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Cooke SJ, Starks I, Kathuria V. The results of arthroscopic anterior stabilisation of the shoulder using the bioknotless anchor system. BMC Sports Sci Med Rehabil 2009; 1:2. [PMID: 19284697 PMCID: PMC2654032 DOI: 10.1186/1758-2555-1-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2008] [Accepted: 01/19/2009] [Indexed: 11/29/2022]
Abstract
Background Shoulder instability is a common condition, particularly affecting a young, active population. Open capsulolabral repair is effective in the majority of cases, however arthroscopic techniques, particularly using suture anchors, are being used with increasing success. Methods 15 patients with shoulder instability were operated on by a single surgeon (VK) using BioKnotless anchors (DePuy Mitek, Raynham, MA). The average length of follow-up was 21 months (17 to 31) with none lost to follow-up. Constant scores in both arms, patient satisfaction, activity levels and recurrence of instability was recorded. Results 80% of patients were satisfied with their surgery. 1 patient suffered a further dislocation and another had recurrent symptomatic instability. The average constant score returned to 84% of that measured in the opposite (unaffected) shoulder. There were no specific post-operative complications encountered. Conclusion In terms of recurrence of symptoms, our results show success rates comparable to other methods of shoulder stabilisation. This technique is safe and surgeons familiar with shoulder arthroscopy will not encounter a steep learning curve. Shoulder function at approximately 2 years post repair was good or excellent in the majority of patients and it was observed that patient satisfaction was correlated more with return to usual activities than recurrence of symptoms.
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Affiliation(s)
- Stephen J Cooke
- Department of Trauma & Orthopaedics, Stafford General Hospital, Stafford, UK.
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102
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Steinbeck J, Witt KA, Marquardt B. Arthroskopische vs. offene ventrale Schulterstabilisierung. DER ORTHOPADE 2008; 38:36-40. [DOI: 10.1007/s00132-008-1353-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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103
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Cox CL, Kuhn JE. Operative versus Nonoperative Treatment of Acute Shoulder Dislocation in the Athlete. Curr Sports Med Rep 2008; 7:263-8. [DOI: 10.1249/jsr.0b013e318186d26d] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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104
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Elmlund A, Kartus C, Sernert N, Hultenheim I, Ejerhed L. A long-term clinical follow-up study after arthroscopic intra-articular Bankart repair using absorbable tacks. Knee Surg Sports Traumatol Arthrosc 2008; 16:707-12. [PMID: 18446321 DOI: 10.1007/s00167-008-0534-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 03/25/2008] [Indexed: 01/16/2023]
Abstract
The aim of the study was to perform an independent long-term evaluation after arthroscopic Bankart repair using absorbable tacks. We hypothesise that arthroscopic Bankart repair using absorbable tacks will result in stable shoulders. Eighty-one consecutive patients (84 shoulders) with symptomatic, recurrent, anterior, post-traumatic shoulder instability were included in the study. All the patients had a Bankart lesion. The age of the patients was 28 (15-62) years. The number of dislocations prior to surgery was five (sublux-50). The operation was performed 28 (3-360) months after the index injury by one of three surgeons with a special interest in shoulder surgery using an intra-articular arthroscopic Bankart procedure involving absorbable Suretac fixators. Seventy-six/84 (90%) of the shoulders (50 male, 23 female patients) were re-examined by two independent observers, after a follow-up period of 98 (46-129) months. In the long-term, the failure rate in terms of stability was 8/76 (11%) dislocations and a further 6/76 (8%) had experienced or had clinical signs of subluxation. The Rowe score was 91 (38-98) points at follow-up and the Constant score was 90 (56-100) points. The Constant score for the contralateral shoulder was 93 (69-100) points (P < 0.001). In the long-term, the arthroscopic Bankart procedure using Suretac fixators resulted in stable, well-functioning shoulders in the majority of patients. Eighteen per cent of the patients had experienced signs of instability during the follow-up period in terms of dislocations or subluxations.
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Affiliation(s)
- Anna Elmlund
- Department of Orthopaedics, Danderyd Hospital AB, Stockholm, Sweden
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105
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Hiemstra LA, Sasyniuk TM, Mohtadi NGH, Fick GH. Shoulder strength after open versus arthroscopic stabilization. Am J Sports Med 2008; 36:861-7. [PMID: 18319347 DOI: 10.1177/0363546508314429] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND With current techniques, the main difference between arthroscopic and open shoulder stabilization is the violation of the subscapularis tendon. No studies have looked at strength differences of internal and external rotation between these groups. HYPOTHESIS Internal rotation strength deficits will exist in patients having undergone an open shoulder stabilization procedure compared with an arthroscopic one. STUDY DESIGN Piggy-back randomized controlled trial; Level of evidence, 1. METHODS Forty-eight patients (38 men, 10 women), average age, 30.6 years (range, 18-59 years), were randomized to either open (n = 24) or arthroscopic (n = 24) shoulder stabilization. Rehabilitation protocols were standardized. At a mean follow-up of 19.4 months (range, 12-36 months) from surgery, patients underwent isokinetic strength testing (concentric and eccentric peak moments at 60 deg/s and 180 deg/s). Measurements were body-mass normalized. Primary outcome was internal rotation strength at 60 deg/s. RESULTS There were no significant differences between groups with respect to age, gender, or operative limb. There were no statistical differences between operative groups for the primary outcome of internal concentric strength at 60 deg/s (mean difference, 0.011 N.m/kg; 95% confidence interval, -0.043 to 0.066; P = .677) or secondary strength measures. When compared with the contralateral limb, strength deficits existed for both surgical groups for both internal and external rotation. Regression analysis demonstrated that arm dominance is a factor in strength deficits. CONCLUSION The results of this trial suggest there are no side-to-side isokinetic strength deficits between patients having an open stabilization using a subscapularis splitting approach versus arthroscopic stabilization for anterior traumatic shoulder instability at 1 year after surgery. Strength deficits exist in both groups when compared with the contralateral limb.
