Abstract

NUNES, Bernardo  and  GUTIERRES, Manuel. Indicações para a abordagem cirúrgica da instabilidade anterior do ombro. Rev. Port. Ortop. Traum. [online]. 2013, vol.21, n.3, pp.285-295. ISSN 1646-2122.

Anterior Shoulder Instability is a frequent and potentially incapacitating injury. This paper aims to gather up to date information regarding the therapeutic approach of this pathology, as it is permanent matter of controversy. Arthroscopy’s advances have allowed a mini-invasive surgical approach, initially only regarding Bankart technique. When used in patients with precise indications, it has revealed low recurrence rates. To allow for the systematization of these indications, the Instability and Severity Index Score was proposed, integrating criteria such as age, type of sports activity, shoulder hyperlaxity, as well as significant glenoid or umeral bony injuries. A score <4 is usually considered as the cut-off value for the use of this surgical technique. Nevertheless, it is also possible to add plicature or capsuloraphy techniques, in order to improve results in selected cases. As such, coracoid transfer techniques (like Bristow-Latarjet), performed either via open surgery or arthroscopically, have remained to be fundamental in most situations where anatomical reconstruction is not enough to assure the prevention of recurrences. This paper highlights the importance of judicious selection of the appropriate approach to each patient, according to clinical and imaging criteria, and matching the surgeon’s technical differentiation. The main issue, more than an option between open or arthroscopic surgery, is deciding between anatomical reconstruction of soft tissue or bone-transfer techniques. Despite this, more homogeneous studies are lacking, to allow for direct comparisons and more accurate meta-analysis.

Keywords : Anterior dislocation of the shoulder; anterior instability of the shoulder; capsulolabral reconstruction; Bankart; Bristow-Latarjet; surgical indications.

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