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.
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.
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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
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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.
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Frank, R.M., Romeo, A.A. Arthroscopic soft tissue reconstruction in anterior shoulder instability. Orthopäde 47, 121–128 (2018). https://doi.org/10.1007/s00132-018-3532-9
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DOI: https://doi.org/10.1007/s00132-018-3532-9