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106
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Provencher MT, Verma N, Obopilwe E, Rincon LM, Tracy J, Romeo AA, Mazzocca A. A biomechanical analysis of capsular plication versus anchor repair of the shoulder: can the labrum be used as a suture anchor? Arthroscopy 2008; 24:210-6. [PMID: 18237706 DOI: 10.1016/j.arthro.2007.08.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 08/07/2007] [Accepted: 08/07/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the biomechanical strength properties of suture capsulolabral plication to an intact labrum versus glenoid bone anchor fixation. METHODS Fourteen paired fresh frozen shoulders with intact glenoid labrum and mean age of 43.3 +/- 11.1 were randomized to capsular plication in the anteroinferior and posteroinferior quadrants using either two suture-anchor fixation versus suture fixation to an intact labrum. The construct was then preconditioned at 10 N for 10 cycles (1 Hz), and then loaded to failure at 3 mm per minute. RESULTS There was no statistical difference in ultimate load to failure between the suture anchor (304.3 +/- 92.8 N) and the intact labrum (285.6 +/- 66.7 N) groups. The suture anchor group demonstrated significantly less mean displacement (2.15 +/- 1.1 mm) than suture plication (3.43 +/- 1.38 mm; P = .007) at failure. There were no statistical differences of labrum strength and stiffness between the anteroinferior and posteroinferior quadrants. CONCLUSIONS An intact labrum provides similar fixation strength to a glenoid anchor; however, the labrum displacement was higher with plication alone. There were no strength differences between the anteroinferior and posteroinferior labrum. However, displacement of up to 1.5 mm may be expected without the use of glenoid anchors. CLINICAL RELEVANCE The intact posteroinferior or anteroinferior labrum provides similar fixation strength to a glenoid anchor; however, the labrum displacement is higher versus plication alone.
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Affiliation(s)
- Matthew T Provencher
- Division of Shoulder and Sports Surgery, Midwest Orthopaedics at Rush, Rush University, Chicago, Illinois, USA.
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107
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Hobby J, Griffin D, Dunbar M, Boileau P. Is arthroscopic surgery for stabilisation of chronic shoulder instability as effective as open surgery? A systematic review and meta-analysis of 62 studies including 3044 arthroscopic operations. ACTA ACUST UNITED AC 2008; 89:1188-96. [PMID: 17905956 DOI: 10.1302/0301-620x.89b9.18467] [Citation(s) in RCA: 152] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A systematic search of the literature published between January 1985 and February 2006 identified 62 studies which reported the results of arthroscopic procedures for chronic anterior shoulder instability or comparisons between arthroscopic and open surgery. These studies were classified by surgical technique and research methodology, and when appropriate, were included in a meta-analysis. The failure rate of arthroscopic shoulder stabilisation using staples or transglenoid suture techniques appeared to be significantly higher than that of either open surgery or arthroscopic stabilisation using suture anchors or bio-absorbable tacks. Arthroscopic anterior stabilisation using the most effective techniques has a similar rate of failure to open stabilisation after two years.
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Affiliation(s)
- J Hobby
- North Hampshire Hospitals, NHS Trust, Aldermaston Road, Basingstoke, Hampshire RG24 9NA, UK
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108
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Rhee YG, Lim CT, Cho NS. Muscle strength after anterior shoulder stabilization: arthroscopic versus open Bankart repair. Am J Sports Med 2007; 35:1859-64. [PMID: 17664342 DOI: 10.1177/0363546507304329] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A number of reports have been made on the muscle strength at the last follow-up after arthroscopic or open Bankart repairs. Few have analyzed the change over time in muscle strength and compared the changes between different operative methods. HYPOTHESIS Muscle strength recovers faster after arthroscopic Bankart repair than after open Bankart repair, and the final muscle strength is not different between the 2 procedures. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Sixty patients with anterior shoulder instability and an isolated Bankart lesion were enrolled for this study. Thirty patients underwent open Bankart repair (open group), and 30 patients went through arthroscopic Bankart repair (arthroscopic group). RESULTS The open group demonstrated markedly weaker muscle strength during forward elevation than did the arthroscopic group up to 3 months after surgery, but the difference narrowed to about 5% at 6 months (P = .074). At 6 months after surgery, the muscle strength of the open group measured 85.8% +/- 11.5% in forward elevation, 89.5% +/- 10.3% in external rotation, and 89.3% +/- 13.3% in internal rotation. The corresponding figures of the arthroscopic group were 90.6% +/- 8.6%, 92.1% +/- 9.1%, and 92.1% +/- 11.7%. As for external and internal rotations, the open group demonstrated markedly weaker muscle strength 6 weeks after surgery, but the differences were reduced to about 6% and 4%, respectively, at 3 months (P = .092 and .163, respectively). There was no statistically significant difference in final muscle strength 12 months after the operation between the 2 groups (P = .503, .468, and .659, respectively). CONCLUSION Muscle strength recovered faster with an arthroscopic procedure than with an open procedure during the early postoperative periods, and strength was restored to the level of the unaffected side at 6 months postoperatively. In the group with open Bankart repairs, the muscle strength during forward elevation recovered slower than did external and internal rotation muscle strengths.
