Arthroscopic anterior shoulder stabilization in the shoulder instability

Abstract

Introduction: Arthroscopic shoulder stabilization is a widely accepted method. Very often, an arthroscopic treatment is preferred by patients and surgeons because it is minimally invasive, spares the subscapularis muscle, and because it enables better identification and treatment of associated pathological conditions, and decreases morbidity. The frequency of anterior shoulder instability is quite high, due to the anatomical and functional particularities of the shoulder, and the frequent reocurrences after orthopedic treatment of traumatic dislocation of the humerus especially in young people. The atroscopic method of treatment of this type of patology became standart practice and is fairly widespread. Arthroscopic surgery provides significantly higher advantages over traditional surgery, such as minimal tissue trauma, reduced intraoperative morbidity, and optimal functional and cosmetic results. Objective: Rate the postoperative results and arthroscopic treatment possibilities of patients with anterior shoulder instability in our clinic. Methods: Personal experience includes the treatment of 92 patients (82 men and 10 women, with the mean age of 27 years) on whom we performed arthroscopic stabilization of anterior shoulder instability between the years 2010-2015. The diagnosis was confirmed by clinical, radiological, ultrasound and MRI methods. We performed the reinsertion of anteriorinferior part of the glenoid labrum and joint capsule using bioresorbable anchors (13 patients), metal (40), unresorbable thread suture (39 patients). In 11 patients Bankart lesion was associated with the SLAP lesion, and fixation with an additional anchor was performed. Hill-Sachs lesion was found in 11 cases. Results: After surgery the patients were evaluated at an interval of 12 to 24 months using the Rowe and Zarins score. We obtained excellent or good results in 86 patients (76.5%), satisfactory - 5, unsatisfactory - 1 patient. Negative result we have found a year after surgery in a patient, who suffered a minor injury which caused the dislocation of the humerus and recidivism signs of instability. Conclusions: Arthroscopic treatment of anterior shoulder instability is a pretentious technique that requires advanced experience of orthopedic surgeons in arthroscopic surgery, providing good and very good functional and cosmetic results in most cases. The results depend on multiple factors, including age, participation in contact sports technical errors, bone defects, number of dislocations, type of anchors, the presence of Hill-Sachs lesion and the pre-operatory bone geometry.