Rehabilitation Postsurgical Stabilization for Shoulder Instability

Shyam Sundar, David V Rajan

Volume 2 | Issue 1 | Jan – Apr 2017 | Page 40 – 48


Author: Shyam Sundar [1], David V Rajan [1].

[1] Ortho OneOrthopaedic Speciality Centre, Coimbatore, Tamil Nadu, India

Address of Correspondence

Dr. Shyam Sundar,
MS Orthopaedics, Ortho One Orthopaedic Speciality Centre, Coimbatore – 641 005, Tamil Nadu, India.
Email: drshyam.msortho@gmail.com


Abstract

The shoulder joint is a polyaxial joint with the advantage of increased mobility at the cost of stability. The incidence of subluxation/dislocation is on the increase considering the fact that children are more actively involved in sporting activities at a very young age. This has necessitated the orthopedic surgeons to identify those at risk of injuries as well as to treat those with injuries to restore normality without compromising the function. Over the recent past, surgical management for shoulder instability has evolved to a more precise level giving importance to the minutest details in respecting and repairing the injured structures. As a result of which the patient’s recovery and functional outcome has been better than how it was earlier. Nonetheless, the success of surgery depends not only on the surgeon or the patient factors but also in the implementation of a tailored rehabilitation protocol focusing on getting the patient back to normalcy at the earliest with minimal discomfort. The aim of this article is to kindle the various aspects of an ideal rehabilitation following surgical stabilization of shoulder instability and to guide in the optimizing treatment protocol.
Keywords: Shoulder instability, Rehabilitation, Proprioception, Kinetic chain.


References

1. Kim SH, Ha KI, Jung MW, Lim MS, Kim YM, Park JH. Accelerated rehabilitation after arthroscopic Bankart repair for selected cases: A prospective randomized clinical study. Arthroscopy 2003;19(7):722-731.
2. Itoi E, Hsu HC, An KN. Biomechanical investigation of the glenohumeral joint. J Shoulder Elbow Surg 1996;5(5):407-424.
3. Abboud JA, Soslowsky LJ. Interplay of the static and dynamic restraints in glenohumeral instability. ClinOrthopRelat Res 2002;400:48-57.
4. Itoi E. Pathophysiology and treatment of atraumatic instability of the shoulder. J OrthopSci 2004;9(2):208-213.
5. Arciero RA, Wheeler JH, Ryan JB, McBride JT. Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med 1994;22(5):589-594.
6. Hawkins RH, Hawkins RJ. Failed anterior reconstruction for shoulder instability. J Bone Joint Surg Br 1985;67(5):709-714.
7. Hovelius L, Augustini BG, Fredin H, Johansson O, Norlin R, Thorling J. Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study. J Bone Joint Surg Am 1996;78(11):1677-1684.
8. Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: A cadaveric study. J Bone Joint Surg Am 2000;82(1):35-46.
9. Robinson CM, Kelly M, Wakefield AE. Redislocation of the shoulder during the first six weeks after a primary anterior dislocation: Risk factors and results of treatment. J Bone Joint Surg Am 2002;84-A(9):1552-1559.
10. Rowe CR, Pierce DS, Clark JG. Voluntary dislocation of the shoulder. A preliminary report on a clinical, electromyographic, and psychiatric study of twenty-six patients. J Bone Joint Surg Am 1973;55(3):445-460.
11. Weber BG, Simpson LA, Hardegger F. Rotational humeral osteotomy for recurrent anterior dislocation of the shoulder associated with a large Hill-Sachs lesion. J Bone Joint Surg Am 1984;66(9):1443-1450.
12. Robinson CM, Howes J, Murdoch H, Will E, Graham C. Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. J Bone Joint Surg Am 2006;88(11):2326-2336.
13. Hintermann B, Gächter A. Arthroscopic findings after shoulder dislocation. Am J Sports Med 1995;23(5):545-551.
14. Anakwenze OA, Hsu JE, Abboud JA, Levine WN, Huffman GR. Recurrent anterior shoulder instability associated with bony defects. Orthopedics 2011;34(7):538-544.
15. Provencher MT, Frank RM, Leclere LE, Metzger PD, Ryu JJ, Bernhardson A, et al.The Hill-Sachs lesion: Diagnosis, classification, and management. J Am AcadOrthopSurg 2012;20(4):242-252.
16. Skendzel JG, Sekiya JK. Diagnosis and management of humeral head bone loss in shoulder instability. Am J Sports Med 2012;40(11):2633-2644.
17. Taylor DC, Arciero RA. Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med 1997;25(3):306-311.
18. Bigliani LU, Newton PM, Steinmann SP, Connor PM, Mcllveen SJ. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med 1998;26(1):41-45.
19. Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A. Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am 2003;85-A(5):878-884.
20. Mologne TS, Provencher MT, Menzel KA, Vachon TA, Dewing CB. Arthroscopic stabilization in patients with an inverted pear glenoid: Results in patients with bone loss of the anterior glenoid. Am J Sports Med 2007;35(8):1276-1283.
21. Sterling M, Jull G, Wright A. The effect of musculoskeletal pain on motor activity and control. J Pain 2001;2(3):135-145.
22. Itoi E, Hatakeyama Y, Kido T, Sato T, Minagawa H, Wakabayashi I, et al.A new method of immobilization after traumatic anterior dislocation of the shoulder: A preliminary study. J Shoulder Elbow Surg 2003;12(5):413-415.
23. Miller BS, Sonnabend DH, Hatrick C, O’leary S, Goldberg J, Harper W, et al. Should acute anterior dislocations of the shoulder be immobilized in external rotation? A cadaveric study. J Shoulder Elbow Surg 2004;13(6):589-592.
24. McMahon PJ, Lee TQ. Muscles may contribute to shoulder dislocation and stability. ClinOrthopRelat Res 2002;403 Suppl:S18-S25.
25. McAuliffe TB, Pangayatselvan T, Bayley I. Failed surgery for recurrent anterior dislocation of the shoulder. Causes and management. J Bone Joint Surg Br 1988;70(5):798-801.
26. Balg F, Boileau P. The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 2007;89(11):1470-1477.
27. Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: From “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy 2014;30(1):90-98.
28. Purchase RJ, Wolf EM, Hobgood ER, Pollock ME, Smalley CC. Hill-sachs “remplissage”: An arthroscopic solution for the engaging hill-sachs lesion. Arthroscopy 2008;24(6):723-726.
29. Burkhart SS, De Beer JF. 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;16(7):677-694.
30. Lo IK, Parten PM, Burkhart SS. The inverted pear glenoid: An indicator of significant glenoid bone loss. Arthroscopy 2004;20(2):169-174.
31. Fedorka CJ, Mulcahey MK. Recurrent anterior shoulder instability: A review of the Latarjet procedure and its postoperative rehabilitation. PhysSportsmed 2015;43(1):73-79.
32. Frostick SP, Sinopidis C, Al Maskari S, Gibson J, Kemp GJ, Richmond JC. Arthroscopic capsular shrinkage of the shoulder for the treatment of patients with multidirectional instability: Minimum 2-year follow-up. Arthroscopy 2003;19(3):227-233.
33. Bigliani LU, Pollock RG, McIlveen SJ, Endrizzi DP, Flatow EL. Shift of the posteroinferior aspect of the capsule for recurrent posterior glenohumeral instability. J Bone Joint Surg Am 1995;77(7):1011-1020.
34. Antoniou J, Duckworth DT, Harryman DT 2nd. Capsulolabral augmentation for the the management of posteroinferior instability of the shoulder. J Bone Joint Surg Am 2000;82(9):1220-1230.
35. Pollock RG, Bigliani LU. Recurrent posterior shoulder instability. Diagnosis and treatment. ClinOrthopRelat Res 1993;291:85-96.
36. Wirth MA, Groh GI, Rockwood CA Jr. Capsulorrhaphy through an anterior approach for the treatment of atraumatic posterior glenohumeral instability with multidirectional laxity of the shoulder. J Bone Joint Surg Am 1998;80(11):1570-1578.
37. Kim SH, Ha KI, Yoo JC, Noh KC. Kim’s lesion: An incomplete and concealed avulsion of the posteroinferior labrum in posterior or multidirectional posteroinferior instability of the shoulder. Arthroscopy 2004;20(7):712-720.
38. Inman VT, Saunders JB, Abbott LC. Observations of the function of the shoulder joint 1944. ClinOrthopRelat Res 1996;330:3-12.
39. Wilk KE, Arrigo C. Current concepts in the rehabilitation of the athletic shoulder. J Orthop Sports PhysTher 1993;18(1):365-378.
40. Bowen MK, Warren RF. Ligamentous control of shoulder stability based on selective cutting and static translation experiments. Clin Sports Med 1991;10(4):757-782.
41. O’Brien SJ, Neves MC, Arnoczky SP, Rozbruck SR, Dicarlo EF, Warren RF, et al. The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am J Sports Med 1990;18(5):449-456.
42. Cain PR, Mutschler TA, Fu FH, Lee SK. Anterior stability of the glenohumeral joint. A dynamic model. Am J Sports Med 1987;15(2):144-148.
43. Riemann BL, Lephart SM. The sensorimotor system, part I: The physiologic basis of functional joint stability. J Athl Train 2002;37(1):71-79.
44. Vangsness CT Jr, Ennis M, Taylor JG, Atkinson R. Neural anatomy of the glenohumeral ligaments, labrum, and subacromial bursa. Arthroscopy 1995;11(2):180-184.
45. Rossi A, Grigg P. Characteristics of hip joint mechanoreceptors in the cat. J Neurophysiol 1982;47(6):1029-1042.
46. Pedersen J, Lönn J, Hellström F, Djupsjöbacka M, Johansson H. Localized muscle fatigue decreases the acuity of the movement sense in the human shoulder. Med Sci Sports Exerc 1999;31(7):1047-1052.
47. Johansson H, Sjölander P, Sojka P. A sensory role for the cruciate ligaments. ClinOrthopRelat Res 1991;268:161-178.
48. Dietz V, Noth J, Schmidtbleicher D. Interaction between pre-activity and stretch reflex in human triceps brachii during landing from forward falls. J Physiol 1981;311:113-125.
49. Smith RL, Brunolli J. Shoulder kinesthesia after anterior glenohumeral joint dislocation. PhysTher 1989;69(2):106-112.
50. Tibone JE, Fechter J, Kao JT. Evaluation of a proprioception pathway in patients with stable and unstable shoulders with somatosensory cortical evoked potentials. J Shoulder Elbow Surg 1997;6(5):440-443.
51. Carpenter JE, Blasier RB, Pellizzon GG. The effects of muscle fatigue on shoulder joint position sense. Am J Sports Med 1998;26(2):262-265.
52. Lephart SM, Henry TJ. Functional rehabilitation for the upper and lower extremity. OrthopClin North Am 1995;26(3):579-592.
53. Davies GJ, Dickoff-Hoffman S. Neuromuscular testing and rehabilitation of the shoulder complex. J Orthop Sports PhysTher 1993;18(2):449-458.
54. Cavagna GA, Dusman B, Margaria R. Positive work done by a previously stretched muscle. J ApplPhysiol 1968;24(1):21-32.
55. Kibler WB, Wilkes T, Sciascia A. Mechanics and pathomechanics in the overhead athlete. Clin Sports Med 2013;32(4):637-651.
56. Sciascia A, Thigpen C, Namdari S, Baldwin K. Kinetic chain abnormalities in the athletic shoulder. Sports Med Arthrosc 2012;20(1):16-21.
57. McMullen J, Uhl TL. A kinetic chain approach for shoulder rehabilitation. J Athl Train 2000;35(3):329-337.
58. Kibler WB, Sciascia A, Thomas SJ. Glenohumeral internal rotation deficit: Pathogenesis and response to acute throwing. Sports Med Arthrosc 2012;20(1):34-38.
59. Borstad JD, Ludewig PM. The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. J Orthop Sports PhysTher 2005;35(4):227-238.


