Advertisement

Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 17, Issue 2, pp 188–194 | Cite as

Effects of posterior-inferior capsular plications in range of motion in arthroscopic anterior bankart repair: a prospective randomized clinical study

  • Alessandro Castagna
  • Mario Borroni
  • Giacomo Delle Rose
  • Nikolaos Markopoulos
  • Marco Conti
  • Enzo Vinci
  • Raffaele Garofalo
Shoulder

Abstract

The effects of posterior plications associated with anterior shoulder instability surgery are still unclear both on shoulder range of motion (ROM) and on recurrence rate. The objective of this randomized study is to evaluate the influence of posterior-inferior plications, performed in association with repair of anterior Bankart lesion, on gleno-humeral (GH) range of motion. In a 24-month period, 40 patients were prospectively enrolled in this study. The criteria for inclusion were age between 17 and 40 years, traumatic unidirectional instability, no previous shoulder surgery, no more than three episodes of dislocation, no relevant glenoid bone deficiency, no clinical evidence of pathological anterior inferior laxity (measured with external rotation with the arm at the side inferior to 90° and Gagey sign negative) and arthroscopic finding of isolated anterior Bankart lesion. A total of 20 patients (group A) were randomized to treat Bankart lesion using three bioadsorbable anchors loaded with a #2 braided polyester suture. In 20 randomized patients (group B) two posterior-inferior capsular plications performed with a #1 polidioxanone suture without any capsular shift were added to the same anterior capsulorraphy performed in group A. Postoperative rehabilitation protocol was the same for all 40 patients. Patients were examined preoperatively and at a 2-year follow-up by a single independent expert physician unaware of the surgical procedure. GH ROM, Constant, UCLA and ASES rating scores as well as recurrence of instability were recorded. At follow-up, forward flexion (FF) decreased by a mean value of 14.5° (median −10°; range −5° to −35°; P < 0.001) in group B and increased by a mean value of 3.5° (median 0°; range −25° to 40°; P < 0.312) in group A; external rotation with arm adducted (ER1) increased by a mean value of 1.8° (median 0°; range −15°to 30°; P < 0.924) in group B, and increased by a mean value of 2.6° (median 2.5°; range −38° to 40°; P < 0.610) in group A; external rotation with arm abducted at 90° (ER2) decreased by a mean value of 2.9° (median 0°; range: −20° to 10°; P < 0.161) in group B and increased by a mean value of 0.7° (median 0°; range −30° to 25°; P < 0.837) in group A; the IR2 decreased by a mean value of 2.4° (median −3.5°; range −15° to 10°; P < 0.167) in group B and increased by a mean value of 2.2° (median 0°; range −20° to 30°; P < 0.456) in group A. The UCLA mean score gains by 43.1% (median 40; P < 0.001) relatively, and of 45.2% relatively (median 40; P < 0.001), respectively, in group B and A, ASES mean score relatively gains by 21.7% (median 21.2%; P < 0.001) in group B, and of 19.2% (median 18.9%; P < 0.001) in group A, and Constant mean score improves by 20.2% (median 16.5; P < 0.001) in group B, and 10.2% (median 8.4%; P < 0.001) in group A. Thus, the only statistical significant differences were the reduction of forward flexion in group B and the improvements of the scores in both groups. No recurrence of instability was found in the plicated group, while in the non-plicated group we had one traumatic recurrence. In conclusion, arthroscopic posterior-inferior plications associated with a Bankart lesion repair in a selected group of patients seem to reduce only FF, without any effect on rotation. A longer follow-up and a larger number of patients are needed to give definitive conclusions on the benefit to the recurrence rate.

Keywords

Shoulder instability Arthroscopic capsulorraphy Plication Bankart repair 

Notes

Acknowledgments

We would like to thank Bernard Cerutti MD, Statistician of University of Geneve, faculty of Medicine, Switzerland, for his help with statistical analysis.

