Non-anatomical Repair Research Articles

Arthroscopic Transtibial Medial Meniscus Posterior Root Repair Using the “Meniscal Track” to Locate the Anatomical Footprint

The medial meniscus posterior root tears are a common problem in early elder patients. From a biomechanical study, the anatomical repair demonstrated a restored contact area and contact pressure than the nonanatomical repair. Nonanatomical repair of the medial meniscus posterior root resulted in decreased tibiofemoral contact area and increased contact pressure. Various surgical repair techniques were reported in the literature. However, there was no reported precise arthroscopic landmark to define the anatomical footprint of the posterior root attachment of the medial meniscus. We propose the “meniscal track”, an arthroscopic landmark to guide the location of the anatomical footprint of the medial meniscus posterior root attachment.

Augmentation of a Nonanatomical Repair of a Medial Meniscus Posterior Root Tear With Centralization Using Three Knotless Anchors May Be Associated With Less Meniscal Extrusion and Better Compressive Load Distribution in Mid-Flexion Compared With Non-Anatomical Root Repair Alone in a Porcine Knee Model

To investigate the biomechanics of the centralization augmentation using knotless soft anchors to a nonanatomicaltranstibial pull-out root repair in a porcine medial meniscus posterior root tear (MMPRT) model. Porcine knee joints (N= 10) were used to perform one of the following procedures: (1) intact; (2) MMPRT; (3) nonanatomical root repair; (4) nonanatomical root repair with centralization using 2 anchors: anchors were inserted at the posterior medial collateral ligament (MCL) border and 10 mm anterior to the posterior MCL border; and (5) nonanatomical root repair with centralization using 3 anchors: another anchor was placed 10 mm posterior to the posterior MCL border. Contact area on the medial meniscus (MM), contact pressure in the MM and tibial cartilage, and MM extrusion were evaluated at 30°, 45°, 60°, and 90° knee flexions under 200 N compressive force. MM extrusion at the posterior MCL border was significantly reduced after root repair with centralization using 3 anchors than after root repair alone at 30° (-0.063 mm vs 1.5 mm, P= .017), 45° (0.21 mm vs 1.7 mm, P= .018), and 60° (0.78 mm vs 2.3 mm, P= .019). There were no significant differences in MM extrusion between the root repair alone and root repair with centralization using 2 anchors at all flexion angles. The contact area in the middle and posterior MM was significantly greater after centralization with 3 anchors than after root repair alone at all flexion angles (except the posterior MM at 90°). The mean contact pressure in the tibial cartilage was significantly lower after centralization with 3 anchors than after root repair at all angles. Augmentation of a nonanatomical repair of a medial meniscus posterior root tear with centralization using three knotless anchors may be associated with less meniscal extrusion and better compressive load distribution between 30° and 60° flexion compared with nonanatomical root repair alone in a porcine model. This biomechanical study at time zero suggests that the addition of centralization using 3 knotless anchors may reduce MM extrusion and restore the load-distributing function of the MM.

Non-Anatomic All-Inside Arthroscopic Anterior Talofibular Ligament Repair with a High Position Anchor Shows Inferior Clinical Outcomes: A 3D-CT Based Analysis in Chronic Ankle Instability Patients

Category: Arthroscopy; Sports Introduction/Purpose: In chronic ankle instability (CAI), it is important to repair the anterior talofibular ligament (ATFL) at the anatomic origin site. However, there are limited reports on the clinical outcomes according to anatomical ATFL repair. The purpose of this study is to compare the clinical outcomes after arthroscopic ATFL repair, according to whether the anchor is fixed at an anatomic position. Methods: We performed a retrospective review of consecutive patients who underwent arthroscopic ATFL repair for CAI and were available for a minimum of 2 years follow-up. The patients were divided into three groups according to the anchor position at the distal fibula on 3-dimensional computer tomography: group A, anatomical arthroscopic ATFL repair; group S, sub- anatomical arthroscopic ATFL repair; and group N, non-anatomical arthroscopic ATFL repair. The pain (visual analogue scale [VAS]) score, foot and ankle outcome score (FAOS), and the Karlsson ankle functional score were measured as subjective outcomes. Posturographic analysis and radiologic evaluation using stress radiographs and axial view magnetic resonance imaging were performed as objective outcomes. Results: Of 96 patients, 16 were excluded based on the exclusion criteria, and 80 were evaluated (group A, n = 24; group S, n = 42; and group N, n = 14). The mean age of the patients was 34.5 years, and the mean follow-up period was 27.4 months. A between-group comparison revealed significant differences in the FAOS, Karlsson score, and fall risk evaluated by posturography at the final follow-up. Post hoc analysis revealed that group A patients showed better clinical scores in the FAOS than group N patients in all five domains (all p < 0.017). Patients in groups A and S showed better Karlsson score and fall risk than those in group N (p = 0.004 and 0.013, respectively). In terms of objective outcomes, patients in groups A and S showed better outcomes in fall risk than those in group N (both p = 0.001). Conclusion: Non-anatomic ATFL repair showed inferior outcomes compared to anatomic ATFL repair. When performing arthroscopic ATFL repair, the anchor should be fixed in the anatomical position to improve prognosis.

