| 1. |
- Gordins, Vladislavs, et al.
(författare)
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Risk of arthropathy after the Bristow-Latarjet repair : a radiologic and clinical thirty-three to thirty-five years of follow-up of thirty-one shoulders
- 2015
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Ingår i: Journal of shoulder and elbow surgery. - : Elsevier BV. - 1058-2746 .- 1532-6500. ; 24:5, s. 691-699
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Transfer of the coracoid (Bristow-Latarjet [B-L]) is used to stabilize anterior shoulder instability. We report the long-term results of our first 31 operations with this method.MATERIALS AND METHODS: Thirty-six patients (mean age, 26.7 years) had a B-L repair from 1977 to 1979. Five patients died, and during 2012 to 2013, the remaining 31 shoulders had a follow-up with questionnaire, physical examination, Western Ontario Shoulder Instability Index, Subjective Shoulder Value, Subjective Assessment of Shoulder Function, subjective assessment of loss of motion, and radiologic imaging.RESULTS: One patient required revision surgery because of recurrence and another because of repeat dislocation. Six patients reported subluxations. Eighteen patients (58%) were very satisfied, and 13 (42%) were satisfied. The mean Western Ontario Shoulder Instability Index score (100 possible) was 85, and the median score was 93. According to Samilson-Prieto classification of arthropathy of the shoulder, 39% were classified as normal, 27% as mild, 23% as moderate, and 11% as severe. The classification of arthropathy varied with observers and radiologic views. Age younger than 22 years at the primary dislocation meant less arthropathy at follow-up (P = .045).CONCLUSION: The degree of arthropathy 33 to 35 years after the B-L repair seems to follow the natural history of shoulder dislocation with respect to arthropathic joint degeneration. Postoperative restriction of external rotation does not increase later arthropathy.
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| 2. |
- Hovelius, Lennart, et al.
(författare)
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Bristow-Latarjet and Bankart : a comparative study of shoulder stabilization in 185 shoulders during a seventeen-year follow-up
- 2011
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Ingår i: Journal of shoulder and elbow surgery. - St. Louis, MO : Mosby Yearbook, Inc.. - 1058-2746 .- 1532-6500. ; 20:7, s. 1095-1101
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Tidskriftsartikel (refereegranskat)abstract
- Background: In 2 Swedish hospitals, 88 consecutive shoulders underwent Bankart repair (B), and 97 consecutive shoulders underwent Bristow-Latarjet repair (B-L) for traumatic anterior recurrent instability. Materials and methods: Mean age at surgery was 28 years (B-L group) and 27 years (B group). All shoulders had a follow-up by letter or telephone after a mean of 17 years (range, 13-22 years). The patients answered a questionnaire and completed the Western Ontario Shoulder Index (WOSI), Disability of Arm Shoulder and Hand (DASH), and SSV (Simple Shoulder Value) assessments. Results: Recurrance resulted revision surgery in 1 shoulder in the B-L group and in 5 shoulders in the B group (P=.08). Redislocation or subluxation after the index operation occurred in 13 of 97 B-L shoulders and in 25 of 87 of B shoulders (after excluding 1 patient with arthroplasty because of arthropathy, P=.017). Of the 96 Bristow shoulders, 94 patients were very satisfied/satisfied compared with 71 of 80 in the B series (P=.01). Mean WOSI score was 88 for B-L shoulders and 79 for B shoulders (P=.002). B-L shoulders also scored better on the DASH (P=.002) and SSV (P=.007). Patients had 11 degrees loss of subjectively measured outward rotation with the arm at the side after B-L repair compared with 19 degrees after Bankart (P=.012). The original Bankart, with tunnels through the glenoid rim, had less redislocation(s) or subluxation(s) than shoulders done with anchors (P=.048). Conclusions: Results were better after the Bristow-Latarjet repair than after Bankart repairs done with anchors with respect to postoperative stability and subjective evaluation. Shoulders with original Bankart repair also seemed to be more stable than shoulders repaired with anchors. Level of evidence: Level III, Retrospective Case Control Study, Treatment Study. (C) 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.
