a successful and efficient method with better outcomes in daily work profile and no further episode of redislocation.

Arthroscopic subscapularis augmentation for the treatment of recurrent dislocation of shoulder with severe glenoid injury

To investigate the method and clinical effects of the treatment of recurrent shoulder dislocation with severe glenoid injury by arthroscopic subscapularis augmentation. From March 2019 to August 2020, 16 patients with recurrent dislocation of shoulder with severe glenoid injury underwent arthroscopic subscapularis augmentation, including 10 males and 6 females, aged from 18 to 50 years old with an average of (29.06±10.54) years old, 4 cases of left shoulder and 12 cases of right shoulder.Visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score and Rowe score were used to evaluate shoulder function and stability before and after operation. All the 16 patients were followed up from 12 to 29 months, with an average of (18.75±7.26) months. VAS score decreased from 5.25±1.13 before operation to 1.37±0.65 at the final follow-up;ASES score increased from 59.44±9.93 before surgery to 90.88±4.00 at the final follow-up; Rowe score of shoulder increased from 51.56±8.89 before surgery to 92.19±7.06 at the final follow-up, and the differences were statistically significant (P<0.05). No dislocation was observed during follow-up. No clinical complications such as incision infection, vascular and nerve injury occurred in all patients after operation. Arthroscopic subscapularis augmentation in the treatment of recurrent dislocation of shoulder with severe glenoid injury is satisfactory. It is an effective treatment method of recurrent dislocation of shoulder joint with severe glenoid injury, and external rotation function in patients with almost unaffected.

Suspension fixation of iliac bone grafts under arthroscopy is an effective method for the treatment of unstable bony Bankart disease of the shoulder joint in patients with joint relaxation

PurposeTo evaluate the results of arthroscopic autologous iliac bone graft suspension fixation combined with the Remplissage procedure in the treatment of recurrent shoulder dislocation with bony Bankart lesions and joint hyperlaxity.MethodsFrom 2018 to 2020, 22 patients with joint laxity underwent arthroscopic autologous iliac bone graft suspension fixation and Bankart repair combined with the Remplissage procedure due to recurrent shoulder dislocation. Clinical assessment included range of motion (forward flexion, abduction, 90° external rotation, conventional external rotation, adduction, and internal rotation), visual analog scale (VAS) score, Rowe score, University of California Los Angeles (UCLA) score, and Western Ontario Shoulder Instability Index (WOSI) score. Post-operatively, the healing of the bone graft was evaluated with computed tomography (CT) scanning.ResultsAll 22 patients were followed up for a mean of 19.3 ± 4.1 months. CT imaging showed that the healing time of the bone graft was 6–8 weeks. The patient satisfaction rate was 100%, there were no cases of redislocation, all patients returned to their preinjury training state, and the fear test was negative. At the final follow-up, the UCLA, VAS, Rowe, and WOSI scores were 29.8 ± 2.1, 2.2 ± 0.8, 89.4 ± 4.2, and 482.3 ± 46.2, respectively (p < 0.001).ConclusionArthroscopic autologous iliac bone graft suspension fixation and Bankart repair combined with the Remplissage procedure are effective in preventing recurrent instability with joint hyperlaxity. Furthermore, no patient had redislocation.Level of evidenceIV.

High failure rate after conservative treatment for recurrent shoulder dislocation without subjective apprehension on physical examination.

The purpose of this study was to investigate the outcomes of conservative treatment for recurrent shoulder dislocation without subjective apprehension, despite the presence of a Bankart lesion or glenoid defect. A retrospective analysis was performed for 92 patients with recurrent shoulder dislocation treated with conservative treatment due to negative apprehension between 2009 and 2018. The failure of the conservative treatment was defined as a dislocation or subluxation episode or subjective feeling of instability based on a positive apprehension. The Kaplan-Meier method was used to estimate failure rates over time, and a receiver operating characteristic (ROC) curve was constructed to determine a cut-off value for a glenoid defect. The clinical outcomes were compared between patients who completed conservative treatment without recurrence of instability (Group A) and those who failed and subsequently underwent surgical treatment (Group B) using shoulder functional scores and sports/recreation activity level. This retrospective study included 61 of 92 eligible patients with recurrent shoulder dislocation. Among the 61 patients, conservative treatment failed in 46 (75.4%) over the 2-year study period. The cut-off value for a glenoid defect was 14.4%. The association between glenoid defect size (≥ 14.4% or as a continuous variable) and survival was statistically significant (p = 0.039 and p < 0.001, respectively). The mean glenoid defect size in Group B increased from 14.6 ± 3.0% to 17.3 ± 3.1% (p < 0.001), and clinical outcomes for Group A were inferior to those for Group B at the 24-month follow-up. Conservative treatment for recurrent shoulder dislocation in patients without subjective apprehension showed a high failure rate during the study period, especially if the glenoid defect was ≥ 14.4% in size. Despite clinical improvement in patients who completed conservative treatment without recurrence, functional outcome scores and sport/recreation activity levels were better in the patients who underwent arthroscopic Bankart repair. Therefore, for recurrent anterior shoulder instability, even without subjective apprehension, surgical treatment is warranted over conservative treatment. Level IV.

