Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Instability of dominant arm
2%
45/2237
Overhead throwing athlete
12%
278/2237
Age under 25 years
38%
841/2237
Labral tear involving the biceps attachment
43/2237
An inverted pear-shaped glenoid on arthroscopy
45%
1009/2237
Select Answer to see Preferred Response
Of the options available, severe glenoid bone loss (>25%) leading to an inverted-pear shape greatly increases the risk of recurrent instability with labral repair. Many factors come in to play in managing anterior shoulder instability. Initial treatment historically involved isolated Bankart repairs/capsulorraphy but high rates of failure were seen in certain patient demographics. This led to the re-emergence of open bony augmentation procedures which have been shown to reliably stabilize the glenohumeral joint. Though there is no consensus regarding indications for these procedures, significant glenoid bone loss (>20-25%) has been frequently cited as such. Additionally, humeral bone loss creating an off-track lesion is also a relative indication. These factors (glenoid and/or humeral bone loss) in combination with generalized ligamentous laxity, patients under 20 years old, patients participating in contact sports and at a competitive level, were cited as independent risk factors for recurrent instability by Boileau et al., and were used to synthesize their Instability Severity Index Score (ISIS). Harris et al. reviewed long-term outcomes following arthroscopic compared to open Bankart repair. They found no difference in recurrence rates but open repairs returned to sports more commonly. Patient-reported outcomes and rates of arthritis were similar between the two groups as well. Mologne et al. reported a series of 21 active duty service members undergoing isolated arthroscopic labral repair with 25% glenoid bone loss. By 34 months, 9.5% experienced recurrence instability with 4.5% requiring revision surgery. This limited series shows that isolated labral repair may stabilize a glenoid deficient shoulder in the short-term. Illustration A is a sagittal MRI sequence demonstrating an inverted-pear glenoid. Incorrect answers: Answer 1- There is no added risk of recurrence between dominant and non-dominant arms. Answer 2- Overhead sports place the shoulder in the common position of dislocation but don't pose an increased risk of instability following stabilization. Answer 3- Age under 20 years, not 25, increases risk for recurrent instability. Answer 4- Labral tears may extend superiorly and involve biceps anchor but don't pose increased risk for recurrent instability.
1.3
(21)
Please Login to add comment