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Background: Nonoperative management of posterior shoulder instability is common. However, limited data are available to assess the pathomorphologic factors associated with its failure. Purpose/Hypothesis: The purpose of this study was 2-fold: (1) to determine glenohumeral pathomorphologic features predictive of nonoperative management failure of posterior instability; and (2) to determine the relationship between nonoperative management failure and posterior glenoid bone loss (pGBL) progression. It was hypothesized that greater posterior acromial height (PAH) would adversely affect nonoperative survivorship and that shoulders treated nonoperatively would have pGBL progression compared with those undergoing surgical stabilization. Study Design: Case-control study; Level of evidence, 3. Methods: This was a retrospective review of a consecutive series of patients with isolated posterior shoulder instability, defined as isolated posterior labral tear on magnetic resonance imaging (MRI) with corresponding physical examination findings, who underwent nonoperative management for 6 months and had no previous related surgical history. The primary outcome of interest was the failure of nonoperative management, defined as the inability to return to full military duty or requiring surgical intervention. The morphologic features assessed for association with nonoperative management failure included pGBL, glenoid version, acromial morphology, and posterior humeral head subluxation. We secondarily sought to determine the progression of pGBL on serial MRI scans. Cox proportional hazard analysis was used to evaluate risk factors for failure. Results: In this study, 42 of 90 (46.7%) patients had failed nonoperative management and went on to receive an arthroscopic stabilization procedure. The group with failed treatment demonstrated a greater humeral head subluxation ratio than those with successful nonoperative management (0.65 ± 0.2 vs 0.62 ± 0.2; P =.038). Cox proportional hazard analysis identified pGBL, greater PAH, less posterior acromial coverage, and posterior humeral subluxation as significant risk factors for failure. Of those with failed nonoperative management, 17 had repeat MRI scans at a mean of 488.2 ± 87 days after index MRI for comparison, demonstrating a statistically significant progression of pGBL (index MRI, 2.68% ± 1.71%) versus after nonoperative treatment failure (6.54% ± 1.59%; P =.003). Conclusion: Failure occurred 47% of the time in patients who underwent nonoperative management for isolated posterior glenohumeral instability for a minimum of 6 months, and it was associated with a greater posterior humeral head subluxation, less posterior acromial coverage, greater PAH, and greater amounts of glenoid retroversion on index MRI. Additionally, those who had repeat MRI approximately 1 year after the index MRI demonstrated greater pGBL compared with the index MRI. [ABSTRACT FROM AUTHOR]

Background: After arthroscopic Bankart repair (ABR) for anterior glenohumeral instability (GHI), adolescent athletes have higher rates of subsequent recurrent GHI than any other subpopulation. Elucidating which adolescents are at highest risk of postoperative recurrent GHI may optimize surgical decision-making. Purpose: To identify prognostic factors associated with subsequent recurrent GHI requiring revision stabilization surgery (RSS) after ABR. Study Design: Case-control study; Level of evidence, 3. Methods: The study included patients 12 to 21 years old who had undergone ABR for anterior GHI at a pediatric tertiary care hospital by 1 of 5 sports medicine fellowship–trained surgeons between 2000 and 2020. A multivariate Cox proportional hazards model, with percentage of patients with recurrent GHI undergoing subsequent RSS, was used with a time-to-event outcome analysis. The Cox model effects were expressed as the hazard ratio (HR). All tests were 2-sided, with an alpha of.05. Results: Records of 488 adolescent patients with ABR (78% male; mean age, 16.9 ± 1.98 years) were analyzed. Of these, 86 patients (17.6%) underwent subsequent RSS for recurrent GHI, yielding a cumulative risk of 8.8% at 2 years, 16.5% at 5 years, and 20% at 15 years. RSS occurred at a mean of 2.6 ± 2.1 years after ABR. Risk factors for RSS included >1 preoperative dislocation (2 dislocations: HR = 7.4, P =.0003; ≥3 dislocations: HR = 10.9, P <.0001), presence of a Hill-Sachs lesion (small: HR = 2.5, P =.0114; medium-large: HR = 4.2, P =.0004), younger age (1-year decrease: HR = 1.2, P =.0015), and participation in contact sports (HR = 1.8, P =.01). Adolescents with only 1 preoperative dislocation had a cumulative incidence of RSS (3.2%), which was significantly lower than those with 2 (24.2%) or ≥3 preoperative dislocations (33.5%). Conclusion: The number of dislocations before index ABR was the strongest risk factor for recurrent GHI requiring RSS in adolescents with anterior GHI, with 2 dislocations conferring >7-fold increased risk compared with a single preoperative dislocation. Other significant risk factors included the presence of a Hill-Sachs lesion, younger age, and participation in contact sports. [ABSTRACT FROM AUTHOR]

