the allograft group versus 38% in the autograft ... - Arthroscopy Journal

0 downloads 0 Views 55KB Size Report
by comparing post-operative ASES and KJOC scores. Abstract: Introduction: It has been a decade since the last dedi- cated report on the results of SLAP tears ...
e200

ABSTRACTS

the allograft group versus 38% in the autograft group. These differences were significant. The use of BioRCI screws did not significantly alter the widening compared to RCI screws. Conclusion: Tunnel widening after ACL reconstruction is significantly increased with the use of allografts compared to autografts. No differences were observed between BioRCI and RCI cases. The biology of intratunnel phenomena during graft healing is influenced by graft origin. Paper # 194: The Abduction External Rotation Test for the Diagnosis of Slap Tears KEITH D. NORD, MD, MS, USA WILLIAM HUNTER GARRETT, BS, USA BRAD WALL, MD, USA PRITHVIRAJ CHAVAN, MD, USA · Sports, Orthopedics & Spine, Jackson, TN, USA Summary: Arthroscopic confirmation shows the abduction external rotation test to be a sensitive and specific test, 82% and 69% respectively, for the clinical diagnosis of SLAP tears by mimicking the late cocking and acceleration phases of throwing. Abstract: The purpose of this study is to help identify SLAP tears utilizing a new clinical test. Many tests have been devised for differentiating labral pathology. These tests lack the specificity needed for correct diagnosis of labral pathology. The difficulty is finding a test with reproducible results while determining the correct shoulder abnormality. A total of 203 shoulders (117 right, 86 left) were prospectively identified over a 27 month term and each underwent the same physical exam as well as arthroscopic shoulder surgery conducted by the senior author (KDN) or a sports medicine fellow. The tests performed were the O’brien’s test, Speed’s test, and Yeargason’s test in addition to recently developed Abduction External Rotation test or Nord’s test. From the 203 shoulders, 114 were males and 89 were females with an average age of 52 and an age range of 18-88. In this test, the patient’s injured shoulder must be able to obtain 90° of abduction while being maximally externally rotated. The patient then attempts to internally rotate their arm with resistance from the physician by mimicking the late cocking and acceleration during throwing. The idea to perform this test was based upon the peel back mechanism as described and evaluated arthroscopically by Burkhart and Morgan. A positive test was an exam that

reproduced the patient’s shoulder pain. Eight-three of the study population (203 patients) had a positive Nord test, 123 had a positive O’Brien’s test, twenty-eight had a positive Speed’s test, and twenty-four had a positive Yergason’s test. Arthroscopic exam revealed forty patients with a SLAP tear types II-X. Those patients with a type I tear were not recognized as a true positive test for a SLAP tear due to their degenerative nature. There were twenty-six type II tears, one type IV tear, two type V tears, seven type VIII tears, one of type IX, three of type X. We found the Nord test to have a sensitivity and specificity of 82% and 69%, respectively. However, the Nord test is proven arthroscopically to not only reproduce pain of a SLAP tear but other labral pathology. The sensitivity and specificity, 88% and 74% respectively, were examined for all labral tears proving the Nord test is accurate or effective in diagnosing labral pathology. Paper # 195: Risk Factors for Recurrent Shoulder Dislocation after Arthroscopic Bankart Repair JUNJI IDE, MD, PHD, JAPAN KENSHI KIKUKAWA, MD, PHD, JAPAN HIROKI IRIE, MD, PHD, JAPAN KEI SENBA, MD, PHD, JAPAN KEISHI UEZONO, MD, JAPAN HIROSHI MIZUTA, MD, PHD, JAPAN · Kumamoto University, Kumamoto, JAPAN Summary: Purpose was to identify risk factors related to recurrence after arthroscopic Bankart repair. The study comprised 118 consecutive patients with traumatic anterior shoulder instability and without a large bone loss. At a mean follow-up of 42 months, 6 patients (5.1%) experienced redislocation. Patients who are 18 years of age or younger and contact-sports player are at risk for the recurrence. Abstract: Introduction: The purpose of this study was to identify risk factors related to redislocation of the shoulder joint after arthroscopic Bankart repairs. Materials and Methods: 118 consecutive patients underwent arthroscopic stabilization for recurrent anterior traumatic shoulder instability. We excluded the patients with a large bone loss of the anteroinferior glenoid showing an inverted-pear shape and/or a large Hill-Sachs lesion engaging the anterior glenoid at dynamic arthroscopy in abduction and external rotation. The mean age at the time of surgery was 23.9 years (SD 9.1, range 14-47). 45 patients (38%) were 18 years of age or younger. 92

