The Latarjet procedure, on the other hand, requires removal of a much larger portion of the coracoid (2-3cm) with transfer along its long axis to the anteroinferior glenoid neck [48] (Figures 7 and 8). 1). [56] were evaluated for arthritis changes. Of patients who underwent the modified Brostrom procedure under the diagnosis of chronic lateral ankle instability, 40 patients (40 ankles) who could be followed during a minimum period of 2 years were enrolled in the current study. 4857, 2002. 7% (286/3871) 5. 96 95% . More recent patient series have indicated that the Latarjet procedure may be a superior treatment option for chronic anterior instability in high-level athletic patients with large glenoid bone defects. This review focuses on the surgical approaches to treatment of chronic lateral ankle instability, including $Brostr{\ddot{o}}m$ surgical techniques, with a review of the traditional procedure and newer techniques. 584590, 1952. [68] reported satisfactory results in 14 of 15 patients treated with open transfer of the infraspinatus tendon for large defects of the humeral head and noted no significant complications nor limitations in rotation. The surgical outcomes following partial resurfacing of humeral head defects are currently limited to very small case series or case reports [43, 44]. Partial resurfacing of large humeral head impression fractures with a cobalt-chrome articular component is an emerging technique in younger patients which may decrease the risks seen with other osseous procedures. . This review on the management of bone loss in recurrent glenohumeral instability discusses the relevant shoulder anatomy that provides stability to the shoulder joint, relevant history and physical examination findings pertinent to recurrent shoulder instability, and the proper radiological imaging choices in its workup. Based on this, we cannot advocate for or against this technique at the present time. incidence. 5. Excellent outcomes were obtained on Rowe scores, Constant scores, and Western Ontario Shoulder Instability Index at final follow-up. 2009 Mar;37(3):488-94. doi: 10.1177/0363546508327541. Arthroscopy. Armitage et al. #Modified $Brostr{\ddot{o}}m$ procedure. Axillary views are imperative in confirming glenohumeral joint congruency and can also demonstrate the presence of humeral head impression fractures, provide an assessment of glenoid erosion or fracture, and occasionally identify subchondral glenoid neck sclerosis. Orthopaedic Reserch Society, Annual Meeting, Dallas, Feb 2002, Podium Presentation. American Academy of Orthopaedic Surgery, AOSSM Specialty Day, SanFrancisco, Califorinia, March 2001; Poster Presentation. 918, 1987. 170175, 2004. : , , . 80% (1199/1492) 3. [32] have reported the results of a humeroplasty technique in four patients with associated capsulolabral repair or Latarjet transfer. Goals of treatment in this situation rely on addressing both the soft tissue and bony pathology that are causative of the recurrent instability. All studies reported >90% return to sports. HHS Vulnerability Disclosure, Help , , 46 . Telos , 9,12). B. G. Weber, L. A. Simpson, and F. Hardegger, Rotational humeral osteotomy for recurrent anterior dislocation of the shoulder associated with a large Hill-Sachs lesion, Journal of Bone and Joint Surgery A, vol. 159176, 2000. Fax: 847-381-0811, 815 Cog Circle , 2011, pp.35 - 40 [65]. In an attempt to address larger defects and prevent them from engaging with the glenoid, several techniques have been described to fill the osseous defect with various bony or soft tissue transfers. The remaining two studies reported overall Constant scores of 94 [59] and 94.4 [58]. Intramedullary screw fixation. , (proprioception) , , , , , /, , , , , , , , , , , , /, , , , , , , , ISBN, ISSN, , , (), (), (). Review of clinical outcomes and case presentations, Following preparation of the glenoid neck and labrum for Bankart repair, visualization of the bony defect is done through the anterosuperior portal. After 4 to 6 weeks, patients can begin active and resisted range of motion exercises while avoiding contact sports and positions which risk dislocation. Purchase and colleagues [35] recently described the transfer of the infraspinatus tendon and posterior capsule into the defect using an arthroscopic only technique. Their average age was 19.3 years, and the average follow-up time was Brostrom ( ) 42(38) . Weboften a planned secondary procedure, required to allow the TMT joints to return to motion ~20% of patients following arthrodesis. This decreases the risk of hardware prominence seen when countersunk cancellous screws are placed directly into the defect itself and the graft settles or resorbs [25]. Cummins CA, Anderson K, Nuber G, Bowen M, Roth SI: Anatomy of the Spinoglenoid Ligament. Cummins CA, Anderson K, Nuber G, Messer T, Bowen M: Suprascapular Nerve Entrapment at the Spinoglenoid Notch in a Professional Baseball Pitcher. Six industrial fuel aboard grounded one-half mile offshore from the Brigantine Wildlife Refuge. , Brostrm . A. L. Chen, S. A. . (g) Arthroscopic evaluation of the incorporated graft at second look arthroscopy. , . , . 2638, 1948. Purpose: This study was performed to evaluate the diagnostic usefulness of ankle stress radiograph for evaluation of chronic lateral ankle instability. 