Evaluation of arthroscopic repair in recurrent shoulder dislocation

doi:10.21203/rs.3.rs-5221885/v1

Download PDF

Research Article

Evaluation of arthroscopic repair in recurrent shoulder dislocation

https://doi.org/10.21203/rs.3.rs-5221885/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Objective: To evaluate the outcomes of arthroscopic repair for recurrent shoulder dislocation and to identify the risk factors for recurrence and complications.

Method: A retrospective study of 51 patients who underwent arthroscopic repair for recurrent shoulder dislocation at Thong Nhat Hospital, Ho Chi Minh City, Vietnam from June 2015 to June 2020. Preoperative and postoperative data were collected and analyzed, including the Instability Severity Index Score (ISIS), range of motion (ROM), functional scores, pain score, and radiographic findings.

Result: The mean follow-up period was 24 months. The mean preoperative ISIS score was 1.25. The mean postoperative ROM of flexion and abduction improved significantly from 80.1° (58°-105°) to 83.8° (78°-90°), respectively. The mean postoperative functional scores (Constant, UCLA, and Oxford) also improved significantly from 68.6 (59-79) to 86.4 (81-92). The mean postoperative pain score (VAS) decreased significantly from 1.3 (0-7) to 0.45 (0-3). There were no cases of postoperative redislocation. The most common complications were cartilage loss (7.8%) and osteoarthritis (3.9%). The failure rate of arthroscopic repair was 5.9%, which required revision surgery.

Conclusion: Arthroscopic repair for recurrent shoulder dislocation is a safe and effective treatment option with low recurrence rate, good functional outcomes, and few complications. However, longer follow-up and larger sample size are needed to confirm the long-term results and to identify the optimal candidates for this procedure.

shoulder

glenohumeral joint

instability

dislocation

arthroscopy

labrum

Anterior shoulder dislocation accounts for 98% of shoulder dislocations commonly seen among young sportsmen with 1-2% of cases occurring because of glenohumeral instability. The incidence of redislocation in this population measures 38% (1). Recurrence of glenohumeral instability episodes has shown a greater risk of developing larger and deeper lesions, thereby leading to more instability (2). Degenerative glenohumeral arthrosis is one upsetting long-term complication that may occur due to chronic shoulder instability. Although the role of recurrent dislocations is unclear, acute changes leading to repetitive chondral injury and erosive osseous changes may be the reason for a higher predisposition to dislocation arthropathy (3–5). As a result, orthopedists must develop a deep understanding of the anatomy, pathophysiology, risk factors, and treatment of chronic shoulder instability. Latarjet shoulder reconstruction represents the reliable surgical treatment for anterior shoulder dislocation when concomitant bone defects are present or as a revision surgery (6,7). At the same time, Bankart repair is the more popular treatment of anterior shoulder instability with Bankart lesions and is well-preferred for young athletes (8,9). Both interventions have proven reliable in chronic anterior shoulder instability (10). Ultimately, orthopedists should establish suitable protocols for stabilizing shoulder joints in patients experiencing dislocation (11).

Arthroscopic stabilization was first described by Larry Johnson back in 1980 (12). Ever since, several scientists introduced many principles, approaches, and tools which would later refine instability repair procedures (13). Various techniques, such as staple capsulorrhaphy, bioabsorbable tacks, and suture anchors, demonstrate how widely arthroscopic stabilization applies to anterior dislocations (14). Three current principles of the "modern" method of arthroscopy include: using multiple anchors (greater than three), moving the anterior joint capsule superiorly while additionally creating a fold to resolve the issue of loosening, and treating related intra-articular diseases (rotational space injury, Superior Labrum Anterior Posterior (SLAP) tear and joint capsule tear). Arthroscopic shoulder stabilization shows positive results in most low-level athletes and the general population, including cases with severe osteoporosis (15%). Arthroscopic surgery has several advantages over open surgery, including better diagnosis, possible treatment of injuries, reduced risk of post-operative shoulder stiffness, and avoidance of tendonectomy or subscapularis incision (15). Physicians at the Department of Trauma and Orthopaedics, Thong Nhat Hospital, performed arthroscopic surgery to treat recurrent shoulder dislocations. We, therefore, aimed to further evaluate the treatment results of recurrent shoulder dislocations by arthroscopic surgery.

