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1
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Arenas-Miquelez A, Barco R, Cabo Cabo FJ, Hachem AI. Management of bone loss in anterior shoulder instability. Bone Joint J 2024; 106-B:1100-1110. [PMID: 39348897 DOI: 10.1302/0301-620x.106b10.bjj-2024-0501.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
Bone defects are frequently observed in anterior shoulder instability. Over the last decade, knowledge of the association of bone loss with increased failure rates of soft-tissue repair has shifted the surgical management of chronic shoulder instability. On the glenoid side, there is no controversy about the critical glenoid bone loss being 20%. However, poor outcomes have been described even with a subcritical glenoid bone defect as low as 13.5%. On the humeral side, the Hill-Sachs lesion should be evaluated concomitantly with the glenoid defect as the two sides of the same bipolar lesion which interact in the instability process, as described by the glenoid track concept. We advocate adding remplissage to every Bankart repair in patients with a Hill-Sachs lesion, regardless of the glenoid bone loss. When critical or subcritical glenoid bone loss occurs in active patients (> 15%) or bipolar off-track lesions, we should consider anterior glenoid bone reconstructions. The techniques have evolved significantly over the last two decades, moving from open procedures to arthroscopic, and from screw fixation to metal-free fixation. The new arthroscopic techniques of glenoid bone reconstruction procedures allow precise positioning of the graft, identification, and treatment of concomitant injuries with low morbidity and faster recovery. Given the problems associated with bone resorption and metal hardware protrusion, the new metal-free techniques for Latarjet or free bone block procedures seem a good solution to avoid these complications, although no long-term data are yet available.
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Affiliation(s)
| | - Raul Barco
- La Paz University Hospital, Madrid, Spain
| | - Francisco J Cabo Cabo
- Orthopaedics and Traumatolgy, Hospital Universitario de Bellvitge, Hospitalet de llobregat, Barcelona, Spain
| | - Abdul-Ilah Hachem
- Orthopaedics and Traumatolgy, Hospital Universitario de Bellvitge, Hospitalet de llobregat, Barcelona, Spain
- Shoulder unit, Centro Medico Teknon, Barcelona, Spain
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Prigmore B, Tabbaa S, Crawford DC. Osteochondral Allograft Transplantation in the Shoulder: A Systematic Review of Indications and Outcomes. Cartilage 2024; 15:219-228. [PMID: 37937538 PMCID: PMC11418492 DOI: 10.1177/19476035231205678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE To collate current literature pertaining to the published reports of indications for, and outcomes of, osteochondral allograft (OCA) transplantations in the shoulder so as to guide surgeons in the management of various etiologies of osteochondral lesions in this joint. DESIGN A systematic review of the current literature was performed in February 2022 in the PubMed, Cochrane, and EMBASE databases using specific search terms and predetermined inclusion/exclusion criteria. RESULTS One-hundred-twenty-three articles were initially identified, 30 full-text articles were assessed for eligibility, and 17 articles met inclusion criteria. Data were collected for study characteristics, etiology, lesion size/location, intervention/type of graft used, follow-up, and outcomes. In total, 83 shoulders were included (n = 83) in the review with an average follow-up of 45.7 months. Nine specific indications for OCA transplantation in the shoulder included: reverse Hill-Sachs lesions (33), Hill-Sachs lesions (22), pain pump chondrolysis (10), recurrent shoulder instability (7), osteoarthritis/degenerative changes (5), radiofrequency chondrolysis (2), prominent suture anchors (2), glenoid lesion (1), and osteochondritis dissecans (1). Seventeen patients had concomitant surgeries and two patients were lost to follow-up. Of the total 83 shoulders, 68 had favorable outcomes and 13 had unfavorable outcomes as determined by graft incorporation, pain scores, functionality/ROM, patient-reported satisfaction, and/or requirement for revision/arthroplasty. Of the 13 with unfavorable outcomes, a disproportionate number had concomitant surgeries and/or were performed for pain pump chondrolysis (6). CONCLUSIONS The use of OCAs appears to be a viable option for a variety of difficult-to-treat shoulder pathologies, particularly those characterized by isolated osteochondral injuries.
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Affiliation(s)
- Brian Prigmore
- OHSU Department of Orthopaedics & Rehabilitation, Center for Health & Healing, Portland, OR, USA
| | - Suzanne Tabbaa
- UCSF School of Medicine, Department of Orthopaedic Surgery, San Francisco, CA, USA
| | - Dennis C. Crawford
- OHSU Department of Orthopaedics & Rehabilitation, Center for Health & Healing, Portland, OR, USA
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Soderquist M, Barnes L. Osteochondral allograft transplantation for articular humeral head defect from ballistic trauma. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:540-546. [PMID: 39157227 PMCID: PMC11329011 DOI: 10.1016/j.xrrt.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Affiliation(s)
- Melissa Soderquist
- Temple University Hospital Department of Orthopaedic Surgery and Sports Medicine, Philadelphia, PA, USA
| | - Leslie Barnes
- Temple University Hospital Department of Orthopaedic Surgery and Sports Medicine, Philadelphia, PA, USA
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Poursalehian M, Ghaderpanah R, Bagheri N, Mortazavi SMJ. Osteochondral allografts for the treatment of shoulder instability. Bone Jt Open 2024; 5:570-580. [PMID: 38981603 PMCID: PMC11233180 DOI: 10.1302/2633-1462.57.bjo-2023-0186.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
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.
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Affiliation(s)
- Mohammad Poursalehian
- Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Rezvan Ghaderpanah
- Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Bagheri
- Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed M. J. Mortazavi
- Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Fiske JW, Gao S, Wilson SM, Bugbee WD, Hoenecke HR. Treatment of osteochondral injuries of the humeral head using fresh osteochondral allograft transplantation. JSES Int 2024; 8:681-685. [PMID: 39035639 PMCID: PMC11258710 DOI: 10.1016/j.jseint.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background Large osteochondral lesions of the humeral head can result from locked posterior dislocations, avascular necrosis, and osteochondritis dissecans. Fresh osteochondral allograft (OCA) transplantation is a treatment option for young patients with focal osteochondral defects of the humeral head. The purpose of this case series was to assess graft survivorship, subjective patient-reported outcomes, and satisfaction among 7 patients who underwent OCA transplantation of the humeral head. Methods We identified 7 patients who underwent humeral head OCA transplantation between 2008 and 2017. A custom questionnaire including the American Shoulder and Elbow Surgeons score, Quick Disabilities of the Arm, Shoulder, and Hand score (QuickDash), Likert satisfaction, and reoperations was mailed to each patient. Clinical failure was defined as further surgery that involved removal of the allograft. Results Median follow-up duration was 10 years (range, 4.6 to 13.5 years) with a median age of 21.6 years (range, 18.5 to 43.5 years). Most patients (86%) reported improved function and reduced pain. At the final follow-up, 71% of patients reported ongoing problems with their shoulder including pain, stiffness, clicking/grinding, limited range of motion, and instability. Return to recreational activities was high at 86% but 43% expressed limitations with activity due to their shoulder. Overall satisfaction was high at 71% with mean American Shoulder and Elbow Surgeons and QuickDASH scores at 62.4 and 29.2, respectively. Reoperation after OCA occurred in 1 patient (14%). Conclusion Among this case series of 7 patients who underwent OCA transplantation of the humeral head, patient satisfaction was high at 10-year follow-up and most returned to recreational activity although most also had persistent shoulder symptoms.
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Affiliation(s)
- Joseph W. Fiske
- Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Sean Gao
- Department of Orthopedic Surgery, Scripps Clinic, La Jolla, CA, USA
| | - Shane M. Wilson
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
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van der List JP, Glover MA, Mason TW, Parikh N, Waterman BR. Low Recurrence of Instability and Satisfying Patient-Reported Outcomes Following Various Surgical Treatments of Reverse Hill-Sachs Lesions in the Setting of Posterior Instability: A Systematic Review. Arthroscopy 2024; 40:2083-2095. [PMID: 38151167 DOI: 10.1016/j.arthro.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/23/2023] [Accepted: 12/13/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE To systematically review the literature and report the outcomes of various surgical treatments for reverse Hill-Sachs lesions (RHSL) in the setting of posterior shoulder instability. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. All studies assessing outcomes of surgical treatment of RHSL from inception to January 2023 were identified in PubMed, Embase, and Cochrane Library. Inclusion criteria consisted of studies reporting outcomes, minimum mean 1-year follow-up, and minimum Level IV evidence. Outcomes were assessed using Forest plots with random effects models using R software. RESULTS A total of 29 studies consisting of 291 patients were included with a mean age of 42 years (range 16-88 years), 87% male gender, and mean follow-up of 4.5 years. The mean size of impacted or affected cartilage was 35%, and time from injury to surgery was mean 15 weeks. Nearly all studies were Level IV evidence, and quality of studies was low. Random effect models were performed, and data are presented as range. A low incidence of instability was noted for all surgical techniques with good patient-reported outcome measures. Most studies reported outcomes of the modified McLaughlin procedure (13 studies, 126 patients) with overall Constant-Murley Score of 65 to 92. Trends were seen towards better Constant-Murley Score and external rotation with a shorter delay between injury, and when arthroscopic and joint preserving treatments were performed. CONCLUSIONS This systematic review showed low rates of instability recurrence, reproducible range of motion, and favorable patient-reported outcome measures were reported following all treatments for RHSLs with posterior instability. There was a significant association between better outcomes and a shorter delay between injury and surgery. The level of evidence is limited, given the small and retrospective studies which can be explained by the rarity of these injuries. LEVEL OF EVIDENCE: Level IV; systematic review of Level III and IV studies.
