scholarly journals What Are the Effects of Remplissage on 6-Month Strength and Range of Motion After Arthroscopic Bankart Repair? A Multicenter Cohort Study

2020 ◽  
Vol 8 (2) ◽  
pp. 232596712090328
Author(s):  
Travis L. Frantz ◽  
Joshua S. Everhart ◽  
Gregory L. Cvetanovich ◽  
Andrew Neviaser ◽  
Grant L. Jones ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Range Of Motion ◽  
External Rotation ◽  
Significant Loss ◽  
Bankart Repair ◽  
Return To Sports ◽  
Level Of Evidence ◽  
Multicenter Cohort Study ◽  
Arthroscopic Bankart Repair

Background: Patients who have undergone shoulder instability surgery are often allowed to return to sports, work, and high-level activity based largely on a time-based criterion of 6 months postoperatively. However, some believe that advancing activity after surgery should be dependent on the return of strength and range of motion (ROM). Hypothesis: There will be a significant loss of strength or ROM at 6 months after arthroscopic Bankart repair with remplissage compared with Bankart repair alone. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 38 patients in a prospective multicenter study underwent arthroscopic Bankart repair with remplissage (33 males, 5 females; mean age, 27.0 ± 10.2 years; 82% with ≥2 dislocation events in the past year). Strength and ROM were assessed preoperatively and at 6 months after surgery. Results were compared with 104 matched patients who had undergone Bankart repair without remplissage, although all had radiographic evidence of a Hill-Sachs defect. Results: At 6 months, there were no patients in the remplissage group with anterior apprehension on physical examination. However, 26% had a ≥20° external rotation (ER) deficit with the elbow at the side, 42% had a ≥20° ER deficit with the elbow at 90° of abduction, and 5% had persistent weakness. Compared with matched patients who underwent only arthroscopic Bankart repair, the remplissage group had greater humeral bone loss and had a greater likelihood of a ≥20° ER deficit with the elbow at 90° of abduction ( P = .004). Risk factors for a ≥20° ER deficit with the elbow at 90° of abduction were preoperative stiffness in the same plane ( P = .02), while risk factors for a ≥20° ER deficit with the elbow at the side were increased number of inferior quadrant glenoid anchors ( P = .003), increased patient age ( P = .02), and preoperative side-to-side deficits in ER ( P = .04). The only risk factor for postoperative ER weakness was preoperative ER weakness ( P = .04), with no association with remplissage ( P = .26). Conclusion: Arthroscopic Bankart repair with remplissage did not result in significant strength deficits but increased the risk of ER stiffness in abduction compared with Bankart repair without remplissage at short-term follow-up.

scholarly journals Back to Sports After Arthroscopic Revision Bankart Repair

2018 ◽  
Vol 6 (2) ◽  
pp. 232596711875545 ◽  
Author(s):  
Johannes Buckup ◽  
Frederic Welsch ◽  
Yves Gramlich ◽  
Reinhard Hoffmann ◽  
Philip P. Roessler ◽  
...  
Keyword(s):  
External Rotation ◽  
Bankart Repair ◽  
Return To Sports ◽  
Arthroscopic Stabilization ◽  
Recurrent Instability ◽  
Arthroscopic Bankart Repair ◽  
Sporting Activity ◽  
The Mean ◽  
Sporting Activities

