A cadaveric study of the posterior band of the inferior glenohumeral ligament of the shoulder and its dynamic behaviour in different arm positions.

Purpose: The inferior glenohumeral ligament (IGHL) is composed of three parts: the anterior branch or band (AB), the axillary pouch and the posterior band (PB). The latter has rarely been studied. We aim to describe the PB of the IGHL and its dynamic behaviour in different arm positions. Methods: Twelve fresh cadaveric shoulders were used and the two bands (AB and PB) of the IGHL were dissected and isolated, taking away all muscle, ligaments and capsule. Characteristics of the bands were studied in five positions: maximum external rotation (ER1), abduction (ABD), internal rotation (IR), ABD external rotation (ER2) and anterior elevation-adduction-IR (Hawkins-Kennedy test position). Progressive and randomized sectioning of the bands and capsule with a scalpel was performed to study its impact on mobility and translation of the glenohumeral joint. Results: The bands that tensioned first were in ER1, the AB at 97 ± 9° (80-110); in ER2, the AB at 81 ± 19° (30-100); in IR, the PB at 64 ± 9° (50-80); and in ABD, the PB at 87 ± 10° (70-105). Isolated sectioning of the AB had no effect on ABD, whilst isolated sectioning of the PB allowed greater ABD. In ER2, the AB limited anterior translation. After sectioning the AB, anterior translation remained limited by the PB, which wrapped around the humeral head and locked the joint by pressing the two joint surfaces tightly together. In Hawkins-Kennedy position anterior elevation-adduction-IR, the AB is the first constraint and the posterior translation was limited by the PB alone only in four cases. Conclusions: When the IGHL is isolated, ligament limitation of glenohumeral ABD seems to be uniquely dependent on the PB. In the Hawkins and Kennedy position, the AB is the first constraint. In the case of an isolated lesion to the AB, the PB participates in anterior stabilization of the shoulder by wrapping around the humeral head that cannot dislocate. These findings confirm the role of the PB in glenohumeral joint stability. Level of Evidence: Level IV.

Arthroscopic Latarjet yields better union and prevention of instability compared to arthroscopic bony Bankart repair in shoulders with recurrent anterior instability: a systematic review.

PURPOSE: To determine whether arthroscopic Latarjet procedure or arthroscopic bony Bankart repair provide better outcomes in terms of rates of recurrent instability, non-union and complications, as well as clinical scores and range of motion. METHODS: An electronic literature search was performed using PubMed, Embase®, and Cochrane databases, applying the following keywords: "Arthroscopic bony Bankart" OR "Arthroscopic osseous Bankart" AND "Arthroscopic Latarjet" OR "Arthroscopic coracoid bone block". RESULTS: The systematic search returned 1465 records, of which 29 were included (arthroscopic bony Bankart repair, n = 16; arthroscopic Latarjet, n = 13). 37 datasets were included for data extraction, on 1483 shoulders. Compared to arthroscopic Latarjet, arthroscopic bony Bankart repair had significantly higher instability rates (0.14; CI 0.10-0.18; vs 0.04; CI 0.02-0.06), significantly lower union rates (0.63; CI 0.28-0.91 vs 0.98; CI 0.93-1.00), and significantly lower pain on VAS (0.42; CI 0.17-0.67 vs 1.17; CI 0.96-1.38). There were no significant differences in preoperative glenoid bone loss, follow-up, complication rate, ROWE score, ASES score, external rotation, and anterior forward elevation between arthroscopic Latarjet and arthroscopic bony Bankart repair. CONCLUSION: Compared to arthroscopic Latarjet, arthroscopic bony Bankart repair results in significantly (i) higher rates of recurrent instability (14% vs 4%), (ii) lower union rates (63% vs 98%), but (iii) slightly lower pain on VAS (0.45 vs 1.17). There were no differences in complication rates, clinical scores, or postoperative ranges of motion. LEVEL OF EVIDENCE: IV.

Outcomes After Open Latarjet in Patients With or Without SLAP Lesions.

