A Prospective study on arthroscopic Bankart repair: differences in first time dislocators compared with multiple dislocators
Authors: V. Campagna, P.I. Falco, V. Piccinni, G. Minerva
References: SECEC, Rome 2005
AIMS: The purpose of this paper is to compare the outcomes to the kind of anatomic lesions of two groups of patients, affected by Bankart lesion, both repaired arthroscopically with same technique, the first one due to single dislocation and the second one by repetitive dislocations. In this group, the quality of the tissues and the presence of further lesions, not present in the first one, influenced the surgical steps.
MATERIAL: Twenty-five athletic patients, aged between 18 and 32, who underwent a primary shoulder dislocation that required manual reduction, were included to the first group, 25 patients with chronic instability, due to multiple episodes, to the second one. Exclusion criteria were the presence of concomitant bone fractures and neurologic injury, all the patients have been evaluated with preoperative MRI and with an appropriate score scale (Rowe). Rehabilitation starts from the 30th day: return to sports after six months.
RESULTS: The follow up has been from a minimum of twelve months to a maximum of four years. The average score of the first group preoperatively was 84 and postoperatively 98; in the second group the total score average changed from 75 to 92; none of the patients of the first group was affected by recurrence, but in one remained an anterior pain and subluxation (recurrence rate 0%, unsatisfied results 4%). In the second group, two patients had a recurrence (8%) and the unsatisfied outcomes (16%) were secondary to the sensation of non reliable shoulder (2 patients) and to subluxation (2 patients). The quality of the soft tissue appears different: in the first group the anatomical injured structures appeared more rich of a good blood supply, more “red”, more elastic, unretracted, with the sensation of a repair not of a reconstruction; an inflammation “healing” environment is maximised because the good “healthy conditions” of the injured tissue. In the second group the tissues were more pale, stiff, inelastic, of lower quality. Non engaging Hill-Sachs lesions were observed in the first group, but in the second one, 40% of the patients were affected by engaging Hill-Sachs lesion (10/25) and 16% presented a glenoid impact bony lesion (4/25) with a lack of the articular surface inferior to 20%.
CONCLUSION: Arthroscopic stabilisation of traumatic, first-time anterior shoulder dislocation is an effective and safe treatment, which reduces the recurrences rate of dislocations in young population compared with a delayed treatment after multi-episodes, where the recurrence rate is higher, the additional joint damage is always present, the quality of life is reduced.