Arthroscopic Stabilisation in Anterior Shoulder Instability: An Analysis of Mid-term Outcome.

OBJECTIVE: To assess the clinical outcome of arthroscopic stabilisation for recurrent anterior glenohumeral joint dislocations. STUDY DESIGN: Case series. Place and Duration of the Study: Ghurki Trust Teaching Hospital, Lahore, from May 2018 to December 2022. METHODOLOGY: Fifty-two patients who underwent arthroscopic repair of Bankart lesion were studied. Those who had concomitant fractures, neurological injury or underwent any surgery on the same shoulder were excluded. The outcome was assessed in terms of improvement in pain, constant and Rowe scores, postoperatively. RESULTS: The mean delay in the procedure after the first dislocation was 65.15+38.23 months, and the mean follow-up period was 26.61+7.55 months. On final follow-up, improvement in pain was statistically significant (p<0.05): (VAS: 2.17+1.77 to 0.69+0.64 at rest and from 4.5+2.24 to 1.58+1.85 at motion). On subjective assessment, 50% of the sample was very satisfied, and an objective assessment showed statistically significant (p<0.05) improvement in Constant score from 65.4 to 78.6. Rowe score not only showed a significant improvement (from 31.6 to 80.3 with p<0.05), but 69.2% of the follow-up scores lied in the good and excellent results range as well. Recurrence was noted in 8 cases (15.3%). CONCLUSION: Significant clinical improvement was seen after arthroscopic stabilisation in anterior shoulder instability. However, further research is required regarding the recurrence rate and restriction in the range of motion. KEY WORDS: Glenohumeral joint, Dislocation, Stabilisation, Shoulder arthroscopy.

Impact of metal density on deformity correction in posterior fusions for adolescent idiopathic scoliosis: A retrospective cohort study.

INTRODUCTION: Optimal implant density for posterior spinal fusion in adolescent idiopathic scoliosis (AIS) remains controversial. We aimed to examine radiographic outcomes of AIS cases treated with limited density pedicle screw constructs. METHODS: This is a retrospective analysis of 96 patients (89 females and 7 males with mean age of 13.8 ± 4.4 years) with AIS who underwent posterior spinal instrumentation at Ghurki Trust Teaching Hospital between 2014 and 2016. Construct characteristics and radiographic measurements were compared preoperatively and at 2 year follow-up using paired t-test. Pearson's correlation coefficient between curve characteristics and metal density was calculated. RESULTS: Preoperative coronal Cobb angle was 68.5 ± 6.9°. Flexibility of the curve was 47.5 ± 10.3% based on push-prone films. The mean number of vertebrae in the fusion was 10.7 ± 1.6. The implant density was 62%. The mean postoperative Cobb angle was 18.6 ± 4.2°, giving a mean correction of 72.5 ± 6.8%. Metal density was not correlated with preoperative coronal or sagittal radiographic variables; MT Cobb angle (r = 0.02, p = 0.847), MT curve flexibility (r = 0.129, p = 0.210), preoperative thoracic kyphosis (r = -0.119, p = 0.247) or lumbosacral lordosis (r = -0.048, p = 0.645). There was a significant correlation between the flexibility of the curve as assessed by push-prone radiographs with the percentage correction achieved (r = 0.368, p < 0.0001) as well as absolute correction in degrees (r = 0.643, p < 0.0001). No significant correlations were present between metal density and MT curve coronal correction rate/percentage (r = 0.086, p = 0.407) or postoperative Cobb angle (r = 0.098, p = 0.344). CONCLUSION: Metal density does not influence the coronal and sagittal correction of AIS. Neither larger nor stiffer curves necessitate high metal density. LEVEL OF EVIDENCE: IV.

Immediate Effect of Continuous Ultrasound vs Sham Ultrasound for Bilateral Masseter Myalgia: A Double-Blinded Trial.

AIMS: To investigate the local and segmental effects of therapeutic ultrasound at a dose of 0.4 w/cm2 with 100% duty cycle for 5 minutes compared to the effect of sham ultrasound on painful masticatory muscles. METHODS: A total of 20 adult female subjects with bilateral masseter myalgia diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were included. Each subject was randomized to either an active ultrasound group or a sham ultrasound group. The intervention was applied to each masseter muscle for 5 minutes. Measures included pre- and post-self-reported pain intensity recorded on a verbal rating scale (VRS), pressure pain thresholds for the masseter (PPT-M) and temporalis (PPT-T) muscles, and intraoral temperature for the masseter muscle. Preintervention score was subtracted from the postintervention score for all measures to calculate mean change in pain, and nonparametric Mann-Whitney test was used to compare the groups. Statistical significance was set at P < .05. RESULTS: Changes in VRS did not show a significant difference between groups (P > .05). There were significant increases in PPT-M and intraoral temperature in the ultrasound group compared to the sham group (P < .05). There was no significant difference in PPT-T (P > .05), suggesting no segmental effect. CONCLUSION: Therapeutic ultrasound produced an immediate increase in PPT-M and intraoral temperature compared to sham ultrasound in female subjects with bilateral masseter myalgia.