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  • SAGE Publications  (12)
  • Xu, Caiqi  (12)
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  • SAGE Publications  (12)
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  • 1
    Online Resource
    Online Resource
    Clinical and Radiological Outcomes in Patients With Anterior Shoulder Instability and Glenoid Bone Loss after Arthroscopic Free Bone Block Combined With Dynamic Anterior Stabilization
    SAGE Publications ; 2023
    In:  The American Journal of Sports Medicine Vol. 51, No. 1 ( 2023-01), p. 187-197
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 51, No. 1 ( 2023-01), p. 187-197
    Abstract: As an alternative to the Latarjet procedure, the arthroscopic free bone block (FBB) procedure combined with dynamic anterior stabilization (DAS) has been recently proposed to provide both glenoid augmentation and a tendon sling effect for treating anterior shoulder instability (ASI) with glenoid bone loss. Purpose: To evaluate the clinical and radiological outcomes of FBB-DAS for ASI with glenoid bone loss. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent arthroscopic FBB-DAS for ASI with 〉 15% glenoid bone loss between February 2017 and March 2020 were screened and enrolled in this study. Clinical outcome measures were assessed preoperatively and at a minimum 2-year follow-up, including recurrence, complications, shoulder functional scores, range of motion, and return to sports. Postoperative computed tomography and magnetic resonance imaging were also performed. Results: Of a total of 65 patients with a mean follow-up of 46.1 ± 13.1 months, no patients experienced a recurrent dislocation or subluxation postoperatively, while 2 had a positive anterior apprehension test (3.1%). Additionally, 2 patients (3.1%) experienced complications of hematoma and shoulder stiffness, respectively. The mean visual analog scale score, American Shoulder and Elbow Surgeons score, Rowe score, and Oxford Shoulder Instability Score all improved significantly from 3.2 ± 2.4, 75.0 ± 18.9, 43.6 ± 27.3, and 33.8 ± 9.0 preoperatively to 1.3 ± 0.8, 95.1 ± 8.0, 95.5 ± 7.8, and 14.8 ± 3.5 at final follow-up, respectively (all P 〈 .001). No difference was detected in range of motion except for 8.1° and 7.5° external rotation limitations in adduction and abduction, respectively. There were 62 patients (95.4%) who returned to sports, and 54 patients (83.1%) returned to the preinjury level. The transferred biceps tendon was intact in all 59 patients who completed radiological examination at the latest follow-up. Good bone healing was achieved in 98.3% of patients, and the glenoid bone defect decreased from 18.1% to 4.9%. Osseous and labral glenoids were significantly enlarged in width and depth on the latest magnetic resonance imaging (all P 〈 .001). Conclusion: Arthroscopic FBB-DAS provided satisfactory clinical and radiological outcomes for ASI with glenoid bone loss. Despite slight external rotation restrictions, it achieved low recurrence and complication rates, excellent shoulder functional scores, a high return-to-sports rate, and favorable graft healing and remodeling.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465221137883
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2063945-4
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  • 2
    Online Resource
    Online Resource
    Native Glenoid Depth and Hill-Sachs Lesion Morphology in Traumatic Anterior Shoulder Instability
    SAGE Publications ; 2023
    In:  The American Journal of Sports Medicine
    Details
    In: The American Journal of Sports Medicine, SAGE Publications
    Abstract: Although Hill-Sachs lesions (HSLs) are assumed to be influenced by glenoid characteristics in the context of bipolar bone loss, little is known about how glenoid concavity influences HSL morphology. Purpose: To investigate the relationship between the native glenoid depth and HSL morphological characteristics. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Computed tomography images of bilateral shoulders from 151 consecutive patients with traumatic unilateral anterior shoulder instability were retrospectively reviewed. Patients were categorized into flat ( 〈 1 mm), moderate (1-2 mm), and deep ( 〉 2 mm) groups based on the native glenoid depth measured from the contralateral unaffected shoulder. The HSL morphological characteristics included size (depth, width, length, and volume), location (medial, superior, and inferior extent), and orientation (rim and center angle). The glenoid characteristics included diameter, depth, version, and bone loss. The patient, glenoid, and HSL morphological characteristics were compared among the 3 depth groups. Subsequently, the independent predictors of some critical HSL morphological characteristics were determined using multivariate