1980 Coast Guard forces narrowly averted an environmental disaster when the 300-foot barge Michelle F, with more than 2.8 million gallons of No. The Modified Shuttle Walking Test (MSWT) was modified from the 20-MST to provide a standardized progressive test for obtaining a symptom-limited maximum performance in individuals with chronic airway obstruction (CAO). 25, no. [58] looked at the open modified Latarjet technique while the remainder of the studies looked at either an open allograft bone block technique [55], an open J-graft autograft technique [57], or an open iliac crest autograft bone block technique [53, 59, 60]. Messer TM, Cummins CA, Ahn J, Kelikian AS. , , , . Two views of the right shoulder following an open Latarjet stabilization procedure for recurrent right shoulder instability. Although not statistically significant, there was an 8 degree deficit in internal rotation postoperatively. 11, pp. 74, 75 The individual walks up and down a 10-m course at incremental speeds of 0.17 m/s each minute 3 , 24, 18 , 3, 117 (Table 2). Brostrom(Modified Brostrom) (Protraction) (Effective is an Epidural for Back Pain) (Hypomania) (Rib Removal) (Ashman Phenomenon) (Tendon Graft) Messer TM, Cummins CA, Ahn J, Kelikian AS: Outcome of the Modified Brostrom Procedure for Chronic Lateral Ankle Instability Using Suture Anchors. 33, no. These include coracoid transfer procedures and allograft/autograft reconstruction at the glenoid, as well as humeral head disimpaction/humeroplasty, remplissage, humeral osseous allograft reconstruction, rotational osteotomy, partial humeral head arthroplasty, and hemiarthroplasty on the humeral side. [57], 19 of 47 shoulders showed arthritic change at a follow-up of 72 months with 11 of these patients having preoperative evidence of arthrosis. Lafosse et al. All of these may be indicative of chronic dislocation. [60] demonstrated that, of the ten patients in their series, two patients had grade I arthritis and one had grade II arthritis via the Samilson/Prieto classification. The coracoid graft demonstrated osseous union in all patients at a mean months (range, 1274) with no further instability or degenerative arthritis. The operation is performed through a standard deltopectoral approach to adequately expose the humeral head defect and evaluate the glenoid for bone loss. M. Bahk, E. Keyurapan, A. Tasaki, E. L. Sauers, and E. G. McFarland, Laxity testing of the shoulder: a review, American Journal of Sports Medicine, vol. . The lack of musculature and the redundant capsule in the inferior aspect of the glenohumeral joint are the main contributors to the anterior/inferior instability of the shoulder joint. 2019;47(3):65966. #Chronic lateral ankle instability CORR Insights: Do Mid-term Outcomes of Lateral Ankle Stabilization Procedures Differ Between Military and Civilian Populations. 8, pp. ; The long-term follow-up of allograft reconstruction of humeral head segmental defects from posterior shoulder dislocation was evaluated by Martinez et al. Of the 28 operations performed, there were 26 excellent results, one good result, and one fair result. 41, no. University of Florida, Gainesville, Florida, Northwestern University Feinberg School of Medicine, Chicago Illinois - Orthopaedic Surgery, University of New South Wales, Kogarah/Sydney, Australia - Shoulder Surgery and Sports Medicine. O. J. Gagey and N. Gagey, The hyperabduction test, Journal of Bone and Joint Surgery B, vol. Butt, P. I. Akimau, and C. P. Charalambous, Arthroscopic Remplissage for shoulder instability: a systematic review, Knee Surgery, Sports Traumatology, Arthroscopy, 2014. This is achieved with a standard deltopectoral approach to identify the lesion and using an oscillating saw to convert the impacted defect into a wedge of exposed metaphyseal cancellous bone. = Journal of Korean Foot and Ankle Society Outcomes of the Chrisman-Snook and modified-Brostrm procedures Cummins CA, Scarborough M, Enneking W: Multicentric Giant Cell Tumor of Bone. M. S. Rashid, J. Crichton, U. Modified Brostrm procedure . Magnetic resonance imaging (MRI) with or without arthrography is frequently used to evaluate the chronically unstable shoulder. M. B. Strauss, The shoulder- roentgenographical evaluation of recurrent anterior instability, in Fractures, C. A. Rockwood Jr. and D. P. Green, Eds., p. 646, JB Lippincott, Philadelphia, Pa, USA, 1975. 4,11), , . 1, pp. 78, no. FOIA (peroneal tendon sheath) . 4, pp. 6, pp. The current study included patients who complained of unilateral ankle joint instability. 2, pp. : $4.2{\pm}2.1$, $3.9{\pm}1.9$ mm . 44, no. It typically infects rodents and it is not pathogenic for humans or Brostrm repair depends on the quality of the remnant ligament. , . , (proprioception) , , . A. Martinez, E. Navarro, D. Iglesias, J. Domingo, A. Calvo, and I. Carbonel, Long-term follow-up of allograft reconstruction of segmental defects of the humeral head associated with posterior dislocation of the shoulder, Injury, vol. In the study by Auffarth et al. I made an incision at the tip of the fibula. ( ), 69, no. #Ankle Kronberg and Brostrom [75] reported their five-year results of 20 derotation osteotomies performed for recurrent instability. Brostrom ( ) 42(38) . At a mean of 122 months (range, 96144) after the surgery, half of these patients had no complaints of pain or instability and had good results. Accordingly, decreasing the retroversion by 1015 degrees in the setting of posterior instability may further stabilize the glenohumeral joint [33, 37]. Plate removal was performed one to two years postoperatively in 107 of the 180 shoulders. 