Background: Up to 20% of shoulders with anterior instability are associated with superior labrum anterior-posterior (SLAP) lesions, and they remain untreated after an open Latarjet procedure. SLAP lesions can be responsible for pain and feelings of instability in high-demand patients. Purpose/Hypothesis: The aim of this study was to compare the early functional outcomes and return to sport rates in athletes after the Latarjet procedure with versus without associated SLAP lesions. It was hypothesized that untreated SLAP lesions would not influence clinical results. Study Design: Cohort study; Level of evidence, 3. Methods: Inclusion criteria were athletes with anterior shoulder instability treated with Latarjet procedure, a minimum follow-up of 1 year, and an available preoperative computed tomography arthrogram. We recorded patient characteristics; type of sport; bone loss; Rowe, Single Assessment Numeric Evaluation (SANE), and 11-item Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores; 5-point pain and satisfaction scores; reported apprehension; and return to sport. Patients with and without a preoperative type 5 SLAP lesion on imaging were compared. Results: Fifty patients were included (mean age, 22 ± 5 years [range, 16-36 years]; mean follow-up, 27 ± 9 months [range, 12-42 months]). Thirty-four patients practiced contact sports, including 20 rugby players. Twelve patients (24%) had a preoperative SLAP lesion. Groups with (+) and without (-) a SLAP lesion were comparable in terms of age, sex, number of instability episodes, type of sport, and glenoid and humeral bone loss. The SLAP+ group had significantly worse outcomes with a lower Rowe score (79 ± 23 vs 91 ± 15; P = .018) and painless rate (50% vs 77%; P = .04). There were no significant differences between the groups in SANE score (SLAP+ vs SLAP-: 80% vs 87%), QuickDASH score (8% vs 8%), return to sport (83% vs 91%), apprehension (79% vs 50%), and reported satisfaction. There was 1 episode of postoperative subluxation in each group. Conclusion: Patients who underwent an open Latarjet procedure with an associated SLAP tear more frequently reported postoperative pain than those without a SLAP lesion. Patients with untreated SLAP tears had significantly lower Rowe scores, although SANE score and return to sport were not significantly different between the groups.

A new self-assessment tool following shoulder stabilization surgery, the auto-Walch and auto-Rowe questionnaires.

PURPOSE: Patient-reported outcome measures (PROMS) are increasingly used for patient evaluation, as well as for scientific research. Few are used for practical purposes in the clinical setting, and few are reliable enough to allow proper feedback to physicians. Two of the most commonly used assessment tools in shoulder instability are the Walch-Duplay and the Rowe scores. The aim of this study was to evaluate the validity of self-administered versions of the Walch-Duplay and Rowe scores following shoulder stabilization procedure. METHODS: Between the months of May and December 2021, all patients who were followed in one of six institutions for shoulder instability were included. Patients were required to anonymously fill a self-administered version of Walch-Duplay and Rowe score. The classic scores were measured by the surgeon. Correlations between self-assessment and physician-assessment were then recorded. RESULTS: A total of 106 patients were evaluated during the study period. Using the Spearman coefficient for correlation, a strong correlation (r > 0.5) was found between the results of the self-administered questionnaire and the surgeon-measured score. The difference between surgeon- and patient-administered questionnaires was non-significant. CONCLUSION: The self-administered version of the Walch-Duplay and Rowe questionnaires can reliably be used in the clinical setting for post-operative follow-up of patients undergoing shoulder stabilization procedures. LEVEL OF EVIDENCE: Level II.

How much acromial bone should be removed to decrease the critical shoulder angle? A 3D CT acromioplasty planning study.

BACKGROUND: A high critical shoulder angle (CSA) is associated with rotator cuff tear (RCT) and retear rate after repair. CSA reduced to less than 33° by acromioplasty is correlated with better clinical results and healing. But up to 24% of patients retain a CSA above 35° after acromioplasty. The objective of the study was to evaluate the use of 3D when planning acromioplasty and measure acromial bone removal volume dimensions. METHODS: Computed tomography (CT) scans from 45 patients with RCT and CSA ≥ 38° were retrospectively included. A 33° CSA cutting plane was positioned. Acromion was divided into 5 mm slices and acromial bone resection measured on each slice. RESULTS: Intra- and inter-observer reproducibility measurements were rated strong or very strong. Patients' mean preoperative CSA was 40° (38°, 49° ± 2.3°). Measurements of acromial resection were: anteroposterior length: 32.7 mm (20, 50 ± 7.4); inferior width: 7.6 mm (4.2, 19 ± 2.9); superior width: 4.1 mm (0, 16 ± 3.0); height: 6.1 mm (1.7, 6.7 ± 1.6); and cutting angle: 74° (46, 91 ± 8.0). Maximum width of acromial resection was located 10.6 mm (5, 17.5 ± 0.6) from the acromion's anterior edge and decreased gradually moving posteriorly. Preoperative CSA was linearly correlated with width (P < 0.0001, R = 84%) and length (P = 0.0001, R = 28%) of acromioplasty; the higher the CSA, the greater the width and length. CONCLUSIONS: 3D CT reconstructions are valid for planning a CSA decreasing acromioplasty. To reduce CSA to 33°, acromioplasty must be performed anterolaterally and resection is at least 2 cm long anteroposteriorly. For higher CSAs, acromioplasty may require lateral resection over 1 cm in width and up to 5 cm in length. To decrease the CSA efficiently, acromioplasty must be adapted to patient anatomy and 3D planning could be considered. LEVEL OF EVIDENCE: IV.

Quantification of acromioplasty. Systematic review of the literature.

