Como mejorar la capacidad del ancla para llevar suturas en inestabilidad de hombro / Improving anchors capabilities to hold sutures on shoulder instability

El fracaso de la cirugia de inestabilidad de hombro ocurre frecuentemente por abrasion de la sutura en el ancla o por desprendimiento de la sutura de la capsula articular. Para mejorar la capacidad de las anclas de llevar multiples suturas a fin de aumentar la superficie capsular con suturas por numero de anclas, diseñamos una tecnica que utiliza el nudo de la sutura del ancla para albergar suturas libres capsulares mejorando el numero de suturas por ancla, sin riesgo de abrasion en el ojo del arpon.

Shoulder arthroscopy: part II arthroscopic Bankart repair for anterior shoulder instability using suture anchor reconstruction technique

Suture anchor reconstruction technique was used in 19 shoulders over the last 2.7 years in 19 patients in an attempt to restore anterior stability. All the patients had traumatic anterior instability diagnosed on physical examination and at arthroscopy. Discrete Bankart lesion and well formed glenohumeral ligaments, with or without capsular laxity was the evidence consistent with instability in all patients, and each underwent a standardized procedure, however, the number of anchors were different for every patient, range 1-to-3 according to the size of the lesion. Additional capsulorraphy procedures were done to reduce excess capsular volume including; plication sutures in 8 shoulders, and thermal shrinkage in 7. All patients were young active men with high physical demands, the average age at the time of operation was 25.2 years. All were right handed, the dominant side was affected in 11 patients. None of the patients had prior instability operations. The follow-up averaging 18 months, range 9-to-3 1 months. None of the patients developed redislocation, subluxation, or positive apprehension during the follow-up period. No major intra-operative, or pen-operative complications were reported during this study. 75%-to-full range of motion of the shoulder joint as compared with the opposite asymptomatic side was preserved 21 in most patients. Using the shoulder evaluation scale advocated by Rowe; and Zarins, 1981 1421, the patients had excellent-to-good results with an overall average score of 85.82 points; but 5 patients had episodes of moderate pain with activity, and 7 had moderate limitation in overhead work. It would appear that arthroscopic repair of pathologic Bankart lesion in a carefully selected patients using suture anchor technique is a favorable answer restoring stability to the shoulder better than non-operative treatment of first-time dislocation and to surgical treatment of recurrent shoulder dislocation

Shoulder arthroscopy: part III arthroscopic versus open anterior shoulder stabilization

To evaluate the efficacy of a particular line of treatment, criteria based on functional basis and complication rate must be considered. This work was carried out because of the authors' conviction that any new operative procedure must be critically assessed, on this basis, comparison with other procedures must be included. Forty one shoulders were allocated to an arthroscopic repair group [19 shoulders], and an open repair group [22 shoulders]. The two groups were generally comparable in terms of age [a mean of 25.2 years in the arthroscopic group and 27.3 years in the open group], gender [all patients in either group were males], mechanism of injury and etiology of instability [all patients related a history of a traumatic event], dominant extremity [the right and the dominant side was the most vulnerable], duration of symptoms [a mean of 13 months and 19 months for the arthroscopic and open groups respectively], level of daily activities and effort demand [all were young active with high physical demand]. Three variations were existed: [1] pre-selection and pre-conditioning was the strategy in the arthroscopic repair group, so that, procedural option was determined on the basis of the pathological findings, only at the time of surgery, modification of treatment was possible. [2] the arthroscopic procedure involved an anatomic repair of the avulsed anterior capsule and labrum to the glenoid lip using standardized suture anchor technique and an incorporation of capsulorraphy in most shoulders. While in the open repair group, different operative modalities were employed using familiar techniques including: 2 soft tissue reconstructions; Magnuson - Stack [4 shoulders] and Putti-Platt [6 shoulders]. In addition, coracoid tip with its attached muscles transfer [Bristow operation in 9 shoulders] and rerouting [Boytchev operation in 3 shoulders]. [3] the duration of the follow-up, which considered short-to-mid term [averaging 18 months] and long-term [averaging 71 months] in the arthroscopic and open groups respectively. The treatment outcomes for each group were determined according to the recurrence rate, the presence or absence of -pain, the range of motion, the strength and the return to pre-injury activity. Analysis of the measured parameters for both approaches; open and arthroscopic showed no significant differences, both yielded comparable results

Shoulder arthroscopy: part IV idiopathic frozen shoulder: arthroscopic distension, release, and debridment

Twenty three carefully selected patients with frozen shoulder with variable degrees of complaint and severity constituted the material of the present study. All failed to response to the conventional lines of conservative treatment as an initial measures, and then, arthroscopic management was undertaken followed by a well designated physical therapy program and stretching mobilization. The indication for surgery was persistent pain, stiffness, and limited function. There were 15 [65.2%] males, and 8 [34.8%] females with an average age of 49.6 years. All were right handed, and all but 2 were unilateral dominant-side presentation - for bilateral affection, arthroscopy was done in one shoulder, the one with the severe symptoms. Before operation, all the patients had shoulder pain and motion restriction for at least 6 months despite conservative treatment. At operation, synovectomy, rotator interval capsulotomy, and glenohumeral joint and subacromial space debridment and clean-up were done for all cases, additionally, selective release procedures were performed in a controlled manner according to the findings, varied from limited freeing-up to a more aggressive or a complete release of the contracted anterior capsulo-ligamentotendinous structures. The range of external rotation at the side and in abduction was examined intermittently to check improved laxity and motion arc. The functional mobility, the range of motion in the different planes, the power, and pain were assessed and recorded before and after surgery according to the Constant scoring system [9]. Functional assessment was carried out at 3 post-operative intervals during the course of follow-up; immediate postoperative, at 10 th week, and finally at 20 th week. Final re-assessment at the end of the treatment showed appreciable improvement with no significant recorded complications. On conclusion, the combination strategy; arthroscopic management with shoulder exercises can offer effective treatment for frozen shoulder

