FUNCTIONAL OUTCOME OF MODIFIED PUTTI PLATT PROCEDURE IN RECURRENT DISLOCATION OF SHOULDER – A RETROSPECTIVE ANALYSIS

Abstract

Hand, which is considered to be an extension of brain and a tool for the execution of human intellect and will, owes much to the versatility of the movement of the shoulder for its placement on the desired spot of action. The shoulder, by virtue of its anatomy and biomechanics, is one of the most unstable and frequently dislocated joints, accounting for nearly 50% of all dislocations. Most of the recurrent dislocations of shoulder (96%) follow an initial signicant traumatic dislocation. There are two basic types of surgical approaches for shoulders with anterior instability: "anatomic" and "non-anatomic" repairs. With anatomic repairs, the goals are to restore the labrum toits normal position and to reestablish the appropriate tension in the shoulder capsule and ligaments. The goal of non-anatomic surgical procedures is to stabilize the shoulder by compensating for the capsulolabral and osseous injury with an osseous or soft-tissue checkrein that blocks excessive translation and restores stability. In Modied Putti Platt procedure, as done in our institute, after proper positioning and adequate exposure, the subscapularis muscle and capsule is incised at the musculotendinous junction. Aquadrangular unicortical graft, harvested from the iliac crest, is inserted fully into the trough made in the anterior glenoid, resulting in deepening of the glenoid articular surface. Subscapularis and the capsule are closed by double breasting, keeping the arm in external rotation. We did a retrospective analysis to assess the outcome of this procedure done in our institute. 102 patients were assessed and the required data were collected using hospital medical records, telephonic interview and direct clinicoradiological assessment. All the patients had positive apprehension test, pre- operatively. The mean Rowe score was 30.98 (standard deviation 5.846). The mean follow up duration was 44.52 months. 91 patients (89.2%) had no pain at last follow up duration and the rest had slight and occasional pain. All the patients were able to work above shoulder. The mean external rotation at 6 months follow up was 37.89° (SD 9.239), which increased to 65.88° (SD 8.967) at last follow up. The mean internal rotation at 6 months follow up was 61.18° (SD 4.623), which increased to 77.16° (SD 6.234) at last follow up. There was signicant improvement of Rowe's score post-operatively when compared to pre-operative Rowe's score. There was a signicant mean increase of 49.216 points post operatively with a correlation coefcient of +0.513. (p<0.05). All patients, at last follow up had a UCLA score of more than 27, with 96 patients (94.1%) had good clinical outcome (according to UCLA grading system). 6 patients had fair clinical outcome. 77 patients (75.5 %), according to Rowe score had good clinical outcome.12 patients (11.8%) had excellent outcome. 13 patients had fair clinical outcome. None of the patients who were operated in our institute had recurrence of dislocation. None of them were reoperated. 91 patients (89.2%) had negative apprehension with no evidence of subluxation. 10 patients (9.8%) had negative apprehension, but slight discomfort in abduction and external rotation. One person had positive apprehension test, but he was able to continue his activities of daily living and continued to engage in professional non contact sports, though at one level below; and he did not choose to undergo a reoperation. 6 patients, all aged more than 45 years, had clinicoradiological evidence of mild arthrosis of the shoulder joint. They are being treated conservatively with physical therapy and analgesics Mild donor site pain was there in 6 patients in the rst yr of surgery. This subsided with time with analgesics. None had evidence of donor site infection, and none had evidence of visceral injuries.