Clinical outcomes of the reverse McLaughlin procedure for Hill-Sachs lesions in anterior shoulder instability

INTRODUCTION

Engaging Hill-Sachs lesions in recurrent anterior shoulder dislocation have been managed with the remplissage procedure. Clinical and cadaveric studies have reported limitation of rotation after this procedure. We introduce the reverse McLaughlin procedure where the infraspinatus and the underlying capsule are detached and approximated into the Hill-Sachs defect with transosseous sutures. This is a preliminary report using this technique.

METHODS

Seventeen patients with recurrent anterior shoulder dislocations and an engaging Hill-Sachs lesion underwent a Bankart repair and remplissage procedure (n = 9) or the reverse McLaughlin procedure ( n = 8). Patients were evaluated using the SF-36, American Shoulder and Elbow Surgeons (ASES), and Constant scores. Clinical assessment of the shoulders was also performed.

RESULTS

At the final follow-up, all patients in both groups achieved comparable clinical outcome scores. No significant differences were reported in the range of motion of the shoulders between the two groups. There was one dislocation of the operated shoulder in each group after an injury.

CONCLUSION

The reverse McLaughlin procedure for engaging Hill-Sachs lesions is simple, easy to perform, and associated with functional outcomes and range of motion at least equivalent to those obtained via the remplissage technique. It may be an alternative to the latter procedure.

LEVEL OF EVIDENCE

III, Retrospective Comparative Study.

Redislocation risk after an arthroscopic Bankart procedure in collision athletes: a systematic review

BACKGROUND

The purpose of this review was to determine the redislocation risk for collision athletes after an arthroscopic Bankart repair and to compare the redislocation rate between collision athletes and noncollision athletes after an arthroscopic Bankart repair.

METHODS

A PubMed and Embase query was performed, screening all relevant literature of arthroscopic Bankart procedures mentioning redislocation rates in collision athletes. Studies with a follow-up <2 years or lacking information on redislocation rates in collision athletes were excluded. We used the modified Coleman Methodology Score to assess the quality of included studies. Finally, the data in all the studies were combined and analyzed.

RESULTS

There were 1012 studies screened on title and abstract, of which 111 studies were full-text screened, and finally 20 studies were included. Four studies reported on collision athletes only, whereas 16 compared collision with noncollision athletes. Fourteen studies reported increased redislocation rates for collision athletes in comparison to noncollision athletes (absolute risk difference varying from 0.4% to 28.6%), whereas 2 studies reported decreased rates (absolute risk differences of -6% and -2.4%). A combined analysis revealed that collision athletes have an increased absolute risk of 8.09 with 95% CI from 3.61 to 12.57% for development of postoperative instability in comparison to noncollision athletes (P = .001).

CONCLUSION

Collision athletes have an increased risk for redislocation in comparison to noncollision athletes after an arthroscopic Bankart repair, although there were no differences in return to sport.

Arthroscopic bankart surgery: Does gabapentin reduce postoperative pain and opioid consumption? A triple-blinded randomized clinical trial

BACKGROUND

The role of gabapentin as preemptive analgesia in managing acute pain following shoulder bankart arthroscopy is controversial and the studies addressing this issue are limited.

HYPOTHESIS

The present study was undertaken to examine the effects of preemptive single dose of gabapentin on pain management and opioid consumption in patients undergoing arthroscopic bankart surgery.

PATIENTS AND METHODS

In the current triple-blinded randomized clinical trial, 76 eligible patients were randomly divided into two groups either taking gabapentin 600mg (G group) or placebo (P group). The primary outcomes were pain intensity assessed based on Visual Analogue Scale (VAS) and secondary outcomes were opioid consumption and side effects, dizziness, sedation, nausea and vomiting at 6h and 24h follow-up visits.

RESULTS

The pain intensity were not significantly different between the G and P groups (P>0.05). The opioid consumption, however, was significantly reduced in G group at both 6h and 24h follow-up visits (P<0.001). Dizziness and sedation were similar in both groups. Nausea and vomiting were significantly lower in G group only at 6h visit but similar at 24h follow-up visit (P<0.001).

DISCUSSION

The preemptive single dose of gabapentin 600mg administered prior to arthroscopic bankart surgery does not decrease post-operation pain, but reduces opioid consumption. Gabapentin restrained postoperative nausea and vomiting for a short while (less than 6h).

LEVEL OF EVIDENCE

Level I, treatment study.