Arthroscopic Bankart repair of anterior detachments of the glenoid labrum. A prospective study.

BACKGROUND: The purpose of this study was to evaluate the results of an arthroscopic transglenoid suture-stabilization procedure in athletically active patients who had recurrent, unilateral, unidirectional anterior dislocations of the shoulder and an isolated anterior detachment of the glenoid labrum. METHODS: Forty-one patients who had unilateral, unidirectional anterior dislocations of the shoulder and an isolated anterior detachment of the glenoid labrum were managed with arthroscopic repair. All patients were athletic, and seventeen of the male patients were football players. No patient had inferior or posterior laxity or a posterior detachment. The sutures were anchored to the posterior aspect of the scapula, and the knots were tied anteriorly to secure the detached region of the labrum and the inferior glenohumeral ligament to the anterior aspect of the scapula. The mean duration of follow-up was fifty-two months (range, twenty-five months to seven years). The patients were evaluated annually with a physical examination, radiographs, isokinetic strength-testing, the modified shoulder-rating scale of Rowe and Zarins, and the scoring system of the American Shoulder and Elbow Surgeons. RESULTS: Forty (98 percent) of the forty-one athletes returned to their preoperative sport postoperatively. Thirty-nine patients (95 percent) had no additional dislocations or subluxations, and two (5 percent), both of whom were football players, had a single episode of subluxation. Thirty-seven patients (90 percent) had a score of at least 80 points on the scale of Rowe and Zarins, and thirty-four (83 percent) had a score of at least 90 points. Thirty-nine patients (95 percent) had a score of at least 80 points on the scale of the American Shoulder and Elbow Surgeons, and twenty-five (61 percent) had a score of at least 90 points. Lower scores were associated with loose bodies seen on arthroscopy (p = 0.001), osseous lesions seen on postoperative radiographs (p = 0.036), and subluxation (p = 0.000). Twenty-two shoulders (54 percent) had a full range of motion in all planes, and eighteen (44 percent) had no strength deficit in any position on isokinetic testing. With the numbers available for study, no significant association was found between the presence of a Hill-Sachs or an osseous Bankart lesion on preoperative radiographs and the overall score on the scale of Rowe and Zarins or the scale of the American Shoulder and Elbow Surgeons; however, there was a significant association between the range of motion and an osseous Bankart lesion on preoperative radiographs (p = 0.002) and between decreased strength on isokinetic testing and a Hill-Sachs lesion on preoperative radiographs and an osseous lesion on postoperative radiographs (p = 0.022). There also was a significant association between a decreased range of motion (p < 0.002) and decreased strength (p = 0.014) and the arthroscopic finding of loose bodies. Muscle strength also was affected by arm dominance and the number of preoperative dislocations. CONCLUSIONS: Arthroscopic transglenoid repair of isolated anterior labral detachments restored stability of the shoulder and led to a favorable outcome in thirty-nine (95 percent) of the forty-one athletes. Only the two football players who had postoperative subluxation had a score of less than 80 points according to the scale of the American Shoulder and Elbow Surgeons.     

Long-term outcome of anterior stabilization of the shoulder

This study reports long-term experience with anterior shoulder capsule stabilization by performing the Bankart repair when labral tearing was present with a laterally based T-capsule repair in both primary and revision surgery. Between 1979 and 1983, 34 patients underwent this procedure. They were categorized into a primary group of 22 patients and a revision group of 12 patients who had previous surgery to correct anterior shoulder instability. Patients completed our shoulder questionnaire and a Rowe questionnaire. The mean follow-up was 22 years (range, 11-27 years). No recurrent dislocations developed, 4 patients reported shoulder subluxation, and 11 felt apprehension. No patient had further anterior instability surgery. Two received total shoulder arthroplasty. Postoperative average pain was 1.6, average strength was 9.0, and average satisfaction was 8.3 (1-10 scales). Active elevation averaged 169 degrees, external rotation, 65 degrees; and internal rotation was to T12. There was an average of 10.2 "yes" responses on the Simple Shoulder Test. The total American Shoulder and Elbow Surgeons score averaged 84.3. Applying the Rowe rating, results were excellent in 16, good in 10, fair in 2, and poor in 4. Ratings were better in the primary surgery group (P = .0535). The use of this procedure for correction of shoulder instability can prevent recurrent dislocation, but some degree of instability remains. Clinically important arthritis seldom develops.     

