scholarly journals Arthroscopic remplissage: a valuable adjunct to arthroscopic Bankart’s repair in shoulder instability

2021 ◽  
Vol 7 (2) ◽  
pp. 391
Author(s):  
Gunjan Upadhyay ◽  
Gaurav Gupta
Keyword(s):  
Shoulder Instability ◽  
External Rotation ◽  
Arthroscopic Surgery ◽  
Difficult Problem ◽  
Capsular Shift ◽  
Forward Flexion ◽  
Valuable Adjunct ◽  
Arthroscopic Shoulder Surgery ◽  
The Hill

<p class="abstract">Current study present results of arthroscopic shoulder stabilisation surgery. 46 consecutive patients with recurrent anterior shoulder dislocations and less than 25% Glenoid bone loss were treated with arthroscopic surgery in 2017-2020. Arthroscopic repair of Bankart’s lesion with capsular shift was performed in each. In 8 patients, where the Hill sach’s lesion was “off track” or “engaging”, arthroscopic remplissage was performed along with arthroscopic Bankart’s repair. There was no recurrence of shoulder instability after a mean follow up of 1 year. This included the non-engaging Hill sach’s group (treated with Bankart’s repair) as well as the engaging or off track Hill sach’s group (treated with Bankart’s repair and remplissage). All patients went on to obtain full forward flexion, full abduction and internal rotation. The Bankart’s and remplissage group had a mean of 8 degrees restriction of external rotation. SST scores and oxford scores had improved considerably on follow up in both groups Arthroscopic shoulder surgery provides a safe and reliable option in the management of recurrent shoulder dislocations. Arthroscopic remplissage is a useful adjunct to Bankart’s repair when treating the difficult problem of a large engaging Hill Sachs lesion.</p><p class="abstract"> </p>

scholarly journals Failure Rates in Contact versus Non-Contact Athletes Following Arthroscopic Inferior Capsular Shift at 10-Year Follow-Up (237)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0034
Author(s):  
Kevin Plancher ◽  
Thomas Evely ◽  
Stephanie Petterson
Keyword(s):  
Bone Loss ◽  
Revision Surgery ◽  
Shoulder Instability ◽  
Functional Outcomes ◽  
External Rotation ◽  
Return To Sport ◽  
Suture Anchors ◽  
Recurrence Rates ◽  
Capsular Shift