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Affiliation(s)
- Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, 1 Hoiki-dong, Dongdaemoonku, Seoul 130-702, Korea.
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109
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Marquardt B, Garmann S, Schulte T, Witt KA, Steinbeck J, Pötzl W. Outcome after failed traumatic anterior shoulder instability repair with and without surgical revision. J Shoulder Elbow Surg 2007; 16:742-7. [PMID: 17967548 DOI: 10.1016/j.jse.2007.02.132] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 02/04/2007] [Accepted: 02/21/2007] [Indexed: 02/01/2023]
Abstract
The purpose of this study was to evaluate the incidence and reasons of recurrent instability in patients with traumatic anterior shoulder instability and to document the clinical results with regard to the number of stabilizing procedures. Twenty-four patients with failed primary open or arthroscopic anterior shoulder stabilization were followed for a mean of 68 (36-114) months. Following recurrence of shoulder instability, eight patients chose not to be operated on again, whereas 16 underwent repeat stabilization. A persistent or recurrent Bankart lesion was found in all 16 patients and concomitant capsular redundancy in 4. After the first revision surgery, further instability occurred in 8 patients, and 6 of them were stabilized a third time. Only 7 patients (29%) achieved a good or excellent result according to the Rowe score. All shoulder scores improved after revision stabilization. However, the number of stabilizing procedures adversely affected the outcome scores, as well as postoperative range of motion and patient satisfaction. Recurrent instability after a primary stabilization procedure represents a difficult diagnostic and surgical challenge, and careful attention should be paid to address persistent or recurrent Bankart lesions and concomitant capsular reduncancy. A satisfying functional outcome can be expected mainly in patients with one revision surgery. Further stabilization attempts are associated with poorer objective and subjective results.
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Affiliation(s)
- Björn Marquardt
- Department of Orthopaedics, University Hospital of Münster, Münster, Germany.
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110
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Mohtadi N. Arthroscopic or open repairs for recurrent anterior shoulder instability: a review. Clin J Sport Med 2007; 17:434-5. [PMID: 17873561 DOI: 10.1097/01.jsm.0000289519.48861.0c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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111
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Berendes TD, Wolterbeek R, Pilot P, Verburg H, te Slaa RL. The open modified Bankart procedure. ACTA ACUST UNITED AC 2007; 89:1064-8. [PMID: 17785747 DOI: 10.1302/0301-620x.89b8.19280] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the outcome of a modified Bankart procedure using suture anchors in 31 patients (31 shoulders) with a mean follow-up of 11 years (10 to 15). The mean age of the patients was 28 years (16 to 39). At follow-up, the mean Rowe score was 90 points (66 to 98) and the Constant score was 96 points (85 to 100). A total of 26 shoulders (84%) had a good or excellent result. The rate of recurrence varied between 6.7% and 9.7% and depended on how recurrence was defined. Two patients had a significant new injury at one and nine years, respectively after operation. The overall rate of instability (including subluxations) varied between 12.9% and 22.6%. All patients returned to work, with 29 (94%) resuming their pre-operative occupation and level of activity. Mild radiological osteoarthritis was seen in nine shoulders (29%) and severe osteoarthritis in one. We conclude that the open modified Bankart procedure is a reliable surgical technique with good long-term results.
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Affiliation(s)
- T D Berendes
- Department of Orthopaedic Surgery and Traumatology, Reinier de Graaf Groep, 2600 GA, Delft, The Netherlands
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112
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Collins KJ, Mukherjee DP, Ogden AL, Sadasivan KK, Albright JA, Pietrzak WS. A biomechanical study of bankart lesion fixation - biodegradable ArthroRivet tack vs. suture repair. J INVEST SURG 2007; 20:157-66. [PMID: 17613690 DOI: 10.1080/08941930701364740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Bioabsorbable fixation is commonly used in soft tissue procedures performed in the shoulder. ArthroRivettrade mark tacks (referred to as rivets here), made from a copolymer of 82% poly-L-lactic acid and 18% polyglycolic acid, were developed for the Bankart procedure. Although a previous in vivo study demonstrated favorable comparison of the fixation strength and absorption characteristics of this device with that of polyglyconate bioabsorbable tacks, there have been no published biomechanical studies of this rivet in the shoulder. Fourteen shoulders were harvested from fresh-frozen cadavers of average age 74 years (46-89). Biomechanical testing was performed by measuring the energy, or work, required to anteriorly displace the humeral head 6 mm from the glenoid. Each shoulder was tested intact, vented, and before and after repair of a simulated Bankart lesion at 0, 45, and 90 degrees of abduction with and without maximal external rotation. Overall, the average work required ranged from 54.7 N-mm to 178.27 N-mm. Although the biomechanical performance of the rivet, based on resistance to anterior displacement of the humeral head, was indistinguishable from that of the suture repair, the statistical power of the test was low due to the large variance in the cadaver specimens. The results, in general, correlated well with those of previously published studies, suggesting the suitability of the bioabsorbable rivet for use in Bankart repair.
