Publications by authors named "Hannan Mullett"

71 Publications

Arthroscopic Bankart Repair Versus Open Latarjet for Recurrent Shoulder Instability in Athletes.

Orthop J Sports Med 2021 Sep 8;9(9):23259671211023801. Epub 2021 Sep 8.

Sports Surgery Clinic, Dublin, Ireland.

Background: In athletes with recurrent shoulder instability, arthroscopic Bankart repair (ABR) and the open Latarjet procedure (OL) are commonly indicated to restore stability and allow them to return to play (RTP).

Purpose: To compare the outcomes of ABR and OL in athletes with recurrent shoulder instability.

Study Design: Cohort study; Level of evidence, 3.

Methods: We performed a retrospective review of patients with recurrent shoulder instability who underwent ABR and OL and had a minimum 24-month follow-up. Indications for OL over ABR in this population were those considered at high risk for recurrence, including patients with glenohumeral bone loss. The patients were pair-matched in a 1:1 ratio (OL and ABR) by age, sex, sport, and level of preoperative play. We evaluated the rate, level, and timing of RTP, and the Shoulder Instability-Return to Sport after Injury (SIRSI) score between procedures. Additionally we compared the recurrence rate, visual analog scale (VAS) pain score, Subjective Shoulder Value (SSV), Rowe score, satisfaction, and whether patients would undergo the same surgery again.

Results: Participants included 62 athletes who underwent ABR and 62 who underwent OL, with a mean follow-up of 47.7 months. There was no significant difference between ABR and OL in rate of RTP, return to preinjury level, time to return, SIRSI score, VAS score, SSV, or patient satisfaction. OL resulted in a significantly lower recurrence rate (1.6% vs 16.1% for ABR; = .009) and a significantly higher Rowe score (mean ± SD, 90.5 ± 12.2 vs 82.2 ± 20.8 for ABR; = .008). In collision athletes, there was no significant difference between ABR and OL regarding RTP rate (89.1% vs 94.5%; = .489) or SIRSI score (70.4 ± 24.8 vs 73.8 ± 19.6; = .426), but OL resulted in a lower recurrence rate (14.5% vs 1.8%; = .031).

Conclusion: ABR and OL resulted in excellent clinical outcomes, with high rates of RTP in athletes. However, lower recurrence rates were seen with OL.
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http://dx.doi.org/10.1177/23259671211023801DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8436306PMC
September 2021

Arthroscopic Bankart Repair Versus Open Latarjet for First-Time Dislocators in Athletes.

Orthop J Sports Med 2021 Aug 31;9(8):23259671211023803. Epub 2021 Aug 31.

Sports Surgery Clinic, Dublin, Ireland.

Background: In athletes with a first-time shoulder dislocation, arthroscopic Bankart repair (ABR) and the open Latarjet procedure (OL) are the most commonly utilized surgical procedures to restore stability and allow them to return to play (RTP).

Purpose: To compare the outcomes of ABR and OL in athletes with a first-time shoulder dislocation.

Study Design: Cohort study; Level of evidence, 3.

Methods: We performed a retrospective review of patients with first-time shoulder dislocation who underwent primary ABR and OL and had a minimum 24-month follow-up. Indications for OL over ABR in this population were those considered at high risk for recurrence, including patients with glenohumeral bone loss. Patients who underwent ABR were pair-matched in a 2:1 ratio with patients who underwent OL by age, sex, sport, and level of preoperative play. The rate, level, and timing of RTP, as well as the Shoulder Instability-Return to Sport after Injury (SIRSI) score were evaluated. Additionally, we compared recurrence, visual analog scale pain score, Subjective Shoulder Value, Rowe score, satisfaction, and whether patients would undergo the surgery again.

Results: Overall, 80 athletes who underwent ABR and 40 who underwent OL were included, with a mean follow-up of 50.3 months. There was no significant difference between ABR and OL in rate of RTP, return to preinjury level, time to return, or recurrent dislocation rate. There were also no differences between ABR and OL in patient-reported outcome scores or patient satisfaction. When collision athletes were compared between ABR and OL, there were no differences in RTP, SIRSI score, or redislocation rate.

Conclusion: ABR and OL resulted in excellent clinical outcomes, with high rates of RTP and low recurrence rates. Additionally, there were no differences between the procedures in athletes participating in collision sports.
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http://dx.doi.org/10.1177/23259671211023803DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414621PMC
August 2021

Analysis of patients unable to return to play following arthroscopic Bankart repair.

Surgeon 2021 Aug 5. Epub 2021 Aug 5.

Sports Surgery Clinic, Dublin, Ireland.

Purpose: The purpose of this study was to analyze patients that did not return to play (RTP) following arthroscopic Bankart repair (ABR) compared to those who did RTP, and analyze factors associated with not returning to play.

Methods: A retrospective review of patients who underwent ABR, and subsequently did not RTP after a minimum of 24-month follow-up was performed. Additionally, these were pair matched in a 3:1 ratio for age, gender, sport and level of pre-operative play with a control group who RTP. Patients were evaluated for their psychological readiness to return to sport using the SIRSI score. Multivariate regression models were used to evaluate factors affecting RTP.

Results: The study included a total of 52 patients who were unable to RTP and 156 who returned to play. Ten patients (19.2 %) who did not RTP passed the SIRSI benchmark of 56 with a mean overall score of 39.8 ± 24.6, in those who returned 73.0 % passed the SIRSI benchmark of 56 with a mean overall score of 68.9 ± 22.0 (p < 0.0001 for both). The most common primary reasons for not returning were 27 felt physically unable to return, whilst 21 felt it was a natural end to their career or their lifestyle had changed. Multi-logistic regression revealed that 4 of the 12 components of the SIRSI score (p < 0.05 for all) and SSV (p = 0.0049), were the factors that were associated with RTP.

Conclusion: Following ABR, those that do not return to play exhibit poor psychological readiness to return to play, with multi-linear regression revealing the SIRSI questions associated with fear of re-injury were associated with a lower rate of RTP. Additionally, functional limitations were found to be associated with a lower rate of RTP.

Level Of Evidence: Level III; Retrospective Comparative Cohort Study.
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http://dx.doi.org/10.1016/j.surge.2021.06.005DOI Listing
August 2021

Anterior Shoulder Instability Part I-Diagnosis, Nonoperative Management, and Bankart Repair-An International Consensus Statement.

Arthroscopy 2021 Jul 29. Epub 2021 Jul 29.

Sports Surgery Clinic, Dublin, Ireland.