How to Cite this article:. Sundar S, Rajan DV. Rehabilitation Postsurgical Stabilization for Shoulder Instability Asian Journal of Arthroscopy Jan – April 2017;1(2):40-48.

 


(Abstract)      (Full Text HTML)      (Download PDF)


Biomechanics and Management of HAGL Lesions in Anterior Instability

Desmond J Bokor, Yuval Arama

Volume 2 | Issue 1 | Jan – Apr 2017 | Page 36 -39


Author: Desmond J Bokor [1], Yuval Arama [1].

[1] Department of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia

Address of Correspondence

Dr. Desmond Bokor,
Suite 303, 2 Technology Place,Macquarie University. NSW. 2019, Sydney,Australia.
E-mail:desbok@iinet.net.au


Abstract

Humeral avulsion of the glenohumeral ligament is an uncommon but important cause for recurrent anterior instability of the shoulder. It is usually associated with high energy trauma in a slightly older male population with a hyperabduction/axial load mechanism. Associated damage can include avulsion of the glenoid labrum, rotator cuff tears, and bony damage. Diagnosis requires a high index of clinical suspicion, and MR arthrography performed 4-6 weeks post injury is the most reliable investigation. Care should be taken with MRI performed in the first week, as many of the lesions seen at this time will heal. Surgical repair is recommended for recurrent instability or if the patient requirements need them to have a stable shoulder. Repair can be performed using arthroscopic, minopen or full open techniques. Care should be taken when placing sutures through the capsule because of the proximity of the axillary nerve to the inferior capsular edge. Biomechanically, the capsule should be repaired to the medial humeral neck just below the chondral margin. Surgical outcomes are satisfactory in most series reported.
Keywords: Anterior instability, humeral avulsion of the glenohumeral ligament


References

1. Nicola T. Anterior dislocation of the shoulder: The role of the articular capsule. J Bone Joint Surg Am 1942;24:614-616.
2. Wolf EM, Cheng JC, Dickson K. Humeral avulsion of glenohumeral ligaments as a cause of anterior shoulder instability. Arthroscopy 1995;11:600-607.
3. Bokor DJ, Conboy VB, Olson C. Anterior instability of the glenohumeral joint with humeral avulsion of the glenohumeral ligament. A review of 41 cases. J Bone Joint Surg Br 1998;81-B:93-96.
4. Bui-Mansfield LT, Banks KP, Taylor DC. Humeral avulsion of the glenohumeral ligaments: The HAGL lesion. Am J Sports Med 2007;35(11):1960-1966.
5. Bui-Mansfield LT, Taylor DC, Uhorchak JM, Tenuta JJ. Humeral avulsions of the glenohumeral ligament: Imaging features and a review of the literature. AJR Am J Roentgenol 2002;179(3):649-655.
6. Field LD, Bokor DJ, Savoie FH. Humeral and glenoid detachment of the anterior inferior glenohumeral ligament: A cause of anterior shoulder instability. J Shoulder Elbow Surg1997;6:6-10.
7. Rhee YG, Cho NS. Anterior shoulder instability with humeral avulsion of the glenohumeral ligament lesion. J Shoulder Elbow Surg2007;16:188-192.
8. Bach BR, Warren RF, Fronek J. Disruption of the lateral capsule of the shoulder. A cause of recurrent dislocation. J Bone Joint Surg Br 1988;70:274-276.
9. Turkel SJ, Panio MW, Marshall JL, Girgis FG. Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint. J Bone Joint Surg Am 1981;63-A:1208-1217.
10. Bigliani LU, Pollock RG, Soslowsky LJ, Flatow EL, Pawluk RJ, Mow VC. Tensile properties of the inferior glenohumeral ligament. J Orthop Res 1992;10(2):187-197.
11. Norlin R Intraarticular pathology in acute, first-time anterior shoulder dislocation: An arthroscopic study. Arthroscopy 1993;9:546-549.
12. Baker CL, Uribe JW, Whitman C. Arthroscopic evaluation of acute initial anterior shoulder dislocations. Am J Sports Med 1990;18(1):25-28.
13. Gagey O, Gagey N, Boisrenoult P, Hue E, Mazas F. Experimental study of dislocations of the scapulohumeral joint. Rev ChirOrthopReparatriceAppar Mot 1993;79:13-21.
14. Pouliart N, Gagey O. Simulated humeral avulsion of the glenohumeral ligaments: A new instability model. J Shoulder Elbow Surg2006;15:728-735.
15. George MS, Khazzam M, Kuhn JE. Humeral avulsion of glenohumeral ligaments. J Am AcadOrthopSurg2011;19:127-133.
16. Gagey OJ, Gagey N. The hyperabduction test. An assessment of the laxity of the inferior glenohumeral ligament. J Bone Joint Surg Br 2000;82-B:69-74.
17. Melvin JS, Mackenzie JD, Nacke E, Sennett BJ, Wells L. MRI of HAGL lesions: Four arthroscopically confirmed cases of false-positive diagnosis. AJR Am J Roentgenol2008;191:730-734.
18. Liavaag S, Stiris MG, Svenningsen S, Enger M, Pripp AH, Brox JI. Capsular lesions with glenohumeral ligament injuries in patients with primary shoulder dislocation: Magnetic resonance imaging and magnetic resonance arthrography evaluation. Scand J Med Sci Sports 2011;21:e291-e297.
19. O’Brien SJ, Neves MC, Arnoczky SP, Rozbruck SR, Dicarlo EF, Warren RF, et al. The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am J Sports Med 1990;18:449-456.
20. Pouliart N, Gagey O. Reconciling arthroscopic and anatomic morphology of the humeral insertion of the inferior glenohumeral ligament. Arthroscopy 2005;21:979-984.
21. Southgate DF, Bokor DJ, Longo UG, Wallace AL, Bull AM. The effect of humeral avulsion of the glenohumeral ligaments and humeral repair site on joint laxity: A biomechanical study. Arthroscopy 2013;29(6):990-997.
22. Arciero RA, Mazzocca AD. Mini-open repair technique of HAGL (humeral avulsion of the glenohumeral ligament) lesion. Arthroscopy 2005;21:1152.
23. Bhatia DN, DeBeer JF, van Rooyen KS. The “subscapularis-sparing” approach: A new mini-open technique to repair a humeral avulsion of the glenohumeral ligament lesion. Arthroscopy 2009;25:686-690.
24. Bhatia DN, DasGupta B. Surgical treatment of significant glenoid bone defects and associated humeral avulsions of glenohumeral ligament (HAGL) lesions in anterior shoulder instability. Knee Surg Sports TraumatolArthrosc2013;21:1603-1609.
25. Kon Y, Shiozaki H, Sugaya H. Arthroscopic repair of a humeral avulsion of the glenohumeral ligament lesion. Arthroscopy 2005;21:632.
26. Page RS, Bhatia DN. Arthroscopic repair of humeral avulsion of glenohumeral ligament lesion: Anterior and posterior techniques. Tech Hand Up ExtremSurg 2009;13(2):98-103.
27. Richards DP, Burkhart SS. Arthroscopic humeral avulsion of the glenohumeral ligaments (HAGL) repair. Arthroscopy 2004;20 Suppl 2:134-141.
28. Spang JT, Karas SG. The HAGL lesion: An arthroscopic technique for repair of humeral avulsion of the glenohumeral ligaments. Arthroscopy 2005;21:498-502.
29. Bhatia DN, de Beer JF. The axillary pouch portal: A new posterior portal for visualization and instrumentation in the inferior ohumeral recess. Arthroscopy 2007;23:1241, e1-e5.


