Management Of Recurrent Anterior Instability Research Articles

Arthroscopic Anterior Shoulder Capsular Reconstruction Using Human Acellular Dermal Graft in Conjunction With Anatomic Glenoid Reconstruction

Capsular insufficiency of the shoulder associated with glenoid bone loss poses a major challenge to orthopaedic surgeons in the management of recurrent anterior instability. Multiple surgical techniques have been described in the literature with varying rates of success, and the majority of these are open techniques. We present a complete arthroscopic technique for anterior capsular reconstruction using acellular human dermal allograft patch in conjunction to an anatomic glenoid reconstruction using a distal tibial allograft in the lateral decubitus position. If the capsular insufficiency is determined irreparable after glenoid reconstruction, the acellular human dermal graft patch is prepared, inserted into the shoulder joint, and appropriately fixed using suture anchors on both glenoid and humerus, all through arthroscopic portals.

Arthroscopic Autologous Iliac Crest Bone Grafting for Reconstruction of the Glenoid: A Nonrigid Fixation Technique

Massive glenoid bone loss in recurrent anterior instability of the shoulder represents a surgical challenge. Some clinical trials have been published assessing the role of arthroscopic iliac crest bone grafting techniques for the management of recurrent anterior instability with glenoid bone loss. However, bone graft fixation is still controversial. We developed a method for anatomic reconstruction of anterior glenoid bone defects using autologous iliac crest graft. This technique is based on the assumption that anatomic restoration of glenoid depth and width is essential to restore stability to the shoulder.

Comparative study between open and arthroscopic surgical techniques in the management of recurrent anterior instability of the shoulder

Background: Present study was done to compare the effectiveness i.e. range of motion and incidence of failure rates, recurrence and pain of arthroscopic repair versus open surgical techniques for the management of recurrent anterior shoulder instability. Materials and Methods: Institution based open-label, comparative clinical study was done at Medical College and Hospital, Kolkata between March 2016 to August 2017 (1.5 years). Based on the result of a similar previous study, a sample size of 15 in each group was calculated. Therefore, 15 cases of anterior shoulder instability treated by arthroscopic method and 15 cases treated by open surgery have been selected for study. Inclusion criteria were patient with soft tissue Bankart’s lesion, bony Bankart’s lesion, humeral avulsion of glenohumeral ligament (HAGL), anterior labral posterior sleeve avulsion (ALPSA), glenoidlabrum and articular disruption and capsular stretch and injury. Study tools were used like Modified Rowe score, ASES (American Shoulder and Elbow Society) score and Goniometer. Operative techniques were used like arthroscopic capsulolabral repair and latarjet procedure. Results: About 14 (93.3%) patients were negative in bony apprehension test in arthroscopic technique. Approximately 15 (93.8%) patients were positive in bony apprehension test in Open technique. Association between bony apprehension test in two groups was not statistically significant (p difference was found between according to CT scan report in two groups (p=0.30910). Mean Rowe pain was significantly higher according in arthroscopic technique compare to open technique at 6W and 9W follow-up period. Mean Rowe stability was significantly higher according in arthroscopic technique compare to open technique at 6W and 9W follow-up period. Conclusion: Both arthroscopic and open surgical methods are utilized for management of anterior glenohumeral instability. The use of arthroscopy has increased significantly in today’s practice an

Open Instability Repair: The Anterior-Inferior Capsular Shift

Shoulder dislocations in the young patient have been shown to have a high risk of recurrent dislocation or symptomatic subluxation. Repeated episodes of instability can be disabling in the short term and lead to long term degenerative changes of the glenohumeral joint. The associated injuries involve an avulsion of the anterior-inferior glenoid labrum as well as deformation of the capsule. There is a higher rate of failure if these injuries are not addressed at the time of surgery. This article describes our technique of surgical management of recurrent anterior instability: the anterior-inferior capsular shift. This approach includes both capsular shift as well as reattachment of the displaced labrum. This technique allows for titration of the capsular plication for the individual patient.