The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation.
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There is no simple method available to identify patients who will develop recurrent instability after an arthroscopic Bankart procedure and who would be better served by an open operation. We carried out a prospective case-control study of 131 consecutive unselected patients with recurrent anterior shoulder instability who underwent this procedure using suture anchors. At follow-up after a mean of 31.2 months (24 to 52) 19 (14.5%) had recurrent instability. The following risk factors were identified: patient age under 20 years at the time of surgery; involvement in competitive or contact sports or those involving forced overhead activity; shoulder hyperlaxity; a Hill-Sachs lesion present on an anteroposterior radiograph of the shoulder in external rotation and/or loss of the sclerotic inferior glenoid contour. These factors were integrated in a 10-point pre-operative instability severity index score and tested retrospectively on the same population. Patients with a score over 6 points had an unacceptable recurrence risk of 70% (p < 0.001). On this basis we believe that an arthroscopic Bankart repair is contraindicated in these patients, to whom we now suggest a Bristow-Latarjet procedure instead. (+info)
The Roman Bridge: a "double pulley - suture bridges" technique for rotator cuff repair.
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BACKGROUND: With advances in arthroscopic surgery, many techniques have been developed to increase the tendon-bone contact area, reconstituting a more anatomic configuration of the rotator cuff footprint and providing a better environment for tendon healing. METHODS: We present an arthroscopic rotator cuff repair technique which uses suture bridges to optimize rotator cuff tendon-footprint contact area and mean pressure. RESULTS: Two medial row 5.5-mm Bio-Corkscrew suture anchors (Arthrex, Naples, FL), which are double-loaded with No. 2 FiberWire sutures (Arthrex, Naples, FL), are placed in the medial aspect of the footprint. Two suture limbs from a single suture are both passed through a single point in the rotator cuff. This is performed for both anchors. The medial row sutures are tied using the double pulley technique. A suture limb is retrieved from each of the medial anchors through the lateral portal, and manually tied as a six-throw surgeon's knot over a metal rod. The two free suture limbs are pulled to transport the knot over the top of the tendon bridge. Then the two free suture limbs that were used to pull the knot down are tied. The end of the sutures are cut. The same double pulley technique is repeated for the other two suture limbs from the two medial anchors, but the two free suture limbs are used to produce suture bridges over the tendon, by means of a Pushlock (Arthrex, Naples, FL), placed 1 cm distal to the lateral edge of the footprint. CONCLUSION: This technique maximizes the advantages of two techniques. On the one hand, the double pulley technique provides an extremely secure fixation in the medial aspect of the footprint. On the other hand, the suture bridges allow to improve pressurized contact area and mean footprint pressure. In this way, the bony footprint in not compromised by the distal-lateral fixation, and it is thus possible to share the load between fixation points. This maximizes the strength of the repair and provides a barrier preventing penetration of synovial fluid into the healing area of tendon and bone. (+info)
A simple grafting method to repair irreparable distal biceps tendon.
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Arthroscopic Bankart repair for traumatic anterior shoulder instability with the use of suture anchors.
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INTRODUCTION: The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. The results continue to improve with the advancements made in instrumentation and technique. This study aims to evaluate the outcome of arthroscopic Bankart repair with the use of suture anchors for cases that were followed-up for at least two years from the date of surgery. METHODS: This was a consecutive series of 40 shoulders in 37 patients who underwent arthroscopic Bankart repair with suture anchor. The mean age at the time of operation was 26.3 years. The patients were assessed with two different outcome measurement tools (the University of California at Los Angeles [UCLA] shoulder rating scale and simple shoulder test [SST] score). The mean duration of follow-up was 30.2 months. The recurrence rate, range of motion, and postoperative function were evaluated. RESULTS: The two shoulder scores significantly improved after surgery (p-value is less than 0.05). According to the UCLA scale, 37 shoulders (92.5 percent) had excellent or good scores, one shoulder (2.5 percent) had a fair score, and two (five percent) had poor scores. All 12 components of SST showed improvement, which was statistically significant. Overall, the rate of postoperative recurrence was 7.5 percent (three shoulders). All patients either maintained or demonstrated improvement of range of motion. There was no loss of external rotation range of motion postoperatively. CONCLUSION: Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method that can provide a good clinical outcome with excellent postoperative shoulder motion and low recurrence rate. (+info)
Comparative evaluation of the tendon-bone interface contact pressure in different single- versus double-row suture anchor repair techniques.
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Use of suture anchors for coronoid fractures in the terrible triad of the elbow.
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PURPOSE: To report outcomes in 6 patients with the terrible triad of the elbow treated with our modified protocol. METHODS: 6 men aged 26 to 54 years underwent surgery for the terrible triad of the elbow by a single surgeon. All the patients had a displaced comminuted fracture of the radius, posterior dislocation of the elbow, and Morrey type-I fracture of the coronoid. They all underwent replacement of the radial head and repair of the lateral collateral ligament to the isometric part of the lateral condyle using suture anchors. Five had an additional capsular fixation to the anterior coronoid using suture anchors; in patient 6 the coronoid was not repaired because it was stable. Functional outcomes were evaluated using the Hospital for Special Surgery (HSS) elbow assessment score. Bone union, implant loosening, heterotopic ossification, and degenerative changes were assessed using anteroposterior and lateral radiographs. RESULTS: After a mean follow-up of 2.2 (range, 1-3) years, the mean arc of flexion-extension was 116 degrees and the mean flexion contracture was 15 degrees. All patients maintained a concentric reduction of both the ulnotrochlear and the radiocapitellar articulation, with isometric fixation of the lateral collateral ligament. No patient had dislocation of the radial-head prosthesis. All had good-to-excellent HSS elbow scores, and none required re-operation. Patient 2 had neuropraxia of the radial nerve, which recovered within 3 months. Patient 4 had a range of movement of only 20 to 100 degrees, but was satisfied with the outcome. CONCLUSION: Repair of the articular capsule using suture anchors in addition to replacement of the radial head and repair of the lateral collateral ligament achieves favourable outcome in patients with the terrible triad of the elbow. (+info)
Luggage tag technique of anatomic fixation of displaced acromioclavicular joint separations.
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