RESUMEN
In the evaluation of shoulder instability, recognition of relevant pathology on imaging is critical to planning a surgical treatment that minimizes the risk for recurrent instability. The purpose of this review is to (1) discuss the use of radiography, computed tomography, and MRI in evaluating shoulder instability and (2) demonstrate how various imaging modalities are useful in identifying critical pathologies in the shoulder that are relevant for treatment.
Asunto(s)
Inestabilidad de la Articulación , Imagen por Resonancia Magnética , Articulación del Hombro , Tomografía Computarizada por Rayos X , Humanos , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/diagnóstico por imagen , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/cirugía , Traumatismos en Atletas/diagnóstico por imagen , Traumatismos en Atletas/cirugía , Traumatismos en Atletas/diagnóstico , Luxación del Hombro/diagnóstico por imagen , Luxación del Hombro/cirugía , Luxación del Hombro/diagnóstico , Lesiones del Hombro/diagnóstico por imagenRESUMEN
Utilizing fresh distal tibia allograft in anterior glenoid reconstruction has emerged as a highly advantageous approach in addressing instances of failed anterior shoulder stabilization with glenoid bone loss. This procedure offers several benefits, including the absence of donor-site morbidity, restoration of significant glenoid defects, reestablishment of joint congruity with the humeral head, restoration of glenoid biomechanics, and the addition of cartilage to the glenoid. Furthermore, it provides a robust and reliable alternative for managing failed stabilization procedures, leading to improved clinical outcomes and a high graft healing rate, while maintaining a low occurrence of recurrent instability.
Asunto(s)
Trasplante Óseo , Inestabilidad de la Articulación , Articulación del Hombro , Humanos , Inestabilidad de la Articulación/cirugía , Trasplante Óseo/métodos , Articulación del Hombro/cirugía , Tibia/cirugía , Insuficiencia del TratamientoRESUMEN
In-season management of anterior shoulder instability in athletes is a complex problem. Athletes often wish to play through their current season, though recurrent instability rates are high, particularly in contact sports. Athletes are generally considered safe to return to play when they are relatively pain-free, and their strength and range of motion match the uninjured extremity. If an athlete is unable to progress toward recovering strength and range of motion, surgical management is an option, though this is often a season-ending decision.
Asunto(s)
Traumatismos en Atletas , Inestabilidad de la Articulación , Volver al Deporte , Humanos , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/fisiopatología , Inestabilidad de la Articulación/diagnóstico , Traumatismos en Atletas/cirugía , Traumatismos en Atletas/diagnóstico , Articulación del Hombro/fisiopatología , Articulación del Hombro/cirugía , Luxación del Hombro/cirugía , Luxación del Hombro/diagnóstico , Luxación del Hombro/fisiopatología , Lesiones del Hombro , Rango del Movimiento Articular , Toma de Decisiones , AtletasRESUMEN
Anterior glenohumeral instability is one of the most common injuries suffered from sport. Despite padding and conditioning, the shoulder joint remains particularly vulnerable to injury, especially in the setting of contact. The overall rate of anterior instability is reported to be 0.12 injuries per 1000 athlete exposures, although this is increased up to 0.40 to 0.51 in the contact athlete. Successful treatment requires consideration of restoring stability while minimizing loss of glenohumeral motion. Common treatment strategies involve addressing the pathology that results from anterior shoulder dislocation including labral detachment as well as bony defects to the humeral head and glenoid.
Asunto(s)
Artroscopía , Traumatismos en Atletas , Inestabilidad de la Articulación , Luxación del Hombro , Articulación del Hombro , Humanos , Artroscopía/métodos , Inestabilidad de la Articulación/cirugía , Traumatismos en Atletas/cirugía , Luxación del Hombro/cirugía , Articulación del Hombro/cirugía , Articulación del Hombro/fisiopatología , Lesiones del Hombro/cirugíaRESUMEN
Historically considered the gold standard technique for glenohumeral instability, the open Bankart repair is being performed at decreased rates because of the current trends favoring arthroscopic Bankart repair and the lack of consistent training of the open technique. However, open Bankart repairs may be more appropriate for certain high-risk populations (ie, high-level collision athletes) because of their reduced recurrent instability rates. Further investigations are needed to identify the indications for arthroscopic versus open Bankart repair and compare their outcomes in high-level athletes. This review highlights the indications, surgical technique, and clinical outcomes following open Bankart repairs in athletes.