51 patients patients suffered from recurrent shoulder dislocations and underwent primary shoulder arthroplasty were recruited for this retrospective study conducted at Thong Nhat Hospital between June 2015 and June 2020. Patients underwent MRI preoperatively to evaluate the severity of glenoid defects, labrum and capsular tear, concomitant injuries, and complications before and after the operation. ISIS scores were calculated before the operation (16).

Eligibility criteria

All patients included were healthy before the injury, possessed no previous limb injury that required surgery were eligible for surgery, and consented to the procedure. Patients ineligible for surgery or had previous shoulder injuries, limb nerve damage that required surgery, or over 25% of glenoid bone loss were excluded.

Surgical techniques: Patients were put under general anesthesia and positioned in the lateral decubitus (17). The shoulder joint was approached using 3-4 portals: 1 posterior, one anterior, one anteroinferior, and/or two secondary portals (Wilmington, modified Neviaser portal). An arthroscopic evaluation was carried out, assessing the labrum and related areas. After exposing and debriding the capsulolabral lesion, the labrum lesion was repaired using suture anchors (anchor using horizontal mattress suture, knotless suture anchor). Three to seven suture anchors were made 45 or 90 degrees from inferior to superior, depending on lesion size. Associated lesions such as SLAP or Hill-Sachs are debrided or repaired with distal biceps tendon suture anchor attachment (17).

Follow-up process: Patients wore an arm sling following the procedure. The next day, they started practicing pendulum exercises. Afterwards, patients aimed to perform passive range-of-motion exercises (ROM) and stretching exercises for six weeks during outpatient physiotherapy.

Three physicians followed these patients for two years. Team members collected post-operative data at three months, six months, one year, and two years. Researchers evaluated results based on the shoulder joint function, including dislocation recurrence (frequency, subluxation, and instability), recovery to daily activities, functional score assessment of shoulder joint according to Rowe and Constant scale, UCLA shoulder rating scale, Oxford shoulder instability scale, and ROM (including flexion, abduction and external rotation), and visual analog scale of pain. The team defined treatment failure as the patient experiencing subluxation or recurrent dislocation within two years of surgery.

Sign test, Wilcoxon test, and chi-square tests are applied to continuous and discrete variables with a p-value of less than 0.05 considered significant.

This study was approved by Ethics Committee of Thong Nhat Hospital (Reference no 23/2015/BVTN-HĐYĐ). The research was conducted according to the ethical standards outlined in the 1964 Declaration of Helsinki (18).

Basic demographic

There were 35 male and 16 female patients. The patients were younger than 40 years of age, and the mean age was 27 years (range, 19-36 years). The period for which recurrent dislocation occurred is six months (range, 1-27 months). The percentage of patients having dislocation lower or equal two times, between 3 and 4 times, and higher or equal to 5 times were 13.7%, 60.8%, and 25.5%, respectively. Our study's average pre-operative ISIS score is 1.25 (from 0 to 7). In all cases, the dislocation is caused by trauma, including sports injury (74.5%), everyday-life accident (9.8%), traffic accident (9.8%), and work accident (5.9%).

Intra-articular lesion

There were ten patients with SLAP lesions, 38 thirty-eight with Bankart lesions, 3 three with both SLAP and Bankart lesions, and no with a posterior labral tear. Rotator cuff tear was detected in five patients (9.8%) with SLAP lesions and three patients (5.9%) with Bankart labral injury. Humeral head necrosis (Hill-Sachs lesion) was observed in two patients (4.0%) with anteroinferior labral injury. A biceps tendon tear was detected in one patient (2.0%) with an anterosuperior labral injury.