Revision arthroscopic capsulolabral reconstruction for recurrent instability of the shoulder

We have investigated the outcome of arthroscopic revision surgery for recurrent instability of the shoulder after failed primary anterior stabilisation. We identified 40 patients with failed primary open or arthroscopic anterior stabilisation of the shoulder who had been treated by revision arthroscopic capsulolabral reconstruction and followed up for a mean of 36 months (12 to 87). There were 34 men and six women with a mean age of 33.1 years (15 to 48). Details of the patients, the technique of the primary procedure, the operative findings at revision and the clinical outcome were evaluated by reviewing the medical records, physical examination and the use of the Western Ontario shoulder instability index score, the American Shoulder and Elbow Surgeons score and the health status questionnaire 12. Recurrent instability persisted in four patients after the revision arthroscopic procedure. At the final follow-up, the mean American Shoulder and Elbow Surgeons score was 81.1 (17.5 to 99.5) and the mean Western Ontario shoulder instability index score was 68.2 (20 to 98.2). Quality-of-life scoring showed good to excellent results in most patients. Arthroscopic revision capsulolabral reconstruction can provide a satisfactory outcome in selected patients for recurrent instability of the shoulder provided that no large Hill-Sachs lesion is present.     

Arthroscopic pancapsular plication for multidirectional shoulder instability in overhead athletes

Treating shoulder multidirectional instability with an open stabilization procedure has been reported to have good results. However, few studies exist of arthroscopic plication, especially in overhead athletes. The purpose of this study was to evaluate the clinical outcomes of arthroscopic pancapsular plication for multidirectional instability in overhead athletes.Twenty-three athletes with symptomatic multidirectional instability were treated with arthroscopic pancapsular plication and evaluated at a mean follow-up of 36.3 months (range, 24-61 months). Mean patient age was 23.3 years (range, 19-33 years). Functional outcomes were evaluated with the American Shoulder and Elbow Surgeons (ASES) score, Constant shoulder score, and Rowe instability score. The degree of pain and range of motion were also recorded. All postoperative functional scores were rated good to excellent, with an average ASES score of 88.4 (range, 82-95), average Constant shoulder score of 88.1 (range, 81-100), and average Rowe instability score of 86.7 (range, 80-100). Five patients returned to the same level of competitive sports, and 18 returned to a limited level. All patients were satisfied with the stability postoperatively. No significant change was observed in postoperative range of motion, but patients who returned to a limited level of sports had lower functional scores and more pain than did those who fully returned to sports.Arthroscopic pancapsular plication for treating multidirectional instability in overhead athletes can provide good stability. However, the low rate of return to a full level of overhead sports is a problem. Further evaluation of the benefits of this procedure for overhead athletes with symptomatic multidirectional instability is needed.     

Arthroscopic anterior stabilization of the shoulder: two to six-year follow-up

BACKGROUND: The purpose of this study was to evaluate prospectively the surgical outcomes of arthroscopic repair of anterior capsulolabral lesions with use of suture anchors in a large series of patients who were followed for two to six years. METHODS: We evaluated the results of arthroscopic Bankart repair with use of suture anchors and nonabsorbable sutures in 167 patients with traumatic recurrent anterior instability of the shoulder. The mean age at the time of the operation was twenty-five years. Preoperatively and at the time of follow-up (at a mean of forty-four months), the patients were assessed with three objective outcome measurement tools (the Rowe score, the University of California at Los Angeles [UCLA] shoulder rating scale, and the American Shoulder and Elbow Surgeons [ASES] score) and two subjective measurement tools (pain and function visual analog scales). The recurrence rate, range of motion, and risk factors for postoperative recurrence were evaluated. RESULTS: All shoulder scores improved after surgery (p < 0.001). According to the Rowe scale, 130 patients (78%) had an excellent score; twenty-nine (17%), a good score; six (4%), a fair score; and two (1%), a poor score. Overall, the rate of postoperative recurrence of instability was 4% (one dislocation, two subluxations, and four positive results on the anterior apprehension test). Postoperative recurrence was related to an osseous defect of >30% of the entire glenoid circumference. In the patients with recurrent postoperative instability, the episodes were less frequent than they had been preoperatively and shoulder function was related to activity level. A revision arthroscopic Bankart repair stabilized three of the four shoulders in which it was performed. One hundred and fifty-two patients (91%) returned to >/=90% of their preinjury activity level. The mean loss of external rotation (and standard deviation) was 2.0 degrees +/- 4.0 degrees. CONCLUSIONS: We found that, in contrast to previous reports on the results of arthroscopic repair, arthroscopic capsulolabral repair with use of suture anchors can provide satisfactory outcomes in terms of recurrence rate, activity, and range of motion.     