Background: Shoulder instability encompasses a spectrum of glenohumeral pathology ranging from subluxation to dislocation. While dislocation frequently leads to removal from play, athletes are often able to play through subluxation. Previous research on glenohumeral instability among athletes has largely focused on missed-time injuries, which has likely disproportionately excluded subluxation injuries and underestimated the overall incidence of shoulder instability. Purpose: To describe the epidemiology of shoulder instability injuries resulting in no missed time beyond the date of injury (non–missed time injuries) among athletes in the National Football League (NFL). Study Design: Descriptive epidemiology study. Methods: The NFL's electronic medical record was retrospectively reviewed to identify non–missed time shoulder instability injuries during the 2015 through 2019 seasons. For each injury, player age, player position, shoulder laterality, instability type, instability direction, injury timing, injury setting, and injury mechanism were recorded. For injuries that occurred during games, incidence rates were calculated based on time during the season as well as player position. The influence of player position on instability direction was also investigated. Results: Of the 546 shoulder instability injuries documented during the study period, 162 were non–missed time injuries. The majority of non–missed time injuries were subluxations (97.4%), occurred during games (70.7%), and resulted from a contact mechanism (91.2%). The overall incidence rate of game-related instability was 1.6 injuries per 100,000 player-plays and was highest during the postseason (3.5 per 100,000 player-plays). The greatest proportion of non–missed time injuries occurred in defensive secondary players (28.4%) and offensive linemen (19.8%), while kickers/punters and defensive secondary players had the highest game incidence rates (5.5 and 2.1 per 100,000 player-plays, respectively). In terms of direction, 54.3% of instability events were posterior, 31.9% anterior, 8.5% multidirectional, and 5.3% inferior. Instability events were most often anterior among linebackers and wide receivers (50% and 100%, respectively), while posterior instability was most common in defensive linemen (66.7%), defensive secondary players (58.6%), quarterbacks (100.0%), running backs (55.6%), and tight ends (75.0%). Conclusion: The majority of non–missed time shoulder instability injuries (97.4%) were subluxations, which were likely excluded from or underreported in previous shoulder instability studies due to the inherent difficulty of detecting and diagnosing shoulder subluxation. [ABSTRACT FROM AUTHOR]

Background: Lesions that involve humeral avulsions of the glenohumeral ligament (HAGLs), although less common, are primary contributors to recurrent events of dislocation and subluxation of the glenohumeral joint. Purpose: To describe the clinical presentation, examination, and surgical outcomes of patients presenting with HAGL lesions who underwent repair using an arthroscopic or open technique. Study Design: Cohort study; Level of evidence, 3. Methods: A multicenter retrospective review of prospectively collected data was performed of skeletally mature patients without glenohumeral arthritis who presented with HAGL lesions and subsequently underwent arthroscopic or open repair between 2005 and 2017. Independent variables included patient characteristics, clinical presentation, physical examination findings, and arthroscopic findings. Dependent variables included pre- and postoperative Single Assessment Numeric Evaluation (SANE) score, Western Ontario Shoulder Instability Index (WOSI) score, and range of motion outcomes. Results: Eighteen patients diagnosed with a HAGL lesion who underwent primary arthroscopic repair (n = 7) or open repair (n = 11) were included. There were 17 male patients and 1 female patient with a mean age of 24.9 years (range, 16-38 years). Mean follow-up duration was 50.9 months (range, 24-160 months). Seventeen patients (94.4%) reported pain as the most common symptom, and 