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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(01): 014-022
DOI: 10.1055/s-0041-1731357
Artigo de Atualização
Artroscopia e Traumatologia do Esporte

Limites da artroscopia na instabilidade anterior do ombro

Artikel in mehreren Sprachen: português | English
Jair Simmer Filho 
1   Hospital Santa Rita, Vitória, ES, Brasil
,
Raul Meyer Kautsky 
1   Hospital Santa Rita, Vitória, ES, Brasil
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Resumo

Muito se discute sobre os limites do tratamento da instabilidade anterior do ombro por artroscopia. O avanço no entendimento das repercussões biomecânicas das lesões bipolares sobre a estabilidade do ombro, bem como na identificação de fatores relacionados ao maior risco de recidiva têm nos ajudado a definir, de forma mais apurada, os limites do reparo por via artroscópica.

Ressaltamos a importância de diferenciação entre perda óssea por erosão da glenoide (POAG) e fraturas da borda da glenoide, pois o prognóstico do tratamento diverge entre essas formas de falha óssea da glenoide. Neste contexto, entendemos que há três tipos de falha óssea: a) Bankart ósseo (fratura); b) combinada; e c) POAG, e abordaremos as opções de tratamento sugerido em cada situação.

Até há pouco tempo, a escolha do método cirúrgico era norteada basicamente pelo grau de acometimento ósseo. Com a evolução do conhecimento, da biomecânica das lesões bipolares e do conceito do glenoid track (trilho da glenoide), o ponto de corte da lesão crítica, vem sendo alterado com tendência de queda. Além das falhas ou perdas ósseas, outras variáveis foram adicionadas e tornaram a decisão mais complexa, porém um pouco mais objetiva.

O presente artigo de atualização tem como objetivo fazer uma breve revisão da anatomia com as principais lesões encontradas na instabilidade; abordar detalhes importantes na técnica cirúrgica artroscópica, em especial nos casos complexos, e trazer as evidências atuais sobre os assuntos de maior divergência, buscando guiar o cirurgião na tomada de decisão.

Palavras-chave

articulação do ombro - atroscopia - cavidade glenoide - lesões do manguito rotador - lesões do ombro - luxação do ombro