Asunto(s)
Artroscopía , Traumatismos en Atletas , Inestabilidad de la Articulación , Humanos , Inestabilidad de la Articulación/cirugía , Traumatismos en Atletas/cirugía , Artroscopía/métodos , Luxación del Hombro/cirugía , Resultado del Tratamiento , Articulación del Hombro/cirugíaRESUMEN
In young athletes, anterior shoulder instability is a prevalent condition. Because of high-energy traumas, contact athletes often suffer recurrent instability, bone loss and postoperative recurrences. Patients younger than 20 years, symptomatic for more than 6 months, with ≥ 2 dislocations, with off-track Hill-Sachs lesion, glenoid bone loss, ALPSA lesion, Instability Severity Index Score > 3, and Glenoid Track Instability Management Score > 3 are at higher risk of failure. In cases of multiple dislocations with critical or subcritical glenoid bone loss, notably in collision and contact athletes, the Latarjet procedure is widely recognized as the treatment of choice.
Asunto(s)
Traumatismos en Atletas , Inestabilidad de la Articulación , Recurrencia , Luxación del Hombro , Humanos , Inestabilidad de la Articulación/cirugía , Luxación del Hombro/cirugía , Traumatismos en Atletas/cirugía , Articulación del Hombro/cirugía , Articulación del Hombro/fisiopatología , Procedimientos Ortopédicos/métodosRESUMEN
The indications for bone block augmentation of the glenoid following recurrent anterior shoulder instability are expanding. Arthroscopic anatomic glenoid reconstruction (AAGR) is an evolving technique with similar clinical results to the Latarjet procedure and other open bone block procedures. Multiple types of bone grafts and fixation techniques have been described, with varying results on bony integration, resorption, articular congruity, and recurrence rates. This review focuses on biomechanics, patient workup, indications, current evidence, and the authors' preferred surgical technique for AAGR.
Asunto(s)
Artroscopía , Trasplante Óseo , Inestabilidad de la Articulación , Humanos , Artroscopía/métodos , Trasplante Óseo/métodos , Inestabilidad de la Articulación/cirugía , Articulación del Hombro/cirugía , Fenómenos BiomecánicosRESUMEN
Posterior shoulder instability is a distinct subcategory of shoulder instability with an incidence higher than previously reported. Pain is typically the primary complaint, with pathology due to repetitive microtrauma being more common that a specific traumatic event. If nonoperative treatment fails, arthroscopic posterior capsulolabral repair has been shown to result in excellent outcomes and return to sport, with American football players having the best outcomes and throwers being slightly less predictable. Risk factors for surgical failure include decreased glenoid bone width, rotator cuff injury, female gender, and the use of less than 3 anchors.
Asunto(s)
Artroscopía , Inestabilidad de la Articulación , Articulación del Hombro , Humanos , Artroscopía/métodos , Inestabilidad de la Articulación/cirugía , Articulación del Hombro/cirugía , Articulación del Hombro/fisiopatología , Factores de Riesgo , Volver al DeporteRESUMEN
Recurrent posterior shoulder instability after primary repair is uncommon, but presents a challenging clinical scenario. Most revisions in failed labral repair were associated with glenoid bone morphology related to critical bone loss, retroversion, or dysplasia. A variety of treatment options exist which include revision labral repair with or without capsular plication, glenoid osteotomy, humeral rotational osteotomy, or glenoid bone augmentation. No single technique has been shown to be superior and each technique has strengths and limitations. Therefore, thoughtful evaluation and planning is critical to address each patient's individual pathology to maximize success after revision surgery.
Asunto(s)
Inestabilidad de la Articulación , Reoperación , Articulación del Hombro , Humanos , Articulación del Hombro/cirugía , Articulación del Hombro/fisiopatología , Inestabilidad de la Articulación/cirugía , Osteotomía/métodos , Insuficiencia del Tratamiento , Artroscopía/métodos , RecurrenciaRESUMEN
There has been growing interest in the rehabilitation process and timing of returning an athlete to sport following the management options for anterior shoulder instability. The purpose of this article is to review the current rehabilitation and return to sport (RTS) protocols for various nonoperative and operative management strategies following anterior shoulder instability events. When appropriate in the rehabilitation protocol, RTS testing should be criteria based, rather than time based, with a special focus given to psychological readiness in order to promote successful return to athletics and prevention of recurrent instability episodes in the future.
