"Bipolar Fixation": A Novel Concept In The Treatment Of Recurrent Anterior Shoulder Instability-A Prospective Study Of 26 Cases With Minimum 2-Year Follow-Up

The purpose of this study is to introduce a novel concept of arthroscopic "bipolar fixation" in the treatment of recurrent ante-roinferior shoulder dislocations. Between January 2008 and January 2011, 297 patients with the history of recurrent anteroinferior dislocations underwent either open Latarjet procedure or arthroscopic Bankart repair along with the tenodesis of infraspinatus and the posterior capsule (bipolar fixation) on to the bare area irrespective of the presence or absence of Hill-Sachs lesions and hyperlaxity. Twenty-six patients who underwent arthroscopic bipolar fixation in 2008 with a minimum follow-up of 2 years were included in this study. Hyperlaxity was noticed in 53% of the population. Seventy-four percent had HillSachs lesions and glenoid defects were found in 30%. The average instability severity index score was 5.07. The patients were followed up with Walch-Duplay score and Subjective Shoulder Value. At 2-year follow-up, 100% had full range of motion without any deficits. Thirteen percent experienced some residual posterior pain, but all the 26 patients could get back to their sports activities. Eighty-five percent could get back to their previous level of sports. Subjective Shoulder Value improved from 53% to 95% postoperatively. The Walch-Duplay score was 95%. The lone failure (3.84%) was a case of attritional glenoid when he had a redislocation at 1 year postoperatively after a minor injury. Arthroscopic bipolar fixation restores a good balance between the injured anterior and the posterior capsuloligamentous structures. The technique is reliable and reproducible in posttraumatic recurrent anteroinferior dislocations regardless of the presence or absence of Hill-Sachs lesions. The absolute contraindication is a type 3 anterior glenoid defect. Nevertheless, further comparative studies need to be performed to confirm our results, and so far one should correct the pathology as found rather than routinely performing a "bipolar" tightening regularly.