Purpose: The purpose of this study was to establish consensus statements via a modified Delphi process on the diagnosis, nonoperative management, and Bankart repair for anterior shoulder instability.

Methods: A consensus process on the treatment using a modified Delphi technique was conducted, with 65 shoulder surgeons from 14 countries across 5 continents participating. Experts were assigned to one of 9 working groups defined by specific subtopics of interest within anterior shoulder instability.

Results: The independent factors identified in the 2 statements that reached unanimous agreement in diagnosis and nonoperative management were age, gender, mechanism of injury, number of instability events, whether reduction was required, occupation, sport/position/level played, collision sport, glenoid or humeral bone-loss, and hyperlaxity. Of the 3 total statements reaching unanimous agreement in Bankart repair, additional factors included overhead sport participation, prior shoulder surgery, patient expectations, and ability to comply with postoperative rehabilitation. Additionally, there was unanimous agreement that complications are rare following Bankart repair and that recurrence rates can be diminished by a well-defined rehabilitation protocol, inferior anchor placement (5-8 mm apart), multiple small-anchor fixation points, treatment of concomitant pathologies, careful capsulolabral debridement/reattachment, and appropriate indications/assessment of risk factors.

Conclusion: Overall, 84% of statements reached unanimous or strong consensus. The statements that reached unanimous consensus were the aspects of patient history that should be evaluated in those with acute instability, the prognostic factors for nonoperative management, and Bankart repair. Furthermore, there was unanimous consensus on the steps to minimize complications for Bankart repair, and the placement of anchors 5-8 mm apart. Finally, there was no consensus on the optimal position for shoulder immobilization.

Level Of Evidence: Level V, expert opinion.
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http://dx.doi.org/10.1016/j.arthro.2021.07.022DOI Listing
July 2021

Anterior Shoulder Instability Part II-Latarjet, Remplissage, and Glenoid Bone-Grafting-An International Consensus Statement.

Arthroscopy 2021 Jul 29. Epub 2021 Jul 29.

Sports Surgery Clinic, Northwood Avenue, Santry Demesne, Dublin 9, D09 C523, Dublin, Ireland.

Purpose: The purpose of this study was to establish consensus statements via a modified Delphi process on the Latarjet procedure, remplissage, and glenoid-bone grafting for anterior shoulder instability.

Methods: A consensus process on the treatment utilizing a modified Delphi technique was conducted, with 65 shoulder surgeons from 14 countries across 5 continents participating. Experts were assigned to one of 9 working groups defined by specific subtopics of interest within anterior shoulder instability.

Results: The technical approaches identified in the statements on the Latarjet procedure and glenoid bone-graft were that a subscapularis split approach should be utilized, and that it is unclear whether a capsular repair is routinely required. Furthermore, despite similar indications, glenoid bone-grafting may be preferred over the Latarjet in patients with bone-loss greater than can be treated with a coracoid graft, and in cases of surgeon preference, failed prior Latarjet or glenoid bone-grafting procedure, and epilepsy. In contrast, the primary indications for a remplissage procedure was either an off-track or engaging Hill-Sachs lesion without severe glenoid bone loss. Additionally, in contrast to the bone-block procedure, complications following remplissage are rare, and loss of shoulder external rotation can be minimized by performing the tenodesis via the safe-zone and not over medializing the fixation.

Conclusion: Overall, 89% of statements reached unanimous or strong consensus. The statements that reached unanimous consensus were the prognostic factors that are important to consider in those undergoing a glenoid bone-grafting procedure including age, activity level, Hill-Sachs Lesion, extent of glenoid bone-loss, hyperlaxity, prior surgeries, and arthritic changes. Furthermore, there was unanimous agreement that it is unclear whether a capsular repair is routinely required with a glenoid bone graft, but it may be beneficial in some cases. There was no unanimous agreement on any aspect related to the Latarjet procedure or Remplissage.

Level Of Evidence: Level V: expert opinion.
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http://dx.doi.org/10.1016/j.arthro.2021.07.023DOI Listing
July 2021

Anterior Shoulder Instability Part III-Revision Surgery, Rehabilitation and Return to Play, and Clinical Follow-Up-An International Consensus Statement.

Arthroscopy 2021 Jul 29. Epub 2021 Jul 29.

Sports Surgery Clinic, Dublin, Ireland.

Purpose: The purpose of this study was to establish consensus statements via a modified Delphi process on revision surgery, rehabilitation and return to play, and clinical follow-up for anterior shoulder instability.

Methods: A consensus process on the treatment using a modified Delphi technique was conducted, with 65 shoulder surgeons from 14 countries across 5 continents participating. Experts were assigned to one of 9 working groups defined by specific subtopics of interest within anterior shoulder instability.

Results: The primary relative indications for revision surgery include symptomatic apprehension or recurrent instability, additional intra-articular pathologies, and symptomatic hardware failure. In revision cases, the differentiating factors that dictate treatment are the degree of glenohumeral bone loss and rotator cuff function/integrity. The minimum amount of time before allowing athletes to return to play is unknown, but other factors should be considered, including restoration of strength, range of motion and proprioception, and resolved pain and apprehension, as these are prognostic factors of reinjury. Additionally, psychological factors should be considered in the rehabilitation process. Patients should be clinically followed up for a minimum of 12 months or until a return to full, premorbid function/activities. Finally, the following factors should be included in anterior shoulder instability-specific, patient-reported outcome measures: function/limitations impact on activities of daily living, return to sport/activity, instability symptoms, confidence in shoulder, and satisfaction.

Conclusion: Overall, 92% of statements reached unanimous or strong consensus. The statements that reached unanimous consensus were indications and factors affecting decisions for revision surgery, as well as how prior surgeries impact procedure choice. Furthermore, there was unanimous consensus on the role of psychological factors in the return to play, considerations for allowing return to play, as well as prognostic factors. Finally, there was a lack of unanimous consensus on recommended timing and methods for clinical follow-up.

Level Of Evidence: Level V, expert opinion.
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http://dx.doi.org/10.1016/j.arthro.2021.07.019DOI Listing
July 2021

Excellent Clinical Outcomes and Rates of Return to Play After Arthroscopic Rotator Cuff Repair for Traumatic Tears in Athletes Aged 30 Years or Less.

Arthrosc Sports Med Rehabil 2021 Jun 22;3(3):e667-e672. Epub 2021 Mar 22.

Sports Surgery Clinic, Dublin, Ireland.

Purpose: To evaluate clinical outcomes and rate of return to play (RTP) among athletes aged 30 years or younger who have undergone an arthroscopic rotator cuff repair (ARCR) after trauma.

