Anterior Shoulder Instability - David Houlihan-Burne 31/7/2001

INTRODUCTION

 

Many different procedures (>150)

Isolated repair of detatched labrum (Bankart)

Muscle transposition of subscapularis (Magnuson-Stack)

Shortening of subscapularis and anterior capsule (Putti-Platt)

Transfer of corocoid (Bristow)

Proximal humeral osteotomy (Weber)

Glenoid osteotomy (Meyer-Burgdorff)

Reconstruction with fascia lata (Gallie)

 

Most commonly used soft tissue procedure is modified Bankart repair -   detatched labral repair plus anterior capsullorraphy

 

 

Authors

Cole B, Insalata J et al. Pittsburgh

Title

Comparison of Arthroscopic and Open Anterior Shoulder Stabilisation

Reference

JBJS 82-A (8).1108 – 1114. 2000

Summary

63 pts either arthroscopic Bankart or open capsular shift. No difference in failure /recurrence rates. Results Excellent – 91% open, 84% arth. Surgical failure rate 24% arth, 18% open. Minimal loss of mobility.

Critique

Different operation for different pathology. ? comparable groups.   One of the few comparative trials.

 

 

 

Authors

Protzman R

Title

Anterior instability of the shoulder

Reference

JBJS 62-A (6). 909 – 918. 1970

Summary

Review of 89 pts having had surgery (Bankart repair) for   anterior instability. Distinguished 3 types of anterior instability and compared gps. 70% have x-ray evidence of Bankart lesion. Subjectively 91% satisfactory result. 3% surgical failure rate. Objectively 8% further subluxation episode but most of these thought shoulder was more stable post than pre op. <12 degress loss in ROM in any one direction.

Critique

All types of instability analysed. All Army cadets and post op function rated as “number of pull-ups achieved” !

 

OTHER RELEVANT PAPERS

 

Hill HA, Sachs MD :The grooved defect of the humeral head: A frequently unrecognised complication of dislocations of the   

                                   shoulder joint. Radiology 35: 690-700. 1940

 

Bankart AS : The pathology and treatment of recurrent or habitual dislocation of the shoulder joint. Br J Surg 26: 23-29. 1938

 

Osmond-Clarke H ; Habitual dislocation of the shoulder : The Putti Platt operation. JBJS 30B: 19-25, 1948



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