Search Results (36)

Background: Shoulder instability imposes a substantial burden in U.S. military populations, yet epidemiology and outcomes reporting is heterogeneous. This study aims to quantify the epidemiology of shoulder instability among U.S. active-duty servicemembers and to report operative management patterns and outcomes. Methods: A systematic review was performed by searching MEDLINE, EMBASE, Scopus, Cochrane, and SPORTDiscus through 1 August 2025. Eligible studies enrolled U.S. active-duty servicemembers with clinical and/or radiographic evidence of instability. After a single comprehensive search with uniform inclusion criteria, studies were assigned to two prespecified cohorts: (1) epidemiology (incidence, directionality, risk factors) and (2) operative management/outcomes (procedure distribution, failure, complications, return to duty [RTD] and return to sport [RTS]). Incidence was pooled as a person-years–weighted fixed-effect estimate; directionality proportions were meta-analyzed with random-effects (logit-transformed) models among patient-level, unidirectional cases. Results: Forty-nine studies were included (epidemiology, n = 8; outcomes, n = 41). Three epidemiologic datasets (42,310 events; 20,472,363 person-years) yielded a pooled military incidence of 2.07 per 1000 person-years (95% CI, 2.05–2.09). Among unidirectional cases (n = 916 shoulders), anterior instability comprised 83.9% (95% CI, 70.5–91.9) and posterior the remaining 16.1% (95% CI, 8.1–29.5). Outcome series most commonly reported arthroscopic Bankart repair (n = 933 shoulders), bony augmentation (e.g., Latarjet/Bristow; n = 700), posterior labral repair (n = 649), combined repairs (n = 511), and open Bankart (n = 442). Weighted mean failure ranged 4.7–23.6%; complications 5.2–10.9%; and reoperations 5.3–17.7%. RTD ranged 50.0–84.7% and RTS 4.8–75.0%. Conclusions: Shoulder instability in U.S. servicemembers occurs at rates exceeding population-based civilian estimates, with a relatively greater share of posterior and combined patterns. Operative outcomes vary substantially across procedures. Full article

Background: Dynamic anterior stabilization (DAS) is a novel surgical technique for treating chronic anteroinferior glenohumeral instability. It presents an alternative to the currently used Bankart and Latarjet procedures, aiming to reduce associated complications and revision surgeries. However, the value of histopathological and clinical characteristics for the assessment of the prognosis and the efficacy of shoulder instability surgical treatment is still poorly understood. Objectives: The aim of this study was to evaluate the clinical effectiveness of DAS for anterior shoulder instability by analyzing clinical and histopathological characteristics. Methods: Twenty patients with anterior shoulder instability were included in the study. The patients underwent clinical assessments before the surgery and 1, 3, and 6 months after surgery. Tissue specimens from the anterior glenoid bone surface and a segment of the long head of the biceps tendon were evaluated after the surgery. Results: Our results demonstrated that the first three months postoperatively were characterized by worse functional outcomes; however, six months after the surgery, the patients demonstrated functional recovery. The extent of preoperative bone osteonecrosis was associated with functional outcomes after 6 months of surgical treatment (p = 0.034; χ² = 0.482), whereas the extent of lymphocyte infiltration was associated with pain severity (p = 0.022; χ² = 0.402). Conclusions: To conclude, our study showed that dynamic anterior stabilization is a clinically effective method, with functional recovery in 6 months. Furthermore, the associations of clinical and histopathological characteristics for the prognosis and assessment of anterior shoulder instability surgical treatment were observed. Full article

Background/Objectives: The COVID-19 pandemic limited access to in-person physiotherapy, raising concerns about post-operative rehabilitation outcomes. This prospective observational study, without a control group, evaluated whether a self-rehabilitation protocol following a mini-open Learjet procedure influenced short-term clinical outcomes in active military personnel. Materials and Methods: We prospectively enrolled 18 patients (19 shoulders) undergoing mini-open Latarjet between May and October 2020. Patients performed a standardized self-rehabilitation protocol starting on the first post-operative day, with progressive range-of-motion (ROM) exercises added at two weeks. Pain was assessed using the Visual Analog Scale (VAS), ROM was recorded at each follow-up, complications were noted, and patient satisfaction was evaluated at 12 weeks. Results: A total of eighteen patients were prospectively enrolled in the study. At 12 weeks, mean VAS decreased from 1.2 ± 0.6 at week 1 to 0 at week 4 onward. The mean drug consumption was 2.5 ± 0.7 tablets/day only for the first week. Mean assisted forward flexion improved from 155° ± 10° at week 1 to 180° in all patients by week 4. External rotation reached 60° ± 5°at 4 weeks, 75° ± 4° at 8 weeks, and 80° ± 3°at 12 weeks, with no deficits compared to the contralateral side. Internal rotation improved to the T7 level by week 8 and remained stable in week 12. No complications, recurrent instability, or graft displacements were reported. Patient satisfaction at 12 weeks was assessed using a 0–10 numeric rating scale, with a mean score of 9.5 ± 0.4. Conclusions: Implementation of a self-rehabilitation protocol after mini-open Latarjet surgery was associated with favorable short-term outcomes in young military patients, including early recovery, high satisfaction, and absence of complications. Further validation of these findings will require larger, rigorously controlled studies. Full article

