The effectiveness of current methods of surgical treatment of anterior recurrent instability of the shoulder joint, depending on anatomical and functional changes

Introduction. Traumatic anterior dislocation of the shoulder usually results in chronic recurrent shoulder instability, especially in young adults. To reduce the rate of recurrent dislocations, various options of osteoplastic operations have been proposed.

The purpose of our study is to determine the significance of anatomical and functional disorders in patients with anterior shoulder joint instability; to evaluate the results of the methods for surgical treatment of patients with anterior recurrent instability of the shoulder joint, depending on the anatomical and functional disorders.

Materials and methods. The results of diagnostic examination and treatment of 169 patients with recurrent post-traumatic dislocation of the shoulder who were operated on at the Federal State Budgetary Organization “Federal Center for Traumatology, Orthopedics and Arthroplasty” (Cheboksary) were analyzed. The average age of patients was 31.1 ± 13.1 years; the average period of postoperative follow-up was 49.5 ± 24.0 months. Clinical data were assessed by angulometry, using the ROWE, ASES, UCLA, VAS scales. The size of bone defects was determined using radiological methods. 99 patients (58.6 %) underwent arthroscopic Bankart repair, 24 patients (14.2 %) with more than 15 % anterior glenoid bone defect underwent Latarjet operation. Bankart + Remplissage surgery was performed in 39 patients (23.1 %), Latarjet + Remplissage in 7 (4.1 %) patients.

Results. Bone defect of the glenoid of more than 15 % of the area was detected in 32 patients. Hill-Sachs grade 3 injury was reported in 24 patients. Most of these patients had a history of more than 20 dislocation episodes. Hyperelasticity of the shoulder joint was found in 34 patients. In the postoperative period, there was a slight improvement in the mean indicators of flexion and abduction in the shoulder joint from 174.2 ± 15.9° and 170.6 ± 17.8° to 175.6 ± 9.3° and 173.0 ± 12.3°, respectively. The mean external rotation worsened from 61.6 ± 25.7° to 55.9 ± 14.4°. Indicators of the ROWE, ASES, UCLA rating scales improved significantly from 38.5 ± 8.5, 76.0 ± 13.2 and 20.8 ± 3.0 to 89.9 ± 17.5, 94.0 ± 7.1 and 32.7 ± 3.7 points, respectively. Poor results were observed in 7 patients (4.1 %), of which three had a relapse.

Conclusions. Critically significant anatomical and functional disorders in patients with anterior instability of the shoulder joint are the defect of the anterior rim of the articular process of the scapula more than 15 %, the defect of the posterior surface of the humeral head (Hill-Sachs defect) of grade 3, hyperelasticity of the soft tissues of the shoulder joint. The severity of bone defects is directly proportional to the total number of dislocations. The effectiveness of surgical techniques for stabilizing the shoulder joint, depending on the above anatomical and functional disorders, was 95.9 %.

1. Hatta T., Yamamoto N., Shinagawa K., Kawakami J., Itoi E. Surgical decision making based on the on-track/off-track concept for anterior shoulder instability: a case-control study. JSES Open Access, 2019, vol. 3, no. 1, pp. 25-28. DOI: 10.1016/j.jses.2018.10.001

2. Shaiakh A.B.S. MRT pri nestabilnosti plechevogo sustava [MRI for the shoulder instability]. Vestnik Rentgenologii i Radiologii, 2002, no. 6, pp. 32- 36. (in Russian)

3. Beliak E.A., Kubashev A.A., Lazko F.L., Lomtatidze E.Sh., Abdulkhabirov M.A., Ptitsyn K.A., Prizov A.P. Opyt primeneniia operatsii Latarzhe dlia lecheniia patsientov s perednei nestabilnostiu plechevogo sustava [The experience of performing Latarjet surgery for treating patients with anterior instability of the shoulder]. Travmatologiia i Ortopediia Rossii, 2014, no. 3, pp. 115-121. (in Russian)

4. Moore T.K., Hurley E.T., Rowe D.N., Hogan R.E., Kilkenny C.J., Pauzenberger L., Mullett H. Outcomes following arthroscopic Bankart repair in female patients. J. Shoulder Elbow Surg., 2020, vol. 29, no. 7, pp. 1332-1336. DOI: 10.1016/j.jse.2019.12.012

5. Ahmed I., Ashton F., Robinson C.M. Arthroscopic Bankart repair and capsular shift for recurrent anterior shoulder instability: functional outcomes and identification of risk factors for recurrence. J. Bone Joint Surg. Am., 2012, vol. 94, no. 14, pp. 1308-1315. DOI: 10.2106/JBJS.J.01983

6. DeFroda S., Bokshan S., Stern E., Sullivan K., Owens B.D. Arthroscopic Bankart Repair for the Management of Anterior Shoulder Instability: Indications and Outcomes. Curr. Rev. Musculoskelet. Med., 2017, vol. 10, no. 4, pp. 442-451. DOI: 10.1007/s12178-017-9435-2

7. Nakagawa S., Hirose T., Tachibana Y., Iuchi R., Mae T. Postoperative Recurrence of Instability due to New Anterior Glenoid Rim Fractures after Arthroscopic Bankart Repair. Am. J. Sports Med., 2017, vol. 45, no. 12, pp. 2840-2848. DOI: 10.1177/0363546517714476

8. Burkhart S.S., De Beer J.F. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy, 2000, vol. 16, no. 7, pp. 677-694. DOI: 10.1053/jars.2000.17715

9. Rollick N.C., Ono Y., Kurji H.M., Nelson A.A., Boorman R.S., Thornton G.M., Lo I.K. Long-term outcomes of the Bankart and Latarjet repairs: a systematic review. Open Access J. Sports Med., 2017, vol. 8, pp. 97-105. DOI: 10.2147/OAJSM.S106983

