Arthroscopic Bankart repair with suture anchors: results and risk factors of recurrence of instability / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate retrospectively the results of arthroscopic Bankart repair using suture anchors for recurrent anterior shoulder dislocation with a minimum 1-year follow-up and to assess risk factors for recurrence.</p><p><b>METHODS</b>From March 2002 to March 2010, 259 patients with recurrent anterior shoulder dislocation underwent arthroscopic Bankart repair with suture anchors. And 188 patients (50 athletes, 138 nonathletes) were available for follow-up. The mean age at the time of surgery was 25.3 years (range, 13 - 58 years). The mean follow-up was 38.6 months (range, 12 - 110 months). All of the 188 patients were evaluated preoperatively and postoperatively with the American Shoulder and Elbow Society (ASES) shoulder score and Rowe score system. The rate of recurrent instability, range of motion, and risk factors for postoperative recurrence were evaluated. The ASES score was 72.6 preoperatively, and Rowe score was 33.4.</p><p><b>RESULTS</b>The ASES scores improved significantly to 91.9 postoperatively (P < 0.001). The Rowe scores improved to 81.9 postoperatively (P < 0.001). And 152 patients were greatly satisfied with the results, 16 satisfied and 20 unsatisfied. The satisfactory rate was 89.4%. 24 patients (12.8%) suffered a recurrence after surgery, 14 athletes and 10 nonathletes. The recurrence rates were 28.0% in the athlete group and 7.2% in the nonathlete group. On average there was no significant loss of external rotation postoperatively (average, 75.2° preoperatively and 67.2° postoperatively). Patients under age 20, and athlete patients were associated with recurrence (P < 0.05). Other factors including length of time until surgery, type of anchors, number of anchors, presence of bony Bankart lesion, presence of a superior labrum, anterior and posterior tear, presence of posterior or inferior labrum lesion, presence of rotator cuff tear, ligamentous laxity and rotator interval closure did not influence the recurrence rate (P > 0.05).</p><p><b>CONCLUSIONS</b>Arthroscopic Bankart repair is a good option for the treatment of recurrent anterior shoulder dislocation. Identification of risk factors for recurrence allows for consideration of open stabilization. In the series, patients under age 20 and athlete patients are the most important risk factors for recurrence.</p>

Diagnosis and management of septic arthritis after arthroscopic anterior cruciate ligament (ACL) reconstruction / 中华外科杂志

<p><b>OBJECTIVE</b>To summary the experience in the diagnosis and management of septic arthritis after anterior cruciate ligament (ACL) reconstruction.</p><p><b>METHODS</b>The knee joint infections after arthroscopic anterior cruciate ligament reconstruction were retrospectively studied. From January 1997 to July 2007, 16 of 3638 patients undergoing anterior cruciate ligament reconstructions experienced postoperative septic arthritis. The incidence, cause, presentation, laboratory results, treatment, and outcome of all infected patients were analyzed. The experiences of diagnosis and management of septic arthritis after anterior cruciate ligament reconstruction were summarized.</p><p><b>RESULTS</b>The incidence of septic arthritis after ACL reconstruction was 0.44%. The most common symptoms of the infected patients were fever, swelling, severe pain, tenderness, restricted motion. Eleven (68.8%) patients were positive for bacteria cultures, and Staphylococcus epidermidis was the most common bacteria. Nine of the 16 patients were performed arthroscopic debridement, and the other 7 patients were conservatively treated. All patients regained full range of motion and normal stability at the 19.7 months follow-up.</p><p><b>CONCLUSIONS</b>Septic arthritis, which could bring the dysfunction of the joint, is subsequent with cartilage injury and the failure of the ACL grafts. Early diagnosis and treatment of arthroscopic debridement in time are essential to the ultimate clinical outcome.</p>