Cargando…
The Frequency of Glenohumeral Cartilage Lesions at the time of Shoulder Instability Surgery: A Multicenter Comparison of Primary and Revision Surgery Patients
OBJECTIVES: Revision shoulder stabilization procedures present a unique set of challenges that should be recognized by the treating surgeon in order to improve the likelihood of success. The current study aims to compare patient factors, intraoperative findings, and patient reported outcome measures...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5542137/ http://dx.doi.org/10.1177/2325967117S00254 |
_version_ | 1783254925573095424 |
---|---|
author | Duchman, Kyle R. Hettrich, Carolyn M. Westermann, Robert W. Glass, Natalie Kuhn, John E. Wolf, Brian R. |
author_facet | Duchman, Kyle R. Hettrich, Carolyn M. Westermann, Robert W. Glass, Natalie Kuhn, John E. Wolf, Brian R. |
author_sort | Duchman, Kyle R. |
collection | PubMed |
description | OBJECTIVES: Revision shoulder stabilization procedures present a unique set of challenges that should be recognized by the treating surgeon in order to improve the likelihood of success. The current study aims to compare patient factors, intraoperative findings, and patient reported outcome measures between patients undergoing primary versus revision shoulder stabilization surgery. METHODS: The Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort was utilized to identify all patients undergoing primary and revision open or arthroscopic shoulder instability surgery. Patients with concomitant rotator cuff pathology requiring operative repair were excluded. Patient demographic characteristics, intraoperative findings, and patient reported outcome measures at the time of shoulder stabilization were compared between primary and revision shoulder instability surgery patients using univariate methods using chi-square or Fisher exact tests for categorical variables and Wilcoxon rank sum test for continuous variables. RESULTS: Primary shoulder stabilization procedures were performed in 625 (87.0%) patients and revision stabilization procedures in 93 patients (13.0%). Patients undergoing revision surgery were older (25.9 vs. 23.5 years, p<0.001), more frequently smoked (11.8 vs. 6.1%, p = 0.04), had a higher number of reported dislocation events (p = 0.004), and were more likely to undergo an open procedure as opposed to an all arthroscopic shoulder instability procedure (67.7 vs. 5.8%, p<0.001). Patients undergoing revision procedures were more likely to have glenoid or humeral head cartilage lesions at the time of surgery (77.4 vs. 57.8%, p<0.001), with bone loss involving greater than 20% of the glenoid or humeral head more frequently reported in revision procedures (19.4 vs. 2.6%, p <0.001) (Figure 1). However, the presence of glenohumeral bone loss did not negatively impact patient reported outcomes at the time of shoulder instability surgery. CONCLUSION: Glenohumeral articular cartilage lesions are a common finding at the time of shoulder stabilization procedures and are particularly frequent in patients undergoing revision stabilization procedures. Surgeons routinely performing these procedures should be prepared to deal with the technical challenges associated with glenoid or humeral head bone loss. However, at the time of surgery, the presence of articular cartilage lesions did not appear to negatively influence patient reported outcomes. Future studies should investigate the influence of articular cartilage lesions at mid- and long-term follow-up in this cohort of patients. |
format | Online Article Text |
id | pubmed-5542137 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-55421372017-08-24 The Frequency of Glenohumeral Cartilage Lesions at the time of Shoulder Instability Surgery: A Multicenter Comparison of Primary and Revision Surgery Patients Duchman, Kyle R. Hettrich, Carolyn M. Westermann, Robert W. Glass, Natalie Kuhn, John E. Wolf, Brian R. Orthop J Sports Med Article OBJECTIVES: Revision shoulder stabilization procedures present a unique set of challenges that should be recognized by the treating surgeon in order to improve the likelihood of success. The current study aims to compare patient factors, intraoperative findings, and patient reported outcome measures between patients undergoing primary versus revision shoulder stabilization surgery. METHODS: The Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort was utilized to identify all patients undergoing primary and revision open or arthroscopic shoulder instability surgery. Patients with concomitant rotator cuff pathology requiring operative repair were excluded. Patient demographic characteristics, intraoperative findings, and patient reported outcome measures at the time of shoulder stabilization were compared between primary and revision shoulder instability surgery patients using univariate methods using chi-square or Fisher exact tests for categorical variables and Wilcoxon rank sum test for continuous variables. RESULTS: Primary shoulder stabilization procedures were performed in 625 (87.0%) patients and revision