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2021 AOSSM-AANA Combined Annual Meeting Recordings
Arthroscopic Bankart Repair for Primary versus Rec ...
Arthroscopic Bankart Repair for Primary versus Recurrent Instability in Athletes
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Video Transcription
is Owen Hurley. It's nice to be back in person, but these things were a lot easier to do over Zoom when you could pre-record them. So I just finished my PhD on shoulder instability between NYU and the Sports Surgery Clinic in Dublin. So with athletes presenting with shoulder instability, they often raise the concern about being able to get back to sport and how long it's going to take. And while they can be managed non-operatively, our recent meta-analysis showed lower rates of return to play, as well as a seven-fold higher rate of recurrent instability. And while bank heart repair is the most commonly performed procedure, it's unclear how recurrent instability impacts athletes trying to get back to sport. So the purpose of this study was to compare the outcomes of athletes who were treated with primary instability or recurrent instability with bank heart repair. So all patients were done by a single surgeon, and a retrospective review was carried out where we patient-matched for demographics, so age, gender, sport played, and follow-up to generate two comparable groups in a one-to-one ratio. All the surgeries were performed in a beach chair position, and return to play progression was allowed between four and seven months, depending on how they were going through their rehab. These were the outcomes measured. They focused on return to play, level and timing of return, as well as associated factors. And standard statistical analysis was performed, and our power calculation was based on return to play. So in total, we were able to match a hundred patients with primary and recurrent instability, with almost identical patient demographics, although slight discrepancies, and the mean follow-up was about five years. So overall, we found no difference in rate of return to play between the two groups, or level of return. However, those with recurrent instability had a slightly quicker, by a month, timing of return to play. So our reasoning behind this was that, from talking to them, a lot of them, after their first dislocation, would have done non-operative management with physiotherapy, and would have done a lot of shoulder strengthening, and carried this through when they returned to sport. So we feel it functioned almost like a prehab of sorts. There was no significant difference in any patient outcome. Additionally, there was no significant difference in recurrence, with less than 10% in either group experiencing a re-dislocation. However, we would note this was not the purpose of our study, and there is a slight difference, but those with recurrent instability still had a low percent of glenoid bone loss, and we would caution that, when you do dislocate, again, you can get further bone loss, further soft tissue damage, so if we looked at this in our overall cohort, we may have been higher. So there's a few limitations to our study. It was retrospective in nature. As I mentioned, while we did pair matching, there was slight, albeit non-statistically, significant differences between the two groups. No pre-operative patient outcome measure was used in this study, as we only start our registry after, and it was a single surgeon series, which may limit generalizability. So, in conclusion, arthroscopic bank heart repair results in excellent clinical outcomes, high rates of return to play, and low recurrent dislocation rates for athletes with both primary and recurrent instability. And I'd just like to take a moment to thank all my co-authors, my senior author, Mr. Hannan Mullet, and both NYU and SSC for their support over the last few years while doing my thesis. Thank you.
Video Summary
In this video, Owen Hurley presents the findings of a study comparing the outcomes of athletes treated with primary or recurrent instability using arthroscopic bankart repair. The study included 100 patients with similar demographics, and the mean follow-up was five years. The results showed no significant difference in the rate or level of return to play between the two groups. However, athletes with recurrent instability had a slightly quicker return to play by about a month. The study also found no significant difference in recurrence rates, although there was a slight difference in glenoid bone loss. The study has limitations, such as its retrospective nature and being a single surgeon series. Overall, arthroscopic bankart repair showed excellent clinical outcomes for athletes with shoulder instability. Hurley expresses gratitude to his co-authors, senior author Mr. Hannan Mullet, NYU, and SSC for their support during his thesis.
Asset Caption
Eoghan Hurley, MB, BCh, BAO, MCh
Keywords
arthroscopic bankart repair
recurrent instability
return to play
glenoid bone loss
shoulder instability
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