Long-term independent evaluation after arthroscopic extra-articular Bankart repair with absorbable tacks. Surgical technique.

BACKGROUND: Several arthroscopic methods have been developed to treat posttraumatic recurrent anterior shoulder instability in an attempt to match the results that can be achieved with open repair. The aim of this study was to perform an independent long-term clinical and radiographic evaluation after extra-articular arthroscopic Bankart repair with use of absorbable tacks (Suretac fixators). METHODS: Eighty-one consecutive patients with posttraumatic recurrent anterior shoulder instability underwent an extra-articular arthroscopic Bankart procedure. Seventy-one (88%) of the patients were reexamined physically after a median duration of follow-up of 107 months by two independent examiners and constituted the study group. Their clinical and radiographic outcomes were documented. RESULTS: At the time of follow-up, twenty-seven (38%) of the seventy-one patients had experienced some kind of shoulder instability, although fifteen of them had had a new, clinically relevant shoulder injury. Eleven patients had had subluxation only, and sixteen had had redislocation. Fourteen of the twenty-seven patients had had a single episode of instability. Seven patients had undergone additional surgery to treat shoulder instability. The instability episodes occurred less than two years postoperatively in nine patients, between two and five years postoperatively in twelve, and more than five years postoperatively in six. At the time of final follow-up, the median external rotation in abduction was 90 degrees (range, 0 degrees to 120 degrees ) compared with 95 degrees (range, 70 degrees to 125 degrees ) for the contralateral, uninjured shoulders (p < 0.001). Before the injury, fifty-two patients (73%) participated in overhead or contact sports, whereas thirty-four patients (45%) participated in such activities at the time of follow-up. At the time of follow-up, the drill holes used to implant the absorbable tacks were invisible or hardly visible in fifty-eight (91%) of sixty-four patients for whom radiographs had been made. A marked increase in degenerative changes was noted when follow-up radiographs were compared with the preoperative radiographs. CONCLUSIONS: This long-term follow-up study of arthroscopic extra-articular Bankart repairs revealed an unexpectedly high number of patients with new episodes of instability. This finding led to a slight modification of the technique. Since most instability episodes occurred after two years, it is important to follow patients for a longer period of time after surgical treatment of recurrent anterior shoulder instability to identify the true recurrence rate.

Osteoarthritic changes after anterior cruciate ligament reconstruction using bone-patellar tendon-bone or hamstring tendon autografts: a retrospective, 7-year radiographic and clinical follow-up study.

PURPOSE: This study was undertaken to evaluate the long-term radiographic appearance and clinical outcome after anterior cruciate ligament (ACL) reconstruction by use of either bone-patellar tendon-bone (BPTB) or hamstring tendon (HT) autografts and to evaluate how associated meniscal injuries affect the prevalence of osteoarthritis (OA). METHODS: ACL reconstruction was performed in 124 consecutive patients. Of these patients, 113 (91%) (72 BPTB and 41 HT) returned for a follow-up examination at a median of 86 months (range, 67 to 111 months) after reconstruction. The patients underwent standard weight-bearing radiographic examinations and clinical evaluation. RESULTS: The radiographic assessments showed no significant differences between the graft types in terms of OA classified according to the Ahlbäck and Fairbank rating systems. Overall, 23% of the patients had degenerative changes according to the Ahlbäck system, and 74% had degenerative changes according to the Fairbank system. Associated meniscal injuries increased the prevalence of OA. Clinically, no significant differences were found between the graft types in terms of the Tegner activity test, 1-leg hop test, International Knee Documentation Committee evaluation system, disturbed area of sensitivity, manual Lachman test, KT-1000 laxity test (MEDmetric, San Diego, CA), and knee-walking test. The Lysholm score (P = .02) and knee-walking ability (P = .02) were significantly better in the HT group. CONCLUSIONS: At a median of 7 years after ACL reconstruction with either BPTB or HT autografts, the prevalence of OA as seen on standard weight-bearing radiographs and the clinical outcome were comparable. The presence of meniscal injuries increased the prevalence of OA. LEVEL OF EVIDENCE: Level III, therapeutic, retrospective comparative study.

A long-term clinical follow-up study after arthroscopic intra-articular Bankart repair using absorbable tacks.