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Affiliation(s)
- Jelle P van der List
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A..
| | - Mark A Glover
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Thomas W Mason
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Nihir Parikh
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Brian R Waterman
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
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Deivert KT, van der List JP, Trasolini NA, Waterman BR. Humeral Head Reconstruction of Reverse Hill-Sachs Lesions With Osteochondral Allograft. VIDEO JOURNAL OF SPORTS MEDICINE 2024; 4:26350254241226724. [PMID: 40308525 PMCID: PMC11956877 DOI: 10.1177/26350254241226724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/28/2023] [Indexed: 05/02/2025]
Abstract
Background True confirmed posterior shoulder dislocations are relatively uncommon injuries, with an estimated incidence of 1.1 per 100,000 individuals and are initially missed in up to 50% to 80% of cases. There are several treatment options for this injury presentation. In this case, we will focus on reconstruction with osteochondral allograft. Indications If the cartilage cannot be fixed due to comminution or the cartilage is not viable due to chronicity or impact, osteochondral allograft might be a treatment option. This technique is typically considered for defects involving greater than 35% to 40% of the humeral head. Technique Description The anterior defect on the humeral head was exposed on the cadaver specimen. Circular bone plugs were obtained from a distal femur specimen for grafting. Graft sites were prepared with a 15 reamer with an orthogonal approach to avoid oblique entry for a stacked bone plug configuration. Bone plug grafts were placed in the defect via press-fit fixation. The subscapularis is repaired to the lesser tubercle following the reconstruction. Results Various studies reported improvement in pain, shoulder range of motion, and patient-reported outcome scores. A small percentage of patients developed allograft necrosis. Patients who received autografts had lower rates of osteoarthritis than patients who received allograft. Rehab protocol can last up to 12 months and begins with restricted range of motions and slowly advancing to isometric movements and gradually increasing range of motion and strengthening. Discussion/Conclusion Outcomes described in previous studies are limited due to the low incidence of these injuries and small sample size. Missing the initial posterior dislocation as this is often correlated with inferior outcomes when treated in chronic setting. There is a risk of damage to humeral articular cartilage during osteochondral tissue harvesting so care must be taken during tissue harvest. Older, lower-demand patients have been reported to do well with nonoperative treatment, even in the case of a chronic dislocation, so careful discussion with the patient is needed to not perform surgery in a reasonably functioning non-painful shoulder. Patient Consent Disclosure Statement The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
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Affiliation(s)
- Kyle T. Deivert
- Atrium Health Wake Forest Baptist, Department of Orthopaedic and Sports Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jelle P. van der List
- Atrium Health Wake Forest Baptist, Department of Orthopaedic and Sports Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Nicholas A. Trasolini
- Atrium Health Wake Forest Baptist, Department of Orthopaedic and Sports Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Brian R. Waterman
- Atrium Health Wake Forest Baptist, Department of Orthopaedic and Sports Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Rinaldi VG, Coliva F, Favero A, Alesi D, Caravelli S, Zaffagnini S, Marcheggiani Muccioli GM. From Diagnosis to Decision-Making: A Systematic Review of the Management of Reverse Hill-Sachs Lesions after Posterior Shoulder Dislocations. J Clin Med 2024; 13:2085. [PMID: 38610850 PMCID: PMC11012447 DOI: 10.3390/jcm13072085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: The aim of this study is to describe all of the possible surgical procedures that intend to treat the McLaughlin lesion (or Reverse Hill-Sachs) in posterior shoulder dislocation. (2) Methods: Google Scholar, Pubmed, and Embase were used as databases in our research. Studies reporting the results of posterior shoulder dislocations surgically treated with procedures addressing the humeral lesion were evaluated. The studies reporting results after fracture-dislocation and multidirectional instability were excluded. (3) Results: A total of 16 studies were included in our review for a total of 207 shoulders with a mean age of 41.7 years that were evaluated at a mean of 62.1 months. The Modified McLaughlin procedure and the Graft procedures were the most commonly performed. No statistically significant difference was found between the two at the evaluation of the clinical score. (4) Conclusions: Our review highlights the importance of a correct diagnosis and an accurate surgical treatment choice based on the surgeon's experience and on the patients' characteristics.
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Affiliation(s)
- Vito Gaetano Rinaldi
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
| | - Federico Coliva
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
| | - Antongiulio Favero
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
| | - Domenico Alesi
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
| | - Silvio Caravelli
- Bentivoglio Orthopaedic Unit, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy;
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Via San Vitale, 40125 Bologna, Italy
| | - Giulio Maria Marcheggiani Muccioli
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Via San Vitale, 40125 Bologna, Italy
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Testa EJ, van der List JP, Waterman BR, Caldwell PE, Parada SA, Owens BD. Management of Bone Loss in Posterior Glenohumeral Shoulder Instability: Current Concepts. JBJS Rev 2024; 12:01874474-202404000-00005. [PMID: 38619382 DOI: 10.2106/jbjs.rvw.23.00243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
» Posterior glenohumeral instability is relatively uncommon compared with anterior instability, but is becoming an increasingly recognized and surgically managed shoulder pathology.» Soft-tissue stabilization alone may not be sufficient in patients who present with substantial bone loss to the posterior glenoid and/or the anterior humeral head.» For posterior glenoid defects, posterior glenoid osteoarticular augmentation can be used, and posterior glenoid opening wedge osteotomy can be considered in cases of posterior instability with pathologic retroversion.» For humeral head lesions, several surgical treatment options are available including subscapularis transposition into the humeral head defect, autograft or allograft reconstruction, humeral rotation osteotomy, and shoulder arthroplasty.
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Affiliation(s)
- Edward J Testa
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Brian R Waterman
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Paul E Caldwell
- Orthopaedic Research of Virginia, Richmond, Virginia
- Tuckahoe Orthopaedic Associates, Richmond, Virginia
| | - Stephen A Parada
- Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Brett D Owens
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
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Berk AN, Rao AJ, Hysong AA, Ifarraguerri AM, Trofa DP, Schiffern SC, Connor PM, Hamid N, Saltzman BM. Clinical and radiographic outcomes of the modified McLaughlin procedure for locked posterior dislocation of the shoulder: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:8-14. [PMID: 38323196 PMCID: PMC10840568 DOI: 10.1016/j.xrrt.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Background Multiple treatment options for locked posterior dislocation of the shoulder (LPDS) have been described, including the modified McLaughlin procedure. The purpose of this review, therefore, was to perform a systematic review of the literature to synthesize the available data reporting on the clinical and radiographic outcomes of patients undergoing the modified McLaughlin procedure for the treatment of LPDS. Methods A systematic review of the PubMed Central, MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library databases from inception through January 2023 was performed. Outcomes studies reporting on clinical and radiographic outcomes in patients undergoing the modified McLaughlin procedure for LPDS were included. Postoperative complications and episodes of recurrent instability were noted. Results A total of 1322 studies were initially identified, of which 9 were deemed eligible for inclusion in our review. Among included studies, a total of 97 shoulders (96 patients) with a mean age of 37.7 years (range, 26-51) were identified. The most common mechanisms of injury included trauma, seizure, and electrocution. Reverse Hill-Sachs lesions ranged in size from 20% to 50% of the humeral head articular surface. At final follow-up, the weighted mean University of California at Los Angeles shoulder score, Constant-Murley Score, American Shoulder and Elbow Surgeons shoulder score, and visual analog scale for pain score were 29 (range, 27-31), 75 (range, 65-92), 92 (range, 83-98), and 1.9 (range, 1-2.4), respectively. Postoperative Constant-Murley Score and University of California at Los Angeles scores were highest in the one study reporting exclusively on treatment during the acute period. Weighted mean postoperative forward flexion, abduction, external rotation, and internal rotation were 154° (range, 102-176), 144° (range, 118-171), 64° (range, 44-84), and 47° (range, 42-56), respectively. Osteointegration of the lesser tuberosity was noted in all patients at the final follow-up. Postoperative complications occurred in one patient (1.0% of cohort); a screw migration successfully treated with operative removal. Recurrent instability was noted in two epileptic patients (2.1% of cohort). Conclusion The literature surrounding the use of the modified McLaughlin procedure for LPDS remains sparse. This review demonstrates that this procedure is associated with favorable clinical and radiographic outcomes with overall low rates of complication and recurrent instability, especially when the time from injury to surgery is minimized. These findings illustrate that in patients presenting with LPDS and a reverse Hill-Sachs lesion between 20% and 50% of the humeral head articular surface, the modified McLaughlin procedure is a safe and effective treatment option.
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Affiliation(s)
- Alexander N. Berk
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Allison J. Rao
- University of Minnesota Physicians, University of Minnesota – Department of Orthopedic Surgery, Minneapolis, MN, USA
| | | | | | - David P. Trofa
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Shadley C. Schiffern
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Patrick M. Connor
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Nady Hamid
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Bryan M. Saltzman
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
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11
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Buda M, Coco V, Grassi A, Filanti M, Musiani C, Solaro L, Guerra E, Romagnoli M. McLaughlin technique and humeral grafting provide similar results for treatment of reverse Hill-Sachs lesions: A systematic review. J Exp Orthop 2024; 11:e12001. [PMID: 38464507 PMCID: PMC10924757 DOI: 10.1002/jeo2.12001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/20/2023] [Indexed: 03/12/2024] Open
Abstract
Purpose Various surgical treatments have been described for the treatment of reverse Hill-Sachs lesions (rHSls) sized between 20% and 50% in the case of posterior shoulder dislocation. The aim of this systematic review is to report the clinical and radiological outcomes of subscapularis or lesser tuberosity transfer (McLaughlin and modified procedures) compared to bone or osteochondral autograft or allograft. Methods A systematic review was performed on five medical databases up to December 2022. The inclusion criteria were clinical studies of all levels of evidence describing clinical or radiological outcomes of either procedure. The assessment of the quality of evidence was performed with the Modified Coleman Score. Results A total of 14 studies (five prospective and nine retrospective) were included. A total of 153 patients (155 shoulders, 78.4% male) with a mean age of 37.2 (22-79) years were reviewed at an average follow-up of 53.1 (7.1-294) months. No relevant difference was found for the clinical scores, range of motion, complications and redislocation rate between the two treatments. Radiological osteoarthritis (OA) was reported in 11% (10/87) in the McLaughlin group and in 21% (16/73) in the humeral reconstruction group. Conclusions McLaughlin and anatomic humeral reconstruction lead to similar satisfactory clinical results and a low redislocation rate in the treatment of rHSls. Anatomic humeral reconstruction seems associated with an increased risk of OA progression. Level of Evidence Level IV.
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Affiliation(s)
- Matteo Buda
- Ortopedia e Traumatologia Rizzoli ArgentaArgentaFerraraItaly
| | - Vito Coco
- Ortopedia e Traumatologia Rizzoli ArgentaArgentaFerraraItaly
| | - Alberto Grassi
- II Clinica Ortopedica e TraumatologicaIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Mattia Filanti
- Ortopedia e Traumatologia Rizzoli ArgentaArgentaFerraraItaly
| | | | - Luca Solaro
- Chirurgia della Spalla e del GomitoIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Enrico Guerra
- Chirurgia della Spalla e del GomitoIRCCS Istituto Ortopedico RizzoliBolognaItaly
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12
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Kaiser JT, Wagner KR, Menendez ME, Meeker ZD, Damodar D, Haunschild ED, Condron NB, Romeo AA, Yanke AB, Cole BJ. Long-term outcomes after osteochondral allograft transplantation to the humeral head. J Shoulder Elbow Surg 2023; 32:2310-2316. [PMID: 37245618 DOI: 10.1016/j.jse.2023.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 03/28/2023] [Accepted: 04/09/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Long-term outcomes of osteochondral allograft (OCA) transplantation to the humeral head have been sparsely reported in the literature. PURPOSE To evaluate outcomes and survivorship of OCA transplantation to the humeral head in patients with osteochondral defects at a minimum of 10 years of follow-up. METHODS A registry of patients who underwent humeral head OCA transplantation between 2004 and 2012 was reviewed. Patients completed pre and postoperative surveys including the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, Short Form 12 (SF-12), and the visual analog scale. Failure was defined by conversion to shoulder arthroplasty. RESULTS Fifteen of 21 (71%) patients with a minimum of ten year of follow-up (mean: 14.2 ± 2.40) were identified. Mean patient age was 26.1 ± 8.8 years at the time of transplantation and eight (53%) patients were male. Surgery was performed on the dominant shoulder in 11 of the 15 (73%) cases. The use of local anesthetic delivered via an intra-articular pain pump was the most often reported underlying etiology of chondral injury (n = 9; 60%). Eight (53%) patients were treated with an allograft plug, while seven (47%) patients were treated with a mushroom cap allograft. At final follow-up, mean American Shoulder and Elbow Surgeons (49.9 to 81.1; P = .048) and Simple Shoulder Test (43.1 to 83.3; P = .010) significantly improved compared to baseline. Changes in mean SF-12 physical (41.4 to 48.1; P = .354), SF-12 mental (57.5 to 51.8; P = .354), and visual analog scale (4.0 to 2.8; P = .618) did not reach statistical significance. Eight (53%) patients required conversion to shoulder arthroplasty at an average of 4.8 ± 4.7 years (range: 0.6-13.2). Kaplan-Meier graft survival probabilities were 60% at 10 years and 41% at 15 years. CONCLUSION OCA transplantation to the humeral head can result in acceptable long-term function for patients with osteochondral defects. While patient-reported outcomes metrics were generally improved compared to baseline, OCA graft survival probabilities diminished with time. The findings from this study can be used to counsel future patients with significant glenohumeral cartilage injuries and set expectations about the potential for further surgery.
