Investigation performed at University of California, San Francisco, San Francisco, California, USA.
Am J Sports Med. 2020 Apr;48(5):1207-1212. doi: 10.1177/0363546520907916. Epub 2020 Mar 9.
Patients with posterior shoulder instability may have bone and cartilage lesions (BCLs) in addition to capsulolabral injuries, although the risk factors for these intra-articular lesions are unclear.
We hypothesized that patients with posterior instability who had a greater number of instability events would have a higher rate of BCLs compared with patients who had fewer instability episodes.
Cross-sectional study; Level of evidence, 3.
Data from the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group instability patient cohort were analyzed. Patients aged 12 to 99 years undergoing primary surgical treatment for shoulder instability were included. The glenohumeral joint was evaluated by the treating surgeon at the time of surgery, and patients were classified as having a BCL if they had any grade 3 or 4 glenoid or humeral cartilage lesion, reverse Hill-Sachs lesion, bony Bankart lesion, or glenoid bone loss. The effects of the number of instability events on the presence of BCLs was investigated by use of Fisher exact tests. Logistic regression modeling was performed to investigate the independent contributions of demographic variables and injury-specific variables to the likelihood of having a BCL. Significance was defined as < .05.
We identified 271 patients (223 male) for analysis. Bone and cartilage lesions were identified in 54 patients (19.9%) at the time of surgical treatment. A glenoid cartilage injury was most common and was identified in 28 patients (10.3%). A significant difference was noted between the number of instability events and the presence of BCLs ( = .025), with the highest rate observed in patients with 2 to 5 instability events (32.3%). Multivariate logistic regression modeling indicated that increasing age ( = .019) and 2 to 5 reported instability events ( = .001) were significant independent predictors of the presence of BCLs. For bone lesions alone, the number of instability events was the only significant independent predictor; increased risk of bone lesion was present for patients with 1 instability event (OR, 6.1; = .012), patients with 2 to 5 instability events (OR, 4.2; = .033), and patients with more than 5 instability events (OR, 6.0; = .011).
Bone and cartilage lesions are seen significantly more frequently with increasing patient age and in patients with 2 to 5 instability events. Early surgical stabilization for posterior instability may be considered to potentially limit the extent of associated intra-articular injury. The group of patients with more than 5 instability events may represent a different pathological condition, as this group showed a decrease in the likelihood of cartilage injury, although not bony injury.
患有肩关节后向不稳定的患者除了肩袖盂唇复合体损伤外，还可能存在骨软骨病变（BCLs），但这些关节内病变的危险因素尚不清楚。
我们假设，与不稳定发作次数较少的患者相比，肩关节后向不稳定且发作次数较多的患者发生 BCLs 的几率更高。
横断面研究；证据等级，3 级。
对多中心骨科结果网络（MOON）肩组不稳定患者队列的数据进行了分析。纳入年龄在 12 岁至 99 岁之间、因肩关节不稳定接受初次手术治疗的患者。手术时由治疗医生对盂肱关节进行评估，如果患者存在任何 3 级或 4 级盂肱关节软骨损伤、反向 Hill-Sachs 损伤、Bankart 骨缺损或盂肱关节骨丢失，则将其归类为存在 BCLs。采用 Fisher 确切检验，研究不稳定发作次数对 BCLs 存在的影响。采用逻辑回归模型研究人口统计学变量和损伤特异性变量对存在 BCLs 的可能性的独立影响。定义显著性水平为 <.05。
我们共纳入 271 例患者（223 例男性）进行分析。221 例患者接受了手术治疗，其中 54 例（19.9%）存在 BCLs。最常见的是盂肱关节软骨损伤，共 28 例（10.3%）。不稳定发作次数与 BCLs 的存在有显著差异（ =.025），不稳定发作次数为 25 次的患者中 BCLs 的发生率最高（32.3%）。多变量逻辑回归模型表明，年龄增长（ =.019）和 25 次报告的不稳定发作（ =.001）是 BCLs 存在的显著独立预测因素。对于单纯的骨病变，不稳定发作次数是唯一显著的独立预测因素；不稳定发作 1 次的患者发生骨病变的风险增加（OR，6.1； =.012），不稳定发作 2~5 次的患者（OR，4.2； =.033）和不稳定发作次数多于 5 次的患者（OR，6.0； =.011）。
随着患者年龄的增长和不稳定发作次数的增加，骨软骨病变的发生率显著增加。对于肩关节后向不稳定，早期手术稳定可能有助于限制相关关节内损伤的程度。不稳定发作次数多于 5 次的患者可能代表一种不同的病理状态，因为该组患者的软骨损伤发生率降低，但骨损伤发生率没有降低。
