POSTER ABSTRACTS - ISAKOS

Traumatic anterior shoulder instability is a
common cause of functional impairment in young
athletic individuals and is the most common type
of glenohumeral joint instability. A major
disadvantage of arthroscopic surgery is a
historically reported higher failure rate, especially
during the learning curve period. The purpose of
this paper was to present the results of our first 72
cases treated with arthroscopic stabilization of the
anteriorly unstable shoulder.
Between August 1999 and November 2001 57
patients with traumatic anterior instability were
treated arthroscopically by the same surgeon
group. The mean age of the patients was 23 years
old and the number of dislocations and
subluxations ranged between 5 and 50. The
operation had to be cancelled or converted to
open surgery in 7 patients (12.2%). All operations
were performed in the lateral decubitus position
and the avulsed labrum and capsule was
reattached using 2-5 bone anchors. The duration
of the surgery ranged between 110 and 246
minutes. A Bankart lesion was evident in 46
patients (88.4%). Arthroscopic stabilization was
aborted in patients with a HAGL lesion.
Fourty-four patients (88% follow up rate) were
followed up for 28-53 months (mean 27 months)
and evaluated using the Rowe-Zarins score. Range
of motion was almost normal in most patients
and only 2 patients report limitation of external
rotation greater than 10o, but only 1 patient
necessitated arthroscopic arthrolysis. The
redisclocation rate was 9% (4 out of 44 patients).
Despite the poor selection criteria and the initially
faced technical difficulties performance of
satisfactory capsule reattachment was possible in
most patients. The negative effects of the learning
curve can be minimized with appropriate dry lab
practice and careful performance of the surgery.
E-poster #862
Early Specific Rehabilitation After Arthroscopic
Shoulder Stabilization: 36 Cases with a 7
Months to 4, 5 Year Follow-up.
Ewa Witek, Warszawa, POLAND, Presenter
Dariusz Straszewski, Warszawa, POLAND
Renata Jopek, Warszawa, POLAND
Carolina Medical Center, Warszawa, POLAND
Purpose: Presentation of practiced in our clinic
early specific program of rehabilitation without
postoperative full cast immobilization, after
arthroscopic shoulder stabilization procedure.
Material/Method: Thirty six patients with
symptomatic instability of the shoulder were
qualified for arthroscopy. Among them 7
professional athletes (tennis, ballet, javelin
throwing, judo), 19 amateur (windsurfing, ski,
snowboard,judo) and 10 non active in sports.
Four patients had physiotherapy before
arthroscopy. Patients were immobilized in
Dosoult’s splint for six weeks. Rehabilitation was
initiated during first 24 hours after the surgery.
The most important objective of the rehabilitation
was to achieve muscular stability, full
functionality of the upper limb and for the
patients to return to everyday activity and regular
sport life. We applied: manual techniques, PNF,
proprioception, stretching, contraction and
specific sport rehabilitation programs. After 10-12
weeks, the upper limb was fully functional.
Patients ended their rehabilitation period after 4-5
months and returned to active sport after 4
months. A questionnaire was issued which
evaluated subjectively: stability, pain, ROM and
functionality.
Results: We treated thirty six patients after
arthroscopic shoulder stabilization. Patients were
followed from 7 months up to 4.5 years after
surgery. Final results: twenty five excellent notes,
eight good notes, three fair , one bad .Three
patients had crepitation, one patient with chronic
joint instability had dislocation of the shoulder,
three of our patients had limitation of motion .
Thirty two patients finished rehabilitation, four
patients are still continuing rehabilitation. In all
thirty two cases we achieved full functionality, in
sport as well as in normal life. Except two
persons, all patients returned to sport activity at
pre-injury level.
Conclusion: The application of immobilisation
only in Dosoult’s splint and rehabilitation, in the
first 24 hours after the surgery, had a positive
impact on the final result of the treatment. It
allowed, in a short period of time, the recovery of
muscular stabilization, regaining osrhythm and
functionality of the upper limb. Our results
confirm the effectiveness of the proposed
rehabilitation program allowed for early
movement of the scapulohumeral joint according
to PNF patterns for the scapula, cocontraction and
with great emphasis on proprioception and sport
specific rehabilitation