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Affiliation(s)
- Joshua T Kaiser
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | - Kyle R Wagner
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | - Mariano E Menendez
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | - Zachary D Meeker
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | - Dhanur Damodar
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | - Eric D Haunschild
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | - Nolan B Condron
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | | | - Adam B Yanke
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA.
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13
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Prigmore B, Tabbaa S, Crawford DC. Avascular necrosis of the proximal humerus: a novel indication for the use of osteochondral allograft transplantation in the shoulder: Case report. J ISAKOS 2023; 8:387-391. [PMID: 37572786 DOI: 10.1016/j.jisako.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/14/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023]
Abstract
Osteochondral allograft (OCA) transplantation is an increasingly available biologic treatment option for a range of intraarticular aetiologies. To our knowledge, no prior publication has documented the use of this technology to treat a lesion of the proximal humerus secondary to avascular necrosis (AVN). We describe our experience treating a 42-year-old female executive with idiopathic AVN of the proximal humerus with a fresh osteochondral allograft. Computed tomography (CT) at 3 months post-op showed full bony incorporation and a restored native joint contour. Over the initial 7 months post-operatively, she reported continued improvements in pain and function as measured by quick Disabilities of the Arm, Shoulder, and Hand (DASH) scores. She was discharged from physical therapy after 6 months, reporting no rest pain, full active and passive range of motion, and unrestricted occupational and recreational activity.
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Affiliation(s)
- Brian Prigmore
- OHSU Department of Orthopaedics & Rehabilitation, Center for Health & Healing, Building 1, 12th Floor 3303 S. Bond Avenue Portland, OR 97239, USA
| | - Suzanne Tabbaa
- UCSF School of Medicine, Department of Orthopaedic Surgery, 1001 Potrero Ave, San Francisco, CA 94110, USA
| | - Dennis C Crawford
- OHSU Department of Orthopaedics & Rehabilitation, Center for Health & Healing, Building 1, 12th Floor 3303 S. Bond Avenue Portland, OR 97239, USA.
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14
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Ninković S, Milankov V, Tošić M, Majkić M, Baljak B, Milinkov M, Obradović M. Segmental Humeral Head Reconstruction in Patients with Chronic Locked Posterior Shoulder Dislocation. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1736. [PMID: 37893454 PMCID: PMC10608167 DOI: 10.3390/medicina59101736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/16/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: The goal of this study was to evaluate the functional outcomes of patient treatment using an allograft after chronic locked posterior shoulder dislocation associated with a bony defect of the upper edge of the humerus that involves 25-50% of the articular surfaces. Materials and Methods: A total of 20 patients were included in this study. Electrocution was the cause of injury in eight patients; in ten patients, the cause was direct trauma; and in two patients, the cause of injury was a fall due to hypoglycemic coma. A standard deltoid pectoral approach was used and a fresh-frozen osteochondral allograft of the femoral condyle was applied. In evaluating the results, Constant's scoring scale was used. Results: The average value of Constant's point scale for the operated shoulder is 84.14 points. This result is good according to the average value of Constant's point scale. Conclusions: Patients with locked chronic posterior dislocation in combination with a bony defect of the humeral head that covers 25-50% of the articular surface, in our opinion, should be treated using bone allografts rather than non-anatomical reconstruction methods.
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Affiliation(s)
- Srđan Ninković
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia; (M.T.); (M.M.); (B.B.); (M.M.); (M.O.)
- Faculty of Medicine, Department of Surgery, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Vukadin Milankov
- Faculty of Medicine, Department of Surgery, University of Novi Sad, 21000 Novi Sad, Serbia;
- Institute for Children and Youth Health Care of Vojvodina, 21000 Novi Sad, Serbia
| | - Milan Tošić
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia; (M.T.); (M.M.); (B.B.); (M.M.); (M.O.)
| | - Milan Majkić
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia; (M.T.); (M.M.); (B.B.); (M.M.); (M.O.)
| | - Branko Baljak
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia; (M.T.); (M.M.); (B.B.); (M.M.); (M.O.)
| | - Milan Milinkov
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia; (M.T.); (M.M.); (B.B.); (M.M.); (M.O.)
| | - Mirko Obradović
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia; (M.T.); (M.M.); (B.B.); (M.M.); (M.O.)
- Faculty of Medicine, Department of Surgery, University of Novi Sad, 21000 Novi Sad, Serbia;
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15
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Rüttershoff K, Akgün D, Moroder P. Joint Preserving Treatment of Chronic Locked Posterior Shoulder Dislocation by Means of Combined Humeral Allograft Reconstruction and Posterior Glenoid Autograft Augmentation. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:290-296. [PMID: 34763357 DOI: 10.1055/a-1651-0943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Chronic locked posterior shoulder dislocations are challenging to treat and often warrant total shoulder arthroplasty. While joint preserving treatment is preferable in young patients, surgical techniques to treat this pathology have rarely been described in the literature. This technical note presents the treatment of a 30-year-old male patient with a chronic locked posterior shoulder dislocation by means of combined humeral allograft reconstruction and posterior glenoid autograft augmentation. Restoration of the spheric humeral head surface was obtained using a fresh-frozen femoral allograft fixed with two reabsorbable screws. Due to the intraoperatively persistent posterior instability after humeral reconstruction, the posterior glenoid was augmented with a tricortical iliac crest autograft, which was fixed with two metal screws. This treatment strategy resulted in a full range of motion and a centered stable shoulder joint at one-year follow-up. Therefore, the procedure of segmental reconstruction of the humeral head with a fresh-frozen allograft combined with a posterior glenoid augmentation with an iliac crest bone autograft is a joint-preserving treatment alternative to shoulder arthroplasty in young patients when humeral head reconstruction alone does not suffice.
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Affiliation(s)
- Katja Rüttershoff
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin CVK, Berlin, Germany
| | - Doruk Akgün
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin CVK, Berlin, Germany
| | - Philipp Moroder
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin CVK, Berlin, Germany
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16
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Haritinian EG, Stoica IC, Popescu R, Gheorghievici GL, Nové-Josserand L. Treatment and outcomes of chronic locked posterior shoulder dislocations: a retrospective case series. BMC Musculoskelet Disord 2023; 24:82. [PMID: 36721138 PMCID: PMC9887796 DOI: 10.1186/s12891-023-06200-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/25/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Posterior shoulder dislocations are rare injuries that are often missed on initial presentation. Cases left untreated for more than three weeks are considered chronic, cannot be reduced closely (they become locked) and are usually associated with a significant reverse Hill-Sachs defect. The aim of this study was to evaluate the outcomes of chronic locked posterior shoulder dislocations treated with the McLaughlin procedure (classic or modified). METHODS This retrospective study included 12 patients with chronic locked posterior shoulder dislocation operated on between 2000 and 2021 by two surgeons in two institutions. Patients received a thorough clinical examination and radiological assessment before and after surgery. Shoulders were repaired with the McLaughlin or modified McLaughlin procedure. Outcomes were assessed by comparing pre- and postoperative values of clinical variables. RESULTS Most of the dislocations were of traumatic origin. The average delay between dislocation and surgical reduction was 13.5 ± 9.7 weeks. Postoperative clinical outcomes were favourable, with an average subjective shoulder value of 86.4 ± 11.1 and a normalized Constant -Murley score of 90 ± 8.3. None of the patients had a recurrence of shoulder dislocation, but one patient developed avascular necrosis of the humeral head and two patients developed glenohumeral osteoarthritis. CONCLUSIONS In this group of patients with chronic locked posterior shoulder dislocation, the clinical outcomes of McLaughlin and modified McLaughlin procedures were satisfactory, even when surgery was significantly delayed.
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Affiliation(s)
- Emil George Haritinian
- grid.8194.40000 0000 9828 7548Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu, 020021 Bucharest, Romania ,Foișor Orthopaedic Hospital, 35-37 Ferdinand I, 021382 Bucharest, Romania
| | - Ioan Cristian Stoica
- grid.8194.40000 0000 9828 7548Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu, 020021 Bucharest, Romania ,Foișor Orthopaedic Hospital, 35-37 Ferdinand I, 021382 Bucharest, Romania
| | - Roman Popescu
- grid.8194.40000 0000 9828 7548Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu, 020021 Bucharest, Romania
| | - Gavril Lucian Gheorghievici
- grid.8194.40000 0000 9828 7548Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu, 020021 Bucharest, Romania ,Foișor Orthopaedic Hospital, 35-37 Ferdinand I, 021382 Bucharest, Romania
| | - Laurent Nové-Josserand
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008 Lyon, France
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17
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Bryant JD, Caldwell PE, Pearson SE. The "BioHumi" Humeral Head Osteochondral Allograft Transplantation for Reverse Hill-Sachs Lesion of the Shoulder. Arthrosc Tech 2022; 12:e107-e114. [PMID: 36814973 PMCID: PMC9939741 DOI: 10.1016/j.eats.2022.08.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/28/2022] [Indexed: 12/24/2022] Open
Abstract
Osteochondral defects of the shoulder due to posterior instability are less frequent than those caused by anterior instability. Although uncommon, locked posterior dislocations can create sizable osteochondral lesions of the anterior humeral head known as reverse Hill-Sachs lesions. Treatment of these defects to restore the congruent contour of the glenohumeral joint is essential to reduce recurrence of instability and prevent long-term sequelae of arthritis. Historically, nonanatomic options, such as transposition of the subscapularis tendon or lesser tuberosity into the defect and humeral rotational osteotomy, have been endorsed to treat reverse Hill-Sachs lesions. More contemporary techniques have focused on restoring not only the bony architecture but also the chondral surface using fresh osteochondral allografts. The evolution of this approach has been challenging because of the large impacted wedge-shaped defect typically encountered with a locked posterior dislocation. Many surgeons employ techniques using multiple circular grafts or customizing a nonanatomic graft to fill these defects. Given the unstable nature of these grafts, metallic screws are often placed through the chondral surface for fixation. The evolution of the "BioHumi" technique has made treatment of large reverse Hill-Sachs lesions technically simpler and more reproducible using innovative instrumentation to transplant an elliptical osteochondral allograft.
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Affiliation(s)
| | - Paul E. Caldwell
- Orthopaedic Research of Virginia, Richmond, Virginia, U.S.A.,Tuckahoe Orthopaedic Associates, Ltd., Richmond, Virginia, U.S.A.,Address correspondence to Paul E. Caldwell III, M.D., 1501 Maple Ave., Suite 200 Richmond, VA 23226, U.S.A..
