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The treatment of first shoulder dislocation

The treatment of first shoulder dislocation. Manos Antonogiannakis Director center for shoulder arthroscopy IASO gen hospital. Winter sports are becoming more popular in Greece. Better and more Ski Centres. Better organization and equipment advances turns more people to Winter sports.

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The treatment of first shoulder dislocation

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  1. The treatment of first shoulder dislocation Manos Antonogiannakis Director center for shoulder arthroscopy IASO gen hospital

  2. Winter sports are becoming more popular in Greece Better and more Ski Centres. Better organization and equipment advances turns more people to Winter sports

  3. Athletes of every age and level

  4. Athletes of all ages

  5. Ski injuries 3 per 1000 Skier per day Hunter RE Am J Sport Med 1999 Ski injuries 4.33 per 1000 skier per day Shoulder Injuries 0.51 per 1000 skier per day Kocher MS Feagin JA Am J Sport Med 1996

  6. The Shoulder • Greatest Range of Motion in the Body • Motion in all 3 planes of movement • Prone to injuries • 8-20% of all sports injuries

  7. Shoulder dislocation 2% of the population 90% anterior dislocation

  8. First shoulder dislocation is a dramatic event with dare consequences especially in athletic individuals

  9. Redislocation after acute traumatic anterior dislocation of the shoulder 17% to 96% (mean 67%)

  10. Prognosis of recurrence after traumatic first time dislocation • Multicenter study • 245 patients aged 12-40 years • 10 years follow up • 52% recurrence rate • 23% were operated Primary anterior dislocation of the shoulder in young patients. A 10 year prospective study - Hovelius 1996 JBJS(A)

  11. The major prognostic factor of recurrence after acute traumatic anterior shoulder dislocation is the age of the patient and the degree of participation to athletic endeavors

  12. Redislocation rate in patients < 20 years • 90% • 94% • 94.5% • 90% Larrain Rowe Simonet and Cofield Slaa

  13. Age and athletic participation Athletes hockey on ice Recurrence rate: 90% in athletes < 20 years old 65% in athletes 20-25 years old Ηovelius, 1996

  14. The West Point experience • 127 patients • 55 conservative treatment • Recurrence rate 85% De Barandino et al. 1996

  15. Is shoulder arthroscopy the best treatment of the first shoulder dislocation?

  16. Arthroscopy in the treatment of first dislocation What does it offer? To what kind of patients?

  17. What does shoulder arthroscopy offers Better understanding of the pathology Reduction of recurrence rate Treatment of rotator cuff lesions in older individuals

  18. The patient Young professional athlete General population First dislocation in: Athletically oriented individual Loose joint individual

  19. Lesions after first shoulder dislocation • Bankart lesion • Tears of the anterior capsule • Plastic deformation of the posterior capsule • Hill-Sachs lesion, Bony Bankart • rotator cuff tears • SLAP lesions

  20. Our findings in first shoulder dislocation • Hemarthrosis 100% • Bankart 78.2% • Bony Bankart 13.04% • Hill-Sachs 65.21% • capsular laxity 8.69% • SLAP lesions 21.73% C. Yiannakopulos E Mataragas E.Antonogiannakis Arthroscopy Sep 2007

  21. Arthroscopic Shoulder Reconstruction Goal of the Operation: Define the pathology Restoration of the Labrum to its anatomic attachment Reestablishment of the appropriate tension in the IGHL complex and capsule Repair bony Bankart and large Hill-Sachs lesions Repair SLAP lesions Repair rot cuff tears

  22. Surgical technique • EUA • Arthroscopy • Suture anchor technique • Treatment of all the lesions

  23. Joint Inspection

  24. Arthroscope in Anterior-Superior Portal

  25. Mobilization of Anterior Labrum

  26. 1st Anchor Placement

  27. suture passage

  28. Knot Tying

  29. Evaluation of Repair

  30. Plication of the posterior capsule

  31. SLAP repair

  32. Arthroscopic success rate • Savoie 1997 93% • Burchart, De Bear 2000 96% • J Tauro 2000 93% • Kim 2003 96% • Snyder 2006 93% • Fabbriciani 2004 100%

  33. The West Point experience Wheeler et al 1989 NO 92% O 22% Arciero et al 1994 NO 80% O 14% Arciero et 1995 O 10%

  34. Arthroscopic stabilization or non operative treatment for the first shoulder dislocation? • 40 patients • < 30 years old • prospective randomized study • Transglenoid technique • Same postoperative protocol • Follow up > 34 months-75months Κirkley et al 1999-2005

  35. Recurrence rate: Arthroscopic treatment 16% Conservative treatment 47% Quality of life (WOSI) Better in the arthroscopy group Range of motion The same with both methods Sandy Κirkley 1999

  36. First shoulder dislocation Young athletes Transglenoid technique Follow Up 60 months Arthroscopic treatment 96 % excellent results Conservative treatment 5.5 % excellent results Larrain et al. Arthroscopic repair of acute traumatic anterior shoulder dislocation in young athletes. Arthroscopy,April 2001

  37. Treatment success Avoid recurrence Range of motion Minor morbidity Few complication Return to preinjury activity level Reproducible results These are possible with arthroscopic treatment of the first shoulder dislocation in selected patients

  38. First traumatic shoulder dislocation in patients older than 40 years Different lesions Different problems to be solved Rotator cuff tears 63% Ribbans et al JBJS 1990

  39. Findings after 1st shoulder dislocation in skiers older than 40 years • 52 pts follow up more than 2 years • Redislocation rate 4% • Rotator cuff tears 35% T Penvy, R Hunter, J Freeman Arthroscopy 1998

  40. Conclusions • The conservative treatment produces a unacceptable high recurrence rate in young athletic individuals • Arthroscopic treatment has a high success

  41. Conclusions • Arthroscopy can be performed in an outpatient setting • The anatomy can be restored with minimum morbidity and pain for the patient • Careful assessment will allow repair of all lesions after the first dislocation

  42. Conclusions Conclusions In older patients rotator cuff tears are common The arthroscopic treatment of symptomatic rotator cuff tears is fissible with minimum morbidity

  43. Indications for arthroscopic stabilization of first shoulder dislocation • young patients • professional athletes • athletically inclined individuals • dominant shoulder • avoidance of motion loss • return to the same activity level • overhead activity and activity in AB-ER • rotator cuff tears in older patients

  44. Conclusions • Modern arthroscopic techniques are probably the treatment of choice in these patients

  45. Thank you Thank you

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