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Freeman DA, Hao KA, Hones KM, Olowofela BO, Parrish R, Damrow D, King JJ, Farmer KW, Pazik M, Roach RP. Pain scores and functional outcomes of patients with shoulder labral repair using all-suture anchors versus conventional anchors. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1509-1515. [PMID: 38265743 DOI: 10.1007/s00590-023-03820-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
HYPOTHESIS/PURPOSE The purpose of this study was to compare PROMs in patients undergoing anterior glenoid labral repair using all-suture versus conventional anchors. We hypothesized PROMs would be similar between groups. METHODS We performed a retrospective review of the Arthrex Global Surgical Outcomes System (SOS) database, querying patients who underwent arthroscopic glenoid labral repair between 01/01/2015 and 12/31/2020. Patients aged 18-100, who had isolated glenoid labrum repair with at least 12-month follow-up were included. The visual analog pain scale (VAS), Western Ontario Shoulder Instability Index, Veteran's RAND 12-items health survey, single assessment numeric evaluation and the American Shoulder and Elbow Surgeons score (ASES) were compared preoperatively, 3 months, 6 months, 1 year and 2 years postoperatively in patients who received all-suture anchors versus conventional anchors in the setting of anterior glenoid labrum repair. Our primary aim was comparison of PROMs between patients receiving all-suture versus conventional suture anchors. Secondarily, a sub-analysis was performed comparing outcomes based on anchor utilization for patients with noted anterior instability. RESULTS We evaluated 566 patients, 54 patients receiving all-suture anchors and 512 patients receiving conventional anchors. At two-year follow-up there was no significant difference between the two groups in PROMs. In a sub-analysis of isolated anterior labrum repair, there was an improvement in ASES (P = 0.034) and VAS (P = 0.039) with the all-suture anchor at two-year follow-up. CONCLUSIONS All-suture anchors provide similar or superior pain and functional outcome scores up to 2 years postoperatively compared to conventional anchors. CLINICAL RELEVANCE As all-suture anchors gain popularity among surgeons, this is the largest scale study to date validating their use in the setting of glenoid labrum repair. Institutional Review Board (IRB): IRB202102550.
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Affiliation(s)
- David A Freeman
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Keegan M Hones
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | | | - Ryan Parrish
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Derek Damrow
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Kevin W Farmer
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Marissa Pazik
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Roach P Roach
- Department of Orthopaedic Surgery and Sports Medicine, UF Orthopaedic Surgery and Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA.
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Pantekidis I, Piagkou M, Koutserimpas C, Samolis A, Tsakotos G, Kostares M, Troupis T. A Review of the Typical Course of the Musculocutaneous Nerve into the Coracobrachialis Muscle: Its Variability and Possible Clinical Implications. Acta Med Acad 2023; 52:95-104. [PMID: 37933506 DOI: 10.5644/ama2006-124.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/13/2023] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVE This literature review highlights the prevalence of the typical course of the musculocutaneous nerve (MCN) through the coracobrachialis muscle (CB), and evaluates the distance from the entrance point of the MCN to the CB, taking the coracoid process (CP) as a landmark. METHODS PubMed (MEDLINE), Scopus, and CINAHL online databases were searched in December 2022 for studies reporting the prevalence of the MCN's typical course and the distance between the CP and the MCN entrance point to the CB. RESULTS Twenty-eight studies were included (including 2846 subjects) investigating the MCN's typical course, and eliciting a prevalence of 93.4%. The mean distance of the CP to the entrance point of the MCN's main trunk into the CB was 5.6±2cm (median 6.1cm, in 550 subjects). In 76.12% of cases the MCN's accessory branches entered the CB proximally to the MCN's main trunk. The mean distance from the CP to the entrance point of the MCN's proximal branches to the CB was 3.8±1.2cm (median 3.7cm, in 140 subjects). CONLCUSION In the vast majority of cases, the MCN had a typical course through the CB. In cases of altered anatomy, the MCN was either absent or passed medially to the CB (without piercing it). The average entrance point of the MCN into the CB from the CP is 5.6 cm. Proximal motor branches of the MCN to the CB are common and usually arise at a mean distance of 3.8cm from the inferior border of the tip of the CP. Surgeons should be aware of both the MCN's typical and its atypical course and these distances to avoid possible complications when operating in the area.
