Operative Versus Nonoperative Treatment Following First-Time Anterior Shoulder Dislocation

Spanning, Sanne H. van; Verweij, Lukas P.E.; Priester-Vink, Simone; Deurzen, Derek F.P. van; Bekerom, Michel P.J. van den

doi:10.2106/jbjs.rvw.20.00232

Cited by 18 publications

(8 citation statements)

References 55 publications

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“…Young and active patients suffering from first-time anterior shoulder dislocation routinely undergo arthroscopic refixation of the antero-inferior labrum at our hospital [ 23 , 24 ]. Concomitant pathologies can also be addressed during this operative intervention.…”

Section: Methodsmentioning

confidence: 99%

Assessment of Acute Lesions of the Biceps Pulley in Patients with Traumatic Shoulder Dislocation Using MR Imaging

et al. 2022

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Background: Shoulder dislocations represent common injuries and are often combined with rotator cuff tears and potentially damage to the biceps pulley. Purpose: To assess the occurrence and type of biceps pulley lesions in patients after traumatic anterior shoulder dislocation using 3T MRI. Methods: Thirty-three consecutive patients were enrolled between June 2021 and March 2022 (14 women, mean age 48.0 ± 19 years). All patients underwent MR imaging at 3 T within one week. Images were analyzed for the presence and type of pulley tears, subluxation/dislocation of the LHBT, rotator cuff lesions, joint effusion, labral lesions, and osseous defects. Results: Seventeen patients (52%) with traumatic anterior shoulder dislocation demonstrated biceps pulley lesions. Of those, eleven patients (33%) showed a combined tear of the sGHL and CHL. All seventeen patients with lesions of the biceps pulley showed associated partial tearing of the rotator cuff, whereas three patients showed an additional subluxation of the LHBT. Patients with pulley lesions after dislocations were significantly older than those without (mean age 52 ± 12 years vs. 44 ± 14 years, p = 0.023). Conclusion: Our results suggest an increased awareness for lesions of the biceps pulley in acute traumatic shoulder dislocation, particularly in patients over 45 years.

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Section: Methodsmentioning

confidence: 99%

Assessment of Acute Lesions of the Biceps Pulley in Patients with Traumatic Shoulder Dislocation Using MR Imaging

et al. 2022

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“…There is an increasing body of literature investigating the benefits of early stabilization following a traumatic anterior shoulder dislocation, especially in younger patients 38-40 . A recent systematic review and meta-analysis found that operative treatment following a first-time dislocation yielded significantly lower recurrent instability rates (10%) at >10-year follow-up compared with nonoperative management (55% recurrence) 40 . Additionally, that study found that recurrence rates were also significantly different in patients who underwent operative treatment after their first dislocation compared with after multiple dislocations (17% in this pooled group).…”

Section: Discussionmentioning

confidence: 99%

Gene Expression in Glenoid Articular Cartilage Varies Across Acute Instability, Chronic Instability, and Osteoarthritis

Aleem

Farooq

Cai

et al. 2023

Journal of Bone and Joint Surgery

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Background: Shoulder instability is a common pathology associated with an elevated risk of osteoarthritis (OA). Little is known about gene expression in the cartilage of the glenohumeral joint after dislocation events, particularly as it relates to the risk of posttraumatic OA. This study tested the hypothesis that gene expression in glenoid cartilage varies among acute instability (<3 dislocations), chronic instability ( ‡3 dislocations), and OA.Methods: Articular cartilage was collected from the anteroinferior glenoid of consenting patients undergoing shoulder stabilization surgery (n = 17) or total shoulder arthroplasty (n = 16). Digital quantitative polymerase chain reaction was used to assess the relative expression of 57 genes (36 genes from OA risk allele studies, 21 genes from differential expression studies), comparing (1) OA versus instability (acute and chronic combined), (2) acute versus chronic instability, (3) OA versus acute instability, and (4) OA versus chronic instability.Results: The expression of 11 genes from OA risk allele studies and 9 genes from differential expression studies was significantly different between cartilage from patients with instability and those with OA. Pro-inflammatory genes from differential expression studies and genes from OA risk allele studies were more highly expressed in cartilage in the OA group compared with the instability group, which expressed higher levels of extracellular matrix and pro-anabolic genes. The expression of 14 genes from OA risk allele studies and 4 genes from differential expression studies, including proinflammatory genes, anti-anabolic genes, and multiple genes from OA risk allele studies, was higher in the acute instability group compared with the chronic instability group. Cartilage in the OA group displayed higher expression of CCL3, CHST11, GPR22, PRKAR2B, and PTGS2 than cartilage in the group with acute or chronic instability. Whereas cartilage in both the acute and chronic instability groups had higher expression of collagen genes, cartilage in the OA group had expression of a subset of genes from OA risk allele studies or from differential expression studies that was lower than in the acute group and higher than in the chronic group.Conclusions: Glenoid cartilage has an inflammatory and catabolic phenotype in shoulders with OA but an anabolic phenotype in shoulders with instability. Cartilage from shoulders with acute instability displayed greater (cellular) metabolic activity compared with shoulders with chronic instability.Clinical Relevance: This exploratory study identified genes of interest, such as CCL3, CHST11, GPR22, PRKAR2B, and PTGS2, that have elevated expression in osteoarthritic glenoid cartilage. These findings provide new biological insight into the relationship between shoulder instability and OA, which could lead to strategies to predict and potentially modify patients' risk of degenerative arthritis due to shoulder instability. O steoarthritis (OA) of the glenohumeral joint affects up to 30% of adults over the age of...