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18
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Yazdi AA, Dib AG, Elphingstone JW, Schick S, Ponce BA, Momaya AM, Brabston EW. Allograft reconstruction for humeral head defects in the setting of shoulder instability: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:489-496. [PMID: 37588454 PMCID: PMC10426630 DOI: 10.1016/j.xrrt.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Glenohumeral joint instability and dislocation are common orthopedic pathologies that can produce osseous humeral head defects such as Hill-Sachs (HS) or Reverse Hill-Sachs (RHS) lesions. Numerous reconstruction techniques have been reported in the literature, including remplissage, disimpaction, and allograft reconstruction. No group has previously assessed the outcomes of allograft reconstruction for RHS lesions, nor compared the outcomes of allograft reconstruction for HS and RHS lesions. In this study, we aim to provide a comprehensive assessment of osteochondral allograft reconstruction for the distinct pathologies of RHS lesions and HS lesions by comparing postreconstruction patient-reported outcomes, complications, and radiographic assessments for each lesion. Methods Using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review was performed to identify and include studies that reported patient outcomes after the use of osteochondral allografts in the reconstruction of HS or RHS lesions of the humeral head. A comprehensive search of the Google Scholar, PubMed, and Embase databases was conducted with the key terms "allograft," "Hill-Sachs," and "reverse Hill-Sachs." Results Eight studies, with a total of 84 patients, were included for review. Of the 84 allograft-treated patients, there were 44 patients with HS lesions and 40 patients with RHS lesions. The average patient age was 27.3 years for HS lesions and 43.0 years for RHS lesions. Postoperative range of motion and average Constant-Murley score (87.9 for HS and 80.1 for RHS) appeared to be greater for those with HS lesions. In addition, 20.5% of HS patients experienced postoperative complications, whereas 42.5% of RHS patients had postoperative complications (P = .03). HS and RHS patients experienced similar proportions of graft resorption or collapse rate (22.7% for HS and 12.5% for RHS; P = .2). Conclusion Patient-reported outcomes indicate that osteochondral allograft reconstruction for large RHS and HS lesions is an acceptable intervention. RHS patients had lower rates of graft resorption and collapse but worse postoperative range of motion and functional outcomes, although these differences were not statistically significant. HS patients experienced significantly fewer complications than those with RHS lesions.
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Affiliation(s)
- Allen A. Yazdi
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Aseel G. Dib
- Atrium Health Musculoskeletal Institute Department of Orthopaedic Surgery, Charlotte, NC, USA
| | - Joseph W. Elphingstone
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Samuel Schick
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | | | - Amit M. Momaya
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Eugene W. Brabston
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
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19
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Long-term follow-up of a posterior glenohumeral fracture-dislocation treated with open reduction and internal fixation: a case report. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Egiazaryan KA, Ershov DS, Badriev DA, Soshnikov DY. Chronic non-treated posterior fracture-dislocation of the shoulder. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2022. [DOI: 10.24075/brsmu.2022.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Posterior fracture-dislocations often remain undiagnosed at initial medical attendance. In dislocation, the head of the humerus extends beyond the glenoid to form a zone of impaction, which “fixes” it. The injury is almost unidentifiable in standard frontal X-ray images. Meanwhile, continued fixation of the humerus in the state of posterior dislocation leads to a rapid progression of the traumatic impaction over up to 50% of the articular surface area. The associated damage to the articular lip of the scapula, rupture of the rotator cuff muscles, symptoms of shoulder instability after relocation, and severe pain syndrome require advanced treatments for this type of injury. Here we report a clinical case of anatomical neck fracture of the humerus with displaced consolidation, combined to posterior dislocation. To avoid subacromial impingement, instead of correcting the position of the head, we abandoned the reposition and performed an osteotomy with distal displacement of the greater tubercle of the humerus.
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Affiliation(s)
- KA Egiazaryan
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - DS Ershov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - DA Badriev
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - DY Soshnikov
- Pirogov Russian National Research Medical University, Moscow, Russia
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21
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Cohen M, Fonseca R, Galvão Amaral MV, Monteiro MT, Motta Filho GR. Treatment of chronic locked posterior dislocation of the shoulder with the modified McLaughlin procedure. J Shoulder Elbow Surg 2022; 31:100-106. [PMID: 34216784 DOI: 10.1016/j.jse.2021.05.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 05/16/2021] [Accepted: 05/23/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Locked posterior dislocation of the shoulder (LPDS) is a challenging condition for the orthopedic surgeon. The problem with cases of chronic LPDS is that they may result in worse clinical outcomes because the size of the reverse Hill-Sachs lesion and cartilage damage can increase over time. Multiple treatment strategies have been reported in the literature for the treatment of chronic cases. The purpose of this study was to report our experience with the modified McLaughlin technique for the treatment of chronic LPDS and evaluate the mid- and long-term functional outcomes. METHODS This was a retrospective single-center study including a consecutive series of 10 patients who underwent the modified McLaughlin procedure for the treatment of chronic LPDS. The time between dislocation and treatment ranged from 6 weeks to 14 months (mean, 20.9 weeks). Postoperative imaging and functional evaluation were performed with a minimum of 2 years' follow-up (range, 24-110 months). Functional outcomes were assessed by means of a visual analog scale score for pain and patient satisfaction regarding the operation, the Constant-Murley score, and the University of California, Los Angeles shoulder rating scale. RESULTS The mean follow-up period was 59.4 months (range, 24-110 months). Range of motion improved significantly after surgery: Mean forward flexion improved from 71° ± 5° to 126°± 37° (P < .001), mean external rotation improved from 7°± 7° to 52° ± 18° (P = .012), and mean internal rotation improved from gluteal region ± 1 vertebral level to L1 ± 4 vertebral levels (P = .001). Functional outcome measures demonstrated significant improvements: The mean Constant-Murley score improved from 22 ± 2.4 (range, 20-26) to 65 ± 21.5 (P < .001); the mean University of California, Los Angeles score improved from 9.8 ± 1.3 (range, 8-12) to 27 ± 9.7 (P < .001); and the mean visual analog scale score improved from 4.6 ± 0.8 (range, 3-6) to 2.4 ± 2.3 (P < .001). Of the patients, 8 (80%) were satisfied with the procedure. The 2 remaining cases had a delay from injury to diagnosis > 6 months and evolved with poor functional outcomes and severe glenohumeral degenerative joint disease. There were no cases of recurrent dislocation, infection, or neurologic injury during the follow-up. CONCLUSION Our study findings demonstrated that the modified McLaughlin procedure showed good results over a 2-year minimum follow-up period. The clinical outcomes of this procedure are worse when there is a delay from injury to diagnosis > 6 months.
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Affiliation(s)
- Marcio Cohen
- Department of Shoulder and Elbow Surgery, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil.
| | - Raphael Fonseca
- Department of Shoulder and Elbow Surgery, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
| | - Marcus Vinicius Galvão Amaral
- Department of Shoulder and Elbow Surgery, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
| | - Martim Teixeira Monteiro
- Department of Shoulder and Elbow Surgery, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
| | - Geraldo Rocha Motta Filho
- Department of Shoulder and Elbow Surgery, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
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22
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Surgical treatment of the humeral head osteochondral defects in chronic shoulder dislocation: Literature review. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.6-2.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. The shoulder joint is the one most amenable to dislocation. Dislocation of the humeral head is complicated by combined injuries of the shoulder joint, and if the patient does not seek treatment on the first day after the dislocation, irreversible changes in bone and soft tissue structures are formed.The aim of this review was to analyze modern methods of diagnosis and treatment of patients with defects in the articular surfaces of the scapula and humerus head with chronic shoulder dislocations.Material and methods. To search for literature data, we used the electronic databases MEDLINE, PudMed, eLIBRARY with a selection of sources published from 2000 to 2020. The analysis was carried out on works devoted to the diagnosis, surgical treatment and complications of traumatic shoulder dislocations.Results. When analyzing the literature on the surgical treatment of shoulder dislocations, we did not find clear criteria for planning the extent of surgery. The obtained results of surgical treatment testify to well-studied technologies for treating osteochondral defects of the humeral head up to 25 % of its total area. In the presence of a defect of 50 % of humeral head area or more, satisfactory results are shown when carrying out arthroplasty of the joint using a reverse endoprosthesis. However, the treatment of defects ranging in size from 25 to 50 % is still an unexplored problem. There are single techniques using allografts, mainly in English-speaking countries and, to a lesser extent, on the territory of the Russian Federation. Thus, the search for an algorithm for choosing a surgical treatment based on multi-layer spiral computed tomography and/or magnetic resonance imaging data, and the development of a new method of surgical treatment taking into account the obtained data are priority areas in modern traumatology and orthopedics.
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Kandeel AAM. Chronic locked posterior gleno-humeral dislocation: technical note on fibular grafting for restoration of humeral head sphericity. J Orthop Surg Res 2021; 16:683. [PMID: 34794483 PMCID: PMC8600741 DOI: 10.1186/s13018-021-02835-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/09/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Reconstruction of reverse Hill-Sachs defect using osteo-chondral allograft has the advantages of spherical re-contouring and provision of smooth biological articular surface of the reconstructed humeral head. However, worldwide availability and risk of disease transmission of osteo-chondral allograft remain points of increasing concerns. As an alternative to lacking osteo-chondral allograft, the current technical note describes a reconstructive technique of reverse Hill-Sachs defect using autologous fibular grafting. METHODS Following open reduction of the dislocated humeral head, reverse Hill-Sachs defect was reconstructed using 3-4 autologous fibular pieces (each is of 10 mm in length) fixed in flush with the articular cartilage using 4-mm cancellous screws. Defect reconstruction was then followed by modified McLaughlin's transfer and posterior capsulorrhaphy. RESULTS Spherical contour of the humeral head and gleno-humeral range of motion were restored. Intra-operative dynamic testing of the reconstruct revealed no residual posterior gleno-humeral instability. CONCLUSION Currently reported technique might offer advantages of graft availability, technical simplicity, familiarity and reproducibility, safety (i.e. no disease transmission) and bone preservation facilitating future revision management (if needed). Nevertheless, long-term outcomes of this technique should be investigated via further cohort clinical studies.
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Affiliation(s)
- Amr Abdel-Mordy Kandeel
- Department of Orthopedics and Traumatology, Faculty of Medicine, Menoufia University, Gamal Abdel-Nasser Street, Shebien El-kom, Menoufia Governorate, Egypt.
