Hospital for Special Surgery Sports Medicine and Shoulder Service, New York, New York 10021, USA.
Am J Sports Med. 2010 Feb;38(2):302-7. doi: 10.1177/0363546509348049. Epub 2009 Dec 22.
Arthroscopic treatment has evolved to become the primary surgical option in the management of anterior shoulder instability as studies show comparable outcomes between open and arthroscopic techniques.
To evaluate prospectively the results of our institutional database for arthroscopic Bankart repairs at a minimum 2-year follow-up for patients with anterior instability treated with suture anchors.
Case series; Level of evidence, 4.
Eighty-three consecutive patients underwent arthroscopic Bankart repair with suture anchors. The mean age at the time of surgery was 33 years (range, 15-55 years). At an average follow-up of 33 months (range, 24-49 months), 73 patients (61 males, 12 females) were assessed with outcomes scores including the American Shoulder and Elbow Surgeons, L'Insalata, and visual analog scores. The rate of recurrent instability, range of motion, and risk factors for postoperative recurrence were evaluated.
Thirteen patients (18%) suffered a recurrence after surgery. Seven patients (10%) had a subsequent dislocation and 6 (8%) a subluxation event or apprehension. Six of the 13 had a traumatic event that resulted in recurrent episodes of instability. Revision surgery was needed for 2 patients (3%) for instability and 2 for postoperative shoulder stiffness. On average there was no significant loss of external rotation postoperatively (average, 71 degrees pre- and postoperatively). The American Shoulder and Elbow Surgeons and L'Insalata scores improved from 75.4 to 94.9 and 66.5 to 90.9, respectively (P <.0001). The visual analog score improved from 2.4 to 0.4 (P <.001). Patient age under 25, ligamentous laxity, and the presence of a large (>250 mm(3)) Hill-Sachs lesion were associated with recurrence (P <.05). Patients under age 20 had a 37.5% recurrence rate.
In the arthroscopic treatment of anterior instability, identification of risk factors for recurrence allows for appropriate patient counseling and consideration of open stabilization. In our series, patients under age 25, with ligamentous laxity, and with a large (>250 mm(3)) Hill-Sachs lesion were at the greatest risk of recurrence.
关节镜治疗已经发展成为治疗前肩不稳定的主要手术选择，因为研究表明开放和关节镜技术的结果相当。
前瞻性评估我们机构数据库中使用缝线锚钉治疗前肩不稳定的关节镜 Bankart 修复的结果，随访时间至少为 2 年。
病例系列；证据水平，4 级。
83 例连续患者接受关节镜 Bankart 修复术，缝线锚钉固定。手术时的平均年龄为 33 岁（范围，15-55 岁）。平均随访 33 个月（范围，24-49 个月），73 例（61 例男性，12 例女性）用美国肩肘外科医生协会（American Shoulder and Elbow Surgeons）、L'Insalata 和视觉模拟评分（visual analog score）进行评估。评估了复发性不稳定的发生率、运动范围以及术后复发的危险因素。
13 例（18%）患者术后复发。7 例（10%）发生再次脱位，6 例（8%）发生半脱位或有不安感。其中 6 例有创伤性事件导致不稳定反复发作。2 例（3%）因不稳定和 2 例（3%）因术后肩部僵硬需要翻修手术。平均术后外旋无明显丧失（平均术前和术后分别为 71 度）。美国肩肘外科医生协会和 L'Insalata 评分分别从 75.4 分提高到 94.9 分和 66.5 分提高到 90.9 分（P<.0001）。视觉模拟评分从 2.4 分改善至 0.4 分（P<.001）。患者年龄<25 岁、韧带松弛和存在较大（>250 mm(3)）Hill-Sachs 病变与复发相关（P<.05）。<20 岁的患者复发率为 37.5%。
在前肩不稳定的关节镜治疗中，识别复发的危险因素可以为患者提供适当的咨询，并考虑开放稳定。在我们的系列中，年龄<25 岁、韧带松弛和存在较大（>250 mm(3)）Hill-Sachs 病变的患者复发风险最大。
