Long-term independent evaluation after arthroscopic extra-articular Bankart repair with absorbable tacks. A clinical and radiographic study with a seven to ten-year follow-up.
ABSTRACT Several arthroscopic methods have been developed to treat posttraumatic recurrent anterior shoulder instability in an attempt to match the results that can be achieved with open repair. The aim of this study was to perform an independent long-term clinical and radiographic evaluation after extra-articular arthroscopic Bankart repair with use of absorbable tacks (Suretac fixators).
Eighty-one consecutive patients with posttraumatic recurrent anterior shoulder instability underwent an extra-articular arthroscopic Bankart procedure. Seventy-one (88%) of the patients were reexamined physically after a median duration of follow-up of 107 months by two independent examiners and constituted the study group. Their clinical and radiographic outcomes were documented.
At the time of follow-up, twenty-seven (38%) of the seventy-one patients had experienced some kind of shoulder instability, although fifteen of them had had a new, clinically relevant shoulder injury. Eleven patients had had subluxation only, and sixteen had had redislocation. Fourteen of the twenty-seven patients had had a single episode of instability. Seven patients had undergone additional surgery to treat shoulder instability. The instability episodes occurred less than two years postoperatively in nine patients, between two and five years postoperatively in twelve, and more than five years postoperatively in six. At the time of final follow-up the median external rotation in abduction was 90 degrees (range, 0 degrees to 120 degrees) compared with 95 degrees (range, 70 degrees to 125 degrees) for the contralateral, uninjured shoulders (p<0.001). Before the injury, fifty-two patients (73%) participated in overhead or contact sports, whereas thirty-four patients (45%) participated in such activities at the time of follow-up. At the time of follow-up, the drill holes used to implant the absorbable tacks were invisible or hardly visible in fifty-eight (91%) of sixty-four patients for whom radiographs had been made. A marked increase in degenerative changes was noted when follow-up radiographs were compared with the preoperative radiographs.
This long-term follow-up study of arthroscopic extra-articular Bankart repairs revealed an unexpectedly high number of patients with new episodes of instability. This finding led to a slight modification of the technique. Since most instability episodes occurred after two years, it is important to follow patients for a longer period of time after surgical treatment of recurrent anterior shoulder instability to identify the true recurrence rate.
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ABSTRACT: Traumatic anterior-inferior shoulder joint dislocations are common injuries among the young athletic population. The aim of this study was to assess which factors, including concomitant injury (rotator cuff tears, superior labral anterior posterior [SLAP] lesions), patient age, and fixation methods, led to redislocation after arthroscopic stabilization. There are several risk factors for the outcome after arthroscopic anterior-inferior glenohumeral stabilization. Cohort Study; Level of evidence, 3. Between 1996 and 2000, 221 patients were treated with arthroscopic stabilization for anterior-inferior shoulder dislocation. Of these 221 consecutive patients, 190 (140 male, 50 female) with an average age of 28.0 years (range, 14.4-59.2 years) were available for follow-up (average follow-up, 37.4 +/- 15.8 months). Fixation methods were FASTak (n = 138), Suretac (n = 28), or Panalok (n = 24) anchors. Concomitant SLAP lesions were seen in 38 of 190 cases (20%). Redislocation rates varied between anchor systems (FASTak, 6.5%; Suretac, 25%; Panalok, 16.8%). Superior labral anterior posterior lesions, when treated, did not influence clinical outcomes or redislocation rate. A concomitant rotator cuff tear did not influence redislocation rate. Postoperative outcomes (Rowe score, Constant score, American Shoulder and Elbow Surgeons [ASES] shoulder index, 12-item questionnaire) in patients with a partial tear were also not altered. On the other hand, the redislocation rate correlated with patient age and number of prior dislocations. Return to sports at preinjury level was possible in 80% of cases. Arthroscopic repair of anterior-inferior instability using the 5:30-o'clock portal is dependent on anchor type and can show good to excellent results. Because of several coinjuries in anterior-inferior instability, an arthroscopic approach may be required to identify and treat such lesions.The American journal of sports medicine 09/2010; 38(9):1795-803. · 3.61 Impact Factor
