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The majority of the current literature on arthroscopic Bankart repair is retrospective, and discrepancies exist regarding clinical outcomes including recurrent instability and return to play among studies of different levels of evidence. The purpose of this study is to perform a systematic review of the literature to compare the outcomes of prospective and retrospective studies on arthroscopic Bankart repair. A search was performed using the PubMed/Medline database for all studies that reported clinical outcomes on Bankart repair for anterior shoulder instability. The search term "Bankart repair" was used, with all results being analyzed via strict inclusion and exclusion criteria. Three independent investigators extracted data and scored each included study based on the 10 criteria of the Modified Coleman Methodology Score out of 100. A χ2 test was performed to assess if recurrent instability, revision, return to play, and complications are independent of prospective and retrospective studies. A total of 193 studies were included in the analysis, with 53 prospective studies and 140 retrospective in design. These studies encompassed a total of 13,979 patients and 14,019 surgical procedures for Bankart repair for shoulder instability. The rate of redislocation in the prospective studies was 8.0% vs. 5.9% in retrospective studies (P <.001). The rate of recurrent subluxation in the prospective studies was 3.4% vs. 2.4% in retrospective studies (P =.004). The rate of revision was higher in retrospective studies at 4.9% vs. 3.9% in prospective studies (P =.013). There was no significant difference in terms of overall rate to return to play between prospective and retrospective studies (90% and 91%, respectively; P =.548). The overall rate of non-instability complications in the prospective cohort was 0.27% vs. 0.78% in the retrospective studies (P =.002). The overall rates of recurrent dislocations-subluxations are higher in prospective studies than retrospective studies. However, rates of revision were reportedly higher in retrospective studies. Complications after arthroscopic Bankart repair are rare in both prospective and retrospective studies, and there was no difference in rates of return to play. [ABSTRACT FROM AUTHOR]

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The rationale for the Latarjet procedure was described as the "triple blocking" effect. Satisfactory surgical outcomes have been reported after surgery. However, it has been reported that the "triple blocking" effect increases joint stability, but it does not fully restore it. Moreover, the procedure is nonanatomic and concerns remain regarding the effects. The study of scapulohumeral rhythm, which is a clinical parameter used for the functional evaluation of shoulder kinematics, can offer new perspectives on the rationale for the procedure. This study aimed to compare the shoulder kinematics of patients after the Latarjet procedure to the shoulders of a healthy population using magnetic and inertial measurement units with a motion analysis system. A retrospective study with prospective data collection was conducted on 28 patients who underwent the open Latarjet procedure for recurrent shoulder instability. At a minimum 12-month follow-up, each patient was evaluated by assessing the range of motion, the Rowe score, and the Constant-Murley score. Patients were examined using the ShowMotion 3D kinematic tracking system (NCS Lab, Modena, Italy), which uses wireless wearable noninvasive magnetic and inertial measurement units sensors to assess the three-dimensional kinematics of the shoulder. For each plane of elevation (ie, flexion and abduction), the scapulohumeral rhythm was described by three scapulothoracic rotations (ie, protraction–retraction, mediolateral rotation and posterior–anterior tilting) as a function of humeral anteflexion or humeral abduction. The mean time from first shoulder dislocation to surgery was 6.6 ± 3 years (range, 1-12 years). No intraoperative complications occurred, and computed tomography (CT) performed 3 months after surgery showed graft union in all patients. After a mean follow-up time of 32.4 ± 20 months (range, 12-96), the mean Constant-Murley score and Rowe scores were 94.5 ± 4.8 (range, 84-100) and 96.7 ± 3.5 (range, 90-100), respectively. All patients showed no signs of glenohumeral arthritis on X-ray examination. Scapular posterior tilt and scapular internal rotation were significantly greater in the patient group than in the healthy population for the flexion–extension and abduction–adduction movements along the whole shoulder range of motion (all P <.05); no differences were found in upward/downward scapular rotation. A greater scapular posterior tilt and scapular internal rotation were observed after the Latarjet procedure. The modified position of the scapula was maintained during the entire range of motion, suggesting a shoulder-stabilizing kinematic effect in addition to the bony, sling and bumper effects. [ABSTRACT FROM AUTHOR]

The indications for bone block augmentation of the glenoid following recurrent anterior shoulder instability are expanding. Arthroscopic anatomic glenoid reconstruction (AAGR) is an evolving technique with similar clinical results to the Latarjet procedure and other open bone block procedures. Multiple types of bone grafts and fixation techniques have been described, with varying results on bony integration, resorption, articular congruity, and recurrence rates. This review focuses on biomechanics, patient workup, indications, current evidence, and the authors' preferred surgical technique for AAGR. [ABSTRACT FROM AUTHOR]

Overhead athletes with anterior, posterior, and multidirectional shoulder instability present with a wide range of symptoms, especially considering the injury mechanism and affected supportive structures. As such, the management of shoulder instability is widely variable and relies on rehabilitation, operative management, and sport-specific considerations, such as positional and seasonal demands on the athlete. Biomechanical analysis may further aid in the recovery process or serve as a predictive tool to identify an increased risk for injury. [ABSTRACT FROM AUTHOR]

Anterior glenohumeral instability is one of the most common injuries suffered from sport. Despite padding and conditioning, the shoulder joint remains particularly vulnerable to injury, especially in the setting of contact. The overall rate of anterior instability is reported to be 0.12 injuries per 1000 athlete exposures, although this is increased up to 0.40 to 0.51 in the contact athlete. Successful treatment requires consideration of restoring stability while minimizing loss of glenohumeral motion. Common treatment strategies involve addressing the pathology that results from anterior shoulder dislocation including labral detachment as well as bony defects to the humeral head and glenoid. [ABSTRACT FROM AUTHOR]

In the evaluation of shoulder instability, recognition of relevant pathology on imaging is critical to planning a surgical treatment that minimizes the risk for recurrent instability. The purpose of this review is to (1) discuss the use of radiography, computed tomography, and MRI in evaluating shoulder instability and (2) demonstrate how various imaging modalities are useful in identifying critical pathologies in the shoulder that are relevant for treatment. [ABSTRACT FROM AUTHOR]

Shoulder glenohumeral joint dislocations and subluxations are a relatively common injury among athletic populations. Evaluating the patient both on the field initially and through early recovery helps to determine the best treatment strategies and predict the natural history of each unique injury. [ABSTRACT FROM AUTHOR]

Background: Postoperative infection after the Latarjet procedure, ranging from 1% to 6%, can compromise the functional outcome of young athletes. Cutibacterium acnes is a main pathogen as a consequence of an intraoperative contamination. Purpose: To evaluate intraoperative contamination with C. acnes and the effectiveness of the local application of vancomycin during the Latarjet procedure. Study Design: Cohort study; Level of evidence, 2. Methods: This was a single-center study including 75 patients (mean age, 26 years; range, 15-55 years) operated on for anterior shoulder instability with the primary open Latarjet procedure; they underwent the same protocol of skin preparation and preoperative prophylactic antibiotics. Three groups of 25 patients were created and divided sequentially, without the results of each group being known before the end of the study: group A (5 mg/mL of vancomycin), group B (20 mg/mL of vancomycin), and group C (control group with no vancomycin). Swab samples of the coracoid were taken before sectioning the coracoid process (time 1) and after its preparation (time 2). The coracoid was then wrapped in gauze impregnated with different concentrations of vancomycin, except for group C. A final sample (time 3) was taken before screwing the bone block onto the glenoid. All samples were cultured for 21 days, and patients underwent clinical and radiological follow-up for 6 months. Results: The C. acnes contamination rates at times 1, 2, and 3 were 25%, 44%, and 45%, respectively, without significant difference. There was no significant difference between groups A and B with respect to the number of positive cultures at each time point. Of 9 positive cultures at time 1, all were still positive at time 3 in group A, whereas 3 of 5 were negative in group B (P =.027). The rate of C. acnes at time 3 in the control group was higher than that in the 2 other groups (68% vs 44% for group A and 20% for group B; P =.003). Body mass index was the only prognostic factor for a C. acnes –positive culture (26.05 ± 3.39 vs 23.34 ± 2.33; P =.018). No clinical infection was reported at the 6-month postoperative follow-up. Conclusion: The rate of C. acnes contamination ranged from 25% to 68% during the open Latarjet procedure in young athletes. Vancomycin reduced the bacterial contamination when it was used at high concentrations in a gauze wrap on the coracoid. The type of C. acnes detected and its clinical implications remain to be studied. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare clinical outcomes and recurrence of instability after arthroscopic Bankart repair (ABR) in patients with anterior shoulder instability, with and without a GLAD lesion, while distinguishing between primary and recurrent instability. Methods: Consecutive patients who underwent isolated ABR between January 2012 and December 2021 were included. Patients with a concomitant GLAD lesion were matched in with patients without a GLAD lesion according to the following criteria: age, sex, BMI, follow-up time, and primary versus recurrent instability. At minimum two-year follow-up, the clinical outcome (Rowe score, redislocation rate) and the functional outcome, including the American Shoulder and Elbow Surgeons (ASES) score, Western Ontario Shoulder Instability Index (WOSI), Oxford Shoulder Instability Score (OSIS), satisfaction (1–10 scale, 0 = unsatisfied, 10 = very satisfied), and Visual Analogue Scale (VAS), were compared between groups. Results: In total, 28 patients (14 GLAD vs. 14 Bankart; age: 32.5 ± 13.0 years; sex: 92.9% male; BMI: 24.6 ± 2.2) were included 6.9 ± 2.8 (2–11) years after isolated ABR (follow-up rate 63.6%). Clinical and functional outcome did not differ significantly between patients with versus without GLAD lesions (ASES score: 100 [96.5–100] vs. 97.5 [93.3–100], p = 0.27); WOSI (%): 9.0 [3.7–24.5] vs. 3.8 [0.8–8.9], p = 0.22; Rowe score: 90.0 [75.0–100] vs. 95.0 [78.8–100], p = 0.57; OSIS: 46 [44.7–48] vs. 46 [43.0–48], p = 0.54; satisfaction: 8.9 ± 1.4 vs. 8.0 ± 1.4, p = 0.78; VAS 0 [0–1.3] vs. 0 [0–1.0]. In both groups, two patients (14.3%) reported a redislocation during the observation period. Conclusions: At short- to mid-term follow-up, ABR showed favorable outcomes, low dislocation rates, and high patient satisfaction, regardless of the presence of a GLAD lesion or primary versus recurrent instability. However, follow-up time was heterogeneous, and the follow-up rate was marginal. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present systematic review is to collect all the available evidence regarding the clinical and radiological results of revision to reverse shoulder arthroplasty (RSA) of modular anatomic shoulder prostheses (TSA) using a convertible metal-backed glenoid (MBG). Methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies investigating revision of TSA to RSA utilizing a convertible MBG and reporting clinical and radiological outcomes were identified. Results: A total of five studies on the use of convertible modular glenoid component in the setting of TSA revision to RSA were finally included in the present systematic review. A total of 60 procedures were reported. Mean operative times was 65 min. Intraoperative complications included 3 cases of glenoid loosening. Only one case of dislocation was reported as postoperative complication. At mean follow-up of 32.3 months post-revision, no glenoid loosening was reported, VAS score decreased from 7.7 to 1.5, Constant Score increased from 24.8 to 57.6. Conclusions: Revision to RSA after failed TSA using a convertible modular glenoid component was associated with a low rate of intraoperative and postoperative complications, low surgical time and led to good results in term of pain relieve and functional outcomes. Given the complexity and risk associated with revision of anatomic shoulder prosthesis having a convertible glenoid may help to simplify the procedure and improve clinical results. [ABSTRACT FROM AUTHOR]

