RESUMO
INTRODUCTION: in patients with anterior glenohumeral (GH) instability together with an off-track or engaging Hill-Sachs (HS) defect, Bankart-remplissage (B-R) surgery reduces the recurrence rate when compared to Bankart (B) surgery alone. There is controversy regarding whether the recurrence rate also decreases in patients with on-track or non-engaging Hill-Sachs defects. OBJECTIVE: to compare the recurrence rate and clinical evolution of patients with anterior glenohumeral instability with 'on-track' Hill-Sachs defect treated with either B or B-R surgery. MATERIAL AND METHODS: non-randomized, retrospective, single-center cohort study of patients with anterior glenohumeral instability and on-track Hill-Sachs defect, operated between January 2010 and December 2018. Patients operated with B versus B-R were compared. Recurrence, complications and re-operation were recorded. In addition, VAS, SSV, WOSI and qDASH scores were obtained and compared in both groups. RESULTS: of the 105 patients who met the inclusion criteria, 78 (74.3%) patients had a complete follow-up (52 B and 26 B-R, 4.3 years median follow-up). There was a higher recurrence rate in group B compared to B-R, with this difference not reaching statistical significance (17.3% vs 7.7%, p = 0.21). There were no significant differences in residual pain, feeling of instability, complications or VAS, qDASH, SSV or WOSI scores between both groups. In the subgroup analysis, patients who practiced contact sports and were operated with B showed higher recurrence rates (24.1% vs 0%, p = 0.08) and complications (41.4% vs 18.2%, p = 0.16) when compared to B + R, although these differences were not significant. CONCLUSION: there were no significant differences in recurrence rates and functional evolution between patients with anterior glenohumeral instability operated with B or B-R surgery. Comparative, prospective studies should be performed to establish definitive recommendations.
INTRODUCCIÓN: en pacientes con inestabilidad glenohumeral (GH) anterior con defecto de Hill-Sachs (HS) off-track o enganchante, Bankart-remplissage (B + R) reduce tasa de recurrencia en comparación a Bankart aislado (B). Hay controversia si tasa de recurrencia también disminuye en pacientes con defecto de HS on-track o no enganchantes. OBJETIVO: comparar la tasa de recurrencia y evolución clínica entre la cirugía de B versus B-R en pacientes operados por inestabilidad glenohumeral anterior con defecto de Hill-Sachs on-track. MATERIAL Y MÉTODOS: estudio de cohorte, no randomizado, retrospectivo y unicéntrico, en pacientes operados por inestabilidad glenohumeral anterior, entre Enero 2010 y Diciembre de 2018. Se incluyen sólo pacientes con defecto de Hill-Sachs on-track. Fueron comparados pacientes operados con cirugía de B versus B + R. Se consigna recurrencia, complicación, reoperación y sensación de inestabilidad. Además, se realizan y comparan puntajes de EVA, SSV, WOSI y qDASH. RESULTADOS: de los 105 pacientes que cumplieron criterios de inclusión, 78 (74.3%) realizaron seguimiento completo (52 B y 26 B + R, 4.3 años mediana de seguimiento). Hubo mayor tasa de recurrencia en grupo B en comparación a B + R, siendo esta diferencia no significativa (17.3% versus 7.7%, p = 0.21). No hubo diferencia significativa en dolor residual, sensación de inestabilidad residual, complicaciones o puntajes de escala EVA, qDASH, SSV ni WOSI. En análisis por subgrupo, pacientes con deportes de contacto, B tienen mayor tasa de recurrencia (24.1% versus 0%, p = 0.08) y complicaciones comparadas con B + R (41.4% versus 18.2%, p = 0.16), siendo estas diferencias no significativas. CONCLUSIÓN: no hubo diferencias significativas en tasa de recurrencia y evolución funcional entre cirugía de Bankart aislado o Bankart-remplissage para inestabilidad glenohumeral anterior asociada a defecto de Hill-Sachs on-track. Estudios comparativos, prospectivos deben realizarse para establecer recomendaciones definitivas.
