Modified Latarjet Procedure Without Capsulolabral Repair for the Treatment of Failed Previous Operative Stabilizations in Athletes.

PURPOSE: To analyze time to return to sport, functional outcomes, and recurrences of the modified Latarjet procedure without capsulolabral repair in athletes with recurrent anterior shoulder instability after a failed previous operative stabilization. METHODS: We included athletes with recurrent anterior shoulder instability with a previous failed operative stabilization treated with the modified Latarjet procedure without capsulolabral repair with a minimum of 2-year follow-up. Return to sports, range of motion, the Rowe score, a visual analog scale for pain in sport activity, and the Athletic Shoulder Outcome Scoring System were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed with computed tomography. RESULTS: Between June 2008 and June 2015, 68 athletes were treated with the modified Latarjet procedure without capsulolabral reconstruction for recurrent shoulder instability after a previous failed stabilization surgery. The mean follow-up was 44 months (range, 24-108 months), and the mean age at the time of operation was 26.8 years (range, 17-35 years). All the patients returned to sports, and 95% returned to the same sport they practiced before the surgery, all to the same level. No significant difference in shoulder range of motion was found between preoperative and postoperative results. The Rowe score, visual analog scale, and Athletic Shoulder Outcome Scoring System showed statistical improvement after operation (P < .001). There was no recurrence of shoulder dislocation or subluxation. The bone block healed in 92% of patients. There were 8 complications (12.3%) and 2 reoperations (3%). CONCLUSIONS: In athletes with previous failed operative stabilization procedures, the modified Latarjet without capsulolabral repair produced excellent functional outcomes with most athletes returning to sport at the same level they had before the surgery without recurrences. LEVEL OF EVIDENCE: Level IV, therapeutic, case series study.

Modified Latarjet Without Capsulolabral Repair in Rugby Players With Recurrent Anterior Glenohumeral Instability and Significant Glenoid Bone Loss.

BACKGROUND: The optimal management of recurrent anterior shoulder instability with significant glenoid bone loss in high-demand collision athletes remains a challenge. PURPOSE: To analyze the time to return to sport, clinical outcomes, and recurrences following a modified Latarjet procedure without capsulolabral repair in rugby players with recurrent anterior shoulder instability and significant glenoid bone loss. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between June 2008 and June 2015, 50 competitive rugby players (practice >2 times per week and competition during weekends) with recurrent anterior shoulder instability underwent operation with the modified congruent arc Latarjet procedure without capsulolabral repair in our institution. Cases included 18 primary repairs and 32 revisions. Return to sports, range of motion (ROM), the Rowe score, a visual analog scale for pain in sport activity (VAS), and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed with computed tomography. The final analysis included 49 shoulders in 48 patients (31 revision cases). RESULTS: The mean follow-up was 48 months (range, 24-108 months) and the mean age at the time of operation was 22.8 years (range, 17-35 years). Forty-five patients (93.7%) returned to playing rugby, all at their preinjury level of play. No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe, VAS, and ASOSS scores showed statistically significant improvement after operation ( P < .001). The Rowe score increased from a mean of 39.5 points preoperatively to 94 points postoperatively ( P < .01). The VAS score decreased from 3.6 points preoperatively to 1.2 points postoperatively ( P < .01). The ASOSS score improved significantly from a mean of 44 points preoperatively to 89.5 points postoperatively ( P < .01). No recurrence of shoulder dislocation or subluxation was noted. The bone block healed in 43 shoulders (88%). CONCLUSION: In rugby players with recurrent anterior shoulder instability and significant glenoid bone loss, the modified Latarjet procedure without capsulolabral repair produced excellent functional outcomes, with most athletes returning to rugby at their preinjury level of play without recurrences.

Comparison Between Modified Latarjet Performed as a Primary or Revision Procedure in Competitive Athletes: A Comparative Study of 100 Patients With a Minimum 2-Year Follow-up.