Objectives: Arthroscopic Bankart repair has become the surgical procedure of choice for many in the United States, over the Latarjet in Europe, for first time anterior shoulder instability with minimal bone loss, less than 20%. However, high recurrence rates in contact athletes have led many to proceed with open type procedures. Our purpose was to compare failure rates and functional outcomes of the arthroscopic inferior capsular shift in contact and non-contact athletes. We hypothesized that contact and non-contact athletes would exhibit excellent functional outcomes and return to sport with low recurrence rates. Methods: A consecutive series of 69 shoulders in 61 contact and non-contact athletes underwent an arthroscopic inferior capsular shift with ≥3 suture anchors by a single surgeon (1999-2018). Thirty shoulders in 26 contact athletes (6 women; 25.3±8.1 years) and 39 shoulders in 35 non-contact athletes (7 women; 34.8±10.0 years) were included. Inclusion criteria were complete anterior inferior labral detachment (6 unit hours) and ≥2-year follow-up. Exclusion criteria included multidirectional instability, engaging Hill Sachs lesion or glenoid bone loss >30%. A modified 3-portal technique utilizing the outside-in method was employed. A conservative rehabilitation program was followed with return to sport no sooner than 3 months in non-contact, 4-5 months in contact, and 9 months in throwing athletes. Functional outcomes were measured using Constant Scores, American Shoulder and Elbow Surgeons (ASES) Score, Western Ontario Shoulder Instability Index (WOSI), Melbourne Instability Shoulder Scale (MISS), and Rowe. Forward elevation, external rotation at side and 90° abduction and internal rotation range of motion (ROM) were measured. Independent samples t-tests were used to assess differences in outcomes between contact and non-contact athletes (Bonferroni correction: p<0.006). Results: Follow-up was 11.0±3.5 years (range 2-16 years) in contact athletes and 12.2±4.3 years (range 2-21 years) in non-contact athletes (p=0.264). Contact athletes were significantly younger than non-contact athletes (p<0.0001). An average of 3.9±1.7 and 3.1±1.0 suture anchors were used in contact and non-contact groups, respectively (p=0.348). There were no significant differences in post-operative functional scores (all p>0.053) or shoulder ROM (all p>0.034) between groups. Forward flexion was 163.75±16.8° pre-operatively and 168.89±13.0° post-operatively in contact athletes (p=0.212) and 162.5±13.7° preoperatively and 170±7.7° post-operatively in non-contact athletes (p=0.005). External rotation at the side was 59.04±19.4° pre-operatively and 67.9±18.6° value post-operatively in contact athletes (p=0.094) and 52.94±25.1° pre-operatively and 62.83±14.3° post-operatively in non-contact athletes (p=0.062). External rotation at 90° abduction was 92.61±20.1° pre-operatively and 93.39±12.9° post-operatively in contact athletes (p=0.867) and 88.33±21.1° pre-operatively and 87.5±8.1° post-operatively in non-contact athletes (p=0.842).Internal rotation behind the back was to an average of T11 pre-operatively and T9 post-operatively in contact athletes (p=0.004) and L1 pre-operatively and T9 post-operatively in non-contact athletes (p=0.001).In contact and non-contact athletes, respectively, Rowe scores were 65.35±17.6 and 51.25±13.2 preoperatively and 89.22±17.6 and 96.25±12.4 post-operatively (p=0.002 and p<0.001); Constant Scores were 75.69±12.6 and 61.67±11.3 pre-operatively 85.79±19.6 and 89.71±13.6 post-operatively; ASES scores were 80.40±15.3 and 62.14±22.2 pre-operatively and 93.91±9.9 and 86.06±20.7 post-operatively (p<0.001 and p<0.001); MISS scores were 59.36±12.4 and 48.39±15.5 preoperatively and 88.20±13.5 and 75.75±19.7 post-operatively (p<0.001 and p<0.001); WOSI was 3.50±1.3 and 4.55±1.4 pre-operatively and 1.70±3.0 and 2.94±2.7 post-operatively (p=0.101 and p=0.066). Overall recurrence rate was 4.3% (3/69). Two contact athletes (2/30; 6.7%) and one non-contact athlete (1/39; 2.6%) experienced a traumatic recurrent instability event requiring revision surgery (p=0.439). These three patients underwent a revision arthroscopic inferior capsular shift with an additional 3-4 plication sutures and returned to pre-injury sports including hockey, football, skiing, and tennis without recurrence of instability at greater than 7 years following the revision surgery. Conclusions: Modified arthroscopic inferior capsular shift utilizing ≥3 suture anchors with plication sutures returns contact and non-contact athletes to sports with excellent functional outcomes, low recurrence rates (3/69), and full unrestricted ROM. While loss of ROM is a concern, particularly in overhead athletes, ROM was successfully restored in all patients, most notably in external rotation at 90° abduction. We recommend a modified arthroscopic inferior capsular shift with plication sutures as the primary procedure in all athletes with anterior instability with less than 30% bone loss excluding those with high Beighton scores rather than a Latarjet.

A Modified Capsular Shift for Atraumatic Anterior-Inferior Shoulder Instability

2005 ◽  
Vol 33 (7) ◽  
pp. 1011-1015 ◽  
Author(s):  
Björn Marquardt ◽  
Wolfgang Pötzl ◽  
Kai-Axel Witt ◽  
Jörn Steinbeck
Keyword(s):  
Shoulder Instability ◽  
Case Series ◽  
Consecutive Series ◽  
Study Group ◽  
Level Of Evidence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Capsular Shift ◽  
Redislocation Rate

Purpose To evaluate the long-term outcome of a modified inferior capsular shift procedure in patients with atraumatic anterior-inferior shoulder instability by analyzing a consecutive series of patients who had undergone a modified inferior capsular shift for this specific type of shoulder instability. Study Design Case series; Level of evidence, 4. Methods Between 1992 and 1997, 38 shoulders of 35 patients with atraumatic anterior-inferior shoulder instability that were unresponsive to nonoperative management were operated on using a modified capsular shift procedure with longitudinal incision of the capsule medially and a bony fixation of the inferior flap to the glenoid and labrum in the 1 o'clock to 3 o'clock position. The patient study group consisted of 9 men and 26 women with a mean age of 25.4 years (range, 15-55 years) at the time of surgery. The mean follow-up was 7.4 years (range, 4.0-11.4 years); 1 patient was lost to follow-up directly after surgery. The study group was evaluated according to the Rowe score. Results After 7.4 years, 2 patients experienced a single redislocation or resubluxation, 1 patient had recurrent dislocations, and 1 patient had a positive apprehension sign, which is an overall redislocation rate of 10.5%. The average Rowe score increased to 90.6 (SD = 19.7) points from 36.2 (SD = 13.5) points before surgery. Seventy-two percent of the patients participating in sports returned to their preoperative level of competition. Conclusions Results in this series demonstrate the efficacy and durability of a modified capsular shift procedure for the treatment of atraumatic anterior-inferior shoulder instability.