7 (38.9%) reported sensation of instability. Scores significantly improved from pre- to postoperative for the arthroscopic and open groups (P <.001): SANE (mean ± SD; arthroscopic, 30.7 ± 15.7 to 92.1 ± 12.2; open, 45.5 ± 8.50 to 90.7 ± 5.24) and WOSI (arthroscopic, 51.4 ± 11.4 to 2.49 ± 3.70; open, 45.5 ± 7.37 to 11.5 ± 5.76). The magnitude of improvement in SANE scores was significantly higher for patients treated arthroscopically (Δ60.0; open, Δ46.5; P =.012). Postoperative WOSI scores were also significantly better in the arthroscopic cohort (2.49 ± 3.70; open, 11.5 ± 5.76; P =.00094). Conclusion: Symptomatic HAGL tears present primarily with pain as opposed to instability, necessitating a high index of suspicion for injury. The tears may be treated successfully with an arthroscopic or open technique with significant improvements in patient-reported outcomes and stability. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic status has been shown to influence patients' ability to access health care. Purpose: To evaluate the socioeconomic status and/or insurance provider of patients and to determine whether these differences influence the management of shoulder instability. Study Design: Descriptive epidemiology study. Methods: The Rhode Island All-Payers Claims Database (APCD) was used to identify all patients between the ages of 5 and 64 years who made an insurance claim related to a shoulder instability event between January 1, 2011, and December 31, 2019. Chi-square analysis and multivariate logistic regression were utilized to determine whether insurance status, social deprivation index (SDI), or median income by zip code were significant predictors of treatment methodology and recurrent instability. Kaplan-Meier failure analysis and Cox regression were used to assess for variation in the cumulative rates of surgical intervention and recurrent instability over 20-year age groups (5-24, 25-44, and 45-64 years). Results: There were 3310 patients from the APCD query included in the analysis. Bivariate analysis demonstrated significant variation in the rates of surgical stabilization between patients with public and commercial insurance providers (P <.001). Patients with public insurance received surgery 1.8% of the time compared with 5.8% of the time in patients with commercial insurance. After controlling for recurrent instability, age, instability type (subluxation or dislocation) and directionality, and sex, patients with public insurance were 79% less likely to receive surgery within 30 days (P =.035) and 64% less likely to receive surgery within 1 year (P =.002). This disparity was most notable in the 5- to 24-year (hazard ratio [HR] = 0.28; 95% CI, 0.13-0.61) and 25- to 44-year (HR = 0.26; 95% CI, 0.08-0.89) age groups. Neither SDI quartile nor income quartile based on patient primary zip code had a clinically significant influence on rates of surgery or recurrent instability. Conclusion: These data demonstrate that patients with public insurance have a decreased likelihood of undergoing surgical stabilization to address glenohumeral instability compared with patients with commercial insurance. [ABSTRACT FROM AUTHOR]

Background: The scapular spine has been described as a relatively new bone graft alternative used in glenoid augmentation. The classic Latarjet procedure, which transfers the coracoid as a graft, is regarded as the gold standard. The comparison of these 2 techniques has not been fully reported. Purpose: To compare the anatomic and biomechanical properties of glenoid augmentation using scapular spine graft or coracoid graft. Study Design: Controlled laboratory study. Methods: The study used 20 fresh-frozen human cadaveric shoulders. A 25% anterior glenoid defect was created, and the specimens were divided randomly to receive glenoid augmentation by scapular spine or coracoid grafts. For both procedures, the grafts were secured to the glenoid defect with 2 screws. Morphometric data, including the glenoid articular area, amount of restoration, and graft dimensions, were obtained. A biomechanical test was conducted in a direct-loading scenario. The construct stiffness, cyclic displacement, and ultimate failure of each specimen were collected. Results: No significant difference was found in glenoid articular restoration between the scapular spine group and the coracoid group (31% vs 33%, respectively; P =.311). Morphometric analysis indicated that coracoid grafts exhibited significantly greater thickness and height than scapular spine grafts. In biomechanical results, the scapular spine group exhibited significantly greater construct stiffness than the coracoid group (206.3 ± 58.8 vs 148.3 ± 76.0 N/mm, respectively; P =.023). The average failure load in the scapular spine group was not significantly higher than that in the coracoid group. No significant differences in cyclic displacement were found between the 2 techniques. Conclusion: In a simulated 25% anterior glenoid bony defect, a scapular spine graft was comparable with the classic Latarjet procedure in restoring the glenoid articular dimension and exhibited superior construct stiffness in a cadaveric model. Clinical Relevance: The scapular spine may serve as an alternative graft choice in glenoid augmentation surgery considering the amount of articular restoration and initial fixation stability. [ABSTRACT FROM AUTHOR]

Background: There is a lack of information regarding the reasons why patients do not return to sports after an arthroscopic Bankart repair and whether there is a relationship between return to sports and functional outcomes. Purpose: To evaluate the reasons why competitive athletes who underwent arthroscopic Bankart repair did not return to sports and whether there was a relationship between returning to sports and postoperative outcome scores and complications. Study Design: Cohort study; Level of evidence, 3. Methods: Of 217 competitive athletes who underwent arthroscopic Bankart repair for isolated anterior glenohumeral instability between June 2014 and December 2017, a total of 208 athletes (96%) were evaluated at minimum 2-year follow-up. Return to sports, the level of sports achieved, and the time between surgery and return to competition were assessed, and patients who did not return to sports were asked to provide the reasons for cessation. The Rowe score and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences, reoperations, and complications were also evaluated. Results: The mean patient age was 24 years (range, 18-30 years), and the mean follow-up was 44 months (range, 24-90 months). Of the 208 athletes, 73% were able to return to sports (65% returned to their preinjury level), and 27% did not return to sports. Of those who did not return, the most frequent reasons were fear of reinjury (44%), lack of confidence in their shoulder (12%), and concern about a new rehabilitation process in case of recurrence (10%). The Rowe and ASOSS scores showed significant postoperative improvement in all patients (P <.001), with no significant differences between the 2 study groups at the final follow-up. There were 21 recurrences (10%) and 5 complications (2.4%), and 11 patients (5.3%) underwent revision surgery, with no significant differences in these rates between the groups. Conclusion: Of patients who did not return to sports, 74% left for a reason independent of shoulder function, with the most frequent causes being fear of reinjury and a concern about new rehabilitation process. Neither outcome scores nor complications varied significantly between patients who returned and those who did not return to sports. [ABSTRACT FROM AUTHOR]

Background: Shoulder instability is a common and potentially debilitating injury among collision sport athletes that can lead to long-term damage of the glenohumeral joint. Limited data exist regarding instability among elite athletes in the National Football League (NFL). Purpose: To describe the epidemiology of shoulder instability in the NFL from 2012 through 2017. Study Design: Descriptive epidemiology study. Methods: The NFL's injury database was reviewed for shoulder instability injuries resulting in missed time during the study inclusion dates. Injuries were classified by type and direction, as well as timing, setting, and mechanism. Median missed time was determined for the different types and directions of instability. Incidence rates for game-related injuries were calculated based on timing during the season and player position. Finally, the relationship between player position and instability direction was assessed. Results: During the 6-year study period, 355 players sustained 403 missed-time shoulder instability injuries. Most injuries occurred during games (65%) via a contact mechanism (85%). The overall incidence rate of game-related instability was 3.6 injuries per 100,000 player-plays and was highest during the preseason (4.9 per 100,000 player-plays). The defensive secondary position accounted for the most injuries, but quarterbacks had the highest incidence rate in games (5.5 per 100,000 player-plays). Excluding unspecified events (n = 128; 32%), 70% (n = 192) of injuries were subluxations and 30% (n = 83) were dislocations; 75% of dislocations were anterior, while subluxations were more evenly distributed between the anterior and