Intraoperative decision making in the treatment of shoulder instability

Between April 1990 and April 1994, 100 patients with a preoperative diagnosis of anterior instability underwent a diagnostic arthroscopy of the shoulder. Patients with isolated SLAP lesions were excluded from the study. Patients with multidirectional instability, bony Bankart lesions, and large Hill-Sachs lesions were also excluded. Football players and dominant arm throwing athletes were also excluded. Thirty patients remained who had post-traumatic, unidirectional, anterior instability and a repairable Bankart lesion and did not have any exclusions as noted above. All of these patients underwent an initial attempt at an arthroscopic Sure-Tac stabilization (Smith & Nephew, Andover, MA). Twenty-three patients met our criteria for a secure fixation but 7 did not. These 7 underwent an immediate arthrotomy and open Bankart repair. All of the patients were available at follow-up at an average of 47 months (range, 36 to 72 months). The patients were evaluated by the Rowe shoulder rating scale. There have been two cases of recurrent subluxation and one case of recurrent dislocation in the Sure-Tac group. All three occurred over 2 years later. All three had recurrent Bankart lesions and underwent an arthrotomy and Bankart repair. There were no cases of recurrence of subluxation or dislocation in our initial open Bankart repair group. Sure-Tac arthroscopic anterior stabilization of the shoulder can initially give good results but these results appear to deteriorate over time and increased activity of the patient. We currently do not recommend a Sure-Tac repair even in a selective group of patients with an isolated Bankart lesion. This is based on our excellent results following an open Bankart repair and a 13% recurrence rate following Sure-Tac stabilization in carefully selected patients.Arthroscopy 1998 May-Jun;14(4):389-94     

关节镜下Bankart修复术治疗肩关节复发性前脱位:手术效果及复发危险因素分析

目的 探讨关节镜下Bankart修复术(缝合锚钉技术)治疗肩关节复发性前脱位的临床效果,并对术后复发不稳的可能危险因素进行分析.方法 2002年3月至2010年3月连续收治肩关节复发性前脱位患者259例,均采用关节镜下缝合锚钉技术进行Bankart修复手术,其中188例患者获得随访.患者手术时平均年龄25.3岁(13～58岁);其中男性143例、女性45例;运动员50名、非运动员138名.随访时采用美国肩肘关节外科协会评分系统(ASES)肩关节评分、Rowe评分以及患者满意度评价手术效果.术前肩关节ASES评分平均72.6分,Rowe评分平均33.4分.对于肩关节术后不稳的复发率、关节活动范围以及术后复发不稳的危险因素进行评估.结果 188例患者术后平均随访38.6个月(12～110个月).术后肩关节ASES评分平均91.9分,与术前比较差异具有统计学意义(P＜0.001);术后Rowe评分平均81.9分,与术前比较差异具有统计学意义(P＜0.001).患者手术满意度调查显示,满意152例、基本满意16例、不满意20例,满意率为89.4%.术后有24例患者复发脱位,总体复发率为12.8%;运动员患者复发率为28.0%,非运动员复发率为7.2%.术后患者平均肩关节外展外旋为75.2°,与术前比较无明显丧失(P＞0.05).关节镜Bankart修复术后复发不稳与患者年龄及是否为运动员明显相关(P＜0.05);而与术前病程长短、锚钉类型、锚钉数目、骨性Bankart损伤、合并肩关节上盂唇撕裂损伤、合并后或下方盂唇损伤、合并肩袖撕裂、关节松弛以及肩袖间隙闭合等因素无明显相关(P＞0.05).结论 关节镜下采用缝合锚钉进行Bankart修复术是治疗肩关节复发性前脱位的有效方法,临床效果比较满意.年轻患者(≤20岁)和运动员患者是术后肩关节复发不稳的高危因素,必要时选择切开手术.

