Anatomic risk factors for arthroscopic Bankart repair failure: A case-control study comparing failure and non-failure groups in an Asian population.

Introduction: Post-arthroscopic Bankart repair failure/re-dislocation rates are influenced by several risk factors, including anatomic defects. There is limited evidence on the role of anatomic defects, especially for Hill-Sachs size in on-track lesions. This study aimed to assess glenoid bone loss, Hill-Sachs lesion and labral tear size and evaluate their contribution to post-operative instability after a primary repair. Material and methods: Across 169 patients with on-track Bankart lesions who underwent primary arthroscopic Bankart repair from 2010 to 2015, this study matched 14 failure with 14 non-failure cases based on age/gender. Patient demographics, pre-operative radiological parameters (including size of glenoid bone loss and Hill-Sachs lesion) and labral tear size were compared between the failure and non-failure groups. Result: All patients were male with a mean age of 21.01 ± 4.97. Significantly greater glenoid bone loss (p = 0.024) and labral tear size (p = 0.039) were found in the failure group. However, there was no significant difference in mean volume of Hill-Sachs lesion between the two groups (p = 0.739). Conclusion: Extensive glenoid bone loss and labral tears are risk factors for post-arthroscopic Bankart failure. However, the size of Hill-Sachs lesion is not a risk factor for failure, in a specific group of on-track Hill-Sachs lesions. Level of evidence: Retrospective Study, Level IV.

Early cement augmentation may be a good treatment option for pain relief for osteoporotic compression fractures: a systematic review and meta-analysis.

PURPOSE: The incidence of osteoporotic compression fractures (VCFs) have been rising over the past decades. Presently, vertebral cement augmentation procedures such as balloon kyphoplasty and vertebroplasty are common treatments allowing pain relief and functional recovery. However, there is controversy on whether different timeframes for cement augmentation affects clinical outcomes. Hence, this study aimed to compare pain relief and complication rates between early versus late cement augmentation. METHODS: A comprehensive systematic review of PubMed, EMBASE, Scopus and Cochrane Library was conducted, identifying studies that compared early versus late cement augmentation for VCFs. As the definitions of "early" and "late" phases across studies are heterogenous, we established the cut-off between early and late phase as intervals to accommodate as many studies as possible for analysis. We conducted two separate analyses with different cut-off intervals and included studies that reported interventions within these respective time intervals. In analysis 1, we included studies which grouped patients into "early" and "late" group based on a cut-off time frame of 2-4 weeks. On the other hand, in analysis 2, we included studies which grouped patients into "early" and "late" groups based on a cut-off time frame of 6-8 weeks. Meta-analysis was conducted via random-effect models, comparing outcomes of interest between early and late groups. RESULTS: Eleven studies were included. The total cohort size was 712 and 775 patients in analysis 1 and 2 respectively. Mean follow-up was 12.9 ± 3.7 months and 11 ± 0.6 months respectively. VAS change at final follow-up was significantly greater in the early group for both analyses. (MD = - 0.66, p = 0.01; and MD = - 1.18, p < 0.005 respectively). There was no significant difference in post-operative absolute VAS score, number of cement leakage, number of adjacent compression fractures and local kyphotic angle, for both analyses. Patients in both groups experienced reductions in VAS score that exceeded the minimum clinically important difference. CONCLUSION: Both early and late timeframes for cement augmentation offered significant improvement in pain relief, with similar post-operative absolute pain score, kyphotic angle, cement leakage and adjacent vertebral fractures. Early surgery may offer substantial pain relief in patients presenting with pain as early as < 2-4 weeks of VCFs.

Selective bundle versus complete anterior-cruciate ligament reconstruction: A systematic review and meta-analysis.

Purpose: Selective bundle reconstruction (SLB) refers to preservation of the intact bundle and reconstruction of the ruptured bundle in a partial tear while complete ACL reconstruction involves the removal of all remnant tissue and reconstruction of one or both bundles. As the evidence for SLB versus complete ACL reconstruction remains unclear, this study aimed to compare the two techniques. This study's hypothesis was that SLB reconstruction allows better function and stability compared to complete ACL reconstruction. Methods: A systematic search of PubMed, EMBASE, Scopus and Cochrane Library was conducted, identifying studies that compared SLB ('selective' group) versus complete ('complete' group) ACL reconstruction. Meta-analysis was conducted for post-operative functional scores, stability outcomes and complications as well as pre-operative to post-operative change. Results: Eleven studies were included in the meta-analysis, with 1107 patients and a pooled mean follow-up of 29.5 months. Post-operatively, the Selective group had significantly reduced anterior laxity, shown by a lower mean arthrometry side-to-side difference (p<0.01). Analysis of change results showed that the Selective group had a lower mean improvement in arthrometry side-to-side difference as well (p<0.01). No significant difference was shown for all other post-operative outcomes. Conclusion: This study provides valuable insight to the management of partial tears. It has demonstrated that the preservation of the intact bundle offers stability and function that is as good as complete reconstruction and that SLB is a potentially viable option in the management of partial tears. Level of evidence: Meta-analysis; Level of evidence, 4.