Non-Anatomical Arthroscopic All-Inside Repair of Medial Meniscus Posterior Root Tear to Posterior Cruciate Ligament for Patients with Normal Lower Limb Alignment.

ObjectiveTo describe a non‐anatomical arthroscopic all‐inside repair of medial meniscus posterior root tear (MMPRT) to posterior cruciate ligament (PCL) technique for patients with normal lower limb alignment and to evaluate the short‐term clinical and radiologic outcomes.MethodsMMPRT directly to PCL was repaired with all‐inside horizontal mattress suturing technique rather than by the transtibial pullout suture technique or anchor suturing repair technique in 20 Laparade Type II MMPRT patients with normal lower limb alignment during 2018–2019. The clinical and radiological outcomes were evaluated retrospectively for at least 2 years follow‐up. The VAS score, Lysholm score, Tegner activity score were evaluated preoperatively and at the final follow‐up. The status of the medial meniscus posterior root were assessed on magnetic resonance imaging (MRI) preoperatively and at the final follow‐up.ResultsTwenty patients (mean age 54.5 ± 19.5 years) were included in the present study. The mean follow‐up duration was 32.5 ± 5.8 months. The VAS score was significantly decreased from preoperative 6.5 ± 1.5 to 2.1 ± 1.4 at the final follow‐up (P < 0.01). The mean Lysholm score was significantly improved from 43.7 ± 10.9 preoperatively to 85.7 ± 10.8 (P < 0.01). The median Tegner activity score was improved from 1.0 (range 1–4) to 3.0 (range 2–4, P < 0.01). On MRI, a total of 12 cases (60%) had complete healing, while eight cases (40%) had partial healing.ConclusionNon‐anatomical arthroscopic all‐inside repair of MMPRT to PCL may yield beneficial clinical outcomes and a higher rate of clinical healing in Type II MMPRT patients with normal lower limb alignment. It is an easy and reliable alternative technique to the transtibial pullout suture or anchor suture repair technique.

Clinical and Functional Comparison between Anatomical and Non-Anatomical Acute Repair of Tears of the Distal Tendon of Biceps Brachii

Clinical and Functional Comparison between Anatomical and Non-Anatomical Acute Repair of Tears of the Distal Tendon of Biceps Brachii

Meniscus Root Repair

Meniscal root tears defined as bony or soft tissue root avulsion injuries or radial tears within 1cm of the meniscal root attachment. If it is not treated properly can cause early development of osteoarthritis. The meniscal root tears leading to compromised hoop stress and decreased tibiofemoral contact area and increased contact pressures in the involved compartment. To confirm the diagnosis is through arthroscopic as a diagnostic and treatment and through magnetic resonance imaging. Not all meniscal root tears can be treated surgically, especially if they have multiple comorbidities or advanced age, severe osteoarthritis, non-symptomatic chronic meniscal root tears and significant mal-alignment of the affected compartment then the treatment of choice is to give a symptomatic treatment like non-steroid anti-inflammatory drug, and activity modification. Meniscectomy has been found to induce a high rate of arthritis progression postoperatively. There are two most common meniscal root repair techniques which are trans-tibial pullout repair and suture anchor repair that now preferred over meniscectomy. The most important thing to consider when repairing the meniscal root is the right anatomically repair. It has been proven that non-anatomical meniscal root repair will not able to restore to the normal function because the conversion of femorotibial loads into circumferential tension may be altered, with functional impairment of the knee. Anchor suture technique shows a greater degree of healing and better biomechanical outcome. The suture anchor technique uses “all-inside" fixation and avoids the need for a distal fixation which potentially places abrasive forces on the sutures used. The trans-tibial pullout repair can restore the attachment and contact pressure near normal value, also the tunnel drilling stimulating growth factors and progenitor cells from bone marrow and facilitate the ability of meniscus to convert axial load into hoop stress. The concern of trans-tibial pullout repair is its ‘bungee effect’ and repetitive loading resulted in the displacement of this repair complex and might compromise healing because of decreased stiffness and micromotion of the meniscus-suture complex.