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Affiliation(s)
- Kevin J Collins
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, 71130, USA
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113
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Kropf EJ, Tjoumakaris FP, Sekiya JK. Arthroscopic shoulder stabilization: is there ever a need to open? Arthroscopy 2007; 23:779-84. [PMID: 17637415 DOI: 10.1016/j.arthro.2007.03.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2006] [Revised: 02/24/2007] [Accepted: 03/06/2007] [Indexed: 02/02/2023]
Abstract
Recent studies show comparable results of arthroscopic shoulder stabilization techniques compared with the gold standard open Bankart reconstruction. Great technical advances and ever-increasing surgeon experience have rendered pathology once deemed an indication for open surgery as treatable by arthroscopic means. With this movement toward a more universal application of all-arthroscopic techniques, we might consider the following question: Is there ever a need to open? To answer this question, we must first consider normal anatomy and then appreciate the contribution of deranged pathoanatomy to recurrent instability in each individual case. The surgeon must then determine whether this is best addressed via an arthroscopic or open technique. Arthroscopy, as compared with open stabilization procedures, holds the potential benefits of decreased morbidity rates, early functional rehabilitation, and improved range of motion. Despite potential advantages, arthroscopic stabilization is clearly contraindicated when a significant pathologic lesion contributing to recurrent instability cannot be adequately addressed as a result of the limitations of current techniques or instrumentation. On the basis of this principle, we believe that sizable glenohumeral bone defects remain the only absolute contraindication to an all-arthroscopic approach. Many complicating issues, such as attenuated capsule, humeral avulsion of the glenohumeral ligament lesions, cases of revision surgery, and collision or contact athletes, exist and warrant close attention. We prefer to think of these situations as "challenges" for which both arthroscopic and open surgery should be considered, rather than as true contraindications to arthroscopic shoulder stabilization. We are, by no means, advocating arthroscopic treatment in all cases of shoulder instability, because this would represent a gross oversimplification of the issues at hand. However, we do acknowledge that the steadfast contraindications to arthroscopic shoulder stabilization are decreasing every day.
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Affiliation(s)
- Eric J Kropf
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15203, USA
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114
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Effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability. INT J EVID-BASED HEA 2007. [DOI: 10.1097/01258363-200706000-00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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115
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Boileau P, Bicknell RT, El Fegoun AB, Chuinard C. Arthroscopic Bristow procedure for anterior instability in shoulders with a stretched or deficient capsule: the "belt-and-suspenders" operative technique and preliminary results. Arthroscopy 2007; 23:593-601. [PMID: 17560473 DOI: 10.1016/j.arthro.2007.03.096] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Revised: 02/26/2007] [Accepted: 03/24/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE We report the results of a new technique consisting of a combined arthroscopic Bankart repair associated with a transfer of the coraco-biceps tendon to reinforce the deficient anterior capsule by lowering the subscapularis. METHODS The procedure combines 2 parts: an arthroscopic Bankart repair, which recreates the glenoid concavity and retensions the inferior glenohumeral ligament (i.e., "the belt," or intra-articular ligamentoplasty), and an arthroscopic transfer of the conjoined tendon with a coracoid fragment, to reinforce the stretched or torn inferior glenohumeral ligament (i.e., "the suspenders," or extra-articular ligamentoplasty). The coracoid fragment is exteriorized, shaped, and calibrated, and a tenodesis of the coraco-biceps tendon is performed above the subscapularis tendon by fixing the coracoid fragment with a bioabsorbable interference screw in a glenoid socket in the scapular neck. Thirty-six patients were available for clinical and radiographic review with a minimum 1-year follow-up. RESULTS Of the patients, 28 (78%) were very satisfied, 5 (14%) were satisfied, and 3 (8%) were disappointed. In comparison to the contralateral shoulder, postoperative mobility revealed no loss of active anterior elevation, a mean deficit of 9 degrees in external rotation with the arm at the side, a mean deficit of 15 degrees in external rotation in abduction, and no loss of internal rotation. The mean Walch-Duplay score was 87 points. Failures occurred in 3 patients (8%) who presented with recurrent instability. CONCLUSIONS This new intra- and extra-articular combined technique constitutes an alternative in the treatment of anterior shoulder instability in patients with deficient or stretched anterior capsule. It combines the theoretic advantages of the Bristow bone-block procedure and the arthroscopic Bankart repair while eliminating the potential disadvantages of each. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Pascal Boileau
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, University of Nice, Nice, France.
