[Arthroscopic treatment of chronic anterior instability of the shoulder by staple capsulorrhaphy. Apropos of a series of 55 patients with a minimum of 18 months follow-up].
PURPOSE OF THE STUDY: The authors studied the results of the arthroscopic staple capsulorrhaphy of 55 patients who had recurrent anterior shoulder instability. MATERIALS AND METHODS: There were 38 men and 17 women. The average age at operation was 30.3 years (17 to 68) and the dominant side was injured in 33 patients. 28 (51 per cent) patients had recurrent dislocations, 19 (38 per cent) patients had recurrent subluxations and 8 (14 per cent) complained of a painful shoulder with instability. Multidirectionnal hyperlaxity and glenoid rim fracture cases were excluded from this study. The average duration of symptoms was 43 months (i to 180). At operation, 46 patients had a Bankart lesion (Adolfsson A or C) and 9 had "non Bankart" lesion (Adolfsson B and intra ligamentous disruption). There were 6 (11 per cent) SLAP II lesions and 23 (42 per cent) other glenoid labral tears associated with main instability lesions. 58 staples were inserted. 53 inferior glenoid humeral ligament were fixed to the glenoid rim and in 2 cases we performed a subscapularis tendon tenodesis. RESULTS: The follow-up was continued for at least 18 months after treatment by an examiner different from the operating surgeon. (Average follow-up was 29.8 months). The results were assessed according to "Duplay" rating scale. Overall we have obtained 64 per cent excellent and good results. 71 per cent of shoulders were considered stable at revision whereas 7 per cent showed recurrent dislocation. 60 per cent of patients were able to return to their previous sport level. A limited range of motion was noted in only 11 per cent of cases. On the other hand 54 per cent of patients presented persistent pain. With regard to the shoulder stability, the factors possibly having a negative influence were the occurrence of an initial acute dislocation, the destruction of the inferior glenohumeral ligament (disruption or absence) and the sub-equatorial position of the staple on the anterior glenoid rim. Pain was more frequent in cases where there was associated subacromial impingement and where the staples had been badly positioned. DISCUSSION: We have compared our results with those of other authors who also performed stapling procedures, including different arthroscopic techniques and results of open stabilization surgery. Our results regarding shoulder instability were better than those obtained by arthroscopic sutures, equivalent to those obtained by the "Open Bankart" procedure, but less impressing than those obtained by the "Bone Block" procedure (Patte). However, pain was observed much more frequently than with all the other stabilization techniques, arthroscopic or not. CONCLUSION: Arthroscopic stapling therefore seemed to be less reliable than the "Patte Bone Block" procedure. At present, we reserve arthroscopic stabilization for patients with a good inferior glenohumeral ligament. Until an adapted biodegradable staple is perfected, we still use an anchorsuture technique to avoid pain due to metallic implant.