A new modified technique in hernia repair in patients with decompensated cirrhosis and complicated hernia: single center experience

Patients with decompensated cirrhosis have a high incidence of abdominal wall hernias To evaluate the outcome of a new technique in the repair of complicated hernias in decompensated cirrhotic patients. Thirty decompensated cirrhotic patients underwent herniorraphy for complicated hernia. Patients were in G I (New technique:15): and II (non-anatomical repair, 15). Patients were followed for one year. Comparable between G I and II regarding age (48.27± 9.51vs. 44.33±9.98, P=0.279), sex [12 males (80%) vs. 12males (80%), P=1], grade of ascites [moderate: 3 (20%) vs. 11 (73.3%) and marked: 12 (80%) vs. 4 (26.6%), P=0.003]. Wound dehiscence and leakage (ascitic fluid) were significantly lower in group I [0% vs. 5 (33.3%), P=< 0.005 and 0% vs. 8 (53.3%), P=0.003, respectively]. In concern to morbidity there is significant difference between GI and II (negative in GI 11(73.3%) vs. 5(33.3%) in GII (P=0.028). The grade of ascites was reduced in GI vs. II [marked: 0% vs. 7 (46.7%), P=0.003]. Postoperative hematemesis was lower in GI {negative in 15(100%) in G I vs. 7(46.7%) in GII and P=0.003)}, and hospital stay was shorter in GI vs. II (6.5±4.0 vs. 12.8±3.0, P< 0.0001). Hernia recurrence was lower in GI at 6 and 12 months [no recurrence in GI 13 (86.67%) vs. G II 5 (35.7%), P=0.014. and no recurrence in GI, 11 (73.33%) vs. G II 4 (28.57%), P=0.011 respectively]. The new technique of hernia repair was associated with a significant reduction in wound leakage, dehiscence, hospital stay, morbidity and recurrence.

Stability of the ankle joint in anatomical or non-anatomical anterior talofibular ligament repair

Category: Ankle Introduction/Purpose: Chronic ankle instability (CAI) often needs surgical treatment if conservative treatment is ineffective. Recently, arthroscopic surgeries have become widely used to treat CAI. Although it is crucial to accurately ascertain the anterior talofibular ligament (ATFL) attachment site under arthroscopy, previous study showed that it might not be feasible to thoroughly observe the ATFL attachment site, and repair or reconstruction position were often unintentionally carried out proximal to the ATFL attachment site at the fibula as a result. Currently, there are few reports about stability of the ankle joint by different repair position of ATFL. The aim of this study was to evaluate the stability of the ankle joint by different repair position of ATFL. Methods: Six fresh-frozen human cadaveric ankles with the mean age of 83.5 ± 7.3 years were used. The ankles were tested using a six-degrees of freedom robotic system. The following ankle states were evaluated: intact, ATFL transection, ATFL anatomical repair, and ATFL non-anatomical repair. ATFL was transected at fibular attachment. Anatomical repair was performed at the center of original ATFL attachment of the fibula. Non-anatomical repair was set 8mm proximal from anatomical ATFL attachment of the fibula. At each state, laxity of anterior translation under 60 N load, inversion under 1.7 Nm load, and internal rotation under 1.7 Nm load were evaluated. Each test was performed at 30 degrees plantarflexion (PF), 15 degrees PF, 0 degree, and 15 degrees dorsiflexion (DF). The one-way repeated measures analysis of variance (ANOVA) with post hoc pairwise comparisons with Dunnett’s test was adopted. A P value of 0.05 was chosen as the level of significance. Results: Anterior translation under 60 N load was significantly increased in transection condition at 30 degrees PF compared with the intact condition (P=0.005). Anatomical repair and Non-anatomical repair did not show significant differences. Inversion under 1.7 Nm load was significantly increased in transection condition at 30 and 15 degrees PF compared with the intact condition (P=0.004, =0.049). Anatomical repair and Non-anatomical repair did not show significant differences. Internal rotation under 1.7 Nm load was significantly increased in transection condition at 30, 15 degrees PF and 0 degree compared with the intact condition (P&lt;0.001, &lt;0.001, and &lt;0.001). Although anatomical repair did not show significant differences, non-anatomical repair showed significant increase at 30 and 15 degrees compared with the intact condition (P=0.006, =0.026). (Fig. 1). Conclusion: Anatomical repair did not show significant difference in all three loads with the intact condition. In non-anatomical repair, anterior translation and inversion did not show significant difference, but internal rotation significantly increased at 30 and 15 degrees PF compared with the intact condition. Compared with anatomical repair, non-anatomical repair might become more vertical ligament running because its attachment site of the fibula was more proximal. This difference might affect stability of the ankle joint. Anatomical repair of the ATFL might be essential to obtain the stability of the ankle joint like the intact condition.