References

  1. 1.
    Ahmad C, Wang VM, Sugalski MT, Levine WN, Bigliani LU (2005) Biomechanics of shoulder capsulorrhaphy procedures. J Shoulder Elbow Surg 14(1S):12S–18SPubMedCrossRefGoogle Scholar
  2. 2.
    Alberta FG, ElAttrache NS, Mihata T, McGarry MH, Tibone JE, Lee TQ (2006) Arthroscopic anteroinferior suture placation resulting in decreased glenohumeral translation and external rotation. J Bone Joint Surg Am 88:179–187PubMedCrossRefGoogle Scholar
  3. 3.
    Altchek DW, Warren RF, Skyhar MJ, Ortiz G (1991) T-plasty modification of the Bankart procedure for multidirectional instability of the anterior and inferior types. J Bone Joint Surg Am 73:105–112PubMedGoogle Scholar
  4. 4.
    Bacilla P, Field LD, Savie FHIII (1997) Arthroscopic Bankart repair in a high demand patient population. Arthroscopy 13:51–60PubMedGoogle Scholar
  5. 5.
    Bankart ASB (1923) Recurrent or habitual dislocation of the shoulder joint. BMJ 2:1132–1133CrossRefGoogle Scholar
  6. 6.
    Bankart ASB (1938) The pathology and treatment of recurrent dislocation of the shoulder joint. Br J Surg 26:23–29CrossRefGoogle Scholar
  7. 7.
    Bigliani LU, Pollock RG, Soslowsky LJ (1992) Tensile properties of the inferior glenohumeral ligament. J Orthop Res 10:187–197PubMedCrossRefGoogle Scholar
  8. 8.
    Caspari RB, Savoie FHIII (1991) Arthroscopic reconstruction of the shoulder: the Bankart repair. In: McGinty JB (ed) Operative arthroscopy. Raven, New York, pp 507–515Google Scholar
  9. 9.
    Gartsman GM, Roddey TS, Hammerman SM (2000) Arthroscopic treatment of anterior-inferior glenohumeral instability. Two to five-year follow-up. J Bone Joint Surg Am 82:991–1003PubMedGoogle Scholar
  10. 10.
    Gerber C, Werner CML, Macy JC, Jacob HAC, Nyffeler RW (2003) Effect of selective capsulorraphy on the passive range of motion of the glenohumeral joint. J Bone Joint Surg Am 85:48–55PubMedGoogle Scholar
  11. 11.
    Grana WA, Buckley PD, Yates CK (1993) Arthroscopic Bankart suture repair. Am J Sports Med 21:348–353PubMedCrossRefGoogle Scholar
  12. 12.
    Hawkins RJ, Angelo RL (1990) Glenohumeral osteoarthritis. A late complication of the Putti-Platt repair. J Bone Joint Surg Am 72:1193–1197PubMedGoogle Scholar
  13. 13.
    Ide J, Maeda S, Takagi K (2004) Arthroscopic Bankart repair using sutura anchors in athletes: patient selection and postoperative sports activity. Am J Sports Med 32:1899–1905PubMedCrossRefGoogle Scholar
  14. 14.
    Jobe FW, Giangarra CE, Kvitne RS, Glosman RE (1991) Anterior capsulolabral reconstruction of the shoulder in athletes in overhead sports. Am J Sports Med 19:428–434PubMedCrossRefGoogle Scholar
  15. 15.
    Lane JG, Sachs RA, Riebl B (1993) Arthroscopic staple capsulorraphy: a long term follow-up. Arthroscopy 9:190–194PubMedGoogle Scholar
  16. 16.
    Lusardi DA, Wirth MA, Wurtz D, Rockwood CA Jr (1993) Loss of external rotation following anterior capsulorraphy of the shoulder. J Bone Joint Surg Am 75:1185–1192PubMedGoogle Scholar
  17. 17.
    MacDonald PB, Hawkins RJ, Fowler PJ, Miniaci A (1992) Release of the subscapolaris for internal rotation contracture and pain after anterior repair for recurrent anterior dislocation of the shoulder. J Bone Joint Surg Am 74:734–737PubMedGoogle Scholar
  18. 18.
    Nebelung W, Ropke M, Urbach D, Becker R (2001) A new technique of arthroscopic capsular shift in anterior shoulder instability. Arthroscopy 17:426–429PubMedGoogle Scholar
  19. 19.