Publikationsverlauf

Eingereicht: 07. Dezember 2020

Angenommen: 15. April 2021

Artikel online veröffentlicht:
25. Oktober 2021

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 Locher J, Wilken F, Beitzel K. et al. Hill-Sachs Off-track Lesions as Risk Factor for Recurrence of Instability After Arthroscopic Bankart Repair. Arthroscopy 2016; 32 (10) 1993-1999
    CrossrefPubMedGoogle Scholar
  • 2 Pogorzelski J, Fritz EM, Horan MP, Katthagen JC, Provencher MT, Millett PJ. Failure following arthroscopic Bankart repair for traumatic anteroinferior instability of the shoulder: is a glenoid labral articular disruption (GLAD) lesion a risk factor for recurrent instability?. J Shoulder Elbow Surg 2018; 27 (08) e235-e242
    CrossrefPubMedGoogle Scholar
  • 3 Leroux TS, Saltzman BM, Meyer M. et al. The Influence of Evidence-Based Surgical Indications and Techniques on Failure Rates After Arthroscopic Shoulder Stabilization in the Contact or Collision Athlete With Anterior Shoulder Instability. Am J Sports Med 2017; 45 (05) 1218-1225
    CrossrefPubMedGoogle Scholar
  • 4 Streubel PN, Krych AJ, Simone JP. et al. Anterior glenohumeral instability: a pathology-based surgical treatment strategy. J Am Acad Orthop Surg 2014; 22 (05) 283-294
    CrossrefPubMedGoogle Scholar
  • 5 Bankart AS. Recurrent or habitual dislocation of the shoulder-joint. BMJ 1923; 2 (3285): 1132-1133
    CrossrefPubMedGoogle Scholar
  • 6 Greis PE, Scuderi MG, Mohr A, Bachus KN, Burks RT. Glenohumeral articular contact areas and pressures following labral and osseous injury to the anteroinferior quadrant of the glenoid. J Shoulder Elbow Surg 2002; 11 (05) 442-451
    CrossrefPubMedGoogle Scholar
  • 7 Stefko JM, Tibone JE, Cawley PW, ElAttrache NE, McMahon PJ. Strain of the anterior band of the inferior glenohumeral ligament during capsule failure. J Shoulder Elbow Surg 1997; 6 (05) 473-479
    CrossrefPubMedGoogle Scholar
  • 8 Neviaser TJ. The GLAD lesion: another cause of anterior shoulder pain. Arthroscopy 1993; 9 (01) 22-23
    CrossrefPubMedGoogle Scholar
  • 9 Ozbaydar M, Elhassan B, Diller D, Massimini D, Higgins LD, Warner JJ. Results of arthroscopic capsulolabral repair: Bankart lesion versus anterior labroligamentous periosteal sleeve avulsion lesion. Arthroscopy 2008; 24 (11) 1277-1283
    CrossrefPubMedGoogle Scholar
  • 10 Yiannakopoulos CK, Mataragas E, Antonogiannakis E. A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy 2007; 23 (09) 985-990
    CrossrefPubMedGoogle Scholar
  • 11 Ilahi OA, Labbe MR, Cosculluela P. Variants of the anterosuperior glenoid labrum and associated pathology. Arthroscopy 2002; 18 (08) 882-886
    CrossrefPubMedGoogle Scholar
  • 12 Williams MM, Snyder SJ, Buford Jr D. The Buford complex--the “cord-like” middle glenohumeral ligament and absent anterosuperior labrum complex: a normal anatomic capsulolabral variant. Arthroscopy 1994; 10 (03) 241-247
    CrossrefPubMedGoogle Scholar
  • 13 Schmiddem U, Watson A, Perriman D, Liodakis E, Page R. Arthroscopic repair of HAGL lesions yields good clinical results, but may not allow return to former level of sport. Knee Surg Sports Traumatol Arthrosc 2019; 27 (10) 3246-3253
    CrossrefPubMedGoogle Scholar
  • 14 Bhatia DN, DasGupta B. Surgical treatment of significant glenoid bone defects and associated humeral avulsions of glenohumeral ligament (HAGL) lesions in anterior shoulder instability. Knee Surg Sports Traumatol Arthrosc 2013; 21 (07) 1603-1609
    CrossrefPubMedGoogle Scholar
  • 15 Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A. Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am 2003; 85 (05) 878-884
    CrossrefPubMedGoogle Scholar
  • 16 Sugaya H, Moriishi J, Kanisawa I, Tsuchiya A. Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability. Surgical technique. J Bone Joint Surg Am 2006; 88 (Suppl 1 Pt 2): 159-169
    CrossrefPubMedGoogle Scholar
  • 17 Jiang CY, Zhu YM, Liu X, Li FL, Lu Y, Wu G. Do reduction and healing of the bony fragment really matter in arthroscopic bony Bankart reconstruction?: a prospective study with clinical and computed tomography evaluations. Am J Sports Med 2013; 41 (11) 2617-2623
    CrossrefPubMedGoogle Scholar
  • 18 Kitayama S, Sugaya H, Takahashi N. et al. Clinical Outcome and Glenoid Morphology After Arthroscopic Repair of Chronic Osseous Bankart Lesions: A Five to Eight-Year Follow-up Study. J Bone Joint Surg Am 2015; 97 (22) 1833-1843