stabilization procedures in 93 patients (13.0%). Patients undergoing revision surgery were older (25.9 vs. 23.5 years, p<0.001), more frequently smoked (11.8 vs. 6.1%, p = 0.04), had a higher number of reported dislocation events (p = 0.004), and were more likely to undergo an open procedure as opposed to an all arthroscopic shoulder instability procedure (67.7 vs. 5.8%, p<0.001). Patients undergoing revision procedures were more likely to have glenoid or humeral head cartilage lesions at the time of surgery (77.4 vs. 57.8%, p<0.001), with bone loss involving greater than 20% of the glenoid or humeral head more frequently reported in revision procedures (19.4 vs. 2.6%, p <0.001) (Figure 1). However, the presence of glenohumeral bone loss did not negatively impact patient reported outcomes at the time of shoulder instability surgery. CONCLUSION: Glenohumeral articular cartilage lesions are a common finding at the time of shoulder stabilization procedures and are particularly frequent in patients undergoing revision stabilization procedures. Surgeons routinely performing these procedures should be prepared to deal with the technical challenges associated with glenoid or humeral head bone loss. However, at the time of surgery, the presence of articular cartilage lesions did not appear to negatively influence patient reported outcomes. Future studies should investigate the influence of articular cartilage lesions at mid- and long-term follow-up in this cohort of patients. SAGE Publications 2017-07-31 /pmc/articles/PMC5542137/ http://dx.doi.org/10.1177/2325967117S00254 Text en © The Author(s) 2017 http://creativecommons.org/licenses/by-nc-nd/3.0/ This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For reprints and permission queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav. |
spellingShingle | Article Duchman, Kyle R. Hettrich, Carolyn M. Westermann, Robert W. Glass, Natalie Kuhn, John E. Wolf, Brian R. The Frequency of Glenohumeral Cartilage Lesions at the time of Shoulder Instability Surgery: A Multicenter Comparison of Primary and Revision Surgery Patients |
title | The Frequency of Glenohumeral Cartilage Lesions at the time of Shoulder Instability Surgery: A Multicenter Comparison of Primary and Revision Surgery Patients |
title_full | The Frequency of Glenohumeral Cartilage Lesions at the time of Shoulder Instability Surgery: A Multicenter Comparison of Primary and Revision Surgery Patients |
title_fullStr | The Frequency of Glenohumeral Cartilage Lesions at the time of Shoulder Instability Surgery: A Multicenter Comparison of Primary and Revision Surgery Patients |
title_full_unstemmed | The Frequency of Glenohumeral Cartilage Lesions at the time of Shoulder Instability Surgery: A Multicenter Comparison of Primary and Revision Surgery Patients |
title_short | The Frequency of Glenohumeral Cartilage Lesions at the time of Shoulder Instability Surgery: A Multicenter Comparison of Primary and Revision Surgery Patients |
title_sort | frequency of glenohumeral cartilage lesions at the time of shoulder instability surgery: a multicenter comparison of primary and revision surgery patients |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5542137/ http://dx.doi.org/10.1177/2325967117S00254 |
work_keys_str_mv | AT duchmankyler thefrequencyofglenohumeralcartilagelesionsatthetimeofshoulderinstabilitysurgeryamulticentercomparisonofprimaryandrevisionsurgerypatients AT hettrichcarolynm thefrequencyofglenohumeralcartilagelesionsatthetimeofshoulderinstabilitysurgeryamulticentercomparisonofprimaryandrevisionsurgerypatients AT westermannrobertw thefrequencyofglenohumeralcartilagelesionsatthetimeofshoulderinstabilitysurgeryamulticentercomparisonofprimaryandrevisionsurgerypatients AT glassnatalie thefrequencyofglenohumeralcartilagelesionsatthetimeofshoulderinstabilitysurgeryamulticentercomparisonofprimaryandrevisionsurgerypatients AT kuhnjohne thefrequencyofglenohumeralcartilagelesionsatthetimeofshoulderinstabilitysurgeryamulticentercomparisonofprimaryandrevisionsurgerypatients AT wolfbrianr thefrequencyofglenohumeralcartilagelesionsatthetimeofshoulderinstabilitysurgeryamulticentercomparisonofprimaryandrevisionsurgerypatients AT duchmankyler frequencyofglenohumeralcartilagelesionsatthetimeofshoulderinstabilitysurgeryamulticentercomparisonofprimaryandrevisionsurgerypatients AT hettrichcarolynm frequencyofglenohumeralcartilagelesionsatthetimeofshoulderinstabilitysurgeryamulticentercomparisonofprimaryandrevisionsurgerypatients AT westermannrobertw frequencyofglenohumeralcartilagelesionsatthetimeofshoulderinstabilitysurgeryamulticentercomparisonofprimaryandrevisionsurgerypatients AT glassnatalie frequencyofglenohumeralcartilagelesionsatthetimeofshoulderinstabilitysurgeryamulticentercomparisonofprimaryandrevisionsurgerypatients AT kuhnjohne frequencyofglenohumeralcartilagelesionsatthetimeofshoulderinstabilitysurgeryamulticentercomparisonofprimaryandrevisionsurgerypatients AT wolfbrianr frequencyofglenohumeralcartilagelesionsatthetimeofshoulderinstabilitysurgeryamulticentercomparisonofprimaryandrevisionsurgerypatients |