Open Surgical Stabilization of Glenohumeral Dislocations

Abstract

Traumatic anterior shoulder dislocations are the most common dislocations of the shoulder, and the recurrence rate is high when they are treated nonoperatively in young patients (<30 years old). This has led to a trend toward early surgical stabilization. Originally open Bankart repair was considered the standard of care, with good clinical outcomes and a low recurrence rate. However, the majority of Bankart repairs are now performed with newer arthroscopic techniques because of their potential advantages and similar results. Both open and arthroscopic repairs have been shown to decrease the recurrence rate to 6% to 23%. Although arthroscopic Bankart repair is now more common, open repair should be considered for younger patients participating in contact sports or military activity, osseous Bankart lesions, revision cases, shoulder instability with "subcritical" (20% to 25%) glenoid bone loss, ligamentous laxity, or cases not considered repairable with arthroscopic techniques. Therefore, knowing how to perform an open Bankart repair is essential. The major steps of the procedure are (1) preoperative planning, (2) induction of anesthesia, (3) patient positioning and setup, (4) examination under anesthesia, (5) possible arthroscopic examination of the shoulder, (6) incision along the anterior axillary fold, (7) exposure using the deltopectoral interval, (8) clavipectoral fascia incision, (9) vertical tenotomy of the subscapularis tendon, (10) dissection of the capsule from the subscapularis, (11) assessment of the quality of the capsule, (12) "T" capsulotomy, (13) repair of the Bankart lesion, (14) anterior capsulorrhaphy, (15) subscapularis repair, (16) possible closure of the rotator interval, (17) wound closure, and (18) postoperative rehabilitation. Studies have shown that surgical stabilization after traumatic anterior shoulder instability decreases the recurrence rate, and open and arthroscopic techniques have similar clinical outcomes.

Arthroscopic evaluation and management of anterior shoulder instability

“…This could be due to the use of all suture anchors in our study which have a higher pullout strength as shown by a study by Ntalos D et al, 17 Post operatively there was an increase in the mean Row and Zarin score from 31.5 to 86.3 for the entire study group with 70% of the patients having excellent function of the affected shoulder, 15% of them had a good outcome, and the remaining 15% had a fair shoulder score on the Row and Zarin scoring system. Most of the patients returned to their work without any complication or without any limitation of function except 2 patients who had recurrence of the instability, which can be attributed to early enthusiastic return to heavy weight training and return to playing volleyball which required overhead full range of motion, this can be compared to open shoulder repair of shoulder instability which showed a similar result as shown in a study by Cohen et al, 18 comparing open reduction with arthroscopic repair which showed a 90-95% success with open reduction.…”

Alternative Management of the Capsule in the Bristow-Latarjet Procedure

“…Most discussions and studies of the Bristow-Latarjet procedure focus on the coracoid transfer; however, many forms of capsulotomy have been reported to uncover the glenohumeral joint. These techniques for capsular management include excision of the capsule and labrum, 2-flap elevation, T-capsulotomy, or an L-shaped incision into the capsule 11, 12, 13. Capsular management during open shoulder procedures may vary among surgeons and may or may not include capsulolabral repair after the Bristow-Latarjet procedure 14, 15.…”