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2022 AOSSM Annual Meeting Recordings with CME
Remplissage Reduces the Risk of Postoperative Recu ...
Remplissage Reduces the Risk of Postoperative Recurrent Instability versus Bankart Repair Alone: Medium-term Results from a Randomized Controlled Trial
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Video Transcription
To present our work, we have no disclosures related to this project. So arthroscopic repair of capsulolabral complex has become the most common intervention for recurrent anterior instability, but there's an increased risk of recurrent dislocation after repair in patients of younger age, those that participate in competitive contact or overhead sports, hyperlaxity, and radiographic findings of glenoid bone loss and or Hill Sachs lesion. The Hill Sachs lesion has been identified as a common pathology and has been found to be significantly associated with recurrent instability. And as was just presented, the importance of bony defects play in recurrent instability following soft tissue procedures led to the concept of the engaging Hill Sachs lesion with the evolution of the on-track off-track lesions further highlighted the role of bone defects in post-op failure. So the term remplissage translated from French means to fill in, and the arthroscopic remplissage was first described by Wolf and Purchase, was thought to prevent the engagement phenomena by making the Hill Sachs defect extra articular. Our research group conducted a randomized trial beginning in 2011 comparing remplissage versus no remplissage with anterior shoulder stabilization in patients with traumatic recurrent shoulder instability, a Hill Sachs lesion confirmed on CT or MRI, and less than 15% glenoid bone loss. The endpoint for that original trial was two years post-op, and we found no differences in our patient-reported outcomes, but there was a difference in recurrent instability in favor of remplissage at 18% versus 4%. So this provided support for the benefits of remplissage in the short term, but its effectiveness in preventing late failures remained unclear. The aim of the current study was to compare medium-term outcomes of patients previously randomized, the rate of recurrent instability, and instances of re-operation were examined. The original study was double-blind RCT with two parallel groups conducted at two sites between 2011 and 2017. In early 2020, an attempt was made by a blind assessor to contact all patients by phone. Participants were asked a series of standardized questions regarding instances of subluxation or dislocation on the affected side and dates of these occurrences, and they were asked if they'd undergone any additional surgeries, and a chart review was done. We defined failure as a recurrence of a dislocation, and recurrent instability was defined as the participant reporting a dislocation or two or more occurrences of subluxation sometime after the first year post-op. So here's the demographics of the two groups, which were comparable based on sex, age, BMI, and the proportion that played contact sports. The mean number of months from surgery to follow-up was 49.3 for the no-REMP group and 53.8 for the REMP group. 11 of 50 in the no-REMP group dislocated in an average of 16 months post-op, compared to 4 of 52 in the REMP group at an average of 24 months. 15 of 50 in the no-REMP group had recurrent instability at an average of 11 months, compared to 5 of 52 in the REMP group at an average of 16 months. So based on Kapler-Meier's survival curve analyses, we found a significant difference between groups for dislocation favoring REMPlessage, as you can see by the diverging lines here. And this was also the case for recurrent instability, as seen here. As in our original study, we also conducted a sub-analysis of those that we deemed high risk for re-injury, with the heel socks greater than or equal to 15% of the humeral head diameter, or a width greater than or equal to 2 centimeters. And once again, the results favored having undergone a REMPlessage. Looking at re-operations, we also looked at re-operations in those that did not undergo REMPlessage had higher incidence of re-operation than those that did. So in summary, those that did not undergo REMPlessage had higher rates of recurrence, earlier time to recurrence, and higher rate of re-operation. And at medium-term follow-up REMPlessage, in conjunction with arthroscopic bank heart repair results in lower risk of post-op recurrent instability and dislocation, compared to those who undergo bank heart repair alone. Thank you.
Video Summary
In this video, the speaker discusses the use of arthroscopic repair of the capsulolabral complex for recurrent anterior instability in the shoulder. They mention the increased risk of recurrent dislocation after repair in younger patients, those who participate in competitive sports, and those with glenoid bone loss or Hill Sachs lesions. The speaker explains the concept of engaging Hill Sachs lesion and the use of arthroscopic remplissage to prevent engagement by making the defect extra articular. They discuss the results of a randomized trial comparing remplissage to no remplissage, showing a difference in recurrent instability in favor of remplissage. The aim of the current study is to compare medium-term outcomes and rates of re-operation in these patients. The speaker presents the demographic details of the two groups and discusses the results, which show a significant difference in dislocation and recurrent instability favoring remplissage. They also note that re-operations were more common in the group that did not undergo remplissage. In summary, remplissage in conjunction with arthroscopic bankart repair leads to a lower risk of recurrent instability and dislocation compared to bankart repair alone. No credits were mentioned in the video.
Asset Caption
Sheila McRae
Keywords
arthroscopic repair
recurrent instability
remplissage
dislocation
re-operations
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