Pazdnikov R. Anchor stabilization of the capsule in case of traumatic anterior instability of the shoulder joint

Object: traumatic anterior instability of the shoulder joint, stabilization of the capsule of the shoulder joint using anchors. Purpose: to develop ways of optimization of arthroscopic anchor stabilization of the capsule of the shoulder joint with its anterior traumatic instability. Methods: information-analytical; clinical, including radiographic; magnetic resonance imaging; CT scan; ultrasonography; biomechanical; arthroscopic; math modeling; statistical. For the first time, on the basis of clinical and experimental biomechanical studies it was proved that the anchors are not inferior in strength to fixation in the bone to transosseous ligature sutures, which are used in the case of the classical Bankart procedure. Anchors can be effectively used to stabilize the anterior portion of the capsule of the shoulder joint. For the first time theoretically, experimentally and clinically, the criteria for optimizing the arthroscopic anchor stabilization of the capsule in patients with instability of the shoulder joint were justified. New data have been obtained that the optimal number of instrument ports depends, in particular, on the extent of rupture of the capsule of the shoulder joint and should not be artificially limited. A new criterion for assessing the effectiveness of the instrumental port - the optimal angle of attack was proposed. It characterizes the angle of inclination of the instrument to the edge of the glenoid for the convenience of carrying out manipulations on the preparation of the channel and the introduction of an anchor. For the first time, the optimal interval between anchors interval (12-13 mm) for arthroscopic stabilization of the shoulder joint capsule was determined on the basis of mathematical calculations. Dependence of the number of anchors required to perform remplissage of the defect zone of the humerus head by the capsule of the joint and the tendon of the infraspinatus muscle, from the depth of the defect was revealed. The depth of the defect determines the magnitude of the angle of action of the pulling force. In the range of the angle of action of the pulling force from 90° to 65°-70°, it is sufficient to use one anchor for remplissage, from 65° and less - at least two. The original designs of the anchors (patents of Ukraine No. 24112 and No. 78069) for the open stabilization of the capsule of the shoulder joint have been developed. They exceed in characteristics of strength of fixation available devices and transosseous ligature sutures. The use of the proposed anchors in patients with anterior instability of the shoulder joint allows increase the effectiveness of surgical intervention, begin early development of movements in the treated joint. The use of anchor stabilization during open arthrotomy diminishes the operational access, shortens the surgery time and its traumatism, reduces the duration of the recovery period in comparison with the classic Bankart procedure. The proposed criterion for evaluation arthroscopic access (optimal angle of attack) makes it possible to justify the necessary number and location of instrumental ports. The justification of the number of instrumental ports and their location, as well as the use of an optimal interval between the anchors, allow to optimize the performance of surgical intervention under arthroscopic control in patients with anterior traumatic instability of the shoulder joint and to shorten the periods of its immobilization and normalization of function. The results of the dissertation research are introduced in clinical practice in SI "Sytenkо Institute of Spine and Joints Pathology National Academy of Medical Sciences of Ukraine", KUZ "Kharkov city multidisciplinary hospital № 18", Educational and scientific medical complex "University Clinic" of Kharkov National Medical University. Traumatology and Orthopaedics.