Long-term results with the Bankart and Bristow-Latarjet procedures: recurrent shoulder instability and arthropathy.

We retrospectively analyzed 26 shoulders in 24 patients 16 to 20 years (mean, 17.5 years) after a Bankart repair and compared these with a prospective series of 30 shoulders in 28 patients 15 years (mean, 15.1 years) after a Bristow-Latarjet repair for recurrent anterior dislocation of the shoulder. At follow-up one patient in each group had undergone revision surgery for recurrent instability. Two patients in the Bankart group had spontaneous stabilization of postoperative instability. Further, one patient in this group had had one subluxation during the follow-up period. In the Bristow group one patient reported 3 recurrences 3 years postoperatively. This patient has had no further redislocations during the past 12 years. Subluxations occurred occasionally several times in 2 patients in the Bristow group, but these patients were satisfied with the procedures at follow-up. No patient in the Bankart group had apprehension at follow-up. Eight patients in the Bristow group had subjective and/or objective apprehension. Throwing ability after surgery in the dominant shoulder was considered normal in 8 of 12 patients in the Bristow series and in 1 of 11 patients in the Bankart series. In the Bankart group 17 patients were "very satisfied" with the operative result, 7 were "satisfied," and 1 was "dissatisfied." The corresponding figures for the Bristow group were 24 who were very satisfied and 5 who were satisfied. Dislocation arthropathy was found in 16 of 26 Bankart shoulders (14 mild and 2 moderate) and in 9 of 30 Bristow shoulders (5 mild, 3 moderate, and 1 severe). The Bankart procedure seemed to be more successful than the Bristow-Latarjet repair when stability at follow-up was considered. However, when other criteria, as well as the patients' assessment of the operative result, are included, both methods can be recommended without any major differences.

Reduced bleeding through temporary balloon occlusion in hip and knee revision surgery.

We used temporary balloon occlusion of the iliac or femoral artery to reduce blood loss in major hip or knee operations in 15 cases in 13 patients. The balloon was introduced by an interventional radiologist in the afternoon of the day before surgery or in the morning before. A latex occlusion balloon was inserted via the transfemoral ipsi- or contralateral route. The patients received two 40 mg doses of low molecular weight heparin. At the beginning of the operation, saline was injected into the predetermined volume to inflate the balloon. The balloons were inflated during 1-6 hours. In each case, the balloon occlusion clearly reduced bleeding in the surgical field and facilitated surgery. The perioperative bleeding was reduced by half, as compared to a retrospective control group. We measured the intraarterial blood pressures distally to the balloon in 2 patients. They decreased from 120 to 40 mm Hg and 155 to 50 mm Hg, respectively, after inflation. Two complications occurred, one bleeding due to catheter dislocation the night before surgery and one postoperative necrosis of the tip of a toe in a patient in whom the deflated balloon was not extruded until the day after surgery and the dose of heparin was too low.

Arthroscopic lavage speeds reduction in effusion in the glenohumeral joint after primary anterior shoulder dislocation: a controlled randomized ultrasound study.

Recent studies have shown that arthroscopic lavage of the glenohumeral joint within 10 days following a primary anterior dislocation significantly lowers the recurrence rate when compared with a nonoperative regime. We hypothesize that the lavage reduces distension in the joint and thereby facilitates adaptation and healing of the soft tissue lesion. Using ultrasound, we assessed the hemarthrosis in the glenohumeral joint weekly in 16 consecutive patients after traumatic primary anterior shoulder dislocation. The patients were randomized into two groups for treatment with either arthroscopic lavage or a nonoperative regime. Except for the lavage the two groups followed an identical rehabilitation program. Transversal dorsal ultrasound of the glenohumeral joint was performed, in which the joint effusion was assessed as the distance between the humeral head and the glenoid. Prior to the lavage the two groups had a similar amount of excessive joint effusion. The effusion declined to a steady state level within 3-7 weeks. The joint effusion decreased more rapidly (33%) in the group treated with arthroscopic lavage (P = 0.02) than in the nonoperated group.

Arthroscopic lavage reduced the recurrence rate following primary anterior shoulder dislocation. A randomised multicentre study with 1-year follow-up.

