FAILED
ANTERIOR
RECONSTRUCTION
FOR
SHOULDER
INSTABILITY ROBERT
From
Shaughnessy
We report a shoulder multidirectional 20
Hospital,
a retrospective
instability. instability with significant
HAWKINS,
RICHARD
Vancouver
study
for
patients
H.
of46
and
patients
with
J.
HAWKINS
St Joseph’s
Hospital,
continuing
London,
difficulties
after
Canada
anterior
In 31 patients instability was still present; in 12 had not been recognised and a further 1 1 had an uncorrected pain there was often more than one cause: impingement
reconstruction
of
of
these, posterior anatomical defect. syndrome was seen
or In in
nine, osteoarthritis in seven, implant irritation in four and instability alone in two. A disabling medial rotation contracture was seen in 10 patients, four of whom had painful osteoarthritis. We conclude that recurrence of symptoms may imply that the direction of the instability was not recognised, that an anterior repair should not be too tight, and that pain after successful stabilisation is often due to impingement. Glenohumeral major
instability
cause
of
Recurrent
dislocations
directions
are
1983).
Bankart,
Du
Toit
ity
persists
one
(Moseley
of
these
Foster
1980;
an
incomplete
of failure
retrospective
are
reasons
for
becoming
of
the
shoulder
persistence
46
cases
and
of the
MATERIAL Successful restore
stability
range
ofmovement.
of instability, loss
ofmovement.
these
problems
for
while
were
R. J. Hawkins, MD, paedic Surgery University ofWestern Requests for reprints Shaughnessy Hospital British Columbia V6H
FRCS(C),
to us by other
(C),
Clinical
Instructor
Vancouver, FACS,
a the
London,
should be sent Pavilion, G627, 3N1, Canada.
ior
of Bone
to
and
Dr
functional
surgeons
tive
VOL.
5, NOVEMBER
1985
their by
this
initial us and Revision
patients.
Clinical
in Table
I.
for
of Ortho-
instability
marked
loss
than one instability.
the
31
with
a major
in 3 1 cases,
of mobility
in 10.
cause of failure. Three separate
patients
diagnosis
ofanterior
in
this
categor-
for
The
group.
recurrence
re-injury;
was
of anter-
these
patients,
may
procedure
either
was
third
had
For
a minor
been
injury. but
were
these
those
patients)
whose
instability
12 we
been
or
Nine
patients
seven
felt
that
the
incomplete
we found had
of them (Neer
osteoarthritis, and ciated with a tight had intra-articular damage
from
the
the
opera-
five
or
later
diagnosis
incorrect
and
1972). in six anterior staples
recurrence
problem causes
a successful
Seven
patients
the
for (Table
impingement
had
(10
original
underlying
subacromial
was
multidirectional
original procedure therefore inappropriate. Postoperative pain. This was a major and
Here
correct
inadequate.
(two
probably
after have
group
posterior
patients).
probably
instability
diagnosis The
in Orthopaedic
Surgery
of
FAILURE
among
after
original
by recurrence
Robert H. Hawkins, Oak Street, Vancouver,
Joint
after
27
persisting
and
of eight
instability
mioplasty
__________________________________
basis
correct and the original procedure appropriate, but the violence of the new injury broke down what had been a satisfactory repair. The second group comprised 1 1 patients with recurthe
rence
Canada.
4500
on
OF
was
in 20,
consisted
and Ontario,
the
evaluated direction.
summarised
distinguished
original
should
Professor
are
of failure pain
were
first
recon-
Canada. Associate
Editorial Society I 54 52.00
No.
cause
patients,
1985 British 030 1-620X/855
67-B,
ies
pain or marked with one or more of
patients
were our
performed
Many cases had more Persisting or renewed
report
analyse
a painless
be caused
postoperative
R. H. Hawkins, MD, FRCS Surgery University of British Columbia,
to
form
problems
all under
patients
significant
based other
instability
may
referred
The
METHODS
maintaining
Forty-six
We
had
CAUSES
suggest
anterior
attempt
anterior
Failure significant
failed
they
and
instability.
AND
operation
1984)
have been diagnosis;
evident. of
ofall
instabil-
dislocation. instability
Ganz
often incorrect
an
now
study
of
structions
and
patients
were
details
it is frequently
may
or
When
46
anterior reconstruction; subsequently treated operations
described
ofanterior glenohumeral
Gerber
operations
on
Bristow
1945).
All
different
those
procedures,
to be due to recurrence recent studies of and
causes
reported;
Putti-Platt,
popular
subsequent
upon
been
focused
many
treatment;
report.
(DePalma
has
which
and
assessment
or inferior
writings
for
as a athletes.
posterior
attention
Magnuson-Stack,
However, that
most have
after
recognised among
earlier
dislocation,
remain
presumed (Neer
in
recently,
procedures
by
been
in anterior,
anterior
surgical
long especially
described
More
recurrent
has
disability,
20 II).
syndrome,
anterior had
acropainful
of these it seemed to be assorepair; the seventh (Case 25) and sustained severe articular during
a seizure.
Irritation
by 709
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