Abstract：

Objective To evaluate retrospectively the results of arthroscopic Bankart repair using suture anchors for recurrent anterior shoulder dislocation with a minimum 1-year follow-up and to assess risk factors for recurrence.Methods From March 2002 to March 2010,259 patients with recurrent anterior shoulder dislocation underwent arthroscopic Bankart repair with suture anchors.And 188 patients(50 athletes,138 nonathletes)were available for follow-up.The mean age at the time of surgery was 25.3 years (range,13-58 years).The mean follow-up was 38.6 months(range,12-110 months).All of the 188 patients were evaluated preoperatively and postoperatively with the American Shoulder and Elbow Society (ASES)shoulder score and Rowe score system.The rate of recurrent instability,range of motion,and risk factors for postoperative recurrence were evaluated.The ASES score was 72.6 preoperatively,and Rowe score was 33.4.Results The ASES scores improved significantly to 91.9 postoperatively(P＜0.001).The Rowe scores improved to 81.9 postoperatively(P＜0.001).And 152 patients were greatly satisfied with the results,16 satisfied and 20 unsatisfied.The satisfactory rate was 89.4%.24 patients(12.8%)suffered a recurrence after surgery,14 athletes and 10 nonathletes.The recurrence rates were 28.0% in the athlete group and 7.2% in the nonathlete group.On average there was no significant loss of external rotation postoperatively(average,75.2° preoperatively and 67.2° postoperatively).Patients under age 20,and athlete patients were associated with recurrence(P＜ 0.05).Other factors including length of time until surgery,type of anchors,number of anchors,presence of bony Bankart lesion,presence of a superior labrum,anterior and posterior tear,presence of posterior or inferior labrum lesion,presence of rotator cuff tear,ligamentous laxity and rotator interval closure did not influence the recurrence rate(P＞0.05).Conclusions Arthroscopic Bankart repair is a good option for the treatment of recurrent anterior shoulder dislocation.Identification of risk factors for recurrence allows for consideration of open stabilization.In the series,patients under age 20 and athlete patients are the most important risk factors for recurrence.     

Iliac crest allograft glenoid reconstruction for recurrent anterior shoulder instability in athletes: Surgical technique and results

Performing a labral repair alone in patients with recurrent anterior instability and a large glenoid defect has led to poor outcomes. We present a technique involving the use of the iliac crest allograft inserted into the glenoid defect in athletes with recurrent anterior shoulder instability and large bony defects of the glenoid (>25% of glenoid diameter). All athletes with recurrent anterior shoulder instability and a large glenoid defect that underwent open anterior shoulder stabilization and glenoid reconstruction with the iliac crest allograft were followed over a 4-year period. Preoperatively, a detailed history and physical exam were obtained along with standard radiographs and magnetic resonance imaging of the affected shoulder. All patients also completed the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) evaluation forms preoperatively. A computed tomography scan was obtained postoperatively to assess osseous union of the graft and the patient again went through a physical exam in addition to completing the SST, ASES, and Western Ontario Shoulder Instability Index (WOSI) forms. 10 patients (9 males, 1 female) were followed for an average of 16 months (4–36 months) and had a mean age of 24.4 years. All patients exhibited a negative apprehension/relocation test and full shoulder strength at final follow-up. Eight of 10 patients had achieved osseous union at 6 months (80.0%). ASES scores improved from 64.3 to 97.8, and SST scores improved from 66.7 to 100. Average postoperative WOSI scores were 93.8%. The use of the iliac crest allograft provides a safe and clinically useful alternative compared to previously described procedures for recurrent shoulder instability in the face of glenoid deficiency.     

Revision anterior capsular shoulder stabilization using hamstring tendon autograft and tibialis tendon allograft reinforcement: minimum two-year follow-up

Surgical treatment of anterior shoulder capsular deficiency has been a challenge for orthopaedic surgeons dealing with failed anterior shoulder stabilization procedures. We have used hamstring tendon autograft or tibialis tendon allograft to reinforce deficient anterior capsular tissue in patients with failed anterior shoulder stabilization. We performed a clinical follow-up of 15 patients at a minimum of 2 years after surgery, using the American Shoulder and Elbow Surgeons questionnaire, a physical examination, and radiographs. Thirteen patients were satisfied with their surgery. The mean American Shoulder and Elbow Surgeons score was 73, (range, 7-100). There were no postoperative dislocations. The operative shoulder had decreased range of motion compared with the contralateral shoulder. The operative arm lacked 10 degrees of forward flexion, 21 degrees of external rotation at the side, 24 degrees of external rotation with the arm in abduction, and 4 spinal levels of internal rotation. Two patients required total shoulder arthroplasty for painful glenohumeral arthritis. Clinical failure was related to glenohumeral arthritis or residual anterior shoulder apprehension. Our results support the use of hamstring autograft or tibialis anterior allograft for the reconstruction of the anterior capsule during revision shoulder stabilization surgery.     

