Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A.
Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A..
Arthroscopy. 2017 Nov;33(11):2081-2092. doi: 10.1016/j.arthro.2017.06.038. Epub 2017 Aug 31.
Recurrent instability remains of concern after arthroscopic Bankart reconstruction. We evaluated various technical factors including anchor design, anchor material, number of anchors used, and interval closure on risk of recurrent instability after arthroscopic Bankart reconstruction.
A systematic review of MEDLINE and Cochrane databases was conducted, following PRISMA guidelines. Extracted data were recorded on a standardized form. Methodological index for non-randomized studies (MINORS) and Newcastle-Ottawa Scale (NOS) were used to assess study quality and risk bias. Because of study heterogeneity and low levels of evidence, meta-analysis was not possible. Pooled weighted means were calculated and individual study evaluation and comparisons (qualitative analysis) were performed for systematic review.
Of 2097 studies identified, 26 met criteria for systematic review. Pooled weighted means revealed 11.4% versus 15% recurrent instability with 3 or more suture anchors versus fewer than 3 anchors, 10.1% versus 7.8% with absorbable versus nonabsorbable suture anchors, respectively, and 8.0% versus 9.4% with knotless versus standard anchors, respectively. Interval closure did not qualitatively decrease recurrent instability or decrease range of motion.
Our systematic review reveals that despite individual study, and previous systematic reviews pointing to the contrary, the composite contemporary published literature would support no difference in the risk of recurrent instability after arthroscopic Bankart reconstruction with rotator interval closure, differing numbers of anchors used for the repair, use of knotless versus standard anchors, or use of bioabsorbable versus nonabsorbable anchors. We recommend surgeons focus on factors that have been shown to modify the risk factors after arthroscopic Bankart reconstruction, such as patient selection.
Level IV, systematic review of Level III and IV studies.
关节镜下 Bankart 重建后，复发性不稳定仍然令人担忧。我们评估了各种技术因素，包括锚定设计、锚定材料、使用的锚定数量以及间隔闭合，以评估关节镜下 Bankart 重建后复发性不稳定的风险。
根据 PRISMA 指南，对 MEDLINE 和 Cochrane 数据库进行了系统评价。从研究中提取的数据记录在标准化表格上。使用非随机研究的方法学指数 (MINORS) 和纽卡斯尔-渥太华量表 (NOS) 评估研究质量和风险偏倚。由于研究异质性和证据水平低，无法进行荟萃分析。计算了汇总加权均值，并对系统评价进行了个体研究评估和比较（定性分析）。
在 2097 项研究中，有 26 项符合系统评价标准。汇总加权均值显示，使用 3 个或更多缝线锚钉与少于 3 个锚钉相比，复发性不稳定的发生率分别为 11.4%和 15%，使用可吸收缝线锚钉与不可吸收缝线锚钉相比，复发性不稳定的发生率分别为 10.1%和 7.8%，使用无结锚钉与标准锚钉相比，复发性不稳定的发生率分别为 8.0%和 9.4%。间隔闭合并未定性地降低复发性不稳定或降低活动范围。
我们的系统评价显示，尽管个别研究和以前的系统评价表明相反，但综合当代发表的文献支持在关节镜下 Bankart 重建后，使用带或不带旋转间隔闭合、使用不同数量的锚钉修复、使用无结锚钉与标准锚钉或使用生物可吸收锚钉与不可吸收锚钉，复发性不稳定的风险没有差异。我们建议外科医生专注于已被证明可以改变关节镜下 Bankart 重建后危险因素的因素，如患者选择。
IV 级，对 III 级和 IV 级研究进行系统评价。