Bankart repair and clinical results in the treatment of recurrent shoulder dislocation

Bankart repair and clinical results in the treatment of recurrent shoulder dislocation

Latarjet Cerclage: The All-Arthroscopic Metal-Free Fixation

The Bristow–Latarjet procedure has been one of the most recognized procedures for the treatment of recurrent shoulder dislocation with anterior glenoid bone loss, revision surgery after failed Bankart repair, contact and collision sport injuries, and patients with a high risk of recurrence. Open and arthroscopic approaches have recently shown similar outcomes by several authors. However, complications related to metal implants, despite being low, are still a matter of concern. We describe an all-arthroscopic Latarjet technique with a metal-free fixation method using 2 ultra-high-strength sutures, creating a cerclage construct through 2.4mm glenoid and coracoid tunnels with a final capsulolabral complex reconstruction.

The Surgical Treatment of Recurrent Shoulder Dislocation with the Latarjet Procedure (A Report of 32 Cases)

The Surgical Treatment of Recurrent Shoulder Dislocation with the Latarjet Procedure (A Report of 32 Cases)

Microfracture in Linear, Isolated, Narrow, Engaging Hill-Sachs Lesion

Treatment of Hill-Sachs lesions is still controversial despite the frequent incidence in patients with recurrent shoulder dislocation. We report the use of arthroscopic microfracture for the treatment of recurrent shoulder dislocation with a linear, isolated, narrow, engaging Hill-Sachs lesion. Arthroscopic microfracture can be an alternative treatment option to obtain healing of defects and avoid external rotation limitation in young, active patients with recurrent dislocation with linear, isolated, narrow, engaging lesions.

Complications of coracoid transfer procedures for the treatment of recurrent shoulder dislocation

BackgroundDifferent surgical procedures have been described for the treatment of the recurrent anterior dislocation of the shoulder. Despite the documented success of the open procedures, some studies suggest that the arthroscopic technique leads to more favorable results. However, there still seems to be some disagreement concerning the incidence of complications, when comparing open and arthroscopic techniques. Objective and methodsAs an attempt to clarify these doubts about the incidence of complications associated with the different techniques, this study contains a free literature review along with a retrospective case series of the patients who underwent these procedures in an University hospital in the past 10 years. Discussion and conclusionThere are various techniques for the treatment of the recurrent dislocation of the shoulder, all of them with known success when it comes to prevention of recurrence. However, all of them are invariably associated with high complication rates.Despite being associated with a slightly higher re-operation rate, in the literature, the arthroscopic technique was found to have an overall lower rate of complications when compared to the open procedures. Centro Hospitalar São João (CHSJ) presented a higher rate of screw related complications and revision surgery than the literature. However, concerning other complications and when assessing the procedures individually, no tendency was verified. One can therefore conclude that, despite being scarce, the Centro Hospitalar São João CHSJ data roughly overlap the literature.

Evaluation of postoperative results from videoarthroscopic treatment for recurrent shoulder dislocation using metal anchors

ObjectiveTo clinically and radiologically evaluate the results from videoarthroscopic treatment using metal anchors in patients with recurrent shoulder dislocation and its complications. MethodsThis was a retrospective study on 47 patients (47 shoulders) operated by the shoulder group of the orthopedic hospital between February 2010 and February 2012. A questionnaire, interview and physical and radiographic examinations were used, with the classification of Samilson and Pietro. The mean postoperative follow-up was 33 months (range 12–47 months). The statistical analysis consisted of using Fisher's exact test through the IBM SPSS 22 statistical software. The significance level used was 5%. ResultsRecurrence was observed in nine cases. The patients were, on average, 26.5 years old at the first episode, and 19.1% were aged 20 years or under. Among these, 55.6% presented recurrence. In relation to age at the time of the surgical procedure, the average age was 27 years, and 12.8% were aged 20 years or under. Nineteen patients presented prominent anchors and, of these, 21% manifested arthrosis. ConclusionThere was a statistically identified correlation between the recurrence rate and age less than or equal to 20 years at the times of first dislocation and the surgical procedure. Further studies should be conducted in order to compare the use of absorbable anchors, which despite higher cost, may provide lower risk of developing glenohumeral arthrosis in some cases.