Background: Recurrent instability following primary arthroscopic stabilization of the shoulder is a common complication. Young, athletic patients are at the greatest risk of recurring instability. To date, the literature contains insufficient description regarding whether return to sports is possible after revision arthroscopic Bankart repair. Hypothesis: Patients presenting with recurrent instability after primary arthroscopic stabilization should expect limitations in terms of their ability to partake in sporting activities after revision surgery. Study Design: Case series; Level of evidence, 4. Methods: Twenty athletes who underwent arthroscopic revision stabilization of the shoulder after failed primary arthroscopic Bankart repair were included in the study after completing inclusion and exclusion criteria surveys. Athletic Shoulder Outcome Scoring System (ASOSS), Shoulder Sport Activity Score (SSAS), and the Subjective Patient Outcome for Return to Sports (SPORTS) scores were determined to assess the participants’ ability to partake in sporting activities. Furthermore, sport type and sport level were classified and recorded. To assess function and stability, Rowe, American Shoulder and Elbow Surgeons, Constant-Murley, and Walch-Duplay scores were measured and recorded. Results: Follow-up consultations were carried out after a mean of 28.7 months. The mean age at follow-up examination was 27.75 years. At the time of follow-up, 70% of the patients were able to return to their original sporting activities at the same level. However, 90% of patients described a limitation in their shoulder when participating in their sports. At 28.7 months after surgery, the mean ASOSS score was 76.8; the SSAS score decreased from 7.85 before first-time dislocation to 5.35 at follow-up ( P < .005). The SPORTS score was 5.2 out of 10 at the follow-up consultation. Function- and instability-specific scores showed good to excellent results. The mean external rotational deficit for high external rotation was 9.25°, and for low external rotation it was 12°. Conclusion: Patients can return to their original type and level of sport after arthroscopic revision Bankart repair, but they must expect persistent deficits and limitations to the shoulder when put under the strains of sporting activity. Patients with shoulder injuries who partake in sports that put greater demand on the shoulder show the smallest probabilities of returning to sporting activity.

scholarly journals Physical Therapy Protocols for Arthroscopic Bankart Repair

2018 ◽  
Vol 10 (3) ◽  
pp. 250-258 ◽  
Author(s):  
Steven F. DeFroda ◽  
Nabil Mehta ◽  
Brett D. Owens
Keyword(s):  
Physical Therapy ◽  
Range Of Motion ◽  
Orthopaedic Surgery ◽  
Initial Period ◽  
Return To Sport ◽  
Bankart Repair ◽  
Consensus Protocol ◽  
Level Of Evidence ◽  
Arthroscopic Bankart Repair ◽  
Rehabilitation Protocols

Background: Outcomes after arthroscopic Bankart repair can be highly dependent on compliance and participation in physical therapy. Additionally, there are many variations in physician-recommended physical therapy protocols. Hypothesis: The rehabilitation protocols of academic orthopaedic surgery departments vary widely despite the presence of consensus protocols. Study Design: Descriptive epidemiology study. Level of Evidence: Level 3. Methods: Web-based arthroscopic Bankart rehabilitation protocols available online from Accreditation Council for Graduate Medical Education (ACGME)–accredited orthopaedic surgery programs were included for review. Individual protocols were reviewed to evaluate for the presence or absence of recommended therapies, goals for completion of ranges of motion, functional milestones, exercise start times, and recommended time to return to sport. Results: Thirty protocols from 27 (16.4%) total institutions were identified out of 164 eligible for review. Overall, 9 (30%) protocols recommended an initial period of strict immobilization. Variability existed between the recommended time periods for sling immobilization (mean, 4.8 ± 1.8 weeks). The types of exercises and their start dates were also inconsistent. Goals to full passive range of motion (mean, 9.2 ± 2.8 weeks) and full active range of motion (mean, 12.2 ± 2.8 weeks) were consistent with other published protocols; however, wide ranges existed within the reviewed protocols as a whole. Only 10 protocols (33.3%) included a timeline for return to sport, and only 3 (10%) gave an estimate for return to game competition. Variation also existed when compared with the American Society of Shoulder and Elbow Therapists’ (ASSET) consensus protocol. Conclusion: Rehabilitation protocols after arthroscopic Bankart repair were found to be highly variable. They also varied with regard to published consensus protocols. This discrepancy may lead to confusion among therapists and patients. Clinical Relevance: This study highlights the importance of attending surgeons being very clear and specific with regard to their physical therapy instructions to patients and therapists.

scholarly journals Arthroscopic remplissage is safe and effective: clinical and magnetic resonance results at a minimum 3 years of follow-up

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Pietro S. Randelli ◽  
Riccardo Compagnoni ◽  
Simone Radaelli ◽  
Mauro B. Gallazzi ◽  
Alberto Tassi ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
External Rotation ◽  
Fatty Infiltration ◽  
Bankart Repair ◽  
Rotator Cuff Tears ◽  
Minimal Amount ◽  
Safe Procedure ◽  
Level Of Evidence ◽  
Arthroscopic Bankart Repair

