Open Trillat Procedure for Recurrent Anterior Instability of the Shoulder in Elderly Patients.
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ABSTRACT:
SUBMITTER: Housset V
PROVIDER: S-EPMC8185572 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionThe aim of this study is to compare the outcomes of surgical management after primary anterior shoulder dislocation to the outcomes of patients who have surgical stabilization after recurrent anterior shoulder instability.MethodsA Medline (PubMed) search was performed in November of 2016 using the following key terms: shoulder, labrum, Bankart, instability, repair, outcome, recurrent. In May 2017 a Cochrane search was performed using similar key terms to ensure we included all studies. Only level I and II studies were included.ResultsThere were three studies that compared primary repair to delayed repair. In all three studies, the rate of recurrence was higher in group R than group S. When pooled, there was not a statistically significant difference between these groups, but there was a slightly higher odds of recurrence in group R (pooled OR 2.08, CI 0.69-6.26, p = 0.19). No significant differences were appreciated in functional outcomes or complications in these two groups.ConclusionFurther level I and level II studies to compare surgical treatment after first time and recurrent instability are needed. This study failed to find a statistically significant difference in recurrence rates in patients who had stabilization acutely after a single episode compared to patients with recurrent instability events, although results suggest there may be a small benefit in primary stabilization.
| S-EPMC6383179 | biostudies-literature
Project description:Surgical procedures to treat anterior shoulder instability are basically split into 2 groups: those for patients with important bone loss and those for patients with no bone loss. However, there is a gray zone between these procedures in which a bone graft would not be needed but bone grafting would result in a desirable improvement in stabilizing mechanisms. We describe a technique based on the triple soft-tissue block, Bankart reconstruction, and long head of the biceps tenodesis at the anterior glenoid rim. The long head of the biceps would add an anterior restrictor by itself, as well as by tensioning the inferior part of the subscapularis.
| S-EPMC6948139 | biostudies-literature
Project description:There are numerous arthroscopic techniques available to address anterior shoulder instability. Complications are various, and in pursuit of new treatment options, an alternative arthroscopic technique with less potential for complications has been developed. The novel subscapular sling with a semitendinosus graft provides both dynamic and static stability. This procedure uses a semitendinosus graft as a sling around the upper two-thirds of the subscapular tendon, attached to the anterior glenoid rim. The sling phenomenon present in the Latarjet procedure was the basis of the development. The efficacy of the subscapular sling procedure has been verified in biomechanical studies and further investigated in a clinical pilot study. The procedure can be performed without altering the anatomy of nearby structures such as the coracoid process, the conjoined tendon, and the axillary and musculocutaneous nerves. The authors propose the arthroscopic subscapular sling procedure as an alternative to existing surgical treatment options for recurrent anterior shoulder instability.
| S-EPMC8322630 | biostudies-literature
Project description:Although anterior shoulder instability is most commonly treated with arthroscopic fixation, open labral repair with capsular shift may be best for select patients and in cases of revision stabilization without significant bone loss. The technique described in this article uses the deltopectoral interval; it involves careful dissection of the subscapularis from the anterior capsule, repair of the Bankart lesion, and a lateral and superior capsular shift using all-suture anchors in the humeral head. Advantages of this technique include meticulous control of anchor placement and the ability to provide additional stability via a lateral and superiorly directed capsular shift. This operation can be performed in a reliable, efficient, and reproducible manner.
| S-EPMC6714345 | biostudies-literature
Project description:The Trillat procedure has been proposed to treat chronic anterior shoulder instability by performing a closing wedge osteotomy of the coracoid process fixed with a coracoscapular screw above the subscapularis. The goal of this osteotomy is to distalize and medialize the coracoid tip to place the conjoint tendon in front of the glenohumeral joint. This in turn distalizes and reinforces the subscapularis in abduction and allows the conjoint tendon to act as a sling and push the humeral head posteriorly. It is commonly accepted to perform this surgery for patients with chronic shoulder anterior instability associated with massive irreparable rotator cuff tear (to preserve and retension the residual subscapularis muscle) or in patients with anterior instability and hyperlaxity. We present a less invasive arthroscopic technique for this procedure. This arthroscopic technique allows assessment and treatment of associated lesions and allows for intraoperative assessment of the subscapularis after the coracoid process is moved to prevent subcoracoid impingement and loss of external rotation.
| S-EPMC6410926 | biostudies-literature
Project description:The purpose of the study was to analyse the clinical results of an open Bankart repair for anterior instability in patients with a glenoid defect and those without a glenoid defect, and to identify factors related to the glenoid defect associated with anterior instability. The prospective study involved 20 patients with a glenoid defect (glenoid defect group) and 20 patients without a glenoid defect (control group) who were enrolled after an open Bankart repair. The average age of each group at the time of surgery was 28 and 23 years respectively. The average follow-up periods were 48 and 55 months. There were no significant differences in subjective pain and stability between the two groups. But the final Rowe score decreased significantly as the size of the glenoid defect increased. Redislocation or subluxation was seen in three patients in the glenoid defect group. The open Bankart procedure restored stability and improved shoulder functions in the patients with a glenoid defect associated with anterior instability, even though the glenoid defect group experienced a significant loss in the range of external rotation with the arm at the side, and the final outcome of the surgery depended upon the size of a glenoid defect. This was a therapeutic, level III case-control study.
