Abstract
Purpose
Some young individuals present with shoulder pain without a definite history or complaint of instability. However, careful history taking, physical examination, and high-quality magnetic resonance imaging may reveal evidence of instability of which the patient is unaware. Therefore, a clearer definition of these ambiguous patients is needed. This study aimed to report the characteristics and surgical outcomes of patients with microinstability compared to those of patients with classic recurrent anterior shoulder instability.
Methods
From 2005 to 2018, 35 patients with microinstability (group M) underwent arthroscopic anterior labral repair (AALR) and were compared to 35 sex- and age-matched patients with classic recurrent anterior shoulder instability (group C) who also underwent AALR. Baseline characteristics, preoperative apprehension test findings, preoperative imaging for the presence of anterior labral and Hill–Sachs lesions, preoperative and postoperative (over 2 years) range of motion (ROM) and functional scores, final complications, and patient satisfaction were analysed.
Results
The most common chief complaints in groups M and C were pain (29/35) and both pain and instability (27/35), respectively. Only pain during the apprehension test was predominant in group M (M vs. C, 27 vs. 1, p < 0.001). High incidence of chronic repetitive injuries (26/35) and acute trauma (28/35) were observed in groups M and C, respectively. Over half of the patients in group M showed anterior labral lesions on magnetic resonance arthrography (MRA, 18/35), and 21 patients had Hill–Sachs lesions on MRA/three-dimensional computed tomography. Finally, 29 patients showed either anterior labral or Hill–Sachs lesions on preoperative imaging. The lesion severity was higher in group C than that in group M. All patients underwent AALR with/without the remplissage procedure, with no significant differences in final clinical outcomes, complications, and patient satisfaction between the groups.
Conclusions
Microinstability is diagnostically challenging and can be diagnosed in young patients with ambiguous shoulder pain during motion, without instability. Pain on anterior apprehension test and subtle labral and/or Hill–Sachs lesion on imaging study could be diagnostic clues. This condition can be managed with arthroscopic anterior labral repair with or without the remplissage procedure. The possibility of microinstability in young patients with shoulder pain should always be considered, and small anterior labral or Hill–Sachs lesions should be closely monitored.
Level of evidence
III.
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References
Alkaduhimi H, Saarig A, Amajjar I, van der Linde JA, van Wier MF, Willigenburg NW, van den Bekerom MPJ (2021) Interobserver agreement for detecting Hill-Sachs lesions on magnetic resonance imaging. Clin Shoulder Elb 24(2):98–105
Boileau P, Zumstein M, Balg F, Penington S, Bicknell RT (2011) The unstable painful shoulder (UPS) as a cause of pain from unrecognized anteroinferior instability in the young athlete. J Shoulder Elbow Surg 20(1):98–106
Castagna A, Borroni M, Rose GD (2016) Multidirectional, microinstability, and acquired instability. In: Randelli P, Dejour D, van Dijk CN, Denti M, Seil R (eds) Arthroscopy: basic to advanced. Springer, Berlin, pp 511–513
Castagna A, Nordenson U, Garofalo R, Karlsson J (2007) Minor shoulder instability. Arthroscopy 23(2):211–215
Depovere T, Pouliart N (2019) Do patients with minor shoulder instability have a different outcome from those with recurrent anteroinferior instability? Eur J Orthop Surg Traumatol 29(8):1649–1657
