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11/08/2013
1
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“Surgery for Primary Shoulder Instability”
Presented by: Prof. George Murrell MBBS (Adel), MD (UNSW), DPhil (Oxon)
Will commence LIVE from Sydney, Australia at 8pm AEST
Andrew Ellis BSc (Ex. Sci), M. Phty
World Health Webinars CEO
World Health Webinars Host
Musculoskeletal Physiotherapist
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Prof George Murrell
• Director of the Orthopaedic Research Institute at St George Hospital
• Professor at the UNSW
• 1984 South Australian Rhodes Scholar
• completed a DPhil (PhD) at Oxfor and was awarded the Royal College of Surgeons Arris and Gale medal.
• gained a National Institutes of Health First Award
• serves on the editorial boards of the Journal of Shoulder and Elbow Surgery, Shoulder and Elbow, Techniques in Shoulder and Elbow Surgery and the British Journal of Sports Medicine.
• His team has won over 30 awards for their work and his fellowship program attracts surgeons from around the world.
Orthopaedic Surgeon
11/08/2013
2
Surgery for Primary Shoulder Instability
Gleno-humeral Ligaments
Ligaments with abduction
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Proprioception
Reduced in a shoulder that has dislocated
Restored following surgical repair
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11/08/2013
3
Shoulder Instability
Diagnosis
• History
• Clinical exam
Mechanism of Injury Load and Shift
Apprehension sign PREVIEW ONLY
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Augmentation sign
11/08/2013
4
Relocation sign Treatment
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Non-operative Rx
Increasing the rigidity of immob
No change in rec rate
Increasing the length of immob
No change in rec rate
No effect on reduced proprioception
Eiji Itoi, MD, PhD
Bankart
lesion
11/08/2013
5
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Immobilization in ER
Prototype brace (2003 – 2004)
Itoi et al: JBJS-Am 2007
ER Brace
Immob in ER reduces RR by 38-49%
Length of immob = 3 weeks
Position of immob
Method of immob
Shoulder Brace ER® (ALCARE)
(2004 – Present)
Non-operative Rx
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Open stabilisation
Arthroscopic stabilisation
Putti Platt
Open capsular Shift
Open Bankart Repair
Bankart Repair
Tacks, Metal anchors, Bioabsorbable anchors
11/08/2013
6
Bristow Putti-Platt
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Open Bankart Repair Arthroscopy
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11/08/2013
7
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Aims
Determine the clinical outcomes of four (4) knotless suture anchors
Karin Peters
Methods
Suretac Smith and Nephew Poly-glconate-B (PLA)
Bioknotless DePuy Mitek Poly-D-L-lactic acid (PLLA)
OPUS® Labrafix® ArthroCare Stainless steele
Pushlock Arthrex PEEK
Methods
Suretac Smith and Nephew Poly-glconate-B (PLA)
Bioknotless DePuy Mitek Poly-D-L-lactic acid (PLLA)
OPUS® Labrafix® ArthroCare Stainless steele
Pushlock Arthrex PEEK
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11/08/2013
8
Methods
Suretac Smith and Nephew Poly-glconate-B (PLA)
Bioknotless DePuy Mitek Poly-D-L-lactic acid (PLLA)
OPUS® Labrafix® ArthroCare Metal
Pushlock Arthrex PEEK
Methods
Suretac Smith and Nephew Poly-glconate-B (PLA)
Bioknotless DePuy Mitek Poly-D-L-lactic acid (PLLA)
OPUS® Labrafix® ArthroCare Metal
Pushlock Arthrex PEEK
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Methods
Suretac Smith and Nephew Poly-glconate-B (PLA)
Bioknotless DePuy Mitek Poly-D-L-lactic acid (PLLA)
OPUS® Labrafix® ArthroCare Stainless steele
Pushlock Arthrex PEEK
Ab
sorb
able
Pe
rman
ent
Surgery - Interscalene Block Beach Chair
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11/08/2013
9
Primary Outcome
Stability
Complications
Intra-operative Suretac 3 cases: tac pulled out
Bioknotless 3 cases: tip of inserter
broke off
Post-operatively Pushlock 1 case of adhesive
capsulitis
Labrafix 1 case loose anchor
Suretac 1 case of synovitis
secondary to
Suretac anchors
Survival Analysis
Time
0 2 4 6 8 10 12
Surv
ival
0,0
0,2
0,4
0,6
0,8
1,0SURETAC
BIOKNOTLESS
PUSHLOC
OPUS LABRAFIX
20%
40%
60%
80%
100%
(Years)
*** **
Kaplan-Meier analysis for redislocation
Time (years)
Survival Analysis
Time
0 2 4 6 8 10 12
Surv
ival
0,0
0,2
0,4
0,6
0,8
1,0SURETAC
BIOKNOTLESS
PUSHLOC
OPUS LABRAFIX
20%
40%
60%
80%
100%
(Years)
*** **
Kaplan-Meier analysis for redislocation
Time (years)
Survival Analysis
Time
0 2 4 6 8 10 12
Surv
ival
0,0
0,2
0,4
0,6
0,8
1,0SURETAC
BIOKNOTLESS
PUSHLOC
OPUS LABRAFIX
20%
40%
60%
80%
100%
(Years)
*** **
Kaplan-Meier analysis for redislocation
Time (years)
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Survival Analysis
Time
0 2 4 6 8 10 12
Surv
ival
0,0
0,2
0,4
0,6
0,8
1,0SURETAC
BIOKNOTLESS
PUSHLOC
OPUS LABRAFIX
20%
40%
60%
80%
100%
(Years)
*** **
Kaplan-Meier analysis for redislocation
Time (years)
11/08/2013
10
Survival Analysis
Time
0 2 4 6 8 10 12
Surv
ival
0,0
0,2
0,4
0,6
0,8
1,0SURETAC
BIOKNOTLESS
PUSHLOC
OPUS LABRAFIX
20%
40%
60%
80%
100%
(Years)
*** **
Kaplan-Meier analysis for redislocation
Time (years)
Survival Analysis
Time
0 2 4 6 8 10 12
Surv
ival
0,0
0,2
0,4
0,6
0,8
1,0SURETAC
BIOKNOTLESS
PUSHLOC
OPUS LABRAFIX
20%
40%
60%
80%
100%
(Years)
*** **
Kaplan-Meier analysis for redislocation
Time (years)
***
***
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Survival Analysis
Time
0 2 4 6 8 10 12
Surv
ival
0,0
0,2
0,4
0,6
0,8
1,0SURETAC
BIOKNOTLESS
PUSHLOC
OPUS LABRAFIX
20%
40%
60%
80%
100%
(Years)
*** **
Kaplan-Meier analysis for redislocation
Time (years) Time
0 2 4 6 8 10 12
Surv
ival
0,0
0,2
0,4
0,6
0,8
1,0SURETAC
BIOKNOTLESS
PUSHLOC
OPUS LABRAFIX
20%
40%
60%
80%
100%
(Years)
No significant differences between the groups
Kaplan-Meier analysis for revision surgery
Summary
Bankart lesion
Summary
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11/08/2013
11
Summary
Restore detached labrum
Avoid biodgradable anchors
Summary
Metal or PEEK
Excellent outcomes
Minimal complications
< 6-8% recurrence at 4 years
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Summary
Ongoing follow-up essential
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THANK YOU
Live Q & A With George Murrell
Coming up next week
11/08/2013
12
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Live Q & A With George Murrell
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From George Murrell
&
World Health Webinars Australia http://worldhealthwebinars.com.au
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