Background: Recurrent anterior shoulder instability is a common problem and may be associated with glenoid bone defects. Surgical procedures, including Latarjet, are the usual treatment for anterior shoulder instability, associated with significant glenoid bone defects. The aim of this study was to evaluate the clinical outcome and glenohumeral arthritis progression in patients with recurrent anterior shoulder instability and significant bone loss treated by a modified Latarjet procedure. Methods: From July 2018 to November 2021, a prospective observational case series was carried out on 21 patients with recurrent anterior shoulder instability associated with significant bone defects treated by a modified Latarjet procedure in which the coracoid process was rotated 90° on its longitudinal axis and the subscapularis muscle was horizontally split. Patients with a glenoid defect of more than 21% were included. Post-operatively, the patients were clinically assessed using modified Rowe scoring. Glenohumeral arthritis, graft position, union, and resorption were radiologically evaluated. Results: The mean age at the time of surgery was 28.52 ± 8.0 (range: 19–45) years. The mean number of dislocations was 18.33 ± 8.67 (range: 6–35) times. The mean glenoid defect size was 26.19 ± 4.85 (range: 21–37) % and Hill–Sachs lesions were off-track in 19 cases. The mean follow-up period was 30.67 ± 7.53 (range: 16–40) months. Eighteen patients (85.7%) showed good to excellent results. The mean modified Rowe score was 85.00 ± 18.77 (range: 30–100) points. The mean external rotation loss was 8.09 ± 5.11° (range: 0–20°). No cases of recurrent instability were observed, and there was no progression of glenohumeral arthritis. Conclusions: The modified Latarjet is an effective and reliable surgical option to treat traumatic anterior shoulder instability with significant bone loss. Most of the reported complications associated with this procedure did not affect the functional outcome. Full article

Anteroinferior shoulder dislocations require surgical intervention when related to critical glenoid bone loss. Scapular spine bone blocks have emerged as a promising alternative to traditional bone augmentation techniques. However, limited data exist on their biomechanical stability when using different suture-based fixation techniques. This study aimed to evaluate primary stability and micromotion after glenoid augmentation using a scapular spine bone block. A total of 31 fresh-frozen human shoulder specimens underwent bone block augmentation. The specimens were randomized into three groups: double-screw fixation (DSF), single-suture bone block cerclage (SSBBC), and double-suture bone block cerclage (DSBBC). Biomechanical testing was conducted using cyclic loading (5000 cycles at 1 Hz) and micromotion was analyzed using an optical 3D measurement system. Statistical analysis showed that medial irreversible displacement was significantly greater in the SSBBC group compared to DSF (p = 0.0386), and no significant differences were found in anterior or inferior irreversible displacements. A significant difference was noted in posterior reversible displacement (p = 0.0035), while no differences were found in inferior or medial reversible displacements. Between DSF and DSBBC, no significant differences were found in irreversible or reversible displacements in any direction. DSBBC provided stability comparable to DSF while offering a viable metal-free alternative. In contrast, SSBBC displayed inferior biomechanical properties, raising concerns about its clinical reliability. Full article

Arthroscopic shoulder surgery has undergone significant advancements over the past decades, transitioning from a primarily diagnostic tool to a comprehensive therapeutic approach. Technological innovations and refined surgical techniques have expanded the indications for arthroscopy, allowing minimally invasive management of shoulder instability and rotator cuff pathology. Methods: This narrative review explores the historical evolution, current trends, and future perspectives in arthroscopic shoulder surgery. Results: Key advancements in shoulder instability management include the evolution of the arthroscopic Bankart repair, the introduction of the remplissage technique for Hill–Sachs lesions, and the development of arthroscopic Latarjet procedures. Additionally, novel techniques such as Dynamic Anterior Stabilization (DAS) and bone block procedures have emerged as promising solutions for complex instability cases. In rotator cuff repair, innovations such as the suture-bridge double-row technique, superior capsular reconstruction (SCR), and biological augmentation strategies, including dermal allografts and bioinductive patches, have contributed to improving tendon healing and functional outcomes. The role of biologic augmentation, including biceps tendon autografts and subacromial bursa augmentation, is also gaining traction in enhancing repair durability. Conclusions: As arthroscopic techniques continue to evolve, the integration of biologic solutions and patient-specific surgical planning will likely define the future of shoulder surgery. This review provides a comprehensive assessment of current state-of-the-art techniques and discusses their clinical implications, with a focus on optimizing patient outcomes and minimizing surgical failure rates. Full article

