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Weber procedure in chronic instable shoulder — a ten year experience
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Abstracts
J. Shoulder Elbow Surg. March~April 1996
333
OPEN VERSUS ARTHROSCOPIC BANKART REPAIR Chian-Her Lee, Leou-Chyr Lin, Man-Kuan Au Department of Orthopedics, Tti-Service General Hospital, Taipei, Taiwan, R.O.C. From Sep 1992 to Jan 1994, 26 patients with 30 recurrent traumatic anterior dislocation and subluxation of shoulders were treated with open Bankart repair in 15 shoulders and arthroseopic transglenoid Bankart suture repair (Morgan method) in another 15 shoulsers. There were 4 patients with bilateral dislocations treated with one side open repair and the other arthroscopic repair. They all were male and aged from 20 to 35 years old. The interval of follow-up was from 12 to 26 months (average, 18 months ). The results were evaluated by Rowe rating sheet. Results: In open repair, 10 shoulders (67%) had excellent, 4 (27%) good and 1 shoulder had resubluxation and was classified as poor. In arthroscopie repair, 7 shoulders (47%) had excellent, 4 (27%) good and 3 fair ad 1 redisloeated as a poor result. In the postoperative range of motion, full or nerarly full (<10 degrees external rotation loss) in 90% of open repair was noted and 74% in arthroscopic group. In the postoperative instability, there was 27% in arthroseopic group with 3 subtle subluxation and 1 redislocation due to chin-up exercise injury in postoperation 6 months. There were 4 patients with bilateral operations, 3 of 4 satisfied with arthroscopic reapir because of mild pain and less scar and short time of hospitalization. The capsulolabral tissue has healed to glenoid but the capsular attenuation still noted by sceeond-look arthroscopy in 3 subluxators of arthroscopic repair group. Conclusion: Open repair could predict a good result and rare postoperative instability. Arthroscopic repair had a relative higher rate of postoperative instability and residual pain. Initial dislocation or dislocator with capsulolabral detachment without capsular attenuation is a good candidate for arthroscopic repair.
335
THE MODIFIED BRISTOW PROCEDURE FOR RECURRENT ANTERIOR GLENOHUMERAL INSTABILITY Leou-Chyr Lin, Mon-Kun Au Dept. of Ortho., Tri-Service General Hospital, National Defense Medical Center, Tolwon R.O.C. The purpose of this study was to present the results of recurrent anterior glenohumeral instability Ireated with May's modified Bristaw procedure.El970) Patients and methods: 48 modified Bristaw procedures were done between 1984-1989. The average age was 21 years [ range from 18-32L The average interval between the initial injury and surgery was 38 months. Every patients had at least three episodes prior to surgery. During preparing the patient, a sandbag about 10 cm height was put firmly under the operated shoulder to keep the scapula elevation and tilted about 30" to the operation table to provide good visualization and facilitate proper drill hole for graft placement. The average operatlon 6me is sixty minutes. Results: With minimum of 36 months follow up, there was one [2~ of recllslacation with average loss of external ratatien of 10" and internal rotation 7" 42 188%1 patients felt no limitation of their daily activities, 9 120%1 limited in throwing sports, and 5 110%1 limited in swimming and tennis playing. Radiographic studies revenled the union rote of the graft was 90%. The Cybex study showed there was no difference in muscle strength during internal or external rotation of the operated shoulder as compare to the normal side. There was no screw migratiou but 3 [7%1 cases of transient hyl~othesia of the musculocutaneaus nerve were noted for 2 months. Conclusion: Elevation of the operated scapula could facilitate the procedure.The modified Bristow procedure is a relatively easy and reliable operation that provides good long-term stubilily with minimal loss of motion. Except the throwing athlete, patient's setisfectory rate is high, the postoperative complication is low.
