Muhammed Çağatay ENGİN, Mehmet KÖSE, Serdar TOY, Mehmet Cenk TURGUT

Differences in the arthroscopic treatment of anterior and posterior shoulder instability in long-term follow-up

Background: Shoulder dislocations are frequent orthopedic injuries encountered in emergency services. Increasing the arthroscopic experience of physicians and developing technology has left the place of open surgical repair to arthroscopic reconstruction procedures. This study aimed to examine the results of arthroscopic reconstruction procedures for anterior and posterior shoulder instability.Methods: In this study, 89 patients diagnosed with shoulder instability and treated arthroscopically in our clinic between January 1, 2013, and September 1, 2020, postoperative range of motion and functional results are evaluated with Rowe and WOSI scores.Results: Fifty-seven of 89 patients had anterior, and 32 patients had posterior glenohumeral instabilities. In our study, 14 patients (15.7%) were under 20 years old, 55 patients (61.8%) between 21-30 years, 16 patients (18.0%) between 31-40 years, and 4 patients (4.5%) over 40 years. A total of 72 males (80.9%) were included in the study, with 17 females (19.1%). In the postoperative period, the mean shoulder joint flexion of all patients was recorded as 166.6 degrees, internal rotation 79.8 degrees, and external rotation was 79.9 degrees. The mean preoperative total WOSI score of all patients was 1062.6, whereas this score was 150.7 postoperatively. According to the Rowe score, there were poor results in all patients in the preoperative period, whereas the Rowe score of 70 patients was excellent; three patients were good, 11 patients were moderate, and five patients were poor in the postoperative period.Conclusions: Arthroscopic treatment of glenohumeral instability could provide predictable success in unidirectional shoulder instability.

Keywords:

Glenohumeral Instability, Arthroscopy, Shoulder, Dislocation,

PDF

___

1. Veeger HE, van der Helm FC. Shoulder function: the perfect compromise between mobility and stability. J Biomech. 2007;40(10):2119-29.
2. Peltz CD, Zauel R, Ramo N, Mehran N, Moutzouros V, Bey MJ. Differences in glenohumeral joint morphology between patients with anterior shoulder instability and healthy, uninjured volunteers. J Shoulder Elbow Surg. 2015;24(7):1014-20.
3. US Bone and Joint Decade. The burden of musculoskeletal diseases in the United States. 2nd ed Rosemont, Illinois: American Academy of Orthopedic Surgeons; 2010.
4. Robinson C, Dobson R. Anterior instability of the shoulder after trauma. J Bone Joint Surg Br. 2004;86(4):469-79.
5. Owens MBD, Duffey ML, Nelson LBJ, DeBerardino LTM, Mountcastle SB. The incidence and characteristics of shoulder instability at the United States Military Academy. Am J Sports Med. 2007;35(7):1168-73.
6. Shah R, Chhaniyara P, Wallace WA, Hodgson L. Pitch-side management of acute shoulder dislocations: a conceptual review. BMJ Open Sport Exerc Med. 2017;2(1):e000116.
7. Lanzi Jr JT, Chandler PJ, Cameron KL, Bader JM, Owens BD. Epidemiology of posterior glenohumeral instability in a young athletic population. Am J Sports Med. 2017;45(14):3315-21.
8. Antoniou J, Duckworth DT, Harryman DT. Capsulolabral augmentation for the management of posteroinferior instability of the shoulder. J Bone Joint Surg Am. 2000;82(9):1220-.
9. Aydin N, Enes Kayaalp M, Asansu M, Karaismailoglu B. Treatment options for locked posterior shoulder dislocations and clinical outcomes. EFORT Open Rev. 2019;4(5):194-200.
10. Dekker TJ, Peebles LA, Goldenberg BT, Millett PJ, Bradley JP, Provencher MT. Location of the glenoid defect in shoulders with recurrent posterior glenohumeral instability. Am J Sports Med. 2019;47(13):3051-6.
11. Smith BI, Bliven KC, Morway GR, Hurbanek JG. Management of primary anterior shoulder dislocations using immobilization. J Athl Train. 2015;50(5):550-2.
12. Whelan DB, Kletke SN, Schemitsch G, Chahal J. Immobilization in External Rotation Versus Internal Rotation After Primary Anterior Shoulder Dislocation: A Meta-analysis of Randomized Controlled Trials. Am J Sports Med. 2016;44(2):521-32.
13. Ikemoto RY, Murachovsky J, Nascimento LGP, Bueno RS, Almeida LHO, Kojima C. Evaluation of surgical treatment of patients with shoulder instability. Acta Ortop Bras. 2017;25:266-9.
14. Wolf BR, Tranovich MA, Marcussen B, Powell KJ, Fleming JA, Shaffer MA. Team Approach: Treatment of Shoulder Instability in Athletes. JBJS Rev. 2021;9(11):e21.
15. Postacchini F, Gumina S, Cinotti G. Anterior shoulder dislocation in adolescents. J Shoulder Elb Surg. 2000;9(6):470-4.
16. Robinson CM, Seah M, Akhtar MA. The epidemiology, risk of recurrence, and functional outcome after an acute traumatic posterior dislocation of the shoulder. J Bone Joint Surg Am. 2011;93(17):1605-13.
17. Garofalo R, Mocci A, Moretti B, Callari E, Di Giacomo G, Theumann N, et al. Arthroscopic treatment of anterior shoulder instability using knotless suture anchors. Arthroscopy. 2005;21(11):1283-9.
18. Cole BJ, L’insalata J, Irrgang J, Warner JJ. Comparison of arthroscopic and open anterior shoulder stabilization: a two to six-year follow-up study. J Bone Joint Surg Am. 2000;82(8):1108.
19. Yan H, Cui GQ, Wang JQ, Yin Y, Tian DX, Ao YF. Arthroscopic Bankart repair with suture anchors: results and risk factors of recurrence of instability. Zhonghua Wai Ke Za Zhi. 2011;49(7):597-602.
20. Iwaso H, Uchiyama E, Sakakibara S, Fukui N. Modified double-row technique for arthroscopic Bankart repair: surgical technique and preliminary results. Acta Orthop Belg. 2011;77(2):252-7.
21. Bottoni CR, Smith EL, Berkowitz MJ, Towle RB, Moore JH. Arthroscopic versus open shoulder stabilization for recurrent anterior instability: a prospective randomized clinical trial. Am J Sports Med. 2006;34(11):1730-7.
22. Mologne TS, Provencher MT, Menzel KA, Vachon TA, Dewing CB. Arthroscopic stabilization in patients with an inverted pear glenoid: results in patients with bone loss of the anterior glenoid. Am J Sports Med. 2007;35(8):1276-83.
23. Blomquist J, Solheim E, Liavaag S, Schroder CP, Espehaug B, Havelin LI. Shoulder instability surgery in Norway. Acta Orthop. 2012;83(2):165-70.
24. Meehan RE, Petersen SA. Results and factors affecting outcome of revision surgery for shoulder instability. J Shoulder Elbow Surg. 2005;14(1):31-7.