Evaluation of Latarjet procedure in female athletes: a 3-year follow-up prospective cohort study.

Background: Although there is a low incidence of shoulder instability in women, this population is still representative and is often associated with lower rates of return to sports. Few studies have evaluated the results of the Latarjet procedure in this population. Methods: This was a prospective cohort study of female athletes who underwent the Latarjet procedure between 2013 and 2018. The participants were followed up for 3 years. The primary outcomes of the study included the visual analog scale for pain; range of motion: active elevation, passive elevation, active external rotation, and passive external rotation. The functional scores were as follows: American Shoulder and Elbow Surgeons score, the Western Ontario Shoulder Instability Index, and the Athletic Shoulder Outcome Rating Scale. Additional data were collected regarding return to sport, complication rates, and patient satisfaction. Results: Thirteen female athletes who practice Soccer, Volleyball, Basketball, Handball, Judo, or Weight training were evaluated. There was a significant reduction in the mean range of motion for all movements at 4 weeks after surgery. Patients recovered a range of motion similar to the preoperative values after 6 months. The mean visual analog scale reached 6.39 at the first week after surgery and decreased to values below preop at 8 weeks. The mean preoperative Western Ontario Shoulder Instability Index was 126.77 (min 118; max 135), and at the end of follow-up, the WOSI index was 45.08 (min 37; max 65; P < .05). The mean preoperative American Shoulder and Elbow Surgeons score was 41.61 (min 35; max 46), and at the end of follow-up, the mean ASES score was 84.46 (min 80; max 90; P < .05). The mean Athletic Shoulder Outcome Rating Scale in the preoperative period was 39.38 (min 37; max 42), and at the end of follow-up, the mean ASORS score was 83.15 (min 77; max 85; P < .05). The rate of return to sports was 92.3%, and 84.6% of patients were satisfied with the surgery. The aesthetic satisfaction rate was 76.9%. The complication rate was 15.4% (1 screw failure and 1 dislocation recurrence). Conclusion: Latarjet surgery in female athletes showed high rates of return to sports and improved functional scores without impairing range of motion after the procedure. Recurrence and complication rates were low. In addition, treatment was associated with improved functionality and patient satisfaction.

Genetic Aspects in Shoulder Disorders / Aspectos genéticos nas afecções do ombro

Abstract The influence of genetic inheritance has been increasingly investigated in shoulder disorders, such as rotator cuff injury, instability and frozen shoulder. Although the initial findings are enlightening, it is necessary to progressively build a database of genetic markers to catalog genomic profiles that, later, may contribute for predicting the risk of the disease, as well as to the development of better diagnostic and treatment tools. The present article seeks to update what is evidence of genetic studies in the literature for these diseases, from polymorphism analyses, expression of candidate genes in tissues and broad genomic association studies (GWAS). However, it is necessary to point out that there is great difficulty in replicating and using the findings, mainly due to the lack of statistical power, the high rate of false-positive results and the large number of variables involved.

Resumo A influência da herança genética tem sido cada vez mais investigada nas afecções do ombro, como a lesão do manguito rotador, instabilidade e ombro congelado. Ainda que os achados iniciais sejam pouco esclarecedores, é necessário construir progressivamente um banco de marcadores genéticos para catalogar perfis genômicos que, mais adiante, poderão contribuir para a previsão do risco da doença, desenvolvimento de melhores ferramentas de diagnóstico e tratamento. O presente artigo busca atualizar o que há de evidências de estudos genéticos na literatura para essas doenças, desde análises de polimorfismos, expressão de genes candidatos em tecidos e estudos de associação genômica ampla (GWAS, na sigla em inglês). Porém, é necessário apontar que existe grande dificuldade na replicação e utilização dos achados, principalmente em razão da falta de poder estatístico, da alta taxa de resultados falso-positivos e da grande quantidade de variáveis envolvidas.

Rotator Cuff Tear Susceptibility Is Associated With Variants in Genes Involved in Tendon Extracellular Matrix Homeostasis.

Rotator cuff tears (RCT) is a multifactorial disease with genetic factors contributing for the disease etiology. We hypothesized that genetic variants in genes involved in extracellular matrix (ECM) homeostasis may alter susceptibility to RCT. We evaluated 20 polymorphisms of genes involved in ECM homeostasis in 211 cases of full-thickness tears of the supraspinatus (Nfemales = 130; Nmales = 81) and 567 age-matched controls (Nfemales = 317; Nmales = 250). Multivariate logistic regressions were carried out with age, gender, genetic ancestry (based on the analysis of 61 biallelic short insertion/deletion polymorphisms), and common co-morbidities (diabetes, dyslipidemia, and smoking habits) as covariates. We observed that carriers of the rare allele of both studied variants of TGFB1, as well as their G/A (rs1800470/rs1800469) haplotype, were less susceptible to RCT (p < 0.05). In contrast, carriers of the G allele of MMP9 rs17576 (p = 0.014) or G/G haplotype (rs17576/rs17577; p < 0.001) had an increased risk for tendon tears. The presence of the T allele of MMP2 rs2285053 (p = 0.033), the T allele of MMP3 rs679620 (p = 0.024), and the TT-genotype of TIMP2 rs2277698 (p = 0.01) was associated with susceptibility to tears, especially in females. In males, the A allele of COL5A1 rs3196378 (p = 0.032) and the G allele of TGFBR1 rs1590 (p = 0.039) were independent risk factors for RCT. The C/T COL5A1 (rs3196378/rs11103544) haplotype was associated with a reduced risk of tears in males (p = 0.03). In conclusion, we identified the genetic variants associated with RCT susceptibility, thereby reinforcing the role of genes involved in the structure and homeostasis of the ECM of tendons in disease development. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:192-201, 2020.

Rodeo athletes: management of shoulder instability.

BACKGROUND: The aim of this study was to describe epidemiological data and evaluate the clinical results of traumatic anterior glenohumeral instability in rodeo athletes. METHODS: Thirteen patients, all male, with a mean age of 23.2 (18-31) years old, with anterior glenohumeral instability were include in this study. In 9 patients, the right side was affected. The mean time elapsed between injury and undergoing surgery was 56 months (24-120 months). The surgical technique used (arthroscopic or open bone block procedure) was chosen based on the ISIS (Instability Severity Index Score). Only professional athletes who had been in the sport for at least 60 months were included. Functional evaluation was conducted using the UCLA scale, after a 24-month follow-up period. RESULTS: The number of dislocation episodes varied from 10 to 100 (mean 27 episodes). All of the patients were submitted a surgical treatment open bone block procedure, due to their degree of sport participation, type of sport (forced overhead and collision) and the presence of associated bone defect lesions. According to UCLA criteria, the results were excellent in 12 patients and good in one. The mean time elapsed before returning to the sport was five months, varying between two and ten months. Complications included one patient developing axillary neuropraxia, which was completely resolved six months after the operation, and another patient developed a superficial skin infection. CONCLUSIONS: The rodeo athletes with anterior shoulder instability had serious associated bony lesions and has good outcome after bone block procedure.