Reinig Y, Welsch F, Hoffmann R, Müller D, Schüttler K F, Zimmermann E, Stein Thomas
Department of Sports Orthopedics, Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany.
Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany.
Arch Orthop Trauma Surg. 2018 Sep;138(9):1273-1285. doi: 10.1007/s00402-018-2951-8. Epub 2018 May 22.
Arthroscopic repair is one option for the surgical treatment of type II superior labrum tears from anterior to posterior (SLAP) lesions in athletes' shoulders.
Sixty-one of 78 (78.2%) athletes were retrospectively examined after isolated arthroscopic SLAP repair (group 1/G1: 28x knot-tying anchors; group 2/G2: 33 knotless anchors; follow-up 24 months) and compared to two specific, separate matched volunteer athlete control groups (group 3/G3: 28 athletes matched to G1; group 4/G4: 33 athletes matched to G2). The assessment of G1-4 included numerical analogue scales (NASs: 1-15 scales) and the Athletic Shoulder Outcome Scoring System (ASOSS) score, and the Shoulder Sport Activity Score (SSAS). The preinjury status (FU-1), the status before surgery (FU0), and at follow-up (FU1) were assessed.
High external rotation at abduction (hER) was significantly worse in G1 than G2 (FU1: G1, 86.6° ± 7.7° versus = vs G2, 91.1° ± 10.7°; p = 0.03). The ASOSS and SSAS revealed significant impairment in G1-2 compared to G3-4 (ASOSS FU1: 83.9 ± 19.9 G1 vs 94.6 ± 7.7 G3; p = 0.002 and 80.3 ± 17.7 G2 vs 91.8 ± 9.1 G4; p = 0.002; SSAS 5.9 ± 2.7 G1 vs 6.9 ± 1.8 G3; p = 0.02 and 6.3 ± 2.5 G2 vs 7.4 ± 1.4 G4; p = 0.06), with 17-20% loss on ASOSS and 23-25% deficits on SSAS. The NAS analysis detected for pain (4 ± 3.5 vs 3.2 ± 2.6), satisfaction (2 ± 0.8 vs 1.8 ± 0.9), reduction of function (4.6 ± 3.9 vs 3.9 ± 3.8) and proficiency (9.6 ± 4.7 vs 10.9 ± 3.9) similar impairments in G1-2 (p > 0.05) and better results in G3 and G4 (all p < 0.001).
After SLAP repair, athletes showed underestimated impairment of shoulder sport resumption and proficiency with high rates of shoulder sports cessation. The present data favor the knotless fixation technique, because this fixation technique allowed bilaterally equivalent ranges of motions. The uninjured shoulder athletes also showed functional deficits with significant shoulder sport impairments, which must be considered in outcome analysis and for the rehabilitation program.
III, retrospective cohort study.
关节镜修复术是运动员肩部从前到后的II型上盂唇前向至后向（SLAP）损伤手术治疗的一种选择。
对78名运动员中的61名（78.2%）进行回顾性研究，这些运动员接受了单纯关节镜下SLAP修复术（第1组/G1：28例使用打结锚钉；第2组/G2：33例使用无结锚钉；随访24个月），并与两个特定的、单独匹配的志愿者运动员对照组（第3组/G3：28名与G1匹配的运动员；第4组/G4：33名与G2匹配的运动员）进行比较。对G1 - 4组的评估包括数字模拟量表（NASs：1 - 15分制）、运动员肩部结果评分系统（ASOSS）得分以及肩部运动活动评分（SSAS）。评估了伤前状态（FU - 1）、手术前状态（FU0）和随访时状态（FU1）。
外展时高外旋（hER）在G1组显著差于G2组（FU1：G1组，86.6°±7.7°，G = vs G2组，91.1°±10.7°；p = 0.03）。与G3 - 4组相比，ASOSS和SSAS显示G1 - 2组有显著损伤（ASOSS FU1：G1组83.9±19.9，G3组94.6±7.7；p = 0.002，G2组80.3±17.7，G4组91.8±9.1；p = 0.002；SSAS：G1组5.9±2.7，G3组6.9±1.8；p = 0.02，G2组6.3±2.5，G4组7.4±1.4；p = 0.06），ASOSS损失17 - 20%，SSAS deficits 23 - 25%。NAS分析发现，G1 - 2组在疼痛（4±3.5 vs 3.2±2.6）、满意度（2±0.8 vs 1.8±0.9）、功能减退（4.6±3.9 vs 3.9±3.8）和熟练程度（9.6±4.7 vs 10.9±3.9）方面有类似损伤（p > 0.05），而G3组和G4组结果更好（所有p < 0.001）。
SLAP修复术后，运动员肩部运动恢复和熟练程度的损伤被低估，肩部运动停止率较高。目前的数据支持无结固定技术，因为这种固定技术允许双侧运动范围相等。未受伤肩部的运动员也表现出功能缺陷和明显的肩部运动损伤，在结果分析和康复计划中必须予以考虑。
III，回顾性队列研究。