The extent of measurement errors of statistical shape models that predict native glenoid width based on glenoid height to subsequently determine the amount of anterior glenoid bone loss is unclear. Therefore, the aim of this study was to (1) create a statistical shape model based on glenoid height and width measured on 3-dimensional computed tomography (3D-CT) and determine the accuracy through measurement errors and (2) determine measurement errors of existing 3D-CT statistical shape models. A retrospective cross-sectional study included all consecutive patients who underwent CT imaging before undergoing primary surgical treatment of traumatic anterior shoulder dislocation between 2007 and 2022 at the Tohoku University Hospital and affiliated hospitals. Patients were included when instability was unilateral and CT scans of both the injured and contralateral uninjured shoulder were available. 3D segmentations were created and glenoid height and width of the injured and contralateral uninjured side (gold standard) were measured. Accuracy was determined through measurement errors, which were defined as a percentage error deviation from native glenoid width (contralateral uninjured glenoid), calculated as follows: measurement error = [(estimated glenoid width with a statistical shape model – native glenoid width) / native glenoid width] × 100%. A linear regression analysis was performed to create a statistical shape model based on glenoid height according to the formula: native glenoid width = a × glenoid height + b. The diagnosis and procedure codes identified 105 patients, of which 69 (66%) were eligible for inclusion. Glenoid height demonstrated a very strong correlation (r = 0.80) with native glenoid width. The linear regression formula based on this cohort was as follows: native glenoid width = 0.75 × glenoid height – 0.61, and it demonstrated an absolute average measurement error of 5% ± 4%. The formulas by Giles et al, Chen et al and Rayes et al demonstrated absolute average measurement errors of 10% ± 7%, 6% ± 5%, and 9% ± 6%, respectively. Statistical shape models that estimate native glenoid width based on glenoid height demonstrate unacceptable measurement errors, despite a high correlation. Therefore, great caution is advised when using these models to determine glenoid bone loss percentage. To minimize errors caused by morphologic differences, preference goes to methods that use the contralateral side as reference. [ABSTRACT FROM AUTHOR]

Background: Management of glenohumeral instability in the adolescent population can be both challenging and controversial. There are no current guidelines for optimal management of glenohumeral instability in this population (unidirectional or multidirectional), and the cutoff ages for transition to adult treatment are not known. Purpose: To develop consensus-based guidelines for the management of glenohumeral instability in adolescents. Study Design: Consensus statement. Methods: A 26-question, multiple-choice survey was developed after 2 rounds of iterations and was submitted to the orthopaedic surgeons of the Pediatric Research in Sports Medicine (PRiSM) Society. The survey comprised 3 sections—demographics, practice setting, and decision-making—and included cutoff ages and management in 5 specific case scenarios. Consensus-based guidelines were generated with 66% response agreement. An indication score was then applied to each response related to more aggressive management to determine if variables related to consensus (or lack thereof) could be identified. Results: A total of 54 responses were returned. Of the respondents, 59% were from academic practice, 84% were pediatric orthopaedic fellowship trained, and 46% performed >25 shoulder instability cases per year. In the setting of first-time anterior shoulder dislocation, nonoperative treatment was preferred for boys aged <14 years and girls aged <13 years. Besides age, proximal humerus physeal status, injury mechanism, sport, and presence of bony injury affected treatment selection. The presence of a Bankart lesion was an indication for stabilization in first-time dislocations for contact athletes with a closing or closed physis, but not in patients with an open physis or noncontact injury mechanisms. For recurrent anterior shoulder dislocation, stabilization was preferred irrespective of physis status. Initial nonoperative treatment was preferred for multidirectional instability. Conclusion: In the setting of first-time anterior shoulder dislocation in patients with open physes, nonoperative treatment was preferred for boys <14 years and girls <13 years. Future multicenter prospective studies focusing on outcomes would help to validate current practice patterns, especially in scenarios for which no consensus was reached. [ABSTRACT FROM AUTHOR]

Background: Hill-Sachs lesions are common after shoulder instability, and treatment options vary but include remplissage or implantation of structural bone graft. Large Hill-Sachs lesions not addressed by remplissage are challenging to manage and may frequently require an open surgical approach for bone filling treatment options. The optimal approach to maximize visualization of the humeral head during these procedures remains unclear. Purpose/Hypothesis: The purpose of this study was to compare the area of the humeral head accessed using a modified posterior deltoid split approach versus a standard deltopectoral approach without surgical dislocation, with particular attention to access of engaging Hill-Sachs lesions for the purpose of bone grafting in the setting of anterior shoulder instability. It was hypothesized that both approaches would provide equal access to a simulated Hill-Sachs lesion. Study Design: Controlled laboratory study. Methods: Four human cadaveric shoulders were mounted in the beach-chair position. The modified posterior deltoid split approach and nonextensile deltopectoral approaches were performed. A typical Hill-Sachs lesion was simulated on the humeri. The percentage of the total surface area of the humeral head that was accessed, including access to the simulated Hill-Sachs lesion, was mapped using 3-dimensional digitizing software. Results: The deltopectoral approach provided 45% ± 15.2% access (range, 24% to 58%) to the humeral head versus 22.2% ± 6.1% (range, 17% to 30%) for the modified posterior deltoid split approach (P =.057). The modified posterior deltoid split approach enabled 100% access of the simulated Hill-Sachs lesion compared with 0% for the nonextensile deltopectoral approach. The angle of access to the articular surface was direct and perpendicular with the modified posterior deltoid split approach. Conclusion: The overall surface area of the humeral head accessed via the modified posterior deltoid split approach was less compared with the deltopectoral approach; however, the entire area of a typical Hill-Sachs lesion was able to be accessed from the modified posterior deltoid split approach, whereas this area was not well visualized from the standard deltopectoral approach. Clinical Relevance: The modified posterior deltoid split approach provided sufficient access to the humeral head for the purposes of grafting an engaging Hill-Sachs lesion in the setting of anterior shoulder instability. [ABSTRACT FROM AUTHOR]

