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Dislocations & Instability

Elbow dislocations & instability: simple reduction, fracture-dislocations (terrible triad), and chronic instability repair options.

Overview

Operative management generally yields superior outcomes compared to nonoperative care for first-time patellar dislocations, with lower rates of subsequent dislocation [1]. A multivariable risk model can identify patients prone to recurrent lateral patellar dislocation who are optimal candidates for early surgical intervention [13]. Conversely, while quality of life may improve in stabilized groups, current evidence remains insufficient to definitively mandate acute stabilization for all first-time traumatic shoulder dislocations [8]. However, recent data supports surgical stabilization after the initial shoulder instability episode in specific adolescent populations [2].

For elbow pathology, patients with moderate joint instability following simple dislocation face significantly worse clinical outcomes, higher complication rates, and increased need for revision surgery under conservative management compared to those with slight instability [25]. Consequently, patients exhibiting red flags for persistent instability after simple elbow dislocation should be considered for a primary surgical approach [72]. In cases of slight initial instability, surgical procedures provide outcomes regarding MEPS and ROM similar to conservative treatment [72].

Chronic and complex dislocations present distinct prognostic challenges. Closed pantalar dislocations are rare injuries that may portend a poor prognosis [3]. Arthroplasty for chronic glenohumeral dislocations results in improved long-term clinical outcomes [7]. In anterior glenohumeral instability, open Latarjet procedures reduce residual apprehension, redislocation, and the risk of dislocation arthropathy compared to arthroscopic Bankart repair, even in the setting of greater bipolar bone loss [28]. Patients with dislocations associated with specific lesions or morbid obesity face a risk of poorer functional results following lateral elbow ligament reconstruction for posterolateral rotatory instability [6]. The Instability Severity Index Score (ISIS) failed to predict recurrent instability in cohorts where scores did not differ significantly between successful and failed repairs [4].

Anatomy & Pathophysiology

Understanding elbow biomechanics and injury mechanisms elucidates the pathological variations seen in complex dislocations [30], while restoring function demands recognition of the joint's unique humeroradial and humeroulnar articulations [35]. Successful reconstruction of chronically dislocated joints and management of stiff elbows require integrating anatomical knowledge, biomechanical principles, and surgical technique [32, 33]. Restoration of function further depends on acknowledging the critical role of ligaments and dynamic stabilizers [35].

Osseous & Articular Stability: Optimal outcomes for coronoid fractures and traumatic instability are founded upon concentric reduction of the elbow [58]. Biomechanically, monopolar radial head prostheses enhance elbow stability superior to bipolar designs [36].

Ligamentous & Soft Tissue Reconstruction: Tearing of the ulnar collateral ligament (UCL) significantly increases valgus laxity, elongating the ulnar nerve during simulated throwing [60]. Pitching 100 balls induces a significant reduction in dynamic stabilizing ability against elbow valgus laxity in high school players [57]. For multidirectional instability, the circumferential graft technique has been evaluated for stability against valgus and varus/posterolateral rotatory forces [53]. Regarding UCL reconstruction, both proximal docking and single-point fixation hybrid methods provide sufficient joint stability and strength compared to intact elbows [54]; however, the proximal docking method shows this sufficiency at all angles except low flexion [54]. Reattachment of flexor and extensor tendons at the epicondyle should be considered to improve repair techniques for elbow stabilizers [49].

Kinematics & Instability: Posterolateral rotatory instability (PLRI) of the elbow remains incompletely understood [45]. In professional baseball pitchers, no significant relationships exist between shoulder strength/ROM adaptations and chronic structural elbow adaptations [42]. The posterior (Boyd) approach offers superior visualization of lateral structures for repair and confers excellent joint stability [44]. For unstable elbows, the overhead motion protocol is a safe early range of motion method [62].

Surgical Approach & Contracture Management: Endoscopic anterior capsulectomy for severe contractures is technically difficult and should be performed by experienced surgeons familiar with neurovascular and musculoligamentous anatomy [56].

Classification

Wrightington: This system provides a comprehensive, reliable, and valid classification for elbow fracture-dislocations, incorporating treatment algorithms associated with good functional outcomes [38][50][55]. It describes patterns of injury to guide anatomically based reconstruction, achieving good to excellent results in 90% of cases for complex proximal ulna fracture-dislocations [47].

