[Post-traumatic anterior shoulder instability--arthroscopic stabilization method using bone anchors].
PURPOSE OF THE STUDY: To evaluate the short-term results of re-insertion of the ventral labrum associated with plication of the capsular structures in anterior post-traumatic instability of the shoulder. MATERIAL: The patients treated in our institution between April 2000 and December 2002 and followed up for periods ranging from 3 to 20 months were included. A total of 65 patients were treated for post-traumatic ventral instability. Open capsular shift, after a final evaluation of preoperative examination under total anesthesia and arthroscopic inspection of the labroligamentous complex affected, was used in four patients. Arthroscopic stabilization was carried out in 49 men and 12 women, aged 18 to 49 years (average, 28.5). These patients were allocated to groups according to the number of previous dislocations as follows: group 1 (24 patients), one to five dislocations; group 2 (27 patients) six to ten dislocations; and group 3 (10 patients) 11 and more dislocations. The glenohumeral joint was inspected arthroscopically to find out potential lesions and evaluate them in relation to the number of previous dislocations. METHODS: Stabilization was carried out by means of non-absorbable anchors. It involved re-insertion of the ventral labrum and plication of the ventral capsular structures. The patients were evaluated on the basis of a modified system of Rowe and Zarins. RESULTS: In group 1, the anterior labrum or capsule showed only isolated lesions; most injury-related lesions were found in group 3. With the increasing number of dislocations, there was an increase in associated findings and severity of injury to the labroligamentous complex. The average score before the operation was 37.87 points (range, 20 to 60). After rehabilitation was completed, 57 (93.44%) patients scored good or excellent (70 or more points), with 29 (47.54%) having over 90 points; only four (6.56%) patients scored less than 70 points. Fifty-seven patients resumed their previous sports and four patients carried on with recreational sports activities. DISCUSSION: Open stabilization has been reported as being slightly more effective in maintaining stability, as compared with arthroscopic procedures. The major advantages of arthroscopy include a good view of the intra-articular structures, minimal invasiveness and less restricted range of postoperative motion. However, the arthroscopic stabilization technique becomes more difficult with an increasing number of dislocations sustained before this procedure. The ventral structures of the shoulder joint, known as labroligamentous complex, should be regarded in their complexity and anterior stability should be achieved both by re-insertion or adaptation of the glenoid labrum and by stretching the capsular structures, particularly the inferior glenohumeral ligament. Studies reporting a high degree of recurrence after the initial dislocation in subjects aged 20 to 30 years are discussed. In top, active sportsmen and sportswomen, stabilization after the first dislocation followed by instability appears to be a very effective therapy. CONCLUSIONS: Arthroscopic stabilization with the use of non-absorbable anchors for the treatment of anterior post-traumatic instability of the humeral joint is a method that, in indicated cases assessed mainly by mobility of the labrum and laxity of the anterior capsule, shows a high success rate. Indications are based on medical histories, clinical and radiographic findings and, most importantly, clinical tests under total anesthesia and arthroscopic confirmation of lesions of the ventral structures of the joint.