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Mi M, Zhang JM, Jiang XY, Huang Q. Management of Locked Posterior Shoulder Dislocation with Reverse Hill-Sachs Lesions via Anatomical Reconstructions. Orthop Surg 2021; 13:2119-2126. [PMID: 34636160 PMCID: PMC8528979 DOI: 10.1111/os.13152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the outcomes of locked posterior shoulder dislocation with reverse Hill–Sachs lesions in patients treated with anatomical reconstructions. Methods Patients who were treated at our institution between January 2016 and June 2020 were retrospectively reviewed. The demographics of the patients including gender, age, occupation, and dominant arm were recorded. Eleven cases from 10 patients qualified in this study. Nine males and one female were included. The mean age of the patients was 44.8 years (range, 33–54 years). Mechanism of injury, duration between injuries and definitive diagnosis, misdiagnosis, size of humeral head impaction, treatment maneuver, and details of operation performed were reviewed. Plain radiographs and computed tomography (CT) scan were taken to determine the size of defects preoperatively and fracture healing during follow‐up. During surgery, the deltopectoral approach was employed. Anatomical reconstruction procedure including reduction, disimpaction, bone grafting, and fixation were sequentially performed. Either cancellous autograft from iliac crest or allograft were used and the fractures were anatomically reduced and stabilized by screws or plates. Visual Analog Scale (VAS) and Constant–Murley score were recorded to determine the functional outcomes preoperatively, at 3 months and 6 months postoperatively, and at the last follow‐up. The range of motion in forward flexion was recorded at 6 months follow‐up postoperatively. Results Causes of injuries included epileptic seizure in four cases, fall in three cases, and road traffic accident in three cases. Misdiagnoses occurred in five out of 10 patients. The mean time between injury and definitive treatment among those misdiagnosed was 112 days. The mean size of the impacted reverse Hill–Sachs lesions was 33.95% (range, 19.1%–42.6%). All patients received surgical management with anatomical reconstruction approach, including open reduction, disimpaction, bone grafting, and internal fixation. The mean amount of bleeding during operation was 450 mL. The mean follow‐up period was 22.6 months. Fracture healing was observed by 8 weeks in all cases postoperatively and evidence of bone grafting could not be further detected on CT scan at 6 month during follow‐up. VAS was significantly lower at the last follow‐up (0.68 ± 0.21) in comparison to preoperative scores (4.96 ± 0.97) (P < 0.05). Constant–Murley was improved significantly at the last follow‐up (91.7 ± 8.3) in comparison to that preoperatively (40.6 ± 10.3) (P < 0.05). The mean range of motion in forward flexion was 38.25° ± 9.36° preoperatively and significantly improved to 162.48° ± 12.68° at 6‐month follow‐up (P < 0.05). Conclusion The anatomical reconstruction procedure by open reduction and bone augmentation for the treatment of locked posterior shoulder dislocation with reverse Hill–Sachs lesion was promising in both fracture healing and functional outcomes.
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Affiliation(s)
- Meng Mi
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing, China
| | - Jin-Ming Zhang
- Department of Orthopaedics, Beijing Mentougou District Hospital, Beijing, China
| | - Xie-Yuan Jiang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing, China
| | - Qiang Huang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing, China
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25
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Peterson EE, Caldwell PE, Pearson SE. The "BioHumi" Humeral Head Elliptical Osteochondral Allograft Transplantation. Arthrosc Tech 2021; 10:e2325-e2330. [PMID: 34754741 PMCID: PMC8556667 DOI: 10.1016/j.eats.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/01/2021] [Indexed: 02/03/2023] Open
Abstract
Cartilage defects of the humeral head in young, active patients provide a challenge to treating surgeons. The causes of humeral head osteochondral lesions are variable, but these lesions most commonly result from trauma and recurrent glenohumeral instability. Palliative and reparative techniques such as arthroscopic debridement and microfracture have traditionally been used as surgical treatment but have high failure rates. Similarly to surgical trends in the knee, cartilage restoration in the shoulder is becoming more prevalent in younger patients. Osteochondral allograft transplantation (OAT) has been used as a joint-preserving surgical option to restore hyaline cartilage in multiple joints for decades. Although OAT is more commonly used to re-establish the subchondral bony architecture in the treatment of recurrent shoulder instability, the procedure may also be indicated in young, active patients with focal humeral head chondral defects. OAT has been shown in early studies to provide improvement in functional outcome scores and good long-term graft survival with relatively low rates of complications. This report describes our straightforward, reproducible technique for the treatment of large, oblong chondral defects of the humeral head using OAT.
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Affiliation(s)
| | - Paul E. Caldwell
- Orthopaedic Research of Virginia, Richmond, Virginia, U.S.A.,Tuckahoe Orthopaedic Associates, Richmond, Virginia, U.S.A.,Address correspondence to Paul E. Caldwell III, M.D., 1501 Maple Ave, Ste 200, Richmond, VA 23226, U.S.A.
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26
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Marcheggiani Muccioli GM, Rinaldi VG, Lullini G, Ritali A, Mosca M, Romagnoli M, Guerra E, Zaffagnini S. Mid-Term outcomes following fresh-frozen humeral head osteochondral allograft reconstruction for reverse Hill Sachs lesion: a case series. BMC Musculoskelet Disord 2021; 22:768. [PMID: 34496807 PMCID: PMC8427886 DOI: 10.1186/s12891-021-04657-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background Locked posterior glenohumeral dislocations with a reverse Hill-Sachs impaction fracture involving less than 30% of the humeral head are most frequently treated with lesser tuberosity transfer into the defect, whereas those involving more than 50% undergo humeral head arthroplasty. Reconstruction of the defect with segmental femoral osteochondral allografts has been proposed to treat patients between these two ranges, but the medium−/long-term outcomes of this joint-preserving procedure are controversial. Methods Between 2001 and 2018, 12 consecutive patients with a unilateral locked posterior shoulder dislocation and an impaction fracture from 30 to 50% (mean 31% ± 1.32) of the humeral head were treated with segmental reconstruction of the defect with fresh-frozen humeral head osteochondral allografts. Patients were assessed clinically, radiographically and with computed tomography (CT) at a medium follow-up of 66 ± 50.25 months (range, 24–225). Results All twelve shoulders presented a slight limitation in anterior elevation (average, 166.6° ± 22.76). The mean active external rotation with the shoulder at 90° of abduction was 82.5° ± 6.61, and that with the arm held in stable adduction was 79.16 ± 18.80. The mean abduction was 156.25° ± 25.09. The mean Constant-Murley score (CS) was 82 ± 15.09 points (range, 40–97 points), and the mean ASES was 94 ± 8.49 points. The mean pre- and postoperatively Western Ontario Shoulder Instability index (WOSI) was 236.5 ± 227.9 and 11.20 ± 10.85, respectively. Development of osteoarthrosis (OA) was minimal. The average allograft resorption rate was 4% ± 2.4. There were no cases of failure (reoperation for any reason) in this series. Conclusion Segmental humeral head reconstruction with humeral head fresh-frozen osteochondral allografts provides good to excellent clinical results with low-grade OA and low allograft resorption in patients with locked posterior shoulder dislocation. Trial registration ClinicalTrials.gov PRS, ClinicalTrials.gov ID: NCT04823455. Registered 29 March 2021 - Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AU8P&selectaction=Edit&uid=U0004J36&ts=12&cx=6cykp8 Level of evidence Level IV, Case Series, Treatment Study.
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Affiliation(s)
- Giulio Maria Marcheggiani Muccioli
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy. .,DIBINEM, University of Bologna, via Pupilli, 1 c/o IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy.
| | - Vito Gaetano Rinaldi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giada Lullini
- UOC Medicina Riabilitativa e Neuroriabilitazione, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Alice Ritali
- Chirurgia della Spalla e del Gomito, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano Mosca
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Matteo Romagnoli
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Enrico Guerra
- Chirurgia della Spalla e del Gomito, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,DIBINEM, University of Bologna, via Pupilli, 1 c/o IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
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27
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Ker AM, Veen EJ, Maharaj JC, Launay MM, Cutbush K, Gupta A. Pedicled-lesser tuberosity osteotomy for glenohumeral joint exposure: a technical note and case report highlighting its use in allograft reconstruction of a large engaging reverse Hill-Sachs lesion after posterior shoulder dislocation. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:224-228. [PMID: 37588950 PMCID: PMC10426683 DOI: 10.1016/j.xrrt.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Exposure of the humeral articular surface through an anterior approach to the shoulder for grafting humeral bone defects requires partial or complete detachment of the subscapularis tendon and traditionally is achieved through a subscapularis tenotomy, peel tuberosity osteotomy, or lesser tuberosity osteotomy. This case report presents a technique of performing a pedicled-lesser tuberosity osteotomy to allow adequate access for allograft reconstruction of a large reverse Hill-Sachs lesion after a traumatic posterior dislocation, to restore humeral head sphericity and prevent recurrent glenohumeral joint instability. The inferior subscapularis insertion is left intact leaving a periosteal sleeve and preserving the blood supply to the lesser tuberosity and humeral head, with the aim of improving healing of the osteotomy and preventing graft-related complications, such as resorption. Successful union of the pedicled-lesser tuberosity osteotomy and allograft was seen on a 6-month follow-upcomputed tomography scan, with adequate restoration of subscapularis function.
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Affiliation(s)
- Andrew M. Ker
- Greenslopes Private Hospital, Brisbane, QLD, Australia
- Brisbane Private Hospital, Brisbane, QLD, Australia
| | - Egbert J.D. Veen
- Greenslopes Private Hospital, Brisbane, QLD, Australia
- Brisbane Private Hospital, Brisbane, QLD, Australia
| | - Jashint C. Maharaj
- Shoulder Surgery QLD Research Institute (SSQRI), Brisbane, QLD, Australia
| | - Marine M. Launay
- Shoulder Surgery QLD Research Institute (SSQRI), Brisbane, QLD, Australia
| | | | - Ashish Gupta
- Greenslopes Private Hospital, Brisbane, QLD, Australia
- Shoulder Surgery QLD Research Institute (SSQRI), Brisbane, QLD, Australia
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Romano AM, Edwards TB, Nastrucci G, Casillo P, Di Giunta A, Zappia M, Susanna M, Ascione F. Arthroscopic reduction and subscapularis remplissage (ARR) of chronic posterior locked shoulder dislocation leads to optimized outcomes and low rate of complications. Knee Surg Sports Traumatol Arthrosc 2021; 29:2348-2355. [PMID: 33074421 DOI: 10.1007/s00167-020-06317-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/02/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Unrecognized posterior shoulder dislocation with a concomitant humeral head fracture affects joint function and no consensus exists regarding treatment. The present study analyses clinical and radiographic outcomes of a novel arthroscopic technique for reducing chronic locked posterior shoulder dislocation associated with subscapularis remplissage. METHODS The study comprises a retrospective analysis of consecutive chronic posterior locked shoulders (CPLS) with minimum 2-years follow-up of patients who had undergone McLaughlin technique arthroscopic modification for the treatment of CPLS with a reverse Hill-Sachs lesion. Active range of motion (ROM), Western Ontario (WOSI) and Constant Score (CS), were evaluated pre- and postoperatively. Plain radiographs and magnetic resonance imaging (MRI) scans were collected pre- and post-operatively, recording bone defect, osteoarthritis, cuff integrity/fatty infiltration, and the grade of filling of the reverse Hill-Sachs. RESULTS Twelve male patients with a mean follow-up of 37.3 months ± 10.5 (range, 24-58) were included. Mean WOSI and CS scores improved from 41 to 92 and 28 to 94 points, respectively. ROM measurements all had significantly increased at final follow-up, with no significant differences in arm rotation. No defects were left unfilled at final MRI examination. CONCLUSION The results of this uncontrolled study with a limited number of patients confirm that arthroscopic reduction and subscapularis remplissage is a highly effective and satisfactory treatment method resulting in no shoulder rotation deficits. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Alfonso M Romano
- Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy.,Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via A. Manzoni 220, 80123, Napoli, Italy
| | - T Bradley Edwards
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA
| | | | - Pasquale Casillo
- Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy
| | - Angelo Di Giunta
- Orthopaedic Division of Policlinico 'G.B. Morgagni', Catania, Italy
| | - Marcello Zappia
- Department of Medicine and Health Sciences, Università del Molise, Campobasso, Italy
| | | | - Francesco Ascione
- Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy. .,Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via A. Manzoni 220, 80123, Napoli, Italy.
