-
British Medical Bulletin Jul 2020This review aims to provide information on outcomes of surgical procedures for soft tissue or bony glenoid and/or humeral abnormalities in case of posterior shoulder...
INTRODUCTION
This review aims to provide information on outcomes of surgical procedures for soft tissue or bony glenoid and/or humeral abnormalities in case of posterior shoulder instability.
SOURCE OF DATA
A systematic review of the literature according to the PRISMA guidelines was performed. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, Ovid and Google Scholar databases using various combinations of the keywords 'shoulder', 'posterior instability', 'dislocation', 'reversed bony bankart', 'reversed Hill Sachs', and 'capsulolabral' was performed.
AREAS OF AGREEMENT
A total of 847 shoulders in 810 patients were included. A redislocation event occurred in 33 (8.7%) of 411 shoulders with soft tissue abnormalities and in 12 (9.1%) of 132 shoulders with bony abnormalities of the glenoid, humeral head or both.
AREAS OF CONTROVERSY
The optimal treatment modalities for posterior shoulder dislocation remain to be defined.
GROWING POINTS
Operative stabilization for posterior shoulder instability should be lesion-specific and should correct all components of the posterior instability.
AREAS TIMELY FOR DEVELOPING RESEARCH
Future prospective studies should aim to establish the optimal treatment modalities for posterior shoulder instability.
Topics: Arthroscopy; Humans; Joint Instability; Shoulder Dislocation; Shoulder Joint
PubMed: 32419023
DOI: 10.1093/bmb/ldaa009 -
British Journal of Sports Medicine Mar 2015Traumatic anterior shoulder instability (TASI) accounts for 95% of glenohumeral dislocations and is associated with soft tissue and bony pathoanatomies. Non-operative... (Review)
Review
BACKGROUND
Traumatic anterior shoulder instability (TASI) accounts for 95% of glenohumeral dislocations and is associated with soft tissue and bony pathoanatomies. Non-operative treatments include slings, bracing and physiotherapy. Operative treatment is common, including bony and soft-tissue reconstructions performed through open or arthroscopic approaches. There is management variation in patient pathways for TASI including when to refer and when to operate.
METHODS
A scoping review of systematic reviews, randomised controlled trials, comparing operative with non-operative treatments and different operative treatments were the methods followed. Search was conducted for online bibliographic databases and reference lists of relevant articles from 2002 to 2012. Systematic reviews were appraised using AMSTAR (assessment of multiple systematic reviews) criteria. Controlled trials were appraised using the CONSORT (consolidation of standards of reporting trials) tool.
RESULTS
Analysis of the reviews did not offer strong evidence for a best treatment option for TASI. No studies directly compare open, arthroscopic and structured rehabilitation programmes. Evaluation of arthroscopic studies and comparison to open procedures was difficult, as many of the arthroscopic techniques included are no longer used. Recurrence rate was generally considered the best measure of operative success, but was poorly documented throughout all studies. There was conflicting evidence on the optimal timing of intervention and no consensus on any scoring system or outcome measure.
CONCLUSIONS
There is no agreement about which validated outcome tool should be used for assessing shoulder instability in patients. There is limited evidence regarding the comparative effectiveness of surgical and non-surgical treatment of TASI, including a lack of evidence regarding the optimal timing of such treatments. There is a need for a well-structured randomised control trial to assess the efficacy of surgical and non-surgical interventions for this common type of shoulder instability.
Topics: Arthroscopy; Humans; Joint Instability; Observer Variation; Randomized Controlled Trials as Topic; Recurrence; Reoperation; Review Literature as Topic; Shoulder Dislocation; Shoulder Injuries; Suture Techniques; Time-to-Treatment
PubMed: 23966417
DOI: 10.1136/bjsports-2013-092296 -
Knee Surgery, Sports Traumatology,... Jan 2022To develop and validate a novel score to more objectively assess the performance of diagnostic knee arthroscopy using a simulator.
PURPOSE
To develop and validate a novel score to more objectively assess the performance of diagnostic knee arthroscopy using a simulator.
METHODS
A Diagnostic Arthroscopy Skill Score (DASS) was developed by ten AGA (AGA-Society for Arthroscopy and Joint-Surgery) instructors for the assessment of arthroscopic skills. DASS consists of two parts: the evaluation of standardized diagnostic knee arthroscopy (DASS) and the evaluation of manual dexterity, including ambidexterity and triangulation, using objective measurement parameters (DASS). Content validity was determined by the Delphi method. One hundred and eleven videos of diagnostic knee arthroscopies were recorded during simulator training courses and evaluated by six specially trained instructors using DASS. Construct validity, measurement error calculated by the minimum detectable change (MDC), internal consistency using Cronbach's alpha and interrater and intrarater reliability were assessed. The Bland-Altman method was used to calculate the intrarater agreement.
