抄録
Many authors have reported that anterior dislocations of the shoulder are often associated with rotator cuff tears in older patients. After manual reduction, some patients complain of pain and functional disability. If conservative treatment is not effective, there are two operative methods. One is a rotator cuff tear repair alone, and the other is repairing a cuff tear together with a Bankart lesion. Usually, we operated a cuff repair alone in such cases. The purpose of this study is to assess our operative cases retrospectively, and to clarify the indications for and limits of a cuff repair.
15 patients with no axillary nerve palsy were operated on. They consisted of nine males and six females with an average age of 65 years. The rotator cuff was repaired alone in all the cases except one(Case 3). The clinical results were evaluated according to JOA score and discussed with respect to the size of the tear, the exsistence of a Bankart and Hill-Sachs lesion, whether recurrent or not, the stabiity and reductional sensation at manual reduction.
The average preoperative JOA score was 46 points and the postoperative one was 86 points. Three cases redislocated. Case 1 and case 3 redislocated in some everyday motion, but Case 2 fell. There were nine cases of a small tear of the supraspinatus, two of which (Case 1 and Case 3)redislocated. A Bankart lesion was found in seven cases, five of them had a supraspinatus tear only, and a Hill-Sachs lesion was found in seven. In five recurrent cases, only one (Case 3)dislocated again. Case 1 and Case 3 had poor reductional sensations at manual reduction.
In summary, repair of the cuff alone is almost sufficient in the older cases. Two of the redislocated cases; case 1 and case 3, which a small tear and a poor reductional sensation, can imply that an anterior capsular mechanism is associated, and a Bankart repair is sometimes needed.
