Open Stabilization Procedures of the Shoulder in the Athlete: Indications, Techniques, and Outcomes

Haratian, Aryan; Yensen, Katie; Bell, John; Hasan, Laith K; Shelby, Tara; Yoshida, Brandon; Bolia, Ioanna K; Weber, Alexander E.; Petrigliano, Frank A.

doi:10.2147/oajsm.s321883

Cited by 4 publications

(13 citation statements)

References 106 publications

(195 reference statements)

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“… 37) Accordingly, an open Latarjet procedure can be indicated following three dislocation events necessitating formal reduction. 7 38) Hence, with recurrent instability events, surgical options tend to lean more towards open procedures rather than arthroscopic.…”

Section: Indications For Open Stabilization Proceduresmentioning

confidence: 99%

“… 2 6) When a shoulder dislocation ensues, a tear in the labrum often results (termed a Bankart tear), along with a concomitant potential loss in glenoid bone, humeral head bone (termed a Hill-Sachs lesion), and injury to joint capsule. 7 8) As such, joint instability rises and increases with every subsequent dislocation event.…”

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confidence: 99%

“… 9 10 11) Risk factors often include contact sports, young age, joint hypermobility, and prior dislocation events. 7 12) It is estimated that the incidence of anterior shoulder instability is 0.08 per 1,000 person-years in the general population, with much higher reported rates for young high risk men at 3% per year. 13 14) These high rates of anterior shoulder instability, along with the debilitating presenting symptoms—evident by pain, apprehensive mobility, and decreased function—necessitate careful consideration when deciding appropriate management plans.…”

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confidence: 99%

“… 9) Surgical options include minimally invasive procedures like arthroscopic Bankart repair and more invasive open procedures like open Bankart repair, coracoid transfer procedure or Latarjet, and bone augmentation procedures using different autograft sources. 7 9 16) Each of these procedures possesses its own set of advantages and disadvantages, and management decisions are often based on the severity of instability, evident through clinical and radiographic examination. 9) …”

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confidence: 99%

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Anterior Shoulder Instability and Open Procedures: History, Indications, and Clinical Outcomes

et al. 2023

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The shoulder, being the most mobile joint in the human body, is often susceptible to dislocations and subluxations more so than other joints. As such, shoulder instability constitutes a common complaint among patients worldwide, especially those who are young, participate in contact sports, and have increased innate flexibility in their joints. Management options in the setting of instability vary between conservative and surgical options that aim to mitigate symptoms and allow return of function. Surgical options can be arthroscopic and open, with a general shift among surgeons towards utilizing arthroscopic surgery in the past several decades. Nevertheless, open procedures still play a role in managing shoulder instability patients, especially those with significant bone loss, recurrent instability, coexisting shoulder pathologies, and high risk of failure with arthroscopic surgery. In these clinical settings, open procedures, like the Latarjet procedure, open Bankart repair, glenoid bone augmentation using iliac crest autograft or distal tibial allograft, and salvage options like glenohumeral arthrodesis and arthroplasty may show good clinical outcomes and low recurrence rates. Each of these open procedures possesses its own set of advantages and disadvantages and entails a specific set of indications based on published literature. It is important to cater treatment options to the individual patient in order to optimize outcomes and reduce the risk of complications. Future research on open shoulder stabilization procedures should focus on the long-term outcomes of recently utilized procedures, investigate different graft options for procedures involving bone augmentation, and conduct additional comparative analyses in order to establish concrete surgical management guidelines.

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Section: Indications For Open Stabilization Proceduresmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Anterior Shoulder Instability and Open Procedures: History, Indications, and Clinical Outcomes

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“…3,7,14,15 The Latarjet procedure-transfer of the coracoid process for glenoid augmentation-has been well established in the literature and remains the preferred autograft reconstruction option by many surgeons. 3,8,9 However, significant variance in patient coracoid anatomy exists. 11 Therefore, the Latarjet procedure cannot accommodate every bony defect, especially in severe glenoid bone loss.…”

mentioning

confidence: 99%

Distal Radius Allograft for Glenohumeral Instability: A Novel Osteochondral Allograft Reconstruction Option in the Setting of Glenoid Bone Loss

Khan,

Fares,

Abboud

2024

Am J Sports Med

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Background: Distal tibial allograft (DTA) reconstruction for glenoid bone loss is nonanatomic, as it does not match the glenoid radius of curvature (ROC) in the anterior-posterior (AP) plane. The dorsal articular portion of the distal radius has not been previously described as an allograft reconstruction option for glenoid bone loss. Purpose: To evaluate distal radius fresh-frozen allograft (DRA) as a potential match for glenoid reconstruction. Study Design: Controlled laboratory study. Methods: Eighteen fresh-frozen human cadaveric specimens—including 6 shoulder, 6 wrist, and 6 tibia specimens—were used. The ROC and the graft length were measured in the superior-inferior (SI) plane. A 30% defect was created in all glenoid specimens, and both DTAs and DRAs were harvested to assess graft fit after fixation. Computed tomography analysis was used to assess bony ROC and bone mineral density (BMD). Results: The cadaveric specimens had a mean age of 77 years. The mean SI glenoid length was 39.7 mm compared with 36.8 mm for the DRA and 30 mm for the DTA. The ROC in the SI plane was 29 ± 5.3 mm for the glenoid, 37.8 ± 4.9 mm for the DRA, and 24 ± 3.7 mm for the DTA. In the AP plane, the ROC was 39.6 ± 6.6 mm for the glenoid, 30.4 ± 18.6 mm for the DRA, and 126.3 ± 9.5 mm for the DTA. On computed tomography analysis, the ROC in the SI plane was 30.4 ± 1.5 mm for the glenoid, 30.3 ± 5.6 mm for the DRA, and 24.5 ± 9.4 mm for the DTA. In the AP plane, the ROC was 30.8 ± 2 mm for the glenoid, 19.1 ± 2.3 mm for the DRA, and 46.7 ± 21.7 mm for the DTA. The BMD was 226.3 ± 79 Hounsfield units (HU) for the glenoid, 228.5 ± 94.7 HU for the DRA, 235 ± 96.2 HU for the coracoid process, and 235.1 ± 84.6 HU for the DTA. Conclusion: Compared with the DTA, the DRA had a greater mean graft length in the SI plane, providing utilization in cases of larger bony defects; the DRA has a more acute ROC in the AP plane (closer to that of the glenoid), providing a greater potential buttress to anterior humeral translation. Compared with currently utilized grafts, the DRA BMD was not significantly diminished. This study presents the DRA as a novel allograft reconstruction option in the setting of anterior glenoid bone loss; further biomechanical and clinical investigation is indicated.

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Overhead athletes have comparable intraoperative injury patterns and clinical outcomes to non-overhead athletes following surgical stabilization for first-time anterior shoulder instability at average 6-year follow-up

Herman,

Nazzal,

Engler

et al. 2024

Journal of Shoulder and Elbow Surgery

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Open Stabilization Procedures of the Shoulder in the Athlete: Indications, Techniques, and Outcomes

Cited by 4 publications

References 106 publications

Anterior Shoulder Instability and Open Procedures: History, Indications, and Clinical Outcomes

Anterior Shoulder Instability and Open Procedures: History, Indications, and Clinical Outcomes

Distal Radius Allograft for Glenohumeral Instability: A Novel Osteochondral Allograft Reconstruction Option in the Setting of Glenoid Bone Loss

Overhead athletes have comparable intraoperative injury patterns and clinical outcomes to non-overhead athletes following surgical stabilization for first-time anterior shoulder instability at average 6-year follow-up

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