RESULTS
Six skill domains were identified and evaluated for each knee compartment. DASS, DASS and DASS showed construct validity, with experts achieving significantly higher scores than competents and novices. MDC was 4.5 ± 1.7 points for DASS. There was high internal consistency for all domains in each compartment from 0.78 to 0.86. The interrater reliability showed high agreement between the six raters (ICC = 0.94). The evaluation of intrarater reliability demonstrated good and excellent agreement for five raters (ICC > 0.80) and moderate agreement for one rater (ICC = 0.68). The Bland-Altman comparison showed no difference between the first and second evaluations in five out of six raters. Precision, estimated by the regression analysis and comparison with the method of Bland and Altman, was excellent for four raters and moderate for two raters.
CONCLUSIONS
The results of this study indicate good validity and reliability of DASS for the assessment of the surgical performance of diagnostic knee arthroscopy during simulator training. Standardized training is recommended before arthroscopy surgery is considered in patients.
LEVEL OF EVIDENCE
II.
Topics: Arthroscopy; Clinical Competence; Humans; Internship and Residency; Knee Joint; Reproducibility of Results
PubMed: 33914120
DOI: 10.1007/s00167-021-06554-3 -
Sports Medicine and Arthroscopy Review Dec 2020The specific approach to rehabilitation after surgical management of the unstable shoulder is dependent on the severity and chronicity of the instability. Establishing... (Review)
Review
The specific approach to rehabilitation after surgical management of the unstable shoulder is dependent on the severity and chronicity of the instability. Establishing dynamic stability throughout the athlete's functional range of movement is critical to a successful outcome. The pace progression is guided by surgical (technique, injury pattern, and strength of repair) and patient factors (healing potential, prior health status, and psychosocial factors). The primary goal of treatment is to restore function and return the athlete to sport. The process should be guided by surpassing functional criteria for progression and tissue healing time.
Topics: Arthroscopy; Athletic Injuries; Humans; Joint Instability; Range of Motion, Articular; Recurrence; Return to Sport; Risk Factors; Shoulder Injuries
PubMed: 33156232
DOI: 10.1097/JSA.0000000000000284 -
Arthroscopy : the Journal of... Nov 2023To perform a systematic review of complications associated with elbow arthroscopy in adults and children. (Review)
Review
PURPOSE
To perform a systematic review of complications associated with elbow arthroscopy in adults and children.
METHODS
A literature search was performed in the PubMed, EMBASE, and Cochrane databases. Studies reporting complications or reoperations after elbow arthroscopy with at least 5 patients were included. Based on the Nelson classification, the severity of complications was categorized as minor or major. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized clinical trials, and nonrandomized trials were assessed using the Methodological Items for Non-randomized Studies (MINORS) tool.
RESULT
A total of 114 articles were included with 18,892 arthroscopies (16,815 patients). A low risk of bias was seen for the randomized studies and a fair quality for the nonrandomized studies. Complication rates ranged from 0% to 71% (median 3%; 95% confidence interval [CI], 2.8%-3.3%), and reoperation rates from 0% to 59% (median 2%; 95% CI, 1.8%-2.2%). A total of 906 complications were observed, with transient nerve palsies (31%) as the most frequent complication. According to Nelson classification, 735 (81%) complications were minor and 171 (19%) major. Forty-nine studies reported complications in adults and 10 studies in children, showing a complication rate ranging from 0% to 27% (median 0%; 95% CI, 0%-0.4%) and 0% to 57% (median 1%; 95% CI, 0.4%-3.5%), respectively. A total of 125 complications were observed in adults, with transient nerve palsies (23%) as the most frequent complication, and 33 in children, with loose bodies after surgery (45%) as the most frequent complication.
CONCLUSIONS
Predominantly low-level evidence studies demonstrate varying complication rates (median 3%, range 0%-71%) and reoperation rates (median 2%, range 0%-59%) after elbow arthroscopy. Higher complication rates are observed after more complex surgery. The incidence and type of complications can aid surgeons in patient counseling and refining surgical techniques to further reduce the complication rates.
LEVEL OF EVIDENCE
Level IV; systematic review of Level I-IV studies.
Topics: Humans; Adult; Child; Elbow; Arthroscopy; Elbow Joint; Reoperation; Paralysis
PubMed: 37146664
DOI: 10.1016/j.arthro.2023.04.015 -
Der Unfallchirurg Jun 2019Arthroscopy is a technically challenging surgical procedure with a relatively shallow learning curve compared to open procedures. To become an expert special cognitive... (Review)
Review
Arthroscopy is a technically challenging surgical procedure with a relatively shallow learning curve compared to open procedures. To become an expert special cognitive and manual abilities have to be acquired and trained. The current situation in further medical education combined with the increasing economic pressure in the medical field does not leave enough room for a time-consuming training in arthroscopic techniques. A structured simulation training could be an alternative solution to this problem. The benefits of arthroscopic simulation training are meanwhile well documented. The complex tasks that an expert carries out during arthroscopy can be fragmented into more simple and elementary exercises and can be trained in a stress-free environment outside the operation room. An essential advantage of simulation training is the assessment of objective measurement parameters during the individual exercises. These parameters can be used to evaluate the learning process and performance of arthroscopic tasks. The aim of this review is to reflect the current state of simulation technology in arthroscopy and to show how simulator training can be meaningfully and effectively integrated into arthroscopic further training, exemplified by a modern medical further education concept.