scholarly journals Arthroscopic Latarjet for Recurrent Shoulder Instability

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 582 ◽  
Author(s):  
Castricini ◽  
Longo ◽  
Petrillo ◽  
Candela ◽  
De Benedetto ◽  
...  
Keyword(s):  
Los Angeles ◽  
Clinical Outcomes ◽  
Shoulder Instability ◽  
External Rotation ◽  
University Of California ◽  
Simple Shoulder Test ◽  
Recurrent Shoulder Instability ◽  
Arthroscopic Latarjet ◽  
Contralateral Shoulder

Background and Objectives: The all-arthroscopic Latarjet (aL) procedure was introduced to manage recurrent shoulder instability. Our study aimed to report the outcomes of aL procedures with the Rowe, University of California-Los Angeles (UCLA), simple shoulder test (SST) scores, and range of motion (ROM) in external rotation at a minimum follow-up of 2 years. Material and Methods: A total of 44 patients presenting recurrent shoulder instability were managed with aL procedure. Clinical outcomes were assessed at a mean follow-up of 29.6 ± 6.9 months. The postoperative active ROM was measured and compared with the contralateral shoulder. The Rowe, UCLA, and SST scores were administered preoperatively and postoperatively. Results: No patients experienced infections or neuro-vascular injuries. Seven (15%) patients required revision surgery. After surgery, the external rotation was statistically lower compared to the contralateral shoulder, but it improved; clinical outcomes also improved in a statistically significant fashion. Conclusions: The aL produced good results in the management of recurrent shoulder instability, but the complication rate was still high even in the hands of expert arthroscopist.

E-REHABILITATION SOLUTION FOR ROTATOR CUFF SYNDROME IN COVID-19 PANDEMIC ERA

2021 ◽  
pp. 2150002
Author(s):  
Amit Lakhani ◽  
Ena Sharma ◽  
Sarita Khadayat
Keyword(s):  
Rotator Cuff ◽  
External Rotation ◽  
Mobile Apps ◽  
Health Sector ◽  
The Elderly ◽  
Cross Infection ◽  
Main Mode ◽  
Forward Flexion ◽  
Rehabilitation Centers

Objectives: COVID-19 pandemic has severely affected the health sector in the whole world. Routine OPDs including rehabilitation centers are partially functional to minimize the risk of cross-infection. In elderly patients, rotator cuff syndrome is a common cause of shoulder pain and daily physiotherapy is the main mode of management. To minimize the risk of cross-infection (COVID-19), we introduced E-rehabilitation services via various mobile apps to our patients. In developing countries like India, E-rehabilitation is still a new concept. Methods: This study evaluated 70 patients who had been enrolled for E-rehabilitation with a minimum of 4 weeks follow-up. Every patient was asked to use the rehabilitation App as per their requirement. Results were assessed with Disabilities of the Arm, Shoulder and Hand (DASH), visual analogue scale (VAS) and active ranges of movement (forward flexion and external rotation). Results: The average age of enrolled patients at the time of surgery was 55.0 years (range, 40–65 years). In 2 and 4 weeks, the range of forward flexion and external rotation has improved significantly. DASH and VAS Score has also been decreased significantly at an average of 2 and 4 weeks with [Formula: see text]. Conclusion: In this paper, we summarized the management of rotator cuff syndrome by using various mobile apps and also the various challenges faced in the elderly population with the newer concept of E-rehabilitation in this pandemic.

