Operative Management of Anterior Glenohumeral Instability

摘要

Introduction: Management of glenohumeral instability focuses more on operative treatment, while non-operative management, especially in young, active patients, may cause recurrent instability in a high percentage,Aim: Management of anterior glenohumeral instability, their advantages and limitations, the operative techniques and results will be described and discussed,Materials and Methods: A total of 379 patients who were operated between 1985 and 1994for recurrent shoulder instability were followed up; no patients were managed with open Bankart procedure, 165 patients with arthroscopic Bankart and 98 patients were treated with a bone-block procedure, Follow-up evaluation was performed 53 months on average postoperatively According to Rowe the functional results were classified as excellent and good in 91% with the open Bankart procedure, 80.6% with the arthroscopic Bankart repair and the results using the bone-block were rated as excellent and good in 95.4%, Overall complication rate was 16.3% (arthroscopic), 6.4% (open Bankart) and 4.4% (bone-block group). In patients with long-time results, degenerative signs at the glenoid and/or the humeral head were evaluated on plane radiographs (according to Rosenberg). In 17 long-term results of the bone-block procedure, Stage I osteoarthritis was identified in 25,5%, but no severe osteoarthrosis (stage II or III), while in the open Bankart group an osteoarthrosis rate of 18,6% (stages Hand III) was found.Conclusion: Different types and causes of glenohumeral instability recommend different techniques for operative treatment of anterior glenohumeral instability, The bone-block procedure provided the best results regarding stability and function; long-term radiological results indicate that bony repair prevents and does not cause osteoarthrosis.