Centre Hospitalier Universitaire, Rennes, France.
iULS, Hôpital Pasteur 2, Nice, France.
Am J Sports Med. 2019 Apr;47(5):1057-1061. doi: 10.1177/0363546519833920. Epub 2019 Mar 18.
An isolated arthroscopic Bankart repair carries a high mid- and long-term risk of recurring instability. Preoperative patient selection based on the Instability Severity Index Score should improve outcomes.
To report the overall long-term recurrence rate for isolated Bankart repair, investigate the predictive factors for recurrence, analyze time to recurrence, and determine a quantitative cutoff point for recurrence in terms of Instability Severity Index Score.
Cohort study; Level of evidence, 2.
This was a prospective multicenter study. Inclusion criteria were recurring anterior instability and an Instability Severity Index Score of 4 or less. Of the 125 patients included, 20 patients had a score of 0, 31 patients scored 1, 29 patients scored 2, 34 patients scored 3, and 11 patients scored 4. All centers used the same arthroscopic technique and rehabilitation protocol. Follow-up data were collected at 3, 6, 12, and 24 months and 3 and 9 years. The primary endpoint was recurrence of instability (total or partial dislocation). The statistical analysis was performed by use of the software package SAS 9.4.
We initially identified 328 patients, of whom 125 patients were prospectively included. The main reason for excluding the 202 patients was the presence of bony lesions, which carry 2 points each in the Instability Severity Index Score (humeral head notch and/or glenoid lesion visible on standard radiographs). Of the 125 eligible patients, 73% were athletes and 22.5% competitors; 16% were lost at the last follow-up. At the endpoint, 23% had experienced a recurrence after a mean interval of 35 months (range, 5.5-103 months). No statistical differences were found between patients with and without bony lesions in the overall group of 125 patients or in the subgroup with an Instability Severity Index Score of 3 or 4 points ( P = .4). According to univariate analysis, the only predictive factor for recurrence was age less than 20 years at the time of surgery, with a 42% rate of recurrence in this group ( P = .03). Multivariate analysis showed that the Instability Severity Index Score was the only predictive factor with a quantitative cutoff point (namely, a score of ≤2 points) that was statistically associated with a decreased long term recurrence rate ( P = .02). The recurrence rate was 10% for a preoperative Instability Severity Index Score of 2 or less compared with 35.6% for a score of 3 or 4. The survival curves demonstrated no new dislocations after year 4 for patients with an Instability Severity Index Score of up to 2 points.
In a preselected population, mainly without bony lesions, the Instability Severity Index Score cutoff value that provides an acceptable recurrence rate at 9 years after isolated Bankart repair is 2 out of 10.
孤立性关节镜下 Bankart 修复术具有较高的中期和长期复发不稳定风险。基于不稳定严重程度指数评分的术前患者选择应改善结果。
报告孤立性 Bankart 修复术的总体长期复发率，探讨复发的预测因素，分析复发时间，并确定稳定性严重程度指数评分的复发定量截断点。
队列研究；证据水平，2 级。
这是一项前瞻性多中心研究。纳入标准为复发性前不稳定和不稳定严重程度指数评分 4 或以下。在纳入的 125 例患者中，20 例评分为 0，31 例评分为 1，29 例评分为 2，34 例评分为 3，11 例评分为 4。所有中心均采用相同的关节镜技术和康复方案。在 3、6、12 和 24 个月以及 3 和 9 年时收集随访数据。主要终点是不稳定（完全或部分脱位）的复发。统计分析使用 SAS 9.4 软件包进行。
我们最初确定了 328 例患者，其中 125 例患者前瞻性纳入。排除 202 例患者的主要原因是存在骨质病变，这些病变在不稳定严重程度指数评分中各占 2 分（标准 X 线片可见肱骨颈切迹和/或肩胛盂病变）。在 125 例合格患者中，73%为运动员，22.5%为竞技运动员；16%在最后一次随访时丢失。在终点时，平均间隔 35 个月（5.5-103 个月）后，23%的患者经历了复发。在整体 125 例患者或稳定性严重程度指数评分为 3 或 4 分的亚组中，未发现有骨质病变的患者与无骨质病变的患者之间存在统计学差异（P=.4）。根据单因素分析，唯一的复发预测因素是手术时年龄小于 20 岁，该组复发率为 42%（P=.03）。多因素分析显示，稳定性严重程度指数评分是唯一的预测因素，具有定量截断点（即评分≤2 分），与长期复发率降低具有统计学关联（P=.02）。术前稳定性严重程度指数评分为 2 或更低的患者复发率为 10%，而评分为 3 或 4 的患者复发率为 35.6%。生存曲线显示，对于稳定性严重程度指数评分不超过 2 分的患者，在 4 年后没有新的脱位。
在预先选择的人群中，主要是没有骨质病变的人群，孤立性 Bankart 修复术后 9 年时提供可接受复发率的稳定性严重程度指数评分截断值为 2 分。
