Inestabilidad posterior de hombro. Resultados de la reconstrucción artroscópica en pacientes sin defectos óseos significativos / Posterior shoulder instability. Arthroscopic reconstruction in patients without significant bone defects

RESUMEN

Presentamos los resultados de una serie de casos de pacientes con inestabilidad posterior de hombro, sin defectos óseos ni retroversión glenoidea significativos, tratados con técnica artroscópica de reparación cápsulolabral con anclajes. Entre 2010 y 2019, dieciocho pacientes con inestabilidad posterior de hombro fueron tratados con una reparación cápsulolabral artroscópica con anclajes, en el mismo centro quirúrgico y por el mismo cirujano. Fueron dieciséis hombres y dos mujeres con una edad promedio de 30.5 años (en un rango de diecinueve a cuarenta y cuatro años). Con un seguimiento promedio de 64.4 meses (en un rango entre trece y ciento dieciséis meses) los pacientes fueron evaluados clínicamente con el test de Kim, Jerk y test de aprehensión. También utilizamos los scores de WOSI, ASES, Rowe, radiografía, tomografía computada y resonancia magnética, para las evaluaciones pre y postoperatorias. Tipo de estudio Serie de casos. Nivel de evidencia IV

ABSTRACT

Objective: We present the results of a case series of patients with posterior shoulder instability without significant bone defects or excessive glenoid retroversion treated with arthroscopic capsule-labral repair with suture anchors.Methods: Between 2010 and 2019, 18 patients with posterior shoulder instability underwent an arthroscopic capsule-labral repair with suture anchors. All the cases were operated on at the same surgical center by the same surgeon. The patients were 16 men and two women with an average age of 30.5 years (range 19 to 44 years). With a mean follow up of 64.4 months (range 13-116 months), the patients were clinically evaluated by the Kim, Jerk, and Apprehension tests. Furthermore, the WOSI, ASES, and ROWE scores, X Rays, CT Scans, and MRIs were also used for pre and postoperative assessment. Results: We did not find any case of recurrence of instability. At the final follow up, the Kim's, Jerk, and Apprehension tests were negative in all the patients. The posterior drawer test decreased translation at an average of 2 pluses. The mean WOSI Score risen from 35.2 to 86.5, the ASES from 33.3 to 85.3, and the Rowe from 20.3 to 91.1. Two patients showed moderate to severe degenerative changes at the final X-Rays. The postoperative MRIs of 12 patients demonstrated an anatomic reduction and adequate healing of the posterior labrum.Conclusions: The arthroscopic repair of the labrum with anchors is a reliable, reproducible, and effective technique that warrants satisfactory results in selected posterior shoulder instability cases without significant glenoid bone loss or excessive retroversion. Type of study Case series. Level of evidence IV