Aims. The risk factors for recurrent instability (RI) following a primary traumatic
Introduction: This study was performed to assess the incidence of generalized ligament laxity in patients presented with 1st time
[Hong Kong Orthopaedic Association, Travelling Fellow]. Glenoid bone loss predisposes to further dislocation and failure of arthroscopic Bankart repair in patients with recurrent shoulder dislocation. This study investigates quantification of glenoid bone loss in
Purpose: To determine whether generalized ligamentous laxity is a predisposing factor for primary traumatic
Aim: To survey how acute, traumatic, first-time
To discover how traumatic
Aims. To discover how the management of traumatic
Aims: To discover how the management of traumatic
Introduction: Various surgical methods have been described to manage the problem of recurrent anterior dislocation of the shoulder. Older procedures Putti-Platt’s, Magnuson-Stack’s or Bristow;’s and Boytchev’s repair are not used today due to a high percentage of failure of 7%–17% incidence of recurrence associated with limited ROM. However, in the last decade the goal of treatment has changed. It is directed now towards restoration of normal function with full ROM of the affected shoulder, based mainly on arthroscopic stabilization or on “open” Neer’s capsular shift procedures combined with Bankart’s repair. However, during the last few years there are more and more papers dealing with a surprising unexpected high number of patients with shoulder instability following arthroscopic repair. The purpose of this study is to review the long term results of “open” Neer’s capsular shift procedure. Materials &
Methods: This is a presentation of 87 (78M; 9F) consecutive patients, 19 to 47 year old (mean 23 Y) with a length of follow-up of 4Y–15Y (mean 6Y). 45 of them with traumatic recurrent anterior dislocation of the shoulder had a capsular shift procedure according to Rockwood’s modification. In 42 other patients that had a multidirectional instability with proved dislocations of the affected shoulder a Protzman’s modified capsular shift procedure was used. Results: 82/87 patients had a stable shoulder without recurrent dislocation. 3 patients had an episode of traumatic shoulder dislocation within 2 months following operation. Two other patients of 42 with multidirectional instability had a recurrence of traumatic dislocation. One patient developed partial brachial plexus injury, most probably due to traction of the affected limb following operation. 78/87 had at follow-up normal shoulder function with full ROM, and the remaining 9 patients had only a slight limitation in shoulder abduction and in external rotation. Conclusions: Based on this study, it is suggested that capsular shift procedure is an excellent method for repair of recurrent
The purpose of this study was to determine arthroscopically the pathology following
Aims. Extensive literature exists relating to the management of shoulder instability, with a more recent focus on glenoid and humeral bone loss. However, the optimal timing for surgery following a dislocation remains unclear. There is concern that recurrent dislocations may worsen subsequent surgical outcomes, with some advocating stabilization after the first dislocation. The aim of this study was to determine if the recurrence of instability following arthroscopic stabilization in patients without significant glenoid bone loss was influenced by the number of dislocations prior to surgery. Methods. A systematic review and meta-analysis was performed using the PubMed, EMBASE, Orthosearch, and Cochrane databases with the following search terms: ((shoulder or glenohumeral) and (dislocation or subluxation) and arthroscopic and (Bankart or stabilisation or stabilization) and (redislocation or re-dislocation or recurrence or instability)). Methodology followed the PRISMA guidelines. Data and outcomes were synthesized by two independent reviewers, and papers were assessed for bias and quality. Results. Overall, 35 studies including 7,995 shoulders were eligible for analysis, with a mean follow-up of 32.7 months (12 to 159.5). The rate of post-stabilization instability was 9.8% in first-time dislocators, 9.1% in recurrent dislocators, and 8.5% in a mixed cohort. A descriptive analysis investigated the influence of recurrent instability or age in the risk of instability post-stabilization, with an association seen with increasing age and a reduced risk of recurrence post-stabilization. Conclusion. Using modern arthroscopic techniques, patients sustaining an
Patients suffering from generalised convulsions may dislocate their shoulders either anteriorly or posteriorly. Those with anterior dislocation are likely to have recurrent episodes because of secondary bony damage to the anterior rim of the glenoid and head of the humerus. In such patients there is high rate of failure of the standard soft-tissue stabilisation procedures. We have therefore devised a bone buttress operation in which autograft or allograft is secured to the deficient anterior glenoid and shaped to form an extension of its articular surface. We report our experience in 14 patients with grandmal epilepsy and recurrent anterior dislocation of the shoulder. After the bone buttress operation there were no further dislocations and all patients were satisfied despite a small restriction in their range of movement. We believe this to be the operation of choice for patients with this difficult problem.