Purpose: This study aimed to determine the relationship between alpha angle (the angle between the screws and the glenoid) and thoracic diameters in patients undergoing the Latarjet procedure. Defining the relationship between thoracic morphology and alpha angle is aimed at filling the gap in the literature and improving surgical outcomes. Methods: This retrospective study analyzed 74 patients who underwent the Latarjet procedure for recurrent anterior shoulder instability between 2022 and 2024. All procedures were performed by the same surgeon using a standardized protocol to ensure consistency of surgical technique across cases. In postoperative chest CT scans, alpha angle, anteroposterior diameter of the thorax, transverse diameter of hemithorax, scapular inclination, and glenoid version were evaluated. Results: The study included predominantly male patients (90%) with a mean age of 26.4 ± 6.4 years who underwent Latarjet procedures predominantly on the right side (60%). Significant associations were observed between thoracic morphology and alpha angle on postoperative CT scans. There was a significant positive correlation between anterior-posterior/transverse diameter ratio (AP/T) and alpha angle (r = 0.407, p < 0.001), as well as correlations between scapular inclination, glenoid version, thoracoscapular angle, and alpha angle (r = 0.275, p = 0.018; r = 0.241, p = 0.039; r = −0.288, p = 0.013, respectively). Patients were divided based on an alpha angle threshold of 15 degrees, with results indicating worse outcomes for angles above this threshold. Additionally, the AP/T ratio demonstrated predictive value for poor outcomes (AUC = 0.660, p = 0.018) with a threshold of 1.2545. Conclusions: This study highlights the direct impact of thoracic morphology on the alpha angle observed on post-Latarjet chest CT scans. Specifically, patients with a higher ratio of anterior-posterior to transverse thoracic diameter (AP/T) show a proportional increase in alpha angle. When the AP/T ratio exceeds 1.25, surgeons may face challenges in achieving the target alpha angle. Full article

Background: The treatment of patients affected by recurrent anterior shoulder instability has received more attention in the last ten years, focusing on the management of bone loss, which is crucial in predicting postoperative recurrence risk. Recently, various bone grafting techniques and different fixation methods have been developed to preserve native anatomy and reduce complications. Nowadays, glenoid bone reconstruction is usually carried out via the Latarjet procedure or free bone block technique. While the Latarjet procedure has traditionally been considered the best option, the bone block has been demonstrated to be a successful procedure. Even though the indication to perform a free bone block or a Latarjet procedure may be given preoperatively, in cases where the choice between the two procedures is unclear, the decision can be made intraoperatively, given the possibility to switch from one to another. This technical note aims to outline our techniques for the arthroscopic Latarjet procedure and the arthroscopic free bone block, as well as discuss the indications, benefits and downsides of each procedure. Technical tips and tricks are provided. Methods: A step-by-step thorough description of bone block and Latarjet procedures is provided, as well as a comparison of advantages and disadvantages of each technique and tips to avoid complications. Respective indications are discussed. Results: Both the procedures have benefits and downsides. The arthroscopic Latarjet procedure is the most effective in addressing anterior shoulder instability, but is more elaborate, has a shallow learning curve and can have a high complication rate. The bone block technique is an anatomic procedure with a shorter learning curve but has fewer indications. Conclusion: The Latarjet is currently considered the gold standard for glenoid bone grafting. The bone block technique can allegedly be seen as being “in the middle” of the soft tissue repair and Latarjet procedures. Many factors should be considered when choosing the right surgical technique, and treatment plans must be customized for each patient. More studies with long-term follow-up are needed to evaluate the efficacy of arthroscopic bone grafting procedures in various subtypes of patients based on bipolar bone loss assessment and individual risk factors. Full article