Background: The Chinese unique inlay Bristow (Cuistow) procedure is a modified Bristow surgery in which an inlay (mortise-and-tenon) structure is added to the contact surface between the coracoid tip and the glenoid. Patients who have undergone the Cuistow procedure have had satisfying clinical performance and excellent postoperative bone healing rates (96.1%). Purpose: To compare the clinical and radiographic outcomes after the arthroscopic Cuistow procedure and the arthroscopic Bristow procedure. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 91 patients who underwent either the Cuistow or Bristow procedure between January 2017 and March 2018 were selected, and 69 patients (70 shoulders; 35 in the Cuistow group and 35 in the Bristow group) were included. Clinical assessment at minimum 24 months postoperatively, including the visual analog scale for pain and instability, American Shoulder and Elbow Surgeons score, Rowe score, subjective shoulder value score, and active range of motion, was completed by independent observers and compared with values collected preoperatively. Assessment with 3-dimensional computed tomography scans was performed preoperatively; immediately after the operation; at 3, 6, and 12 months postoperatively; and at the final follow-up. Results: A total of 69 patients (70 shoulders) were included, with a mean follow-up duration of 34.41 ± 5.99 months (range, 24-50 months). Both groups saw significant improvement in visual analog scale for pain and instability, American Shoulder and Elbow Surgeons, Rowe, and subjective shoulder value scores at the final follow-up compared with the preoperative values (P <.001 for all), with no significant between-group differences on any clinical outcomes at the final follow-up. The 3-month postoperative graft union rate on computed tomography was significantly higher in the Cuistow group compared with the Bristow group (82.9% vs 51.4%, respectively, P =.003), although the graft union rate at the final follow-up was not significantly different (94.3% vs 85.7%, respectively; P =.449). Conclusion: Patients receiving the Cuistow procedure had equivalent clinical outcomes and a significantly higher bone union rate at 3 months postoperatively than those in the Bristow group. The inlay structure used in the Cuistow procedure was found to be associated with accelerated bone union. [ABSTRACT FROM AUTHOR]

Purpose of Review: The management of shoulder instability in throwing athletes remains a challenge given the delicate balance between physiologic shoulder laxity facilitating performance and the inherent need for shoulder stability. This review will discuss the evaluation and management of a throwing athlete with suspected instability with a focus on recent findings and developments. Recent Findings: The vast majority of throwing athletes with shoulder instability experience subtle microinstability as a result of repetitive microtrauma rather than episodes of gross instability. These athletes may present with arm pain, dead arms or reduced throwing velocity. Recent literature reinforces the fact that there is no "silver bullet" for the management of these athletes and an individualized, tailored approach to treatment is required. While initial nonoperative management remains the hallmark for treatment, the results of rehabilitation protocols are mixed, and some patients will ultimately undergo surgical stabilization. In these cases, it is imperative that the surgeon be judicious with the extent of surgical stabilization as overtightening of the glenohumeral joint is possible, which can adversely affect athlete performance. Summary: Managing shoulder instability in throwing athletes requires a thorough understanding of its physiologic and biomechanical underpinnings. Inconsistent results seen with surgical stabilization has led to a focus on nonoperative management for these athletes with surgery reserved for cases that fail to improve non-surgically. Overall, more high quality studies into the management of this challenging condition are warranted. [ABSTRACT FROM AUTHOR]

Introduction: Ehlers–Danlos Syndrome (EDS) is a hereditary and heterogeneous syndrome that affects conjunctive tissue, due to collagen production compromise. Hypermobile EDS (hEDS) is the most common subtype of this syndrome and can cause shoulder joint instability, which can lead to chronic pain and significant functional impairment.Methods: A case report of a patient with hEDS followed in our local health unit was made. The authors describe their clinical insight regarding the case, as well as the rehabilitation program the patient was submitted to.Results: Female patient, 32 years old. Functionally autonomous in every daily living activity. Clinically diagnosed with hEDS in 2013, after reporting bilateral shoulder instability. The patient presented herself in a Physical and Rehabilitation Medicine consultation, 6 months after being submitted to the third surgical intervention of the right shoulder. She presented an overall limited range of motion, decreased muscle strength and positive apprehension and drawer tests. An extensive rehabilitation program was prescribed, focusing on joint mobilization, dynamic stabilizers strengthening and proprioceptive training. After 12 weeks, the patient presented reduced shoulder pain and a better functional status.Conclusion: hEDS compromises the integrity of the static and dynamic stabilizers of the shoulder. Clinical management of these cases involves a multidisciplinary approach with early and adequate rehabilitation care treatments. [ABSTRACT FROM AUTHOR]

Background: Evidence-based care relies on robust research. The fragility index (FI) is used to assess the robustness of statistically significant findings in randomized controlled trials (RCTs). While the traditional FI is limited to dichotomous outcomes, a novel tool, the continuous fragility index (CFI), allows for the assessment of the robustness of continuous outcomes. Purpose: To calculate the CFI of statistically significant continuous outcomes in RCTs evaluating interventions for managing anterior shoulder instability (ASI). Study Design: Meta-analysis; Level of evidence, 2. Methods: A search was conducted across the MEDLINE, Embase, and CENTRAL databases for RCTs assessing management strategies for ASI from inception to October 6, 2022. Studies that reported a statistically significant difference between study groups in ≥1 continuous outcome were included. The CFI was calculated and applied to all available RCTs reporting interventions for ASI. Multivariable linear regression was performed between the CFI and various study characteristics as predictors. Results: There were 27 RCTs, with a total of 1846 shoulders, included. The median sample size was 61 shoulders (IQR, 43). The median CFI across 27 RCTs was 8.2 (IQR, 17.2; 95% CI, 3.6-15.4). The median CFI was 7.9 (IQR, 21; 95% CI, 1-22) for 11 studies comparing surgical methods, 22.6 (IQR, 16; 95% CI, 8.2-30.4) for 6 studies comparing nonsurgical reduction interventions, 2.8 for 3 studies comparing immobilization methods, and 2.4 for 3 studies comparing surgical versus nonsurgical interventions. Significantly, 22 of 57 included outcomes (38.6%) from studies with completed follow-up data had a loss to follow-up exceeding their CFI. Multivariable regression demonstrated that there was a statistically significant positive correlation between a trial's sample size and the CFI of its outcomes (r = 0.23 [95% CI, 0.13-0.33]; P <.001). Conclusion: More than a third of continuous outcomes in ASI trials had a CFI less than the reported loss to follow-up. This carries the significant risk of reversing trial findings and should be considered when evaluating available RCT data. We recommend including the FI, CFI, and loss to follow-up in the abstracts of future RCTs. [ABSTRACT FROM AUTHOR]

Purpose: Measurement of glenoid bone loss in the shoulder instability can be assessed by CT or MRI multiplanar imaging and is crucial for pre-operative planning. The aim of this study is to determine the intra and interobserver reliability of glenoid deficiency measurement using MRI multiplanar reconstruction with 2D assessment in the sagittal plane (MPR MRI). Methods: We reviewed MRI images of 80 patients with anterior shoulder instability with Osirix software using MPR. Six observers with basic experience measured the glenoid, erosion edge length, and bone loss twice, with at least one-week interval between measurements. We calculated reliability and repeatability using the intra-class correlation coefficient (ICC) and minimal detectable change with 95% confidence (MDC95%). Results: Intra and Inter-observer ICC and MDC95% for glenoid width and height were excellent (ICC 0,89-0,96). For erosion edge length and area of the glenoid were acceptable/good (ICC 0,61-0,89). Bone loss and Pico Index were associated with acceptable/good ICC (0,63 -0,86)) but poor MDC95% (45 - 84 %). Intra-observer reliability improved with time, while inter-observer remained unchanged. Conclusion: The MPR MRI measurement of the anterior glenoid lesion is very good tool for linear parameters. This method is not valid for Pico index measurement, as the area of bone loss is variable. The pace of learning is individual, therefore complex calculations based on MPR MRI are not resistant to low experience as opposed to true 3D CT [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare clinical scores and imaging outcomes of bony Bankart lesions that underwent single‐point and modified double‐pulley fixation after at least 2 years of follow‐up. Methods: Patients who underwent surgery to treat bony Bankart injuries were included and divided into groups A and B. A total of 69 patients were included (32 in group A and 37 in group B). Patients in group A underwent arthroscopic modified double‐pulley fixation and patients in group B underwent arthroscopic single‐point fixation. Three‐dimensional computed tomography (3D‐CT) was used to assess glenoid reduction one day after surgery. Postoperative bony union was assessed using 3D‐CT and multiplanar reconstruction images 6 months after surgery. Constant–Murley, Rowe rating system, visual analogue scale and University of California at Los Angeles and American Shoulder and Elbow Surgeons scores were recorded before and after surgery. Results: In terms of imaging measurements, there was no significant group difference in the preoperative size of the glenoid defect, the size of the bony fragment or the expected postoperative size of the glenoid defect. The sizes of the actual postoperative glenoid defects differed significantly between the groups (p = 0.027), as did the absolute difference between the expected and actual glenoid defect sizes (p < 0.001). At 6 months postoperatively, 50.0% of group A patients and 24.3% of group B patients exhibited complete bony union (p = 0.027); the rates of partial union were 37.5% and 56.8%, respectively. At the final follow‐up, all clinical scores were significantly better than the preoperative scores (all p < 0.05), with no significant group differences (not significant). Conclusions: The use of the modified double‐pulley technique with two anchors to treat bony Bankart injuries provides a better reduction of bone fragments than single‐point fixation with two anchors and was associated with a higher rate of early bone union. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Background: Several studies have examined return to play (RTP) and outcomes following the Latarjet procedure in contact athletes. Purpose: To investigate clinical outcomes affecting RTP following the Latarjet procedure in contact athletes. Study Design: Case series; Level of evidence, 4. Methods: A total of 67 contact athletes (72 shoulders) ≤35 years old who underwent Latarjet procedure for recurrent shoulder instability between January 1, 2018, and March 31, 2022, were retrospectively identified. Demographic information, medical history, surgical history, number of dislocations before surgery, and postoperative complications up to 6 months after surgery were reviewed. Outcomes evaluated included RTP, competition level, satisfaction, and patient-reported outcomes including visual analog scale for pain, American Shoulder and Elbow Surgeons (ASES) Score, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: There were a total of 67 patients (72 shoulders) included in the study with a mean age at surgery of 19.7 years for all shoulders. Of the total cohort, 46 patients (50 shoulders; [69.4%]) were available for follow-up by phone. Of the 46 patients contacted by phone, 22/46 were football players; 30/50 [60.0% of all shoulders]) were contact athletes and 19/46 [41.3%] limited contact athletes) were interviewed with a mean follow-up of 25.5 months (range, 10-49 months). Of 72 patients, 22 (30.6% of shoulders and 32.8% of patients) patients had prior shoulder surgery, most commonly arthroscopic stabilization. Only 1 patient experienced hardware failure, but this did not require reoperation. Sixteen of 46 (35%) athletes competed at the collegiate level, and 24/46 (52%) were high school athletes at the time of surgery; 34 of 46 patients (74%) returned to play, of which 30 of the 34 (88%) returned to playing at the same competition level; 15 of 22 (68%) football players returned to play. Only 4 of 51 (8%) reported subjective recurrent instability. Postoperative mean ASES score was 92.2, DASH score was 5.6, and visual analog scale for pain score was 4 (range, 0-50). A total of 43 of 46 (93%) patients reported improvement in quality of life after undergoing the Latarjet procedure for shoulder instability. Eight of 72 (11.1%) shoulders had unresolved pain or stiffness 6 months postoperatively, and 2 of 72 (2.8%) required revisions. Conclusion: Patient RTP, outcomes, and satisfaction were high following the Latarjet procedure in young contact athletes. [ABSTRACT FROM AUTHOR]