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29
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Camenzind RS, Martin Becerra J, Gossing L, Serane-Fresnel J, Wagner ER, Lafosse L. Acceptable Long-Term Outcomes of Arthroscopic Bone Grafting for Recurrent Posterior Shoulder Instability: Minimum Follow-Up of 5 Years. Arthroscopy 2021; 37:816-823. [PMID: 33385491 DOI: 10.1016/j.arthro.2020.10.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the long-term clinical outcome associated with arthroscopically placed autologous iliac crest bone graft (ICBG) for recurrent posterior shoulder instability. METHODS From January 2008 to December 2013, patients treated with posterior ICBG and a minimum follow-up of 5 years were included. Clinical outcome of patients operated with a posterior ICBG was analyzed with multiple patient-reported outcome measures included Constant (CS), American Shoulder and Elbow Surgeons (ASES), Walch-Duplay, and Rowe scores, shoulder subjective value, and pain visual analog score. Patient satisfaction was assessed by asking the patients their overall level of satisfaction at last follow-up on a 1 to 10 scale. RESULTS In total, 18 patients (19 shoulders) were included. At a mean follow-up of 7.3 years (range, 5-10 years), patients had significant improvements in their mean CS from 63 (standard deviation [SD] 18) to 80 (SD 18; P = .005), ASES from 57 (SD 18) to 81 (SD 18; P = .003), Walch-Duplay from 34 (SD 31) to 79 (SD 22; P < .001), and Rowe score from 37 (SD 23) to 79 (SD 24; P < .001). Pain level decreased from 5.6 (SD 2.5) preoperative to 2.3 (SD 2.3; P < .001) and shoulder subjective value improved 58 (SD 20) to 76 (SD 24; P = .002). Global satisfaction with the procedure was 8.4 (SD 2.1). Clinical significance was met or exceeded by 84% for CS and 89% of the patients for ASES and 95% met or exceeded satisfaction threshold for CS. There were 7 shoulders (37%) reoperated for symptomatic screw irritation. CONCLUSIONS This series reporting on the long-term follow-up after arthroscopic posterior ICBG for recurrent posterior shoulder instability demonstrates, despite a high number of reoperations for symptomatic screw irritation, its effectiveness with acceptable clinical outcomes and satisfied patients. LEVEL OF EVIDENCE IV, therapeutic case series.
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Affiliation(s)
- Roland Stefan Camenzind
- Alps Surgery Institute, Clinique Générale Annecy, Annecy, France; Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zurich, Switzerland.
| | - Javier Martin Becerra
- Alps Surgery Institute, Clinique Générale Annecy, Annecy, France; Ortomove, Centro Medico ABC, Mexico City, Mexico
| | - Louis Gossing
- Alps Surgery Institute, Clinique Générale Annecy, Annecy, France; Department of Orthopaedic Surgery, Braine-l'Alleud-Waterloo Hospital, Centre Hospitalier Interrégional Edith Cavell (CHIREC), Braine-l'Alleud, Belgium
| | - Julien Serane-Fresnel
- Alps Surgery Institute, Clinique Générale Annecy, Annecy, France; IECEM Research Unit, Polyclinique Saint Côme, Compiègne, France
| | - Eric R Wagner
- Alps Surgery Institute, Clinique Générale Annecy, Annecy, France; Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - Laurent Lafosse
- Alps Surgery Institute, Clinique Générale Annecy, Annecy, France
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30
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Griswold BG, Paré DW, Herzwurm ZP, Murphy CS, Morpeth BG, Provencher MT, Parada SA. Utility of Allograft Talus as a Source for Grafting of Concurrent Humeral and Glenoid Defects Associated With Anterior Glenohumeral Instability: An Anthropometric Analysis. Arthroscopy 2021; 37:845-851. [PMID: 33276051 DOI: 10.1016/j.arthro.2020.11.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare morphologic data of the talus using magnetic resonance images with previously reported values of the humeral head and the glenoid as a potential graft source for both the humeral head as well as glenoid reconstruction in the setting of concomitant glenoid and humeral head defects. METHODS All magnetic resonance images of the ankle were reviewed for assessment of the morphology and variation of the talus among individuals. Patients with post-traumatic, osteoarthritic, or surgical changes to the distal tibia about the mid- or hind- foot, or patients with incomplete medical records were excluded. Radiographic parameters that were measured included the maximum vertical height (MVH), the height to the talar neck, the radius of curvature (ROC) of the talar dome, ROC of the subtalar joint, and the maximum medial-to-lateral width of the talar dome. Demographic data also were collected on each individual. Statistical analysis was performed via a linear regression model with backwards elimination to determine which demographic data correlated most strongly with talar anthropometric values. RESULTS A total of 82 study patients met inclusion criteria (59 male, 23 female; mean age 40.91 ± 14.69 years). Sex was found have a positive correlation of the following talar dimensions: MVH (P = .039), talar dome ROC (P < .001), and subtalar joint ROC (p = 0.001). Height was the most positive correlation for medial-to-lateral width (P < .001), height to the talar neck (P = .004), and also correlate for MVH (P = .004). Body mass index was found to have multicollinearity and was therefore not used as a variable. CONCLUSIONS Allograft talus appears to be a viable graft, as demonstrated in this anthropometric study for both reconstruction of the glenoid and humeral head when cases of bipolar glenohumeral bone loss are present. CLINICAL RELEVANCE This study aims to further evaluate potential allograft donor sites for bipolar lesions.
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Affiliation(s)
- B Gage Griswold
- Department of Orthopaedics, Augusta University Medical Center, Augusta, Georgia, U.S.A..
| | - Daniel W Paré
- Medical College of Georgia, Augusta University, Augusta, Georgia, U.S.A
| | - Zachary P Herzwurm
- Department of Orthopaedics, Augusta University Medical Center, Augusta, Georgia, U.S.A
| | - Cameron S Murphy
- Department of Orthopaedics, Augusta University Medical Center, Augusta, Georgia, U.S.A
| | - Brice G Morpeth
- Medical College of Georgia, Augusta University, Augusta, Georgia, U.S.A
| | | | - Stephen A Parada
- Medical College of Georgia, Augusta University, Augusta, Georgia, U.S.A
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31
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Sahu D, Rathod V, Phadnis A, Shyam A. Results and complications of head-preserving techniques in chronic neglected shoulder dislocation: a systematic review. J Shoulder Elbow Surg 2021; 30:685-694. [PMID: 33197594 DOI: 10.1016/j.jse.2020.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Humeral head-preserving procedures may be needed for chronic neglected shoulder dislocation because the presenting age of the patient is often reported to be less than 45 years. The aim of this systematic review was to evaluate the results of the various head-preserving procedures for chronic anterior dislocation (CAD) and chronic posterior dislocation (CPD). This review also aimed to evaluate the results of conservative neglect for CAD. METHODS PubMed, Embase, and Cochrane library databases were queried for studies that reported on results of head-preserving procedures for CAD or CPD and for studies that reported on the results of conservative neglect for CAD. Case reports, review articles, acute dislocations, and fracture-dislocations were excluded. The results of the different techniques were pooled for further evaluation. RESULTS Seventeen studies were selected for qualitative analysis. These were further subdivided into 9 studies for the CAD group and 11 studies for the CPD group. In the CAD intervention group, 53 shoulders in 7 studies were managed by 5 different head-preserving techniques. The choice of procedure to stabilize the shoulder after open reduction varied between coracoid transfer, capsulolabral repair, remplissage, and Putti-Platt procedure and acromiohumeral K-wire fixation. High resubluxation rates and early arthrosis were reported after open reduction techniques for CAD. In the CAD conservative group, 8 shoulders in 2 studies were managed by conservative methods. In the CPD group, the 2 most common techniques, McLaughlin or modified McLaughlin and bone grafting, were used to treat 74 shoulders in 7 studies and showed good functional outcomes. CONCLUSION The choice of open reduction and stabilization technique for CAD was highly variable between the different studies and led to a wide variation in the reported outcomes with a high number of complications such as resubluxation and early arthrosis. The conservative treatment of CAD led to poor functional results. The choice of treatment for CPD was mostly between 2 techniques-McLaughlin and modified McLaughlin reconstruction or the bone graft reconstruction-and they consistently led to good functional outcomes with less complications.
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Affiliation(s)
- Dipit Sahu
- Mumbai Shoulder Institute, Jupiter Hospital Thane, Sir H.N. Reliance Foundation Hospital, Mumbai, Maharashtra, India.
| | | | | | - Ashok Shyam
- Indian Orthopaedics Research Group, Mumbai, Maharashtra, India
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Paparoidamis G, Iliopoulos E, Narvani AA, Levy O, Tsiridis E, Polyzois I. Posterior shoulder fracture-dislocation: A systematic review of the literature and current aspects of management. Chin J Traumatol 2021; 24:18-24. [PMID: 32980216 PMCID: PMC7878447 DOI: 10.1016/j.cjtee.2020.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/31/2020] [Accepted: 08/25/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Posterior fracture-dislocation of shoulder is an infrequent traumatic event; however, most orthopaedic surgeons may face the challenge of treating it. The aim of this study is to review and summarise systematically the current principles of the management of this complex injury, and create a treatment algorithm. METHODS Both PubMed and Scopus Databases were systematically searched for the terms "posterior shoulder fracture-dislocation" or "posterior glenohumeral fracture-dislocation" or "posterior glenoid fracture-dislocation" for articles written in English and published in the last decade. RESULTS A total of 900 articles were identified, of which 13 were retained for analysis. A total of 153 patients (161 shoulders) were identified. These patients were treated either with open reduction and internal fixation, modified McLaughlin procedure, allograft/autograft humeral head reconstruction or shoulder arthroplasty. The mean age was 40.15 years. The mean postoperative Constant score in cases treated by open reduction and internal fixation was 86.45, whereas by bone graft was 84.18. Further, the mean postoperative Constant score was between 79.6 and 67.1 in those that were managed by modified McLaughlin and arthroplasty procedure, respectively. CONCLUSION The management of posterior shoulder fracture-dislocation may be challenging, and the best surgical option depends on many variables such as the chronicity of the injury, the presence of a fracture at the level of the surgical neck or tuberosities and the extend of the Hill-Sachs lesion if any. A treatment algorithm is proposed, based on the current literature in an effort to create a consensus for these injuries. For the acute shoulder fracture-dislocations, an open reduction should be performed. For the chronic fracture/dislocations in the elderly low-demand patients, conservative treatment should be performed. For the rest of the patients, depending on the severity of the Hill-Sachs lesion different surgical options are available such as the McLaughlin technique, the use of an allograft, osteotomy or arthroplasty.