Most patients undergoing arthroscopic surgery had lost less than 10% of their glenoid bone (41 patients accounted for 80.4% of all cases, and nearly 60.8% of the patients had lost less than 5% of glenoid bone). There are 8 patients (15.7%) that had glenoid bone loss from 10 to less than 20% and only two cases (3.9%) were reported, with the most significant bone loss of 20%, resulting from a fall in a sports accident. These cases also had Hill-Sachs humeral head deformity.

Pain

The subjective pain score (visual analog scale) was comparable and improved compared to that of preoperation, it decreased from a pre-operative mean of 1.3 (range, 0-7) to 0.45 (range, 0-3) at 24-month-postoperative time.

Evaluation of shoulder joint function

Improvements in the function score were slightly lower but not statistically significant. Both the ROM of flexion and the ROM of abduction scores have significantly improved in comparison with the pre-operative values; however, they were not genuinely different from each other after two years of follow-up and did not have any statistical significance. The pre-operative and two-year-postoperative clinical results and the improvements are presented in Table 1.

There was no difference in Constant score, UCLA score, and Oxford score. The temporal change of the mean shoulder score over the 2-year follow-up is shown in Figure 1. There was a common trend of improvement across all scores over time. A significant improvement was observed in the Constant score from the preoperative mean/median of 68.6 points (range, 59 – 79) to the 24-month-postoperative mean/median of 86.4 points (range, 81 – 92). However, a slight decrease in Constant's shoulder score was noted three months after the operation, and an increase was noticed afterwards. All patients returned to normal activities after six months, and their symptoms improved, and they started to participate in sports after two years.

Complications

Serious complications recorded in our studies, such as infection, nerve damage, and suture loosening, are rare. One patient (2%) suffered from transient axillary nerve injury, most likely due to stretch and edema from prolonged surgery, and he recovered almost completely after two months of combined physiotherapy. Two patients (3.9%) with suture anchor problems were reported to have suture loosening due to poor bone quality after suffering consecutive dislocations (more than five times). These patients underwent the Latarjet technique afterwards. It has not been reported that body reaction to anchor materials caused severe bone destruction.

Complications related to osteoarthritis (cartilage loss or osteoarthritis) were evaluated based on post-operative radiographs. The images displayed joint space narrowing, bone spurs, and bone fibrosis. This complication had a slightly higher incidence (four patients accounting for 7.8% with cartilage loss and two patients accounting for 3.9% with osteoarthritis), which may be related to the pumping pressure during the operation and the fact that some patients had a chondral lesion of grade I, which was diagnosed intraoperatively. In our study, there were no cases of post-operative redislocation.

Failure rate

Failure to fix the anchor during labral repair and suture loosening in our study account for 3.9% and 2.0% of cases, respectively (Table 2). However, those peri-operative problems could be fixed promptly and required change to another surgical approach if there was any emergent issue (Latarjet procedure).

The shoulder joint tends to displace from its socket after high-impact forces. Injuries in contact sports, motor vehicle collisions, and everyday-life accidents represent common causes of shoulder dislocation (19). In our study, 44 patients (86.3%) visited the hospital for examination and surgery whenever they experienced greater than or equal to three shoulder dislocations. Furthermore, sports injuries accounted for 38 patients, constituting 74.5% of all patients. Sports accidents more commonly occur in young, active individuals (8). We speculate our result reflects the increasing number of young people participating in physical activities in the community.

Moreover, young and active individuals present a higher risk of redislocation following the initial insult (1,20). Male patients constitute the majority of cases, and we believe that men more frequently participate in sports activities. 33/35 or 94.3% of male patients suffered a sports-related injury. In other studies, most of the shoulder dislocation cases pertained to men or the state of hyperactivity (21,22).

Frequently, patients fell backward onto an outstretched arm resulting in injury. Other mechanisms include abduction and external rotation of the shoulder. Some patients, particularly those involved in traffic accidents, struggled to recall how they injured themselves. Nonetheless, acute dislocation is considered an emergency and requires immediate relocation. Delays further than 24 hours may negate the possibility of achieving a stable closed reduction (23). Insurance and treatment costs may play a role in management. As a result, patients sometimes receive care from unlicensed practitioners without follow-up with licensed physicians.

