Posterior Shoulder Instability Part I - Diagnosis, Non-Operative Management, and Labral Repair for Posterior Shoulder Instability - An International Expert Delphi Consensus Statement.
arthroscopy
dislocation
labral repair
non-operative management
posterior shoulder instability
shoulder
Journal
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
ISSN: 1526-3231
Titre abrégé: Arthroscopy
Pays: United States
ID NLM: 8506498
Informations de publication
Date de publication:
10 May 2024
10 May 2024
Historique:
received:
23
11
2023
revised:
25
03
2024
accepted:
03
04
2024
medline:
13
5
2024
pubmed:
13
5
2024
entrez:
12
5
2024
Statut:
aheadofprint
Résumé
The purpose of this study was to establish consensus statements on the diagnosis, non-operative management, and labral repair for posterior shoulder instability. A consensus process on the treatment of posterior shoulder instability was conducted, with 71 shoulder/sports surgeons from 12 countries participating based on their level of expertise in the field. Experts were assigned to one of 6 working groups defined by specific subtopics within posterior shoulder instability. Consensus was defined as achieving 80-89% agreement, whereas strong consensus was defined as 90-99% agreement, and unanimous consensus was indicated by 100% agreement with a proposed statement. Unanimous agreement was reached on the indications for non-operative management and labral repair which include whether patients had primary or recurrent instability, with symptoms/functional limitations, and whether there was other underlying pathology, or patient's preference to avoid or delay surgery. Additionally, there was unanimous agreement that recurrence rates can be diminished by attention to detail, appropriate indication and assessment of risk factors, recognition of abnormalities in glenohumeral morphology, careful capsulolabral debridement and reattachment, small anchors with inferior placement and multiple fixation points that create a bumper with the labrum, treatment of concomitant pathologies, and a well-defined rehabilitation protocol with strict postoperative immobilization. The study group achieved strong or unanimous consensus on 63% of statements related to the diagnosis, nonoperative treatment, and labrum repair for posterior shoulder instability. The statements that achieved unanimous consensus were the relative indications for non-operative management, and the relative indications for labral repair, as well as the steps to minimize complications for labral repair. There was no consensus on whether an arthrogram is needed when performing advanced imaging, the role of corticosteroids/orthobiologics in non-operative management, whether a poster-inferior portal is required.
Identifiants
pubmed: 38735410
pii: S0749-8063(24)00341-4
doi: 10.1016/j.arthro.2024.04.035
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
George S Athwal
(GS)
Julie Y Bishop
(JY)
Yaw Boache-Adjei
(Y)
Kendall E Bradley
(KE)
Robert H Brophy
(RH)
Emilio Calvo
(E)
Christopher L Camp
(CL)
Tristan Cassidy
(T)
Peter N Chalmers
(PN)
Frank A Cordasco
(FA)
Richard M Danilkowicz
(RM)
Travis A Dekker
(TA)
Ruth A Delaney
(RA)
Patrick J Denard
(PJ)
Xavier A Duralde
(XA)
Brandon J Erickson
(BJ)
Lukas Ernstbrunner
(L)
Salvatore J Frangiamore
(SJ)
Michael T Freehill
(MT)
Daniel E Goltz
(DE)
Timothy B Griffith
(TB)
Philipp R Heuberer
(PR)
Greg Hoy
(G)
Benjamin W Hoyt
(BW)
Andreas B Imhoff
(AB)
Eiji Itoi
(E)
Kelly G Kilcoyne
(KG)
Alexandre Laedermann
(A)
Brian C Lau
(BC)
Lance E Leclere
(LE)
William N Levine
(WN)
Natalia Martinez-Catalan
(N)
Bogdan A Matache
(BA)
Eric C McCarty
(EC)
Mariano E Menendez
(ME)
Peter J Millett
(PJ)
Raffy Mirzayan
(R)
Philipp Moroder
(P)
Hannan Mullett
(H)
Lionel Neyton
(L)
Gregory P Nicholson
(GP)
Michael J O'Brien
(MJ)
Brett D Owens
(BD)
Stephen A Parada
(SA)
Nata Parnes
(N)
Ignacio Pasqualini
(I)
Leo Pauzenberger
(L)
Matthew T Provencher
(MT)
Rachel M Frank
(RM)
Maximiliano Ranalletta
(M)
Scott A Rodeo
(SA)
Luciano A Rossi
(LA)
Joaquin Sanchez-Sotelo
(J)
John P Scanaliato
(JP)
Tally Lassiter
(T)
Dean C Taylor
(DC)
Alison P Toth
(AP)
Nicholas A Trasolini
(NA)
Eric R Wagner
(ER)
Brian R Waterman
(BR)
Daniel B Whelan
(DB)
John R Wickman
(JR)
Jocelyn R Wittstein
(JR)
Ivan Wong
(I)
Informations de copyright
Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.