How to Cite this article:. Bokor DJ, Arama Y. Biomechanics and management of HAGL lesions in Anterior Instability. Asian Journal of Arthroscopy Jan – April 2017;1(2):36-39.


(Abstract)      (Full Text HTML)      (Download PDF)


Arthroscopic Stabilisation Techniques for Anterior Shoulder Instability

Shiraz Michael Bhatty, Jonathan Herald

Volume 2 | Issue 1 | Jan – Apr 2017 | Page 29 -35


Author: Shiraz Michael Bhatty [1], Jonathan Herald [1].

[1] Fellow, Orthoclinic, Sydney

Address of Correspondence

Dr. Shiraz Michael Bhatty, Fellow, Orthoclinic, Sydney.
Email: shirazbhatty@gmail.com


Abstract

Traumatic anteroinferior dislocation of shoulder in young patients often results in recurrent instability and can be a challenging problem to solve surgically. Treatment of anterior shoulder instability continues to evolve. Arthroscopic shoulder stabilization has become a preferred method of treatment for shoulder instability because reported success rates are parallel to those of open stabilization techniques. This is due to continuing advancement in techniques, instrumentation, improved understanding of the associated pathoanatomy and proper patient selection. In addition to the typical capsulolabral disruptionsseen following a primary dislocation, patients with recurrent instability often have coexistent osseous injury to the humeral head and glenoid. Important considerations during arthroscopy include identifying all pathology, adequate mobilization of the capsulolabral sleeve, retensioning of glenohumeral sleeve and secure anatomic fixation. With advancements in technique and more accurate diagnoses, these outcomes will continue to rise, and patients will more reliably be able to return to prior functioning levels.
Keywords: disclocation of shoulder, pathoanatomy, capsulolabral sleeve.


References

1. Taverna E, Garavaglia G, Ufenast H, D’AmbrosiR, .Arthroscopic treatment of glenoid bone loss. Knee Surg Sports TraumatolArthrosc2016;24:546-556.
2. Lafosse L, Lejeune E, Bouchard A, Kakuda C, Gobezie R, Kochhar T. The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Arthroscopy 2007;23:1242.e1-e5.
3. Fabbriciani C, Milano G, Demontis A, Fadda S, Ziranu F, Mulas PD. Arthroscopic versus open treatment of Bankart lesion of the shoulder: A prospective randomized study. Arthroscopy 2004;20:456-462.
4. Grossman MG, Tibone JE, McGarry MH, Schneider DJ, Veneziani S, Lee TQ. A cadaveric model of the throwing shoulder: A possible etiology of superior labrum anterior-to-posterior lesions. J Bone Joint Surg Am 2005;87:824-831.
5. Robinson CM, Dobson RJ. Anterior instability of the shoulder after trauma. J Bone Joint Surg Br 2004;86:469-479.
6. Van Thiel GS, Romeo AA, Provencher MT. Arthroscopic treatment of Antero-inferior shoulder instability. MinnervaOrthop E Traumatol 2010;61(5):393-414.
7. Cole BJ, Millett PJ, Romeo AA, Burkhart SS, Andrews JR, Dugas JR, et al. Arthroscopic treatment of anterior glenohumeral instability: Indications and techniques. Instr Course Lect2004;53:545-558.
8. Purchase RJ, Wolf EM, Hobgood ER, Pollock ME, Smalley CC. Hill-sachs “remplissage”: An arthroscopic solution for the engaging hill-sachs lesion. Arthroscopy 2008;24(6):723-726.
9. Turkel SJ, Panio MW, Marshall JL, Girgis FG. Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint. J Bone Joint Surg Am 1981;63:1208-1217.
10. Voos JE, Livermore RW, Feeley BT, Altchek DW, Williams RJ, Warren RF, et al. Prospective evaluation of arthroscopic Bankart repairs for anterior instability. Am J Sports Med 2010;38(2):302-307.
11. Warner JJ, McMahon PJ. The role of the long head of the biceps brachii in superior stability of the glenohumeral joint. J Bone Joint Surg Am 1995;77:366-372.
12. Burkart AC, Debski RE. Anatomy and function of the glenohumeral ligaments in anterior shoulder instability. ClinOrthopRelat Res 2002;32-39.
13. Dumont GD, Russell RD, Robertson WJ. Anterior shoulder instability: A review of pathoanatomy, diagnosis and treatment. Curr Rev Musculoskelet Med 2011;4(4):200-207.
14. Howell SM, Galinat BJ. The glenoid-labral socket. A constrained articular surface. ClinOrthopRelat Res 1989;122-125.
15. Ferrari DA. Capsular ligaments of the shoulder. Anatomical and functional study of the anterior superior capsule. Am J Sports Med 1990;18(1):20-24.
16. Matsen FA 3rd, Chebli C, Lippitt S; American Academy of Orthopaedic Surgeons. Principles for the evaluation and management of shoulder instability. J Bone Joint Surg Am 2006;88(3):648-659.
17. Murray IR, Ahmed I, White NJ, Robinson CM. Traumatic anterior shoulder instability in the athlete. Scand J Med Sci Sports 2013;23:387-405.
18. Provencher MT, Bhatia S, Ghodadra NS, Grumet RC, Bach BR Jr, Dewing CB, et al. Recurrent shoulder instability: Current concepts for evaluation and management of glenoid bone loss. J Bone Joint Surg Am 2010;92 Suppl 2:133-151.
19. Kim SH, Ha KI, Cho YB, Ryu BD, Oh I. Arthroscopic anterior stabilization of the shoulder: Two to six-year follow-up. J Bone Joint Surg Am 2003;85-A:1511-1518.
20. Castagna A, Garofalo R, Conti M, Flanagin B. Arthroscopic Bankart repair: Have we finally reached a gold standard? Knee Surg Sports TraumatolArthrosc2016;24:398-405.
21. Kim SJ, Kim SH, Park BK, Chun YM. Arthroscopic stabilization for recurrent shoulder instability with moderate glenoid bone defect in patients with moderate to low functional demand. Arthroscopy 2014;30:921-927.
22. Kinnard P, Tricoire JL, Levesque R, Bergeron D. Assessment of the unstable shoulder by computed arthrography. A preliminary report. Am J Sports Med 1983;11:157-159.
23. Neviaser TJ. The anterior labroligamentous periosteal sleeve avulsion lesion: A cause of anterior instability of the shoulder. Arthroscopy 1993;9(1):17-21.
24. Lafosse L, Boyle S, Gutierrez-Aramberri M, Shah A, Meller R. Arthroscopic latarjet procedure. OrthopClin North Am 2010;41:393-405.
25. Burkhart SS, De Beer JF. 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;16(7):677-694.
26. HantesM and TsarouhasA (2011). Arthroscopic Treatment of Recurrent Anterior Glenohumeral Instability, Modern Arthroscopy, Dragoo JL (Ed.), InTech, DOI: 10.5772/28374. Available from: http://www.intechopen.com/books/modern-arthroscopy/arthroscopic-treatment-of-recurrent-anterior-glenohumeral-instability
27. Nebelung W, Jaeger A, Wiedemann E. Rationales of arthroscopic shoulder stabilization. Arch Orthop Trauma Surg 2002;122(8):472-487.
28. Rokous JR, Feagin JA, Abbott HG. Modified axillary roentgenogram. A useful adjunct in the diagnosis of recurrent instability of the shoulder. ClinOrthopRelat Res 1972;82:84-86.
29. Neviaser TJ. The GLAD lesion: Another cause of anterior shoulder pain. Arthroscopy 1993;9:22-23.
30. Torshizy H. MR Imaging of glenoid cartilage lesions. Applied Radiol. 2006;35:14-21.
31. Chandnani VP, Yeager TD, DeBerardino T et al. Glenoid labral tears: Prospective evaluation with MRI imaging, MR arthrography, and CT arthrography. AJR Am J Roentgenol 1993;161(6):1229-1235.
32. Oberlander MA, Morgan BE, Visotsky JL. The BHAGL lesion: A new variant of anterior shoulder instability. Arthroscopy 1996;12(5):627-633.
33. Abrams JS. Role of arthroscopy in treating anterior instability of the athlete’s shoulder. Sports Med Arthrosc 2007;15(4):230-238.
34. Boileau P, Villalba M, Héry JY, Balg F, Ahrens P, Neyton L. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am 2006;88(8):1755-1763.
35. Zhu YM, Lu Y, Zhang J, Shen JW, Jiang CY Arthroscopic Bankart repair combined with remplissage technique for the treatment of anterior shoulder instability with engaging Hill-Sachs lesion: A report of 49 cases with a minimum 2-year follow-up. Am J Sports Med 2011;39(8):1640-1647.
36. Stein D, Laith M, Jazrawi ER, Loebenberg MI. Arthroscopic Stabilization of anterior shoulder instability a historical perspective. Bull Hosp Joint Dis 2001;60(3-4):124-129.