Methods: We performed a retrospective review of patients who underwent an ARCR with a minimum of 12 months' follow-up between 2012 and 2019. Patients were followed up to assess the American Shoulder and Elbow Surgeons score, Subjective Shoulder Value, visual analog scale score, and satisfaction level. Whether patients were able to RTP was reported, in addition to the timing of return and the level to which they returned.

Results: Our study included 20 athletes (20 shoulders), with a mean follow-up period of 31.8 months. All patients were satisfied with their surgical procedure, and all would opt to undergo surgery again. Overall, 85% returned to sport and 50.0% returned to the same level or a higher level. The overall mean American Shoulder and Elbow Surgeons score was 92.4; mean Subjective Shoulder Value, 87.0; and mean visual analog scale score, 0.7. At final follow-up, only 1 patient (5.0%) had undergone a revision procedure. Of the 15 patients who played collision sports, 93.3% returned to sport but only 60.0% returned to the same level or a higher level.

Conclusions: After ARCR, athletes aged 30 years or younger show excellent functional outcomes with high rates of patient satisfaction and RTP after the procedure.

Level Of Evidence: Level IV, therapeutic case series.
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http://dx.doi.org/10.1016/j.asmr.2021.01.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220565PMC
June 2021

A physiotherapy triage service for orthopaedic upper limb service: an effective way to reduce clinic visits and identify patients for operative intervention.

Ir J Med Sci 2021 May 27. Epub 2021 May 27.

National, Orthopaedic Hospital, Cappagh, Finglas, Dublin, Ireland.

Introduction: Waiting times for orthopaedic outpatient clinics are steadily increasing over the past number of years worldwide. Physiotherapy triage clinics are being utilised to improve access for patients with non-urgent or routine musculoskeletal disorders, to be seen in a timely manner in specialised out-patient clinics. Using these clinics, the aim is to ultimately stratify patients into appropriate management pathways. The aim of our study is to review the effectiveness of a physiotherapy triage clinic run by advanced practitioner physiotherapists (APP), who specialise in the review of upper limb referrals from primary care physicians.

Methods: For this study, a prospective, observational design was used. Patients were referred to the Department of Orthopaedic Surgery, Upper Limb Service at a national elective Orthopaedic Unit. The patients' referrals were reviewed and allocated to a physiotherapy triage pathway if deemed routine, non-urgent cases. After assessment in the APP clinic, the physiotherapist made recommendations and highlighted patients who required review or case discussion with an orthopaedic surgeon. The discharge rate and outcome of patients referred on for further interventions or operative procedures was followed over a 3-year period. The outcomes for the patients were reviewed, including whether patients who met an orthopaedic surgeon went on to have surgical intervention.

Results: During the study, 646 patients were reviewed in an upper limb APP physiotherapy triage clinic. Of those reviewed, only 201 patients required review by an orthopaedic surgeon. Of those, 56 patients were scheduled for an operative procedure. Within the 3-year period, 50 patients of those scheduled underwent the procedure. The most commonly performed procedure being an arthroscopic subacromial decompression with or without acromioplasty or rotator cuff repair. A total of 145 patients referred by the physiotherapist had a shoulder injection including subacromial and glenohumeral intra-articular injection. The initial discharge rate was 68%.

Conclusions: There is a high initial discharge rate after initial assessment by APP triage clinics for upper limb musculoskeletal pathology. This is beneficial in alleviating waiting list pressures allowing only those patients in need of intervention to be placed on the ever expanding waiting lists to see orthopaedic surgeons. This study shows a high proportion of patients being offered surgical intervention after being referred by the APP. We conclude from this that the agreement between the physiotherapist's initial diagnosis and that of the consultant surgeon being similar in identifying patients who would benefit from operative intervention.
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http://dx.doi.org/10.1007/s11845-021-02606-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8154104PMC
May 2021

Magnetic Resonance Arthrography in Rugby Players Undergoing Shoulder Stabilization for Glenohumeral Instability: Professionals Have Higher Frequencies of More Pathologies.

Arthrosc Sports Med Rehabil 2021 Apr 23;3(2):e543-e547. Epub 2021 Feb 23.

Sports Surgery Clinic, Dublin, Ireland.

Purpose: To quantify the magnetic resonance arthrography (MRA) findings in rugby players during preoperative workup for anterior surgical stabilization for glenohumeral instability.

Methods: All patients who underwent glenohumeral instability surgery in our institution between 2008 and 2018 were considered for inclusion. Rugby players were identified using the patient's medical notes, with subsequent identification of all professional players. All rugby player's preoperative MRA findings were recorded and analyzed.

Results: Overall, 267 rugby players were included, 261 of whom were male (97.8%), with a mean age of 22.7 years (range 13-55 years). There were 58 professional rugby players (21.7%). The mean number of pathologies in nonprofessional rugby players was 5.0 pathologies versus 6.2 pathologies in the professional rugby players, with a significant difference in nonprofessional rugby players with up to 3 pathologies versus professional rugby players (26.3% vs 10.3%,  = .01). Professional rugby players had a statistically significant increased incidence of bicipital tendon lesions (25.9% vs 13.9%,  = .009), acromioclavicular joint degeneration (60.3% vs 42.1%,  = .016), glenohumeral bone loss (87.9% vs 69.9%,  = .006), and degenerative changes (67.2% vs 44.0%,  = .002) on their MRAs.

Conclusions: Rugby players undergoing surgical stabilization for glenohumeral instability often have a significant number of pathologies identified on MRA at the time of surgery. Professional rugby players showed concerningly greater frequencies of early degenerative changes when compared with nonprofessional rugby players.

Level Of Evidence: III; Retrospective Cohort Study.
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http://dx.doi.org/10.1016/j.asmr.2020.12.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129450PMC
April 2021

Ulnar collateral ligament reconstruction of the elbow at minimum 48-month mean follow-up demonstrates excellent clinical outcomes with low complication and revision rates: systematic review.

J ISAKOS 2021 09 17;6(5):290-294. Epub 2021 May 17.

Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland.

Importance: Tears of the ulnar collateral ligament (UCL) of the elbow occur predominantly as an overuse injury, most commonly affecting throwing athletes, particularly baseball players. UCL reconstruction (UCLR) has been described as an effective treatment modality in the short term.

Objective: The purpose of this study was to systematically review the evidence in the literature to ascertain the clinical outcomes, complication and revision rates in baseball players following UCLR of the elbow at a minimum of 48 months of follow-up.

Evidence Review: Two independent reviewers performed a search of the literature based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the EMBASE, PubMed and Scopus databases. Clinical studies were included if they reported outcomes of baseball players at a minimum of 48 months following UCLR.

