THE ROLE OF ARTHROSCOPIC ROTATOR INTERVAL CLOSURE IN THE ARTHROSCOPIC MANAGEMENT OF RECURRENT ANTERIOR DISLOCATIONS OF THE SHOULDER. A COMPARATIVE STUDY ON 175 SHOULDERS

Introduction: The increasing use of Arthroscopic surgery for recurrent anterior shoulder dislocations (RASD) has questioned the indications and contraindications for this procedure. The ideal candidate for this kind of surgery is an overhead athlete, who participates in a noncontact sport, with traumatic unidirectional anterior instability with a well-defined Bankart lesion. Purpose of the paper : To demonstrate that complementing the Arthroscopic Bankart Repair (ABR) with an Arthroscopic Rotator Interval Closure (ARIC) the indication for Arthroscopic management of Anterior shoulder instability can be broaden for patients who has a less defined Bankart lesion and has additional multidirectional hyperlaxity. Patients and Methods : Between January 1, 1999 and December 31, 2002, 166 patients (175 shoulders) suffering from recurrent anterior dislocations were treated by ABR. In the first two years, only patients who had unidirectional instability with no Hyperlaxity or grade 1 Hyperlaxity were selected for this specific method of treatment. Encouraged by the results, beginning of October 2001, in addition to the first group of patients we started to operate patients suffering of recurrent dislocations having grade 2 or grade 3 Hyperlaxity. In this second group of patients we added to the ABR an ARIC procedure. In the first group 130 shoulders whereas in the second group 45 shoulders were operated on. We used Panalok-Panacryl Smith and Nephew 3.5mm x2 Ethibond sutures (OBL) suture anchors or Bioknotless (Mitek) anchors. 157 cases had one side operated whereas in 9 cases both sides were operated on. There were 150 male patients and 16 females in these two groups, 91 patients had the left shoulder, 66 patients had the right shoulder and nine patients had both shoulders operated on. The mean follow-up was 3 years ranging between 4.5 to 1.7 years. Results : In spite of the relatively short follow-up for the second group of patients we encountered very good preliminary results. At revision of all the cases we found 9 recurrences for the ABR group (representing 6.9%) in comparation of the one reoccurrence in the ABR supplemented by ARIC procedure (2.2%). Conclusions : The ARIC is a new technique that broadens the indications for Arthroscopic shoulder surgery as a solution for recurrent dislocations associated with joint Hyperlaxity.