POSTER ABSTRACTS - ISAKOS

E-poster #856
Humeral Avulsion of the Glenohumeral
Ligaments - Incidence and Treatment in
Contact Sports Athletes
Mario Larrain, Buenos Aires, ARGENTINA,
Presenter
Hugo J. Montenegro, Buenos Aires, ARGENTINA
David M. Mauas, Buenos Aires, ARGENTINA
Cristian Collazo, Buenos Aires, ARGENTINA
Horacio Carlos Galante, Buenos Aires,
ARGENTINA
Mansilla, Buenos Aires, ARGENTINA
PURPOSE: Humeral avulsion of the glenohumeral
ligaments (HGHLA) may be the cause for anterior
shoulder instability. The purpose of this study is
to analyse the incidence of this lesion in our
series of shoulder instability, its characteristics
and anatomical variants, its treatment and results.
METHODS: We retrospectively analysed 313
patients, operated for anterior shoulder instability
between March 1992 and March 2002. We
detected 9 cases (2.88%) with humeral
detachment of the glenohumeral ligaments. All of
them were males and contact players, 7 were
rugbiers and the other two basquetball players.
MRI reports were as follows: 3 capsular pockets
(laxity), 3 glenohumeral ligament lesions with
anteroinferior labrum alteration, and 3 normal
images. Definite diagnosis was performed
arthroscopically. We found that 3 of the cases had
detachment of isolated glenohumeral ligaments
and the remaining 6 were associated to lesions on
the glenoid side of the capsulolabral complex. We
call these lesions ''bipolar''. These presented as
partial detachments of the labrum with some
degree of lesion in the capsular structures in that
area. The surgical technique used in this
pathology was: First, arthroscopy, debridment and
repair of the lesion on the glenoid side if this was
present in bipolar lesions, then, because the angle
was not convenient for arthroscopic repair, miniopen
reconstruction of the lesion on the humeral
side. Bone anchors were used for both sides.
RESULTS: The mean follow-up was 3.7 years
(range 2-12 y). The results obtained using the
Rowe Scale were excellent in all the cases, with no
relapses, nor residual instability, complete motion
range, no functional deficits and a 100% return to
competitive sports practice.
CONCLUSIONS: It is necessary to perform a
thorough arthroscopic evaluation to identify this
lesion, especially when there are significant
capsular pockets (laxity) and/or alterations in the
labrum insertion. The lack of diagnosis and proper
treatment of this lesion would be the cause of
failure in its reconstruction. Treatments
performed in a combined fashion (arthroscopy +
open surgery) offer great possibilities to contact
athletes.
E-poster #857
A Technique to Improve Anchor Capsular
Fixation and Tightening on Shoulder Instability
Surgery
Daniel Slullitel, Santa Fe ARGENTINA, Presenter
Sebastian Malier, Rosario, Santa Fe ARGENTINA
Elisabet Vaieretti, Rosario, Santa Fe ARGENTINA
Instituto Dr. Jaime Slullitel, Rosario, Santa Fe,
ARGENTINA
Introduction
As anchors can carry only 1 or 2 sutures, they have
a limited capability of capsular fixation and
tigthening. In case we need multiple sutures we
have to add multiple anchors, but the numbers of
anchors we can use is limited. We would like to
report a technique to improve anchor capability of
carrying sutures and also to present a modified
punch to bite thin capsules without harming them
that is the other weak spot in the arthroscopic
reconstruction of fragile capsules.
Material and Methods
With a modified Caspary punch, through an
anteroinferior portal, we passed 1 to 3 0 PDS
sutures as needed on the articular capsular side
as far anteroinferior possible, then we retrieved
one limb on the posterior portal in a canula and
the other one out of the anteroinferior portal
canula while viewing from anterosuperior.
Through the anteroinferior canula, we put on the 5
o´ clock position an anchor using the PDS sutures,
as traction devices. We capture one limb of the
anchor stitch with a regular instrumentation and
then by using a sliding knot we began to settle it,
but just before finishing to tighten the knot and
into the residual hole of it, we retrieved one of
each limb of the PDS sutures already passed. Then
we finished to tie the anchor stitch, using the knot
as anchor to fix the PDS sutures.
Thus transforming each one pair suture anchor in
a 2 to 4 carrying device. Also we show a modified
Caspary punch so we can harm less the fragile
capsule as we can bite a minimum surface of
capsule.
Conclusion