RECURRENT ANTERIOR INSTABILITY OF THE SHO ULDER TREATED BY ARTHROSCOPIC STAPLE CAPSULORRHAPHY - A 55-PATIENT CONSECUTIVE SERIES WITH A MINIMUM OF 18 MONTHS FOLLOW-UP

Purpose of the study The authors studied the results of the arthroscop ic staple capsulorrhaphy of 55 patients who had recurrent anterior sho ulder instability. Materials and methods There were 38 men and 17 wome n. The average age at operation was 30,3 years (17 to 68) and the domi nant side was injured in 33 patients. 28 (51 per cent) patients had re current dislocations, 19 (38 per cent) patients had recurrent subluxat ions and 8 (14 per cent) complained of a painful shoulder with instabi lity. Multidirectionnal hyperlaxity and glenoid rim fracture cases wer e excluded from this study. The average duration of symptoms was 43 mo nths (I to 180). At operation, 46 patients had a Bankart lesion (Adolf sson A or C) and 9 had ''non Bankart'' lesion (Adolfsson B and intra l igamentous disruption), There were 6 (11 per cent) SLAP II lesions and 23 (42 per cent) other glenoid labral tears associated with main inst ability lesions. 58 staples were inserted. 53 inferior gleno humeral l igament were fixed to the glenoid rim and in 2 cases we performed a su bscapularis tendon tenodesis. Results The follow-up was continued for at least 18 months after treatment by an examiner different from the o perating surgeon. (Average follow-up was 29,8 months), The results wer e assessed according to ''Duplay'' rating scale. Overall we have obtai ned 64 per cent excellent and good results. 71 per cent of shoulders w ere considered stable at revision whereas 7 per cent showed recurrent dislocation. 60 per cent of patients were able to return to their prev ious sport level. A limited range of motion was noted in only 11 per c ent of cases. On the other hand 54 per cent of patients presented pers istent pain. With regard to the shoulder stabillity, the factors possi bly having a negative influence were the occurrence of an initial acut e dislocation, the destruction of the inferior glenohumeral ligament ( disruption or absence) and the sub-equatorial positiion of the staple on the anterior glenoid rim. Pain was more frequent in cases where the re was associated subacromial impingement and where the staples had be en badly positioned. Discussion We have compared our results with thos e of other authors who also performed stapling procedures, including d ifferent arthroscopic techniques and results of open stabilization sur gery. Our results regarding shoulder instability were better than thos e obtained by arthroscopic sutures, equivalent to those obtained by th e ''Open Bankart'' procedure, but less impressing than those obtained by the ''Bone Block'' procedure (Patte). However, pain was observed mu ch more frequently than with all the other stabilization techniques, a rthroscopic or not. Conclusion Arthroscopic stapling therefore seemed to be less reliable than the ''Patte Bone Block'' procedure. At presen t, we reserve arthroscopic stabilization for patients with a good infe rior glenohumeral ligament. Until an adapted biodegradable staple is p erfected, we still use an anchorsuture technique to avoid pain due to metallic implant.