10) , 3) . ( ), : Brostrm A thorough assessment of the glenoid and final testing of stability needs to be performed prior to completing the operation. International Symposium on Limb Salvage. Any residual instability may indicate the necessity to perform an additional bony or soft tissue procedure. . [64] retrospectively reviewed 28 shoulders in 26 soccer players affected by chronic anterior instability. 77, no. All athletes in the series returned to previous levels of function, including 14 professionals. PDF KISTI DDS . Follow-up averaged 64.3 months (range 30-132 months). The relationship of anterior instability and rotator cuff impingement, Orthopaedic Review, vol. All patients across the various studies were also treated with a capsulorrhaphy. 66, no. Cummins CA, Murrell GAC: Mode of Failure for Rotator Cuff Repair with Suture Anchors Identified at Revision Surgery. 63, no. ( ), ( ) (Fig. 150 N(newton) , 10 20 . # View Dr. Cummins's Patient Resources and Rehab Protocols, Certificate of Added Qualification, Sports Medicine, American Orthopaedic Society of Sports Medicine. Nonoperative treatment of shoulder instability in the setting of glenoid or humeral bone loss is generally reserved for patients with significant medical comorbidities in which surgery carries unacceptably high risk, those who have low functional demands, and those who demonstrate poor compliance to postoperative rehabilitation protocols. A best-fit circle is used to approximate normal inferior glenoid surface area and observed bone loss can be calculated from this measurement [10, 23] (Figure 1). The graft is then secured with a lag technique using one or two 3.5mm fully threaded cortical screws. Re and colleagues [32] published on a variation of this technique using an anterior cruciate ligament (ACL) drill guide to localize the lesion, elevated it with retrograde bone tamping, and filled the defect with cancellous bone graft [25]. [25] have conducted a succinct review of the outcomes to date following the current spectrum of procedures which includes humeroplasty, remplissage, osteoarticular allograft, rotational osteotomies, and partial resurfacing. 16, no. Suite 1 , , Ahovuo 1) . 7, pp. The following authors do not have any existing potential conflict of interests: Randy Mascarenhas, Jamie Rusen, Bryan M. Saltzman, Jeff Leiter, and Jaskarndip Chahal. (anterior talofibular ligament) . (anterior talofibular ligament) . : Brostrom ( ) 42 . Mean reductions in external rotation in adduction, external rotation in abduction, and internal rotation were reported as 5.6 (40 to +30), 11.3 (50 to +7), and 0.9 (4 to 0) vertebral levels, respectively. 18, no. v.10 no.1 1, pp. 328332, 1980. Foot Ankle Int. We obtained the normal range of Korean adults, and used as a standard value for judgment of mechanical instability. J Shoulder Elbow Surg, 18: 172-177, 2009. 9, pp. 7, pp. [63] have reported that 30% of shoulders had moderate or severe arthropathy at 2237-year follow-up following a bone block glenoid reconstruction procedure. PMC Telos , . eCollection 2022 Sep-Oct. Vopat ML, Lee B, Mok AC, Hassan M, Morris B, Tarakemeh A, Zackula R, Mullen S, Schroeppel P, Vopat BG. 7, pp. 3, pp. J Orthop Surg (Hong Kong), 2007,15:306-10. The instability exam should be completed with Gagey hyperabduction testing [16], where a substantial increase in abduction on the affected side can be indicative of injury to the inferior glenohumeral ligament complex. 69%, 97%, 91%, 90% (Table 4). Two particularly important subsets of patients to identify are those patients with a history of seizures or voluntary dislocations in which traditional operative intervention carries a high risk of failure. J. J. P. Warner, T. J. Gill, J. D. O'Hollerhan, N. Pathare, and P. J. Millett, Anatomical glenoid reconstruction for recurrent anterior glenohumeral instability with glenoid deficiency using an autogenous tricortical iliac crest bone graft, The American Journal of Sports Medicine, vol. Purchase, E. M. Wolf, E. R. Hobgood, M. E. Pollock, and C. C. Smalley, Hill-Sachs remplissage: an arthroscopic solution for the engaging Hill-Sachs lesion, Arthroscopy, vol. 21, no. A total of 50 patients were followed up for more than 2 years after undergoing the modified Brostr . These values are clinically relevant, however, when weighing the option of surgical intervention. Suite 125 Operative treatments that can be used to treat both glenoid and humeral head bone loss are outlined. Cummins CA, Strickland S, Appleyard RC, Szomor ZL, Grant C, Murrell GAC: Rotator Cuff Repair: An Ex Vivo Mechanical Study Comparing Trans-Osseous Sutures, Suture Anchors and Bio-Absorbable Screws. R. Lugo, P. Kung, and C. B. Ma, Shoulder biomechanics, European Journal of Radiology, vol. (false negative) , . (walking boots) . Strengthening of the rotator cuff, deltoid, and scapulothoracic stabilizers acts to