[Arthroscopic stabilization of a primary traumatic dislocation of the glenohumeral joint]

L Pasa, V Pokorný, P Visna, P Nestrojil, R Hart, S Kalandra
Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca 2004, 71 (3): 142-6

PURPOSE OF THE STUDY: The authors present their experience with arthroscopic stabilization of a primary traumatic dislocation of the glenohumeral joint in young patients.

MATERIAL: In up to 80% of patients younger than 25 years, traumatic dislocation of the glenohumeral joint is associated with its recurrence within one year of treatment even in well performed conservative therapy. Repeated dislocations gradually damage the joint and eventually result in the development of arthritis. The articular capsule becomes loose, glenoid surface is reduced and cartilage of the humeral head is affected. Repeated dislocation, reduction and immobilization are causes of patients' discomfort as well as morbidity. For these reasons, the stabilization of recurrent dislocations of the glenohumeral joint is performed by an open procedure or, most recently, arthroscopic method. Arthroscopic stabilization of a primary traumatic dislocation of the glenohumeral joint is an invasive yet gentle method that permits an exact reconstruction of the injured articular capsule and provides good conditions for complete healing of the affected tissues.

METHOD: In order to prevent dislocations from recurring, we offered to perform minimal invasive arthroscopic stabilization in 30 patients who had undergone reduction of a primary dislocation of the glenohumeral joint in the 1999/2001 period. Of these, 18 (45%) accepted this offer. In 11 men and 7 women (average age, 22 years) 12 right and six left glenohumeral joints were treated arthroscopically with the use of absorbable or non-absorbable sutures. The procedure was performed at 2 to 7 days after injury and reduction. The joint was immobilized in an elastic Desault bandage for 6 weeks, but with exercising the elbow. From the 4th postoperative week, the glenohumeral joint was passively exercised in the sagittal plane, but abduction and external rotation were avoided. From the 7th week on, the joint was exercised to achieve its full range of motion.

RESULTS: The patients were followed up for 12 to 26 months. No repeated dislocation occurred. The range of motion comparable with the contralateral healthy joint was achieved in all patients by 12 weeks after surgery. One patient with a combined injury involving fracture of the first lumbar vertebra with signs of articular fibrosis underwent redress of the glenohumeral joint under general anesthesia at 6 weeks after arthroscopy. All patients returned to their previous everyday life, working and sports activities.

DISCUSSION: Arthroscopic stabilization of the glenohumeral joint is an invasive though gentle method which, when exactly performed and followed by adequate postoperative rehabilitation, can considerably or even completely reduce recurrence of joint dislocation. Its disadvantages include costs of surgery and hospital stay, and a risk of potential intra- or post-operative complications. The statistical evaluation of primary dislocations in young patients showed that, in 80% of them, recurrent dislocations would probably require surgical treatment. In addition, a joint suffering from repeated dislocation may develop lesions to such an extent that dislocation may continue to recur even after surgical treatment; this happens in about 10% of the cases. Our estimate was that only 20% of the patients with primary traumatic dislocation (ruptured articular capsule) would not be in need of further repair. However, it was impossible to determine who they would be. Our results, i. e., the absence of recurrent dislocations, suggest a way of reducing the recurrence of dislocations following a primary injury of the glenohumeral joint.

CONCLUSIONS: Arthroscopic stabilization of a primary traumatic dislocation of the glenohumeral joint in young patients (under 25 or maximally 30 years of age) is the method that allows us, invasively but with a good outcome, to reduce a high number of post-traumatic dislocations and to return sporting and/or manually working subjects to their previous way of life.

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