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Paper # 21: Intrarticular Shoulder Injuries Associated With Acromioclavicular Dislocation or Clavicle Fracture
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ABSTRACTS
with wide intercondylar fossa may be in favor of the shape and the synovium covering of the reconstructed doulble-bundle ACL, and decreased the impingement syndrome. Paper # 20: The Incidence of Failed ACL Reconstruction by Tunnel Malposition THOMAS BARTELS, MD, GERMANY HANNI BARTELS, MD, GERMANY MARTIN PYSCHIK, MD, GERMANY KAY BREHME, MD, GERMANY · Sportklinik Halle Halle, GERMANY Summary: We find in 271 ACL revisions a malposition femoral 51% and tibial 24% even though the latest scientific findings are well published. The failed reconstruction of the rotational stability cause additional intraarticular lesions and poor results. Abstract: The past 30 years have brought remarkable changes in ACL surgery. Reconstruction of a ruptured ACL is one of the most common performed procedere by orthopedic surgeons today. The definition of a failed ACL reconstruction includes a return to knee instability. This manifest oneself often as an increased tibial translation together with internal tibial rotation accompanied by associated pathologies. A failed ACL reconstruction needs to be clearly defined. The absence of an universally accepted definition of ACL reconstruction failure makes it difficult to calculate the number or true incidence of clinical failures. Unsuccessful results from ACL reconstruction have a range from 3% to 52% in the literature depending on the criteria used to define failure. Tunnel malposition is reported to be one of the most frequent technical errors that occurs during primary ACL reconstruction. It has been estimated that 70% to 80% of the failures may be caused by nonanatomic tunnel placement. From 2001 till 2009 we reconstructed 3235 ACL=s. 271 of whom were revisions. 88% of these ACL revisions we accomplished got their primary reconstruction in external facilities. 51% exhibited a failed femoral placement and 24% a failed tibial placement. Also the latest and published scientific knowledge in tunnel placement does not decrease rate of failure. 115 of the ACL revisions have had a vertical graft position (“high noon”) and 83 have had a more central femoral position (measured by method Bernard and Hertel). The combination of a posteriorly placed tibial tunnel with a more central an vertically oriented femoral tunnel results in a graft with nonanatomic vertical orientation in
the sagital and coronal planes. The vertical graft may provide stability to anteroposterior translation as seen with the Lachman and anterior drawer examination, but it is unlikely to accomplish adequately control rotation, eliminate the pivot shift or provide an optimal outcome to the return of competitive level in sports. The majority of studies report that the outcome of ACL revisions is inferior to that of primary reconstruction but it should be considered that the revision procedures are used to be performed many month or years after the failed primary reconstruction. Within this interval of time occuring recurrent episodes and joint deterioration compromise final outcome. The goal would be to restore the best possible function of the knee before ACL revision to maximize the success rate. The potential of revision surgery to accomplish the patients goals must be reasonably discussed. Paper # 21: Intrarticular Shoulder Injuries Associated With Acromioclavicular Dislocation or Clavicle Fracture BYRON TORRES, MD, ECUADOR MAURICIO GUTIERREZ, MD, COLOMBIA EDUARDO GIL OSORIO, MD, COLOMBIA · CMI: Instituto de enfermedades osteoarticulares Cali, Valle, COLOMBIA Summary: In patients with severe acromioclavicular dislocation, clavicle fracture or those with persistent pain after a conservative management, our present data suggest that is important to perform an arthroscopic evaluation to rule out any associated intrarticular injuries Abstract: Objective: The purpose of this report is to present the correlation between intra-articular shoulder injuries and acromioclavicular dislocation or clavicle fractures. Materials and Methods: Between February 2009 and September 2010 we performed twelve arthroscopic procedures to search for any glenohumeral injury in patients who underwent acute or chronic acromioclavicular dislocations, or clavicle fractures that required surgical treatment at the same time. Twelve patients are included in this first report: Six with clavicle fracture and six with acromioclavicular dislocation. Regarding the time between trauma and surgical treatment, nine were chronic injuries and three were acute. Results: 9 patients had some intrarticular pathology associated as identified by an arthroscopic evaluation. The injuries were single or multiple and included: 8 SLAP lesions, one type III subscapularis tendon tear, one crescent-moon shape supraspinatus tendon tear, one glenoid fracture. All of these intrarticular lesions were man-
