Taha YİLDİZ, Egemen TURHAN, Durmus Ali OCGUDER, Gazi HURİ, İrem DÜZGÜN

OMUZ ANTERİOR KAPSÜLOLABRAL TAMİR YAPILAN BİREYLERDE CERRAHİ ÖNCESİ RİSK FAKTÖRLERİNİN FONKSİYONEL SONUÇLARA ETKİSİ

Giriş: Yetersiz fonksiyonel kapasite, omuz stabilizasyon cerrahisi yapılan bireylerde, cerrahi sonrası meydana gelen tekrarlı dislokasyonlar için önemli bir risk faktörüdür. Amaç: Cerrahi öncesi risk faktörlerinin, omuz stabilizasyon cerrahisi olan bireylerin fonksiyonel kapasitesine etkisini araştırmak. Yöntem: Çalışmaya artroskopik omuz anterior kapsülolabral tamiri (AOAKT) yapılan 24 birey dahil edildi (yaş: 18-51 yıl arası, boy: vücut ağırlığı:). Bireyler, cerrahi öncesi dislokasyon sayısına ve cerrahiye kadar geçen süreye göre 2 farklı şekilde gruplandırıldı. Cerrahiye kadar geçen süreye göre; erken tamir (6 aydan kısa sürede cerrahi olanlar, n=14) ve geç tamir (6 aydan daha uzun sürede cerrahi olanlar, n=12), dislokasyon sayısına göre: bir dislokasyon (n=8) ve çoklu dislokasyon (n=18) yaşayanlar. Bireylerin rotator kılıf kas kuvvetleri, cerrahi sonrası 6. ayda izokinetik sistem kullanılarak 60/sn ve 180/sn açısal hızlarda ölçüldü. Omuz eklem fonksiyonu kapalı kinetik halka üst ekstremite stabilizasyon (KKHÜST) testi kullanılarak test edildi. Oluşturulan gruplarda, kas kuvveti ve omuz fonksiyonu hem grup içi hem de gruplar arasında Will-Coxon ve Mann Whitney-U testleri ile ayrı ayrı analiz edildi. Bulgular: Geç cerrahi tamir yapılan bireylerde 60/sn (p=0,008) ve 180/sn (p=0,02) açısal hızlarda cerrahi yapılan tarafta, cerrahi yapılmayan tarafa göre eksternal rotator kas kuvveti daha düşüktü. Dislokasyon sayısına göre oluşturulan gruplamada ise, her iki grupta 60/sn ve 180/sn açısal hızlarda, cerrahi yapılan tarafta, cerrahi yapılmayan tarafa göre omuz internal rotator kas kuvveti daha düşüktü. Sonuç: Omuz instabilitesi olanlarda geç cerrahi tamir yapılması fonksiyonelliği negatif etkileyebilir. Erken cerrahi tamir yapılması ise daha hızlı toparlanmayı sağlar.

Anahtar Kelimeler:

Omuz instabilitesi, spora dönüş, rotator kılıf

The effects of Pre-operative Risk Factors on Functional Outcomes on Patients with Shoulder Stabilization Surgery

Abstract: Poor shoulder functional capacity is one of the risk factors for the re-dislocation after shoulder stabilization surgery. Aim: To investigate the effects of pre-operative risk factor on the functional capacity of the patients with shoulder stabilization surgery. Method: Twenty-four patients with arthroscopic anterior shoulder stabilization surgery (age: between 18-51 years, weight: height) (AASSS) were included to the study. Patients were divided into groups based the elapsed time until surgery; early repair (surgical repair within the six months after initial dislocation, n=14) or delayed repair (surgical repair after six months from the initial surgery, n=12), and number of pre-operative dislocations; one dislocation (n=8) or multiple dislocations (n=18). Rotator cuff strength were measured using isokinetic device at 60/sec and 180/sec angular velocities at the post-operative six months. Closed kinetic chain upper extremity stability test (CKCUEST) was use to assess the shoulder function. RC strength and shoulder function were analyzed using Wilcoxon and Mann-Whitney U test in both groups. Results: There were decreased RC strength on the operated side compared to the non-operated side at 60/sec (p=0,008) and 180/sec (p=0,02) angular velocities on patients with delayed repair. Internal rotator strength was decreased on the operated side compared to the non-operated side at 60/sec and 180/sec angular velocities on both one-time dislocation and multiple dislocation groups. Conclusion: Delayed surgical repair may affect negatively post-operative functional outcomes on patients with AASSS. In contrast, early surgical repair after the initial dislocation provide faster recovery.

