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[PMID]: 28135130 [Au] Autor: Nakagawa S; Iuchi R; Mae T; Mizuno N; Take Y [Ad] Endereço: Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan. [Ti] Título: Clinical Outcome of Arthroscopic Bankart Repair Combined With Simultaneous Capsular Repair. [So] Source: Am J Sports Med;45(6):1289-1296, 2017 May. [Is] ISSN: 1552-3365 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: A capsular tear and humeral avulsion of the glenohumeral ligament lesion are not uncommon findings in association with a Bankart lesion. However, there have been few reports regarding the prevalence of such capsular lesions and the postoperative recurrence after capsular repair. Purpose/Hypothesis: This study investigated the prevalence of capsular lesions and clarified their influence on the postoperative recurrence of instability. In addition, factors were identified that were associated with the occurrence of capsular lesions and the postoperative recurrence of instability. We hypothesized that clinical outcomes would be improved by combining arthroscopic Bankart repair with simultaneous capsular repair. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Capsular lesions were retrospectively examined through operative records, still pictures, and videos in 172 shoulders with traumatic anterior instability. First, the prevalence of capsular lesions and their severity were investigated. Then, postoperative recurrence was determined in shoulders observed for a minimum of 2 years. Finally, factors were assessed that were associated with the occurrence of capsular lesions and the postoperative recurrence of instability. RESULTS: A capsular lesion was recognized in 37 shoulders (21.5%), being severe and mild in 20 and 17, respectively. All were repaired simultaneously with the arthroscopic Bankart procedure. After follow-up for at least 2 years, recurrence of instability was detected in 10 of 34 shoulders (29.4%), including 6 (31.6%) with severe capsular lesions and 4 (26.7%) with mild lesions. The recurrence rate was significantly higher in shoulders with a capsular lesion than in shoulders without a capsular lesion (18 of 120, 15%; P = .013), but there was no significant difference between severe and mild lesions. Regardless of the sport played, capsular lesions were significantly more frequent in patients ≥30 years old, patients with complete dislocation, and patients with a coexisting Hill-Sachs lesion. Postoperative recurrence of instability was significantly more frequent in patients <30 years and competitive athletes. CONCLUSION: In shoulders undergoing arthroscopic Bankart repair, capsular lesions were often present and were associated with higher postoperative recurrence of instability. While these lesions were more frequent in older patients, postoperative recurrence of instability was more likely in young competitive athletes. [Mh] Termos MeSH primário: Artroscopia/métodos Lesões de Bankart/epidemiologia Liberação da Cápsula Articular Cápsula Articular/cirurgia Articulação do Ombro/cirurgia [Mh] Termos MeSH secundário: Adolescente Adulto Idoso Lesões de Bankart/cirurgia Estudos de Coortes Feminino Seres Humanos Masculino Meia-Idade Estudos Retrospectivos Cicatrização Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171027 [Lr] Data última revisão: 171027 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170131 [St] Status: MEDLINE [do] DOI: 10.1177/0363546516687752

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[PMID]: 27872125 [Au] Autor: Aboalata M; Plath JE; Seppel G; Juretzko J; Vogt S; Imhoff AB [Ad] Endereço: Department of Orthopaedic Surgery, Upper Limb Unit, Mansoura University, Mansoura, Egypt. [Ti] Título: Results of Arthroscopic Bankart Repair for Anterior-Inferior Shoulder Instability at 13-Year Follow-up. [So] Source: Am J Sports Med;45(4):782-787, 2017 Mar. [Is] ISSN: 1552-3365 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Anterior-inferior shoulder instability is a common injury in young patients, particularly those practicing overhead-throwing sports. Long-term results after open procedures are well studied and evaluated. However, the long-term results after arthroscopic repair and risk factors of recurrence require further assessment. HYPOTHESIS: Arthroscopic Bankart repair results are comparable with those of open repair as described in the literature. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 180 shoulders with anterior-inferior shoulder instability were stabilized arthroscopically, met the inclusion criteria and the patients were able to be contacted at a minimum of 10-year follow-up. Of these patients, 143 agreed to participate in the study. Assessment was performed clinically in 104 patients using the American Shoulder and Elbow Surgeons score, Constant score, American Academy of Orthopaedic Surgeons score, Rowe score, and the Dawson 12-item questionnaire. The Samilson-Prieto score was used to assess degenerative arthropathy in radiographs available for 100 shoulders. Additionally, 15 patients participated through a specific questionnaire and 24 patients through a telephone survey. RESULTS: The overall redislocation rate was 18.18%. Redislocation rates for the different types of fixation devices were as follows: FASTak/Bio-FASTak, 15.1% (17/112); SureTac, 26.3% (5/19); and Panalok, 33.3% (4/12). Concomitant superior labral anterior-posterior repair had no effect on clinical outcome. Redislocation rate was significantly affected by the patient's age and duration of postoperative rehabilitation. Redislocation rate tended to be higher if there had been more than 1 dislocation preoperatively ( P = .098). Severe dislocation arthropathy was observed in 12% of patients, and degenerative changes were significantly correlated with the number of preoperative dislocations, patient age, and number of anchors. The patient satisfaction rate was 92.3%, and return to the preinjury sport level was possible in 49.5%. CONCLUSION: Clinical outcome at a mean follow-up of 13 years after arthroscopic repair of anterior-inferior shoulder instability is comparable with the reported results of open Bankart repair in the literature and allows management of concomitant lesions arthroscopically. Modifiable risk factors of postoperative redislocation and arthropathy must be considered. Stabilization after the first-time dislocation achieves better clinical and radiological outcomes than after multiple dislocations. [Mh] Termos MeSH primário: Artroscopia Lesões de Bankart/cirurgia Instabilidade Articular/cirurgia Luxação do Ombro/cirurgia Articulação do Ombro/cirurgia [Mh] Termos MeSH secundário: Adolescente Adulto Lesões de Bankart/diagnóstico por imagem Lesões de Bankart/fisiopatologia Feminino Seguimentos Seres Humanos Incidência Instabilidade Articular/diagnóstico por imagem Instabilidade Articular/epidemiologia Instabilidade Articular/etiologia Masculino Radiografia Recidiva Estudos Retrospectivos Fatores de Risco Luxação do Ombro/complicações Luxação do Ombro/diagnóstico por imagem Articulação do Ombro/diagnóstico por imagem Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171010 [Lr] Data última revisão: 171010 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 161123 [St] Status: MEDLINE [do] DOI: 10.1177/0363546516675145

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[PMID]: 26924834 [Au] Autor: Assunção JH; Gracitelli ME; Borgo GD; Malavolta EA; Bordalo-Rodrigues M; Ferreira Neto AA [Ad] Endereço: Shoulder and Elbow Group, Institute of Orthopedics and Traumatology, University of São Paulo (Universidade de São Paulo - USP), São Paulo, Brazil drjorgeassuncao@gmail.com. [Ti] Título: Tomographic evaluation of Hill-Sachs lesions: is there a correlation between different methods of measurement? [So] Source: Acta Radiol;58(1):77-83, 2017 Jan. [Is] ISSN: 1600-0455 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: BACKGROUND: Several methods are currently available to evaluate and quantify the glenoid or humeral bone loss; however, none is universally accepted, particularly in the case of Hill-Sachs (HS) lesions. PURPOSE: To establish whether there is correlation among different methods of measuring HS lesions, and to investigate the correlation between glenoid bone loss and the various HS lesion measurements and to assess the inter-observer reliability of such measurements. MATERIAL AND METHODS: We assessed computed tomography (CT) or arthro-CT scans taken from individuals with recurrent anterior glenohumeral dislocation. The scans were independently assessed by two examiners. The parameters