Anterior shoulder dislocations commonly occur in the young, athletic population. The mechanism of dislocation occurs when the shoulder is placed in an abducted, externally rotated position while a forceful anterior moment is applied to the humerus. This position, combined with the force applied, results in an anterior and inferiorly directed dislocation of the humeral head away from the glenoid. Due to the limited stretching capacity of the glenohumeral capsule and associated glenohumeral ligaments, the force of the traumatic dislocation overcomes the tensile strength of these ligaments, resulting in a tear. Although the injury more commonly results in an avulsion of the anteroinferior capsulolabral complex from the glenoid, called a Bankart lesion, other injuries have been described. The anterior inferior glenohumeral ligaments (aIGHLs), may be torn from their humeral attachment, which is referred to as a humeral avulsion of the glenohumeral ligament (HAGL). Although other structures may be injured, the topic of this surgical technique focuses on a mini-open approach for repair of the HAGL lesion.
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http://dx.doi.org/10.1016/j.eats.2020.08.013 | DOI Listing |
Orthop J Sports Med
January 2025
Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, New York, USA.
Background: While glenoid bone loss (GBL) after anterior shoulder instability correlates with poor functional outcomes, the specific effects of GBL in posterior and combined-type shoulder instability remain poorly characterized, especially in a high-risk military population.
Purpose/hypothesis: The purpose of this study was to compare GBL between unidirectional anterior or posterior instability versus combined-type instability in active-duty servicemembers. It was hypothesized that total GBL and GBL in the direction of instability would be greater in those with combined-type instability compared with unidirectional instability.
Am J Sports Med
January 2025
Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Background: The anterior oblique bundle of the medial ulnar collateral ligament (UCL) inserts on the anteroinferior aspect of the humeral medial epicondyle, while the flexor pronator mass (FPM) originates superficial and proximal to the UCL. With valgus stress, these distinct footprints may produce injury patterns that affect only focal areas of the medial epicondyle.
Hypothesis: The proximal UCL can act on the medial epicondyle either in isolation or in conjunction with the FPM to form partial avulsion fracture patterns within the pediatric medial epicondyle, and the predominant pattern involves only the proximal UCL footprint.
J Pediatr Orthop
December 2024
Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia.
Background: The purpose of this study was to develop and validate a classification system that describes the injury pattern of pediatric medial humeral condyle fractures and provide treatment guidelines.
Methods: Patients less than 18 years old with medial humeral condyle fractures from 2012 to 2022 were identified. A classification system was developed based on fracture pattern and putative mechanism of injury.
Arthroscopy
December 2024
Thomas Jefferson University Hospital and Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A.
Since Dr. Frank Jobe performed the initial surgery on Tommy John in 1974, the ulnar collateral ligament (UCL) reconstruction (UCLR), colloquially "Tommy John Surgery," described in 1986 has evolved as the gold standard treatment for UCL tears. The crux of technique modifications involve flexor pronator mass (FPM) management, ulnar nerve transposition (UNT), graft selection, or graft-fixation options.
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October 2024
Orthopaedic Surgery, Tohoku Rosai Hospital, Sendai, JPN.
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