Tratamiento quirúrgico de la inestabilidad glenohumeral multidireccional / Surgical treatment for multidirectional instability of the shoulder

Ensayo clínico realizado entre 1987 y 1992; la muestra estuvo conformada por 22 pacientes que reunieron los criterios de inclusión (inestabilidad glenohumeral multidireccional), las variables de estudios fueron: signos de hiperelasticidad, de inestabilidad glenohumeral, y de alamiento escapular. En todos se realizó tratamiento quirúrgico, y posteriormente llevaron a cabo tratamiento de rehabilitación. Se estudiaron 22 pacientes, 14 de sexo masculino y 8 de sexo femenino; rango de edad de 16 a 35 años; todos mostraron signos de alamiento escapular y en 20 se identificaron signos de alamiento escapular y en 20 se identificaron signos positivos de hiperelasticidad e inestabilidad anterior e inferior. Se mostró negativización de los signos clínicos a las 12 semanas del postoperatorio y hubo reintegración a las actividades deportivas al 5º mes de la cirugía. La técnica quirúrgica utilizada es un procedimiento sencillo, que no limita la movilidad articular y permite una rápida reintegración a las actividades ocupacionales y deportivas. No se registraron complicaciones

Tratamento da luxaçäo recidivante anterior de ombro: uso de enxerto ósseo na deficiência da glenóide / Treatment of anterior recurrent shoulder dislocation: bone graft in glenoid deficiency

Alguns pacientes com luxaçäo recidivante anterior de ombro apresentam um defeito ósseo na borda ântero-inferior da cavidade glenóide associado à lesäo cápsulo-labial, defeito este que, dependendo de seu tamanho, deve ser corrigido durante o ato cirúrgico. Entre junho de 1987 e abril de 1997 foram operados 413 ombros, pelo Grupo de Ombro do Departamento de Ortopedia e Traumatologia da Santa Casa de Säo Paulo, para o tratamento de instabilidade. Destes, 23 (5,6 por cento) foram submetidos, além da capsuloplastia e reparaçäo da lesäo de Bankart, à colocaçäo de um enxerto ósseo na borda ântero-inferior da cavidade glenóide, porque esta se apresentava insuficiente. Foram reavaliados 13 pacientes com seguimento mínimo de 12 meses, média de 22,6 meses, obtendo-se resultados satisfatórios em todos os casos (11 excelentes e 2 bons), com limitaçäo média de rotaçäo externa de 15§. Os autores discutem a indicaçäo para a reconstruçäo óssea da cavidade glenóide, pois näo existe consenso na literatura quanto ao tamanho do defeito a partir do qual o enxerto se torna necessório. Concluem que esse procedimento leva a altos índices de bons resultados, já que nenhum dos pacientes evoluiu com instabilidade residual.

Desenvolvimento de um aparelho portátil de movimentaçäo contínua passiva para a mäo / Development of the portatil equipment of continuous passive motions for hand

A movimentação contínua passiva (MCP) visa uma movimentação lenta. Ela é realizada através de aparelhos adaptados para cada articulação. Empregado precocemente, previne sequelas e deformidades, diminuindo o tempo de tratamento, com consequente diminuição dos custos e com melhores resultados funcionais. O objetivo deste trabalho é desenvolver, com tecnologia nacional, um dispositivo de MCP para a mão, baseado em modelos de aparelhos estrangeiros. O aparelho deve ser portátil e de simples manuseio

Abstract - Continuous Passive Motion (CPM) units promote gentle passive motion to the joints. Different models are used for different joints. CPM helps mantain the potential for motion by moving tissues while healing occurs, preventing adhesion and deformities. The goal ofthis research is to develop national technology in this field creating a CPM unit for the hand

Técnica artroscópica para o tratamento da instabilidade anterior do ombro: resultados / Arthroscopic technique for the treatment of anterior instability of the shoulder: results

Os autores comentam as indicaçoes e os resultados obtidos no tratamento de 30 ombros com instabilidade anterior, operados pela técnica artroscópica que utiliza um ponto para reparar a lesao da cápsula articular na regiao anterior do ombro(4). O seguimento variou de nove a 73 meses (média = 29,4 + 19,8 meses). Foram operados 28 (93 por cento) ombros classificados como instabilidade traumática e dois (7 por cento), como atraumática. Os resultados obtidos foram satisfatórios em 24 (80 por cento) casos e insatisfatórios em seis (20 por cento). Os dois casos com instabilidade atraumática foram insatisfatórios. A instabilidade anterior traumática demonstrou tendência a resultados satisfatórios, sendo mais favorável do que aquela atraumática.

Técnica artroscópica para correçäo da lesäo de Bankart / Arthroscopic approach for correction of Bankart lesion

Os autores descrevem técnica cirúrgica por via artroscópica para a reconstruçäo da lesäo da cápsula articular e do lábio glenoidal na regiäo anterior do ombro (lesäo de Bankart). A técnica consiste em dar um ponto em formato de "U", com auxílio de uma agulha reta, envolvendo toda a regiäo lesada da cápsula articular e do lábio glenoidal, atravessando o colo da glenóide, da regiäo anterior para a posterior do ombro. A cápsula articular e o lábio glenoidal säo reinseridos sob tensäo na borda anterior da glenóide, com fio inabsorvível. Foram operados 28 ombros, com seguimento que variou de nove meses a seis anos (média = 29,4 meses)