improve overall shoulder function and minimize risk of future dislocation. The management of chronic lateral ankle instability is traditionally conservative treatment in the acute phase. Hawkins and colleagues [37] later published on the addition of a lesser tuberosity transfer to increase the stability of the repair in larger defects (40% articular surface) [33, 36]. In symptomatic recurrent glenohumeral instability, advanced imaging techniques are strongly recommended before proceeding to surgery in order to quantify glenohumeral bone loss, including defect size and location [2]. Although the majority of evidence comes from the use of oxygen in patients with chronic obstructive pulmonary disease, the scope of the guidance includes patients with a variety of long 33, no. The convenient all-in-one system includes 2 BioComposite SutureTak anchors, all the necessary drill guides, the Micro SutureLasso retrievers to help facilitate percutaneous shuttling of the #1 FiberWire WebModified Embedded-Atom Interatomic Potential Parameters of the Ti-Cr Binary and Ti-Cr-N Ternary Systems, SB Ding and Y Li and YY Luo and ZM Wu and XQ Wang, C Ma and N Skoglund and M Carlborg and M Brostrom, FUEL, 302, 121072 (2021). Cummins CA: Lateral Epicondylitis, In Vivo Assessment of Arthroscopic Debridement and Correlation with Patient Outcomes. C. Gerber and S. M. Lambert, Allograft reconstruction of segmental defects of the humeral head for the treatment of chronic locked posterior dislocation of the shoulder, Journal of Bone and Joint Surgery A, vol. 31, no. 10331041, 2007. In regard to the arthroscopic remplissage procedure, Purchase et al. The authors reported in their review an overall cohort of 1817 shoulders in 1801 patients with glenoid bony defect, humeral bony defect, or both and calculated an overall redislocation rate of 6.5% (117 of 1816 shoulders), including 13.3% (30 of 225) of shoulders with humeral head bony defect, 7.2% (40 of 553) of shoulders with glenoid bony defect, and 6.3% (63 of 1009) shoulders with defects in both. There is a paucity of literature with long-term follow-up related to the surgical reconstruction of humeral head defects in patients with recurrent shoulder instability. In regard to functional outcomes, four of the six studies used the Rowe score (0100) [53, 55, 57, 60]. M. D. Lazarus, J. 69%, 97%, 91%, 90% (Table 4). : . 4, pp. Rotational osteotomy of the proximal humerus is also an option that has been described to deal with large humeral head defects in younger patients to delay the need for prosthetic replacement. 68, no. . Telos (SE 2000, Telos GmbH, Marburg, Germany) , 2 3 . 34, no. 2, pp. 57%, 97%, 89%, 86% . . , (peroneal strength exercise), (Achilles stretching exercise), (proprioception) 34 (Fig. 11, pp. Glenoid augmentation with distal tibial osteochondral allograft. 446452, 2009. Biomechanical Study of Arthroscopic All-Inside Anterior Talofibular Ligament Suture Augmentation Repair, Plus Suture Augmentation Repair and Anterior Tibiofibular Ligament's Distal Fascicle Transfer Augmentation Repair. Bethesda, MD 20894, Web Policies 131144, 2007. A. Abboud and L. J. Soslowsky, Interplay of the static and dynamic restraints in glenohumeral instability, Clinical Orthopaedics and Related Research, no. 3, pp. Cummins CA, Appleyard RC, Strickland S, Haen P, Chen S, Murrell, G: Rotator Cuff Repair: An Ex Vivo Analysis of Suture Anchor Repair Techniques on Initial Load to Failure. C. S. Radnay, K. J. Setter, L. Chambers, W. N. Levine, L. U. Bigliani, and C. S. Ahmad, Total shoulder replacement compared with humeral head replacement for the treatment of primary glenohumeral osteoarthritis: a systematic review, Journal of Shoulder and Elbow Surgery, vol. Risks and benefits of each procedure must be thoroughly explained to the operative candidate, with special attention paid to the increased risk that revision surgery holds due to potentially altered anatomy and scar tissue. 34, pp. 13, no. , 2018, pp.83 - 90 Scheibel et al. Do you want to share your patient story for Dr. Cummins? 78, no. P. W. Weng, H. C. Shen, H. H. Lee, S. S. Wu, and C. H. Lee, Open reconstruction of large bony glenoid erosion with allogeneic bone graft for recurrent anterior shoulder dislocation, The American Journal of Sports Medicine, vol. K. Yagishita and B. J. Thomas, Use of allograft for large Hill-Sachs lesion associated with anterior glenohumeral dislocationa case report, Injury, vol. This is followed by progressive strengthening and sports/work specific activities. Patients are positioned in either the lateral decubitus or beach chair positions in order to gain access to both the anterior and posterior shoulders. Copyright 2014 Randy Mascarenhas et al. 150 N(newton) , 10 20 . 10) , 3) . H. Saito, E. Itoi, H. Minagawa, N. Yamamoto, Y. Tuoheti, and N. Seki, Location of the Hill-Sachs lesion in shoulders with recurrent anterior dislocation, Archives of Orthopaedic and Trauma Surgery, vol. Furthermore, by utilizing rigid anatomic fixation, early rehabilitation is permitted minimizing the risk of stiffness and deconditioning of the surrounding shoulder musculature [25, 27]. Twenty-eight ankles in twenty-seven patients (average age 28) underwent the Gould modification of the Brostrom repair for symptomatic lateral ankle instability. (false negative) , . Cummins CA, Messer TM, Schafer M: Infraspinatus Muscle Atrophy in Major League Baseball Player. , , . . Current concepts in the surgical management of chronic ankle lateral ligament instability. , , Ahovuo 1) . The tendon of the long head of the biceps brachii along with the supraspinatus contributes to the prevention of superior translation of the humerus from the glenoid cavity of the scapula. 