Long-Term Results of Arthroscopic Bankart Repair for Anterior Glenohumeral Instability: Does Associated Postero-inferior Capsulolabral Repair Still Have a Role?

Purpose: To compare the outcomes of arthroscopic anterior Bankart repair with and without associated postero-inferior capsulolabral repair as treatment of anterior glenohumeral instabiliy at minimun 10 year follow-up. Methods: A retrospective comparative study including patients who underwent arthroscopic anterior Bankart repair to treat anterior glenohumeral instability with glenoid bone-loss < 15% between January 2000 and February 2010 was performed. Outcomes were reported as recurrence rate, type of recurrence (dislocation or subluxation), need for revision surgery, range of motion, complications, and functional status. Outcomes were compared depending on whether a postero-inferior capsulolabral repair was added to the anterior Bankart repair. Results: 70 shoulders [59 males, mean age 28.2 (range 14-56), mean follow-up 146.1 (range 120-208) months] were included. Recurrence occurred in 9 cases (12.8%), including 3 dislocations and 6 subluxations. Revision surgery was needed in 8 (11.4%). Mean Rowe score improved from 29.7 (11.6) preoperatively to 87.1 (12.3) postoperatively. 83.3% returned to previous sports activities. Mean forward flexion changed from 173.5° (19.2) to 168.4º(10.4) (P < 0.01), external rotation from 81.4° (18) to 75.7° (10.5) (P < 0.01), and internal rotation decreased from 66.2% reaching T12 to 14.1% (P < 0.01). Addition of postero-inferior capsulolabral repair did not influence any of the outcomes significantly. Conclusion: Postero-inferior capsulolabral repair added to anterior Bankart repair as treatment of anterior glenohumeral instability in abscence of significant glenoid bone-loss did not influence the outcomes in terms of recurrence, range of motion, return to sports, or functional status, compared to isolated anterior Bankart repair at 12.2 year follow-up. Level of Evidence: Level III.

Resultados de la artrolisis artroscópica seguida de un programa de rehabilitación precoz ambulatoria con catéter interescalénico permanente como tratamiento de la rigidez secundaria de hombro / Arthroscopic arthrolysis followed by an early rehabilitation protocol using an indwelling interscalene catheter as treatment of secondary shoulder stiffness

Introducción: Evaluar los resultados de la artrolisis artroscópica seguida de un protocolo de rehabilitación acelerada empleando un catéter interescalénico permanente para tratar rigideces secundarias de hombro.Material y métodos: Revisión retrospectiva de casos intervenidos de artrolisis de hombro con alguna causa identificable de la rigidez. Se emplea un catéter interescalénico para bloqueo nervioso de la extremidad afecta que se mantiene al menos 5 días. El alta hospitalaria se realiza después de la primera sesión de rehabilitación en las siguientes 24 horas tras la intervención. Se evalúa variación de la movilidad articular, mejoría del dolor y de la capacidad funcional.Resultado: Se incluyen 11 pacientes en el estudio. Las causas de la rigidez fueron cirugías previas de osteosíntesis de fracturas de húmero proximal, reparaciones de manguito rotador, reparación de Bankart y traumatismos sin fractura. El seguimiento medio fue de 26.4 (8.3) meses. Se observa una mejoría estadísticamente significativa en la flexión [95.6 (32)º - 153.4 (59)º], rotación externa [33.9 (17)º - 59.2 (32)º], EVA [7.2 (2.9) - 2.1 (1.7)] y Quick-DASH Score [68.2 (33)º - 22.7 (13)º], pero no en la rotación interna ni en la ASES Score. No se registró ninguna complicación. Un paciente precisó una nueva artrolisis por no mejoría de movilidad a los 3 meses. La causa de la rigidez no influyó en los resultados.Conclusión: La artrolisis artroscópica seguida del inicio precoz de la fisioterapia con bloqueo de la extremidad con catéter interescalénico permanente es segura y proporciona buenos resultados funcionales. Tipo de estudio: Serie de Casos. Nivel de Evidencia: IV

Objective: To evaluate outcomes of arthroscopic arthrolysis followed by an early rehabilitation protocol using an indwelling interscalene catheter as treatment of secondary shoulder stiffness.Materials and methods: A retrospective review of cases who had surgery for shoulder stiffness with an identifiable cause is performed. An interscalene catheter is left after surgery for nervous blockade for at least 5 days. Hospital check-out is carried out immediately after first physical therapy session, at 24 hours from surgery. Outcomes are presented as improvement of range of motion, pain and functional status.Results: 11 patients were included in the study. Causes of stiffness were previous surgeries consisting on osteosynthesis for proximal humeral fractures, repair of rotator cuff tears, Bankart repair and trauma without fracture. Mean follow-up was 26.4 (8.3) months. Significant differences on flexion [95.6 (32)º - 153.4 (59)º], external rotation [33.9 (17)º - 59.2 (32)º], VAS [7.2 (2.9) - 2.1 (1.7)] and Quick-DASH Score [68.2 (33)º - 22.7 (13)º] were observed, while no differences on internal rotation and ASES Score. No complications were registered. One case required re-operation at 3 months due to no progression of shoulder motion. Cause of stiffness did not influence outcomes.Conclusion: Arthroscopic arthrolysis followed by early rehabilitation with nervous blockade of the extremity by an indwelling interscalene catheter is safe and provides good functional outcomes. Study type: case report. Level of evidence: IV

All-Suture Repair for Compressive Rotator Cuff Tears: Reducing the Traction of the Tissue.

Tears of the rotator cuff are a frequent pathology, but the best surgical procedure remains unclear. The arthroscopic approach has become the gold standard, but there are many different suture configurations that can be used. We describe an all-suture repair system with which the anatomical reduction of the rotator cuff is achieved performing traction from the anchor of the lateral row to subsequently performing a suture bridge suture from the medial row. The major advantage of this technique is that it creates compression forces and minimizing tensioning of the tissue.

Resonancia magnética de las plastías del ligamento cruzado anterior de rodilla / Magnetic resonance of anterior cruciate ligament of the knee

Proponemos un protocolo de estudio de resonancia magnética (RM) que optimiza la valoración de los injertos de Ligamento Cruzado Anterior (LCA) de la rodilla. Se estudiaron 12 rodillas con una plastia de tendón rotuliano hueso-tendón-hueso, al protocolo habitual se añadieron planos oblicuos siguiendo la dirección del injerto, planos coronales y secuencias tras la adminsitración de gadolinio. En ocho pacientes se mejoró la visualización del injerto en los planos oblicuos. Se observó un realce periférico del injerto en ocho casos, favoreciendo la visualización de su límite en cuatro de ellos, y en dos pacientes con exploración anormal se constató un tejido vascularizado hipertrófico. En los planos coronales se demostró en un caso el espacio intercondíleo estrecho. Existen diferencias morfológicas entre una ligamentoplastía y un LCA nativo que dificultan su estudio mediante RM. La introducción de secuencias oblicuas y con gadolinio puede favorecer su visualización. Es necesario complementarlo con planos coronales para estudiar su relaciones con estructuras laterales