Episode 48. Dr. Brian Lau: Shoulder Instability- Part I
On today’s episode we’re focusing on anterior shoulder instability with Dr. Brian Lau, orthopedic sports medicine surgeon, team physician for Duke Athletics and Director of the FIFA Medical Center at Duke.
We have some great articles for you that contribute well to our conversation on the treatment of primary anterior shoulder instability. We’ll start off our discussion today with a level I RCT published in the March 2020 issue of JBJS titled Primary Arthroscopic Stabilization for a First-Time Anterior Dislocation of the Shoulder, a single-center double-blinded clinical trial compared arthroscopic washout to arthroscopic Bankart repair for the management of primary anterior shoulder instability. At an average follow up of 14 years, the rate of recurrent dislocation was significantly higher in the washout group compared to the Bankart repair group, at 47% compared to 12%.
The arthroscopic Bankart repair group also demonstrated significantly better clinical outcome scores, including the WOSI and DASH scores. Then, from the June issue of JSES this year, we review the publication titled Remplissage Reduces Recurrent Instability in High-risk Patients with On-track Hill-Sachs Lesions. Albert Lin and Pat Denard performed a multicenter retrospective study of patients with on-track Hill Sachs lesions who underwent arthroscopic Bankart repair with or without the addition of a Remplissage procedure. We’ll discuss on-track versus off-track Hill Sachs lesions, how you go about calculating this and what to do with this information in a little bit with our guest. So, for now, we’ll just focus on the results of this study, which showed that the addition of a remplissage was associated with a lower rate of recurrent dislocation
(1.8% vs. 11%) and revision surgery (0% vs. 6%). Remplissage protected against recurrent instability, particularly in high-risk patients.
We are joined today by Dr. Brian Lau, a board-certified orthopedic surgeon dual-fellowship-trained in both sports medicine surgery and foot & ankle surgery. Dr. Lau obtained his medical degree from the University of Pittsburgh and completed his orthopedic residency at UC San Francisco. He then went on to complete two fellowships – the first in Sports Medicine and Shoulder Surgery at Duke University and the second in Foot & Ankle Surgery at Stanford University. Following training, Dr. Lau returned to Duke University, where he is a team physician for Duke Athletics and the Director of the FIFA Medical Center at Duke. Dr. Lau is the associate program director of the Duke Orthopedic Sports Medicine and Shoulder fellowship and serves on numerous educational committees in AOSSM, AANA and ASES. He is passionate about research and leads the Duke Sports Medicine Research Committee.
