Transcript Ligaments And Tendons in Orthopedics

New Technique in Shoulder Surgery
for Sports Injury
Dennis Crawford MD, PhD
Assistant Professor
Surgical Director, Sports Medicine Program
Department of Orthopedics & Rehabilitation
Oregon Health Sciences University
Center for Health & Healing
Portland Oregon
Shoulder Surgery: State of the Art ‘07
• All Arthroscopic
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Stabilization for dislocation
Stabilization for instability
Rotator cuff repairs
SLAP repairs
Biceps tendon repair
Capsular release
• Internal Rotation
•
contracture
Frozen Shoulder
• Open
– Clavicle fixation
• Improved outcomes
Definitions
• Instability
– Failure of the dynamic and
static mechanisms of joint
biomechanics to maintain a
functional position of two
articulating surfaces
• Subluxation
– Partial, transient loss of
articulating congruency
• Dislocation
– Complete loss of
articulating congruency
Shoulder Dislocations
• First time dislocators
– < 20 yrs
• > 75% redislocation rate
– 20-30 yrs
• 30-50% redislocation rate
• Arthroscopic repair
– Out-patient
– Reduce re-dislocation rate
• <2-5%
– Return to Sports
• 3-6 months
Type of Instability> Surgical Timing
• Traumatic Injury
– Most commonly
• anterior dislocation
– Anatomic Injury
• “Bankart” Lesion
– Labral Tear
• Acquired laxity
– Swimmers/Gymnasts
• multidirection
• Subtle capsular injuries
– Globally “stretched”
Fundamental Shoulder Arthroscopy
Arthroscopic Exam of Shoulder
Arthroscopic Exam: SLAP ? & Biceps
Arthroscopic Exam: Bankart lesion
Arthroscopic Bankart Repair: 1
Arthroscopic Bankart Repair: 2
Arthroscopic Bankart Repair: 3
Arthroscopic Bankart Repair: 4
Return to Sports after Scope Bankart
• Sling for 4-6 weeks
– Immediate
• Rhomboid strengthening
• Core & conditioning
• Weeks 4-10
– Restore normal ROM
• Weeks 8-16
– Restore Rotator Cuff strength
– Restore Scapulo-thoracic kinetics
• Weeks 12-20
– Return to sports
– Throwing/overhead athletes
• Graded increase in stress
– Throwing programs
• 6 months
– Unrestricted activity
• Assuming full strength and ROM
Thank you
Dennis C. Crawford, MD. PhD
Assistant Professor
Director, Sports & Arthroscopic Surgery
Department of Orthopedics
Oregon Health & Science University