Distal Biceps Rupture—Achilles Augmentation Technique

The treatment of chronic distal biceps ruptures is challenging. Direct anatomical reinsertion is often difficult as a consequence of tendon retraction, muscle atrophy, and scar tissue. Nonanatomical repair is a controversial option. Repair and reinforcement with autografts or allografts is a reliable option. Achilles allograft has several advantages over other grafts. Indications to this procedure are discussed as well as surgical tips and tricks; in addition, outcomes and complications from the available literature are reported. The literature is lacking on this specific field. Only few case series describe surgical tips and report clinical outcomes. Good results are generally reported in terms of function and strength recovery bot in flexion and supination. Complications, mainly involving neurological problem, are similar to those observed in acute cases. Achilles tendon allograft is a reliable option to reinforce the anatomical repair of chronic distal biceps tendon ruptures. Proximal tendinous portion wraps biceps muscle to ensure solid interface. Distal calcaneus bone plug allows for bone-to-bone fixation. The choice of which is the best option for distal fixation and postoperative protocol are still debated issues.

Progress on diagnosis and treatment for chronic ankle instability

Chronic ankle instability is a common disease which is caused by missed diagnosis or inappropriate treatment of acute ankle sprain. It could lead to long-term pain, traumatic arthritis and malfunctions. While the consistent standard for its diagnosis and treatment has not yet formed. There are a lot of inspection items, such as X-ray, MRI, B ultrasoud. For the treatment of CAI, surgery is the primary method for treatment of chronic ankle instability, but clinicians may be confused with variety operation ways, which were reported with different clinical efficacy. In recent years, the non-anatomical repair has been turn to anatomy reconstruction in the surgical treatment of CAI.

Effect of standard physical therapy protocol on two different techniques of same non-anatomical latarjet repair procedure of anterior shoulder instability

Effect of standard physical therapy protocol on two different techniques of same non-anatomical latarjet repair procedure of anterior shoulder instability

Effect of Standard Physical Therapy Protocol on Two Different Techniques of Same Non-Anatomical Repair Procedure of Anterior Shoulder Instability

Effect of Standard Physical Therapy Protocol on Two Different Techniques of Same Non-Anatomical Repair Procedure of Anterior Shoulder Instability

