Abstract
The repair of the capsuloligamentous complex during shoulder stabilisation procedures can be followed by a persistent restricted capacity of external rotation. The prognostic importance of this loss in external rotation for patient satisfaction has not previously been evaluated. We therefore followed 68 consecutive patients operated for recurrent traumatic unidirectional anterior instability of the glenohumeral joint to assess the association between loss of external rotation and patient satisfaction. All patients underwent open Bankart repair. Two independent observers carried out a follow-up (5 years on average) after surgery. At follow-up, recurrent dislocation had developed in four of the 68 patients (6%). The median pre-operative Rowe score was 65 (range 42–87), which can be compared with 92 (range 46–100) at the follow-up. Three patients rated their outcome as poor, 13 as fair, 23 as good and 29 as excellent. There was a five-fold increased risk for a poor or fair outcome among patients with loss of external rotation in 0° of abduction (age- and gender-adjusted odds ratio [OR] 5.3; 95% confidence interval [CI] 1.3–22.0, P = 0.0007). A linear association between the degree of loss in external rotation and patient dissatisfaction was found. The risk of being dissatisfied, independent of recurrent dislocation, occasional pain, positive apprehension test, age and gender, more than doubled (OR 2.6; 95% CI 1.4–4.8, P = 0.002) for every 10° of post-operative loss of external rotation. Loss of external rotation almost explained all of the variation in patient satisfaction with a population attributable risk of 0.85 (95% CI 0.20–0.94). We conclude that open Bankart repair with a modified Rowe procedure is an excellent surgical option regarding stability, but restriction in external rotation reduces the likelihood of a satisfied patient.
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References
Bankart ASD (1938) The pathology and treatment of recurrent dislocation of the shoulder joint. Br J Surg 26:23–29
Berendes TD, Wolterbeek R, Pilot P, Verburg H, te Slaa RL (2007) The open modified Bankart procedure: outcome at follow-up of 10 to 15 years. J Bone Joint Surg Br 89:1064–1068
Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164
Hawkins RJB DJ (1985) Clinical evaluation of shoulder problems. In: Rockwood CAM FA (ed) The shoulder. Churchill Livingstone, Edinburgh, pp 1169–1170
Hobby J, Griffin D, Dunbar M, Boileau P (2007) Is arthroscopic surgery for stabilisation of chronic shoulder instability as effective as open surgery? a systematic review and meta-analysis of 62 studies including 3044 arthroscopic operations. J Bone Joint Surg Br 89:1188–1196
Hovelius L (1999) The natural history of primary anterior dislocation of the shoulder in the young. J Orthop Sci 4:307–317
Hovelius L, Augustini BG, Fredin H, Johansson O, Norlin R, Thorling J (1996) Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study. J Bone Joint Surg Am 78:1677–1684
Hovelius L, Sandstrom B, Saebo M (2006) One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years: study II-the evolution of dislocation arthropathy. J Shoulder Elbow Surg 15:279–289
Hubbell JD, Ahmad S, Bezenoff LS, Fond J, Pettrone FA (2004) Comparison of shoulder stabilization using arthroscopic transglenoid sutures versus open capsulolabral repairs: a 5-year minimum follow-up. Am J Sports Med 32:650–654
Kartus C, Kartus J, Matis N, Forstner R, Resch H (2007) Long-term independent evaluation after arthroscopic extra-articular Bankart repair with absorbable tacks. A clinical and radiographic study with a seven to ten-year follow-up. J Bone Joint Surg Am 89:1442–1448
Lenters TR, Franta AK, Wolf FM, Leopold SS, Matsen FA (2007) Arthroscopic compared with open repairs for recurrent anterior shoulder instability. A systematic review and meta-analysis of the literature. J Bone Joint Surg Am 89:244–254
Magnusson L, Ejerhed L, Rostgard L, Sernert N, Kartus J (2006) Absorbable implants for open shoulder stabilization. A 7–8-year clinical and radiographic follow-up. Knee Surg Sports Traumatol Arthrosc 14:182–188
Milgrom C, Mann G, Finestone A (1998) A prevalence study of recurrent shoulder dislocations in young adults. J Shoulder Elbow Surg 7:621–624
Mohtadi NG, Bitar IJ, Sasyniuk TM, Hollinshead RM, Harper WP (2005) Arthroscopic versus open repair for traumatic anterior shoulder instability: a meta-analysis. Arthroscopy 21:652–658
Pouliart N, Marmor S, Gagey O (2006) Simulated capsulolabral lesion in cadavers: dislocation does not result from a bankart lesion only. Arthroscopy 22:748–754
Rhee YG, Ha JH, Cho NS (2006) Anterior shoulder stabilization in collision athletes: arthroscopic versus open Bankart repair. Am J Sports Med 34:979–985
Robinson CM, Dobson RJ (2004) Anterior instability of the shoulder after trauma. J Bone Joint Surg Br 86:469–479
Rowe CR (1988) The shoulder. Churchill Livingstone, New York
Rowe CR, Patel D, Southmayd WW (1978) The Bankart procedure: a long-term end-result study. J Bone Joint Surg Am 60:1–16
Salomonsson B, Abbaszadegan H, Revay S, Lillkrona U (2009) The Bankart repair versus the Putti-Platt procedure. Acta Orthop. doi:10.3109/17453670902988345
Warren RFC EV, Altchek DW (1999) The unstable shoulder. Lippincott-Raven, New York
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Rahme, H., Vikerfors, O., Ludvigsson, L. et al. Loss of external rotation after open Bankart repair: an important prognostic factor for patient satisfaction. Knee Surg Sports Traumatol Arthrosc 18, 404–408 (2010). https://doi.org/10.1007/s00167-009-0987-6
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DOI: https://doi.org/10.1007/s00167-009-0987-6