Open and arthroscopic techniques for the treatment of traumatic anterior shoulder instability in Australian rules football players.

Australian Rules football (ARF) is a potentially violent, overhead, body-contact sport. We reviewed 56 shoulders in patients who sustained their initial traumatic anterior subluxation or dislocation during ARF and who underwent reconstructive surgery for traumatic anterior instability, whether by arthroscopic or by open techniques. Patients were followed up for a mean of 29.4 months after operation, and clinical evaluation was performed with the Rowe grading system. Three types of surgical procedures were performed: arthroscopic suture repair, arthroscopic Bankart repair with an absorbable polyglyconate tack, and open capsular shift with repair of the Bankart lesion. Shoulders treated with arthroscopic suture repair had a 70% rate of recurrent subluxation or dislocation on return to ARF Dislocations treated arthroscopically with the biodegradable tack had a 38% rate of recurrence of instability; three fourths of the recurrences were after minimal to moderate trauma. Shoulders treated with an open capsular shift and Bankart procedure had a 30% rate of recurrent instability, with half of the recurrences caused by violent trauma. In the open group there were no failures in patients who did not return to ARF. We suggest that arthroscopic repair in shoulders with anterior instability and recurrent dislocation does not adequately address the plastic deformation of the anterior capsule that may occur after repeated episodes of dislocation. We advocate open shoulder procedures in ARF athletes to address all areas of the capsulolabral pathologic condition and to provide the most secure repair possible with minimal chance of recurrence.     

Excellent Clinical and Radiological Midterm Outcomes for the Management of Recurrent Anterior Shoulder Instability by All-Arthroscopic Modified Eden-Hybinette Procedure Using Iliac Crest Autograft and Double-Pair Button Fixation System: 3-Year Clinical Case Series With No Loss to Follow-Up

PurposeTo evaluate the clinical, functional, and radiological midterm outcomes of the all-arthroscopic modified Eden-Hybinette procedure in patients with recurrent anterior shoulder instability.MethodsA retrospective, single-center case series with prospectively collected data was conducted. The inclusion criterion was traumatic recurrent anterior shoulder instability with significant glenoid bone loss; patients with atraumatic or multidirectional instability were excluded. An all-arthroscopic modified Eden-Hybinette procedure using iliac crest autograft and double-pair button fixation was carried out. All patients were postoperatively assessed for recurrence and apprehension. Shoulder range of motion values and functional scores, including American Shoulder and Elbow Surgeons Score, Oxford instability, Rowe instability, and Walch-Dupplay, were recorded. Graft positions, healing, and absorption were evaluated with computed tomography. Comparisons of values were performed with paired t tests for normally distributed differences and with nonparametric Wilcoxon’s signed rank test otherwise.ResultsThe final study cohort included 28 patients, mean age 36 ± 10 years, and mean follow-up period 43 ± 6 months (range 36 to 53). Median glenoid bone loss was 12.4% (range 8% to 33%). No recurrence occurred, no subjective shoulder instability was reported, and no major complications were documented through the last follow-up. Postoperative shoulder range of motion had no significant differences compared with the healthy side. All final postoperative functional scores significantly increased to show excellent results compared with preoperative values. All grafts were positioned and healed optimally, and none was completely reabsorbed.ConclusionsThe all-arthroscopic modified Eden-Hybinette procedure is safe, leading to excellent clinical and radiological midterm outcomes in patients with recurrent anterior shoulder instability. This technique restores glenoid bone defects and preserves the normal shoulder anatomy.Level of EvidenceIV, therapeutic, retrospective case series     

The effectiveness of arthroscopic stabilisation for failed open shoulder instability surgery

We identified ten patients who underwent arthroscopic revision of anterior shoulder stabilisation between 1999 and 2005. Their results were compared with 15 patients, matched for age and gender, who had a primary arthroscopic stabilisation during the same period. At a mean follow-up of 37 and 36 months, respectively, the scores for pain and shoulder function improved significantly between the pre-operative and follow-up visits in both groups (p = 0.002), with no significant difference between them (p = 0.4). The UCLA and Rowe shoulder scores improved significantly (p = 0.004 and p = 0.002, respectively), with no statistically significant differences between groups (p = 0.6). Kaplan-Meier analysis for time to recurrent instability showed no differences between the groups (p = 0.2). These results suggest that arthroscopic revision anterior shoulder stabilisation is as reliable as primary arthroscopic stabilisation for patients who have had previous open surgery for recurrent anterior instability.     

