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Article in Chinese | WPRIM | ID: wpr-879467


The surgical treatment of recurrent anterior shoulder dislocation is a difficult problem in the field of sports injury medicine. The main reason focus on dynamic and osseous constraints of shoulder joint could not recover well. At present, arthroscopic surgery is used at home and abroad, and could receive statisfied postoperative effect, but the choice of specific surgical methods is still controversial. According to presence and size of glenoid and humeral skull defects, different treatments should be selected in clinic. The author recommends that no articular glenoid defect or glenoid defect 40% or Bristow-Latarjet if the surgical repair fails, bone grafting is used. In addition, if (humeral avulsion of glenohumeral ligaments, HAGL) injury existed, HAGL injury repair should be used. In addition to considering the important factor of bone defects, it is necessary to combine patient's age, exercise level and surgeon's technique to comprehensively select the bestsurgical method.

Arthroscopy , Humans , Joint Instability , Recurrence , Scapula , Shoulder Dislocation/surgery , Shoulder Joint
Article in Chinese | WPRIM | ID: wpr-888302


OBJECTIVE@#To investigate the method and clinical effects of the treatment of recurrent anterior dislocation of shoulder with Hill-Sachs injury by arthroscopic Bankart repair and Remplissage.@*METHODS@#From March 2016 to March 2019, 106 patients with recurrent anterior dislocation of shoulder with glenoid bone defect less than 20% underwent arthroscopic Bankart repair, including 76 males and 30 females, aged from 18 to 45 (27.3±8.6) years, 59 cases of left shoulder and 47 cases of right shoulder. Range of motion (ROM), American Shoulder and Elbow Surgeons(ASES) score, Constant-Murley score and Rowe score were used to evaluate shoulder functionand stability before and after operation.@*RESULTS@#All patients were followed up, and the duration ranged from 21 to 60 months, with a mean of (41.5± 8.5) months. One patient developed infection after operation, and the infection was controlled after arthroscopic debridement again. The remaining patients did not have clinical complications such as infection, intra articular hematocele and redislocation. Shoulder flexion and lifting increased from (158.33±15.72) ° preoperatively to (169.43±10.04) ° at the latest follow up, and internal rotation changed from T7 (T4 to T10) preoperatively to T8 (T5 to T10) at the latest follow up;the average lateral external rotation and abduction 90 ° external rotation decreased from (58.46±15.51) ° preoperatively and (99.37±14.09) ° to (53.18±14.90) ° and (92.52±13.10) ° at the latest follow up, respectively. The ASES score, Constant -Murley score and Rowe score were significantly improved.@*CONCLUSION@#The clinical effect of rehabilitation of Bankart repair combined with Remplissageunder arthroscopy in the treatment of recurrent dislocation of shoulder joint in adults with Hill-Sachs defect is satisfactory. Although the external rotation function is weaker than that before operation, it can effectively reconstruct the shoulder function and avoid the occurrence ofdislocation after operation.

Adult , Arthroplasty , Arthroscopy , Female , Humans , Joint Instability/surgery , Male , Range of Motion, Articular , Recurrence , Shoulder/surgery , Shoulder Dislocation/surgery , Shoulder Joint/surgery
Article in Chinese | WPRIM | ID: wpr-921911


Recurrent anterior dislocation of shoulder with bone defect is one of the common diseases of shoulder joint. How to effectively repair glenoid bone defect and reduce recurrence rate of shoulder dislocation is a problem that clinicians focus on. Bone grafting could stimulate bone, promote bone regeneration and bone remodeling, and restore the normal anatomical structure of glenoid. Among them, Bristow-Latarjet procedure is a classic operation for recurrent shoulder dislocation. Latarjet procedure could repair larger glenoid bone defects, but with higher surgical skills for surgeons;autogenous iliac grafting is the first choice for revision once Latarjet procedure failed;osteochondral grafting (autogenous and allogenous) has certain advantages in reconstructing original articular surface and preventing joint degeneration, but autologous osteochondral grafting may cause secondary injury, while immune rejection is difficult to avoid for allogenous osteochondral grafting. With the improvement of composite materials, and the mechanism of bone regeneration and remodeling, as well as the advantages and disadvantages of bone grafting, tissue engineering technology may become an effective method for the treatment of glenoid bone defect in the future.

Bone Transplantation , Humans , Joint Instability , Recurrence , Shoulder , Shoulder Dislocation/surgery , Shoulder Joint
Acta ortop. mex ; 34(2): 119-122, mar.-abr. 2020. graf
Article in Spanish | LILACS | ID: biblio-1345099


Resumen: La luxación glenohumeral recurrente suele asociarse a pérdida ósea de la porción glenoidea, siendo la localización anteroinferior la más afectada. El entendimiento de las estructuras relacionadas así como el uso de estudios de imagen actuales tales como la tomografía axial computarizada y la resonancia magnética han permitido avanzar respecto a la comprensión de la patología, asimismo el desarrollo de materiales quirúrgicos y herramientas de mínima invasión nos permiten continuar innovando respecto a los tratamientos previamente descritos, siendo posible intervenir en detalles técnicos con la intención de mejorar los resultados. Es por eso que hemos realizado lo descrito por Eden-Hybinette utilizando injerto tricortical cadavérico con tornillos canulados como método de fijación, limitando las comorbilidades asociadas a la toma de autoinjerto, dando como resultado un amplio beneficio para el paciente durante el procedimiento quirúrgico y en el período de recuperación.

Abstract: Recurrent glenohumeral dislocation is usually associated with bone loss of the glenoid portion, with the anteroinferior location being the most affected. The understanding of the related structures, as well as the use of current imaging studies such as computed axial tomography and magnetic resonance imaging, have made progress in understanding the pathology, as well as the development of surgical materials and minimally invasive tools, they allow us to continue innovating with respect to the previously described treatments, being possible to intervene in technical details with the intention of improving the results. That is why we have done what described by Eden-Hybinette, using tricortical cadaveric graft and as fixation method, limiting the comorbidities associated with the autograft taking, resulting a wide benefit for the patient, during the surgical procedure and in the recovery period.