Dyrna FGE, Ludwig M, Imhoff AB, Martetschlager F (2021) Off-track Hill-Sachs lesions predispose to recurrence after nonoperative management of first-time anterior shoulder dislocations. Knee Surg Sports Traumatol Arthrosc 29(7):2289–2296
Godinho AC, Godinho PC, Ribeiro EJS, de Toledo DC, Bem FdMFC, Godinho GG (2021) Influence of the glenoid track and glenoid bone loss on the apprehension test for shoulder instability. JSES Int 5(4):616–622
Kim SH, Jung W, Rhee SM, Kim JU, Oh JH (2020) Outcomes of arthroscopic capsulolabral reconstruction for anterior instability with greater than 20% glenoid bone defects: are Latarjet procedures absolutely indicated for these patients? Clin Shoulder Elb 23(2):62–70
Kuberakani K, Aizawa K, Yamamoto N, Shinagawa K, Suzuki T, Hatta T, Kawakami J, Itoi E (2020) Comparison of best-fit circle versus contralateral comparison methods to quantify glenoid bone defect. J Shoulder Elbow Surg 29(3):502–507
Ladermann A, Denard PJ, Collin P, Ibrahim M, Bothorel H, Chih-Hao Chiu J (2021) Single assessment numeric evaluation for instability as an alternative to the Rowe score. J Shoulder Elbow Surg 30(5):1167–1173
Lee BI, Kim BM, Kho DH, Kim HJ (2017) Clinical results of the arthroscopic “multiple pulled suture” technique for large or comminuted bony Bankart lesion. Clin Shoulder Elbow 20(3):138–146
Lee SH, Joo MS, Lim KH, Kim JW (2018) Arthroscopic Treatment of a Type II Superior Labrum Anterior to Posterior (SLAP) Lesion Combined with a Bankart Lesion: comparative Study between Debridement and Repair of Type II SLAP Lesion by the Status of Lesion. Clin Shoulder Elb 21(1):37–41
Moroder P, Danzinger V, Maziak N, Plachel F, Pauly S, Scheibel M, Minkus M (2020) Characteristics of functional shoulder instability. J Shoulder Elbow Surg 29(1):68–78
Park I, Lee JH, Hyun HS, Lee TK, Shin SJ (2018) Minimal clinically important differences in Rowe and Western Ontario Shoulder Instability Index scores after arthroscopic repair of anterior shoulder instability. J Shoulder Elbow Surg 27(4):579–584
Park I, Oh M-J, Shin S-J (2020) Effects of Glenoid and humeral bone defects on recurrent anterior instability of the shoulder. Clin Orthop Surg 12(2):145–150
Richards RR, An K-N, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG, Iannotti JP, Mow VC, Sidles JA, Zuckerman JD (1994) A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg 3(6):347–352
Rowe CR, Zarins B (1981) Recurrent transient subluxation of the shoulder. J Bone Jt Surg Am 63(6):863–872
Savoie FH 3rd, Papendik L, Field LD, Jobe C (2001) Straight anterior instability: Lesions of the middle glenohumeral ligament. Arthroscopy 17(3):229–235
Sgroi M, Huzurudin H, Ludwig M, Dornacher D, Reichel H, Kappe T (2021) With the exception of the Hill-Sachs interval, CT and MRI show no significant differences in the diagnostic value of the HSL measurement regardless of the measurement technique. Knee Surg Sports Traumatol Arthrosc 29(12):3981–3988
Shim SB, Jeong JY, Keum DH, Yoo JC (2019) Does creating a trough on the anterior glenoid rim make a difference in Arthroscopic Bankart repair using suture anchors? A mid-term follow-up retrospective study. J Orthop Sci 24(2):250–257
Wermers J, Schliemann B, Raschke MJ, Michel PA, Heilmann LF, Dyrna F, Sussiek J, Frank A, Katthagen JC (2021) Glenoid concavity has a higher impact on shoulder stability than the size of a bony defect. Knee Surg Sports Traumatol Arthrosc 29(8):2631–2639
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Kim, S.C., Kim, K.H., Park, J.H. et al. Microinstability characterised by small and easily overlooked anterior labral or Hill–Sachs lesions can be managed with arthroscopic anterior labral repair. Knee Surg Sports Traumatol Arthrosc 30, 3818–3826 (2022). https://doi.org/10.1007/s00167-022-06941-4
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DOI: https://doi.org/10.1007/s00167-022-06941-4