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Arthroscopic Treatment of Anterior Glenohumeral Instability

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Sports Injuries

Abstract

Although inferior glenohumeral ligamentous complex is the major static strain of the anterior translation of the humeral head over glenoid, an isolated Bankart lesion is not adequate to create anterior glenohumeral instability. Mostly, another bony or soft tissue pathology accompanies the Bankart lesion. Traditional open surgical procedures have been accepted as gold-standard in treatment. However, after greater understanding of pathoanatomy, evolution of new arthroscopic instruments and the increment of surgical skills, arthroscopic treatment outcomes reach the level of those achieved with open methods. Because of the decreased morbidity, time of hospitalization and the advantage of early postoperative rehabilitation, arthroscopic interventions are becoming the first choice treatment options. Also, indications of arthroscopic modalities tending to expand to include initial dislocations, multidirectional instability, and revision surgery have helped.

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References

  1. Adolfsson, L., Lysholm, J.: Arthroscopy and stability testing for anterior shoulder instability. Arthroscopy 5, 315–320 (1989)

    Article  PubMed  CAS  Google Scholar 

  2. Altchek, D.W., Dines, D.M.: Shoulder injuries in the throwing athlete. J. Am. Acad. Orthop. Surg. 3, 159–165 (1995)

    PubMed  Google Scholar 

  3. Arciero, R.A., Wheeler, J.H., Ryan, J.B., McBride, J.T.: Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am. J. Sports Med. 22(5), 589–594 (1994)

    Article  PubMed  CAS  Google Scholar 

  4. Bach, B.R., Warren, R.F., Fronek, J.: Disruption of the lateral capsule of the shoulder: a cause of recurrent dislocation. J. Bone Joint Surg. Br. 70, 274–276 (1988)

    PubMed  CAS  Google Scholar 

  5. Baker, C.L., Uribe, J.W., Whitman, C.: Arthroscopic evaluation of acute initial anterior shoulder dislocations. Am. J. Sports Med. 18, 25 (1990)

    Article  PubMed  CAS  Google Scholar 

  6. Bankart, A.S.B.: Recurrent or habitual dislocation of the shoulder-joint. BMJ 2, 1132–1133 (1923)

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  7. Bankart, A.S.B.: The pathology and treatment of recurrent dislocation of the shoulder-joint. Br. J. Surg. 26, 23–29 (1938)

    Article  Google Scholar 

  8. Bigliani, L.U., Pollock, R.G., Soslowsky, L.J., Flatow, E.L., Pawluk, R.J., Mow, V.C.: Tensile properties of the inferior glenohumeral ligament. J. Orthop. Res. 10, 187–197 (1992)

    Article  PubMed  CAS  Google Scholar 

  9. Bigliani, L.U., Newton, P.M., Steinmann, S.P., Connor, P.M., McIlveen, S.J.: Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am. J. Sports Med. 26, 41–45 (1998)

    PubMed  CAS  Google Scholar 

  10. Bottoni, C.R., Smith, E.L., Berkowitz, M.J., Towle, R.B., Moore, J.H.: Arthroscopic versus open shoulder stabilization for recurrent anterior instability: a prospective randomized clinical trial. Am. J. Sports Med. 34, 1730–1737 (2006)

    Article  PubMed  Google Scholar 

  11. Bowen, M.K., Warren, R.F.: Ligamentous control of shoulder stability based on selective cutting and static translation experiments. Clin. Sports Med. 10, 757–782 (1991)

    PubMed  CAS  Google Scholar 

  12. 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 16, 677–694 (2000)

    Article  PubMed  CAS  Google Scholar 

  13. Calandra, J.J., Baker, C.L., Uribe, J.: The incidence of Hill– Sachs lesions in initial anterior shoulder dislocations. Arthroscopy 5, 254–257 (1989)

    Article  PubMed  CAS  Google Scholar 

  14. Chandnani, V.P., Yeager, T.D., DeBerardino, T., et al.: Glenoid labral tears: prospective evaluation with MRI imaging, MR arthrography, and CT arthrography. Am. J. Roentgenol. 161, 1229–1235 (1993)

    Article  CAS  Google Scholar 

  15. Chandnani, V.P., Gagliardi, J.A., Murnane, T.G., et al.: Glenohumeral ligaments and shoulder capsular mechanism: evaluation with MR arthro-graphy. Radiology 196, 27–32 (1995)