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| 3. |
- Hovelius, Lennart, et al.
(författare)
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Documentation of disclocation arthropathy of the shoulder "area index" : a better method to objectify the humeral osteophyte?
- 2008
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Ingår i: Journal of shoulder and elbow surgery. - St. Louis, MO : Mosby Yearbook, Inc.. - 1058-2746 .- 1532-6500. ; 17:2, s. 197-201
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Tidskriftsartikel (refereegranskat)abstract
- We suggest a method to validate the Samilson-Prieto classification system of dislocation arthropathy of the shoulder. Based on a mean standard sagital measure of the humeral head, we calculate an area index for the humeral osteophyte. The application of this method is done on a previous published series of 56 shoulders with a follow-up time of 15 years minimum after surgery with the Bankart or Bristow repairs. This technique of evaluation showed that the Bristow shoulders had a higher mean area index value on all radiological projections compared to the Bankart shoulders. The highest index was found on AP radiogrammes angulated 45° from above with the arm in neutral rotation (subcoracoid view) followed by the AP view in inward rotation. Our observations indicate that the humeral osteophyte mostly has its largest size at 4 to 5 o'clock position, as visualized with its greatest index on the subcoracoid view. Mild arthropathy, according to Samilson-Prieto, had a mean osteophyte area index of 3.7 (standard deviation, 3.4) on the AP inward rotation view. The corresponding figures for moderate arthropathy were 10.6 (standard deviation, 13.3) and 30.3 for severe (standard deviation, 24.1), respectively. The use of this index, based on the AP view in inward and outward rotation, will make future comparisons between different series of patients more reliable than using just the Samilson-Prieto classification. The radiological change over time should also be more appropriately described. Furthermore, this paper emphasizes the importance of using the same radiological views when dislocation arthropathy of the shoulder is documented.
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| 4. |
- Hovelius, Lennart, et al.
(författare)
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Increased mortality after anterior shoulder dislocation - 255 patients aged 12-40 years followed for 25 years
- 2007
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Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3682 .- 1745-3674. ; 78:6, s. 822-826
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Tidskriftsartikel (refereegranskat)abstract
- Background No data exist regarding mortality rate in young patients with a first-time anterior shoulder dislocation. A cohort of 255 patients aged 1240 years had a primary anterior shoulder dislocation during the years 1978 and 1979. After 10 years, 9 of the patients had died-which is a high figure for this cohort of patients. The question thus arose as to whether these patients had an increased mortality rate. In this study we have examined the mortality rate in these patients 25 years after the primary dislocation, relative to that of the Swedish population in general. Patients and methods In 1978 and 1979, 255 patients aged 1240 years (257 shoulders) with first-time anterior shoulder dislocation were treated with or without immobilization. During 2003 and 2004, a follow-up of all patients who were alive was undertaken and the certificates of causes of death of 27 deceased patients were also analyzed. Results The mortality rate (SMR) for the patients in this study was more than double that of the general Swedish population (p < 0.001). A higher proportion of the deceased patients had etiology other than sports-related activity as a cause of their initial dislocation (p = 0.04). 11 of the 27 who were deceased had died from injury or intoxication (S00-T98, ICD10), which was more than expected relative to the causes of death for the general Swedish population in 2003 and 2004 (p < 0.001). Interpretation The doubled mortality rate in our cohort of patients is most probably explained by the inclusion of a disproportionate number of patients with alcoholic behavior, which may affect the long-term outcome in trauma series.
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| 5. |
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| 6. |
- Hovelius, Lennart, et al.