Montecranon: This classification is helpful for the management of complex proximal ulna fracture-dislocations, leading to good to excellent results in 90% of cases despite a high rate of secondary surgeries [47].

FEDS: The FEDS classification, particularly the frequency and etiology of the patient's shoulder instability, may be helpful in identifying patients with a higher likelihood of undergoing surgical treatment [18].

Rockwood: In a prospective cohort study, Rockwood type III was the most common type of acromioclavicular joint dislocation, constituting 55.7% of the injuries [64].

Other Considerations: Recent evidence favors surgical stabilization after the first episode of instability in certain situations for anterior shoulder instability in the adolescent population [2]. While indications suggest quality of life is better in the stabilized group, it cannot yet be definitively concluded whether first-time traumatic shoulder dislocations should undergo acute stabilization procedures [8]. The Instability Severity Index Score (ISIS) failed to predict recurrent instability in a cohort where ISIS scores were not significantly different between successful and failed repairs [4]. Non-traumatic shoulder instability's aetiologies and clinical manifestations are multifactorial [5]. Substantial variability was observed in the scoring of important elements in the radiological report for the evaluation of anterior shoulder instability, regardless of modality [10]. Closed pantalar dislocations are very rare injuries that may portend a poor prognosis [3]. Current elbow fracture dislocation classification systems only describe one element of the injury or only include one pattern [31]. The paper presents a review of the literature regarding the anatomy, biomechanics, classification, diagnosis, and management of acute and chronic acromioclavicular joint dislocations, discussing both conservative and surgical options without presenting new primary data [46].

Clinical Presentation

Operative intervention for first-time patellar dislocations yields more frequent favorable outcomes and lower subsequent dislocation rates compared to nonoperative management [1]. Risk stratification identifies individuals at high risk of recurrence, indicating that conservative treatment is not universally successful [21]. Similarly, recent evidence supports surgical stabilization after the initial episode of anterior shoulder instability in specific adolescent populations [2]. However, while quality of life may improve in stabilized groups, it remains unestablished whether acute stabilization is indicated for all first-time traumatic shoulder dislocations [8].

For shoulder instability, the aetiologies and clinical manifestations of non-traumatic cases are multifactorial [5]. Magnetic resonance arthrography accurately assesses accompanying lesions in both first-time and recurrent anterior dislocations [20]. Preoperative MRI is also useful to exclude subtle elbow instability, particularly in patients with severe pain or a history of multiple corticosteroid injections (≥3) [22]. Despite these tools, substantial variability exists among musculoskeletal radiologists and orthopedic surgeons regarding the scoring of important elements in radiological reports for anterior shoulder instability evaluation [10].

Diagnosis of posterior shoulder dislocations requires a high level of suspicion in the pediatric population, as these injuries are rare [19]. Unusual injury patterns include posterior glenohumeral dislocation associated with a posterior acromion fracture [37]. In the elbow, atraumatic posterolateral rotatory instability should be considered in the differential diagnosis for lateral elbow pain presenting with a protracted clinical course [43]. Proper injury pattern recognition and standardized surgical management lead to stable joints and good range of motion in elbow fracture dislocations [23].

Red-flag patterns and complex presentations: Closed pantalar dislocations are very rare injuries that may portend a poor prognosis [3]. Complete anterior dislocation of the sacro-iliac joint is an unusual injury occurring in skeletally mature individuals following severe trauma [17]. Persistent dislocation necessitating closed reduction, a longer duration of dislocation, and a delay to surgery are associated with higher rates of heterotopic ossification in operatively treated terrible triad injuries [9]. Patients with dislocation associated with other lesions or morbid obesity face a risk of poorer functional results following lateral elbow ligament reconstruction for posterolateral rotatory instability [6].

Special populations and congenital considerations: Management of shoulder instability in hypermobile Ehlers-Danlos syndrome requires a multidisciplinary approach and special considerations due to severe instability and connective tissue abnormalities [41]. The ultimate prognosis for congenital hip dislocation with intra-articular osteocartilaginous obstruction to reduction can be poor due to persistent subluxation despite surgical intervention [11]. There is no single procedure that reliably treats every patient with anterior shoulder instability; surgical methods must be adapted to the specific pathomorphology of the patient [39].

