Thomas, J Bone Joint Surg Am 1989 - An Approach to the Repair of Avulsion of the Glenohumeral Ligaments in the Management of Traumatic Anterior Glenohumeral Instability
|
An Approach to the Repair of Avulsion of the Glenohumeral Ligaments in the Management of Traumatic Anterior Glenohumeral Instability
Thomas, Matsen·J Bone Joint Surg Am·1989·324 citations
Thomas and Matsen described their direct repair of the avulsed anterior glenohumeral ligaments and its results, and sorted recurrent instability into two groups, TUBS and AMBRI.
61 patients (63 shoulders) operated at the University of Washington from 1976 to 1985. 37 patients (39 shoulders) examined at a mean 5.5 years.
Key Findings
By Rowe's rating, 97% of the 39 shoulders followed were good or excellent (34 excellent, 4 good, 1 poor) at a mean 5.5 years.
One shoulder redislocated, 4 years after surgery, and no patient needed reoperation.
Mean forward elevation was 171°, external rotation 68° at the side and 84° in 90° abduction. The authors believe repairing the ligament, rather than compensating with capsular overlap, helps preserve external rotation.
At surgery, 61 of 63 shoulders (97%) had rupture of the anterior glenohumeral ligaments. The authors suggest the high rate probably reflects including only traumatic cases.
A posterolateral humeral head defect was seen in 30 shoulders (48%) and did not change treatment. A glenoid rim fracture was found in 6 (10%).
Outcomes rest on 37 of 61 patients because 24 could not be located. The authors note that recurrence after repair tends to rise with time.
We believe that emphasis on re-pair, rather than on compensation for the rupture of the capsule and the ligaments, contributes to the maintenance of excellent external rotation (average, 68 degrees).
Thomas and Matsen described their direct repair of the avulsed anterior glenohumeral ligaments and its results, and sorted recurrent instability into two groups, TUBS and AMBRI.
61 patients (63 shoulders) operated at the University of Washington from 1976 to 1985. 37 patients (39 shoulders) examined at a mean 5.5 years.
Key Findings
By Rowe's rating, 97% of the 39 shoulders followed were good or excellent (34 excellent, 4 good, 1 poor) at a mean 5.5 years.
One shoulder redislocated, 4 years after surgery, and no patient needed reoperation.
Mean forward elevation was 171°, external rotation 68° at the side and 84° in 90° abduction. The authors believe repairing the ligament, rather than compensating with capsular overlap, helps preserve external rotation.
At surgery, 61 of 63 shoulders (97%) had rupture of the anterior glenohumeral ligaments. The authors suggest the high rate probably reflects including only traumatic cases.
A posterolateral humeral head defect was seen in 30 shoulders (48%) and did not change treatment. A glenoid rim fracture was found in 6 (10%).
Outcomes rest on 37 of 61 patients because 24 could not be located. The authors note that recurrence after repair tends to rise with time.
We believe that emphasis on re-pair, rather than on compensation for the rupture of the capsule and the ligaments, contributes to the maintenance of excellent external rotation (average, 68 degrees).