Asunto(s)
Traumatismos en Atletas , Inestabilidad de la Articulación , Volver al Deporte , Humanos , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/rehabilitación , Traumatismos en Atletas/cirugía , Traumatismos en Atletas/rehabilitación , Luxación del Hombro/cirugía , Luxación del Hombro/rehabilitación , Luxación del Hombro/terapia , Articulación del Hombro/cirugía , Articulación del Hombro/fisiopatologíaRESUMEN
¼ Instability and dislocation after reverse shoulder arthroplasty may occur in up to 31% of patients.¼ Clinical risk factors for instability include younger age, male sex, increased body mass index, preoperative diagnosis of proximal humerus fracture or rotator cuff pathology, history of instability of the native shoulder or after surgery, and a medical history of Parkinson's disease.¼ Patients with rheumatoid arthritis and decreased proximity to the coracoid may also be at greater risk.¼ In patients at a high risk of instability, surgeons should consider a more lateralized prosthesis (particularly in patients with an incompetent rotator cuff), repairing the subscapularis (particularly when using a medialized prosthesis), and upsizing the glenosphere (>40 mm in male and 38-40 mm in female patients).¼ While potentially useful, less evidence exists for the use of a constrained liner (particularly with a lateralized glenosphere and/or in low-demand patients) and rotating the polyethylene liner posteriorly to avoid impingement.
Asunto(s)
Artroplastía de Reemplazo de Hombro , Inestabilidad de la Articulación , Humanos , Artroplastía de Reemplazo de Hombro/efectos adversos , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/etiología , Factores de Riesgo , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Articulación del Hombro/cirugía , Articulación del Hombro/fisiopatología , Prótesis de Hombro/efectos adversos , Femenino , MasculinoRESUMEN
BACKGROUND: Acute ankle sprains represent one of the most common traumatic injuries to the musculoskeletal system. Many individuals with these injuries experience unresolved symptoms such as instability and recurrent sprains, leading to chronic ankle instability (CAI), which affects their ability to maintain an active lifestyle. While rehabilitation programs focusing on sensorimotor, neuromuscular, strength and balance training are primary treatments, some patients require surgery when rehabilitation fails. A critical analysis of the patient-reported outcome tools (PROs) used to assess CAI surgical outcomes raises some concerns about their measurement properties in CAI patients, which may ultimately affect the quality of evidence supporting current surgical practice. The aim of this research is to develop and validate a new PRO for the assessment of ankle instability and CAI treatment outcomes, following recent methodological guidelines, with the implicit aim of contributing to the generation of scientifically meaningful evidence for clinical practice in patients with ankle instability. METHODS: Following the COnsensus-based Standards for the selection of Health Measurement Instruments (COSMIN), an Ankle Instability Treatment Index (AITI) will be developed and validated. The process begins with qualitative research based on faceâtoâface interviews with CAI individuals to explore the subjective experience of living with ankle instability. The data from the interviews will be coded following an inductive approach and used to develop the AITI content. The preliminary version of the scale will be refined through an additional round of faceâtoâface interviews with a new set of CAI subjects to define the AITI content coverage, relevance and clarity. Once content validity has been examined, the AITI will be subjected to quantitative analysis of different measurement properties: construct validity, reliability and responsiveness. DISCUSSION: The development of AITI aims to address the limitations of existing instruments for evaluating surgical outcomes in patients with CAI. By incorporating patient input and adhering to contemporary standards for validity and reliability, this tool seeks to provide a reliable and meaningful assessment of treatment effects. TRIAL REGISTRATION: Not applicable.