The aim of the study was to perform an independent long-term evaluation after arthroscopic Bankart repair using absorbable tacks. We hypothesise that arthroscopic Bankart repair using absorbable tacks will result in stable shoulders. Eighty-one consecutive patients (84 shoulders) with symptomatic, recurrent, anterior, post-traumatic shoulder instability were included in the study. All the patients had a Bankart lesion. The age of the patients was 28 (15-62) years. The number of dislocations prior to surgery was five (sublux-50). The operation was performed 28 (3-360) months after the index injury by one of three surgeons with a special interest in shoulder surgery using an intra-articular arthroscopic Bankart procedure involving absorbable Suretac fixators. Seventy-six/84 (90%) of the shoulders (50 male, 23 female patients) were re-examined by two independent observers, after a follow-up period of 98 (46-129) months. In the long-term, the failure rate in terms of stability was 8/76 (11%) dislocations and a further 6/76 (8%) had experienced or had clinical signs of subluxation. The Rowe score was 91 (38-98) points at follow-up and the Constant score was 90 (56-100) points. The Constant score for the contralateral shoulder was 93 (69-100) points (P < 0.001). In the long-term, the arthroscopic Bankart procedure using Suretac fixators resulted in stable, well-functioning shoulders in the majority of patients. Eighteen per cent of the patients had experienced signs of instability during the follow-up period in terms of dislocations or subluxations.

Long-term independent evaluation after arthroscopic extra-articular Bankart repair with absorbable tacks. A clinical and radiographic study with a seven to ten-year follow-up.

BACKGROUND: Several arthroscopic methods have been developed to treat posttraumatic recurrent anterior shoulder instability in an attempt to match the results that can be achieved with open repair. The aim of this study was to perform an independent long-term clinical and radiographic evaluation after extra-articular arthroscopic Bankart repair with use of absorbable tacks (Suretac fixators). METHODS: Eighty-one consecutive patients with posttraumatic recurrent anterior shoulder instability underwent an extra-articular arthroscopic Bankart procedure. Seventy-one (88%) of the patients were reexamined physically after a median duration of follow-up of 107 months by two independent examiners and constituted the study group. Their clinical and radiographic outcomes were documented. RESULTS: At the time of follow-up, twenty-seven (38%) of the seventy-one patients had experienced some kind of shoulder instability, although fifteen of them had had a new, clinically relevant shoulder injury. Eleven patients had had subluxation only, and sixteen had had redislocation. Fourteen of the twenty-seven patients had had a single episode of instability. Seven patients had undergone additional surgery to treat shoulder instability. The instability episodes occurred less than two years postoperatively in nine patients, between two and five years postoperatively in twelve, and more than five years postoperatively in six. At the time of final follow-up the median external rotation in abduction was 90 degrees (range, 0 degrees to 120 degrees) compared with 95 degrees (range, 70 degrees to 125 degrees) for the contralateral, uninjured shoulders (p<0.001). Before the injury, fifty-two patients (73%) participated in overhead or contact sports, whereas thirty-four patients (45%) participated in such activities at the time of follow-up. At the time of follow-up, the drill holes used to implant the absorbable tacks were invisible or hardly visible in fifty-eight (91%) of sixty-four patients for whom radiographs had been made. A marked increase in degenerative changes was noted when follow-up radiographs were compared with the preoperative radiographs. CONCLUSIONS: This long-term follow-up study of arthroscopic extra-articular Bankart repairs revealed an unexpectedly high number of patients with new episodes of instability. This finding led to a slight modification of the technique. Since most instability episodes occurred after two years, it is important to follow patients for a longer period of time after surgical treatment of recurrent anterior shoulder instability to identify the true recurrence rate.

Knee-laxity measurements examined by a left-hand- and a right-hand-dominant physiotherapist, in patients with anterior cruciate ligament injuries and healthy controls.