Topics: Arthroscopy; Clinical Competence; Education, Medical, Graduate; Forecasting; Humans; Simulation Training; Video Games; Virtual Reality
PubMed: 31065737
DOI: 10.1007/s00113-019-0653-5 -
Arthroscopy : the Journal of... Jul 2017To examine surgical complications, length of stay, surgical time, cost, revision rates, clinical outcomes, current surgical trends. and minimum number of cases in... (Review)
Review
PURPOSE
To examine surgical complications, length of stay, surgical time, cost, revision rates, clinical outcomes, current surgical trends. and minimum number of cases in relationship to surgeon volume for shoulder arthroplasty and rotator cuff repair.
METHODS
We performed a systematic review of studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All studies that met inclusion criteria from January 1990 to January 2016 were included. Inclusion criteria included Level IV evidence or greater, contained specific surgeon volume, and were written in or translated into English. Exclusion criteria included non-English manuscripts, abstracts, and review papers. A written protocol was used to extract relevant data and evaluate study results. Data extracted included volume-specific data pertaining to length of stay, operating time, complications, and cost.
RESULTS
A total of 10 studies were included. Seven studies evaluated arthroplasty with 88,740 shoulders, and 3 studies evaluated rotator cuff repair with 63,535 shoulders. Variation was seen in how studies defined low- versus high-volume surgeon. For arthroplasty, <5 cases per year met the criteria for a low-volume surgeon and were associated with increased length of stay, longer operating room time, increased in-hospital complications, and increased cost. Mortality was not significantly increased. In rotator cuff surgery, <12 surgeries per year met the criteria for low volume and were associated with increased length of stay, increased operating room time, and increase in reoperation rate.
CONCLUSIONS
Our systematic review demonstrates increased surgical complications, length of stay, surgical time, and surgical cost in shoulder arthroplasty and rotator cuff repair when performed by a low-volume shoulder surgeon, which is defined by those performing <5 arthroplasties and/or <12 rotator cuff repairs per year.
LEVEL OF EVIDENCE
Level III, systematic review of Level II and III studies.
Topics: Arthroplasty; Arthroscopy; Humans; Practice Patterns, Physicians'; Rotator Cuff Injuries; Surgeons; Treatment Outcome
PubMed: 28456358
DOI: 10.1016/j.arthro.2017.03.005 -
Sports Medicine and Arthroscopy Review Dec 2018The field of hip arthroscopy has undergone considerable change in the past 25 years and continues to evolve at a rapid pace. Lessons from the early complications and... (Review)
Review
The field of hip arthroscopy has undergone considerable change in the past 25 years and continues to evolve at a rapid pace. Lessons from the early complications and challenges of hip arthroscopy have led to improved safety and refinement of instrumentation and techniques. The pathophysiology of hip injuries is better understood, and advances in surgical technique have helped expand indications, particularly as a shift from pathology resection to anatomic repair and reconstructive procedures has occurred. As the field has progressed, longitudinal outcome studies are now available to help judge efficacy. The purpose of this review is to highlight the past 30 years of hip arthroscopy, the current practice trends, and future directions of the field.
Topics: Arthroscopy; Hip Injuries; Hip Joint; Humans; Plastic Surgery Procedures
PubMed: 30395065
DOI: 10.1097/JSA.0000000000000223 -
The Journal of Rheumatology Mar 2018
Topics: Arthritis, Rheumatoid; Arthroscopy; Humans; Operating Rooms; Osteoarthritis, Knee; Rheumatologists; Rheumatology; Synovectomy; Synovitis; Ultrasonography
PubMed: 29496915
DOI: 10.3899/jrheum.170397 -
Clinics in Sports Medicine Jan 2017Anterior cruciate ligament (ACL) reconstruction is a commonly performed procedure. Drilling the femoral tunnel independent of the tibial tunnel has become popular as... (Review)
Review
Anterior cruciate ligament (ACL) reconstruction is a commonly performed procedure. Drilling the femoral tunnel independent of the tibial tunnel has become popular as surgeons strive to create tunnels in the anatomic locations of the femoral and tibial attachments of the native ligament. The 2-incision technique effectively and reproducibly accomplishes this goal. The 2-incision technique for ACL reconstruction is a valuable tool in the skillset of the reconstructive knee surgeon. Indications for the 2-incision surgery are reviewed in detail. Furthermore, technical tips, complications, and outcomes are discussed.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Arthroscopy; Autografts; Bone Development; Bone-Patellar Tendon-Bone Grafts; Humans; Patient Positioning; Postoperative Complications; Reoperation
PubMed: 27871662
DOI: 10.1016/j.csm.2016.08.004