Panzram Benjamin, Kentar Yasser, Maier Michael, Bruckner Thomas, Hetto Pit, Zeifang Felix
Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany.
Heidelberg University Hospital, Clinic for Orthopaedics and Trauma Surgery, Schlierbacher Landstraße 200A, 69118, Heidelberg, Germany.
BMC Musculoskelet Disord. 2020 Mar 27;21(1):191. doi: 10.1186/s12891-020-03223-3.
The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. The aim of the study is to determine the mid-/long-term functional outcome, failure rates and predictors of failure after primary arthroscopic Bankart repair for traumatic anterior shoulder instability.
A total of 100 patients were primarily operated using arthroscopic Bankart repair after traumatic anterior shoulder instability. Medical records were retrospectively reviewed, and patients were assessed using postal questionnaire after a mean follow-up of 8.3 years [3-14]. Clinical assessment was performed using Constant score, Rowe score, and American Shoulder and Elbow Surgeons score.
The overall recurrence rate was 22%. The Kaplan-Meier failure-free survival estimates. were 80% at 5 years and 70% at 10 years. Nearly half (54.5%) of recurrences occurred at 2 years postoperative. Compared with normal shoulder, there were statistical differences in all 3 scores. Failure rate was significantly affected by age at the time of surgery with 86% of recurrence cases observed in patients aged 30 years or younger. Nevertheless, Younger age at the time of surgery (P = 0.007) as well age at the time of initial instability (P = 0.03) was found to correlate negatively with early recurrence within 2 years of surgery. Among those with recurrent instability, recurrence rate was found to be higher if there had been more than 5 instability episodes preoperatively (P = 0.01). Return to the preinjury sport and occupational level was possible in 41 and 78%, respectively.
Failure-free survival rates dropped dramatically over time. Alternative reconstruction techniques should be considered in those aged ≤30 years due to the high recurrence rate.
关节镜手术为创伤性前肩不稳的Bankart修复提供了一种侵入性较小的技术。本研究的目的是确定初次关节镜下Bankart修复治疗创伤性前肩不稳后的中长期功能结果、失败率及失败的预测因素。
共有100例患者在创伤性前肩不稳后接受了初次关节镜下Bankart修复手术。对病历进行回顾性分析，并在平均随访8.3年（3 - 14年）后通过邮寄问卷对患者进行评估。使用Constant评分、Rowe评分和美国肩肘外科医师评分进行临床评估。
总体复发率为22%。Kaplan-Meier无失败生存率估计值在5年时为80%，在10年时为70%。近一半（54.5%）的复发发生在术后2年。与正常肩部相比，所有3项评分均存在统计学差异。手术时的年龄对失败率有显著影响，30岁及以下患者的复发率为86%。然而，手术时年龄较小（P = 0.007）以及初次不稳时的年龄（P = 0.03）与术后2年内的早期复发呈负相关。在复发性不稳患者中，如果术前不稳发作超过5次，复发率更高（P = 0.01）。分别有41%和78%的患者能够恢复到伤前的运动和职业水平。
无失败生存率随时间显著下降。由于复发率高，对于年龄≤30岁的患者应考虑采用替代重建技术。
