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Pawłuś N, Kanak M, Frankiewicz A, Piwnik J, Popescu IA, Borowski A, Kwapisz A. Remplissage May Decrease the Redislocation Rate After Arthroscopic Bankart Repair in Patients With an Engaging Hill-Sachs Defect: A Systematic Review and Meta-analysis of Studies With Minimal 2-Year Follow-up. Am J Sports Med 2024:3635465241249492. [PMID: 38742747 DOI: 10.1177/03635465241249492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND The redislocation rate after arthroscopic Bankart repair (BR) among patients with a Hill-Sachs lesion (HSL) may be reduced with the use of remplissage. PURPOSE To investigate the outcomes of adding remplissage to an arthroscopic BR in patients with concomitant HSL. STUDY DESIGN Meta-analysis; Level of evidence, 3. METHODS PubMed and ScienceDirect databases were searched between February 2022 and April 2023 with the terms "remplissage" and "shoulder instability" according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were formed using the population, intervention, control, and outcome method; the investigation included studies that compared BR with and without remplissage and had ≥24 months of follow-up. RESULTS From 802 articles found during the initial search, 7 studies with a total of 837 patients-558 receiving isolated BR (BR group) and 279 receiving BR with remplissage (BR+REMP)-were included. The probability of recurrence of instability among patients with an engaging HSL was significantly diminished in the BR+REMP group compared with the BR group (odds ratio, 0.11; 95% CI, 0.05 to 0.24; P < .001). Regarding shoulder range of motion, the BR+REMP group achieved increased forward flexion (mean difference [MD], 1.97°; 95% CI, 1.49° to 2.46°; P < .001) and decreased external rotation in adduction (MD, -1.43°; 95% CI, -2.40° to -0.46°; P = .004) compared with the BR group. Regarding patient-reported outcome measures, the BR+REMP group had Rowe (MD, 2.53; 95% CI, -1.48 to 6.54; P = .21) and Western Ontario Shoulder Instability Index (WOSI) (MD, -61.60; 95% CI, -148.03 to 24.82; P = .162) scores that were comparable with those of the BR group. CONCLUSION Remplissage resulted in a 9-fold decrease in the recurrence of instability after arthroscopic BR in patients with HSL. Remplissage not only led to an increase in forward flexion but also only slightly limited patients' external rotation in adduction. WOSI and Rowe scores after remplissage at the final 24-month follow-up were comparable with those obtained after isolated Bankart repair.
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Affiliation(s)
- Natalia Pawłuś
- Clinic of Orthopedic and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland
| | - Michał Kanak
- Orthopedic and Trauma Department, Veterans Memorial Teaching Hospital in Lodz, Medical University of Lodz, Lodz, Poland
| | | | - Joanna Piwnik
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Ion-Andrei Popescu
- Ortopedicum-Orthopedic Surgery and Sports Clinic, Romanian Shoulder Institute, Bucharest, Romania
| | - Andrzej Borowski
- Clinic of Orthopedic and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland
| | - Adam Kwapisz
- Clinic of Orthopedic and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland
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Klungsøyr JA, Vagstad T, Klungsøyr PJ, Myklebust TÅ, Lund Hanssen H, Hoff SR, Drogset JO. The Arthroscopic Subscapular Sling Procedure Results in Low Recurrent Anterior Shoulder Instability at 24 Months of Follow-Up. Arthroscopy 2024:S0749-8063(24)00167-1. [PMID: 38453096 DOI: 10.1016/j.arthro.2024.02.032] [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: 10/23/2023] [Revised: 02/18/2024] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To analyze the results of the subscapular sling procedure developed for anterior shoulder instability in patients with less than 10% anterior glenoid bone loss. METHODS Patients were treated surgically with the arthroscopic subscapular sling procedure. A semitendinosus graft was used to reconstruct the anterior labrum and to establish a sling suspension around the upper part of the subscapularis tendon. The patients were followed up with radiographs (at 12 and 24 months). Magnetic resonance imaging (MRI) of the shoulder region and clinical examinations were performed at 3, 12, and 24 months. Recurrent dislocation was the primary endpoint. The Western Ontario Shoulder Instability Index (WOSI) and MRI results were secondary outcome measures. An independent physiotherapist assessed residual instability and range of motion. RESULTS Fifteen patients were included with a dislocation rate of 0% after 24 months follow-up. There was a significant clinical improvement of the WOSI score from 57% (904) at baseline to 88% (241) at 24 months (P < .001). The proportion of patients with an improvement in the WOSI Total score larger than the estimated minimal clinically important difference was 100% both at 12 and 24 months. MRI showed an intact sling in all patients. External rotation was not significantly reduced (52° at baseline vs 47° at 24 months, P = .211). Flexion and abduction were significantly improved from 152° to 174° (P = .001) and 141° to 170° (P < .001) after 24 months. The surgical procedures were completed without any intraoperative complications. CONCLUSIONS The subscapular sling procedure resulted in low recurrent shoulder instability and improved patient-reported outcome measures at 24 months of follow-up. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Jan Arild Klungsøyr
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway.