Assuntos
Lesões de Bankart , Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Humanos , Articulação do Ombro/cirurgia , Estudos de Coortes , Luxação do Ombro/cirurgia , Estudos Retrospectivos , Ombro , Estudos Prospectivos , Instabilidade Articular/cirurgia , Instabilidade Articular/etiologia , Artroscopia , Lesões de Bankart/cirurgia , RecidivaRESUMO
Resumen: Introducción: en pacientes con inestabilidad glenohumeral (GH) anterior con defecto de Hill-Sachs (HS) off-track o enganchante, Bankart-remplissage (B + R) reduce tasa de recurrencia en comparación a Bankart aislado (B). Hay controversia si tasa de recurrencia también disminuye en pacientes con defecto de HS on-track o no enganchantes. Objetivo: comparar la tasa de recurrencia y evolución clínica entre la cirugía de B versus B-R en pacientes operados por inestabilidad glenohumeral anterior con defecto de Hill-Sachs on-track. Material y métodos: estudio de cohorte, no randomizado, retrospectivo y unicéntrico, en pacientes operados por inestabilidad glenohumeral anterior, entre Enero 2010 y Diciembre de 2018. Se incluyen sólo pacientes con defecto de Hill-Sachs on-track. Fueron comparados pacientes operados con cirugía de B versus B + R. Se consigna recurrencia, complicación, reoperación y sensación de inestabilidad. Además, se realizan y comparan puntajes de EVA, SSV, WOSI y qDASH. Resultados: de los 105 pacientes que cumplieron criterios de inclusión, 78 (74.3%) realizaron seguimiento completo (52 B y 26 B + R, 4.3 años mediana de seguimiento). Hubo mayor tasa de recurrencia en grupo B en comparación a B + R, siendo esta diferencia no significativa (17.3% versus 7.7%, p = 0.21). No hubo diferencia significativa en dolor residual, sensación de inestabilidad residual, complicaciones o puntajes de escala EVA, qDASH, SSV ni WOSI. En análisis por subgrupo, pacientes con deportes de contacto, B tienen mayor tasa de recurrencia (24.1% versus 0%, p = 0.08) y complicaciones comparadas con B + R (41.4% versus 18.2%, p = 0.16), siendo estas diferencias no significativas. Conclusión: no hubo diferencias significativas en tasa de recurrencia y evolución funcional entre cirugía de Bankart aislado o Bankart-remplissage para inestabilidad glenohumeral anterior asociada a defecto de Hill-Sachs on-track. Estudios comparativos, prospectivos deben realizarse para establecer recomendaciones definitivas.
Abstract: Introduction: in patients with anterior glenohumeral (GH) instability together with an off-track or engaging Hill-Sachs (HS) defect, Bankart-remplissage (B-R) surgery reduces the recurrence rate when compared to Bankart (B) surgery alone. There is controversy regarding whether the recurrence rate also decreases in patients with on-track or non-engaging Hill-Sachs defects. Objective: to compare the recurrence rate and clinical evolution of patients with anterior glenohumeral instability with 'on-track' Hill-Sachs defect treated with either B or B-R surgery. Material and methods: non-randomized, retrospective, single-center cohort study of patients with anterior glenohumeral instability and on-track Hill-Sachs defect, operated between January 2010 and December 2018. Patients operated with B versus B-R were compared. Recurrence, complications and re-operation were recorded. In addition, VAS, SSV, WOSI and qDASH scores were obtained and compared in both groups. Results: of the 105 patients who met the inclusion criteria, 78 (74.3%) patients had a complete follow-up (52 B and 26 B-R, 4.3 years median follow-up). There was a higher recurrence rate in group B compared to B-R, with this difference not reaching statistical significance (17.3% vs 7.7%, p = 0.21). There were no significant differences in residual pain, feeling of instability, complications or VAS, qDASH, SSV or WOSI scores between both groups. In the subgroup analysis, patients who practiced contact sports and were operated with B showed higher recurrence rates (24.1% vs 0%, p = 0.08) and complications (41.4% vs 18.2%, p = 0.16) when compared to B + R, although these differences were not significant. Conclusion: there were no significant differences in recurrence rates and functional evolution between patients with anterior glenohumeral instability operated with B or B-R surgery. Comparative, prospective studies should be performed to establish definitive recommendations.
RESUMO
BACKGROUND: The investigation of Hill-Sachs and bony Bankart lesions continues to evolve. Patients with large bone lesions can present with a positive apprehension test even at ranges below 45° of abduction and external rotation of the shoulder. Modern concepts, such as glenoid track and quantification of glenoid bone loss, have been increasingly applied to shoulder instability. The objective of this study was to assess the correlation of the glenoid track and glenoid bone loss on the apprehension test conducted at 0°, 45°, and 90° of shoulder abduction. METHODS: Ninety-four shoulders of 90 patients with anterior glenohumeral instability were retrospectively assessed. The apprehension test was performed at 0°, 45°, and 90° of shoulder abduction. Computed tomography, magnetic resonance imaging, or magnetic resonance arthrogram scans were performed to calculate the glenoid track and glenoid bone loss. A descriptive analysis, an association analysis, and a logistic regression analysis were used in this study. Logistic regression analysis was used to assess the influence of glenoid track and glenoid bone loss when the apprehension test was positive in lower degrees of abduction. RESULTS: A positive apprehension test at 0°, 45°, and 90° of abduction revealed significant association with off-track lesions, glenoid bone losses greater than 13.5%, and bipolar bone lesions. Shoulders classified as off-track were 36.4 times more likely to test positive at 0°, 45°, and 90° than on-track shoulders. The logistic regression analysis revealed that the positive apprehension test at 0°, 45°, and 90° of abduction seems to be more influenced by off-track lesions than by glenoid bone loss greater than the 13.5% threshold. CONCLUSION: Shoulders with a positive apprehension test at 0°, 45°, and 90° are significantly associated with off-track lesions, bipolar bone lesions, and glenoid bone losses greater than 13.5%.
