SureTac Stabilization of Acute Shoulder Dislocation in Young Athletes
Abstract & Commentary
Synopsis: In a follow-on study of acute arthroscopic treatment of young first-time anterior shoulder dislocations, stability was restored in 88% of patients using the SureTac device.
Source: DeBerardino TM, et al. Prospective evaluation of arthroscopic stabilization of acute, initial anterior shoulder dislocations in young athletes. Am J Sports Med. 2001;29(5): 586-592.
This is a follow-on study of acute shoulder dislocations in young athletes at West Point. In their first study, researchers at the US Military Academy demonstrated a recurrence rate of 92% after nonoperative treatment of these cadets.1 In the second study, they compared arthroscopic stabilization with a transglenoid technique with nonoperative treatment. They reported recurrent instability in 14% of their operative group compared to 80% in their nonoperative group.2 The present study reports their results with an evolution to a technique using the SureTac (Acufex Microsurgical Inc) device.
In an ongoing prospective study, 57 patients with 58 acute, initial, traumatic, anterior shoulder dislocations were offered arthroscopic treatment. Six patients selected nonoperative treatment. Of these 6 patients, 4 (67%) had recurrent instability. Three patients underwent primary open repair because of the presence of capsular pathology. The remaining 48 patients with 49 anterior dislocations were treated within 10 days of injury with arthroscopy surgery and Bankart repair with the SureTac device. Average follow-up at 37 months (range, 24-60 months) demonstrated good to excellent results using the Rowe, SANE, and SF-36 scales. DeBerardino and colleagues report complete stability in 88% of patients. Factors associated with failure included a history of bilateral shoulder instability, MDI, poor capsular tissue, and a return to collision sports after repair.
Comment by Mark D. Miller, MD
This report, originally presented in 1998, comes as no surprise. The only surprise that I had was that it was not already published! These West Point studies are important because they challenge conventional dogma, and present good science to support acute arthroscopic stabilization for young first-time traumatic shoulder dislocators. The key issue, as Bigliani and associates have pointed out,3 is that multiple dislocation episodes result in capsular laxity. The more dislocations, the more importance should be placed on addressing capsular as well as labral pathology. The corollary should also hold true then—first-time dislocators may be treated with a procedure designed primarily to address labral pathology (the Bankart lesion). This is why arthroscopic procedures are successful in this group. The debate rages as to what is the threshold for successful arthroscopic vs. open procedures. As arthroscopic procedures improve, and allow surgeons to address labral and capsular pathology simultaneously, then this threshold will increase.
The SureTac device addresses Bankart lesions well. It does not address capsular laxity well, even with proper use of the grasper that comes with the set. Newer devices, including suture anchors and other devices, may allow an even greater capsular shift as a part of the repair. DeBerardino et al emphasize that their failures occurred in patients with MDI, poor capsular tissue, and a return to collision sports. These patients, and those with multiple recurrent instability episodes (again the threshold issue applies, but certainly double-digit occurrences apply in my book) should still be addressed with an open capsulolabral procedure. The next West Point study will hopefully include more careful patient selection and the use of newer techniques. I suspect they will have even better results if that is the case.
References
1. Wheeler JH, et al. Arthroscopic versus nonoperative treatment of acute shoulder dislocations in young athletes. Arthroscopy. 1989;5:213-217.
2. Arciero RA, et al. Arthroscopic bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med. 1994;22: 589-594.
3. Bigliani LU, et al. Tensile properties of the inferior glenohumeral ligament. J Orthop Res. 1992;10: 187-197.
Dr. Miller, Associate Professor, University of Virginia Health System, Department of Orthopaedic Surgery, Charlottesville, is Associate Editor of Sports Medicine Reports.
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