Clinical effect of modified anterolateral acromioarthroplasty during arthroscopic rotator cuff repair.

BACKGROUND: This study aimed to compare the clinical effect of modified anterolateral and traditional acromioplasty in arthroscopic rotator cuff repair. METHODS: The clinical data of 92 patients with total rotator cuff tears admitted to the Department of Joint Surgery of Jinhua Central Hospital from January 2016 to December 2019 were retrospectively analyzed. Among them, 42 patients underwent traditional acromioplasty during arthroscopic rotator cuff repair, and 50 underwent modified anterolateral acromioplasty. Patients were evaluated for preoperative and postoperative shoulder function, pain and critical shoulder angle, and incidence of rotator cuff re-tear at 12 months postoperatively. RESULTS: The preoperative general data of patients in the classic and modified anterolateral acromioplasty groups did not differ significantly (P > 0.05) and were comparable. The UCLA, ASES, and Constant shoulder joint scores were significantly improved in both groups. The VAS score was significantly decreased at 12 months postoperative than preoperative, with a statistically significant difference (P ≤ 0.05). Shoulder function and pain scores did not differ significantly between the two groups at 12 months postoperatively (P > 0.05). The CSA did not differ significantly between preoperative and postoperative 12 months in the traditional acromioplasty group (P > 0.05). However, 12 months postoperative CSA in the modified anterolateral acromioplasty group was significantly smaller than the preoperative CSA, with a statistically significant difference (P ≤ 0.05). The rates of rotator cuff re-tears were 16.67% (7/42) and 4% (2/50) in the two groups at 12 months postoperatively, respectively, with statistically significant differences (P ≤ 0.05). CONCLUSIONS: Traditional and modified anterolateral acromioplasty while treating total rotator cuff tears using arthroscopic rotator cuff repair significantly improves shoulder joint function. However, modified anterolateral acromioplasty significantly reduced the CSA value and decreased the incidence of rotator cuff re-tears.

Musculoskeletal embolization - endovascular treatment of adhesive capsulitis.

Adhesive capsulitis, commonly known as frozen shoulder, is a painful and restrictive condition that significantly impairs the quality of life for affected individuals. We present the successful endovascular treatment of adhesive capsulitis in the first-ever case performed in Portugal. A 6-month follow-up with objective results is presented, using the visual analog scale for pain and the Quick Dash questionnaire. Trans-arterial, musculoskeletal embolization, as a cutting-edge technique, offers a promising avenue for patients with adhesive capsulitis unresponsive to traditional management, opening new possibilities for improved outcomes and enhanced quality of life.

The Use of a Distal Radius Allograft for Severe Glenoid Bone Loss in the Setting of Revision Shoulder Arthroplasty: A Case Report.

CASE: A 71-year-old female patient presented with severe glenoid bone loss and deformity after 2 subsequent failed arthroplasty procedures because of baseplate failures. The patients then underwent a conversion from reverse shoulder arthroplasty to hemiarthroplasty, while using a distal radius allograft to augment the deformed glenoid. At the 2-year follow-up, the patient reported minimal pain and satisfactory outcomes. CONCLUSION: This case presents the distal radius as a potentially useful allograft option for augmenting severe glenoid bone loss in the setting of revision shoulder arthroplasty.

Efficacy of soothing cream gel in the range of motion and chronic pain at the shoulder and elbow: protocol of a double-blinded, randomised, placebo-controlled trial.

INTRODUCTION: Upper limb problems have a significant impact on the global population leading to pain and restricted joint mobility, ultimately impacting their quality of life. Traditional treatments, such as non-steroidal anti-inflammatory drugs and corticosteroids, often come with undesirable side effects, prompting patients to seek alternative therapies. In this trial, we hypothesise that soothing cream gel (SCG) will improve range of motion and chronic pain in the shoulder and elbow. The objective of this trial is to evaluate the efficacy of SCG in improving the range of motion and chronic pain in the shoulder and elbow. METHODS AND ANALYSIS: A double-blinded, randomised, placebo-controlled trial is conducted to compare the effects of SCG and placebo gel. SCG contains Vitis vinifera essence, Melaleuca viridiflora essential oil, etc, and is manufactured according to Good Manufacturing Practice standards. The placebo gel will be processed with similar appearance, texture and scent but will lack active ingredients. 70 participants with upper limb problems will be recruited from four study sites, including clinical centres and a sport department at the Chinese University of Hong Kong (CUHK). Participants will be randomly assigned to either treatment group or placebo group for 2 weeks. Primary outcome will be the range of motion in the upper limb, assessed by a goniometer, to measure active flexion and abduction for the shoulder, and active flexion and extension for the elbow. The primary efficacy analyses will be based on the full analysis set following the intention-to-treat principle. ETHICS AND DISSEMINATION: The trial has obtained approval from the joint CUHK-New Territories East Cluster (CRE-2023.142), and the patient enrolment commenced in July 2023. Written informed consent will be obtained from all participants prior to participation. Study results will be disseminated through publication in peer-reviewed journals and presentations at conference. TRIAL REGISTRATION NUMBER: NCT05799391.

Comparison of the clinical efficacy and prognosis of the two techniques for treating partial articular-sided supraspinatus tendon tears under arthroscopy.

