‘On-track’ and ‘off-track’ shoulder lesions

EFORT Open Reviews - Tập 2 Số 8 - Trang 343-351 - 2017
Eiji Itoi1
1E. Itoi, Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan

Tóm tắt

Shoulder stability depends on the position of the arm as well as activities of the muscles around the shoulder. The capsulo-ligamentous structures are the main stabilisers with the arm at the end-range of movement, whereas negative intra-articular pressure and concavity-compression effect are the main stabilisers with the arm in the mid-range of movement. There are two types of glenoid bone loss: fragment type and erosion type. A bone loss of the humeral head, known as a Hill-Sachs lesion (HSL), is a compression fracture of the humeral head caused by the anterior rim of the glenoid when the humeral head is dislocated anteriorly in front of the glenoid. Four out of five patients with anterior instability have both Hill-Sachs and glenoid bone lesions, which is called a ‘bipolar lesion’. With the arm moving along the posterior end-range of movement, or with the arm in various degrees of abduction, maximum external rotation and maximum horizontal extension, the glenoid moves along the posterior articular margin of the humeral head. This contact zone of the glenoid with the humeral head is called the ‘glenoid track’. A HSL, which stays on the glenoid track (on-track lesion), cannot engage with the glenoid and cannot cause dislocation. On the other hand, a HSL, which is out of the glenoid track (off-track lesion), has a risk of engagement and dislocation. Clinical validation studies show that the ‘on-track/off-track’ concept is able to predict reliably the risk of a HSL being engaged with the glenoid. For off-track lesions, either remplissage or Latarjet procedure is indicated, depending upon the glenoid defect size and the risk of recurrence.Cite this article: EFORT Open Rev 2017;2:343-351.

Từ khóa


Tài liệu tham khảo

Hertz H, 1984, Wien klin Wochenschr Suppl, 152, 1

Itoi E, 2009, The shoulder, 213

10.1302/0301-620X.67B5.4055867

10.1016/S0749-8063(05)80314-7

Matsen FA, 1991, Clin Sports Medicine, 10, 783, 10.1016/S0278-5919(20)30583-4

10.1007/s00776-003-0748-1

Howell SM, 1989, Clin Orthop Relat Res, 243, 122, 10.1097/00003086-198906000-00018

10.1016/S1058-2746(09)80134-1

Matsen FA, Surgery of the Musculoskeletal System, 1990, 1439

Matsen FA, 1998, The Shoulder, 611

10.2106/00004623-200001000-00005

10.1177/0363546504271521

10.1177/0363546508330139

10.2106/JBJS.I.00261

10.1097/00003086-197201000-00012

Bernageau J, 1976, Rev Chir Orthop Reparatrice Appar Mot, 62, 142

10.2106/00004623-198466090-00020

Baudi P, 2005, La Chirurgia degli organi di movimento, 90, 145

10.2214/ajr.180.5.1801423

10.1016/j.jse.2007.02.115

10.1053/jars.2002.32212

10.2106/JBJS.J.00906

10.1007/s11999-012-2607-x

10.2106/00004623-200305000-00016

10.1007/s00256-011-1184-5

10.1016/j.arthro.2013.10.004

10.1007/s00256-013-1728-y

10.1007/s00402-005-0006-4

10.1016/j.arthro.2007.05.009

10.1007/s00402-009-0854-4

10.1016/j.jse.2012.12.033

10.1177/0363546511398644

10.1186/1749-799X-6-29

10.1177/0363546511400018

Parke CS, Yoo JH, Cho NS, Rhee YG . Arthroscopic remplissage for humeral defect in anterior shoulder instability: Is it needed? [abstract] 39th Annual Meeting of Japan Shoulder Society, 2012.

10.1016/j.jse.2006.12.012

10.1177/0363546514527406

10.1097/BCO.0b013e318265e0a1

10.1016/j.arthro.2016.03.005

10.2106/JBJS.15.01099

10.2106/JBJS.L.00777

10.1016/j.jse.2012.01.023

Guity MR, 2014, Med J Islam Repub Iran, 28, 20

10.1177/0363546515571555

10.1016/j.arthro.2005.02.006

10.2106/JBJS.N.01033

Thông tin
Thông tin xuất bản

EFORT Open Reviews

Tập 2 Số 8

343-351

Thông tin tác giả