Background: Neglected anterior glenohumeral dislocations provide a challenging problem for physicians. For many patients with these injuries, reverse shoulder arthroplasty has been the treatment of choice, although the preservation of the patient’s own humeral head might have significant advantages. Methods: We present a case of a 66-year-old male with a neglected anterior glenohumeral dislocation that he sustained 6 weeks prior when he was hit by a car as a pedestrian. Radiographic imaging revealed a large off-track Hill-Sachs deformity and a fracture of the greater tuberosity in addition to the persisting glenohumeral dislocation. We performed open reduction and to aid stability, an infraspinatus tendon remplissage and a Latarjet procedure were performed. Results: Apart from minor and self-limiting neuropraxia, recovery was without complications. At 24 month follow-up, the patient had no impairment in general activities, had no residual pain, and had a good active range of motion. Conclusions: The authors, therefore, believe that a combination of infraspinatus tendon remplissage and the Latarjet procedure seems a feasible alternative for reverse shoulder arthroplasty and can preserve the patient’s own humeral head. Full article

Background/Objectives: Recurrent shoulder instability following Bankart lesion repair often necessitates surgical revision. This systematic review aims to understand the failure rates of arthroscopic revision Bankart repair. Methods: Following the PRISMA guidelines and registered on PROSPERO, this systematic review examined twenty-five articles written between 2000 and 2024. Two independent reviewers assessed eligibility across three databases, focusing on recurrent instability as the primary endpoint, while also noting functional measures, adverse events, revision operations, and return-to-sport rates when available. Results: The key surgical techniques for recurrent instability post-Bankart repair were identified, with revision arthroscopic Bankart being the most common (685/1032). A comparative analysis revealed a significantly lower recurrence for open coracoid transfer compared to arthroscopic revision Bankart repair (9.67% vs. 17.14%; p < 0.001), while no significant difference was observed between remplissage plus Bankart repair and Bankart repair alone (23.75% vs. 17.14%; p = 0.24). The majority of studies did not include supracritical glenoid bone loss or engaging Hill–Sachs lesions, and neither subcritical nor non-engaging lesions significantly influenced recurrence rates (p = 0.85 and p = 0.80, respectively). Conclusions: Revision arthroscopic Bankart repair remains a viable option in the absence of bipolar bone loss; however, open coracoid transfer appears to have lower recurrence rates than arthroscopic Bankart repair, consistent with prior evidence. Further studies should define cutoffs and investigate the roles of critical glenoid bone loss and off-track Hill–Sachs lesions. Preoperative measurements of GBL on three-dimensional computed tomography and characterizing lesions based on glenoid track will help surgeons to choose ideal candidates for arthroscopic revision Bankart repair. Full article

Paediatric and adolescent shoulder instability is caused by a unique combination of traumatic factors, ligamentous laxity, and pattern of muscle contractility. The multifactorial nature of its aetiology makes interpretation of the literature difficult as nomenclature is also highly variable. The purpose of this review is to summarize the existing literature and shed light on the nuances of paediatric and adolescent shoulder instability. The epidemiology, clinical features, imaging, and management of all forms of paediatric shoulder instability are presented. The main findings of this review are that structural abnormalities following a dislocation are uncommon in pre-pubertal paediatric patients. Young post-pubertal adolescents are at the highest risk of failure of non-operative management in the setting of traumatic instability with structural abnormality, and early stabilisation should be considered for these patients. Remplissage and the Latarjet procedure are safe treatment options for adolescents at high risk of recurrence, but the side-effect profile should be carefully considered. Patients who suffer from instability due to generalized ligamentous laxity benefit from a structured, long-term physiotherapy regimen, with surgery in the form of arthroscopic plication as a viable last resort. Those who suffer from a predominantly muscle patterning pathology do not benefit from surgery and require focus on regaining neuromuscular control. Full article

