PurposeBoth open and arthroscopic Bankart repair are established procedures in the treatment of anterior shoulder instability. While the open procedure is still considered as the "golden standard" functional outcome is supposed to be better in the arthroscopic procedure. The aim of this retrospective study was to compare the functional outcome between open and arthroscopic Bankart repair.Materials and methodsIn 199 patients a Bankart procedure with suture anchors was performed, either arthroscopically in presence of an detached, but not elongated capsulolabral complex (40) or open (159). After a median time of 31 months (12 to 67 months) 174 patients were contacted and agreed to follow-up, 135 after open and 39 after arthroscopic Bankart procedure.ResultsRe-dislocations occurred in 8% after open and 15% after arthroscopic Bankart procedure. After open surgery 4 of the 11 re-dislocations occurred after a new adequate trauma and 1 of the 6 re-dislocations after arthroscopic surgery. Re-dislocations after arthroscopic procedure occured earlier than after open Bankart repair. An external rotation lag of 20° or more was observed more often (16%) after open than after arthroscopic surgery (3%). The Rowe score demonstrated "good" or "excellent" functional results in 87% after open and in 80% patients after arthroscopic treatment.ConclusionIn this retrospective investigation the open Bankart procedure demonstrated good functional results. The arthroscopic treatment without capsular shift resulted in a better range of motion, but showed a tendency towards more frequently and earlier recurrence of instability. Sensitive patient selection for arthroscopic Bankart repair is recommended especially in patients with more than five dislocations.
Arthroplasty has become the most successful surgical procedure in developed countries. Replacement of severely damaged joints results in a substantial relief of pain, as the main symptom of osteoarthritis, in the majority of treated patients. With improved results in endoprosthetic surgery over the last decades, however, patients are increasingly undergoing the procedure to enhance their functional capacity and physical mobility. Especially younger patients, who cannot accept a restriction in their professional or sports activity, have become demanding candidates for surgery. This review summarizes the published results on shoulder, hip, knee, ankle and first metatarsophalangeal joint replacement in patients who are younger than 50 years of age. Mid- and long-term follow-up studies in this age group are evaluated in terms of prosthesis survival as well as functional improvement.
Anterior knee pain is a common problem in childhood and adolescence with a prevalence of 4-30% in regional surveys. Although different etiologic theories are discussed in a large number of published studies, most cases are probably attributed to lower extremity malalignment, muscular imbalance, or physical overactivity (or even a combination of all three). Thorough clinical investigation should result in a definition of relevant static or functional problems as underlying causes of the disease. Radiographic analysis is mainly performed to exclude severe pathology (i.e., malignancies), as the correlation between described morphometric variables and clinical problems is weak. Prior to therapeutic recommendations, the benign natural course of the disease should be discussed with patients and their parents. In a large number of published studies with different conservative treatment protocols, positive results for many regimens are reported. The size,however, is not always large enough to prove superior outcome when compared to the natural course of the disease. There is also no evidence to support the superiority of one physiotherapy intervention over others.
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