stepwise regression. Results: After exclusion of 55 patients, a total of 96 patients were enrolled and classified into the flat group (n = 31), moderate group (n = 35), and deep group (n = 30). Compared with those in the flat group, patients in the deep group were more likely to have dislocation (38.7% vs 93.3%; P = .009) at the primary instability and had a significantly larger number of dislocations (1.1 ± 1.0 vs 2.2 ± 1.8; P = .010); moreover, patients in the deep group had significantly deeper, wider, larger volume, more medialized HSLs and higher incidences of off-track HSLs (all P≤ .025). No significant differences were detected among the 3 groups in HSL length, vertical position, and orientation (all P≥ .064). After adjustment for various radiological and patient factors in the multivariate regression model, native glenoid depth remained the strongest independent predictor for HSL depth (β = 0.346; P 〈 .001), width (β = 0.262; P = .009), volume (β = 0.331; P = .001), and medialization (β = −0.297; P = .003). Conclusion: The current study sheds light on the association between native glenoid depth and the morphology of HSLs in traumatic anterior shoulder instability. Native glenoid depth was independently and positively associated with HSL depth, width, volume, and medialization. Patients with deeper native glenoids were more likely to have off-track HSLs and thus require more attention in the process of diagnosis and treatment.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465231200246
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2063945-4
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  • 3
    Online Resource
    Online Resource
    Correlation of Tibial Torsion With Lower Limb Alignment and Femoral Anteversion in Patients With Patellar Instability
    SAGE Publications ; 2022
    In:  Orthopaedic Journal of Sports Medicine Vol. 10, No. 12 ( 2022-12-01), p. 232596712211414-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 10, No. 12 ( 2022-12-01), p. 232596712211414-
    Abstract: Alignment and rotation of the lower extremities have been suggested to be predisposing pathologic factors for patellar instability. Purpose: To elucidate the relationship between the lower limb alignment and lower extremity rotation in patients with patellar instability. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 83 patients with patellar instability. Computed tomography scans and standing full-leg radiographs were used to measure the tibial tuberosity–trochlear groove (TT-TG) distance, mechanical femorotibial angle (mFTA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), femoral torsion, and tibial torsion of the different segments. The relationships between femoral torsion, tibial torsion of the different segments, and the mFTA, mLDFA, and mMPTA were evaluated. The levels of tibial torsion and femoral torsion in patients with varus, normal, or valgus alignment were compared with 1-way analysis of variance and chi-square test. Results: The total tibial torsion was significantly associated with total femoral anteversion ( r = 0.329; P = .002) and mFTA ( r = –0.304; P = .005). There were no significant correlations between mFTA and TT-TG distance or femoral anteversion. Compared with patients with valgus malalignment, patients with varus malalignment tended to have higher tibial torsion. Conclusion: Tibial torsion was associated with leg axis alignment and femoral anteversion in patients with patellar instability. Patients with patellar instability, especially those with concurrent leg axis deformities, should undergo further radiological imaging so that tibial torsion can be assessed and a diagnosis of torsion deformity made early in the treatment pathway and the proper surgical plan formulated.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/23259671221141484
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2706251-X
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  • 4
    Online Resource
    Online Resource
    Effect of Lower Extremity Torsion on Clinical Outcomes After Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Transfer for Recurrent Patellofemoral Instability
    SAGE Publications ; 2023
    In:  The American Journal of Sports Medicine Vol. 51, No. 9 ( 2023-07), p. 2374-2382
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 51, No. 9 ( 2023-07), p. 2374-2382