ABSTRACTS aged by arthroscopic means at the time of the surgery. One patient developed an arthrofibrosis as a late complication and needed arthroscopic management. All patients had a satisfactory outcome with a follow-up between 2 and 19 months with an average of 9.4 months. Conclusion: In patients with severe acromioclavicular dislocation, clavicle fracture or those with persistent pain after a conservative management, our present data suggest that is important to perform an arthroscopic evaluation to rule out any associated intrarticular injuries. The literature has limited reports about the correlation between clavicle fractures and intra-articular shoulder injuries. There are no studies which assess glenohumeral joint arthroscopy before clavicle osteosynthesis and should be further investigated. Key words: acromioclavicular joint dislocation, clavicle fracture, associated lesions, SLAP. Paper # 22: Clinical Result of Arthroscopic Treatment for First-Time Traumatic Anterior Shoulder Dislocation KUO-CHUNG CHENG, MD, TAIWAN · Taoyoun General Hospital Taoyoun, TAIWAN Summary: Clinical result of arthroscopic treatment for first-time traumatic anterior shoulder dislocation. Abstract: Purpose: To compare the results of primary arthroscopic stabilization with nonoperative treatment in a highlydemand military population with acute first-time traumatic anterior shoulder dislocation at five to seven years follow-up. Methods: A prospective nonrandomized study was performed with 64 high-demand military personnel after a first episode of traumatic anterior shoulder dislocation between January 2001 and July 2004. The patients were offered an arthroscopic procedure or nonoperative treatment. The average age was 22 years (range, 17 to 29 years). There were 25 patients treated by nonoperative methods and 39 patients treated by acute arthroscopic repair with metallic suture anchor fixation. Outcome was evaluated based on the Western Ontario Shoulder Instability Index (WOSI) score, the Disabilities of the Arm, Shoulder and Hand (DASH) score, range of motion, and return to duty activity. The mean follow-up was 71 months (range, 60-84 months). Results: There were significant differences in the functional scores of the WOSI and DASH score at the 18 months follow up (P⬍0.05), but there are no significant differences at the final follow up between two groups. In
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the nonoperative group, 92% suffered a redislocation between 5 and 18 months (average, 10 months). In the operative group, only 2 patients (5.1%) suffered a redislocation 1 year after surgery. The average follow-up was 71 months (range, 60 to 84). There were no surgical complications. There was no statistical difference noted in the range of motion of injured sites between two groups. Conclusions: Due to the high recurrent rate in activeduty young military personnel with acute traumatic anterior shoulder instability, we believe that primary arthroscopic stabilization is a useful method. Subjective patient self-assessment tools demonstrated high satisfaction results. The arthroscopy technique significantly reduces the recurrence rate of shoulder dislocations in high-demand military population when compared with nonoperative treatment. Keywords: acute first-time anterior shoulder dislocation, Bankart repair, suture anchor, arthroscopy, military Paper # 23: The Results of Arthroscopic Repair for Shoulder Instability in Patients with First-Time and Multiple Dislocations AKSEL SEYAHI, MD, TURKEY NAZAN CANBULAT, MD, TURKEY ATA CAN ATALAR, MD, TURKEY ONUR TETIK, MD, ASSOC. PROF IN ORTHO, TURKEY LÜTFÜ ÖZGÜR KOYUNCU, MD, TURKEY MEHMET DEMIRHAN, MD, PROF., TURKEY · American Hospital Istanbul, TURKEY Summary: Arthroscopic capsulolabral repair can yield better functional results in the early postoperative period in patients with first-time dislocation. However the functional results at the last control did not reveal any significant advantage of either timing. Abstract: Purpose: The purpose of this study was to compare the outcomes of arthroscopic repair for anterior shoulder instability in patients with first-time and multiple dislocations. Patients and Methods: Fifty-two patients (mean age 30.4 (17-50); 48 men/4 women; 32 right/20 left) were included in the study. First time dislocation group consisted of 18 patients (mean age 28.4 (17-42); 15 men/3 women, 10 right/8 left side); while multiple dislocation group consisted of 34 patients (mean age 31.4 (19-50); 33 male/1 woman, 22 right/12 left side) who had a mean 4.8 (2-8) previous dislocations. Both groups received the same standard rehabilitation program for a mean of 14.3
