Arner Justin W, McClincy Michael P, Bradley James P
University of Pittsburgh Medical Center; Burke and Bradley Orthopedics, Pittsburgh, PA.
Am J Orthop (Belle Mead NJ). 2018 Jan;47(1). doi: 10.12788/ajo.2018.0005.
In a previous study, compared with throwing athletes with superior labral anterior posterior (SLAP) tears, those with concomitant SLAP tears and rotator cuff tears (RCTs) had significantly poorer outcome scores and return to play. Posterior shoulder instability also occurs in throwing athletes, but no studies currently exist regarding outcomes of these patients with concomitant RCTs. The authors hypothesized that throwing athletes treated with arthroscopic capsulolabral repair for posterior shoulder instability with coexistent rotator cuff pathology would have poorer outcome scores and return to play. Fifty-six consecutive throwing athletes with unidirectional posterior shoulder instability underwent arthroscopic capsulolabral repair. Preoperative and postoperative patient-centered outcomes of pain, stability, function, range of motion, strength, and American Shoulder and Elbow Surgeons Shoulder (ASES) scores, as well as return to play, were evaluated. Patients with and without rotator cuff pathology were compared. Forty-three percent (24/56) of throwing athletes had rotator cuff pathology in addition to posterior capsulolabral pathology. All RCTs were débrided. At a mean of 3 years, there were no differences in preoperative and postoperative patient-centered outcomes between those with and without RCTs. Return-to-play rates showed no between-group differences; 92% (22/24) of athletes with concomitant RCTs returned to sport (P = .414), and 67% (16/24) returned to the same level (P = .430). Arthroscopic capsulolabral reconstruction is successful in throwing athletes with RCTs treated with arthroscopic débridement. Unlike the previous study evaluating throwers outcomes after surgical treatment for concomitant SLAP tears and RCTs, the authors found no difference in patient-reported outcome measures or return to play for throwing athletes with concomitant posterior shoulder instability and RCTs. In throwing athletes with concomitant posterior instability and RCTs, arthroscopic posterior capsulolabral repair with rotator cuff débridement is successful.
在之前的一项研究中，与单纯存在上盂唇前后部（SLAP）损伤的投掷运动员相比，同时存在SLAP损伤和肩袖撕裂（RCT）的运动员预后评分显著更差，且恢复运动的情况也更差。后肩部不稳定也会发生在投掷运动员中，但目前尚无关于这些合并RCT的患者预后的研究。作者推测，对于存在肩袖病变的后肩部不稳定接受关节镜下关节囊盂唇修复术治疗的投掷运动员，其预后评分会更差，恢复运动的情况也更差。56例连续的单向性后肩部不稳定的投掷运动员接受了关节镜下关节囊盂唇修复术。评估了术前和术后以患者为中心的疼痛、稳定性、功能、活动范围、力量以及美国肩肘外科医师学会肩部（ASES）评分等预后指标，以及恢复运动的情况。对合并和未合并肩袖病变的患者进行了比较。43%（24/56）的投掷运动员除了存在后关节囊盂唇病变外还存在肩袖病变。所有RCT均进行了清创。平均随访3年时，合并和未合并RCT的患者术前和术后以患者为中心的预后指标没有差异。恢复运动率在组间没有差异；合并RCT的运动员中有92%（22/24）恢复了运动（P = 0.414），67%（16/24）恢复到了之前的运动水平（P = 0.430）。关节镜下关节囊盂唇重建术对于接受关节镜清创治疗的合并RCT的投掷运动员是成功的。与之前评估合并SLAP损伤和RCT手术治疗后投掷运动员预后的研究不同，作者发现对于合并后肩部不稳定和RCT的投掷运动员，患者报告的预后指标或恢复运动情况没有差异。对于合并后肩部不稳定和RCT的投掷运动员，关节镜下后关节囊盂唇修复术联合肩袖清创术是成功的。
