Remplissage in Addition to Arthroscopic Bankart Repair for Shoulder Instability With On-Track Hill-Sachs Lesions Reduces Residual Apprehension Without External Rotation Limitation.

PURPOSE: To evaluate the role of remplissage as an adjunct to Bankart repair in patients with recurrent anterior shoulder dislocation combined with on-track Hill-Sachs lesion. METHODS: Arthroscopic Bankart repair with remplissage data (December 2018-2020) were collected (BR group). Inclusion criteria were (1) recurrent anterior shoulder dislocation, (2) on-track Hill-Sachs lesion, (3) minimal/subcritical glenoid bone loss (<17%), and (4) postoperative follow-up >1 year. Exclusion criteria were (1) revision surgery, (2) first dislocation with acute glenoid rim fracture, and (3) combined with other surgery. The control group was identified in Bankart repair-only cohort (B group). All patients were evaluated preoperatively, and at 3 weeks, 6 weeks, 3 months, 6 months, and then annually postoperatively. Visual analogue scale for pain, Self-Assessment Numerical Evaluation, American Shoulder and Elbow Surgeons Shoulder score, ROWE, and Western Ontario Shoulder Instability were evaluated at preoperative and final follow-up. Residual apprehension experience and external rotation deficit were evaluated. Patients, who were followed-up for more than 1 year, were asked how often they experienced any subjective apprehension in 4 grades (1: always, 2: frequently, 3: occasionally, 4: never). Patients who had a history of recurrent dislocation or revision surgery were investigated. RESULTS: In total, 53 patients (B, 28; BR, 25) were included. At final follow-up, both groups showed improvement in 5 clinical scores postsurgery (P < .001). The BR group showed greater ROWE scores than the B group (B: 75.2 ± 13.6, BR: 84.4 ± 10.8; P = .009). Residual apprehension patient ratio (B: 71.4% [20/28], BR: 32% [8/25]; P = .004) and the mean subjective apprehension grade (B: 3.1 ± 0.6, BR: 3.6 ± 0.6; P = .005) showed statistically significant difference, whereas no patients in either group experienced external rotation deficit (B: 14.8 ± 12.9°, BR: 18.0 ± 15.2°, P = .420). Only 1 patient in the B group had not responded to surgery, with dislocation recurrence (P = .340). CONCLUSIONS: Remplissage with arthroscopic Bankart repair in on-track Hill-Sachs lesion has a role in reducing residual apprehension without external rotation limitation. LEVEL OF EVIDENCE: Level III, retrospective comparative therapeutic trial.

Is It Beneficial to Remove the Pedicle Screw Instrument After Successful Posterior Fusion of Thoracolumbar Burst Fractures?

STUDY DESIGN: Case-control study. OBJECTIVE: To investigate the clinical and radiological outcomes of pedicle screw removal after successful fusion of thoracolumbar burst fractures. SUMMARY OF BACKGROUND DATA: Implant removal is a common procedure in orthopedic surgery, although the benefits of and indications for removal remain controversial. Previous studies on pedicle screw removal have reported conflicting outcomes, because the study subjects and surgical goals were heterogeneous in nature. METHODS: We studied 45 consecutive patients who underwent implant removal and a control cohort of 45 age- and sex-matched patients who retained their spinal implants after successful posterior fusion of thoracolumbar burst fractures using pedicle screw instrument. In most cases, long-segment instrumentation with short-segment posterior fusion was performed. The mean elapsed period prior to implant removal after index fracture surgery was 18.3 ± 17.6 months. A visual analogue scale for back pain was applied, the Oswestry disability index calculated, and radiological parameters derived at the time of implant removal and 1 and 2 years postoperatively obtained. These data were compared with those of the control group evaluated at the same times after index fracture surgery. RESULTS: Patient demographics, mechanisms of injury, fracture morphologies, and the outcomes of index fracture surgery were similar between the 2 groups. The mean visual analogue scale and Oswestry disability index scores were better at both the 1- and 2-year follow-ups in the implant removal group than in the control group (all P values = 0.000). The segmental motion angle of the implant removal group was 1.6° ± 1.5° at the time of implant removal, and increased significantly to 5.8° ± 3.9° at 1-year follow-up (P = 0.000), and was maintained at this level at the 2-year follow-up (5.9° ± 4.1°) (P = 0.000). CONCLUSION: In patients treated successfully for thoracolumbar burst fractures, pedicle screw removal is beneficial because it alleviates pain and disability. Restoration of the segmental motion angle after implant removal may contribute to the clinical improvement. LEVEL OF EVIDENCE: 3.