Investigations

Plain radiography: Serial radiographs are beneficial for monitoring sequelae in pediatric posterior shoulder dislocations [19]. However, substantial variability exists in the scoring of important elements in radiological reports for the evaluation of anterior shoulder instability, regardless of the imaging modality used [10]. The classic dimple sign may be absent in chronic irreducible posterolateral knee dislocations [73].

MRI: Magnetic resonance arthrography is an accurate method to assess accompanying lesions in both first-time and recurrent anterior dislocation of the shoulder [20]. MRI is recommended for all patients presenting with acute patellar dislocation to evaluate soft tissue damage and guide management [24]. Significant MRI findings occur frequently in pediatric first-time acute patellar dislocations, supporting the standard of care for obtaining MRI after first-time patellofemoral instability events in the pediatric population [75]. Preoperative MRI could be used to exclude subtle instability in patients with lateral epicondylitis, particularly those with a history of multiple corticosteroid injections (≥3) or severe pain [22]. MRI allows accurate preoperative identification of soft tissues impeding reduction in irreducible elbow dislocations [74]. Conversely, conventional MRI technique demonstrates weak interobserver and intraobserver agreement for the evaluation of ligamentous injuries after simple elbow dislocation [76].

Other Considerations: Operative treatment for first-time patellar dislocations is associated with more frequent favorable outcomes and lower subsequent dislocation rates compared to nonoperative treatment [1]. Recent evidence favors surgical stabilization after the first episode of instability in certain adolescent populations with anterior shoulder instability [2]. Patients with dislocation associated with lesions or morbid obesity are at risk of poorer functional results following lateral elbow ligament reconstruction for posterolateral rotatory instability [6]. Persistent dislocation necessitating closed reduction, longer duration of dislocation, and delay to surgery are associated with higher rates of heterotopic ossification in operatively treated terrible triad injuries [9]. Recurrent instability following anterior shoulder stabilization does not vary by region but occurs more frequently following soft-tissue procedures compared to bony stabilization procedures [15]. The Instability Severity Index Score (ISIS) must be used as a whole and is a useful clinical tool when used in conjunction with computed tomography [79]. Closed pantalar dislocations are very rare injuries that may portend a poor prognosis [3]. The ultimate prognosis for congenital hip dislocation with intra-articular osteocartilaginous obstruction to reduction is poor due to persistent subluxation despite surgical intervention [11]. Complete anterior dislocation of the sacro-iliac joint is a very unusual injury that can occur in skeletally mature individuals following severe trauma [17]. Posterior shoulder dislocations are rare in the pediatric population and require a high level of suspicion for diagnosis [19]. Positioning the shoulder in abduction and external rotation helps maintain reduction in pediatric posterior shoulder dislocations [19].

Treatment

Non-Operative

Conservative management remains the gold standard for most simple elbow dislocations [67], with functional treatment showing comparable effectiveness to plaster casting in randomized trials [40]. Non-traumatic shoulder instability presents with multifactorial aetiologies and clinical manifestations, often managed without immediate surgery [5]. Conservative treatment of acute posterior shoulder dislocations yields good mid- to long-term clinical outcomes, particularly in older patients [12]. For anteromedial coronoid facet fractures, nonoperative management is a viable consideration for nondisplaced subtype 1 and 2 fractures under strict preconditions, demonstrating satisfactory functional outcomes [70]. While conservative treatment is often the initial approach for first-time patellar dislocations, risk stratification identifies individuals at high risk of recurrent instability who may not achieve satisfactory outcomes with this method alone [21].

Operative

Indications: Operative treatment for first-time patellar dislocations is associated with more frequent favorable outcomes and lower subsequent dislocation rates compared to nonoperative treatment [1]. Recent evidence favors surgical stabilization after the first episode of instability in certain adolescent populations with anterior shoulder instability [2]. MRI is recommended for all patients presenting with acute patellar dislocation to evaluate soft tissue damage and guide management decisions [24]. For chronic glenohumeral dislocations, arthroplasty is indicated to improve clinical outcomes at long-term follow-up [7]. In the setting of simple elbow dislocations, patients with moderate joint instability have significantly worse clinical outcomes, more complications, and a higher need for secondary revision surgery following conservative treatment compared to those with slight instability [25]. The clearest indication for arthroscopy after traumatic posterior hip dislocation is the presence of loose fragments inside the joint [68].