Asunto(s)
Traumatismos del Tobillo , Inestabilidad de la Articulación , Medición de Resultados Informados por el Paciente , Humanos , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/fisiopatología , Traumatismos del Tobillo/cirugía , Traumatismos del Tobillo/terapia , Articulación del Tobillo/fisiopatología , Articulación del Tobillo/cirugía , Reproducibilidad de los ResultadosRESUMEN
PURPOSE: Compared with open surgery, arthroscopic anterior talofibular ligament (ATFL) repair has many advantages and good clinical outcome. Inferior extensor retinaculum (IER) reinforcement is a supplement procedure that increase the strength of the ATFL. There is still no gold standard for arthroscopic ATFL repair. The purposes of this study were to describe a simplified technique for arthroscopic ATFL repair with IER reinforcement and to analyze its preliminary clinical results. METHODS: Twenty-seven patients with chronic lateral ankle instability (CLAI) who underwent this simplified surgery were analyzed in this retrospective study. The patients' characteristics and operative times were evaluated. Intraoperative photos, radiographs from the anterior drawer test and talar tilt test and postoperative MR images were recorded. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analog scale (VAS) score were also recorded. With the assistance of a needle, we performed ATFL repair and IER reinforcement with one Pushlock anchor and nonabsorbable sutures. RESULTS: No complications namely skin necrosis, superficial fibular nerve injury or wound infection, were reported. The AOFAS score and VAS score improved from 64.74 ± 9.47 and 6.00 ± 1.56 to 90.74 ± 6.46 and 1.07 ± 1.09, respectively. The talar advancement and talar tilt angle were improved after surgery. One year after the operation, the ATFL appeared to be continuous on MR images. CONCLUSION: In this study, we proposed a simple and effective arthroscopic ATFL repair with IER reinforcement technique. The short-term follow-up examination revealed satisfactory clinical outcomes. Our technique might be a new surgical option for the treatment of CLAI.
Asunto(s)
Artroscopía , Inestabilidad de la Articulación , Ligamentos Laterales del Tobillo , Humanos , Masculino , Femenino , Artroscopía/métodos , Adulto , Ligamentos Laterales del Tobillo/cirugía , Ligamentos Laterales del Tobillo/lesiones , Ligamentos Laterales del Tobillo/diagnóstico por imagen , Estudios Retrospectivos , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/diagnóstico por imagen , Adulto Joven , Persona de Mediana Edad , Resultado del Tratamiento , Articulación del Tobillo/cirugía , Articulación del Tobillo/diagnóstico por imagen , AdolescenteRESUMEN
BACKGROUND: Bone-patellar tendon-bone (BPTB) and double-looped semitendinosus and gracilis (hamstring) grafts are commonly used for anterior cruciate ligament (ACL) reconstruction. Short-term and midterm studies show little or no differences between the 2 grafts; however, there are only a few long-term studies to compare results between the 2 grafts. PURPOSE: To compare the results after using either BPTB grafts or hamstring tendon grafts 18 years after ACL reconstruction. STUDY DESIGN: Randomized controlled trial; Level of evidence 2. METHODS: A total of 114 patients with ACL rupture between 2001 and 2004 were randomized to reconstruction with either a BPTB graft or a hamstring tendon graft. Patients were operated on at 4 major hospitals. The 18-year follow-up evaluation included anterior knee laxity measured with a KT-1000 arthrometer, defined as the primary outcome, while clinical examination (Lachman and pivot-shift tests), isokinetic testing of muscle strength, patient-reported outcome measures, and an assessment of radiographic osteoarthritis using the Kellgren-Lawrence classification were defined as secondary outcomes. RESULTS: A total of 96 patients (84%, 47 BPTB and 49 hamstring grafts) were available for follow-up, 71 of these for clinical examination. Seven of 96 patients were excluded for ACL revision (n = 5) or knee replacement (n = 2) surgery. In total, 25 patients (10 BPTB and 15 hamstring grafts) had undergone additional surgery other than ACL revision or total knee arthroplasty. There were no significant differences between the groups in terms of anterior laxity test with KT-1000 arthrometer (primary outcome). In secondary outcomes, no significant differences between groups were reported regarding clinical examination, patient-reported outcome scores, or radiographic osteoarthritis (Kellgren-Lawrence grade 2-4 for patellofemoral joint [18 hamstring and 14 BPTB] or tibiofemoral joint [20 hamstring and 19 BPTB]), while isokinetic testing revealed that the hamstring group had a 10.7% reduction in mean peak flexion torque compared with the BPTB group at 60 deg/s (df = 59; P = .011). At 60 deg/s the mean total flexion work in the hamstring group was reduced by 17.2% compared with the BPTB group (df = 59; P = .002). CONCLUSION: The flexion strength in the hamstring group was significantly reduced in the operated knee after 18 years. There were no significant differences between the groups regarding subjective outcomes, patient-reported outcomes, range of motion, clinical and instrumented knee laxity, and the development of osteoarthritis. REGISTRATION: NCT05876013 (ClinicalTrials.gov identifier).