Abstract Background Large Hill–Sachs lesions are considered a risk factor for recurrence of instability after arthroscopic Bankart repair alone. The aim of this study was to demonstrate that remplissage is a safe procedure that effectively reduces the risk of recurrent dislocations without causing fatty degeneration of the infraspinatus at medium-term follow-up. Methods Patients who underwent arthroscopic Bankart repair and remplissage with a minimum 3 years of follow-up were included. Constant–Murley (CMS), American Shoulder and Elbow Surgeons (ASES), and Walch–Duplay scores were evaluated. Magnetic resonance imaging (MRI) was performed to detect the appearance of fatty infiltration inside the infraspinatus muscle, the percentage of the Hill–Sachs lesion filled by the tendon and its integration, and the onset of rotator cuff tears. Results Thirteen patients (14 shoulders) with a mean follow-up of 55.93 (± 18.16) months were enrolled. The Walch–Duplay score was 95.00 [87.25–100.00], with a return to sport rate of 100%. Both the CMS and the ASES indicated excellent results. The affected shoulders showed a statistically significant reduction in active external rotation both with the arm at the side (ER1) and with the arm at 90° of abduction (ER2) (p = 0.0005 and p = 0.0010, respectively). A reduction in infraspinatus isometric strength was found for both ER1 and ER2, but this reduction was only statistically relevant in ER2 (p = 0.0342). There was a traumatic recurrence of instability in two cases (14.28%). MRI evaluation demonstrated an absence of adipose infiltration in 50% of cases and only a minimal amount in the remaining 50%. In 12 cases (85.72%), the capsulotenodesis completely filled the lesion and good tendon–bone integration was observed. Conclusion Arthroscopic remplissage provided successful clinical outcomes without fatty infiltration of the infraspinatus and with good healing of the tissues. The low risk of recurrence was associated with an objective limitation on active external rotation, but this did not influence the patients' daily or sports activities. Level of evidence: Cohort study, level of evidence 3.

scholarly journals Patient Outcomes and Fear of Returning to Sports After Arthroscopic Bankart Repair With Remplissage

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712110017
Author(s):  
Sijia Feng ◽  
Mo Chen ◽  
Jun Chen ◽  
Hong Li ◽  
Jiwu Chen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Recurrence Rate ◽  
Shoulder Instability ◽  
Shoulder Function ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Return To Sports ◽  
Arthroscopic Bankart Repair ◽  
Group B

Background: Although Bankart repair with remplissage is commonly performed to treat anterior shoulder instability, there is limited information on specific outcomes or patients’ fears regarding return to sports (RTS). Purpose: To study recurrence rates, pain, shoulder function, active range of motion (ROM), RTS rate, and patients’ fears and expectations for RTS after arthroscopic Bankart repair with remplissage for anterior shoulder instability. We compared these outcomes with those after Bankart repair alone. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study was carried out between 2007 and 2017 among patients who underwent arthroscopic Bankart repair with remplissage (group BR) and Bankart repair alone (group B). At the final follow-up, outcomes including recurrence, pain, shoulder function, active ROM, RTS rate, and fear toward RTS were assessed. The specific outcomes for RTS were evaluated based on 3 levels: return to normal life, RTS at any level (RTSA), and RTS at previous level (RTSP). Results: A total of 70 patients were included (29 in group BR and 41 in group B) with a mean 67.2 months of follow-up. Group BR demonstrated a significantly lower recurrence rate than did group B (0 vs 22.0%, respectively; P = .007) as well as higher postoperative Rowe score (92.8 ± 7.1 vs 83.3 ± 16.2, respectively; P = .005). There were no differences between the groups in postoperative visual analog scale for pain score, American Shoulder and Elbow Surgeons score, Oxford Shoulder Instability Score, or active ROM. The rates of RTSA (100% vs 84.2%; P = .03) and RTSP (77.8% vs 50.0%; P = .02) were higher in group BR than in group B, respectively, and significantly fewer patients in group BR reported fear of RTS (40.7% vs 63.2%; P = .04). Conclusion: In this study, recurrence rate, pain, shoulder function, active ROM, and RTS rate were satisfactory after arthroscopic Bankart repair with remplissage. Patients who underwent this procedure reported less fear toward RTS and higher rates of RTSA and RTSP than did those who undergo Bankart repair alone.