posterior directions (45% vs 52%, respectively). Players missed substantially more time after dislocation compared with subluxation (median, 47 days vs 13 days, respectively). When instability direction was known, the majority of instability events among quarterbacks and offensive linemen were posterior (73% and 53%, respectively), while anterior instability was most common for all other positions. Conclusion: Shoulder instability is a common injury in the NFL and can result in considerable missed time. Dislocations occur less frequently than subluxations but lead to greater time lost. While most dislocations are anterior, more than half of subluxations are posterior, which is likely the result of repetitive microtrauma to the posterior capsulolabral complex sustained during sport-specific motions such as blocking. The risk of instability varies by player position, and position may also influence instability direction. [ABSTRACT FROM AUTHOR]

Background: While several studies have qualitatively described the anatomy of the glenohumeral ligaments, there remains a lack of consensus regarding their quantitative humeral and glenoid attachment sites. Purpose: To quantitatively and qualitatively describe the anatomic humeral and glenoid attachment sites of the glenohumeral ligaments and their relationship to well-established anatomic landmarks. Study Design: Descriptive laboratory study. Methods: A total of 10 nonpaired, fresh-frozen human cadaveric shoulders were included in this study. A 3-dimensional coordinate measuring device was used to quantify the location of pertinent bony landmarks and soft tissue attachment areas. All subcutaneous tissues and musculature were removed, with the exception of the rotator cuff (respective muscle bellies cut at their musculotendinous junctions) and the long head of the biceps tendon. The superior glenohumeral ligament (SGHL), middle glenohumeral ligament (MGHL), anteroinferior glenohumeral ligament (AIGHL), posteroinferior glenohumeral ligament (PIGHL), and coracohumeral ligament (CHL) were then transected. Coordinates of points along the perimeters of attachment sites were used to calculate areas, while coordinates of center points were used to determine distances between surgically relevant attachment sites and pertinent bony landmarks. Results: The mean length of the SGHL humeral attachment along the intra-articular cartilage margin was 9.5 ± 3.2 mm, spanning from 12:55 to 1:40, while the SGHL glenoid attachment to the labrum was 1.9 ± 1.2 mm medial to the most lateral extent of the labral rim, spanning from 12:30 to 12:45. The mean length of the MGHL attachment along the intra-articular cartilage margin was 16.4 ± 3.0 mm, equating to 2:10 to 3:35 on the humeral head clockface, and the glenoid attachment was confluent with the labrum, attaching 1.5 ± 1.0 mm medial to the most lateral extent of the labral rim and thus extending from 1:50 to 2:35 on the glenoid clockface. The mean length of the AIGHL attachment along the intra-articular cartilage margin was 12.0 ± 3.0 mm, spanning from 4:05 to 5:10 on the humeral head clockface. The AIGHL bony footprint on the glenoid neck was 48.4 ± 24.5 mm2. The confluent attachment of the AIGHL to the labrum was 1.2 ± 0.9 mm medial to the most lateral extent of the labral rim, corresponding to 3:30 to 4:05 on the glenoid clockface. The mean length of the PIGHL attachment along the intra-articular cartilage margin was 12.0 ± 1.4 mm, spanning from 7:40 to 8:50 on the humeral head clockface. The PIGHL attachment to the labrum was 1.2 ± 0.5 mm medial to the most lateral extent of the labral rim. This attachment to the labrum was calculated to span from 7:35 to 8:50 on the glenoid clockface. The mean length of the CHL origin from the coracoid was 12.9 mm, with its most anterior point located a mean of 14.1 mm from the tip of the coracoid. The mean length of the CHL attachment along the intra-articular cartilage margin was 10.0 ± 4.0 mm, spanning from 11:55 to 12:40 on the humeral head clockface. Conclusion: Glenohumeral ligaments were consistently identified in all specimens with minor anatomic variability for the SGHL, MGHL, AIGHL, and PIGHL. Important landmarks including the cartilage surface of the humerus, the bicipital groove, and the clockface can be utilized intraoperatively when attempting anatomic repair of these structures. Clinical Relevance: There are multiple open and arthroscopic shoulder procedures that rely on anatomic restoration of these static stabilizers to provide optimal shoulder function and prevent recurrent instability. The qualitative descriptions are comparable with current literature; however, this study is the first to quantify the glenohumeral capsular and ligamentous attachments. The data provided allow for reliable landmarks to be established from known bony and soft tissue structures. [ABSTRACT FROM AUTHOR]

