|
Year |
2002 |
|---|---|
|
Question Number |
145. |
|
Category |
Shoulder and Elbow |
Question
A 20-year old man who underwent arthroscopic Bankart repair lesion one year ago for recurrent anterior inferior dislocation now reports two episodes of subluxation. He denies any history of additional trauma. A CT arthrogram is shown in Figure 35. What is the most likely cause of the persistent instability?
1- Capsular redundancy
2- Labral detachment
3- Subscapularis tear
4- Glenoid deficiency
5- Hill-Sachs lesion
Figures
Answer (click for answer)
Preferred Response: 4
The CT arthrogram show deficiency of the anterior aspect of the glenoid. The two studies cited are reviews of arthroscopic stabilization for anterior instability or recurrent anterior shoulder dislocations. Both of the studies showed that in patients with bony lesion on the anterior edge of the glenoid or inferior glenohumeral ligament complex attenuation the recurrence of instability or dislocation was significant and arthroscopic Bankart repair should be abandon in favor of open repair. Simple detachment of the labrum was not a contraindication for arthroscopic repair. The second study had a 70% failure rate when an anterior glenoid fracture was found.
Reference: *Green MR, et al. Arthroscopic bankart procedure: two to five year follow-up with clinical correlation to severity of glenoid labral lesion. Am J sports med; 23: 276-281.
*Walch G, et al. Arthroscopic stabilization for recurrent anterior shoulder dislocation; results of 59 cases. J of arthro and rel surg; 11: 173-178.