Criteria for arthroscopic treatment of anterior instability of the shoulder

Abstract

We prospectively evaluated 61 patients treated arthroscopically for anterior instability of the shoulder at a mean follow-up of 44.5 months (24 to 100) using the Rowe scale. Those with post-operative dislocation or subluxation were considered to be failures. Logistic regression analysis was used to identify patients at increased risk of recurrence in order to develop a suitable selection system. The mean Rowe score improved from 45 pre-operatively to 86 at follow-up (p < 0.001). At least one episode of post-operative instability occurred in 11 patients (18%), although their stability improved (p = 0.018), and only three required revision. Subjectively, eight patients were dissatisfied. Age younger than 28 years, ligamentous laxity, the presence of a fracture of the glenoid rim involving more than 15% of the articular surface, and post-operative participation in contact or overhead sports were associated with a higher risk of recurrence, and scored 1, 1, 5 and 1 point, respectively. Those patients with a total score of two or more points had a relative risk of recurrence of 43% and should be treated by open surgery.

Neer Modification of Open Bankart Procedure: What are the Rates of Recurrent Instability, Functional Outcome, and Arthritis?

“…In addition, eight patients (13%) had persistent apprehension or pain with an anterior apprehension test. Several poor prognostic factors for recurrent instability after an open Bankart repair have been described [8,10,12,22,26,37,39,58]. In our series, patients younger than 25 years showed a trend for a higher risk of recurrence.…”

Latarjet/Bristow Procedure: Indications, Techniques, and Outcomes

“…The rationale for this indication is to reconstruct the glenoid surface with the coracoid. There is not clear consensus on the minimum size of the bony lesion to indicate the procedure, but we found that glenoid loss of more than 15 % of the inferior glenoid diameter represents a superior risk of postoperative recurrence after shoulder stabilization with arthroscopic Bankart [8].…”

Luxação recidivante do ombro: aspectos do período entre o primeiro episódio e o tratamento cirúrgico

“…Boileau et al (4) , em seu trabalho de 2006, observaram que os fatores que predispõem à recidiva pós-operatória são perda óssea substancial, seja no úmero ou na cavidade glenoidal, e distensão capsular provocada por repetidos episó-dios de luxação (Figuras 4 e 5). Outros autores também têm demonstrado que a erosão na borda anteroinferior da cavidade glenoidal é um fator importante no aumento da taxa de recidiva dos pacientes operados por luxação recidivante traumática anterior do ombro (4,(13)(14)(15)(16) . Em nosso estudo, os pacientes apresentavam em mé-dia 18 episódios de luxação no momento da cirurgia, que julgamos ser um número elevado e injustificável de episódios para uma afecção que tem sua indicação cirúrgica classicamente orientada após o seu segundo episódio.…”