The Trillat procedure, initially described by Albert Trillat, is historically one of the first techniques for addressing recurrent anterior shoulder instability, incorporating fascinating biomechanical mechanisms. After lowering, medializing, and fixing the coracoid process to the glenoid neck, the subcoracoid space is reduced, the subscapularis lowered, and its line of pull changed, accentuating the function of the subscapularis as a humeral head depressor centering the glenohumeral joint. Furthermore, the conjoint tendon creates a ‘seatbelt’ effect, preventing anteroinferior humeral head dislocation. Even though contemporary preferences lean towards arthroscopic Bankart repair with optional remplissage, bone augmentation, and the Latarjet procedure, enduring surgical indications remain valid for the Trillat procedure, which offers joint preservation and superior outcomes in two distinct scenarios: (i) older patients with massive irreparable cuff tears and anterior recurrent instability with an intact subscapularis tendon regardless of the extent of glenoid bone loss; (ii) younger patients with instability associated shoulder joint capsule hyperlaxity without concomitant injuries (glenoid bone loss, large Hill–Sachs lesion). Complications associated with the Trillat procedure include recurrent anterior instability, potential overtightening of the coracoid, leading to pain and a significant reduction in range of motion, risk of subcoracoid impingement, and restriction of external rotation by up to 10°, a limitation that is generally well-tolerated. The Trillat procedure may be an effective alternative technique for specific indications and should remain part of the surgical armamentarium for addressing anterior shoulder instability.

Background: Shoulder instability in pediatric and adolescent patients can be treated operatively via arthroscopic or open procedures, but there a paucity of evidence to support the incidence of these treatment modalities over time. It is hypothesized that the overall rate of arthroscopic shoulder stabilization procedures will increase over time. Given advances in open stabilization techniques, we also hypothesized that the rate of open procedures may be increasing. Methods: The Pediatric Health Information System database was queried for patients 19 years or younger who underwent arthroscopic or open surgery for shoulder instability and pediatric orthopedic surgeries between 2009 and 2019. Data from 37 of the 52 pediatric hospitals with Pediatric Health Information System data was included in the analysis. Annual and overall incidence rates were estimated for arthroscopic and open procedures, along with 95% confidence intervals. The yearly incidence for secondary (homolateral revisions) or primary contralateral arthroscopic and open procedures was also examined. Results: 4747 patients underwent primary arthroscopic procedures and 384 patients had primary open procedures. There were 8.2 primary open shoulder stabilization procedures per 10,000 orthopedic surgical patients in 2009, which decreased by 19% to 6.7 per 10,000 orthopedic surgical patients in 2019. There was an increase seen in both arthroscopic and open secondary stabilization procedures. In 2009, there were 0.97 secondary arthroscopic procedures per 10,000 orthopedic surgical patients. This increased by 672% to 7.5 per 10,000 orthopedic surgical patients in 2019. No secondary open procedures were recorded in 2009; however, an increase to 2.6 secondary open procedures per 10,000 orthopedic surgical patients was seen by 2019. Conclusion: This study shows a rise in primary arthroscopic pediatric shoulder stabilization surgeries across the U.S. over the last decade. There was a slight decrease in the rate of primary open shoulder stabilization surgeries and an increase in both arthroscopic and open secondary (homolateral revisions or primary contralateral) shoulder stabilization surgeries, implying an increasing revision burden in this population.

Background: Anterior humeral avulsions of the glenohumeral ligament (aHAGL) lesions are relatively rare causes of shoulder instability that affect athletes at a higher rate than other populations. The purpose of this study is to evaluate rate of return to sport (RTS) after HAGL repair. Methods: A search of the PubMed (MEDLINE), Scopus, and Cochrane CENTRAL databases was conducted on April 13, 2022 with the search terms “HAGL” or “humeral avulsion glenohumeral ligament” was used to conduct the systematic review. Inclusion criteria required that lesions were limited to aHAGL, axillary pouch or central HAGL, or both anterior and posterior HAGL lesions as specified by lesion description or direction of instability. Results: Screening and full-text manuscript review identified 7/967 studies eligible for inclusion with a total of 46 aHAGL lesions in athletes. Average rate of RTS was 93.5% (standard deviation [SD] = 13.4%, n = 43/46) with rate of RTS at previous levels of play averaging 80.0% (SD = 22.1%, n = 28/35). Neither rates of concomitant procedures nor concomitant pathology were associated with variation in RTS rates overall or level of RTS. Weighted average Rowe, subjective shoulder value, and Constant scores were 87.5 (SD = 4.9), 86.0 (SD = 2.0), and 82.2 (SD = 5.1), respectively, and 78.6% (n = 22/28) of patients reported postoperative satisfaction or “good/excellent” ratings following aHAGL repair. Adverse events occurred in 18.5% of patients (n = 10/54), most frequently recurrent instability (n = 3/54). Ultimately, 6.2% of patients eventually underwent reoperation (n = 3/17). Conclusion: As with other forms of anterior shoulder instability, RTS rates after aHAGL repair are high and many patients achieve their previous level of play. The most frequent adverse event was subjective recurrent instability with reoperation in 6.2% of patients. The findings from this study provide valuable pooled data on outcomes specific to aHAGL repair, particularly in the athlete population, and contribute to further understanding of outcomes regarding operative management of this rare pathology.

BACKGROUND: Humeral avulsion of the glenohumeral ligament (HAGL) lesions are an uncommon cause of anterior glenohumeral instability and may occur in isolation or combination with other pathologies. As HAGL lesions are difficult to detect via magnetic resonance imaging (MRI) and arthroscopy, they can remain unrecognized and result in continued glenohumeral instability. PURPOSE: To compare patients with anterior shoulder instability from a large multicenter cohort with and without a diagnosis of a HAGL lesion and identify preoperative physical examination findings, patient-reported outcomes, imaging findings, and surgical management trends associated with HAGL lesions. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Patients with anterior glenohumeral instability who underwent surgical management between 2012 and 2020 at 11 orthopaedic centers were enrolled. Patients with HAGL lesions identified intraoperatively were compared with patients without HAGL lesions. Preoperative characteristics, physical examinations, imaging findings, intraoperative findings, and surgical procedures were collected. The Student t test, Kruskal-Wallis H test, Fisher exact test, and chi-square test were used to compare groups. RESULTS: A total of 21 HAGL lesions were identified in 915 (2.3%) patients; approximately one-third (28.6%) of all lesions were visualized intraoperatively but not identified on preoperative MRI. Baseline characteristics did not differ between study cohorts. Compared with non-HAGL patients, HAGL patients were less likely to have a Hill-Sachs lesion (54.7% vs 28.6%; P = .03) or an anterior labral tear (87.2% vs 66.7%; P = .01) on preoperative MRI and demonstrated increased external rotation when their affected arm was positioned at 90° of abduction (85° vs 90°; P = .03). Additionally, HAGL lesions were independently associated with an increased risk of undergoing an open stabilization surgery (odds ratio, 74.6 [95% CI, 25.2-221.1]; P < .001). CONCLUSION: Approximately one-third of HAGL lesions were missed on preoperative MRI. HAGL patients were less likely to exhibit preoperative imaging findings associated with anterior shoulder instability, such as Hill-Sachs lesions or anterior labral pathology. These patients underwent open procedures more frequently than patients without HAGL lesions.