RESUMO
BACKGROUND: The Latarjet procedure is often used to address off-track Hill-Sachs lesions (OFF-HS) in shoulders with anterior instability. There are concerns as to whether the Latarjet procedure is able to convert all OFF-HS into on-track Hill-Sachs lesions (ON-HS) and whether this limitation could explain the cases of recurrent postoperative instability. HYPOTHESIS: Latarjet surgery converts many preoperative OFF-HS lesions, but not all of them, and there is a difference in the failure rate between shoulders with converted lesions and those with persistent OFF-HS lesions. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Patients with anterior shoulder instability and an OFF-HS lesion treated with an arthroscopic classic Latarjet procedure between January 2010 and September 2017 were retrospectively evaluated. Patients with moderate or severe shoulder arthrosis, rotator cuff tears, or age older than 50 years were excluded. Glenoid track (GT), HS, HS interval (HSI), and the difference between HSI and GT (ΔHSI-GT) were measured preoperatively. A postoperative computed tomography scan and a clinical evaluation, including the Rowe and Western Ontario Shoulder Instability scores, were performed at a minimum 1- and 2-year follow-up, respectively. Postoperatively, 2 groups of patients were obtained: (1) patients with postoperative persistent OFF-HS; (2) patients with postoperative ON-HS. Clinical and imaging data were compared between the 2 groups. RESULTS: A total of 51 patients (n = 51 shoulders), with a mean age of 29.8 ± 8.4 years (range, 15-50 years), met the inclusion criteria. Six shoulders (11.8%) still showed OFF-HS lesions despite Latarjet surgery. There were no postoperative dislocations, but 3 patients reported subluxations. The subluxation rate was significantly higher in the postoperative persistent OFF-HS group (2 [33%] vs 1 [2.2%]; P = .033). There was a wider preoperative HSI (29.8 ± 2.4 mm vs 22.9 ± 3.5 mm; P < .001) and a larger preoperative ΔHSI-GT (12.2 ± 3.8 mm vs 4.82 ± 3.2 mm; P < .001) in the persistent OFF-HS group. A receiver operating characteristic curve was performed based on preoperative ΔHSI-GT values. A preoperative ΔHSI-GT value ≥7.45 mm predicted a persistent OFF-HS after Latarjet surgery (sensitivity, 100%; specificity, 87%; positive predictive value, 50%; and negative predictive value, 100%). CONCLUSION: Latarjet surgery converted many preoperative OFF-HS lesions into ON-HS lesions, but not all of them. Six patients (11.8%) retained an OFF-HS and had a statistically significantly higher failure rate after Latarjet surgery compared with those with postoperative ON-HS lesions. Because there were few postoperative OFF-HS lesions and few recurrences, findings are statistically fragile and should be confirmed with larger series.
Assuntos
Lesões de Bankart , Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Adolescente , Adulto , Artroscopia , Humanos , Instabilidade Articular/cirurgia , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Luxação do Ombro/etiologia , Luxação do Ombro/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Adulto JovemRESUMO
Abstract: Introduction: Glenoid track is used to assess the engagement of Hill-Sachs lesions. The objective of this study was to identify if off-track glenoid track was a risk factor for recurrence of anterior glenohumeral instability in postoperative patients with arthroscopic anterior labrum repair. Material and methods: Sixty patients with glenohumeral instability who underwent arthroscopic repair of the anterior labrum were studied. Study group (patients with recurrence of postoperative dislocation) and control (no dislocation). Radiographic measurements were made on magnetic resonance imaging and computed tomography. Measurements of glenoid diameter, glenoid bone loss, as well as the presence and size of Hill-Sachs lesions were obtained. Later they were classified as «on-track¼ or «off-track¼. Results: Seven (11.67%) patients suffered recurrence, of which six (10%) were carriers of an off-track injury and 1 (1.67%) on-Track. 53 (88.33%) patients did not experience recurrence, of which 11 (18.33%) were carriers of an off-track injury and 42 (70%) on track. A 23.47 increased risk of recurrence of instability was interpreted in patients with «off-track¼ lesions compared to patients with «On track¼ lesions. Conclusions: Off-track injuries were a risk factor for recurrence of instability in patients who underwent Bankart-type arthroscopic repair. This allows us to recommend that the presence of lesions be routinely studied and classified as «on-track¼ or «off-track¼ to provide a better therapeutic approach.