assessed were as follows: HS lesion width and depth on the axial and coronal planes, articular arc loss on the axial plane, and percentage of glenoid bone loss on the sagittal plane. RESULTS: Scans from 50 shoulders were assessed. The percentage of articular arc loss and HS lesion width on the axial plane were the only measurements that exhibited strong correlation (r = 0.83; P < 0.001). The values of the correlation coefficient corresponding to HS lesion depth on the coronal plane were the lowest. Most of the measurements exhibited moderate correlation. The inter-examiner reliability was good relative to all measurements except for HS lesion width and depth on the coronal plane, for which it was moderate. CONCLUSION: The measurements of articular arc loss and HS lesion width on the axial plane exhibited strong correlation. The inter-examiner reliability relative to articular arc loss, HS lesion width and depth on the axial plane, and glenoid bone loss was good. [Mh] Termos MeSH primário: Lesões de Bankart/diagnóstico Cavidade Glenoide/efeitos dos fármacos Posicionamento do Paciente/métodos Interpretação de Imagem Radiográfica Assistida por Computador/métodos Luxação do Ombro/diagnóstico por imagem Tomografia Computadorizada por Raios X/métodos [Mh] Termos MeSH secundário: Lesões de Bankart/complicações Feminino Seres Humanos Masculino Variações Dependentes do Observador Reprodutibilidade dos Testes Sensibilidade e Especificidade Luxação do Ombro/etiologia Estatística como Assunto Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1701 [Cu] Atualização por classe: 170120 [Lr] Data última revisão: 170120 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 160301 [St] Status: MEDLINE

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[PMID]: 28850207 [Au] Autor: Fakih R; Hamie MR; Yassine MS [Ti] Título: COMPARATIVE STUDY on the MANAGEMENT of GLENOHUMERAL JOINT DISLOCATION. Closed Reduction vs. Arthroscopic Remplissage with Bankart Lesion Repair. [So] Source: J Med Liban;64(3):175-80, 2016 Jul-Sep. [Is] ISSN: 0023-9852 [Cp] País de publicação: Lebanon [La] Idioma: eng [Ab] Resumo: BACKGROUND: Conservative treatment of posttraumatic anteroinferior shoulder instability leads to a high failure rate and consequently high recurrence in young and active population. Each recurrence can increase the structural damage of both bony structures and soft tissues (Hill-Sachs lesion, Bankart lesion). Remplissage technique combined with Bankart repair have been proposed as a treatment option. HYPOTHESIS: Early arthroscopic treatment for shoulder dislocation will result in better outcome and lower recurrence rate than nonoperative management. METHODS: We retrospectively reviewed 60 cases from 2010 to 2015 treated by remplissage technique with Bankart repair or closed reduction for anterior shoulder dislocation. All surgeries and closed reductions were done by the same surgeon. Mean age of patients was 30 years, most of them males having experienced one or more recurrent dislocations; mean follow-up was 2 years. Patients with Hill-Sachs lesions < 40% on the articular surface and < 20% of bone defect in the glenoid cavity were included. Exclusion criteria were: glenohumeral arthritis or other inflammation, fracture around the shoulder joint, elderly patients with osteoporosis. All patients included in the study were followed up after 6, 12 and 24 months. Rowe score was used to assess the stability of the shoulders and goniometry to assess the range of motion of the glenohumeral joints. RESULTS: The results confirm that the remplissage technique with Bankart repair takes the upper hand over the conservative management and does not produce any severe adverse effect on postoperative shoulder range of motion. A slight restriction (≈10º) observed in external rotation did not prevent 69% of patients from resuming their preinjury sports activities. At the last follow-up, 90% of patients had a stable shoulder. Conservative management was associated with high rate of recurrence limiting the daily activity of our patients and interfering with their return to sports activities. Except from the recurrence of glenohumeral instability, no patient had a complication following arthroscopic Hill-Sachs remplissage. CONCLUSION: Conservative management after anterior shoulder