The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Traumatic Anterior Shoulder Instability: A Systematic Review and Proposed Modern Classification System

Document Type : In Brief

Authors
Al-Achraf Khoriati 1
Zien A. Fozo 2
Tony Antonios 1
Richard Dimock 3
Mohamed Imam 4
Ali Narvani 5
1 Ashford and St Peters Hospital NHS Trust, Surrey, UK
2 Ysbyty Gwynedd Hospital, Wales, UK
3 Maidstone & Tunbridge Wells Hospitals NHS Trust, Kent, UK
4 Ashford and St Peters Hospital NHS Trust, Surrey, UK- Smart Health Centre, University of East London, London, UK
5 Ashford and St Peters Hospital NHS Trust, Surrey, UK- Fortius Clinic, London, UK
10.22038/abjs.2024.78466.3617
Abstract
Numerous surgical techniques have been developed to address recurrent anterior shoulder instability, 
with the Bankart repair and the Latarjet procedure emerging as dominant. With recent advancements 
in keyhole surgery, there's been a surge in popularity for all-arthroscopic procedures. Our systematic 
review aims to determine if there's justification for incorporating these techniques into a classification 
system for guiding treatment of traumatic anterior recurrent instability. We identified and an alysed a 
variety of key studies, including 12 systematic reviews, three prospective studies, seven non -
randomized prospective and retrospective studies, along with one biomechanical study. Our study 
sheds light on the wide range of procedures available to shoulder surgeons dealing with traumatic 
anterior recurrent instability. We introduce a novel classification system (BoTH) designed to simplify 
the decision-making process in this context.
 Level of evidence: I
Keywords
Classification
Instability
Shoulder
Subjects
  1. Markatos K, Karamanou M, Tsourouflis G, Androutsos G, Mavrogenis AF. Ambroise Paré (1510-1590): on the diagnosis and treatment of shoulder dislocations. Int Orthop. 2018; 42(1):215-218. doi:10.1007/s00264-017-3585-0.
  2. Rashid MS, Arner JW, Millett PJ, Sugaya H, Emery R. The Bankart repair: past, present, and future. Journal of Shoulder and Elbow Surgery. 2020; 29(12):e491-e498. doi:10.1016/j.jse.2020.06.012.
  3. Zhang M, Liu J, Jia Y, et al. Risk factors for recurrence after Bankart repair: a systematic review and meta-analysis. J Orthop Surg Res. 2022; 17:113. doi:10.1186/s13018-022-03011-w.
  4. Ekhtiari S, Horner NS, Bedi A, Ayeni OR, Khan M. The Learning Curve for the Latarjet Procedure: A Systematic Review. Orthop J Sports Med. 2018; 6(7):2325967118786930. doi:10.1177/2325967118786930.
  5. Gupta A, Delaney R, Petkin K, Lafosse L. Complications of the Latarjet procedure. Curr Rev Musculoskelet Med. 2015; 8(1):59-66. doi:10.1007/s12178-015-9258-y.
  6. Ernstbrunner L, Waltenspül M, Suter C, El-Nashar R, Scherr J, Wieser K. Primary Open Latarjet Procedure Results in Functional Differences but No Structural Changes in Subscapularis Muscle Quality vs the Healthy Contralateral Shoulder at Long-term Follow-up. Am J Sports Med. 2022; 50(6):1495-1502. doi:10.1177/03635465221079858.
  7. Bliven KCH, Parr GP. Outcomes of the Latarjet Procedure Compared With Bankart Repair for Recurrent Traumatic Anterior Shoulder Instability. J Athl Train. 2018; 53(2):181-183. doi:10.4085/1062-6050-232-16.
  8. Imam MA, Shehata MSA, Martin A, et al. Bankart Repair Versus Latarjet Procedure for Recurrent Anterior Shoulder Instability: A Systematic Review and Meta-analysis of 3275 Shoulders. Am J Sports Med. 2021; 49(7):1945-1953. doi:10.1177/0363546520962082.
  9. Goodrich E, Wolf M, Vopat M, et al. Sex-specific differences in outcomes after anterior shoulder surgical stabilization: a

 

meta-analysis and systematic review of literature. JSES Int. 2021; 6(1):123-131. doi:10.1016/j.jseint.2021.10.002.