Revisiting the Open Bankart Experience

2002 ◽  
Vol 30 (6) ◽  
pp. 778-782 ◽  
Author(s):  
Lennart Magnusson ◽  
Jüri Kartus ◽  
Lars Ejerhed ◽  
Ingrid Hultenheim ◽  
Ninni Sernert ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
External Rotation ◽  
Constant Score ◽  
Surgical Reconstruction ◽  
Anterior Shoulder Instability ◽  
Reconstruction Procedure ◽  
Bankart Procedure ◽  
Number Of Patients

Background The open Bankart technique for posttraumatic recurrent anterior instability has become the procedure of choice for patients who do not respond to nonoperative treatment. Hypothesis The open Bankart procedure renders stable and well-functioning shoulders in the long term in a large proportion of patients. Study Design Retrospective follow-up study with independent reexaminers. Methods Fifty-four patients (54 shoulders) with symptomatic, posttraumatic, recurrent anterior shoulder instability underwent an open Bankart reconstruction procedure with suture anchors. All of the patients had a Bankart lesion. Forty-seven patients (87%) were reexamined by independent observers at a mean follow-up period of 69 months (range, 48 to 114). Results The recurrence rate, including both dislocations and subluxations, was 17% (8 of 47). The median Rowe score was 90 points (range, 24 to 100) at the follow-up, and the median Constant score was 88.5 points (range, 41 to 100). External rotation in abduction was a median of 90° (range, 25° to 125°) in the involved shoulders, as compared with 97.5° (80° to 125°) in the noninjured shoulders (P < 0.0001). Conclusions We conclude that, in the long term, the open Bankart procedure resulted in an unexpectedly high number of patients with failure in terms of stability. These results emphasize the importance of performing long-term follow-up studies after surgical reconstruction for unidirectional, posttraumatic, anterior shoulder instability using any type of technique.

scholarly journals Clinical Outcomes of Revision Arthroscopic Capsulolabral Repair for Recurrent Anterior Shoulder Instability With Moderate Glenoid Bone Defects: A Comparison With Primary Surgery

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110598
Author(s):  
Young Dae Jeon ◽  
Hyong Suk Kim ◽  
Sung-Min Rhee ◽  
Myeong Gon Jeong ◽  
Joo Han Oh
Keyword(s):  
Clinical Outcomes ◽  
Bone Defect ◽  
Shoulder Instability ◽  
External Rotation ◽  
Anterior Shoulder Instability ◽  
Level Of Evidence ◽  
Primary Surgery ◽  
Significant Difference ◽  
Primary Groups

Background: The optimal revision surgery for failed primary arthroscopic capsulolabral repair (ACR) has yet to be determined. Revision ACR has shown promising results. Purpose: To compare the functional, strength, and radiological outcomes of revision ACR and primary ACR for anterior shoulder instability. Study Design: Cohort study; Level of evidence, 3. Methods: Between March 2007 and April 2017, a total of 85 patients underwent ACR (revision: n = 23; primary: n = 62). Functional outcome scores and positive apprehension signs were evaluated preoperatively, at 1 year, and then annually. Isokinetic internal and external rotation strengths were evaluated preoperatively and at 1 year after surgery. Results: The mean follow-up was 36.5 ± 10.2 months (range, 24-105 months). There was no significant difference between the revision and primary groups in the glenoid bone defect size at the time of surgery (17.3% ± 4.8% vs 15.4% ± 5.1%, respectively; P = .197). At the final follow-up, no significant differences were found in the American Shoulder and Elbow Surgeons score (97.6 ± 3.1 vs 98.0 ± 6.2, respectively; P = .573), Western Ontario Shoulder Instability Index score (636.7 ± 278.1 vs 551.1 ± 305.4, respectively; P = .584), or patients with a positive apprehension sign (17.4% [4/23] vs 11.3% [7/62], respectively; P = .479) between the revision and primary groups. There was no significant difference between the revision and primary groups for returning to sports at the same preoperative level (65.2% vs 80.6%, respectively; P = .136) and anatomic healing failure at 1 year after surgery (13.0% vs 3.2%, respectively; P = .120). Both groups recovered external rotation strength at 1 year after surgery (vs before surgery), although the strength was weaker than in the uninvolved shoulder. In the revision group, a larger glenoid bone defect was significantly related to a positive apprehension sign (22.0% ± 3.8%) vs a negative apprehension sign (16.0% ± 3.2%; cutoff = 20.5%; P = .003). Conclusion: In patients with moderate glenoid bone defect sizes (10%-25%), clinical outcomes after revision ACR were comparable to those after primary ACR. However, significant glenoid bone loss was related to a positive remaining apprehension sign in the revision group. Surgeons should consider these findings when selecting their revision strategy for patients with failed anterior shoulder stabilization.

scholarly journals Midterm Outcomes After Arthroscopic Coracoid Decompression Combined With Manipulation for the Treatment of Frozen Shoulder Associated With Subcoracoid Impingement