BACKGROUND: The literature lacks evidence comparing outcomes between the Latarjet procedure performed as a primary procedure versus a revision procedure in competitive athletes. PURPOSE: To compare return to sport, functional outcomes, and complications of the modified Latarjet performed as a primary or revision procedure in competitive athletes. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Between June 2008 and June 2015, a total of 100 competitive athletes with recurrent anterior shoulder instability underwent surgery with the congruent arc Latarjet procedure without capsulolabral repair. There were 46 patients with primary repairs and 54 with revisions. Return to sport, range of motion (ROM), the Rowe score, a visual analog scale (VAS) for pain in sport activity, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed by computed tomography. RESULTS: The mean follow-up period was 58 months (range, 24-108 months). A total of 96 patients (96%) returned to competitive sports; 91% returned to their preinjury level of play. No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe, VAS, and ASOSS scores showed statistically significant improvements after surgery (P < .001). The Rowe score increased from a preoperative mean of 43.8 to a postoperative mean of 96.1 (P < .01). Subjective pain during sports improved from a preoperative VAS score of 3.3 to a postoperative score of 1.2 (P < .01). The ASOSS score improved significantly from a preoperative mean of 46.3 to a postoperative mean of 88.1 (P < .001). No significant differences in shoulder ROM and functional scores were found between patients who underwent a primary versus a revision procedure. No recurrence of shoulder dislocation or subluxation was noted. The bone block healed in 91 patients (91%). CONCLUSION: In competitive athletes with recurrent anterior glenohumeral instability, the modified Latarjet procedure produced excellent functional outcomes, with most athletes returning to sport at the same level they had before surgery and without recurrence, regardless of whether the surgery was performed as a primary or a revision procedure.

Arthroscopic Stabilization After a First-Time Dislocation: Collision Versus Contact Athletes.

BACKGROUND: There is no universally accepted definition of "contact" or "collision" sports in the literature. The few available studies evaluating contact and collision sports consider them to be synonymous. However, athletes in collision sports purposely hit or collide with each other or with inanimate objects with greater force and frequency than in contact sports, which could jeopardize functional outcomes. PURPOSE: To compare the functional outcomes, return to sports, and recurrences in a series of contact and collision athletes with a first-time anterior shoulder dislocation treated using arthroscopic stabilization with suture anchors. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 56 athletes were enrolled in this study, including 22 contact athletes and 34 collision athletes. All athletes underwent arthroscopic shoulder stabilization using suture anchors. Range of motion, the Rowe score, a visual analog scale (VAS) for pain, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Return to sports and recurrences were also evaluated. RESULTS: The mean age at the time of surgery was 22.2 years, and the mean follow-up was 62.4 months (range, 36-94 months). No significant difference in shoulder motion was found between preoperative and postoperative results or between the contact and collision groups. The Rowe, VAS, and ASOSS scores showed statistical improvement in both groups after surgery (P = .001). Patients in the contact group returned to sports significantly faster than those in the collision group (5.2 vs 6.9 months, respectively; P = .01). In all, 43 athletes (76.8%) returned to near-preinjury sports activity levels (≥90% recovery) after surgery: 86.4% of patients in the contact group and 70.6% in the collision group (P = .04). The total recurrence rate was 8.9%. There were 5 recurrences (14.7%) in the collision group and no recurrences in the contact group (P < .01). CONCLUSION: Arthroscopic stabilization for anterior instability of the shoulder is a reliable procedure with respect to shoulder function, range of motion, and postoperative return to sports in contact and collision athletes. Compared with the contact group (0%), the collision group yielded a higher failure rate (14.7%). Moreover, patients in the contact group returned significantly faster (5.2 vs 6.9 months, respectively) and to and more returned to preinjury or near-preinjury activity levels (86.4% vs 70.6% of patients, respectively) than patients in the collision group.

Return to Sports and Recurrences After Arthroscopic Anterior Shoulder Stabilization in Martial Arts Athletes.