Background: The Trillat procedure is a surgical treatment for recurrent anterior shoulder instability. It consists of an inferior closed-wedge osteoclasy of the coracoid process. Nowadays, it is used to treat selected cases of shoulder instability. This systematic review aims to provide an overview of clinical and functional outcomes, recurrence rate, and complications of the Trillat procedure for recurrent anterior shoulder instability. Methods: A systematic review of the literature regarding the Trillat procedure for recurrent anterior shoulder instability was carried out on Medline, through PubMed, and Embase. The English and French literature published before the 4th of November 2023 was analyzed. The data regarding demographics, outcome, recurrency, and complications were reported. Results: From 38 articles with the primary search, seven manuscripts were enrolled. A total of 419 patients and 443 shoulders were analyzed, with a mean age of 35.46 (range 25-61) years. The mean follow-up was 65.01 (range 24.8-132) months postoperative. The pooled data showed 91.2% of subjective satisfaction, weighted mean postoperative Rowe score of 86.25 points, Walch–Duplay of 84.6 points, and a Constant–Murley Score of 84.82 points. The recurrence rate was 10.28% for all the articles involved and 8.51% for the articles proposing the procedure for selected case of anterior instability, with low-grade glenoid bone loss. The most common complications were a loss of external rotation and the development of osteoarthritis. Conclusion: The Trillat procedure for recurrent anterior shoulder instability showed promising results, especially in selected cases, such as low-grade glenoid bone loss, with massive irreparable cuff tears or hyperlaxity.

Background: Glenohumeral instability is a complex clinical problem with underlying pathology in the bony, labral, and capsular tissues. The rate of specific capsular injuries varies widely in the literature and the clinical importance of these specific injury patterns remains unclear. Methods: Following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, a systematic review was performed of multiple databases for all primary research articles between 2008 and 2023 which included advanced imaging and included rates of capsular injury in patients with glenohumeral instability. Results: Twelve studies met inclusion criteria. The most prevalent capsular injury seen was in the inferior glenohumeral ligament (34.1%) across all studies, followed by anterior labroligamentous periosteal sleeve avulsions with 24.9% prevalence. Humeral avulsions of the glenohumeral ligaments lesions were the least common (6.2%) of subjects, followed closely by capsular tears (8.3%) of subjects. Conclusion: Capsular injury is commonly seen in magnetic resonance imaging of patients with anterior shoulder instability. Significant heterogeneity in language and imaging techniques was found in the existing literature. Further research is needed to explore these specific capsular lesions’ clinical implications and rehabilitation strategies.

Aims: To systematically review the predominant complication rates and changes to patient-reported outcome measures (PROMs) following osteochondral allograft (OCA) transplantation for shoulder instability. Methods: This systematic review, following PRISMA guidelines and registered in PROSPERO, involved a comprehensive literature search using PubMed, Embase, Web of Science, and Scopus. Key search terms included “allograft”, “shoulder”, “humerus”, and “glenoid”. The review encompassed 37 studies with 456 patients, focusing on primary outcomes like failure rates and secondary outcomes such as PROMs and functional test results. Results: A meta-analysis of primary outcomes across 17 studies revealed a dislocation rate of 5.1% and an increase in reoperation rates from 9.3% to 13.7% post-publication bias adjustment. There was also a noted rise in conversion to total shoulder arthroplasty and incidence of osteoarthritis/osteonecrosis over longer follow-up periods. Patient-reported outcomes and functional tests generally showed improvement, albeit with notable variability across studies. A concerning observation was the consistent presence of allograft resorption, with rates ranging from 33% to 80%. Comparative studies highlighted similar efficacy between distal tibial allografts and Latarjet procedures in most respects, with some differences in specific tests. Conclusion: OCA transplantation presents a promising treatment option for shoulder instability, effectively addressing both glenoid and humeral head defects with favourable patient-reported outcomes. These findings advocate for the inclusion of OCA transplantation in treatment protocols for shoulder instability, while also emphasizing the need for further high-quality, long-term research to better understand the procedure’s efficacy profile. Cite this article: Bone Jt Open 2024;5(7):570–580.

Background: This study’s primary aim was to assess the safety and performance of second-generation all-soft suture anchors following arthroscopic labral tear repair. Methods: This prospective, multicenter study was conducted by 6 surgeons at 6 sites in Europe and the United States between November 2018 and August 2020. Patients who required shoulder arthroscopic repair, for a range of labral injuries, were treated with a second-generation all-soft suture anchor. The primary outcome was clinical success rate (percentage of patients without signs of failure and/or reintervention) at 6 months. Secondary outcomes included clinical success rate at 12 months, intraoperative anchor deployment success rate, and patient-reported outcomes (PROs) at 6 and 12 months, including visual analog scale (VAS) pain assessment, VAS satisfaction assessment, EQ-5D-5L Index Score, EQ-5D-5L VAS Health Score, Rowe Shoulder Score for Instability, American Shoulder and Elbow Surgeons score, and Constant-Murley Shoulder Score. Serious adverse events and serious adverse device effects were collected throughout the study. Results: Forty-one patients were enrolled (mean age, 28.2 years; 87.8% male, 12.2% female). Clinical success was achieved in 27/28 and 31/32 patients at 6 months and 12 months, respectively. Anchor deployment had a 100% success rate. Significant improvements over baseline were reported for all PROs except Constant-Murley Shoulder (6 months) and VAS Satisfaction Score (12 months). One patient experienced 1 serious adverse event and 1 patient experienced 1 serious adverse device effect. Conclusion: Second-generation all-soft suture anchors used in this study demonstrated a high clinical success rate, a favorable safety profile, and patients exhibited significant improvement in PROs.

Abstract Background The Latarjet procedure (LP) is performed as a primary stabilization procedure (primary LP) and a salvage procedure when an earlier shoulder stabilization procedure has failed (salvage LP). However, whether primary LP or salvage LP provides better outcomes for anterior shoulder instability remains unknown. Methods Two independent reviewers performed the literature search based on the PRISMA guidelines. A comprehensive search of PubMed, Embase, web of science and Cochrane Library was performed from their inception date to December 4, 2023. Inclusion criteria mainly included the comparison of postoperative outcomes between primary and salvage LP, English language, and full text availability. Two reviewers independently examined the literature, collected data, and evaluated the methodological robustness of the included studies. The Methodological Index for Nonrandomized Studies was used to evaluate the quality of nonrandomized studies. Recurrent instability, complications, reoperations, return to sports, patient-reported outcomes, and range of motion were assessed. Statistical evaluations were conducted using Manager V.5.4.1 (The Cochrane Collaboration, Software Update, Oxford, UK). Results Twelve studies were included in the systematic review, with 940 shoulders undergoing primary LP and 631 shoulders undergoing salvage LP. Statistically significant differences in favor of primary LP were found in 2 of the 11 and 2 of 4 included studies in terms of recurrent instability and returning to the same sports (RTS) at preinjury level, respectively. In terms of the visual analog scale, subjective shoulder value and the Western Ontario Shoulder Instability Index, 2 of the 4, 1 of the 3 and 1 of the 3 included studies reported statistically significant differences in favor of primary LP. Differences were not noticed regarding complications, reoperations, the time to RTS, the Rowe score, the Athletic Shoulder Outcome Scoring System, and forward flexion. Conclusion Current evidence suggests that compared with primary LP, salvage LP may provide inferior postoperative outcomes in terms of recurrent instability and the rate of RTS at preinjury level. Primary and salvage LP may yield comparable efficacy in terms of complications, reoperations, the rate of RTS, the time to RTS, pain, shoulder function, and range of motion. Prospero id CRD42023492027.

Rotator cuff tears (RCT) and instability are the most common surgically treated shoulder pathologies. The concept of augmentation using the long head of the biceps tendon (LHBT) autograft was created to improve the results of surgical treatment of these pathologies, especially in cases of chronic and massive injuries. The popularity of using the LHBT for augmentation is evidenced by the significant number of publications on this topic published in the last 3 years; however, only one systematic review has been published regarding only LHBT augmentation for massive RCTs. Several studies comparing partial repair with partial repair and additional LHBT augmentation for RCT showed superior clinical outcomes and lower re-tear rates when LHBT augmentation was performed. There is a rising popularity of using LHBT as an autograft to perform superior capsule reconstruction (SCR) in case of irreparable rotator cuff tears. In recent years, shoulder stabilization by arthroscopic Bankart repair with biceps augmentation has been promoted with very promising short-term results. The evidence provided by studies appears to be sufficient to recommend the use of LHBT for augmentation whenever necessary; however, larger studies with long-term follow-up are needed.