Surgical Approach / Technique: The open Latarjet procedure is preferred for patients with anterior glenohumeral instability who have more dislocations and greater bipolar bone loss, as it provides lower rates of residual apprehension, redislocation, and dislocation arthropathy compared to arthroscopic Bankart repair [28]. Dynamic anterior stabilization of the shoulder using buttons demonstrated effectiveness and safety as a viable option for treating anterior shoulder instability with glenoid bone loss of less than 20%, especially in athletes [51]. The modified McLaughlin procedure is a safe and effective treatment option for patients with locked posterior dislocation of the shoulder and a reverse Hill-Sachs lesion between 20% and 50% of the humeral head articular surface, demonstrating favorable clinical and radiographic outcomes with low complication and recurrent instability rates [63]. In total hip arthroplasty, the posterior approach with posterior soft tissue repair produced more favorable results regarding joint stability and dislocation rates compared to the lateral approach [65].

Implant Selection: The internal joint stabilizer is a safe and effective implant that complements the management of chronic elbow dislocations [52]. Operative treatment for recurrent patellar dislocation achieved good results, although functional scores remain inferior in some cases [66]. Asymptomatic non-unions following the "purse string" technique for anterior glenohumeral instability should not be considered failures as they are related to satisfactory outcomes, and no additional surgery should be performed [69].

Other Considerations: While quality of life may be better in stabilized groups, there is currently insufficient evidence to definitively determine if first-time traumatic shoulder dislocations should undergo acute stabilization procedures [8]. The Instability Severity Index Score (ISIS) failed to predict recurrent instability in a cohort of patients with glenohumeral instability, as scores were not significantly different between successful and failed repairs [4].

Complications

Instability: Operative treatment for first-time patellar dislocations yields more favorable outcomes and lower subsequent dislocation rates compared to nonoperative management [1], with recent evidence supporting surgical stabilization after the initial instability episode in specific adolescent populations [2]. A multivariable model based on individual risk factors can identify patients at high risk for recurrent lateral patellar dislocation who are suitable for early operative treatment [13]. Patellar dislocators with a history of instability are more likely to be female, older, and face a greater risk of subsequent episodes than first-time dislocators [78]. In the shoulder, recurrent instability occurs more frequently following soft-tissue compared to bony stabilization procedures for anterior instability, though rates do not vary by region [15]. Glenoid bone loss increases significantly from 6.8% after a first-time anterior instability event to 22.8% total bone loss with recurrent instability [26]. Conservative treatment of acute posterior shoulder dislocations leads to good clinical outcomes in mid- to long-term follow-up, particularly in older patients [12], while arthroplasty for chronic glenohumeral dislocations demonstrates improved clinical outcomes at long-term follow-up [7]. Non-traumatic shoulder instability presents with multifactorial aetiologies and clinical manifestations [5].

Stiffness / Arthrofibrosis: In operatively treated terrible triad injuries, persistent dislocation necessitating closed reduction, longer duration of dislocation, and delayed surgery are associated with higher rates of heterotopic ossification [9]. Conversely, immediate motion protocols for simple elbow dislocation result in no flexion contractures or clinically significant recurrent instability within a 1-year follow-up [29].

Other Considerations: Closed pantalar dislocations are very rare injuries that may portend a poor prognosis [3]. The Instability Severity Index Score (ISIS) failed to predict recurrent instability in a cohort where scores were not significantly different between successful and failed repairs [4]. Patients with dislocation associated with lesions or morbid obesity are at risk of poorer functional results following lateral elbow ligament reconstruction for posterolateral rotatory instability [6]. Patellar dislocation in children influences subjective knee function in the long term [27]. In a case of bilateral elbow dislocation in a patient with Rubinstein-Taybi syndrome, there was no re-dislocation on the right elbow five years postsurgery [77].

