Dissertation

14-Jahres-Follow-Up nach operativer Versorgung einer Bankart-Läsion

Bauer, Anne

2022

Overview

Shoulder dislocation is the most common joint dislocation in the human body. The complete separation of the humeral head from the glenoid cavity is usually accompanied by bony and cartilaginous injuries of the shoulder joint. The most common lesion is the Bankart lesion, a tear of the labrum from the glenoid. It occurs when the humeral head dislocates from the glenoid cavity and tears off the anterior part of the labrum.Arthroscopic refixation of the Bankart lesion is the most commonly used surgical procedure worldwide. The long-term clinical outcomes collected in this study are intended to provide information on whether patients experience limitations after refixation and whether long-term consequences such as osteoarthritis exist. Due to the high rate of rein stability after this procedure, it is essential to evaluate risk factors for the occurrence of rein stability.A specially developed questionnaire and the Constant, Rowe, and WOSI (Western Ontario Shoulder Index) scores were used to assess long-term outcomes. For evaluation, a magnetic resonance imaging image of shoulder-specific changes was also taken at the Stuttgart Sports Clinic.The average follow-up period was 14.0 years (range, 10-18 years). 46 men with an average age of 21.6 years at the time of surgery were examined. The re-dislocation rate was 21.7% (10 of 46 patients). The overall population showed very good (Constant score 96.8 out of 100 points) and good (Rowe score 83.4 out of 100 points) results in the shoulder-specific scores (Constant and Rowe scores). The WOSI score, which determines shoulder-specific quality of life, was also in the excellent range (90.7 out of 100 points). 84.8% of the athletes were able to return to sport. Mild to moderate osteoarthritis occurred in 28.1% of patients.Significant risk factors for the occurrence of re-dislocation were confirmed to be age under 20 years and participation in contact, collision, or overhead sports. Furthermore, significant limitations in the ability to participate in sports, poorer functional and shoulder-related quality of life, and a higher incidence of osteoarthritis were observed.The extent of the initial trauma was the main risk factor for the occurrence of osteoarthritis. Re-dislocations and atraumatic re-dislocations, in particular, also contributed to the risk contribute significantly to the development of osteoarthritis. Contact, collision, and overhead sports also represented a significant risk factor. The osteoarthritis group showed no loss of function or shoulder-related quality of life.The long-term results show that the overall collective had no limitations in function and quality of life related to the shoulder, which is consistent with the results in the literature. This supports the use of arthroscopic repair, especially given the high re-dislocation rate. The re-dislocation rate of 21.7% after a 10-18 hour follow-up period is high, but comparable to data in the literature on arthroscopic Bankart repair.The risk factors known from the literature for the occurrence of rein stability, such as young age and contact, collision, and overhead sports, were confirmed. In particular, the increased risk-taking behavior of younger athletes, as well as the greater forces that occur during exercise in the aforementioned high-risk sports, increase the risk of rein stability. Bony Hanikart lesions and bone loss at the glenoid alter the limb length of the shoulder joint and, in some cases, favor the occurrence of instability. These changes also explain the significant incidence of osteoarthritis in patients with re-dislocation. The ongoing impairment primarily limits shoulder-related quality of life.As already described in the literature, the extent of the initial bony and carpal injury is crucial for the development of osteoarthritis, but pre- and postoperative re-dislocations may also be important. In other cases, postoperative atraumatic rehabilitations represent a newly identified risk factor due to ongoing microtrauma.The arthroscopic Hanikart repair is a suitable treatment option, even for first-time traumatic shoulder dislocation, in terms of long-term clinical outcomes. The primary goal should be a surgical procedure that is tailored to the patient's needs in terms of sports and daily life, while providing sufficient stability. Especially in young patients and athletes with contact, collision, or cross-country sports, advanced procedures should be considered to ensure good long-term clinical outcomes and minimize long-term consequences such as osteoarthritis.Especially to prevent osteoarthritis, a traumatically refusing patients should be stabilized as quickly as possible to prevent microtraumas that promote osteoarthritis.

• Publisher: ProQuest Dissertations & Theses
• Subject: Antennas / Bandwidths / CMOS / Composite materials / Designers / Electrons / Gallium arsenide / Gases / Indium / Medicine / Physiology / Receivers & amplifiers / Semiconductors / Spectrum allocation / Spectrum analysis / Technology / Transistors / Transmitters / VOCs / Volatile organic compounds / Wireless communications
• ISBN: 9798288850530