[Arthroscopic stabilization of the shoulder using anchors]

P Valis, M Nýdrle
Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca 2003, 70 (4): 233-6

PURPOSE OF THE STUDY: The purpose of the current report was to present our initial experience with an arthroscopic technique for anterior stabilization of the shoulder with an anchor in 64 patients who had recurrent anterior glenohumeral instability.

MATERIAL: The application of arthroscopic techniques for the operative treatment of recurrent anterior instability of the glenohumeral joint has generated widespread interest. The goal of all arthroscopic techniques for stabilization of the shoulder is the re-establishment of a functioning inferior glenohumeral ligament. This is achieved by reattaching the avulsed anteroinferior aspect of the labrum or capsule to the anterior aspect of the glenoid neck with one of a variety of methods. Arthroscopically assisted repair of the anterior aspect of the labrum with use of a bioabsorbable/nonabsorbable suture with an anchor was performed in 64 consecutive patients who had chronic anterior instability of the shoulder. The average age of the patients was twenty-seven years (range, sixteen to fifty-two years). The etiology of the instability was a traumatic injury in 53 patients. All fifty-three shoulders had a Bankart lesion. The patients were evaluated at an average of 18 months (range, 3 to 36 months) after the procedure.

METHODS: During shoulder arthroscopy in typical laying position with traction applied on upper extremity we made diagnosis of capsule defect or laxity in all the cases. Using anchor technique we sutured capsule defect, or tightened loose capsule to glenoid rim. Two or three sutures were used. The anchors were Mitek GII implants, or Arthrex screws, with non-absorbable sutures in most cases.

RESULTS: Fifty (78 per cent) of the patients were asymptomatic and were able to participate in sports without restriction. The repair was considered to have failed in three (4.5 per cent) of the patients. In one of them, the failure resulted from a single traumatic reinjury during participation in a contact sport, and was treated operatively. The remaining two failures occurred atraumatically.

DISCUSSION: It is difficult to compare the results from the present study with those from other reports on arthroscopic techniques of anterior stabilization because of variation among the indications, the techniques, and the implants that were used. The degree of capsular laxity is central to the success or failure of arthroscopic stabilization.

CONCLUSION: Anterior stabilization of the shoulder with an anchor may be indicated for patients who have anterior instability with or without Bankart lesion and need suture of the lesion and capsulorrhaphy or capsular imbrication to reduce the joint volume.

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