All patients suffered from anterior shoulder dislocations. We speculate this occurred due to the "slip and fall" event, leading to the arm instinctively moving backward to lessen the impact of the fall. Superior labral tear from anterior to posterior (SLAP) due to sports injuries accounted for 50% of all SLAP cases (5 sports injuries, three traffic accidents, and two everyday-life accidents). The figure for inferior anterior dislocation (Bankart) due to sports injuries constituted 86.3% of injuries. These injuries comprised 44 sports injuries, three work accidents, and four everyday-life accidents. SLAP and Bankart resulting from traffic accidents constituted 66.7% of injuries. These injuries consisted of 2 traffic accidents and one everyday-life accident. Overall, we see that the traumatic force from sports injuries may cause Bankart or SLAP injuries. Furthermore, we speculate that traffic accidents lead to large tears of the labrum resulting in more severe injury.
Anterior shoulder dislocations occur in roughly 1.7% of the population (24). These lesions often relate to anterior inferior labral tear (Bankart lesion), Hill-Sachs lesion of the humeral head, superior labral tear from anterior to posterior (SLAP), and glenoid rim fracture.

In our study, we selected patients suffering from a glenoid bone loss of less than 25% to reduce the possibility of arthroscopic surgery failure (25). The majority of patients (80.4%) undergoing arthroscopic surgery lost less than 10% of their glenoid bone, which potentially explains the high success rate of arthroscopic repair. Of these patients, 60.8% lost less than 5% of glenoid bone, with only 3.9% (two cases) reporting 20% of glenoid bone loss. We believe this finding is the result of a sports-related injury. Additionally, these cases also presented with Hill-Sachs humeral head deformity. Medical literature sources reported that severe glenoid bone loss combined with large Hill-Sachs lesions are frequently associated with recurrent instability (1). Some authors recommended open surgery instead of endoscopic surgery for patients with recurrent shoulder dislocations due to significant instability and bone loss (20).

Anterior dislocation or anterior-superior dislocation of the shoulder frequently resulted in rotator cuff injuries involving the supraspinatus and subscapularis. The Hill-Sachs injury presented in two cases with glenoid bone loss of 19% and 21%. The long head of biceps tendon rupture was evident in one patient, who got involved in a traffic accident and fell on the road with an outstretched arm, resulting in a large anteroinferior labral tear and SLAP. Medical literature also reports associated shoulder joint instability such as rotator cuff tear, rupture of the long head of biceps tendon accompanying anterosuperior labral tear, and Hill-Sachs lesions with anteroinferior labral tear (26–28).

An ISIS score of less than or equal to 6 points constitutes a 10% rate of instability recurrence which may act as a prognostic indicator for the Bankart procedure. Phadnis and coworkers confirmed the independence of ISIS as a useful pre-operative tool (29). In a case-control study, 141 patients underwent anterior shoulder stabilization via arthroscopy. Researchers found that a failure rate of 70% occurred in patients with an ISIS of ≥ 4, while only a 4% failure rate occurred in patients with an ISIS of < 4. Moreover, Loppini et al. have also highlighted the significance of an Instability Severity Index Score. A 93.7% success rate accompanied an ISIS of <3. Meanwhile it dropped to 54.6% in patients with an ISIS of >4 (30). We believe these results highlight the high success rate of arthroscopic surgery in patients with low ISIS scores.

The pain score (VAS) showed post-operative improvement compared to pre-operative measurements. No difference occurred preoperatively in the Constant score, UCLA score, and Oxford score compared to post-operatively. Improvements in the function score slightly decreased. However, these results were not statistically significant. The ROM of flexion and the ROM of abduction scores significantly improved compared with the pre-operative values; however, the results failed to display any statistical significance after two years of follow-up. Improvement across all scores was a common trend during the follow-up period. However, patients saw a decrease in Constant's shoulder score three months after the operation, with an increase after that.

