C I I I ISTITU TO CLIN IC O HU M A N ITA S IRCCS CLINICAL INSTITUTE HUMANITAS IRCCS CLINICAL INSTITUTE HUMANITAS Milano - Italy Milano - Italy Shoulder and Elbow Department Shoulder and Elbow Department Director: A. Castagna Director: A. Castagna Scientific Director: M. Randelli Scientific Director: M. Randelli
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IRCCS CLINICAL INSTITUTE HUMANITAS Milano - Italy Shoulder and Elbow Department Director: A. Castagna Scientific Director: M. Randelli.
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CI I IISTITUTO CLINICO
HUMANITAS
IRCCS CLINICAL INSTITUTE HUMANITASIRCCS CLINICAL INSTITUTE HUMANITASMilano - ItalyMilano - Italy
Shoulder and Elbow DepartmentShoulder and Elbow DepartmentDirector: A. CastagnaDirector: A. Castagna
Scientific Director: M. RandelliScientific Director: M. Randelli
CI I IISTITUTO CLINICO
HUMANITAS
Arthroscopic Bankart suture anchor repair: radiological and clinical outcome
at minimum 10 years F.U.
SECEC- ASESEurope- USA Travelling Fellowship 2008
N. Markopoulos, G. Delle Rose, M. Conti, E. Papadakou, A. Castagna
CI I IISTITUTO CLINICO
HUMANITAS
“Arthroscopic stabilisation using suture anchors seems to be the most effective technique for
Bankart repair with similar rate of failure to open stabilisation”.
• Kartus, Resch, JBJS Am 2007; evidence of significant arthritic changes at 7 to 10 yrs F.U. using absorbable tacks (extra- articular repair) in a study of 81 patients
Few studies about degenerative changes after arthroscopic Bankart repair
• A long term (minimum 10 years) evaluation of the clinical and radiological results after arthroscopic Bankart repair using suture anchors with particular concern to the recurrence and the arthritis
• Assessment of negative predicting factors
CI I IISTITUTO CLINICO
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Materials and methods
• From 1995 to 1997, 47 consecutive patients (48 shoulders) with traumatic instability were treated arthroscopically
• Excluded cases with multidirectional instability or with associated RC tears
CI I IISTITUTO CLINICO
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Materials and methods
• Study of 30 patients / 31 shoulders (66% of all cases)
• Same surgeon, same technique• Age 17- 41yrs (average 26,1yrs)• 26 M and 4 F• Mean F.U.: 11,2yrs (9,8- 12,9yrs)
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Materials and methods
• Clinical evaluation (independent physician)– Rowe,UCLA, SST rating scores – ROM, return to sports and working activity
• Radiological assessment of degenerative changes according to the classification of Samilson- Prieto
• Patients satisfaction
CI I IISTITUTO CLINICO
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Materials and methods
• Standard posterior portal• Antero- superior portal• Anterior midglenoid portal
Suture anchors 2 to 5; mean value 2,4 (mini-Revo; Linvatec)
Surgical Technique
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Postoperative treatment
• Arm in a sling at 20° of abduction for 4 weeks
• Early mobilization of the elbow and hand
• At 2 weeks progressive passive mobilization of the shoulder with ER1 at 0°
• Active mobilization and resistence exercises at 6 to 8 weeks postop
• Return to sports activity at 5 months after the operation
CI I IISTITUTO CLINICO
HUMANITAS Results
Recurrence in 6 patients
Subluxation in 1 patient
Patients satisfaction 83%
One patients has undergone a revision arthroscopy
Total recurrence rate 22,5%
CI I IISTITUTO CLINICO
HUMANITAS Results
7 patients experienced shoulder instability; although 2 of them had a new clinically relevant shoulder injury (atraumatic recurrences 16 %).
3 of the patients with recurrence, were satisfied and able to return to their previous activity level
(two patients with a recurrence after 6 yrs experienced some apprehention, one had a subluxation and now practices snow board in a competitive level).
The results deteriorate during time: three (out of seven) recurrences occured after 6 yrs.
Critical evaluation of these data
CI I IISTITUTO CLINICO
HUMANITAS Results
Recurrence Group:
Six out of 7 patients with recurrence were competitive or overhead athletes (85,7%),
Non Recurrence Group:
Nine out of 24 patients (37,5%) were competitive/overhead athletes
• 36% of recurrence in the athletes vs 15% in the other group
Critical evaluation of these data
CI I IISTITUTO CLINICO
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Clinical outcomes
UCLA 21,8 32,1
SST 9 11,2
Return to sports activities (same level) 70 %
Return to work 96,6 %
In 83,4% of all cases no loss of ROM (five patients with limitation of the ER2 < 15°)
Rowe excellent 58%
good 19,3% fair 3,3% poor 19,4%
CI I IISTITUTO CLINICO
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Radiological outcomes
No arthrosis (grade 1) 61 %
Mild (grade 2) 29 %
Moderate (grade 3) 10 %
Severe (grade 4) 0 %
No evidence of suture anchor loosening or osteolysis
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Discussion
• Results showed a relative high rate of recurrence instability compared to other studies but we think that a long follow up is necessary to assess “true” outcomes (non traumatic recurrence at 5 yrs = 9,6%).
• Mild degenerative changes were noted at 39% of all cases but did not influence the final result regarding the % of recurrence, ROM, function and satisfaction of the patient.
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Discussion
• We didn’t find any correlation between recurrence and number of preoperative dislocations, age or number of anchors used.
• Involvement in competitive or overhead sports might have been recurrence risk factor after arthroscopic Bankart repair.
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Conclusions
• Good clinical and subjective outcomes at a 5 yrs follow up with deterioration at a longer period.
• Better results in non competitive athletes or in those who are not involved in overhead sports.
• Radiologic evidence of arthritis but of a mild entity without consequences on the result.
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Conclusions
• Further studies must be undertaken to assess the results in terms of recurrence, ROM and degenerative changes observed in our latest series using new devices with a better experience.