    Abstract: Increased femoral torsion (FT) or tibial torsion (TT) has been suggested to be a potential risk factor for recurrent patellofemoral instability. However, the influence of increased FT or TT on the postoperative clinical outcomes of recurrent patellofemoral instability has rarely been investigated. Purpose: To assess the effect of increased FT or TT on postoperative results in patients with recurrent patellofemoral instability after combined medial patellofemoral ligament reconstruction (MPFLR) and tibial tubercle transfer, along with the influence of other risk factors. Study Design: Cohort study; Level of evidence, 3. Methods: Out of 91 patients, the study’s analyses included 86 patients with recurrent patellofemoral instability who were treated with MPFLR and tibial tubercle transfer and enrolled between April 2020 and January 2021. FT and TT were assessed using preoperative computed tomography images. According to the torsion value of FT or TT, patients were categorized into 3 groups for each of FT and TT: group A ( 〈 20°), group B (20°-30°), and group C ( 〉 30°). Patellar height, femoral trochlear dysplasia, and the tibial tuberosity–trochlear groove (TT-TG) distance were also assessed. Patient-reported outcome scores (Tegner, Kujala, International Knee Documentation Committee [IKDC], Lysholm, and Knee injury and Osteoarthritis Outcome Score [KOOS] ) were evaluated pre- and postoperatively. Clinical failure of MPFLR was recorded. Subgroup analysis was conducted to evaluate the effect of increased FT or TT on the postoperative outcomes. Results: A total of 86 patients were enrolled with a median follow-up time of 25 months. At the final follow-up, all functional scores improved significantly. Patella alta, high-grade trochlear dysplasia, and increased TT-TG distance did not have any significant effect on the postoperative functional scores. Regarding FT, subgroup analysis indicated that all functional scores of group C were lower than those of groups A and B except the KOOS knee-related Quality of Life score. For TT, group C had lower scores than group A for all functional outcomes except Tegner and KOOS Quality of Life and lower scores than group B for Kujala, IKDC, KOOS (Symptoms and Sport and Recreation subscales), Tegner, and Lysholm scores. The comparison between group A and group B, whether for FT or TT, revealed no significant differences. Conclusion: For patients with recurrent patellofemoral instability, increased lower extremity torsion (FT or TT 〉 30°) was associated with inferior postoperative clinical outcomes after combined MPFLR and tibial tubercle transfer.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465231177059
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2063945-4
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  • 5
    Online Resource
    Online Resource
    Increased Expression of Adipokines in Patients With Frozen Shoulder
    SAGE Publications ; 2023
    In:  The American Journal of Sports Medicine Vol. 51, No. 12 ( 2023-10), p. 3261-3267
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 51, No. 12 ( 2023-10), p. 3261-3267
    Abstract: Adipokines represent a spectrum of bioactive molecules that could modulate fibroblastic and inflammatory processes. The role of adipokines in the pathogenesis of frozen shoulder (FS), a common musculoskeletal disorder characterized by chronic inflammation, remains obscure. Purpose: To evaluate whether adipokines contribute to the pathogenic mechanisms of FS and to evaluate any potential correlation of adipokines with patients’ symptoms. Study Design: Controlled laboratory study. Methods: Shoulder capsule specimens were obtained from 10 patients with FS and 10 patients with shoulder instability (control group). The specimens were dyed using hematoxylin and eosin and immunohistochemically assessed with antibodies targeting adipokines, collagen I, collagen III, and tumor necrosis factor α. Immunoreactivity was graded from “no” to “strong” in a blinded manner. Reverse transcription–quantitative real-time polymerase chain reaction (RT-qPCR) analysis was conducted. Before the surgery, patient-reported frequency of pain, severity of pain, stiffness, and shoulder range of motion were documented. Results: In comparison with the control group, patients with FS had significantly greater pain frequency, pain severity, and stiffness and more limited shoulder range of motion ( P 〈 .001). Hematoxylin and eosin- and Masson trichrome–stained samples from the FS group displayed hypercellularity and increased collagen fibers. Immunohistochemistry and RT-qPCR analyses indicated that expression of adipokines was significantly increased in FS capsules compared with the control group. The expression of collagen I, collagen III, and tumor necrosis factor α was also increased in FS capsules. No significant correlation was noted between adipokine expression and patient-reported outcomes in the control group, whereas in patients with FS, adiponectin expression was correlated with pain frequency ( r = 0.78; P = .01) and stiffness ( r = 0.73; P = .02). Visfatin was also correlated with pain frequency ( r = 0.70; P = .02). Conclusion/Clinical Relevance: This study indicated a potential role for adipokines in the pathogenesis of FS and demonstrated a correlation between adipokine expression and patients’ pain and stiffness.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465231189797
