Der Orthopäde

, Volume 47, Issue 2, pp 121–128 | Cite as

Arthroscopic soft tissue reconstruction in anterior shoulder instability

Leitthema
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Abstract

Anterior glenohumeral instability remains a difficult problem in the athletic and working patient populations. Treatment strategies are variable and range from nonoperative approaches incorporating immobilization and rehabilitation to surgical management. Surgical decision-making can be challenging, especially with a high-level patient who wishes to return to high-demand activities. Operative options range from open soft tissue stabilization to arthroscopic soft tissue stabilization, with both open and arthroscopic options for bony reconstruction in the setting of clinically significant anterior glenoid bone loss. In all cases, understanding appropriate indications and utilizing sound surgical techniques are critical for achieving a successful result. For the majority of patients with anterior shoulder instability, arthroscopic soft tissue reconstruction with suture anchors is a successful, minimally invasive approach that results in a stable shoulder with excellent outcomes and low complication rates.

Keywords

Shoulder stabilization Suture Anchors Arthroscopy Surgical procedures Glenohumeral subluxation 

Abbreviations

ALPSA

Anterior labral periosteal sleeve avulsion

CT

Computed tomography

GLAD

Glenoid labrum articular disruption

HAGL

Humeral avulsion of the glenohumeral ligament

MRI

Magnetic resonance imaging

NCAA

National Collegiate Athletic Association

Arthroskopische Weichteilrekonstruktion bei vorderer Schulterinstabilität

Zusammenfassung

Die vordere glenohumerale Instabilität ist weiterhin ein schwieriges Problem in den Patientengruppen der Sportler und Berufstätigen. Es gibt verschiedene Behandlungsstrategien. Sie reichen von nichtoperativen Ansätzen mit Immobilisation und Rehabilitation bis hin zu einer chirurgischen Versorgung. Die chirurgische Entscheidungsfindung kann eine Herausforderung sein, insbesondere bei anspruchsvollen Patienten, die belastende Aktivitäten wiederaufnehmen möchten. Die operativen Möglichkeiten umfassen die offene oder arthroskopische Weichteilstabilisierung, mit offenen wie auch arthroskopischen Optionen zur Knochenrekonstruktion bei klinisch relevantem vorderem glenoidalem Knochenverlust. In allen Fällen sind das Verständnis der angebrachten Indikationen und die Anwendung geeigneter chirurgischer Verfahren entscheidend für ein erfolgreiches Behandlungsergebnis. Bei der Mehrheit der Patienten mit vorderer Schulterinstabilität ist die arthroskopische Weichteilrekonstruktion mit Fadenankern ein erfolgreicher minimal-invasiver Ansatz, der die Schulter stabilisiert und mit exzellenten Behandlungsergebnissen und geringen Komplikationsraten einhergeht.

Schlüsselwörter

Schulterstabilisierung Fadenanker Arthroskopie Chirurgische Verfahren Glenohumerale Subluxation 

Notes

Compliance with ethical guidelines

Conflict of interest

R.M. Frank declares that she has no competing interests. A.A. Romeo: AANA: other financial or material support; Aesculap/B.Braun: research support; American Orthopaedic Society for Sports Medicine: board or committee member; American Shoulder and Elbow Surgeons: board or committee member; Arthrex, Inc: IP royalties, other financial or material support, paid consultant, paid presenter or speaker, research support; Atreon Orthopaedics: board or committee member; Histogenics: research support; Medipost: research support; MLB: other financial or material support; NuTech: research support; Orthopedics: editorial or governing board; Orthopedics Today: board or committee member, editorial or governing board; OrthoSpace: research support; SAGE: editorial or governing board; Saunders/Mosby-Elsevier: publishing royalties, financial or material support; SLACK Incorporated: editorial or governing board; publishing royalties, financial or material support; Smith & Nephew: research support; Wolters Kluwer Health – Lippincott Williams & Wilkins: editorial or governing board; Zimmer: research support.