dislocation including immobilization in neutral position leads to significantly higher and unacceptable high failure rate compared with early arthroscopic remplissage with Bankart repair. The slight restriction in external rotation post remplissage does not significantly affect the quality of life and return to sports activities and further supports the use of this safe, relatively short procedure, in the management of glenohumeral instability with concurrent Hill-Sachs lesions. [Mh] Termos MeSH primário: Artroscopia Lesões de Bankart/cirurgia Redução Fechada Manipulação Ortopédica Luxação do Ombro/terapia [Mh] Termos MeSH secundário: Adulto Feminino Seres Humanos Masculino Estudos Retrospectivos [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 170919 [Lr] Data última revisão: 170919 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170830 [St] Status: MEDLINE

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[PMID]: 27510714 [Au] Autor: Ganeshan RM; Bakr AI [Ad] Endereço: Pennine Acute Hospitals NHS Trust, Manchester, UK raghu.mg@gmail.com. [Ti] Título: Not "just" a shoulder dislocation. [So] Source: BMJ;534:i4062, 2016 Aug 10. [Is] ISSN: 1756-1833 [Cp] País de publicação: England [La] Idioma: eng [Mh] Termos MeSH primário: Lesões de Bankart/diagnóstico Luxação do Ombro/diagnóstico por imagem Tomografia Computadorizada por Raios X [Mh] Termos MeSH secundário: Adulto Lesões de Bankart/complicações Lesões de Bankart/terapia Feminino Seres Humanos Recidiva Luxação do Ombro/etiologia Luxação do Ombro/terapia [Pt] Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE [Em] Mês de entrada: 1703 [Cu] Atualização por classe: 170817 [Lr] Data última revisão: 170817 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 160812 [St] Status: MEDLINE [do] DOI: 10.1136/bmj.i4062

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[PMID]: 27496904 [Au] Autor: Eichinger JK; Massimini DF; Kim J; Higgins LD [Ad] Endereço: Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA. [Ti] Título: Biomechanical Evaluation of Glenoid Version and Dislocation Direction on the Influence of Anterior Shoulder Instability and Development of Hill-Sachs Lesions. [So] Source: Am J Sports Med;44(11):2792-2799, 2016 Nov. [Is] ISSN: 1552-3365 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Abnormal glenoid version is a risk factor for shoulder instability. However, the degree to which the variance in version (both anteversion and retroversion) affects one's predisposition for instability is not well understood. PURPOSE: To determine the influence of glenoid version on anterior shoulder joint stability and to determine if the direction of the humeral head dislocation is a stimulus for the development of Hill-Sachs lesions. STUDY DESIGN: Controlled laboratory study. METHODS: Ten human cadaveric shoulders (mean age, 59.4 ± 4.3 years) were tested using a custom shoulder dislocation device placed in a position of apprehension (90° of abduction with 90° of external rotation). Glenoid version was adjusted in 5° increments for a total of 6 version angles tested: +10°, +5°, 0°, -5°, -10°, and -15° (anteversion angles are positive, and retroversion angles are negative). Two humeral dislocation directions were tested. The first direction was true anterior through the anterior-posterior glenoid axis. The second dislocation direction was 35° inferior from the anterior-posterior glenoid axis based on the deforming force role of the pectoralis major. The force and energy to dislocate were recorded. RESULTS: Changes in glenoid version manifested a linear effect on the dislocation force. The energy to dislocate increased as a second-order polynomial as a function of increasing glenoid retroversion. Glenoid version of +10° anteversion and -15° retroversion was highly unstable, resulting in spontaneous dislocation in one-quarter (10/40) and one-half (25/40) of the specimens anteriorly and posteriorly, respectively, in the absence of an applied dislocation force. The greater tuberosity was observed to engage with the anterior glenoid rim, consistent with Hill-Sachs lesions, 40% more frequently when the dislocation direction was true anterior compared with 35° inferior from the anterior-posterior glenoid axis. The engagement of the greater tuberosity caused an increase in the energy