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116
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Lenters TR, Franta AK, Wolf FM, Leopold SS, Matsen FA. Arthroscopic Compared with Open Repairs for Recurrent Anterior Shoulder Instability. J Bone Joint Surg Am 2007. [DOI: 10.2106/00004623-200702000-00003] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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117
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Lenters TR, Franta AK, Wolf FM, Leopold SS, Matsen FA. Arthroscopic compared with open repairs for recurrent anterior shoulder instability. A systematic review and meta-analysis of the literature. J Bone Joint Surg Am 2007; 89:244-54. [PMID: 17272436 DOI: 10.2106/jbjs.e.01139] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Both arthroscopic and open surgical repairs are utilized for the management of anterior glenohumeral instability. To determine the evidence supporting the relative effectiveness of these two approaches, we conducted a rigorous and comprehensive analysis of all reports comparing arthroscopic and open repairs. METHODS A systematic analysis of eighteen published or presented studies was performed to determine if there were significant differences between the two approaches with regard to recurrence (recurrent dislocation, subluxation, and/or apprehension and/or a reoperation for instability), return to work and/or sports, and Rowe scores. We also performed subgroup analysis to determine if the quality of the study or the arthroscopic technique influenced the results. RESULTS We identified four randomized controlled trials, ten controlled clinical trials, and four other comparative studies. Results were influenced both by the quality of the study and by the arthroscopic technique. Meta-analysis revealed that, compared with open methods, arthroscopic repairs were associated with significantly higher risks of recurrent instability (p < 0.00001, relative risk = 2.37, 95% confidence interval = 1.66 to 3.38), recurrent dislocation (p < 0.0001, relative risk = 2.74, 95% confidence interval = 1.75 to 4.28), and a reoperation (p = 0.002, relative risk = 2.32, 95% confidence interval = 1.35 to 3.99). When considered alone, arthroscopic suture anchor techniques were associated with significantly higher risks of recurrent instability (p = 0.01, relative risk = 2.25, 95% confidence interval = 1.21 to 4.17) and recurrent dislocation (p = 0.004, relative risk = 2.57, 95% confidence interval = 1.35 to 4.92) than were open methods. Arthroscopic approaches were also less effective than open methods with regard to enabling patients to return to work and/or sports (p = 0.03, relative risk = 0.87, 95% confidence interval = 0.77 to 0.99). On the other hand, analysis of the randomized clinical trials indicated that arthroscopic repairs were associated with higher Rowe scores (p = 0.002, standardized mean difference = 0.43, 95% confidence interval = 0.16 to 0.70) than were open methods. Similarly, analysis of the arthroscopic suture anchor techniques alone showed the Rowe scores to be higher (p = 0.04, standardized mean difference = 0.29, 95% confidence interval = 0.01 to 0.56) than those associated with open methods. CONCLUSIONS The available evidence indicates that arthroscopic approaches are not as effective as open approaches in preventing recurrent instability or enabling patients to return to work. Arthroscopic approaches resulted in better function as reflected by the Rowe scores in the randomized clinical trials. The study design and the arthroscopic technique had substantial effects on the results of the analysis.
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Affiliation(s)
- Tim R Lenters
- Department of Orthopaedics and Sports Medicine, Box 356500, University of WashingtonMedical Center, 1959 N.E. Pacific Street, Seattle, WA 98195, USA
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118
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Ng C, Bialocerkowski A, Hinman R. Effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability. ACTA ACUST UNITED AC 2007; 5:1-49. [PMID: 27820219 DOI: 10.11124/01938924-200705040-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Anterior instability is a frequent complication following a traumatic glenohumeral dislocation. Frequently the underlying pathology associated with recurrent instability is a Bankart lesion. Surgical correction of Bankart lesions and other associated pathology is the key to successful treatment. Open surgical glenohumeral stabilisation has been advocated as the gold standard because of consistently low postoperative recurrent instability rates. However, arthroscopic glenohumeral stabilisation could challenge open surgical repair as the gold standard treatment for traumatic anterior glenohumeral instability. OBJECTIVES Primary evidence that compared the effectiveness of arthroscopic versus open surgical glenohumeral stabilisation was systematically collated regarding best-practice management for adults with traumatic anterior glenohumeral instability. SEARCH STRATEGY A systematic search was performed using 14 databases: MEDLINE, Cumulative Index of Nursing and Allied Health (CINAHL), Allied and Complementary Medicine Database (AMED), ISI Web of Science, Expanded Academic ASAP, Proquest Medical Library, Evidence Based Medicine Reviews, Physiotherapy Evidence Database, TRIP Database, PubMed, ISI Current Contents Connect, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Studies published between January 1984 and December 2004 were included in this review. No language restrictions were applied. SELECTION CRITERIA Eligible studies were those that compared the effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability, which had more than 2 years of follow up and used recurrent instability and a functional shoulder questionnaire as primary outcomes. Studies that used non-anatomical open repair techniques, patient groups that were specifically 40 years or older, or had multidirectional instability or other concomitant shoulder pathology were excluded. DATA COLLECTION AND ANALYSIS Two independent reviewers assessed the eligibility of each study for inclusion into the review, the study design used and its methodological quality. Where any disagreement occurred, consensus was reached by discussion with an independent researcher. Studies were assessed for homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format; otherwise a meta-analysis was conducted. RESULTS Eleven studies were included in the review. Two were randomised controlled trials. Evidence comparing arthroscopic and open surgical glenohumeral stabilisation was of poor to fair methodological quality. Hence, the results of primary studies should be interpreted with caution. Observed clinical heterogeneity in populations and outcomes was highlighted and should be considered when interpreting the meta-analysis. Authors also used variable definitions of recurrent instability and a variety of outcome measures, which made it difficult to synthesise results. When comparable data were pooled, there were no significant differences (P > 0.05) between the arthroscopic and open groups with respect to recurrent instability rates, Rowe score, glenohumeral external rotation range and complication rates. CONCLUSIONS Statistically, it appears that both surgical techniques are equally effective in managing traumatic anterior glenohumeral instability. In light of the methodological quality of the included studies, it is not possible to validate arthoscopic stabilisation to match open surgical stabilisation as the gold standard treatment. Further research using multicentred randomised controlled trials with sufficient power and instability-specific questionnaires with sound psychometric properties is recommended to build on current evidence. The choice of treatment should be based on multiple factors between the clinician and the patient.
