2017 ISAKOS Biennial Congress ePoster #2006
Functional Outcome Following Bipolar Procedure for Recurrent Dislocation of Shoulder: Retrospective Analysis Including Ultrasound and Strength Assessment of Infraspinatus
Rajkumar S. Amaravathi, MBBS, DNB, MNAMS, FRCS, Bangalore, Karnataka INDIA
Keith Behram Tamboowalla, MBBS, MS, DNB, Wigan UNITED KINGDOM
Padmanaban Sekaran, MSc PT, Bangalore INDIA
Shreeraam Venkatachalam, M.S(Orthopaedics).,DNB.,MNAMS.,FIA.,Dip SICOT, OMALUR TALUK,SALEM DISTRICT., TAMILNADU INDIA
St. John’s Medical College Hospital, BANGALORE, KARNATAKA, INDIA
FDA Status Not Applicable
Summary
Functional outcome following bipolar procedure for recurrent dislocation of shoulder: retrospective analysis including ultrasound and strength assessment of infraspinatus
ePosters will be available shortly before Congress
Abstract
Background
In comparison to isolated Bankart repair, a bipolar procedure with arthroscopic remplissage is often considered to be a better option for recurrent shoulder instability patients especially with large Hill-Sachs lesions. Since infraspinatus strength could be affected after Hill-Sachs remplissage, it is necessary to document the infraspinatus strength and the healing of the capsulotenodesis, both of which may influence the functional outcomes of the procedure.
Methods
In a retrospective Cohort study, thirty patients of traumatic anterior shoulder
instability treated by a single surgeon with arthroscopic Bankart repair and
Hill-Sachs remplissage with adequate follow up (6months -4 years) were assessed in our hospital. Preoperative assessments included magnetic resonance imaging for Bankart lesion identification and computed tomography to quantify the humeral head defect. Primary outcome measures were Infraspinatus Isometric strength assessed by a hand held dynamometer and Infraspinatus tenodesis and posterior capsulodesis healing documented by dynamic ultrasound imaging. Secondary outcomes include, Active range of motion and clinical scores (Walch-Duplay, Constant- Murley, Oxford and shoulder subjective value).
Results
The mean follow-up period was 28.4 months (Range 6- 48 months) one patient experienced a recurrence of instability at 24 months. The mean Infraspinatus strength values did not show significant differences as compared to the non-operated side. A good capsulotenodesis healing and filling of the Hill-Sachs defect was observed and confirmed by dynamic ultrasound imaging in all subjects. The mean AROM especially the ER and IR ROM was slightly decreased as compared to the non-operated side, however the difference was not clinically or statistically significant with all the patients reporting good functional range. The mean clinical scores Constant-Murley, Walch-Duplay, Oxford and SSV showed good improvement as compared to preoperative status.
Conclusion
Bipolar repair with Bankart & Remplissage is a reliable approach to treat recurrent shoulder dislocations. Infraspinatus strength recovery is good over the long term. Ultrasound examination allows accurate evaluation of Capsulotenodesis healing. Restrictions in the ER and IR ROM does not significantly affect the functional outcomes.