Shoulder Dislocation/surgery , Shoulder Dislocation/diagnostic imaging , Shoulder Joint/surgery , Shoulder Joint/diagnostic imaging , Joint Instability , Scapula , Cadaver , Bone Transplantation
Article in Chinese | WPRIM | ID: wpr-879364


OBJECTIVE@#To evaluate early clinical effects of bioabsorbable suture anchors for the treatment of Bankart lesion.@*METHODS@#Total 23 patients with the Bankart lesion were treated with arthroscopic repair using bioabsorbable suture anchors from January 2010 to June 2017. There were 20 males and 3 females, with an average age of (23.4±3.9) years old (ranged, 19 to 34 years old). Fourteen patients had injuries on the right shoulder joint and 9 patients had the injuries on the left side. The mechanism of primary dislocation included 17 cases of training, 5 cases of sports injury and 1 case of falling down. The mean interval time from injury to surgery was(10.9±5.8) months (ranged, 3 to 36 months). The Bankart lesion was repaired by bio-cortical suture anchors. The Rowes rating system for Bankart repair was used to evaluate therapeutic effects.@*RESULTS@#All 23 patients were followed up, with a mean duration of(24.5±3.7) months(ranged, 18 to 39 months). At the latest follow up, there was no recurrent dislocation occurred, and all patients had returned to sports and work. The Rowes rating system for Bankart repair was 53.91±11.67 pre-operationally and 91.74±12.30 post operationally, respectively (@*CONCLUSION@#Applying bio-cortical bone suture anchors for the Bankart lesion is a reliable, efficient and cost effective treatment, which is also suitable for the revision of the Bankart lesion.

Absorbable Implants , Adult , Arthroscopy , Bankart Lesions , Female , Humans , Joint Instability , Male , Range of Motion, Articular , Recurrence , Shoulder Dislocation/surgery , Shoulder Joint , Suture Anchors , Treatment Outcome , Young Adult
Article in Chinese | WPRIM | ID: wpr-879361


OBJECTIVE@#To explore the effects of single anterior approach under shoulder arthroscopy in the treatment of Bankart injury, and to provide a scheme to overcome the difficulties and simplify the operation process.@*METHODS@#From July 2016 to January 2019, 62 patients with recurrent dislocation caused by Bankart leision were treated under shoulder arthroscopy, including 50 males and 12 females, ranging in age from 19 to 44 years old with an average age of (26.5±6.1) years old. There were 25 cases of left shoulder and 37 cases of right shoulder. The patients were divided into two groups according to the operation mode, 35 patients in the front modified single approach group (experimental group) and 27 patients in the traditional double approachgroup (control group). The results of the operation were evaluated by assessing the preoperative and postoperative ASES scores of the shoulder joint, and the time of the approach establishment and the overall operation process was recorded to evaluate whether the operation time of the experimental group was shortened.@*RESULTS@#Three patients were lost during the follow-up after operation, and except for one case of re-dislocation, all patients achieved satisfactory results without neurovascular injury and other complications. The patients were followed up before operation and 3, 6, 12 months after operation, and the ASES scores were significantly enhanced at the latest follow-up compared with those of before operation. The time of establishing surgical approach in the experimental group was (7.5±1.5) minutes, which was shorter than that of control group (13.7±1.2) minutes.@*CONCLUSION@#The improved technique of single-channel anterior approach has the advantages of reducing the surgical incision and shortening the operationtime while ensuring the quality of the operation, which is worthy of popularization and application.

Adult , Arthroscopy , Bankart Lesions , Female , Humans , Joint Instability , Male , Recurrence , Shoulder/surgery , Shoulder Dislocation/surgery , Shoulder Joint/surgery , Treatment Outcome , Young Adult
An. Facultad Med. (Univ. Repúb. Urug., En línea) ; 6(2): 58-65, dic. 2019. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1088703


La luxación erecta expuesta de hombro es una asociación lesional de muy baja frecuencia en la edad pediátrica. Son más frecuentes las lesiones fisarias y epifisarias que las luxaciones y lesiones ligamentarias. Esto es debido a la presencia de un tejido óseo con gran poder de deformidad elástica y un periostio grueso. Presentamos un caso clínico de un paciente de 11 años de edad que sufrió una luxación erecta expuesta de hombro derecho, producto de una caída de 1 metro y medio de altura. El tratamiento consistió en una limpieza quirúrgica de urgencia, reducción gleno humeral y antibioticoterapia empírica, penicinila 400.000 UI/kg/día fraccionado cada 6 hs y gentamicina 3mg/Kg/día fraccionada cada 8 h por 10 días, inmovilización por 3 semanas con cabestrillo seguido de rehabilitación, y un follow up de 2 años al final del cual el paciente no presento secuelas funcionales en la articulación glenohumeral derecha.

The exposed erect dislocation of the shoulder is a very low frequency lesion association in the pediatric age. The physical and epiphyseal lesions are more frequent than the dislocations and ligament injuries. This is due to the presence of a bone tissue with great elastic deformity power and a thick periosteum. We present a clinical case of an 11-year-old patient who suffered an exposed erect dislocation of the right shoulder, due to a fall of 1 meter and a half high. The treatment consisted of emergency surgical cleaning, humeral gleno reduction and empirical antibiotic therapy, penicinila 400,000 IU/kg/day divided every 6 hours and gentamicin 3mg/Kg/day divided every 8 hours for 10 days, immobilization for 3 weeks with a sling followed by rehabilitation, and a follow-up of 2 years at the end of which the patient did not present functional sequelae in the right glenohumeral joint.

A luxação ereta exposta do ombro é uma associação de lesão de freqüência muito baixa na idade pediátrica. As lesões físicas e epifisárias são mais freqüentes que as luxações e lesões ligamentares. Isto é devido à presença de um tecido ósseo com grande poder de deformidade elástica e um periósteo espesso. Apresentamos um caso clínico de um paciente de 11 anos de idade que sofreu uma luxação ereta exposta do ombro direito, devido a uma queda de 1 metro e meio de altura. O tratamento consistiu em limpeza cirúrgica de emergência, redução de gleno umeral e antibioticoterapia empírica, penicinila 400.000 UI / kg / dia dividida a cada 6 horas e gentamicina 3mg / Kg / dia dividida a cada 8 horas por 10 dias, imobilização por 3 semanas com tipóia seguida de reabilitação e seguimento de 2 anos no final dos quais o paciente não apresentava sequela funcional na articulação glenoumeral direita.

Humans , Male , Child , Shoulder Dislocation/surgery , Shoulder Dislocation/rehabilitation , Shoulder Dislocation/diagnostic imaging , Fractures, Open/surgery , Fractures, Open/rehabilitation , Fractures, Open/diagnostic imaging , Penicillins/administration & dosage , Shoulder Dislocation/drug therapy , Restraint, Physical , Gentamicins/administration & dosage , Follow-Up Studies , Exercise Therapy , Closed Fracture Reduction , Anti-Bacterial Agents/administration & dosage
Acta ortop. mex ; 33(5): 333-336, sep.-oct. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1284967


Resumen: Introducción: Las luxaciones posteriores de hombro son raras (2%) y se asocian a convulsiones, electrocuciones y traumatismos de alta energía. Pueden presentarse asociadas a una lesión de Hill Sachs reversa. Uno de los principios del tratamiento consiste en la transferencia del tendón subescapular hacia el área de lesión o procedimiento de McLaughlin. Caso clínico: Se expone el caso de un masculino con un defecto de Hill-Sachs reverso tratado con una modificación de la técnica original de McLaughlin. Se reportan los resultados funcionales tras 13 meses de la cirugía. Resultados: Actualmente con un Constant Score de 98 puntos. Discusión: La modificación técnica empleada para el tratamiento quirúrgico de la lesión de Hill Sachs reversa presentada en este paciente demostró bueos resultados funcionales con material de bajo costo.

Abstract: Introduction: Posterior shoulder dislocations are rare (2%) and are associated with seizures, electrocutions and high-energy trauma. They may be associated with a reverse Hill-Sachs lesion. One of the treatment principles consists of the subscapular tendon transfer to the injury area or McLaughlin procedure. Clinical case: A case of a man with a reverse Hill-Sachs defect treated with a modification of McLaughlin's original technique is presented. The functional results after 13 months of surgery are reported. Results: Currently with a Constant Score of 98 points. Conclusion: The technical modification used for the surgical treatment of the reverse Hill-Sachs lesion presented in this patient demonstrated good functional results with low cost material.

Humans , Male , Shoulder , Shoulder Dislocation/surgery , Tendon Transfer
Rev. bras. ortop ; 54(5): 483-490, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057934


Abstract A review involving the six major international orthopedic journals has been published recently. It described the tools used for the evaluation of outcomes in the surgical treatment of recurrent anterior dislocation of the shoulder. There are no studies that exhibit the main outcome tools for this disease in Brazil. The authors evaluated the outcomes of clinical studies involving anterior glenohumeral instability that were published in the last decade in the two leading Brazilian orthopedic journals, Revista Brasileira de Ortopedia and Acta Ortopédica Brasileira. A review of the literature was performed, including all clinical papers published between 2007 and 2016 describing at least one outcome measure before and after surgical intervention. The outcomes were range of motion, muscle strength, physical examination testing, patient satisfaction, return to sports, imaging, complications, and functional outcomes scores. Twelve studies evaluating the clinical outcomes of surgical treatment for anterior shoulder instability were published. Ten studies (83%) were case series (level of evidence IV), 1 (8%) was a case-control study (III), and 1 was a retrospective cohort (III). On average, the number of outcomes assessed was 3.7 ± 1.7. The Rowe score was used in 9 studies (75%), and 7 (58%) papers used the University of California Los Angeles (UCLA) scale. Ten studies (83%) reported complications related to surgical treatment. The complication most frequently reported was recurrent instability, found in 9 studies (75%). The national studies have preferentially used scales considered to be of low reliability, responsiveness, and internal consistency.

Resumo Uma revisão que envolveu as seis principais revistas ortopédicas internacionais foi publicada recentemente. A publicação descreveu as ferramentas usadas para a avaliação dos desfechos no tratamento cirúrgico da luxação anterior recidivante do ombro. Não existe um levantamento que mostre as principais formas de avaliação para essa doença no Brasil. Os autores avaliaram os desfechos usados nos estudos clínicos que envolveram a instabilidade glenoumeral anterior e que foram publicados na última década nos dois principais periódicos ortopédicos brasileiros, Revista Brasileira de Ortopedia e Acta Ortopédica Brasileira. Foi feita uma revisão da literatura na qual foram incluídos todos os artigos clínicos publicados entre 2007 e 2016 que descreveram ao menos uma medida de desfecho antes e após intervenção cirúrgica. Os desfechos avaliados foram amplitude de movimento, força muscular, testes de exame físico, satisfação, retorno ao esporte, exames de imagem, complicações e escalas clínicas. Foram publicados 12 estudos que avaliaram os resultados clínicos do tratamento cirúrgico da instabilidade anterior do ombro. Dez estudos (83%) eram séries de caso (nível de evidência IV), 1 (8%) caso-controle (III), e 1 coorte retrospectiva (III). A média de desfechos avaliados por estudo foi de 3,7 ± 1,7. A escala Rowe foi usada em 9 estudos (75%), e 7 publicações (58%) usaram a escala da University of California Los Angeles (UCLA). Dez estudos (83%) relataram as complicações relacionadas ao tratamento cirúrgico. A complicação mais frequentemente relatada foi a recidiva da luxação glenoumeral, encontrada em 9 estudos (75%). Os estudos nacionais usaram preferencialmente escalas consideradas de baixa conficabilidade, responsividade, e consistência interna.

