関節包断裂が主病因と考えられた反復性肩関節前方脱臼症例の臨床的特徴と手術成績の検討

抄録

Most common pathology of recurrent anterior shoulder dislocation is Bankart lesion. However, anterior dislocation can also occur by humeral side avulsion of IGHL (HAGL lesion) or a midsubstance tear of IGHL (capsular tear). The purpose of this study was to evaluate the clinical features and surgical results of recurrent anterior shoulder dislocation with an isolated capsular tear. During the last 5 years,303 shoulder joints with traumatic anterior instability underwent surgery. Among these, the visible isolated capsular was 12 (3.9%). Gender was male in 9 and female in 3. The average age at operation was 25 years old. Twelve patients underwent 11 arthroscopic repairs and 1 an open-salvage repair. The location of the tear was classified into 3types: glenoid-side for 7 patients, mid-portion for 3, and humeral-side for 2. The average ages at the initial dislocation, of the patients of glenoid-side type(23.5 years old) or mid-portion type(24 years old) were older than those of patients with Bankart lesion. There were no Hill-Sachs lesions but very small adjacent to the bare area. Eight patients with a minimum follow-up of one year were studied. According to the JSS scoring system, the average preoperative score was 62.1 points and the postoperative score was 92.6 points. One patient had a recurrence 2 years after surgery. If there are any patients with recurrent anterior shoulder dislocation with a small Hill-Sachs lesion and their age an initial dislocation was high, they should be examined by ABER-MRI. A capsular tear should be fully recognized as one of the essential lesions in recurrent anterior shoulder dislocation. The arthroscopic examination and repair were useful for a capsular tear.