All patients returned to normal activities within six months. Patients reported improvement of symptoms with a return to sports activities after two years. Our team utilized heterogeneous subjective and objective measures to assess surgical outcomes and "success." Recurrence of instability falls occurs along a spectrum ranging from apprehension in provocative positions to subluxations and dislocations. Regardless, this parameter alone cannot be the sole measure of success. A study must report outcomes of true dislocations to evaluate post-operative instability appropriately. Fear of dislocation/subluxation with provocative physical examination maneuvers due to the humeral head articular surface not articulating with the articular facet of the glenoid, subluxations, and apprehension may result in inaccurate results (31).
The loss of external rotation is commonly presented as the most common limitation of motion following anterior shoulder instability surgery. Shibano et al. found that loss of external rotation increased by about 4° when the amount of imbrication of AIGHL increased by 1 mm (32). However, our study conveyed the results in an alternative manner, but with time, the overall limitation of movement improved within two years of follow-up [80.1 (58-105) to 83.8 (78-90)].

Serious complications such as infection, nerve damage, and suture loosening rarely occur (33,34). We received no reports of severe bone damage from body reaction to anchor materials. Teams evaluated complications related to cartilage loss or osteoarthritis based on post-operative radiographs. The images displayed joint space narrowing, bone spurs, and bone fibrosis. These complications occurred at a higher incidence rate, potentially due to the pumping pressure present during the operation and possibly due to grade I chondral lesions diagnosed in some patients perioperatively. We speculate these complications arose due to prolonged intervention following initial dislocation. These patients were then followed up with physiotherapy and showed improved results.

Literature commonly described anchor complications such as slipping, drifts, fractures, and osteoarthritis following arthroscopic repair of the shoulder joint. Patients rarely reported other post-operative complications such as axillary nerve damage, infection, cartilage loss, post-operative stiffness, and dislocation (35). Other studies reported an approximate 7% rate of recurrent instability or redislocation following arthroscopic intervention to strengthen the anterior aspect of the shoulder joint (36). Those cases in which arthroscopic surgery failed underwent open surgery. Also, the rate of subluxation after Bankart surgery increased over the years after surgery (35). Our study reports an almost zero percent rate of post-operative redislocation. We believe this occurred due to close follow-up, meticulous execution of post-operative physiotherapy, and possibly identifying the ideal candidate for an arthroscopic repair which is not so easily achieved due to multiple risk factors that may lead to surgery failure (37). A more extended follow-up period (longer than two years) might have revealed different outcomes than ours. Aboalata et al. reported an overall redislocation rate of 18.18% at a 13-year follow-up following arthroscopy (38). Similarly, Owens and Gasparini reported a post-operative redislocation rate of 14.3% and 23.1% at a mean follow-up of 11.7 years and 81 months, respectively (39,40).

However, with a small sample size, caution must be applied; it is essential to bear in mind the possible bias in these findings. The small number of included patients might have influenced the recurrence rate post-operatively. One retrospective case-control study by Lee et al. included 170 patients under 30; the recurrence rate following arthroscopic repair was 18.8%. The crucial risk factors that might have influenced such results were: more than two pre-operative dislocations, performing arthroscopic repair more than six months from the first dislocation, and off-track Hill-Sachs lesions (41). Another limitation of our study was the lack of randomization and a control group which could have made the data more valid. Patients' age is also a significant risk factor to bear in mind. Various age groups are related to different recurrence rates, and patients under 20 have a much higher chance of recurrence (42,43). Older patients are also susceptible to recurrence. Ro et al. reported a recurrence rate of 14% post-operatively in 50 patients who were 40 years or older and received arthroscopic surgery for recurrent anterior dislocation (44).

Notably, our study reported arthroscopic labral repair failure in 3 patients accounting for 5.9% of all cases. Surgeons resorted to another surgical intervention, such as the Latarjet procedure, only if an emergent issue arose. Medical literature reports similar findings (45).

Bringing arthroscopy into practice to treat recurrent shoulder dislocations is a viable option. The procedure has a low rate of redislocation, good functional outcomes, and very few complications. However, a more significant number of studies, a longer follow-up time, and a more in-depth analysis are indispensable for a more accurate assessment of arthroscopic surgery in repairing shoulder instability.

