No Clear Difference in Clinical Outcomes Between Knotted and Knotless Arthroscopic Bankart Repair: A Systematic Review.

PURPOSE: The objective of the current study was to analyze if the arthroscopic Bankart repair using a knotless suture anchor has a better functional outcome than the conventional knot-tying Bankart repair. METHODS: Comprehensive literature search was done in Pubmed, Scopus, Embase, and Cochrane databases in May 2023. Studies comparing the clinical outcome of Bankart repair using knotless and knot-tying techniques were included in the study. In vitro, animal, and level 4 and 5 studies were excluded. The risk of bias of randomized controlled trials (RCT) was calculated according to the RoB 2 tool, and for non-randomized studies, MINORS criteria were used. Statistical analysis was done using RevMan software. RESULTS: A total of nine studies, including two RCT and seven non-randomized comparative studies involving 720 patients, were included in the systematic review. The ROWE score ranged 81.7 to 94.3 in the knot-tying and 86 to 96.3 in the knotless group. VAS scores at final follow-up ranged between 0.1 to 1.7 in the knot-tying and 0.7 to 2.5 in the knotless group. The rate of redislocation, subluxation, and revision surgery in the knot-tying group ranged from 0 to 14.7%, 16.7 to 29.7%, and 1.6 to 17.6%, respectively, while that in the knotless group ranged from 2.4 to 23.8%, 7.4 to 22.2%, and 2.4 to 19%, respectively. The mean external rotation was 54 to 65 degrees in the knot-tying and 61 to 99 in the knotless group. The mean forward-flexion was 164 to 172 in the knot-tying and 165 to 174 in the knotless group. Our subjective synthesis doesn't reveal any difference in the outcome between the two groups. CONCLUSION: The available literature does not demonstrate a clear difference in functional outcomes, residual pain, and rate of complications like redislocation, subluxation and revision surgery between Bankart repair performed with knotted and knotless anchors.

Association of Various Spinopelvic Parameters and the Quality of Life in Those With Degenerative Lumbar Scoliosis in the Indian Population.

Purpose The current study aimed to find any association between various spinopelvic parameters and the quality of life in patients with degenerative lumbar scoliosis (DLS) measured as per the Oswestry disability index (ODI) and visual analog scale (VAS) in the Indian population. Methods We included 20 DLS patients of more than 40 years with a Cobb angle of more than 10° and without any trauma, tumour, infection, or congenital scoliosis presented in our tertiary care centre in the study. The VAS and ODI were calculated for each patient. Radiological parameters were recorded for every patient, including sagittal balance, coronal balance, Cobb angle, pelvic incidence, pelvic tilt, and lumbar lordotic angle. We evaluated the results and sought any association between clinical and radiological variables for DLS. Results Patients with positive sagittal balance had significantly higher disability than those with neutral sagittal balance (p-value 0.007). Furthermore, patients with coronal imbalance had more severe pain (p-value 0.013) and disability (p-value 0.038) than those with neutral coronal balance. We also found that the ODI and VAS were not associated with any other spinopelvic parameters. Conclusion From the present study, we can conclude that in the Indian population, both positive sagittal and coronal imbalances are associated with poor functional status in patients with DLS. Therefore, while planning surgical correction for these patients, both coronal and sagittal balance are important and need to be considered.

Management of Neglected Locked Anterior Dislocation of Shoulder: A Report of Two Cases.

There is a paucity of literature regarding a neglected shoulder dislocation, as it is unusual to miss it clinically due to the apparent deformity. Nevertheless, in some cases, particularly those who received the primary treatment from a local bonesetter, present with neglected dislocation. No high-level studies comparing different treatment modalities in such a situation are available. Therefore, most of the treatment recommendations are based on level four studies and the literature for recurrent dislocation of the shoulder. We herewith describe two cases of neglected anterior dislocation of the shoulder, which we have managed by open reduction and Latarjet procedure in one and Bankart surgery in the other patient. Both of our patients after one-year follow-up had a painless joint with improved yet limited range of motion. This case discussion helps in learning the approach towards the treatment of these patients. It also suggests a sub-optimal functional outcome in them.

Anteromedial Portal Reference Technique for Femoral Tunnel Depth Measurement During Arthroscopic Anterior Cruciate Ligament Reconstruction.

Femoral tunnel preparation during the anterior cruciate ligament reconstruction is a technically demanding step. The anteromedial (AM) portal technique necessitates knee hyperflexion during the femoral tunnel reaming. In a hyperflexed knee, the arthroscopic visualization of the laser markings on the femoral tunnel reamer becomes obscured. Thus, the calculation of the depth of the femoral tunnel becomes difficult. Our technique helps in femoral tunneling reliably without the need for arthroscopic visualization using the AM portal as a reference point to calculate the depth while drilling. This technique can be performed without the need for a second assistant to hold the arthroscope. Furthermore, this technique does not require any specific instruments, and there is no obligation for an additional incision.