J. Steinbeck

Arthroscopic Transglenoid Stabilization Versus Open Anchor Suturing in Traumatic Anterior Instability of the Shoulder

Sixty-two consecutive patients with recurrent traumatic anterior instability of the shoulder were prospectively observed. Thirty patients were observed after arthroscopic stabilization, and 32 were observed after open Bankart repair during a mean follow-up of 36 and 40 months, respectively (range, 24 to 60 months for both groups). To reattach the labrum, the arthroscopic technique used transglenoid sutures and the open technique used bone anchors. Redislocation occurred in two patients (6%) in the open repair group and in five patients (17%) in the arthroscopic repair group. Three of the five patients with redislocations in the arthroscopic repair group underwent reoperation. According to the criteria of Rowe et al., 29 patients (90.6%) who had open repair and 24 patients (80%) who had arthroscopic repair had good-to-excellent results. The patients averaged 90.6 points in the open repair group and 83.1 points in the arthroscopic repair group postoperatively. Little or no limitations in their postoperative sports activities were reported by 30 patients (94%) who underwent open repair and by 25 patients (83%) who had arthroscopic repair. Despite similar patient populations and using arthroscopic examination to select the type of repair in both groups, the results of arthroscopic shoulder stabilization are inferior to those of the classic open Bankart procedure.

The anatomy of the glenohumeral ligamentous complex and its contribution to anterior shoulder stability.

One hundred four enbalmed cadaver shoulders were evaluated. With a dorsal approach we opened the dorsal capsule after resecting the infraspinatus and teres minor muscles. For reaching the anterior capsule and the glenohumeral ligaments, the humeral head was resected. In this way we could quantify and qualify the glenohumeral ligaments and classify the synovial recesses based on the classification system of DePalma into type I to VI. Secondary signs of shoulder instability were documented. The superior glenohumeral ligament was missing in 6 (5.8%) shoulders, the middle glenohumeral ligament in 16 (15.4%) shoulders, and the inferior glenohumeral ligament in 7 (6.8%) shoulders. Most of the synovial recesses belonged to group I (38.5%) and III (46.2%). As a secondary sign of instability four shoulders had a Hill-Sachs fracture and a bony Bankart lesion. All four shoulders had no middle glenohumeral ligament and a large anterior type IV recess.