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“… 31 Patients with first-time dislocations who receive operative treatment are most often treated with labrum repair. 31 Risk factors associated with failure of an arthroscopic Bankart repair include young age (≤30 years), participation in competitive sports, multiple preoperative dislocations, >6 months surgical delay from first-time dislocation to surgery, ISIS >3 and associated lesions (Hill-Sachs, glenoid bone loss and anterior labrum periosteal sleeve avulsion (ALPSA) lesions. 19 It is impossible to take all these risk factors into account and make an objective decision on what treatment is most suitable.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Operative treatment significantly reduces the risk of recurrent shoulder instability compared with non-operative treatment 31. Patients with first-time dislocations who receive operative treatment are most often treated with labrum repair 31. Risk factors associated with failure of an arthroscopic Bankart repair include young age (≤30 years), participation in competitive sports, multiple preoperative dislocations, >6 months surgical delay from first-time dislocation to surgery, ISIS >3 and associated lesions (Hill-Sachs, glenoid bone loss and anterior labrum periosteal sleeve avulsion (ALPSA) lesions 19.…”

Section: Discussionmentioning

confidence: 99%

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Development and training of a machine learning algorithm to identify patients at risk for recurrence following an arthroscopic Bankart repair (CLEARER): protocol for a retrospective, multicentre, cohort study

et al. 2022

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IntroductionShoulder instability is a common injury, with a reported incidence of 23.9 per 100 000 person-years. There is still an ongoing debate on the most effective treatment strategy. Non-operative treatment has recurrence rates of up to 60%, whereas operative treatments such as the Bankart repair and bone block procedures show lower recurrence rates (16% and 2%, respectively) but higher complication rates (<2% and up to 30%, respectively). Methods to determine risk of recurrence have been developed; however, patient-specific decision-making tools are still lacking. Artificial intelligence and machine learning algorithms use self-learning complex models that can be used to make patient-specific decision-making tools. The aim of the current study is to develop and train a machine learning algorithm to create a prediction model to be used in clinical practice—as an online prediction tool—to estimate recurrence rates following a Bankart repair.Methods and analysisThis is a multicentre retrospective cohort study. Patients with traumatic anterior shoulder dislocations that were treated with an arthroscopic Bankart repair without remplissage will be included. This study includes two parts. Part 1, collecting all potential factors influencing the recurrence rate following an arthroscopic Bankart repair in patients using multicentre data, aiming to include data from >1000 patients worldwide. Part 2, the multicentre data will be re-evaluated (and where applicable complemented) using machine learning algorithms to predict outcomes. Recurrence will be the primary outcome measure.Ethics and disseminationFor safe multicentre data exchange and analysis, our Machine Learning Consortium adhered to the WHO regulation ‘Policy on Use and Sharing of Data Collected by WHO in Member States Outside the Context of Public Health Emergencies’. The study results will be disseminated through publication in a peer-reviewed journal. No Institutional Review Board is required for this study.

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Operative Versus Nonoperative Treatment Following First-Time Anterior Shoulder Dislocation

Cited by 18 publications

References 55 publications

Assessment of Acute Lesions of the Biceps Pulley in Patients with Traumatic Shoulder Dislocation Using MR Imaging

Assessment of Acute Lesions of the Biceps Pulley in Patients with Traumatic Shoulder Dislocation Using MR Imaging

Gene Expression in Glenoid Articular Cartilage Varies Across Acute Instability, Chronic Instability, and Osteoarthritis

Development and training of a machine learning algorithm to identify patients at risk for recurrence following an arthroscopic Bankart repair (CLEARER): protocol for a retrospective, multicentre, cohort study

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