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ABSTRACT: ZielIm Rahmen der Studie sollte ein Patientenselbsteinschätzungs-Scores für die Überprüfung der Schulterfunktion nach Bankart-Operation entwickelt werden. Der Score sollte eine möglichst gute Korrelation und Übereinstimmung mit einem international anerkannten Score haben. MethodikDer Rowe-Score von 1982 wurde als Basis für die Entwicklung des Selbsteinschätzungs-Scores genutzt. Der Score wurde ins Deutsche übersetzt und dort angepasst, wo Anpassungen für die Selbsteinschätzung erforderlich waren. Anschließend wurde der so entwickelte Selbsteinschätzungs-Score an 62Patienten evaluiert und mit den Ergebnissen des Rowe-Scores von 1982 verglichen. Im Rahmen dieser Studie wurden zusätzlich alle vier original Rowe-Scores (1978, 1981, 1982, 1988) erhoben und die Ergebnisse dieser Original-Rowe-Scores miteinander verglichen. ErgebnisDer Selbsteinschätzungs-Score korreliert gut mit dem Rowe-Score von 1982 und es konnten keine signifikanten Unterschiede der Ergebnisse nachgewiesen werden. Die original Rowe-Scores zeigen untereinander eine sehr gute Korrelation, allerdings wurden signifikante Unterschiede in den tatsächlichen Ergebnissen nachgewiesen. SchlussfolgerungenDer von uns auf Grundlage des Rowe-Scores von 1982 entwickelte Selbsteinschätzungs-Score wird als gute Alternative zum Rowe-Score von 1982 bewertet, insbesondere wenn eine Nachuntersuchung nicht möglich ist. Bei der Veröffentlichung von Ergebnissen unter Verwendung der Original-Rowe-Scores sollte immer deren Version angegeben werden, denn Rowe-Score ist nicht gleich Rowe-Score. AimThe aim of the present study was to develop a patient self-assessment score for the evaluation of the postoperative shoulder function after Bankart repair. This score should provide a good correlation and consistency with an internationally recognized score. MethodsThe self-assessment score was established on the basis of the 1982 Rowe score. It was translated into German and adjusted where required for the self assessment. The developed self-assessment score was then evaluated on 62patients and compared to the results of the 1982Rowe score. Within the scope of this study, the four original Rowe scores (1978, 1981, 1982, and 1988) were determined and the results of these original Rowe scores were compared with each other. ResultsThe self-assessment score correlates well with the 1982Rowe score and no significant differences were observed. All original Rowe scores show a close correlation; however, significant deviations of the actual results were observed. ConclusionsOur self-assessment score established on the basis of the 1982Rowe score is considered a good alternative to the 1982Rowe score, especially in those cases where a follow-up examination is not possible. If results are published using the original Rowe scores, the Rowe score version used should always be specified, because not all Rowe scores are the same.Obere Extremität 04/2012; 4(3):178-183.
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ABSTRACT: Conventionally, radiography studies revealed prolonged glenoidal drill hole visibilities with an unclear influence to the clinical outcome after arthroscopic Bankart repair using Poly-Laevo-Lactic-Acid (PLLA) anchors. The primary aim of the present study was the separated assessment of drill hole consolidation (DHC) and the concomitant osseous reaction (OR) of the glenoidal bio-degradation process in new specific magnetic resonance grading systems. In accordance with the specific DHC and the OR graduation, the clinical relevance was the secondary focus. Twenty-eight patients with arthroscopic Bankart repair using knotless PLLA anchors were prospectively followed and analyzed using a clinical scoring system (3, 6, 15 and 32 months). The T2-weighted OR and T1-weighted DHC were assessed using specific magnetic resonance imaging grading protocols (15 and 32 months). Longitudinal assessments revealed successive clinical status improvements over time (32 months: Rowe 95.7 ± 3.8; Walch-Duplay 93.8 ± 6.6; Constant 93.9 ± 4.5; ASES 93.8 ± 6.9; DASH 28.6 ± 7.2; NAS(pain) 1.1 ± 1.3; NAS(function) 1.3 ± 1.4). The initial OR level regressed over the 15-32 month period while the DHC showed significant drill hole reductions (P < 0.05). The inferior glenoid revealed a significantly increased bio-degradation capacity (P < 0.05) with drill hole enlargements in 14.3%. Neither the OR nor the drill hole enlargements influenced the clinical status. In no case were clinical or radiologic signs for a foreign body reaction. Knotless bio-anchors provide secure glenoidal fixation for Bankart repair without any specific clinical or MR evidence of an inflammatory response. The clinical status remained unaffected by the bio-degradation process. IV.Knee Surgery Sports Traumatology Arthroscopy 11/2011; 20(11):2163-73. · 2.68 Impact Factor