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Comprehensive Review of Shoulder Instability Includes Diagnosis, Nonoperative Management, Bankart, Latarjet, Remplissage, Glenoid Bone-Grafting, Revision Surgery, Rehabilitation and Return to Play, and Clinical Follow-Up

      Abstract

      The Delphi method is a structured communication technique used to allow a panel of experts to achieve a consensus in a systematic manner. Expert consensus on shoulder instability includes review of diagnosis, nonoperative management, Bankart, Latarjet, remplissage, glenoid bone-grafting, revision surgery, rehabilitation and return to play, and clinical follow-up. Amplified by Editorial Commentary, this is much to study, clinically relevant, and to the ultimate benefit of our patients.
      Hats off to an extremely productive author whose work has burst onto the scene of this journal and others in recent years, Eoghan T. Hurley, M.B., B.Ch., M.Ch., Ph.D., his co-authors, and The Anterior Shoulder Instability International Consensus Group for a Herculean effort resulting in a three-part series of articles on “Anterior Shoulder Instability.”
      • Hurley E.T.
      • Matache B.A.
      • Wong I.
      • et al.
      Anterior shoulder instability part I–Diagnosis, nonoperative management, and Bankart repair–An international consensus statement.
      • Hurley E.T.
      • Matache B.A.
      • Wong I.
      • et al.
      Anterior shoulder instability part II–Latarjet, remplissage, and glenoid bone-grafting–An international consensus statement.
      • Matache B.A.
      • Hurley E.T.
      • Wong I.
      • et al.
      Anterior shoulder instability part III–Revision surgery, rehabilitation and return to play, and clinical follow-up–An international consensus statement.
      We editors do not prefer multi-part series, but in collaboration with shoulder specialist and expert reviewer Stephen Weber, Editorial Board member Samar Hasan, and Associate Editor Erik Hohmann, we thoughtfully considered requesting that the authors combine the three parts into a single article. However, rigid adherence to editorial preference was superseded in this case by the enormous wealth of information included by Hurley et al. As we said, the effort was Herculean (and formidable and exacting), and the result, “An International Consensus Statement” on shoulder instability covering diagnosis, nonoperative management, Bankart repair, Latarjet, remplissage, glenoid bone-grafting, revision surgery, rehabilitation and return to play, and clinical follow-up, merits Parts I, II, and III.
      • Hurley E.T.
      • Matache B.A.
      • Wong I.
      • et al.
      Anterior shoulder instability part I–Diagnosis, nonoperative management, and Bankart repair–An international consensus statement.
      • Hurley E.T.
      • Matache B.A.
      • Wong I.
      • et al.
      Anterior shoulder instability part II–Latarjet, remplissage, and glenoid bone-grafting–An international consensus statement.
      • Matache B.A.
      • Hurley E.T.
      • Wong I.
      • et al.
      Anterior shoulder instability part III–Revision surgery, rehabilitation and return to play, and clinical follow-up–An international consensus statement.
      The three reviewers of these articles, Hasan, Weber, and Hohmann, are all shoulder authorities and all demonstrate experience as authors of studies using the Delphi method,
      • Hohmann E.
      • Glatt V.
      • Tetsworth K.
      • et al.
      Subacromial decompression in patients with shoulder impingement with an intact rotator cuff: An expert consensus statement using the modified Delphi technique comparing North American to European shoulder surgeons.
      • Hohmann E.
      • Angelo R.
      • Arciero R.
      • et al.
      Degenerative meniscus lesions: An expert consensus statement using the modified Delphi technique.
      • Hohmann E.
      • Cote M.P.
      • Brand J.C.
      Research pearls: Expert consensus-based evidence using the Delphi method.
      • Hohmann E.
      Editorial commentary: Delphi expert consensus clarifies evidence-based medicine for shoulder instability and bone loss.
      • Schumaier A.
      • Kovacevic D.
      • Schmidt C.
      • et al.
      Defining massive rotator cuff tears: A Delphi consensus study.
      a structured communication technique allowing a panel of experts to achieve a consensus in a systematic manner.
      The Delphi method
      Wikipedia.
      Each of our reviewers was invited to provide Editorial Commentary on the series by Hurley et al.
      • Hohmann E.
      Editorial commentary: Wider acceptance of medical expert consensus research requires strict adherence to Delphi panel methodology.
      • Weber S.C.
      Editorial commentary: To properly apply Delphi consensus conclusions, strengths and weaknesses of the process require consideration: Unified expert opinion or toxic fumes resulting in a strange trance?.
      • Hasan S.S.
      Editorial commentary: A consensus of experts complements the clinical evidence on diagnosis and treatment of anterior glenohumeral instability.
      Three articles and three commentaries, in the context of another comprehensive issue of Arthroscopy, is much to study, so following the trend of threes, we’ll keep this editorial to three short paragraphs. We hope our readers find this to be a clinically relevant series, and a clinically relevant issue of Arthroscopy, to the ultimate benefit of our patients.

      References

        • Hurley E.T.
        • Matache B.A.
        • Wong I.
        • et al.
        Anterior shoulder instability part I–Diagnosis, nonoperative management, and Bankart repair–An international consensus statement.
        Arthroscopy. 2022; 38: 214-223
        • Hurley E.T.
        • Matache B.A.
        • Wong I.
        • et al.
        Anterior shoulder instability part II–Latarjet, remplissage, and glenoid bone-grafting–An international consensus statement.
        Arthroscopy. 2022; 38: 224-233
        • Matache B.A.
        • Hurley E.T.
        • Wong I.
        • et al.
        Anterior shoulder instability part III–Revision surgery, rehabilitation and return to play, and clinical follow-up–An international consensus statement.
        Arthroscopy. 2022; 38: 234-242
        • Hohmann E.
        • Glatt V.
        • Tetsworth K.
        • et al.
        Subacromial decompression in patients with shoulder impingement with an intact rotator cuff: An expert consensus statement using the modified Delphi technique comparing North American to European shoulder surgeons.
        ([published online October 13, 2021]. Arthroscopy doi:)
        • Hohmann E.
        • Angelo R.
        • Arciero R.
        • et al.
        Degenerative meniscus lesions: An expert consensus statement using the modified Delphi technique.
        Arthroscopy. 2020; 36: 501-512
        • Hohmann E.
        • Cote M.P.
        • Brand J.C.
        Research pearls: Expert consensus-based evidence using the Delphi method.
        Arthroscopy. 2018; 34: 3278-3282
        • Hohmann E.
        Editorial commentary: Delphi expert consensus clarifies evidence-based medicine for shoulder instability and bone loss.
        Arthroscopy. 2021; 37: 1729-1730
        • Schumaier A.
        • Kovacevic D.
        • Schmidt C.
        • et al.
        Defining massive rotator cuff tears: A Delphi consensus study.
        J Shoulder Elbow Surg. 2020; 29: 674-680
        • The Delphi method
        Wikipedia.
        https://en.wikipedia.org/wiki/Delphi_method
        Date accessed: December 29, 2021
        • Hohmann E.
        Editorial commentary: Wider acceptance of medical expert consensus research requires strict adherence to Delphi panel methodology.
        Arthroscopy. 2022; 38: 250-252
        • Weber S.C.
        Editorial commentary: To properly apply Delphi consensus conclusions, strengths and weaknesses of the process require consideration: Unified expert opinion or toxic fumes resulting in a strange trance?.
        Arthroscopy. 2022; 38: 247-249
        • Hasan S.S.
        Editorial commentary: A consensus of experts complements the clinical evidence on diagnosis and treatment of anterior glenohumeral instability.
        Arthroscopy. 2022; 38: 243-246