Evaluation of outcomes following thermal, open and arthroscopic glenohumeral capsulorrhaphy for recurrent anterior instability Public Deposited

http://ir.library.oregonstate.edu/concern/graduate_thesis_or_dissertations/gh93h2898

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  • PURPOSE: To compare glenohumeral joint position sense (JPS), concentric internal (IR) and external rotation (ER) strength, functional ability, and level of satisfaction in patients who underwent three types of glenohumeral capsulorrhaphy with age-matched controls. RESEARCH DESIGN: Four 4x2 and two 4x3 ANOVAs were used to identify differences in JPS and concentric IR/ER strength between groups: Open Capsulorrhaphy (n=21), Thermal Capsulorrhaphy (n=16), Arthroscopic Capsulorrhaphy (n=14) and Controls (n=22). Pearson correlation analyses were performed to determine the relationship between objective American Shoulder and Elbow Surgeons (ASES) evaluations and subjective Shoulder Rating Questionnaire (SRQ) scores. Stepwise multiple regression analyses were performed to predict ASES and SRQ scores from various objective and subjective outcome measures. SUBJECTS: 73 adults (51 postsurgical patients, 22 healthy controls; mean age, 23.7 ± 6.8 yrs) participated in this retrospective study. The 51 patients who underwent capsulorrhaphy for recurrent, anterior glenohumeral instability were evaluated at an average of 32.1 months postsurgery. MEASUREMENTS: JPS was measured bilaterally using a reproduction of passive positioning protocol at 2 target angles: 60% and 90% of maximum passive external rotation (60% and 90% ER[subscript max]). Concentric IR and ER peak torques were measured bilaterally at 90°/sec, 180°/sec and 270°/sec. Objective postoperative function was quantified with the clinician-based ASES form, while functional status and patient satisfaction were assessed with the patient-based SRQ form. RESULTS: The accuracy of JPS in patients' surgical limbs was similar to that present in their contralateral, uninjured shoulders at both target angles. The Open group demonstrated significantly better involved-limb JPS acuity (4.2° ± 1.9°) than the Arthroscopic group (6.8° ± 3.2°) and Control group (6.6° ± 3.5°) (p<.05). However, the Open group had 31% less IR strength than Control subjects and 33% less than the Arthroscopic group, with IR peak torques significantly less in their postsurgical shoulders than their uninvolved limbs (p<.002). There was a strong, positive correlation (r =.64, p≤.001) between objective ASES and subjective SRQ scores. Patients' postoperative level of pain and ASES scores were significant predictors of their SRQ clinical scores (R=.81, p<.003). CONCLUSIONS: Glenohumeral JPS and rotator cuff strength were similar in both the postsurgical and uninvolved shoulders of the Arthroscopic and Thermal groups. Patients in the Open capsulorrhaphy group demonstrated significantly better involved-limb JPS than Arthroscopic and Control groups. The large strength deficits observed in the Open group, particularly in IR, were of significant concern. We observed a higher failure rate, more revision surgeries, and lower patient satisfaction with the Thermal capsulorrhaphy technique. Patient-based outcomes were significant predictors of operative success as measured by clinician-based evaluation. Prospective, randomized controlled studies are still needed to evaluate the outcomes of these glenohumeral capsulorrhaphy procedures over the longer term.
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