Department of Sports Medicine, Huashan Hospital, Shanghai, China.
Department of Radiology, Huashan Hospital, Shanghai, China.
Am J Sports Med. 2020 Sep;48(11):2628-2637. doi: 10.1177/0363546520945723. Epub 2020 Aug 17.
No study has reported clinical evidence for cartilage change in the glenohumeral joint or the cause of loss in range of motion (ROM) after arthroscopic Bankart repair with remplissage technique (BR).
To investigate the postoperative features of glenohumeral joint cartilage, ROM, and anchor placement for remplissage at a minimum of 2 years of follow-up after BR and to analyze the correlations.
Case-control study; Level of evidence, 3.
A total of 21 patients who underwent BR received follow-up for a minimum of 2 years. At both preoperative assessment and final follow-up, passive shoulder ROM, Oxford Shoulder Instability Score, Simple Shoulder Test score, and Single Assessment Numerical Evaluation score were assessed. All patients underwent 3.0-T magnetic resonance imaging (MRI) examination at final follow-up. The clinical outcomes, glenohumeral cartilage or Hill-Sachs lesion-related MRI parameters, and their potential correlations were analyzed.
The mean follow-up was 55.0 months (range, 24-119 months). Compared with preoperative assessment, all functional scores significantly improved ( < .001). At the final follow-up, a significant ROM loss (>15°) of external rotation (ER) at the side (ER) was found in 12 patients, among whom 8 patients had significant ROM loss of ER at 90° of abduction as well. Further, 12 patients with decreased ER had significantly higher signal intensity of cartilage on the anterior, middle, and posterior humeral head (anterior, = .002; middle, < .001; posterior, < .001) than 9 patients with normal ER. The ratio of the width of the remplissage anchor to the diameter of the humeral head (w:d ratio) was significantly greater ( = .031) in the decreased ER group than in the normal ER group. Correlation analysis showed that signal intensity on the posterior humeral head and ER loss (ΔER) had a significantly positive correlation ( = 0.516; = .034), while the w:d ratio and ΔER had a significantly positive correlation ( = 0.519; = .039).
At a minimum of 2 years of follow-up, patients who underwent BR showed significant clinical improvement compared with preoperative assessment, except for limitations in ER. The glenohumeral cartilage degeneration (higher signal intensity) after BR had a significantly positive correlation with the postoperative ER loss, which was found to be associated with a relatively medial placement of the remplissage anchor.
尚无研究报告关节镜下 Bankart 修复加填充术（BR）后盂肱关节软骨变化的临床证据，也没有研究报告关节镜下 Bankart 修复加填充术（BR）后活动范围（ROM）丧失的原因。
探讨 BR 加填充术后盂肱关节软骨、ROM 和锚定位置的术后特征，并分析其相关性。
病例对照研究；证据水平，3 级。
共 21 例患者接受 BR 治疗，随访至少 2 年。术前评估和最终随访时均评估被动肩部 ROM、牛津肩不稳定评分、简易肩部测试评分和单因素评估数值评分。所有患者最终随访时均行 3.0-T 磁共振成像（MRI）检查。分析临床结果、盂肱关节软骨或 Hill-Sachs 病变相关 MRI 参数及其潜在相关性。
平均随访时间为 55.0 个月（范围，24-119 个月）。与术前评估相比，所有功能评分均显著改善（<0.001）。在最终随访时，12 例患者存在明显的外旋（ER）ROM 丢失（>15°），其中 8 例患者外展 90°时 ER 明显丢失。进一步的，12 例 ER 降低的患者在前、中、后肱骨头上的软骨信号强度明显升高（前，=0.002；中，<0.001；后，<0.001），而 9 例 ER 正常的患者则没有。在 ER 降低组中，填充锚的宽度与肱骨头直径的比值（w:d 比值）明显大于 ER 正常组（=0.031）。相关性分析显示，肱骨后头部信号强度与 ER 丢失（ΔER）呈显著正相关（=0.516；=0.034），而 w:d 比值与ΔER 呈显著正相关（=0.519；=0.039）。
至少随访 2 年，与术前评估相比，接受 BR 治疗的患者的临床症状明显改善，除了 ER 受限外。BR 后盂肱关节软骨退变（信号强度升高）与术后 ER 丢失呈显著正相关，这与填充锚的相对内侧放置有关。