ABSTRACTS
with wide intercondylar fossa may be in favor of the shape and the synovium covering of the reconstructed doulble-bundle ACL, and decreased the impingement syndrome. Paper # 20: The Incidence of Failed ACL Reconstruction by Tunnel Malposition THOMAS BARTELS, MD, GERMANY HANNI BARTELS, MD, GERMANY MARTIN PYSCHIK, MD, GERMANY KAY BREHME, MD, GERMANY · Sportklinik Halle Halle, GERMANY Summary: We find in 271 ACL revisions a malposition femoral 51% and tibial 24% even though the latest scientific findings are well published. The failed reconstruction of the rotational stability cause additional intraarticular lesions and poor results. Abstract: The past 30 years have brought remarkable changes in ACL surgery. Reconstruction of a ruptured ACL is one of the most common performed procedere by orthopedic surgeons today. The definition of a failed ACL reconstruction includes a return to knee instability. This manifest oneself often as an increased tibial translation together with internal tibial rotation accompanied by associated pathologies. A failed ACL reconstruction needs to be clearly defined. The absence of an universally accepted definition of ACL reconstruction failure makes it difficult to calculate the number or true incidence of clinical failures. Unsuccessful results from ACL reconstruction have a range from 3% to 52% in the literature depending on the criteria used to define failure. Tunnel malposition is reported to be one of the most frequent technical errors that occurs during primary ACL reconstruction. It has been estimated that 70% to 80% of the failures may be caused by nonanatomic tunnel placement. From 2001 till 2009 we reconstructed 3235 ACL=s. 271 of whom were revisions. 88% of these ACL revisions we accomplished got their primary reconstruction in external facilities. 51% exhibited a failed femoral placement and 24% a failed tibial placement. Also the latest and published scientific knowledge in tunnel placement does not decrease rate of failure. 115 of the ACL revisions have had a vertical graft position (“high noon”) and 83 have had a more central femoral position (measured by method Bernard and Hertel). The combination of a posteriorly placed tibial tunnel with a more central an vertically oriented femoral tunnel results in a graft with nonanatomic vertical orientation in
the sagital and coronal planes. The vertical graft may provide stability to anteroposterior translation as seen with the Lachman and anterior drawer examination, but it is unlikely to accomplish adequately control rotation, eliminate the pivot shift or provide an optimal outcome to the return of competitive level in sports. The majority of studies report that the outcome of ACL revisions is inferior to that of primary reconstruction but it should be considered that the revision procedures are used to be performed many month or years after the failed primary reconstruction. Within this interval of time occuring recurrent episodes and joint deterioration compromise final outcome. The goal would be to restore the best possible function of the knee before ACL revision to maximize the success rate. The potential of revision surgery to accomplish the patients goals must be reasonably discussed. Paper # 21: Intrarticular Shoulder Injuries Associated With Acromioclavicular Dislocation or Clavicle Fracture BYRON TORRES, MD, ECUADOR MAURICIO GUTIERREZ, MD, COLOMBIA EDUARDO GIL OSORIO, MD, COLOMBIA · CMI: Instituto de enfermedades osteoarticulares Cali, Valle, COLOMBIA Summary: In patients with severe acromioclavicular dislocation, clavicle fracture or those with persistent pain after a conservative management, our present data suggest that is important to perform an arthroscopic evaluation to rule out any associated intrarticular injuries Abstract: Objective: The purpose of this report is to present the correlation between intra-articular shoulder injuries and acromioclavicular dislocation or clavicle fractures. Materials and Methods: Between February 2009 and September 2010 we performed twelve arthroscopic procedures to search for any glenohumeral injury in patients who underwent acute or chronic acromioclavicular dislocations, or clavicle fractures that required surgical treatment at the same time. Twelve patients are included in this first report: Six with clavicle fracture and six with acromioclavicular dislocation. Regarding the time between trauma and surgical treatment, nine were chronic injuries and three were acute. Results: 9 patients had some intrarticular pathology associated as identified by an arthroscopic evaluation. The injuries were single or multiple and included: 8 SLAP lesions, one type III subscapularis tendon tear, one crescent-moon shape supraspinatus tendon tear, one glenoid fracture. All of these intrarticular lesions were man-
