Arthroscopic Bankart Repair for Recurrent Traumatic Anterior Shoulder Dislocation

Transcription

1 Arthroscopic Bankart Repair for Recurrent Traumatic Anterior Shoulder Dislocation Thavatchai Tiamklang M.D. Department of Orthopedic, Khon Kaen Hospital Abstract Purpose & Method To evaluate results of arthroscopic Bankart repair for patients with recurrent traumatic anterior shoulder dislocation at Khon Kaen Hospital between January 2005 and December 2007.A consecutive series of 15 patients(13 men, 2 women; mean age 29.9 years) with recurrent traumatic anterior shoulder dislocation were treated with arthroscopic Bankart repair and were evaluated the results from shoulder scores of Modified scale of Rowe and Zarins and shoulder scores of American Shoulder and Elbow Surgeon scale. Results The mean shoulder scores of Modified scale of Rowe and Zarins were 25.3, preoperatively and were improved to 86.0,postoperatively. And the mean shoulder scores of American Shoulder and Elbow Surgeon scale were 28.5,preoperatively and were improved to 90.8, postoperatively. The mean shoulder scores between preoperative and postoperative treatment were significantly different(p<0.01).the failure rate was 6.7%. Conclusion The results of arthroscopic Bankart repair for patients with recurrent traumatic anterior shoulder dislocation were good and appreciated in pain-relief, stability and function with the acceptable failure rate. Keywords : Shoulder dislocation, Arthroscopic Bankart Repair

2 Khon Kaen Hospital Medical Journal Vol. 32 Supplement 5 June Bankart.., Bankart Modified scale of Rowe and Zarins American Shoulder and Elbow Surgeon scale Modified scale of Rowe and Zarins American Shoulder and Elbow Surgeon scale (p <0.01) 6.7% :, Bankart

3 44 (1,2) glenoid labrum Bankart lesion Hill-Sachs lesion (Bankart procedure) 2 (open Bankart procedure) ( Arthroscopic Bankart Repair) (3,4) (5-14) (15) 1. 3 (recurrent, unidirectional, anterior shoulder instability) 2. (multidirectional instability) 3. 1.) 2 1.Modified scale of Rowe and Zarins (Table 1) 2.American Shoulder and Elbow Surgeon scale (Table 2) 2.) neurological deficit 3.) Table 1: Shoulder Score of Modified scale of Rowe and Zarins Description Score (point) Pain None 10 Moderate 5 Severe 0 Stability Negative apprehension test ; no subluxation 30 Negative apprehension test ; but discomfort with arm in abducted and externally

4 Khon Kaen Hospital Medical Journal Vol. 32 Supplement 5 June Description Score (point) Rotated position 15 Positive apprehension test and sense of subluxation 0 Motion Full range of motion 10 As much as 25 % loss of motion in any plane 5 More than 25% loss of motion in any plane 0 Function No limitation in throwing, working, or return to sport 50 No limitation in throwing or working : return to sport at lower level 40 No limitation in working : un-able to return to sport 35 Moderate limitation in overhead work; unable to return to sport 20 Marked limitation in throwing; unable to perform overhead work 0 Table 2: Shoulder Score of American Shoulder and Elbow Surgeon scale Description Score(points) Pain(36% of total score) None 5 Slight 4 After unusual activity 3 Moderate 2 Marked 1 Complete disability 0 Stability(36% of total score) Normal 5 Apprehension 4 Rare subluxation 3 Recurrent subluxation 2 Recurrent dislocation 1 Fixed dislocation 0 Function(28%of total score) Normal 4 Mild limitation 3 With difficulty 2 With aid 1 Unable 0

5 46 1. general anesthesia 2. (beach-chair) 3. anterior apprehension test, sulcus sign, degree of anterior translation 4. (standard posterior portal) Bankart lesion, Hill-Sachs lesion 5. (anterior working portal) small cannula a) Anteroinferior portal subscapularis coracoid process b) Anterosuperior portal rotator interval biceps (long head) 6. anteriorsuperior working portal (scar tissue) (anterior capsulolabral ligamentous complex) glenoid 6 cutting bone rasp mm power drill drilling guide anteroinferior portal inferior hole 5.30 glenoid (bioabsorbable suture anchor) suture bioabsorbable anchor sliding knot (secondary suture) arm sling (adduction and internal rotation) 3 Arm sling pendulum 6 3 6, SPSS version 13.0 descriptive data pair-sample t-test p< (86.7%) 26.1 (73.3%) 6.2 (Table 3) Table 3 : Demographic data of the patients Variables Age(yrs)(mean+SD) (17-67) Sex Male 13(86.7%) Female 2(13.3%) Age at initial dislocation (mean+sd) (14-66) Side of injury Left 4(26.7%) Right 11(73.3%)

