Abstract
Purpose: The results of coracoid blocks for the treatment of anterior shoulder instability are satisfactory (SOFCOT 1991 and 1999). Little work has been devoted to complications of this operation. We report our results after surgical revision in a consecutive series of seventeen patients.
Material and methods: Fourteen men and three women, mean age 34 years, required a second interention after anterior coracoid block: for recurent instability in ten cases and for painful stiff shoulder in seven. Radiographic assessment demonstrated a conflict between the block and/or the screw with the humeral head in 13 cases and signs of joint degeneration in three. The block was malpositioned in eight shoulders. The stabilisation procedure (Bankart ± capsuloplasty) was performed for these unstable shoulders with debridement and removal of the screw and or the block for painful stiff shoulders. The subscapular tendon was normal preoperatively in two shoulders, fibrous or thin in eleven and torn in one. The time from the first operation to revision was eleven years on the average.
Results: At mean follow-up of 21 months, the patients were assessed with the Duplay score. Results were good or excellent for eleven patients (70% for stabilised unstable shoulders and 57% for debrided painful stiff shoulders), fair for four and poor for two. Clinical assessment of the subscapular demonstrated a deficiency in ten shoulders. The force of internal rotation of the operated shoulder was 3.3 kg less than for the controlateral shoulder. Computed tomography demonstrated significant fatty degeneration of the subscapular in four patients. Glenohumeral joint degeneration was observed in nine shoulders. The most significant prognostic factor for final outcome was the number of prior interventions (p< 0.01).
Discussion: The result of revision surgery after coarcoid block depends on the clinical presentation. While the results for painful stiff shoulders remained very limited due to frequent intra-articular lesions, adjunction of a capsuloplasty with or without reinsertion of the glenoid rim yielded satsifactory results in more than two-thrids of the unstable shoulders. Involvement of the subscapular muscle appears to be related to multiple interventions in these shoulders, as well as to the deleterious effect of the block (Picard 1998, Glasson 1999) and continues to be the crucial prognostic factor for final outcome.
The abstracts were prepared by Docteur Jean Barthas. Correspondence should be addressed to him at Secrétariat de la Société S.O.F.C.O.T., 56 rue Boissonade, 75014 Paris.
