Rehabilitation after Shoulder Instability Surgery.

Shoulder instability can occur in any direction and presents across a broad spectrum including traumatic dislocations, repetitive microinstability events or subluxations, and global joint laxity. The development of pain, functional decline, and articular pathologic condition is a multifaceted process that is influenced by the underlying bony morphology, biology of the surrounding soft tissue structures, dynamic coordination of the periscapular musculature, and patient factors such as age, activity level, and associated injuries. This article will focus on the younger, active patient with instability due to deficiencies in the capsulolabral complex and dynamic stabilizers.

Latarjet procedure for anterior shoulder instability: a 24-year follow-up study.

INTRODUCTION: Different surgical techniques (open and arthroscopic) have been described for the treatment of post-traumatic recurrent anterior instability. The aim of the surgery is to restore when possible, normal shoulder anatomy by repairing the underlying pathology responsible for the instability. Sometimes other surgical techniques are indicated. The purpose of this retrospective study was to investigate the long-term clinical and radiographic results and complications of the open Latarjet procedure after a minimum follow-up of 24 years. MATERIALS AND METHODS: A retrospective study was performed for 67 patients treated with an open Latarjet procedure in a single center. Forty of these 67 patients returned for follow-up evaluation and clinical/radiological examination during the year 2018, having had a minimum of 24-year follow-up. Clinical outcomes were analyzed using two functional scores, in addition to the ROM and strength assessment. Radiographic evaluation included several views (AP views in neutral, internal and external rotation and a comparative Bernageau view) RESULTS: A total of 40 patients underwent an open Latarjet procedure. All the patients were avaible for follow-up at an average of 25.6 years. Clinically, no patient reported any episode of dislocation at the time of follow-up. The mean Rowe score and the Walch-Duplay score were 84.5 (range 45-100) and 83.5 (range 55-100), respectively. Non-union/fibrous union was reported in 12.5% of cases, partial resorption of the graft was found in 7.5% of cases, while total resorption was found in 5% of cases. Osteoarthritis was identified in 52.5% (21) of the patients. CONCLUSIONS: This long-term follow-up study demonstrated that the open Latarjet procedure is a safe and reliable technique for recurrent anterior shoulder instability. The Latarjet procedure provides good long-term stability although associated with a slight limitation in external rotation. LEVEL OF EVIDENCE: Level III; retrospective cohort comparison; treatment study.

Correção da lesão de Bankart por cirurgia artroscópica comparada com a cirurgia aberta: uma revisão sistemática / The Bankart lesion repaired by arthroscopic surgery versus open surgery: a systematic review

Introdução: A instabilidade anterior traumática do ombro é uma doença ortopédica comum que acomete pacientes jovens e/ou atletas. Na maioria das vezes, a lesão de Bankart encontra-se associada. Nesta situação o tratamento cirúrgico é comumente indicado. O objetivo deste estudo é comparar, através de revisão sistemática da literatura, a taxa de insucesso da técnica de Bankart, via artroscópica, com a técnica de Bankart aberta, através da taxa de insucesso de ambas as técnicas nos artigos revisados. Métodos: Através do MEDLINE/Pubmed, pesquisaram-se as palavraschave: a) anterior shoulder instability; b) Bankart lesion; c) traumatic recurrent anterior shoulder instability; d) open Bankart repair; e) arthroscopic Bankart repair; f ) arthroscopic versus open Bankart repair em artigos publicados entre 1998 a 2008, que comparavam a técnica aberta com a técnica artroscópica, exclusivamente operados pela técnica de Bankart. Sete artigos preencheram os critérios de seleção. Entre as variáveis estudadas estavam o número de pacientes e ombros operados por cada técnica, o sexo, o tipo de escore de avaliação e o desfecho. Resultados: Foram abarcados 478 pacientes, 481 ombros, dos quais 54,9% foram operados pela técnica de Bankart contra 45,1% pela técnica aberta. 84,7% (405) eram homens, 15,3% (73) eram mulheres. O escore de Rowe foi mencionado em todos os artigos avaliados. A taxa de insucesso na técnica artroscópica foi de 10,6% contra 7,8% na técnica aberta. Conclusão: As técnicas artroscópica e aberta produziram bons resultados para o tratamento da instabilidade anterior traumática de ombro. Ambas as técnicas apresentaram resultados similares na taxa de insucesso

