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298 The effectiveness of arthroscopic versus open shoulder stabilisation for traumatic anterior glenohumeral instability
The effectiveness of arthroscopic versus open shoulder stabilisation for traumatic anterior glenohumeral instability
c. Ng*, A. Bialocerkowski & R. Hinman Center for Health, Exercise And Sports Medicine, School Of Physiotherapy, The University Of Melbourne
Anterior glenohumeral instability, a frequent complication of traumatic shoulder dislocation, can be managed by arthroscopic or open surgical stabilization. This research systematically evaluated primary evidence which compared the effectiveness of these two techniques, to provide evidence-based recommendations regarding best-practice management for anterior glenohumeral instability. Primary studies, published between 1984-2004, were located by searching 14 internet/library databases. Of 1454 hits accrued, 14 studies were reviewed for eligibility by two independent researchers. 10 studies, comparing the effectiveness of arthroscopic and open shoulder stabilization, had> 2 years of follow-up and used recurrent instability as a primary outcome, were included. Methodological quality of these studies was independently evaluated, and data regarding the effectiveness of the interventions was synthesised using meta-analysis and a narrative format. Evidence comparing the effectiveness of arthroscopic and open shoulder stabilization is of poor to fair methodological quality. Thus the results of primary studies should be interpreted with caution. Authors also used variable definitions of recurrent instability (primary outcome) and a variety of other 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, shoulder external rotation range and complication rates. Thus, it appears that both surgical techniques are equally effective in managing anterior glenohumeral instability and the choice of treatment should be based on multiple factors between the clinician (e.g. experience with the surgical technique) and the patient (e.g. sports participation, cosmesis outcome and cost).
III ••
Foot orthoses function and alteration in sensory input
C. Payne*, G. Zammitt &D. Patience La Trobe University
The effects of foot orthoses altering sensory input has been speculated as one mechanism of their action. The aim of this project was to determine the effects of foot orthoses on foot function with altered sensory input. Digital videos were taken of 10 steps through the Silicon Coach system. A pen mark was placed on the lowest part of the centre of the heel (HC) of the shoes. Four conditions were used: no orthoses, foot orthoses, identical foot orthoses covered in 40 grit sandpaper and for the fourth, the foot of the subject was immersed in ice to reduce plantar sensation. Using the Silicon Coach software, vertical lines was placed on HC, on the medial malleolus (MM) and the lateral malleolus (LM). The horizontal distance (mm) between these vertical lines were measured. An increase in the distance between the HC and LM and a decrease between the HC and the MM was consider to be indicative of a more inverted position (and vice versa). The frames chosen for analysis were when the forefoot contacted the ground and immediately prior to heel off. The mean of 5 left steps was used for analysis. Forefoot contact frame Heel off frame LM MM LM MM No orthoses 4.1 (±0.5) 5.3 (±1.4) 4.2 (±0.6) 5.6 (±1.1) Orthoses 5.0 (±0.6) 3.? (±1.0) 5.1 (±0.9) 4.9 (±1.6) Sandpaper 4.8 (±O.?) 3.9 (±1.1) 5.1 (±0.9) 4.9 (±1.3) Iced 4.9 (±O.?) 3.9 (±1.2) 5.1 (±0.9) 4.9 (±1.4) Friedman's test showed differences between the 4 conditions at both frames for the LM measurement (p=0.01; p=0.01) and for the MM (p<0.01; p<0.01). Post hoc test indicated the differences were only between the non orthoses condition and the 3 orthoses conditions with no differences between the 3 sensory conditions. This study has shown that the alteration of sensory input by the methods used did not result in differences in foot function based on the parameters measured. 175
c. Ng*, A. Bialocerkowski & R. Hinman Center for Health, Exercise And Sports Medicine, School Of Physiotherapy, The University Of Melbourne
Anterior glenohumeral instability, a frequent complication of traumatic shoulder dislocation, can be managed by arthroscopic or open surgical stabilization. This research systematically evaluated primary evidence which compared the effectiveness of these two techniques, to provide evidence-based recommendations regarding best-practice management for anterior glenohumeral instability. Primary studies, published between 1984-2004, were located by searching 14 internet/library databases. Of 1454 hits accrued, 14 studies were reviewed for eligibility by two independent researchers. 10 studies, comparing the effectiveness of arthroscopic and open shoulder stabilization, had> 2 years of follow-up and used recurrent instability as a primary outcome, were included. Methodological quality of these studies was independently evaluated, and data regarding the effectiveness of the interventions was synthesised using meta-analysis and a narrative format. Evidence comparing the effectiveness of arthroscopic and open shoulder stabilization is of poor to fair methodological quality. Thus the results of primary studies should be interpreted with caution. Authors also used variable definitions of recurrent instability (primary outcome) and a variety of other 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, shoulder external rotation range and complication rates. Thus, it appears that both surgical techniques are equally effective in managing anterior glenohumeral instability and the choice of treatment should be based on multiple factors between the clinician (e.g. experience with the surgical technique) and the patient (e.g. sports participation, cosmesis outcome and cost).
III ••
Foot orthoses function and alteration in sensory input
C. Payne*, G. Zammitt &D. Patience La Trobe University
The effects of foot orthoses altering sensory input has been speculated as one mechanism of their action. The aim of this project was to determine the effects of foot orthoses on foot function with altered sensory input. Digital videos were taken of 10 steps through the Silicon Coach system. A pen mark was placed on the lowest part of the centre of the heel (HC) of the shoes. Four conditions were used: no orthoses, foot orthoses, identical foot orthoses covered in 40 grit sandpaper and for the fourth, the foot of the subject was immersed in ice to reduce plantar sensation. Using the Silicon Coach software, vertical lines was placed on HC, on the medial malleolus (MM) and the lateral malleolus (LM). The horizontal distance (mm) between these vertical lines were measured. An increase in the distance between the HC and LM and a decrease between the HC and the MM was consider to be indicative of a more inverted position (and vice versa). The frames chosen for analysis were when the forefoot contacted the ground and immediately prior to heel off. The mean of 5 left steps was used for analysis. Forefoot contact frame Heel off frame LM MM LM MM No orthoses 4.1 (±0.5) 5.3 (±1.4) 4.2 (±0.6) 5.6 (±1.1) Orthoses 5.0 (±0.6) 3.? (±1.0) 5.1 (±0.9) 4.9 (±1.6) Sandpaper 4.8 (±O.?) 3.9 (±1.1) 5.1 (±0.9) 4.9 (±1.3) Iced 4.9 (±O.?) 3.9 (±1.2) 5.1 (±0.9) 4.9 (±1.4) Friedman's test showed differences between the 4 conditions at both frames for the LM measurement (p=0.01; p=0.01) and for the MM (p<0.01; p<0.01). Post hoc test indicated the differences were only between the non orthoses condition and the 3 orthoses conditions with no differences between the 3 sensory conditions. This study has shown that the alteration of sensory input by the methods used did not result in differences in foot function based on the parameters measured. 175