BACKGROUND: The high demands to the glenohumeral joint and the violent shoulder blows experienced during martial arts (MA) could compromise return to sports and increase the recurrence rate after arthroscopic stabilization for anterior shoulder instability in these athletes. PURPOSE: To report the functional outcomes, return to sports, and recurrences in a series of MA athletes with anterior shoulder instability treated with arthroscopic stabilization with suture anchors. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 20 consecutive MA athletes were treated for anterior shoulder instability at a single institution between January 2008 and December 2013. Range of motion (ROM), the Rowe score, a visual analog scale (VAS), and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Return-to-sport and recurrence rates were also evaluated. RESULTS: The mean age at the time of surgery was 25.4 years (range, 18-35 years), and the mean follow-up was 71 months (range, 36-96 months). No significant difference in preoperative and postoperative shoulder ROM was found. The Rowe, VAS, and ASOSS scores showed statistical improvement after surgery (P < .001). In all, 19 athletes (95%) returned to sports. However, only 60% achieved ≥90% recovery after surgery. The recurrence rate was 20%. CONCLUSION: In this retrospective study of a consecutive cohort of MA athletes, arthroscopic anterior shoulder stabilization significantly improved functional scores. However, only 60% of the athletes achieved the same level of competition, and there was a 20% recurrence rate.

Arthroscopic in Situ Repair of Partial Bursal Rotator Cuff Tears Without Acromioplasty.

PURPOSE: To evaluate functional outcomes and complications in a consecutive group of patients with partial bursal rotator cuff tears (PBRCTs) treated with insitu repair without acromioplasty. METHODS: Seventy-four patients who had undergone an arthroscopic single row in situ repair for bursal-sided rotator cuff tears were evaluated. Clinical assessment consisted of glenohumeral range of motion measurement, the American Shoulder and Elbow Surgeons score, and the University of California at Los Angeles score. Pain was recorded using a visual analog scale. Postoperative complications were also assessed. RESULTS: Mean age was 55.2 years (±6.3) with a minimum of 2-year follow-up. After arthroscopic repair, all active range of motion parameters improved significantly (P < .0001). The American Shoulder and Elbow Surgeons scores improved from 42.5 to 86.1; the University of California at Los Angeles scores improved from 15.8 to 31.4, and the visual analog scale scores improved from 6.6 to 0.7 (P < .0001). Only 3 patients developed a postoperative adhesive capsulitis that responded to physical therapy. CONCLUSIONS: In the midterm follow-up (42 months), arthroscopic in situ repair of PBRCTs without acromioplasty is a reliable procedure that produces significant functional improvements and pain relief. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Minimally Invasive Double-Button Fixation of Displaced Lateral Clavicular Fractures in Athletes.

BACKGROUND: Early union and a rapid return to prior function are the priorities for young athletes with lateral clavicular fractures. Furthermore, it is essential to avoid nonunion in this subgroup of patients, as this is frequently associated with persistent pain, restriction of movement, and loss of strength and endurance of the shoulder. PURPOSE: To analyze the time to return to sport, functional outcomes, and complications in a group of athletes with displaced lateral clavicular fractures treated using closed reduction and minimally invasive double-button fixation. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 21 athletes with displaced lateral clavicular fractures were treated with closed reduction and minimally invasive double-button fixation between March 2008 and October 2013. Patients completed a questionnaire focused on the time to return to sport and treatment course. Functional outcomes were assessed with the Constant score and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Pain was evaluated with the visual analog scale (VAS). Radiographs were reviewed to identify radiographic union, malunion, and nonunion. RESULTS: Of the 21 study patients, 20 returned to sport after treatment; 100% returned to the same level. The mean time to return to play was 78 days (range, 41-120 days). Four patients (20%) returned to sport less than 6 weeks after surgery, 14 (70%) returned between 6 and 12 weeks after surgery, and 2 (10%) returned after 12 weeks. The mean Constant score was 89.1 ± 4.2 (range, 79-100), the mean QuickDASH score was 0.4 ± 2.6 (range, 0-7.1), and the mean VAS pain score was 0.4 ± 1.0 (range, 0-3) at final follow-up (mean, 41 months). The only complication was asymptomatic nonunion. Hardware removal was not necessary in any patient. CONCLUSION: Closed reduction and minimally invasive double-button fixation of displaced lateral clavicular fractures in athletes was successful in terms of returning to the previous level of athletic activity regardless of the type of sport, with excellent clinical results and a low rate of complications.

