Ialenti Marc N, Mulvihill Jeffrey D, Feinstein Max, Zhang Alan L, Feeley Brian T
Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, USA.
Orthop J Sports Med. 2017 Sep 14;5(9):2325967117726055. doi: 10.1177/2325967117726055. eCollection 2017 Sep.
Anterior shoulder instability can be a disabling condition for the young athlete; however, the best surgical treatment remains controversial. Traditionally, anterior shoulder instability was treated with open stabilization. More recently, arthroscopic repair of the Bankart injury with suture anchor fixation has become an accepted technique.
No systematic reviews have compared the rate of return to play following arthroscopic Bankart repair with suture anchor fixation with the Bristow-Latarjet procedure and open stabilization. We hypothesized that the rate of return to play will be similar regardless of surgical technique.
Systematic review; Level of evidence, 4.
We performed a systematic review and meta-analysis focused on return to play following shoulder stabilization. Inclusion criteria included studies in English that reported on rate of return to play and clinical outcomes following primary arthroscopic Bankart repair with suture anchors, the Latarjet procedure, or open stabilization. Statistical analyses included Student tests and analyses of variance.
Sixteen papers reporting on 1036 patients were included. A total of 545 patients underwent arthroscopic Bankart repair with suture anchors, 353 with the Latarjet procedure, and 138 with open repair. No significant difference was found in patient demographic data among the studies. Patients returned to sport at the same level of play (preinjury level) more consistently following arthroscopic Bankart repair (71%) or the Latarjet procedure (73%) than open stabilization (66%) ( < .05). Return to play at any level and postoperative Rowe scores were not significantly different among studies. Recurrent dislocation was significantly less following the Latarjet procedure (3.5%) than after arthroscopic Bankart repair (6.6%) or open stabilization (6.7%) ( < .05).
This systematic review demonstrates a greater rate of return to play at the preinjury level following arthroscopic Bankart repair and the Latarjet procedure than open stabilization. Despite this difference, >65% of all treated athletes returned to sport at their preinjury levels, with other outcome measures being similar among the treatment groups. Therefore, arthroscopic Bankart repair, the Latarjet procedure, and open stabilization remain good surgical options in the treatment of the athlete with anterior shoulder instability.
对于年轻运动员而言，肩关节前向不稳可能是一种致残性疾病；然而，最佳的手术治疗方法仍存在争议。传统上，肩关节前向不稳采用切开复位固定术进行治疗。近年来，采用缝线锚钉固定对Bankart损伤进行关节镜修复已成为一种公认的技术。
尚无系统评价比较采用缝线锚钉固定的关节镜下Bankart修复术与Bristow-Latarjet手术及切开复位固定术后的重返运动率。我们假设无论采用何种手术技术，重返运动率将相似。
系统评价；证据级别为4级。
我们进行了一项系统评价和荟萃分析，重点关注肩关节稳定术后的重返运动情况。纳入标准包括以英文发表的研究，这些研究报告了初次采用缝线锚钉进行关节镜下Bankart修复术、Latarjet手术或切开复位固定术后的重返运动率和临床结果。统计分析包括Student检验和方差分析。
纳入了16篇报告1036例患者情况的论文。共有545例患者接受了采用缝线锚钉的关节镜下Bankart修复术，353例接受了Latarjet手术，138例接受了切开修复术。各研究中的患者人口统计学数据无显著差异。与切开复位固定术（66%）相比，采用关节镜下Bankart修复术（71%）或Latarjet手术（73%）的患者更一致地以相同运动水平（伤前水平）重返运动（P<0.05）。各研究中在任何水平重返运动的情况及术后Rowe评分无显著差异。Latarjet手术后复发性脱位（3.5%）明显少于关节镜下Bankart修复术（6.6%）或切开复位固定术（6.7%）（P<0.05）。
该系统评价表明，与切开复位固定术相比，采用关节镜下Bankart修复术和Latarjet手术在伤前水平的重返运动率更高。尽管存在这一差异，但所有接受治疗的运动员中有超过65%以伤前水平重返运动，各治疗组的其他结果指标相似。因此，关节镜下Bankart修复术、Latarjet手术和切开复位固定术仍是治疗肩关节前向不稳运动员的良好手术选择。