6 Khon Kaen Hospital Medical Journal Vol. 32 Supplement 5 June Variables Dominant side Yes 11(73.3%) No 4(26.7%) Mean number of dislocation(range) (3-10) Mechanism of initial injury Trauma 7(46.7%) Sport-related 8(53.3%) Mean time to surgery (yrs) (1-10) Modified scale of Rowe and Zarins American Shoulder and Elbow Surgeons scale 46.7% 46.7% 6.7% (Table 5) (Table 3) 1. Modified scale of Rowe and Zarins American Shoulder and Elbow Surgeon scale Table 4 : Scores of the patients on the two shoulder-rating scales Score (point) Modified scale of Rowe and Zarins (46.7%) (46.7%) <79 1(6.7%) mean,86.0( ) American Shoulder and Elbow Surgeons scale (46.7%) (46.7%) <79 1(6.7%) mean,90.8( ) No. of the patients Table 5 : Shoulder score of the patients before and after arthroscopic surgery Shoulder score Score(mean+SD) p-value preoperative postoperative Modified scale of Rowe and Zarins <0.001 American Shoulder and Elbow Surgeon scale < (6.7%)

7 48 Kralinger (2) physiotherapy immobilization Robinson (1) 86.7% % 26 Bankart repair open Bankart procedure arthroscopic Bankart repair Lenters (3) % Shoulder Scores Modified scale of Rowe and Zarins American Shoulder and Elbow Surgeons scale (randomized controlled trial) 1. Robinson CM, Howes J, Murdoch H, Will E, Graham C. Functional outcome and risk of recurrent instability after primary traumatic anterior shoulder dislocation in young patients. J Bone Joint Surg Am 2006; 88(11): Kralinger FS, Golser K, Wischatta R, Wambacher M, Sperner G. Predicting recurrence after primary anterior shoulder dislocation. Am J Sports Med 2002; 30(1): Lenters TR, Franta AK, Wolf FM, Leopold SS, Matsen FA 3rd. Arthroscopic compared with open repairs for recurrent anterior shoulder instability. A systematic review and meta-analysis of the literature. J Bone Joint Surg Am 2007; 89(2): Tjoumakaris FP, Abboud JA, Hasan SA, Ramsey ML, Williams GR. Arthroscopic and open Bankart repairs provide similar outcomes. Clin Orthop Relat Res 2006; 446:

8 Khon Kaen Hospital Medical Journal Vol. 32 Supplement 5 June Carreira DS, Mazzocca AD, Oryhon J, Brown FM, Hayden JK, Romeo AA. A prospective outcome evaluation of arthroscopic Bankart repairs: minimum 2-year follow-up. Am J Sports Med 2006; 34(5) : Gartsman GM, Roddey TS, Hammerman SM. Arthroscopic treatment of anterior-inferior glenohumeral instability. Two to five-year follow-up. J Bone Joint Surg Am 2000; 82-A(7): Hoffmann F. [Arthroscopic Bankart operation using absorbable suture anchors]. Oper Orthop Traumatol 2006; 18(2): Kim SH, Ha KI, Cho YB, Ryu BD, Oh I. Arthroscopic anterior stabilization of the shoulder: two to six-year follow-up. J Bone Joint Surg Am 2003; 85-A(8): Marquardt B, Witt KA, Gotze C, Liem D, Steinbeck J, Potzl W. Long-term results of arthroscopic Bankart repair with a bioabsorbable tack. Am J Sports Med 2006; 34(12): Marquardt B, Witt KA, Liem D, Steinbeck J, Potzl W. Arthroscopic Bankart repair in traumatic anterior shoulder instability using a suture anchor technique. Arthroscopy 2006; 22(9): O Neill DB. Arthroscopic Bankart repair of anterior detachments of the glenoid labrum. A prospective study. J Bone Joint Surg Am 1999; 81(10): Ozbaydar MU, Tonbul M, Baca E, Yalaman O. [Arthroscopic treatment of anterior-inferior shoulder instability]. Acta Orthop Traumatol Turc 2007; 41(2): Ozbaydar MU, Tonbul M, Bekmezci T, Yurdoglu C. [The results of arthroscopic Bankart repair with suture anchors]. Acta Orthop Traumatol Turc 2005; 39(5): Thal R, Nofziger M, Bridges M, Kim JJ. Arthroscopic Bankart repair using knotless or Bioknotless suture anchors: 2- to 7-year results. Arthroscopy 2007; 23(4): Calvo E, Granizo JJ, Fernandez-Yruegas D. Criteria for arthroscopic treatment of anterior instability of the shoulder: a prospective study. J Bone Joint Surg Br 2005; 87(5):