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πρωτο εξάρθρημα
- 1. The treatment offirst shoulder dislocation Manos Antonogiannakis Director center for shoulder arthroscopy IASO gen hospital
- 2. Winter sports arebecoming more popular in Greece Better and more Ski Centres. Better organization and equipment advances turns more people to Winter sports
- 3. Athletes of everyage and level
- 4. Athletes of allages
- 5. Ski injuries 3per 1000 Skier per day Hunter RE Am J Sport Med 1999 Ski injuries 4.33 per 1000 skier per day Shoulder Injuries 0.51 per 1000 skier per day Kocher MS Feagin JA Am J Sport Med 1996
- 6. The Shoulder GreatestRange of Motion in the Body Motion in all 3 planes of movement Prone to injuries 8-20% of all sports injuries
- 7. Shoulder dislocation 2% ofthe population 90% anterior dislocation
- 8. First shoulder dislocationis a dramatic event with dare consequences especially in athletic individuals
- 9. 17% to 96%(mean 67%) Redislocation after acute traumatic anterior dislocation of the shoulder
- 10. • Multicenter study •245 patients aged 12-40 years • 10 years follow up • 52% recurrence rate • 23% were operated Prognosis of recurrence after traumatic first time dislocation Primary anterior dislocation of the shoulder in young patients. A 10 year prospective study - Hovelius 1996 JBJS(A)
- 11. The major prognosticfactor of recurrence after acute traumatic anterior shoulder dislocation is the age of the patient and the degree of participation to athletic endeavors
- 12. Redislocation rate inpatients < 20 years Larrain Rowe Simonet and Cofield Slaa •90% • 94% • 94.5% • 90%
- 13. Ηovelius, 1996 Athletes hockeyon ice Recurrence rate: 90% in athletes < 20 years old 65% in athletes 20-25 years old Age and athletic participation
- 14. The West Pointexperience 127 patients 55 conservative treatment Recurrence rate 85% De Barandino et al. 1996
- 15. Is shoulder arthroscopythe best treatment of the first shoulder dislocation?
- 16. Arthroscopy in thetreatment of first dislocation What does it offer? To what kind of patients?
- 17. Better understanding ofthe pathology Reduction of recurrence rate Treatment of rotator cuff lesions in older individuals What does shoulder arthroscopy offers
- 18. The patient Young professionalathlete General population First dislocation in: Athletically oriented individual Loose joint individual
- 19. • Bankart lesion •Tears of the anterior capsule • Plastic deformation of the posterior capsule • Hill-Sachs lesion, Bony Bankart • rotator cuff tears • SLAP lesions Lesions after first shoulder dislocation
- 20. Our findings infirst shoulder dislocation Hemarthrosis 100% Bankart 78.2% Bony Bankart 13.04% Hill-Sachs 65.21% capsular laxity 8.69% SLAP lesions 21.73% C. Yiannakopulos E Mataragas E.Antonogiannakis Arthroscopy Sep 2007
- 22. Arthroscopic Shoulder Reconstruction Goal ofthe Operation: Define the pathology Restoration of the Labrum to its anatomic attachment Reestablishment of the appropriate tension in the IGHL complex and capsule Repair bony Bankart and large Hill-Sachs lesions Repair SLAP lesions Repair rot cuff tears
- 23. EUA Arthroscopy Suture anchor technique Treatment of all the lesions Surgical technique
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- 26. Mobilization of AnteriorLabrum
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- 31. Plication of theposterior capsule
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- 33. Arthroscopic success rate Savoie 1997 93% Burchart, De Bear 2000 96% J Tauro 2000 93% Kim 2003 96% Snyder 2006 93% Fabbriciani 2004 100%
- 34. Wheeler et al1989 NO 92% O 22% Arciero et al 1994 NO 80% O 14% Arciero et 1995 O 10% The West Point experience
- 35. 40 patients < 30 years old prospective randomized study Transglenoid technique Same postoperative protocol Follow up > 34 months-75months Arthroscopic stabilization or non operative treatment for the first shoulder dislocation? Κirkley et al 1999-2005
- 36. Sandy Κirkley 1999 Recurrencerate: Arthroscopic treatment 16% Conservative treatment 47% Quality of life (WOSI) Better in the arthroscopy group Range of motion The same with both methods
- 37. Larrain et al.Arthroscopic repair of acute traumatic anterior shoulder dislocation in young athletes. Arthroscopy,April 2001 First shoulder dislocation Young athletes Transglenoid technique Follow Up 60 months Arthroscopic treatment 96 % excellent results Conservative treatment 5.5 % excellent results
- 38. Treatment success Avoid recurrence Rangeof motion Minor morbidity Few complication Return to preinjury activity level Reproducible results These are possible with arthroscopic treatment of the first shoulder dislocation in selected patients
- 39. First traumatic shoulderdislocation in patients older than 40 years Rotator cuff tears 63% Ribbans et al JBJS 1990 Different lesions Different problems to be solved
- 40. Findings after 1st shoulderdislocation in skiers older than 40 years 52 pts follow up more than 2 years Redislocation rate 4% Rotator cuff tears 35% T Penvy, R Hunter, J Freeman Arthroscopy 1998
- 41. Conclusions The conservativetreatment produces a unacceptable high recurrence rate in young athletic individuals Arthroscopic treatment has a high success
- 42. Arthroscopy canbe performed in an outpatient setting The anatomy can be restored with minimum morbidity and pain for the patient Careful assessment will allow repair of all lesions after the first dislocation Conclusions
- 43. In older patientsrotator cuff tears are common The arthroscopic treatment of symptomatic rotator cuff tears is fissible with minimum morbidity ConclusionsConclusions
- 44. Indications for arthroscopicstabilization of first shoulder dislocation • young patients • professional athletes • athletically inclined individuals • dominant shoulder • avoidance of motion loss • return to the same activity level • overhead activity and activity in AB-ER • rotator cuff tears in older patients
- 45. Modern arthroscopic techniques areprobably the treatment of choice in these patients Conclusions