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Affiliation(s)
- Ioannis Pantekidis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens. ;
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Greece
| | - Alexandros Samolis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens
| | - George Tsakotos
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens
| | - Michael Kostares
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens
| | - Theodore Troupis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens
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Knotless All-Suture, Soft Anchor Bankart Repair Results in Excellent Patient-Reported Outcomes, High Patient Satisfaction, and Acceptable Recurrent Instability Rates at Minimum 2-Year Follow-Up. Arthroscopy 2023:S0749-8063(23)00201-3. [PMID: 36868532 DOI: 10.1016/j.arthro.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE The purpose of this study was to evaluate minimum 2-year outcomes after arthroscopic knotless all-suture soft anchor Bankart repair in patients with anterior shoulder instability. METHODS This was a retrospective case series of patients who underwent Bankart repair using soft, all-suture, knotless anchors (FiberTak anchors) from 10/2017 to 06/2019. Exclusion criteria were concomitant bony Bankart lesion, shoulder pathology other than that involving the superior labrum or long head biceps tendon, or previous shoulder surgery. Scores collected preoperatively and postoperatively included SF-12 PCS, ASES, SANE, QuickDASH, and patient satisfaction with various sports participation questions. Surgical failure was defined as revision instability surgery or redislocation requiring reduction. RESULTS A total of 31 active patients, 8 females and 23 males, with a mean age of 29 (range: 16-55) years were included. At a mean of 2.6 years (range: 2.0-4.0), patient-reported outcomes significantly improved over preoperative levels. ASES score improved from 69.9 to 93.3 (P < .001), SANE improved from 56.3 to 93.8 (P < .001), QuickDASH improved from 32.1 to 6.3 (P < .001) and SF-12 PCS improved from 45.6 to 55.7 (P < .001). Median patient postoperative satisfaction was 10/10 (range: 4-10). Patients reported a significant improvement sports participation (P < .001), pain with competition (P = .001), ability to compete in sports (P < .001), painless use of arm for overhead activities (P = .001), and shoulder function during recreational sporting activity (P < .001). Postoperative shoulder redislocations were reported in 4 cases (12.9%)-all after major trauma-with 2 patients progressing to Latarjet (6.45%) at 2 and 3 years postoperatively. There were no cases of postoperative instability without major trauma. CONCLUSIONS Knotless all-suture, soft anchor Bankart repair resulted in excellent patient-reported outcomes, high patient satisfaction, and acceptable recurrent instability rates, in this series of active patients. Redislocation after arthroscopic Bankart repair with a soft, all-suture anchor only occurred after return to competitive sports with new high-level trauma. STUDY DESIGN Level IV, retrospective cohort study.
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Haase L, Wise K, Kelly B, Harris J, Macalena J. No Difference Between Anchorless and Traditional Suture Anchors in Arthroscopic Bankart Repair: A Clinical Comparison. Cureus 2022; 14:e26988. [PMID: 35989839 PMCID: PMC9385306 DOI: 10.7759/cureus.26988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background Shoulder instability and recurrent dislocations are common problems encountered by orthopedic surgeons and are frequently associated with a Bankart lesion. These are classically treated with either open or arthroscopic repair utilizing traditional suture anchors, though anchorless fixation techniques have recently been developed as an alternate fixation method that reduces native bone loss and has comparable pull-out strength. Methods A retrospective review was performed at a single institution for patients who underwent Bankart repair from January 2008 through February 2014. American Shoulder and Elbow Surgeons (ASES) questionnaires were mailed to 35 patients with anchorless fixation and 35 age-, gender-, and surgeon-matched patients with traditional suture anchors. Statistical analysis was performed comparing re-dislocation, additional surgery, and ASES scores with statistical significance set at p < 0.05. Results Eleven patients in the anchorless implant group and 15 patients in the anchor group completed the questionnaire. The mean follow-up was 4.1 years in the anchorless group and 5.6 years in the anchor group (p=0.04). The number of implants was 4.82 in the anchorless group and 3.87 in the anchor group (p = 0.04). No difference was found in re-dislocation rates (p = 0.80) or additional surgery on the affected shoulder (p = 0.75). ASES scores were found to have no statistical difference (89.89 for the anchorless group versus 85.37 for the anchor group; p = 0.78). Conclusion In patients undergoing arthroscopic Bankart lesion repair with traditional anchors compared to anchorless fixation, there appears to be no difference in shoulder re-dislocation rates, recurrent ipsilateral shoulder surgery, or ASES scores.
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