anterior instability

Revision Stabilisation

Causes for failure

 

1.  Patient factors

 

A.  Recurrent Trauma

- contact athletes higher risk

 

B.  MDI / Ligamentous Laxity / Voluntary dislocaters

 

C.  Poor rehabilitation

- poor motivation

- too rapid

- patients rarely get stiff, better to go very slow

 

2.  Surgeon Factors

 

A.  Unrecognised bony defect

Open Bankart Repair

Aim

 

Repair of the anterior capsule & avulsed labrum to anterior glenoid 

- anatomic repair

 

Usually combined with a capsular shift

 

Contraindications

 

Bony bankart > 25% glenoid

 

Technique

 

Position

- beach chair position

- arm free

- Mayfield head ring / Spyder and Tmax

 

Anterior Instability

Epidemiology

 

Traumatic initial cause in 95%

 

M:F 2:1

 

Age of initial dislocation inversely related to recurrence rate

- patients younger than 20 have a redislocation rate of 90%

- between 20 - 40 years, redislocation rate of 60%

- patients > 40 years have a 10% rate of dislocation but a higher rate of cuff tears (up to 40% in patients > 60yrs)

 

Anatomy & Stability

 

1. Passive Stabilisers