    Article  PubMed  CAS  Google Scholar 

  16. Choi, J.A., Suh, S.I., Kim, B.H., et al.: Comparison between conventional MR arthrography and abduction and external rotation MR arthrography in revealing tears of the antero-inferior glenoid labrum. Korean J. Radiol. 2, 216–221 (2001)

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  17. Cvitanic, O., Tirman, P.F., Feller, J.F., et al.: Using abduction and external rotation of the shoulder to increase the sensitivity of MR arthrography in revealing tears of the anterior glenoid labrum. Am. J. Roentgenol. 169, 837–844 (1997)

    Article  CAS  Google Scholar 

  18. De Beer, J.F.: Arthroscopic Bankart repair: some aspects of suture and knot management. Arthroscopy 15, 660–662 (1999)

    Article  PubMed  Google Scholar 

  19. DePalma, A.F., Cooke, A.J., Prabhakar, M.: The role of the subscapularis in recurrent anterior dislocations of the shoulder. Clin. Orthop. 54, 35–49 (1967)

    Article  PubMed  CAS  Google Scholar 

  20. Duncan, R., Savoie III, F.H.: Arthroscopic inferior capsular shift formultidirectional instability of the shoulder: a preliminary report. Arthroscopy 9(1), 24–27 (1993)

    Article  PubMed  CAS  Google Scholar 

  21. Gartsman, G.M., Roddey, T.S., Hammerman, S.M.: Arthroscopic treatment of anterior-inferior glenohumeral instability. Two to 5-year follow-up. J. Bone Joint Surg. Am. 82-A(7), 991–1003 (2000)

    PubMed  CAS  Google Scholar 

  22. Gerber, C., Werner, C.M., Macy, J.C., Jacob, H.A., Nyffeler, R.W.: Effect of selective capsulorrhaphy on the passive range of motion of the glenohumeral joint. J. Bone Joint Surg. Am. 85-A(1), 48–55 (2003)

    PubMed  CAS  Google Scholar 

  23. Henry, J.H., Genung, J.A.: Natural history of glenohumeral dislocation—revisited. Am. J. Sports Med. 10, 135–137 (1982)

    Article  PubMed  CAS  Google Scholar 

  24. Hertz, H.: Significance of the limbus glenoidalis for the stability of the shoulder joint. Wien. Klin. Wochenschr. Suppl. 152, 1–23 (1984)

    PubMed  CAS  Google Scholar 

  25. Hintermann, B., Gachter, A.: Arthroscopic assessment of the unstable shoulder. Knee Surg. Sports Traumatol. Arthrosc. 2, 64–69 (1994)

    Article  PubMed  CAS  Google Scholar 

  26. Hintermann, B., Gächter, A.: Arthroscopic findings after shoulder dislocation. Am. J. Sports Med. 23, 545–551 (1995)

    Article  PubMed  CAS  Google Scholar 

  27. Hovelius, L., Eriksson, K., Fredin, H., et al.: Recurrences after initial dislocation of the shoulder: results of a prospective study of treatment. J. Bone Joint Surg. Am. 65, 343–349 (1983)

    PubMed  CAS  Google Scholar 

  28. Hovelius, L.: Anterior dislocation of the shoulder in teenagers and young adults. J. Bone Joint Surg. 69A, 393–399 (1987)

    Google Scholar 

  29. Hovelius, L., Augustini, G.B.G., Fredin, O.H., et al.: Primary anterior dislocation of the shoulder in young patients. J. Bone Joint Surg. 78A, 1677–1684 (1996)

    Google Scholar 

  30. Itoi, E., Hatakeyama, Y., Urayama, M., Pradhan, R.L., Kido, T., Sato, K.: Position of immobilization after dislocation of the shoulder. A cadaveric study. J. Bone Joint Surg. Am. 81(3), 385–390 (1999)

    Article  PubMed  CAS  Google Scholar 

  31. Itoi, E., Sashi, R., Minagawa, H., Shimizu, T., Wakabayashi, I., Sato, K.: Position of immobilization after dislocation of the glenohumeral joint. A study with use of magnetic resonance imaging. J. Bone Joint Surg. Am. 83-A(5), 661–667 (2001)

