Evaluation of the functional results of management of traumatic anterior glenohumeral instability by arthroscopic capsular shift using suture anchors

This study aimed to evaluate the functional results of management of traumatic anterior gleno-humeral instability by arthroscopic capsular shift using suture anchors. This prospective study was carried out on 20 patients who attended to the outpatient clinic of Suez Canal University hospital, during the period from 2004 to the end of 2006. Patients [19 male patients and 1 female with range of age from 20-50 years] included in the study had the criteria of chronic traumatic anterior glenohumeral instability. Every patient had complete history taking, complete physical examination of shoulders and cervical spine and range of motion of the shoulder joint, evaluation of the strength of the deltoid and rotators and screening neurological examination and investiagations of the shoulder joint by radiographs as plain x-ray and sometimes MRI. All patients had Bankart lesion managed by capsular shift using Mitek suture anchors. Average follow- up period was 16.5 months. Assessment of the improvement of motion ranges were registered, and satisfaction of each patient as well as in the criteria of the UCLA scale. The UCLA score revealed significant improvement in the status of the shoulder. Preoperatively: none of the patients rated their satisfaction as good or excellent. Postoperatively 16 [80%] rated their satisfaction as good or excellent and 4 [20%] rated it as fair or poor. For range of motion, most of the patients show improvement in range of elevation from 158.25 to 172.25 degrees. The mean external rotation measured 48.75 degrees preoperative and 45.20 postoperative with loss less than 5%. The mean abduction was 173.25 degrees preoperative and 172.25 postoperative with loss less than 5%. Most of the patients show improvement in range of all movements within three months of operations. For the degree of instability, the final mean UCLA score was found to be 34.11 points for the patients with recurrent dislocation, 35 points for the patient with recurrent subluxation after an initial dislocation, and 33 points for the patient with Apprehension [p = 0.519]. After one year of follow up no patient suffered from recurrence of dislocation or apprehension and only one patient [5%] suffered from subluxation. Arthroscopic repair with suture anchors is an effective surgical technique for the treatment of degenerated labrum using capsular shift. Open repair does not offer a significantly better result in terms of stability, and what is more, can negatively affect the recovery of full ROM of the shoulder. Because the arthroscopic procedure has some advantages regarding duration of surgery, morbidity, postoperative pain, time of hospitalization, and risk of complications, also it is more cost-effective

Intramedullary versus extramedullary tibial resection in total knee replacement

This study was performed to compare the accuracy of intramedullary versus extramedullary tibial resection in 54 total knee arthroplasties. An intramedullary guide was used in 27 patients[group 1] and an extramedullary guide was used in another 27 patients [group 2]. Femorotibial angles were measured postoperatively with group 1 averaging 7.52-degree valgus in 25 out of 27 patients and 1.5-degree varus in 2 out of 27 patients. In group 2, the average femorotibial angles were 6.92-degree valgus in 26 out of 27 patients and 1.0-degree varus in one patient. The tibial component alignment angles averaged 89.78-degree varus in group I versus 90.85- valgus in group 2. However, 77.8% of the patients were aligned within the range of 7 +/- 2-degree valgus femorotibial angle in group 1 versus 62.96% in group 2