(författare)
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Non-operative treatment of primary anterior shoulder dislocation in patients forty years of age and younger : a prospective twenty-five-year follow-up
- 2008
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Ingår i: Journal of Bone and Joint Surgery. American volume. - : Journal of Bone and Joint Surgery. - 0021-9355 .- 1535-1386. ; 90:5, s. 945-952
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Tidskriftsartikel (refereegranskat)abstract
- Background: During 1978 and 1979, we initiated a prospective multicenter study to evaluate the results of nonoperative treatment of primary anterior shoulder dislocation. In the current report, we present the outcome after twenty-five years.Methods: Two hundred and fifty-five patients (257 shoulders) with an age of twelve to forty years who had a primary anterior shoulder dislocation were managed with immobilization (achieved by tying the arm to the torso with use of a bandage) or without immobilization. All 227 living patients (229 shoulders) completed the follow-up questionnaire, and 214 patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.Results: Ninety-nine (43%) of 229 shoulders had not redislocated, and seventeen (7%) redislocated once. Thirty-three recurrent dislocations had become stable over time (14.4%), and eighteen were considered to be still recurrent (7.9%). Sixty-two shoulders (27%) had undergone surgery for the treatment of recurrent instability. Immobilization after the primary dislocation did not change the prognosis. Only two of twenty-four shoulders with a fracture of the greater tuberosity at the time of the primary dislocation redislocated (p < 0.001). When shoulders with a fracture of the greater tuberosity were excluded, forty-four (38%) of 115 shoulders in patients who had been twelve to twenty-five years of age at the time of the original dislocation and sixteen (18%) of ninety shoulders in patients who had been twenty-six to forty years of age had undergone surgical stabilization. At twenty-five years, fourteen (23%) of sixty-two shoulders that had undergone surgical stabilization were in patients who subsequently had a contralateral dislocation, compared with seven (7%) of ninety-nine shoulders in patients in whom the index dislocation had been classified as solitary (p = 0.01). Gender and athletic activity did not appear to affect the redislocation rate; however, women had worse DASH scores than men did (p = 0.006).Conclusions: After twenty-five years, half of the primary anterior shoulder dislocations that had been treated nonoperatively in patients with an age of twelve to twenty-five years had not recurred or had become stable over time.Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.
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| 7. |
- Hovelius, Lennart, et al.
(författare)
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One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years : Study I - clinical results
- 2004
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Ingår i: Journal of shoulder and elbow surgery. - : Elsevier BV. - 1058-2746 .- 1532-6500. ; 13:5, s. 509-16
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Tidskriftsartikel (refereegranskat)abstract
- In this prospective study on the Bristow-Latarjet repair, which started in 1980 and ended in 2001, we report the outcome in 118 shoulders where the patients have been followed up for 15 years (mean, 15.2 years; range, 14.3-20.8 years). The study was based on a physical examination, scoring with the system of Rowe et al, and the patients' subjective assessment of the operative result. After 2 years, 1 of 118 shoulders had redislocated and 98% of patients were satisfied with the operative repair. At 15 years' follow-up, 1 patient had undergone revision surgery as a result of recurrence of instability. One patient had had one redislocation during the follow-up period, and one patient reported three recurrences 3 years postoperatively.This patient has had no redislocations during the last 12 years. Furthermore, one more patient had had two recurrences 9 and 12 years after surgery but was very satisfied at follow-up. Subluxations occurred once in 4 patients and several times in 7 patients. These patients were, however, satisfied with the procedures at follow-up. One patient reported posterior subluxations at follow-up. Apprehension was significantly more common in patients with bilateral instability (P =.04) and was found in 19 of 109 shoulders. Of the patients, 90 (76%) were very satisfied with the operative result, 26 were satisfied (22%), and 1 did not know. The patient with revision surgery was considered to be dissatisfied. The incidence of bilateral shoulder instability increased from 22 of 118 (19%) at the time of surgery to 41 of 117 (35%) at 15 years after surgery. We conclude that the overall clinical results, with a satisfaction rate of 98% 15 years after the Bristow-Latarjet repair, were as good as the results reported after any operative method for recurrent anterior shoulder dislocation. However, until the radiologic part of this study is completed, we recommend the procedure only for shoulders with revision because of failed previous surgery and to surgeons familiar with the method.
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| 8. |
- Hovelius, Lennart, et al.