Keywords:

shoulder instability, return to sport, rotator cuff,

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Referans1. Marshall T, Vega J, Siqueira M, Cagle R, Gelber JD, Saluan P. Outcomes After Arthroscopic Bankart Repair: Patients With First-Time Versus Recurrent Dislocations. The American journal of sports medicine. 2017;45(8):1776-82.
Referans2. Longo UG, van der Linde JA, Loppini M, Coco V, Poolman RW, Denaro V. Surgical Versus Nonoperative Treatment in Patients Up to 18 Years Old With Traumatic Shoulder Instability: A Systematic Review and Quantitative Synthesis of the Literature. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2016;32(5):944-52.
Referans3. Olds M, Ellis R, Donaldson K, Parmar P, Kersten P. Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis. British journal of sports medicine. 2015;49(14):913-22.
Referans4. Cordasco FA, Lin B, Heller M, Asaro LA, Ling D, Calcei JG. Arthroscopic shoulder stabilization in the young athlete: return to sport and revision stabilization rates. Journal of shoulder and elbow surgery. 2020;29(5):946-53.
Referans5. Memon M, Kay J, Cadet ER, Shahsavar S, Simunovic N, Ayeni OR. Return to sport following arthroscopic Bankart repair: a systematic review. Journal of shoulder and elbow surgery. 2018;27(7):1342-7.
Referans6. Gerometta A, Rosso C, Klouche S, Hardy P. Arthroscopic Bankart shoulder stabilization in athletes: return to sports and functional outcomes. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 2016;24(6):1877-83.
Referans7. Abdul-Rassoul H, Galvin JW, Curry EJ, Simon J, Li X. Return to Sport After Surgical Treatment for Anterior Shoulder Instability: A Systematic Review. The American journal of sports medicine. 2019;47(6):1507-15.
Referans8. Van der Linde JA, van Kampen DA, Terwee CB, Dijksman LM, Kleinjan G, Willems WJ. Long-term results after arthroscopic shoulder stabilization using suture anchors: an 8- to 10-year follow-up. The American journal of sports medicine. 2011;39(11):2396-403.
Referans9. Brophy RH, Marx RG. The treatment of traumatic anterior instability of the shoulder: nonoperative and surgical treatment. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2009;25(3):298-304.
Referans10. Shibata H, Gotoh M, Mitsui Y, Kai Y, Nakamura H, Kanazawa T, et al. Risk factors for shoulder re-dislocation after arthroscopic Bankart repair. Journal of orthopaedic surgery and research. 2014;9:53.
Referans11. Porcellini G, Campi F, Pegreffi F, Castagna A, Paladini P. Predisposing factors for recurrent shoulder dislocation after arthroscopic treatment. The Journal of bone and joint surgery American volume. 2009;91(11):2537-42.
Referans12. Randelli P, Ragone V, Carminati S, Cabitza P. Risk factors for recurrence after Bankart repair a systematic review. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 2012;20(11):2129-38.
Referans13. Zhu W, Lu W, Zhang L, Han Y, Ou Y, Peng L, et al. Arthroscopic findings in the recurrent anterior instability of the shoulder. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie. 2014;24(5):699-705.
Referans14. Gasparini G, De Benedetto M, Cundari A, De Gori M, Orlando N, McFarland EG, et al. Predictors of functional outcomes and recurrent shoulder instability after arthroscopic anterior stabilization. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 2016;24(2):406-13.
Referans15. Wilk KE, Macrina LC. Nonoperative and postoperative rehabilitation for glenohumeral instability. Clinics in sports medicine. 2013;32(4):865-914.
Referans16. Adam M, Attia AK, Alhammoud A, Aldahamsheh O, Al Ateeq Al Dosari M, Ahmed G. Arthroscopic Bankart repair for the acute anterior shoulder dislocation: systematic review and meta-analysis. International orthopaedics. 2018;42(10):2413-22.
Referans17. Bigoni M, Gorla M, Guerrasio S, Brignoli A, Cossio A, Grillo P, et al. Shoulder evaluation with isokinetic strength testing after arthroscopic rotator cuff repairs. Journal of shoulder and elbow surgery. 2009;18(2):178-83.
Referans18. Westrick RB, Miller JM, Carow SD, Gerber JP. Exploration of the y-balance test for assessment of upper quarter closed kinetic chain performance. International journal of sports physical therapy. 2012;7(2):139-47.
Referans19. Tucci HT, Martins J, Sposito Gde C, Camarini PM, de Oliveira AS. Closed Kinetic Chain Upper Extremity Stability test (CKCUES test): a reliability study in persons with and without shoulder impingement syndrome. BMC musculoskeletal disorders. 2014;15:1.
Referans20. Lädermann A, Denard PJ, Tirefort J, Kolo FC, Chagué S, Cunningham G, et al. Does surgery for instability of the shoulder truly stabilize the glenohumeral joint?: A prospective comparative cohort study. Medicine. 2016;95(31):e4369.
Referans21. Smith RL, Brunolli J. Shoulder kinesthesia after anterior glenohumeral joint dislocation. Physical therapy. 1989;69(2):106-12.
Referans22. Edouard P, Degache F, Beguin L, Samozino P, Gresta G, Fayolle-Minon I, et al. Rotator cuff strength in recurrent anterior shoulder instability. The Journal of bone and joint surgery American volume. 2011;93(8):759-65.