BACKGROUND: At present, shoulder arthroscopy is usually used for treatment of rotator cuff injuries. There is still debate over the precise technique of using shoulder arthroscopy to treat partial articular-sided supraspinatus tendon injuries. OBJECTIVE: To compare the clinical efficacy of the arthroscopic transtendon repair method and the arthroscopic full-thickness repair method in the treatment of patients with Ellman III partial articular-sided supraspinatus tendon tears and to analyze the influencing factors of postoperative efficacy. STUDY DESIGN: Cohort study; level of evidence,4. METHODS: A total of 84 partial-thickness rotator cuff tear (PTRCT) patients with Ellman III injuries who underwent surgical treatment in our hospital between January 2017 and January 2020 were selected and divided into the arthroscopic trans-tenon repair group (32 cases) and the arthroscopic full-thickness repair group (52 cases). Shoulder joint pain and functional status were assessed by the Constant score, ASES score and VAS score; shoulder mobility was assessed by measuring shoulder ROM. The clinical outcomes of the two groups of patients were compared, and the factors affecting the postoperative efficacy of the patients were investigated. RESULTS: All patients were followed up for at least 2 years. The Constant score, ASES score, and VAS score of the two groups of patients were all improved compared with those before surgery, and the differences were statistically significant (P < 0.05). There were no significant differences in the Constant score, ASES score, or VAS score between the two groups (P > 0.05). The results of binary logistic regression analysis showed that the preoperative ASES score and whether biceps tenotomy was performed were independent risk factors for satisfactory postoperative efficacy (P < 0.05). CONCLUSION: For patients with Ellman III partial articular-sided supraspinatus tendon tears, the arthroscopic transtendon repair method and the arthroscopic full-thickness repair method can both significantly improve the shoulder pain and function of the patient, but there is no significant difference between the efficacy of the two surgical methods. The preoperative ASES score and whether biceps tenotomy was performed were independent risk factors for satisfactory postoperative efficacy in PTRCT patients with Ellman III injury.

Shoulder muscle weakness and proprioceptive impairments in type 2 diabetes mellitus: exploring correlations for improved clinical management.

Background: Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder with systemic implications, potentially affecting musculoskeletal health. This study aimed to assess shoulder muscle strength and joint repositioning accuracy in individuals with T2DM, exploring potential correlations and shedding light on the musculoskeletal consequences of the condition. The objectives were two-fold: (1) to assess and compare shoulder strength and joint repositioning accuracy between individuals with T2DM and asymptomatic counterparts, and (2) to examine the correlation between shoulder strength and joint repositioning accuracy in individuals with T2DM. Methods: A cross-sectional study enrolled 172 participants using the convenience sampling method, including 86 individuals with T2DM and an age-matched asymptomatic group (n = 86). Shoulder strength was assessed using a handheld dynamometer, while joint repositioning accuracy was evaluated with an electronic digital inclinometer. Results: Individuals with T2DM exhibited reduced shoulder muscle strength compared to asymptomatic individuals (p < 0.001). Additionally, joint repositioning accuracy was significantly lower in the T2DM group (p < 0.001). Negative correlations were observed between shoulder strength and joint repositioning accuracy in various directions (ranging from -0.29 to -0.46, p < 0.001), indicating that higher muscle strength was associated with improved joint repositioning accuracy in individuals with T2DM. Conclusion: This study highlights the significant impact of T2DM on shoulder muscle strength and joint repositioning accuracy. Reduced strength and impaired accuracy are evident in individuals with T2DM, emphasizing the importance of addressing musculoskeletal aspects in diabetes management. The negative correlations suggest that enhancing shoulder muscle strength may lead to improved joint repositioning accuracy, potentially contributing to enhanced physical functioning in this population.

Shoulder mobility and strength impairments in patients with rotator cuff related shoulder pain: a systematic review and meta analysis.

Background: The methods previously proposed in the literature to assess patients with rotator cuff related shoulder pain, based on special orthopedic tests to precisely identify the structure causing the shoulder symptoms have been recently challenged. This opens the possibility of a different way of physical examination. Objective: To analyze the differences in shoulder range of motion, strength and thoracic kyphosis between rotator cuff related shoulder pain patients and an asymptomatic group. Method: The protocol of the present research was registered in the International Prospective Register of Systematic Review (PROSPERO) (registration number CRD42021258924). Database search of observational studies was conducted in MEDLINE, EMBASE, WOS and CINHAL until July 2023, which assessed shoulder or neck neuro-musculoskeletal non-invasive physical examination compared to an asymptomatic group. Two investigators assessed eligibility and study quality. The Newcastle Ottawa Scale was used to evaluate the methodology quality. Results: Eight studies (N = 604) were selected for the quantitative analysis. Meta-analysis showed statistical differences with large effect for shoulder flexion (I2 = 91.7%, p < 0.01, HG = -1.30), external rotation (I2 = 83.2%, p < 0.01, HG = -1.16) and internal rotation range of motion (I2 = 0%, p < 0.01, HG = -1.32). Regarding to shoulder strength; only internal rotation strength showed statistical differences with small effect (I2 = 42.8%, p < 0.05, HG = -0.3). Conclusions: There is moderate to strong evidence that patients with rotator cuff related shoulder pain present less shoulder flexion, internal and external rotation range of motion and less internal rotation strength than asymptomatic individuals.

