Algorithm of surgical tactics in patients with chronic anterior shoulder instability
We offer an algorithm for the diagnosis and surgical treatment of patients with anterior instability of the shoulder joint, which reflects current views on the causes of this disease, the current trend to consider the intervention as a complex individual surgical procedures aimed at correcting specific pathological changes, taking into account the individual characteristics of the patient. It was found that patients with anterior instability of the shoulder joint due to a defect glenoid in excess of 25% or more of its width, the most reasonable is the plastic defect due to the transposition of the coracoid. It was shown that the operation Bristow-Latarjet has triple stabilizing effect due to the restoration and expansion of the area of support for the head of the humerus; expansion «glenoid track» to such an extent that damage to Hill-Sachs will not go beyond it; sling-effect convergent tendons - creating more muscle-tendon joint protection in the anterior-inferior part of; restore joint and shoulder tension ligaments and isolate bone graft from the joint cavity. With this combination of stabilizing factors, this operation is effective even with bipolar significant bone defects by type «Off-Track» and avoiding procedures «reimplissage», which can lead to restriction of external rotation of the shoulder and pain in individual sports lessons. When glenoid defect is less than 25% of its width, combined with minor injuries Hill-Sachs-type «On-Track» in the absence of additional adverse prognostic factors joint stability is achieved by performing arthroscopic Bankart surgery. In the case of «Off-Track» damage the operation procedure should be supplemented «reimplissage». Athletes of young age with signs of hyper-elasticity capsular ligament surgery of choice for any size glenoid defect is osteoplastic operation Bristow-Latarjet with possible combination with capsulodese or tenodesis of infraspinatus tendon muscles and capsuloplication.