ABSTRACTS (78%) were male, 58 (49%) were involved in sports (32 (27%) in contact-sports) and 74 (63%) were injured at dominant arm. Capsulolabral reattachment and capsule retensioning was performed with use of 3 or more absorbable suture anchors and non-absorbable sutures. Bony Bankart lesion, SLAP lesion, and rotator interval lesion were repaired in 21 (18%), 31(26%), and 18 (15%), respectively. A logistic regression model and Chi-square test were used for statistical analysis. Results: At a mean follow-up of 42 months (range 24-96), mean Rowe score improved from 30.1 to 92.3 points (p⬍0.0001); 6 patients (5.1%) experienced redislocation. The mean delay to redislocation was 30 months (range 10-94). Age at the time of surgery (⬍19 years) and contact-sports were significant risk factors for redislocation (p⫽0.019, 0.00026, recurrence rate 11.1%, 18.9%, respectively) while male sex, dominant arm and combined lesions were not (p⬎0.05). Conclusions: In the treatment of traumatic recurrent anterior shoulder instability without a large bone loss of glenohumeral articulation, patients who are 18 years of age or younger at the time of surgery and contact-sports player are at risk for recurrent shoulder dislocation after arthroscopic Bankart repair.

Paper # 196: Results of Arthroscopic Repair of Type II Slap Repairs in Overhead Athletes: Assessment of Return to Pre-Injury Playing Level and Satisfaction MICHAEL G. CICCOTTI, MD, USA BRIAN NEUMAN, MD, USA CATHERINE BRITTANY BOISVERT, MD, USA BRIAN REITER, MD, USA KEVIN LAWSON, BA, USA STEVEN B. COHEN, MD, USA · Rothman Institute Orthopaedics, Philadelphia, PA, USA Summary: This study demonstrates the difficulty that remains in returning overhead athletes to their pre-injury level of play following arthroscopic repair of type II SLAP tears by comparing post-operative ASES and KJOC scores. Abstract: Introduction: It has been a decade since the last dedicated report on the results of SLAP tears on overhead athletes. Since then, techniques and approaches to repairs have evolved. Also much of the literature on surgical outcomes of SLAP repair has focused on short-term follow-up of one to two years. To improve our under-

e201

standing of the outcomes of repairs of type II SLAP tears, and the impact of surgical intervention on these athletes, we focused our research, on mid-term follow-up to allow time for full rehabilitation and return to maximum level of competition. The purpose of this study was to determine the results of type II SLAP repairs in overhead athletes using one generalized and one athleticspecific shoulder questionnaire. Methods: A retrospective review of 35 patients with symptomatic type II SLAP tears who underwent arthroscopic repair of the superior labrum between 2002 and 2007 was performed. Patients were operated on by two surgeons at the same institution following the same rehabilitation protocol. Patients with other pathologic shoulder findings were excluded. The outcome of treatment was evaluated using the American Shoulder and Elbow Society (ASES) scoring system, which best assesses activities of daily living and the Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and elbow score, assessing sport-specific activities and performance. Also, the length of time to return and how successfully the athletes returned to play was evaluated. There were 26 male patients and 9 female patients with a mean age of 28.8. Twenty-four patients participated in baseball or softball at a high school level or above and the remainder of patients was involved in rowing, javelin, or tennis. The average follow-up was 3.6 years (minimum 12 months). All arthroscopic repairs were performed with suture anchors (average ⫽ 3.0). Results: Repairs resulted in validated ASES scores comparable to prior studies (ASES ⫽ 87.1). The KJOC score in the over-head athlete averaged at 71.6. On average, athletes’ perception was they returned to about 84.1% of their pre-injury level of function with a mean time to return to play of 12.5 months. “Other” overhead athletes perception of their percentage of return to their preinjury level was significantly greater than baseball players (94% vs. 79.6% respectively p-value 0.048). Also, There was a significant drop from the ASES to KJOC score for the baseball/softball players (89 & 72.1 respectively, p⫽0.0016). Patients reported an overall satisfaction rate of 94.3% with the procedure with the majority being very satisfied. Conclusion: Arthroscopic SLAP repairs show excellent results with worse outcome in throwers. Our study found throwers have a successful outcome with a high rate of satisfaction. This study supports the hypothesis that SLAP repair leads to improved shoulder function during routine daily activities, but that consistent return to elite throwing sports remains somewhat problematic.