| | - Terje Vagstad
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Peter Johannes Klungsøyr
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Håkon Lund Hanssen
- Department of Radiology and Nuclear Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Solveig Roth Hoff
- Department of Radiology, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jon Olav Drogset
- Department of Orthopedic Surgery, Trondheim University Hospital and Norwegian University of Science and Technology (NTNU) Trondheim, Norway
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Hurley ET, Lunn K, Bethell M, Levin J, Pasqualini I, Frangiamore S, Anakwenze O, Klifto CS. Return to play following operative management of anterior shoulder instability in overhead athletes-A systematic review. Shoulder Elbow 2024; 16:15-23. [PMID: 38435042 PMCID: PMC10902415 DOI: 10.1177/17585732231205175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 03/05/2024]
Abstract
Background The purpose of this study was to systematically review the rate and timing of return to play in overhead athletes following operative management of anterior shoulder instability. Methods A systematic literature search based on PRISMA guidelines, utilizing the EMBASE, MEDLINE, and The Cochrane Library Databases. Eligible for inclusion were clinical studies reporting on return to play among overhead athletes following arthroscopic Bankart repair, open Latarjet procedure or Remplissage procedure. Results There are 23 studies included with 961 patients. Among those undergoing arthroscopic Bankart repair, the rate of return to play was 86.2%, with 70.6% returning to the same level of play and the mean time to return to play was 7.1 months. Among those undergoing an open Latarjet procedure, the rate of return to play was 80.9%, with 77.7% returning to the same level of play and the mean time to return to play was 5.1 months. Among those undergoing a Remplissage procedure, the rate of return to play was 70.6%, with 70.0% returning to the same level of play or mean time to return to play. Discussion Overall, there were high rates of return to play following operative management of anterior shoulder instability in overhead athletes.
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Affiliation(s)
- Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Kiera Lunn
- School of Medicine, Duke University, Durham, NC, USA
| | | | - Jay Levin
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | | | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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Villarreal-Espinosa JB, Kay J, Ramappa AJ. Arthroscopic Bankart with remplissage results in lower rates of recurrent instability with similar range of motion compared to isolated arthroscopic Bankart for anterior glenohumeral instability: A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2024; 32:243-256. [PMID: 38258962 DOI: 10.1002/ksa.12054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/20/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024]
Abstract
PURPOSE The addition of the remplissage procedure to an arthroscopic Bankart procedure has been shown to improve clinical outcomes, yet at the expense of potentially decreasing shoulder range of motion. The purpose of this study was to assess recurrent instability, range of motion, functional outcomes and rates of return to sport outcomes in patients undergoing an isolated arthroscopic Bankart repair compared to those undergoing arthroscopic Bankart repair in addition to the remplissage procedure. METHODS According to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, a search was conducted using three databases (MEDLINE/OVID, EMBASE and PubMed). Retrieved studies were screened based on predefined inclusion and exclusion criteria for comparative studies. Data were extracted and meta-analysis performed using a random-effects model. RESULTS A total of 16 studies (13 level III studies, 2 level II studies and 1 level I) were included with a total of 507 and 704 patients in the Bankart plus remplissage and isolated Bankart repair groups, respectively. No studies reported glenoid bone loss of >20% with the least percentage of glenoid bone loss reported among studies being <1%. There was a significantly increased rate of recurrent dislocations (odds ratio [OR] = 4.22, 95% confidence interval [CI]: 2.380-7.48, p < 0.00001) and revision procedures (OR = 3.36, 95% CI: 1.52-7.41, p = 0.003) in the isolated Bankart repair group compared to the Bankart plus remplissage group. Additionally, there were no significant differences between groups in terms of external rotation at side (n.s.), in abduction (n.s.) or at forward flexion (n.s.) at final follow-up. Furthermore, return to preinjury level of sport favoured the Bankart plus remplissage group (OR = 0.54, 95% CI: 0.35-0.85, p = 0.007). CONCLUSION Patients undergoing arthroscopic Bankart plus remplissage for anterior shoulder instability have lower rates of recurrent instability, higher rates of return to sport, and no significant difference in range of motion at final follow-up when compared to an isolated arthroscopic Bankart repair. Further large, prospective studies are needed to further determine which patients and degree of bone loss would benefit most from augmentation with the remplissage procedure. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Juan Bernardo Villarreal-Espinosa
- Carl J. Shapiro Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jeffrey Kay
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Arun J Ramappa
- Carl J. Shapiro Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Gibbs D, Mallory N, Hoge C, Jones G, Bishop J, Cvetanovich G, Rauck R. Psychological Factors That Affect Return to Sport After Surgical Intervention for Shoulder Instability: A Systematic Review. Orthop J Sports Med 2023; 11:23259671231207649. [PMID: 38035214 PMCID: PMC10686029 DOI: 10.1177/23259671231207649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/02/2023] [Indexed: 12/02/2023] Open
