Arthroscopy Limits on Anterior Shoulder Instability

Simmer Filho, Jair; Kautsky, Raul Meyer

doi:10.1055/s-0041-1731357

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ortopedia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Update Articles • Rev. bras. ortop. 57 (01) • 2022 • https://doi.org/10.1055/s-0041-1731357 copy

Arthroscopy Limits on Anterior Shoulder Instability

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Much is discussed about the limits of the treatment of anterior shoulder instability by arthroscopy. The advance in understanding the biomechanical repercussions of bipolar lesions on shoulder stability, as well as in the identification of factors related to the higher risk of recurrence have helped us to define, more accurately, the limits of arthroscopic repair.

We emphasize the importance of differentiation between glenoid bone loss due to erosion (GBLE) and glenoid edge fractures, because the prognosis of treatment differs between these forms of glenoid bone failure. In this context, we understand that there are three types of bone failure: a) bone Bankart (fracture); b) combined; and c) glenoid bone loss due to anterior erosion (GBLE), and we will address the suggested treatment options in each situation.

Until recently, the choice of surgical method was basically made by the degree of bone involvement. With the evolution of knowledge, the biomechanics of bipolar lesions and the concept of glenoid track, the cutoff point of critical injury, has been altered with a downward trend. In addition to bone failures or losses, other variables were added and made the decision more complex, but a little more objective.

The present update article aims to make a brief review of the anatomy with the main lesions found in instability; to address important details in arthroscopic surgical technique, especially in complex cases, and to bring current evidence on the issues of greatest divergence, seeking to guide the surgeon in decision making.

Keywords
shoulder joint; arthroscopy; glenoid cavity; rotator cuff injuries; shoulder injuries; shoulder dislocation

Types of bone failure	Failure presentation	Conduct
Bony Bankart/Fracture	Viable bone fragment	Consider arthroscopic repair, especially if fragment < 25% of the anteroposterior diameter of the glenoid.
Combined	Erosion + partially reabsorbed fragment	Consider arthroscopic repair when there is a possibility of reconstruction of 80% of the area of the lower circle of the glenoid
Bone loss (GBLE)	Erosion	Consider bone graft depending on failure size and demand

Tips and tricks	Possible advantages
Preference for lateral decubitus.	It allows a better visualization of bone injury as well as of secondary lesions in the other quadrants of the glenoid and facilitates implant insertion and balanced capsuloligamentar tensioning.
Use 3 cannulas.	Facilitates switching between portals, decreases tissue infiltration.
Liberal use of anchors (at least 3 to 4).	Decrease the risk of relapse.
Use delicate suture needles.	Prevents tissue straining, decreases surgical time and allows a more accurate stitch passage.
Mastering of the technique of using accessory portals (in particular the transubscapular or 5-hour portal and the accessory rear portal).	Allows the positioning of anchors with a better angle of attack.
In the preparation of the posterior portal, enter the stitch that is 2 cm posterior and 1 cm medial to the posterolateral angle of the achromial.	Thus, it is possible to have a better view of labrum repair, as it allows a broader view, from lateral to medial.
Remplissage	- Positioning of the anchor in the deep region of the bone defect. - Pass stitches at the beginning of the procedure when there is still no infiltration and tie after previous labrum repair - Be careful not to pass the suture stitched too medially, as this restricts movement.

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence Raul Meyer Kautsky, M.D., Rua Carlos Eduardo Monteiro de Lemos, 262, sala 209, Jardim da Penha, Vitória, ES, 29060-120, Brasil (e-mail: raulkautsky@gmail.com).