Salvage Latarjet may provide worse outcomes in terms of recurrent instability and returning to sports compared to primary Latarjet: a systematic review of comparative studies.

BACKGROUND: The Latarjet procedure (LP) is performed as a primary stabilization procedure (primary LP) and a salvage procedure when an earlier shoulder stabilization procedure has failed (salvage LP). However, whether primary LP or salvage LP provides better outcomes for anterior shoulder instability remains unknown. METHODS: Two independent reviewers performed the literature search based on the PRISMA guidelines. A comprehensive search of PubMed, Embase, web of science and Cochrane Library was performed from their inception date to December 4, 2023. Inclusion criteria mainly included the comparison of postoperative outcomes between primary and salvage LP, English language, and full text availability. Two reviewers independently examined the literature, collected data, and evaluated the methodological robustness of the included studies. The Methodological Index for Nonrandomized Studies was used to evaluate the quality of nonrandomized studies. Recurrent instability, complications, reoperations, return to sports, patient-reported outcomes, and range of motion were assessed. Statistical evaluations were conducted using Manager V.5.4.1 (The Cochrane Collaboration, Software Update, Oxford, UK). RESULTS: Twelve studies were included in the systematic review, with 940 shoulders undergoing primary LP and 631 shoulders undergoing salvage LP. Statistically significant differences in favor of primary LP were found in 2 of the 11 and 2 of 4 included studies in terms of recurrent instability and returning to the same sports (RTS) at preinjury level, respectively. In terms of the visual analog scale, subjective shoulder value and the Western Ontario Shoulder Instability Index, 2 of the 4, 1 of the 3 and 1 of the 3 included studies reported statistically significant differences in favor of primary LP. Differences were not noticed regarding complications, reoperations, the time to RTS, the Rowe score, the Athletic Shoulder Outcome Scoring System, and forward flexion. CONCLUSION: Current evidence suggests that compared with primary LP, salvage LP may provide inferior postoperative outcomes in terms of recurrent instability and the rate of RTS at preinjury level. Primary and salvage LP may yield comparable efficacy in terms of complications, reoperations, the rate of RTS, the time to RTS, pain, shoulder function, and range of motion. PROSPERO ID: CRD42023492027.

Effect of ultrasound-guided injection of botulinum toxin type A into shoulder joint cavity on shoulder pain in poststroke patients: study protocol for a randomized controlled trial.

BACKGROUND: Hemiplegic shoulder pain (HSP) is a common complication after stroke. It severely affects the recovery of upper limb motor function. Early shoulder pain in hemiplegic patients is mainly neuropathic caused by central nerve injury or neuroplasticity. Commonly used corticosteroid injections in the shoulder joint can reduce shoulder pain; however, the side effects also include soft tissue degeneration or increased tendon fragility, and the long-term effects remain controversial. Botulinum toxin injections are relatively new and are thought to block the transmission of pain receptors in the shoulder joint cavity and inhibit the production of neuropathogenic substances to reduce neurogenic inflammation. Some studies suggest that the shoulder pain of hemiplegia after stroke is caused by changes in the central system related to shoulder joint pain, and persistent pain may induce the reorganization of the cortical sensory center or motor center. However, there is no conclusive evidence as to whether or not the amelioration of pain by botulinum toxin affects brain function. In previous studies of botulinum toxin versus glucocorticoids (triamcinolone acetonide injection) in the treatment of shoulder pain, there is a lack of observation of differences in changes in brain function. As the content of previous assessments of pain improvement was predominantly subjective, objective quantitative assessment indicators were lacking. Functional near-infrared imaging (fNIRS) can remedy this problem. METHODS: This study protocol is designed for a double-blind, randomized controlled clinical trial of patients with post-stroke HSP without biceps longus tenosynovitis or acromion bursitis. Seventy-eight patients will be randomly assigned to either the botulinum toxin type A or glucocorticoid group. At baseline, patients in each group will receive shoulder cavity injections of either botulinum toxin or glucocorticoids and will be followed for 1 and 4 weeks. The primary outcome is change in shoulder pain on the visual analog scale (VAS). The secondary outcome is the assessment of changes in oxyhemoglobin levels in the corresponding brain regions by fNIRS imaging, shoulder flexion, external rotation range of motion, upper extremity Fugl-Meyer, and modified Ashworth score. DISCUSSION: Ultrasound-guided botulinum toxin type A shoulder joint cavity injections may provide evidence of pain improvement in patients with HSP. The results of this trial are also help to analyze the correlation between changes in shoulder pain and changes in cerebral hemodynamics and shoulder joint motor function. TRIAL REGISTRATION: Chinese clinical Trial Registry, ChiCTR2300070132. Registered 03 April 2023, https://www.chictr.org.cn/showproj.html?proj=193722 .

A Biological Spacer to Treat Irreparable Rotator Cuff Tears: A Biomechanical Study Utilizing a Secured Versus Unsecured Tensor Fascia Lata Graft.

