ARTHROSCOPIC ANTERIOR STABILISATION OF THE SHOULDUR USING RESORBABLE PEGS: 58 CASES

Abstract

Purpose: Outome after arthroscopic management of anterior instability of the shoulder has varied since the early series. The results proposed at the 1993 symposium of the French Society of Arthroscopy suggest we should be using this technique with prudence. We report here our experience with patients operated on between 1993 and 1997 who were selected on the basis of the 1993 conclusions that excluded patients with multiple recurrent instability and fractures of the anterior rim of the glenoid cavity.

Material and methods: Sixty-seven shoulders were operated on between 1993 and 1997. Mean follow-up for 58 of these shoulders (86%) was five years. These 58 patients constituted the study group. There were 31 men and 27 women, mean age 25 years, who had 30 recurrent shoulder dislocations, 12 shoulder subdislocations and 16 painful unstable shoulders. Forty-six percent of the patients participated in competition-level sports with forced shoulder movements in 39.6% of the cases. The surgical technique involved retightening the inferior glenohumeral ligament that was fixed with resorbable sutures. Immobilisation with elbow-to-body contention was strictly applied for three weeks at least followed by progressive rehabilitation exercises until renewed sports activities starting four months postoperatively.

Results: The mean overall Duplay score was 85.5 (sport 21/25; stability 18/25; mobility 24/25; pain 22/25). Outcome was good and very good in 82.7% of the patients, fair in 8.6%, and poor in 5 (recurrence). Subjectively, 55% of the patients were very satisfied, 27.5% were satisfied, 15.5% were disappointed and 1.7% were displeased. There were four complications (one infection cured with antibiotic therapy with a final score of 100 and three serious cases of capsulitis that recovered before one year). Gender, age, type and duration of instability, level of sports activity, and articular laxity appeared to affect outcome.

Discussion: The rate of failure (8.6%) is similar to that with open surgery (4.6% in the SOFCOT symposium 1999) and would be well below the rates observed in the 1993 arthroscopy series although the different patient selection does not allow valid comparison.

Conclusion: Arthroscopic stabilisation of the shoulder is a technically difficult procedure that has progressively shown its effectiveness after an appropriate learning curve and in carefully selected patients. Favourable elements include age over 20 years, competition level sports activity, recent instability, and absence of constitutional hyperlaxity.