Return to Sports After Arthroscopic Treatment of Rotator Cuff Calcifications in Athletes.

BACKGROUND: Arthroscopic treatment of calcific deposits of rotator cuff tears has been described with successful results in the general population. However, despite the high frequency of this condition, there is no information in the literature regarding arthroscopic treatment of rotator cuff calcifications in athletes. PURPOSE: To analyze the time to return to sport, clinical outcomes, and complications of complete arthroscopic removal of intratendinous calcific deposits and repair of the tendon lesion without acromioplasty in athletes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: This study retrospectively evaluated 24 consecutive patients with a mean age of 36.2 years. The mean follow-up was 59 months (range, 24-108 months). Patients completed a questionnaire focused on the time to return to sport and treatment course. Pre- and postoperative functional assessment was performed using the Constant score and University of California Los Angeles (UCLA) score. Pain was assessed by visual analog scale (VAS). Radiographs and magnetic resonance imaging (MRI) were performed to evaluate the recurrence of calcifications and the indemnity of the supraspinatus tendon repair. RESULTS: Of the 24 patients, 23 (95.8%) were able to return to sports; 91.3% returned to the same level. The mean time to return to play was 5.3 months (range, 3-9 months): 26% of patients (6/23) returned to sports in less than 4 months, 61% (14/24) returned between 4 and 6 months, and 13% (3/24) returned after the sixth month. The mean Constant score increased from 26.9 preoperatively to 89.7 postoperatively (P < .001), and the UCLA score increased from 17.3 preoperatively to 33.2 postoperatively (P < .001). Significant improvement was obtained for pain (mean VAS, 8.4 [before surgery] vs 0.6 [after]; P < .001). The overall majority (91.6%) of patients were satisfied with their result. MRI examination at last follow-up (79% of patients) showed no tendon tears. CONCLUSION: In athletes with calcifying tendinitis of the supraspinatus tendon with failed nonoperative treatment, complete arthroscopic removal of calcific deposits and tendon repair without acromioplasty results in significant pain relief and improvement in functional outcomes. Most patients return to the same level of proficiency regardless of the type of sport and the level of competition before injury, with 91.6% of patients satisfied with their results.

Corticosteroid Injections Accelerate Pain Relief and Recovery of Function Compared With Oral NSAIDs in Patients With Adhesive Capsulitis: A Randomized Controlled Trial.

BACKGROUND: Intra-articular corticosteroid injection is a common therapy for adhesive capsulitis, but there is a lack of prospective randomized controlled studies analyzing the efficacy of single injections applied blindly to accelerate improvement in pain and function. HYPOTHESIS: In patients with adhesive capsulitis, a single intra-articular corticosteroid injection without image control applied before the beginning of a physical therapy program will accelerate pain relief and recovery of function compared with oral nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 74 patients with primary adhesive capsulitis in the freezing stage were randomized to receive either intra-articular injections with betamethasone or oral NSAIDs. Clinical outcome was documented at baseline and after 2, 4, 8, and 12 weeks and comprised a visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) Shoulder Score, the abbreviated Constant-Murley score, and the abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) score for function. Passive range of motion was measured with a goniometer. RESULTS: Patients treated with corticosteroid injections achieved faster pain relief compared with control patients during the first 8 weeks after treatment (P < .001). However, no significant difference in pain was observed among the groups at final follow-up. Likewise, shoulder function and motion improved significantly in both groups at all follow-up points. Shoulder function scores and most motion parameters improved faster in the injection group up to week 8 (P < .001). Again, no significant differences in function or motion were seen at final follow-up. CONCLUSION: In patients with adhesive capsulitis, a single corticosteroid injection applied without image control provides faster pain relief and earlier improvement of shoulder function and motion compared with oral NSAIDs.

Case reports: heritable thrombophilia associated with deep venous thrombosis after shoulder arthroscopy.

