Traumatic Anterior Instability of the Pediatric Shoulder

Shymon, Stephen; Roocroft, Joanna H.; Edmonds, Eric W.

doi:10.1097/bpo.0000000000000215

Cited by 44 publications

(23 citation statements)

References 22 publications

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“…The negative influence of recurrent shoulder instability on the functional status of the shoulder and quality of life was not reported in previous studies. 3,17,21 Return to level of work and return to level of sports rates were similar to or higher than scores found in other studies. 1,7,16 Prognostic factors…”

Section: Discussionsupporting

confidence: 80%

Long-term clinical outcome of arthroscopic Bankart repair with suture anchors

Vermeulen

Landman

Veen

et al. 2019

Journal of Shoulder and Elbow Surgery

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Background: The most common surgical technique in traumatic anterior shoulder instability is the arthroscopic Bankart repair, which has excellent short-term results. The longterm results of the arthroscopic Bankart repair are less frequently studied with a high recurrence rate of 23 to 35%. The aim of this study was to evaluate the medium to long-term results of arthroscopic Bankart repair using suture anchors and to identify specific risk factors for recurrent instability. Methods: 147 patients after traumatic anterior shoulder dislocation who underwent an arthroscopic Bankart repair were included. The primary outcome was recurrent instability, defined as dislocation or subluxation as perceived by the patients. The secondary outcome was subjective shoulder stability and function, and quality of life, evaluated using the Western Ontario Shoulder Instability Index (WOSI), the Simple Shoulder Test (SST) and the Short Form-12 (SF-12). Prognostic factors for recurrent instability were analysed. Results: 22% of the patients experienced recurrent instability with a mean follow-up of 6.3 years. 5-years and 10-years survival without recurrent instability was 79% and 78%, respectively (95% CI: 72-85% and 71-85%, respectively). The WOSI-score, the SST-score and the SF-12 physical scale improved significantly in the non-recurrence group (p<0.001, p=0.004 and p=0.002, respectively). Younger age and use of less than three anchors were associated with a higher risk of recurrent dislocation (p=0.008 and p=0.039, respectively). Conclusion: We found an overall recurrent instability rate of 22% (dislocation or subluxation). Good long-term results were observed after arthroscopic Bankart repair in patients above age of 20 years with 3 or more suture anchors used.

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Section: Discussionsupporting

confidence: 80%

Long-term clinical outcome of arthroscopic Bankart repair with suture anchors

Vermeulen

Landman

Veen

et al. 2019

Journal of Shoulder and Elbow Surgery

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“…Although the graft choice does not appear to affect long-term outcomes with respect to recurrent patellar instability, pain, and return to activity, there is a clear trend toward questioning the long-term survival of MPFLR in the adolescent patient, independent of graft selection. As with all stabilizing surgeries in this high-risk population (shoulder instability, anterior cruciate ligament reconstruction 2 , 13 ), time may be a significant player in driving the reporting of unsuccessful outcomes.…”

Section: Discussionmentioning

confidence: 99%

Adolescent Medial Patellofemoral Ligament Reconstruction: A Comparison of the Use of Autograft Versus Allograft Hamstring

