دانلود رایگان مقاله تعمیر آرتروسکوپی قدامی لابروم نامرغوب به خلفی آسیب کتف

Abstract

Inferior labrum anterior to posterior lesions as an isolated injury or as part of an extensive traumatic labral tear are uncommon and may present as multidirectional instability of the shoulder. These lesions are hard to visualize radiographically and many times are diagnosed only during surgery. Arthroscopic repair of these lesions requires advanced arthroscopic skills and is required for restoration of glenohumeral stability. We report a combined double-pulley simple knot technique that anatomically reconstructs the inferior labrum while overcoming the typical technical challenges, providing a large footprint for healing along the inferior glenoid rim and minimizing the amount of suture material in direct contact with the articular cartilage and the risk of knot migration. The authors report the following potential conflict of interest or source of funding: N.P. receives educational support from Arthrex and Smith & Nephew. P.C. receives educational support (courses, lectures, and/or travel) from Arthrex and Smith & Nephew.

Discussion Labral tears that encompass the inferior hemisphere can be isolated lesions between the 4- and 8-o’clock position (ILAP)9 or can be part of a 270
lesion7 or 360
lesion8 in traumatic multidirectional instability.10 These tears destabilize the inferior labrum along with the corresponding anterior and posterior bands of the inferior glenohumeral ligament, creating multidirectional shoulder instability. Previous studies have shown the importance of diagnosing and incorporating the inferior labral and glenohumeral ligament repair in the surgical reconstruction.7-9 Inferior labral lesions are hard to visualize radiographically; the magnetic resonance imaging appearance is less obvious in comparison with other locations of labral injury, and direct contact with the articular cartilage and the risk of knot migration. This technique can be performed while the patient is in the beach-chair or lateral decubitus position. It is simple and does not add to the complexity level, cost, or surgical time of the currently used techniques. Moreover, the surgeon can easily convert back to traditional techniques at any stage of the surgical procedure if needed.