title: Arthroscopic labrum refixation for post-traumatic anterior shoulder instability: suture anchor versus transglenoid fixation technique.
abstract: The aim of this retrospective study was to compare recurrence rates following transglenoid labrum refixation or fixation using the suture anchor (FASTak, Arthrex, Naples, FL) technique. Additionally, parameters that apparently influence the rate of redislocation were investigated. There were 163 patients with post-traumatic anterior shoulder instability treated with an arthroscopic labrum refixation; 108 patients (66.3%) were stabilized with the transglenoid suture technique (group I) and 55 patients (33. 7%) with the suture anchor (FASTak) technique (group II). The average follow-up was 4.5 years (range, 2.0 to 7.9 years) in group I and 3.2 years (range, 2.0 to 5.0 years) in group II. The Rowe score increased from a preoperative average of 35.0 points in group I and 35.4 points in group II to a postoperative average of 68.3 points in group I and 84.6 points in group II (P <.01). There was recurrence in 35 patients (32.4%) in group I and 9 patients (16.4%) in group II (P <.05). All incidents of redislocation occurred during the first 21 postoperative months; 58.4% of the patients (n = 63) in group I and 16.4% of the patients in group II (n = 9) had to reduce their sporting activity (P <.001). Independent of the type of surgery, there was a significant correlation of the postoperative rate of redislocation and age (P <.001), number of preoperative dislocations (P <.01), and degree of labrum lesion (P <.001). No correlation with the rate of redislocation was shown for gender, handedness, dislocation-operation interval, degree of Hill-Sachs lesion, or number of transglenoid sutures or anchors. Concerning post-traumatic anterior shoulder instability, the arthroscopic labrum reconstruction with the suture anchor (FASTak) technique was superior to the transglenoid technique but has not yet achieved the level of success obtained by open surgery. With fewer than 5 preoperative redislocations after a first traumatic shoulder dislocation, the arthroscopic treatment is recommended. In cases of more frequent preoperative dislocations, open surgery in combination with a capsular shift should be performed.
authors.affiliation: Orthopädische Universitätsklinik der J. W. Goethe Universität, Frankfurt am Main, Berlin, Germany. frank.kandziora@charite.de
authors.forename: F
authors.initials: F
authors.lastname: Kandziora
authors.forename: A
authors.initials: A
authors.lastname: Jäger
authors.forename: F
authors.initials: F
authors.lastname: Bischof
authors.forename: J
authors.initials: J
authors.lastname: Herresthal
authors.forename: M
authors.initials: M
authors.lastname: Starker
authors.forename: T
authors.initials: T
authors.lastname: Mittlmeier
mesh_terms: D000328:Adult; D001182:Arthroscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation*; D013997:Time Factors