Findings: Our review included 8 studies including 1104 baseball players (1105 elbows) at mean 69.9 months (48-205) following UCLR. The majority of baseball players were pitchers (92.3%), with a mean age of 22.2 years (13-42). At final follow-up, the overall return to play (RTP) was 95.3%%, with 85.3% returning at pre-injury level. In addition, the mean reported Conway-Jobe score was 86.8%, the revision rate was 6.0% with postoperative neuropathy reported in 2.4% of patients. A total of 479 (43.4%) were professional baseball players, with an overall RTP rate of 97.5% and 82.3% managing to RTP at their pre-injury level. The mean number of career years following UCLR was 4.7 years (0-22).

Conclusion And Relevance: UCLR provides excellent patient-reported and clinical outcomes to patients at medium-term follow-up with low complication and revision rates. In addition, high rates of RTP at pre-injury level and career longevity were reported by baseball players following UCLR.

Level Of Evidence: Level IV; Systematic Review.
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http://dx.doi.org/10.1136/jisakos-2021-000614DOI Listing
September 2021

Open Latarjet Procedure in Athletes Following Failed Prior Instability Surgery Results in Lower Rates of Return to Play.

Arthroscopy 2021 08 16;37(8):2412-2417. Epub 2021 Apr 16.

Sports Surgery Clinic, Dublin, Ireland.

Purpose: The purpose of this study was to compare the outcomes of open Latarjet (OL) in competitive athletes with primary shoulder instability versus those with recurrent instability versus those undergoing OL for failed prior instability surgery.

Methods: A retrospective review of patients who underwent OL with a minimum of 24-month follow-up was performed. Additionally, these were pair-matched in a 1:2:1 ratio for age, gender, sport, level of preoperative play, and follow-up length for primary instability, recurrent instability and failed prior instability surgery. Return to sport, the level of return and the timing of return were assessed. Additionally, recurrence, Visual Analogue Scale for pain (VAS), Subjective Shoulder Value (SSV), Rowe score, Shoulder Instability-Return to Sport after Injury (SIRSI) score, satisfaction, and whether they would undergo the same surgery again were compared.

Results: After pair-matching, a total of 200 patients were included, with a mean age of 22.7 years and a mean follow-up of 38.8 months. Overall, there was no significant difference in any of the clinical outcome scores (VAS, Rowe, SIRSI, SSV) used for the 3 groups (P > 0.05 for all). However, there was a significantly lower rate of return to play for those undergoing OL because of failed prior instability surgery (88% vs 91% vs 64%, P < 0.0001) and for return at the same or a higher level (66% vs 78% vs 56%, P = 0.02). There was no significant difference in the rate of recurrent instability among the 3 groups (6% vs 5% vs 6%, P = 0.95).

Conclusion: OL results in excellent clinical outcomes and low recurrence rates for those with primary shoulder instability, those with recurrent instability and those undergoing OL for failed prior instability surgery. However, in those undergoing OL for failed prior stabilization surgery, there was a lower rate of return to play.

Level Of Evidence: Level III: Retrospective Comparative Study.
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http://dx.doi.org/10.1016/j.arthro.2021.03.062DOI Listing
August 2021

Long-term outcomes of radial head arthroplasty for radial head fractures-a systematic review at minimum 8-year follow-up.

J Shoulder Elbow Surg 2021 Oct 1;30(10):2438-2444. Epub 2021 Apr 1.

Department of Orthopaedic Surgery, Sports Surgery Clinic, Dublin, Ireland.

Background: The purpose of this study was to systematically review the literature to evaluate the functional outcomes, radiologic outcomes, and revision rates following radial head arthroplasty (RHA) at a minimum of 8 years follow-up.

Methods: Two independent reviewers performed a literature search using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines using PubMed, Embase, and Web of Science databases. Only studies reporting on outcomes of RHA with a minimum of mean 8 years' follow-up were considered for inclusion.

Results: Our search found 10 studies including 432 elbows (51% males), with average age of 50 years (15-93) and mean follow-up of 117 months (98-145) met our inclusion criteria. At final follow-up, the mean Mayo Elbow Performance Score and Quick Disabilities of the Arm, Shoulder, and Hand questionnaire score were 83 (45-100) and 17 (0-63) respectively, and 86% of patients reported having no or minimal pain. The overall dislocation, subluxation, ulnar neuritis, and infection rates were 2%, 4%, 3%, and 3%, respectively. The rates of radiologic loosening, radiolucency, degenerative change, and heterotopic ossification were 9%, 46%, 27%, and 38%, respectively. The overall surgical revision rates were 20%, with 3%, 15%, and 5% requiring RHA implant revision, removal of metal or implants, and arthrolysis, respectively.

Conclusion: Our systematic review established that RHA results in satisfactory clinical outcomes and modest complication and revision rates at long-term follow-up, despite high levels of radiologic degenerative changes over the same period.
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http://dx.doi.org/10.1016/j.jse.2021.03.142DOI Listing
October 2021

Internship commencement during COVID-19: the impact of an extended induction model.

Ir J Med Sci 2021 Feb 8. Epub 2021 Feb 8.

Beaumont University Hospital, Dublin, Ireland.

Background: The COVID-19 pandemic necessitated an enforced 8-week induction period (18 May to 12 July 2020) for all new interns in Ireland. These unprecedented circumstances presented a unique opportunity to assess this induction period.

Aim: To assess the impact of a prolonged induction period on the technical abilities of interns embarking on their clinical careers.

Method: We distributed a 12-item questionnaire to new interns at our institution during the COVID-19 pandemic. Section 1 of the questionnaire was designed to assess the rate of self-reported improvement in the successful and independent execution of practical 'intern' tasks. Section 2 of the questionnaire captured the subjective experience of interns during this time in relation to the effectiveness of an 8-week induction period with senior intern support available. Statistical analysis of categorical predictor and ordinal outcome variables was performed using the two-sample Wilcoxon rank-sum (Mann-Whitney) test.

Results: Our results demonstrated a statistically significant improvement in the proficiency at first attempt phlebotomy in week 8 compared with week 1 (p < 0.0001). There was a significant improvement in placing first-attempt peripheral IV lines in week 8 compared with week 1 (p < 0.001). Regarding the need for senior assistance, we demonstrated a statistically significant reduction in week 8 compared with week 1 (p = 0.046). There were 95.56% (n = 43) of interns that said they would recommend the induction period for future incoming interns.