334
T H E USE O F S U T U R E A N C H O R S IN O P E N B A N K A R T OPERATION ~: K a r | s s o n MD, L. Swiird MD. Department of Orthopaedics, O s t r a Universify Hospital, G~iteborg, Sweden Although arthroscopic shoulder stabilisation has gained increasing popularity during recent ),ears, open Bankart reconstruction is still much used. This is, however, a technically difficult procedure and several modifications have been described. The aim of this study is to report on the use of suture anchors in patients with recurrent shoulder instability. MATERIAL AND METHOD: Open Bankart reconstruction was performed in 50 consecutive patients, with post-traumatic, recurrent, anterior instability of the shoulder. All patients had uni directional instability only. A modified surgicat technique, using suture anchors was used in all patients, to simplify the soft-tissue attaehement to the anterior glenoid rim. The mean follow-up period was 3 (2 5) years. All patients were followed prospectively, with repeated clinical and functional evaluation using the assessment system described by Rowe. RESULTS: 47/50 (94 %) patients regained normal stability, while there were two recurrent dislocations and one subluxation. T h e functional results were satisfactory in 43/50 (86 %) of patients, and unsatisfactory in 7/50 (14 %). O f the patients with unsatisfactory functional results three have had recurrent instability and four did not regain full range of shoulder motion. .CONCLUSION: The suture anchors were found to simplify the procedure, and no specific complications as a result of the modified technique were seen. It is concluded that open Bankart reconstruction is a safe method and can still be considered the first choice in the treatment of recurrent anterior shoulder instability.
336
WEBER P~0CI~3URE IN CHRONIC INSTABLE SHOULDER - A T~N YEAR EXPERIENCE. Z.Temelkovski,MD,Kamnar J,~.Karevski Lj, N~),Zafiroski Gj ,ND.Clinic for Orthop.Surgery, Skopje,R Mac Chronic instable or luxable shoulder followed by greater n ~ b e r of luxations is a clinical entity for which treatment n%m~-rous procedures and their modifications a r e described.In the period frcm 1984 to 1994, 19 patients w e r e surgically treated.15 of them were men and 4 wsmen. Average age was 28,5 years.Active sportists were 3 men and one w~r~an.ln all patients a standard derotational osteotcmia of the h~m~-rus with plastics on m.subscapularis w a s applied.All patients underwent X-ray in internal rotation and Bernageau profile in order to be able to s e e if there is Hill-Sachs or Bankart lesion.The processing of the material and evaluation of the results is performed according to Constant's Score System.The average s c o r e according to Constant is 92,6.1n one patient t/~ere is an appearance of three reluxations.The reason f o r t h e s e rel~xations is glen dysplasia (CT investigation - Frledzaan method) .In all other patients there is no appearance of reluxations and all continue with the s~ne life and sport activities in their postoperative period.The derotational osteotcmy in chronically instable shoulder in o u r s e r i e s show good results.In future the indication for its applicatoin will be supplemented by CT investigation and determination of retrotorsion of the h~nerus head and retroversion of the glen.
Abstracts
J. Shoulder Elbow Surg. March~April 1996
333
OPEN VERSUS ARTHROSCOPIC BANKART REPAIR Chian-Her Lee, Leou-Chyr Lin, Man-Kuan Au Department of Orthopedics, Tti-Service General Hospital, Taipei, Taiwan, R.O.C. From Sep 1992 to Jan 1994, 26 patients with 30 recurrent traumatic anterior dislocation and subluxation of shoulders were treated with open Bankart repair in 15 shoulders and arthroseopic transglenoid Bankart suture repair (Morgan method) in another 15 shoulsers. There were 4 patients with bilateral dislocations treated with one side open repair and the other arthroscopic repair. They all were male and aged from 20 to 35 years old. The interval of follow-up was from 12 to 26 months (average, 18 months ). The results were evaluated by Rowe rating sheet. Results: In open repair, 10 shoulders (67%) had excellent, 4 (27%) good and 1 shoulder had resubluxation and was classified as poor. In arthroscopie repair, 7 shoulders (47%) had excellent, 4 (27%) good and 3 fair ad 1 redisloeated as a poor result. In the postoperative range of motion, full or nerarly full (<10 degrees external rotation loss) in 90% of open repair was noted and 74% in arthroscopic group. In the postoperative instability, there was 27% in arthroseopic group with 3 subtle subluxation and 1 redislocation due to chin-up exercise injury in postoperation 6 months. There were 4 patients with bilateral operations, 3 of 4 satisfied with arthroscopic reapir because of mild pain and less scar and short time of hospitalization. The capsulolabral tissue has healed to glenoid but the capsular attenuation still noted by sceeond-look arthroscopy in 3 subluxators of arthroscopic repair group. Conclusion: Open repair could predict a good result and rare postoperative instability. Arthroscopic repair had a relative higher rate of postoperative instability and residual pain. Initial dislocation or dislocator with capsulolabral detachment without capsular attenuation is a good candidate for arthroscopic repair.