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior , Tendones Isquiotibiales , Fuerza Muscular , Humanos , Masculino , Reconstrucción del Ligamento Cruzado Anterior/métodos , Femenino , Adulto , Tendones Isquiotibiales/trasplante , Lesiones del Ligamento Cruzado Anterior/cirugía , Lesiones del Ligamento Cruzado Anterior/fisiopatología , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/fisiopatología , Articulación de la Rodilla/cirugía , Articulación de la Rodilla/fisiopatología , Persona de Mediana Edad , Ligamento Rotuliano/cirugía , Ligamento Rotuliano/trasplante , Estudios de Seguimiento , Adulto Joven , Medición de Resultados Informados por el Paciente , Rango del Movimiento ArticularRESUMEN
BACKGROUND: Despite improved visualization, the use of arthroscopic surgery to perform the Latarjet procedure has not decreased the rates of complications and glenohumeral osteoarthritis (OA) in the long term. Many of the reported complications are related to the use of screws for bone block fixation with freehand drilling. PURPOSE: To evaluate the long-term (at a minimum 10-year follow-up) clinical and radiological outcomes of the arthroscopic Bristow-Latarjet procedure using a posterior guided drilling technique and suture button for coracoid bone graft fixation. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Consecutive patients who underwent the arthroscopic Bristow-Latarjet procedure with suture button fixation between 2011 and 2013 were reviewed by 2 independent evaluators. Complications and revision surgery were recorded, and we evaluated patient-reported outcomes including subjective scores, recurrence of shoulder instability (dislocation or subluxation), range of motion limitations, and return to sports. Patients had radiographs taken at least 10 years after surgery to assess glenohumeral OA according to the Samilson-Prieto classification system and computed tomography scans to assess bone block positioning and healing. RESULTS: A total of 65 consecutive patients (68 shoulders) with a mean follow-up of 135 months (range, 120-156 months) were included. The mean age at the time of surgery was 25 ± 8 years; 7 patients had previous failed Bankart repair. At follow-up, 94% (64/68) of the shoulders had no recurrence of instability. The 4 cases of instability recurrence were traumatic and occurred at 3 weeks (a fall), 4 months, 2 years, and 7 years after surgery. No hardware failures, coracoid fractures, or neurological complications were observed. Overall, 61 patients (94%) were still participating in sports, with 44 (68%) at the same or higher level. Range of motion showed nonsignificant restrictions in external rotation with the arm at the side (7° ± 9°) and with the arm at 90° of abduction (9° ± 10°) compared with the contralateral side. Additionally, 11 shoulders (16%) had some residual anterior apprehension on clinical examination. At last follow-up, 77% (47/61) of the shoulders had no OA development or progression. Previous failed Bankart repair was a risk factor for the development of OA. Patients with OA had significantly lower Subjective Shoulder Value scores (79% vs 91%, respectively; P = .01) and decreased external rotation with the arm at the side (40° vs 65°, respectively; P = .001) compared with patients with no or little OA. CONCLUSION: The arthroscopically guided Bristow-Latarjet procedure with suture button fixation is a safe and durable surgical treatment method for recurrent anterior shoulder instability, allowing a high rate of return to sports without significant motion restrictions and no or little OA in the long term.