The purpose of the study was to analyse and compare KT-1000 knee laxity as examined by a left-hand- and a right-hand-dominant physiotherapist in a group of patients with an anterior cruciate ligament (ACL) injury and a group of patients, 2 years after ACL reconstruction. The other aim was to measure and analyse knee laxity in a group of persons without any known knee problems. A cross-sectional examination of two groups of patients pre-operatively and post-operatively after ACL reconstruction and examination of healthy controls on two different occasions was performed. Fifty-three patients who were scheduled for ACL reconstruction and 39 patients who attended a 2-year follow-up examination were included in the study. In the ACL-deficient group, 32 patients had a right-sided ACL injury and 21 patients a left-sided ACL injury. The corresponding figures in the post-operative group were 21 patients with a right-sided ACL injury and 18 patients with a left-sided ACL injury. Twenty-eight healthy persons without any known knee problems served as controls. One left-hand- and one right-hand-dominant experienced physiotherapist performed all the examinations. To be able to evaluate the intra and inter-reliability of the examiners the controls were examined at two occasions. The left-hand-dominant physiotherapist measured significantly higher absolute laxity values in the left knee, both injured and non-injured ones, compared with the right-hand-dominant physiotherapist. This was found irrespectively of whether the patients belonged to the ACL deficient or the post-operative group. In the healthy control group, the right-hand-dominant physiotherapist measured significantly higher knee-laxity values in the right knee compared with the left-hand-dominant physiotherapist. Correspondingly, the left-hand-dominant physiotherapist measured significantly higher knee laxity values in the left knee. We conclude that KT-1000 arthrometer laxity measurements can be affected by the hand dominance of the examiner. This might affect the reliability of KT-1000 arthrometer measurements. Level of evidence is II.

Long-term clinical and ultrasound evaluation after arthroscopic acromioplasty in patients with partial rotator cuff tears.

PURPOSE: Clinical and ultrasound evaluation of patients who had undergone debridement of a partial rotator cuff tear in conjunction with an arthroscopic acromioplasty. TYPE OF STUDY: Retrospective follow-up study. METHODS: Thirty-three consecutive patients were included in the study; 26 of the 33 (79%) patients underwent ultrasound evaluation of both shoulders and were examined by independent observers after a follow-up period of 101 months (range, 60 to 128 months; minimum, 5 years). RESULTS: The median time between onset of symptoms and surgery was 24 months (range, 6 to 360 months). At follow-up, the Constant score was 65 points (range, 15-98). The Constant score on the contralateral side was 84 points (range, 15-96; P < .0001). The strength in abduction was 4.7 kg (range, 1.2 to 11.1 kg) on the operated side and 5.1 kg (range, 1.8 to 10.4 kg) on the contralateral side (not significant). Twelve of the 26 patients reported discomfort or pain in the contralateral shoulder and during the follow-up period, and 3 of 26 had undergone an arthroscopic acromioplasty of the contralateral shoulder. Two of 26 patients underwent further surgery of the index shoulder during the follow-up period. The visual analogue score for pain for the index shoulder was 20 mm (range, 0 to 85). The ultrasound evaluation revealed that 9 of 26 patients had a full-thickness rotator cuff tear in the index shoulder and, of these, 3 of 9 were bilateral. CONCLUSIONS: It appears that an arthroscopic acromioplasty and rotator cuff debridement in patients with partial tears does not protect the rotator cuff from undergoing further degeneration. LEVEL OF EVIDENCE: Level IV.

Repair of type-2 SLAP lesions using Corkscrew anchors. A preliminary report of the clinical results.

The aim of the study was to perform a clinical assessment of patients who had undergone arthroscopic repair of a type-2 SLAP lesion using one double-looped Corkscrew anchor. Fifteen consecutive patients who agreed to fill in a pre- and post-operative questionnaire were included in the study. The aetiology was traumatic in 10/15 patients and non-traumatic in 5/15. At the index operation four patients underwent a concomitant acromioplasty, while four patients underwent supplementary anterior labrum fixation using suture anchors. Thirteen/15 (87%) of the patients were physically re-examined by independent observers after a follow-up period of 25 months (11-32). The questionnaire involved a patient-administered assessment of ten common activities of daily living. At follow-up, the Rowe score was 84 points (51-98) and the Constant score was 83 points (35-100). The external rotation in abduction was 85 degrees (60-110) on the operated side and 90 degrees (80-110) on the non-operated side ( p<0.05). The isometric strength in abduction was 8.3 kg (0.8-14.4) on the operated side and 8.9 kg (2.7-15.5) on the non-operated side ( p=0.006). Significant improvements ( p<0.05) compared with the pre-operative assessments were found in 2/10 activities of daily living. Another 4/10 activities seemed to improve but did not reach statistical significance ( p<0.08). Eleven of 15 patients returned to their pre-injury activity level. In conclusion, the majority of patients returned to their pre-injury activity level and the subjective patient-administered evaluations appeared to improve after arthroscopic repair of type-2 SLAP lesions using one double-looped Corkscrew anchor. We feel encouraged to continue using this technique.