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Affiliation(s)
- Choong Ng
- 1Centre for Health, Exercise and Sports Medicine and 2Rehabilitation Sciences Research Centre, School of Physiotherapy, The University of Melbourne, Melbourne, Victoria, and 3Centre for Allied Health Evidence (a collaborating centre of The Joanna Briggs Institute), University of South Australia, Adelaide, South Australia, Australia
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Marquardt B, Witt KA, Götze C, Liem D, Steinbeck J, Pötzl W. Long-term results of arthroscopic Bankart repair with a bioabsorbable tack. Am J Sports Med 2006; 34:1906-10. [PMID: 16902234 DOI: 10.1177/0363546506290404] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Short-term to midterm data are available on arthroscopic shoulder stabilization using bioabsorbable tacks or suture anchors. It remains unknown whether these techniques can equal the success of open Bankart repair in the long term. PURPOSE To assess the long-term outcome of arthroscopic Bankart repair using bioabsorbable tacks in patients with traumatic anterior shoulder instability with a minimum follow-up of 7 years. STUDY DESIGN Case series; Level of evidence, 4. METHODS Treatment outcomes were determined prospectively according to the Rowe score and retrospectively according to the Constant and American Shoulder and Elbow Surgeons scores. Included in this study were 18 consecutive patients with a mean age of 26.8 years (range, 16-62 years) who underwent arthroscopic Bankart repair using bioabsorbable tacks for traumatic anterior shoulder instability. The study group consisted of 14 male and 4 female patients. The mean follow-up was 8.7 years (range, 7.0-9.8 years). RESULTS One patient had recurrent dislocations requiring further surgery, for an overall failure rate of 5.6%. An additional patient had 1 traumatic subluxation episode within the first postoperative year that did not recur. According to the Rowe score, which increased to 90.3 (17.8) from 32.8 (8.3) points preoperatively, 15 patients (83.3%) achieved a good or excellent result. The mean Constant score was 91.3 (SD, 6.9) points, and the mean American Shoulder and Elbow Surgeons score was 92.1 (SD, 6.9) points postoperatively. A return to the preinjury level of sports competition was reported by 64% of patients. No signs of synovitis occurred in any patient postoperatively. CONCLUSION Arthroscopic Bankart repair for the treatment of recurrent traumatic anterior shoulder instability repair using bioabsorbable tacks offers reliable results with respect to failure rate, range of motion, and shoulder function during a minimum follow-up of 7.0 years. In contrast to previous reports on arthroscopic Bankart repair, results did not deteriorate during follow-up.
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Affiliation(s)
- Björn Marquardt
- Department of Orthopaedics, University Hospital of Münster, Albert-Schweitzer Str 33, 48129 Münster, Germany.
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van Oostveen DPH, Schild FJA, van Haeff MJ, Saris DBF. Suture anchors are superior to transglenoid sutures in arthroscopic shoulder stabilization. Arthroscopy 2006; 22:1290-7. [PMID: 17157727 DOI: 10.1016/j.arthro.2006.07.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Revised: 05/28/2006] [Accepted: 07/06/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE We retrospectively compared 2 groups of high-demand patients with post-traumatic anterior shoulder instability to determine whether arthroscopic stabilization was superior with transglenoid suture or suture anchors. METHODS In a retrospective comparative study we investigated the results of 246 high-demand patients, with post-traumatic anterior shoulder instability, who underwent arthroscopic capsulolabral reconstruction: 165 (mean age, 27.5 years; mean follow-up, 80 months) were evaluated after treatment with transglenoid sutures, and 81 (mean age, 26.6 years; mean follow-up, 27 months) were treated with suture anchors in a consecutive period. We compared both techniques with regard to recurrence rate, postoperative complications, range of motion, sport activity, work, and patient satisfaction. RESULTS In the anchor group recurrent dislocation after surgery occurred in 7 patients (8.7%), all within 18 months postoperatively. This finding was significantly (P = .009) better than that in the transglenoid group, in which recurrent postoperative dislocation occurred in 57 patients (34%), in a period of 0 to 115 months after surgery. Postoperative complications were seen in 4 of 81 patients in the suture anchor group, whereas a significantly (P = .01) higher rate was found in the transglenoid suture group, with 36 complications in 35 of 165 patients. CONCLUSIONS The data presented in this study suggest that the modern suture anchor technique results in a better outcome after shoulder stabilization, with fewer complications and lower recurrence rates, than the transglenoid repair. We conclude that the suture anchor technique should be a preferred method for arthroscopic shoulder stabilization surgery. LEVEL OF EVIDENCE Level III, retrospective, comparative therapeutic study.
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Affiliation(s)
- Dirk P H van Oostveen
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
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Marquardt B, Hurschler C, Schneppendahl J, Witt KA, Pötzl W, Steinbeck J. Quantitative assessment of glenohumeral translation after anterior shoulder dislocation and subsequent arthroscopic bankart repair. Am J Sports Med 2006; 34:1756-62. [PMID: 16840776 DOI: 10.1177/0363546506289702] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND During the past decade, developments in arthroscopic technology have made arthroscopic repair of labral lesions feasible. However, results with the use of the transglenoid suture technique, or with the use of bioabsorbable tacks, have remained variable in the literature, and the recurrence rates are still inferior to those of open Bankart repair. HYPOTHESIS Arthroscopic Bankart repair with suture anchors can re-create translational and rotational range of motion of the intact glenohumeral joint, and the number of preoperative dislocations has an influence on the result. STUDY DESIGN Controlled laboratory study. MATERIALS Twelve cadaveric shoulders were tested in a robot-assisted shoulder simulator. Anterior and posterior translation and external rotation were measured for intact, dislocated (shoulders were randomly selected to 1 of 3 groups, which were dislocated 1, 3, or 7 times), and repaired conditions at 0 degrees and 90 degrees of glenohumeral elevation. RESULTS After shoulder dislocation, a significant increase was found in translation and rotation, confirming the creation of a traumatic shoulder instability model. Further testing of the specimen revealed that translational and rotational ranges of motion were reduced by arthroscopic Bankart repair at both testing positions. External rotation was decreased significantly at 0 degrees and 90 degrees of abduction. No significant differences were found between the 3 dislocation groups. CONCLUSION The results demonstrate a sufficient biomechanical performance of arthroscopic Bankart repair using suture anchors in a traumatic anterior shoulder instability model. With the numbers available, no relationship was found between the number of dislocations and the postoperative result concerning translational or rotational motion. CLINICAL RELEVANCE Glenohumeral translation and rotation after arthroscopic Bankart repair with use of suture anchors approached near normal values, confirming the clinical success of this technique.