Background: The Latarjet procedure is increasingly being utilized for the treatment of glenoid bone loss and has a relatively high neurological complication rate. Understanding the position-dependent anatomy of the axillary nerve (AN) is crucial to preventing injuries. Purpose: To quantify the effects of changes in the shoulder position and degree of glenoid bone loss during the Latarjet procedure on the position of the AN. Study Design: Controlled laboratory study. Methods: A total of 10 cadaveric shoulders were dissected, leaving the tendons of the rotator cuff and deltoid for muscle loading. The 3-dimensional position of the AN was quantified relative to the inferior glenoid under 3 conditions: (1) intact shoulder, (2) Latarjet procedure with 15% bone loss, and (3) Latarjet procedure with 30% bone loss. Measurements were obtained at 0°, 30°, and 60° of glenohumeral abduction (equivalent to 0°, 45°, and 90° of shoulder abduction) and at 0°, 45°, and 90° of humeral external rotation (ER). Results: Abduction of the shoulder to 60° resulted in a posterior (9.5 ± 1.1 mm; P <.001), superior (3.0 ± 1.2 mm; P =.013), and lateral (19.1 ± 2.3 mm; P <.001) shift of the AN, and ER to 90° resulted in anterior translation (10.0 ± 1.2 mm; P <.001). Overall, ER increased the minimum AN-glenoid distance at 30° of abduction (14.9 ± 1.3 mm [0° of ER] vs 17.3 ± 1.5 mm [90° of ER]; P =.045). The Latarjet procedure with both 15 and 30% glenoid bone loss resulted in a superior and medial shift of the AN relative to the intact state. A decreased minimum AN-glenoid distance was seen after the Latarjet procedure with 30% bone loss at 60° abduction and 90° ER (17.7 ± 1.6 mm [intact] vs 13.9 ± 1.6 mm [30% bone loss]; P =.007), but no significant differences were seen after the Latarjet procedure with 15% bone loss. Conclusion: Abduction of the shoulder induced a superior, lateral, and posterior shift of the AN, and ER caused anterior translation. Interestingly, the Latarjet procedure, when performed on shoulders with extensive glenoid bone loss, significantly reduced the minimum AN-glenoid distance during shoulder abduction and ER. These novel findings imply that patients with substantial glenoid bone loss may be at a higher risk of AN injuries during critical portions of the procedure. Consequently, it is imperative that surgeons account for alterations in nerve anatomy during revision procedures. Clinical Relevance: This study attempts to improve understanding of the position-dependent effect of shoulder position and glenoid bone loss after the Latarjet procedure on AN anatomy. Improved knowledge of AN anatomy is crucial to preventing potentially devastating AN injuries during the Latarjet procedure. [ABSTRACT FROM AUTHOR]

Purpose of Review: Arthroscopic remplissage has continued to gain popularity as an adjunct to Bankart repair for patients with anterior shoulder instability. Although the original remplissage technique was described over 15 years ago, our understanding of when and how to use this procedure continues to evolve. This article provides a review of how remplissage affects shoulder biomechanics, compares clinical outcomes between remplissage and other procedures for shoulder instability, and discusses current indications for remplissage. Recent Findings: Current research focuses on the use of remplissage across a wide range of glenoid bone loss. Remplissage appears effective at preventing recurrent instability in patients with glenoid bone loss up to 15% of the glenoid width. However, once glenoid bone exceeds 15%, outcomes tend to favor bony reconstruction procedures such as Latarjet. Results of biomechanical studies examining shoulder range of motion (ROM) after remplissage are mixed, though clinical studies tend to report no significant limitations in ROM when remplissage is added to a Bankart repair. Summary: Adding a remplissage to conventional Bankart repair may improve clinical outcomes and lower rates of recurrent instability without significantly altering shoulder ROM. However, surgeons should recognize its limitations in treating patients with large amounts of glenoid bone loss and should be prepared to discuss alternative procedures on a case-by-case basis. Absolute indications and contraindications for remplissage are not well defined currently and require further scientific research. [ABSTRACT FROM AUTHOR]

Purpose of Review: The purpose of this review is to describe the evolution of the open labral repair with capsular shift, including the current role of this procedure in the treatment of shoulder instability. Recent Findings: Currently, a subset of patients – high-level collision/contact sport athletes, patients with significant inferior or multi-directional instability, and individuals with failed arthroscopic Bankart repair without bone loss – may experience benefit from undergoing open Bankart repair with capsular shift. Surgeons performing open stabilization can benefit from instrumentation and anchors developed to assist with arthroscopic techniques. Summary: Understanding the history and evolution behind the procedure not only allows the surgeon to appreciate principles behind an arthroscopic approach, but also permits the utilization of an open approach when required by patient pathology and risk factors. [ABSTRACT FROM AUTHOR]

Background: The Latarjet procedure (LP) is performed as a primary stabilization procedure (primary LP) and a salvage procedure when an earlier shoulder stabilization procedure has failed (salvage LP). However, whether primary LP or salvage LP provides better outcomes for anterior shoulder instability remains unknown. Methods: Two independent reviewers performed the literature search based on the PRISMA guidelines. A comprehensive search of PubMed, Embase, web of science and Cochrane Library was performed from their inception date to December 4, 2023. Inclusion criteria mainly included the comparison of postoperative outcomes between primary and salvage LP, English language, and full text availability. Two reviewers independently examined the literature, collected data, and evaluated the methodological robustness of the included studies. The Methodological Index for Nonrandomized Studies was used to evaluate the quality of nonrandomized studies. Recurrent instability, complications, reoperations, return to sports, patient-reported outcomes, and range of motion were assessed. Statistical evaluations were conducted using Manager V.5.4.1 (The Cochrane Collaboration, Software Update, Oxford, UK). Results: Twelve studies were included in the systematic review, with 940 shoulders undergoing primary LP and 631 shoulders undergoing salvage LP. Statistically significant differences in favor of primary LP were found in 2 of the 11 and 2 of 4 included studies in terms of recurrent instability and returning to the same sports (RTS) at preinjury level, respectively. In terms of the visual analog scale, subjective shoulder value and the Western Ontario Shoulder Instability Index, 2 of the 4, 1 of the 3 and 1 of the 3 included studies reported statistically significant differences in favor of primary LP. Differences were not noticed regarding complications, reoperations, the time to RTS, the Rowe score, the Athletic Shoulder Outcome Scoring System, and forward flexion. Conclusion: Current evidence suggests that compared with primary LP, salvage LP may provide inferior postoperative outcomes in terms of recurrent instability and the rate of RTS at preinjury level. Primary and salvage LP may yield comparable efficacy in terms of complications, reoperations, the rate of RTS, the time to RTS, pain, shoulder function, and range of motion. Prospero id: CRD42023492027. [ABSTRACT FROM AUTHOR]

Introduction: Arthroscopic revision anterior shoulder instability repair has been proposed, and early clinical results have been promising. However, long-term results after this procedure and the probable risk factors for failure have not been sufficiently discussed in the literature. Materials and methods: Thirty-eight patients who were diagnosed with recurrent anteroinferior shoulder instability after failed Bankart repair, treated with ACRR between September 1998 and November 2003 and able to be contacted were included. Of these patients, 2 were excluded from the study due to the use of SureTak anchors for fixation, and 5 other patients refused to participate in the study due to lack of interest (3 patients) or lack of time (2 patients). The remaining shoulders were clinically examined at a minimum of ten years after surgery via the ASES, Constant, AAOS, Rowe, Dawson and VAS scores for pain and stability. Degenerative arthropathy was assessed with the modified Samilson-Prieto score. Results: All 31 remaining shoulders were evaluated at a mean time of 11.86 years (142.4 months) after surgery. Six patients (19.35%) reported redisolcation after the revision procedure, 4 of whom were affected by a new significant shoulder trauma. The ROWE and Constant scores improved significantly. Moderate to severe dislocation arthropathy was observed in 19.4% of patients. Five patients (16.2%) were not satisfied with the procedure. Conclusion: Long-term follow-up after ACRR shows predictable results, with a high degree of patient satisfaction, good to excellent patient-reported outcome scores and minimal radiological degenerative changes. However, with an average recurrence rate of 19.3% after 11.86 years, the redislocation rate appears high. With careful patient selection, recurrence rates can be significantly reduced. [ABSTRACT FROM AUTHOR]

To translate, cross-culturally adapt, and psychometric testing the Western Ontario Shoulder Instability index (WOSI) into Persian Seventy-two patients diagnosed with shoulder instability participated in reliability, construct validity, and responsiveness analysis. All the patients filled out the WOSI with an interval of two weeks to assess reliability. The shortened Disability of Arm, Shoulder and Hand (Quick-DASH), Shoulder Pain and Disability Index (SPADI), and the 36-Item Short-Form Survey (SF-36) were assessed to evaluate construct validity. In order to assess responsiveness patients filled out WOSI before and after the physiotherapy and global rating of change scale at last session of physiotherapy. Reliability was assessed by intra-class correlation coefficient (ICC (1,2)), construct validity by two tailed Pearson (r), and responsiveness by longitudinal validity and receiver operating characteristics (ROC) curve analysis. The ICC (1,2) was 0.90 and correlation analysis revealed high level of correlation with: Quick-DASH (r = 0.82); SPADI (r = 0.72); physical SF-36 (r = −0.52); and mental SF-36 (r = −0.48). Responsiveness analysis demonstrated the area under curve was 0.90, with minimal clinical important difference 46.87. We found the Persian-WOSI as a valid, reliable, and responsive questionnaire to evaluate quality of life of patients with shoulder instability. [ABSTRACT FROM AUTHOR]

