Instability Repair in a Young Patient
Pediatric instability cases have been reported as relatively rare occurrences in the literature. In a study of 500 patients reporting instability, only 19.8% of them were under the age of 20. This percentage decreases if the pediatric population is reduced to include pre-adolescent children only, as was displayed by 7 in 107 (6.5%) cases being those of instability in children under 10. The most common mechanism of injury in this patient population is traumatic sports injuries, followed by fall injuries and finally non-traumatic dislocations. Although the initial injury is rare, potentially due to the tendency of the growth plate to fracture before the arm would dislocate, the recurrence of instability after the initial injury is extremely high. Studies report a range of persistent instability in anywhere from 75% as reported by Deitch et al. to 100% in skeletally immature patients as reported by Marans et al. Most of these repeated incidences of dislocation or subluxation are due to quick movements or overhead activity.
At the time of traumatic dislocation cadaver studies reveal there is a great amount of deformation of the capsule and the glenohumeral joint before ultimate failure. Due to the inability of spontaneous healing of the joint and the necessity of the glenohumeral ligament in shoulder stabilization, recurrent dislocation often occurs, which in the short-term disrupts participation in sports and work, and in the long-term leads to symptomatic osteoarthritis. Nevertheless, with new arthroscopic techniques that have equal recurrence rates to open techniques and better postoperative functional outcomes, surgical intervention is a safe and effective method of treatment. The purpose of the present article is to describe the surgical technique for the arthroscopic repair of a ruptured anterior band of the inferior glenohumeral complex in a pediatric patient.