Chronic Anterior Shoulder Instability - Long-Term Results after Open Reconstruction

Abstract

Introduction: This paper attempts to evaluate the long-term results of open reconstruction in cases of chronic anterior shoulder instability using a modified Bankart’s technique.
Materials and Methods: In a retrospective analysis, clinical and functional results (Constant Score) of two groups of patients (operative [n=29] vs. non-operative [n=66] control group) were compared (on average 8 years post-operatively). Open Bankart’s procedures were performed in the reconstruction group.
Results: The data show that neither the patient’s age nor the number of dislocations has an impact on the clinical outcome. Comparing both groups, the operative group shows better clinical and functional results than the non-operative group, according to the Constant Score.
Conclusion: As a conclusion, the authors recommend open reconstruction using the open Bankart’s procedure after recurrent, anterior shoulder dislocation, even in older patients with a high number of redislocations, if multidirectional instability can definitely be ruled out.

Key words

Recurrent - Anterior shoulder instability - Open reconstruction - Bankart’s procedure - Long-term results

References

• 1 Angelo R L, Hawkins R J. Osteoarthritis following an excessivly tight Putti-Platt Repair. American Shoulder and Ellbow Surgeons 4th Open Meeting, Atlanta GA 1988
• 2 Bankart A SB. The pathology and treatment of recurrent dislocation of the shoulder joint.  Br J Surg. 1938;  26 23-30
• 3 Cofield R H, Irving F J. Evaluation and classification of shoulder instability with special reference to examination under anaesthesia.  Clin Orthop. 1987;  112 32-43
• 4 Cofield R H, Nessler J F, Weinstabl R. Diagnosis of shoulder instability by examination under anaesthesia.  Clin Orthop. 1993;  291 45-53
• 5 Constant C R, Murley A HG. A clinical method of functional assessment of the shoulder.  Clin Orthop. 1987;  214 160-164
• 6 Eden R. Zur Operation der habituellen Schulterluxation unter Mitteilung eines neuen Verfahrens bei Abriß am inneren Pfannenrand.  Dtsch Zschr Chir. 1918;  144 269-280
• 7 Fredriksson A S, Tegner Y. Results of the Putti-Platt operation for recurrent anterior dislocation of the shoulder.  Int Orthop (SICOT). 1991;  15 185-188
• 8 Gebhard F, Draeger M, Steinmann R, Hoellen I, Hartel W. Funktionelle Ergebnisse nach Eden-Hybbinette-Lange-Operation bei posttraumatischer rezidivierender Schulterluxation.  Unfallchirurg. 1997;  100 770-775
• 9 Guanche C A, Quick D C, Sodergren K M, Buss D D. Arthroscopic versus open reconstruction of the shoulder in patients with isolated Bankart-lesion.  Am J Sports Med. 1996;  24 144-148
• 10 Hawkins R J, Angelo R L. Glenohumeral osteoarthritis: A late complication after Putti-Platt repair.  J Bone Joint Surg [Am]. 1990;  72 1193-1197
• 11 Hertz H, Scharf W, Berr T, Wunderlich M. Häufigkeit von Rezidiven nach traumatischer vorderer Schulterluxation.  Unfallchirurg,. 1985;  88 437-441
• 12 Hertz H, Kwasny O, Wöhry G. Die Limbusplastik bei rezidivierender vorderer Schulterluxation.  Unfallchirurgie. 1991;  17 72-75
• 13 Hovelius L, Akermark C, Albrektsson B. Bistrow-Latarjet procedure for recurrent anterior dislocation of the shoulder.  Acta Orthop Scand. 1983;  54 284-290
• 14 Hovelius L, Thoring J, Fredin H. Recurrent anterior dislocation of the shoulder: Results after the Bankart and Putti-Platt operations.  J Bone Joint Surg [Am]. 1979;  61 566-569
• 15 Hybbinette S. De la transplantation d’un fragment osseux pour remendir aux luxation recidivantes de l’epaule; constatations et resultats operatoires.  Acta Chir Scand. 1932;  71 411-445
• 16 Jerosch J. Arthroskopische Therapie des instabilen Schultergelenkes - Akzeptanz und kritische Überlegungen.  Z Orthop. 1997;  135 79-83
• 17 Jobe F W. Unstable shoulders in the athlete.  AAOS Instructional Course Lectures. 1985;  34 228-231
• 18 Lazarus M D, Sidles J A, Harryman D T, Matsen F A. Effect of a chondral-labral defect on glenoid concavity and glenohumeral stability.  J Bone Joint Surg [Am]. 1996;  78 94-102
• 19 Levine W N, Richmond J C, Donaldson W R. Use of suture anchor in open Bankart reconstruction. A follow-up report.  Am J Sports Med. 1994;  22 723-726
• 20 Neer II C S, Foster C R. Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder.  J Bone Joint Surg [Am]. 1980;  62 897-908
• 21 Niskanen R O, Lehtonen J Y, Kaukonen J P. Alvik’s glenoplasty for humeroscapular dislocation.  Acta Orthop Scand. 1991;  62 279-283
• 22 O’Driscoll S W, Evans D C. Long-term results of staple-capsulorrhaphy for anterior instability of the shoulder.  J Bone Joint Surg [Am]. 1993;  75 249-258
• 23 Paavollainen P, Bjorkenheim J M, Ahouvuo J, Slatis P. Recurrent anterior dislocation of the shoulder. Results of Eden-Hybbinette and Putti-Platt operations.  Acta Orthop Scand. 1984;  55 556-560
• 24 Rockwood C A. Subluxations and Dislocations of the Shoulder. In: Rockwood CA, Green DP (eds.). Fractures in Adults. 2nd edn. Lippincott, Philadelphia 1984; 807 - 856
• 25 Rockwood C A, Matsen III F A. The Shoulder. 2nd edn. WB Saunders Comp, Philadelphia 1990
• 26 Rowe C R, Patel D, Southmayed W N. The Bankart Procedure.  J Bone Joint Surg [Am]. 1978;  60 1-16
• 27 Schneeberger A G, Hersch O, Gerber C. Die instabile Schulter. Klassifikation und Therapie.  Unfallchirurg. 1998;  101 226-231
• 28 Simonet W T, Cofield R H. Prognosis in anterior shoulder dislocation.  Am J Sports Med. 1984;  12 19-23
• 29 Steinbeck J, Jerosch J. Die offene Bankart-Operation mit Nahtankern als Therapie der posttraumatischen vorderen Schulterinstabilität. 2-5 Jahres-Ergebnisse.  Unfallchirurg. 1997;  100 938-942
• 30 Weinstabl R, Huber G, Kropik K, Khakpour Z, Barisani G R, Fialka C, Krosel P. Biomechanik der Schulter und ihre therapeutische Anwendung.  Radiologe. 1996;  36 981-990
• 31 Vécsei V, Poigenfürst J, Zöch G. Ergebnisse der Bankartschen Operation bei rezidivierender Schulterluxation.  Unfallchirurgie. 1982;  8 200-204