Shoulder , Shoulder Dislocation/surgery , Surgical Procedures, Operative , Evaluation of Results of Therapeutic Interventions , Outcome Assessment, Health Care
Prensa méd. argent ; 105(7): 405-409, agosto 2019. tab
Article in English | LILACS, BINACIS | ID: biblio-1022186


Background: Shoulder dislocation is the most common form of joint dislocation. With conseguent episodes of dislocation, humeral head, the glenoid, capsule, ligaments and the labrum experiences progressive changes. Objetive of study: To evaluate the results of open surgery that follows the latarjet protocol in patients with recurrent anterior shoulder dislocation. Patients and methods: Across sectional study included 22 patients with recurrent anterior shoulder dislocation conducted in upper extremities of Al-Wasity Teaching Hospital between Ja. 2017 to Nov. 2018. All patients were evaluated preoperatively by complete medical history, physical examination, and imaging modalities that includes: plain X-rays, CT scanning and MRI then operated on by latarjet surgery that followed by physiotherapy and followed up for 9 months. Results: According to the Rowe score, significant excellent autcome was reported with 72.3% as well as the WOSI score was decreased significantly and ROW score was increased significantly post operativey. Recurrent dislocation was reported with 2 cases only (9.1%). Unesplained pain during activity was reported with 13.6% of cases and limitation of the external rotation that not effect on job and daily activity was reported with 18.2% of cases. Conclusion: latarjet surgery for recurrent anterior shoulder dislocation is effective, as long as indications are used (AU)

Humans , Adolescent , Adult , Athletic Injuries , Shoulder Dislocation/surgery , Injury Severity Score , Medical Records
Acta ortop. mex ; 31(4): 196-201, jul.-ago. 2017. graf
Article in Spanish | LILACS | ID: biblio-886565


Resumen: Introducción: La luxación glenohumeral (LGH) es frecuente, pero la luxación glenohumeral posterior traumática (LGHPT) es rara. Su diagnóstico es un reto, puede omitirse o pasar inadvertida; en ello influye un sinnúmero de factores, como una evaluación radiológica inadecuada y ausencia de signos-síntomas característicos. Se reporta una omisión diagnóstica de 60-79% y confirmación diagnóstica con una demora desde 24 horas hasta un año. Objetivo: Transmitir experiencia previa para proporcionar herramientas que ayuden a evitar omisión diagnóstica en la LGHPT. Reporte de casos: Caso 1. Masculino, 34 años. Diagnóstico tardío de LGHPT izquierda en la cuarta semana. Hill-Sachs inversa < 25%. Reducción cerrada (DePalma), inmovilización por cuatro semanas. Seguimiento a la semana 20. Recuperación funcional buena (UCLA = 32). Caso 2. Masculino, 32 años. Diagnóstico tardío de LGHPT izquierda en el octavo mes. Hill-Sachs inversa de 25%. Reducción abierta (McLaughlin-Neer), inmovilización por cuatro semanas. Seguimiento postquirúrgico a ocho meses. Recuperación funcional buena (UCLA = 29). Discusión: El diagnóstico de LGHPT es difícil por su poca frecuencia. Para evitar retraso en el diagnóstico e inadecuada atención, debe considerarse siempre una evaluación inicial que tome en cuenta la posición del brazo, el mecanismo de lesión; en la exploración física, el brazo en rotacion interna y poco dolor, déficit funcional para la rotación externa, flexión y abducción.

Abstract: Introduction: Glenohumeral dislocation (GHD) is frequent, but traumatic posterior glenohumeral dislocation (TPGHD) is rare, with an incidence of 1-4% of all GHD. The diagnosis is a challenge: sometimes, it can be omitted due to incorrect diagnosis, absence of consideration in the differential diagnosis, suboptimal radiographic evaluation and an absence of characteristic signs and symptoms; missed diagnosis reaches 60-79% and the diagnosis can delay from 24 hours to a year. Objective: To transmit previous experiences to provide support for better diagnosing TPGHD, favoring appropriate attention. Case reports: Case 1. 34-year-old male. Delayed diagnosis of left TPGHD in the 4th week. Reverse Hill-Sachs < 25%. Closed reduction, immobilization for four weeks. Follow-up at week 20, good functional recovery (UCLA = 32). Case 2. 32-year-old male. Eight months with undiagnosed left TPGHD. Reverse Hill-Sachs 25%. Open reduction, immobilization for four weeks. Eight-month post-surgical follow-up. Good functional recovery (UCLA = 29). Discussion: The diagnosis of TPGHD is difficult because of its lack of frequency. Even with delayed diagnosis-treatment, evolution can be favorable provided that the reverse Hill-Sachs injury is 25% or minor. To avoid a delayed diagnosis and inadequate attention, we must always consider the injury mechanism, physical examination with the arm fixed in internal rotation, clinical suspicion in functional deficit for external rotation, flexion and abduction, radiographic studies including true AP and scapula lateral (Y view).

Humans , Male , Child, Preschool , Shoulder Dislocation/surgery , Shoulder Dislocation/psychology , Reconstructive Surgical Procedures , Physical Examination , Range of Motion, Articular , Recovery of Function
Rev. bras. ortop ; 52(4): 458-462, July-Aug. 2017. tab
Article in English | LILACS | ID: biblio-899165


ABSTRACT OBJECTIVE: Analyze the postoperative follow-up of patients undergoing shoulder arthroscopy for treatment of anterior instability and correlate with the prevalence of recurrence. METHODS: A six-question survey was applied by phone and mail to 65 patients, seeking information on the current result of the surgical procedure. All patients were treated arthroscopically for anterior shoulder instability, with at least 12 months of postoperative time. Patients with associated posterior labial lesions and revision surgeries were not included. RESULTS: At the time of the survey the patients had a median of 56 (IQR: 34.5-110.5) postoperative months. The mean sample age was 24.6 years (maximum = 47, minimum = 12; SD = 7.3). Complaint of pain in the shoulder was observed in 20 patients (30.7%). Dislocation recurrence was observed in 10 patients (15.3%). Forty-four patients (67.6%) considered their shoulder normal, which was more frequent in non-recurrence patients (p< 0.001). Forty-three patients (66.1%) returned to their previous level of sport and there was no difference between recurrence and non-recurrence patients (p= 0.456). It was found that the prevalence of recurrence was 5.6 (95% CI: 1.30-24.46) times higher in individuals who abandoned monitoring before six months postoperatively (p= 0.012). CONCLUSION: The abandonment of postoperative monitoring in the early stages, when the patients receive orientation for muscle strengthening, proprioceptive education, and dangerous movements to avoid, can increase the rates of recurrent shoulder dislocation in patients treated for anterior instability by arthroscopy.