BACKGROUND: Designed to help treat pain and loss of function after rotator cuff repair, allograft spacer procedures utilize a graft to act as a spacer in the subacromial space, decreasing pain from impingement of the greater tuberosity on the acromion at the extremes of overhead motion. PURPOSE: To evaluate the biomechanical characteristics of secured versus unsecured tensor fascia lata allografts used in an allograft spacer procedure. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 8 fresh-frozen cadaveric shoulder specimens were used. There were 4 conditions tested: (1) intact rotator cuff, (2) stage III rotator cuff tear (complete supraspinatus tendon and superior one-half of the infraspinatus tendon), (3) unsecured tensor fascia lata graft, and (4) secured tensor fascia lata graft. Both superior and posterior translation of the humeral head were calculated in each condition. A 4-cm × 5-cm × 6-mm tensor fascia lata graft was used in the subacromial space to act as a spacer. Grafts were secured at the lateral edge of the native rotator cuff footprint with 2 knotless anchors. RESULTS: With unbalanced loading, both secured and unsecured grafts varied in their ability to limit superior and posterior translation at various rotation angles back to levels seen with intact rotator cuffs at 0° and 20° of abduction. During balanced loading, both unsecured and secured grafts limited superior and posterior translation more than those seen in the rotator cuff-deficient condition (P < .01) and similar to those seen in the intact condition (P > .05). The secured and unsecured grafts allowed similar amounts of translation at every position with both unbalanced and balanced loading (P > .05). Finally, total graft motion was <7 mm in all positions. CONCLUSION: Unsecured tensor fascia lata grafts were biomechanically equivalent to secured grafts when used during allograft spacer procedures. CLINICAL RELEVANCE: While both grafts were successful at limiting superior and posterior translation of the humeral head during early range of motion, the unsecured graft represents a cheaper, easier option to utilize during allograft spacer procedures.

Location of Shoulder Glenoid Labral Tears: A Study of 1763 Consecutive Patients.

BACKGROUND: Anterior shoulder labral tearing has historically been considered the most common location of shoulder labral pathology. Recently, smaller studies have reported that posterior labral involvement may be more common than previously recognized. PURPOSE: To examine the location of surgically repaired labral tears by a single surgeon over a consecutive 23-year period. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 1763 consecutive patients who underwent arthroscopic or open shoulder labral repair by a single seniorsports medicine fellowship-trained orthopaedic surgeon between April 2000 and April 2023 were retrospectively reviewed. Current Procedural Terminology codes were used to identify patients, which included 29806, 29807, 29822, and 29823. Exclusion criteria included isolated shoulder manipulation or glenohumeral joint or labral debridement that did not include repair. Intraoperative glenoid labral tears observed were categorized into 7 broad categories: (1) anterior labral tears, (2) posterior labral tears, (3) superior labral anterior posterior (SLAP) type II tears (A, B, or C), (4) SLAP type V tears, (5) SLAP type VIII tears, or (6) circumferential labral tears (combined SLAP, anterior, and posterior labral tear). Shoulders diagnosed with multiple tear patterns (ie, anterior and posterior) were also noted. RESULTS: During the 23-year period, 1763 patients underwent arthroscopic or open labral repair; they included 1295 male and 468 female patients, ranging in age from 12 to 70 years, with a mean age of 23.2 years and median age of 19 years. Overall, 28.4% of tears involved the anterior labrum, 64.9% involved the posterior labrum, and 59.6% involved the superior labrum. Regarding isolated tears, 9.3% were isolated anterior labral tears, 19.7% were isolated posterior labral tears, 11.5% involved the anterior and posterior labrum, 22.2% were isolated superior (SLAP type II-IV) tears, 3.63% were isolated SLAP type V tears, 29.8% were isolated SLAP type VIII tears, and 4.1% were circumferential tears. CONCLUSION: Posterior shoulder labral tearing was more common than anterior tearing in a large consecutive series of 1763 patients who underwent surgical repair. This highlights the importance of posterior labral pathology, which sometimes may be overlooked because of more vague complaints, with pain and loss of function being the most common.

Arthroscopic Bankart Repair With Remplissage in Anterior Shoulder Instability Results in Fewer Redislocations Than Bankart Repair Alone at Medium-term Follow-up of a Randomized Controlled Trial.