Background: The incremental biological changes in the synovial microenvironment of the shoulder in acute and chronic instability that may contribute to joint degeneration are poorly understood. Proteomic analysis of synovial fluid in patients with shoulder instability may improve our understanding of proteins that are shed into shoulder synovial fluid after an injury. Hypothesis: Injury-specific factors such as the direction of instability and the severity of glenoid and humeral bone loss are associated with the proteome of synovial fluid in patients with shoulder instability. Study Design: Descriptive laboratory study. Methods: Synovial fluid lavage samples were compared between patients with anterior (n = 12) and posterior (n = 8) instability and those without instability (n = 5). Synovial proteins were identified with liquid chromatography–tandem mass spectrometry. Orthogonal validation of protein targets found to be significant on tandem mass spectrometry was performed in a separate set of prospective patients with Western blotting. Data were processed and analyzed, and P values were adjusted with the Benjamini-Hochberg method for multiple comparisons. Results: A total of 25 patients were included. Tandem mass spectrometry identified 720 protein groups in synovial fluid of patients with shoulder instability. There were 4 synovial proteins that were significantly expressed in patients with anterior instability relative to posterior instability: periostin (POSTN) (adjusted P value =.03; log fold change [logFc] = 4.7), transforming growth factor beta–induced protein ig-h3 (adjusted P value =.05; logFc = 1.7), collagen type VI alpha-3 chain (adjusted P value =.04; logFc = 2.6), and coagulation factor V (adjusted P value =.04; logFc = −3.3). Among these targets, POSTN showed a moderate correlation with the Hill-Sachs lesion size (r = 0.7). Prospective validation with Western blotting confirmed a significantly higher level of POSTN in synovial fluid of patients with anterior instability (P =.00025; logFc = 5.1). Conclusion: Proteomic analysis enriched our understanding of proteins that were secreted into shoulder synovial fluid of patients with shoulder instability. The identification of POSTN, a proinflammatory catabolic protein involved with tissue remodeling and repair, as a significant target in anterior shoulder instability is a novel finding. Therefore, further study is warranted to determine the role that POSTN may play in the progression of bone loss and posttraumatic osteoarthritis. Clinical Relevance: Proteomic analysis of synovial fluid in patients with shoulder instability improved our understanding of this abnormality after an injury. [ABSTRACT FROM AUTHOR]

Background: Several arthroscopic glenoid bone augmentation techniques have been introduced to treat patients affected by anterior shoulder instability associated with critical bone loss. The efficacy of the different arthroscopic bony procedures has not been compared yet. Purpose: To compare the recurrence, complication, and reoperation rates of the arthroscopic Latarjet (AL) and arthroscopic free bone block (ABB) procedures for anterior shoulder instability. Study Design: Meta-analysis and systematic review; Level of evidence, 4. Methods: A systematic search was conducted in MEDLINE/PubMed, Web of Science, and Embase to identify clinical studies reporting the outcomes of the AL and ABB procedures. The following search phrases were used: "Arthroscopic" AND "Bone Block" OR "Bone Graft," and "Arthroscopic" AND "Glenoid Augmentation" OR "Glenoid Reconstruction," and "Arthroscopic" AND "Latarjet" OR "Coracoid Graft" OR "Coracoid Transfer." Exclusion criteria were <24 months of minimum follow-up, sample size <10 cases, revision after previous glenoid bone grafting, epilepsy, and multidirectional instability. Data regarding the study design, patient characteristics, surgical technique, and outcomes were extracted and analyzed. A proportional meta-analysis was conducted to compare the complication, recurrence, and reoperation rates between the 2 groups. Multiple subgroup analyses were performed to analyze the incidence of each complication and assess the weight of different fixation methods (in the whole cohort) or different graft types (in the ABB group). The modified Coleman Methodology Score was used to assess the risk of bias. Results: Of 5010 potentially relevant studies, 18 studies regarding the AL procedure (908 cases) and 15 studies regarding the ABB procedure (469 cases) were included. The 2 groups were comparable in age (P =.07), sex (P =.14), glenoid bone loss (P =.14), number of preoperative dislocations (P =.62), proportion of primary and revision procedures (P =.95), length of follow-up (P =.81), modified Coleman Methodology Score (P =.21), and level of evidence (P =.49). There was no difference in the recurrence (P =.88), reoperation (P =.79), and complication (P =.08) rates. The subgroup analyses showed a higher rate of hardware-related complications for screw fixation compared with flexible fixation (P =.01). Conclusion: The AL and ABB procedures had similar recurrence, reoperation, and complication rates. Screw fixation of the bone graft was related to an increased risk of complications compared with flexible fixation. Registration: CRD42022368153 (PROSPERO). [ABSTRACT FROM AUTHOR]

Background: There is a lack of data regarding the long-term clinical outcomes of open repair of humeral avulsion of the glenohumeral ligament (HAGL). Purpose: To examine the long-term patient outcomes, prevalence of related shoulder lesions, and return to sports in patients who have had open HAGL repair. Study Design: Case series; Level of evidence, 4. Methods: Included were 47 patients who underwent open repair of an HAGL lesion between 1995 and 2013. Clinical results were assessed using the Western Ontario Shoulder Instability Index (WOSI). Recurrence of instability, additional surgeries, confidence in the shoulder, level and type of sport before and after surgery, and return to sports were documented. Results: The mean follow-up duration was 105 months (range, 16-247 months). The mean postoperative WOSI score was 410. Postoperatively, 10 patients experienced a recurrence of instability. Subgroup analysis of patients who reported recurrence demonstrated significantly worse WOSI scores compared with patients who did not experience recurrence (730 [95% CI, 470-990] vs 320 [95% CI, 210-430], respectively; P =.007). Before surgery, 33 patients participated in competitive sports, compared with 22 patients after surgery. No postoperative neurologic or vascular complications were recorded. In 51% of patients, a labral tear was noted as a concomitant injury. Conclusion: Open repair of an HAGL lesion restored shoulder stability with good results. However, recurrence was significant (21%) with longer follow-up, and return to sports was affected. Associated lesions were prevalent. [ABSTRACT FROM AUTHOR]

Purpose of Review: Anterior shoulder instability is associated with concomitant injury to several stabilizing structures of the shoulder, including glenoid bone loss. While instability is most common in young athletes and patients with predisposing conditions of hyperlaxity, recurrent shoulder instability can occur throughout various age ranges and may lead to longer term effects including pain and shoulder arthritis. Glenoid bone loss exceeding certain thresholds is generally treated by glenoid reconstruction via bone block augmentation to adequately stabilize the glenohumeral joint. These procedures increase the width of the articular surface on which the humeral head can translate before dislocation and, based on the procedure performed, provide a sling effect via the conjoined tendon, and increase tension to support the anterior capsule. The purpose of this review is to summarize the available literature regarding bone block fixation techniques. Recent Developments: Various fixation techniques have been utilized to secure bone block transfers. Though screw fixation has traditionally been used for bone block fixation, suture buttons, suture anchors, and all-suture techniques have been utilized in attempts to avoid complications associated with the use of screws. Biomechanical studies report variable force-resistance, displacement, and mode of failure when comparing screw to suture button–based fixation of glenoid bone blocks. Clinical and radiographic studies have shown these novel suture-based techniques to be comparable, and in some cases advantageous, to traditional screw fixation techniques. Summary: While screw fixation has long been the standard of care in glenoid bone block procedures, it is associated with high complication rates, leading surgeons to endeavor toward new fixation techniques. In available biomechanical studies, screw fixation has consistently demonstrated high maximal load-to-failure and displacement with cyclic loading. Studies have reported similar clinical and radiographic outcomes in both screw and suture-based fixation methods, with evidence of reduced bone resorption with suture fixation. While suture button fixation is associated with a higher rate of recurrent instability, overall complication rates are low. Future research should address biomechanical shortcomings of suture-based fixation techniques and continue to assess long-term follow-up of patients treated with each fixation method. [ABSTRACT FROM AUTHOR]

To translate and culturally adapt the shoulder instability-return to sport after injury (SI-RSI) scale into Turkish (SI-RSI-Tr) and examine the psychometric properties of the Turkish version of athletes following a traumatic shoulder instability. The SI-RSI was translated into Turkish using Beaton guidelines. Sixty-nine patients with shoulder instability completed the translated SI-RSI, Western Ontario Shoulder Instability Index (WOSI), the Tampa Scale of Kinesiophobia (TSK), and the Walch-Duplay Scores. We analysed the internal consistency, agreement, reliability, and validity of the SI-RSI-Tr. The SI-RSI-Tr demonstrated excellent internal consistency (Cronbach's alpha = 0.92), test–retest reliability (ICC = 0.95), and feasibility with no ceiling or floor effect. SI-RSI-Tr correlated with WOSI total score (r = −0.824, p < 0.001), its subscales: WOSI-physical (r = −0.683, p < 0.001), WOSI-sports (r = −0.832, p < 0.001), WOSI-lifestyle (r = −0.739, p < 0.001), and WOSI-emotions (r = −0.734, p < 0.001) respectively), Walch-Duplay (r = 0.840, p < 0.001) and TSK (r = −0.828, p < 0.001) scores. The Turkish SI-RSI is a reliable, internally consistent, and valid tool for athletes with shoulder instability. Researchers and clinicians could safely use the SIRSI-Tr to evaluate the shoulder-specific psychological factors on return to sports following an episode of shoulder instability. [ABSTRACT FROM AUTHOR]

