• Clinics in Shoulder and Elbow
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• v.15 no.2
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• pp.79-85
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• 2012

Objective: It has been expected that patient with posttraumatic recurrent anterior shoulder dislocation might have limited daily life activity because of pain and apprehension of dislocation. But there have been only a small number of investigations regarding the rotator strength in this patient. The aim of this study is to find the characteristics about rotator strength of patient with posttraumatic recurrent anterior shoulder dislocation using an isokinetic testing. Method: We enrolled thirteen patients with posttraumatic recurrent anterior shoulder dislocation and fifteen sex, age-matched healthy nonathletic subjects in this controlled study. All participants were male and there were no significant differences between the two groups in age, height, weight, BMI. Isokinetic internal rotator and external rotator strength was evaluated with a Biodex Isokinetic Testing machine (Biodex Medical Systems, Shirley, NY, USA), tests were performed at 60 deg/sec and 180 deg/sec for both sides. Peak torque normalized to body weight, external rotator to internal rotator ratio, total work and fatigue were calculated for each angular velocity. The association between internal rotator and external rotator strength and shoulder instability was analyzed by comparisons with a control group. Results: Any notable differences could not be found between the two groups given all data from no symptomatic left shoulder. There were no significant differences between the two groups statistically in internal rotation strength of right shoulder. However, there has been a tendency that at all angular velocities, external rotator peak torque to body weight, total work and external rotator to internal rotator ratio were significantly lower in the anterior instability group than the control group at all angular velocities. There was no substantial difference between those groups with respect to the fatigue of external rotator and internal rotator in our study. Conclusion: The prominent characteristics of posttraumatic recurrent anterior shoulder dislocation are external rotator weakness and loss of balance with external rotator and internal rotator. Therefore selective training using this information rotator might be helpful in conservative treatment and rehabilitation.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2001.03a
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• pp.62-63
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• 2001

• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.33-41
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• 2007

Purpose: The purpose of this study was to prove the effectiveness of the open medial (glenoid-based) anterior-inferior capsular shift in patients with multidirectional shoulder instability. Materials and Methods: We reviewed 19 patients treated by medial anterior-inferior capsular shift for multidirectional shoulder instability from March, 1998 to December, 2003. 15 patients of them have experienced recurrent dislocation. 8 patients(42%) showed bilateral laxity and 11 patients(58%) generalized ligamentous laxity, and 2 patients(10.5%) voluntary subluxation. An average follow-up was 24 months (range : $9{\sim}32$ months). Results: Pain improved in 18 patients of all. There was an average loss of 10 degree of external rotation, but no limitation of activity of daily living. There was no redislocation and subluxation, but two patients had some apprehension in sports activity. With Rowe score, the result was excellent or good in all patients. There were hematoma and local skin problem in 1 patient, but all had healed up. Conclusion: Medial anterior-inferior capsular shift in multidirectional shoulder instability provided satisfactory results in pain relief, patient's satisfactions and stability of glenohumeral joint. Though some of them have anterior gleniod deformities and large Hill-Sachs lesions, we could get good stabilities.

• Clinics in Shoulder and Elbow
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• v.23 no.4
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• pp.178-182
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• 2020

Background: The purpose of this study is to investigate clinical outcomes and radiological findings of cyst formation in the glenoid around suture anchors after arthroscopic Bankart repair with either biocomposite suture anchor or all-suture anchor in traumatic anterior shoulder instability. We hypothesized that there would be no significant difference in clinical and radiological outcomes between the two suture materials. Methods: This retrospective study reviewed 162 patients (69 in group A, biocomposite anchor; 93 in group B, all-suture anchor) who underwent arthroscopic Bankart repair of traumatic recurrent anterior shoulder instability with less than 20% glenoid defect on preoperative en-face view three-dimensional computed tomography. Patient assignment was not randomized. Results: At final follow-up, the mean subjective shoulder value, Rowe score, and University of California, Los Angeles shoulder score improved significantly in both groups. However, there were no significant differences in functional shoulder scores and recurrence rate (6%, 4/69 in group A; 5%, 5/93 in group B) between the two groups. On follow-up magnetic resonance arthrography/computed tomography arthrography, the incidence of peri-anchor cyst formation was 5.7% (4/69) in group A and 3.2% (3/93) in group B, which was not a significant difference. Conclusions: Considering the low incidence of peri-anchor cyst formation in the glenoid after Bankart repair with one of two anchor systems and the lack of association with recurrence instability, biocomposite and all-suture anchors in Bankart repair yield satisfactory outcomes with no significant difference.

