Posterior shoulder instability: Prospective non-randomised comparison of operative and non-operative treatment in 51 patients

Cruz-Ferreira, Eduardo; Abadie, Pierre; Godenèche, Arnaud; Mansat, Pierre; Clavert, Philippe; Flurin, Pierre-Henri

doi:10.1016/j.otsr.2017.08.004

Cited by 24 publications

(15 citation statements)

References 9 publications

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“…14 Arthroscopic posterior capsulolabral repair has demonstrated improvements in clinical outcome scores and return to play of up to 88% for nonthrowing athletes. 2,6,10,11,16,18,26 Similar improvements in clinical outcomes postoperatively and return to play have been found in throwing athletes. 20…”

supporting

confidence: 69%

Risk Factors for Revision Posterior Shoulder Stabilization in Throwing Athletes

Vaswani

Arner

Freiman

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Revision posterior shoulder capsulolabral repair has inferior outcomes compared with primary surgery. Risk factors for revision in throwing athletes are unknown. Purpose/Hypothesis: The purpose of this study was to characterize the revision rate and risk factors for revision surgery in throwing athletes. It was hypothesized that female athletes and those with smaller glenoid bone width would be at higher risk for revision surgery. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 105 throwing athletes who underwent arthroscopic posterior capsulolabral repair of their throwing shoulder were reviewed at a minimum of 2-year follow-up, and patients who required a revision were compared with those who did not. Collected data compared between the revision and no-revision groups included age, sex, contact sport participation, and return to sport (RTS). American Shoulder and Elbow Surgeons (ASES) score, Kerlan-Jobe Orthopaedic Clinic (KJOC) score, stability, pain, strength, range of motion (ROM), and patient satisfaction. Radiographic parameters including glenoid bone version, cartilage version, labral version, bone width, labral width, glenoid labral version and width weight were also compared between both groups. Results: Nine throwers required revision (8.6%) at an average of 2.8 years postoperatively. There were more female athletes in the revision than no-revision group (55.5% vs 23.4%; P = .03). There was no significant difference in age, proportion of contact athletes, rotator cuff tears, glenoid bone version, cartilage version, labral version, labral version weight, bone width, labral width, or labral width weight. Both groups had similar preoperative, postoperative, and change in ASES, KJOC, pain, strength, stability, and ROM scores. The proportion of patients with full strength and with full ROM, as well as patients who were satisfied with outcomes was similar between groups. Fewer patients in the revision group returned to sports compared with those in the no-revision group (14.3% vs 83.6%; P < .001), although return to sports at same level was not significantly different between groups (14.3% vs 37.2%; P = .41). Conclusion: The revision rate of arthroscopic posterior shoulder stabilization in throwers was 8.6%. Female athletes were at higher risk for revision, and return to sports was lower in patients who underwent revision surgery.

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supporting

confidence: 69%

Risk Factors for Revision Posterior Shoulder Stabilization in Throwing Athletes

Vaswani

Arner

Freiman

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…The clinical treatment depends on a number of anatomical and functional factors that must be evaluated in each patient. The treatment can be either nonoperative or surgical: The nonoperative approach is adopted when the dislocation is stable after a reduction maneuver and when there are no significant bone deficits; after the maneuver, the shoulder is immobilized for a limited period of time [8,9]. On the other hand, surgical treatments are preferred when the trauma has caused joint instability or lesions of bone or soft tissues that require surgical stabilization.…”

Section: Discussionmentioning

confidence: 99%

“…The choice of the operative technique depends on the joint defect: anatomical reconstruction of the articular surface is recommended for deficits between 25 and 40%, while prosthetic surgery is usually preferred for injuries that reduce the shoulder mobility by more than 40%. In 2017, the French Society of Arthroscopy [8] compared the clinical outcomes of nonoperative and surgical treatments in a prospective multi-center non-randomized study, and they showed that operative techniques have better outcomes.…”

Section: Discussionmentioning

confidence: 99%

Posterior Shoulder Dislocation with Engaging Reverse Hill–Sachs Lesion: A Retrospective Study of Ten Patients Treated with Arthroscopy or Open Reduction and Stabilization