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Affiliation(s)
- Georgios Paparoidamis
- The Rowley Bristow Unit, Ashford & St Peter's Hospitals, NHS Foundation Trust, Chertsey, Surrey, United Kingdom,Academic Orthopaedic Department, Papageorgiou General Hospital, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, and CORE Lab, CIRI - AUTh, Thessaloniki, Greece
| | - Efthymios Iliopoulos
- The Rowley Bristow Unit, Ashford & St Peter's Hospitals, NHS Foundation Trust, Chertsey, Surrey, United Kingdom
| | - A. Ali Narvani
- The Rowley Bristow Unit, Ashford & St Peter's Hospitals, NHS Foundation Trust, Chertsey, Surrey, United Kingdom,Shoulder and Elbow Centre - Reading Shoulder Unit, United Kingdom
| | - Ofer Levy
- Shoulder and Elbow Centre - Reading Shoulder Unit, United Kingdom
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, and CORE Lab, CIRI - AUTh, Thessaloniki, Greece,International Center for Arthroplasty & Robotic Orthopaedic Surgery (ICAROS), European Interbalkan Medical Center, Thessaloniki, Greece
| | - Ioannis Polyzois
- The Rowley Bristow Unit, Ashford & St Peter's Hospitals, NHS Foundation Trust, Chertsey, Surrey, United Kingdom,Shoulder and Elbow Centre - Reading Shoulder Unit, United Kingdom,Surrey Orthopaedic Clinic, United Kingdom,Corresponding author. The Rowley Bristow Unit, Ashford & St Peter's Hospitals, NHS Foundation Trust, Chertsey, Surrey, United Kingdom.
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33
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Daoudi A, Abdeljaouad N, Yacoubi H. Chronic posterior fracture-dislocation of the shoulder: case report and a literature review. Pan Afr Med J 2020; 36:275. [PMID: 33088404 PMCID: PMC7545983 DOI: 10.11604/pamj.2020.36.275.25046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023] Open
Abstract
Posterior shoulder fracture-dislocation is a rare injury accounting for approximately 0.9% of shoulder fracture-dislocations and often misdiagnosed during the initial presentation to a physician. Though the reverse Hill-Sachs lesion is a common injury associated with posterior shoulder dislocation, the associated scapula fracture represents only 6% of the lesions associated with a posterior dislocation of the shoulder. We report the case of a neglected posterior shoulder dislocation with a reverse Hill-Sachs lesion treated by filling with an autologous graft associated with an extra articular fracture of the scapula fixed by a plate and a posterior bone end-stop because of the posterior instability. After two years of follow-up, the patient has no episode of dislocation and is satisfied with the functional result with a constant score of 68/100 points.
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Affiliation(s)
- Ahmed Daoudi
- Trauma-Orthopedic Service B, Mohammed VI University Hospital Center, Oujda, Morocco
| | - Najib Abdeljaouad
- Trauma-Orthopedic Service B, Mohammed VI University Hospital Center, Oujda, Morocco
| | - Hicham Yacoubi
- Trauma-Orthopedic Service B, Mohammed VI University Hospital Center, Oujda, Morocco
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The utilization of computer planning and 3D-printed guide in the surgical management of a reverse Hill-Sachs lesion. JSES Int 2020; 4:569-573. [PMID: 32939488 PMCID: PMC7479040 DOI: 10.1016/j.jseint.2020.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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A Modified Reverse Remplissage Procedure for Management of a Locked Posterior Shoulder Dislocation. Case Rep Orthop 2020; 2020:8625368. [PMID: 32550033 PMCID: PMC7275965 DOI: 10.1155/2020/8625368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 11/18/2022] Open
Abstract
Posterior shoulder dislocation is rare and often represents a diagnostic and therapeutic challenge. An impaction fracture of the anteroinferior aspect of the humeral head (called a reverse Hill-Sachs (RHS) fracture) is always present in case of chronic locked posterior dislocation. Surgical management is required and decided on the delay between the trauma and the diagnosis and the importance of the RHS (in percentage). The authors present a chronic locked posterior shoulder dislocation in a 32-year-old active male with a reverse Hill-Sachs lesion of more than 40%. An open reduction was required, and stabilization was achieved with a modified remplissage technique with detachment of the upper quarter of the subscapularis tendon. Three years after the surgery, the patient recovered an excellent functional level with a stable shoulder.
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Sochacki KR, Dillingham MF, Abrams GD, Sherman SL, Donahue J. Humeral Head Osteochondral Allograft Reconstruction with Arthroscopic Anterior Shoulder Stabilization at a Long-Term Follow-Up: A Case Report. JBJS Case Connect 2020; 10:e0555. [PMID: 32649125 DOI: 10.2106/jbjs.cc.19.00555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CASE The authors report a case of recurrent anterior shoulder instability in a 19-year-old man. Intraoperative arthroscopic examination identified Bankart and engaging Hill-Sachs lesions. The patient was treated with humeral head osteochondral allograft reconstruction and concomitant arthroscopic anterior stabilization. At the 14-year follow-up, there was no recurrent instability. CONCLUSION Humeral head osteochondral allograft reconstruction combined with an arthroscopic anterior stabilization procedure can be successful for recurrent shoulder instability and engaging Hill-Sachs lesion.
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Affiliation(s)
- Kyle R Sochacki
- 1Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California
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Brilakis E, Malahias MA, Patramani M, Avramidis G, Gerogiannis D, Trellopoulos A, Antonogiannakis E. All-Arthroscopic McLaughlin's Procedure in Patients with Reverse Hill-Sachs Lesion Caused by Locked Posterior Shoulder Dislocation. JOINTS 2019; 7:71-77. [PMID: 34195533 PMCID: PMC8236323 DOI: 10.1055/s-0039-3401820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/04/2019] [Indexed: 10/31/2022]
Abstract
Purpose This study aims to investigate the clinical and functional outcomes of the all-arthroscopic McLaughlin procedure in a clinical series of patients suffering by neglected locked posterior shoulder dislocation. Methods A retrospective clinical study based on prospectively collected data was conducted in a single center regarding 10 patients with neglected locked posterior shoulder dislocation and concomitant reverse Hill-Sachs lesion, who were treated with the all-arthroscopic Mclaughlin procedure. The average humeral bone defect was 39 ± 7% according to the preoperative computed tomography evaluation. The mean time of follow-up was 77 ± 16 months (range, 63-104 months). Results No patient had suffered a new dislocation, whereas all of them were satisfied with the surgical outcome and returned to their previous activities of daily living. External rotation was restored to every patient studied from 0 degrees at the baseline. At the last follow-up, the median external rotation beside the body was 90 degrees (range, 50-90 degrees; p < 0.01) and the respective measurement at 90 degrees of abduction was 90 degrees (range, 80-90 degrees; p < 0.01). The active forward flexion was increased ( p < 0.01), from 60 degrees (range, 30-180 degrees) at the baseline to 180 degrees (range, 160-180 degrees) at the last follow-up and the internal rotation was gained ( p < 0.01) from the level of buttock (range, lateral thigh-T12) at the baseline to the T11 level (range, T7-L3) at the last follow-up. The median UCLA score was increased from 8 (range, 4-22) to 35 (range, 33-35; p < 0.01) and the Oxford instability score from 5 (range, 3-16) to 46 (range, 43-48; p < 0.01), respectively. Conclusion The arthroscopic McLaughlin procedure in substantial reverse Hills-Sachs lesion caused by locked posterior dislocation leads to excellent clinical and functional results in the long-term follow-up. Level of Evidence This is a therapeutic study, case series with no comparison group, Level IV.
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Affiliation(s)
| | | | - Maria Patramani
- 3rd Orthopaedic Department, Hygeia General Hospital, Athens, Greece
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Arthroscopic Posterior Glenohumeral Capsular Augmentation With Gracilis Tendon Allograft. Arthrosc Tech 2019; 8:e1277-e1282. [PMID: 31890495 PMCID: PMC6926306 DOI: 10.1016/j.eats.2019.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/26/2019] [Indexed: 02/03/2023] Open
Abstract
Recurrent shoulder instability complicated by capsular insufficiency due to underlying soft-tissue disorders or multiple prior failed surgical procedures poses a challenging surgical problem. Traditional capsulolabral soft-tissue reconstruction techniques are less effective in this setting, and bony procedures sacrifice normal anatomic relations. The described arthroscopic technique aims to prevent instability while maintaining range of motion through creation of a soft-tissue allograft "sling" augmenting the posterior glenohumeral capsule.
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Prasathaporn N, Laohathaimongkol T, Umprai V, Kuptniratsaikul V. Arthroscopically Assisted Reduction in a Chronic Locked Posterior Shoulder Dislocation. Arthrosc Tech 2019; 8:e769-e774. [PMID: 31485405 PMCID: PMC6714613 DOI: 10.1016/j.eats.2019.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/13/2019] [Indexed: 02/03/2023] Open
Abstract
Neglected posterior shoulder dislocation is a difficult condition in terms of decision making and surgical technique. Not only the bony deformity but also the soft tissue and patient's underlying disease are of concern. Whether the poor results are associated with a time delay or the treatment method is not clear yet. To date, there is neither a consensus nor treatment guidelines. We describe an arthroscopically assisted reduction and open McLaughlin procedure. The advantage of this procedure is preservation of the soft tissue of the anterior part of the shoulder during the surgical reduction technique for chronic neglected posterior shoulder dislocation cases.
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Affiliation(s)
| | | | | | - Vanasiri Kuptniratsaikul
- Address correspondence to Vanasiri Kuptniratsaikul, M.D., Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, 290 Jermjomphol Rd, Sriracha Province, Chonburi, Thailand.
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40
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Aydin N, Enes Kayaalp M, Asansu M, Karaismailoglu B. Treatment options for locked posterior shoulder dislocations and clinical outcomes. EFORT Open Rev 2019; 4:194-200. [PMID: 31191987 PMCID: PMC6540946 DOI: 10.1302/2058-5241.4.180043] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Posterior dislocations are rare and diagnostically difficult injuries. Diagnosis is often delayed and this leads to a locked posteriorly dislocated humeral head. Treatment options include conservative methods and surgical anatomic reconstruction options as well as non-anatomic surgical procedures such as subscapularis tendon transfer, hemiarthroplasty and total shoulder arthroplasty. Decision-making for treatment as well as prognosis depend on the extent of the articular defect size of the humeral head, duration of the dislocation and patient-specific conditions such as age and activity levels. Cite this article: EFORT Open Rev 2019;4:194-200. DOI: 10.1302/2058-5241.4.180043
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Affiliation(s)
- Nuri Aydin
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Orthopaedics and Traumatology Department, Istanbul, Turkey
| | - Mahmut Enes Kayaalp
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Orthopaedics and Traumatology Department, Istanbul, Turkey
| | - Mustafa Asansu
- Baltalimani Bone Diseases Training and Research Hospital, Orthopaedics and Traumatology Department, Istanbul, Turkey
| | - Bedri Karaismailoglu
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Orthopaedics and Traumatology Department, Istanbul, Turkey
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41
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Arafa MS, Abdelbadie A. The dual subscapularis procedure: a modified Hawkins’ technique for neglected posterior fracture/dislocation of the shoulder. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:999-1007. [DOI: 10.1007/s00590-019-02417-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/16/2019] [Indexed: 11/28/2022]
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Zafra M, Uceda P, Ruiz-Bonilla C. Subtraction osteotomy of the humeral head in posterior shoulder dislocation: a case report. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:933-936. [PMID: 30693386 DOI: 10.1007/s00590-019-02388-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/17/2019] [Indexed: 11/28/2022]
Abstract
Locked posterior dislocations of the shoulder with an impacted fracture of the humeral head and an articular surface defect greater than 35-40% are generally treated with a femoral head bone graft or prosthesis. We present a case in which a subtraction osteotomy with osteoclasia on the impacted zone was performed to try to make the articular surface of the humeral head congruent and continuous. With a 42-month follow-up, the clinical outcome, in terms of mobility and pain, was very good; X-rays show there was no avascular necrosis of the humeral head nor signs of articular arthrosis. The aim of this work is to present a detailed description of our procedure, which can be a therapeutic option for this type of pathology.