RESUMO OBJETIVO: Analisar o acompanhamento pós-operatório dos pacientes submetidos à artroscopia do ombro para tratamento de instabilidade anterior e correlacionar com a prevalência de recidiva. MÉTODOS: Foi aplicado em 65 pacientes, através de ligação telefônica, um questionário que buscava informações sobre a situação atual do resultado do procedimento cirúrgico. Todos os pacientes foram operados para corrigir uma instabilidade anterior do ombro por artroscopia e tinham pelo menos 12 meses de pós-operatório. Não foram incluídos pacientes com associação de lesão labral posterior e cirurgias de revisão. RESULTADOS: O questionário foi aplicado com uma mediana de 56 (IIQ: 34,5 a 110,5) meses. A média de idade da amostra foi de 24,6 anos (máxima de 47 e mínima de 12 - DP 7,3). Foi verificada queixa de dor em 20 pacientes (30,7%) e recidiva da luxação em dez (15,3%). 44 pacientes (67,6%) consideraram seu ombro normal e 43 (66,1%) retornaram ao esporte prévio. Foi verificado que os indivíduos que abandonaram o acompanhamento pós-operatório antes dos seis meses tiveram uma prevalência 5,6 (IC 95%: 1,30-24,46) vezes maior de recidiva (p = 0,012). CONCLUSÃO: O abandono do acompanhamento pós-operatório na fase inicial, na qual o paciente recebe orientações para o reforço muscular e a educação proprioceptiva, pode colaborar no aumento do índice de recidiva da luxação nos pacientes tratados por artroscopia.

Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Arthroscopy/methods , Shoulder Dislocation/surgery , Shoulder Joint/surgery , Treatment Outcome
Acta ortop. mex ; 31(2): 95-97, mar.-abr. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-886543


Resumen: Es de suma importancia tener en cuenta las complicaciones de la luxación glenohumeral inferior que, aunque poco frecuentes, pueden llegar a ser incapacitantes a mediano y largo plazo, incluso en algunos casos reportados ponen en riesgo la vida del paciente. Material y métodos: Se presenta el caso clínico de un joven paciente adulto con diagnóstico de luxación glenohumeral inferior (luxatio erecta) recurrente derecha, con lesión de Bankart y lesión de Hill Sachs, tratado mediante artroscopía con reparación de la lesión de Bankart, plicatura del receso capsular inferior y remplissage. Resultados: Evaluamos la funcionalidad del paciente al cabo de 18 meses con la escala de UCLA obteniendo una puntuación final de 30 puntos con buenos resultados funcionales.

Abstract: It is extremely important to take into account the complications of inferior gelnohumeral dislocation, which, although infrequent, may become incapacitating in the medium and long term, even in some cases reported, endangering the life of the same. Material and methods: We present the case of a young adult patient diagnosed with inferior rectal glenohumeral dislocation (luxatio erecta), with Bankart lesion and Hill Sachs lesion, treated by arthroscopy with repair of the Bankart lesion, plication of the lower capsular recess and remplissage. Results: We evaluated the functionality of the patient at 18 months with the UCLA scale, obtaining a final score of 30 points with good functional results.

Humans , Young Adult , Shoulder Dislocation/surgery , Shoulder Dislocation/diagnosis , Bankart Lesions/surgery , Bankart Lesions/diagnosis , Joint Instability/surgery , Joint Instability/diagnosis , Arthroscopy , Recurrence
Artrosc. (B. Aires) ; 24(4): 142-145, 2017.
Article in Spanish | LILACS, BINACIS | ID: biblio-907442


Introducción: El objetivo de este estudio es evaluar los resultados funcionales, el retorno al deporte y las complicacionesde una serie consecutiva de pacientes con inestabilidad glenohumeral posterior, luego de la estabilización artroscópica.La hipótesis del siguiente estudio es que la estabilización artroscópica produce mejorías funcionales importantes con unalto porcentaje de retorno al deporte y con un número mínimo de complicaciones.Material y métodos: Se evaluó una serie consecutiva de pacientes tratados con estabilizaciones artroscópicas porinestabilidad posterior de hombro unidireccional, entre enero del 2008 y junio del 2014. Se recolectó la historia clínica,los hallazgos intraoperatorios. Se evaluó en el preoperatorio y en el postoperatorio el rango de movilidad, la función delhombro con el score de Rowe y el dolor ante la actividad física con la Escala visual análoga. Se les realizó radiografíasy resonancia magnética preoperatoria. Se realizó una misma técnica quirúrgica y manejo postoperatorio en todos lospacientes. Se interrogó a los pacientes acerca de si pudieron retornar al deporte que realizaban antes de la lesión ysi pudieron volver al mismo nivel que tenían previo a la misma, y en el caso correspondiente el motivo de no retorno.Además se analizaron las complicaciones intraoperatorias y postoperatorias. El protocolo de investigación del siguientetrabajo fue aprobado por el comité de ética e investigación de nuestra institución IRB 00010193...