Conflict of interest

The authors declare no conflicts of interest.

Funding

This research was not funded by any organization.

Data availability

Corresponding authors take full responsibility for the data, analyses and interpretation of the data, and for providing accurate data availability policies.

Informed consent

Written informed consent was obtained from all patients and/or families.

Authors' contribution

VTT proposed the idea, together with NTD led the study. VTT and NTD mainly wrote the manuscript and edited it finally. VTP contributed significantly to data analysis and manuscript editing. VTT, NTD was the main surgeon who performed the procedures, collected the data. VTP supervised the study and commented on the final manuscript.

Acknowledgments

This work was supported by The Department of Orthopedics, Thong Nhat Hospital at Ho Chi Minh City, Vietnam.

Gottschalk LJ 4th, Walia P, Patel RM, Kuklis M, Jones MH, Fening SD, et al. Stability of the Glenohumeral Joint With Combined Humeral Head and Glenoid Defects: A Cadaveric Study. Am J Sports Med. 2016 Apr;44(4):933–40.
Boileau P, O'Shea K, Vargas P, Pinedo M, Old J, Zumstein M. Anatomical and functional results after arthroscopic Hill-Sachs remplissage. J Bone Jt Surg - Ser A. 2012;94(7):618-626. doi:10.2106/JBJS.K.00101.
Marx RG, McCarty EC, Montemurno TD, Altchek DW, Craig E V., Warren RF. Development of arthrosis following dislocation of the shoulder: A case-control study. J Shoulder Elb Surg. 2002;11(1):1–5.
Arthrosis DG, Richmond JC, William N. Long-Term Followup Reconstruction Incidence of Late of Bankart. 1993;(July).
Varacallo M, Musto MA, Mair SD. Anterior Shoulder Instability. [Updated 2021 Jan 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538234/.
Domos P, Lunini E, Walch G. Contraindications and complications of the Latarjet procedure. Shoulder Elb. 2018;10(1):15–24.
Huxel Bliven KC, Parr GP. Outcomes of the latarjet procedure compared with bankart repair for recurrent traumatic anterior shoulder instability. J Athl Train. 2018;53(2):181–3.
Lafosse L, Lejeune E, Bouchard A, Kakuda C, Gobezie R, Kochhar T. The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc. 2007 Nov;23(11):1242.e1-5.
Garcia GH, Taylor SA, Fabricant PD, Dines JS. Shoulder Instability Management: A Survey of the American Shoulder and Elbow Surgeons. Am J Orthop (Belle Mead NJ). 2016;45(3):E91-7.
Bah A, Lateur GM, Kouevidjin BT, Bassinga JYS, Issa M, Jaafar A, et al. Chronic anterior shoulder instability with significant Hill–Sachs lesion: Arthroscopic Bankart with remplissage versus open Latarjet procedure. Orthop Traumatol Surg Res. 2018;104(1):17–22.
Sofu H, Gürsu S, Koçkara N, Oner A, Issın A, Camurcu Y. Recurrent anterior shoulder instability: Review of the literature and current concepts. World J Clin cases. 2014 Nov;2(11):676–82.
Johnson LL. Arthroscopy of the shoulder. Orthopedic Clinics of North America. 1980 Apr 1;11(2):197-204.
Desai SS. History and evolution of shoulder arthroscopy. J Arthrosc Surg Sport Med. 2020;1(1):11–5.
Mohapatra RGA, Kumar J. Evaluation of arthroscopic Bankart repair in recurrent shoulder dislocation. Int J Res Orthop. 2019;5(4):675.
Randelli P, Ragone V, Carminati S, Cabitza P. Risk factors for recurrence after Bankart repair a systematic review. Knee Surg Sports Traumatol Arthrosc. 2012 Nov;20(11):2129–38.