Conclusion: The COVID-19 pandemic has inadvertently identified a model of internship induction that benefits interns, their colleagues and their patients through the production of more technically capable interns.
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http://dx.doi.org/10.1007/s11845-021-02543-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870124PMC
February 2021

Long-term outcomes of total elbow arthroplasty: a systematic review of studies at 10-year follow-up.

J Shoulder Elbow Surg 2021 Jun 5;30(6):1423-1430. Epub 2021 Jan 5.

Sports Surgery Clinic, Dublin, Ireland.

Background: The purpose of this study was to systematically review the literature to evaluate the functional outcomes, dislocation, and revision rates following total elbow arthroplasty (TEA) at a minimum 10 years' mean follow-up.

Materials And Methods: Two independent reviewers performed a literature search using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using PubMed, Embase, and Cochrane Library databases. Studies were only included if they focused on outcomes post-TEA at a minimum 10 years' mean follow-up.

Results: Our search found 23 studies including 1429 elbows (60.4% linked TEA) that met our inclusion criteria. There were 1276 patients (79.0% female), with an average age of 64.7 years (19-93) and a mean follow-up of 137.2 months (120-216). At final follow-up, the mean Mayo Elbow Performance Score, Oxford Elbow Score, and Quick Disabilities of the Arm, Shoulder, and Hand scores were 89.1 (35-100), 64.4 (16-48), and 39.2 (3-93), respectively, and 63.3% of patients reported having no pain. The rates of aseptic loosening, infection, implant dislocation, and nerve injury were 12.9%, 3.3%, 4.2%, and 2.1%, respectively. The overall complication and revision rates were 16.3% and 14.6%, respectively.

Discussion And Conclusion: Our systematic review established that TEA offers patients satisfactory clinical outcomes at long-term follow-up, with relatively stable revision and complication rates compared to short and medium term.
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http://dx.doi.org/10.1016/j.jse.2020.11.014DOI Listing
June 2021

Type V superior labral anterior-posterior tears results in lower rates of return to play.

Knee Surg Sports Traumatol Arthrosc 2021 Jul 1;29(7):2364-2369. Epub 2021 Jan 1.

Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, IE, Ireland.

Purpose: The purpose of this study was to evaluate the rate of return to play (RTP) in patients who underwent Type V superior labrum anterior-posterior (SLAP) repair compared to patients who underwent isolated Bankart repair in the setting of traumatic anterior shoulder instability.

Methods: A retrospective review of patients who underwent arthroscopic Bankart repair and SLAP repair by a single surgeon between 2012 and 2017 was performed. Additionally, these were pair-matched in a 1:2 ratio for age, sex, sport and level of pre-operative play, with those undergoing isolated arthroscopic Bankart repair alone as a control group. RTP, level of RTP and the timing of RTP were assessed.

Results: The study included a total of 96 patients, with 32 in the study group and 64 in the control group, and a mean follow-up of 59 months. Overall, there was no significant difference in the overall rate of return to play (26/32 (81.3%) vs 56/64 (87.5%), n.s), but there was a significantly higher rate of RTP at the same/higher level in the control group (14/32 (43.6%) vs 43/64 (67.2%), p = 0.0463). There was no significant difference in timing of RTP between the groups (n.s). There was no significant difference in recurrent instability (6/32 (18.8%) vs 5/64 (7.8%), n.s) but there was a significant difference in revision rates (5/32 (15.6%) vs. 2/64 (3.1%), p = 0.0392) between the Type V SLAP repair group and the control group.

Conclusion: Following arthroscopic repair, patients with Type V SLAP tears had a similar overall rate of RTP when compared directly to a control group of patients who underwent arthroscopic Bankart repair alone. However, those who underwent Type V SLAP repair reported significantly lower rates of RTP at the same or higher level compared to the control group.

Level Of Evidence: III.
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http://dx.doi.org/10.1007/s00167-020-06388-5DOI Listing
July 2021

Return to Play after Arthroscopic Bankart Repair Combined with Open Subpectoral Biceps Tenodesis.

Arthrosc Sports Med Rehabil 2020 Oct 24;2(5):e499-e503. Epub 2020 Oct 24.

Sports Surgery Clinic, Dublin, Ireland.

Purpose: To evaluate the clinical outcomes and rate of return to play (RTP) in patients who underwent arthroscopic Bankart repair and open subpectoral biceps tenodesis.

Methods: A retrospective review of patients who underwent combined arthroscopic Bankart repair and open subpectoral biceps tenodesis by a single surgeon between 2012 and 2016 was performed. RTP, the level of return, and the timing of return were assessed. Visual analog scale for pain, Rowe score, Shoulder Instability-Return to Sport after Injury score, and Subjective Shoulder Value were evaluated.

Results: The study included 14 patients, with a mean follow-up of 34.2 ± 12.1 months. Of the 14 patients, 13 (92.9%) returned to sport at a mean of 4.8 ± 1.2 months and 9 (64.3%) returned to the same or higher level of sport. At final follow-up, the mean Rowe was 80.0 ± 16.3, the mean Subjective Shoulder Value was 81.0 ± 15.1, the mean Shoulder Instability-Return to Sport after Injury was 57.3 ± 25.6, and the mean visual analog scale score was 2.6 ± 1.5. One patient had a recurrent dislocation, whereas no patients underwent a further operation on the ipsilateral shoulder.

Conclusion: Patients undergoing arthroscopic Bankart repair combined with open subpectoral biceps tenodesis had a high rate of RTP with a low rate of recurrent instability.

Level Of Evidence: IV, Therapeutic Case Series.
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http://dx.doi.org/10.1016/j.asmr.2020.05.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588640PMC
October 2020

90-Day Complication Rate After the Latarjet Procedure in a High-Volume Center.

Am J Sports Med 2020 12 30;48(14):3467-3471. Epub 2020 Oct 30.

Sports Surgery Clinic, Dublin, Ireland.

Background: The Latarjet procedure is indicated for patients with recurrent anterior shoulder instability, previous failed soft tissue stabilization, glenoid bone loss, or high-risk factors for recurrence, although there is still a concern with the surgical complication rates associated with the Latarjet procedure.

Purpose: To evaluate the 90-day complication rate after the open Latarjet procedure in a high-volume center.

Study Design: Case series; Level of evidence, 4.

Methods: A retrospective review was performed of patients who underwent an open Latarjet procedure at our institution over a 5-year period between January 2015 and December 2019. The complications, readmissions, and reoperations within 90 days were evaluated.

