[Treatment of anterior glenohumeral instability: personal experience with an arthroscopic stabilization technique, its indications and results].

PURPOSE OF THE STUDY

Arthroscopic treatment of anterior post-traumatic instability of the glenohumeral joint is a recent surgical procedure. The aim of this study was to evaluate the outcomes of the method and define criteria on which indications for this treatment are based.

MATERIAL

Fifty-six active, young patients less than 30 years of age were distributed into three groups according to the method of treatment. Twenty patients were treated conservatively (group A), 12 patients had open surgery (B) and 23 patients underwent arthroscopic stabilization of the glenohumeral joint (C). The average follow-up periods in groups A, B and C were 26, 38 and 18 months, respectively. The treatment of all patients in groups B and C was preceded by physical therapy lasting at least 3 months. Contraindications to arthroscopic treatment included Hill-Sachs bony defects, instability involving a fracture of the glenoid cavity, conditions after previous surgery, posterior or multidirectional instability and anterior instability due to a full rupture of the rotator cuff.

METHODS

Conservative treatment consisted of early closed reduction, 3 to 4 weeks of immobilization and subsequent physical therapy. Open procedures for Bankart lesions were carried out according to either Cave and Rowe or Bristow, with post-operative immobilization for 4 weeks. Arthroscopic stabilization was performed by the Wolf method. After the size of the defect had been identified, the glenoid rim was scratched to bleed, the detached labrum, including the inferior glenohumeral ligament, was mobilized and, after drilling holes in the glenoid rim, the capsulolabral complex was fixed by means of a Mitek GII anchor with a 1-0 PDS fibre. Three anchors were inserted as a rule. In each group, the number of recurrent dislocations was recorded. In the patients undergoing surgery, the loss of passive external rotation in 90 degrees abduction was assessed and the outcome was evaluated according to the Rowe rating system.

RESULTS

Recurrent dislocations were experienced by 13 patients (65%) in group A and two patients (8.7%) in group C; no recurrent dislocation occurred in group B patients. The average loss of external rotation in 90 degrees abduction was 11.3 degrees and 6.7 degrees in groups B and C, respectively. The Rowe scores showed an excellent outcome in 80%, good in 8%, satisfactory in 2% and poor outcomes in 10% of the group B patients; in group C 78% had excellent, 7% had good, 8% had satisfactory, and 7% had poor outcomes.

DISCUSSION

The number of recurrent dislocations (8.7%) in our patients treated by arthroscopy was in agreement with the literature data (1 to 40%); both figures refer to recurrent dislocations in subjects involved in body-contact sports. In our patients treated by arthroscopy, the average post-operative loss of external rotation in 90 degrees abduction was lower than in the open surgery group. There were no differences in the Rowe scores between the two surgically treated groups. The patients treated conservatively showed a high number of recurrent dislocations (65%), thus confirming reports by other authors on the failure of this method.

CONCLUSIONS

The arthroscopic treatment of anterior post-traumatic glenohumeral instability, using the Wolf method, resulted in a reduction of recurrent dislocations, supposing indication criteria were observed. Its outcomes were comparable with the results of conventional open surgery.