Advertisement

Soft-Tissue Procedures: Indications

  • Ladislav KovačičEmail author
Chapter
  • 44 Downloads

Abstract

The surgical treatment of anterior shoulder instability includes various open and arthroscopic surgical techniques. Soft-tissue procedures can be successful treatment options for patients with predominant soft-tissue lesions. The results in terms of stability after the surgical procedure in these cases can be comparable to other surgical procedures such as stabilization using bone block or coracoid transfer. Identification of risk factors that can influence the outcome is of the utmost importance. Among these, the most important factor is the bony status of the glenoid and humeral head. In the absence of important bony injuries, including a bony Bankart lesion and a Hill–Sachs lesion, soft-tissue procedures are frequently successful. Additional important factors that should be taken into account in the surgeon’s decision-making process are shoulder laxity, underlying lesions, concomitant shoulder injuries, and the presence and quantity of instability events that predispose the quality of the soft tissue, especially the capsule and ligaments. To better describe and illustrate diagnostic process in the patients with anterior shoulder instability, some scenarios from clinical practice are used, showing the author’s preferred choice of treatment.

Keywords

Anterior shoulder instability Arthroscopic treatment Soft-tissue procedures Soft-tissue stabilization Decision making 

References

  1. 1.
    Boileau P, Villalba M, Héry JY, Balg F, Ahrens P, Neyton L. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am. 2006;88:1755–63.CrossRefGoogle Scholar
  2. 2.
    Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill–Sachs lesion. Arthroscopy. 2000;16:677–94.CrossRefGoogle Scholar
  3. 3.
    Lee SH, Lim KH, Kim JW. Risk factors for recurrence of anterior-inferior instability of the shoulder after arthroscopic Bankart repair in patients younger than 30 years. Arthroscopy. 2018;34:2530–6.CrossRefGoogle Scholar
  4. 4.
    Nakagawa S, Mae T, Sato S, Okimura S, Kuroda M. Risk factors for the postoperative recurrence of instability after arthroscopic Bankart repair in athletes. Orthop J Sports Med. 2017;5:2325967117726494.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Porcellini G, Campi F, Pegreffi F, Castagna A, Paladini P. Predisposing factors for recurrent shoulder dislocation after arthroscopic treatment. J Bone Joint Surg Am. 2009;91:2537–42.CrossRefGoogle Scholar
  6. 6.
    Voss JE, Livermore RW, Feeley BT, Altcheck DW, Williams RJ, Warren RF, Cordasco FA, Allen AA, HSS Sports Medicine Service. Prospective evaluation of arthroscopic Bankart repairs for anterior instability. Am J Sports Med. 2010;38:302–7.CrossRefGoogle Scholar
  7. 7.
    Hovelius L, Augustini BG, Fredin H, Johansson O, Norlin R, Thorling J. Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study. J Bone Joint Surg. 1996;78:1677–84.CrossRefGoogle Scholar
  8. 8.
    Dumont GD, Russell RD, Robertson WJ. Anterior shoulder instability: a review of pathoanatomy, diagnosis and treatment. Curr Rev Musculoskelet Med. 2011;4:200–7.CrossRefGoogle Scholar
  9. 9.
    Lippitt S, Matsen F. Mechanisms of glenohumeral joint stability. Clin Orthop Relat Res. 1993;291:20–8.Google Scholar
  10. 10.
    Olds M, Ellis R, Donaldson K, Parmar P, Kersten P. Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis. Br J Sports Med. 2015;49:913–22.CrossRefGoogle Scholar
  11. 11.
    Balg F, Boileau P. The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilization. J Bone Joint Surg Br. 2007;89:1470–7.CrossRefGoogle Scholar
  12. 12.
    Milano G, Grasso A, Russo A, Magarelli N, Santagada DA, Deriu L, Baudi P, Bonomo L, Fabricciani C. Analysis of risk factors for glenoid bone defect in anterior shoulder instability. Am J Sports Med. 2011;39:1870–6.CrossRefGoogle Scholar