Young individuals have a high recurrence rate following non-operative treatment of traumatic primary anterior shoulder dislocation. The present multicentre study was undertaken to find out whether the results could be improved by using arthroscopic lavage as treatment. Sixty patients aged 16-30 years, with traumatic primary anterior shoulder dislocation were randomised into two groups. One group was treated with arthroscopic lavage within 10 days, while the other group was treated non-operatively. Rehabilitation was otherwise identical. At 1-year follow-up, 4 of 30 patients (13%) in the lavage group had had redislocation compared with 13 of 30 (43%) in the group treated non-operatively (P = 0.01). The difference in recurrence rate was more pronounced in younger patients. The functional outcome according to the Rowe shoulder score was better in the lavage group (P = 0.003), as was the anterior stability according to the apprehension test (P = 0.008). We conclude that arthroscopic lavage reduced the recurrence rate and produced a better functional outcome at 1-year follow-up than the non-operative treatment in young individuals.

Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study.

Two hundred and forty-five patients who had had 247 primary anterior dislocations of the shoulder were followed for ten years in a multicenter study at twenty-seven Swedish hospitals. The ages of the patients at the time of the dislocation ranged from twelve to forty years. The patients were assigned to one of three treatment groups: immobilization with the arm tied with a bandage to the torso for three to four weeks after reduction of the dislocation; use of a sling, which was discontinued after the patient was comfortable; or immobilization for various durations. At the ten-year follow-up evaluation, no additional dislocation had occurred in 129 shoulders (52 per cent). Recurrent dislocation necessitating operative treatment had developed in fifty-eight shoulders (23 per cent): thirty-four (34 per cent) of the ninety-nine shoulders in patients who were twelve to twenty-two years old, sixteen (28 per cent) of the fifty-seven shoulders in patients who were twenty-three to twenty-nine years old, and eight (9 per cent) of the ninety-one shoulders in patients who were thirty to forty years old. Twenty-four (22 per cent) of the shoulders that had had at least two recurrences during the first two or five years seemed to have stabilized spontaneously without operative intervention at ten years. Dislocation of the contralateral shoulder occurred in association with sixteen (16 per cent) of the ninety-nine shoulders in patients who were twelve to twenty-two years old, twelve (21 per cent) of the fifty-seven shoulders in patients who were twenty-three to twenty-nine years old, and only three (3 per cent) of the ninety-one shoulders in patients who were thirty to forty years old. The type and duration of the initial treatment had no effect on the rate of recurrence. Radiographs, made for 185 shoulders at the time of the primary dislocation, demonstrated an evident Hermodsson (Hill-Sachs) lesion in ninety-nine shoulders (54 per cent); this finding was associated with a significantly worse prognosis with regard to recurrence than was no evident lesion (p < 0.04). Radiographs made for 208 shoulders at the ten-year follow-up examination were evaluated for post-dislocation arthropathy. Twenty-three shoulders (11 per cent) had mild arthropathy and eighteen (9 per cent) had moderate or severe arthropathy. Some of the shoulders that had arthropathy had had no recurrence.

Impacted morsellized allograft and cement for revision total knee arthroplasty: a preliminary report of 3 cases.

In 3 cases we have revised a failed knee arthroplasty with intramedullary impaction of morsellized allograft similar to the technique described for the hip. Follow-up after 18, 21 and 28 months showed good clinical and radiographic results.

Function after tibial osteotomy for medial gonarthrosis below aged 50 years.

Twenty-seven patients (28 knees), with a median age of 42 (27-50) years treated with a high tibial osteotomy for early medial gonarthrosis (Ahlbäck's Stage I) were examined after 11 (7-18) years. Twenty-four were men; 18 knees had had previous meniscus and ligament lesions. At follow-up, 22 knees were satisfactory and 9 patients managed high-activity sports or heavy work. In 25/28 knees, the arthrotic process had not progressed radiographically.

Anterior dislocation of the shoulder in teen-agers and young adults. Five-year prognosis.