Clinical Outcome after Surgical Treatment of Recurrent Shoulder Dislocation with Small Bony Bankart

Background: The consensus is that a bony Bankart lesion shorter than 25% of the length of glenoid does not affect the clinical result; hence, such lesions were often neglected. However, small bony Bankart lesions are associated with various types of capsulolabral lesions. Methods: A total of 82 patients who had undergone arthroscopic capsulolabral lesion repair surgery for anterior shoulder dislocation were reviewed. The prevalence rates of early and late type of capsulolabral lesions were compared between a group of patients with and a group without small bony Bankart lesions. In addition, the types of accompanying capsulolabral lesion were analyzed according to the type of bony Bankart lesion. Finally, the clinical outcomes were evaluated (active range of motion, American Shoulder and Elbow Surgeons score and Rowe’s score). Results: Among the 13 patients who had small bony Bankart lesions, the prevalence rate of early and late type of capsulolabral lesions was 38.5% and 61.5%, respectively. Among the 69 patients without bony Bankart lesion, the prevalence rates of early and late type of capsulolabral lesions were 74% and 26%, respectively. Significantly worse clinical outcome was observed for the group of patients with both small bony Bankart lesions and late type of capsulolabral lesion. Conclusions: More severe type of small bony Bankart lesion appears to be associated with late type of capsulolabral lesion. The significantly worse clinical outcome for patients with both small bony Bankart lesion and late type of capsulolabral lesion indicates that small bony Bankart lesions cannot always be neglected.

The characteristics of the iliac bone graft for treatment of recurrent shoulder dislocation due to large glenoid bone defect

The characteristics of the iliac bone graft for treatment of recurrent shoulder dislocation due to large glenoid bone defect

Autogenous Tricorticocancellous Iliac Bone Graft Fixed With Absorbable Pins for the Reconstruction of Engaging Hill-Sachs Lesion

There have been several surgical options for the treatment of recurrent shoulder dislocation associated with significant size of Hill-Sachs lesion. The purpose of the study is to evaluate new surgical technique filling up engaging Hill-Sachs lesion with autogenous tricorticocancellous iliac bone graft fixed by absorbable pins. Tricorticocancellous bone graft is easily available, inexpensive and structurally stable, and demonstrates a higher union rate. Multiple absorbable pins provide sufficient stability, and there are little concerns of osteoarthritis when grafted materials were resorbed, or pins were protruded, and do not require second operation to be removed. We suggested that autogenous tricorticocancellous iliac bone graft fixed with absorbable pins in addition to conventional open capsular shift can be another option in patients with recurrent shoulder dislocation with engaging Hill-Sachs lesion.

Value of heterologous bone transplants in the surgical therapy of habitual shoulder dislocation

45 heterologous bone grafts of "Kiel Bone" were radiologically examined after operative treatment of recurrent shoulder dislocation in the technique of M. Lange. The postoperative period differed between 1 and 17 years. Bony consolidation was achieved in 80% of the cases. Signs of resorption were postoperatively found in 14 cases. Five of them consolidated secondaryly. The results of our study show the usefulness of "Kiel Bone" in the treatment of recurrent shoulder dislocation. It should not be used as a bone graft in cases which require quick an secure consolidation. In these cases autologous bone grafts are superior.

Results of rotation osteotomy using the Weber method in the treatment of habitual shoulder dislocation

Weber's rotational osteotomy is a surgical treatment of recurrent shoulder dislocation. While eliminating recurrence of the complaint, it attempts to regain full range of movement in the joint. Of the 39 operated patients it was possible to follow up 34 cases. The percentage of recurrent dislocation was 5.7%. The range of movement was reduced in some patients; in one by 10 degrees - 20 degrees. Otherwise there were no significant complications or post-operative complaints. The operative technique, the X-ray procedure and the pathogenesis of the original dislocation are described. Typical accompanying injuries require a particular operative method. The most common accompanying damage was normally the typical defect of the humeral head (incidence 91%). The regular overstretching of the subscapular muscle and the defect of the humeral head are considered by the operational technique introduced by Weber.

Arthroscopic Stapling for Treatment of Recurrent Shoulder Dislocation

Arthroscopic Stapling for Treatment of Recurrent Shoulder Dislocation

Shoulder dislocation in skiing: choice of surgical method depending on the degree of humeral retrotorsion.

Shoulder dislocation is one of the typical upper extremity injuries in skiing, first following a violent accident but quite frequently recurring without new trauma. This article discusses the retrotorsional angle of the humerus as an etiological factor in the occurrence of an initial dislocation and as a triggering element for its recurrence. It focuses on the consequences to be drawn for the surgical treatment of recurrent shoulder dislocation. A technique for exact determination of the humeral angle of retrotorsion by X-ray is presented. In patients with recurrent anterior dislocations of the shoulder joint, the retrotorsional angle of the humerus is pathologically reduced as compared to the control group. The method of surgical therapy is determined by the individual deviance from the average value.