Nanocomposites of cyanate ester resin (CER) filled with three different reactive amino-functionalized polyhedral oligomeric silsesquioxane (POSS) were synthesized and characterized. The addition of a small quantity (0.1 wt.%) of amino-POSS chemically grafted to the CER network led to the increasing thermal stability of the CER matrix by 12–15 °C, depending on the type of amino-POSS. A significant increase of the glass transition temperature, T_g (DSC data), and the temperature of α relaxation, T_α (DMTA data), by 45–55 °C of the CER matrix with loading of nanofillers was evidenced. CER/POSS films exhibited a higher storage modulus than that of neat CER in the temperature range investigated. It was evidenced that CER/aminopropylisobutyl (APIB)-POSS, CER/N-phenylaminopropyl (NPAP)-POSS, and CER/aminoethyl aminopropylisobutyl (AEAPIB)-POSS nanocomposites induced a more homogenous α relaxation phenomenon with higher T_α values and an enhanced nanocomposite elastic behavior. The value of the storage modulus, E′, at 25 °C increased from 2.72 GPa for the pure CER matrix to 2.99–3.24 GPa for the nanocomposites with amino-functionalized POSS nanoparticles. Furthermore, CER/amino-POSS nanocomposites possessed a higher specific surface area, gas permeability (CO₂, He), and diffusion coefficients (CO₂) values than those for neat CER, due to an increasing free volume of the nanocomposites studied that is very important for their gas transport properties. Permeability grew by about 2 (He) and 3.5–4 times (CO₂), respectively, and the diffusion coefficient of CO₂ increased approximately twice for CER/amino-POSS nanocomposites in comparison with the neat CER network. The efficiency of amino-functionalized POSS in improving the thermal and transport properties of the CER/amino-POSS nanocomposites increased in a raw of reactive POSS containing one primary (APIB-POSS) < eight secondary (NPAP-POSS) < one secondary and one primary (AEAPIB-POSS) amino groups. APIB-POSS had the least strongly pronounced effect, since it could form covalent bonds with the CER network only by a reaction of one -NH₂ group, while AEAPIB-POSS displayed the most highly marked effect, since it could easily be incorporated into the CER network via a reaction of –NH₂ and –NH– groups with –O–C≡N groups from CER. Full article

Some original poly(tetrasubstituted imidazole)s incorporating different units were synthesized and characterized. These materials were obtained via a cascade polycondensation process assisted by microwave irradiation that was developed by our team. This time, we integrated two well-known chromophore structures into the macromolecular backbone, which were benzothiadiazole (BTD) and diketopyrrolopyrrole (DKPP). These new polymers were fully characterized: their chemical structures were confirmed using NMR spectroscopy and their thermal, optical and electrochemical properties were investigated and compared with a reference polymer containing a phenyl spacer instead of the mentioned chromophore units. These materials were found to exhibit a large Stokes shift of up to 350 nm. Furthermore, a polymer presenting large absorption on the UV–visible range and an emission close to the near-infrared region was obtained by coupling the mentioned moieties. According to the established properties of this latter polymer, it presents a potential for applications in biological imaging or optoelectronic devices. Full article

The arthroscopic Bankart–Latarjet procedure is used in the surgical management of anterior shoulder instability. This technique is mainly performed in referral centers due to its high technicity. This study aimed to evaluate surgical outcomes in a peripheral hospital center. This is a retrospective study of patients treated for recurrent anterior shoulder instability. The clinical scores (Walch–Duplay, Rowe, and Western Ontario Shoulder Instability Index (WOSI)) were assessed preoperatively and at 12 months after surgery. The consolidation and the position of the bone block were evaluated at 6 months using a CT scan. Between 2016 and 2020, 40 patients had been operated on (mean age: 28.5 ± 7.9 years). During a mean follow-up of 29.5 ± 11.6 months, we noted only one complication, a case of fracture of the callus of a consolidated bone block. No recurrence of instability was recorded. The Walch–Duplay score increased from 17.8 to 94.6, the Rowe score from 24.9 to 96.8, and the WOSI score decreased from 52.1% to 6.9%. The bone block was consolidated in 35 patients (87.5%), and a flush position with the anterior edge of the glenoid was noted for all patients. At one year, 67.0% of the patients practicing sport had returned to sports. The arthroscopic Bankart–Latarjet technique was a reliable procedure in the hands of an experienced shoulder surgeon, even in a peripheral hospital center. Full article

Phenolic compounds in olive leaves have an excellent antioxidant activity and good antimicrobial properties. These bioactive molecules have beneficial properties for health, arousing great scientific and commercial interest. This study reports lyophilized olive leaf extracts (OLE) encapsulated by spray-drying using maltodextrins, maltodextrins–pectin and maltodextrins–gum Arabic as encapsulating agents. Lyophilized OLE were collected from two varieties cultivated in a harsh pedo-climatic conditions of the arid region of Tunisia. The effects of the genetic factor and the different encapsulating agents on the physicochemical properties of microcapsules and their behavior during storage, as well as their antimicrobial activities, were studied. Microcapsules successfully passed heat treatment and storage conditions and their antimicrobial activities were preserved. The encapsulating agent combination improved the encapsulation efficiency and the product yield in Zarrazi variety compared to Dhokar one. In addition, Dhokar variety microparticles showed the best heat stability at 4 and 25 °C after 90 days of storage and the higher inhibition percent against bacteria. The results of the present study evidenced that the best conditions for OLE encapsulation were obtained when the maltodextrins–pectin and maltodextrins–gum Arabic were combined to form a hybrid coating material. Full article