required to dislocate. CONCLUSION: Glenoid version has a direct effect on the force required for a dislocation. An anterior-inferior dislocation direction requires less energy for a dislocation and results in a lower risk of the development of a Hill-Sachs lesion than a direct anterior dislocation direction. CLINICAL RELEVANCE: Consideration should be given to glenoid version when choosing a surgical treatment option for anterior shoulder instability. [Mh] Termos MeSH primário: Lesões de Bankart/fisiopatologia Cavidade Glenoide/fisiopatologia Instabilidade Articular/fisiopatologia Articulação do Ombro/fisiopatologia [Mh] Termos MeSH secundário: Idoso Fenômenos Biomecânicos Cadáver Feminino Seres Humanos Cabeça do Úmero/fisiopatologia Instabilidade Articular/cirurgia Masculino Meia-Idade Rotação Articulação do Ombro/cirurgia [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1706 [Cu] Atualização por classe: 170629 [Lr] Data última revisão: 170629 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 160807 [St] Status: MEDLINE

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[PMID]: 27480979 [Au] Autor: Shin SJ; Koh YW; Bui C; Jeong WK; Akeda M; Cho NS; McGarry MH; Lee TQ [Ad] Endereço: Department of Orthopaedic Surgery, Ewha Womans University, Seoul, Korea. [Ti] Título: What Is the Critical Value of Glenoid Bone Loss at Which Soft Tissue Bankart Repair Does Not Restore Glenohumeral Translation, Restricts Range of Motion, and Leads to Abnormal Humeral Head Position? [So] Source: Am J Sports Med;44(11):2784-2791, 2016 Nov. [Is] ISSN: 1552-3365 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: A general consensus has been formed that glenoid bone loss greater than 20% to 25% is the critical amount at which bony augmentation procedures are needed; however, recent clinical results suggest that the critical levels must be reconsidered to lower values. PURPOSE: This study aimed to find the critical value of anterior glenoid bone loss when a soft tissue repair is not adequate to restore anterior-inferior glenohumeral translation, rotational range of motion, or humeral head position using a biomechanical anterior shoulder instability model. STUDY DESIGN: Controlled laboratory study. METHODS: Eight cadaveric shoulders were tested with a customized shoulder testing system. Range of motion, translation, and humeral head position were measured at 60° of glenohumeral abduction in the scapular plane under a total of 40-N rotator cuff muscle loading in the following 11 conditions: intact; soft tissue Bankart lesion and repair; Bankart lesion with 10%, 15%, 20%, and 25% glenoid bone defects based on the largest anteroposterior width of the glenoid; and soft tissue Bankart repair for each respective glenoid defect. Serial osteotomies for each percentage of bone loss were made parallel to the long axis of the glenoid. RESULTS: There was significantly decreased external rotation (121.2° ± 2.8° to 113.5° ± 3.3°; P = .004), increased anteroinferior translation with an externally applied load (3.0 ± 1.2 mm to 7.5 ± 1.1 mm at 20 N; P = .008), and increased posterior (0.2 ± 0.6 mm to 2.7 ± 0.8 mm; P = .049) and inferior shift (2.9 ± 0.7 mm to 6.6 ± 1.1 mm; P = .018) of the humeral head apex in the position of maximum external rotation after soft tissue Bankart repair of a 15% glenoid defect compared with the repair of a Bankart lesion without a glenoid defect, respectively. CONCLUSION: Glenoid defects of 15% or more of the largest anteroposterior glenoid width should be considered the critical bone loss amount at which soft tissue repair cannot restore glenohumeral translation, restricts rotational range of motion, and leads to abnormal humeral head position. CLINICAL RELEVANCE: The critical level of anterior glenoid bone loss at which bony restorations should be considered is closer to 15% of the largest anteroposterior width of glenoid for defects perpendicular to the superoinferior glenoid axis, which is lower than the commonly accepted threshold of 20% to 25%. [Mh] Termos MeSH primário: Lesões de Bankart/patologia Cavidade Glenoide/patologia Cabeça do Úmero/patologia Instabilidade Articular/patologia Articulação do Ombro/patologia [Mh] Termos MeSH secundário: Adulto Idoso Lesões de Bankart/fisiopatologia Lesões de Bankart/cirurgia Fenômenos Biomecânicos Cadáver Feminino Cavidade Glenoide/fisiopatologia Cavidade Glenoide/cirurgia Seres Humanos Cabeça do Úmero/fisiopatologia Cabeça do Úmero/cirurgia Instabilidade Articular/fisiopatologia Instabilidade Articular/cirurgia Masculino Meia-Idade Osteotomia Amplitude de Movimento Articular Rotação Manguito Rotador/fisiopatologia Articulação do Ombro/fisiopatologia Articulação do Ombro/cirurgia [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1706 [Cu] Atualização por classe: 170629 [Lr] Data última revisão: 170629 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 160803 [St] Status: MEDLINE