scholarly journals A Comparison of Physical Therapy Protocols Between Open Latarjet Coracoid Transfer and Arthroscopic Bankart Repair

2020 ◽  
Vol 12 (2) ◽  
pp. 124-131
Author(s):  
Alexander Beletsky ◽  
Jourdan M. Cancienne ◽  
Brandon J. Manderle ◽  
Nabil Mehta ◽  
Kevin E. Wilk ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Sports Medicine ◽  
Return To Sport ◽  
Return To Play ◽  
Bankart Repair ◽  
Level Of Evidence ◽  
Arthroscopic Bankart Repair ◽  
Rehabilitation Protocols ◽  
Level 3 ◽  
Tissue Stabilization

Context: Recent studies examining return to sport after traumatic shoulder instability suggest faster return-to-sport time lines after bony stabilization when compared with soft tissue stabilization. The purpose of the current study was to define variability across online Latarjet rehabilitation protocols and to compare Latarjet with Bankart repair rehabilitation time lines. Evidence Acquisition: Online searches were utilized to identify publicly available rehabilitation protocols from Accreditation Council for Graduate Medical Education (ACGME)–accredited academic orthopaedic surgery programs. Study Design: Descriptive epidemiology study. Level of Evidence: Level 3. Results: Of the 183 ACGME-accredited orthopaedic programs reviewed, 14 institutions (7.65%) had publicly available rehabilitation protocols. A web-based search yielded 17 additional protocols from private sports medicine practices. Of the 31 protocols included, 31 (100%) recommended postoperative sling use and 26 (84%) recommended elbow, wrist, and hand range of motion exercises. Full passive forward flexion goals averaged 3.22 ± 2.38 weeks postoperatively, active range of motion began on average at 5.22 ± 1.28 weeks, and normal scapulothoracic motion by 9.26 ± 4.8 weeks postoperatively. Twenty (65%) protocols provided specific recommendations for return to nonoverhead sport–specific activities, beginning at an average of 17 ± 2.8 weeks postoperatively. This was compared with overhead sports or throwing activities, for which 18 (58%) of protocols recommended beginning at a similar average of 17.1 ± 3.3 weeks. Conclusion: Similar to Bankart repair protocols, Latarjet rehabilitation protocols contain a high degree of variability with regard to exercises and motion goal recommendations. However, many milestones and start dates occur earlier in Latarjet protocols when compared with Bankart-specific protocols. Consequently, variability in the timing of rehabilitation goals may contribute to earlier return to play metrics identified in the broader literature for the Latarjet procedure when compared with arthroscopic Bankart repair. Strength of Recommendation Taxonomy (SORT): Level C.

scholarly journals Sex differences in outcomes after arthroscopic bankart repair

2020 ◽  
Vol 6 (1) ◽  
pp. e000965
Author(s):  
Natalie A Lowenstein ◽  
Peter J Ostergaard ◽  
Daniel B Haber ◽  
Kirsten D Garvey ◽  
Elizabeth G Matzkin
Keyword(s):  
Mental Health ◽  
Sex Differences ◽  
Patient Reported Outcomes ◽  
Strength Function ◽  
Bankart Repair ◽  
Level Of Evidence ◽  
Arthroscopic Bankart Repair ◽  
Patient Reported ◽  
Males And Females