Purpose: The purpose of this study is to evaluate functional results, the returning to sports activities and complications ofa consecutive number of patients with posterior glenohumeral instability, after the arthroscopic stabilization. Hypothesis ofthe following study is that arthroscopic stabilization produces important functional improvements with a high percentage ofreturning to sports activities and with a minimum number of complications.Material and methods: A consecutive series of patients treated with arthroscopic stabilization for unidirectional posteriorshoulder instability, were evaluated between January 2008 and June 2014. Medical history and intraoperative findingswere collected. Range of motion; shoulder function with Rowe Score; and pain on physical activity with Visual AnalogueScale during preoperative and postoperative periods, were evaluated. Preoperative X-Ray and Magnetic Resonance wereperformed. Patients underwent the same surgical technique and postoperative management. Patients were examined inorder to know whether they were able to return to the same sports activities they performed before the injury and whetherthey were able to return to the same level they had before the injury, and in the corresponding case the reason for nonreturning. Moreover, intraoperative and postoperative complications were analyzed. The ethics and research committee of ourinstitution IRB 00010193 approved the research protocol of the following work...

Adult , Arthroscopy/methods , Joint Instability/surgery , Shoulder Dislocation/surgery , Shoulder Joint/injuries , Shoulder Joint/surgery , Range of Motion, Articular , Treatment Outcome
Acta ortop. mex ; 30(6): 291-295, nov.-dic. 2016. tab, graf
Article in Spanish | LILACS | ID: biblio-949766


Resumen: Antecedentes: En el tratamiento de la inestabilidad glenohumeral anterior se han descrito multitud de técnicas quirúrgicas, todas ellas con ventajas e inconvenientes. Nuestro objetivo es analizar los resultados obtenidos a medio plazo en los pacientes que hemos intervenido mediante la técnica de Bristow-Latarjet teniendo en cuenta el valor del ISIS preoperatorio. Material y métodos: Estudio retrospectivo de 33 pacientes intervenidos entre 2005 y 2012 con edad media de 33.2 años y seguimiento medio de 75 meses. Se recogió el resultado con las escalas de Rowe y Constant, cuestionario DASH y una encuesta de valoración subjetiva del resultado por parte de cada paciente. Resultados: No se presentaron recidivas. La puntuación media postoperatoria en la escala de Rowe fue de 74.6 puntos y de 70 puntos en la escala de Constant. En el cuestionario DASH el valor promedio fue 22.9 puntos. En 78.8% de los pacientes se valoró positivamente el resultado. Se produjo la migración del tornillo en un paciente, encontrándose asintomático. No se identificaron otras complicaciones. Conclusiones: La técnica de Bristow-Latarjet en el tratamiento de la inestabilidad glenohumeral anterior es una técnica fiable y con una mínima tasa de recidivas, por lo que debe emplearse como cirugía de elección en determinados casos y, para ello, la valoración preoperatoria con la escala ISIS es una buena guía a la hora de indicar el tipo de cirugía.

Abstract: Background: In treatment of anterior shoulder instability, many surgical techniques have been described, all of them with advantages and disadvantages. Our goal is to study the half term results on patients that underwent open Bristow-Latarjet surgery considering the preoperative ISIS value. Material and methods: This is a retrospective study of 33 patients which underwent open Bristow-Latarjet surgery in our center between 2005 and 2012. Average age of 33.2 years and follow up of 75 months. Results were taken by Rowe and Constant scores, DASH questionnaire and we also recorded a subjective assessment of the result by each patient. Results: No recurrence was reported. No reoperations. Mean Rowe score was 74.6 points and mean Constant score was 70 points. In the disability questionnaire (DASH), the mean value was 22.9 points. The outcome assessment by the patients was positive in 78.8%. The migration of a screw occurred in one patient but he still asymptomatic. No other complication was identified. Conclusions: The Bristow-Latarjet technique is a reliable technique, with few complications and with an excellent rate of recurrence in treatment of chronic shoulder instability as reported in literature; it should be used as primary surgery in some cases and the preoperative ISIS score is an excellent and simple guide to select correctly the surgical technique for each patient.

Humans , Male , Female , Adult , Shoulder Dislocation/surgery , Joint Instability/surgery , Recurrence , Shoulder Joint , Retrospective Studies , Range of Motion, Articular
Rev. AMRIGS ; 60(4): 327-332, out.-dez. 2016. ilus, tab
Article in Portuguese | LILACS | ID: biblio-847776


Introdução: O estudo tem por objetivo analisar o resultado do tratamento cirúrgico da luxação inveterada anterior e posterior do ombro e comparar seus resultados. Métodos: Foram avaliados 14 pacientes com luxação inveterada da articulação do ombro que evoluíram para o tratamento cirúrgico no período de julho de 2010 e agosto de 2014. Um paciente foi excluído por não completar o acompanhamento mínimo de seis meses. Diferentes tipos de abordagens cirúrgicas foram utilizadas, dependendo da direção da luxação, do tempo decorrido entre o trauma e o tratamento cirúrgico e da idade do paciente. A amostra foi avaliada com uma média de 17,6 meses de pós-operatório. Resultados: A média de idade da amostra foi de 57,5 anos. Nove (69,2%) pacientes eram masculinos e quatro (30,8%), femininos. O lado direito foi acometido em seis (46,1%) pacientes. O tempo mínimo de luxação foi de 45 dias e o máximo foi de 24 meses. Sete (53,8%) luxações eram anteriores, enquanto seis (46,1%) eram posteriores. A média do índice da UCLA da amostra foi de 17,85. O índice da UCLA para as luxações anteriores foi de 20,29, enquanto o UCLA para as luxações posteriores foi de 15. Conclusão: O tratamento da luxação inveterada da articulação do ombro alcança resultados pobres na maioria dos casos. A luxação inveterada anterior parece alcançar melhores resultados que a posterior (AU)

Introduction: The aim of this study is to analyze the outcome of the surgical treatment of anterior and posterior inveterate dislocation of the shoulder and to compare its results. Methods: We evaluated 14 patients with inveterate dislocation of the shoulder joint that progressed to surgical treatment from July 2010 to August 2014. One patient was excluded for not completing the minimum follow-up of six months. Different types of surgical approaches were used, depending on the direction of the dislocation, elapsed time between trauma and surgical treatment, and the age of the patient. The sample was evaluated with an average of 17.6 months postoperatively. Results: The mean age of the sample was 57.5 years. Nine (69.2%) patients were male and four (30.8%) female. The right side was affected in six (46.1%) patients. The minimum dislocation time was 45 days and the maximum time was 24 months. Seven (53.8%) dislocations were anterior, while six (46.1%) were posterior. The mean UCLA index of the sample was 17.85. The UCLA index for anterior dislocations was 20.29, while for posterior dislocations it was 15. Conclusion: The treatment of inveterate dislocation of the shoulder joint achieves poor results in most cases. The anterior inveterate dislocation seems to achieve better results than the posterior one (AU)

