Arthroscopic Treatment of Anterior-Inferior Glenohumeral Instability : Two to Five-Year Follow-up

• Published in: Journal of bone and joint surgery. American volume 2000-07, Vol.82 (7), p.991-991
• Main Authors: Gartsman, Gary M, Roddey, Toni S, Hammerman, Steven M
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Arthroscopy; Biological and medical sciences; Chi-Square Distribution; Debridement; Elbow Joint - physiopathology; Female; Follow-Up Studies; Humans; Joint Capsule - surgery; Joint Instability - physiopathology; Joint Instability - surgery; Laser Coagulation; Ligaments, Articular - surgery; Male; Medical sciences; Middle Aged; Orthopedic surgery; Range of Motion, Articular - physiology; Recurrence; Reoperation; Rotation; Rotator Cuff - surgery; Shoulder Joint - physiopathology; Shoulder Joint - surgery; Sports - physiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Suture Techniques; Treatment Outcome
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-200007000-00011

BackgroundPrevious studies on arthroscopic treatment of anterior-inferior glenohumeral instability have focused on the repair of lesions of the anterior-inferior aspect of the labrum (Bankart lesions) and have demonstrated failure rates of as high as 50 percent. The current investigation supports the concept that anterior-inferior instability is associated with multiple lesions and that success rates can be increased by treating all of the lesions at the time of the operation. We present the results of arthroscopic treatment of anterior-inferior glenohumeral instability after a minimum duration of follow-up of two years.MethodsThe study group consisted of fifty-three patients who had a mean age of thirty-two years (range, fifteen to fifty-eight years) at the time of the operation. There were forty-four male and nine female patients. The mean interval from the time of the operation to the final follow-up evaluation was thirty-three months (range, twenty-six to sixty-three months). The scores on the American Shoulder and Elbow Surgeons (ASES) Shoulder Index and the rating systems of Constant and Murley, Rowe et al., and the University of California at Los Angeles (UCLA) were recorded preoperatively and at the time of the final follow-up.ResultsPreoperatively, none of the patients had an overall rating of good or excellent according to the system of Rowe et al.; however, 92 percent (forty-nine) of the fifty-three patients had a rating of good or excellent at the time of the final follow-up. The mean score improved from 45.5 points to 91.7 points on the ASES Shoulder Index, from 56.4 points to 91.8 points with the system of Constant and Murley, from 11.3 points to 91.9 points with the system of Rowe et al., and from 17.6 points to 32.0 points according to the UCLA Shoulder Score (p = 0.001 for all comparisons). The mean passive external rotation with the shoulder in 90 degrees of abduction measured 88.2 degrees. Thirty-four of thirty-eight patients returned to their desired level of sports activity following the operation. Four patients who had persistent instability were considered to have had a failure of the index operation, and one of them had a second operative procedure.ConclusionsThe results of the present study suggest that our technique of arthroscopic treatment of anterior-inferior glenohumeral instability is better than previous arthroscopic techniques and is equivalent to open repair. We believe that the improved rate of success demonstrated in the