Summary

Extra-articular reinforcement ligamentoplasty prevents recurrent instability in the population with hyperlaxity.

Abstract

The aim of this study is to determine whether extra-articular reinforcement ligamentoplasty prevents recurrent instability in the population with hyperlaxity.
Recurrent glenohumeral dislocation is a common condition that usually requires surgical treatment. In the presence of risk factors such as hyperlaxity, arthroscopic capsulolabral repair with anchors does not achieve good results. One of the reasons for this high incidence of failure suggests the existence of a glenohumeral capsuloligamentous deficiency, of the labral complex or a bone defect. The management of complex shoulder instability by synthetic extra-articular reinforcement ligament repair (“internal brace”) is a technique described and used since the 1990s.
This retrospective study collected 235 shoulders intervened between 1991 and 2014 by Synthetic extra-articular reinforcement ligamentoplasty with the original technique. Reluxation rate, active range of motion, joint degeneration according to Samilson-Prieto classification, and the WOSI, UCLA, ROWE and Subjective Shoulder Score (SSV) questionnaires were collected. Variables were determined using mean and standard deviation for parametric data, and median and CI95% for nonparametric data. Comparisons were performed using Χ2 test for percentages, the Student's T-test for parametric data and the Mann-Whitney test for nonparametric data; the distribution was assessed using Shapiro-Wilk. Data were considered statistically significant at p<0.05. Survival study were conducted using the Kaplan-Meier analysis.
The median age at first dislocation was 20 years (19-22). The median age of intervention was 27 (25-28). Fifty-nine percent of the patients were followed for more than 20 years and 93% for more than 15 years. Signs of associated hyperlaxity were observed in 76.56% of the patients, and bilateral glenohumeral instability in 18.9% of the patients.
6% of the total patients reported apprehension during follow-up. 24 patients (10%) required new surgery due to recurrence of instability with a mean time to event of 7.7 ± 6.8 years and of traumatic etiology in 83.7% of the cases. The Kaplan-Meier curve estimated a survival rate of 85.7% at 30 years. In x-ray analysis only 11.67% of the patients had moderate or severe arthropathy, and 97.1% of the patients presented an active elevation of more than 160º without external rotation limitation.
The median on the WOSI scale was 77.41, 31.5 on the UCLA, and 80.00 on the ROWE. Outcome satisfaction was excellent or good in 84.4%. Scale results were significantly worse in the group with reluxation event (p<0.001).
This technique presented a low reoperation rate with a good long-term range of motion and high patient satisfaction. The progression of instability arthropathy was reduced in the long term. Long-term follow-up studies are necessary to evaluate instability techniques.