• Journal of the Korean Arthroscopy Society
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• v.15 no.2
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• pp.121-124
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• 2011

Hill-Sachs lesion is the most common lesion in shoulder dislocation patient and it represented by postero-lateral bony defect of humerus. The lesion could be found in patients who dislocate shoulder joint first time, and it is reported that Hill-Sachs lesion proportionally increases as dislocation does. The location and presence of Hill-Sachs lesion play significant roles in shoulder instability. Authors experienced a double Hill-Sachs lesion in a recurrent anterior shoulder dislocation patient, and thereby report the case with a review of the literature.

• Clinics in Shoulder and Elbow
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• v.2 no.1
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• pp.53-59
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• 1999

Initial treatment of multidirectional instability of the shoulder would be a thorough rehabilitation program. If rehabilitation fails to resolve a patient's symptoms, the most commonly performed surgical procedure remains the inferior capsular shift. Eleven patients who had disabling multidirectional instability of the shoulder were managed with the inferior capsular shift. All of the procedure were performed by means of an anterior approach and a laterally based capsular shift. All of the patients were the contact athletes. The purpose of our study was to evaluate the efficacy of the inferior capsular shift procedure in the contact athletic patients, to review the loss of external rotation postoperatively and to discuss their return to sports. Mean follow up duration was 14.5 months(range, 12 to 24). Pain was relieved postoperatively in all cases and most patients could get stability except one case of recurrent subluxation. The average loss of external rotation and forward flexion after the operation were Y and 30 at last follow up. By the rating scale from American Shoulder and Elbow Society, overall scores improved from 49 points to 85 points. The results were excellent or good in 9 patients(82%) out of 11 patients. In reference to return to sports, 10 patients(91 %) of 11 patients returned to their sports with 7 patients (64%) returning at the same levels of competitiveness. The inferior capsular shift procedure was considered to be a recommendable method for the management of the multidirectional instability of the shoulder.

• Clinics in Shoulder and Elbow
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• v.20 no.4
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• pp.195-200
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• 2017

Background: This study investigated and evaluated the clinical outcomes of intra-articular lesions of traumatic anterior shoulder dislocation (TASD) associated with greater tuberosity (GT) fracture of the humerus. Methods: Subjects included 20 patients who were surgically or non-surgically treated for GT fracture of the humeurs with TASD, and followed-up for at least 2 years. The mean follow-up period was 54.1 months (range, 24-105 months). Of the 20 patients, 12 were treated surgically. Intra-articular lesions were identified randomly on magnetic resonance imaging scans (repeated thrice) by experienced radiologists and orthopedic surgeons. The accompanying intra-articular lesions were left untreated. Clinical outcomes were evaluated by Simple Shoulder Test (SST) and Western Ontario Shoulder Instability index (WOSI) at the last follow-up. Results: Intra-articular lesions were identified in 19 patients: 7 Bankart lesions, 15 humeral avulsion of the glenohumeral ligament lesions, 3 glenoid avulsion of the glenohumeral ligament lesion, and 6 inferior capsular tears. Two or more intra-articular lesions were identified in 6 patients. The mean SST score was 10.9 and the mean WOSI score was 449.3 at the last follow-up. Conclusions: For GT fracture of the humerus with TASD, a high frequency of diverse intra-articular lesions was identified. There were no incidence of recurrent shoulder dislocations, and good clinical outcomes were obtained without treatment of the intra-articular lesions. We thereby comprehend that although intra-articular lesions may occur in TASD associated with GT fracture of the humeurs, merely treating the GT fracture of the humerus is sufficient.