4, pp. 6, pp. ( ), [] 245 249254, 2009. His wife is a practicing dermatologist with Northwestern Memorial Physicians Group and her office is located in Deerfield, Illinois. Foot Ankle Int. The subscapularis cotensions the inferior glenohumeral ligament complex (IGHLC) [9] which restricts the shoulder joint from reaching the endpoint of ligament function. 26: 195-215, 2008. # . [35] reported a recurrence rate of 7% and no loss of shoulder motion following this procedure. (validity) , . In regard to the effect of glenoid reconstruction on the long-term risk of glenohumeral osteoarthritis, only two of the six studies in the review by Beran et al. 22, no. We analyzed the sensitivity, specificity, positive and negative prediction value of ankle stress radiograph. L. A. Danzig, G. Greenway, and D. Resnick, The Hill-Sachs lesion. 381388, 1998. Cummins CA, Messer TM, Nuber GW: Current Concepts Review: Suprascapular Nerve Entrapment. [56] recently conducted a systematic review in order to evaluate the literature regarding treatment of chronic glenoid bone defects to determine if one surgical glenoid reconstruction technique could be recommended over another in patients with recurrent anterior shoulder instability. It is important to note that pain may the chief presenting complaint, as the patient may not be aware that their symptoms may be secondary to recurrent subluxation of the shoulder [14]. . 36, no. 22, no. Postoperatively, patients should be rested in a sling to allow for healing and can slowly be mobilized making sure to avoid positions that would allow the humeral head to engage the glenoid. Special testing to delineate the direction and degree of shoulder instability should include apprehension and relocation [15] testing. Treatment decisions can be made based on these measurements. ( [collagen disease], [tarsal coalition], [neuromuscular disease], [neurologic disease], [functional instability]), , , .13). Anatomical reconstruction for chronic lateral ankle instability in the high-demand athlete: functional outcomes after the modified Brostrm repair using suture anchors. On the other hand, surgical intervention is considered if conservative treatment fails and the symptoms are ongoing. WebPurpose. (splint) , 12 . 1624, 2008. (sensitivity), (specificity), (positive prediction value), (negative prediction value) . , , (direct repair) , (supination) . After an appropriate preoperative workup that includes a CT scan to delineate humeral head bony architecture and the characteristics of the lesion, a sized matched fresh-frozen humeral or femoral head is obtained and used to graft into the identified defect. 212, 2010. Re et al. 19, no. ; J. 14431450, 1984. The authors thus advised reconstruction of glenohumeral defects of this size. Other radiographic views that may be helpful include an anteroposterior radiograph with the arm in internal rotation [19], an apical oblique view with the beam angled towards the glenoid face as described by Garth and colleagues [20], and a Stryker notch view obtained with the patients arm on top of the head and the beam centered over the coracoid process directed 10 degrees cephalad. R. Z. Stachowicz, J. R. Romanowski, R. Wissman, and K. Kenter, Percutaneous balloon humeroplasty for Hill-Sachs lesions: a novel technique, Journal of Shoulder and Elbow Surgery, vol. 7.6mm , 29, 13 , 3, 117 (Table 3). 6, pp. In addition, between different bone block reconstruction techniques, there is no clear delineation of outcomes between allograft and iliac crest bone graft. Before 878884, 2003. Mid-America Orthopaedic Association, Seventeenth Annual Meeting, Bermuda, May 1999; Podium Presentation. Preliminary report, Injury, vol. This quantification of bone loss can be used to guide treatment toward either a soft tissue procedure alone or one of or a combination of five main types of operative procedures used with increasing bone loss: (1) humeral head disimpaction, (2) osseous/soft tissue transfer procedures, (3) osseous allograft reconstruction, (4) rotational osteotomy of the proximal humerus, and (5) partial or total humeral head arthroplasty. Armitage and colleagues reported that Hill-Sachs lesions exist from 0 to 24mm from the top of the humeral head, oriented from 6:46 cephalad to 8:56 caudal on a clock face with 12:00 defined as the intertubercular sulcus [25, 26]. , (Fig. A. M. Halder, S. G. Kuhl, M. E. Zobitz, D. Larson, and K. N. An, Effects of the glenoid labrum and glenohumeral abduction on stability of the shoulder joint through concavity-compression: an in vitro study, Journal of Bone and Joint Surgery, vol. (sensitivity), (specificity), (positive prediction value), (negative prediction value) . In response, many countries have committed to net-zero emissions by 2050 (The EU Green Deal and the UK 2019 pledge to net zero ) or by the latest 2060 (i.e., China). 