コリジョン・コンタクトスポーツ選手の外傷性肩関節前方不安定症に対する鏡視下Bankart & Bristow変法－烏口突起の設置位置および手術成績－

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  • Evaluation of Coracoid Graft Location and Clinical Results of a Modified Arthroscopic Bankart-Bristow Procedure for Collision and Contact Athletes with Traumatic Anterior Shoulder Instability
  • コリジョン ・ コンタクトスポーツ センシュ ノ ガイショウセイ カタカンセツ ゼンポウ フアンテイショウ ニ タイスル キョウシ カ Bankart & Bristow ヘンポウ : カラスグチ トッキ ノ セッチ イチ オヨビ シュジュツ セイセキ

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Objective: The objective of this study was to investigate the location of coracoid graft and screw direction and to examine the clinical results of a modified arthroscopic Bankart-Bristow (ASBB) procedure in high-demand collision and contact athletes with traumatic anterior shoulder instability.<br>Methods: This study reviewed the clinical results of surgery in 22 collision and contact athletes ranging from 15 to 24 years of age (average age, 19.5 years). The mean follow-up period was 25 months (range, 24-36 months) after surgery. The period of return to preoperative sports activities after surgery was evaluated in each case. Clinical outcome measures included the Japan Shoulder Society Shoulder Instability Score (JSS-SIS) and the Rowe Score. Thirty-five shoulders of 33 cases were evaluated with regard to improvement in the range of motion (ROM) at 1, 2, 3, 4, and 6 months postoperatively. Sixteen cases were evaluated in terms of coracoid graft location (horizontal position: HP; vertical position: VP) and screw direction (the angle of screw to glenoid surface: A-angle) using computed tomography scan images.<br>Results: All of the cases returned to their preoperative sports between 3 to 5.5 months postoperatively (average, 4.1 months). No cases experienced re-dislocation. At the time of the last investigation, the average JSS-SIS and Rowe Scores were 98.4 and 98.5 points, respectively. There were significant improvements of ROM in all the directions gradually over time. The recovery rates of ROM at 4 months after surgery were 96.5% for flexion, 96.9% for abduction, 90.3% for 1st external rotation (ER), 95.3% for 2nd ER, and 97.1% for 3rd ER, respectively. The average settled angle of the coracoid graft from the sagittal view was 32.1 ± 12.8°, which was considered a suitable position of the glenoid between the 3 o'clock and 5 o'clock position. The average HP was −0.7 ± 0.4 mm and the average A-angle was 23 ± 9°.<br>Conclusion: In this study, the modified ASBB procedure transferred the coracoid process to a more suitable position of the glenoid neck, and allowed an early return to preoperative collision sports in high-demand athletes with traumatic anterior shoulder instability.

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