Can arthroscopic revision surgery for shoulder instability be a fair option?

Giorgi, Silvana De; Garofalo, Raffaele; Tafuri, Silvio; Cesari, E.; Rose, Giacomo Delle; Castagna, Anna

doi:10.32098/mltj.02.2014.24

Cited by 14 publications

(9 citation statements)

References 21 publications

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“…(continued) e6 71 DS 10 (11) Boileau et al 72 DS 6 (7) 8 ( 9) 9 (10) 14 ( 15) Calvo et al 73 DS 11 (18) Kim et al 97 DSA 0 (0) 0 (0) 4 ( 6) 4 (6) Kim et al 74 167 DSA 1 (1) 2 (1) 4 (2) 7 (4) Sperber et al 38 DS 0 7 (23) Nakagawa et al 39 257 DS 42 (16) Nakagawa et al 40 DS 22 (24) Chechik et al 41 DS 9 (11) 7 ( 8) 16 ( 19) Cole et al 98 DSA 3 (8) 9 (24) Anderl et al 42 DSA 0 (0) 0 (0) 0 (0) 0 (0) Constantinou et al 75 DS 6 (19) De Giorgi et al 43 DS 4 (19) 1 ( 5) 3 ( 14 48 Recurrent dislocation, symptomatic subluxation or instability preventing return to full active duties or necessitating an additional surgical stabilization procedure. 2).…”

Section: Critical Appraisal and Definition Of Recurrencementioning

confidence: 99%

High Variability of the Definition of Recurrent Glenohumeral Instability: An Analysis of the Current Literature by a Systematic Review

Alkaduhimi¹,

Connelly

Deurzen³

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To determine the definitions for recurrence used in the literature, assess the consensus in using these definitions, and determine the impact of these definitions on recurrence rates. Methods: A literature search was performed in PubMed and EMBASE including studies from 2000 to 2020 reporting on recurrence rates after anterior arthroscopic shoulder instability surgery. Dislocation, apprehension, subluxation and recurrence rates were compared. Results: Ninety-one studies were included. In 68% of the eligible studies, recurrence rates are not well defined. Thirty (33%) studies did not report on dislocations, 45 (49%) did not report on subluxations, and 58 (64%) did not report on apprehension. Seventeen different definitions for recurrence of instability, 4 definitions of dislocations, and 8 definitions of subluxation were used. Conclusion: Recurrence rates are poorly specified and likely underreported in the literature, hampering comparison with results of other studies. This highlights the need for a consensus on definition of recurrence across shoulder instability studies. We recommend not using the definition recurrence of instability anymore. We endorse defining dislocations as a radiographically confirmed dislocation or a dislocation that is manually reduced, subluxations as the feeling of a dislocation that can be (spontaneously) reduced without the need for a radiographically confirmed dislocation, and a positive apprehension sign as fear of imminent dislocation when placing the arm in abduction and external rotation during physical examination. Reporting on the events resulting in a dislocation or subluxation aids in making an estimation of the severity of instability. Level of Evidence: Level IV, systematic review.

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Section: Critical Appraisal and Definition Of Recurrencementioning

confidence: 99%

High Variability of the Definition of Recurrent Glenohumeral Instability: An Analysis of the Current Literature by a Systematic Review

Alkaduhimi¹,

Connelly

Deurzen³

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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“…Seven studies dating between 2002 and 2014 reported return to play after arthroscopic revision Bankart repair in a total of 153 athletes. 2 – 4 , 9 , 17 , 24 , 28 The average follow-up was 39.1 months (SD, 8.29). Table 1 shows the weighted mean complication rate of 3.3% (range, 0%-6.25%), and Table 2 demonstrates the weighted mean and return-to-play mean rate of 84.0% (range, 56.25%-100%).…”

Section: Resultsmentioning

confidence: 99%

Return to Play After Revision Anterior Shoulder Stabilization: A Systematic Review