    PubMed  CAS  Google Scholar 

  32. Itoi, E., Hatakeyama, Y., Kido, T., et al.: A new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study. J. Shoulder Elbow Surg. 12(5), 413–415 (2003)

    Article  PubMed  Google Scholar 

  33. Jakobsen, B.W., Johannsen, H.V., Suder, P., Søjbjerg, J.O.: Primary repair versus conservative treatment of first-time traumatic anterior dislocation of the shoulder: a randomized study with 10-year ­follow-up arthroscopy. J. Arthrosc. Relat. Surg. 23, 118–123 (2007)

    Article  Google Scholar 

  34. Jobe, F.W., Kvitne, R.S., Giangarra, C.E.: Shoulder pain in the overhand or throwing athlete. The relationship of anterior instability and rotator cuff impingement. Orthop. Rev. 18, 963–975 (1989)

    PubMed  CAS  Google Scholar 

  35. Kandziora, F., Jager, A., Bischof, f, Herresthal, J., Starker, M., Mittlmeier, T.: Arthroscopic labrum refixation for post-traumatic anterior shoulder instability: suture anchor versus transglenoid fixation technique. Arthroscopy 16, 359–366 (2000)

    Article  PubMed  CAS  Google Scholar 

  36. Karas, S.G., Creighton, R.A., DeMorat, G.J.: Glenohumeral volume reduction in arthroscopic shoulder reconstruction: a cadaveric analysis of suture plication and thermal capsulorrhaphy. Arthroscopy 20(2), 179–184 (2004)

    Article  PubMed  Google Scholar 

  37. Kieft, G.J., Bloem, J.L., Rozing, P.M., Obermann, W.R.: MR imaging of recurrent anterior dislocation of the shoulder: comparison with CT arthrography. AJR Am. J. Roentgenol. 150, 1083–1087 (1988)

    Article  PubMed  CAS  Google Scholar 

  38. Kirkley, A., Werstine, R., Ratjek, A., Griffin, S.: 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(1), 55–63 (2005)

    Article  PubMed  Google Scholar 

  39. Kiviluoto, O., Pasila, M., Jaroma, H., Sundholm, A.: Immobilization after primary dislocation of the shoulder. Acta Orthop. Scand. 51(6), 915–919 (1980)

    Article  PubMed  CAS  Google Scholar 

  40. Levine, W.N., Arroyo, J.S., Pollock, R.G., Flatow, E.L., Bigliani, L.U.: Open revision stabilization surgery for recurrent anterior glenohumeral instability. Am. J. Sports Med. 28, 156–160 (2000)

    PubMed  CAS  Google Scholar 

  41. Matsen III, F.A., Harryman II, D.T., Sidles, J.A.: Mechanics of glenohumeral instability. Clin. Sports Med. 10, 783–788 (1991)

    PubMed  Google Scholar 

  42. Mazzocca, A.D., Brown Jr., F.M., Carreira, D.S., Hayden, J., Romeo, A.A.: Arthroscopic anterior shoulder stabilization of collision and contact athletes. Am. J. Sports Med. 33(1), 52–60 (2005)

    Article  PubMed  Google Scholar 

  43. McFarland, E.G., Neira, C.A., Gutierrez, M.I., Cosgarea, A.J., Magee, M.: Clinical significance of the arthroscopic drivethrough sign in shoulder surgery. Arthroscopy 17, 38–43 (2001)

    Article  PubMed  CAS  Google Scholar 

  44. McLaughlin, H.L., Cavallaro, W.U.: Primary anterior dislocation of the shoulder. Am. J. Surg. 80, 615–621 (1950)

    Article  PubMed  CAS  Google Scholar 

  45. Millet, P.J., Clavert, P., Warner, J.J.P.: Open operative treatment for anterior shoulder instability: when and why? J. Bone Joint Surg. 87-A(2), 419–432 (2005)

    Article  Google Scholar 

  46. Miniaci, A., McBirnie, J.: Thermal capsular shrinkage for treatment of multidirectional instability of the shoulder. J. Bone Joint Surg. Am. 85-A(12), 2283–2287 (2003)

    PubMed  Google Scholar 

  47. Mologne, T.S., Provencher, M.T., Menzel, K.A., Vachon, T.A., Dewing, C.B.: Arthroscopic stabilization in patients with an inverted pear glenoid: results in patients with bone loss of the anterior glenoid. Am. J. Sports Med. 35, 1276–1283 (2007)