BACKGROUND: A multicenter, double-blinded randomized controlled trial comparing isolated Bankart repair (NO REMP) to Bankart repair with remplissage (REMP) reported benefits of remplissage in reducing recurrent instability at 2 years postoperative. The ongoing benefits beyond this time point are yet to be explored. PURPOSE: To (1) compare medium-term (3 to 9 years) outcomes of these previously randomized patients undergoing isolated Bankart repair (NO REMP) or Bankart repair with remplissage (REMP) to manage recurrent anterior glenohumeral instability; (2) examine the failure rate, overall recurrent instability, and reoperation rate. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Recruitment and randomization for the original randomized trial occurred between 2011 and 2017. Patients ≥14 years diagnosed with recurrent traumatic anterior shoulder instability with an engaging Hill-Sachs defect of any size were included. Those with a glenoid defect >15% were excluded. In 2020, participants were contacted by telephone and asked standardized questions regarding ensuing instances of subluxation, dislocation, or reoperation on their study shoulder. "Failure" was defined as a redislocation, and "overall recurrent instability" was described as a redislocation or ≥2 subluxations. Descriptive statistics, relative risk, and Kaplan-Meier survival curve analyses were performed. RESULTS: A total of 108 participants were randomized, of whom 50 in the NO REMP group and 52 in the REMP group were included in the analyses in the original study. The mean number of months from surgery to the final follow-up was 49.3 and 53.8 months for the NO REMP and REMP groups, respectively. Failure rates were 22% (11/50) in the NO REMP group versus 8% (4/52) in the REMP group. Rates of overall recurrent instability were 30% (15/50) in the NO REMP group versus 10% (5/52) in the REMP group. Survival curves were significantly different, favoring REMP in both scenarios. CONCLUSION: For the treatment of traumatic recurrent anterior shoulder instability with a Hill-Sachs lesion and subcritical glenoid bone loss (<15%), a significantly lower rate of overall postoperative recurrent instability was observed with arthroscopic Bankart repair and remplissage than with isolated Bankart repair at a medium-term follow-up (mean of 4 years). Patients who did not receive a remplissage experienced a failure (redislocated) earlier and had a higher rate of revision/reoperation than those who received a concomitant remplissage. REGISTRATION: NCT01324531 (ClinicalTrials.gov identifier).

[Mid-term effectiveness of LU-tarjet procedure for recurrent anterior shoulder dislocation].

Objective: To evaluate the mid-term effectiveness of limited unique coracoid osteotomy suture button fixation Latarjet (LU-tarjet) procedure in treatment of recurrent anterior shoulder dislocation. Methods: Between March 2017 and February 2019, 56 patients with recurrent shoulder dislocation were treated with arthroscopic LU-tarjet procedure. There were 44 males and 12 females with an average age of 26.3 years (range, 18-41 years). Shoulder joint dislocation occurred 2-16 times, with an average of 7.5 times. The time from the initial dislocation to operation ranged from 6 months to 13 years, with a median of 4.6 years. Preoperative shoulder joint fear test and re-reduction test were positive in all patients. The Beighton score of joint relaxation ranged from 1 to 7, with an average of 4.1. The shoulder Instability Severity Index Score (ISIS) ranged from 5 to 10, with an average of 7.8. The size of glenoid defects on the affected side ranged from 15% to 32% (mean, 22.4%). All patients had Hill-Sachs injuries of varying degrees. Six patients had re-dislocation after Bankart surgery. The operation time, incision healing, and postoperative complications were recorded. The range of motion (shoulder flexion, extension, abduction, external rotation, 90° external rotation, and internal rotation) and muscle strength in shoulder flexion, abduction, external rotation, and internal rotation) of shoulder joint were compared between pre- and post-operation. The improvement of shoulder function was evaluated using the American Association for Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, and Rowe score. X-ray films and three-dimensional CT were used to analyze the location, healing, and remolding of bone graft, the repair of glenoid defect, and degenerative changes of the shoulder joint. Results: All operations were successfully completed. The operation time ranged from 42 to 98 minutes, with an average of 63 minutes. All incisions healed by first intention. All patients were followed up 5-7 years (mean, 6.3 years). During follow-up, 2 patients experienced shoulder subluxation within 1 year after operation and 1 patient experienced recurrent shoulder joint pain. The remaining patients had no related complications. At last follow-up, there was no significant difference between the two groups ( P>0.05) in range of motion (shoulder flexion, extension, abduction, external rotation, 90° external rotation, and internal rotation) and muscle strength in shoulder flexion, abduction, external rotation, and internal rotation). The ASES score, Rowe score, and Walch-Duplay score of shoulder significantly improved when compared with those before operation ( P<0.05). Postoperative CT showed that 53 cases (94.64%) of coracoid bone masses were centered placed vertically, 2 cases (3.57%) were superior, and 1 case (1.79%) was inferior; 49 cases (87.50%) of the coracoid bone grafts were flush with the glenoid, 2 cases (3.57%) and 5 cases (8.93%) were medially and laterally positioned. The volume of coracoid bone graft decreased first and then increased, and the shape of the bone graft was continuously remodeling and gradually matched with the track of the humerus head (the optimal circle of the glenoid), all coracoid bone grafts healed. At last follow-up, the coverage rate of optimal glenoid circle was 89.6%-100%, with an average of 97.4%. The area of glenoid defect was 2.6%±1.3%, which significantly decreased when compared with preoperative (22.4%±5.4%) ( P<0.05). At last follow-up, no obvious degenerative changes of shoulder joint was observed. Conclusion: LU-tarjet procedure for recurrent anterior shoulder dislocation has good mid-term effectiveness with short operation time and few complications.

[Effectiveness analysis of double EndoButton suture fixation Latarjet procedure for treatment of anterior shoulder dislocation with glenoid bone defect caused by military training injuries].