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Romeo AA, Cohen BS, Carreira DS (2001) Traumatic anterior shoulder instability. Orthop Clin North Am 32:399–409CrossRefPubMedGoogle Scholar
  2. 2.
    Owens BD, Duffey ML, Nelson BJ, DeBerardino TM, Taylor DC, Mountcastle SB (2007) The incidence and characteristics of shoulder instability at the United States Military Academy. Am J Sports Med 35:1168–1173CrossRefPubMedGoogle Scholar
  3. 3.
    Bedi A, Ryu RK (2009) The treatment of primary anterior shoulder dislocations. Instr Course Lect 58:293–304PubMedGoogle Scholar
  4. 4.
    Millett PJ, Clavert P, Hatch GF 3rd, Warner JJ (2006) Recurrent posterior shoulder instability. J Am Acad Orthop Surg 14:464–476CrossRefPubMedGoogle Scholar
  5. 5.
    Wang RY, Arciero RA, Mazzocca AD (2009) The recognition and treatment of first-time shoulder dislocation in active individuals. J Orthop Sports Phys Ther 39:118–123CrossRefPubMedGoogle Scholar
  6. 6.
    Hovelius L, Augustini BG, Fredin H, Johansson O, Norlin R, Thorling J (1996) Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study. J Bone Joint Surg Am 78:1677–1684CrossRefPubMedGoogle Scholar
  7. 7.
    Kralinger FS, Golser K, Wischatta R, Wambacher M, Sperner G (2002) Predicting recurrence after primary anterior shoulder dislocation. Am J Sports Med 30:116–120CrossRefPubMedGoogle Scholar
  8. 8.
    Rowe CR, Sakellarides HT (1961) Factors related to recurrences of anterior dislocations of the shoulder. Clin Orthop 20:40–48PubMedGoogle Scholar
  9. 9.
    Simonet WT, Cofield RH (1984) Prognosis in anterior shoulder dislocation. Am J Sports Med 12:19–24CrossRefPubMedGoogle Scholar
  10. 10.
    Vermeiren J, Handelberg F, Casteleyn PP, Opdecam P (1993) The rate of recurrence of traumatic anterior dislocation of the shoulder. A study of 154 cases and a review of the literature. Int Orthop 17:337–341CrossRefPubMedGoogle Scholar
  11. 11.
    Jaggi A, Lambert S (2010) Rehabilitation for shoulder instability. Br J Sports Med 44:333–340CrossRefPubMedGoogle Scholar
  12. 12.
    Abrams JS, Savoie FH 3rd, Tauro JC, Bradley JP (2002) Recent advances in the evaluation and treatment of shoulder instability: anterior, posterior, and multidirectional. Arthroscopy 18:1–13CrossRefPubMedGoogle Scholar
  13. 13.
    Cox CL, Kuhn JE (2008) Operative versus nonoperative treatment of acute shoulder dislocation in the athlete. Curr Sports Med Rep 7:263–268CrossRefPubMedGoogle Scholar
  14. 14.
    Aronen JG, Regan K (1984) Decreasing the incidence of recurrence of first time anterior shoulder dislocations with rehabilitation. Am J Sports Med 12:283–291CrossRefPubMedGoogle Scholar
  15. 15.
    Stein DA, Jazrawi L, Bartolozzi AR (2002) Arthroscopic stabilization of anterior shoulder instability: a review of the literature. Arthroscopy 18:912–924CrossRefPubMedGoogle Scholar
  16. 16.
    Bottoni CR, Wilckens JH, DeBerardino TM et al (2002) A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations. Am J Sports Med 30:576–580CrossRefPubMedGoogle Scholar
  17. 17.
    Robinson CM, Howes J, Murdoch H, Will E, Graham C (2006) Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. J Bone Joint Surg Am 88:2326–2336CrossRefPubMedGoogle Scholar
  18. 18.
    Hobby J, Griffin D, Dunbar M, Boileau P (2007) Is arthroscopic surgery for stabilisation of chronic shoulder instability as effective as open surgery? A systematic review and meta-analysis of 62 studies including 3044 arthroscopic operations. J Bone Joint Surg Br 89:1188–1196CrossRefPubMedGoogle Scholar
  19. 19.
    Kirkley A, Werstine R, Ratjek A, Griffin S (2005) Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder: long-term evaluation. Arthroscopy 21:55–63CrossRefPubMedGoogle Scholar
  20. 20.
    Arciero RA, Pierre StP (1995) Acute shoulder dislocation. Indications and techniques for operative management. Clin Sports Med 14:937–953PubMedGoogle Scholar
  21. 21.
    Arciero RA, Wheeler JH, Ryan JB, McBride JT (1994) Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med 22:589–594CrossRefPubMedGoogle Scholar
  22. 22.
    Larrain MV, Botto GJ, Montenegro HJ, Mauas DM (2001) Arthroscopic repair of acute traumatic anterior shoulder dislocation in young athletes. Arthroscopy 17:373–377CrossRefPubMedGoogle Scholar
  23. 23.
    Bottoni CR (2006) Anterior instability. In: Johnson DLMS (ed) Clinical sports medicine. Elsevier, Philadelphia, pp 189–200CrossRefGoogle Scholar
  24. 24.
    Frank RM, Chalmers PN, Moric M, Leroux T, Provencher MT, Romeo AA (2017) Incidence and changing trends of shoulder stabilization in the United States. Arthroscopy.  https://doi.org/10.1016/j.arthro.2017.08.289 Google Scholar
  25. 25.
    Riff AJ, Frank RM, Sumner S et al (2017) Trends in shoulder stabilization techniques used in the United States based on a large private-payer database. Orthop J Sports Med 5:2325967117745511PubMedPubMedCentralGoogle Scholar