Background: Given the variability across populations and settings, defining the MCID and the PASS for the Rowe and ASOSS scores and patients undergoing primary and revision Latarjet it is essential to have accurate benchmarks relevant to these groups when interpreting clinical results. Purpose: To determine the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) thresholds for the visual analog scale (VAS) for pain during sports, Athletic Shoulder Outcome Scoring System (ASOSS), and Rowe scores after primary and revision Latarjet procedures for treatment of shoulder instability. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Between January 2018 and January 2020, a retrospective review of 149 patients undergoing primary Latarjet (n = 82) and revision Latarjet (n = 67) to treat shoulder instability was performed in a single institution. Patient-reported outcome measures were collected preoperatively and 1 year postoperatively. The delta was defined as the change between the pre- and postoperative scores. Distribution-based and anchored-based approaches were used to estimate the MCID and the PASS, respectively. The optimal cutoff point and the percentage of patients achieving those thresholds were also calculated. Results: The distribution-based MCIDs after primary Latarjet were 1.1, 7.5, and 9.6 for the VAS, Rowe, and ASOSS scores, respectively. The rates of patients who achieved the MCID thresholds were 93.9%, 98.7%, and 100% for the VAS, Rowe, and ASOSS scores, respectively. The PASS thresholds after primary Latarjet were ≤1, ≥90, and ≥85 for the VAS, Rowe, and ASOSS scores, respectively. The percentages of patients who achieved PASS thresholds were 82.9%, 89%, and 86.5% for the VAS, Rowe, and ASOSS scores, respectively. The distribution-based MCIDs after revision Latarjet were 0.6, 6.2, and 3.4 for the VAS, Rowe, and ASOSS scores, respectively. The rates of patients who achieved MCID thresholds were 89.3%, 100%, and 100% for the VAS, Rowe, and ASOSS scores, respectively. The PASS thresholds were ≤3, ≥87, and ≥86 after revision Latarjet for the VAS, Rowe, and ASOSS scores, respectively. The rates of patients who achieved the PASS thresholds were 88%, 88%, and 91% for the VAS, Rowe, and ASOSS, respectively. Conclusion: This study identified useful values for the MCID and PASS thresholds in VAS, Rowe, and ASOSS scores after primary and revision Latarjet procedures for treating shoulder instability. Most patients achieved MCID and PASS benchmarks, indicating successful primary and revision Latarjet procedure outcomes. These metrics can serve as valuable parameters when analyzing parameters in future studies and have the potential to enhance patient care by optimizing treatment strategies and surgical decision making. [ABSTRACT FROM AUTHOR]

Purpose of Review: This paper aims to analyze and compare the existing research on open and arthroscopic Latarjet procedures for treating anterior shoulder instability. The review will assess different factors such as graft positioning, functional outcomes, complications, and return-to-play rates for both approaches. The study's primary goal is to establish which technique yields superior outcomes. Recent Findings: Recent studies have suggested that arthroscopic Latarjet surgery can produce outcomes similar to open surgery regarding functional scores and patient satisfaction. Some research indicates that arthroscopy may even provide slightly better results. Both techniques have similar complication rates, but arthroscopy requires a longer learning curve and operating time. It is crucial to ensure the proper placement of the graft, and some studies suggest that arthroscopy may be better at achieving accurate positioning. Summary: Both open and arthroscopic Latarjet procedures are equally effective in treating shoulder instability. While arthroscopy offers a faster recovery time and causes less soft tissue damage, it requires surgeons to undergo a steeper learning curve. The optimal graft position for both techniques is still debated. More long-term data is needed to establish superiority. Future research should compare approaches in larger cohorts and identify outcome-affecting factors to improve the treatment of shoulder instability. Both techniques are promising, but arthroscopy may be a better option as the procedure evolves into a less invasive reconstruction. [ABSTRACT FROM AUTHOR]

As capsule elongation is assumed to weaken the static stability of the shoulder joint, the purpose of this biomechanical study was to demonstrate that capsule elongation occurs immediately after a first-time shoulder dislocation and not just after recurrent dislocation events. We hypothesize an increment in joint clearance due to joint capsule elongation after a first-time dislocation. An experimental in-vitro study was conducted on 6 paired fresh frozen human shoulders (4 females; 2 males; 12 specimen) with a mean age of 80 (Range 67–89) years. The shoulder joint with the articular capsule was exposed and an inferior static tension force of 2.5 N was applied to the humerus prior to dislocation. Next, the humeral head was dislocated and was then immediately reduced back into the start position. The joint gap as well as joint capsule deformation was assessed using optical techniques. The radiographic joint gap increased from 13.7 ± 6.9 mm (prior to dislocation) to 18.1 ± 6.5 mm (post dislocation) (p <.001). The increase in joint clearance was 4.4 mm. The joint capsule elongated from 5.9 ± 0.005 % (prior to dislocation) to 9.4 ± 0.007 % (post dislocation) (p <.001). The mean increase in joint capsule elongation was 3.5 %. Capsule elongation was observed immediately after a simulated first-time shoulder dislocation in an in-vitro model of elderly human cadavers. It might therefore not only be a phenomenon of recurrent dislocation events. [ABSTRACT FROM AUTHOR]

Background: This study aims to determine the effect of time and imaging modality (three-dimensional (3D) CT vs. 3D magnetic resonance imaging (MRI)) on the surgical procedure indicated for shoulder instability. The hypothesis is there will be no clinical difference in procedure selection between time and imaging modality. Methods: Eleven shoulder surgeons were surveyed with the same ten shoulder instability clinical scenarios at three time points. All time points included history of present illness, musculoskeletal exam, radiographs, and standard two-dimensional MRI. To assess the effect of imaging modality, survey 1 included 3D MRI while survey 2 included a two-dimensional and 3D CT scan. To assess the effect of time, a retest was performed with survey 3 which was identical to survey 2. The outcome measured was whether surgeons made a “major” or “minor” surgical change between surveys. Results: The average major change rate was 14.1% (standard deviation: 7.6%). The average minor change rate was 12.6% (standard deviation: 7.5%). Between survey 1 to the survey 2, the major change rate was 15.2%, compared to 13.1% when going from the second to the third survey (P = .68). The minior change rate between the first and second surveys was 12.1% and between the second to third interview was 13.1% (P = .8). Discussion: The findings suggest that the major factor related to procedural changes was time between reviewing patient information. Furthermore, this study demonstrates that there remains significant intrasurgeon variability in selecting surgical procedures for shoulder instability. Lastly, the findings in this study suggest that 3D MRI is clinically equivalent to 3D CT in guiding shoulder instability surgical management. Conclusion: This study demonstrates that there is significant variability in surgical procedure selection driven by time alone in shoulder instability. Surgical decision making with 3D MRI was similar to 3D CT scans and may be used by surgeons for preoperative planning.

Background: The Latarjet procedure is a common bony augmentation procedure for anterior shoulder instability. Historically, screw fixation is used to secure the coracoid graft to the anterior glenoid surface; however, malpositioning of the graft leads to oblique screw insertion that contributes to complications. Suture buttons (SBs) are a more recent fixation technique that have not been studied alongside standard screw fixation in the context of biomechanical models of angulated fixation. This study aims to compare the biomechanical strength of single and double, screw and SB fixation at various levels of angulation. Methods: Testing was performed using polyurethane models from Sawbones. The graft piece was secured with screw fixation (Arthrex, Naples, FL, USA) or suspensory button (ABS Tightrope, Arthrex, Naples, FL, USA). Single or double constructs of screws and SBs were affixed at 0°, 15°, and 30° angles to the face of the glenoid component. An aluminum testing jig held the samples securely while a materials testing system applied loads. Five constructs were used for each condition and assessed load to failure testing. Results: For single fixation constructs, suspensory buttons were 60% stronger than screws at 0° (P

Background: This study aims to investigate the impact of shoulder surgery on professional gymnasts through a case series, analyzing the mechanisms of injury and the shoulder lesion patterns, and reporting the clinical outcomes and return to sport. Methods: Twenty-nine surgically treated shoulders in twenty-seven professional gymnasts were retrospectively analyzed. Patients were stratified based on predominant symptoms and anatomical lesions in painful or unstable shoulders. Demographic and injury data, pathological findings, surgical procedure information, and data on time and level of return to sport were collected. Results: The average age of participants was 20.2 ± 3.8 years. Acute traumatic onset was reported in 51.8% of cases. Shoulders were categorized as painful in 13 cases and unstable in 16 cases. The most common pathologies were capsulolabral injuries (72%), biceps injuries (48%), and rotator cuff injuries (40%). All of the athletes returned to training within an average of 7.3 months, while the return to competition rate was 56%, achieved in an average of 10.3 months. The sport-specific subjective shoulder value was 84.8% ± 16.6%. Half of the patients who stopped competition reported reasons related to symptom persistence, while the other half reported personal reasons. No significant difference in the return to sport was reported in the cases of painful or unstable shoulder. Conclusions: Professional gymnasts requiring shoulder surgery commonly present multiple and complex lesions. Returning to training was possible in all cases; however, the possibility of persisting symptoms and other personal factors which may compromise the return to competition should be discussed with the athlete to give them insights into the possible outcomes. [ABSTRACT FROM AUTHOR]