Objective: To investigate the effectiveness of double EndoButton suture fixation Latarjet procedure in the treatment of shoulder anterior dislocation with glenoid bone defect caused by military training injuries. Methods: The clinical data of 14 patients with anterior shoulder dislocation with glenoid bone defect due to military training injuries who met the selection criteria and admitted between August 2021 and December 2022 were retrospectively analyzed. All patients were male, the age ranged from 21 to 38 years, with an average of 26.8 years. The time from initial dislocation to operation was 6-15 months, with an average of 10.2 months. Anterior shoulder dislocation occurred 5-12 times, with an average of 8.2 times. All glenoid bone defects were more than 10%, including 5 cases of 10%-15%, 8 cases of 15%-20%, and 1 case of 24%. All patients were treated by double EndoButton suture fixation Latarjet procedure. The operation time and complications were recorded. The shoulder function and pain were evaluated by the American Association for Shoulder and Elbow Surgery (ASES) score, Rowe score, Instability Severity Index Score (ISIS), and visual analogue scale (VAS) score before and after operation. The range of motion of the shoulder was recorded, including forward flexion, 0° external rotation, and abduction 90° external rotation. The position, healing, and resorption of the bone mass were evaluated by three-dimensional CT of shoulder joint after operation. Results: All patients successfully completed the operation, and the operation time was 100-150 minutes, with an average of 119.7 minutes. There was no complications such as infection, vascular and nerve injury. All patients were followed up 12-20 months, with an average of 15.6 months. During the follow-up, 4 patients had bone mass separation, absorption, and recurrent anterior dislocation, and the shoulder joint fear test was positive. Imaging of the remaining patients showed that the bone mass healed well, no anterior dislocation recurrence occurred, and the healing time was 3-7 months (mean, 4.7 months). At last follow-up, the range of motion, ASES score, Rowe score, ISIS score, and VAS score of the patients significantly improved when compared with those before operation ( P<0.05). Conclusion: The effectiveness of double EndoButton suture fixation Latarjet procedure for the treatment of anterior shoulder dislocation with glenoid bone defect caused by military training injury is satisfactory.

[Development and research progress of suture button fixation Latarjet procedure].

Objective: To review the development and research progress of suture button fixation Latarjet procedure. Methods: A comprehensive literature review was conducted to summarize the development and related modified techniques of the suture button fixation Latarjet procedure. Results: Since the Latarjet procedure was first introduced by French scholar Latarjet in 1954, it has undergone three key transformations, resulting in suture button fixation Latarjet procedure, which has shown satisfactory outcomes in treatment of recurrent shoulder dislocation. However, there are still drawbacks such as the risk of impingement of the graft on surrounding tissues, and the surgical disruption of anatomical structures like the coracoclavicular ligament and the pectoralis minor muscle. The scholars have proposed several modified techniques based on the suture button fixation Latarjet procedure to further reduce complications from impingement of the graft, to lower the glenohumeral contact pressure, and to eliminate the impact of surgery on the physiological structures of the shoulder joint. The modified techniques include the arthroscopic suture button fixation Latarjet procedure using FiberTape Cerclage, reconstruction of the coracoacromial ligament during congruent-arc Latarjet procedures, and limit unique coracoid osteotomy suture button Latarjet procedure (LU-tarjet procedure). These modified techniques have also shown good clinical outcomes. Additionally, other related modified techniques for reconstruction of the glenoid, such as Chinese unique Inlay Bristow procedure (Cuistow procedure), arthroscopic glenoid bone grafting with soft fixation, and all-arthroscopic modified Eden-Hybinette procedure, have also demonstrated favorable efficacy. However, there is still a lack of long-term follow-up results for these techniques and comparative studies between them. Conclusion: Suture button fixation Latarjet procedure is an effective method for the treatment of recurrent shoulder dislocation. There are various techniques, but there is no recognized gold standard, and further clinical and basic research is needed.

[Suture button fixation Latarjet procedure under total arthroscopy for treatment of anterior shoulder instability with severe bone defect].

Objective: To assess the effectiveness of suture button fixation Latarjet procedure under total arthroscopy for anterior shoulder instability with severe bone defects. Methods: The clinical data of 15 patients with severe bone defects and anterior shoulder instability treated with suture button fixation Latarjet procedure under total arthroscopy between June 2020 and February 2023 was retrospectively analyzed, including 11 males and 4 females, with an average age of 31.1 years (range, 20-54 years). Three-dimensional CT showed that the average glenoid bone defect was 24.4% (range, 16.3%-35.2%). The average number of shoulder dislocation was 4.2 times (range, 3-8 times). The disease duration ranged from 6 to 21 months with an average of 10.6 months. The operation time and intraoperative blood loss were recorded. The pain relief was evaluated by visual analogue scale (VAS) score, and the functional recovery of shoulder joint was evaluated by Rowe score, Walch-Duplay score, and American Association for Shoulder and Elbow Surgery (ASES) score before and after operation. The range of motion (ROM) of the shoulder joint was assessed, including active flexion, lateral external rotation, abduction 90° external rotation, and internal rotation. Three-dimensional CT was performed at 6 months after operation and at last follow-up to observe the absorption of bone graft, the position of bone graft and glenoid, and the healing of bone graft. Results: The operation was successfully completed in all patients. The operation time was 85-195 minutes, with an average of 123.0 minutes. The intraoperative blood loss was 20-75 mL, with an average of 26.5 mL. All patients were followed up 13-32 months, with an average of 18.7 months. During the follow-up, there was no serious complication such as shoulder joint infection, joint stiffness, or vascular and nerve injury. One patient had partial absorption of the transplanted bone and bone nonunion at 3 months after operation, but the pain of the shoulder joint relieved at last follow-up, and no redislocation of the shoulder joint occurred; no obvious bone fracture or dislocation of the shoulder joint was found in the other patients. Bone union was achieved at 6 months during follow-up. At last follow-up, the VAS score, Rowe score, Walch-Duplay score, and ASES score significantly improved when compared with those before operation ( P<0.05), while the ROM of active flexion, lateral external rotation, abduction 90° external rotation, and internal rotation of the shoulder joint was not significantly different from those before operation ( P>0.05). Conclusion: Suture button fixation Latarjet procedure under total arthroscopy can improve shoulder joint function in patients with severe anterior shoulder instability caused by bone defects, and imaging also indicates satisfactory placement of transplanted bone blocks.