Recovery

Light activity (weeks): Immediate motion protocols for simple elbow dislocations allow for early functional use without flexion contractures or clinically significant recurrent instability within a 1-year follow-up [29]. Conservative treatment of acute posterior shoulder dislocations yields good clinical outcomes in mid- to long-term follow-up, particularly in older patients [12].

Full activity (months): Proper injury pattern recognition and standardized surgical management for elbow fracture dislocations lead to a stable joint and good range of motion results [23]. The functional result of operative treatment for adult elbow dislocation depends primarily on the extent of osseous damage to the articulation, the time interval between injury and operation, and the technical adequacy of ligament repair and removal of intra-articular loose bodies [81].

Complete recovery / outcome plateau (months): Arthroplasty for chronic glenohumeral dislocations results in improved clinical outcomes at long-term follow-up [7]. Patellar dislocation in skeletally immature patients influences subjective knee function in the long term [27]. The natural history of infant hip instability without subluxation or dislocation involves spontaneous normalization of the acetabular index within 3 years of age [16].

Rehabilitation protocol: Early arthrolysis is preferable for post-traumatic elbow stiffness, suggesting the conventionally observed interval of greater than 1 year after injury could be shortened [82]. Persistent dislocation necessitating closed reduction, a longer duration of dislocation, and a delay to surgery are associated with higher rates of heterotopic ossification in operatively treated terrible triad injuries [9].

Functional milestones: Operative treatment for first-time patellar dislocations is associated with more frequent favorable outcomes and lower subsequent dislocation rates compared to nonoperative treatment [1]. A multivariable model based on individual risk factors can identify patients at high risk for recurrent lateral patellar dislocation who are good candidates for early operative treatment [13]. Recurrent instability following anterior shoulder instability procedures does not vary by region but occurs more frequently after soft-tissue stabilization compared to bony stabilization procedures [15].

Other Considerations: The Instability Severity Index Score (ISIS) failed to predict recurrent instability in a cohort of glenohumeral instability patients, as scores were not significantly different between successful and failed repairs [4]. Glenoid bone loss of 6.8% is observed after a first-time anterior instability event, while recurrent instability results in 22.8% total bone loss [26]. The ultimate prognosis for congenital hip dislocations with intra-articular osteocartilaginous obstruction was poor due to persistent subluxation despite surgical intervention [11]. Surgical procedure selection for shoulder instability shows significant variability driven by time alone, regardless of whether preoperative planning uses 3D CT or 3D MRI [80]. Historic physicians established the foundation for the modern conservative treatment of shoulder dislocations [14].