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Affiliation(s)
- Björn Marquardt
- Department of Orthopaedics, University Hospital of Münster, Albert-Schweitzer Strasse 33, 48149 Münster, Germany.
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Marquardt B, Witt KA, Liem D, Steinbeck J, Pötzl W. Arthroscopic Bankart repair in traumatic anterior shoulder instability using a suture anchor technique. Arthroscopy 2006; 22:931-6. [PMID: 16952720 DOI: 10.1016/j.arthro.2006.04.105] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Revised: 04/27/2006] [Accepted: 04/27/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to prospectively evaluate the surgical outcome of arthroscopic Bankart repair via suture anchors in patients with recurrent traumatic anterior shoulder instability with a minimum follow-up of 2 years. METHODS We included 54 consecutive patients without an osseous Bankart lesion of greater than 25% of the glenoid circumference with a mean age of 25.3 years (range, 16 to 58 years) undergoing arthroscopic Bankart repair via suture anchors for traumatic anterior shoulder instability. The mean follow-up was 3.7 years (range, 2.3 to 5.2 years) at the final follow-up examination. Patients were evaluated prospectively according to the rating scales of Rowe, the American Shoulder and Elbow Surgeons, and Constant and Murley. One patient was lost to follow-up. RESULTS After 3.7 years, 4 patients had recurrent instability: 3 had redislocated and 1 had recurrent subluxations. Thus the overall redislocation rate was 7.5%. Of the 4 redislocators, 3 had a traumatic onset of the redislocation. All shoulder scores (Rowe, American Shoulder and Elbow Surgeons, and Constant and Murley) revealed highly significant improvements postoperatively. At final follow-up, 85.7% of patients had returned to their preoperative sports level. CONCLUSIONS Our results in this series demonstrate the efficacy of arthroscopic Bankart repair with suture anchors for the treatment of recurrent traumatic anterior shoulder instability with respect to recurrence rate, range of motion, and shoulder function during a mean follow-up of 3.7 years. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Björn Marquardt
- Department of Orthopaedics, University Hospital of Münster, Münster, Germany.
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Tjoumakaris FP, Abboud JA, Hasan SA, Ramsey ML, Williams GR. Arthroscopic and open Bankart repairs provide similar outcomes. Clin Orthop Relat Res 2006; 446:227-32. [PMID: 16467628 DOI: 10.1097/01.blo.0000205883.73705.19] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED Recurrent instability after arthroscopic Bankart repair has decreased, largely because of improvements in surgical technique. We wanted to know whether there were differences in functional outcomes (using a validated outcomes measure) in patients who had arthroscopic Bankart repair or open Bankart repair for recurrent anterior glenohumeral instability. We retrospectively reviewed 106 patients who had a Bankart repair for recurrent anterior glenohumeral instability from 1998-2001. Of the 93 patients included, 69 patients had arthroscopic Bankart repair and 24 patients had open Bankart repair. The indications for surgery in the two groups were similar. The average age of the patients was 29.9 years (arthroscopic Bankart repair, 31 years; open Bankart repair, 28 years). The followup ranged from 24-77 months. The average modified American Shoulder and Elbow Surgeons score (PENN score) for pain, satisfaction, and function were 26.3, 8.5, and 55.1, respectively, in the arthroscopic Bankart repair group and 26.6, 8.8, and 54.2, respectively, in the open Bankart repair group. The total score was 90 in the arthroscopic Bankart repair group and 89.5 in the open Bankart repair group. Recurrent instability occurred in one patient in each group. We found no difference in outcomes between the arthroscopic and open Bankart repair groups using patient-assessed outcomes. LEVEL OF EVIDENCE Therapeutic Study, Level III (retrospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Fotios P Tjoumakaris
- University of Pennsylvania School of Medicine, Presbyterian Medical Center, Philadelphia, Pennsylvania 19104, USA.