ObjectivesRisk factors for anterior shoulder dislocation include young age, contact activities and male sex. The influence of sex on patient-reported outcomes of arthroscopic Bankart repair (ABR) is unclear, with few studies reporting potential differences. This study’s purpose was to compare patient-reported outcomes of males and females following ABR.MethodsProspectively collected data was analysed for 281 patients (males: 206, females: 75) after ABR with preoperative, 1-year and 2-year follow-up responses. The Wilcoxon signed-rank and χ2 tests, preoperative, 1 year and 2 year follow-up results were examined to determine differences of scores in males versus females.ResultsNo statistically significant sex differences were observed in Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), Visual Analogue Scale (VAS) or Single Assessment Numerical Evaluation (SANE) Scores at 1-year or 2-year follow-up. Females had lower Veterans RAND 12-item health survey (VR-12) mental health subscores at 2-year follow-up (females: 52.3±9.0, males: 55.8±7.6, p=0.0016). Females were more likely to report that treatment had ‘exceeded expectations’ at 2-year follow-up regarding motion, strength, function and normal sports activities.ConclusionResults of study demonstrate that ABR has similar outcomes for both males and females. There were no statistically significant sex-related differences in SST, ASES, VAS or SANE scores following ABR. VR-12 mental health subscores showed a minimal difference at 2-year follow-up, with lower scores in females.Level of evidenceRetrospective cohort study; level II.

Arthroscopic Bankart repair: results and risk factors of recurrence of instability

2010 ◽  
Vol 18 (12) ◽  
pp. 1752-1758 ◽  
Author(s):  
Tapio Flinkkilä ◽  
Pekka Hyvönen ◽  
Pasi Ohtonen ◽  
Juhana Leppilahti
Keyword(s):  
Risk Factors ◽  
Bankart Repair ◽  
Arthroscopic Bankart Repair

The playing position significantly influences return to sports and recurrences after an arthroscopic Bankart repair in competitive rugby players

2021 ◽  
pp. 175857322199308
Author(s):  
Ignacio Pasqualini ◽  
Luciano Andrés Rossi ◽  
Franco Luis De Cicco ◽  
Ignacio Tanoira ◽  
Ignacio Alonso Hidalgo ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Functional Outcomes ◽  
The Other ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Return To Sports ◽  
Arthroscopic Bankart Repair ◽  
Rugby Players

Background The purpose of our study was to investigate the influence of the different rugby playing positions on return to sports, functional outcomes, and recurrences after an arthroscopic Bankart repair. Methods A total of 88 rugby players were treated for anterior shoulder instability in our institution between 2010 and 2018. Functional outcomes, return to sports, recurrences, complications, and revisions rates were evaluated according to the playing position. Results Overall, 73.8% of the patients returned to rugby and 60% returned at the same level as before the injury. The tight forwards and outside backs experienced a significant decrease in their competitive level after surgery, and showed the lowest functional outcomes. The tight forwards and outside backs showed a statistically significant increase in recurrence and revision rates, and an OR for recurrence of 12.8 and 9.6, respectively. Discussion The playing position significantly influenced return to sports and recurrences after an arthroscopic Bankart repair in competitive rugby players. Specifically, the tight forwards and outside backs have returned to a lower level than they had before surgery, showed the lowest functional outcomes, and a significant increase in recurrences and revisions rates than the other groups.

Examining the Dynamic Nature of Anterior Cruciate Ligament Injury Risk Factors in Women’s Collegiate Soccer

2021 ◽  
pp. 1-8
Author(s):  
Elena M. D’Argenio ◽  
Timothy G. Eckard ◽  
Barnett S. Frank ◽  
William E. Prentice ◽  
Darin A. Padua
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Range Of Motion ◽  
Injury Risk ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Dynamic Risk Factors ◽  
Dynamic Risk ◽  
Anterior Cruciate

Context: Anterior cruciate ligament (ACL) injuries are a common and devastating injury in women’s soccer. Several risk factors for ACL injury have been identified, but have not yet been examined as potentially dynamic risk factors, which may change throughout a collegiate soccer season. Design: Prospective cohort study. Methods: Nine common clinical screening assessments for ACL injury risk, consisting of range of motion, movement quality, and power, were assessed in 29 Division I collegiate women’s soccer players. Preseason and midseason values were compared for significant differences. Change scores for each risk factor were also correlated with cumulative training loads during the first 10 weeks of a competitive soccer season. Results: Hip external rotation range of motion and power had statistically significant and meaningful differences at midseason compared with preseason, indicating they are dynamic risk factors. There were no significant associations between the observed risk factor changes and cumulative training load. Conclusions: Hip external rotation range of motion and power are dynamic risk factors for ACL injury in women’s collegiate soccer athletes. Serial screening of these risk factors may elucidate stronger associations with injury risk and improve prognostic accuracy of screening tools.

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