해부학적 봉합이 불가능한 회전근 개 파열에서 관절경하 모서리 맞춤 술식을 이용한 봉합의 결과

Purpose: This study was performed to assess the usefulness of non-anatomical repair for irreparable large and massive rotator cuff tears by the arthroscopic margin convergence technique. Materials and Methods: Twenty-two patients were followed up more than 1 year after non-anatomical repair for irreparable large and massive rotator cuff tears using the arthroscopic margin convergence technique. The clinical evaluation was performed according to the KSS score, the UCLA score and the Visual analogue scale (VAS). The measurement of the acromio-humeral distance was performed using the shoulder anterior-posterior radiographs. The measurement of fatty degeneration and the healing status was performed using the shoulder MRI after 6 months. Results: Among twenty-two patients, follow up MRI was performed in eleven cases. Three cases were well healed, four cases were partial healed and another four cases were re-torn. The KSS and UCLA scores had significantly improved from a preoperative average of 45.0±8.014 and 10.8±2.302 points to 77.1±10.151 and 30.0±1.521 points, respectively, and the pain VAS had decreased from a preoperative average of 7.7±0.616 points to 3.0±1.021 points at the last follow up. Less favorable results were obtained when the patient had a grade of fatty degeneration higher than grade 3 on the preoperative MRI. Conclusion: Non-anatomical repair for irreparable large and massive rotator cuff tears by the arthroscopic margin convergence technique showed good functional results. It seems to be one of the effective treatment methods for irreparable large and massive rotator cuff tears.

Hemi-Castaing ligamentoplasty for the treatment of chronic lateral ankle instability: a retrospective assessment of outcome.

PurposeIn the treatment of chronic ankle instability, most non-anatomical reconstructions use the peroneus brevis tendon. This, however, sacrifices the natural ankle stabilising properties of the peroneus brevis muscle. The aim of this study was to evaluate the functional outcome of patients treated with a hemi-Castaing procedure, which uses only half the peroneus brevis tendon.MethodsWe performed a retrospective cohort study of patients who underwent hemi-Castaing ligamentoplasty for chronic lateral ankle instability between 1993 and 2010, with a minimum of one year follow-up. Patients were sent a postal questionnaire comprising five validated outcome measures: Olerud-Molander Ankle Score (OMAS), Karlsson Ankle Functional Score (KAFS), Tegner Activity Level Score (pre-injury, prior to surgery, at follow-up), visual analog scale on pain (VAS) and the Short Form 36 (SF-36).ResultsTwenty patients completed the questionnaire on functional outcome. The OMAS showed good to excellent outcome in 80% and the KAFS in 65%, the Tegner Score improved from surgery but did not reach pre-injury levels, the VAS on pain was 1 of 10 and the SF-36 returned to normal compared with the average population.ConclusionsEven though most patients were satisfied with the results, outcome at long-term follow-up was less favourable compared with the literature on anatomical reconstructions. In accordance with the literature, we therefore conclude that the initial surgical treatment of chronic lateral ankle instability should be an anatomical repair with augmentation (i.e. the Broström-Gould technique) and the non-anatomical repair should be reserved for unsuccessful cases after anatomical repair or in cases where no adequate ligament remnants are available for reconstruction.

Medial Patellofemoral Ligament Repair for Recurrent Patellar Dislocation

Background The medial patellofemoral ligament (MPFL) is the primary restraint to extreme lateral displacement and is typically disrupted with an acute lateral patellar dislocation. Patients who fail a comprehensive nonoperative program and experience recurrent lateral patellar instability episodes are candidates for surgical treatment. Current surgical procedures include a variety of proximal realignment techniques, including repair or reconstruction of the MPFL along with distal realignment of the tibial tubercle when indicated. Purpose The objective of this study was to review the clinical, functional, and radiographic outcomes of isolated MPFL repair for recurrent lateral patellar dislocation. Study Design Case series; Level of evidence, 4. Methods The records of all patients undergoing MPFL repair for recurrent patellar dislocation at the Mayo Clinic from 2001 to 2006 were retrospectively reviewed. Twenty-seven patients (29 knees) with an average age of 19 years (range, 11-32 years) were included in this study. Clinical, functional, and radiographic outcomes were assessed at an average of 4 years after surgery (range, 2-7 years), using recurrent instability as the primary end point. Results The success rate of MPFL repair for preventing recurrent dislocations was 72% (21 of 29 knees). Eight patients (28%) experienced a recurrent lateral patellar dislocation. Five of these patients required a reoperation, including two MPFL reconstructions, 1 tibial tubercle osteotomy with MPFL reconstruction, 1 tibial tubercle osteotomy with revision MPFL repair, and 1 revision MPFL repair. At final follow-up, the mean Lysholm and Kujala scores were 86 (range, 42-100) and 92 (range, 57-105), respectively. Postoperative radiographs revealed a mean patellofemoral congruence angle improvement of 27° (range, 5°-44°). The only statistically significant risk factor for failure was nonanatomical MPFL repair at the medial femoral condyle (P = .004). Conclusion Isolated repair of the MPFL for recurrent patellar instability is associated with a relatively high failure rate, but remains a viable surgical option if surgical technique principles are followed. The clinical success of this operation depends on restoration of the anatomical origin of the MPFL and careful patient selection.