Asunto(s)
Artroscopía , Inestabilidad de la Articulación , Articulación del Hombro , Humanos , Masculino , Adulto , Femenino , Artroscopía/métodos , Estudios de Seguimiento , Inestabilidad de la Articulación/cirugía , Adulto Joven , Articulación del Hombro/cirugía , Adolescente , Rango del Movimiento Articular , Trasplante Óseo/métodos , Persona de Mediana Edad , Osteoartritis/cirugía , Luxación del Hombro/cirugía , Estudios Retrospectivos , Recurrencia , Volver al Deporte , Apófisis Coracoides/cirugíaRESUMEN
BACKGROUND: An isolated medial patellofemoral ligament (MPFL) reconstruction (MPFLR) has been demonstrated to be an effective treatment option in the prevention of patellar instability, but there is growing support for performing a tibial tubercle osteotomy (TTO) in patients with an elevated tibial tubercle-trochlear groove distance. The purpose of this study was to evaluate the impact of adding a TTO to MPFLR on patient reported outcomes. METHODS: A retrospective review of patients who underwent MPFLR with or without TTO with a minimum of 12-month follow-up was performed. Patients in both groups were matched based on age, sex, and follow-up time. Recurrent instability (including re-dislocation and subluxation), visual analog scale (VAS) for pain score, Kujala score, and satisfaction were evaluated. RESULTS: There were 59 patients who underwent MPFLR with concomitant TTO performed at our institution and met our inclusion and exclusion criteria. These patients were then matched to patients undergoing isolated MPFLR based on demographics and follow-up time. The mean age was 25.0, 76.3% were female, and the mean follow-up time was 49 months. There was a significant difference in mean tibial tubercle-trochlear groove distance (19.8 ± 3.9 vs. 14.1 ± 2.8) between groups. There was no significant difference in VAS (1.48 ± 2.0 vs. 1.49 ± 2.1, p = 0.972), satisfaction (86.1% ± 24.2% vs. 81.2% ± 27.9, p = 0.311), or revision surgeries (10.2% vs. 10.2%) between groups. CONCLUSION: There was a low complication rate, excellent patient reported outcomes, and a low rate of recurrent patellar instability following TTO and MPFLR with allograft.
Asunto(s)
Inestabilidad de la Articulación , Osteotomía , Articulación Patelofemoral , Tibia , Humanos , Femenino , Osteotomía/métodos , Osteotomía/efectos adversos , Inestabilidad de la Articulación/cirugía , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/fisiopatología , Masculino , Estudios Retrospectivos , Adulto , Tibia/cirugía , Articulación Patelofemoral/cirugía , Articulación Patelofemoral/fisiopatología , Articulación Patelofemoral/diagnóstico por imagen , Adulto Joven , Resultado del Tratamiento , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/efectos adversos , Adolescente , Luxación de la Rótula/cirugía , Luxación de la Rótula/fisiopatología , Luxación de la Rótula/diagnóstico por imagen , Recurrencia , Ligamentos Articulares/cirugía , Ligamento Rotuliano/cirugíaRESUMEN
¼ Patellar instability is challenging to address, and although there are many surgical options, proximal patellar realignment (PPR) and medial patellofemoral ligament (MPFL) reconstruction are both used-recently, the MPFL reconstruction has become more popularized.¼ Both procedures have demonstrated similar recurrent dislocation rates and rates of arthritic progression.¼ PPR is a cost-efficient procedure using just suture alone as compared with MPFL reconstruction, which uses different grafts and methods of fixation.¼ PPR has demonstrated durable results, with a lower overall complication rate, much of which is caused by the MPFL reconstruction having unique complications due to fixation methods.¼ The PPR is a beneficial procedure and should still be considered when dealing with patellar instability.