Humans , Male , Female , Shoulder Dislocation/surgery , Retrospective Studies , Treatment Outcome
Artrosc. (B. Aires) ; 23(2): 87-92, mayo 2016.
Article in Spanish | LILACS, BINACIS | ID: lil-786946


Se presenta una descripción detallada de la reconstrucción artroscópica de un defecto posterior de glena con injerto autólogo tricortical de cresta iliaca en la posición de decúbito lateral. A nuestro entender esto no se ha publicado previamente en la literatura. Se han descripto diferentes técnicas quirúrgicas para el tratamiento de la inestabilidad posterior recurrente de hombro. Algunas abordan los tejidos blandos como la capsulorrafia abierta o artroscópica, otras como las osteotomías glenoideas o la colocación de un injerto óseo posterior, abordan la anatomía ósea. Este trabajo muestra que la colocación artroscópica de un injerto óseo posterior es segura y reproducible. La misma permite el posicionamiento y la colocación adecuada del injerto y podría potencialmente reducir el riesgo de lesión de estructuras neurovasculares, las estructuras musculotendinosas posteriores y problemas cutáneos debido a la técnica mínimamente invasiva. Adicionalmente, los scores funcionales y el rango de movilidad mejoran rápidamente y el paciente pudo volver rápidamente a la competencia. Tipo de estudio: Reporte de Caso. Nivel de evidencia: V

In this case report we present a detailed description of an arthroscopic reconstruction of a posterior glenoid defect with iliac bone graft with the decubitus lateral position. To our knowledge this was not previously reported. Various surgical techniques have been described for the treatment of recurrent posterior shoulder instability. Some address the soft tissues, such as open or arthroscopic capsulorrhaphy, others, such as glenoid osteotomy and the posterior bone graft procedure, address the bony anatomy. Placement of a bone block on the posterior glenoid rim increases the posterior glenoid surface and improves stability. This study shows that arthroscopic posterior bone graft procedure is safe and reproducible. It allows accurate positioning and healing of the posterior bone block, and it could potentially reduce the risk of injury of neurovascular structures, the posterior musculotendinous structures, and skin problems due to the minimally invasive technique. Further, functional scores and ROM improved quickly and the patient was able to rapidly return to competitive sports. Type of study: Case report. Level of evidence: V

Adult , Arthroscopy/methods , Glenoid Cavity/surgery , Glenoid Cavity/pathology , Joint Instability/surgery , Shoulder Dislocation/surgery , Recurrence
Acta ortop. mex ; 30(1): 2-6, ene.-feb. 2016. graf
Article in Spanish | LILACS | ID: biblio-827714


Resumen: Introducción: el tratamiento quirúrgico de la luxación acromioclavicular es aún motivo de controversia. En esta publicación se describirá una técnica combinada en la que se realizó un primer tiempo artroscópico y un segundo tiempo con abordaje miniinvasivo. Material y métodos: 41 pacientes con luxación acromioclavicular grados III, IV y V. Para el seguimiento se incluyeron luxaciones agudas, crónicas y cirugías de revisión; se excluyeron pacientes con otras patologías de hombro, la edad promedio fue de 28.6 años. Los pacientes fueron evaluados con el score de UCLA Constant, la escala visual analógica para dolor preoperatorio y control radiológico para evaluar la estabilidad tanto en plano coronal como axial, osificaciones coracoclaviculares, signos de artrosis acromioclavicular y/o osteólisis distal de clavícula a los 6 y 12 meses postoperatorio. Resultados: se obtuvo un score de Constant preoperatorio de 41.3; 6 meses: 89.4; 12 meses: 92.3. El score de UCLA preoperatorio: 21.7; 6 meses: 29.1 y 12 meses: 31.4. VAS: 8.4; 2.3; 1.2. Hubo dos casos de relesión por trauma y un caso de insatisfacción estética de la cicatriz. En cuanto al examen radiológico se presentaron dos casos de pérdida de estabilidad y un caso de osteólisis distal de clavícula. Conclusión: la combinación de dos métodos de reducción, uno sintético y otro biológico, permitió una reconstrucción anatómica sólida, estable en plano coronal y axial con muy buenos resultados a mediano plazo.

Abstract: Introduction: The surgical treatment of acromioclavicular dislocation remains controversial. We describe herein a combined two-stage technique that includes an arthroscopic approach followed by a mini-invasive approach. Material and methods: 41 patients with acromioclavicular dislocation grades III, IV and V. Acute and chronic lesions and revision surgeries were included during the follow-up. Patients with other shoulder conditions were excluded. Mean age was 28.6 years. Patients were assessed preoperatively with the UCLA and Constant scores, and the pain visual analog scale. The 6- and 12-month postoperative evaluation included X-rays to assess coronal and axial stability, coracoclavicular ossifications, signs of acromioclavicular arthrosis and/or distal clavicular osteolysis. Results: The Constant scores were as follows: 41.3 preoperatively; 89.4 at 6 months; 92.3 at 12 months. The UCLA scores were as follows: 21.7 preoperatively; 29.1 at 6 months; 31.4 at 12 months. The VAS scores were 8.4, 2.3 and 1.2, for the same periods respectively. Two cases had repeated injury due to trauma and one case was dissatisfied with the cosmetic appearance of the scar. The X-ray assessment showed two cases of loss of stability and one case of distal clavicular osteolysis. Conclusion: The combination of two reduction methods, a synthetic one and a biological one allows for a solid anatomical reconstruction that is stable in the coronal and axial planes and good medium-term results.