| S-EPMC2266647 | biostudies-other
Project description:BackgroundCoracoid transfer is a reliable method for managing anterior shoulder instability in athletes who play contact sports; however, differences between the Bristow and Latarjet procedures are unclear.PurposeTo compare clinical outcomes and rates of bone union and bone resorption of the coracoid process between the open Bristow and open Latarjet procedures in rugby players.Study designCohort study; Level of evidence, 3.MethodsRugby players who underwent an open Bristow or an open Latarjet procedure were retrospectively reviewed for anterior shoulder instability, and 66 shoulders in the Bristow group and 35 in the Latarjet group were included. Graft union and resorption were evaluated using computed tomography at 3 months to 1 year postoperatively. Patient-reported outcome measures (American Shoulder and Elbow Surgeons score, Rowe score, and satisfaction rate) were obtained at a mean follow-up of 74 months (range, 45-160 months) for Bristow and 64 months (range, 50-76 months) for Latarjet procedures. Recurrence and the rate of return to play (RTP), frequency of pain after RTP, and retirement rate after RTP were also assessed.ResultsIn 97.1% of the Latarjet procedure cases, bone union of the coracoid was achieved at 3 months postoperatively; however, bone union was achieved in only 72.7% of the Bristow procedure cases at 6 months postoperatively. Bone resorption of the coracoid process occurred in 6.1% of shoulders after the Bristow procedure, whereas 100% of shoulders showed bone resorption after the Latarjet procedure. No statistical differences were found in outcome scores between the 2 procedures. Subluxation and persistent pain after returning to sports were identified at a significantly higher rate in the Latarjet group (5 shoulders [14%] and 9 shoulders [26%], respectively) than in the Bristow group (2 shoulders [3%] and 2 shoulders [3%]) (P = .0471 and P = .001, respectively).ConclusionThe Latarjet procedure had an advantage in the early and high rate of bone union but was at a disadvantage in bone resorption compared with the Bristow procedure. Subluxation and pain after returning to sports were more frequent in patients who underwent the open Latarjet procedure than in those who underwent the open Bristow procedure.
| S-EPMC9118436 | biostudies-literature
Project description:It remains unknown if arthroscopic repair of recurrent anterior shoulder instability is as effective as open repair.The purpose of this study is to analyze the literature to provide clinical recommendations regarding the most appropriate therapeutic intervention for recurrent anterior shoulder instability.Systematic review of level I and II studies.PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and secondary references from 1967 to March 2010 were appraised for studies that met the inclusion criteria.Inclusion criteria were English-language level I or level II trials involving the treatment of recurrent anterior shoulder instability. Exclusion criteria included non-English-language studies; level III, IV, or V studies; and trials examining treatment of first-time shoulder dislocation, posterior shoulder dislocation, or diagnoses other than recurrent anterior shoulder dislocations.Included studies underwent quality appraisal independently by each author identifying strengths, weaknesses, and biases.Four randomized controlled trials compared the use of arthroscopic and open repair for recurrent anterior shoulder dislocations. These studies show no statistically significant difference between the 2 operative approaches. No long-term follow-up data describing the effects of either surgical approach are available at this time. Each investigation had weaknesses in study design that decreased the validity of its findings.While limited, the available evidence from randomized controlled trials does not show a statistically significant difference in redislocation rates, return to activity, and functional outcomes between the arthroscopic and open repair groups. Range of motion is marginally better following arthroscopic treatment when compared with open repair. Recommendations on the optimal surgical intervention cannot be provided.
| S-EPMC3445197 | biostudies-other
Project description:PurposeTo assess and compare glenoid version in patients with anterior shoulder instability (ASI), posterior shoulder instability (PSI), and a control group.MethodsThe operative notes of all patients that had undergone arthroscopic shoulder instability repair between January 2017 and May 2022 were retrospectively reviewed. Magnetic resonance imaging scans were then analyzed, and glenoid version was measured by a single blinded observer. A P value <.05 was considered statistically significant.ResultsThere were 100 patients included in the ASI group, 65 in PSI group, and 100 in the control group. The mean glenoid versions for the ASI group were -16°, -9.1°, and -9.2° for the vault version, simplified vault version, and chondrolabral version, respectively. The mean glenoid versions for the PSI group were -21°, -13.4°, and -16.6° for the vault version, simplified vault version, and chondrolabral version, respectively. The mean versions for the control group were -17.8°, -9.5°, and -9.8° for the vault version, simplified vault version and chondrolabral version, respectively. ANOVA testing and post hoc comparisons revealed the PSI group to be significantly more retroverted than both other groups P < .001. The ASI group's degree of glenoid version was not significantly different to that of the control P = .009.ConclusionPatients with PSI have a higher degree of retroversion in comparison to those with ASI and control. There is no significant difference in glenoid version among patients with ASI when compared with control.Level of evidenceLevel III, retrospective comparative study.
| S-EPMC10497783 | biostudies-literature
Project description:Anterior shoulder instability remains one of the main indications for shoulder surgery. We present a modified way of treating anterior shoulder instability in the beach-chair position from an anterior arthroscopic approach through the rotator interval. This technique opens the rotator interval, which increases the working area and allows us to work without cannulae. Through this approach, we can treat all injuries comprehensively and, if necessary, switch to other arthroscopic techniques used for instability such as arthroscopic Latarjet or anterior ligamentoplasties.
| S-EPMC10066418 | biostudies-literature