[Anatomical study of the limited osteotomy suture button fixation Latarjet procedure with coracoacromial ligament preservation].

Objective: To investigate the morphological characteristics of the glenohumeral joint (including the glenoid and coracoid) in the Chinese population and determine the feasibility of designing coracoid osteotomy based on the preoperative glenoid defect arc length by constructing glenoid defect models and simulating suture button fixation Latarjet procedure. Methods: Twelve shoulder joint specimens from 6 adult cadavers donated voluntarily were harvested. First, whether the coracoacromial ligament and conjoint tendon connected was anatomically observed and their intersection point was identified. The vertical distance from the intersection point to the coracoid, the maximum allowable osteotomy length starting from the intersection point, and the maximum osteotomy angle were measured. Next, the anteroinferior glenoid defect models of different degrees were randomly constructed. The arc length and area of the glenoid defect were measured. Based on the arc length of the glenoid defect of the model, the size of coracoid oblique osteotomy was designed and the actual length and angle of the coracoid osteotomy were measured. A limited osteotomy suture button fixation Latarjet procedure with the coracoacromial ligament and pectoralis minor preservation was performed and the position of coracoid block was observed. Results: All shoulder joint specimens exhibited crossing fibers between the coracoacromial ligament and the conjoint tendon. The vertical distance from the tip of the coracoid to the coracoid return point was 24.8-32.2 mm (mean, 28.5 mm). The maximum allowable osteotomy length starting from the intersection point was 26.7-36.9 mm (mean, 32.0 mm). The maximum osteotomy angle was 58.8°-71.9° (mean, 63.5°). Based on the anteroinferior glenoid defect model, the arc length of the glenoid defect was 22.6-29.4 mm (mean, 26.0 mm); the ratio of glenoid defect was 20.8%-26.2% (mean, 23.7%). Based on the coracoid block, the length of the coracoid osteotomy was 23.5-31.4 mm (mean, 26.4 mm); the osteotomy angle was 51.3°-69.2° (mean, 57.1°). There was no significant difference between the arc length of the glenoid defect and the length of the coracoid osteotomy ( P>0.05). After simulating the suture button fixation Latarjet procedure, the highest points of the coracoid block (suture loop fixation position) in all models located below the optimal center point, with the bone block concentrated in the anteroinferior glenoid defect position. Conclusion: The size of the coracoid is generally sufficient to meet the needs of repairing larger glenoid defects. The oblique osteotomy with preserving the coracoacromial ligament may potentially replace the traditional Latarjet osteotomy method.

[Application of LU-tarjet congruent-arc technique in treatment of recurrent shoulder dislocation with huge glenoid defect].

Objective: To investigate the early effectiveness of the limited unique coracoid osteotomy suture button fixation Latarjet (LU-tarjet)-congruent-arc (CA) technique (LU-tarjet-CA) in treating recurrent shoulder dislocations with huge glenoid defect. Methods: The clinical data of 12 patients with recurrent shoulder dislocation and huge glenoid defect who met the selection criteria and treated with arthroscopic LU-tarjet-CA between January 2021 and December 2023 were retrospectively analyzed. The cohort included 8 males and 4 females, aged 20-40 years with an average age of 30.4 years. The range of glenoid bone loss was 30%-40%, with an average of 35.5%. The time from symptom onset to hospital admission ranged from 1 to 36 months, with an average of 18.5 months. The University of California Los Angeles (UCLA) score, American Association for Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, and Rowe score were used to evaluate shoulder function preoperatively and at 3, 6, and 12 months postoperatively. CT three-dimensional (3D) reconstruction was used to assess coracoid healing and plasticity at 3, 6, and 12 months postoperatively. Subjective satisfaction of patient was recorded at last follow-up. Results: All incisions healed by first intention, with no incision infection or nerve injury. All 12 patients were followed up 12 months. One patient developed Propionibacterium acnes infection within the joint postoperatively and recovered after initial arthroscopic debridement and anti-inflammatory treatment. At 3 months after operation, CT 3D-reconstruction showed 1 case of complete coracoid absorption; neither of these two patients experienced redislocation. The remaining patients exhibited partial coracoid absorption but displayed local reshaping, filling the preoperative defect area, and bony fusion between the coracoid and the glenoid. At last follow-up, 9 patients (75%) were very satisfied with the outcome, and 3 patients (25%) were satisfied; the satisfied patients experienced postoperative shoulder stiffness caused by suboptimal functional exercise but did not have impaired daily life activities. The UCLA score, ASES score, Walch-Duplay score, and Rowe score at 3, 6, and 12 months postoperatively were significantly better than preoperative scores, and each score improved further over time postoperatively, with significant differences between different time points ( P<0.05). Conclusion: The arthroscopic LU-tarjet-CA technique for treating recurrent shoulder dislocations with huge glenoid defect can achieve the surgical objective of bony blockade and filling bone defects to prevent shoulder dislocation, thereby improving patients' quality of life and shoulder joint function and stability.

