Department of Orthopaedic and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
Center of Orthopaedic Sports Medicine, Breisacher Str. 84, 79110, Freiburg, Germany.
Knee Surg Sports Traumatol Arthrosc. 2021 Jan;29(1):230-239. doi: 10.1007/s00167-020-05952-3. Epub 2020 Apr 2.
Capsular volume reduction in the context of anterior arthroscopic shoulder stabilization represents an important but uncontrolled parameter. The aim of this study was to analyse capsular volume reduction by arthroscopic Bankart repair with an individualized capsular shift in patients with and without ligamentous hyperlaxity compared to a control group.
In the context of a prospective controlled study, intraoperative capsular volume measurements were performed in 32 patients with anterior shoulder instability before and after arthroscopic Bankart repair with an individualized capsular shift. The results were compared to those of a control group of 50 patients without instability. Physiological shoulder joint volumes were calculated and correlated with biometric parameters (sex, age, height, weight and BMI).
Patients with anterior shoulder instability showed a mean preinterventional capsular volume of 35.6 ± 10.6 mL, which was found to be significantly reduced to 19.3 ± 5.4 mL following arthroscopic Bankart repair with an individualized capsular shift (relative capsular volume reduction: 45.9 ± 21.9%; P < 0.01). Pre-interventional volumes were significantly greater in hyperlax than in non-hyperlax patients, while post-interventional volumes did not differ significantly. The average shoulder joint volume of the control group was 21.1 ± 7.0 mL, which was significantly correlated with sex, height and weight (P < 0.01). Postinterventional capsular volumes did not significantly differ from those of the controls (n.s.).
Arthroscopic Bankart repair with an individualized capsular shift enabled the restoration of physiological capsular volume conditions in hyperlax and non-hyperlax patients with anterior shoulder instability. Current findings allow for individual adjustment and intraoperative control of capsular volume reduction to avoid over- or under correction of the shoulder joint volume. Future clinical studies should evaluate, whether individualized approaches to arthroscopic shoulder stabilization are associated with superior clinical outcome.
在关节镜下肩前稳定术中，囊袋容积减少是一个重要但不可控的参数。本研究旨在分析伴有和不伴有韧带松弛的患者行关节镜下 Bankart 修复术伴个体化囊袋移位术时的囊袋容积减少情况，并与对照组进行比较。
在一项前瞻性对照研究中，对 32 例有前肩不稳的患者在关节镜下 Bankart 修复伴个体化囊袋移位术前和术后进行术中囊袋容积测量。将结果与 50 例无不稳定的对照组患者进行比较。计算生理性肩关节容积，并与生物计量参数（性别、年龄、身高、体重和 BMI）相关联。
前肩不稳定患者术前囊袋容积平均为 35.6±10.6ml，行关节镜下 Bankart 修复伴个体化囊袋移位术后，囊袋容积明显减少至 19.3±5.4ml（相对囊袋容积减少：45.9±21.9%；P<0.01）。松弛患者术前容积明显大于非松弛患者，而术后容积无明显差异。对照组的平均肩关节容积为 21.1±7.0ml，与性别、身高和体重显著相关（P<0.01）。术后囊袋容积与对照组无显著差异（n.s.）。
关节镜下 Bankart 修复伴个体化囊袋移位术可使前肩不稳定的松弛和非松弛患者恢复生理囊袋容积。目前的研究结果允许对囊袋容积减少进行个体化调整和术中控制，以避免对肩关节容积的过度或不足矫正。未来的临床研究应评估个体化的关节镜下肩关节稳定术是否与更好的临床结果相关。