Balg F, Boileau P. The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br. 2007 Nov;89(11):1470–7.
Jinnah AH, Mannava S, Plate JF, Stone A V., Freehill MT. Basic Shoulder Arthroscopy: Lateral Decubitus Patient Positioning. Arthrosc Tech. 2016;5(5):e1069-e1075. doi:10.1016/j.eats.2016.05.010.
World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-2194. doi:10.1001/jama.2013.281053.
Abrams R, Akbarnia H. Shoulder Dislocations Overview. In Treasure Island (FL); 2021.
Williams AA, Mancini NS, Kia C, Wolf MR, Gupta S, Cote MP, et al. Recurrent Shoulder Instability: Do Morbidity and Treatment Differ Based on Insurance? Orthop J Sport Med. 2019 Apr;7(4):2325967119841079.
Micheo W, Castillo B, Vives JR GJ. Shoulder fractures, separation-dislocation, and other soft tissue injuries. Available from: https://now.aapmr.org/shoulder-fractures-separation-dislocation-and-other-soft-tissue-injuries/
Shah A, Judge A, Delmestri A, et al. Incidence of shoulder dislocations in the UK, 1995-2015: A population-based cohort study. BMJ Open. 2017;7(11). doi:10.1136/bmjopen-2017-016112.
Cutts S, Prempeh M, Drew S. Anterior shoulder dislocation. Ann R Coll Surg Engl. 2009;91(1):2-7. doi:10.1308/003588409X359123.
Romeo AA, Cohen BS, Carreira DS. Traumatic anterior shoulder instability. Orthop Clin North Am. 2001 Jul;32(3):399–409.
Boileau P, Villalba M, Héry J-Y, Balg F, Ahrens P, Neyton L. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am. 2006;88(8):1755-1763. doi:10.2106/JBJS.E.00817.
Abbot AE, Li X, Busconi BD. Arthroscopic treatment of concomitant superior labral anterior posterior (SLAP) lesions and rotator cuff tears in patients over the age of 45 years. Am J Sports Med. 2009 Jul;37(7):1358–62.
Calcei JG, Boddapati V, Altchek DW, Camp CL, Dines JS. Diagnosis and Treatment of Injuries to the Biceps and Superior Labral Complex in Overhead Athletes. Curr Rev Musculoskelet Med. 2018 Mar;11(1):63–71.
Fox JA, Sanchez A, Zajac TJ, Provencher MT. Understanding the Hill-Sachs Lesion in Its Role in Patients with Recurrent Anterior Shoulder Instability. Curr Rev Musculoskelet Med. 2017 Dec;10(4):469–79.
Phadnis J, Arnold C, Elmorsy A, Flannery M. Utility of the Instability Severity Index Score in Predicting Failure After Arthroscopic Anterior Stabilization of the Shoulder. Am J Sports Med. 2015 Aug;43(8):1983–8.
Loppini M, Delle Rose G, Borroni M, et al. Is the Instability Severity Index Score a Valid Tool for Predicting Failure After Primary Arthroscopic Stabilization for Anterior Glenohumeral Instability? Arthrosc - J Arthrosc Relat Surg. 2019;35(2):361-366. do.
Harris JD, Gupta AK, Mall NA, Abrams GD, McCormick FM, Cole BJ, et al. Long-term outcomes after Bankart shoulder stabilization. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc. 2013 May;29(5):920–33.
Shibano K, Koishi H, Futai K, Yoshikawa H, Sugamoto K. Effect of Bankart repair on the loss of range of motion and the instability of the shoulder joint for recurrent anterior shoulder dislocation. J Shoulder Elb Surg [Internet]. 2014;23(6):888–94. Available from: http://dx.doi.org/10.1016/j.jse.2013.09.004
Moen TC, Rudolph GH, Caswell K, Espinoza C, Burkhead WZ, Krishnan SG. Complications of shoulder arthroscopy. J Am Acad Orthop Surg. 2014;22(7):410-419. doi:10.5435/JAAOS-22-07-410.
Weber SC, Abrams JS, Nottage WM. Complications associated with arthroscopic shoulder surgery. Arthroscopy. 2002;18(2 SUPPL. 1):88-95. doi:10.1053/jars.2002.31801.
