Bessière Charles, Trojani Christophe, Carles Michel, Mehta Saurabh S, Boileau Pascal
Department of Orthopaedic Surgery & Sports Traumatology, Hôpital de L'Archet, University of Nice-Sophia Antipolis, 151, Route de St Antoine de Ginestière, 06202, Nice, France.
Clin Orthop Relat Res. 2014 Aug;472(8):2345-51. doi: 10.1007/s11999-014-3550-9.
Arthroscopic Bankart repair and open Latarjet bone block procedure are widely considered mainstays for surgical treatment of recurrent anterior shoulder instability. The choice between these procedures depends mainly on surgeon preference or training rather than published evidence.
QUESTIONS/PURPOSES: We compared patients with recurrent posttraumatic anterior shoulder instability treated with arthroscopic Bankart or open Latarjet procedure in terms of (1) frequency and timing of recurrent instability, (2) risk factors for recurrent instability, and (3) patient-reported outcomes.
In this retrospective comparative study, we paired 93 patients undergoing open Latarjet procedures with 93 patients undergoing arthroscopic Bankart repairs over the same period for posttraumatic anterior shoulder instability by one of four surgeons at the same center. Both groups were comparable except that patients in the Latarjet group had more glenoid lesions and more instability episodes preoperatively. Minimum followup was 4 years (mean, 6 years; range, 4-10 years). Patients were assessed with a questionnaire, including stability, Rowe score, and return to sports. Recurrent instability was defined as at least one episode of recurrent dislocation or subluxation. Return to sports was evaluated using a 0% to 100% scale that patients completed after recovery from surgery. Various risk factors for recurrent instability were also analyzed.
At latest followup, 10% (nine of 93) in the Latarjet group and 22% (20 of 93) in the Bankart group demonstrated recurrent instability (p = 0.026; odds ratio, 0.39; 95% CI, 0.17-0.91). Ten recurrences in the Bankart group (50%) occurred after 2 years, compared to only one (11%) in the Latarjet group. Reoperation rate was 6% and 7% in the Bankart and Latarjet groups, respectively. In both groups, patients younger than 20 years had higher recurrence risk (p = 0.019). In the Bankart group, independent factors predictive for recurrence were practice of competitive sports and shoulder hyperlaxity (ie, passive external rotation > 85° in the contralateral uninjured shoulder). Although return to sports was not different between groups, the mean Rowe score was higher in the Latarjet group (78 versus 68, p = 0.018).
Patients who had the open Latarjet procedure had less recurrent instability and better Rowe scores over a mean 6-year followup. We now perform isolated arthroscopic Bankart repair for carefully selected patients, including patients with an Instability Severity Index Score of 3 or less.
Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
关节镜下Bankart修复术和开放Latarjet骨块手术被广泛认为是复发性前肩不稳手术治疗的主要方法。这两种手术方式的选择主要取决于外科医生的偏好或培训，而非已发表的证据。
问题/目的：我们比较了接受关节镜下Bankart手术或开放Latarjet手术治疗的复发性创伤后前肩不稳患者在以下方面的情况：（1）复发性不稳的频率和时间；（2）复发性不稳的危险因素；（3）患者报告的结果。
在这项回顾性比较研究中，我们将93例行开放Latarjet手术的患者与同期93例行关节镜下Bankart修复术的患者配对，这些患者均因创伤后前肩不稳由同一中心的四位外科医生之一进行治疗。两组具有可比性，只是Latarjet组患者术前有更多的肩胛盂损伤和更多的不稳发作。最短随访时间为4年（平均6年；范围4 - 10年）。通过问卷调查对患者进行评估，包括稳定性、Rowe评分和恢复运动情况。复发性不稳定义为至少一次复发性脱位或半脱位发作。使用患者术后恢复后完成的0%至100%量表评估恢复运动情况。还分析了复发性不稳的各种危险因素。
在最近一次随访时，Latarjet组10%（93例中的9例）和Bankart组22%（93例中的20例）出现复发性不稳（p = 0.026；比值比，0.39；95%可信区间，0.17 - 0.91）。Bankart组20例复发中有10例（50%）发生在2年后，而Latarjet组仅1例（11%）。Bankart组和Latarjet组的再次手术率分别为6%和7%。在两组中，年龄小于20岁的患者复发风险更高（p = 0.019）。在Bankart组中，预测复发的独立因素是参加竞技运动和肩部过度松弛（即对侧未受伤肩部被动外旋>85°）。尽管两组恢复运动情况无差异，但Latarjet组的平均Rowe评分更高（78分对68分，p = 0.018）。
在平均6年的随访中，接受开放Latarjet手术的患者复发性不稳更少，Rowe评分更高。我们现在为精心挑选的患者，包括不稳定严重程度指数评分为3分或更低的患者，进行单纯的关节镜下Bankart修复术。
III级，治疗性研究。有关证据水平的完整描述，请参阅作者须知。