• Clinics in Shoulder and Elbow
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• v.27 no.2
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• pp.176-182
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• 2024

Background: This study compares the outcomes of Latarjet-Patte procedures (LPs) performed for primary glenohumeral instability in the setting of critical bone loss (LP-BL) versus salvage surgery performed after a failed arthroscopic Bankart repair (LP-FB). Methods: LP's performed by senior author from 2017 to 2021 were separated into cohorts by LP indication. Data abstracted from electronic medical records included demographic information, preoperative clinical scores, radiological imaging, and complications. Postoperative clinical outcome scores collected after a 2-year minimum follow-up included: patient-reported outcomes measurement information system (PROMIS) upper extremity (UE), PROMIS pain interference, PROMIS pain intensity, American Shoulder and Elbow Surgeons (ASES), and visual analog scale pain scores. Results: A total of 47 patients (LP-BL: n=29, LP-FB: n=18) with a mean age of 29 years (range, 15-58 years) were included in this study. Both cohorts achieved good upper extremity functionality without significant differences as indicated by mean PROMIS UE (LP-BL: 52.6±10.0 vs. LP-FB: 54.6±7.6, P=0.442) and ASES score (LP-BL: 89.9±15.7 vs. LP-FB: 91.5±14.4, P=0.712). However, the LP-FB cohort reported lower levels of pain (LP-FB: 0.5±1.1 vs. LP-BL: 1.9±2.7, P=0.020) at their latest follow-up. There were no significant differences in complication rates including re-dislocation between cohorts (LP-BL: 2/29 [6.9%] vs. LP-FB: 2/18 [11.1%], P=0.629). Conclusions: When performed after failed Bankart repair, the LP results in similar postoperative functional outcomes and similar rates of complications and re-dislocations when compared to the primary indication of recurrent glenohumeral instability in the setting of critical bone loss.

• Clinics in Shoulder and Elbow
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• v.12 no.1
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• pp.27-32
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• 2009

Purpose: We wanted to evaluate the effectiveness of inferior capsular plication for treating the anterior instability of the shoulder by comparing the prospective outcomes and the incidence of complications of the group (group1) that underwent arthroscopic vertical shift of the anteroinferior capsulo-labral complex and plication of the anterior band of inferior glenohumeral ligament and the group (group2) that underwent inferior capsular plication that was augmentated by the same method. Materials and Methods: From March 2005 to August 2007, we compared group 1 (42 cases) that underwent arthroscopic vertical shift of the anteroinferior capsulo-labral complex and plication of the anterior band of the inferior glenohumeral ligament and group 2 (33 cases) that underwent augmentated inferior capsular plication for recurrent anterior instability of the shoulder. The mean age was 22.5 years (range: 17~31 years) in group I, and 21.8 years (range: 16~30 years) in group II. The mean follow up was 23.5 months (range: 12~45 months in group I, and 20.1 months (range: 12~49 months) in group II. We checked the Rowe score and ROM preoperatively and at postoperative 6 months, 1 year and at the last follow up and we compared the incidence of complications. Results: The Rowe score increased from a preoperative mean of 20.6 to the last follow up mean of 86.8 after surgery in group I, and the Rowe score increased from a preoperative mean of 20.5 to the last follow up mean of 94.1 after surgery in group II. For the anterior instability of the shoulder, arthroscopic reconstruction had a good outcome in all of the cases, but group II had better outcomes and less complications than did group I (p<0.05). Conclusion: We thought that arthroscopic vertical shift of the anteroinferior capsulo-labral complex and plication of the anterior band of the inferior glenohumeral ligament with inferior capsular plication can lower the complication rate and show better outcomes.

• Clinics in Shoulder and Elbow
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• v.8 no.2
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• pp.148-153
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• 2005

Purpose: To assess the usefulness of early stabilization for initial shoulder dislocation which is indicated in some patients by comparing the arthroscopic findings and the outcomes of Bankart repair in the initial and recurrent dislocation. Materials and Methods: The study was performed on 16 cases of initial dislocation and 44 cases of recurrent dislocation. The follow-up period was 25 months in the initial dislocation group and 28 months in the recurrent group. Bankart lesion and the adjacent tissues were compared, and the results were evaluated by the Rowe rating scale. Results: Detached labrum and capsular ligament of the initial dislocation group were elastic and unretracted. While in the recurrent dislocation those were inelastic, and displaced and adhesive in many cases. The outcomes were mean 95 points in the initial group and 91 points in the recurrent group. In the initial group, apprehension was detected in only 1 case(6%). In the recurrent group, instability was detected in 4 cases(9%). Conclusion: Our data suggest that Bankart lesion in the initial dislocation can be repaired readily by surgery, the recovery is efficient, and the recurrence would be reduced. Thus, in active young sports lovers as well as athletes, early stabilization surgery for initial shoulder dislocation may be more helpful.