2021 ◽  
Author(s):  
Shengyang Jin ◽  
Xiaohong Wang ◽  
Yu He ◽  
Wei Huang ◽  
Ze Wang ◽  
...  
Keyword(s):  
Los Angeles ◽  
Rating Scale ◽  
External Rotation ◽  
Frozen Shoulder ◽  
Final Analysis ◽  
Pain Rating ◽  
Rating Score ◽  
Sleep Complaints ◽  
Forward Flexion

Abstract Background Patients with frozen shoulder (FS) suffer considerably, and some also present with subcoracoid impingement. However, effective treatments for frozen shoulder associated with subcoracoid impingement (FSASI) are limited. Primary purpose of this study was to introduce an arthroscopic coracoid decompression method combined with manipulation to treat FSASI and investigate its mid-term efficacy. Methods From April 2015 to May 2018, 177 patients with frozen shoulder who had no positive response to conservative therapy after a minimum of 6 months underwent arthroscopic coracoid decompression combined with manipulation. Shoulder condition was evaluated using the abbreviated Constant-Murley score (ACMS) and the modified University of California at Los Angeles Shoulder Rating Scale (MUCLA) preoperatively; at the 1st, 3rd, and 6th months postoperatively; and at the final follow-up (May 15, 2020). Results Eight patients were lost to follow-up, and 169 were included in the final analysis. The mean follow-up duration was 38.22 (range, 24–60) months. The ACMS improved from 16.39 ± 2.99 points (preoperative) to 72.08 ± 1.04 points at the last follow-up (p < 0.001). The MUCLA improved from 10.84 ± 0.71 points (preoperative) to 32.94 ± 0.74 points at the last follow-up (p < 0.001). Improvements in ACMS and MUCLA scores were significant in the first 3 months, then leveled off, and remained stable between the 6th month and the final follow-up. Recovery of forward flexion and abduction progressed synchronously, and almost full scores were achieved (9.96 ± 0.08 and 9.92 ± 0.11 points, respectively). Some patients lost ranges of motion: eight patients partially lost forward flexion and abduction, four partially lost external rotation, and fourteen partially lost internal rotation. The ACMS pain rating score improved from 1.12 ± 0.68 (preoperative) to 13.06 ± 0.71 points, and the MUCLA pain rating score improved from 1.67 ± 0.27 (preoperative) to 8.94 ± 0.43 points (last follow-up). Most improvements occurred in the first month after surgery. Timely pain improvement can effectively help patients improve sleep; complaints of sleep disturbance decreased significantly postoperatively. No complications or recurrence occurred. Conclusion Arthroscopic coracoid decompression combined with manipulation was an alternative method for treating FSASI, and satisfactory results were maintained through midterm follow-up.

Evaluation of Shoulder Instability Braces

1996 ◽  
Vol 5 (2) ◽  
pp. 143-150 ◽  
Author(s):  
Mark DeCarlo ◽  
Kathy Malone ◽  
Brad Gerig ◽  
Mike Hunker
Keyword(s):  
Shoulder Instability ◽  
External Rotation ◽  
Shoulder Abduction ◽  
Isokinetic Exercise ◽  
Forward Flexion ◽  
Shoulder Flexion ◽  
Flexion Extension ◽  
Limit Motion ◽  
Male Subjects ◽  
Active Abduction

The comparative abilities of three types of shoulder orthoses to limit motion following isokinetic exercise were studied on 10 male subjects. Maximum active abduction, forward flexion, and external rotation were measured under a control and three braced conditions. Braced conditions included Sawa, Duke Wyre, and Shoulder Subluxation Inhibitor. Subjects performed 10 repetitions each of flexion/extension and abduction/adduction exercise at isokinetic speeds of 120 and 180°/s. Data were analyzed using a pairedt-test and ANOVA. Significant differences were found for each of the devices in pre/post gonio-metric measurements of forward shoulder flexion. Only the Sawa brace demonstrated significant pre/post change for shoulder abduction. No significant differences were detected in any of the devices for external rotation. A trainer who is selecting a motion-limiting shoulder device for an athlete returning to competition following injury should consider the “loosening” effect that may occur during activity as well as the desire for overhead motion.

scholarly journals Chronic anterior instability with hyperlaxity treated by arthroscopy using the Trillat technique with endobutton fixation: results for 14 cases

2020 ◽  
Vol 8 (2_suppl) ◽  
pp. 2325967120S0000
Author(s):  
Philippe Valenti ◽  
Marco Cartaya ◽  
Jean-David Werthel
Keyword(s):  
External Rotation ◽  
Arthroscopic Surgery ◽  
Bone Lesions ◽  
X Rays ◽  
Anterior Instability ◽  
Reliable Technique ◽  
Subscapularis Muscle ◽  
Locking Mechanism ◽  
Conjoint Tendon