  1. Verweij LPE, van Spanning SH, Grillo A, et al. Age, participation in competitive sports, bony lesions, ALPSA lesions, > 1 preoperative dislocations, surgical delay and ISIS score > 3 are risk factors for recurrence following arthroscopic Bankart repair: a systematic review and meta-analysis of 4584 shoulders. Knee Surg Sports Traumatol Arthrosc. 2021; 29(12):4004-4014. doi:10.1007/s00167-021-06704-7.
  2. Tahir M, Malik S, Jordan R, Kronberga M, D’Alessandro P, Saithna A. Arthroscopic bone block stabilisation procedures for glenoid bone loss in anterior glenohumeral instability: A systematic review of clinical and radiological outcomes. Orthop Traumatol Surg Res. 2021; 107(5):102949. doi:10.1016/j.otsr.2021.102949.
  3. Bah A, Lateur GM, Kouevidjin BT, et al. Chronic anterior shoulder instability with significant Hill-Sachs lesion: Arthroscopic Bankart with remplissage versus open Latarjet procedure. Orthop Traumatol Surg Res. 2018; 104(1):17-22. doi:10.1016/j.otsr.2017.11.009.
  4. Nicholson AD, Carey EG, Mathew JI, et al. Biomechanical analysis of anterior stability after 15% glenoid bone loss: comparison of Bankart repair, dynamic anterior stabilization, dynamic anterior stabilization with Bankart repair, and Latarjet. J Shoulder Elbow Surg. 2022; 31(11):2358-2365. doi:10.1016/j.jse.2022.04.017.
  5. Polyzois I, Dattani R, Gupta R, Levy O, Narvani AA. Traumatic First Time Shoulder Dislocation: Surgery vs Non-Operative Treatment. The Archives of Bone and Joint Surgery. 2016; 4(2):104-108. doi:10.22038/abjs.2016.5305
  6. Rosenberg SI, Padanilam SJ, Pagni BA, Tjong VK, Sheth U. A lower Instability Severity Index score threshold may better predict recurrent anterior shoulder instability after arthroscopic Bankart repair: a systematic review. J ISAKOS. 2021; 6(5):295-301. doi:10.1136/jisakos-2020-000584.
  7. Dekker TJ, Peebles LA, Bernhardson AS, et al. Limited Predictive Value of the Instability Severity Index Score: Evaluation of 217 Consecutive Cases of Recurrent Anterior Shoulder Instability. Arthroscopy. 2021; 37(5):1381-1391. doi:10.1016/j.arthro.2020.12.185.
  8. Xu Y, Wu K, Ma Q, et al. Comparison of clinical and patient-reported outcomes of three procedures for recurrent anterior shoulder instability: arthroscopic Bankart repair, capsular shift, and open Latarjet. J Orthop Surg Res. 2019; 14:326. doi:10.1186/s13018-019-1340-5.
  9. Moroder P, Schulz E, Wierer G, et al. Neer Award 2019: Latarjet procedure vs. iliac crest bone graft transfer for treatment of anterior shoulder instability with glenoid bone loss: a prospective randomized trial. Journal of Shoulder and Elbow Surgery. 2019; 28(7):1298-1307. doi:10.1016/j.jse.2019.03.035.
  10. Garcia JC, do Amaral FM, Belchior RJ, de Carvalho LQ, Markarian GG, Montero EF de S. Comparative Systematic Review of Fixation Methods of the Coracoid and Conjoined Tendon in the Anterior Glenoid to Treat Anterior Shoulder Instability. Orthop J Sports Med. 2019; 7(1):2325967118820539. doi:10.1177/2325967118820539.
  11. Taverna E, Garavaglia G, Perfetti C, Ufenast H, Sconfienza LM, Guarrella V. An arthroscopic bone block procedure is effective in restoring stability, allowing return to sports in cases of glenohumeral instability with glenoid bone deficiency. Knee Surg Sports Traumatol Arthrosc. 2018;26(12):3780-3787. doi:10.1007/s00167-018-4921-7.
  12. Camus D, Domos P, Berard E, Toulemonde J, Mansat P, Bonnevialle N. Isolated arthroscopic Bankart repair vs. Bankart repair with “remplissage” for anterior shoulder instability with engaging Hill-Sachs lesion: A meta-analysis. Orthop Traumatol Surg Res. 2018; 104(6):803-809. doi:10.1016/j.otsr.2018.05.011.
  13. Miyamoto R, Yamamoto A, Shitara H, et al. Clinical Outcome of Arthroscopic Remplissage as Augmentation During Arthroscopic Bankart Repair for Recurrent Anterior Shoulder Instability. Open Orthop J. 2017; 11:1268-1276. doi:10.2174/1874325001711011268.
  14. Itoi E. ‘On-track’ and ‘off-track’ shoulder lesions. EFORT Open Reviews. 2017; 2(8):343-351. doi:10.1302/2058-5241.2.170007.
  15. Wu C, Xu J, Fang Z, et al. Clinical and Radiological Outcomes in Patients With Anterior Shoulder Instability and Glenoid Bone Loss after Arthroscopic Free Bone Block Combined With Dynamic Anterior Stabilization. Am J Sports Med. 2023; 51(1):187-197. doi:10.1177/03635465221137883.
  16. de Campos Azevedo C, Ângelo AC. Onlay Dynamic Anterior Stabilization with Biceps Transfer for the Treatment of Anterior Glenohumeral Instability Produces Good Clinical Outcomes and Successful Healing at a Minimum 1 Year of Follow-Up. Arthrosc Sports Med Rehabil.2023; 5(2):e445-e457. doi: 10.1016/j.asmr.2023.01.012.
  17. Wu C, Xu J, Fang Z, et al. Arthroscopic Dynamic Anterior Stabilization Using Either Long Head of the Biceps or Conjoined Tendon Transfer for Anterior Shoulder Instability Results in a Similarly Low Recurrence Rate. Arthroscopy.2023; 39(7):1618-1627. doi: 10.1016/j.arthro.2022.12.040.
  18. Memon SD, Dimock RAC, Shah J, Ajami S, Imam M, Narvani AA. Arthroscopic Allograft Bone Block Procedure with Remplissage for Bipolar Lesions. Arch Bone Jt Surg.2022; 10(10):899-910. doi: 10.22038/ABJS.2022.64126.3085.

 

 

 

The Archives of Bone and Joint Surgery
Volume 12, Issue 9
September 2024
Pages 669-673

  • Receive Date 10 March 2024
  • Revise Date 13 July 2024
  • Accept Date 12 June 2024