Biomechanical and Biologic Augmentation for the Treatment of Massive Rotator Cuff Tears

Recent studies have reported that massive rotator cuff tears do not heal as predictably as, and may have diminished clinical outcomes compared with, smaller rotator cuff tears. An improved understanding of the biologic degeneration and the biomechanical alterations of massive rotator cuff tears should provide better strategies to optimize outcomes. The approach to patients with massive rotator cuff tears requires careful assessment of the patient and the extent of rotator cuff degeneration to determine the appropriate treatment. For a rotator cuff tear that is repairable, the goal is to produce a tension-free, anatomical repair that restores the footprint using soft tissue releases and various suturing techniques, including double-row, transosseous-equivalent suture bridges or the rip-stop stitch. For irreparable cuff tears, the surgeon may elect to proceed with 1 of 2 approaches: (1) palliative surgical treatment—that is, rotator cuff debridement, synovectomy, biceps tenotomy, tuberoplasty and/or nonanatomical repair with partial repair; or (2) salvage treatment with various tendon transfers. Even though the biomechanical constructs for rotator cuff repairs have been improved, the integrity of the repair still depends on biologic healing at the tendon-to-bone junction. There has been much interest in the development of a scaffold to bridge massive rotator cuff tears and adjuvant biologic modalities including growth factors and tenocyte-seeded scaffolds to augment tendon-to-bone healing. The treatment of rotator cuff disease has improved considerably, but massive rotator cuff tears continue to pose a challenging problem for orthopaedic surgeons.

Closed Tibialis Anterior Tendon Rupture: A Case Series

Closed tibialis anterior tendon rupture is an uncommon condition typically occurring in the middle aged to elderly patient. Diagnosis may be delayed due to unfamiliarity with the problem by the treating physician. We treated seven patients (4 males aged 54 to 80; 3 females aged 43 to 82) with this problem. Four patients had a history of systemic corticosteroid use and one had had a local steroid injection. Four of the seven patients were managed with direct operative repair and one with a non-anatomical repair to the talar neck. Two patients were managed non-operatively of whom one subsequently required late surgical reconstruction. Patients were reviewed clinically and completed a Foot and Ankle Outcome Score (FAOS). Followup ranged from 12 months to 12 years. In the operative group four patients had no functional limitations from the injury and one had mild ankle weakness. One in the nonoperative group required salvage surgery four years after rupture. At followup the mean FAOS was 85 (range, 64 to 98) in the operative group and 52 (range, 28 to 75) in the nonoperative group. A ruptured tibialis anterior tendon is a rare condition. There is an association with systemic steroid use as well as local steroid injection. Early diagnosis allows operative repair by various techniques leading to predictably good results. Our experience supports operative repair even in the elderly patient.

Anatomical Repair of the Distal Biceps Tendon Using the Tension-Slide Technique

Rupture of the distal biceps brachii tendon has received significant attention in the recent literature as a result of increased incidence, improvements in diagnosis, and the numerous methods of fixation. The current controversies that surround distal biceps repair include the following: single versus dual incision, anatomical footprint restoration versus nonanatomical repair, type of fixation, and the amount of restriction on early range of motion. We describe a modified cortical button repair, the tension-slide technique, which allows for a transverse anterior incision and the ability to tension the repair through the anterior incision. There is no need to pre-determine the length of suture between the button and the biceps, no suture diastasis between button and tendon, and eliminates the technical concern regarding the button flipping.