Arthroscopic labral reconstruction for anterior shoulder instability. Failure analysis in 187 patients]

Comparing open with arthroscopic labral reconstruction for anterior shoulder instability we found a higher recurrence rate after arthroscopic capsulolabral repair. The aim of this study was, to analyse the reasons for recurrent instability after arthroscopic labral repair. MATERIALS AND METHODS: Between 1989 and 1995 we performed a arthroscopic labral reconstruction on 187 patients with anterior shoulder instability. 118 patients (63%) were treated with a transglenoid suture technique and 69 patient (37%) with a suture anchor technique. The average age at the time of the operation was 26.4 +/- 6.3 years (14-52 years). There were 41 women (21.9%) and 146 men (78.1%). RESULTS: The minimum follow-up was 18 months. The average follow-up was 3.7 +/- 1.1 years. The average Rowe Score increased from 34.7 points (0-75) preoperatively to 75.3 points (15-100) postoperatively. There were 47 (25.1%) excellent. 76 (40.6%) good, 21 (11.3%) fair, and 43 (23.0%) poor results. 105 patients (56.1%) regained their preoperative level of activity. 50 patients (26.7%) had recurrent subluxations or dislocations postoperatively. All failures occurred within two years (0.5-21 months) after the operation. Failure rates were associated with the patients age (p < 0.001), the level of activity (p < 0.05), the number of the preoperative dislocations (p < 0.01), the degree of the labral lesion (p < 0.001), and the operation method (p < 0.05). No correlation was found for the parameters sex, handiness, time between luxation and operation, size of Hill-Sachs-lesion and numbers of used sutures or anchors. CONCLUSION: We prefer the arthroscopic suture anchor technique if there are less than 5 preoperative dislocation and a type 1 or 2 labral lesion. If there are more than 5 preoperative dislocations and a degenerative labrum defect we favor the open Bankart repair technique.     

Arthroscopic repair of Bankart lesion in traumatic anterior-inferior shoulder instability using the two-portal method: A preliminary report

BackgroundIn this report, we describe our preliminary clinical results of arthroscopic Bankart repair in traumatic anterior-inferior shoulder instability using the two-portal method.MethodFrom August 2009 to December 2011, arthroscopic repair of Bankart lesion using this method was performed in 16 consecutive patients who were prospectively enrolled. Fifteen shoulders were treated with two-anchor sutures and one was treated with three-anchor sutures. Twelve patients received metallic anchor screws and four patients received bioanchor screws. The assessments were performed using the Rowe score, the University of California at Los Angeles shoulder rating scale, the American Shoulder and Elbow Surgeons score, and the shoulder range of motion (ROM) deficit.ResultsWith an average follow-up period of 22.9 months, all shoulder scores improved after surgery (p < 0.001). The average ROM deficit of the operated shoulders was not significant as compared with the healthy side in forward elevation (p > 0.05), but was significant in external rotation (p < 0.05). All of the 16 shoulders remained stable (100%) after the arthroscopic repair surgery. All patients returned to their preinjury levels of daily activity without recurrent problems.ConclusionIn patients with traumatic anterior glenohumeral instability, arthroscopic Bankart repair with the two portal method can provide good results. It can be an alternative method of treating patients with Bankart lesion without associated major glenoid defect or rotator cuff lesion in traumatic anterior-inferior instability.     

Arthroscopic staple capsulorrhaphy for recurrent anterior shoulder instability

Beginning in 1983, the principles of staple capsulorrhaphy of the shoulder utilizing arthroscopic techniques were applied to the treatment of patients with recurrent anterior shoulder instability. This paper describes the results of arthroscopic staple capsulorrhaphy of the shoulder in the first 25 consecutive cases in which these techniques were utilized. The patient population includes 4 females and 19 males, 2 of whom underwent bilateral staged procedures. Eleven of the patients had documented recurrent anterior dislocations while the remaining 12 patients were determined to have subluxation of the shoulder. The average age of the patient population was 23 years. Follow-up averaged 36 months. Results were determined by utilizing a strict 100 point rating scale as described by Rowe. Utilizing this scale, 67% of patients achieved good or excellent results. Five patients came to undergo additional surgical procedures. There were no complications of infection or neurovascular injury, but one patient suffered staple impingement upon the humeral head leading to excoriation thereof and secondary pain. An average loss of external rotation of 9 degrees, as compared to the contralateral shoulder, was noted postoperatively.     