Kumar

Bastrom

Dennis

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:Recurrent patellar instability is commonly treated with medial patellofemoral ligament reconstruction (MPFLR), and the use of allograft in anterior cruciate ligament reconstructions has demonstrated inferior outcomes.Purpose:To compare the outcomes of allografts versus autografts in adolescent MPFLR for patellar instability.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective chart review was completed on patients younger than 18 years who underwent MPFLR for recurrent instability after failed nonoperative management over an 8-year period with a minimum 2-year follow-up. Patients were divided into autograft or allograft hamstring cohorts for comparison. Primary outcome measures were return to normal activity, incidence of redislocation/subluxation, pain, stiffness, other complications, and Kujala scores. Statistical analysis using unpaired t tests was performed, with an alpha value set at P < .05.Results:After criteria were applied, 59 adolescents (36 allograft, 23 autograft; 38 girls, 21 boys) with a mean ± SD age of 15.2 ± 1.7 years and a mean follow-up of 4.1 ± 1.9 years (allograft, 3.3 ± 1.1 years; autograft, 5.7 ± 2.1 years; P ≤ .001) were included. Seven patients had concurrent osteotomies (3 allograft, 4 autograft), 11 patients had concurrent loose body removals (5 allograft, 6 autograft), and 9 patients had concurrent lateral release (7 allograft, 2 autograft). Between groups, no significant difference was found in change between preoperative and most recent follow-up (mean, 1.2 ± 2.1) or rate of return to sports (mean, 73.3%). In total, 9 surgeries failed (3 allograft, 6 autograft). For the surviving grafts, a statistical difference in mean Kujala scores at final follow-up was noted (allograft, 92.7; autograft, 97.4; P = .02).Conclusion:We identified no significant differences in return to activity, pain score changes, and incidences of failure between patients undergoing MPFLR with allograft versus autograft. Although teenagers with surviving autograft MPFLR reported statistically higher Kujala scores, the mean score difference of 5 points was not clinically significant. It appears that using allograft tendon instead of autograft tissue for MPFLR in this teenage population does not adversely affect long-term outcomes.

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“…Despite lower reported recurrent anterior instability with operative treatment, recurrence after primary stabilization surgery remains high in adolescents. Studies looking specifically at adolescent patients have shown recurrence after primary stabilization surgery to range from 17 to 51%, and rates for specific subpopulations, such as contact athletes or those with glenoid or bipolar bone loss, may be even higher [11][12][13][14][15][16]. Thus, identifying risk factors for failure of primary stabilization surgery is of vital importance to choose the appropriate primary procedure or, when needed, address sources of possible failure in revision surgery.…”

Section: Introductionmentioning

confidence: 99%

Management of Recurrent Anterior Shoulder Instability After Surgical Stabilization in Children and Adolescents

Bonazza

Riboh

2020

Curr Rev Musculoskelet Med

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Purpose of Review Recurrent shoulder instability after stabilization is common in pediatric and adolescent athletes. The purpose of this review is to understand the risk factors that lead to failure of primary surgery and management principles in the setting of recurrent instability following surgical stabilization. Recent Findings Rates of recurrence after primary and revision surgical stabilization remain higher than desirable. Risk factors for failure in include glenoid and humeral bone loss, capsular or ligamentous laxity, and young age though few studies have focused specifically on the adolescent population. Arthroscopic, open, and bone block techniques have been described in this population similar to adults. Summary Failure after a primary shoulder stabilization remains a common problem in adolescents in no small part because a high proportion of these athletes return to high levels of activity. A thorough understanding of the index procedure and patient-specific risk factors for failure are key to successful planning of revision surgery. The current literature does not allow for firm treatment recommendations in individual pediatric or adolescent athletes, but the guiding principles are similar to those in adults. Specifically, all bony and soft tissue pathology should be identified and assessed, with an understanding that simply repeating the steps of the index procedure typically results in poor outcomes, and often an "escalation" of surgical complexity is required at the time of revision. When appropriately indicated, arthroscopic or open soft tissue procedures and Latarjet coracoid transfer can be safely and successfully implemented for revision shoulder stabilization in young athletes.

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Traumatic Anterior Instability of the Pediatric Shoulder

Abstract: Level III-retrospective comparative study.

Cited by 44 publications

References 22 publications

Long-term clinical outcome of arthroscopic Bankart repair with suture anchors

Long-term clinical outcome of arthroscopic Bankart repair with suture anchors

Adolescent Medial Patellofemoral Ligament Reconstruction: A Comparison of the Use of Autograft Versus Allograft Hamstring

Management of Recurrent Anterior Shoulder Instability After Surgical Stabilization in Children and Adolescents

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