Key Evidence

  • [L1] Meta-analysis showed more frequent favorable outcomes and lower subsequent dislocation rates with operative treatment. (10.1016/j.arthro.2025.02.013)
  • [L5] Recent evidence favors surgical stabilization after the first episode of instability in certain situations. (10.5397/cise.2025.00227)
  • [L4] Closed pantalar dislocations are very rare injuries that may portend a poor prognosis. (10.5435/jaaos-d-20-00836)
  • [L3] The Instability Severity Index Score (ISIS) failed to predict recurrent instability in this cohort, as ISIS scores were not significantly different between successful and failed repairs. (10.1016/j.jse.2014.06.007)
  • [L5] Non-traumatic shoulder instability's aetiologies and clinical manifestations are multifactorial. (10.1177/17585732251320070)
  • [L4] Patients who had dislocation with associated lesions or morbid obesity are at risk of poorer functional results. (10.1016/j.jseint.2022.12.009)
  • [L4] We found improved clinical outcomes after arthroplasty for the treatment of chronic glenohumeral dislocations at a long-term follow-up. (10.1016/j.xrrt.2021.06.001)
  • [L5] We cannot yet answer this question definitively; while there are indications that quality of life is better in the stabilized group, the authors state we must wait before deciding definitely on how to treat first-time traumatic dislocations. (10.1007/s00167-003-0357-8)
  • [L3] Persistent dislocation necessitating a closed reduction, a longer duration of dislocation, and a delay to surgery were associated with the development of heterotopic ossification. (10.1016/j.jseint.2020.02.002)
  • [L5] Substantial variability was observed in the scoring of important elements in the radiological report for the evaluation of anterior shoulder instability, regardless of modality. (10.1016/j.jseint.2024.03.012)
  • [L4] The ultimate prognosis for the hips was poor due to persistent subluxation despite surgical intervention. (10.2106/00004623-198870050-00018)
  • [Abstract] Conservative treatment of acute posterior shoulder dislocations leads to good clinical outcomes in a mid- to long-term follow-up especially in patients with older age. (10.1016/j.jse.2022.01.025)
  • [L3] This multivariable model can identify patients who are at high risk for recurrent dislocation and would be good candidates for early operative treatment. (10.2106/jbjs.20.00020)
  • [L5] This review demonstrates that historic physicians paved the way for the modern conservative treatment of shoulder dislocations. (10.1177/17585732211058407)
  • [L2] Recurrent instability does not vary by region but occurs more frequently following soft-tissue compared to bony stabilization procedures. (10.1016/j.xrrt.2023.08.005)
  • [L3] The natural history of infant hip instability (without subluxation or dislocation) has spontaneous normalization of the acetabular index within 3 years of age. (10.1186/1471-2474-15-355)
  • [Case_report] Complete anterior dislocation of the sacro-iliac joint is a very unusual injury that can occur in skeletally mature individuals following severe trauma. (10.2106/00004623-197658010-00028)
  • [L2] The FEDS classification, particularly the frequency and etiology of the patient's shoulder instability, may be helpful in identifying patients with a higher likelihood of undergoing surgical treatment. (10.1016/j.jse.2016.07.054)
  • [Case_report] Posterior shoulder dislocations are rare in the pediatric population and require a high level of suspicion for diagnosis; positioning the shoulder in abduction and external rotation helps maintain reduction, and serial radiographs may be beneficial to monitor for sequelae. (10.1016/j.xrrt.2020.12.003)
  • [L3] Magnetic resonance arthrography was an accurate method to assess accompanying lesions in first-time and recurrent anterior dislocation of the shoulder. (10.1177/0363546510371607)
  • [L5] Risk stratification can identify individuals at high risk of recurrent instability, and while treatment remains controversial, not all patients do well with conservative treatment. (10.1016/j.arthro.2019.05.039)
  • [L4] Preoperative MRI could be used to exclude subtle instability, and surgeons should consider checking for subtle instability, especially when patients have a history of multiple corticosteroid injections (≥3) or severe pain. (10.1186/s12891-018-2069-8)
  • [L4] Proper injury pattern recognition and a standardized surgical management lead to a stable joint and good results in range of motion. (10.1016/j.jseint.2020.12.004)
  • [L4] MRI is recommended for all patients presenting with acute patellar dislocation to evaluate soft tissue damage and guide management. (10.1186/1749-799x-7-21)
  • [L3] Patients with moderate joint instability after simple elbow dislocation have a significantly worse clinical outcome, more complications, and a higher need for secondary revision surgery following conservative treatment compared to patients with slight elbow instability. (10.1186/s13018-015-0273-x)
  • [L2] Glenoid bone loss of 6.8% was observed after a first-time anterior instability event, while recurrent instability resulted in 22.8% total bone loss. (10.1016/j.jse.2018.11.002)
