Research progress of the diagnosis and treatment of anterior shoulder instability_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANG Xin ¹ ,  CHEN Shiyi ^2,3

1. Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;
2. Department of Sports Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, 200040, P. R. China;
3. Sports Medicine Institute, Fudan University, Shanghai, 200040, P. R. China;

Corresponding author：

CHEN Shiyi, Email: cshiyi@163.com

Keywords：

Anterior shoulder instability; diagnosis and treatment; new concepts

DOI：

10.7507/1002-1892.202305002

Video：

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The shoulder joint is the most prone to dislocation in the whole body, and more than 95% of them are anterior dislocation. Improper treatment after the initial dislocation is easy to lead to recurrent anterior dislocation or anterior shoulder instability, and the outcomes following conservative treatment is poor. Anterior shoulder instability can damage the soft tissue structure and bone structure that maintain the stability of shoulder joint, among which bone structure is the most important factor affecting the stability of shoulder joint. Diagnosis should be combined with medical history, physical examination, and auxiliary examination. Currently, three-dimensional CT is the most commonly used auxiliary examination means. However, various bone defect measurement and preoperative evaluation methods based on three-dimensional CT and the glenoid track theory have their own advantages and disadvantages, and there is still a lack of gold standard. Currently, the mainstream treatment methods mainly include Bankart procedure, coracoid process transposition, glenoid reconstruction with free bone graft, Bankart combined with Remplissage procedure, and subscapular tendon binding tamponade, etc. Each of these procedures has its own advantages and disadvantages. For the diagnosis and treatment of anterior shoulder instability, there are still too many unknown, further research and exploration need to be studied.

Citation： TANG Xin, CHEN Shiyi. Research progress of the diagnosis and treatment of anterior shoulder instability. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(5): 509-517. doi: 10.7507/1002-1892.202305002 Copy

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2. Rowe CR. Prognosis in dislocations of the shoulder. J Bone Joint Surg (Am), 1956, 38-A(5): 957-977.
3. Owens BD, Agel J, Mountcastle SB, et al. Incidence of glenohumeral instability in collegiate athletics. Am J Sports Med, 2009, 37(9): 1750-1754.
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5. Hindle P, Davidson EK, Biant LC, et al. Appendicular joint dislocations. Injury, 2013, 44(8): 1022-1027.
6. Zacchilli MA, Owens BD. Epidemiology of shoulder dislocations presenting to emergency departments in the United States. J Bone Joint Surg (Am), 2010, 92(3): 542-549.
7. Bottoni CR, Wilckens JH, DeBerardino TM, et al. A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations. Am J Sports Med, 2002, 30(4): 576-580.
8. Leroux T, Wasserstein D, Veillette C, et al. Epidemiology of primary anterior shoulder dislocation requiring closed reduction in Ontario, Canada. Am J Sports Med, 2014, 42(2): 442-450.
9. Pougès C, Hardy A, Vervoort T, et al. Arthroscopic Bankart repair versus immobilization for first episode of anterior shoulder dislocation before the age of 25: A randomized controlled trial. Am J Sports Med, 2021, 49(5): 1166-1174.
10. Taylor DC, Arciero RA. Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med, 1997, 25(3): 306-311.
11. Sugaya H, Moriishi J, Dohi M, et al. Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg (Am), 2003, 85(5): 878-884.
12. Rowe CR, Patel D, Southmayd WW. The Bankart procedure: a long-term end-result study. J Bone Joint Surg (Am), 1978, 60(1): 1-16.
13. Bigliani LU, Newton PM, Steinmann SP, et al. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med, 1998, 26(1): 41-45.
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15. Nakagawa S, Ozaki R, Take Y, et al. Relationship between glenoid defects and Hill-Sachs lesions in shoulders with traumatic anterior instability. Am J Sports Med, 2015, 43(11): 2763-2773.
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