ARTHROSCOPIC TREATMENT OF THE SHOULDER INSTABILITY USING A BIODEGRADABLE FIXATION DEVICE

Abstract

Purpose: The purpose of this study is to evaluate the role of a biodegradable fixation device (Suretac, Acufex Microsurgical, Inc, Mansfield, Massachusetts) in the treatment of the shoulder instability.

Materials & methods: From January 1995 to December 1996, fifteen patients diagnosed as the shoulder instability were treated arthroscopically by using a biodegradable fixation device. All the patients were found to have Bankart lesions, and had the definite histories of trauma. 6 of fifteen patients had suffered from shoulder pain before the trauma, and all of them showed generalized ligamentous laxity sign and grade 2 or 3 positive sulcus sign in examination under the anesthesia, as well as positive apprehension sign, positive fulcrum and relocation test. So they were diagnosed as concomitant TUBS and AMBRI group shoulder instability. The rest of 9 out of fifteen patients were diagnosed as TUBS group shoulder instability. There were twelve males and three females, and their mean age was twenty five years (range: 16 to 47).

In all the patients, the Bankart lesions were repaired or reconstructed by using at least 2 Suretac devices after extensive, sufficient superior-medial shift of the anterior-inferior glenohumeral capsuloligamentous complexes(GHLC) down to the 6 o¡Çclock positions of the glenoid rim. As for the patients with concomitant TUBS and AMBRI group shoulder instability, we did not only the plication of the anterior capsule for AMBRI component, but also the repair of Bankart lesion for TUBS component. Follow-up time averaged five years and six months (range: 4 years 5 months to 6 years 3 months).

Results: One patient (one shoulder) demonstracted persistent apprehension associated with popping sensation because of injury with fracture of the anterior glenoid rim two year and six months after the operation. A subsequent reconstruction was performed. The recurrence rate was 6.7%. But there were no other complications including any pain, and stiffness.

Conclusion: It is my impression that an arthroscopic Bankart repair or reconstruction by using Suretac devices after extensive, sufficient superior-medial shift of the anterior-inferior GHLC and if needed, plication of the anterior capsule played a role on the treatment of the shoulder instability.