[Painful or unstable shoulder after coracoid transfer: result of surgical treatment].
BACKGROUND
The purpose of this study was to investigate the results of revision surgery for complications related to previous coracoïd transfer for recurrent anterior instability of the shoulder.


METHODS
Seventeen patients with previous surgery for anterior shoulder instability underwent a new surgical procedure, because of recurrent instability in 10, and painful shoulder with limitation of motion in 7. A soft tissue procedure (Bankart and/or capsuloplasty) was performed in the 10 unstable shoulders, and a joint debridement with removal of the coracoid transfer in the 7 painful shoulders. The subscapularis was found to be normal in only 2 cases, fibrotic in 11, thin in 3, and teared in 1. The interval between the initial procedure and the revision surgery was eleven years on average.


RESULTS
At an average of 21 months follow-up, the patients were evaluated according to the Duplay scoring system. A radiographic analysis was also performed for all the patients, and a CT-examination for fourteen. The results were good or excellent for 11 patients (70% in the soft tissue procedure group, and 57% in the debridement group with removal of the coracoid transfer), fair for 4, and poor for 2. Clinical evaluation of the subscapularis showed a lag of muscle function in 10 patients. Strength in internal rotation was 3.3 kg lesser in the operated shoulder compared to the opposite side. CT-examination showed that 4 patients presented a significantly fatty degeneration of the subscapularis. Finally on radiographic examination, osteoarthritis was present in 9 patients.The most important preoperative factor that affected the final results was the number of previous surgical procedures.


CONCLUSIONS
Recurrent instability, problems related to the bone graft or ostheosynthesis material, osteoarthritis, and neurological damage can complicate a coracoid transfer procedure. Our study shows that this procedure can also induce irreversible damage to the subscapularis muscle.


CONCLUSIONS
Revision surgery for complications related to coracoid transfer for anterior shoulder instability is a challenging procedure. Only 2/3 of patients achieved excellent or satisfactory results. Patients with recurrent instability had better results than those with painful impingement and or osteoarthritis. The high rate of late osteoarthritis and irreversible damage of the subscapularis muscle remain sources of concern.
Service d'Orthopédie-Traumatologie, CHU Purpan, place du Docteur-Baylac, 31059 Toulouse Cedex.
M R
MR
Guity
B
B
Roques
P
P
Mansat
Y
Y
Bellumore
M
M
Mansat
D003646:Debridement / Q000009:adverse effects / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D010146:Pain / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D012008:Recurrence; D012086:Reoperation / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D012399:Rotation; D012785:Shoulder Joint; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome