Elsenbeck Michael J, Dickens Jonathan F
Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bldg. 19, Fl 2, Bethesda, MD, 20889, USA.
Curr Rev Musculoskelet Med. 2017 Dec;10(4):491-498. doi: 10.1007/s12178-017-9440-5.
Young athletes continue to experience traumatic shoulder instability and are often plagued by recurrent instability, limiting their return to sport. The purpose of this paper was to review return to sport in athletes after shoulder stabilization surgery for anterior shoulder instability.
Athletes managed nonoperatively demonstrate unacceptably high rates of recurrent instability and are less likely to successfully return to sport. Operative management includes capsuloligamentous repair (arthroscopic versus open) and bone augmentation techniques. While modern arthroscopic techniques have provided favorable outcomes, open techniques have demonstrated lower recurrence rates among young collision athletes. A subset of athletes continue to experience recurrent instability, leading to further investigation of concomitant pathologies, which may put patients at risk of failure following Bankart repair. Bony augmentation procedures remain favorable for patients with glenoid bone loss; however, what constitutes critical bone loss in the decision between anterior labral repair versus bone augmentation has recently been questioned. Operative management of anterior shoulder instability provides superior results, including lower recurrent instability and return to sport. Future research on patient-specific risk factors may aid surgical decision-making and optimization of outcomes.
年轻运动员持续经历创伤性肩关节不稳定，且常受反复不稳定困扰，限制了他们重返运动。本文旨在综述前肩关节不稳定患者行肩关节稳定手术后重返运动的情况。
非手术治疗的运动员复发性不稳定发生率高得令人难以接受，且成功重返运动的可能性较小。手术治疗包括关节囊韧带修复（关节镜手术与开放手术）和骨增强技术。虽然现代关节镜技术已取得良好效果，但开放手术在年轻碰撞项目运动员中复发率更低。一部分运动员仍经历反复不稳定，这促使人们进一步研究相关合并病变，这些病变可能使患者在Bankart修复术后面临失败风险。骨增强手术对存在肩胛盂骨质流失的患者仍有优势；然而，在前盂唇修复与骨增强决策中，何为关键骨质流失近来受到质疑。前肩关节不稳定的手术治疗效果更佳，包括更低的复发性不稳定和更高的重返运动率。未来针对患者特异性风险因素的研究可能有助于手术决策及优化治疗结果。