Humans , Adult , Arthroscopy , Shoulder Dislocation/surgery , Shoulder Dislocation/diagnostic imaging , Acromioclavicular Joint , Radiography , Treatment Outcome , Clavicle , Joint Dislocations
Article in Spanish | LILACS, BINACIS | ID: biblio-835443


Objetivo: Analizar los resultados obtenidos a mediano plazo en los pacientes operados con la técnica de Bristow-Latarjet, según el valor del ISIS preoperatorio. Materiales y Métodos: Estudio retrospectivo de 33 pacientes intervenidos entre 2005 y 2012; media de la edad: 33 años (rango 21-68); media del seguimiento 6 años (rango 2-9). Se recogieron los resultados de las escalas de Rowe y Constant, el cuestionario DASH y una encuesta de valoración subjetiva del resultado por parte de cada paciente. Resultados: No hubo recidivas. Los puntajes medios posoperatorios fueron 74,6 (rango 15-100)en la escala de Rowe y 70 (rango 32-98) en la escala de Constant. En el cuestionario DASH, el valor promedio fue 22,9 (rango 0-73). El 79% de los pacientes se mostraron satisfechos con el resultado. En un paciente, se produjo la migración del tornillo, sin síntomas. No se identificaron otras complicaciones. Conclusiones: Consideramos, como está reflejado en la literatura, que la técnica de Bristow-Latarjet para tratar la inestabilidad glenohumeral anterior es una técnica fiable, y con una tasa de recidivas baja, por lo que debe emplearse como cirugía deelección en determinados casos. Para ello, creemos que la valoración preoperatoria con la escala ISIS es una buena guía a la hora de indicar el tipo de cirugía.

Objective: To analyze medium-term results in patients who underwent an open Bristow-Latarjet surgery considering the preoperative ISIS value. Methods: Retrospective study of 33 patients operated on between 2005 and 2012; average age: 33 years (range 21-68), median follow-up: 6 years (range 2-9). Results from Rowe and Constant scores, DASH questionnaire were registered and a subjective assessment of the result by each patient was also used. Results: No recurrence was reported. Mean Rowe score was 74.6 (range 15-100) and mean Constant score was 70 (range 32-98). The DASH questionnaire showed a mean value of 22.9 (range 0-73). Seventy-nine percent of patients were satisfied with the results. The migration of a screw occurred in one patient. There were no complications. Conclusions: We believe that Bristow-Latarjet technique is a reliableoption, with few complications and a low recurrence rate to treat chronic shoulder instability as reported in literature. Therefore, we believe that it should be used as primary surgery in some cases and the preoperative ISIS scale is an excellent and simple guide to correctly select the surgical technique for each patient.

Adult , Shoulder Joint/surgery , Joint Instability/surgery , Shoulder Dislocation/surgery , Retrospective Studies , Treatment Outcome
Artrosc. (B. Aires) ; 22(3): 93-98, sept.2015.
Article in Spanish | LILACS, BINACIS | ID: lil-767407


Evaluar los resultados de la estabilización artroscópica de la lesión de Bankart en la inestabilidad anterior de hombro en pacientes que practican deportes de contacto y colisión. Método: Se realizó una revisión sistemática siguiendo los protocolos de PRISMA. La búsqueda fue hecha en Pubmed, utilizando los siguientes términos: “anterior”, “shoulder instability”, “collision”, “arthroscopic treatment”, “results”. Esta búsqueda fue realizada en mayo del 2015 y se dirigió en el período desde enero del 2005 a mayo del 2015. Los criterios de inclusión fueron: deportistas de contacto o colisión, reparación artroscópica de lesión de Bankart por inestabilidad anterior y evaluación objetiva de los resultados con dicha técnica. Se excluyeron aquellos casos que no presentaban lesión de Bankart clásica, o que presentaban inestabilidad multidireccional, inestabilidad posterior, o cambios degenerativos. Resultados: Solo cuatro trabajos reunieron el criterio de elegibilidad y fueron incluidos para esta revisión sistemática. Se evaluaron un total de 236 hombros, con una edad promedio de 21,4 años y un seguimiento promedio de 58,3 meses. Todas las publicaciones analizadas son de nivel de evidencia IV. La escala de Rowe reveló buenos y excelentes resultados en todos los pacientes evaluados en el post-operatorio. La tasa de recurrencia fue de 8,89 % y la tasa de retorno al deporte fue de 89,6 %. Conclusión: Las publicaciones evaluadas junto con los resultados que derivan de dicho análisis ponen de manifiesto que la técnica de reparación artroscópica en la inestabilidad gleno-humeral de hombro en deportistas de contacto y colisión constituye una opción correcta con resultados aceptables. Tipo de Estudio: Revisión Sistemática. Nivel de Evidencia: IV...

To evaluate the results of arthroscopic stabilization of Bankart lesion in anterior instability of the shoulder in collision or contact sports athetes. Methods: We conducted a systematic review using the PRISMA guidelines. The literature search was performed in PubMed, using the following terms: “Previous”, “shoulder instability”, “collision”, “arthroscopic treatment”, “results”. This search was made in May 2015 and was limited to the period from January 2005 to May 2015. Studies that described arthroscopic Bankart lesion repair for anterior instability in collision and contact athletes were included. Cases who had no classic Bankart lesion, or who had multidirectional, posterior instability or degenerative changes were excluded. Results: Only four studies were found that met eligibility criteria and were included in this systematic review. A total of 236 shoulders were evaluated, with an average age of 21.4 years and an average of 58.3 months follow-up. All the studies had a level of evidence of IV. Rowe score reported good and excellent results in all postoperative patients. The recurrence rate found was 8.89% and the rate of return to sport was 89.6%. Conclusion: The results show that arthroscopic repair for glenohumeral shoulder instability in contact and collision athletes is a good choice with acceptable results. Type of Sudy: Sistematic Review. Level of Evidence: IV...

Adult , Shoulder Joint/surgery , Arthroscopy/methods , Football/injuries , Joint Instability/surgery , Shoulder Dislocation/surgery , Athletic Injuries , Follow-Up Studies , Treatment Outcome