Two hundred and fifty-six of 257 shoulders in 254 patients who were between the ages of twelve and forty years and who had primary anterior dislocation of the shoulder that was treated by immobilization for at least three weeks or by early movement were followed for five years in a prospective multicenter study. Two or more recurrences had occurred in 55 per cent of the shoulders in patients who were twenty-two years old or younger, in 37 per cent of the shoulders in patients who were twenty-three to twenty-nine years old, and in 12 per cent of the shoulders in patients who were thirty to forty years old. Surgery for the treatment of instability had been performed or was scheduled to be performed in 28, 18, and 5 per cent of the shoulders, respectively, in the three age-groups. The dislocation recurred in only one of thirty-two shoulders that had a fracture of the greater tuberosity (p less than 0.001). The results as regards recurrence after five years were not influenced by immobilization of the shoulder for three to four weeks after the initial dislocation, bilateral dislocation, or the type of initial trauma and athletic activity. A moderate impression fracture of the humeral head (Hermodsson or Hill-Sachs) did not change the prognosis in the younger patients (twenty-two years old or younger). However, in the patients who were twenty-three to forty years old the rate of recurrence was significantly higher (p less than 0.01) when this injury was demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)

Pes anserinus transfer for the unstable knee. A 7-year follow-up of 43 cases of ruptured anterior cruciate ligament.

On average 7 years postoperatively, we evaluated 43 consecutive patients who had had pesoplasty for chronic injury of the anterior cruciate ligament. Fourteen patients had undergone further surgery during the follow-up period; ten of these had extra- or intra-articular stabilizing procedures, and eight meniscectomies were performed after the index operation. At follow-up of the 33 knees that had not had additional stabilizing surgery, only one-third of the knees had normal radiograms, and the majority had anterolateral rotational instability (pivot shift) which, however, did not exclude satisfactory knee function. We conclude that improvement after transfer of the pes anserinus tendons was due to the simultaneous meniscectomy; we do not believe that the pesoplasty changed the natural course of the chronic rupture of the anterior cruciate ligament.

Acromioplasty for impingement syndrome.

In 51 patients (27-67 years) with subacromial impingement syndrome, an acromioplasty according to Neer was performed. In 11 patients, acromioclavicular arthrosis was found, and in these patients the lateral end of the clavicle was resected as well. The patients have been followed for an average of 21 (6-42) months. The result was excellent or good in 33 patients. In seven patients there was no improvement.

Arthrodesis after failed knee arthroplasty. A nationwide multicenter investigation of 91 cases.

Ninety-one patients with attempted arthrodesis after failed knee arthroplasty were identified in a prospective nationwide study of knee arthroplasties performed from October 1975 through January 1982 in Sweden. The study included 43 hinged or stabilized, 34 bi- or tricompartment, and 14 unicompartment endoprostheses. Three-fourths of the failures were caused by infections. At follow-up evaluation, two patients had expired from infection and four patients had amputations. Fusion was achieved in only 50% of 108 attempts in 91 knees. Patients with unstable joints had limited function. The fusion rate was relatively high after unicompartment endoprostheses, in cases with sustained rigid fixation, or in cases where infection was brought under control at arthrodesis. Rigid fixation was best achieved with an external double frame or an intramedullary nail. Repeated attempts were worthwhile. Removal of all foreign material, eradication of the infectious lesion, and an arthrodesis performed in a one- or two-stage procedure with insertion of gentamicin beads seemed to be the best way to combat infection. The treatment of prosthetic failures should be referred to centers with special interest in knee arthroplasty.

Acromio-clavicular separations treated conservatively. A 5-year follow-up study.

Seventy patients with acute acromio-clavicular separation were examined retrospectively after treatment with a minimum of immobilization. The mean interval between injury and follow-up was 6 years. In 37 patients with partial separation, the results were excellent in 24 and good in 13. In 30 patients with complete separation, the results were excellent in 7, good in 23 and unsatisfactory in 3. The radiographic findings are discussed. At follow-up, complete separation had often caused remodeling with stability of the joint.

The coracoid transfer for recurrent dislocation of the shoulder. Technical aspects of the Bristow-Latarjet procedure.

One hundred and twelve shoulders with recurrent anterior dislocation were treated with the Bristow-Latarjet procedure and had a two to five-year follow-up after surgery. The incidence of redislocation was 6 per cent, and an additional 7 per cent of the patients reported occasional subluxation. In 106 shoulders, a radiographic study was carried out in order to determine the importance of factors such as healing and position of the transferred coracoid process with regard to the postoperative clinical results. No redislocation or subluxation occurred in the forty patients in whom the transplant showed osseous or fibrous union at the scapula and was located inferior to the equator of the glenoid and less than one centimeter medial to its rim. In shoulders in which either the transplant had migrated more than 1.5 centimeters from that position or was placed one centimeter or more medial to the glenoid rim, the incidence of redislocation or subluxation was significantly increased.