Results: A total of 441 patients with a mean age of 23.0 ± 5.7 years was included; 97.5% of the patients were male. There were 2 intraoperative complications (0.5%): 1 coracoid fracture and 1 anaphylactic reaction to vancomycin. Overall, there were 19 postoperative complications (4.3%) in 18 patients, with 4 (0.9%) readmissions for revision surgery. Hematomas were the most common complication, occurring in 12 patients (2.7%), with 9 (2.0%) requiring a return to the operating theater during their stay for an evacuation. In those who required a readmission for a reoperation, 1 was for a hematoma requiring a washout, 2 were for irrigation and debridement of a surgical site infection, and the third was for a biceps tenodesis in a patient with severe bicipital pain. No patients had recurrence or any postoperative graft complications; additionally, there were no neurovascular complications.

Conclusion: We found that in a high-volume center, the open Latarjet procedure has a low 90-day complication rate with a low revision rate. Hematomas were the most common complication experienced by patients who underwent the Latarjet procedure, while there was no recurrent instability or neurological or hardware complications reported among the 441 patients included in this study.
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http://dx.doi.org/10.1177/0363546520964488DOI Listing
December 2020

Clinical Outcomes of Patients With Anterior Shoulder Instability and Glenolabral Articular Disruption Lesions: A Retrospective Comparative Study.

Am J Sports Med 2020 12 26;48(14):3472-3477. Epub 2020 Oct 26.

Sports Surgery Clinic, Dublin, Ireland.

Background: Anterior shoulder instability is a common clinical condition that often requires surgical stabilization. Glenoid labral tears are often associated with instability, with glenolabral articular disruption (GLAD) lesions occasionally being identified arthroscopically during repair, particularly in collision athletes.

Purpose: To evaluate the clinical outcomes and recurrence rates in patients who had GLAD lesions and underwent arthroscopic Bankart repair (ABR) and compare them with a control group without GLAD lesions.

Study Design: Cohort study; Level of evidence, 3.

Methods: A retrospective review of patients who underwent ABR with GLAD lesions, by a single surgeon between July 2012 and March 2017, was performed. Additionally, these were pair matched in a 2:1 ratio for age, sex, sport, and level of play with a control group who underwent ABR without GLAD lesions. Return to sport, the level of return, and the timing of return were assessed. The visual analog scale (VAS) for pain score, Rowe score, Shoulder Instability-Return to Sport after Injury (SIRSI) score, and Subjective Shoulder Value (SSV) were evaluated.

Results: The study included a total of 66 patients (22 and 44 patients for the GLAD and control groups, respectively), with a mean age of 25.8 years and a mean follow-up of 66 months. Overall, there was no significant difference in any of the clinical outcome scores (VAS, Rowe, SIRSI, and SSV) utilized for the GLAD and control groups ( > .05 for all). Similarly, there was no significant difference in the total rate of return to play (90.9% vs 88.6%; > .99) or return at the same/higher level (68.2% vs 72.7%; = .78). There was no significant difference in timing of return to play (6.3 ± 6.6 months vs 6.4 ± 2.5 months; = .98). There were 3 cases (13.6%) requiring further surgery (1 revision stabilization, 1 arthroscopic release, and 1 rotator cuff repair) in the GLAD group and 2 cases (4.5%) requiring further surgery (both revision stabilization) in the control group; the difference was not statistically significant ( = .32).

Conclusion: After arthroscopic repair, patients with GLAD lesions had similar midterm outcomes when compared with a control group without GLAD lesions.
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http://dx.doi.org/10.1177/0363546520964479DOI Listing
December 2020

Outcomes of mini-open carpal tunnel release for severe carpal tunnel syndrome: a 10-year follow-up.

J Hand Surg Eur Vol 2021 Mar 25;46(3):320-322. Epub 2020 Sep 25.

Department of Trauma and Orthopaedics, Beaumont Hospital, Dublin, Ireland.

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http://dx.doi.org/10.1177/1753193420958996DOI Listing
March 2021

Response to Cao et al regarding: "Surgical treatment for long head of the biceps tendinopathy: a network meta-analysis".

J Shoulder Elbow Surg 2021 01 19;30(1):e36-e37. Epub 2020 Sep 19.

Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.

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http://dx.doi.org/10.1016/j.jse.2020.07.051DOI Listing
January 2021

Current practices in the management of anterior glenohumeral instability in rugby union players.

Surgeon 2021 Oct 12;19(5):e88-e94. Epub 2020 Sep 12.

Sports Surgery Clinic, Northwood Avenue, Santry Demesne, Dublin 9, Ireland.

Background: Rugby has the highest incidence of traumatic injuries of any sport, and glenohumeral injuries result in the lengthy delay in return to play. The purpose of this study is to survey surgeons from the American Shoulder and Elbow Surgeons (ASES), and the British Elbow and Shoulder Society (BESS) to evaluate the current state of management of anterior glenohumeral instability, and compare the differences in practices.

Methods: A survey of surgeons from ASES and BESS was conducted. Treatment options were proposed in a variety of clinical scenarios of glenohumeral instability. The time of immobilization post-operatively, return to play, and attitudes on current contact regulations. Results were compared using the chi-square test or t-test.

Results: Ninety-seven surgeons responded to the survey. There was a significant difference in treatment between ASES and BESS surgeons in the setting of primary dislocation (p < 0.05), but not recurrent dislocation (p > 0.05). The period of immobilization following injury and surgery was different between both treating groups. There was a significant difference in return to play between ASES and BESS surgeons with arthroscopic stabilization and open Bankart repair (p < 0.05), but not following conservative treatment or the Latarjet procedure (p > 0.05).

Conclusions: There remains wide variance on the management of glenohumeral instability in rugby union players among surgeons. While immobilization times post-operatively were similar, the BESS surgeons were more confident in allowing earlier return to play. There is also a significant concern that contact levels should be regulated to protect player safety.

Level Of Evidence: Level 4 (case series).
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http://dx.doi.org/10.1016/j.surge.2020.08.005DOI Listing
October 2021

Return to sport following reverse shoulder arthroplasty: a systematic review.

J Shoulder Elbow Surg 2021 Jan 25;30(1):216-221. Epub 2020 Aug 25.

Sports Surgery Clinic, Dublin, Ireland.

Background: The purpose of this study is to systematically review the evidence in the literature to ascertain the rate and timing of return to sport following reverse shoulder arthroplasty (RSA).

Methods: A systematic literature search based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using the Embase, MEDLINE, and Cochrane Library Databases. Eligible for inclusion were clinical studies reporting on return to sport following RSA. Statistical analysis was performed using SPSS.

