• Clinics in Shoulder and Elbow
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• 제2권1호
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• pp.53-59
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• 1999

Initial treatment of multidirectional instability of the shoulder would be a thorough rehabilitation program. If rehabilitation fails to resolve a patient's symptoms, the most commonly performed surgical procedure remains the inferior capsular shift. Eleven patients who had disabling multidirectional instability of the shoulder were managed with the inferior capsular shift. All of the procedure were performed by means of an anterior approach and a laterally based capsular shift. All of the patients were the contact athletes. The purpose of our study was to evaluate the efficacy of the inferior capsular shift procedure in the contact athletic patients, to review the loss of external rotation postoperatively and to discuss their return to sports. Mean follow up duration was 14.5 months(range, 12 to 24). Pain was relieved postoperatively in all cases and most patients could get stability except one case of recurrent subluxation. The average loss of external rotation and forward flexion after the operation were Y and 30 at last follow up. By the rating scale from American Shoulder and Elbow Society, overall scores improved from 49 points to 85 points. The results were excellent or good in 9 patients(82%) out of 11 patients. In reference to return to sports, 10 patients(91 %) of 11 patients returned to their sports with 7 patients (64%) returning at the same levels of competitiveness. The inferior capsular shift procedure was considered to be a recommendable method for the management of the multidirectional instability of the shoulder.

• Clinics in Shoulder and Elbow
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• 제3권1호
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• pp.1-9
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• 2000

Purpose: To report the mid-term results of the inferior capsular shift procedure for the multidirectional instability, and to analyze whether the bilateral laxity, the generalized ligamentous laxity and the voluntary instability can influence upon the final outcome. Material and Method: We reviewed 95 patients with 96 shoulders treated by the inferior capsular shift procedure for multidirectional instability through an anterior approach. In total, 49 shoulders(51%) showed generalized ligamentous laxity, 56 shoulders(58%) bilateral laxity, and 65 shoulders(68%) voluntary subluxation. Mean follow-up was 27 months(11-60 months). Result: The final Rowe score was 75 points in patients who had had at least one of the bilateral laxity, generalized ligamentous laxity, or the voluntary subluxation and 84 points without any of these in each element. Seventy-five percent of the bilateral laxity and 87% of the unilateral instability continued to function well without any pain and instability postoperatively. Those with a voluntary(74%), those with an involuntary instability(83%), those with a generalized ligamentous laxity(73%) and without laxity(84%) could do well a daily living activity without instability Eighty-six percent who had had the voluntary instability was eliminated completely the voluntability. Eighty-four percent of the patients stated that they were subjectively satisfied with the status of their shoulder. Nine shoulders(9.4%) had recurrence of symptomatic and disabling instability and theses patients had had at least voluntary instability preoperatively. Seven patients(7.3%) suffered from the stiff shoulder after the inferior capsular shift procedure. Conclusion: The inferior capsular shift procedure in multidirectional instability provided satisfactory results both in objective and subjective terms. Nonetheless, a patient who has a bilateral laxity, a generalized ligamentous laxity or a voluntary instability could be expected less favorable results compared to those with neither of these. A careful selection of the inferior capsular shift procedure for the multidirectional instability is needed before surgery. But our results suggests that a voluntary instability is not always poor candidate for the inferior capsular shift procedure.

• Clinics in Shoulder and Elbow
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• 제3권1호
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• pp.10-19
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• 2000

The aims of this retrospective study were to evaluate the results of inferior capsular shift operation which were approached anteriorly or posteriorly according to a main instability direction in contact sports population who had multidirectional shoulder instability. Fifty-three shoulders in 47 athletes who engaged in contact sports underwent an anterior or posterior inferior capsular shift procedure for the correction of multidirectional instability of the shoulder joint. The surgical approach was selected according to the predominant direction of the instability. Follow up was average of 42 months(24∼73 months). After anterior inferior capsular shift, anterior dislocation was recurred in three shoulders, posterior dislocation in one, and inferior dislocation in two shoulders. After posterior inferior capsular shift, one dislocation occurred anteriorly, one inferiorly and one posteriorly. The excessive tightening of capsule or improper diagnosis could be causative factors for the development of dislocation in the opposite direction to the preoperative major instability. Of six patients who could not return to their sports, five had bilateral repairs. Successful repair based on the criteria of the American shoulder and elbow association was achieved in 92% of anterior repairs, and 81 % of posterior repairs.

