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Humeral and glenoid bone defects as factors

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Humeral and glenoid bone defects as factors

  1. 1. E. Mataragas, C. Vassos, N. Tzanakakis, G. Mouzopoulos, C.K. Yiannakopoulos, Emm. Antonogiannakis 2nd Orthopaedic Dpt. – Shoulder and Arthroscopy Unit, IASO GENERAL Hospital
  2. 2.  Age of 1st Dislocation  Loose Joints  Overhead Profession  Overhead/Contact Sports  Collagen Related Pathology  Number of Dislocations  Osseous Defects Rockwood Ch A Jr., THE SHOULDER 4th ED.
  3. 3. There is a well-recognized association between osseous defects of the glenoid or humerus and shoulder dislocation, which often leads to recurrent instability. Boileau P., J Bone Joint Surg Am. 2006 Aug;88(8):1755-63. Lynch JR., J Shoulder Elbow Surg. 2009 Mar-Apr;18(2):317-28. Burkhart SS., Instr Course Lect. 2009;58:323-36.
  4. 4. To evaluate humeral and glenoid bone loss, in patients arthroscopically treated for shoulder instability, as factors of recurrence.
  5. 5.  Retrospective, continuous, monocentric.  Series of 114 patients from 2000-2008. One surgeon performed all the procedures!
  6. 6. Glenoid Index in 3D CT scan of both shoulders Critical Limit Glenoid index 0.75 SS Burkhart Arthroscopy: Vol 24, No 4 (April), 2008: pp 376-382
  7. 7. Taverna et al. Pico Method 2D CT – measurement of glenoid surface Critical Limit 25% loss of glenoid surface
  8. 8. Scope on anterior portal, measurement of anteroposterior defect width Sugaya et al. JBJS Am 2005
  9. 9. Arm at 35˚Abduction Neutral rotation
  10. 10. -Mean age of patients: 28 1st episode: 21 dislocations: 17 Men: v=103 Women: v=11 -Revision surgery: 7
  11. 11. Athletes: 75 15 Overhead 23 Contact 22 Overhead & Contact No sports: 39
  12. 12. Complete follow up existed for 92 patients. Follow up ranged from 4-108 months (Mean=44). Post op rehabilitation was supervised by a doctor dedicated to shoulder problems. Recurrence and functional outcome were evaluated pre-op and post-op with the Rowe Zarins Score.
  13. 13. Osseous Lesions: Hill Sachs 97 (66 Large, 23 Medium & 8 Small) Glenoid Bone loss 104 (16 Large, 59 Medium & 29 Small) “Inverted pear” glenoid shape 13 “Bony” Bankart Lesion 13
  14. 14. Bankart LesionsBankart Lesions 77/11477/114 (67,5%)(67,5%) RC TearRC Tear 18/114 (15,8%)18/114 (15,8%) SLAPSLAP 44/11444/114 (38,6%)(38,6%) ALPSAALPSA 24/11424/114 (21,6%)(21,6%)
  15. 15. Recurrence of instability was noted in 5 patients (4,38%): 2 MVA 2 Fall 1 Involuntary
  16. 16. All 5 of them presented Hill Sachs lesions. Their glenoid bone loss was measured as: (2 Large, 2 Medium, 1 Small) None showed “inverted pear” glenoid shape. None presented with joint hypermobility. All 5 of them were into Overhead/Contact sports. (2 Professional: Mean=15hr/w and 3 Amateur: Mean=2,5hr/w).
  17. 17. All 5 patients were reoperated arthroscopically and have not showed recurrent instability so far.
  18. 18. Patient Satisfaction 87 Very Satisfied/ 5 Satisfied 94,6% / 5,4% Return to Work 100% Return to Sports 50 patients (mostly because they didn’t try) 66,6%
  19. 19. Pre-Op Post-Op p Rowe Zarins 33 95 < 0.05 Range of Scores Pre-op: 15-80 Post-op: 80-100
  20. 20. At least in this series, it seems that humeral and glenoid bone loss do not significantly contribute to the recurrence of arthroscopically treated shoulder instability.

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