The use of a distal tibial allograft (DTA) for reconstruction of a glenoid defect in anterior shoulder instability has grown significantly over the past decade. However, few large-scale clinical studies have investigated the clinical and radiographic outcomes of the DTA procedure.To conduct a systematic review and meta-analysis of clinical studies with data on outcomes and complications in patients who underwent the DTA procedure for recurrent anterior shoulder instability with glenoid bone loss.Systematic review and meta-analysis; Level of evidence, 4.A comprehensive search of major bibliographic databases was conducted for articles pertaining to the use of a DTA for the management of anterior shoulder instability with associated glenoid bone loss. Postoperative complications and outcomes were extracted and compiled in a meta-analysis.Of the 8 included studies with 329 total participants, the mean patient age was 28.1 ± 10.8 years, 192 (83.8%) patients were male, and the mean follow-up was 38.4 ± 20.5 months. The overall complication rate was 7.1%, with hardware complications (3.8%) being the most common. Partial graft resorption was observed in 36.5% of the participants. Recurrent subluxation was reported in 1.2% of the participants, and recurrent dislocation prompting a reoperation was noted in 0.3% of the participants. There were significant improvements in clinical outcomes, including American Shoulder and Elbow Surgeons score (40.9-point increase; P < .01), Single Assessment Numeric Evaluation (47.2-point increase; P < .01), Western Ontario Shoulder Instability Index (49.4-point decrease; P < .01), Disabilities of the Arm, Shoulder and Hand (20.0-point decrease; P = .03), and visual analog scale (2.1-point decrease; P = .05). Additionally, postoperative shoulder range of motion significantly increased from baseline values.The DTA procedure was associated with a low complication rate, good clinical outcomes, and improved range of motion among patients with anterior shoulder instability and associated glenoid defects. [ABSTRACT FROM AUTHOR]

Background: Current structural bone graft options used for glenoid augmentation in glenohumeral instability have known drawbacks. The scapular spine may be a possible alternative graft choice, but its dimensions and anatomy are not fully reported. Hypothesis: The scapular spine's harvestable graft dimensions will be similar to harvestable dimensions of the coracoid and iliac crest. Study Design: Descriptive laboratory study. Methods: The scapular spine, coracoid, and iliac crest dimensions were recorded and compared bilaterally in 50 patients with 3-dimensional computed tomography imaging. The portion of the scapular spine with the largest harvestable dimensions was quantified and its location defined. Measurements were independently taken by 2 investigators and averaged for the final result. Results: The scapular spine has 81.5 mm of harvestable length and a "flare" located approximately 49.6 mm lateral to the medial scapular border, where the widest harvestable cross section is located (mean harvestable dimensions: 10.9-mm height, 11.5-mm width). Mean coracoid dimensions were 24-mm length, 14.2-mm height, and 10.6-mm width. Mean iliac crest width was 14.7 mm. In sum, 96% of scapular spines, 85% of coracoids, and 100% of iliac crests exceeded minimum dimensions of 8 mm × 8 mm × 20 mm. The coronal radius of curvature of the glenoid was significantly different from the corresponding plane of all measured structures. Conclusion/Clinical Relevance: The scapular spine has dimensions similar to the coracoid and iliac crest in the majority of patients and is therefore appropriate for further investigation as a potential graft choice in glenohumeral instability. A harvest location 49.6 mm lateral to the medial scapular border will provide the largest cross-sectional graft while avoiding the acromial base. [ABSTRACT FROM AUTHOR]