[Mid-term effectiveness of modified arthroscopic suture button fixation Latarjet procedure for treatment of recurrent anterior shoulder dislocations].

Objective: To summarize mid-term effectiveness of modified arthroscopic suture button fixation Latarjet procedure for treatment of recurrent anterior shoulder dislocations. Methods: Between January 2018 and October 2020, 30 patients with recurrent anterior shoulder dislocations were treated with modified arthroscopic suture button fixation Latarjet procedure. There were 19 males and 11 females with an average age of 27.3 years (range, 18-41 years). The shoulder dislocation occurred 3-7 times, with an average of 4.9 times. The time from the last dislocation to operation was 3-10 days, with an average of 4.1 days. Glenoid defects exceeded 20% in all cases. There were 27 cases of Hill-Sachs lesions. The joint pain and function were estimated by visual analogue scale (VAS) score, University of California, Los Angeles (UCLA) score, Rowe score, American Association for Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, and the range of external rotation at 0° and external rotation at 90° abduction of shoulder before operation and at 1 month, 6 months, and last follow-up. The X-ray film, CT scan and three-dimensional reconstruction were reviewed to observe the position, healing, and absorption of the coracoid graft, correction of glenoid defect, and joint degeneration. Results: The operation time ranged from 51 to 79 minutes, with an average of 68.4 minutes. All incisions healed without complications such as nerve or blood vessel injury. All patients were followed up 36-60 months with an average of 44.6 months. The VAS score, UCLA score, Rowe score, ASES score, Walch-Duplay score, and the range of external rotation at 0° and external rotation at 90° abduction after operation significantly improved when compared with preoperative values ( P<0.05). All indicators further improved with time, and the differences between different time points after operation were significant ( P<0.05). Imaging review showed that the coracoid graft was located in the anteroinferior glenoid at 1 day after operation, and no occurrence of shoulder osteoarthritis was found during follow-up. The anatomical structure of the glenoid was normal, and no delayed healing or non-union of the coracoid graft occurred. At 20 months after operation, arthroscopic re-exploration was performed in 1 case due to fracutre caused by falling injury revealed the good shaping of the coracoid graft, smooth glenoid, and no bone resorption or osteoarthritis. Conclusion: For recurrent anterior shoulder dislocations, the modified arthroscopic suture button fixation Latarjet procedure can obtain good recovery of shoulder function and low incidence of complications and has a good mid-term effectiveness.

[Surgical accidents and postoperative complications of recurrent shoulder dislocation treated by suture button fixation with bone occlusion].

Objective: To summarize the surgical accidents and postoperative complications of the treatment of recurrent shoulder dislocation by suture button fixation and bone occlusion, and to provide clinical reference. Methods: The clinical data of 16 patients with recurrent shoulder dislocation treated with modified arthroscopic Latarjet suture button fixation and bone occlusion between July 2017 and April 2023 were retrospectively analyzed. Among them, 15 were male and 1 was female. The age ranged from 16 to 45 years, with an average of 26 years. Admission examination showed the range of motion of shoulder joint was normal; the shoulder joint fear test was positive; En-face CT scan measured 10%-20% of the glenoid defects, averaging 13.4%; and MRI examination revealed bone Bankart injury. The disease duration ranged from 2 to 20 years, with an average of 7.1 years. The shoulder joint was dislocated 8- 45 times, with an average of 17.4 times, and the shoulder joint was unstable. The occurrence of surgical accidents and postoperative complications as well as corresponding measures and outcomes were recorded. Results: All the incisions healed by first intention without any complications such as incision infection or vascular injury. All 16 cases were followed up for an average of 3.6 years (range, 1-7 years), and no shoulder redislocation occurred. Four types of intraoperative surgical accidents and two types of postoperative complications occurred in the early stage of implementation of the technique. Intraoperative surgical accidents included 1 case of difficulty in passing subscapular muscle through coracotomy with large size, which was treated with exchange rod or finger through subscapular muscle split; 2 cases of coracoidal process fracture, of which 1 case was treated conservatively, and the other case was sutured to the base of tendon and fixed through tunnel; 1 case of glenoid fracture occurred in the glenoid tunnel, which was fixed with knot-free anchors; the posterior loop plate fixation was abnormal in 2 cases, of which 1 case was re-fixed and the other case was renovated. Postoperative complications included coracoid bone mass displacement in 1 case, conservative biceps rehabilitation was given to avoid premature external rotation; 1 case of radial nerve injury of healthy upper limb and musculocutaneous nerve injury of affected side was given oral medication and physiotherapy. The above conditions recovered well after corresponding treatment. Conclusion: Suture button fixation with bone occlusion is a safe method for the treatment of recurrent shoulder dislocation. Careful operation should be performed during coracoid interception and glenoid tunnel drilling, especially in the fixation process.