How to Cite this article:. Bhatty SM, Herald J. Arthroscopic Stabilisation Techniques for Anterior Shoulder Instability. Asian Journal of Arthroscopy Jan – April 2017;1(2):29-35.


(Abstract)      (Full Text HTML)      (Download PDF)


Current Trends in Management of Glenoid Bone Loss in Anterior Shoulder Instability

Vikram K Kandhari, Bibhas DasGupta, Deepak N Bhatia

Volume 2 | Issue 1 | Jan – Apr 2017 | Page 20 – 28


Author: Vikram K Kandhari [1], Bibhas DasGupta [1], Deepak N Bhatia [1].

[1] Department of Orthopaedic Surgery, Seth GS Medical College, King Edward VII Memorial Hospital, Parel, Mumbai, Maharashtra,
[2] Sportsmed Mumbai, Parel, Mumbai, Maharashtra, India

Address of Correspondence

Dr. Deepak N Bhatia,
Department of Orthopaedic Surgery,  Seth GS Medical College, and King Edward VII Memorial Hospital,
Parel, Mumbai – 400 012, Maharashtra, India.
E-mail: shoulderclinic@gmail.com


Abstract

Significant bone defects of glenohumeral joint play an important role in the management of shoulder instability. Bony instability is an important cause of failed soft-tissue repair and recurrent episodes of shoulder dislocations. Bony instability can also be associated with labral (superior and posterior) tears, humeral avulsion of glenohumeral ligament lesions, or rotator cuff tears. Computed tomography (CT) scan with three-dimensional reconstruction is essential for quantification of glenohumeral bone loss. Magnetic resonance imaging (MRI) is reliable for quantification of bone loss, and in addition, demonstrates the soft tissue pathology. Surface area based methods of quantifying glenoid bone loss are more accurate than width based methods. Certain factors important in managing patients with anterior glenohumeral instability include patients’ age, level of sports participation, involvement with contact sports, time of presentation (acute or chronic), and type of bony defect (bony Bankart or attritional bone loss). Soft-tissue reconstruction procedures (labroplasty and remplissage) are usually used in managing patients with nonsignificant bone loss. Patients having significant bone defects of glenoid (>25%) and humerus (off-track/engaging Hill-Sachs lesions) are candidates for open bone grafting of glenohumeral bone defects. Coracoid transfer(Latarjet procedure), either mini-open or arthroscopic gives good functional results and decreases chances of recurrence. Associated lesions should be addressed concomitantly to improve the functional outcome in patients with bony instability of the shoulder. This review presents an evidence-based comprehensive diagnostic and treatment options for patients with bony glenoid deficiency in anterior shoulder instability.
Keywords: Shoulder instability, Hill-Sachs lesion,Labroplasty, Latarjet procedure,Remplissage, Glenoid bone loss, Bony Bankart.