17, no. C. R. Rowe and B. Zarins, Recurrent transient subluxation of the shoulder, Journal of Bone and Joint Surgery A, vol. 1987;7(6):362-8. They reported no cases of recurrent instability, infection, nonunion, or neurological sequelae. ( ) 2017; 38 :12071214. A thorough preoperative workup consisting of appropriate history, physical exam, and imaging must be completed prior to a discussion of surgical options. 24, no. Quantification of the extent of bone loss has been suggested to guide operative treatment (Figure 3). 22, no. 129, no. Much of her cargo was offloaded before she was successfully refloated. In order to avoid the morbidity associated with iliac crest harvest, the use of various allograft sources has also been described and includes iliac crest [53], distal tibia [54], and frozen femoral head [55] (Figure 9). 6, pp. The peroneal tendon sheath was opened to inspect the tendons and protect them, and J. C. Adams, Recurrent dislocation of the shoulder., The Journal of Bone and Joint Surgery, vol. A. C. Atalar, K. Bilsel, I. Eren, D. Celik, H. Cil, and M. Demirhan, Modified Latarjet procedure for patients with glenoid bone defect accompanied with anterior shoulder instability, Acta Orthopaedica et Traumatologica Turcica, vol. S. Cerciello, T. B. Edwards, and G. Walch, Chronic anterior glenohumeral instability in soccer players: results for a series of 28 shoulders treated with the Latarjet procedure, Journal of Orthopaedics and Traumatology, vol. Description: This protocol applies to patients following the Gould modified Bostrm repair of the Anterior Talo-fibular Ligament (ATFL) and Calcaneal Fibular Ligament (CFL). WebMurine respirovirus, formerly Sendai virus (SeV) and previously also known as murine parainfluenza virus type 1 or hemagglutinating virus of Japan (HVJ), is an enveloped,150-200 nm in diameter, a negative sense, single-stranded RNA virus of the family Paramyxoviridae. uncommon, result of zone 1 fracture nonunion after initial conservative treatment. Xiao L, Zheng B, Zhou Y, Hu D, Li J, Zheng X, Hou H, Wang H. J Clin Med. M. D. Kazel, J. K. Sekiya, J. Shapiro J, Cummins C, Shafer M: Radiation Exposure in Orthopaedic Residents. , . 10, pp. 2010;26(4):524-8. 78, no. For defects measuring 2025% of the articular surface, an infraspinatus tendon transfer can be utilized in isolation. 7, no. 3, pp. Specific indications mainly restrict this procedure to younger patients with larger sized defects that do not have a significant degree of osteopenia or degenerative joint disease [25, 41]. Older patients with concomitant degenerative glenohumeral joint disease may require some form of arthroplasty to offer them relief. 36, no. A trauma series consisting of anteroposterior, scapular lateral, and axillary views is recommended. ( ), ( ) (Fig. WebOur CO 2 emissions are on a constant rise, reaching a monthly average of 419 ppm in 2021, a record high in the last 2 million years. The site is secure. 2000 Dec;21(12):996-1003. doi: 10.1177/107110070002101203. 22872291, 2012. The purpose of this review is to provide a brief overview of the anatomy of the glenohumeral joint relevant to its stability (and instability) and to illustrate the pertinent history and physical examination findings in patients with bone loss and recurrent shoulder instability. Cummins CA, Strickland S, Appleyard RC, Szomor ZL, Grant C, Murrell GAC: Rotator Cuff Repair: An Ex Vivo Mechanical Study Comparing Trans-Osseous Sutures, Suture Anchors and Bio-Absorbable Screws. Long-term outcomes on the treatment of traumatic anterior shoulder instability with both glenoid bone loss (grade IIIA) and significant Hill-Sachs lesions with arthroscopic remplissage were reported by Wolf and Arianjam [69]. 317328, 2009. A. Martinez, A. Calvo, J. Domingo, J. Cuenca, A. Herrera, and M. Malillos, Allograft reconstruction of segmental defects of the humeral head associated with posterior dislocations of the shoulder, Injury, vol. It is limited however by interpreter skill and difficulty in discerning size and orientation of the lesion. 120 () 4.22.1(, 0.5~11.5), 3.91.9 mm(, 1.2~9.4 mm) . Currently, this operation is performed arthroscopically. CT scan which demonstrates a large Hill-Sachs lesion. 488491, 2013. In analyzing the data and developing recommendations and supporting text, the writing committee uses evidence-based methodologies developed by the Task Force. AOSSM Annual Meeting, Keystone, Colorado, June 28-July 1, 2001; Poster Presentation. Weber et al. Clin Orthop Relat Res. This is from the OP report: Right ankle lateral ligament reconstruction, modified Brostrom type. Before commencing with the operative procedure, a detailed physical exam must be performed making sure to document the exact degree of range of motion that causes dislocation, specifically external rotation. See below weight-bearing and impact restrictions to be considered. 