The unstable painful shoulder (UPS) as a cause of pain from unrecognized anteroinferior instability in the young athlete

Boileau, Pascal; Zumstein, Matthias A.; Balg, Frédéric; Penington, Scott; Bicknell, Ryan T.

doi:10.1016/j.jse.2010.05.020

Cited by 75 publications

(60 citation statements)

References 20 publications

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“…Therefore, our indications are now well adapted to the demographic data and anatomic lesions [7]. Furthermore, new stabilizing procedures have been described since 2005: arthroscopic Hill-Sachs remplissage [21,28], capsular shift and open bone block [15], and arthroscopic Bankart and bone block simultaneously [6,9]. These techniques aim to repair different lesions at the same time.…”

Section: Discussionmentioning

confidence: 99%

The Open Latarjet Procedure Is More Reliable in Terms of Shoulder Stability Than Arthroscopic Bankart Repair

Bessière

Trojani

Carlès

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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238

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Background Arthroscopic Bankart repair and open Latarjet bone block procedure are widely considered mainstays for surgical treatment of recurrent anterior shoulder instability. The choice between these procedures depends mainly on surgeon preference or training rather than published evidence. Questions/purposes We compared patients with recurrent posttraumatic anterior shoulder instability treated with arthroscopic Bankart or open Latarjet procedure in terms of (1) frequency and timing of recurrent instability, (2) risk factors for recurrent instability, and (3) patient-reported outcomes. Methods In this retrospective comparative study, we paired 93 patients undergoing open Latarjet procedures with 93 patients undergoing arthroscopic Bankart repairs over the same period for posttraumatic anterior shoulder instability by one of four surgeons at the same center. Both groups were comparable except that patients in the Latarjet group had more glenoid lesions and more instability episodes preoperatively. Minimum followup was 4 years (mean, 6 years; range, 4-10 years). Patients were assessed with a questionnaire, including stability, Rowe score, and return to sports. Recurrent instability was defined as at least one episode of recurrent dislocation or subluxation. Return to sports was evaluated using a 0% to 100% scale that patients completed after recovery from surgery. Various risk factors for recurrent instability were also analyzed. Results At latest followup, 10% (nine of 93) in the Latarjet group and 22% (20 of 93) in the Bankart group demonstrated recurrent instability (p = 0.026; odds ratio, 0.39; 95% CI, 0.17-0.91). Ten recurrences in the Bankart group (50%) occurred after 2 years, compared to only one (11%) in the Latarjet group. Reoperation rate was 6% and 7% in the Bankart and Latarjet groups, respectively. In both groups, patients younger than 20 years had higher recurrence risk (p = 0.019). In the Bankart group, independent factors predictive for recurrence were practice of competitive sports and shoulder hyperlaxity (ie, passive external rotation [ 85°in the contralateral uninjured shoulder). Although return to sports was not different between groups, the mean Rowe score was higher in the Latarjet group (78 versus 68, p = 0.018). Conclusions Patients who had the open Latarjet procedure had less recurrent instability and better Rowe scores over a mean 6-year followup. We now perform isolated arthroscopic Bankart repair for carefully selected patients, including patients with an Instability Severity Index Score of 3 or less. Level of Evidence Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

The Open Latarjet Procedure Is More Reliable in Terms of Shoulder Stability Than Arthroscopic Bankart Repair

Bessière

Trojani

Carlès

et al. 2014

Clinical Orthopaedics &Amp; Related Research

Self Cite

238

188

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“…In the latter instance, patients report pain with everyday activities without instability or apprehension but on examination may be noted to be hyper lax and have positive relocation examinations. 24 In patients with a history of instability, the clinical examination will produce pain as injured structures are stressed or will lead to an uncomfortable feeling of instability. Although there are numerous examinations described in the literature, most have low specifi city and reproducibility.…”

Section: Discussionmentioning

confidence: 99%

Evaluation and Treatment of Shoulder Instability

Anakwenze

Huffman

2011

The Physician and Sportsmedicine

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The shoulder joint has a wide range of motion as a result of a complex interplay of soft tissue and bone structures. It is also the most frequently dislocated joint in the body. Shoulder dislocations are generally classified as traumatic and nontraumatic. There are many specific causes, each of which necessitate individualized treatment modalities. Accurate diagnosis requires a careful history and physical examination. Arthroscopic surgery and advances in imaging have expanded our understanding of anatomy and pathology relevant to shoulder instability and its treatment. Surgery is the treatment of choice for recurrent traumatic instability. Surgery may also be indicated in some first-time traumatic dislocations in young contact athletes, whereas rehabilitation is the initial treatment of choice in older patients with initial instability and in those with nontraumatic dislocations. Results of arthroscopic capsulolabral repair now equal those of open capsulolabral repair and have become the surgical treatment of choice for most patients. However, in cases of recurrent instability and significant bone deficiency of either the glenoid or humeral head, open bone reconstructive procedures are often necessary to ensure successful outcomes.

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“…10,37 Further, Walch and Mol e 72 noted that instability may also manifest as chronic pain (at least 6 months' duration) in abduction and external rotation, without a defined history of dislocation or subluxation. Similarly, Boileau et al 12 recently described the unstable painful shoulder (UPS) as an unrecognized anteroinferior instability (without any apparent history of instability, but with anatomic lesions indicative of instability) that causes shoulder pain in the young athlete.…”

Section: Rates Of Recurrent Instabilitymentioning

confidence: 99%