Results: Overall, 8 studies including 455 patients (464 shoulders) met our inclusion criteria. The majority of patients were female (77.7%), with an average age of 74.2 years. The overall rate of return to sport was 79.1%; with 66.7% of golfers, 74.3% of swimmers, 50.0%, of tennis players, 94.4% of joggers, and 69.7% of cyclists returning. In addition, 71.4% of patients returned to the same level of sporting activity. The average time to return to sport was 3.4 months with a mean follow-up of 34.0 months.

Discussion And Conclusion: The results from our systematic review show that the majority of patients are able to return to sport following RSA, with a large number returning to the same level of sport. However, results were modest in overhead athletes, with a concerning number unable to return to tennis post-RSA.
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http://dx.doi.org/10.1016/j.jse.2020.08.006DOI Listing
January 2021

Operative Treatment of Anterior Shoulder Instability A Network Meta-Analysis.

Bull Hosp Jt Dis (2013) 2020 Sep;78(3):202-209

Background: Traumatic anterior shoulder instability is a common clinical problem among athletic populations, with several surgical treatment options available. The optimal treatment remains undetermined. Currently the main current treatment options are the Latarjet procedure or open or arthroscopic Bankart repair. The purpose of this study was to network meta-analyze the recent evidence to ascertain if the open Latarjet procedure and open or arthroscopic Bankart repair result in lower recurrence rates and subsequent revision procedures. The results were ranked with the P-score.

Methods: A literature search was performed based on the PRISMA guidelines. Cohort studies comparing any of the open Latarjet procedure and open or arthrosopic Bankart repair for anterior shoulder instability were included. Clinical outcomes were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R.

Results: Twenty-nine studies with 2,474 patients were included. The open Latarjet procedure resulted in lower rates of recurrent instability and revisions due to recurrence compared to both open and arthroscopic Bankart repairs. The open Latarjet procedure resulted in the highest rate of return to play. However, the open Latarjet procedure also resulted in the highest complication rate.

Conclusion: Our network meta-analysis found the open Latarjet procedure had the lowest recurrence rates, lowest revisions rates, and highest rates of return to play in the surgical treatment of anterior shoulder instability. However, the Latarjet procedure has been shown to result in a higher complication rate, which needs to be considered when deciding which stabilization procedure to perform.
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September 2020

Low rate of recurrent instability following the open Latarjet procedure as a revision procedure for failed prior stabilization surgery.

Knee Surg Sports Traumatol Arthrosc 2021 Jul 24;29(7):2110-2117. Epub 2020 Jul 24.

Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, Ireland.

Purpose: The purpose of this study is to systematically review the literature to ascertain functional outcomes, recurrence rates and subsequent revision rates following the open Latarjet procedure when performed as a revision procedure.

Methods: Two independent reviewers performed the literature search based on PRISMA guidelines, utilizing the EMBASE, MEDLINE, and The Cochrane Library Databases. Studies where the Latarjet procedure was performed as a revision procedure were included. Clinical outcomes analyzed were: (1) functional outcomes, (2) recurrent instability, (3) revisions, and (4) complications.

Results: The review found 16 studies with 713 shoulders that met the inclusion criteria. 605 of the patients were male (84.9%), with an average age of 28.2 years (15-62) and follow-up of 47.7 months. The most commonly reported functional outcome measure was the Rowe score, with a weighted mean of 92.7. 86/95 patients had good-excellent outcomes (90.4%). 136/143 patients reported return to play (95.1%). 141/161 patients returned to the same level of competition (87.6%). 50 patients experienced recurrence (8.4%). Five patients experienced redislocation (0.9%) and 37 patients experienced subluxation (6.7%). There were 29 revisions (5.1%), with 12 revisions due to recurrence (2.1%). There were 68 total complications, not including recurrence (11%). The most common complications were 13 cases of nerve damage and infection respectively (2.1%). There was 17 cases of new instability arthropathy (6.5%), and 31 cases of residual pain (6.7%).

Conclusion: This review shows that the revision Latarjet provides excellent functional outcomes, low rates of recurrence and complications, and a high rate of return to sport among athletes. This results from study can be used to explain the expected outcomes associated with the Latarjet procedure performed as a revision.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s00167-020-06155-6DOI Listing
July 2021

Remplissage for anterior shoulder instability with Hill-Sachs lesions: a systematic review and meta-analysis.

J Shoulder Elbow Surg 2020 Dec 7;29(12):2487-2494. Epub 2020 Jul 7.

Sports Surgery Clinic, Dublin, Ireland.

Background: The purpose of this study was to perform a systematic review and meta-analysis of the current evidence in the literature to determine how arthroscopic Bankart repair (ABR) and remplissage compare with ABR alone and the open Latarjet procedure for anterior shoulder instability in patients with concomitant Hill-Sachs lesions.

Methods: A literature search was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Studies comparing ABR and remplissage vs. ABR alone or the Latarjet procedure for anterior shoulder instability in patients with Hill-Sachs lesions were included. Clinical outcomes were compared, with all statistical analysis performed using Review Manager (version 5.3). P < .05 was considered statistically significant.

Results: Twelve clinical trials were included. There was a significant difference between ABR plus remplissage and ABR alone in total recurrence rate (3.2% vs. 16.8%, P < .05) but not the rate of revision due to recurrence (1.7% vs. 8.5%, P = .06). There was no significant difference between the Latarjet procedure and ABR plus remplissage in total recurrence rate (7.0% vs. 9.8%, P = .39), total revision rate (3.7% vs. 5.7%, P = .41), and rate of revision due to recurrence (1.6% vs. 2.1%, P = .79). There was a significantly lower rate of complications with ABR and remplissage compared with the Latarjet procedure (0.5% vs. 8.6%, P = .003).

Conclusion: In patients with Hill-Sachs lesions and subcritical glenoid bone loss, ABR with remplissage resulted in lower rates of recurrent instability compared with ABR alone while resulting in similar recurrence rates, as well as similar patient-reported outcomes, with lower morbidity and fewer complications, compared with the Latarjet procedure.

Level Of Evidence: Level III; Systematic Review.
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http://dx.doi.org/10.1016/j.jse.2020.06.021DOI Listing
December 2020

Return to Sport Following Arthroscopic Repair of 270° Labral Tears.

Arthrosc Sports Med Rehabil 2020 Jun 29;2(3):e237-e240. Epub 2020 May 29.

Sports Surgery Clinic, Dublin, Ireland.

Purpose: To evaluate the rate of return to sport following arthroscopic repair of 270° labral tears.

