Summary

Recurrent anterior dislocations associated with full thickness rotator cuff tear carry a difficult therapeutic problem: should we treat instability and rotator cuff tear at the same time or only one of both pathologies? The goal of this study was to analyse a retrospective series of patients operated on to try to answer this question.

Abstract

Background

Combined arthroscopic repair of Bankart lesions (BL) and Rotator cuff (RC) injuries after acute shoulder dislocations, when present, is still a matter of controversy in the literature.

Purpose

The purpose of our study is to evaluate the functional outcome of simultaneous arthroscopic RC and BL repair after acute shoulder dislocation in a 2 year-follow-up.

Materials And Methods

Seventeen consecutive patients (11 male – 6 female) of mean age M=31.5 (18-42) who underwent arthroscopic simultaneous RC and BL repair with a minimum of 2 years' follow-up were recruited from 2011 to 2015. All patients had suffered an acute shoulder dislocation and were operated in a mean 4.6 weeks (2-6 weeks). X-rays and shoulder MRIs were performed pre-operatively in all cases. The American Shoulder and Elbow Surgeons (ASES) and UCLA Shoulder rating scale scores were obtained pre- and post-operatively. In 2 years follow up these scores were compared with the non-injured, asymptomatic shoulder side.
To evaluate the scores’ differences, the Mann–Whitney test was used; using the SPSS 17. The significance level was taken to be p < 0.05, for all the statistical measurements made.

Results

Both scores ASES and UCLA were statistically significant improved pre- operatively from M=38.4 (34-45) and M=5.6 (4-10) to M=95.5 (89-100) and M=32.4 (29-35) post-operatively respectively. Furthermore, in a comparison of the affected versus unaffected shoulder, there were no significant differences in the mean ASES (90.7 ±11.6 vs 94.0 ± 6.4, respectively) and UCLA scores (89.2 ±11.5 vs 94.6 ± 6.9, respectively) at last 2 year follow-up. The rehabilitation protocol need caution and modification based on the extent of RC injury and BL. Rehabilitation protocol started in 4 weeks post-operatively till 3 months in order to succeed the best result.

Conclusion

Simultaneous arthroscopic repair of the RC and a BL after acute shoulder dislocation, is an attempting operation and demand caution in the rehabilitation protocol. Based on our study the affected extremity after reconstruction had similar functional outcomes compared to the non-injured, asymptomatic side at a mean of 2 years follow-up.