Background: Suture anchor repair for anterior shoulder instability can be performed using a number of different repair techniques, but none has been proven superior in terms of anatomic and biomechanical properties. Purpose/Hypothesis: The purpose was to compare the anatomic footprint coverage and biomechanical characteristics of 4 different Bankart repair techniques: (1) single row with simple sutures, (2) single row with horizontal mattress sutures, (3) double row with sutures, and (4) double row with labral tape. The hypotheses were as follows: (1) double-row techniques would improve the footprint coverage and biomechanical properties compared with single-row techniques, (2) horizontal mattress sutures would increase the footprint coverage compared with simple sutures, and (3) repair techniques with labral tape and sutures would not show different biomechanical properties. Study Design: Controlled laboratory study. Methods: Twenty-four fresh-frozen cadaveric specimens were dissected. The native labrum was removed and the footprint marked and measured. Repair for each of the 4 groups was performed, and the uncovered footprint was measured using a 3-dimensional digitizer. The strength of the repair sites was assessed using a servohydraulic testing machine and a digital video system to record load to failure, cyclic displacement, and stiffness. Results: The double-row repair techniques with sutures and labral tape covered 73.4% and 77.0% of the footprint, respectively. These percentages were significantly higher than the footprint coverage achieved by single-row repair techniques using simple sutures (38.1%) and horizontal mattress sutures (32.8%) (P < .001). The footprint coverage of the simple suture and horizontal mattress suture groups was not significantly different (P = .44). There were no significant differences in load to failure, cyclic displacement, or stiffness between the single-row and double-row groups or between the simple suture and horizontal mattress suture techniques. Likewise, there was no difference in the biomechanical properties of the double-row repair techniques with sutures versus labral tape. Conclusion: Double-row repair techniques provided better coverage of the native footprint of the labrum but did not provide superior biomechanical properties compared with single-row repair techniques. There was no difference in footprint coverage or biomechanical strength between the simple suture and horizontal mattress suture repair techniques. Clinical Relevance: Although the double-row repair techniques had no difference in initial strength, they may improve healing in high-risk patients by improving the footprint coverage. [ABSTRACT FROM AUTHOR]

The article discusses a study which calculated the incidence density rate (IDR) of primary anterior shoulder dislocation requiring closed reduction in the general population and demographic subgroups in Ontario. Results showed that young male patients have the highest incidence of primary anterior shoulder dislocation requiring CR and the greatest risk of repeat shoulder CR. The study also found that patient, provider, and injury factors all influence repeat shoulder CR risk.

Humeral head bone defects (Hill-Sachs lesions) are caused by anterior shoulder dislocation with impaction of the posterosuperior humeral head onto the anterior glenoid rim. Frequently, these bony lesions are associated with glenohumeral instability, and large lesions may contribute to recurrent instability after failure of a soft tissue repair. To improve outcomes and minimize the risk of persistent instability, a thorough understanding of the biomechanics of humeral bone loss is required. Detection and quantification of clinically relevant humeral head bone loss are performed through an accurate history, physical examination, and interpretation of imaging studies. The diagnosis and treatment options for reverse Hill-Sachs lesions are discussed, and the various treatment options for Hill-Sachs lesions are reviewed, including operative techniques to limit engagement of the deformity by soft tissue transfer, rotational osteotomy, bone grafting, or osteochondral transplantation. [ABSTRACT FROM PUBLISHER]

Anterior shoulder instability is a complex problem and necessitates accurate pre- and intraoperative assessment of soft-tissue and bony pathology. Soft tissue pathology plays a major role in anterior instability without bone loss, and includes glenoid lesions (glenoid labral tears/avulsions), capsular lesions (plastic deformation and tears), and humeral side lesions (humeral avulsion of glenohumeral ligament lesion referred to as 'HAGL' lesions). Glenoid labral tears and capsular lesions are adequately addressed with the 'labroplasty' procedure. This involves a sequential capsulolabral shift using correctly oriented suture-anchors, to effectively reduce the capsular volume. In addition, technical maneuvers like the 'double-grasper shift' and 'Noose maneuver' are crucial to recreate a labral bumper effect at the glenoid edge. HAGL lesions may be difficult to detect, and use of the axillary-pouch portal (Bhatia portal) facilitates identification of the tear. A new mini-open subscapularis-sparing technique permits secure repair of the HAGL lesion without a subscapularis tenotomy or even a split. Postoperative rehabilitation is guided by intra-operative tensioning of the capsulolabral tissue. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to quantify anteroposterior glenohumeral translation of patients undergoing arthroscopic capsulolabral repairs using cutaneous electromagnetic position sensors. Hypothesis: Anteroposterior translation will be restored after arthroscopic capsulolabral repairs to values similar to the contralateral or uninjured shoulder. Study Design: Cohort study; Level of evidence, 2. Methods: With use of an electromagnetic tracking system, preoperative anteroposterior translation was measured in the injured and uninvolved shoulders of 32 patients with a diagnosis of glenohumeral labral tears. Testing was done with patients placed in the supine position with the arm suspended in 90° of abduction and neutral rotation. The American Shoulder and Elbow Society index and range of motion were also measured. Patients with capsulolabral injuries requiring arthroscopic repair were reexamined at 3 and 6 months postoperatively. Results: In patients with anteroinferior/posteroinferior capsulolabral repairs, glenohumeral translation at 3 and 6 months post-operative (P < .0001) was significantly decreased compared with preoperative values (P = .0007) and the uninvolved side (pre- operative, P = .04; postoperative, P = .002). In patients with superior capsulolabral (superior labral anterior-posterior) repairs, the mean glenohumeral translation at 3 and 6 months postoperative was decreased significantly compared with the preoperative value; however, no significant differences were found between the uninvolved side (preoperative, P = .5) and the operative shoulder (postoperative, P = .2). By 6-month follow-up, no significant difference existed in external rotation when compared with preoperative values for either repair group. Conclusion: Arthroscopic superior capsulolabral reconstructions successfully restored anteroposterior translation. However, arthroscopic capsulolabral techniques for treating recurrent anterior or posterior instability resulted in decreased anteroposterior translation compared to the uninvolved side while restoring external rotation. [ABSTRACT FROM AUTHOR]

Background: Lesions to the axillary artery are reported in overhead athletes. One speculated cause is repeated transient compression by the humeral head due to excessive laxity at the glenohumeral joint. Hypotheses: (1) Anterior translation of the glenohumeral joint alters axillary artery diameter and blood flow characteristics, and (2) individuals demonstrating inducible axillary artery compression with the arm in an overhead position (as indicated by diameter and blood flow characteristics) will demonstrate greater magnitudes of anterior translation. Study Design: Descriptive laboratory study. Methods: After receiving ethical approval and screening for problematic conditions/injuries, 26 subjects were tested (10 men and 16 women; mean age [standard deviation], 25 years [4]). Axillary artery diameter and peak systolic velocity were measured with B-mode and Doppler ultrasound before, during, and after glenohumeral anterior translation at 90° of abduction, 600 of external rotation, and 30° of horizontal flexion, and at baseline and a simulated overhead throwing position (120° of abduction, 90° of external rotation, and 30° of horizontal extension). The magnitude of anterior translation was captured with B-mode ultrasound using a posterior transverse approach. Results: Application of the glide resulted in a significant (F2,21 = 9.965, P = .001) reduction in axillary artery diameter and a significant increase in peak systolic velocity (F2,21 = 5.286, P = .014). Subjects demonstrating clinically significant levels of axillary artery compression (>50% reduction in vessel diameter with the arm in the overhead throwing position) exhibited significantly (t = -2.260, P = .040) greater ranges of anterior translation at the glenohumeral joint than the 9 subjects who exhibited <10% reduction in arterial diameter. Conclusions: This investigation provides the first empirical support for the clinical opinion that glenohumeral anterior translation could be a mechanism for inducible axillary artery compression. Clinical Relevance: The response of axillary artery hemodynamics in normal, healthy individuals is the first step in the process of determining whether the finding of inducible axillary artery compression in overhead athletes with arterial pathology is related to glenohumeral translation. [ABSTRACT FROM AUTHOR]