    Article  PubMed  Google Scholar 

  48. Moseley, H.F., Övergaard, B.: The anterior capsular mechanism in recurrent anterior dislocation of the shoulder: morphological and clinical studies with special reference to the glenoid labrum and the gleno-humeral ligaments. J. Bone Joint Surg. Br. 44, 913–927 (1962)

    Google Scholar 

  49. Noonan, T.J., Tokish, J.M., Briggs, K.K., Hawkins, R.J.: Laser-assisted thermal capsulorrhaphy. Arthroscopy 19(8), 815–819 (2003)

    Article  PubMed  Google Scholar 

  50. Norlin, R.: Intraarticular pathology in acute, first-time anterior shoulder dislocation: an arthroscopic study. Arthroscopy 9, 546–549 (1993)

    Article  PubMed  CAS  Google Scholar 

  51. O’Brien, S.J., Neves, M.C., Arnoczky, S.P., et al.: The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am. J. Sports Med. 18, 449–456 (1990)

    Article  PubMed  Google Scholar 

  52. Porcellini, G., Campi, F., Paladini, P.: Arthroscopic approach to acute bony Bankart lesion. Arthroscopy 18, 764–769 (2002)

    Article  PubMed  Google Scholar 

  53. Rafii, M., Firooznia, H., Bonamo, J.J., Minkoff, J., Golimbu, C.: Athlete shoulder injuries: CT arthrographic findings. Radiology 162, 559–564 (1987)

    Article  PubMed  CAS  Google Scholar 

  54. Ribbans, W.J., Mitchell, R., Taylor, G.J.: Computerised arthrotomography of primary anterior dislocation of the shoulder. J. Bone Joint Surg. Br. 72, 181–185 (1990)

    PubMed  CAS  Google Scholar 

  55. Rockwood, C.A.J.: Subluxation of the shoulder the classification, diagnosis and treatment [abstr]. Orthop. Trans. 4, 306 (1979)

    Google Scholar 

  56. Rowe, C.R.: Prognosis in dislocations of the shoulder. J. Bone Joint Surg. 38A, 957–976 (1956)

    Google Scholar 

  57. Rowe, C.R.: Acute and recurrent anterior dislocations of the shoulder. Orthop. Clin. North Am. 11, 253–270 (1980)

    PubMed  CAS  Google Scholar 

  58. Rowe, C.R., Zarins, B., Ciullo, J.V.: Recurrent anterior dislocation of the shoulder after surgical repair. J. Bone Joint Surg. 66A, 159–168 (1984)

    Google Scholar 

  59. Saito, H., Itoi, E., Sugaya, H., Minagawa, H., Yamamoto, N., Tuoheti, Y.: Location of the glenoid defect in shoulders with recurrent anterior dislocation. Am. J. Sports Med. 33, 889–893 (2005)

    Article  PubMed  Google Scholar 

  60. Seeger, L.L., Gold, R.H., Bassett, L.W.: Shoulder instability: evaluation with MR imaging. Radiology 168, 695–697 (1988)

    Article  PubMed  CAS  Google Scholar 

  61. Silliman, J.F., Hawkins, R.J.: Classification and physical diagnosis of instability of the shoulder. Clin. Orthop. 291, 7–19 (1993)

    PubMed  Google Scholar 

  62. Simonet, W.T., Cofield, R.H.: Prognosis in anterior shoulder dislocation. Am. J. Sports Med. 12, 19–24 (1984)

    Article  PubMed  CAS  Google Scholar 

  63. Speer, K.P., Deng, X., Borrero, S., Torzilli, P.A., Altchek, D.A., Warren, R.F.: Biomechanical evaluation of a simulated Bankart lesion. J. Bone Joint Surg. Am. 76, 1819–1826 (1994)

    PubMed  CAS  Google Scholar 

  64. Su, B., Levine, W.N.: Arthroscopic Bankart repair. J. Am. Acad. Orthop. Surg. 13, 487–490 (2005)

    PubMed  Google Scholar 

  65. Sugaya, H., Moriishi, J., Dohi, M., Kon, Y., Tsuchiya, A.: Glenoid rim morphology in recurrent anterior glenohumeral instability. J. Bone Joint Surg. Am. 85, 878–884 (2003)

