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Long-term outcomes after repair of recurrent post-traumatic anterior shoulder instability: comparison of arthroscopic transglenoid suture and open Bankart reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study is to report long-term outcomes of the arthroscopic modified Caspari technique compared to an open capsular shift surgery to treat post-traumatic anterior shoulder recurrent instability. The hypothesis was that the open surgery group would show higher degenerative changes than to the modified Caspari technique group after a follow-up from 10 to 17 years.

Methods

One hundred and ten nonrandomized consecutive patients who underwent a surgical repair of recurrent unilateral anterior shoulder instability between 1990 and 1999 were retrospectively analyzed. Eighty-two patients were available for long-term follow-up. In particular, 49 patients (59.8%) (group A) were treated with arthroscopic transglenoid modified Caspari suturing technique (mean follow-up 13.7 ± 2.2 years), whereas 33 patients (40.2%) (group B) were treated with combined open capsular shift and Bankart repair (mean follow-up 15.7 ± 2.2 years). Patients were evaluated according to the failure rate (re-dislocation), Rowe, UCLA, and Constant scores. Radiological osteoarthritis changes were ranked according to Samilson score.

Results

There were no statistically significant differences between the two groups concerning the failure rate (n.s.), Rowe (n.s.), UCLA (n.s.), and Constant (n.s.) scores. Group A: re-dislocation rate 12.5% (6 re-dislocations), Rowe 85.0 ± 22.6, UCLA 26.4 ± 4.8, and Constant 86.3 ± 16.7. Group B: re-dislocation rate 9% (3 re-dislocations), Rowe 83.2 ± 24.4, UCLA 26.9 ± 4.2, and Constant 87.4 ± 14.1. Radiographic findings of osteoarthritis: 2 severe (4%), 4 moderate (8%), and 12 mild (25%) in group A; 2 severe (6%), 4 moderate (12%), and 9 mild (27%) in group B; differences between groups were not statistically significant (n.s).

Conclusions

The results after both techniques were good in majority of patients, with no significant differences in terms of re-dislocation and osteoarthritis development. Compared to the current literature, the recurrence rate was high in both groups. The modified Caspari technique could be an arthroscopic alternative for older, non-athletic shoulders.

Level of evidence

Therapeutic Study—Retrospective Comparative Study, Level III.

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Acknowledgments

The authors thank Simone Bignozzi, Eng, PhD, and Nicola Lopomo, Eng, PhD for help in statistical analysis; Laura Bragonzoni, PhD, Costanza Musiani, MD, Antonio Scarale, Federico Raggi, Tommaso Roberti di Sarsina, Vito Amabile, Silvia Bassini, Susanna Asta, and the Library staff of Istituto Ortopedico Rizzoli for technical assistance.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Laboratorio di Biomeccanica, Istituto Ortopedico Rizzoli, Via Di Barbiano, 1/10, 40136, Bologna, Italy

    Stefano Zaffagnini, Giulio Maria Marcheggiani Muccioli, Giovanni Giordano, Tommaso Bonanzinga, Alberto Grassi, Marco Nitri, Danilo Bruni & Maurilio Marcacci

  2. Radiology Department, Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40136, Bologna, Italy

    Giovanni Ravazzolo

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  1. Stefano Zaffagnini
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Correspondence to Stefano Zaffagnini.

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Zaffagnini, S., Marcheggiani Muccioli, G.M., Giordano, G. et al. Long-term outcomes after repair of recurrent post-traumatic anterior shoulder instability: comparison of arthroscopic transglenoid suture and open Bankart reconstruction. Knee Surg Sports Traumatol Arthrosc 20, 816–821 (2012). https://doi.org/10.1007/s00167-011-1674-y

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