(författare)
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One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years : Study II - the evolution of dislocation arthropathy
- 2006
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Ingår i: Journal of shoulder and elbow surgery. - : Elsevier BV. - 1058-2746 .- 1532-6500. ; 15:3, s. 279-289
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Tidskriftsartikel (refereegranskat)abstract
- Dislocation arthropathy after surgical treatment of recurrent anterior dislocation of the shoulder has been a subject of discussion over the years. The objective of this prospective study was to evaluate the Bristow-Latarjet repair at 2 and 15 years after surgery with respect to arthropathy and to evaluate factors responsible for this development. At 2 and 15 years after a Bristow-Latarjet repair for recurrent anterior dislocation, we prospectively analyzed the radiographs of 115 of 118 shoulders. The majority of the patients also had radiography of the nonindex shoulder (111/118). Dislocation arthropathy was found on ordinary anteroposterior views in 46 of 115 shoulders (mild in 39, moderate in 5, and severe in 2). The anteroposterior view angulated 45 degrees from above gave the best visualization of the humeral osteophyte and, together with the axial view, doubled the incidence of moderate and severe arthropathy at follow-up (mild in 40, moderate in 11, and severe in 5). Of 38 shoulders with a postoperative position of the transferred coracoid process 2 to 4 mm medial to the glenoid rim and the screw and transplant parallel to the glenoid, 3 had moderate arthropathy (8%) compared with 8 shoulders with moderate arthropathy and 5 with severe arthropathy out of 77 shoulders with a nonoptimal position of the coracoid (17%) (P = not significant). The degree of restriction of outward rotation at 2 years did not influence the degree of arthropathy after 15 years. Global assessment of the operative result was not related to arthropathy at follow-up. When the first dislocation occurred before age 23 years, the incidence of arthropathy was significantly lower than when it occurred in age 23 years or older (P = .006). When all views were included, moderate or severe dislocation arthropathy was found in 14% of the shoulders, and a further 35% had mild arthropathy. When follow-up studies of operated series of shoulder dislocations with the Bristow-Latarjet method are done, it is important to have the same radiologic views to compare the incidence of dislocation arthropathy correctly.
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| 9. |
- Hovelius, Lennart, et al.
(författare)
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Primary anterior dislocation of the shoulder : long-term prognosis at the age of 40 years or younger.
- 2016
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 24:2, s. 330-42
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We describe the long-term prognosis in 257 first-time anterior shoulder dislocations (255 patients, aged 12-40 years) registered at 27 Swedish emergency units between 1978 and 1979.METHODS: Half the shoulders were immobilised for 3-4 weeks after repositioning. Follow-ups were performed after two (questionnaire), five (questionnaire), 10 (questionnaire and radiology) and 25 (questionnaire and radiology) years in 227 patients (229 shoulders). Twenty-eight patients died during the 25 years of observation.RESULTS: Early movement or immobilisation after the primary dislocation resulted in the same long-term prognosis. Recurrences increased up to 10 years of follow-up, but, after 25 years, 29 % of the shoulders with ≥2 recurrences appeared to have stabilised over time. Arthropathy increased from 9 % moderate to severe and 11 % mild at 10 years, to 34 % moderate to severe and 27 % mild after 25 years. Alcoholics had a poorer prognosis with respect to dislocation arthropathy (P < 0.001). Age <25 years and/or bilateral instability represent a poorer prognosis, where stabilising surgery is necessary in every second shoulder. Fracture of the greater tuberosity means a good prognosis, and we have found no evidence that athletic activity, gender, a Hill-Sachs lesion and minor rim fractures had any prognostic impact. During the 25 years in which these patients were followed, 28/255 died (11 %), representing a mortality rate (SMR) that was more than double that of the general Swedish population (P < 0.001).CONCLUSION: Almost half of all first-time dislocations at the age of <25 years will have stabilising surgery and two-thirds will develop different stages of arthropathy within 25 years.
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| 10. |
- Hovelius, Lennart
(författare)
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Shoulder diseases
- 2008
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Ingår i: Läkartidningen. ; 104:19, s. 1492-1496
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Tidskriftsartikel (populärvet., debatt m.m.)
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