    PubMed  Google Scholar 

  66. Sugaya, H., Moriishi, J., Kanisawa, I., Tsuchiya, A.: Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability. J. Bone Joint Surg. Am. 87, 1752–1760 (2005)

    Article  PubMed  Google Scholar 

  67. Symeonides, P.P.: The significance of the subscapularis muscle in the pathogenesis of recurrent anterior dislocation of the shoulder. J. Bone Joint Surg. Br. 54, 476–483 (1972)

    PubMed  CAS  Google Scholar 

  68. Tauro, J.C.: Arthroscopic inferior capsular split and advancement for anterior and inferior shoulder instability: technique and results at 2–5-year follow-up. Arthroscopy 16(5), 451–456 (2000)

    Article  PubMed  CAS  Google Scholar 

  69. Taylor, D.C., Arciero, R.A.: Pathologic changes associated with shoulder dislocations: arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am. J. Sports Med. 25, 306–311 (1997)

    Article  PubMed  CAS  Google Scholar 

  70. Thomas, S.C., Matsen 3rd, F.A.: An approach to the repair of avulsion of the glenohumeral ligaments in the management of traumatic anterior glenohumeral instability. J. Bone Joint Surg. Am. 71(4), 506–513 (1989)

    PubMed  CAS  Google Scholar 

  71. Townley, C.O.: The capsular mechanism in recurrent dislocation of the shoulder. J. Bone Joint Surg. Am. 32, 370–380 (1950)

    Google Scholar 

  72. Tsai, L., Wredmark, T., Johansson, C., Gibo, K., Engström, B., Törnqvist, H.: Shoulder function in patients with unoperated anterior shoulder instability. Am. J. Sports Med. 19, 469–473 (1991)

    Article  PubMed  CAS  Google Scholar 

  73. Turkel, S.J., Panio, M.W., Marshall, J.L., Girgis, F.G.: Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint. J. Bone Joint Surg. Am. 63, 1208–1217 (1981)

    PubMed  CAS  Google Scholar 

  74. Urayama, M., Itoi, E., Sashi, R., Minagawa, H., Sato, K.: Capsular elongation in shoulders with recurrent anterior dislocation: quantitative assessment with magnetic resonance arthrography. Am. J. Sports Med. 31, 64–67 (2003)

    PubMed  Google Scholar 

  75. Walch, G., Ascani, C., Boulahia, A., Nove-Josserand, L., Edwards, T.B.: Static posterior subluxation of the humeral head: an unrecognized entity responsible for glenohumeral osteoarthritis in the young adult. J. Shoulder Elbow Surg. 11, 309–314 (2002)

    Article  PubMed  Google Scholar 

  76. Wall, M.S., Warren, R.F.: Complications of shoulder instability surgery. Clin. Sports Med. 14, 973–1000 (1995)

    PubMed  CAS  Google Scholar 

  77. Warner, J.J.: Management of massive irreparable rotator cuff tears: the role of tendon transfer. Instr. Course Lect. 50, 63–71 (2001)

    PubMed  CAS  Google Scholar 

  78. Wheeler, J.H., Ryan, J.B., Arciero, R.A., Molinari, R.N.: Arthroscopic versus nonoperative treatment of acute shoulder dislocations in young athletes. Arthroscopy 5(3), 213–217 (1989)

    Article  PubMed  CAS  Google Scholar 

  79. Wichman, M.T., Snyder, S.J.: Arthroscopic capsular plication for multidirectional instability of the shoulder. Oper. Tech. Sports Med. 5, 238–243 (1997)

    Article  Google Scholar 

  80. Wirth, M.A., Rockwood Jr., C.A.: Operative treatment of irreparable rupture of the subscapularis. J. Bone Joint Surg. Am. 79, 722–731 (1997)

    PubMed  CAS  Google Scholar 

  81. Zarins, B., Rowe, C., Stone, J.: Shoulder instability: management of failed reconstructions. Instr. Course Lect. 38, 217–230 (1989)

    PubMed  CAS  Google Scholar 

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Atay, Ö.A. et al. (2012). Arthroscopic Treatment of Anterior Glenohumeral Instability. In: Doral, M. (eds) Sports Injuries. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-15630-4_19

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