PurposeThe evaluation of the long-term outcome of the arthroscopic remplissage performed in addition to the classic Bankart repair for the primary management of recurrent anterior shoulder instability with engaging Hill-Sachs lesion without inverted pear appearance of the glenoid during arthroscopy. Methods During a 6-year period, from 2007 to 2012, 65 patients whose average age was 30.1 ± 7.6 years were operated on in our department and satisied the inclusion criteria of this study. They all had a positive apprehension sign preoperatively. Among them, 51 patients (82%) were available for long-term evaluation. The mean follow-up period was 8.1 ± 1.8 years (range 5.6-10.6). Results Three patients (5.6%) had sufered a new dislocation. The remaining patients (94.4%) were satisied with the surgical result and returned to their previous daily activities, whereas 71% continued to participate in sports without restrictions. The ASES score increased from 72.5 (range 18-100) preoperatively to 100 (range 85-100) postoperatively (p < 0.01). The modiied Rowe score increased from 40 (range 15-70) to 100 (range 70-100) (p < 0.001), and the Oxford Instability score from 29 (range 9-47) to 48 (range 36-48) (p < 0.001). No signiicant restriction in the shoulder range of motion was documented. Conclusions The combination of the arthroscopic remplissage with the classic Bankart repair was proven to be a safe and efective procedure for the treatment of "engaging" Hill-Sachs lesions without inverted pear appearance of the glenoid. This combination has long-term outcomes in terms of the recurrence rate and does not signiicantly inluence the range of motion of the shoulder. Level of evidence Therapeutic Study-Case series with no comparison group, Level IV.

Background:The surgical treatment of a Superior Labrum Anterior and Posterior (SLAP) lesion becomes more and more frequent as the surgical techniques, the implants and the postoperative rehabilitation of the patient are improved and provide in most cases an excellent outcome.Objective:However, a standard therapy of SLAP lesions in the shoulder surgery has not been established yet. An algorithm on how to treat SLAP lesions according to their type and data on the factors that influence the surgical outcome is essential for the everyday clinical practice.Method:In this article, a retrospective evaluation of patients with SLAP lesion, treated surgically in our orthopaedic clinic was conducted.Results:According to the clinical outcome and our experience with the surgical therapy of SLAP lesions we demonstrate an algorithm on the proper therapeutic approach.Conclusion:SLAP I lesions are treated with debridement. Most controversies concern patients with SLAP II lesions, whose therapy is either fixation of the superior labrum or tenotomy/tenodesis of the long head of the biceps tendon. For patients with SLAP III or IV lesions the most commonly accepted approach is tenotomy or tenodesis of the long head of biceps tendon.

after PIAC. There was no difference in regard to knee function (n.s.), but straight leg raising was significant better following PIAC. There were two falls in patients with CFNB. Conclusion Peri-capsular injections combined with an intra-articular catheter provide better pain control, no rebound pain with better function and might decrease the risk of complications related to motor weakness. Level of evidence I.

No abstract

Background:TKA is a worldwide established surgery with periarticular infiltrations being scientifically funded is the superiority of in the perioperative setup of TKA nowadays. However, nerve blocks are still widely used as perioperative standard meaning possible analgesia beyond surger, but simultaneously with sensomotoric deficiency and resulting risk of fall as well as increased pain after removal of nerval catheters. Also a standard procedure is intubation which means immediate pain after awakening of patients with resulting need for sufficient oral, intravenous, intramuscular or subcutaneous analgesia. We present an actual review of the literature and an own RCT comparing infiltrations with nerve blocks, which to our best knowledge presents the first RCT combined with an additional continous part.Methods: Literature review (PubMed)Own RCT: 50 TKA were randomized and prospectively included. 25 patients received nerve blocks with a single ischiadicus block and a femoralis block with additional perineural catheter. 25 patients received periarticular infiltrations together with an intraarticular catheter (PIA). All catheters stayed for 4 days. Both groups received a laryngeal masc. Postoperative mobilisation, surgeon and type of prosthesis were the same in all patients. The following was evaluated pre- and postoperatively (first, third and sixth hour, first until sixth day): VAS, additional analgetics/ opioids, KSS score, knee function and ability to raise the straightened leg. Complications as infection, falls, DVT etc. were recorded. Results:Periarticular infiltrations are superior to other options in the perioperative setup of TKA which is clearly shown by literature (several studies including reviews) as well as the results of our own RCT: Pain occured in both groups, however, VAS, additional analgetics/ opioids and KSS score as well as the ability to raise the straightened leg were significantly better following PIA (p<0,01), with comparable knee function in both groups. There were two falls and one superficial infection of catheter site following nerve blocks, however, without sequelae.Conclusion:All analgesic/ anaesthetic options can be done perioperatively in TKA with success with, however, clear superiority of PIA. Compared to nerve blocks PIA reduces the risk for falls, prevents a pain-„rebound“ with removal of perineural catheters and is beneficial for patients throughout the whole hospitalisation.