| 1. |
- Constantinou, C. C., et al.
(författare)
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Large Drill Holes Are Still Present in the Long Term After Arthroscopic Bankart Repair With Absorbable Tacks: An 18-Year Randomized Prospective Study
- 2020
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Ingår i: American Journal of Sports Medicine. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 48:8, s. 1865-1872
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Tidskriftsartikel (refereegranskat)abstract
- Background: Studies have demonstrated the development of an osseous reaction at the drill sites of anchors after arthroscopic shoulder surgery. Purpose: To investigate the drill-hole size at 18 years after arthroscopic Bankart repair using either fast polygluconate acid (PGA) or slow polylevolactic acid (PLLA) absorbable tacks and to compare the functional outcomes and development of osteoarthritis. Study design: Randomized controlled trial; Level of evidence, 2. Methods: 40 patients with unidirectional anterior shoulder instability, treated with arthroscopic Bankart repair, were randomized into the PGA group (n = 20) or the PLLA group (n = 20). Plain radiographs of both shoulders, as well as computed tomography (CT) images of the operated shoulder, were used to evaluate the drill-hole size, volume, and degenerative changes. Functional outcomes were assessed by use of the Rowe score, Constant score, and Western Ontario Shoulder Instability (WOSI) index. Results: Of the 40 patients, 32 patients returned for the follow-up (15 PGA and 17 PLLA). No significant differences were found in the population characteristics between the study groups. The mean follow-up time was 18 years for both groups. No significant differences were seen in range of motion, strength in abduction, or Constant, Rowe, and WOSI scores between the groups. Recurrence rate was 33% in the PGA group and 6% in the PLLA group during the follow-up period (P = .07). The drill-hole appearance on plain radiographs (invisible/hardly visible/visible/cystic) was 11/2/2/0 and 6/5/5/1 for the PGA and PLLA groups, respectively (P = .036). The mean +/- SD drill-hole volume as estimated on CT images was 89 +/- 94 and 184 +/- 158 mm(3) in the PGA and PLLA groups, respectively (P = .051). Degenerative changes (normal/minor/moderate/severe) on plain radiographs were 7/4/4/0 and 3/8/5/1 for the PGA and PLLA groups, respectively (P = .21), and on CT images were 5/7/3/0 and 2/6/6/3 for the PGA and PLLA groups, respectively (P = .030). Conclusion: This long-term follow-up study demonstrated that the PLLA group had significantly more visible drill holes than the PGA group on plain radiographs. However, this difference was not evident on CT imaging, with both groups having several visible cystic drill holes and a substantial drill-hole volume defect. No significant differences were found between the study groups in terms of clinical outcomes.
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| 2. |
- Kartus, C., et al.
(författare)
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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
- 2007
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Ingår i: J Bone Joint Surg Am. - 0021-9355. ; 89:7, s. 1442-8
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Tidskriftsartikel (refereegranskat)abstract
- 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. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
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| 3. |
- Kartus, Jüri, 1955, et al.
(författare)
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Long-term clinical and ultrasound evaluation after arthroscopic acromioplasty in patients with partial rotator cuff tears
- 2006
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Ingår i: Arthroscopy. - 1526-3231. ; 22:1, s. 44-9
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 4. |
- Kartus, Jüri, 1955, et al.
(författare)
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Repair of type-2 SLAP lesions using Corkscrew anchors. A preliminary report of the clinical results
- 2004
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Ingår i: Knee Surg Sports Traumatol Arthrosc. - 0942-2056. ; 12:3, s. 229-34
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 5. |
- Sernert, Ninni, 1954, et al.
(författare)
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Knee-laxity measurements examined by a left-hand- and a right-hand-dominant physiotherapist, in patients with anterior cruciate ligament injuries and healthy controls
- 2007
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Ingår i: Knee Surg Sports Traumatol Arthrosc. - 0942-2056.
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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