Introduction: The traumatic anterior instability of the shoulder is a common orthopedic disease that affects young patients and/or athletes. Most often the Bankart lesion is associated. In this situation surgery is usually indicated. The aim of this study is to compare, through a systematic review of the literature, the Bankart technique via arthroscopy with the open Bankart technique through the failure rates of both techniques in the reviewed articles. Methods: Using the MEDLINE/PubMed databases, the following keywords were searched: a) anterior shoulder instability; b) Bankart lesion; c) traumatic recurrent anterior shoulder instability; d) open Bankart repair; e) arthroscopic Bankart repair, and f ) arthroscopic versus open Bankart repair, in articles published from 1998 to 2008 comparing the open technique with the arthroscopic technique performed exclusively with the Bankart technique. Seven articles met the selection criteria. Among the variables studied were the number of patients and shoulders operated by each technique, sex, type of evaluation score, and outcome. Results: The study covered 478 patients, 481 shoulders, of which 54.9% were operated by the Bankart technique against 45.1% by the open technique. 84.7% (405) were men and 15.3% (73) were women. The Rowe score was mentioned in all of the reviewed articles. The failure rate in the arthroscopic technique was 10.6% versus 7.8% in the open technique. Conclusion: The open and arthroscopic techniques have produced good results for the treatment of traumatic anterior shoulder instability. Both techniques showed similar results in the failure rate

Result of Early Active Range of Motion Exercise after Bankart Repair of Traumatic Anterior Instability

PURPOSE: To evaluate prospectively the results of early active exercise after open Bankart repair of traumatic anterior shoulder instability. MATERIALS AND METHODS: From January, 2001 to June, 2003, 26 patients who were followed up at least 1 year after open Bankart repair for traumatic anterior shoulder instability were evaluated. Average age was 23.9 years old (range, 19~43) with 24 males and 2 females. We evaluated them using the functional shoulder scores (modified Rowe score, ASES score), range of motion, VAS pain scale, patient's subjective satisfaction and return to unlimited daily living activity. RESULTS: The shoulder functional scores increased significantly. At last follow up, the final range of motion were flexion in average 5° deficit in comparison to normal side, external rotation in average 10o deficit, and internal rotation in T9. The patient's subjective satisfaction was good in 2l patients (81%). Return to unlimited daily activity was possible in 23 patients (88.5%), and 19 patients (73%) rejoined to sports activity before injury. There were complications including anterior recurrent subluxation in 1 case, weakness of subscapularis muscle in 1 case. CONCLUSION: In traumatic anterior shoulder instability, early active range of motion exercise after open Bankart repair does not decrease shoulder stability. Early exercise can be useful for returning to previous level of sports activity in young active patients.

Capsular Imbrication and Bankart Repair in Traumatic Anterior Shoulder Instability : Effect of Subscapularis Tendon Division on Internal Rotator Strength and Shoulder Function / 대한정형외과학회잡지

PURPOSE: To evaluate the function of the shoulder and the effect of the division of the subscapularis tendon on the strength of the inter-nal rotator after capsular imbrication and Bankart repair. MATERIALS AND METHODS: From January, 1996 to December, 2000, we reviewed thirty cases of traumatic anterior shoulder instability, which underwent capsular imbrication and Bankart repair. The follow up period was minimally one year. The clinical results were evaluated using the ASES (American Shoulder and Elbow Surgeons) score and the muscle power of the internal rotator as measured by a myometer. RESULTS: All cases showed satisfactory results; nineteen cases (63%) were excellent, and eleven cases (37%) were good. Mean value of ASES score increased from 78.6 (60-82) ponts to 94.5 (84-100) points. Mean value of the score increased was 16 (14-38) points. Postoperatively, the muscle power of the internal rotator compared with contralateral was increased in 12 cases (40%), decreased in 17 cases (57%), and was the same in one case (3%). There was no cases of deterioration of function, recurrence or requiring revision surgery. CONCLUSION: In capsular imbrication and Bankart repair, the division of the subscapularis tendon did not produce a significant adverse effect in the strength of the internal rotator. We believe that this is one of the useful treatment methods in traumatic anterior shoulder insta-bility, because it provides stability and a good range of motion.