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[PMID]: 27477475 [Au] Autor: Gilotra MN; Christian MW; Lovering RM [Ti] Título: Rotator Cuff Tear Consequent to Glenohumeral Dislocation. [So] Source: J Orthop Sports Phys Ther;46(8):708, 2016 Aug. [Is] ISSN: 1938-1344 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: The patient was a 21-year-old collegiate running back who was tackled during a football game and sustained a posterior glenohumeral dislocation. He was referred to an orthopaedist and presented 3 weeks after the injury, and, following examination, further imaging was ordered by the orthopaedist due to rotator cuff weakness. Magnetic resonance imaging showed a complete tear of the supraspinatus and infraspinatus, as well as a posterior Bankart lesion, a subscapularis tear, and a dislocation of the biceps long head tendon into the reverse Hill-Sachs lesion. J Orthop Sports Phys Ther 2016;46(8):708. doi:10.2519/jospt.2016.0413. [Mh] Termos MeSH primário: Futebol Americano/lesões Lesões do Manguito Rotador/diagnóstico por imagem Luxação do Ombro/diagnóstico por imagem Luxação do Ombro/etiologia [Mh] Termos MeSH secundário: Atletas Lesões de Bankart/diagnóstico por imagem Terapia por Exercício Seres Humanos Imagem por Ressonância Magnética Masculino Volta ao Esporte Lesões do Manguito Rotador/etiologia Adulto Jovem [Pt] Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE [Em] Mês de entrada: 1703 [Cu] Atualização por classe: 170817 [Lr] Data última revisão: 170817 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 160802 [St] Status: MEDLINE [do] DOI: 10.2519/jospt.2016.0413

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[PMID]: 27432588 [Au] Autor: Hartzler RU; Bui CN; Jeong WK; Akeda M; Peterson A; McGarry M; Denard PJ; Burkhart SS; Lee TQ [Ad] Endereço: Burkhart Research Institute for Orthopaedics and The San Antonio Orthopaedic Group, San Antonio, Texas, U.S.A. [Ti] Título: Remplissage of an Off-track Hill-Sachs Lesion Is Necessary to Restore Biomechanical Glenohumeral Joint Stability in a Bipolar Bone Loss Model. [So] Source: Arthroscopy;32(12):2466-2476, 2016 Dec. [Is] ISSN: 1526-3231 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: PURPOSE: To validate the glenoid track concept in a cadaveric bipolar bone loss model and to test whether "on-track" and "off-track" lesions can be stabilized with Bankart repair (BR) with or without Hill-Sachs remplissage (HSR). METHODS: Eight fresh-frozen cadaveric shoulders were tested in a custom apparatus with passive axial rotation and then progressive translational loading (10 to 40 N) at mid-range (60°) and end-range external rotation (90°). Injury conditions included glenoid bone loss of 15% with on-track (15%) and off-track (30%) Hill-Sachs lesions. Repair conditions included BR with HSR and BR without HSR. RESULTS: For on-track lesions, engagement occurred with translation testing in one shoulder (12.5%) at end-range rotation. After BR, engagement was prevented for this shoulder. For off-track lesions, engagement with translation testing occurred in 8 shoulders (100%) at end-range rotation and in 6 (75%) at mid-range rotation. After BR, engagement was prevented in 4 of 6 engaging shoulders (67%) at mid-range rotation but was prevented in zero of 8 (0%) at end-range rotation. Adding HSR prevented engagement in all 14 engaging shoulders with off-track lesions (100%). BR with HSR resulted in supraphysiological stiffness for off-track lesions at mid- and end-range rotation (13.3 N/m vs 7.0 N/m and 10.0 N/m vs 5.0 N/m, P = .0002) and for on-track lesions at end-range rotation (10.1 N/m vs 5.0 N/m, P = .0002). Stiffness of BR with HSR was not different from the intact