Resumen: Introducción: El encarrilamiento glenoideo se emplea para valorar el enganche de lesiones Hill-Sachs. El objetivo de este estudio fue identificar si el encarrilamiento glenoideo off-track fue un factor de riesgo de recidiva de inestabilidad glenohumeral anterior en pacientes postoperados de reparación de labrum anterior por vía artroscópica. Material y métodos: Se estudiaron 60 pacientes sometidos a reparación artroscópica del labrum anterior. Grupo de estudio (pacientes con recidiva de luxación postoperatoria) y control (sin luxación). Las mediciones radiográficas se realizaron en resonancia magnética y en tomografía axial computarizada. Se obtuvieron mediciones del diámetro glenoideo, pérdida ósea glenoidea así como la presencia y tamaño de lesiones de Hill-Sachs. Posteriormente se clasificaron como on-track u off-track. Resultados: Siete (11.67%) pacientes sufrieron recidiva, de los cuales seis (10%) eran portadores de lesión off-track y uno (1.67%) on-track. 53 (88.33%) pacientes sin recidiva, de los cuales 11 (18.33%) eran portadores de lesión off-track y 42 (70%) on-track. Se interpretó un aumento de riesgo de recidiva de inestabilidad de 23.47 en los pacientes portadores de lesión de tipo off-track en comparación con los pacientes portadores de lesiones on-track. Conclusiones: Las lesiones off-track fueron un factor de riesgo de recidiva de inestabilidad en los pacientes a quienes se realizó reparación artroscópica tipo Bankart, lo cual nos permite recomendar que de forma rutinaria se estudie la presencia de lesiones y clasificarlas como on-track u off-track para brindar un mejor abordaje terapéutico.
Assuntos
Humanos , Luxação do Ombro , Articulação do Ombro , Lesões de Bankart , Instabilidade Articular , Artroscopia , Recidiva , Luxação do Ombro/cirurgia , Luxação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Articulação do Ombro/diagnóstico por imagem , Fatores de Risco , Instabilidade Articular/cirurgia , Instabilidade Articular/etiologia , Instabilidade Articular/diagnóstico por imagemRESUMO
INTRODUCTION: Glenoid track is used to assess the engagement of Hill-Sachs lesions. The objective of this study was to identify if off-track glenoid track was a risk factor for recurrence of anterior glenohumeral instability in postoperative patients with arthroscopic anterior labrum repair. MATERIAL AND METHODS: Sixty patients with glenohumeral instability who underwent arthroscopic repair of the anterior labrum were studied. Study group (patients with recurrence of postoperative dislocation) and control (no dislocation). Radiographic measurements were made on magnetic resonance imaging and computed tomography. Measurements of glenoid diameter, glenoid bone loss, as well as the presence and size of Hill-Sachs lesions were obtained. Later they were classified as "on-track" or "off-track". RESULTS: Seven (11.67%) patients suffered recurrence, of which six (10%) were carriers of an off-track injury and 1 (1.67%) on-Track. 53 (88.33%) patients did not experience recurrence, of which 11 (18.33%) were carriers of an off-track injury and 42 (70%) on track. A 23.47 increased risk of recurrence of instability was interpreted in patients with "off-track" lesions compared to patients with "On track" lesions. CONCLUSIONS: Off-track injuries were a risk factor for recurrence of instability in patients who underwent Bankart-type arthroscopic repair. This allows us to recommend that the presence of lesions be routinely studied and classified as "on-track" or "off-track" to provide a better therapeutic approach.
INTRODUCCIÓN: El encarrilamiento glenoideo se emplea para valorar el enganche de lesiones Hill-Sachs. El objetivo de este estudio fue identificar si el encarrilamiento glenoideo. MATERIAL Y MÉTODOS: off-track fue un factor de riesgo de recidiva de inestabilidad glenohumeral anterior en pacientes postoperados de reparación de labrum anterior por vía artroscópica. Se estudiaron 60 pacientes sometidos a reparación artroscópica del labrum anterior. Grupo de estudio (pacientes con recidiva de luxación postoperatoria) y control (sin luxación). Las mediciones radiográficas se realizaron en resonancia magnética y en tomografía axial computarizada. Se obtuvieron mediciones del diámetro glenoideo, pérdida ósea glenoidea así como la presencia y tamaño de lesiones de Hill-Sachs. Posteriormente se clasificaron como. RESULTADOS: on-track u off-track. Siete (11.67%) pacientes sufrieron recidiva, de los cuales seis (10%) eran portadores de lesión. CONCLUSIONES: off-track y uno (1.67%) on-track. 53 (88.33%) pacientes sin recidiva, de los cuales 11 (18.33%) eran portadores de lesión off-track y 42 (70%) on-track. Se interpretó un aumento de riesgo de recidiva de inestabilidad de 23.47 en los pacientes portadores de lesión de tipo off-track en comparación con los pacientes portadores de lesiones on-track. Las lesiones.