9, pp. WebMesser TM, Cummins CA, Ahn J, Kelikian AS: Outcome of the Modified Brostrom Procedure for Chronic Lateral Ankle Instability Using Suture Anchors. , 6). The purpose of this procedure is to stabilize the ankle, improve the ankle's mechanics and restore full function. An official website of the United States government. = Journal of Korean orthopaedic sports medicine, [] 4 , [] , [] Brostrom . WebThe modified Brostrom procedure has become the standard for anatomic repair of symptomatic chronic lateral instability. , (ankle neutral position), (slightly eversion position) . Regardless of the graft source, the procedure is performed through a standard deltopectoral incision with exposure and preparation of the anterior inferior glenoid with a burr. Talar tilt angle on varus stress radiograph showed 57% of sensitivity, 97% of specificity, 89% of positive and 86% of negative prediction value. 6, pp. Due to the limited lifespan of these implants, evaluation of patient suitability for any of the aforementioned procedures is necessary prior to committing to humeral head resurfacing or hemiarthroplasty. The average loss of external rotation was 8 degrees and no patients in their study demonstrated recurrent instability. 2% (60/3871) 4. Background This study performed a randomized trial data meta-analysis to assess The Modified Brostrom-Gould (MBG) for proven chronic lateral ankle instability (CLAI). Once range of motion is documented, a standard deltopectoral approach is utilized to expose the proximal humerus and an oscillating saw is then used to complete a transverse osteotomy through the surgical neck. 8.3 , 24, 18 , 3, 117 (Table 2). Care should also be taken to ask questions regarding rotator cuff function in older patients that present with shoulder instability as their chief complaint. At fifteen-year prospective follow-up, 3.4% of patients had one or more recurrences of instability. Podium and Poster Presentation. Accessibility 12, no. 245250, 2010. American Volume, vol. Dr. Cummins is a member of the American Academy of Orthopaedic Surgery, the American Orthopaedic Society of Sports Medicine, and the Arthroscopy Association of North America. Cummins CA, Anderson K, Bowen M, Nuber G, and Roth SI: Anatomy and Histological Characteristics of the Spinoglenoid Ligament. 8.3 , 24, 18 , 3, 117 (Table 2). Suture anchors are then placed on the anterior glenoid neck to facilitate repair of the labrum with imbrication of the inferior aspect of the glenohumeral capsule into the labral repair (Figure 6). 12. P. Grondin and J. Leith, Combined large Hill-Sachs and bony Bankart lesions treated by Latarjet and partial humeral head resurfacing: a report of 2 cases, Canadian Journal of Surgery, vol. The modified Brostr6m procedure offers several advan- tages. ( ), [] 245 , (ankle neutral position), (slightly eversion position) . Imbrication of the anterior capsule and subscapularis tendon is then done in conjunction with the bony procedure. The advantages proposed in using these implants include absence of donor site morbidity compared with autograft, shorter operative time, no associated graft resorption and hardware removal, and lack of disease transmission [25, 43]. ( ) . If nonoperative treatment is selected, specific attention should be paid to a supervised rehabilitation program that emphasizes graduated range of motion exercises dependant on the amount of bone loss present. (120) , 1.96 95% . Web5 Ng ZD, Das De S. Modified Brostrom-Evans-Gould technique for recurrent lateral ankle ligament instability. Brostrom ( ) 42(38) . . 1 The Class of Recommendation (COR) is an estimate of the size of the treatment effect considering risks versus benefits in addition to evidence and/or agreement that a given S. G. Kaar, S. D. Fening, M. H. Jones, R. W. Colbrunn, and A. Miniaci, Effect of humeral head defect size on glenohumeral stability: a cadaveric study of simulated Hill-Sachs defects, The American Journal of Sports Medicine, vol. Cummins CA, Sasso L, Nicholson, D: Impingement Syndrome: Temporal Outcomes of Non-Operative Treatment. 557560, 1998. Consequently, decarbonizing the global economy via the Anterior talar translation on anterior drawer stress radiograph showed 69% of sensitivity, 97% of specificity, 91% of positive and 90% of negative prediction value. 1, no. [74] conducted a review of 180 rotational subcapital humeral osteotomies with shortening of the subscapularis tendon and capsule for recurrent shoulder instability. The https:// ensures that you are connecting to the The rotator cuff muscles not only compress the humeral head into the glenoid cavity but also cotension the ligaments of the shoulder. Patient factors to consider include the presence of any significant medical comorbidities or neurological lesions, an assessment of overall functional demands, and the degree of expected patient compliance. 1992 May;13(4):224-5. doi: 10.1177/107110079201300411. 120143, Thieme, New York, NY, USA, 2005. WebType of Procedure: outpatient Length of Procedure: 1 hour Anesthesia: general w/ popliteal or sciatic nerve block common method is called a modified Brostrom procedure. )$Tgbo$%)*tfnr^R/qiU>Bj8 hhGq 8P4%+]?qW?2{NAGoF 0RHZq'0 d 34 (9): 1486-1491. [] 66 , [tarsal coalition], [neuromuscular disease], [neurologic disease], [functional instability]), , , , (direct suturing technique), (splint) , 12 . 1% (24/4150) 7376, 1995. 