• 대한정형외과스포츠의학회지
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• 제1권1호
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• pp.102-107
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• 2002

목적 : 견관절 불안정성의 관절경적 수술로 재발의 가능성이 높은 환자에 대해견갑하근 및 관절낭 수평 분할을 이용한 하방관절낭이동술을시행하고이에대한결과를분석하고자하였다. 대상및방법 : 1994년부터 1999년까지수술을시행한환자중1년이상추시(평균: 2년, 범위: 1$\~$3년)가가능한 15례를대상으로하였다. 남자가13례여자가2례이었으며평균연령은27 이었다. 질환은다방향성불안정성4례, 수의성불안정성3례, 골성Bankart 병변이있는전방불안정성2례, 접촉성운동선수의전방불안정성6례였다. 13례는관혈적봉합술과하방관절낭이동술을 동시에 시행하였고, Bankart 병변이없던2례는하방관절낭이동술만 시행하였다. 관절낭중첩 정도는평균 19 mm (범위: 10$\~$5 mm)였다. 결과 : 14례에서우수혹은양호의결과를보였으며술후1례에서아탈구되었고, 1례에서전방염려검사에양성소견을보였다. 술후전방거상과팔을체간에붙인외회전, 90$^{\circ}$ 외전에서의외회전의운동범위는술전과통계학적인차이가없었다. 결론 : 견갑하근및관절낭수평분할을이용한하방관절낭이동술은관절운동범위의감소없이과잉관절낭과Bankart 병변을치료할수있어관절경적치료로재발의가능성높은환자에서권장될치료법으로사료되었다.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 1999년도 학술대회
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• pp.63-63
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• 1999

• Clinics in Shoulder and Elbow
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• 제7권1호
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• pp.1-4
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• 2004

As the multidirection and posterior instabilities of the shoulder are not only uncommon but responds well to conservative treatment, the shoulder instabilities which requires surgical treatment are traumatic anterior type in most cases, Although various surgical procedures had been used in the past, Bankart procedure is the standard surgical method as a primary procedure in traumatic anterior instability, Nevertheless there has been changes in the techniques of Bankart procedure in order to minimize decrease of external rotation and effectively address capsular laxilty, Capsular shift might be needed if there remains excessive capsular laxity of the inferior capsule after repair of the Bankart lesion, Large bony Bankart lesion should be fixed if possible and severe glenoid rim erosion requires extracapsular bone block after repair of the capsule. Although a few surgical procedures are described for the management of Hill-Sachs lesion in special circumstances, Hill-Sachs lesion does not usually need to be addressed.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2001년도 학술대회
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• pp.62-63
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• 2001

• Clinics in Shoulder and Elbow
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• 제6권1호
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• pp.55-66
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• 2003

Background: The purpose of this study was to evaluated results of arthroscopic treatment of the traumatic recurrent unidirectional posterior subluxation. Materials and Methods: We treated twenty-seven patients who had traumatic recurrent unidirectional posterior subluxation of the shoulder by arthroscopic labral repair and posterior capsular shift and prospectively evaluated for a mean of thirty-nine months (range,24 to 85 months). Patients who had posteroinferior instability, multidirectional instability, atraumatic onset, or revision cases were excluded. There were twenty-five male and two female patients with the mean age of twenty-one years (range, 14 to 33 years). All patients were involved in sports activity. All had a significant traumatic event prior to the onset of the instability. Stability, motion, three objective measurement (UCLA, ASES, and Rowe scores) and two subjective measurements (pain and function visual analogue scale) were evaluated. Results: The most common finding in magnetic resonance image-arthrogram was separation of the posteroinferior labrum without displacement in 9 patients, In arthroscopic examination, all patients had one or more lesions in the posterior inferior labrum and capsule. The most common finding was incomplete stripping of the posterior inferior labrum (18 patients). The posteroinferior capsule subjectively appeared to be stretched in twenty-two patients. At follow-up, all patients had improved shoulder function and scores(p < 0.01). All patients had stable shoulder by subjectivel and objectivel measurements, except one patient who had recurrent subluxation. All but one patient with postoperative recurrence were able to return to their prior sports activity with little or no limitation. Twenty-four patients were graded as having more than 90％ of shoulder function. Their were twenty-one excellent, five good, and one fair UCLA. scores. Pain sore improved from 4.5 to 0.2 point(p : 0.0001). Mean loss internal rotation was one vertebral level. None had operative complications. Conclusion: In conclusion, treatment outcomes of the traumatic unidirectional recurrent posterior subluxation are consistently reliable with respect to the stability, pain relief, and functional restoration by the arthroscopic posterior capsular shift procedure.