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
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  • 6
    Online Resource
    Online Resource
    Biomechanical and Histological Results of Dual-Suspensory Reconstruction Using Banded Tendon Graft to Bridge Massive Rotator Cuff Tears in a Chronic Rabbit Model
    SAGE Publications ; 2022
    In:  The American Journal of Sports Medicine Vol. 50, No. 10 ( 2022-08), p. 2767-2781
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 50, No. 10 ( 2022-08), p. 2767-2781
    Abstract: Bridging rotator cuff tendon defects with a patch is a reasonable treatment for massive rotator cuff tears (MRCTs). However, the poor outcomes associated with routine patch repair have prompted exploration into superior bridging techniques and graft structures. Purpose: To detect whether dual-suspensory reconstruction using a banded graft would be superior to routine bridging using a patch graft to treat MRCTs and to detect the comparative effectiveness of patellar tendon (PT) and fascia lata (FL) grafts in dual-suspensory reconstruction. Study Design: Controlled laboratory study. Methods: Unilateral chronic MRCTs were created in 72 mature male New Zealand White rabbits, which were randomly divided into 3 groups: (1) patch bridging repair using rectangular FL autograft (PR-FL), (2) dual-suspensory bridging reconstruction using banded FL autograft (DSR-FL), and (3) dual-suspensory bridging reconstruction using banded PT autograft (DSR-PT). In each group, the mean failure load and stiffness of the cuff-graft-humerus (C-G-H) complexes of 6-week and 12-week specimens were recorded, with the failure modes and sites noted. Moreover, cuff-to-graft and graft-to-bone interface healing and graft substance remodeling of the complexes were histologically evaluated (via hematoxylin and eosin, Picrosirius red, Masson trichrome, and Safranin O/fast green staining) at 6 and 12 weeks to assess integrations between the bridging constructs and the native bone or rotator cuff tendons. Results: The DSR-PT group had the greatest mean failure loads and stiffness of the C-G-H complexes at 6 and 12 weeks (41.81 ± 7.00 N, 10.34 ± 2.68 N/mm; 87.62 ± 9.20 N, 17.98 ± 1.57 N/mm, respectively), followed by the DSR-FL group (32.04 ± 5.49 N, 8.20 ± 2.27 N/mm; 75.30 ± 7.31 N, 14.39 ± 3.29 N/mm, respectively). In the DSR-PT and DSR-FL groups, fewer specimens failed at the graft-to-bone junction and more failed at the cuff-to-graft junction, but both groups had higher median failure loads at 6 and 12 weeks (DSR-PT: cuff-to-graft junction, 37.80 and 83.76 N; graft-to-bone junction, 45.46 and 95.86 N) (DSR-FL: cuff-to-graft junction, 28.52 and 67.68 N; graft-to-bone junction, 37.92 and 82.18 N) compared with PR-FL (cuff-to-graft junction, 27.17 and 60.04 N; graft-to-bone junction, 30.12 and 55.95 N). At 12 weeks, the DSR-FL group had higher median failure loads at graft substance (72.26 N) than the PR-FL group (61.27 N). Moreover, the PR-FL group showed more inflammatory responses at the 2 healing interfaces and the graft substance in the 6-week specimens and subsequently displayed poorer interface healing (assessed via collagen organization, collagen maturity, and fibrocartilage regeneration) and graft substance remodeling (assessed via collagen organization and maturity) in 12-week specimens compared with the DSR-PT and DSR-FL groups. Superior interface healing and substance remodeling processes were observed in the DSR-PT group compared with the DSR-FL group. Conclusion: When compared with routine patch repair, the dual-suspensory reconstructions optimized biomechanical properties and improved interface healing and graft substance remodeling for bridging MRCTs. Furthermore, the dual-suspensory technique using the PT graft presented superior histological and biomechanical characteristics than that using FL. Clinical Relevance: The dual-suspensory reconstruction technique using banded tendon grafts may enhance bridging constructs for MRCTs in humans, warranting further investigations of clinical outcomes.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465221102744
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
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  • 7
    Online Resource
    Online Resource
    Effect of Anterior Acromial Coverage on Functional and Radiological Outcomes After Arthroscopic Repair of Anteroposterior Massive Rotator Cuff Tears
    SAGE Publications ; 2023
    In:  The American Journal of Sports Medicine Vol. 51, No. 11 ( 2023-09), p. 2831-2841
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 51, No. 11 ( 2023-09), p. 2831-2841
