Atualizações na abordagem cirúrgica da instabilidade anterior do ombro: cirurgia aberta ou artroscópica?
João Bernardo Matos Nunes
The Anterior Dislocation of the Shoulder is a frequent and potentially incapacitating injury. This study aims the collection of the most recent information on the therapeutic approach of this condition, both on its acute (more shortly) and recurrent presentations. The analysis of the current literature shows that there is still a great controversy about which surgical technique grants the best results.
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The development of arthroscopy has allowed a new surgical approach using the Bankart technique, gathering the advantages of mini-invasive surgery and low recurrence rates, mostly when used in patients who fulfilled precise indications: Instability and Severity Index Score ≤ 4, occult instability, non-significant glenoidal and humeral bone loss, ALPSA injury or joint hiperlaxity. The posterior plicature and capsulorraphy techniques can be added in some of these cases, yielding even better results.
Nevertheless, the bone block techniques (Bristow-Latarjet), still performed via open surgery, still have a primary role for more severe injuries, where anatomical reconstruction does not grant efficiently the prevention of recurrences.
This is a subject lacking more homogeneous studies, that would allow the direct comparison and meta-analysis, but this paper reinforces the importance of evaluating each patient according to his/her own injury and choosing the surgical technique that ensures the best combination of high functional recovering and low recurrence rates.
Keywords: Anterior Dislocation of the Shoulder; Anterior Instability of the Shoulder; Capsulolabral Reconstruction; Bankart; Bristow-Latarjet; Surgical Indications.
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