References

1. Burkhart SS, De Beer JF. 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;16(7):677-694.
2. Hovelius L. Incidence of shoulder dislocation in Sweden. ClinOrthopRelat Res 1982;166:127-131.
3. Taylor DC, Arciero RA. Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med 1997;25(3):306-311.
4. Fujii Y, Yoneda M, Wakitani S, Hayashida K. Histologic analysis of bony Bankart lesions in recurrent anterior instability of the shoulder. J Shoulder Elbow Surg 2006;15(2):218-223.
5. Hill HA, Sachs MD. The grooved defect of the humeral head a frequently unrecognized complication of dislocations of the shoulder joint. Radiology1940;35(6):690-700.
6. Calandra JJ, Baker CL, Uribe J. The incidence of Hill-Sachs lesions in initial anterior shoulder dislocations. Arthroscopy 1989;5(4):254-257.
7. de Beer J, Bhatia DN. Shoulder injuries in rugby players. Int J Shoulder Surg 2009;3(1):1-3.
8. Arrigoni P, Huberty D, Brady PC, Weber IC, Burkhart SS. The value of arthroscopy before an open modified latarjet reconstruction. Arthroscopy 2008;24(5):514-519.
9. Bhatia DN, DasGupta B. Surgical treatment of significant glenoid bone defects and associated humeral avulsions of glenohumeral ligament (HAGL) lesions in anterior shoulder instability. Knee Surg Sports TraumatolArthrosc 2013;21(7):1603-1609.
10. Bushnell BD, Creighton RA, Herring MM. Bony instability of the shoulder. Arthroscopy 2008;24(9):1061-1073.
11. Bushnell BD, R. Creighton A, Herring MM. The Bony Apprehension Test for instability of the shoulder: A prospective pilot analysis. Arthroscopy: The Journal of Arthroscopic and Related Surgery 2008;24(9):974-982.
12. Edwards TB, Boulahia A, Walch G. Radiographic analysis of bone defects in chronic anterior shoulder instability. Arthroscopy 2003;19(7):732-739.
13. Rokous JR, Feagin JA, Abbott HG. Modified axillary roentgenogram. A useful adjunct in the diagnosis of recurrent instability of the shoulder. ClinOrthopRelat Res 1972;82:84-86.
14. Garth WP Jr, Slappey CE, Ochs CW. Roentgenographic demonstration of instability of the shoulder: The apical oblique projection. A technical note. J Bone Joint Surg Am 1984;66(9):1450-1453.
15. Pavlov H, Warren RF, Weiss CB Jr, Dines DM. The roentgenographic evaluation of anterior shoulder instability. ClinOrthopRelatRes 1985;194:153-158.
16. Gerber C, Nyffeler RW. Classification of glenohumeral joint instability. ClinOrthopRelat Res 2002;400:65-76.
17. Murachovsky J, Bueno RS, Nascimento LG, Almeida LH, Strose E, Castiglia MT, et al. Calculating anterior glenoid bone loss using the Bernageau profile view. Skeletal Radiol 2012;41(10):1231-1237.
18. Itoi E, Lee SB, Amrami KK, Wenger DE, An KN. Quantitative assessment of classic anteroinferior bony Bankart lesions by radiography and computed tomography. Am J Sports Med 2003;31(1):112-118.
19. Sugaya H. Techniques to evaluate glenoid bone loss. Curr Rev Musculoskelet Med 2014;7(1):1-5.
20. Ito H, Takayama A, Shirai Y. Radiographic evaluation of the Hill-Sachs lesion in patients with recurrent anterior shoulder instability. J Shoulder Elbow Surg 2000;9(6):495-497.
21. Bhatia DN, de Beer JF, du Toit DF. Coracoid process anatomy: Implications in radiographic imaging and surgery. ClinAnat 2007;20(7):774-784.
22. Bhatia DN, Dasgupta B, Rao N. Orthogonal radiographic technique for radiographic visualization of coracoid process fractures and pericoracoid fracture extensions. J Orthop Trauma 2013;27(5):e118-e121.
23. Goldberg RP, Vicks B. Oblique angled view for coracoid fractures. Skeletal Radiol 1983;9(3):195-197.
24. Griffith JF, Antonio GE, Tong CW, Ming CK. Anterior shoulder dislocation: Quantification of glenoid bone loss with CT. AJR Am J Roentgenol 2003;180(5):1423-1430.
25. Sekiya JK, Cutuk A. Humeral head defects – Biomechanics, measurements, and treatments. In: Provencher MT, Romeo AA, editors. Shoulder Instability: AComprehensive Approach. Philadelphia, PA:Elsevier, Saunders; 2012.p. 234-247.
26. Saito H, Itoi E, Minagawa H, Yamamoto N, Tuoheti Y, Seki N. Location of the Hill-Sachs lesion in shoulders with recurrent anterior dislocation. Arch Orthop Trauma Surg 2009;129(10):1327-1334.
27. Miniaci A, Gish M. Management of anterior glenohumeral instability associated with large Hill-Sachs defects. Tech Shoulder Elbow Surg2004;5(3):170-175.
28. Lee RK, Griffith JF, Tong MM, Sharma N, Yung P. Glenoid bone loss: Assessment with MR imaging. Radiology 2013;267(2):496-502.
29. Huijsmans PE, Haen PS, Kidd M, Dhert WJ, van der Hulst VP, Willems WJ. Quantification of a glenoid defect with three-dimensional computed tomography and magnetic resonance imaging: A cadaveric study. J Shoulder Elbow Surg 2007;16(6):803-809.
30. Bencardino JT, Gyftopoulos S, Palmer WD. Imaging in anterior glenohumeral instability. Radiology 2013;269(2):323-337.
31. Simão MN, Nogueira-Barbosa MH, Muglia VF, Barbieri CH. Anterior shoulder instability: Correlation between magnetic resonance arthrography, ultrasound arthrography and intraoperative findings. Ultrasound Med Biol 2012;38(4):551-560.
32. Bigliani LU, Newton PM, Steinmann SP, Connor PM, Mcllveen SJ. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med 1998;26(1):41-45.
33. Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: A cadaveric study. J Bone Joint Surg Am 2000;82(1):35-46.
34. Lo IK, Parten PM, Burkhart SS. The inverted pear glenoid: An indicator of significant glenoid bone loss. Arthroscopy 2004;20(2):169-174.
35. Greis PE, Scuderi MG, Mohr A, Bachus KN, Burks RT. Glenohumeral articular contact areas and pressures following labral and osseous injury to the anteroinferior quadrant of the glenoid. J Shoulder Elbow Surg 2002;11(5):442-451.
36. Flatow EL, Miniaci A, Evans PJ, Simonian PT, Warren RF. Instability of the shoulder: Complex problems and failed repairs: Part II. Failed repairs. Instr Course Lect 1998;47:113-125.
37. Yamamoto N, Itoi E, Abe H, Minagawa H, Seki N, Shimada Y, et al. 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;16(5):649-656.
38. Huysmans PE, Haen PS, Kidd M, Dhert WJ, Willems JW. The shape of the inferior part of the glenoid: A cadaveric study. J Shoulder Elbow Surg 2006;15(6):759-763.
39. Bhatia S, Saigal A, Frank RM, Bach BRJr, Cole BJ, Romeo AA, et al. Glenoid diameter is an inaccurate method for percent glenoid bone loss quantification: Analysis and techniques for improved accuracy. Arthroscopy 2015;31(4):608-614.
40. Baudi P, Campochiaro G, Rebuzzi M, Matino G, Catani F. Assessment of bone defects in anterior shoulder instability. Joints 2013;1(1):40-48.
41. Dumont GD, Russell RD, Browne MG, Robertson WJ. Area-based determination of bone loss using the glenoid arc angle. Arthroscopy 2012;28(7):1030-1035.
42. Burkhart SS, Debeer JF, Tehrany AM, Parten PM. Quantifying glenoid bone loss arthroscopically in shoulder instability. Arthroscopy 2002;18(5):488-491.
43. Detterline AJ, Provencher MT, Ghodadra N, Bach BR Jr, Romeo AA, Verma NN. A new arthroscopic technique to determine anterior-inferior glenoid bone loss: Validation of the secant chord theory in a cadaveric model. Arthroscopy 2009;25(11):1249-1256.
44. Bakshi NK, Patel I, Jacobson JA, Debski RE, Sekiya JK. Comparison of 3-dimensional computed tomography-based measurement of glenoid bone loss with arthroscopic defect size estimation in patients with anterior shoulder instability. Arthroscopy 2015;31(10):1880-1885.
45. Rowe CR, Zarins B, Ciullo JV. Recurrent anterior dislocation of the shoulder after surgical repair. Apparent causes of failure and treatment. J Bone Joint SurgAm 1984;66(2):159-168.
46. Montgomery WH Jr, Wahl M, Hettrich C, Itoi E, Lippitt SB, Matsen FA 3rd. Anteroinferior bone-grafting can restore stability in osseous glenoid defects. J Bone Joint Surg Am 2005;87(9):1972-1977.
47. Hardy P. Bony Lesions Influence on the Result of the Arthroscopic Treatment of Glenohumeral Instability. Symposium: Shoulder Instability-Limits of Arthroscopic Surgery: Bone Deficiency, Shrinkage, Acute Instability. Presented at the 5th International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Congress, March 10-14, 2003; Auckland, New Zealand.
48. Forsythe B, Frank RM, Ahmed M, Verma NN, Cole BJ, Romeo AA, et al. Identification and treatment of existing copathology in anterior shoulder instability repair. Arthroscopy 2015;31(1):154-166.
49. Balg F, Boileau P. The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 2007;89(11):1470-1477.
50. Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: From “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy 2014;30(1):90-98.
51. Yamamoto N, Itoi E. Osseous defects seen in patients with anterior shoulder instability. ClinOrthopSurg 2015;7(4):425-429.
52. Bhatia DN, DeBeer JF. Management of anterior shoulder instability without bone loss: arthroscopic and mini-open techniques. Shoulder Elbow 2011;3:1-7.
53. Wolf EM, Arianjam A. Hill-Sachs remplissage, an arthroscopic solution for the engaging Hill-Sachs lesion: 2-to10-year follow-up and incidence of recurrence. J Shoulder Elbow Surg 2014;23(6):814-820.
54. Argintar E, Heckmann N, Wang L, Tibone JE, Lee TQ. The biomechanical effect of shoulder remplissage combined with Bankart repair for the treatment of engaging Hill-Sachs lesions. Knee Surg Sports TraumatolArthrosc 2016;24(2):585-592.
55. Haviv B, Mayo L, Biggs D. Outcomes of arthroscopic “remplissage”: Capsulotenodesis of the engaging large Hill-Sachs lesion. J OrthopSurg Res 2011;6:29.
56. Elkinson I, Giles JW, Faber KJ, Boons HW, Ferreira LM, Johnson JA, et al. The effect of the remplissage procedure on shoulder stability and range of motion: An in vitro biomechanical assessment. J Bone Joint Surg Am 2012;94(11):1003-1012.
57. Bhatia DN. The “double-barrel” knot: A new sliding knot for arthroscopic soft tissue fixation using single-pulley and double-pulley techniques. Tech Hand Up ExtremSurg 2013;17(3):128-133.
58. Bhatia DN. Double-barrel remplissage: An arthroscopic all-intra-articular technique using the double-barrel knot for anterior shoulder instability. Arthrosc Tech 2015;4(1):e65-e70.
59. HelfetAJ. Coracoid transplantation for recurring dislocation of the shoulder. J Bone Joint Surg Br 1958;40-B(2):198-202.
60. Schroder DT, Provencher MT, Mologne TS, Muldoon MP, Cox JS. The modified Bristow procedure for anterior shoulder instability: 26-year outcomes in Naval Academy midshipmen. Am J Sports Med 2006;34(5):778-786.
61. Boileau P, Bicknell RT, El Fegoun AB, Chuinard C. Arthroscopic Bristow procedure for anterior instability in shoulders with a stretched or deficient capsule: The “belt-and-suspenders” operative technique and preliminary results. Arthroscopy 2007;23(6):593-601.
62. Latarjet M. Treatment of recurrent dislocation of the shoulder. Lyon Chir 1954;49(8):994-997.
63. Allain J, Goutallier D, Glorion C. Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder. J Bone Joint Surg Am 1998;80(6):841-852.
64. Mizuno N, Denard PJ, Raiss P, Melis B, Walch G. Long-term results of the Latarjet procedure for anterior instability of the shoulder. J Shoulder Elbow Surg 2014;23(11):1691-1699.
65. Patte D, Debeyre J. Luxations recidivantes de l’epaule. Encycl Med Chir (Ed. Elsevier, Paris), Techniques chirurgicales–orthopédie–traumatologie 1980;44-265.
66. de Beer JF, Roberts C. Glenoid bone defects- Open latarjet with congruent arc modification. OrthopClin North Am 2010;41(3):407-415.
67. Burkhart SS, De Beer JF, Barth JR, Cresswell T, Roberts C, Richards DP. Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss. Arthroscopy 2007;23(10):1033-1041.
68. Noonan B, Hollister SJ, Sekiya JK, Bedi A. Comparison of reconstructive procedures for glenoid bone loss associated with recurrent anterior shoulder instability. J Shoulder Elbow Surg 2014;23(8):1113-1119.
69. Ghodadra N, Gupta A, Romeo AA, Bach BR Jr, Verma N, Shewman E, et al. Normalization of glenohumeral articular contact pressures after Latarjet or iliac crest bone-grafting. J Bone Joint Surg Am 2010;92(6):1478-1489.
70. Bhatia DN. Dual-window subscapularis-sparing approach: A new surgical technique for combined reconstruction of a glenoid bone defect or bankart lesion associated with a HAGL lesion in anterior shoulder instability. Tech Hand Up ExtremSurg 2012;16(1):30-36.
71. Lafosse L, Lejeune E, Bouchard A, Kakuda C, Gobezie R, Kochhar T. The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Arthroscopy 2007;23(11):1242.e1-e5.
72. Bhatia DN. Arthroscopic Latarjet and Capsular Shift (ALCS) procedure: A new “freehand” technique for anterior shoulder instability associated with significant bone defects. Tech Hand Up ExtremSurg 2015;19(1):11-17.
73. Hindmarsh J, Lindberg A. Eden-hybbinette’soperation for recurrent dislocation of the humero-scapular joint. ActaOrthopScand 1967;38:459-478.
74. Niskanen RO, Lehtonen JY, Kaukonen JP. Alvik’sglenoplasty for humeroscapular dislocation 6-year follow-up of 52 shoulders. ActaOrthopScand 1991;62(3):279-283.
75. Auffarth A, Schauer J, Matis N, Kofler B, Hitzl W, Resch H. The J-bone graft for anatomical glenoid reconstruction in recurrent posttraumatic anterior shoulder dislocation. Am J Sports Med 2008;36(4):638-647.
76. Provencher MT, Bhatia S, Ghodadra NS, Grumet RC, Bach BR Jr, Dewing CB, et al. Recurrent shoulder instability: Current concepts for evaluation and management of glenoid bone loss. J Bone Joint Surg Am 2010;92Suppl 2:133-151.


How to Cite this article:. Kandhari VK, DasGupta B, Bhatia DN. Current Trends in Management of Glenoid Bone Loss in Anterior Shoulder Instability. Asian Journal of Arthroscopy Jan – April 2017;1(2):20-28.

 

 


(Abstract)      (Full Text HTML)      (Download PDF)


Investigations for the Unstable Shoulder

Oliver James Negus, Jonathan James Negus

Volume 2 | Issue 1 | Jan – Apr 2017 | Page 7 – 14


Author: Oliver James Negus [1], Jonathan James Negus [2].

