抄録
We have been using a modified Caspari technique to treat recurrent anterior dislocation of the shoulder, but some patients have shown a sudden extension of their range of motion at 5-6 weeks postoperatively or residual instability. We speculated that these problems were related to the use of absorbable sutures, and so we began using non-absorbable sutures. To clarify the efficacy of this new technique, we assessed the clinical results of our modified Caspari method using non-absorbable or absorbable sutures.
We retrospectively studied 30 patients (24 males and 6 females) who underwent a modified Caspari technique for traumatic anterior shoulder instability and were followed-up for more than one year postoperatively. Group A was patients operated on using only absorbable sutures (PDS II). There were 15 patients (mean age: 20 years) and the average number of sutures was 8. Group N comprised of 15patients (mean age: 22 years), who received an average of 4.3 non-absorbable sutures (Prolene) and 3.5 PDS II sutures. In group N, both suture materials were used because non-absorbable Prolene sutures should not be inserted into the lower part of the labrum where they could ride over the glenoid surface. After surgery, the arm was immobilized in a Velpeau bandage for 3 weeks and then in a sling for 1 more week in both groups.
At follow-up, Rowe's rating scale (1978) was used for the assessment. There were 13 excellent,1 fair, and 1 poor results in group A (success rate: 87%), while there were 12 excellent and 3 good results in group N (success rate: 100%). One recurrence and 2 cases of residual instability occurred in group A, while there was no recurrence or instability in group N. However, the mean postoperative limitation of external rotation was 2.0°at 0°abduction and 1.0°at 90°abduction in group A as compared to 10.0°and 6.8°in group N, with obvious limitations in the latter group. All three good results in group N showed decrease of the score due to a limitation of external rotation. Although there were 7 contact sports athletes in group N, their clinical results were still favorable.
The modified Caspari technique using non-absorbable sutures achieved excellent stability, but the limitation of external rotation was more common when absorbable sutures were used.
