反復性肩関節前方（亜）脱臼に合併した SLAP lesion に対する治療の是非
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概要
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We have performed arthroscopic Bankart procedure using an absorbable or metallic suture anchor for traumatic anterior shoulder instability. In this study, we report the frequency, pathology and therapeutic results of patients treated for SLAP lesion concomitant with Bankart lesion. The subjects were 20 patients (Group A). The mean age at the time of surgery was 33.8 years old. On arthroscopic findings, SLAP lesions were classified into type 2 in 15 cases and type 4 in 5 cases based on Snyders criteria. Also, SLAP lesion with intra-articular free bodies was presented in 2 cases, and SLAP lesion with capsular tear in 1. We performed the only debridment (Group A1) or re-attachment (Group A2) to the superior glenoid edge of these lesions, considering whether these lesions communicated to Bankart lesion or not. The therapeutic results were evaluated according to the JOA score and JSS shoulder instability score. The mean JOA and JSS Shoulder Instability score was 95.1 and 90.8. No pain remained and there was no recurrence of instability in any cases of Group A. Meanwhile, on detailed analysis in JSS Shoulder Instability score between Group A1 and A2, the mean score of function and the range of motion were 18.9 points and 15.1 points in Group A1, and 17.5 and 10.1 in Group A2, respectively. There was a significant correlation in the range of motion between Group A1 and A2 (P=0.04). Regarding the postoperative limitation in external rotation with the arm at side, the difference in the range from that on the healthy side was 9.8 degrees in Group A (7.0 in Group A1 and 12.6 in Group A2). When SLAP lesion communicated to Bankart lesion, we could have satisfactory results for these patients without repair for SLAP lesions. Therefore, we think that we should avoid the unnecessary repair or address for the concomitant pathology, or that we should perform the different postoperative care for these patients with Bankart repair with re-attachment of SLAP lesion.
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