[1] Department of Orthopaedics, Norfolk and Norwich University Hospital, Norwich, England,
[2] Department of Orthopaedics, University College Hospital, London, England.

Address of Correspondence

Dr. Jonathan Negus,
Department of Orthopaedics, University College Hospital, London, England.
E-mail: jonathan.negus@cantab.net


Abstract

The unstable shoulder has a wide spectrum of presentations from the obvious dislocations to the subtle chronic instabilities. It is the job of the clinician who is interpreting the imaging to correlate a clear history with the pathology that can be seen and to go searching for the pathology that may not be obvious but could drastically alter management. For most cases, imaging is used mainly to direct further management than to diagnose. Therefore, it is critical to have access to the appropriate imaging modality taken in the correct manner to maximize the possibility of picking up all lesions. This review looks at the possible lesions and imaging modalities needed to diagnose them and more importantly, direct their future management.
Keywords: Shoulder instability, Shoulder imaging, Unstable shoulder, Shoulder dislocation.


References

1. Kim SH, Ha KI, Jung MW, Lim MS, Kim YM, Park JH. Accelerated rehabilitation after arthroscopic Bankart repair for selected cases: A prospective randomized clinical study. Arthroscopy 2003;19(7):722-731.
2. Itoi E, Hsu HC, An KN. Biomechanical investigation of the glenohumeral joint. J Shoulder Elbow Surg 1996;5(5):407-424.
3. Abboud JA, Soslowsky LJ. Interplay of the static and dynamic restraints in glenohumeral instability. ClinOrthopRelat Res 2002;400:48-57.
4. Itoi E. Pathophysiology and treatment of atraumatic instability of the shoulder. J OrthopSci 2004;9(2):208-213.
5. Arciero RA, Wheeler JH, Ryan JB, McBride JT. Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med 1994;22(5):589-594.
6. Hawkins RH, Hawkins RJ. Failed anterior reconstruction for shoulder instability. J Bone Joint Surg Br 1985;67(5):709-714.
7. Hovelius L, Augustini BG, Fredin H, Johansson O, Norlin R, Thorling J. Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study. J Bone Joint Surg Am 1996;78(11):1677-1684.
8. Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: A cadaveric study. J Bone Joint Surg Am 2000;82(1):35-46.
9. Robinson CM, Kelly M, Wakefield AE. Redislocation of the shoulder during the first six weeks after a primary anterior dislocation: Risk factors and results of treatment. J Bone Joint Surg Am 2002;84-A(9):1552-1559.
10. Rowe CR, Pierce DS, Clark JG. Voluntary dislocation of the shoulder. A preliminary report on a clinical, electromyographic, and psychiatric study of twenty-six patients. J Bone Joint Surg Am 1973;55(3):445-460.
11. Weber BG, Simpson LA, Hardegger F. Rotational humeral osteotomy for recurrent anterior dislocation of the shoulder associated with a large Hill-Sachs lesion. J Bone Joint Surg Am 1984;66(9):1443-1450.
12. Robinson CM, Howes J, Murdoch H, Will E, Graham C. Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. J Bone Joint Surg Am 2006;88(11):2326-2336.
13. Hintermann B, Gächter A. Arthroscopic findings after shoulder dislocation. Am J Sports Med 1995;23(5):545-551.
14. Anakwenze OA, Hsu JE, Abboud JA, Levine WN, Huffman GR. Recurrent anterior shoulder instability associated with bony defects. Orthopedics 2011;34(7):538-544.
15. Provencher MT, Frank RM, Leclere LE, Metzger PD, Ryu JJ, Bernhardson A, et al.The Hill-Sachs lesion: Diagnosis, classification, and management. J Am AcadOrthopSurg 2012;20(4):242-252.
16. Skendzel JG, Sekiya JK. Diagnosis and management of humeral head bone loss in shoulder instability. Am J Sports Med 2012;40(11):2633-2644.
17. Taylor DC, Arciero RA. Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med 1997;25(3):306-311.
18. Bigliani LU, Newton PM, Steinmann SP, Connor PM, Mcllveen SJ. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med 1998;26(1):41-45.
19. Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A. Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am 2003;85-A(5):878-884.
20. Mologne TS, Provencher MT, Menzel KA, Vachon TA, Dewing CB. Arthroscopic stabilization in patients with an inverted pear glenoid: Results in patients with bone loss of the anterior glenoid. Am J Sports Med 2007;35(8):1276-1283.
21. Sterling M, Jull G, Wright A. The effect of musculoskeletal pain on motor activity and control. J Pain 2001;2(3):135-145.
22. Itoi E, Hatakeyama Y, Kido T, Sato T, Minagawa H, Wakabayashi I, et al.A new method of immobilization after traumatic anterior dislocation of the shoulder: A preliminary study. J Shoulder Elbow Surg 2003;12(5):413-415.
23. Miller BS, Sonnabend DH, Hatrick C, O’leary S, Goldberg J, Harper W, et al. Should acute anterior dislocations of the shoulder be immobilized in external rotation? A cadaveric study. J Shoulder Elbow Surg 2004;13(6):589-592.
24. McMahon PJ, Lee TQ. Muscles may contribute to shoulder dislocation and stability. ClinOrthopRelat Res 2002;403 Suppl:S18-S25.
25. McAuliffe TB, Pangayatselvan T, Bayley I. Failed surgery for recurrent anterior dislocation of the shoulder. Causes and management. J Bone Joint Surg Br 1988;70(5):798-801.
26. Balg F, Boileau P. The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 2007;89(11):1470-1477.
27. Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: From “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy 2014;30(1):90-98.
28. Purchase RJ, Wolf EM, Hobgood ER, Pollock ME, Smalley CC. Hill-sachs “remplissage”: An arthroscopic solution for the engaging hill-sachs lesion. Arthroscopy 2008;24(6):723-726.
29. Burkhart SS, De Beer JF. 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;16(7):677-694.
30. Lo IK, Parten PM, Burkhart SS. The inverted pear glenoid: An indicator of significant glenoid bone loss. Arthroscopy 2004;20(2):169-174.
31. Fedorka CJ, Mulcahey MK. Recurrent anterior shoulder instability: A review of the Latarjet procedure and its postoperative rehabilitation. PhysSportsmed 2015;43(1):73-79.
32. Frostick SP, Sinopidis C, Al Maskari S, Gibson J, Kemp GJ, Richmond JC. Arthroscopic capsular shrinkage of the shoulder for the treatment of patients with multidirectional instability: Minimum 2-year follow-up. Arthroscopy 2003;19(3):227-233.
33. Bigliani LU, Pollock RG, McIlveen SJ, Endrizzi DP, Flatow EL. Shift of the posteroinferior aspect of the capsule for recurrent posterior glenohumeral instability. J Bone Joint Surg Am 1995;77(7):1011-1020.
34. Antoniou J, Duckworth DT, Harryman DT 2nd. Capsulolabral augmentation for the the management of posteroinferior instability of the shoulder. J Bone Joint Surg Am 2000;82(9):1220-1230.
35. Pollock RG, Bigliani LU. Recurrent posterior shoulder instability. Diagnosis and treatment. ClinOrthopRelat Res 1993;291:85-96.
36. Wirth MA, Groh GI, Rockwood CA Jr. Capsulorrhaphy through an anterior approach for the treatment of atraumatic posterior glenohumeral instability with multidirectional laxity of the shoulder. J Bone Joint Surg Am 1998;80(11):1570-1578.
37. Kim SH, Ha KI, Yoo JC, Noh KC. Kim’s lesion: An incomplete and concealed avulsion of the posteroinferior labrum in posterior or multidirectional posteroinferior instability of the shoulder. Arthroscopy 2004;20(7):712-720.
38. Inman VT, Saunders JB, Abbott LC. Observations of the function of the shoulder joint 1944. ClinOrthopRelat Res 1996;330:3-12.
39. Wilk KE, Arrigo C. Current concepts in the rehabilitation of the athletic shoulder. J Orthop Sports PhysTher 1993;18(1):365-378.
40. Bowen MK, Warren RF. Ligamentous control of shoulder stability based on selective cutting and static translation experiments. Clin Sports Med 1991;10(4):757-782.
41. O’Brien SJ, Neves MC, Arnoczky SP, Rozbruck SR, Dicarlo EF, Warren RF, et al. The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am J Sports Med 1990;18(5):449-456.
42. Cain PR, Mutschler TA, Fu FH, Lee SK. Anterior stability of the glenohumeral joint. A dynamic model. Am J Sports Med 1987;15(2):144-148.
43. Riemann BL, Lephart SM. The sensorimotor system, part I: The physiologic basis of functional joint stability. J Athl Train 2002;37(1):71-79.
44. Vangsness CT Jr, Ennis M, Taylor JG, Atkinson R. Neural anatomy of the glenohumeral ligaments, labrum, and subacromial bursa. Arthroscopy 1995;11(2):180-184.
45. Rossi A, Grigg P. Characteristics of hip joint mechanoreceptors in the cat. J Neurophysiol 1982;47(6):1029-1042.
46. Pedersen J, Lönn J, Hellström F, Djupsjöbacka M, Johansson H. Localized muscle fatigue decreases the acuity of the movement sense in the human shoulder. Med Sci Sports Exerc 1999;31(7):1047-1052.
47. Johansson H, Sjölander P, Sojka P. A sensory role for the cruciate ligaments. ClinOrthopRelat Res 1991;268:161-178.
48. Dietz V, Noth J, Schmidtbleicher D. Interaction between pre-activity and stretch reflex in human triceps brachii during landing from forward falls. J Physiol 1981;311:113-125.
49. Smith RL, Brunolli J. Shoulder kinesthesia after anterior glenohumeral joint dislocation. PhysTher 1989;69(2):106-112.
50. Tibone JE, Fechter J, Kao JT. Evaluation of a proprioception pathway in patients with stable and unstable shoulders with somatosensory cortical evoked potentials. J Shoulder Elbow Surg 1997;6(5):440-443.
51. Carpenter JE, Blasier RB, Pellizzon GG. The effects of muscle fatigue on shoulder joint position sense. Am J Sports Med 1998;26(2):262-265.
52. Lephart SM, Henry TJ. Functional rehabilitation for the upper and lower extremity. OrthopClin North Am 1995;26(3):579-592.
53. Davies GJ, Dickoff-Hoffman S. Neuromuscular testing and rehabilitation of the shoulder complex. J Orthop Sports PhysTher 1993;18(2):449-458.
54. Cavagna GA, Dusman B, Margaria R. Positive work done by a previously stretched muscle. J ApplPhysiol 1968;24(1):21-32.
55. Kibler WB, Wilkes T, Sciascia A. Mechanics and pathomechanics in the overhead athlete. Clin Sports Med 2013;32(4):637-651.
56. Sciascia A, Thigpen C, Namdari S, Baldwin K. Kinetic chain abnormalities in the athletic shoulder. Sports Med Arthrosc 2012;20(1):16-21.
57. McMullen J, Uhl TL. A kinetic chain approach for shoulder rehabilitation. J Athl Train 2000;35(3):329-337.
58. Kibler WB, Sciascia A, Thomas SJ. Glenohumeral internal rotation deficit: Pathogenesis and response to acute throwing. Sports Med Arthrosc 2012;20(1):34-38.
59. Borstad JD, Ludewig PM. The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. J Orthop Sports PhysTher 2005;35(4):227-238.