Background: Recurrent anterior instability associated with hyperlaxity remains a difficult challenge. In 1954, Trillat proposed osteoclasis of the coracoid process in order to make it more distal and more medial to place the conjoint tendon just in front of the humeral head. The conjoint tendon lowers and reinforce the stabilizing action of the subscapularis muscle in abduction. This open surgery technique has provided satisfactory results in patients with chronic anterior glenohumoral instability associated with massive irreparable rotator cuff tears. We hypothesized that this procedure could be arthroscopy-assisted with the use of an endobutton to treat anterior glenohumoral instability with hyperlaxity without engaging bone defects. Methods: This is a prospective study on 14 patients (9 females, 5 males; average age 25 years) who underwent surgery between 05/2014 and 12/2016. These were patients with anterior instability with hyperlaxity (external rotation > 85° / positive sulcus sign and no associated bone lesions). Arthroscopic surgery consisted of an antero-inferior capsuloplasty with Bankart repair combined with coracoid osteoclasis and fixation with an endobutton with a self-locking mechanism. The results were evaluated using SSV, Walch-Duplay, Rowe and Constant scores. Standard X-rays and a CT scan with 3D reconstructions were also performed at follow-up. Results: With an average follow-up of 26 months (24 to 32 months), no recurrent instability was reported, but persistent apprehension was found in 2 cases. The average Walch-Duplay score was 85 points, Rowe 89 points, the SSV 91% and adjusted Constant score 95.8%. The average VAS score was 0.8 points. The mean preoperative active anterior elevation of 178° decreased to 165° postoperatively and similarly, external rotation with the elbow at side decreased from 90° to 57°. At the last follow-up, all osteotomies healed. No complications were reported. Conclusion: Arthroscopy-assisted Trillat technique with the use of an endobutton appears to be a reliable technique for the treatment of hyperlaxity associated with chronic anterior glenohumoral instability without bone defect. Stabilization and adjustment of coracoid osteoclasis are provided by the endobutton; lowering and medial placement of the coracoid causes lowering of the subscapularis muscle by the conjoint tendon in abduction and thereby reinforces anterior capsuloplasty. Longer follow-up is required to confirm the reliability of this technique.

Neer Modified Inferior Capsular Shift Procedure for Recurrent Anterior Instability of the Shoulder in Judokas

2009 ◽  
Vol 37 (5) ◽  
pp. 995-1002 ◽  
Author(s):  
Yoshiyasu Uchiyama ◽  
Kazutoshi Hamada ◽  
Seiji Miyazaki ◽  
Akiyoshi Handa ◽  
Hiroaki Fukuda
Keyword(s):  
External Rotation ◽  
Case Series ◽  
Activity Levels ◽  
Anterior Instability ◽  
Level Of Evidence ◽  
Sports Activity ◽  
Capsular Shift ◽  
Minimal Restriction ◽  
Average Loss

Background Little has been written about the operative repair of recurrent anterior instability of the shoulder in a single sport: in this case, Judo. Purpose The clinical efficacy of the Neer modified inferior capsular shift as an open procedure for injured judokas was investigated. Study Design Case series; Level of evidence, 4. Methods Fifty athletes (42 male and 8 female, 52 shoulders) took part in this study. The average age at surgery was 20 years (range, 14-38 years), and the mean follow-up period was 61 months (range, 24-172 months). The operation was performed on 29 tsurité (a lapel grip) shoulders and on 23 hikité (a sleeve grip) shoulders. The 2 grips are functionally and technically different from each other. Results Three cases of shoulder instability (5.8%) recurred after surgery. The average loss of external rotation was 9.6° with the arm at the side and 11.6° with the arm in 90° of abduction. The average Rowe and UCLA scores were 37.3 and 20.8 points preoperatively and 86.7 and 32.4 points at the final follow-up, respectively (P < .05). The return rate to the near-preinjury sports activity levels (>90% recovery: grades 1 and 2) was significantly lower in the tsurité shoulders (48.1%) than in the hikité shoulders (85.7%). Conclusion The overall recovery of more than 90% of preinjury activity levels in judo was 65% after modified inferior capsular shift for traumatic anterior instability of the shoulder. The tsurité shoulder should be treated with minimal restriction limitation in external rotation so that it is not limited postoperatively.

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