INTRODUCTION: Acromioplasty is controversial. Technically, it consists in bone resection, but there is no gold-standard technique and resection is often not quantified. The aims of the present study were 1/to assess the methodological quality of studies of acromioplasty; 2/to identify reports in which acromioplasty was quantified; and 3/to assess any correlation between clinical results and resection quantity. MATERIAL AND METHODS: A systematic literature review was performed on PRISMA criteria in the PubMed, Springer and Ovid databases, including all articles in French or English referring to acromioplasty. Articles were analyzed by 2 surgeons and those with complete procedural description were selected. 1/Methodology was assessed on 3 grades according to aim of acromioplasty, intraoperative assessment of resection, and postoperative radiologic assessment. 2/Results were extracted from articles with robust methodology and quantitative data. 3/Correlations were assessed between clinical results and resection quantity. RESULTS: Out of the 250 articles retrieved, 94 were selected. 1/44 of these (47%) specified the aim of the acromioplasty, 53 (56%) included an intraoperative clinical assessment criterion, and 13 (14%) included postoperative radiographic assessment. Methodologic quality was insufficient in 33 articles (35%), poor in 23 (24%) and robust in 38 (40%). 2/Seven articles (7.5%) included quantitative results. 3/Three articles assessed correlation between clinical results and resection quantity, but only 1 used reproducible radiographic assessment by critical shoulder angle (CSA); this study reported a significant positive correlation between clinical results and decreased CSA. CONCLUSION: Methodology in studies of acromioplasty was largely insufficient and resection was usually not quantified. Current data to assess the usefulness of the procedure are sparse. We advocate including a Checklist for Acromioplasty Studies in the methodology of future studies. There is at present no gold-standard for assessing and quantifying acromial resection. CSA seems contributive, but other methods might be worth developing. LEVEL OF EVIDENCE: IV; systematic review of level 1-4 studies.

Critical shoulder angle: what do radiologists need to know?

The critical shoulder angle (CSA) constitutes a straightforward and highly reproducible tool. Degenerative rotator cuff tears (RCT) are associated with a significantly larger CSA. In this review, the most relevant features of the CSA are summarized: (1) the relationship between the CSA and RCT pathophysiology, (2) accurate measurement of the CSA according to various imaging modalities, (3) the contribution of the CSA in predicting the occurrence of RCT, and (4) RCT recurrence after surgical repair.

Does the critical shoulder angle decrease after anterior acromioplasty?

INTRODUCTION: No clinical studies to date have analyzed the critical shoulder angle (CSA) following anterior acromioplasty. Our study's main objective was to measure the change in the CSA after acromioplasty. MATERIALS AND METHODS: Ninety patients were included in this retrospective series. The CSA and the type of acromion were evaluated before and after surgery. RESULTS: The average CSA for patients before surgery was 35.9° (± 3.7, 26.2, 44.2) and 33° after the acromioplasty (± 3.5, 24.8, 41.4). The decrease was significant and 2.9° on average (± 2.2, - 2.2, 11.9, p = 0.000). Preoperatively, 58% of patients had a CSA ≥ 35° (n = 52) and 24% postoperatively (n = 22, p = 0.000). CONCLUSIONS: Standardized anterior acromioplasty allows for a significant decrease in the CSA without lateral resection of the acromion. This study confirms the tight link between the CSA and the anterior acromion as well as the interest of this angle to quantify acromioplasty whether anterior or lateral. LEVEL OF EVIDENCE: Level IV, Case Series, Retrospective design.

Long-term results with Bankart procedure: a 26-year follow-up study of 50 cases.

BACKGROUND: The purpose of this study was to evaluate the long-term outcome (>20 years) of patients who underwent an open Bankart procedure, many of them contact athletes, in terms of shoulder stability, return to sport, and the development of osteoarthritis. METHODS: We retrospectively reviewed 49 patients (50 shoulders) who underwent an open Bankart procedure for recurrent shoulder instability. There were 36 contact athletes (73%) in this cohort. Mean follow-up was 28 years (25-32). Clinical examination was performed by an independent reviewer, with standard shoulder radiographs obtained. RESULTS: Eight patients had recurrence of dislocation after a new traumatic episode, in six cases while playing rugby, with two of them requiring re-operation. Forty (82%) patients returned to their previous level of sports activities, including all 31 rugby players. No statistically significant loss of motion occurred in this group, although there was slight loss of flexion (6 degrees ) and external rotation (9 degrees ). The mean Rowe score at final follow-up was 82 (25-97), and all but two patients considered themselves satisfied with the results of the surgery. Thirty-four (69%) patients showed signs of osteoarthritis at follow-up, as follows: Stage 1 -18, Stage 2 - 5, Stage 3 - 5, and Stage 4 - 1. CONCLUSION: At long-term follow-up, patients undergoing an open Bankart procedure for recurrent shoulder instability obtained a high percentage of shoulder stability, and reliably returned to high-level sports activities. However, 69% did show radiographic signs of osteoarthritis.