Lau

Pineda

Johnston

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Revision shoulder stabilizations are becoming increasingly common. Returning to play after revision shoulder stabilizations is important to patients. Purpose: To evaluate the return-to-play rate after revision anterior shoulder stabilization using arthroscopic, open, coracoid transfer, or free bone block procedures. Study Design: Systematic review; Level of evidence, 4. Methods: All English-language studies published between 2000 and 2020 that reported on return to play after revision anterior shoulder stabilization were reviewed. Clinical outcomes that were evaluated included rate of overall return to play, level of return to play, and time to return to play. Study quality was evaluated using the Downs and Black quality assessment score. Results: Eighteen studies (1 level 2; 17 level 4; mean Downs and Black score, 10.1/31) on revision anterior shoulder stabilization reported on return to play and met inclusion criteria (7 arthroscopic, 5 open, 3 Latarjet, and 3 bony augmentation), with a total of 564 revision cases (mean age, 27.9 years; 84.1% male). The weighted mean length of follow-up was 52.5 months. The overall weighted rate of return to play was 80.1%. The weighted mean rate of return to play was 84.0% (n = 153) after arthroscopic revision, 91.5% (n = 153) after open revision, 88.1% (n = 149) after Latarjet, and 73.8% (n = 65) after bone augmentation. The weighted mean rate of return to same level of play was 69.7% for arthroscopic revision, 70.0% for open revision, 67.1% for Latarjet revision, and 61.8% after bone block revision. There were 5 studies that reported on time to return to play, with a weighted mean of 7.75 months (4 arthroscopic) and 5.2 months (1 Latarjet). The weighted mean rates of complication (for studies that provided it) were 3.3% after arthroscopic revision (n = 174), 3.5% after open revision (n = 110), 9.3% after Latarjet revision (n = 108), and 45.8% after bone block revision (n = 72). Conclusion: Revision using open stabilization demonstrated the highest return-to-play rate. Revision using Latarjet had the quickest time to return to play but had higher complication rates. When evaluated for return to same level of play, arthroscopic, open, and Latarjet had similar rates, and bone block had lower rates. The choice of an optimal revision shoulder stabilization technique, however, depends on patient goals. Higher-quality studies are needed to compare treatments regarding return to play after revision shoulder stabilization.

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“…6,7 The primary goal of any stabilization procedure is to prevent reccurence of instability and Percentage of failure or recurrence after revision arthroscopic surgery was 36.4%, so an Arthroscopic revision procedure for failed instability surgery may generally be not recommendable. 6,8 The open latarjet operation procedure after failed arthroscopic bankart repair resulted in a low reccurence rate and good functional scores after a minimum of 24 months follow up. 3 Described in 1954 by Latarjet, the essential feature of this procedure was the transplantation of the coracoid process to the neck of the scapula through the subscapularis tendon.…”

Section: Discussionmentioning

confidence: 99%

Latarjet procedure for failed arthroscopic Bankart repair: a case report

Aryana

Zainuraditya

2020

Int J Res Med Sci

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Arthroscopic Bankart Repair (ABR) provides acceptable results for recurrent anterior shoulder dislocation. However, recent studies have shown recurrent rates of 4-19% or even up to 35-40% in patients aged <25 years, and the results tend to get worse after long-term follow-up. The Latarjet procedure can improve anterior stability by multiple mechanisms, not only can the Bankart lesion be repaired and provide stability, but the transfer of the coracoid process extends the bony articular arc of the glenoid, and the addition of the conjoint tendon may provide dynamic stability as well. The Latarjet procedure for correcting recurrent anterior shoulder dislocation led to good and excellent results in 82.7% of the cases. The Latarjet procedure had the lowest re-dislocation rate, which was significantly lower than the arthroscopic Bankart repair. Latarjet procedure is effective in terms of restoring anteroinferior glenohumeral stability and good option for failed arthroscopic Bankart repair. Recurrence rates of instability are acceptable and re-operation rates were low.

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Can arthroscopic revision surgery for shoulder instability be a fair option?

Cited by 14 publications

References 21 publications

High Variability of the Definition of Recurrent Glenohumeral Instability: An Analysis of the Current Literature by a Systematic Review

High Variability of the Definition of Recurrent Glenohumeral Instability: An Analysis of the Current Literature by a Systematic Review

Return to Play After Revision Anterior Shoulder Stabilization: A Systematic Review

Latarjet procedure for failed arthroscopic Bankart repair: a case report

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