Methods: We performed a retrospective review of patients with 270° labral tears treated arthroscopically between 2013 and 2017 by a single surgeon. Patients were followed-up to assess whether they were able to return to sport, the level to which they returned and the timing of return. Complications, the Visual Analogue Scale for pain (VAS), the Rowe score, the Shoulder Instability-Return to Sport after Injury (SIRSI) score, and the Subjective Shoulder Value (SSV) were recorded.

Results: The study included 25 patients, with a mean follow-up of 42.2 ± 16.5 months. Of the 25 patients, 19 (76.0%) returned to sport at a mean of 6.8 ± 2.6 months, while 15 (60%) returned at the same or a higher level. At final follow-up, the mean Rowe score was 80.6 ± 14.2; the mean SIRSI score was 61.8 ± 25.4; the mean SSV was 86.4 ± 15.2; and the mean VAS score was 2.2 ± 2.0. One patient reported recurrent subluxation, but no patients suffered a recurrent dislocation during the study period. No revision surgeries were performed within the study period.

Conclusion: Patients with 270° labral tears who were treated with arthroscopic repair showed an overall high rate of return to sport. Despite a low rate of recurring instability, not all patients were able to return to their previous levels of sports.

Level Of Evidence: Level IV, therapeutic case series.
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http://dx.doi.org/10.1016/j.asmr.2020.02.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283938PMC
June 2020

Arthroscopic Bankart Repair Versus Conservative Management for First-Time Traumatic Anterior Shoulder Instability: A Systematic Review and Meta-analysis.

Arthroscopy 2020 09 8;36(9):2526-2532. Epub 2020 May 8.

Department of Orthopaedic Surgery, New York University Langone Health, New York, New York, U.S.A.

Purpose: To perform a meta-analysis of the current evidence in the literature comparing arthroscopic Bankart repair versus conservative management for first-time anterior shoulder dislocation.

Methods: A literature search of the MEDLINE, Embase, and Cochrane Library databases was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Prospective studies comparing arthroscopic Bankart repair versus conservative management as treatment for first-time anterior shoulder dislocation were included. Recurrence, further treatment, and return to play were compared, with all statistical analysis performed using Review Manager, version 5.3. P < .05 was considered statistically significant.

Results: Ten prospective studies with 569 patients were included. Arthroscopic Bankart repair resulted in a lower rate of total recurrent instability (9.7% vs 67.4, I = 0, P < .0001) and further surgical treatment for anterior shoulder instability (5.9% vs 46.7%, I = 0, P < .0001). Additionally, arthroscopic Bankart repair resulted in a higher rate of return to play (92.8% vs 80.8%, I = 0, P = .002).

Conclusions: Arthroscopic Bankart repair resulted in a 7-fold lower recurrence rate and a higher rate of return to play than conservative management. Thus, arthroscopic Bankart repair may be advisable to perform routinely in patients with first-time dislocation who participate in sports.

Level Of Evidence: Level II, systematic review of Level I and II studies.
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http://dx.doi.org/10.1016/j.arthro.2020.04.046DOI Listing
September 2020

Tranexamic acid for the Latarjet procedure: a randomized controlled trial.

J Shoulder Elbow Surg 2020 May;29(5):882-885

Sports Surgery Clinic, Dublin, Ireland; Royal College of Surgeons in Ireland, Department of Trauma & Orthopaedic Surgery, Dublin, Ireland.

Background: Tranexamic acid (TXA) is commonly used in orthopedic surgery to reduce perioperative bleeding and the need for transfusion. The purpose of the study was to assess whether TXA could reduce the incidence of postoperative swelling and hematoma formation and pain and opioid use in the early postoperative period following the Latarjet procedure.

Methods: A randomized controlled trial was conducted in 100 patients undergoing open Latarjet surgery for anterior shoulder instability by a single surgeon. Patients were randomized to receive either 1 g TXA or a placebo intravenously preoperatively. Outcomes measured during the perioperative period were (1) intraoperative blood loss, (2) postoperative blood loss (via drain output), (3) postoperative swelling/hematoma formation, (4) visual analog scale (VAS) score, and (5) postoperative opioid use (in morphine milligram equivalents).

Results: There was no significant difference in intraoperative blood loss (60.9 vs. 68.9 mL, P = .18). However, there was significantly lower postoperative blood loss with TXA (29.6 vs. 64.9 mL, P < .01). There was a significantly lower rate of painful postoperative swelling (4% vs. 32%, P < .01). Additionally, we found a significantly lower VAS score for pain (1.7 vs. 3.0, P < .01) and significantly less postoperative opioid use (9.4 vs. 22 mg, P < .01) in the TXA group. Postoperative swelling was shown to correlate with increased pain and opioid use (P < .01).

Conclusion: Our study found that TXA significantly reduced postoperative blood loss, painful postoperative swelling, and hematoma formation and subsequently reduced postoperative pain and opioid use following the Latarjet procedure.
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http://dx.doi.org/10.1016/j.jse.2020.01.066DOI Listing
May 2020

Outcomes following arthroscopic Bankart repair in female patients.

J Shoulder Elbow Surg 2020 Jul 19;29(7):1332-1336. Epub 2020 Feb 19.

Sports Surgery Clinic, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland.

Purpose: The purpose of this study is to evaluate clinical outcomes and recurrence among women who have undergone an arthroscopic Bankart repair for recurrent anterior shoulder instability.

Methods: A retrospective review of patients with anterior shoulder instability that have undergone an arthroscopic Bankart repair between 2012-2017 was performed. Patients were followed up to assess their visual analog scale (VAS) score, Rowe score, Shoulder Instability-Return to Sport after Injury (SIRSI), and the Subjective Shoulder Value (SSV) and their satisfaction level. Whether they were able to return to sport, the timing of return, and the level to which they returned were reported.

Results: Our study included 31 female patients (34 shoulders), with a mean follow-up of 51.9 months. Overall, 82.4% (28/34 shoulders) were satisfied/very satisfied with their surgery. The mean scores were as follows: Rowe, 79.2; SIRSI, 53.9; SSV, 81.9; and VAS, 1.9. Of the 29 patients (32 shoulders) who played sport prior to surgery, 24 returned to play and 17 returned to the same or higher level. One patient suffered a recurrent dislocation and 2 patients suffered recurrent subluxation. No patients underwent a revision procedure.

Conclusion: Female patients with anterior shoulder instability treated with arthroscopic Bankart repair have low recurrence rates, with good patient-reported outcomes and high satisfaction rates. Of those participating in sport prior to surgery, there was a high rate of return to play. The overall rate of complications was low, with a low rate of revision surgery.
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http://dx.doi.org/10.1016/j.jse.2019.12.012DOI Listing
July 2020
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