反復性肩関節前方不安定症に対する鏡視下手術

適応拡大と成績向上の試み

抄録

It is generally recognized that postoperative recurrence rate of arthroscopic stabilization for traumatic anterior shoulder instability is higher than that of the open procedure and the appropriate patient spectrum is limited. We perform arthroscopic stabilization using the anchor suture technique to a wider spectrum of patients by applying rotator interval(RI) reinforcement and anterior portal closure seeking excellent postoperative outcome.
In this series,27 shoulders including poor ligament-labrum tissue quality as well as bony Bankart lesions and contact/collision athletes underwent arthroscopic procedure. Exclusive criteria are large bony defect at the glenoid surface greater than 25% and humeral avulsion of the glenohumeral ligement(HAGL lesion). Average age at time of surgery was 26.9 years and average postoperative follow-up 6.5 months. All patients were seated in the beach-chair position under general anesthesia. Anchor suture technique using FAStak_TM and Panalok_TM anchors with #2 permanent braded suture was performed after preoperative manual evaluation and arthroscopic inspection. In cases of poor ligamentlabrum complex and wider RI, we performed arthroscopic RI reinforcement and portal closure besides ordinary Bankart repair and capsular shift.
Fourteen shoulders required only Bankart repair and capsular shift while other 13 required RI reinforcement and anterior portal closure as well. Currently, no recurrence is observed and no patient complains of apprehension. Seventeen patients observed for more than 4 months postoperatively returned to their former recreational level sports. It is possible that application of RI reinforcement and portal closure as well as capsular shift enables better postoperative outcome of arthroscopic stabilization even to the patients who has not been considered to be good candidates for arthroscopic treatme nt.