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Posterior instability

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Posterior instability

  1. 1. Posterior shoulder instability ESSKA Treasurer esska.org Associate Professor University of Thessaly, Orthopaedic Department Larissa, GREECE. www.ortho-uth.org/lamilc Michael Hantes
  2. 2. www.ortho-uth.org/lamilc Associate Editor JBJS Connector Cases Editorial board member: AJSM & KSSTA Disclosures
  3. 3. Spectrum of posterior instability Locked posterior dislocation Traumatic unidirectional posterior instability Atraumatic posterior /MDI Non instability labral lesions internal impingement www.ortho-uth.org/lamilc
  4. 4. Making the diagnosis Mechanism of injury? Position of apprehension? Is it a painful shoulder? Can you demonstrate your instability? www.ortho-uth.org/lamilc
  5. 5. Can you demonstrate your instability? www.ortho-uth.org/lamilc
  6. 6. Sport specific pathology? Repetitive trauma? www.ortho-uth.org/lamilc
  7. 7. Sports and posterior instability Bradley et al AJSM 2006 www.ortho-uth.org/lamilc
  8. 8. www.ortho-uth.org/lamilc Diagnosis Pain Instability Arm position Activity
  9. 9. www.ortho-uth.org/lamilc Diagnosis Amount of posterior translation/subluxation Crepitation Traumatic unidirectional Posterior clunk test
  10. 10. Diagnosis Position of apprehension Can you demonstrate your instability? Labrum Capsule Bone (glenoid dysplasia, retroversion) www.ortho-uth.org/lamilc
  11. 11. Assessing joint hypermobility Beighton scale www.ortho-uth.org/lamilc
  12. 12. SULCUS SIGN Posterior instability component is usually part of MDI www.ortho-uth.org/lamilc
  13. 13. Imaging redundant joint capsuleLabral tear www.ortho-uth.org/lamilc
  14. 14. Kim et al Arthroscopy 2004 Kim classification www.ortho-uth.org/lamilc
  15. 15. Imaging Labral tear & glenoid dysplasia www.ortho-uth.org/lamilc
  16. 16. Posterior Shoulder Instability: Does Glenoid Retroversion Predict Recurrence and Contralateral Instability? Gottschalk M Arthroscopy 2015 www.ortho-uth.org/lamilc
  17. 17. Patients with posterior instability had significantly more glenoid retroversion than patients with anterior instability Patients with retroversion of more than −16° showed a higher incidence of contralateral injuries (P < .036). However, no difference in postsurgical recurrent instability was noted. Gottschalk M Arthroscopy 2015 www.ortho-uth.org/lamilc
  18. 18. Treatment of traumatic unidirectional posterior instability Conservative treatment? Avoidance of repetitive trauma (microtrauma) Physiotherapy Surgical treatment if failure of conservative treatment after 6 months??? Arthroscopic techniques much better results www.ortho-uth.org/lamilc
  19. 19. Lateral decubitus position www.ortho-uth.org/lamilc
  20. 20. Diagnostic arthroscopy through the posterior portal www.ortho-uth.org/lamilc
  21. 21. Antero-superior and midglenoid portal www.ortho-uth.org/lamilc
  22. 22. Posterolateral accessory portal 2 cm lateral and 1 cm anterior to the original posterior portal or just 2 cm directly lateral to the posterior corner of the acromion www.ortho-uth.org/lamilc
  23. 23. Posterolateral portal & anchor placement www.ortho-uth.org/lamilc
  24. 24. Knot tying www.ortho-uth.org/lamilc
  25. 25. Postop rehab 30-degree abduction pillow in neutral rotation for 6 weeks Passive ROM for 3 weeks www.ortho-uth.org/lamilc
  26. 26. Careful history and clinical examination is the key point If the patient can demonstrate his/her instability…. ...it is posterior Portal placement is key to accessing posterior labrum appropriately Be aware of common non-instability labral lesions and glenoid dysplsia CONCLUSION www.ortho-uth.org/lamilc
  27. 27. www.ortho-uth.org/lamilc Larisa Arthoscopic and Minimally Invasive Learning Center (LAMILC)
  28. 28. Infection after ACL reconstruction was very rare in our series (0.56%). An initial arthroscopic debridement and irrigation of the knee joint is the first step for the management of the septic knee In case of persistence of the infection, knee irrigation with hardware and graft removal should be performed and a later re-implantation is recommended Similar results to a primary ACL reconstruction regarding knee function could be obtained www.ortho-uth.org/lamilc Discussion & Take home messag
  29. 29. www.ortho-uth.org/lamilc Larisa Arthroscopic and Minimally Invasive Learning Center (LAMILC)

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