Outcome after failed traumatic anterior shoulder instability repair with and without surgical revision.

The purpose of this study was to evaluate the incidence and reasons of recurrent instability in patients with traumatic anterior shoulder instability and to document the clinical results with regard to the number of stabilizing procedures. Twenty-four patients with failed primary open or arthroscopic anterior shoulder stabilization were followed for a mean of 68 (36-114) months. Following recurrence of shoulder instability, eight patients chose not to be operated on again, whereas 16 underwent repeat stabilization. A persistent or recurrent Bankart lesion was found in all 16 patients and concomitant capsular redundancy in 4. After the first revision surgery, further instability occurred in 8 patients, and 6 of them were stabilized a third time. Only 7 patients (29%) achieved a good or excellent result according to the Rowe score. All shoulder scores improved after revision stabilization. However, the number of stabilizing procedures adversely affected the outcome scores, as well as postoperative range of motion and patient satisfaction. Recurrent instability after a primary stabilization procedure represents a difficult diagnostic and surgical challenge, and careful attention should be paid to address persistent or recurrent Bankart lesions and concomitant capsular reduncancy. A satisfying functional outcome can be expected mainly in patients with one revision surgery. Further stabilization attempts are associated with poorer objective and subjective results.

The influence of arthroscopic subscapularis tendon and anterior capsular release on glenohumeral translation: a biomechanical model.

The effect of an arthroscopic release of the intraarticular portion of the subscapularis tendon and the anterior capsule on glenohumeral translation was investigated in a cadaveric model. Ten human cadaveric shoulders with a mean age of 63.5 years (range, 52-79 years) were tested in a robot-assisted shoulder simulator. Joint translation was measured before and after an arthroscopic release of the intraarticular portion of the subscapularis tendon and a subsequent release of the anterior capsule at 0 degrees , 30 degrees , 60 degrees , and 90 degrees of glenohumeral elevation. Translation was measured in the anterior, anterior-inferior, and inferior directions under 20 N of applied load. Testing of the specimen revealed that the release of the intraarticular portion of the subscapularis tendon and the anterior capsule increased translation in all directions. Significant increases in translation were observed after release of the intraarticular portion of the subscapularis tendon in the midrange of motion. The influence of the arthroscopic capsular release, in conjunction with the release of the subscapularis tendon, was very high above 60 degrees of elevation. The study indicates that the intraarticular component of the subscapularis tendon functions as a restraint to anterior-inferior translation primarily in the midrange of glenohumeral motion, whereas the anterior capsule adds anterior-inferior stability to the glenohumeral joint mainly above 60 degrees of elevation.

Proprioception of the shoulder joint after surgical repair for Instability: a long-term follow-up study.

BACKGROUND: Proprioceptive capabilities play an important role in stability of the shoulder joint. HYPOTHESIS: Decreased proprioceptive capabilities can improve by surgical repair of shoulder instability. STUDY DESIGN: Prospective long-term study. METHODS: The proprioceptive capabilities of 14 patients with recurrent anterior shoulder instability were examined preoperative and with a minimum follow-up of 5 years postoperative using the angle reproduction test. The patients' data were compared to a healthy control group. RESULTS: The joint position sense improved significantly in abduction, flexion, and rotation (P <.05). The preoperative difference from the target joint position was 9.3 degrees (SD, 4.6 degrees ) for the summarized positions in abduction, 9.1 degrees (SD, 4.5 degrees ) in flexion, and 10.1 degrees (SD, 5.1 degrees ) in rotation. Postoperatively, it improved to 5.6 degrees (SD, 2.9 degrees ) in abduction, 5.6 degrees (SD, 2.7 degrees ) in flexion, and 5.0 degrees (SD, 1.8 degrees ) in rotation. The joint position sense of the uninvolved contralateral shoulder improved too. CONCLUSIONS: Five years after surgical repair for shoulder instability, the joint position sense improved significantly, to a level of normal, healthy shoulders.