Ippolito

Zitiello

Marinis

et al. 2021

JCM

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This study compares two surgical techniques used to treat patients with posterior shoulder dislocation with an engaging reverse Hill–Sachs lesion. We assessed ten patients who were treated at the Surgical Orthopedic and Traumatological Institute (ICOT) of Latina and the Clinic of Orthopedic and Traumatological Surgery of the ASST Sette Laghi of Varese between 2016 and 2019. The patients were divided into two groups: the first comprising six patients who underwent the open surgery McLaughlin procedure as modified by Neer, the second including four patients who underwent the arthroscopic McLaughlin procedure. All patients received postoperative rehabilitation to achieve the best possible functional recovery of the affected shoulder. We then assessed the shoulder range of motion, the pain level, and the impact on quality of life with four tests: the Constant Scale, the Simple Shoulder Test (SST), the OXFORD Scale, and The University of California—Los Angeles (UCLA) Shoulder Scale. The mean scores of the first group were: 81.3 ± 9.8 SD (Constant Scale), 10.8 ± 1.06 SD (SST), 42.5 ± 5.4 SD (Oxford Scale), 30.8 ± 3.02 SD (UCLA Shoulder Scale); we calculated the following mean scores in the second group: 80.25 ± 4.1 SD (Constant Scale), 11.5 ± 0.8 SD (SST), 42 ± 4.06 SD (Oxford Scale), 32 ± 2.9 SD (UCLA Shoulder Scale). We found no significant differences between the two groups.

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“…32,39 When conservative treatment fails, surgery is recommended to grant long-term stability, prevent pain, and enable return to previous activity levels. 10,12,13,26,33,38 Glenoid fractures and bone loss are frequently treated by bone-block procedures, while labral tears are commonly treated by the Bankart procedure. 1,6,9,25,26,28 The choice of surgical technique is critical and requires meticulous analysis of numerous preoperative imaging and clinical findings.…”

mentioning

confidence: 99%

“…45 Posterior shoulder instability, especially in patients with atraumatic lesions, engenders multiple nonspecific symptoms, including pain, subluxation, and functional impairment, which complicate its diagnosis and management. 4,13,38,39,45 Conservative treatment of posterior shoulder instability has low success rates, 12,23,37,38,45 especially in patients with traumatic lesions. 32,39 When conservative treatment fails, surgery is recommended to grant long-term stability, prevent pain, and enable return to previous activity levels.…”

mentioning

confidence: 99%

Glenoid Cartilage Lesions Compromise Outcomes of Surgical Treatment for Posterior Shoulder Instability

Nourissat

Hardy

Garret

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Posterior shoulder instability is associated with nonspecific symptoms, including pain, subluxation, and functional impairment, which complicate its diagnosis and management. Owing to the rarity of the condition, there are no present decision tools for its diagnosis and treatment. Purpose: To investigate demographic, lesional, and surgical factors that influence functional outcomes in patients treated for posterior shoulder instability. Study Design: Case-control study; Level of evidence, 3. Methods: We analyzed the clinical and radiographic records of 150 patients treated surgically for isolated posterior shoulder instability at 10 centers between 2000 and 2015, of which 144 were eligible for inclusion: 114 men (79%) and 30 women (21%) (mean ± SD age, 28.7 ± 9.6 years). The mean time between onset of symptoms and surgery was 66 ± 75 months. Shoulder instability was of traumatic origin in 115 patients (80%). The primary treatment was bone-block procedures for 65 patients (45%), posterior Bankart repair for 67 (47%), and capsular plication for 12 (8%). Patients were assessed with the Constant and Walch-Duplay scores at a mean follow-up of 51 ± 32 months (range, 12-159 months). Uni- and multivariable regression analyses were performed to determine associations between clinical scores and sex, age, traumatic origin, type of lesion, type of procedure, and follow-up. Results: At final follow-up, subluxations or dislocations recurred in 24 patients (17%). The overall Constant score was 86.2 ± 14.5, with a pain component of 12.6 ± 3.5. The Walch-Duplay score was 79.8 ± 24.2. Multivariable regressions revealed that the presence of a glenoid cartilage lesion was the only factor associated with worse Constant score (beta = –10; P = .013) and Walch-Duplay score (beta = –16.7; P = .024) across all subcomponents. Conclusion: The only factor that jeopardized functional outcomes of posterior instability surgery was the presence of glenoid cartilage lesions. Knowing that shoulders with glenoid cartilage lesions are at greater risk of residual pain or instability could help manage patient expectation and justify faster intervention before lesions deteriorate.

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Posterior shoulder instability: Prospective non-randomised comparison of operative and non-operative treatment in 51 patients

Abstract: III, case-control study.

Cited by 24 publications

References 9 publications

Risk Factors for Revision Posterior Shoulder Stabilization in Throwing Athletes

Risk Factors for Revision Posterior Shoulder Stabilization in Throwing Athletes

Posterior Shoulder Dislocation with Engaging Reverse Hill–Sachs Lesion: A Retrospective Study of Ten Patients Treated with Arthroscopy or Open Reduction and Stabilization

Glenoid Cartilage Lesions Compromise Outcomes of Surgical Treatment for Posterior Shoulder Instability

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