    Abstract: Rotator cuff tear size, fatty infiltration, and scapular morphology are correlated with tendon healing and functional outcomes after arthroscopic repair; however, the association between anteroposterior acromial coverage and the clinical outcomes of anteroposterior massive rotator cuff tears (AP-MRCTs; involving all 3 tendons) remains unclear. Purpose: To identify the association between AP acromial coverage and functional and radiological outcomes after arthroscopic repair of AP-MRCTs. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 98 patients who underwent arthroscopic repair of AP-MRCTs between January 2015 and December 2020 were included in the study and classified according to whether anterior acromial coverage (AAC) was anterior (46 patients; positive AAC group) or posterior (52 patients; negative AAC group) to the scapular line on true lateral shoulder radiographs. Demographic characteristics, surgical details, and functional outcomes were prospectively collected. Acromial morphological features, global tear extension (GTE), the global fatty infiltration index (GFII), tendon integrity after repair, proximal humeral migration, and glenohumeral abduction were measured and calculated on radiographs or magnetic resonance imaging scans preoperatively and at 2 years postoperatively. Multivariate logistic regression was performed to identify the independent risk factors of a rotator cuff retear. Results: The positive AAC group showed larger AAC, posterior acromial tilt, and anterior acromial slope as well as smaller posterior acromial coverage compared with the negative AAC group. Postoperatively, the American Shoulder and Elbow Surgeons score (82.5 ± 8.3 vs 77.2 ± 11.5, respectively; P = .013), active abduction (157.8°± 27.1° vs 142.7°± 39.6°, respectively; P = .048), and glenohumeral abduction (45.6°± 10.4° vs 39.7°± 14.9°, respectively; P = .041) in the positive AAC group were significantly higher than those in the negative AAC group, while the retear rate (23.9% vs 44.2%, respectively; P = .035) and proximal humeral migration (1.7 ± 1.0 vs 2.3 ± 1.2 mm, respectively; P = .006) were significantly lower in the positive AAC group than in the negative AAC group. Smaller AAC (odds ratio [OR], 0.93 [95% CI, 0.87-1.00] ; P = .040), larger GTE (OR, 1.03 [95% CI, 1.01-1.06]; P = .017), and a higher GFII (OR, 3.49 [95% CI, 1.09-11.19] ; P = .036) were associated with an increased risk of a rotator cuff retear. Conclusion: Increased AAC was associated with a lower retear rate and better functional outcomes after arthroscopic repair of AP-MRCTs. A preliminary risk evaluation integrating GTE, the GFII, and AAC is recommended to consider the necessity of additional procedures for patients in need of arthroscopic rotator cuff repair.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465231187900
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
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  • 8
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    Effects of Anterolateral Structure Augmentation on the In Vivo Kinematics of ACL-Reconstructed Knees: Response
    SAGE Publications ; 2021
    In:  The American Journal of Sports Medicine Vol. 49, No. 9 ( 2021-07), p. NP43-NP44
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 49, No. 9 ( 2021-07), p. NP43-NP44
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465211023749
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
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  • 9
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    Effects of Anterolateral Structure Augmentation on the In Vivo Kinematics of Anterior Cruciate Ligament–Reconstructed Knees
    SAGE Publications ; 2021
    In:  The American Journal of Sports Medicine Vol. 49, No. 3 ( 2021-03), p. 656-666
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 49, No. 3 ( 2021-03), p. 656-666
    Abstract: Double-bundle anterior cruciate ligament (ACL) reconstruction (ACLR) is a well-known treatment that restores the stability of ACL-deficient knees. However, some isolated ACL-reconstructed knees ultimately show rotatory laxity and develop osteoarthritis. Whether combined ACLR with anterolateral structure (ALS) augmentation (ALSA) can provide better improvement in the in vivo knee rotational kinematics remains unknown. Hypothesis: When compared with isolated double-bundle ACLR, combined double-bundle ACLR with ALSA can improve knee in vivo rotational kinematics and provide better restoration of knee kinematics. Study Design: Controlled laboratory study. Methods: Sixteen patients with unilateral ACL injury were randomly divided into 2 groups to receive either combined double-bundle ACLR and ALSA (ALSA group) or isolated double-bundle ACLR (ACLR group). All patients performed a single-leg lunge using the operative and nonoperative/contralateral legs under dual-fluoroscopic imaging system surveillance during a hospital visit