shoulder for on-track lesions at mid-range rotation (7.2 N/m vs 7.0 N/m, P > .99). CONCLUSIONS: The patterns of engagement of Hill-Sachs lesions with a 15% glenoid defect in this model give support to the glenoid track concept. BR plus remplissage resulted in supraphysiological shoulder stiffness but was necessary to prevent engagement of off-track bipolar bone lesions. CLINICAL RELEVANCE: This biomechanical study provides evidence to aid in surgical decision making by examining the effects of bipolar bone loss and soft-tissue reconstruction on shoulder stability. [Mh] Termos MeSH primário: Artroscopia/métodos Lesões de Bankart/cirurgia Instabilidade Articular/cirurgia Osteólise/fisiopatologia Articulação do Ombro/fisiopatologia [Mh] Termos MeSH secundário: Lesões de Bankart/fisiopatologia Fenômenos Biomecânicos/fisiologia Cadáver Feminino Seres Humanos Instabilidade Articular/fisiopatologia Masculino Meia-Idade Âncoras de Sutura [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 170914 [Lr] Data última revisão: 170914 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 160720 [St] Status: MEDLINE

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[PMID]: 27180149 [Au] Autor: Longo UG; Rizzello G; Ciuffreda M; Locher J; Berton A; Salvatore G; Denaro V [Ad] Endereço: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Trigoria, Rome, Italy. Electronic address: g.longo@unicampus.it. [Ti] Título: Humeral Avulsion of the Glenohumeral Ligaments: A Systematic Review. [So] Source: Arthroscopy;32(9):1868-76, 2016 Sep. [Is] ISSN: 1526-3231 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: PURPOSE: To analyze clinical outcomes, range of motion, rate of recurrence, and complications after procedures to manage shoulder instability in patients with humeral avulsion of the glenohumeral ligament (HAGL) lesions. METHODS: A systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with a PRISMA checklist and algorithm was performed. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the Keywords "shoulder," "HAGL," "treatment," "lesion," "dislocation," "instability," "clinical," "outcome," "Bankart" since inception of databases to 2015 was performed. All the investigators independently extracted the following data: demographics, types of lesions and associated injuries, treatment, outcome measurements, range of motion, recurrent instability, and complications. RESULTS: Eleven articles were included in which 42 shoulders with HAGL lesions were evaluated. Patients were assessed at a median follow-up period of 25.5 months, ranging from 12 to 54 months. The overall rate of recurrence was 0% (0 of 25) in case of surgery and 90% (9 of 10) in case of nonoperative treatment. The surgical approach was associated with lower rate of recurrence when compared with nonoperative treatment (odds ratio 0.05, 95% confidence interval 0.01 to 0.42, and P = .006). Only 2 papers reported loss of external rotation after surgery. No complications were reported after surgery. Complications after nonoperative treatment were not discussed. CONCLUSIONS: Recognizing HAGL lesions is important to manage patients with glenohumeral instability. Patients' complaints are often nonspecific. A high index of suspicion is required in patients with prior failed shoulder surgery. HAGL lesions are often associated with other shoulder lesions. Arthroscopic or open repairs of HAGL lesions are associated with good clinical outcomes and a lower rate of recurrence compared with nonoperative treatment. LEVEL OF EVIDENCE: Level IV, systematic review of Level IV studies. [Mh] Termos MeSH primário: Artroscopia/métodos Instabilidade Articular/terapia Ligamentos Articulares/cirurgia Modalidades de Fisioterapia Amplitude de Movimento Articular Luxação do Ombro/terapia Articulação do Ombro/cirurgia [Mh] Termos MeSH secundário: Lesões de Bankart/complicações Lesões de Bankart/terapia Seres Humanos Instabilidade Articular/complicações Ligamentos Articulares/lesões Razão de Chances Avaliação de Resultados (Cuidados de Saúde) Recidiva Rotação Luxação do Ombro/complicações [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171011 [Lr] Data última revisão: 171011 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 160516 [St] Status: MEDLINE

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