O'Neill Dillon C, Christensen Garrett, Kawakami Jun, Burks Robert T, Greis Patrick E, Tashjian Robert Z, Chalmers Peter N
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
JSES Int. 2020 May 7;4(2):287-291. doi: 10.1016/j.jseint.2020.02.012. eCollection 2020 Jun.
The purpose of this study was to determine the short-term outcomes for patients who underwent revision surgery for shoulder instability, including both revision arthroscopic repair and Latarjet.
This study included patients who underwent revision of a prior arthroscopic labral repair to arthroscopic labral repair or Latarjet at our institution from 2012 to 2017. After collection of preoperative demographic data, preoperative 3-dimensional imaging was reviewed to determine percent glenoid bone loss (%GBL) and to determine whether each shoulder was on-track or off-track. Patients were contacted to obtain postoperative patient-reported outcome metrics including visual analog scale pain, Simple Shoulder Test, American Shoulder and Elbow Surgeons scores, and instability recurrence (full dislocation, subluxation, or subjective apprehension) data at a minimum of 2 years postoperatively.
Of 62 patients who met criteria, 45 patients were able to be contacted. Of them, 21 underwent revision arthroscopy and 24 underwent a Latarjet procedure. In the revision arthroscopy group, 5 of 15 had %GBL >20% and 4 of 21 were contact athletes. In the Latarjet group, 11 of 22 had %GBL >20% and 5 of 24 were contact athletes. Of 21 revision arthroscopy patients, 8 underwent concomitant remplissage. Eight of 21 patients in the revision arthroscopy group and 7 of 21 patients in the Latarjet group reported instability postoperatively. Three of 21 patients in the revision arthroscopy group and 2 of 21 patients in the Latarjet group reported full dislocations postoperatively. Zero patients in the revision arthroscopy group and 1 of 21 patients in the Latarjet group underwent reoperation.
Our results suggest that both revision Latarjet and arthroscopic stabilization can be of benefit in select circumstances. However, in revision settings, postoperative instability symptoms are common with both procedures.
本研究的目的是确定接受肩关节不稳翻修手术的患者的短期疗效，包括翻修关节镜修复术和Latarjet手术。
本研究纳入了2012年至2017年在我院接受过初次关节镜下盂唇修复术翻修至关节镜下盂唇修复术或Latarjet手术的患者。收集术前人口统计学数据后，回顾术前三维成像以确定肩胛盂骨丢失百分比（%GBL），并确定每个肩关节是在轨迹上还是偏离轨迹。在术后至少2年联系患者以获取患者报告的术后结局指标，包括视觉模拟量表疼痛评分、简单肩关节测试、美国肩肘外科医师协会评分以及不稳定复发（完全脱位、半脱位或主观恐惧）数据。
在62例符合标准的患者中，45例能够被联系上。其中，21例接受了翻修关节镜手术，24例接受了Latarjet手术。在翻修关节镜手术组中，15例中有5例%GBL>20%，21例中有4例是接触性运动员。在Latarjet手术组中，22例中有11例%GBL>20%，24例中有5例是接触性运动员。21例接受翻修关节镜手术的患者中，8例同时进行了 remplissage手术。翻修关节镜手术组的21例患者中有8例、Latarjet手术组的21例患者中有7例报告术后存在不稳定。翻修关节镜手术组的21例患者中有3例、Latarjet手术组的21例患者中有2例报告术后出现完全脱位。翻修关节镜手术组中无患者、Latarjet手术组的21例患者中有1例接受了再次手术。
我们的结果表明，在特定情况下，Latarjet手术翻修和关节镜稳定手术都可能有益。然而，在翻修手术中，两种手术术后不稳定症状都很常见。