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Carreira DS, Mazzocca AD, Oryhon J, Brown FM, Hayden JK, Romeo AA. A prospective outcome evaluation of arthroscopic Bankart repairs: minimum 2-year follow-up. Am J Sports Med 2006; 34:771-7. [PMID: 16627629 DOI: 10.1177/0363546505283259] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic treatment of anterior shoulder dislocation has become possible through improvements in instruments and techniques. OBJECTIVE To prospectively evaluate results of arthroscopic Bankart repairs at a minimum 2-year follow-up for patients with histories of shoulder dislocation and an anterior-inferior labral tear at the time of diagnostic arthroscopy. STUDY DESIGN Case series; Level of evidence, 4. METHODS A consecutive series of 85 patients (70 men, 15 women; mean age, 26 years) with Bankart lesions were treated with arthroscopic repair using suture anchors; 18 patients (27%) had extension of the labral injury into the superior labrum affecting some or all of the biceps anchor. Anchors were loaded with no. 2 nonabsorbable braided suture and placed 2 mm into the edge of the glenoid surface. A low anterior (5-o'clock) portal through the subscapularis tendon was used in all patients; 72 patients were evaluated at a minimum of 2 years postoperatively (mean, 46 months). RESULTS Seven patients (10%) experienced recurrent instability after repair. Four patients had redislocations; 3 experienced recurrent subluxations. One patient had pain with the apprehension test without a clear history of recurrent instability. Of 18 collision athletes, 2 had dislocations at 22 and 60 months postoperatively. There were no complications, including no neurologic deficits. Clinical strength testing of the subscapularis muscle was normal in all patients. The mean Rowe score was 88 of 100 points, with 90% excellent or good results. Simple Shoulder Test responses improved from 66% positive preoperatively to 88% positive postoperatively. The American Shoulder and Elbow Surgeons scoring index averaged 92 of 100 points postoperatively. Pain analog scales improved from 5.5 preoperatively to 0.35 postoperatively on a 10-point scale. SF-12 scores improved for physical function. Patient satisfaction was rated 8.9 on a 10-point visual analog scale. CONCLUSION Bankart repairs performed arthroscopically using properly implanted suture anchors and nonabsorbable sutures and in which associated pathoanatomy is addressed demonstrate low recurrence rates (10%) similar to historical open controls.
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Affiliation(s)
- Dominic S Carreira
- Department of Orthopaedic Surgery, Rush University Medical Center, 1725 West Harrison Street, Chicago, IL 60612, USA
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Park HB, Keyurapan E, Gill HS, Selhi HS, McFarland EG. Suture anchors and tacks for shoulder surgery, part II: the prevention and treatment of complications. Am J Sports Med 2006; 34:136-44. [PMID: 16397097 DOI: 10.1177/0363546505284240] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The use of suture anchors and tacks around the shoulder requires a thorough knowledge of the proper use of the devices and how to insert them. Although typically not technically demanding, suture anchors and tacks can present unique and frustrating challenges to the patient and the surgeon. These challenges can occur whether the procedure is performed via an open or arthroscopic approach, but knowledge of the potential challenges may optimize the surgical result and prevent complications. Complications can be categorized as technique-related or device-related issues (mechanical or biologic failure). Technique-related complications include problems with the delivery systems, anchor malpositioning, and suture management issues, such as knots not sliding. Device-related complications include implant fracture, migration secondary to poor fixation, synovitis from implant degradation, and osteolysis. This review describes the prevention of these and other complications, addresses the indications or need for intervention, and suggests potential solutions when intervention is indicated.
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Affiliation(s)
- Hyung Bin Park
- Division of Spaorts Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD 21224-2780, USA
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Böstman OM, Laitinen OM, Tynninen O, Salminen ST, Pihlajamäki HK. Tissue restoration after resorption of polyglycolide and poly-laevo-lactic acid screws. ACTA ACUST UNITED AC 2005; 87:1575-80. [PMID: 16260683 DOI: 10.1302/0301-620x.87b11.16520] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite worldwide clinical use of bio-absorbable devices for internal fixation in orthopaedic surgery, the degradation behaviour and tissue replacement of these implants are not fully understood. In a long-term experimental study, we have determined the patterns of tissue restoration 36 and 54 months after implantation of polyglycolic acid and poly-laevo-lactic acid screws in the distal femur of the rabbit. After 36 months in the polyglycolic acid group the specimens showed no remaining polymer and loose connective tissue occupied 80% of the screw track. Tissue restoration remained poor at 54 months, the amounts of trabecular bone and haematopoietic elements being significantly lower than those in the intact control group. The amount of trabecular bone within the screw track at 54 months in the polyglycolic acid group was less than in the empty drill holes (p = 0.04). In the poly-laevo-lactic acid group, polymeric material was present in abundance after 54 months, occupying 60% of the cross-section of the core area of the screw track. When using absorbable internal fixation implants we should recognise that the degradation of the devices will probably not be accompanied by the restoration of normal trabecular bone.
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Affiliation(s)
- O M Böstman
- Department of Orthopaedics and Trauma Surgery, Helsinki University Hospital, P. O. Box 266, FIN-00029, Helsinki, Finland.
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McFarland EG, Park HB, Keyurapan E, Gill HS, Selhi HS. Suture anchors and tacks for shoulder surgery, part 1: biology and biomechanics. Am J Sports Med 2005; 33:1918-23. [PMID: 16314667 DOI: 10.1177/0363546505282621] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The development and successful clinical application of suture anchors and tacks have revolutionized the surgeon's ability to secure soft tissues to bone via open or arthroscopic surgical techniques. When used carefully and with proper technique, these devices provide viable options for the repair and reconstruction of many intra-articular and extra-articular abnormalities in the shoulder, including rotator cuff tears, shoulder instability, and biceps lesions that require labrum repair or biceps tendon tenodesis. Like many technologies, however, the successful application of these devices requires an understanding of the biology and biomechanics that affect their use in the shoulder as well as knowledge of the factors that can affect subsequent clinical outcomes, including complications.
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Affiliation(s)
- Edward G McFarland
- Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
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Abstract
The purpose of this paper is to outline the present state of treatment for traumatic anterior shoulder dislocation. Pathoanatomic changes as well as intrinsic and extrinsic prognostic factors are discussed. Based on these, treatment options for first time traumatic dislocations and chronic posttraumatic instability are recommended.
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