[Prognostically relevant factors in treatment of the post-traumatic unstable shoulder joint]

The purpose of this prospective study was to determine concomittant lesions of glenohumeral dislocation and their correlation with the outcome, to determine the influence of various stabilizing operation techniques on the outcome. 106 shoulders [104 patients, 81 men, 23 women, mean age 36 (16-83) years] operated because of shoulder instability after at minimum one shoulder luxation between 1988 to 1995 were evaluated 3 years (0.8-8 years) postoperatively using Constant score. Preoperative arthroscopy was performed to document intraarticular lesions. There were 7 reluxations (5 because of a new accident), mostly after Putti-Platt procedures. The average modified Constant Score was 66 (10-85) points (maximum 85). 29 patients (27%) had less than 60 points, mostly because of pain and restriction of function, and were evaluated as poor. Lesions of rotator cuff, long biceps tendon and subscapularis tendon had a bad prognosis. The severity of arthroscopically found lesions correlated with the outcome. Operations with shortening of subscapularis tendon or using a bone graft gave bad results. Anatomic reconstruction of the labrum-ligament complex in combination with a plasty of the extended capsule gave best results. Preoperative arthroscopy can determine the extent of different lesions after shoulder luxation which influence the outcome and is useful to select the optimal operation technique.