    CrossrefPubMedGoogle Scholar
  • 19 Yamamoto N, Muraki T, Sperling JW. et al. Stabilizing mechanism in bone-grafting of a large glenoid defect. J Bone Joint Surg Am 2010; 92 (11) 2059-2066
    CrossrefPubMedGoogle Scholar
  • 20 Burkhart SS, Debeer JF, Tehrany AM, Parten PM. Quantifying glenoid bone loss arthroscopically in shoulder instability. Arthroscopy 2002; 18 (05) 488-491
    CrossrefPubMedGoogle Scholar
  • 21 Bigliani LU, Newton PM, Steinmann SP, Connor PM, Mcllveen SJ. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med 1998; 26 (01) 41-45
    CrossrefPubMedGoogle Scholar
  • 22 Shaha JS, Cook JB, Song DJ. et al. Redefining “Critical” Bone Loss in Shoulder Instability: Functional Outcomes Worsen With “Subcritical” Bone Loss. Am J Sports Med 2015; 43 (07) 1719-1725
    CrossrefPubMedGoogle Scholar
  • 23 Shin SJ, Kim RG, Jeon YS, Kwon TH. Critical Value of Anterior Glenoid Bone Loss That Leads to Recurrent Glenohumeral Instability After Arthroscopic Bankart Repair. Am J Sports Med 2017; 45 (09) 1975-1981
    CrossrefPubMedGoogle Scholar
  • 24 Willemot LB, Elhassan BT, Verborgt O. Bony Reconstruction of the Anterior Glenoid Rim. J Am Acad Orthop Surg 2018; 26 (10) e207-e218
    CrossrefPubMedGoogle Scholar
  • 25 Gowd AK, Liu JN, Cabarcas BC. et al. Management of Recurrent Anterior Shoulder Instability With Bipolar Bone Loss: A Systematic Review to Assess Critical Bone Loss Amounts. Am J Sports Med 2019; 47 (10) 2484-2493
    CrossrefPubMedGoogle Scholar
  • 26 Di Giacomo G, Pugliese M, Lie DTT. et al. How to handle minor and major bone loss in the shoulder? Current concepts. J ISAKOS 2020; 5 (03) 117-122
    CrossrefGoogle Scholar
  • 27 Provencher MT, Frank RM, Leclere LE. et al. The Hill-Sachs lesion: diagnosis, classification, and management. J Am Acad Orthop Surg 2012; 20 (04) 242-252
    CrossrefPubMedGoogle Scholar
  • 28 Purchase RJ, Wolf EM, Hobgood ER, Pollock ME, Smalley CC. Hill-sachs “remplissage”: an arthroscopic solution for the engaging hill-sachs lesion. Arthroscopy 2008; 24 (06) 723-726
    CrossrefPubMedGoogle Scholar
  • 29 Wolf EM, Arianjam A. Hill-Sachs remplissage, an arthroscopic solution for the engaging Hill-Sachs lesion: 2- to 10-year follow-up and incidence of recurrence. J Shoulder Elbow Surg 2014; 23 (06) 814-820
    CrossrefPubMedGoogle Scholar
  • 30 Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy 2014; 30 (01) 90-98
    CrossrefPubMedGoogle Scholar
  • 31 Porcellini G, Paladini P, Campi F, Paganelli M. Shoulder instability and related rotator cuff tears: arthroscopic findings and treatment in patients aged 40 to 60 years. Arthroscopy 2006; 22 (03) 270-276
    CrossrefPubMedGoogle Scholar
  • 32 Nakagawa S, Ozaki R, Take Y, Mae T, Hayashida K. Bone fragment union and remodeling after arthroscopic bony bankart repair for traumatic anterior shoulder instability with a glenoid defect: influence on postoperative recurrence of instability. Am J Sports Med 2015; 43 (06) 1438-1447
    CrossrefPubMedGoogle Scholar
  • 33 Di Giacomo G, de Gasperis N, Scarso P. Bipolar bone defect in the shoulder anterior dislocation. Knee Surg Sports Traumatol Arthrosc 2016; 24 (02) 479-488
    CrossrefPubMedGoogle Scholar
  • 34 Omori Y, Yamamoto N, Koishi H. et al. Measurement of the Glenoid Track In Vivo as Investigated by 3-Dimensional Motion Analysis Using Open MRI. Am J Sports Med 2014; 42 (06) 1290-1295
    CrossrefPubMedGoogle Scholar
  • 35 Yamamoto N, Itoi E, Abe H. et al. Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: a new concept of glenoid track. J Shoulder Elbow Surg 2007; 16 (05) 649-656
    CrossrefPubMedGoogle Scholar
  • 36 Hartzler RU, Bui CNH, Jeong WK. et al. Remplissage of an Off-track Hill-Sachs Lesion Is Necessary to Restore Biomechanical Glenohumeral Joint Stability in a Bipolar Bone Loss Model. Arthroscopy 2016; 32 (12) 2466-2476
    CrossrefPubMedGoogle Scholar
  • 37 Song DJ, Cook JB, Krul KP. et al. High frequency of posterior and combined shoulder instability in young active patients. J Shoulder Elbow Surg 2015; 24 (02) 186-190
    CrossrefPubMedGoogle Scholar
  • 38 Balg F, Boileau P. The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 2007; 89 (11) 1470-1477
    CrossrefPubMedGoogle Scholar
  • 39 Liu JN, Gowd AK, Garcia GH, Cvetanovich GL, Cabarcas BC, Verma NN. Recurrence Rate of Instability After Remplissage for Treatment of Traumatic Anterior Shoulder Instability: A Systematic Review in Treatment of Subcritical Glenoid Bone Loss. Arthroscopy 2018; 34 (10) 2894-2907.e2