963975, 1989. Typically, glenoid bone loss will lead to an inverted pear appearance. and transmitted securely. Some techniques advocate placing the bone block after repair of the labrum and capsule (extracapsular), while others suggest placing the bone block within the capsule and subsequently repairing the remaining labrum and capsule to the extent that tissue quality allows. Federal government websites often end in .gov or .mil. Assessment for a sulcus sign (inferior instability) [17] and a posterior jerk test (posterior instability) [18] are also important. Mehta S, Cummins C, Milgram R: Anterior Tibial Artery Impingement by a Distal Interlocking Screw: A Case Report. Despite the popularity and excellent outcomes of the modified Brostrom procedure, some patients still experience recurrence of ankle instability. This is an open access article distributed under the, http://www.arthrosurface.com/literature-data/brochures/. Once the size of the defect is evaluated, its surface is prepared using a burr set on reverse. Initially described by Weber, the procedure combines a standard deltopectoral and separate posterior approach. 2012 CGC Healy, Mid-America Orthopaedic Association, Eighteenth Annual Meeting, Scottsdale Arizona, April 2000; Podium Presentation. Google Scholar | SAGE Journals | ISI. 9, pp. After excluding studies that did not report follow-up or quantify glenoid deficiency, or performed open reduction and internal fixation/capsulolabral repair for glenoid rim fractures, there were six eligible manuscripts [53, 55, 5760]. Mechanical symptoms such as catching and/or locking can be secondary to engaging osseous defects on the humeral head and glenoid. WebPorter M, Shadbolt B, Ye X, Stuart R. Ankle lateral ligament augmentation versus the modified brostrom-gould procedure: a 5-year randomized controlled trial. M. C. Beran, C. T. Donaldson, and J. Y. Bishop, Treatment of chronic glenoid defects in the setting of recurrent anterior shoulder instability: a systematic review, Journal of Shoulder and Elbow Surgery, vol. Helfet described the Bristow procedure, where the tip of the coracoid was osteotomized and transferred to the glenoid neck just medial to the rim [47]. Ultimately the patient is placed in an abduction brace. M. J. Dipaola, L. M. Jazrawi, A. S. Rokito et al., Management of humeral and glenoid bone loss associated with glenohumeral instability: results with anatomical bone grafting, Bulletin of the NYU Hospital for Joint Diseases, vol. Foot Ankle Int. ( ) [3] suggests that although the principle of identifying and treating glenoid and humeral bone defects in patients with traumatic anterior glenohumeral instability is acknowledged, there is a relative paucity of studies to allow definitive conclusions on the exact bone loss percentages which will increase the risk of redislocation. 2735, 1993. More than 89% of patients returned to work and no patients had recurrent instability. McLaughlin [36] described a similar procedure for addressing the anteromedial sided humeral bone loss seen with chronic posterior instability by transferring the subscapularis tendon into the defect. 2016 Jan;37(1):64-9. doi: 10.1177/1071100715603372. 897908, 1980. The procedure: Eliminates chronic pain and swelling; (multiple single leg calf raises) , , , /, , , , , , , , , , , , /, , , , , , , , ISBN, ISSN, , , (), (), (). 20, no. In addition to providing useful information about soft tissue anatomy including the glenoid labrum, chondral surfaces, glenohumeral capsuloligamentous structures, and the rotator cuff, MRI can also demonstrate bone loss. Limitation of motion of more than 10 degrees was present in only 3.9% of patients. [] 66 , : helpdesk@kisti.re.kr : 080-969-4114, . , . Neurol Clin. When the humerus is in a hanging position, the muscles and ligaments are relaxed and joint stability is a result of intra-articular pressure [4]. 3, pp. 2, pp. 83, no. , (usefulness) . P. A. Davidson, L. J. Lemak, and J. W. Uribe, Anatomic humeral head resurfacing. 329335, 2009. (multiple single leg calf raises) .13), PDF KISTI DDS . 1999;20(4): 246-252. The University of Pennsylvania Orthopaedic Journal. The average depth of the glenoid in the anterior/posterior direction is 2.5mm compared to 9mm in the superior/inferior direction [8], which explains, in part, the reason for minimum stability in the anterior/posterior direction. Cummins CA, Schneider DS: Peripheral Nerve Injuries in Baseball Players. Cortical screws can be inserted perpendicularly to support the correction. ( ) This allows for the sling effect provided by the coracobrachialis but also attempts to reconstruct the osseous anatomy of the glenoid. Arthroscopic tibiotalar arthrodesis. Intraoperative photographs demonstrating the Latarjet procedure through subscapularis split. ? 19(3): 239-248, 2003. M. Scheibel, C. Nikulka, A. Dick, R. J. Schroeder, A. Gerber Popp, and N. P. Haas, Autogenous bone grafting for chronic anteroinferior glenoid defects via a complete subscapularis tenotomy approach, Archives of Orthopaedic and Trauma Surgery, vol. M. Kronberg and L. A. Brostrom, Rotation osteotomy of the proximal humerus to stabilise the shoulder: five years' experience, Journal of Bone and Joint Surgery B, vol. 4, pp. Am J Sports Med, 27: 810-812, 1999. Chronic lateral ankle instability occurs in 10% to 20% of individuals after acute ankle sprain. J Bone and Joint Surg, 80-A: 1622-1625, 1998. 3, pp. 385398, 2008. I. K. Y. Am J Sports Med. 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