  • [L3] Patellar dislocation in children influences subjective knee function in the long term. (10.1155/2014/473281)
  • [L3] The OL procedure is preferred for patients with more dislocations and greater bipolar bone loss, providing lower rates of residual apprehension, redislocation, and dislocation arthropathy. (10.1016/j.jseint.2024.08.181)
  • [L4] The study found no flexion contractures or clinically significant recurrent instability within a 1-year follow-up. (10.1177/03635465990270030701)
  • [L4] Understanding elbow biomechanics and the injury mechanism provides valuable insight into the variations of pathology that may be observed. (10.5435/jaaos-d-14-00023)
  • [L5] Current elbow fracture dislocation classification systems only describe one element of the injury or only include one pattern. (10.1177/1758573219884010)
  • [L4] By combining an understanding of anatomy and biomechanics with surgical technique, the authors could reconstruct chronically dislocated joints to achieve functional and painless elbows. (10.1016/j.jse.2006.09.003)
  • [L5] Treatment of the stiff elbow requires a thorough understanding of normal anatomy and etiological factors to develop effective strategies. (10.1016/j.jisako.2023.10.006)
  • [L5] From a biomechanical perspective, the enhancement of elbow stability with a monopolar radial head prosthesis is superior to that with a bipolar design. (10.1016/j.jse.2010.10.033)
  • [L4] Two cases document an unusual injury pattern in which a posterior glenohumeral dislocation occurred in association with a (posterior) acromion fracture. (10.1016/j.xrrt.2025.09.006)
  • [L4] The Wrightington classification system is a reliable and valid method of classifying fracture-dislocations of the elbow. (10.1302/0301-620x.102b8.bjj-2020-0013.r1)
  • [L5] There is no single procedure that reliably treats every patient with anterior shoulder instability; surgical methods must be adapted to the specific pathomorphology of the patient rather than converting a neuromuscular problem into a purely mechanical one. (10.1177/17585732231224699)
  • [L2] The successful completion of this trial will provide evidence on the effectiveness of a functional treatment for the management of simple elbow dislocations. (10.1186/1471-2474-11-263)
  • [L5] This article reviews the pathoanatomy, recognition, and management of shoulder instability in the patient with hypermobile Ehlers-Danlos syndrome, emphasizing the need for a multidisciplinary approach and special considerations due to severe instability and connective tissue abnormalities. (10.1016/j.xrrt.2021.03.002)
  • [L3] However, no significant relationships between adaptations in shoulder strength or ROM were related to chronic structural adaptations of the elbow. (10.1177/03635465251317509)
  • [L3] Atraumatic posterolateral rotatory instability should be considered in the differential diagnosis of lateral elbow when patients present with a protracted clinical course. (10.1016/j.jseint.2021.02.008)
  • [L4] The authors suggest that the approach allows better visualization of the lateral structures for repair and confers excellent stability to the elbow joint. (10.1016/j.jseint.2021.11.011)
  • [L4] PLRI of the elbow remains to be fully understood. (10.1016/j.arthro.2014.02.029)
  • [L4] The paper presents a review of the literature regarding the anatomy, biomechanics, classification, diagnosis, and management of acute and chronic acromioclavicular joint dislocations, discussing both conservative and surgical options without presenting new primary data. (10.1111/j.1758-5740.2011.00154.x)
  • [L4] The Montecranon classification is helpful for the management of complex proximal ulna fracture dislocations, leading to good to excellent results in 90% of cases despite a high rate of secondary surgeries. (10.1016/j.jseint.2025.07.008)
  • [L5] Thus, it should be considered in the development of improved repair techniques for stabilizers of the elbow. (10.1186/s12891-018-2341-y)
  • [L4] Good outcomes can be achieved for complex elbow fracture-dislocations through pattern recognition and management with an anatomically based reconstruction algorithm as described by the Wrightington classification system. (10.1177/17585732221113534)
  • [L4] The proposed procedure demonstrated effectiveness and safety, being a viable option for treating anterior shoulder instability with glenoid bone loss of less than 20% and especially beneficial for athletes. (10.1016/j.jseint.2024.06.016)
  • [L4] The internal joint stabilizer is a safe and effective implant that complements the management of chronic elbow dislocations. (10.1016/j.xrrt.2022.02.001)
  • [L5] The study evaluated stability against valgus and varus/posterolateral rotatory forces in cadaveric elbows. (10.1016/j.jse.2015.07.016)
  • [L5] Both the proximal docking and the single-point fixation hybrid reconstructions provided sufficient joint stability and strength compared to the intact elbows, with the exception of the proximal docking method at low flexion angles. (10.1016/j.jhsa.2014.07.040)
  • [L5] The Wrightington classification of elbow fracture dislocation is a comprehensive, reliable, and valid classification with treatment algorithms that are associated with good functional outcomes. (10.1016/j.jseint.2022.12.002)