    Neer CSII, Foster CR (1980) Inferior capsular shift for involuntary inferior and muldirectional instability of the shoulder. A preliminary report. J Bone Joint Surg Am 62:897–908PubMedGoogle Scholar
  20. 20.
    Pollock RG, Wang VM, Bucchieri JS et al (2000) Effects of repetitive subfailure strains on the mechanical behavior of the inferior glenohumeral ligament. J Shoulder Elbow Surg 9:427–435PubMedCrossRefGoogle Scholar
  21. 21.
    Pouliart N, Marmor S, Gagey O (2006) Simulated capsulolabral lesion in cadavers: dislocation does not result from a Bankart lesion only. Arthroscopy 22:748–754PubMedGoogle Scholar
  22. 22.
    Regan WD Jr, Webster-Bogaert S, Hawkins RJ, Fowler PJ (1989) Comparative functional analysis of the Bristow, Magnuson-Stack, and Putti-Platt procedures for recurrent dislocation of the shoulder. Am J Sports Med 17:42–48PubMedCrossRefGoogle Scholar
  23. 23.
    Rosenberg BN, Richmond JC, Levine WN (1995) Long-term followup of Bankart reconstruction. Incidence of late degenerative glenohumeral arthrosis. Am J Sports Med 65:456–460Google Scholar
  24. 24.
    Schamblin ML, Snyder SJ (2004) Arthroscopic capsular plication techniques. Tech Shoulder Elbow Surg 5:193–199CrossRefGoogle Scholar
  25. 25.
    Speer KP, Deng X, Borrero S et al (1994) Biomechanical evaluation of a simulated Bankart lesion. J Bone Joint Surg Am 76:1819–1826PubMedGoogle Scholar
  26. 26.
    Speer KP, Warren RF, Pagnani M et al (1996) An arthroscopic technique for anterior stabilization of the shoulder with a bioabsorbable tack. J Bone Joint Surg Am 78:1801–1807PubMedGoogle Scholar
  27. 27.
    Steinbeck J, Jerosch I (1998) Arthroscopic transglenoid stabilization versus open anchor suturing in traumatic anterior instability of the shoulder. Am J Sports Med 26:373–378PubMedGoogle Scholar
  28. 28.
    Tauro JC (2000) Arthroscopic inferior capsular split and advancement for anterior and inferior shoulder instability: technique and results at 2 to 5 year follow up. Arthroscopy 16:451–456PubMedGoogle Scholar
  29. 29.
    Townley C (1950) The capsular mechanism in recurrent dislocation of the shoulder. J Bone Joint Surg Am 32:370–380Google Scholar
  30. 30.
    Walch G, Boileau P, Levigne C et al (1995) Arthroscopic stabilization for recurrent anterior shoulder dislocation. Results of 59 cases. Arthroscopy 11:173–179PubMedGoogle Scholar
  31. 31.
    Wang C, Ghalambor N, Zarins B, Warner JJ (2005) Arthroscopic versus open Bankart repair: analysis of patient subjective outcome and cost. Arthroscopy 21:1219–1222PubMedCrossRefGoogle Scholar
  32. 32.
    Westerheide KJ, Dopirak RM, Snyder SJ (2006) Arthroscopic anterior stabilization and posterior capsular plication for anterior glenohumeral instability: a report of 71 cases. Arthroscopy 22:539–547PubMedGoogle Scholar
  33. 33.
    Wirth MA, Blatter G, Rockwood CA Jr (1996) The capsular imbrication procedure for recurrent anterior instability of the shoulder. J Bone Joint Surg Am 78:246–259PubMedGoogle Scholar
  34. 34.
    Wolf EM, Wilk RM, Richmond JC (1991) Arthroscopic Bankart repair using suture anchors. Oper Tech Orthop 1:184–191CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Alessandro Castagna
    • 1
  • Mario Borroni
    • 1
    • 2
  • Giacomo Delle Rose
    • 1
  • Nikolaos Markopoulos
    • 1
  • Marco Conti
    • 1
  • Enzo Vinci
    • 3
  • Raffaele Garofalo
    • 1
  1. 1.Shoulder DepartmentIRCCS HumanitasRozzano (MI)Italy
  2. 2.MilanItaly
  3. 3.Shoulder DepartmentHumanitas GavazzeniBergamo (BG)Italy

Personalised recommendations