10. Domos P., Ascione F., Wallace A.L. Arthroscopic Bankart repair with remplissage for non-engaging Hill-Sachs lesion in professional collision athletes. Shoulder Elbow, 2019, vol. 11, no. 1, pp. 17-25. DOI: 10.1177/1758573217728414

11. Barber F.A. Editorial Commentary: Open or Arthroscopic Surgery? Practice Makes Perfect… We Do Best What We Do Most Often. Arthroscopy, 2020, vol. 36, no. 3, pp. 872-874. DOI: 10.1016/j.arthro.2019.11.112

12. Wolf E.M., Arianjam A. Hill-Sachs remplissage, an arthroscopic solution for the engaging Hill-Sachs lesion: 2- to 10-year follow-up and incidence of recurrence. J. Shoulder Elbow Surg., 2014, vol. 23, no. 6, pp. 814-820. DOI: 10.1016/j.jse.2013.09.009

13. Pandey V., Gangadharaiah L., Madi S., Acharya K., Nayak S., Karegowda L.H., Willems W.J. A retrospective cohort analysis of arthroscopic Bankart repair with or without remplissage in patients with off-track Hill-Sachs lesion evaluated for functional outcomes, recurrent instability, and range of motion. J. Shoulder Elbow Surg., 2020, vol. 29, no. 2, pp. 273-281. DOI: 10.1016/j.jse.2019.06.005

14. Balg F., Boileau P. The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilization. J. Bone Joint Surg. Br., 2007, vol. 89, no. 11, pp. 1470-1477. DOI: 10.1302/0301-620X.89B11.18962

15. Ruiz Ibán M.A., Asenjo Gismero C.V., Moros Marco S., Ruiz Díaz R., Del Olmo Hernández T., Del Monte Bello G., García Navlet M., Ávila Lafuente J.L., Díaz Heredia J. Instability severity index score values below 7 do not predict recurrence after arthroscopic Bankart repair. Knee Surg. Sports Traumatol. Arthrosc., 2019, vol. 27, no. 12, pp. 3905-3911. DOI: 10.1007/s00167-019-05471-w

16. Oh J.H., Shin S.J., Cho C.H., Seo H.J., Park J.S., Rhee Y.G. Reliability of the Instability Severity Index Score as a Predictor of Recurrence after Arthroscopic Anterior Capsulolabral Reconstruction: A Multicenter Retrospective Study. Clin. Orthop. Surg., 2019, vol. 11, no. 4, pp. 445-452. DOI: 10.4055/cios.2019.11.4.445

17. Itoi E. 'On-track' and 'off-track' shoulder lesions. EFORT Open Rev., 2017, vol. 2, no. 8, pp. 343-351. DOI: 10.1302/2058-5241.2.170007

18. Tikhilov R.M., Dokolin S.Iu., Kuznetsov I.A., Trachuk A.P., Burulev A.L., Mikhailova A.M., Zakharov K.I. Otdalennye rezultaty artroskopicheskogo lecheniia retsidiviruiushchei nestabilnosti plechevogo sustava, prichiny neudachnykh iskhodov [Long-term results of the arthroscopic treatment of the shoulder recurrent instability, reasons for unsuccessful outcomes]. Travmatologiia i Ortopediia Rossii, 2011, no. 1, pp. 5-13. (in Russian)

19. Calandra J.J., Baker C.L., Uribe J. The incidence of Hill-Sachs lesions in initial anterior shoulder dislocations. Arthroscopy, 1989, vol. 5, no. 4, pp. 254-257. DOI: 10.1016/0749-8063(89)90138-2

20. Momaya A.M., Tokish J.M. Applying the Glenoid Track Concept in the Management of Patients with Anterior Shoulder Instability. Curr. Rev. Musculoskelet. Med., 2017, vol. 10, no. 4, pp. 463-468. DOI: 10.1007/s12178-017-9436-1

21. Rowe C.R., Patel D., Southmayd W.W. The Bankart procedure: a long-term end-result study. J. Bone Joint Surg. Am., 1978, vol. 60, no. 1, pp. 1-16.

22. Richards R.R., An K.N., Bigliani L.U., Friedman R.J., Gartsman G.M., Gristina A.G., Iannotti J.P., Mow V.C., Sidles J.A., Zuckerman J.D. A standardized method for the assessment of shoulder function. J. Shoulder Elbow Surg., 1994, vol. 3, no. 6, pp. 347-352. DOI: 10.1016/S1058-2746(09)80019-0

23. Jankauskas L., Rüdiger H.A., Pfirrmann C.W., Jost B., Gerber C. Loss of the sclerotic line of the glenoid on anteroposterior radiographs of the shoulder: a diagnostic sign for an osseous defect of the anterior glenoid rim. J. Shoulder Elbow Surg., 2010, vol. 19, no. 1, pp. 151-156. DOI: 10.1016/j.jse.2009.04.013

24. Yamamoto N., Itoi E., Abe H., Minagawa H., Seki N., Shimada Y., Okada K. Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: a new concept of glenoid track. J. Shoulder Elbow Surg., 2007, vol. 16, no. 5, pp. 649-656. DOI: 10.1016/j. jse.2006.12.012

25. Shaha J.S., Cook J.B., Rowles D.J., Bottoni C.R., Shaha S.H., Tokish J.M. Clinical Validation of the Glenoid Track Concept in Anterior Glenohumeral Instability. J. Bone Joint Surg. Am., 2016, vol. 98, no. 22, pp. 1918-1923. DOI: 10.2106/JBJS.15.01099