Gary M. Gartsman1, Toni S. Roddey, Steven M. Hammerman. 1. Texas Orthopedic Hospital, Fondren Orthopedic Group (G.M.G., S.M.H.); The Department of Orthopaedic Surgery, University of Texas Houston Health Science Center (G.M.G.); and Texas Woman's University (T.S.R.), Houston, Texas, U.S.A.
Abstract
PURPOSE: We present the results of a prospective study evaluating arthroscopic technique in repairing multidirectional glenohumeral instability. Type of Study: Case series. METHODS: The 47 patient study group consisted of 26 men and 21 women. Inclusion criteria were multidirectional glenohumeral instability diagnosed on physical examination and at arthroscopy. Exclusion criteria were unidirectional anterior or posterior instability and prior instability operation. Four patients declined to participate in the study. The average age at the time of operation was 30 years (range, 15 to 56 years). The average interval from operation to final evaluation was 35 months (range 26 to 67 months). The American Shoulder and Elbow Surgeons (ASES) Shoulder Index, Constant, Rowe, and UCLA scores were recorded preoperatively and at final evaluation. RESULTS: Preoperatively, no patients were rated overall as good to excellent according to the Rowe scale; at final follow-up 94% (44 of 47 patients) were rated as good to excellent. One patient was considered a failure of the index operation due to persistent instability and underwent a second operative procedure. One patient noted a loss of strength during sports, and 2 patients had pain that limited their throwing ability. The ASES Shoulder Index improved to 94.7 from 45.4 (P =.001). The absolute Constant score improved to 91.7 from 60 (P =.001). The Rowe score improved to 93.7 from 14.2 (P =.001). The UCLA total score improved to 33.1 from 17.4 (P =.001). Average passive external rotation at 90 degrees abduction measured 88.2 degrees. Twenty-two of 26 patients (85%) returned to their desired levels of sports following the operations. CONCLUSIONS: Patients with multidirectional glenohumeral instability have multiple lesions within the shoulder and the surgeon must individualize the operative treatment. Arthroscopic surgery produced successful results in 44 of 47 patients.
PURPOSE: We present the results of a prospective study evaluating arthroscopic technique in repairing multidirectional glenohumeral instability. Type of Study: Case series. METHODS: The 47 patient study group consisted of 26 men and 21 women. Inclusion criteria were multidirectional glenohumeral instability diagnosed on physical examination and at arthroscopy. Exclusion criteria were unidirectional anterior or posterior instability and prior instability operation. Four patients declined to participate in the study. The average age at the time of operation was 30 years (range, 15 to 56 years). The average interval from operation to final evaluation was 35 months (range 26 to 67 months). The American Shoulder and Elbow Surgeons (ASES) Shoulder Index, Constant, Rowe, and UCLA scores were recorded preoperatively and at final evaluation. RESULTS: Preoperatively, no patients were rated overall as good to excellent according to the Rowe scale; at final follow-up 94% (44 of 47 patients) were rated as good to excellent. One patient was considered a failure of the index operation due to persistent instability and underwent a second operative procedure. One patient noted a loss of strength during sports, and 2 patients had pain that limited their throwing ability. The ASES Shoulder Index improved to 94.7 from 45.4 (P =.001). The absolute Constant score improved to 91.7 from 60 (P =.001). The Rowe score improved to 93.7 from 14.2 (P =.001). The UCLA total score improved to 33.1 from 17.4 (P =.001). Average passive external rotation at 90 degrees abduction measured 88.2 degrees. Twenty-two of 26 patients (85%) returned to their desired levels of sports following the operations. CONCLUSIONS:Patients with multidirectional glenohumeral instability have multiple lesions within the shoulder and the surgeon must individualize the operative treatment. Arthroscopic surgery produced successful results in 44 of 47 patients.