335
THE MODIFIED BRISTOW PROCEDURE FOR RECURRENT ANTERIOR GLENOHUMERAL INSTABILITY Leou-Chyr Lin, Mon-Kun Au Dept. of Ortho., Tri-Service General Hospital, National Defense Medical Center, Tolwon R.O.C. The purpose of this study was to present the results of recurrent anterior glenohumeral instability Ireated with May's modified Bristaw procedure.El970) Patients and methods: 48 modified Bristaw procedures were done between 1984-1989. The average age was 21 years [ range from 18-32L The average interval between the initial injury and surgery was 38 months. Every patients had at least three episodes prior to surgery. During preparing the patient, a sandbag about 10 cm height was put firmly under the operated shoulder to keep the scapula elevation and tilted about 30" to the operation table to provide good visualization and facilitate proper drill hole for graft placement. The average operatlon 6me is sixty minutes. Results: With minimum of 36 months follow up, there was one [2~ of recllslacation with average loss of external ratatien of 10" and internal rotation 7" 42 188%1 patients felt no limitation of their daily activities, 9 120%1 limited in throwing sports, and 5 110%1 limited in swimming and tennis playing. Radiographic studies revenled the union rote of the graft was 90%. The Cybex study showed there was no difference in muscle strength during internal or external rotation of the operated shoulder as compare to the normal side. There was no screw migratiou but 3 [7%1 cases of transient hyl~othesia of the musculocutaneaus nerve were noted for 2 months. Conclusion: Elevation of the operated scapula could facilitate the procedure.The modified Bristow procedure is a relatively easy and reliable operation that provides good long-term stubilily with minimal loss of motion. Except the throwing athlete, patient's setisfectory rate is high, the postoperative complication is low.
334
T H E USE O F S U T U R E A N C H O R S IN O P E N B A N K A R T OPERATION ~: K a r | s s o n MD, L. Swiird MD. Department of Orthopaedics, O s t r a Universify Hospital, G~iteborg, Sweden Although arthroscopic shoulder stabilisation has gained increasing popularity during recent ),ears, open Bankart reconstruction is still much used. This is, however, a technically difficult procedure and several modifications have been described. The aim of this study is to report on the use of suture anchors in patients with recurrent shoulder instability. MATERIAL AND METHOD: Open Bankart reconstruction was performed in 50 consecutive patients, with post-traumatic, recurrent, anterior instability of the shoulder. All patients had uni directional instability only. A modified surgicat technique, using suture anchors was used in all patients, to simplify the soft-tissue attaehement to the anterior glenoid rim. The mean follow-up period was 3 (2 5) years. All patients were followed prospectively, with repeated clinical and functional evaluation using the assessment system described by Rowe. RESULTS: 47/50 (94 %) patients regained normal stability, while there were two recurrent dislocations and one subluxation. T h e functional results were satisfactory in 43/50 (86 %) of patients, and unsatisfactory in 7/50 (14 %). O f the patients with unsatisfactory functional results three have had recurrent instability and four did not regain full range of shoulder motion. .CONCLUSION: The suture anchors were found to simplify the procedure, and no specific complications as a result of the modified technique were seen. It is concluded that open Bankart reconstruction is a safe method and can still be considered the first choice in the treatment of recurrent anterior shoulder instability.
336
WEBER P~0CI~3URE IN CHRONIC INSTABLE SHOULDER - A T~N YEAR EXPERIENCE. Z.Temelkovski,MD,Kamnar J,~.Karevski Lj, N~),Zafiroski Gj ,ND.Clinic for Orthop.Surgery, Skopje,R Mac Chronic instable or luxable shoulder followed by greater n ~ b e r of luxations is a clinical entity for which treatment n%m~-rous procedures and their modifications a r e described.In the period frcm 1984 to 1994, 19 patients w e r e surgically treated.15 of them were men and 4 wsmen. Average age was 28,5 years.Active sportists were 3 men and one w~r~an.ln all patients a standard derotational osteotcmia of the h~m~-rus with plastics on m.subscapularis w a s applied.All patients underwent X-ray in internal rotation and Bernageau profile in order to be able to s e e if there is Hill-Sachs or Bankart lesion.The processing of the material and evaluation of the results is performed according to Constant's Score System.The average s c o r e according to Constant is 92,6.1n one patient t/~ere is an appearance of three reluxations.The reason f o r t h e s e rel~xations is glen dysplasia (CT investigation - Frledzaan method) .In all other patients there is no appearance of reluxations and all continue with the s~ne life and sport activities in their postoperative period.The derotational osteotcmy in chronically instable shoulder in o u r s e r i e s show good results.In future the indication for its applicatoin will be supplemented by CT investigation and determination of retrotorsion of the h~nerus head and retroversion of the glen.