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- 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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| 2. |
- Lofvendahl, S, et al.
(författare)
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Waiting for orthopaedic surgery: factors associated with waiting times and patients' opinion
- 2005
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1464-3677 .- 1353-4505. ; 17:2, s. 133-140
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To assess waiting times for three groups of orthopaedic patients in Sweden and to identify factors explaining variations in waiting time. Also examined were factors associated with patients' perceptions that waiting times were too long. Design. Retrospective study. Setting and study participants. Patients from orthopaedic units at 10 Swedish hospitals participated in the study. A questionnaire was sent to 1336 surgical patients (517 hip replacement, 321 back surgery, and 498 arthroscopic knee surgery) 3 months after surgery. Information extracted from the hospitals' patient administrative systems was also used. Outcome measures. Length of waiting time, socio-economic variables, hospital type, health-related quality of life, and opinion about waiting time. The data were analysed mainly using regression analyses. Results. The overall response rate was 79%. In all pre-operative stages, waiting times were longest in the hip replacement group. Socio-economic variables were not consistent determinants of variation in waiting times except for working status in the back surgery group where. working patients had shorter waiting times than non-working patients irrespective of phase of waiting time. Admission to a county/district county hospital, compared with a university/regional hospital, was associated with shorter time on the waiting fist. Patients with better health-related quality of life had significantly longer waiting times for arthroscopic knee surgery by all waiting time measures. The length of wait was a significant predictor of the patients' acceptance of waiting time. Patients' influence over the date of surgery also appeared to affect their opinion about the waiting time. Conclusions. Hospital-related factors are more important than patient characteristics as explanations of variations in waiting times for orthopaedic surgery. Patients value short waiting times and the possibility of influencing the date of surgery.
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