  • [L5] The procedure is technically difficult and should be performed by experienced surgeons who are familiar with the neurovascular and musculoligamentous elbow anatomy. (10.1016/j.jisako.2024.02.003)
  • [L5] Pitching 100 balls induces a significant reduction in dynamic stabilizing ability against elbow valgus laxity. (10.1016/j.jse.2023.11.001)
  • [L5] Optimal outcomes are founded upon concentric reduction of the elbow. (10.1016/j.jseint.2023.03.020)
  • [L5] Tearing of the UCL significantly increased elbow valgus laxity, which in turn elongated the ulnar nerve during simulated throwing motion. (10.1016/j.jse.2019.02.009)
  • [L5] The overhead motion protocol is a safe early range of motion method for unstable elbows. (10.1016/j.jse.2012.08.012)
  • [L4] The modified McLaughlin procedure is a safe and effective treatment option for patients with locked posterior dislocation of the shoulder and a reverse Hill-Sachs lesion between 20% and 50% of the humeral head articular surface, demonstrating favorable clinical and radiographic outcomes with low complication and recurrent instability rates. (10.1016/j.xrrt.2023.08.007)
  • [L3] Rockwood type III was the most common type of AC joint dislocation constituting 55.7% of the injuries. (10.1177/17585732221123314)
  • [L1] The posterior approach with posterior soft tissue repair produced more favorable results regarding joint stability and dislocation rates compared to the lateral approach. (10.1016/j.arth.2011.06.007)
  • [L3] Operative treatment for recurrent patellar dislocation achieved good results, while in some cases the functional scores remain inferior. (10.1186/s12891-022-05527-y)
  • [L4] Conservative management remains the gold standard for most simple elbow dislocations. (10.1016/j.arthro.2014.02.037)
  • [L4] Asymptomatic non-unions should not be considered as failures as they are related to satisfactory outcomes, and no additional surgery should be performed. (10.1016/j.jse.2021.03.066)
  • [L4] Conservative treatment may be considered under strict preconditions, especially for nondisplaced subtype 1 and 2 fractures, as these fractures show satisfactory functional outcomes when treated nonoperatively. (10.1016/j.jse.2020.09.008)
  • [L4] Revision arthroscopic anterior stabilization of the shoulder can result in satisfactory outcomes in appropriately selected patients who have failed previous capsulolabral repair. (10.1016/j.jse.2014.11.034)
  • [L1] Surgical procedures provide similar outcomes regarding MEPS and ROM for patients with slight initial instability, while those with red flags for persistent instability should be considered for a primary surgical approach. (10.1186/s12891-024-07260-0)
  • [L4] The authors bring attention to the clinical, radiographic, and MRI findings associated with chronic irreducible posterolateral knee dislocation, noting that the classic dimple sign may be absent in chronic cases. (10.1016/j.arthro.2005.12.046)
  • [Case_report] MRI allows accurate preoperative identification of soft tissues impeding reduction in irreducible elbow dislocations. (10.1016/j.jse.2006.09.013)
  • [L4] This study highlights the frequent occurrence of significant MRI findings in pediatric first-time acute patellar dislocations, showing that obtaining MRI after first-time patellofemoral instability events in the pediatric population should be standard of care. (10.1177/03635465251383851)
  • [L4] This study shows difficulties in the evaluation of ligaments by conventional MRI technique as demonstrated by a weak inter- and intraobserver agreement. (10.1186/s12891-017-1451-2)
  • [Case_report] There has been no re-dislocation on the right elbow, five years postsurgery, and we hope that our experience will help clinicians in the future when treating patients with similar conditions. (10.1016/j.jseint.2023.03.021)
  • [L2] Patellar dislocators who present with a history of patellofemoral instability are more likely to be female, are older, and have greater risk of subsequent patellar instability episodes than first-time patellar dislocators. (10.1177/0363546503260788)
  • [Letter] The authors disagree with Bouliane et al.'s conclusions regarding the Instability Severity Index Score (ISIS), arguing that the score must be used as a whole and is a useful clinical tool when used in conjunction with computed tomography. (10.1111/sae.12038)
  • [L4] This study demonstrates that there is significant variability in surgical procedure selection driven by time alone in shoulder instability. (10.1016/j.jseint.2023.08.005)
  • [L4] The functional result depends primarily on the extent of the osseous damage to the articulation, the time interval between injury and operation, and the technical adequacy of the ligament repair and removal of intra-articular loose bodies. (10.2106/00004623-197961020-00012)
  • [L3] Therefore, early arthrolysis is preferable, and the conventionally observed interval of > 1 year after injury could be shortened. (10.1186/s12891-019-2506-3)

See Also

References

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