Traitement des instabilités antérieures de l’épaule par la technique de Bristow-Latarjet : résultats cliniques et radiologiques au recul moyen de 8,2 ans

We reviewed, at a mean follow-up of 8.2 years, clinical and radiographic results after 93 Bristow-Latarjet procedures for anterior instability of the shoulder. There were 84 men and nine female. The average age was 23 years at the time of operative intervention. Forty-four shoulders were on the dominant side. Eighty patients practiced sports activities, with 74 patients a risk sport. Seventy-seven patients have had five or more recurrent of dislocation of the shoulder. The operations were performed by a senior surgeon. Evaluation was done by a clinician, who did not perform the operation. Clinical outcome was assessed with the Duplay score, and the satisfaction of the patients. Radiographic evaluation was done using the standard radiography of the shoulder. According to the Duplay scoring system, we have had 30.1% of excellent results, 43% of good results, 16.1% of fair results, and 10.8% of poor results. The mean Duplay score was 84.7 points with 19 points for the return in sports, 23 points for the stability, 21 points for the pain, and 22 points for the movement. The loss of rotation was less than 13 degrees (mean). Among the patients, 57.4% returned to their former sports activities at the same level, with 59.8% a risk sports. Five patients reported redislocation and eleven patients reported apprehension. The patients were painless in 75.8%. Forty-four patients were very satisfied or satisfied at follow-up. At review, there were radiological degenerative changes in nine shoulders: six in Samilson grade I, one grade II, and two grade III. There was no radiological evidence of loosing, migration or fracture of the coracoid screws, and no nonunion. We have had six cases of resorption of the coracoid tip. We are aware of the limitation of the study. It is a retrospective study and there is no control group. However, we believe that, in regard of our result, the Bristow-Latarjet procedure for anterior glenohumeral instability is safe and effective with good objective and subjective result, and a high degree of patient satisfaction. Radiological findings do not always correlate with the functional outcome and patient satisfaction. Although it is a non-anatomical repair, the Bristow-Latarjet procedure provides desirable functional results.

Effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability

Background Anterior instability is a frequent complication following a traumatic glenohumeral dislocation. Frequently the underlying pathology associated with recurrent instability is a Bankart lesion. Surgical correction of Bankart lesions and other associated pathology is the key to successful treatment. Open surgical glenohumeral stabilisation has been advocated as the gold standard because of consistently low postoperative recurrent instability rates. However, arthroscopic glenohumeral stabilisation could challenge open surgical repair as the gold standard treatment for traumatic anterior glenohumeral instability. Objectives Primary evidence that compared the effectiveness of arthroscopic versus open surgical glenohumeral stabilisation was systematically collated regarding best-practice management for adults with traumatic anterior glenohumeral instability. Search strategy A systematic search was performed using 14 databases: MEDLINE, Cumulative Index of Nursing and Allied Health (CINAHL), Allied and Complementary Medicine Database (AMED), ISI Web of Science, Expanded Academic ASAP, Proquest Medical Library, Evidence Based Medicine Reviews, Physiotherapy Evidence Database, TRIP Database, PubMed, ISI Current Contents Connect, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Studies published between January 1984 and December 2004 were included in this review. No language restrictions were applied. Selection criteria Eligible studies were those that compared the effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability, which had more than 2 years of follow up and used recurrent instability and a functional shoulder questionnaire as primary outcomes. Studies that used non-anatomical open repair techniques, patient groups that were specifically 40 years or older, or had multidirectional instability or other concomitant shoulder pathology were excluded. Data collection and analysis Two independent reviewers assessed the eligibility of each study for inclusion into the review, the study design used and its methodological quality. Where any disagreement occurred, consensus was reached by discussion with an independent researcher. Studies were assessed for homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format; otherwise a meta-analysis was conducted. Results Eleven studies were included in the review. Two were randomised controlled trials. Evidence comparing arthroscopic and open surgical glenohumeral stabilisation was of poor to fair methodological quality. Hence, the results of primary studies should be interpreted with caution. Observed clinical heterogeneity in populations and outcomes was highlighted and should be considered when interpreting the meta-analysis. Authors also used variable definitions of recurrent instability and a variety of outcome measures, which made it difficult to synthesise results. When comparable data were pooled, there were no significant differences (P > 0.05) between the arthroscopic and open groups with respect to recurrent instability rates, Rowe score, glenohumeral external rotation range and complication rates. Conclusions Statistically, it appears that both surgical techniques are equally effective in managing traumatic anterior glenohumeral instability. In light of the methodological quality of the included studies, it is not possible to validate arthoscopic stabilisation to match open surgical stabilisation as the gold standard treatment. Further research using multicentred randomised controlled trials with sufficient power and instability-specific questionnaires with sound psychometric properties is recommended to build on current evidence. The choice of treatment should be based on multiple factors between the clinician and the patient.