The Arm Clinic, HCA The Wilmslow Hospital, Wilmslow, UK.
University of Salford, Salford, UK.
Am J Sports Med. 2018 Oct;46(12):2969-2974. doi: 10.1177/0363546518794673. Epub 2018 Sep 10.
Traumatic glenohumeral dislocation of the shoulder is one of the most common shoulder injuries, especially among adolescent athletes. The treatment of instability for young athletes continues to be controversial owing to high recurrence rates.
To investigate the recurrence rate of shoulder instability after arthroscopic capsulolabral repair for adolescent contact and collision athletes.
Case series; Level of evidence, 4.
Sixty-seven patients aged <18 years underwent an arthroscopic labral repair over a 5-year period. The mean ± SD age of the cohort was 16.3 ± 0.9 years (range, 14-17 years) and consisted of 1 female and 66 males. All patients were contact athletes, with 62 of 67 playing rugby. Demographic, clinical, and intraoperative data for all patients with shoulder instability were recorded in our database. Recurrence rates were recorded and relative risks calculated.
At a follow-up of 33 ± 20 months, 34 of 67 patients had recurrent instability for an overall recurrence rate of 51% among adolescent contact athletes after arthroscopic labral repair surgery. The mean time to recurrence was 68.1 ± 45.3 weeks. All recurrences occurred as a result of a further sporting injury. Relative risk analysis demonstrated that athletes aged <16 years had 2.2 (95% CI, 1.2-2.1) times the risk of developing a further instability episode as compared with athletes aged ≥16 years at the time of index surgery ( P = .0002). The recurrence rate among adolescent athletes after bony Bankart repairs was 57.9% versus 47.9% for soft tissue labral repairs ( P = .4698). The incidence of Hill-Sachs lesions ( P = .0002) and bony Bankart lesions ( P = .009) among adolescent athletes was significantly higher than among adult controls ( P = .002). The presence of bone loss did not lead to a significant increase in recurrence rate over and above the effect of age.
Adolescent contact athletes undergoing arthroscopic labral repair have an overall recurrence rate of 51%. Rugby players who undergo primary arthroscopic shoulder stabilization aged <16 years have 2.2 times the risk of developing a further instability episode when compared with athletes aged ≥16 years at the time of index surgery, with a recurrence rate of 93%.
创伤性肩盂肱关节前脱位是最常见的肩部损伤之一，尤其是在青少年运动员中。由于高复发率，年轻运动员的不稳定治疗仍然存在争议。
探讨关节镜下盂唇修复术治疗青少年接触性和碰撞性运动员肩不稳定的复发率。
病例系列；证据水平，4 级。
67 例年龄<18 岁的患者在 5 年内接受了关节镜下盂唇修复术。队列的平均年龄为 16.3 ± 0.9 岁（范围，14-17 岁），包括 1 名女性和 66 名男性。所有患者均为接触性运动员，其中 67 名中有 62 名打橄榄球。所有肩不稳定患者的人口统计学、临床和术中数据均记录在我们的数据库中。记录复发率并计算相对风险。
在 33 ± 20 个月的随访中，67 例患者中有 34 例出现复发性不稳定，青少年接触性运动员在关节镜下盂唇修复术后总体复发率为 51%。平均复发时间为 68.1 ± 45.3 周。所有复发均因进一步运动损伤所致。相对风险分析表明，与索引手术时年龄≥16 岁的运动员相比，年龄<16 岁的运动员发生进一步不稳定事件的风险高 2.2 倍（95%CI，1.2-2.1；P=.0002）。青少年运动员骨 Bankart 修复后的复发率为 57.9%，而软组织盂唇修复后的复发率为 47.9%（P=.4698）。青少年运动员肩盂前下关节盂（Hill-Sachs）损伤（P=.0002）和骨 Bankart 损伤（P=.009）的发生率明显高于成年对照组（P=.002）。骨丢失的存在并未导致复发率显著高于年龄因素的影响。
接受关节镜下盂唇修复术的青少年接触性运动员总体复发率为 51%。与索引手术时年龄≥16 岁的运动员相比，年龄<16 岁的接受初次关节镜下肩部稳定术的橄榄球运动员发生进一步不稳定事件的风险高 2.2 倍，复发率为 93%。
