D K Mishra1, G S Fanton. 1. Private Practice, Palo Alto, and The University of California, Berkeley, California, USA.
Abstract
PURPOSE: Arthroscopic treatment of chronic anterior shoulder instability in active athletes is reportedly less successful than open techniques. We performed arthroscopic stabilization for confirmed capsulolabral avulsions and followed-up patients prospectively for a minimum of 24 months. TYPE OF STUDY: Prospective nonrandomized study. METHODS: We studied 42 patients (mean age, 26 years) with recurrent traumatic anterior dislocations. They reported an average of 9 dislocations preoperatively. An average of 69 months elapsed from initial dislocation to surgery. The shoulders underwent arthroscopic capsulolabral repair with either a suture anchor and horizontal mattress suture, or an absorbable tack. Each shoulder also was treated with a monopolar radiofrequency probe for thermal shrinkage of the middle, anteroinferior, and posteroinferior glenohumeral ligaments. Patients were evaluated prospectively for pain, motion, stability, and function using the modified Rowe score. RESULTS: At a mean of 28 months postoperatively, 38 patients had returned to their preinjury sports. Three patients (7%) had a traumatic redislocation. Using the modified Rowe score, statistically significant improvements were noted for pain, stability, and function. There was no significant change in motion. The overall modified Rowe score improved from 38 points preoperatively to 89 points at final evaluation (P <.001). CONCLUSIONS: These results indicate that arthroscopic treatment of patients with recurrent traumatic anterior instability yields results comparable to open procedures, including athletes involved in high-level contact and collision sports. We believe that addressing capsular laxity surgically is critical, particularly when dealing with chronic instability. This procedure allows the surgeon to reliably correct the labral detachment and the capsular redundancy while preserving motion and minimizing morbidity.
PURPOSE: Arthroscopic treatment of chronic anterior shoulder instability in active athletes is reportedly less successful than open techniques. We performed arthroscopic stabilization for confirmed capsulolabral avulsions and followed-up patients prospectively for a minimum of 24 months. TYPE OF STUDY: Prospective nonrandomized study. METHODS: We studied 42 patients (mean age, 26 years) with recurrent traumatic anterior dislocations. They reported an average of 9 dislocations preoperatively. An average of 69 months elapsed from initial dislocation to surgery. The shoulders underwent arthroscopic capsulolabral repair with either a suture anchor and horizontal mattress suture, or an absorbable tack. Each shoulder also was treated with a monopolar radiofrequency probe for thermal shrinkage of the middle, anteroinferior, and posteroinferior glenohumeral ligaments. Patients were evaluated prospectively for pain, motion, stability, and function using the modified Rowe score. RESULTS: At a mean of 28 months postoperatively, 38 patients had returned to their preinjury sports. Three patients (7%) had a traumatic redislocation. Using the modified Rowe score, statistically significant improvements were noted for pain, stability, and function. There was no significant change in motion. The overall modified Rowe score improved from 38 points preoperatively to 89 points at final evaluation (P <.001). CONCLUSIONS: These results indicate that arthroscopic treatment of patients with recurrent traumatic anterior instability yields results comparable to open procedures, including athletes involved in high-level contact and collision sports. We believe that addressing capsular laxity surgically is critical, particularly when dealing with chronic instability. This procedure allows the surgeon to reliably correct the labral detachment and the capsular redundancy while preserving motion and minimizing morbidity.
Authors: Alison P Toth; Russell F Warren; Frank A Petrigliano; David A Doward; Frank A Cordasco; David W Altchek; Stephen J O'Brien Journal: HSS J Date: 2010-11-11
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