TREATMENT OF ANTERIOR HABITUAL SHOULDER DISLOCATION WITH HILL-SACKS LESION USING ROTATIONAL OSTEOTOMY OF THE HUMERUS: LONG-TERM RESULTS

Abstract

Most of surgical methods, suggested for habitual shoulder instability treatment provide almost similar percentage of successful results, being 90–95%. However, some investigations show unequal efficiency of standard methods in dependence on bone-cartilage lesions presence. It is revealed that redislocations number after arthroscopic Banckart operation in group of patients with insignificant bone-cartilage lesions is 4%, however, in group of patients with significant lesion this figure becomes 67%. In this case – an actual problem is to find new treatment procedure for patients with habitual shoulder instability with bone-cartilage lesion.

We aimed to demonstrate our results of treatment of patients with habitual anterior shoulder instability and arthroscopically revealed bone-cartilage lesions using rotational osteotomy by Saha-Weber.

In 99 patients with massive bone-cartilage lesion of back surface of humeral head (arthroscopically proved), we have applied rotational osteotomy of the humerus with subscapularis tendon transposition (male/female ratio - 3:1, middle age - 34.6 years). Average duration of disease before the operation was 4.2 years (from 1.2 years to 24 years). In each clinical case the quantity of shoulder dislocations exceeded 6. Long-term result of treatment is studied at 55 patients. Good and excellent clinical results have been reached at 48 patients (87.2%). The moderate functional disorders are revealed in 6 patients (10.9 %). There was one case of redislocation after repeated trauma. There were no cases of nonunion, evident contracture or avascular necrosis of humeral head.

These data were compared with the results of surgical technique of strengthening of anterior wall of shoulder joint according to Boychev-I in treatment of 56 patients with an anterior habitual shoulder dislocation with clinical manifestations of bone- cartilage lesion (high number of dislocations with signs of severe instability, average term of supervision - 7 years). Insufficiency of applied technique almost at each third patient is determined. The unsatisfactory result of treatment (redislocation) is found in 4 cases (7.1%), satisfactory (the moderate and expressed functional deficiency) - in 12 (21.4%).

Rotational osteotomy of a humerus with subscapularis tendon transposition is an effective operation with rather simple postoperative conducting and low frequency of complications. Obtained data show its advantages in comparison with soft-tissue operations. This operation can be recommended in cases of pronounced Hill-Sacks lesion with severe instability of humeral joint and after failed plastic procedures on the soft tissues.