The Journal of Bone and Joint Surgery 82:991 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.
Arthroscopic Treatment of Anterior-Inferior Glenohumeral Instability
Two to Five-Year Follow-up*
Gary M. Gartsman, M.D. ,
Toni S. Roddey, Ph.D., P.T., O.C.S. and
Steven M. Hammerman, M.D.
Investigation performed at the Texas Orthopedic Hospital,
Houston, Texas
*No benefits in any form have been received or will be received
from a commercial party related directly or indirectly to the subject
of this article. Funds were received in total or partial support
of the research or clinical study presented in this article. The
funding source was a grant from Columbia/HCA and Texas Orthopedic
Hospital.
Texas Orthopedic Hospital, Fondren Orthopedic Group, 7410 South
Main Street, Houston, Texas 77030. E-mail address for G. M. Gartsman: garyg{at}onramp.net
Texas Woman's University, 1130 M. D. Anderson Boulevard, Houston,
Texas 77030.
Background: Previous studies on arthroscopic
treatment of anterior-inferior glenohumeral instability have focused
on the repair of lesions of the anterior-inferior aspect of the
labrum (Bankart lesions) and have demonstrated failure rates of
as high as 50 percent. The current investigation supports the concept
that anterior-inferior instability is associated with multiple lesions
and that success rates can be increased by treating all of the lesions
at the time of the operation. We present the results of arthroscopic
treatment of anterior-inferior glenohumeral instability after a
minimum duration of follow-up of two years.
Methods: The study group consisted of fifty-three
patients who had a mean age of thirty-two years (range, fifteen
to fifty-eight years) at the time of the operation. There were forty-four
male and nine female patients. The mean interval from the time of
the operation to the final follow-up evaluation was thirty-three
months (range, twenty-six to sixty-three months). The scores on
the American Shoulder and Elbow Surgeons (ASES) Shoulder Index and
the rating systems of Constant and Murley, Rowe et al., and the
University of California at Los Angeles (UCLA) were recorded preoperatively and
at the time of the final follow-up.
Results: Preoperatively, none of the patients
had an overall rating of good or excellent according to the system of
Rowe et al.; however, 92 percent (forty-nine) of the fifty-three
patients had a rating of good or excellent at the time of the final
follow-up. The mean score improved from 45.5 points to 91.7 points
on the ASES Shoulder Index, from 56.4 points to 91.8 points with
the system of Constant and Murley, from 11.3 points to 91.9 points
with the system of Rowe et al., and from 17.6 points to 32.0 points
according to the UCLA Shoulder Score (p = 0.001 for all comparisons).
The mean passive external rotation with the shoulder in 90 degrees
of abduction measured 88.2 degrees. Thirty-four of thirty-eight
patients returned to their desired level of sports activity following
the operation. Four patients who had persistent instability were
considered to have had a failure of the index operation, and one
of them had a second operative procedure.
Conclusions: The results of the present study
suggest that our technique of arthroscopic treatment of anterior-inferior
glenohumeral instability is better than previous arthroscopic techniques
and is equivalent to open repair. We believe that the improved rate
of success demonstrated in the present study was the result of repair
not only of the anterior-inferior (Bankart) lesion but also (where
necessary) of inferior and superior labral tears. Additionally,
soft-tissue tension within the capsule and ligaments was corrected
with use of a suture technique but was supplemented by laser thermal
capsulorrhaphy in forty-eight of the fifty-three shoulders. Rotator
interval repair was considered a critical factor in fourteen of
the fifty-three shoulders.
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