Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, California.
Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.
Arthroscopy. 2018 Oct;34(10):2894-2907.e2. doi: 10.1016/j.arthro.2018.05.031. Epub 2018 Sep 5.
To report outcomes after arthroscopic remplissage in patients with anterior shoulder instability and subcritical glenoid bone loss, specifically regarding recurrence of instability, return to sport, and changes in range of motion.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to perform a search using the PubMed, Embase, Cochrane Library, and Scopus databases. Forest plots were used to evaluate the overall values for recurrent instability, change in external rotation, and return to sport after arthroscopic Bankart repair with or without remplissage. The Methodological Index for Non-randomized Studies and Risk of Bias in Nonrandomized Studies-Interventions checklist were used to evaluate bias.
Twenty-two articles met the inclusion and exclusion criteria. The Methodological Index for Non-randomized Studies and Risk of Bias in Nonrandomized Studies-Interventions checklists deemed studies as acceptable quality with low bias. Among 694 patients (522 male and 106 female patients) undergoing remplissage, the mean age was 28.3 ± 5.3 years and the mean duration of follow-up was 32.5 ± 13.9 months. The recurrence rate of instability ranged from 0% to 20%. The change in external rotation in 90° of abduction ranged from -11.3° to -1.0°, and the change in external rotation with the arm fully adducted ranged from -8.0° to +4.5°. The overall rate of return to sport ranged from 56.9% to 100% after remplissage. The rate of return to sport at the preinjury level ranged from 41.7% to 100%. In addition, arthroscopic remplissage in addition to Bankart repair had a reduced odds of recurrent instability developing, ranging from 0.07 to 0.88, when compared with isolated Bankart repair.
Arthroscopic remplissage combined with Bankart repair is an effective procedure in the treatment of patients with engaging Hill-Sachs lesions and minimal glenoid bone loss. Patients can expect favorable rates of recurrent instability with a negligible loss of external rotation when compared with isolated Bankart repair. Treatment algorithms may be updated to include this procedure for engaging Hill-Sachs lesions, measuring between 20% and 40% in volume, with subcritical (<20%) glenoid bone loss.
Level IV, systematic review of Level III and IV studies.
报告关节镜下填充治疗肩前不稳定伴亚临界盂骨缺损患者的结果，特别是复发不稳定、重返运动和活动范围变化。
使用 Preferred Reporting Items for Systematic Reviews and Meta-Analyses 指南，通过 PubMed、Embase、Cochrane 图书馆和 Scopus 数据库进行搜索。使用森林图评估关节镜下 Bankart 修复术联合或不联合填充治疗后复发性不稳定、外旋变化和重返运动的总体值。使用非随机研究的方法学指数和非随机研究-干预措施的偏倚风险检查表评估偏倚。
22 篇文章符合纳入和排除标准。非随机研究的方法学指数和非随机研究-干预措施的偏倚风险检查表认为这些研究为高质量低偏倚。在 694 名接受填充治疗的患者（522 名男性和 106 名女性）中，平均年龄为 28.3±5.3 岁，平均随访时间为 32.5±13.9 个月。不稳定的复发率为 0%至 20%。外展 90°时外旋的变化范围为-11.3°至-1.0°，手臂完全内收时外旋的变化范围为-8.0°至+4.5°。填充治疗后重返运动的总体率为 56.9%至 100%。填充治疗后重返术前运动水平的比例为 41.7%至 100%。此外，与单纯 Bankart 修复术相比，关节镜下填充术联合 Bankart 修复术治疗Hill-Sachs 病变伴最小盂骨缺损患者，其复发性不稳定的发生几率降低，范围从 0.07 到 0.88。
关节镜下填充术联合 Bankart 修复术是治疗伴有 Hill-Sachs 病变和最小盂骨缺损患者的有效方法。与单纯 Bankart 修复术相比，患者可获得较好的复发性不稳定发生率，且外旋损失可忽略不计。治疗方案可能会更新，包括对容积为 20%至 40%、伴亚临界（<20%）盂骨缺损的 Hill-Sachs 病变进行此手术。
IV 级，对 III 级和 IV 级研究进行系统评价。