Thromboembolic complications after shoulder arthroscopy are rare and their cause has not been well determined. Heritable thrombophilia has been studied in relation to numerous clinical conditions, and it has been associated with thromboembolic complications after some orthopaedic surgeries, especially after total hip or knee arthroplasty. We report three patients who had deep vein thrombosis develop after shoulder arthroscopy. All three tested positive for heritable thrombophilia, a condition undetected until this complication occurred. This report highlights the possibility that unrecognized coagulation disorders might seriously influence the clinical outcome of minimally invasive surgery. We suggest heritable thrombophilia is a possible risk factor for or etiology of deep vein thrombosis after shoulder arthroscopy.

Inestabilidad postraumática de hombro / Postraumatic instability of shoulder

El presente trabajo tiene como objetivo determinar el mejor tratamiento quirúrgico para la inestabilidad postraumática anterior recidivante del hombro. Para ello se analizaron los principales factores estabilizadores del hombro y su compromiso según los distintos investigadores, encontrando que la lesión del labrum (lesión de Bankart) y la lesión capsuloligamentaria son los más frecuentes e importantes. Se evaluaron 96 hombros operados con diagnóstico de inestabilidad postraumática anterior recidivante con un seguimiento promedio de 44 meses. El 44 por ciento de los hombros eran laxos, asintomáticos antes del traumatismo. En todos los casos el tratamiento consistió en la plicatura capsular anterior con deslizamiento oblicuo o capsular shift y reparación de la lesión de Bankart encontrada en el 51 por ciento de los hombros operados. Según Score de Rowe modificado, los resultados fueron excelentes en 75 hombros (78.1 por ciento), buenos en 13 (13.5 por ciento), regulares en 3 (3.1 por ciento) y malos en 5 (5.2 por ciento). El ínidice de recidiva postoperatorio fue de 5.2 por ciento. A partir del análisis de los mecanismos fisiopatológicos causantes de la inestabilidad (lesión capsular y del labrum) se concluye que las técnicas de reparación labral, capsular y ligamentaria -entre otras, la técnica utilizada- demuestran ser las más racionales para resolver la causa del problema. A la luz del análisis de nuestros resultados clínicos y comparando con los de otros procedimientos publicados se infiere que la plicatura capsular con reparación del labrum a cielo abierto, se destaca entre las técnicas más efectivas. Recomendamos este procedimiento en el tratamiento de las inestabilidades postraumáticas anteriores recidivantes del hombro.

Inestabilidad postraumática de hombro / Postraumatic instability of shoulder

El presente trabajo tiene como objetivo determinar el mejor tratamiento quirúrgico para la inestabilidad postraumática anterior recidivante del hombro. Para ello se analizaron los principales factores estabilizadores del hombro y su compromiso según los distintos investigadores, encontrando que la lesión del labrum (lesión de Bankart) y la lesión capsuloligamentaria son los más frecuentes e importantes. Se evaluaron 96 hombros operados con diagnóstico de inestabilidad postraumática anterior recidivante con un seguimiento promedio de 44 meses. El 44 por ciento de los hombros eran laxos, asintomáticos antes del traumatismo. En todos los casos el tratamiento consistió en la plicatura capsular anterior con deslizamiento oblicuo o capsular shift y reparación de la lesión de Bankart encontrada en el 51 por ciento de los hombros operados. Según Score de Rowe modificado, los resultados fueron excelentes en 75 hombros (78.1 por ciento), buenos en 13 (13.5 por ciento), regulares en 3 (3.1 por ciento) y malos en 5 (5.2 por ciento). El ínidice de recidiva postoperatorio fue de 5.2 por ciento. A partir del análisis de los mecanismos fisiopatológicos causantes de la inestabilidad (lesión capsular y del labrum) se concluye que las técnicas de reparación labral, capsular y ligamentaria -entre otras, la técnica utilizada- demuestran ser las más racionales para resolver la causa del problema. A la luz del análisis de nuestros resultados clínicos y comparando con los de otros procedimientos publicados se infiere que la plicatura capsular con reparación del labrum a cielo abierto, se destaca entre las técnicas más efectivas. Recomendamos este procedimiento en el tratamiento de las inestabilidades postraumáticas anteriores recidivantes del hombro. (AU)