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About “Arthroscopic Bankart Repair …”
684
LETTERS TO THE EDITOR
sions and quantitatively came to the same subjective conclusion that you came to in 1986. Our regret is that the structure of scientific writing does not permit the referencing of subjective observations and hence the recognition of your study in ours. However, my coauthors and I hope that our mutual letters to the editor inspire others to learn about your early work in the
use of a bone plug alongside a soft-tissue anterior cruciate ligament graft to prevent tunnel widening! Stephen M. Howell, M.D. University of California at Davis Davis, California
© 2007 by the Arthroscopy Association of North America
doi:10.1016/j.arthro.2007.01.015
About “Arthroscopic Bankart Repair . . .” To the Editor: After reading the recently published article by Marquardt et al.,1 I have some questions concerning the inclusion and the outcome measures that were used. The Constant score is used as an outcome measure by the authors. Kirkley et al.2,3 stated that this instrument may be useful for discriminating between patients with significant rotator cuff disease or osteoarthritis but it is not useful for patients with instability. In fact, in one study all of the patients with instability of the shoulder scored nearly perfectly (95 to 100) despite having problems of sufficient magnitude to request surgical intervention.4 Reading this, I cannot understand by which criteria a group of athletic young men, with a mean age of 25 years, have an average Constant score at inclusion of 55.3 points! In a patient with recurrent anterior traumatic instability, the score will be normal (as previously mentioned), unless the shoulder is permanently dislocated. A Constant score of 55 is associated with important strength loss, continuous pain, and severely restricted range of motion, which is not the case in recurrent anterior shoulder dislocation. I would like the authors to explain their rationale for using the score and to explain how they calculated the score.
Ronald L. Diercks, M.D., Ph.D. Centre for Sports Medicine Groningen University Medical Center Groningen, The Netherlands
References 1. Marquardt B, Witt KA, Liem D, Steinbeck J, Potzl W. Arthroscopic Bankart repair in traumatic anterior shoulder instability using a suture anchor technique. Arthroscopy 2006;22:931-936. 2. Kirkley A, Griffin S, McLintock H, Ng L. The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability—The Western Ontario Shoulder Instability Index (WOSI). Am J Sports Med 1998; 26:764-772. 3. Kirkley A, Alvarez C, Griffin S. The development and evaluation of a disease-specific quality-of-life questionnaire for disorders of the rotator cuff: The Western Ontario Rotator Cuff Index. Clin J Sport Med 2003;13:84-92. 4. Conboy VB, Morris RW, Kiss J, Carr AJ. An evaluation of the Constant-Morley shoulder assessment. J Bone Joint Surg Br 1996;78:229-232.
© 2007 by the Arthroscopy Association of North America
doi:10.1016/j.arthro.2007.03.095
Author’s Reply We thank Dr. Diercks for his valuable comments regarding our article.1 He may certainly be correct in his concerns about the use of the Constant score as a measurement tool for patients with shoulder instability in our study. The Western Ontario Shoulder Instability Index indeed appears to be a sensitive measurement tool in these patients, because it focuses on the patient’s own perception of changes in health status.2 However, its use in the current literature is not very widespread. The Constant score assesses pain, function, range of motion, and strength and thus combines subjective and objective parameters. It is of common use in clinical studies dealing with shoulder instability and therefore allows good comparison of our own results.3-5 That was the main rationale for our use of this score in our evaluation. A preoperative Constant score of about 60 points seems to be widely reported in the current literature.3,4 In our experience, recurrent traumatic anterior shoulder instability usually results in a
severe loss of strength, loss of motion as a result of apprehension, and thus, restriction in sports and activities of daily living, which finally results in a Constant score between 55 and 65 points. This is even true for a young patient population of collision athletes.5 Björn Marquardt, M.D. University Hospital of Münster Münster, Germany
References 1. Marquardt B, Witt KA, Liem D, Steinbeck J, Potzl W. Arthroscopic Bankart repair in traumatic anterior shoulder instability using a suture anchor technique. Arthroscopy 2006;22:931-936. 2. Kirkley A, Griffin S, McLintock H, Ng L. The development and