Abstract
Background Recent advances have begun to identify the nonphysical factors facilitating successful return to sport (RTS) after shoulder instability surgery, yet little is currently known regarding psychological factors and RTS. Purpose/Hypothesis The purposes of this study were to (1) identify psychological factors associated with RTS, (2) evaluate the prognostic utility of various psychological factors, and (3) evaluate the available metrics used to assess psychological RTS readiness. It was hypothesized that psychological factors would be identified as critical elements influencing a patient's RTS. Study Design Systematic review; Level of evidence, 4. Methods Clinical studies reporting on the psychological determinants of RTS for patients who had surgery for shoulder instability between 1996 and 2022 were identified from MEDLINE, Embase, and Cochrane databases. Demographic, clinical, and psychometric properties were extracted for pooled weighted analysis. Results Of the 969 studies screened, 24 (2.5%) met inclusion criteria. Overall, 2135 patients were included (mean age, 26.0 years; range, 17.4-35.5 years; 84.7% male). The mean time to RTS was 6.8 months (range, 3.7-11.9 months). There was a 76.3% rate of any RTS; of the 1212 patients who reported level of play at return, 305 (25.2%) were unable to perform at their prior level. Psychological reasons were cited by 85% (n = 360) of patients who did not RTS. Fear of reinjury was the most common reason (n = 154; 42.8%); other psychological factors included lack of confidence (n = 46; 12.8%), anxiety (n = 45; 12.5%), depression (n = 44; 12.2%), psychosocial factors (n = 48; 13.3%), and lack of motivation (n = 23; 6.4%). The Shoulder Instability Return to Sport after Injury, Western Ontario Shoulder Instability Index, Quick Inventory of Depressive Symptoms Self Report, Degree of Shoulder Involvement in Sports, Tampa Scale of Kinesiophobia-11, and Veterans Rand 12-Item Health Survey were reported measures for assessing psychology and RTS. Conclusion Fear of reinjury was found to be the most commonly reported impediment to RTS. The psychological characteristics identified through this review may be incorporated into future RTS protocols seeking to address resilience and nonphysical factors associated with RTS.
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Affiliation(s)
- David Gibbs
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Noah Mallory
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Connor Hoge
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Grant Jones
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Julie Bishop
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Gregory Cvetanovich
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ryan Rauck
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Atwan Y, Wang A, Labrum JT, Sanchez-Sotelo J, Barlow JD, Dines JS, Camp CL. Management of Shoulder Instability in Patients with Seizure Disorders. Curr Rev Musculoskelet Med 2023; 16:201-210. [PMID: 37067689 DOI: 10.1007/s12178-023-09833-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE OF REVIEW Patients with seizure disorders commonly suffer shoulder dislocations and subsequent instability. Due to high rates of recurrence and bone loss, management of this instability and associated pathology has proven to be more complex than that of patients without seizure disorders. The ultimate goal of this review is to outline the various treatment modalities and their respective outcomes in this complex patient population. RECENT FINDINGS Optimization of medical management of seizure disorders is imperative. However, despite these efforts, the incidence of post-operative seizure activity continues to be a concern. These subsequent episodes increase the risk of further instability and failure of surgical procedures. Overall, the use of soft tissue procedures has proven to result in increased recurrence of instability compared to bone-block augmenting and grafting procedures. There are a variety of bone-block procedures that have been described for anterior and posterior instability. Despite their success in decreasing further instability, they are associated with several complications that patients should be informed of. There is no consensus regarding the optimal surgical management of shoulder instability in patients with seizure activity. A multidisciplinary approach to the management of the seizure activity is paramount to the success of their treatment. Further studies are required to evaluate the optimal timing and type of surgical intervention for individualized cases.
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Affiliation(s)
- Yousif Atwan
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Allen Wang
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joseph T Labrum
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Joshua S Dines
- Sports Medicine and Shoulder Service, Hospital for Special Surgery Westside Sports Institute, 610 W. 58Th St, New York, NY, 10019, USA
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Lubowitz JH, Brand JC, Rossi MJ. Early Treatment of Shoulder Pathology Is Necessary but Not Enough Is Being Performed. Arthroscopy 2022; 38:2943-2953. [PMID: 36344053 DOI: 10.1016/j.arthro.2022.08.031] [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: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
Delayed treatment of shoulder instability results in bone loss requiring more-complicated surgery, in turn resulting in less-optimal outcomes. Similarly, delayed treatment of repairable rotator cuff tears results in irreparable tears requiring more-complicated surgery and resulting in less-optimal outcomes. Delayed treatment of shoulder pathology is a problem. Solutions include education and research investigation.
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