  13. 13.
    Randelli P, Ragone V, Carminati S, Cabitza P. Risk factors for recurrence after Bankart repair: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2012;20:2129–38.CrossRefGoogle Scholar
  14. 14.
    Rouleau DM, Hébert-Davies J, Djahangiri A, Godbout V, Pelet S, Balg F. Validation of the instability shoulder index score in a multicenter reliability study in 114 consecutive cases. Am J Sports Med. 2013;41:278–82.CrossRefGoogle Scholar
  15. 15.
    Seybold D, Schliemann B, Heyer CH, Muhr G, Gekle C. Which labral lesion can be reduced with external rotation of the shoulder after a first-time traumatic anterior shoulder dislocation? Arch Orthop Trauma Surg. 2009;129:229–304.Google Scholar
  16. 16.
    Kandziora F, Jäger A, Bischof F, Herresthal J, Starker M, Mittlmeier T. Arthroscopic labrum refixation for post-traumatic anterior shoulder instability: suture anchor versus transglenoid fixation technique. Arthroscopy. 2006;16:359–66.CrossRefGoogle Scholar
  17. 17.
    Taylor DC, Arciero RA. Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med. 1997;25:306–11.CrossRefGoogle Scholar
  18. 18.
    Yiannakopoulos CK, Matargas E, Antonogiannakis E. A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy. 2007;23:985–90.CrossRefGoogle Scholar
  19. 19.
    Provencher MT, Bhatia S, Ghodadra NS, Grumer RC, Bach BR Jr, Dewing CB, LeClere L, Romeo AA. Recurrent shoulder instability: current concepts for evaluation and management of glenoid bone loss. J Bone Joint Surg Am. 2010;92(Suppl 2):133–51.CrossRefGoogle Scholar
  20. 20.
    Skendzel JG, Sekiya JK. Diagnosis and management of humeral head bone loss in shoulder instability. Am J Sports Med. 2012;40:2633–44.CrossRefGoogle Scholar
  21. 21.
    Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Joint Surg Am. 2000;82:35–46.CrossRefGoogle Scholar
  22. 22.
    Yamamoto N, Itoi E, Abe H, Kikuchi K, Seki N, Minagawa H, Tuoheti Y. Effect of an anterior glenoid defect on anterior shoulder stability: a cadaveric study. Am J Sports Med. 2009;37:949–54.CrossRefGoogle Scholar
  23. 23.
    Piasecki DP, Verma NN, Romae AA, Levine WN, Bach BR Jr, Provencher MT. Glenoid bone deficiency in recurrent anterior shoulder instability: diagnosis and management. J Am Acad Orthop Surg. 2009;17:482–93.CrossRefGoogle Scholar
  24. 24.
    Provencher MT, Frank RM, Leclere LE, Metzger PD, Ryu JJ, Bernhardson A, Romeo AA. The Hill–Sachs lesion: diagnosis, classification, and management. J Am Acad Orthop Surg. 2012;20:242–52.CrossRefGoogle Scholar
  25. 25.
    Saliken DJ, Bornes TD, Bouliane MJ, Sheps DM, Beaupre LA. Imaging methods for quantifying glenoid and Hill–Sachs bone loss in traumatic instability of the shoulder: a scoping review. BMC Musculoskelet Disord. 2015;16:164.CrossRefGoogle Scholar
  26. 26.
    Arciero RA, Parrino A, Bernhardson AS, Diaz-Doran V, Obopilwe E, Cote MP, Golijanin P, Mazzocca AD, Provencher MT. The effect of a combined glenoid and Hill–Sachs defect on glenohumeral stability: a biomechanical cadaveric study using 3-dimensional modeling of 142 patients. Am J Sports Med. 2015;43:1422–9.CrossRefGoogle Scholar
  27. 27.
    Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill–Sachs lesion: from “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy. 2014;30:90–8.CrossRefGoogle Scholar
  28. 28.
    Yamamoto N, Itoi E, Abe H, Minagawa H, Seki N, Shimada Y, Okada K. Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: a new concept of glenoid track. J Shoulder Elb Surg. 2007;16:649–56.CrossRefGoogle Scholar

Copyright information

© ESSKA 2020

Authors and Affiliations

  1. 1.Department of TraumatologyUniversity Medical Centre LjubljanaLjubljanaSlovenia

Personalised recommendations