Il trattamento artroscopico della instabilità post-traumatica della spalla

Aim. The aim of this study is to analyze our experience on 30 patients with TUBS (Traumatic, Unidirectional, Bankart, Surgery), treated with arthroscopic capsulo-plasty using anchors Bioknotless according to Thai's Technique. Methods. From January 2001 to December 2003 we arthroscopically treated 30 patients with post-traumatic instability of the shoulder. The intervention foresees the following steps: evaluation of the capsular lesion; decortication of the anterior glenoid surface; execution of 3 holes; anchors introduction; application of an immobilizzation for 4 weeks. Results. We clinically appraised the patients through the Constant test with a minimum of 12 to a maximum of 24-month follow-up (average 18 months). The middle value of the Constant score was of 85 compared to the pre-operative value of 55.5. Only one case of relapse was observed. Conclusions. Over the time, thanks to the refinement of surgical techniques, to better knowledge of the role of the propioception in the mechanism of shoulder joint feedback, to a greater knowledge of the articular pathology and to the increased confidence of the surgeons with the arthroscopic technique, many authors are underlining the superimposing role of inherent data of recurrences between arthroscopic and open treatment. We believe that a careful preoperative and intraoperative selection of the patient can sensitively reduce the risks of arthroscopic capsulo-plasty recurrences; excluding patients with bony-Bankart> of 25% and with glenoid inverted pear. We can conclude that the use of these anchors, that do not foresee the execution of the knot, allows a reduction of surgical time, and above all, a good anchorage and capsular shift. Despite the facility of such technique in comparison to others described in Literature, we believe that a long learning curve is essential.