How to Cite this article:. Negus OJ, Negus JJ. Investigations for the Unstable Shoulder. Asian Journal of Arthroscopy Jan – April 2017;1(2):7-14 .


(Abstract)      (Full Text HTML)      (Download PDF)


Patho-anatomy and Patho-mechanics of Glenohumeral Instability

Sagar Vivek Kakatkar, Jonathan Herald

Volume 2 | Issue 1 | Jan – Apr 2017 | Page 3-6


Author: Sagar Vivek Kakatkar [1,2], Jonathan Herald [1]

[1] Vivaan Clinic, Nashik, Maharashtra, India.
[2] Dr. VPMCH, Nashik, Maharashtra, India.
[3] Orthoclinic, Sydney, Australia.

Address of Correspondence

Vivaan Clinic, First floor, N.S.B. center, Canada Corner, Nashik
Email: drsagarkakatkar@gmail.com


Abstract

Patho-anatomy and patho-mechanics form the basis of management of any pathology. Gleno-humeral joint is one of the most functionally complex joint in the body because of its greater range of motion and interrelationship of the forces acting on the joint. All these factors should be considered when planning the management of the glenohumeral instability since inability to address anatomical deficiencies may lead to failure; which may further complicate the treatment. The static and dynamic stabilizers of the glenohumeral joint have been described here in relation to the shoulder instability.
Keywords: Glenohumeral instability, pathoanatomy, pathomechanics, inferior glenohumeral ligament.


References

1. Bost FC, Inman VT. The pathological changes in recurrent dislocation of the shoulder. J Bone Joint Surg Am 1942;24(3):595.
2. Codman EA. The Shoulder. Boston: Thomas Todd; 1934.
3. Steindler A. Kinesiology of the Human Body Under Normal and Pathological Conditions. Springfield, IL: Charles C Thomas; 1955.
4. Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A. Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am 2003;85-A(5):878-884.
5. Griffith JF, Antonio GE, Tong CW, Ming CK. Anterior shoulder dislocation: Quantification of glenoid bone loss with CT. AJR Am J Roentgenol 2003;180(5):1423-1430.
6. Gerber C, Nyffeler RW. Classification of glenohumeral joint instability. Clin Orthop Relat Res 2002;400:65-76.
7. Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: A cadaveric study. J Bone Joint Surg Am 2000;82(1):35-46.
8. Lo IK, Parten PM, Burkhart SS. The inverted pear glenoid: An indicator of significant glenoid bone loss. Arthroscopy 2004;20(2):169-740.
9. Miniaci A, Berlet G. Recurrent anterior instability following failed surgical repair: Allograft reconstruction of large humeral head defects. J Bone Joint Surg Br 2001;83 Suppl 1:19-20.
10. Bühler M, Gerber C. Shoulder instability related to epileptic seizures. J Shoulder Elbow Surg 2002;11(4):339-344.
11. Burkhart SS, De Beer JF. 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;16(7):677-694.
12. Rodosky MW, Harner CD, Fu FH. The role of the long head of the biceps muscle and superior glenoid labrum in anterior stability of the shoulder. Am J Sports Med 1994;22(1):121-130.
13. Lippitt S, Matsen F. Mechanisms of glenohumeral joint stability. Clin Orthop Relat Res 1993;291:20-28.
14. Halder AM, Kuhl SG, Zobitz ME, Larson D, An KN. Effects of the glenoid labrum and glenohumeral abduction on stability of the shoulder joint through concavity-compression: An in vitro study. J Bone Joint Surg Am 2001;83-A(7):1062-1069.
15. Habermeyer P, Schuller U, Wiedemann E. The intra-articular pressure of the shoulder: An experimental study on the role of the glenoid labrum in stabilizing the joint. Arthroscopy 1992;8(2):166-172.
16. O’Brien SJ, Neves MC, Arnoczky SP, Rozbruck SR, Dicarlo EF, Warren RF, et al. The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am J Sports Med 1990;18(5):449-456.
17. Ticker JB, Flatow EL, Pawluk RJ, Soslowsky LJ, Ratcliffe A, Arnoczky SP, et al. The inferior glenohumeral ligament: A correlative investigation. J Shoulder Elbow Surg 2006;15(6):665-674.
18. Gohlke F, Essigkrug B, Schmitz F. The pattern of the collagen fiber bundles of the capsule of the glenohumeral joint. J Shoulder Elbow Surg 1994;3(3):111-128.
19. Ticker JB, Bigliani LU, Soslowsky LJ, Pawluk RJ, Flatow EL, Mow VC. Viscoelastic and geometric properties of the inferior glenohumeral ligament. Orthop Trans 1992;16:304-305.
20. Bigliani LU, Pollock RG, Soslowsky LJ, Flatow EL, Pawluk RJ, Mow VC. Tensile properties of the inferior glenohumeral ligament. J Orthop Res 1992;10(2):187-197.
21. Savoie FH 3rd, Holt MS, Field LD, Ramsey JR. Arthroscopic management of posterior instability: Evolution of technique and results. Arthroscopy 2008;24(4):389-396.
22. Sugalski MT, Wiater JM, Levine WN, Bigliani LU. An anatomic study of the humeral insertion of the inferior glenohumeral capsule. J Shoulder Elbow Surg 2005;14(1):91-95.
23. Warner JJ, Lephart S, Fu FH. Role of proprioception in pathoetiology of shoulder instability. Clin Orthop Relat Res 1996;330:35-39.
24. Lephart SM, Warner JJ, Borsa PA, Fu FH. Proprioception of the shoulder joint in healthy, unstable, and surgically repaired shoulders. J Shoulder Elbow Surg 1994;3(6):371-380.
25. Pötzl W, Thorwesten L, Götze C, Garmann S, Steinbeck J. Proprioception of the shoulder joint after surgical repair for instability: A long-term follow-up study. Am J Sports Med 2004;32(2):425-430.
26. Zuckerman JD, Gallagher MA, Cuomo F, Rokito A. The effect of instability and subsequent anterior shoulder repair on proprioceptive ability. J Shoulder Elbow Surg 2003;12(2):105-109.


How to Cite this article:. Kakatkar SV, Herald J. Patho-anatomy and Patho-mechanics of Glenohumeral Instability. Asian Journal of Arthroscopy Jan – April 2017;2(1):3-6.


(Abstract) (Full Text HTML)      (Download PDF)


Arthroscopic Repair for Massive Bony Bankart Lesions

Dinshaw N Pardiwala, Nandan Rao, Ankit Varshney

Volume 2 | Issue 1 | Jan – Apr 2017 | Page 15-19.


Author: Dinshaw N Pardiwala [1], Nandan Rao [1], Ankit Varshney [1]

[1] Arthroscopy & Shoulder Service Kokilaben Dhirubhai Ambani Hospital, Mumbai, India.

Address of Correspondence

Dr. Dinshaw Pardiwala
Head – Centre for Sports Medicine
Director – Arthroscopy & Shoulder Service, Kokilaben Dhirubhai Ambani Hospital
Mumbai, India.
Email: Dinshaw.Pardiwala@relianceada.com.


Abstract

A bony Bankart lesion is defined as a labro-ligamentous detachment of the glenoid rim along with a fragment of attached bone and is commonly associated with shoulder instability. When the fragment of bone extends over one quadrant of the glenoid, we have termed it as a “massive” bony Bankart lesion. Traditionally considered as a type of glenoid fracture, it is important to appreciate that these fractures are not isolated bony injuries. The bone fragments are always attached to the labrum and are avulsed along with the glenohumeral ligaments. Although these injuries have traditionally been treated with open reduction and fracture fixation techniques, in recent years, surgical repair for these lesions has shifted towards arthroscopic instability repair techniques. Although the choice of technique to fix bony Bankart lesions (single row suture anchor repair, suture bridge dual-row anchor repair, arthroscopic screw fixation) is surgeon-specific, this is often determined by a number of factors, including bone fragment size and quality, and the ease with which the fragment can be manipulated and viewed for reduction and fixation. There is no clinical data currently that proves the superiority of any technique, and all report a high rate of radiographic incorporation and clinical success. This paper describes the detailed technique for arthroscopic single row suture anchor massive bony Bankart repair.
Keywords: Bony Bankart Lesion, Arthroscopic Repair, surgical techniques.


References

1. Porcellini G, Paladini P, Campi F, et al. Long-term outcome of acute versus chronic bony bankart lesions managed arthroscopically. AJSM 2007;35(12):2067-2072.
2. Bigliani LU, Newton PM, Steinmann SP, Connor PM, McIlveen SJ. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. AJSM 1998;26(1):41-45.
3. Griffith JF. et al. Prevalence, pattern, and spectrum of glenoid bone loss in anterior shoulder dislocation: CT analysis of 218 patients. American Journal of Radiology 2008;190:1247-1254.
4. Edwards TB, Boulahia A, Walch G. Radiographic analaysis of bone defects in chronic anterior shoulder instability. Arthroscopy 2003;19:732-739.
5. Burkhart SS, DeBeer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic bankart repairs: Significance of inverted pear glenoid and the humeral engaging Hill Sachs lesion. Arthroscopy 2000; 16: 677-694.
6. Boileau P, Villalba M, Hery JY, Balg F, Ahrens P, Newyton L. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. JBJS 2006; 88(8):1755-1763.
7. Tauber M, Resch H, Forstner R, Raffl M, Schauer J. Reason for failure after surgical repair of anterior shoulder instability. JSES 2004; 13(3); 279-285.
8. Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A. Gleoind rim morphology in recurrent anterior glenohumeral instability. JBJS 2003; 85-A5; 878-884.
9. Burkhart SS, Danaceau SM. Articular arc length mismatch as a cause of failed Bankart repair. Arthroscopyc 2000;16:740-744.
10. Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anterioinferior stability of the shoulder after Bankart repair: A cadaveric study: JBJSA 2000;82(1) :35-46.
11. Ideberg R, Grevsten S, Larsson S. Epidemiology of scapular fractures. Incidence and classification of 338 fractures. Acta Orthop Scand. 1995;66(5):395-397.
12. Porcellini G, Campri F, Paladini P. Arthroscopic approach to acute bony Bankart lesion. Arthroscopy 2002 18(7);764-769.
13. Sugaya H, Moriishi J, Kanisawa I, Tsuchiya A. Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability. JBJS A 2005;87:1752-1760.
14. Mologne TS, Provencher MT, Menzel KA, Vachon TA, Dewing CB. Arthroscopic stabilization in patients with an inverted pear glenoid. AJSM 2007; 35(8): 1276-1283.
15. Kim YK, Cho SH, Son WS, Moon SH. Arthroscopic Repair of small and medium sized bony Bankart lesions. AJSM 2014;42:86.
16. Zhang J, Jiang C. A new “double pulley” dual row technique for arthroscopic fixation of bony Bankart lesion. Knee Surg Sports Traumatol Arthrosc 2011;19(9):1558-1562.
17. Millett PJ, Horan MP, Martstschlager F. The “bony Bankart bridge” technique for restoration of anterior shoulder instability. AJSM 2013; 41:608-614.
18. Giles JW, Puskas GJ, Welsh MF, Johnson JA, Athwal GS. Suture anchor fixation of bony Bankart fractures: Comparison of single-point with double-point “suture bridge” technique. AJSM 2013; 41:2624.
19. Cameron SE. Arthroscopic reduction and internal fixation of anterior glenoid fracture. Arthroscopy 1998; 14: 743-746.
20. Park JY, Lee SJ, Lhee SH, Lee, SH. Follow-up CT arthrographic evaluation of bony Bankart lesions after arthroscopic repair. Arthroscopy 2012;28(4):465-473.
21. Jiang CY et al. Do reduction and healing of the bony fragment really matter in arthrosopic bony Bankart Reconstruction? A prospective study with clinical and computed tomography evaluations. AJSM 2013;4:12617-2623.


How to Cite this article:. Pardiwala DN. Rao N, Varshney A. Arthroscopic Repair for Massive Bony Bankart Lesions. Asian Journal of Arthroscopy Jan – April 2017;2(1):15-19.


(Abstract)      (Full Text HTML)      (Download PDF)


First Anniversary Issue of Asian Journal of Arthroscopy

Sachin Tapasvi, Parag Sancheti , Ashok Shyam

Volume 2 | Issue 1 | Jan – Apr 2017 | Page 1- 2


Author: Sachin Tapasvi [1], Parag Sancheti [2] , Ashok Shyam [2, 3]

[1] Orthopaedic Speciality Clinic, Pune Mahatrahtra.
[2] Sancheti Institute for Orthopaedics & Rehabilitation, Pune, India
[3] Indian Orthopaedic Research Group, Thane, India

Address of Correspondence

Dr Ashok Shyam
AJA Editorial Officie, A-203, Manthan Apts, Shreesh CHS, Hajuri Road, Thane [w], Maharashtra, India.
Email: editor@asianarthroscopy.com


Dear Colleagues,
we proudly present to you the anniversary issue of Asian Journal of Arthroscopy. Also we take this opportunity to thanks all our authors, reviewers and readers for supporting the journal. Special Thanks to all our symposium editors who have done excellent work with all three symposia’s. In last three issues we had three symposia on ‘Graft choices in ACL reconstruction’, ‘Meniscal tear and its management’, and ‘Shoulder Instability’. All three symposia’s were well received and attracted readership from all across the globe. Forthcoming symposia on Wrist arthroscopy and Elbow Arthroscopy are in process of getting ready and will be soon in your hands.
From this year we are soliciting original articles, case reports and technical notes. AJA has received ISSN and has basic indexing with major indexing bodies. The outreach of AJA is more than 20,000 orthopaedic surgeons through the network of Indian Orthopaedic Research Group. Also AJA is open access and all articles are easily downloadable and assessed from all across the globe. This presents a unique opportunity and advantage for all authors and there work can reach maximum readers through our network. We invite authors to submit their work to AJA using the online submission system ‘Scripture’ and if you have any queries please write to us. For special interest to us are video techniques of arthroscopy surgeries. We have received two video techniques which are under peer review and will probably show up soon in the forthcoming issues. We understand that there is always a small variations in techniques that every surgeon had developed over a period of time. These variations represent true experience based learning. Also at times during complex procedures or in cases with intraoperative complications, we have to innovate certain techniques to achieve good results. We at AJA will like to showcase these as ‘Surgical Tips’. Videos of common procedures with such surgical variations or complex procedures with variations are welcomed. Please prepare a video with voiceover and send to us with a brief write up of the technique or variation. The AJA team will help authors in video editing and processing. These video resources are fast becoming one of the most valuable resources and AJA is all geared up to support the authors to showcase their techniques.
This is the first anniversary issue of AJA and this is a major landmark for any journal. It shows the ability and commitment of the editors and the editorial board. Starting and running an academic Journal is not an easy venture. It requires co-ordinating many things including section editors, authors, reviewers, designers, copyeditors and many others. The combined effort of everyone is needed to create every issue and errors by any department will show up in the articles. To maintain the high quality its pertinent that every department does it work sincerely and efficiently. In this one year we are able to build up this co-ordination and a well-oiled mechanism is in place that can take care of submissions and review process. We also request the authors to take care while submitting to AJA. Please read the instructions to authors carefully and format your submissions. This will prevent unnecessary delays and resubmissions. Reviewers are the backbone of any journal. We have managed to get some every good reviewers for AJA but we would sincerely request our readers to participate in the reviewing process in large numbers.
The future of AJA looks very promising. We have received support from many national and international surgeons who have appreciated the platform and many have also joined us in this endeavour. AJA as a journal is young and full of potential. We will take help of advanced technology and our experienced editorial team to create an experience that is truly unique. Journal have to come out of their routine and fixed attitudes and grow with new generation and advancements. We shall leave no stone unturned to make AJA one of the most valuable journal in the world. We will need support from all our colleagues in doing this and if you wish to join the AJA team please feel free to write to us with your visions and plans for joining the team. We will need your comments and suggestions on the past issues of AJA as well as on the probable future course that AJA should take. With this we again thank all our supporters and leave you to enjoy the latest issue of AJA .


How to Cite this article:. Tapasvi S, Sancheti PK, Shyam AK. First Anniversary Issue of Asian Journal of Arthroscopy. Asian Journal of Arthroscopy Jan – April 2017;2(1):1-2Tapasvi S, Sancheti PK, Shyam AK. First Anniversary Issue of Asian Journal of Arthroscopy. Asian Journal of Arthroscopy Jan – April 2017;2(1):1-2.


(Abstract)      (Full Text HTML)      (Download PDF)