关节镜和开放治疗复发性肩关节前方不稳的Meta分析

目的系统评价关节镜下和开放手术治疗青壮年复发性肩关节前方不稳定的疗效。方法计算机检索Cochrane图书馆(2011年第6期)、MEDLINE(1966年至2011年6月)、EMBase(1966年至2011年6月)、中国生物医学文献数据库(1979年1月至2011年6月)、PubMed(1966年6月至2011年6月)、万方数据库和维普数据库,手工检索中文骨科期刊的相关文献。收集所有关节镜与开放手术比较治疗青壮年患者(18～55岁)复发性肩关节前方不稳的随机对照试验,筛选出符合纳入标准的文献,对其进行严格的质量评价后应用RevMan5.0软件进行Meta分析。结果共纳入5个随机对照试验,包含278例患者。Meta分析结果显示,术后肩关节Rowe评分(WMD=4.43,95%CI2.27～6.59),关节镜手术治疗组优于开放手术治疗组。但二者在术后肩关节不稳复发(RR=1.31,95%CI0.51～3.34)、术后神经损伤(RR=0.51,95%CI0.11～2.32)、术后再手术(RR=0.49,95%CI0.11～2.27)、术后恢复伤前功能(RR=0.96,95%CI0.80～1.15)等方面比较均无统计学意义。结论与传统开放手术相比,关节镜手术治疗青壮年复发性肩关节前向不稳,术后肩关节Rowe评分具有优势,但术后并发症等方面二者间无明显差异。     

Clinical results of shoulder arthroscopy combined with an open modified Latarjet procedure for chronic anterior shoulder instability with glenoid bony loss

The purpose of this study was to follow up the clinical results of the modified Latarjet procedure combined with shoulder arthroscopy for chronic anterior shoulder dislocation with glenoid bony defect. From 1999 to 2004, we evaluated 28 patients with 28 shoulders receiving shoulder arthroscopy combined with an open modified Latarjet procedure. The average age of the patients was 28.5 years. The average length of follow-up in this series was 108.2 months (range 86–126 months). At the final follow-up, the Rowe score was excellent in 21 patients (75%), and good in seven patients (25%). No patient reported subluxation or recurrent instability. The average American Shoulder and Elbow Surgeons score was 93.4, and the average total Western Ontario Shoulder Instability score was 72.74%. Shoulder arthroscopy before the Latarjet procedure is recommended because of the higher incidence of intra-articular lesions affecting satisfactory functional outcomes.     

Comparison of arthroscopic and open anterior shoulder stabilization. A two to six-year follow-up study

BACKGROUND: Sixty-three consecutive patients with recurrent traumatic anterior shoulder instability underwent operative repair. The decision to select either arthroscopic Bankart repair or open capsular shift was based on the findings of an examination under anesthesia and the findings at the time of arthroscopy. Thirty-nine patients with only anterior translation on examination under anesthesia and a discrete Bankart lesion underwent arthroscopic Bankart repair with use of absorbable transfixing implants. Twenty-four patients with inferior translation in addition to anterior translation on examination under anesthesia and capsular laxity or injury on arthroscopy underwent an open capsular shift. METHODS: Treatment outcomes for each group were determined according to the scoring systems of Rowe et al., the American Shoulder and Elbow Surgeons, and the Short Form-36. Failure was defined as recurrence of dislocation or subluxation or the finding of apprehension. Fifty-nine (94 percent) of the sixty-three patients were examined and filled out a questionnaire at a mean of fifty-four months (range, twenty-seven to seventy-two months) following surgery. RESULTS: There were no significant differences between the two groups with regard to the prevalence of failure or any of the other measured parameters of outcome. An unsatisfactory outcome occurred after nine (24 percent) of thirty-seven arthroscopic repairs and after four (18 percent) of twenty-two open reconstructions. All cases of recurrent instability resulted from a reinjury in a contact sport or a fall less than two years postoperatively. The treatment groups did not differ with regard to patient age, hand dominance, mechanism of initial injury, duration of follow-up, or delay until surgery. Measured losses of motion were minimal and, with the exception of forward elevation, slightly more of which was lost after the open capsular shifts (p = 0.05), did not differ between the two forms of treatment. Approximately 75 percent of the patients in each group returned to their favorite recreational sports with no or mild limitations. As rated by the patients, the result was good or excellent after thirty-one (84 percent) of the arthroscopic procedures and after twenty (91 percent) of the open procedures. CONCLUSIONS: Arthroscopic and open repair techniques for the treatment of recurrent traumatic shoulder instability yield comparable results if the procedure is selected on the basis of the pathological findings at the time of surgery.     

