Novel and effective arthroscopic extracapsular stabilization technique for anterior shoulder instability-BLS

Abstract

Purpose Arthroscopic Bankart repair for the treatment of anterior shoulder instability is associated with a high rate of recurrent instability. Extracapsular stabilization of the glenohumeral joint with enhancement of anterior wall soft tissues may be an efective alternative treatment technique. The aim of this study is to retrospectively assess clinical outcomes in the treatment of anterior shoulder instability using a novel technique of anterior extracapsular stabilization-"between glenohumeral ligaments and subscapularis tendon" (BLS). Methods Patients with anterior shoulder instability who underwent surgical treatment with a novel arthroscopic BLS technique between 2008 and 2016 were eligible for inclusion. According to the level of glenoid bone loss, patients were separated into four groups. Group 1 comprised patients with GBL equal to or less than 5%, group 2 patients with GBL 6-10%, group 3 patients with GBL 11-15%, and group 4 patients with GBL > 15%. A positive outcome in this study was deined as full restoration of joint stability. To evaluate clinical results, preoperative range of ER and IR measured in 90 degrees of abduction were compared with ER and IR measured at inal follow-up. Additional outcome instruments used consisted of the Constant Score and the Walch-Duplay Score. Results A total of 150 patients underwent arthroscopic BLS surgery. During the study period, 50 patients were lost to followup and 100 patients were available for inal analysis. Mean patient age was 27.5 (± 10.3) years at the time of surgery. Mean duration of follow-up was 82.9 (± 29.4) months. At inal assessment, 86 patients (86%) were categorized as having a positive outcome, with full restoration of joint stability. Recurrence of shoulder instability was observed in 14 (14%) patients, including 6 (6%) cases that were associated with major trauma. At inal follow-up, the mean Constant Score was 88.2 ± 10.1, compared to 82.9 ± 9.1 preoperatively (p < 0.05). The mean inal and mean preoperative Walch-Duplay Scores were 81.5 ± 18.9 and 52.2 ± 11.9, respectively (p < 0.05). There was no statistically signiicant limitation of external or internal rotation. Conclusions The BLS technique has been shown to be an efective method to anterior shoulder instability in patients without signiicant glenoid bone loss. It was shown that this technique provides signiicant improvement in shoulder function without reducing shoulder range of motion. Level of evidence IV.

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

“…On the Coleman methodology score, one scored poor, 11 43 studies scored fair, 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 37 scored good, 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 ...…”

“… 25 136 49 +/− + Retrospective + + 1,2,3 3,4 1 62 Brzóska et al. 67 100 83 + + Retrospective + + 1,2,3 1,2,3,4 1 77 Ernstbrunner et al. 26 36 158 +/− + Retrospective + + 1,2,3 1,2,3,4 1 68 Gül et al.…”

“… 25 136 DS 15 (11.0) 15 (11) Brzóska et al. 67 100 DSA 14 (14) Ernstbrunner et al. 26 36 Any redislocation requiring reduction by a third party or medical professional 6 (17) 3 (8) 3 (8) 6 (17) Gül et al.…”

“…Ono et al 65 51 DS 9 (18) 7 ( 14) (31) Nakagawa et al 22 140 DS (18) Iizawa et al 66 68 DS 17 (25) y 17 (25) y Lavoué et al 23 41 DS 1 (2) 4 ( 10) 11 (27) (1) Pandey et al 25 136 DS 15 (11.0) (11) Brzóska et al 67 100 DSA (…”

Return to Preinjury-Level Sports After Arthroscopic Latarjet for Recurrent Anterior Shoulder Instability in Professional Athletes

“… 3 However, the results of arthroscopic Bankart repair reflect a high recurrence rate in young athletes, with some studies reporting recurrent instability in 48% of the patients aged ≤20 years during long-term follow-up. 9 , 17 , 32 , 33 Moreover, for the combined Bankart and Remplissage procedure, 71% of patients were able to return to restriction-free sport, 8 and 77.8% were able to return to their previous levels. 16 To meet the expectations of such a high-demand group of patients, bony augmentation techniques have gained popularity in recent years, especially the open Bristow-Latarjet method, 26 later developed as an arthroscopic technique.…”