at a minimum 1 year (12-13 months) of follow-up to assess the 6 degrees of freedom knee kinematics. Functional evaluation using the Lysholm and Marx rating scales and clinical examinations were also performed. Results: From full extension to approximately 90° of knee flexion at 5° intervals, the mean ± SD internal rotation of the reconstructed knees in the ALSA group (1.5°± 0.9°) was significantly smaller than that of the contralateral knees (8.2°± 1.9°; P = .008). The ALSA group knees also showed significantly ( P = .045) more medial translation than the contralateral knees. In the ACLR group, the mean internal rotation of the reconstructed knee (6.0°± 2.1°) was significantly smaller than that of the contralateral knees (8.9°± 0.6°; P 〈 .001). At full extension, the tibia was significantly more externally rotated than that of the contralateral legs (0.5°± 7.4° vs 7.6°± 3.4°, P = .049). Conclusion: When compared with isolated double-bundle ACLR, double-bundle ACLR augmented with ALS reconstruction resulted in anterolateral rotatory overconstraint during the lunge motion. Clinical Relevance: Additional ALSA of double-bundle ACL-reconstructed knees overconstrained rotatory stability. Therefore, the use of ALSA for ACL-reconstructed knees should be considered with caution for patients with ACL deficiency and anterolateral rotatory instability. Longer-term follow-up to evaluate long-term outcomes and altered kinematics over time is recommended.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546520981743
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
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  • 10
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    Arthroscopic Glenoid Bone Grafting With Nonrigid Fixation for Anterior Shoulder Instability : 52 Patients With 2- to 5-Year Follow-up
    SAGE Publications ; 2014
    In:  The American Journal of Sports Medicine Vol. 42, No. 4 ( 2014-04), p. 831-839
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 42, No. 4 ( 2014-04), p. 831-839
    Abstract: The healing rate and clinical outcomes of glenoid bone grafting with nonrigid fixation for patients with recurrent anterior shoulder instability are unknown. Hypothesis: Glenoid bone grafting with nonrigid fixation can yield satisfactory results for patients with recurrent anterior shoulder instability with regard to graft healing and the restoration of shoulder stability. Study Design: Case series; Level of evidence, 4. Methods: A total of 52 patients with recurrent anterior shoulder instability underwent Bankart or bony Bankart repair as well as arthroscopic glenoid bone grafting. Allogenic bicortical iliac grafts were used. Instead of firm fixation, the grafts were tethered to the glenoid by sutures from anchors placed in the glenoid surface. Follow-up occurred at 3, 6, 12, and 24 months. Computed tomography and magnetic resonance imaging examinations were performed immediately after surgery and at each follow-up visit to evaluate the healing of the graft and the changes in the repaired capsule-labrum structure. Functional evaluations were taken at 24 months with the Oxford Shoulder Instability Score and the Rowe Score for Shoulder Instability. For the patients who underwent surgery 2.5 years earlier, an additional review was conducted to evaluate the latest stability status of the shoulder. Failure was defined as recurrence of dislocation or instability. Results: The mean follow-up time was 39 months (range, 24-64 months). In all cases, the grafts healed to the glenoid at 3 or 6 months, and glenoid remodeling was complete within 12 months; in most cases, a robust bone-capsule structure formed on the anterior side of the glenoid. The glenoid defect area changed from 32.7% ± 8.7% (range, 10.7% to 53.9%) to −16.3% ± 3.3% (range, −26.7% to 5.9%), and the glenoid defect width changed from 28.3% ± 8.7% (range, 10.4% to 54.5%) to −16.9% ± 7.3% (range, −33.4% to 2.8%). Compared with the presumed normal glenoid, the final glenoid surface area increased in 94.2% of patients and final glenoid width increased in 96.2% of patients. One patient experienced redislocation and 2 experienced a sense of instability without dislocation, which resulted in a failure rate of 5.8%. Six patients exhibited slight pain. The Oxford score improved from 29.7 ± 5.6 preoperatively to 42.4 ± 3.3 at 2 years postoperatively, and the Rowe score improved from 34.7 ± 6.1 preoperatively to 91.8 ± 2.8 at 2 years postoperatively. Conclusion: In this study, arthroscopic glenoid bone grafting with nonrigid fixation in combination with Bankart repair resulted in 100% graft healing and the satisfactory restoration of shoulder stability.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546513519227
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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