“… 13 Such studies reinforce the importance of quantifying bone loss preoperatively to facilitate the surgical decision-making process. 8 , 46 , 79 Figure 1 Modified classification of glenoid rim lesion types associated with anterior shoulder instability: type I, displaced avulsion fracture with attached capsule; type II, medially displaced fragment malunited to glenoid rim; type III, erosion of glenoid rim with <25% deficiency (type IIIA) or >25% deficiency (type IIIB); and type IV, erosion of glenoid rim with >25% deficiency combined with a stretched inferior glenohumeral ligament (ie, capsular laxity). (From Bois AJ, Miniaci A. Surgical management of instability with bone loss.…”
Background
Management of bone loss in recurrent traumatic anterior shoulder instability remains a topic of debate and controversy in the orthopedic community. The purpose of this study was to survey members of 4 North American orthopedic surgeon associations to assess management trends for bone loss in recurrent anterior shoulder instability.
Methods
An online survey was distributed to all members of the American Shoulder and Elbow Surgeons, American Orthopaedic Society for Sports Medicine, and Canadian Orthopaedic Association and to fellow members of the Arthroscopy Association of North America. The survey comprised 3 sections assessing the demographic characteristics of survey respondents, the influence of prognostic factors on surgical decision making, and the operative management of 12 clinical case scenarios of varying bone loss that may be encountered in clinical practice.
Results
A total of 150 survey responses were returned. The age of the patient and quantity of bone loss were consistently considered important prognostic criteria. However, little consensus was reached for critical thresholds of bone loss and how this affected the timing (ie, primary or revision surgery) and type of bony augmentation procedure to be performed once a critical threshold was reached, especially in the context of critical humeral and bipolar bone loss.
Conclusions
Consistent trends were found for the management of recurrent anterior shoulder instability in cases in which no bone loss existed and when isolated critical glenoid bone loss was present. However, inconsistencies were observed when isolated critical humeral bone loss and bipolar bone loss were present.
“… 13 Such studies reinforce the importance of quantifying bone loss preoperatively to facilitate the surgical decision-making process. 8 , 46 , 79 Figure 1 Modified classification of glenoid rim lesion types associated with anterior shoulder instability: type I, displaced avulsion fracture with attached capsule; type II, medially displaced fragment malunited to glenoid rim; type III, erosion of glenoid rim with <25% deficiency (type IIIA) or >25% deficiency (type IIIB); and type IV, erosion of glenoid rim with >25% deficiency combined with a stretched inferior glenohumeral ligament (ie, capsular laxity). (From Bois AJ, Miniaci A. Surgical management of instability with bone loss.…”
Background
Management of bone loss in recurrent traumatic anterior shoulder instability remains a topic of debate and controversy in the orthopedic community. The purpose of this study was to survey members of 4 North American orthopedic surgeon associations to assess management trends for bone loss in recurrent anterior shoulder instability.
Methods
An online survey was distributed to all members of the American Shoulder and Elbow Surgeons, American Orthopaedic Society for Sports Medicine, and Canadian Orthopaedic Association and to fellow members of the Arthroscopy Association of North America. The survey comprised 3 sections assessing the demographic characteristics of survey respondents, the influence of prognostic factors on surgical decision making, and the operative management of 12 clinical case scenarios of varying bone loss that may be encountered in clinical practice.
Results
A total of 150 survey responses were returned. The age of the patient and quantity of bone loss were consistently considered important prognostic criteria. However, little consensus was reached for critical thresholds of bone loss and how this affected the timing (ie, primary or revision surgery) and type of bony augmentation procedure to be performed once a critical threshold was reached, especially in the context of critical humeral and bipolar bone loss.
Conclusions
Consistent trends were found for the management of recurrent anterior shoulder instability in cases in which no bone loss existed and when isolated critical glenoid bone loss was present. However, inconsistencies were observed when isolated critical humeral bone loss and bipolar bone loss were present.
“…9,14,23 Manually segmented 3D MRI also provides accurate measurements of bone loss, which are highly correlated with intraoperative estimates, but manual segmentation is less likely to be clinically feasible, given the time and laboratory resources required. 14,22,24 New imaging methods in addition to 3D MRI and 3D CT, especially specific MRI sequences or advanced processing techniques that would require fewer resources, may be able to identify a broader range of pathologies in the future. More research on the accuracy and clinical impact of 3D MRI and other advanced processing techniques is necessary for patients with shoulder instability.…”
“…According to the preoperative MRI, all patients had glenoid bone loss of less than 15%. 11,30,34 In our practice, computed tomography (CT) is not routinely used to quantify glenoid bone loss in the setting of planned stabilization procedures, as the literature has shown MRI to be as effective a diagnostic tool as CT for determining bone loss. After an in-office assessment, the decision to proceed with surgery was made solely by the senior surgeon (N.P.).…”
Background: There is a high prevalence of combined shoulder instability in military patients. Short-term outcomes after 270° labral repair are promising; however, there is a paucity of longer term outcome data in this high-demand group of patients. Purpose: To report the midterm outcomes of active-duty military patients treated with 270° labral repair for combined shoulder instability. Study Design: Case series; Level of evidence, 4. Methods: All consecutive patients between January 2011 and January 2019 who underwent 270° labral repair by the senior surgeon with complete outcome scores were identified. All patients had experienced a shoulder dislocation after a traumatic event and had magnetic resonance imaging and intraoperative findings consistent with combined-type instability. A total of 52 patients met the inclusion criteria for the study, and all were active-duty servicemembers at the time of surgery. Results: The mean follow-up was 78.21 months (range, 24-117 months). There was a statistically significant increase in the mean American Shoulder and Elbow Surgeons score (from 44.92 to 89.31; P < .0001), Single Assessment Numeric Evaluation score (from 52.32 to 93.17; P < .0001), and Rowe instability score (from 46.63 to 91.35; P < .0001) from preoperatively to postoperatively. Mean pain decreased significantly as measured by the visual analog scale for pain (from 8.04 to 1.44; P < .0001). Range of motion in forward flexion (from 155.29° to 155.96°; P = .6793), external rotation (from 67.50° to 65.29°; P = .0623), and internal rotation (from T9.58 to T9.56; P = .9650) did not change significantly postoperatively. Outcomes did not differ significantly for patients who underwent surgery on their dominant shoulder versus those who underwent surgery on their nondominant shoulder, nor did outcomes vary with the type of anchor utilized (biocomposite vs all-suture). The overall rate of return to active duty was 92.31%. Conclusion: Midterm outcomes in this population of active-duty patients undergoing 270° labral repair for combined shoulder instability demonstrated a statistically and clinically significant improvement in patient-reported outcome scores, a significant decrease in pain, and an overall rate of return to active duty of 92.31%.
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