BACKGROUND Recurrent anterior shoulder instability is a common traumatic injury,the main clinical manifestation of which is recurrent anteroinferior dislocation of the humeral head.The current follow-up study showed t...BACKGROUND Recurrent anterior shoulder instability is a common traumatic injury,the main clinical manifestation of which is recurrent anteroinferior dislocation of the humeral head.The current follow-up study showed that the effect of arthroscopic Bankart repair is unreliable.AIM To evaluate the clinical efficacy of arthroscopy with subscapularis upper one-third tenodesis for treatment of anterior shoulder instability,and to develop a method to further improve anterior stability and reduce the recurrence rate.METHODS Between January 2015 and December 2018,male patients with recurrent anterior shoulder instability were selected.One hundred and twenty patients had a glenoid defect<20%and 80 patients had a glenoid defect>20%.The average age was 25 years(range,18–45 years).Patients with a glenoid defect<20%underwent arthroscopic Bankart repair with a subscapularis upper one-third tenodesis.The patients with a glenoid defect>20%underwent an arthroscopic iliac crest bone autograft with a subscapularis upper one-third tenodesis.All patients were assessed with Rowe and Constant scores.RESULTS The average shoulder forward flexion angle was 163.6°±8.3°and 171.8°±3.6°preoperatively and at the last follow-up evaluation,respectively.The average external rotation angle when abduction was 90°was 68.4°±13.6°and 88.5°±6.2°preoperatively and at the last follow-up evaluation,respectively.The mean Rowe scores preoperatively and at the last follow-up evaluation were 32.6±3.2 and 95.2±2.2,respectively(P<0.05).The mean Constant scores preoperatively and at the last follow-up evaluation were 75.4±3.5 and 95.8±3.3,respectively(P<0.05).No postoperative dislocations were recorded by the end of the follow-up period.CONCLUSION Arthroscopy with subscapularis upper one-third tenodesis was effective for treatment of recurrent anterior shoulder instability independent of the size of the glenoid bone defect,enhanced anterior stability of the shoulder,and did not affect postoperative range of motion of the affected limb.展开更多
Objective: To clarify the indications and to describe the surgical technique and outcomes of surgery involving transfer of the trapezius to the deltoid for the treatment of lesions of the brachial plexus in patients w...Objective: To clarify the indications and to describe the surgical technique and outcomes of surgery involving transfer of the trapezius to the deltoid for the treatment of lesions of the brachial plexus in patients with multidirectional instability in the shoulder. Method: In 17 patients (mean age, 23 years) operated at Sao Vicente de Paulo Hospital and the Institute of Orthopedics and Traumatology of Passo Fundo, Brazil from?1999 to 2009, we performed trapezius transfer to the proximal humerus. In these patients, the mean interval between trauma and surgery was 8 months. Results: Functional improvement and resolution of multidirectional instability of the shoulder were observed in all the patients. No patient showed immediate postoperative complications. The mean active mobility was as follows: 95° flexion, 50° abduction, 45° external rotation, and internal rotation at the level of the first lumbar vertebra (L1). The trapezius muscle strength was classified as grade III, and the UCLA functional outcome was 22 points. The postoperative satisfaction was excellent, and occasional pain and weakness was reported by all the patients. Conclusions: Transfer of the trapezius muscle to the proximal humerus provides better results in patients with a more than 6-month-old lesion. This procedure also preserves passive mobility of the limb, confers shoulder stability, provides active mobility, and prevents osteoarthrosis.展开更多
文摘BACKGROUND Recurrent anterior shoulder instability is a common traumatic injury,the main clinical manifestation of which is recurrent anteroinferior dislocation of the humeral head.The current follow-up study showed that the effect of arthroscopic Bankart repair is unreliable.AIM To evaluate the clinical efficacy of arthroscopy with subscapularis upper one-third tenodesis for treatment of anterior shoulder instability,and to develop a method to further improve anterior stability and reduce the recurrence rate.METHODS Between January 2015 and December 2018,male patients with recurrent anterior shoulder instability were selected.One hundred and twenty patients had a glenoid defect<20%and 80 patients had a glenoid defect>20%.The average age was 25 years(range,18–45 years).Patients with a glenoid defect<20%underwent arthroscopic Bankart repair with a subscapularis upper one-third tenodesis.The patients with a glenoid defect>20%underwent an arthroscopic iliac crest bone autograft with a subscapularis upper one-third tenodesis.All patients were assessed with Rowe and Constant scores.RESULTS The average shoulder forward flexion angle was 163.6°±8.3°and 171.8°±3.6°preoperatively and at the last follow-up evaluation,respectively.The average external rotation angle when abduction was 90°was 68.4°±13.6°and 88.5°±6.2°preoperatively and at the last follow-up evaluation,respectively.The mean Rowe scores preoperatively and at the last follow-up evaluation were 32.6±3.2 and 95.2±2.2,respectively(P<0.05).The mean Constant scores preoperatively and at the last follow-up evaluation were 75.4±3.5 and 95.8±3.3,respectively(P<0.05).No postoperative dislocations were recorded by the end of the follow-up period.CONCLUSION Arthroscopy with subscapularis upper one-third tenodesis was effective for treatment of recurrent anterior shoulder instability independent of the size of the glenoid bone defect,enhanced anterior stability of the shoulder,and did not affect postoperative range of motion of the affected limb.
文摘Objective: To clarify the indications and to describe the surgical technique and outcomes of surgery involving transfer of the trapezius to the deltoid for the treatment of lesions of the brachial plexus in patients with multidirectional instability in the shoulder. Method: In 17 patients (mean age, 23 years) operated at Sao Vicente de Paulo Hospital and the Institute of Orthopedics and Traumatology of Passo Fundo, Brazil from?1999 to 2009, we performed trapezius transfer to the proximal humerus. In these patients, the mean interval between trauma and surgery was 8 months. Results: Functional improvement and resolution of multidirectional instability of the shoulder were observed in all the patients. No patient showed immediate postoperative complications. The mean active mobility was as follows: 95° flexion, 50° abduction, 45° external rotation, and internal rotation at the level of the first lumbar vertebra (L1). The trapezius muscle strength was classified as grade III, and the UCLA functional outcome was 22 points. The postoperative satisfaction was excellent, and occasional pain and weakness was reported by all the patients. Conclusions: Transfer of the trapezius muscle to the proximal humerus provides better results in patients with a more than 6-month-old lesion. This procedure also preserves passive mobility of the limb, confers shoulder stability, provides active mobility, and prevents osteoarthrosis.