    CrossrefPubMedGoogle Scholar
  • 40 Miyazaki AN, Fregoneze M, Santos PD. et al. Avaliação dos resultados do tratamento cirúrgico artroscópico da luxação traumática anterior de ombro: Primeiro episódio. Rev Bras Ortop 2012; 47 (02) 222-227
    CrossrefPubMedGoogle Scholar
  • 41 Seroyer ST, Nho SJ, Provencher MT, Romeo AA. Four-quadrant approach to capsulolabral repair: an arthroscopic road map to the glenoid. Arthroscopy 2010; 26 (04) 555-562 Erratum in: Arthroscopy. 2010;26(6):866
    CrossrefPubMedGoogle Scholar
  • 42 Lo IK, Lind CC, Burkhart SS. Glenohumeral arthroscopy portals established using an outside-in technique: neurovascular anatomy at risk. Arthroscopy 2004; 20 (06) 596-602
    CrossrefPubMedGoogle Scholar
  • 43 Ciccotti MG, Kuri 2nd JA, Leland JM, Schwartz M, Becker C. A cadaveric analysis of the arthroscopic fixation of anterior and posterior SLAP lesions through a novel lateral transmuscular portal. Arthroscopy 2010; 26 (01) 12-18
    CrossrefPubMedGoogle Scholar
  • 44 Simmer Filho J, Pombo EH, de Almeida BPS. A segurança do Portal 5 Horas no tratamento das lesões labiais ântero-inferiores. CBCOC, Búzios-RJ; 2008
    Google Scholar
  • 45 Boileau P, Villalba M, Héry JY, Balg F, Ahrens P, Neyton L. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am 2006; 88 (08) 1755-1763
    CrossrefPubMedGoogle Scholar
  • 46 Nho SJ, Provencher MT, Seroyer ST, Romeo AA. Bioabsorbable anchors in glenohumeral shoulder surgery. Arthroscopy 2009; 25 (07) 788-793
    CrossrefPubMedGoogle Scholar
  • 47 Knapik DM, Kolaczko JG, Gillespie RJ, Salata MJ, Voos JE. Complications and Return to Activity After Arthroscopic Repair of Isolated Type II SLAP Lesions: A Systematic Review Comparing Knotted Versus Knotless Suture Anchors. Orthop J Sports Med 2020; 8 (04) 2325967120911361
    Google Scholar
  • 48 Miyazaki AN, Fregoneze M, Santos PD. et al. Avaliação Dos Resultados Do Tratamento Cirúrgico Artroscópico Da Instabilidade Anterior Traumática Do Ombro Com Sutura Da Lesão Na Margem Cruentizada Da Cavidade Glenoidal. Rev Bras Ortop 2012; 47 (03) 318-324
    CrossrefPubMedGoogle Scholar
  • 49 Ilahi OA, Al-Fahl T, Bahrani H, Luo ZP. Glenoid suture anchor fixation strength: Effect of insertion angle. Arthroscopy 2004; 20 (06) 609-613
    CrossrefPubMedGoogle Scholar
  • 50 Dwyer T, Petrera M, White LM. et al. Trans-subscapularis portal versus low-anterior portal for low anchor placement on the inferior glenoid fossa: a cadaveric shoulder study with computed tomographic analysis. Arthroscopy 2015; 31 (02) 209-214
    CrossrefPubMedGoogle Scholar
  • 51 Provencher MT, Verma N, Obopilwe E. et al. A biomechanical analysis of capsular plication versus anchor repair of the shoulder: can the labrum be used as a suture anchor?. Arthroscopy 2008; 24 (02) 210-216
    CrossrefPubMedGoogle Scholar
  • 52 Bradley JP, McClincy MP, Arner JW, Tejwani SG. Arthroscopic capsulolabral reconstruction for posterior instability of the shoulder: a prospective study of 200 shoulders. Am J Sports Med 2013; 41 (09) 2005-2014
    CrossrefPubMedGoogle Scholar
  • 53 Lädermann A, Arrigoni P, Barth J. et al. Is arthroscopic remplissage a tenodesis or capsulomyodesis? An anatomic study. Knee Surg Sports Traumatol Arthrosc 2016; 24 (02) 573-577
    CrossrefPubMedGoogle Scholar
  • 54 França F, Godinho A, Carneiro Leal D. et al. Resultados clínicos e de imagem da abordagem da lesão de Hill-Sachs pela técnica de remplissage na instabilidade anterior do ombro. Rev Bras Ortop 2019; 54 (01) 13-19
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 55 Yang JS, Mehran N, Mazzocca AD, Pearl ML, Chen VW, Arciero RA. Remplissage Versus Modified Latarjet for Off-Track Hill-Sachs Lesions With Subcritical Glenoid Bone Loss. Am J Sports Med 2018; 46 (08) 1885-1891
    CrossrefPubMedGoogle Scholar
  • 56 Elkinson I, Giles JW, Boons HW. et al. The shoulder remplissage procedure for Hill-Sachs defects: does technique matter?. J Shoulder Elbow Surg 2013; 22 (06) 835-841
    CrossrefPubMedGoogle Scholar
  • 57 Elkinson I, Giles JW, Faber KJ. et al. The effect of the remplissage procedure on shoulder stability and range of motion: an in vitro biomechanical assessment. J Bone Joint Surg Am 2012; 94 (11) 1003-1012
    CrossrefPubMedGoogle Scholar