ABSTRACTS aged by arthroscopic means at the time of the surgery. One patient developed an arthrofibrosis as a late complication and needed arthroscopic management. All patients had a satisfactory outcome with a follow-up between 2 and 19 months with an average of 9.4 months. Conclusion: In patients with severe acromioclavicular dislocation, clavicle fracture or those with persistent pain after a conservative management, our present data suggest that is important to perform an arthroscopic evaluation to rule out any associated intrarticular injuries. The literature has limited reports about the correlation between clavicle fractures and intra-articular shoulder injuries. There are no studies which assess glenohumeral joint arthroscopy before clavicle osteosynthesis and should be further investigated. Key words: acromioclavicular joint dislocation, clavicle fracture, associated lesions, SLAP. Paper # 22: Clinical Result of Arthroscopic Treatment for First-Time Traumatic Anterior Shoulder Dislocation KUO-CHUNG CHENG, MD, TAIWAN · Taoyoun General Hospital Taoyoun, TAIWAN Summary: Clinical result of arthroscopic treatment for first-time traumatic anterior shoulder dislocation. Abstract: Purpose: To compare the results of primary arthroscopic stabilization with nonoperative treatment in a highlydemand military population with acute first-time traumatic anterior shoulder dislocation at five to seven years follow-up. Methods: A prospective nonrandomized study was performed with 64 high-demand military personnel after a first episode of traumatic anterior shoulder dislocation between January 2001 and July 2004. The patients were offered an arthroscopic procedure or nonoperative treatment. The average age was 22 years (range, 17 to 29 years). There were 25 patients treated by nonoperative methods and 39 patients treated by acute arthroscopic repair with metallic suture anchor fixation. Outcome was evaluated based on the Western Ontario Shoulder Instability Index (WOSI) score, the Disabilities of the Arm, Shoulder and Hand (DASH) score, range of motion, and return to duty activity. The mean follow-up was 71 months (range, 60-84 months). Results: There were significant differences in the functional scores of the WOSI and DASH score at the 18 months follow up (P⬍0.05), but there are no significant differences at the final follow up between two groups. In
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the nonoperative group, 92% suffered a redislocation between 5 and 18 months (average, 10 months). In the operative group, only 2 patients (5.1%) suffered a redislocation 1 year after surgery. The average follow-up was 71 months (range, 60 to 84). There were no surgical complications. There was no statistical difference noted in the range of motion of injured sites between two groups. Conclusions: Due to the high recurrent rate in activeduty young military personnel with acute traumatic anterior shoulder instability, we believe that primary arthroscopic stabilization is a useful method. Subjective patient self-assessment tools demonstrated high satisfaction results. The arthroscopy technique significantly reduces the recurrence rate of shoulder dislocations in high-demand military population when compared with nonoperative treatment. Keywords: acute first-time anterior shoulder dislocation, Bankart repair, suture anchor, arthroscopy, military Paper # 23: The Results of Arthroscopic Repair for Shoulder Instability in Patients with First-Time and Multiple Dislocations AKSEL SEYAHI, MD, TURKEY NAZAN CANBULAT, MD, TURKEY ATA CAN ATALAR, MD, TURKEY ONUR TETIK, MD, ASSOC. PROF IN ORTHO, TURKEY LÜTFÜ ÖZGÜR KOYUNCU, MD, TURKEY MEHMET DEMIRHAN, MD, PROF., TURKEY · American Hospital Istanbul, TURKEY Summary: Arthroscopic capsulolabral repair can yield better functional results in the early postoperative period in patients with first-time dislocation. However the functional results at the last control did not reveal any significant advantage of either timing. Abstract: Purpose: The purpose of this study was to compare the outcomes of arthroscopic repair for anterior shoulder instability in patients with first-time and multiple dislocations. Patients and Methods: Fifty-two patients (mean age 30.4 (17-50); 48 men/4 women; 32 right/20 left) were included in the study. First time dislocation group consisted of 18 patients (mean age 28.4 (17-42); 15 men/3 women, 10 right/8 left side); while multiple dislocation group consisted of 34 patients (mean age 31.4 (19-50); 33 male/1 woman, 22 right/12 left side) who had a mean 4.8 (2-8) previous dislocations. Both groups received the same standard rehabilitation program for a mean of 14.3