Matsuki K, Sugaya H. Complications after arthroscopic labral repair for shoulder instability. Curr Rev Musculoskelet Med. 2015 Mar;8(1):53–8.
Antunes JP, Mendes A, Prado MH, Moro OP, Miró RL. Arthroscopic Bankart repair for recurrent shoulder instability: A retrospective study of 86 cases. J Orthop. 2016 Jun;13(2):95–9.
Provencher MT. Editorial Commentary: Is It Time to Take a Stand? When Arthroscopic Bankart Repair Is No Longer a Viable Option for Anterior Shoulder Instability. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc. 2018;34(9.
Aboalata M, Plath JE, Seppel G, Juretzko J, Vogt S, Imhoff AB. Results of Arthroscopic Bankart Repair for Anterior-Inferior Shoulder Instability at 13-Year Follow-up. Am J Sports Med. 2017;45(4):782–7.
Owens BD, Deberardino TM, Nelson BJ, Thurman J, Cameron KL, Taylor DC, et al. Long-term follow-up of acute arthroscopic bankart repair for initial anterior shoulder dislocations in young athletes. Am J Sports Med. 2009;37(4):669–73.
Gasparini G, De Benedetto M, Cundari A, De Gori M, Orlando N, McFarland EG, et al. Predictors of functional outcomes and recurrent shoulder instability after arthroscopic anterior stabilization. Knee Surgery, Sport Traumatol Arthrosc. 2016;24(2):406–13.
Lee SH, Lim KH, Kim JW. Risk Factors for Recurrence of Anterior-Inferior Instability of the Shoulder After Arthroscopic Bankart Repair in Patients Younger Than 30 Years. Arthrosc - J Arthrosc Relat Surg. 2018;34(9):2530-2536. doi:10.1016/j.arthro.2018.03.
Flinkkilä T, Hyvönen P, Ohtonen P, Leppilahti J. Arthroscopic Bankart repair: Results and risk factors of recurrence of instability. Knee Surgery, Sport Traumatol Arthrosc. 2010;18(12):1752–8.
Voos JE, Livermore RW, Feeley BT, Altchek DW, Williams RJ, Warren RF, et al. Prospective evaluation of arthroscopic bankart repairs for anterior instability. Am J Sports Med. 2010;38(2):302–7.
Ro K, Kim MS, Kim JD, Rhee YG. Arthroscopic Findings and Clinical Outcomes in Patients 40 Years of Age and Older With Recurrent Shoulder Dislocation. Arthrosc - J Arthrosc Relat Surg [Internet]. 2019;35(2):314–22. Available from: https://doi.org/10.1016/j.arthro.2018.08.041
Lenters TR, Franta AK, Wolf FM, Leopold SS, Matsen FA 3rd. Arthroscopic compared with open repairs for recurrent anterior shoulder instability. A systematic review and meta-analysis of the literature. J Bone Joint Surg Am. 2007 Feb;89(2):244–54.

Table 1. Evaluation of shoulder joint function

Shoulder score		Pre-operative	24-month-postoperative
Constant		68.6 (59-79)	86.4 (81-92)
UCLA		23.5 (18-27)	31.0 (28-34)
Oxford		30.6 (24-38)	17 (13-25)
ROM	Flexion	131.8 (117-146)	140.1 (130-150)
	Abduction	122.4 (113-136)	137.4 (127-152)
	External rotation	80.1 (58-105)	83.8 (78-90)
VAS		1.3 (0-7)	0.45 (0-3)
Data presented in median [range

Table 2: Intraoperative failures and open surgery conversion rate

Surgical complications	Number of patients (n=20)	Pre-operative ISIS	Percentage (%)
Inability to fixate on the anchor	2	3	3.9
Suture loosening	1	0	2.0
Resorting to open surgery	2	5	3.9

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Evaluation of arthroscopic repair in recurrent shoulder dislocation

Status:

Version 1

Abstract

Figures

INTRODUCTION

METHODS

RESULTS

DISCUSSION

CONCLUSION

DECLARATIONS

REFERENCES

Tables

Additional Declarations

Status:

Version 1