Surgical treatment of posterior instability of the shoulder by anteversion osteotomy of the scapular neck associated with posterior capsulorraphia. Traitement chirurgical des instabilites posterieures d' epaule par osteotomie d' anteversion du col de l' omoplate associee a une capsulorraphie posterieure Djian,-P; Christel,-P; Herman,-S; Demarais,-Y; Roger,-B Journal-de-traumatologie-du-sport-(Paris) 14(3), sept 1997, 137-146 From 1987 to 1996, we operated 10 patients (mean age at operation 25 years) including 6 who were victims of indirect trauma to the shoulder during sports activities. There were seven high-level athletes who practiced judo (n = 2), rugby (n = 2), basketball (n = 2), gymnastics (n = 2) and boxing (n =1). Trauma usually caused medial rotation and retropulsion. The main signs were painful clicking, and apprehension for certain movements requiring antepulsion and medial rotation. All of the signs led to interrupting sports activities. Physical examination demonstrated normal muscle force and mobility. The most important sign was apprehension at medial rotation associated with anteroposterior displacement of the elbow. Among the exploratory tests, arthroscan of the shoulder reliably evidenced distension of the posterior capsule and possible bone damage and allowed comparative measurement of glenoid version. Retroversion of the glenoid cavity was 13 degrees (6-20 degrees) prior to surgery. Posterior access was used for posterior osteotomy of the scapular neck and grafting with the scapular spine together with posterior capsulorraphia. The shoulder was then immobilized in lateral rotation for 21 days followed by rehabilitation exercises. Sports activities could be resumed at best six months after surgery. All patients were seen again for examination at 33 months. Standard radiograms and CT-scans were obtained to evaluate corrections obtained. We used the constant classification. Results were excellent in 6 patients, good in 3 and poor in 1 at 33 months mean follow-up. This technique allows rapid return to sports activities with good stability and nearly normal mobility.
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