LETTERS TO THE EDITOR
sions and quantitatively came to the same subjective conclusion that you came to in 1986. Our regret is that the structure of scientific writing does not permit the referencing of subjective observations and hence the recognition of your study in ours. However, my coauthors and I hope that our mutual letters to the editor inspire others to learn about your early work in the
use of a bone plug alongside a soft-tissue anterior cruciate ligament graft to prevent tunnel widening! Stephen M. Howell, M.D. University of California at Davis Davis, California
© 2007 by the Arthroscopy Association of North America
doi:10.1016/j.arthro.2007.01.015
About “Arthroscopic Bankart Repair . . .” To the Editor: After reading the recently published article by Marquardt et al.,1 I have some questions concerning the inclusion and the outcome measures that were used. The Constant score is used as an outcome measure by the authors. Kirkley et al.2,3 stated that this instrument may be useful for discriminating between patients with significant rotator cuff disease or osteoarthritis but it is not useful for patients with instability. In fact, in one study all of the patients with instability of the shoulder scored nearly perfectly (95 to 100) despite having problems of sufficient magnitude to request surgical intervention.4 Reading this, I cannot understand by which criteria a group of athletic young men, with a mean age of 25 years, have an average Constant score at inclusion of 55.3 points! In a patient with recurrent anterior traumatic instability, the score will be normal (as previously mentioned), unless the shoulder is permanently dislocated. A Constant score of 55 is associated with important strength loss, continuous pain, and severely restricted range of motion, which is not the case in recurrent anterior shoulder dislocation. I would like the authors to explain their rationale for using the score and to explain how they calculated the score.
Ronald L. Diercks, M.D., Ph.D. Centre for Sports Medicine Groningen University Medical Center Groningen, The Netherlands
References 1. Marquardt B, Witt KA, Liem D, Steinbeck J, Potzl W. Arthroscopic Bankart repair in traumatic anterior shoulder instability using a suture anchor technique. Arthroscopy 2006;22:931-936. 2. Kirkley A, Griffin S, McLintock H, Ng L. The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability—The Western Ontario Shoulder Instability Index (WOSI). Am J Sports Med 1998; 26:764-772. 3. Kirkley A, Alvarez C, Griffin S. The development and evaluation of a disease-specific quality-of-life questionnaire for disorders of the rotator cuff: The Western Ontario Rotator Cuff Index. Clin J Sport Med 2003;13:84-92. 4. Conboy VB, Morris RW, Kiss J, Carr AJ. An evaluation of the Constant-Morley shoulder assessment. J Bone Joint Surg Br 1996;78:229-232.
© 2007 by the Arthroscopy Association of North America
doi:10.1016/j.arthro.2007.03.095
Author’s Reply We thank Dr. Diercks for his valuable comments regarding our article.1 He may certainly be correct in his concerns about the use of the Constant score as a measurement tool for patients with shoulder instability in our study. The Western Ontario Shoulder Instability Index indeed appears to be a sensitive measurement tool in these patients, because it focuses on the patient’s own perception of changes in health status.2 However, its use in the current literature is not very widespread. The Constant score assesses pain, function, range of motion, and strength and thus combines subjective and objective parameters. It is of common use in clinical studies dealing with shoulder instability and therefore allows good comparison of our own results.3-5 That was the main rationale for our use of this score in our evaluation. A preoperative Constant score of about 60 points seems to be widely reported in the current literature.3,4 In our experience, recurrent traumatic anterior shoulder instability usually results in a
severe loss of strength, loss of motion as a result of apprehension, and thus, restriction in sports and activities of daily living, which finally results in a Constant score between 55 and 65 points. This is even true for a young patient population of collision athletes.5 Björn Marquardt, M.D. University Hospital of Münster Münster, Germany
References 1. Marquardt B, Witt KA, Liem D, Steinbeck J, Potzl W. Arthroscopic Bankart repair in traumatic anterior shoulder instability using a suture anchor technique. Arthroscopy 2006;22:931-936. 2. Kirkley A, Griffin S, McLintock H, Ng L. The development and