Shoulder Stabilization Arthroscopic Techniques, Indications and Results

7/31/2019 Shoulder Stabilization Arthroscopic Techniques, Indications and Results

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Orthopaedic Research of Virginia

Shoulder StabilizationArthroscopic Techniques,Indications, And Results


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Shoulder InstabilityClassification And Differential Diagnosis

Traumatic

(TUBS)

Intentional

(Muscular)

Atraumatic

(AMBRI)

Unintentional

(Positional)

Voluntary

Etiology


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Shoulder InstabilityClassification And Differential Diagnosis

Acute

Dislocation

Recurrent

Subluxation

Chronic

Timing

Locked


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Open Surgical Procedures forAnterior Shoulder Instability

Repair of capsule & labrum

Muscle & capsule plication procedures

Capsulorraphies Muscle & tendon sling procedures

Bone block procedures

Osteotomies


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Arthroscopic Procedures forAnterior Shoulder Instability

Staple Capsulorraphy

Rivet Capsulorraphy

Canulated screw fixationAllograft Reconstruction

Bioabsorbable tack

Suture repair technique


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Overall Results*

(Bankart Scale)(n = 150)80%

3%5%12%

Excellent

Good

Fair

Poor


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Age/Pathology And

Recurrence

0

2

4

6

8

10

12

14

14 - 20 21 - 30 > 30

Capsular Laxity

Bankart - Capsular Laxity

Bankart Lesion


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Distribution Of Bankart Scores

126

21

212

0

20

40

60

80

100

120

140

Excellent Good Fair Poor

78.3%

13%

1.2%7.5%


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Success Rate OfReconstruction By Age

74

9097.5

0

20

40

60

80

100

22

Percent

20/27

49/54

78/80


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Surgical Technique

Lateral decubitus position

Exam under anesthesia

Standard portals

Diagnostic arthroscopy


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Drill Hole In Scapular Spine

Or Clavicle


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Pull 1/2 Of The Sutures

Through The Drill Hole


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Tension And Tie Down The

Repair


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Suture Anchor Repair Of The

Labrum


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Results Of Arthroscopic

Shoulder Stabilization


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Transglenoid SutureCapsulorrahaphy

Torchia, Caspari et al

ARTHROSCOPY1997;

13:609-613


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Transglenoid Repair

Chronic documented anteriorinstability

Single surgeon (RBC)

Consecutive procedures

No preselection


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Transglenoid Repair

150 shoulders

2 - 8 year follow-up

Mean - 4.1 years


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Transglenoid Repair

Redislocation rate - 7.3%

Resubluxation rate - 9.3%


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Arthroscopic Suture Repair

Multi-directional & PosteriorInstability

McIntyre, Caspari, Savoie

ARTHROSCOPY1997;

13:418-432


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Multi-directional And

Posterior Instability

39 - shoulders 20 - posterior

19 - multi-directional


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Multdirectional Recurrence

Reoperation - 0

Subluxation - 1 (5 %)


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Posterior Instability

Recurrence

Reoperation - 2 (10 %) Subluxation - 3 (15 %)

(all with Bankart lesions)


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Morgan & Bodenstab

ARTHROSCOPY1987;

3:111-122


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25 patients

Follow-up 4 - 7 years Recurrence rate - 4%

Recurrence increases with

younger age and contact athletes


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Savoie, Miller, Field

ARTHROSCOPY1997; 13:

201 - 209


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161 patients Follow up in 3 - 5 years

74

9097.5

0

20

40

60

80

100

22

Percent


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Conclusion

Arthroscopic shoulderstabilization may produceresults comparable to open

procedures


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Conclusion

Higher recurrence rates occurin younger patients (< 20 yrs)and perhaps in contact

athletes


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AAOS Comprehensive

Shoulder And Elbow CourseASES First Open Shoulder

And Elbow Meeting

April 23 - 26, 1998

Kiawah island, SC


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Thank You For Your

Attention

Shoulder Stabilization Arthroscopic Techniques, Indications and Results

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