In the international literature, the rate of recurrence after conservative treatment of traumatic anterior dislocation of the shoulder joint is high. Rates are highest in young subjects and violent sports. Recent publications report a lower rate of recurrence after immobilization in external rotation but with a short follow-up and in heterogeneous groups where contact sports were not individualized. Between August 1989 and April 1997, we conducted a prospective study to assess outcome in contact sports athletes aged at least 30 years (arthroscopy, 2001) Comparing the results of surgical and non-surgical treatment showed excellent or good outcome in 96% of the surgery group and in 94% of the non-surgery group. Later publications showed that chronic disease is an important negative factor for bone and cartilage tissue quality at repair. Between August 1989 and March 2005, we have performed 97 first-intention arthroscopic repair procedures in contact sport athletes and have obtained anatomic repair more easily with better quality tissue and better outcome with a lower rate of recurrence as well as more rapid resumption of training.
A comprehensive postal questionnaire was sent to 164 orthopaedic consultants, all members of the Brit-ish Elbow and Shoulder Society. Questions were asked about the initial reduction, investigations undertaken, timing of any surgery, preferred stabilization procedure, arthroscopic or open, detail of surgical technique, period of immobilization and rehabilitation programmes instigated in first-time and recurrent traumatic dislocators. The response rate was 83% (n=136) The most likely treatment of a young traumatic shoulder dislocation:
It will be reduced under sedation in A&
E by the A&
E doctor. Apart from x-ray, no investigations will be performed It will be immobilised for 3 weeks, then given course of physiotherapy Upon their second dislocation, they will be listed directly for an open Bankart procedure (with capsular shift as indicated) during which subscapularis will be detached and metallic bone anchors used Following surgery, they will be immobilised for 3 to 4 weeks, before being permitted full range of movement at 2 to 3 months and allowed to return to contact sports at 6 to 12 months On the other hand, 54% of surgeons indicated they would investigate prior to surgery, 16% said their first choice operation would be arthroscopic stabilisation, the number of dislocations normally permitted before surgery ranged from 1 to more than 3, and the period of immobilisation post operation from nil to 6 weeks. The results reveal a wide variation in practice and no clear consensus on how to best manage these patients. Open stabilisation remains the firm favourite. Does this mean arthroscopic stabilisation is regarded as an experimental procedure?
Aim: The re-dislocation rates in adults (<
30 years) in the initial 12 months after first, anterior, traumatic (FAT) shoulder dislocations treated non-operatively vary from 25% to 95%. The purpose of this study was to establish if arthroscopic surgery reduces the incidence of recurrent instability (failure) after such dislocations when compared to non-operative treatment. Material and Methods: Specific search terms were used to retrieve relevant studies from various databases extending from 1966 to May 2004. Guidelines for reporting of meta-analysis, adapted from QUOROM statement were followed. Results: 13 studies involving 433 shoulders were reviewed. Group A included 84 shoulders treated by arthroscopic lavage without stabilisation. There were no subluxations. The re-dislocation rate was 14.3% (12/84). Group B had 179 shoulders treated by arthroscopic stabilisation. The incidence of subluxation was 5.02% (9/179) and dislocation was 6.14% (11/179). Failure following arthroscopic lavage (12/84 – 14.3%) was significantly higher than after arthroscopic stabilisation (20/179 – 11.2%). [p= 0.04, Relative risk = 2.32, 95% CI: 1.07 to 5.05]. Group C involved 170 shoulders treated non-operatively. The incidence of subluxation was 8% (12/150) and dislocation was 62% (93/150). The overall incidence of failure was 70% (119/170). Failure following arthroscopic intervention (32/263 – 12.2%) was significantly lower than following non-operative treatment (119/170 – 70%) [p<
0.0001, Relative risk = 0.17, 95% CI: 0.12 to 0.24]. Conclusion: Early arthroscopic surgery appears to reduce recurrent instability during the initial 12 months after FAT shoulder dislocation in young adults (<
30 years) when compared to non-operative treatment. Arthroscopic stabilisation may be considered for young, athletic patients and those involved in contact sports or defence personnel, who are at a high risk of recurrent instability after FAT shoulder dislocation. RCTs reporting on a larger number of patients with a minimum follow-up of 5 years are required before one can draw firm conclusions on the ability of arthroscopic intervention to influence the natural history of traumatic
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
Aims: The re-dislocation rates in adults (<
30 years) in the initial 12 months after FAT (first,
Introduction. We aim to assess whether radiographic characteristics of the greater tuberosity fragment can predict rotator cuff tears inpatients with
The June 2024 Shoulder & Elbow Roundup. 360. looks at: Reverse versus anatomical total shoulder replacement for osteoarthritis? A UK national picture; Acute rehabilitation following traumatic