  26. 26.
    Owens BD, Harrast JJ, Hurwitz SR, Thompson TL, Wolf JM (2011) Surgical trends in Bankart repair: an analysis of data from the American Board of Orthopaedic Surgery certification examination. Am J Sports Med 39:1865–1869CrossRefPubMedGoogle Scholar
  27. 27.
    Degen RM, Camp CL, Werner BC, Dines DM, Dines JS (2016) Trends in bone-block augmentation among recently trained orthopaedic surgeons treating anterior shoulder instability. J Bone Joint Surg Am 98:e56CrossRefPubMedGoogle Scholar
  28. 28.
    Rowe CR, Zarins B (1981) Recurrent transient subluxation of the shoulder. J Bone Joint Surg Am 63:863–872CrossRefPubMedGoogle Scholar
  29. 29.
    Arciero RA, Spang JT (2008) Complications in arthroscopic anterior shoulder stabilization: pearls and pitfalls. Instr Course Lect 57:113–124PubMedGoogle Scholar
  30. 30.
    Boileau P, Villalba M, Hery JY, Balg F, Ahrens P, Neyton L (2006) Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am 88:1755–1763CrossRefPubMedGoogle Scholar
  31. 31.
    Tauber M, Resch H, Forstner R, Raffl M, Schauer J (2004) Reasons for failure after surgical repair of anterior shoulder instability. J Shoulder Elbow Surg 13:279–285CrossRefPubMedGoogle Scholar
  32. 32.
    Forsythe B, Frank RM, Ahmed M et al (2015) Identification and treatment of existing copathology in anterior shoulder instability repair. Arthroscopy 31:154–166CrossRefPubMedGoogle Scholar
  33. 33.
    Frank RM, Saccomanno MF, McDonald LS, Moric M, Romeo AA, Provencher MT (2014) Outcomes of arthroscopic anterior shoulder instability in the beach chair versus lateral decubitus position: a systematic review and meta-regression analysis. Arthroscopy 30:1349–1365CrossRefPubMedGoogle Scholar
  34. 34.
    Petrera M, Patella V, Patella S, Theodoropoulos J (2010) A meta-analysis of open versus arthroscopic Bankart repair using suture anchors. Knee Surg Sports Traumatol Arthrosc 18(12):1742.  https://doi.org/10.1007/s00167-010-1093-5 CrossRefPubMedGoogle Scholar
  35. 35.
    Pulavarti RS, Symes TH, Rangan A (2009) Surgical interventions for anterior shoulder instability in adults. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD005077.pub2 PubMedGoogle Scholar
  36. 36.
    Hiemstra LA, Sasyniuk TM, Mohtadi NG, Fick GH (2008) Shoulder strength after open versus arthroscopic stabilization. Am J Sports Med 36:861–867CrossRefPubMedGoogle Scholar
  37. 37.
    Rhee YG, Lim CT, Cho NS (2007) Muscle strength after anterior shoulder stabilization: arthroscopic versus open Bankart repair. Am J Sports Med 35:1859–1864CrossRefPubMedGoogle Scholar
  38. 38.
    Gill TJ, Zarins B (2003) Open repairs for the treatment of anterior shoulder instability. Am J Sports Med 31:142–153CrossRefPubMedGoogle Scholar
  39. 39.
    Kim SH, Ha KI, Cho YB, Ryu BD, Oh I (2003) Arthroscopic anterior stabilization of the shoulder: two to six-year follow-up. J Bone Joint Surg Am 85-A:1511–1518CrossRefPubMedGoogle Scholar
  40. 40.
    Robins RJ, Daruwalla JH, Gamradt SC et al (2017) Return to play after shoulder instability surgery in national collegiate athletic association division I intercollegiate football athletes. Am J Sports Med 45:2329–2335CrossRefPubMedGoogle Scholar
  41. 41.
    Leroux TS, Saltzman BM, Meyer M et al (2017) The influence of evidence-based surgical indications and techniques on failure rates after arthroscopic shoulder stabilization in the contact or collision athlete with anterior shoulder instability. Am J Sports Med 45:1218–1225CrossRefPubMedGoogle Scholar
  42. 42.
    Hohmann E, Tetsworth K, Glatt V (2017) Open versus arthroscopic surgical treatment for anterior shoulder dislocation: a comparative systematic review and meta-analysis over the past 20 years. J Shoulder Elbow Surg 26:1873–1880CrossRefPubMedGoogle Scholar
  43. 43.
    Grumet RC, Bach BR Jr., Provencher MT (2010) Arthroscopic stabilization for first-time versus recurrent shoulder instability. Arthroscopy 26:239–248CrossRefPubMedGoogle Scholar
  44. 44.
    Rugg CM, Hettrich CM, Ortiz S, Wolf BR, Group MSI, Zhang AL (2018) Surgical stabilization for first-time shoulder dislocators: a multicenter analysis. J Shoulder Elbow Surg.  https://doi.org/10.1016/j.jse.2017.10.041 PubMedGoogle Scholar
  45. 45.
    Buss DD, Lynch GP, Meyer CP, Huber SM, Freehill MQ (2004) Nonoperative management for in-season athletes with anterior shoulder instability. Am J Sports Med 32:1430–1433CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.CU Sports Medicine, Department of OrthopedicsUniversity of Colorado School of MedicineBoulderUSA
  2. 2.Department of Orthopaedic SurgeryRush University Medical CenterChicagoUSA

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