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Treatment of Anterior Instability of the Shoulder
Objectives: The aim of this study is to compare the long term results of the treatment of anterior instability of the shoulder.
Material and method: The study included a total of 37 patients diagnosed with anterior instability of the shoulder, on the basis of clinical data (anamnesis, physical examination) and imaging (X-rays, MRI examination), operated in the Department of Orthopedics and Traumatology – Emergency University Hospital Bucharest, Romania, between 2009-2012. They were divided in 3 groups, according to the surgical technique used (open Bankart, arthroscopic Bankart and Bristow procedure), and the results were evaluated at 2 years postoperatively using Rowe and Constant scores. Statistical analysis was performed using one-way ANOVA test.
Results: There were no intra- or postoperative complications. No reluxations were recorded. Statistically significant differences (F> Fcrit; p <0.05) of the Constant score were recorded between the three groups on the range of movement variable, especially external rotation, their mean values being higher in the group treated arthroscopically compared to the other two groups.
Conclusions: Arthroscopic shoulder stabilization surgery gives the best long time results in terms of functional recovery of the shoulder, objectified by Constant and Rowe scores. Data from the literature show a higher rate of recurrence after arthroscopic interventions, suggesting that the indications of this technique still requires further clarifications. It’s required a more precise preoperative evaluation, in order to detect any lesions associated with Bankart lesion (bone defects of the anterior rim of glenoid, Hill-Sachs lesion, capsular laxity, rotator cuff tears, long head of biceps injuries). Mastering a surgical techniques is not always enough in order to obtain the best results. The choice of proper surgical technique for each patient, however, can significantly reduce the recurrence rate of shoulder dislocation.
Keywords: anterior instability of the shoulder, Bankart lesion, shoulder arthroscopy