Arthroscopic Bankart Repair With and Without Curettage of the Glenoid Edge: A Prospective,Randomized, Controlled Study

PurposeTo determine whether curettage of the cartilage on the glenoid edge in arthroscopic Bankart repair reduces the postoperative recurrence rate compared with noncuretted glenoid.MethodsBetween January 2010 and December 2013, 134 patients underwent arthroscopy and stabilization for recurrent anterior dislocation of shoulder; 42 patients were excluded. Alternate glenoid edge was curetted in 92 patients undergoing arthroscopic Bankart repair. Twelve patients were lost to follow-up. The remaining 80 patients were divided into 2 groups of 40 patients each, curettage and noncurettage. In both groups, the Bankart lesion was repaired using ≥3 bioanchors loaded with nonabsorbable braided sutures. Postoperative rehabilitation was the same for the 2 groups. We recorded recurrence of instability, pain, and Constant and Rowe shoulder scores. Statistical analysis of data was performed using unpaired t test (significance level P < .05).ResultsThe 2 groups were comparable in terms of age, number of dislocations, and bone loss. The average follow-up was 7 years and 9 months (range 6 to 10 years). Of the total 40 patients in the curettage group, 6 (15%) had recurrence of dislocation and none had subluxations, whereas in the noncurettage group, 13 (32.5%) had recurrence of dislocation and 3 (7.5%) had subluxations. The difference in postoperative recurrence of instability was statistically significant (P = .012). The average (standard deviation) Rowe score was 83.75 (23.28) in the curettage group and 70.13 (31.29) in the noncurettage group (P = .030).ConclusionsDuring arthroscopic Bankart repair, curettage of the cartilage on the anterior glenoid edge reduces the incidence of postoperative recurrence of instability.Level of EvidenceII, therapeutic; prospective, randomized, controlled study.     

复发性肩关节前脱位的关节镜治疗

目的 探讨肩关节镜下Bankart重建手术治疗复发性肩关节前脱位的疗效、适应证和手术要点.方法 随访40例应用肩关节镜下Bankart重建进行治疗的复发性肩关节前脱位患者,随访时间为24～58个月,平均35.9个月;年龄15～54岁,平均27.8岁.40例均为单方向性不稳定.术前平均脱位次数为14.1次(2～90次),其中28例发生于主力侧.术中采用金属缝合锚(Mini-Revo)进行Bankart重建.随访内容包括ASKS评分、Constant-Murley评分、VAS不稳定评分及ROWE评分进行功能评估.结果 40例患者术前和终末随访时肩关节前屈上举平均为[(157.5±20.6)°,x ±s.下同]和(170.0±6.7)°,体侧外旋平均为(58.5±18.9)°和(55.9±15.0)°,ASES评分平均为(82.7±16.7)和(97.2±6.9),VAS不稳定评分平均为(6.2±1.6)和(1.3±1.4),Constant-Murley评分平均为(80.5 ±11.1)和(98.1±3.1),Rowe评分平均为(30.4±8.7)和(92.8±15.2).除体侧外旋术前和术后差异无统计学意义外,其余各项结果差异均有统计学意义.终末随访时有1例患者曾出现肩关节半脱位.随访时发现残存恐惧试验阳性3例(占7.5%).所有患者均恢复术前工作,29例(占70.7%)恢复到第一次脱位前的运动水平.结论 肩关节镜下Bankart重建手术是治疗复发性肩关节前脱位的有效方法之一.适当的病例选择、术者的关节镜下操作技术水平及术后长期而严格的功能康复锻炼是手术成功的关键.