Asunto(s)
Ligamentos Articulares , Articulación Patelofemoral , Humanos , Articulación Patelofemoral/cirugía , Ligamentos Articulares/cirugía , Inestabilidad de la Articulación/cirugía , Luxación de la Rótula/cirugía , Procedimientos de Cirugía Plástica/métodosRESUMEN
INTRODUCTION: Individuals with acetabular dysplasia often report hip joint instability, pain, and poor hip-related function. Periacetabular osteotomy (PAO) is a surgical procedure that aims to reposition the acetabulum to improve joint congruency and improve pain and function. We aimed to examine the influence of presurgery clinical measures on functional recovery following PAO and the associations among clinical outcomes after PAO. METHODS: We screened 49 potential participants, 28 were enrolled, and 23 completed both study visits (pre-PAO and 6 months post-PAO). We evaluated dynamometer-measured hip and thigh strength, loading patterns during a squat and countermovement jump (CMJ), pain intensity, and device-measured physical activity (PA) levels (light, moderate-to-vigorous PA [MVPA], and daily steps). We used linear regression models to examine the influence of muscle strength (peak torque; limb symmetry index [LSI]) and loading patterns before PAO on pain intensity and PA levels in individuals 6 months following PAO. Additionally, we used Pearson correlation coefficient to examine cross-sectional associations among all variables 6 months following PAO. RESULTS: Lower extremity muscle strength and loading patterns during the squat and CMJ before PAO did not predict pain intensity or device-measured PA levels in individuals 6 months following PAO (p > 0.05). Six months following PAO, higher knee extensor LSI was associated with higher time spent in MVPA (r = 0.56; p = 0.016), higher hip abductor LSI was associated with both lower pain (r = 0.50; p = 0.036) and higher involved limb loading during the squat task (r = 0.59; p = 0.010). Lastly, higher hip flexor LSI was associated with higher CMJ takeoff involved limb loading (r = 0.52; p = 0.021) and higher involved hip extensor strength was associated with higher CMJ landing involved limb loading (r = 0.56; p = 0.012). CONCLUSION: Six months after PAO, higher hip and thigh muscle strength and strength symmetry were associated with lower pain, higher PA levels, and greater normalized limb loading during dynamic movement tasks.
Asunto(s)
Acetábulo , Ejercicio Físico , Fuerza Muscular , Osteotomía , Humanos , Fuerza Muscular/fisiología , Masculino , Femenino , Adulto , Acetábulo/cirugía , Ejercicio Físico/fisiología , Adulto Joven , Dimensión del Dolor , Estudios Transversales , Articulación de la Cadera/fisiopatología , Recuperación de la Función , Inestabilidad de la Articulación/fisiopatología , Inestabilidad de la Articulación/cirugíaRESUMEN
BACKGROUND: After arthroscopic Bankart repair (ABR) for anterior glenohumeral instability (GHI), adolescent athletes have higher rates of subsequent recurrent GHI than any other subpopulation. Elucidating which adolescents are at highest risk of postoperative recurrent GHI may optimize surgical decision-making. PURPOSE: To identify prognostic factors associated with subsequent recurrent GHI requiring revision stabilization surgery (RSS) after ABR. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: The study included patients 12 to 21 years old who had undergone ABR for anterior GHI at a pediatric tertiary care hospital by 1 of 5 sports medicine fellowship-trained surgeons between 2000 and 2020. A multivariate Cox proportional hazards model, with percentage of patients with recurrent GHI undergoing subsequent RSS, was used with a time-to-event outcome analysis. The Cox model effects were expressed as the hazard ratio (HR). All tests were 2-sided, with an alpha of .05. RESULTS: Records of 488 adolescent patients with ABR (78% male; mean age, 16.9 ± 1.98 years) were analyzed. Of these, 86 patients (17.6%) underwent subsequent RSS for recurrent GHI, yielding a cumulative risk of 8.8% at 2 years, 16.5% at 5 years, and 20% at 15 years. RSS occurred at a mean of 2.6 ± 2.1 years after ABR. Risk factors for RSS included >1 preoperative dislocation (2 dislocations: HR = 7.4, P = .0003; ≥3 dislocations: HR = 10.9, P < .0001), presence of a Hill-Sachs lesion (small: HR = 2.5, P = .0114; medium-large: HR = 4.2, P = .0004), younger age (1-year decrease: HR = 1.2, P = .0015), and participation in contact sports (HR = 1.8, P = .01). Adolescents with only 1 preoperative dislocation had a cumulative incidence of RSS (3.2%), which was significantly lower than those with 2 (24.2%) or ≥3 preoperative dislocations (33.5%). CONCLUSION: The number of dislocations before index ABR was the strongest risk factor for recurrent GHI requiring RSS in adolescents with anterior GHI, with 2 dislocations conferring >7-fold increased risk compared with a single preoperative dislocation. Other significant risk factors included the presence of a Hill-Sachs lesion, younger age, and participation in contact sports.