Santosh Kumar Sahu1, Anant Kumar Garg2, Sanjay Kumar3
BACKGROUND: Shoulder instability and its treatment were described even in ancient times by the Greek and Egyptian physicians. Evidence of shoulder dislocation has been found in archaeological and paleopathological examinations of human shoulders several thousand years old.1 Many techniques have been described in literature for treatment of recurrent shoulder dislocation. Arthroscopic repair of Bankart’s lesion using suture anchors is a noble technique. A suture anchor is a tiny screw with a thread attached to it. The screw is inserted into the bone over the glenoid rim while the sutures hold onto the labral tissue. These anchors provide a stable base for reattachment of the capsulolabral complex. We conducted a study on evaluation of long term effect of arthroscopic repair of Bankart’s lesion using suture anchors and compared our results with other studies published in literature.
MATERIALS & METHODS: Since June 2012, arthroscopic Bankart’s repair using suture anchors was performed on 35 patients, who presented with recurrent anterior dislocation of shoulder. 34 man and 1 woman patients were included in the study. METHOD OF COLLECTION OF DATA: Adult patients with recurrent dislocations of shoulder with.
INCLUSION CRITERIA: All patients >15 years but <60 years of age, with post traumatic recurrent dislocation of the shoulder with Bankart lesion. No. of dislocations >=2.
EXCLUSION CRITERIA: Age group <15 & >60 years. Clinical evidence of multidirectional instability. Surgery of injured shoulder before 1st episode of traumatic shoulder dislocation. Number of dislocations <2. Generalised ligamentous laxity. Presence of neuromuscular disorders. Presence of other comorbid conditions. Majority of patients were in the age group between 17 years to 49years, with mean age of 27.43 years. Most patients were young active individuals in the age group of 25 to 35 years. 20 patients (57%) were involved in significant occupation requiring overhead activity such as students with sporting activities, agriculturists. 21(60%) patients had their Right shoulder involved, rest 14(40%) patients had Left shoulder involved. The mean follow-up period was 12 months (range 8-28 months). The patients were evaluated by visual analogue score (VAS), ROWE’s score at final follow-up.
RESULTS: 34/35 patient’s regained almost preoperative range of forward flexion at the last follow-up. Preoperative scores were compared with the most recent follow-up scores for all variables with the help of paired t test. All patients had significant improvement in visual analogue score and ROWE’s score. In the preoperative period 18(51.43%) patients had full range and 14(48.57%) patient had painful/limited terminal range of motion, as regards external rotation with arm at the side (ER1). And 07(20%) patients had 0-65º, 22(62.85%) patients had 0-70º, 3(8.57%) patient had 0-70º with pain at terminal range of motion, 3(8.57%) of patients had full range of motion, as regards external rotation at 90º abduction (ER2). At the last follow-up, 33/35(94.28%) patients had full range of ER1 & 32/35(91.42%) patients had full range of ER2. This improvement in external rotation deficit was statistically significant (P <.05). Preoperative scores were compared with the most recent follow-up scores for all variables with the help of paired t test. Three of the patients developed apprehension which got resolved after proper physiotherapy. Pre-operative: mean Total Rowe score was 48.51, mean scores of stability 21.17, mean score of function 12.14, mean score of motion 15.77. The mean post-operative Rowe score improved to 97.63, mean stability component to 47.77, mean motion component to19.47 and mean function component to 28.63 compared to the pre-operative Rowe scores. We had final Rowe’s Score excellent in 32 patients, good in 2 and fair in 1 and Poor in 1 (P-value 2.992X10-12). There was no radiological evidence of loosening and migration of anchors or any gleno-humeral arthritis on subsequent follow-up skiagrams in any of our patients.
CONCLUSION: Arthroscopic repair of Bankart’s lesion using suture anchors is a simple & technically easier method in the treatment of post traumatic recurrent shoulder dislocation.
