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Posterior instability


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Posterior instability

  1. 1. Posterior shoulder instability ESSKA Treasurer Associate Professor University of Thessaly, Orthopaedic Department Larissa, GREECE. Michael Hantes
  2. 2. 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
  4. 4. Making the diagnosis Mechanism of injury? Position of apprehension? Is it a painful shoulder? Can you demonstrate your instability?
  5. 5. Can you demonstrate your instability?
  6. 6. Sport specific pathology? Repetitive trauma?
  7. 7. Sports and posterior instability Bradley et al AJSM 2006
  8. 8. Diagnosis Pain Instability Arm position Activity
  9. 9. 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)
  11. 11. Assessing joint hypermobility Beighton scale
  12. 12. SULCUS SIGN Posterior instability component is usually part of MDI
  13. 13. Imaging redundant joint capsuleLabral tear
  14. 14. Kim et al Arthroscopy 2004 Kim classification
  15. 15. Imaging Labral tear & glenoid dysplasia
  16. 16. Posterior Shoulder Instability: Does Glenoid Retroversion Predict Recurrence and Contralateral Instability? Gottschalk M Arthroscopy 2015
  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
  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
  19. 19. Lateral decubitus position
  20. 20. Diagnostic arthroscopy through the posterior portal
  21. 21. Antero-superior and midglenoid portal
  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
  23. 23. Posterolateral portal & anchor placement
  24. 24. Knot tying
  25. 25. Postop rehab 30-degree abduction pillow in neutral rotation for 6 weeks Passive ROM for 3 weeks
  26. 26. Careful history and clinical examination is the key point If the patient can demonstrate his/her instability…. is posterior Portal placement is key to accessing posterior labrum appropriately Be aware of common non-instability labral lesions and glenoid dysplsia CONCLUSION
  27. 27. 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 Discussion & Take home messag
  29. 29. Larisa Arthroscopic and Minimally Invasive Learning Center (LAMILC)