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Affiliation(s)
- Manuel Zafra
- Instituto de Traumatología Cordobés, Avenida de la Arruzafilla S/N, 14011, Córdoba, Spain
| | - Pilar Uceda
- Reina Sofía University Hospital, Avda. Menéndez Pidal, 14004, Córdoba, Spain. .,, Isla Hierro St Number 14, 14011, Córdoba, Spain.
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Mirzayan R, Sherman B, Chahla J. Cryopreserved, Viable Osteochondral Allograft for the Treatment of a Full-Thickness Cartilage Defect of the Glenoid. Arthrosc Tech 2018; 7:e1269-e1273. [PMID: 30591873 PMCID: PMC6306272 DOI: 10.1016/j.eats.2018.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/05/2018] [Indexed: 02/03/2023] Open
Abstract
Glenoid chondral injuries constitute challenging injuries to treat because of the limited access and the limited options and evidence available for their resolution. The purpose of this Technical Note is to describe the procedure, pearls, and pitfalls of implantation of a cryopreserved osteochondral allograft (Cartiform) for the treatment of full-thickness cartilage defects of the shoulder. Cartiform is a cryopreserved osteochondral allograft composed of chondrocytes, chondrogenic growth factors, and extracellular matrix proteins that can be implanted through a single-stage procedure.
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Affiliation(s)
- Raffy Mirzayan
- Kaiser Permanente, Baldwin Park, California, U.S.A.,Address correspondence to Raffy Mirzayan, M.D., Kaiser Permanente, 1011 Baldwin Park Blvd, Baldwin Park, CA 91706, U.S.A.
| | - Benjamin Sherman
- Riverside University Health System, Moreno Valley, California, U.S.A
| | - Jorge Chahla
- Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, U.S.A
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44
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Takamura KM, Chen JB, Petrigliano FA. Nonarthroplasty Options for the Athlete or Active Individual with Shoulder Osteoarthritis. Clin Sports Med 2018; 37:517-526. [PMID: 30201166 DOI: 10.1016/j.csm.2018.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The management of glenohumeral osteoarthritis is difficult in young, active individuals. After nonoperative management fails, arthroscopic debridement with concomitant procedures (eg, loose body removal, capsular release, labral debridement, synovectomy, osteophyte resection, bursectomy, subacromial decompression, microfracture, and biceps tenotomy or tenodesis) to address potential pain generators may be an option in small, contained, unipolar lesions.
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Affiliation(s)
- Karren M Takamura
- Department of Orthopaedic Surgery, University of California Los Angeles, 10833 LeConte Avenue, 76-119 CHS, Los Angeles, CA 90095-6902, USA
| | - James B Chen
- Department of Orthopaedic Surgery, University of California Los Angeles, 10833 LeConte Avenue, 76-119 CHS, Los Angeles, CA 90095-6902, USA
| | - Frank A Petrigliano
- Department of Orthopaedic Surgery, University of California Los Angeles, 10833 LeConte Avenue, 76-119 CHS, Los Angeles, CA 90095-6902, USA.
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45
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Murphy L, Tucker A, Charlwood A. Fresh frozen femoral head osteochondral allograft reconstruction of the humeral head reverse hill sachs lesion. J Orthop 2018; 15:772-775. [PMID: 29946203 PMCID: PMC6014566 DOI: 10.1016/j.jor.2018.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/06/2018] [Indexed: 10/17/2022] Open
Affiliation(s)
- L.E. Murphy
- MRCS, Orthopaedic Registrar, Royal Victoria Hospital, Belfast, United Kingdom
| | - A. Tucker
- MRCS, Orthopaedic Registrar, Musgrave Park, Belfast, United Kingdom
| | - A.P. Charlwood
- FRCS, Consultant Orthopaedic Surgeon, Altnagelvin Area Hospital, Londonderry, United Kingdom
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46
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47
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Abstract
Articular cartilage defects are not often encountered in the glenohumeral joint. These lesions are typically found in patients with shoulder trauma, recurrent instability, or previous surgical treatment. Diagnosis can be difficult; these defects are often found incidentally during arthroscopic or open surgical management of other pathology. Initial management of isolated glenohumeral chondral defects is nonsurgical and includes physical therapy and/or corticosteroid injections. If nonsurgical treatment is unsuccessful, patients may undergo surgery. Because these lesions occur infrequently, few studies have documented surgical techniques and outcomes. Surgical strategies include arthroscopic débridement, microfracture surgery, osteochondral autograft or allograft transplantation, autologous chondrocyte implantation, and particulated juvenile allograft cartilage implantation.
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48
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Pavone V, Caruso VF, Chisari E, Mangano S, Costa D, Sessa G, Testa G. Surgical and Rehabilitative Treatment of Misdiagnosed Posterior Dislocation of the Shoulder: Case Series. J Funct Morphol Kinesiol 2018; 3:30. [DOI: 10.3390/jfmk3020030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2025] Open
Abstract
Background: Posterior gleno-humeral joint (GHJ) dislocation is a rare injury accounting for 2.7–3% of all shoulder dislocations. Early detection is the key for an effective treatment. Poor clinical outcomes or prosthetic solutions depend on the severity of the lesions at the time of trauma and worsening of the McLaughlin lesion during the months when the dislocation remains unrecognized or untreated. The aim of the study is to report our experience in treating, and clinically and radiographically evaluate the outcomes of, four neglected posterior GHJ dislocations. Methods: Four patients with inveterate posterior dislocation of the shoulder were evaluated. In three cases, the technique of McLaughlin was performed, and in one case, plication of the subscapularis tendon was performed. During the follow up, patients were clinically evaluated using the Constant shoulder score; an imaging investigation, using X-ray integrated with computed tomography(CT) and magnetic resonance imaging (MRI), was assessed. Results: Following the Constant criteria, treated shoulders reported an excellent outcome with an average score of 91. The mean score of untreated shoulders was 92.5. The humeral appearance that resulted was radiographically well-structured. Surgical treatment with McLaughlin lesion or transposition of the subscapularis were satisfactory from a subjective and objective point of view. To perform surgery soon as possible after the traumatic episode is considered a positive prognostic factor.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, AOU Policlinico-Vittorio Emanuele, University of Catania, 95100 Catania, Italy
| | - Vincenzo Fabrizio Caruso
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, AOU Policlinico-Vittorio Emanuele, University of Catania, 95100 Catania, Italy
| | - Emanuele Chisari
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, AOU Policlinico-Vittorio Emanuele, University of Catania, 95100 Catania, Italy
| | - Sebastiano Mangano
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, AOU Policlinico-Vittorio Emanuele, University of Catania, 95100 Catania, Italy
| | - Danilo Costa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, AOU Policlinico-Vittorio Emanuele, University of Catania, 95100 Catania, Italy
| | - Giuseppe Sessa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, AOU Policlinico-Vittorio Emanuele, University of Catania, 95100 Catania, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, AOU Policlinico-Vittorio Emanuele, University of Catania, 95100 Catania, Italy
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49
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Miyazaki AN, Silva LA, Sella GDV, Checchia CS, Simionato MC, Checchia SL. Articular reconstruction of the humeral head with autogenous allograft in the treatment of the osteonecrosis. Rev Bras Ortop 2018; 53:113-117. [PMID: 29367916 PMCID: PMC5771782 DOI: 10.1016/j.rboe.2017.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 12/15/2016] [Indexed: 11/16/2022] Open
Abstract
The authors describe a surgical biological reconstruction of the humeral head with frozen autogenous allograft technique for the treatment of young patients with focal osteonecrosis of the humeral head. This represents a possible alternative, maybe even definitive for some patients, when compared to hemiarthroplasty or total shoulder arthroplasty. The technique consists of the fixation of a frozen autogenous allograft with previously-molded articular cartilage from the humeral head, after cleansing the osteonecrotic focus. Five patients under 50 years of age were treated, with three very satisfactory results, one patient was lost to follow-up, and one patient had an unsatisfactory result (converted to hemiarthroplasty). The study describes the technique in detail and the three cases with a longer follow-up time.
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Affiliation(s)
- Alberto Naoki Miyazaki
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Luciana Andrade Silva
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Guilherme do Val Sella
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Caio Santos Checchia
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Marcos Cazer Simionato
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Sergio Luiz Checchia
- Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
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Yates JB, Choudhry MN, Waseem M. Managing Bony Defects of the Shoulder Joint that Occur in Association with Dislocation. Open Orthop J 2018; 11:1245-1257. [PMID: 29290863 PMCID: PMC5721330 DOI: 10.2174/1874325001711011245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/27/2017] [Accepted: 09/30/2017] [Indexed: 11/22/2022] Open
Abstract
Background Defects to the articular surface of the humeral head have been known to be associated with shoulder dislocation since the 19th century. It wasn't until 1934 that the first description of the ubiquitous compression fracture of the posterolateral humeral head that occurs with traumatic anterior instability appeared. From 1940, this defect became referred to as a Hill-Sachs lesion after the investigators who reported the condition. The significance of, and therefore treatment of, these and other such bony defects around the shoulder joint has been hotly debated. Methods We reviewed the available current literature to determine and report on the most up to date concepts and treatment techniques being used to manage bony defects of the shoulder. Results Numerous surgical options have been proposed to manage bony defects of the shoulder, including a variety of defect-filling procedures, with good outcomes. However, the small numbers and diversity of case mix makes for difficult comparisons. Conclusion We are currently developing a greater appreciation of how both the humeral and glenoid defects interact and therefore should be assessed and addressed simultaneously in order to improve patient outcomes. More research and collaboration is needed to determine the optimal method of assessing and managing these patients.
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Affiliation(s)
- Jonathan Brian Yates
- Blackpool Teaching Hospitals NHS Foundation Trust Ringgold standard institution - Trauma and Orthopaedics Blackpool, Blackpool, United Kingdom of Great Britain and Northern Ireland, UK
| | - Muhammad Naghman Choudhry
- Blackpool Teaching Hospitals NHS Foundation Trust Ringgold standard institution - Trauma and Orthopaedics Blackpool, Blackpool, United Kingdom of Great Britain and Northern Ireland, UK
| | - Mohammad Waseem
- Blackpool Teaching Hospitals NHS Foundation Trust Ringgold standard institution - Trauma and Orthopaedics Blackpool, Blackpool, United Kingdom of Great Britain and Northern Ireland, UK
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