We evaluated the factors influencing the recurrence rate after primary anterior traumatic shoulder dislocation, especially sports activity. A significant number of patients changed to athletic activities that produce less shoulder strain. The natural assumption would be that sports activity directly influences recurrence. However, age-adjusted logistic regression analysis revealed that the correlation between sports and recurrence rate was false. Our statistical findings also clearly showed that physical therapy and immobilization do not reduce the risk of recurrence. The only factor associated with recurrence was age between 21 and 30 years. Patients in this age group who participate in high-risk sports activities should undergo primary surgical stabilization because of the increased risk of recurrence.
The arthroscopic extraarticular Bankart procedure tries to imitate the open Bankart procedure. An anterior-inferior transmuscular approach through the subscapular muscle permits to implant self-locking tacks into the anterior inferior third of the glenoid rim. The extraarticular location of the implants makes a superomedial capsular shift possible, if required. A total of 257 arthroscopic repairs following traumatic recurrent anterior shoulder dislocation have been carried out between 1992 and 1996. 177 patients were treated only with bioabsorbable Suretac device. Clinical and radiological follow up was possible in 165 patients. According to the Rowe score 69.7% were classified as excellent, 10.9% as good, 9.7% fair and 9.7% poor. Postoperative complications: the recurrence rate was 9.7%, allergic reactions representing a foreign body reaction to the synthetic material were seen in 5 cases (3%) and a frozen shoulder in 6 cases 3.6%). 61% of the patients involved in overhead or contact sports returned to their preoperative sport activities.
The arthroscopic extraarticular Bankart procedure tries to imitate the open Bankart procedure. An anterior-inferior transmuscular approach through the subscapular muscle permits to implant self-locking tacks into the anterior inferior third of the glenoid rim. The extraarticular location of the implants makes a superomedial capsular shift possible, if required. A total of 257 arthroscopic repairs following traumatic recurrent anterior shoulder dislocation have been carried out between 1992 and 1996. 177 patients were treated only with bioabsorbable Suretac device. Clinical and radiological follow up was possible in 165 patients. According to the Rowe score 69,7 % were classified as excellent, 10,9 % as good, 9,7 % fair and 9,7 % poor. Postoperative complications: the recurrence rate was 9,7 %, allergic reactions representing a foreign body reaction to the synthetic material were seen in 5 cases (3 %) and a frozen shoulder in 6 cases 3,6 %). 61 % of the patients involved in overhead or contact sports returned to their preoperative sport activities.
BackgroundWhile open wedge high tibial osteotomy (owHTO) is an established standard procedure to treat medial osteoarthritis of the knee in combination with varus deformity, it bears the risk of postoperative hardware failures and lateral cortical hinge fractures. This in turn can lead to an accelerated osteoarthritis, non-union, or a loss of correction accuracy. The purpose of the study was to evaluate the radiologic outcomes of owHTO with a carbon fiber reinforced poly-ether-ether-ketone (CF-PEEK) plate fixation in patients with medial osteoarthritis and varus deformity.MethodsThree hundred twenty-four consecutive patients (346 knees) who were treated with owHTO using the PEEKPower HTO plate were included in this retrospective study; 89.9% of the patients were overweight or obese. Patients were followed by conventional radiographs over a 12-month period. Typical plate-related results such as the time and quality of gap healing as well as the correction accuracy were analyzed. Furthermore, the number of lateral cortex fractures was determined.ResultsBony consolidation was observed after a mean gap healing time of 4.0 ± 1.7 months independent on the patients’ weight (p = 0.2302). With increasing gap sizes, bony healing was significantly prolonged (p < 0.001). Additionally, patients with greater gap sizes had a significantly increased risk for a lateral cortex fracture (p = 0.0041). However, none of the patients had a non-union 1 year postoperative. A hinge fracture occurred in 30% of patients. Hinge fractures with Takeuchi grades I and II increased the gap healing time compared to no fracture (p = 0.0069 and p = 0.0002, respectively), but only 1.2% of patients with hinge fracture had a clinical relevant loss of correction ≥ 3 mm. No implant failures were found.ConclusionsOpen wedge HTO using the PEEKPower HTO plate for patients with medial osteoarthritis of the knee in combination with tibial varus deformity leads to excellent bony consolidation also in cases with a hinge fracture, a gap size > 12 mm as well as for severely obese patients.
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