Feng Sijia, Xie Yuxue, Chen Mo, Chen Yuzhou, Ding Zheci, Chen Jun, Chen Shiyi
Sports Medicine Institute of Fudan University, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China.
Department of Radiology & Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China.
Orthop J Sports Med. 2020 Nov 20;8(11):2325967120964881. doi: 10.1177/2325967120964881. eCollection 2020 Nov.
Age at surgery plays a crucial role in the frequency of recurrent shoulder instability. However, there are few studies that evaluate the relationship between age at initial shoulder instability and overall outcomes after stabilization surgery.
To compare clinical outcomes and structural changes after arthroscopic Bankart repair in patients who experienced initial shoulder instability during adolescence versus those with later onset instability.
Cohort study; Level of evidence, 3.
This study included patients who underwent arthroscopic Bankart repair at a single institution between 2007 and 2017. Comparisons were made between patients who experienced initial shoulder instability during adolescence (age 13-19 years; group A) and those with later onset instability (age 20-35 years; group B). Clinical outcomes (recurrence rate, postoperative pain, functional scores, active range of motion, and return to sports) and structural changes demonstrated by magnetic resonance imaging (MRI) were evaluated at minimum 2-year follow-up. In addition, functional outcomes within each group were compared between the patients with and without postoperative recurrence.
A total of 58 patients were included (24 patients in group A and 34 patients in group B). The mean follow-up was 72.1 months. Group A demonstrated a significantly higher recurrence rate than group B (41.7% vs 11.8%, respectively; = .009; risk ratio, 5.36 [95% CI, 1.43-20.09]) as well as significantly lower Rowe (76.9 ± 20.1 vs 88.7 ± 13.2, respectively; = .01) and Constant-Murley scores (92.2 ± 7.6 vs 96.3 ± 4.2, respectively; = .01). Postoperative MRI revealed no significant structural differences between the groups regarding the glenoid labrum, glenohumeral cartilage, or osseous reaction around the implanted anchors. In group A, patients with recurrence had less satisfaction regarding postoperative sports level than those without recurrence, whereas in group B, patients with recurrence had more postoperative pain and functional impairment compared with those without recurrence.
Initial shoulder instability during adolescence was associated with a higher recurrence rate and lower functional scores after arthroscopic Bankart repair compared with later onset instability, although no significant structural differences were found between the groups on MRI at a mean 6-year follow-up.
手术年龄在复发性肩关节不稳定的发生率中起着关键作用。然而，很少有研究评估初次肩关节不稳定时的年龄与稳定手术后的总体结果之间的关系。
比较青少年期初次出现肩关节不稳定的患者与后期出现不稳定的患者在关节镜下Bankart修复术后的临床结果和结构变化。
队列研究；证据等级，3级。
本研究纳入了2007年至2017年间在单一机构接受关节镜下Bankart修复术的患者。比较了青少年期初次出现肩关节不稳定的患者（年龄13 - 19岁；A组）和后期出现不稳定的患者（年龄20 - 35岁；B组）。在至少2年的随访中评估临床结果（复发率、术后疼痛、功能评分、活动范围和恢复运动情况）以及磁共振成像（MRI）显示的结构变化。此外，比较了每组中术后复发和未复发患者的功能结果。
共纳入58例患者（A组24例，B组34例）。平均随访72.1个月。A组的复发率显著高于B组（分别为41.7%和11.8%；P = 0.009；风险比，5.36 [95% CI，1.43 - 20.09]），Rowe评分（分别为76.9 ± 20.1和88.7 ± 13.2；P = 0.01）和Constant - Murley评分（分别为92.2 ± 7.6和96.3 ± 4.2；P = 0.01）也显著更低。术后MRI显示，两组在盂唇、盂肱关节软骨或植入锚钉周围的骨反应方面没有显著的结构差异。在A组中，复发患者对术后运动水平的满意度低于未复发患者，而在B组中，复发患者与未复发患者相比有更多的术后疼痛和功能障碍。
与后期出现不稳定相比，青少年期初次出现肩关节不稳定与关节镜下Bankart修复术后更高的复发率和更低的功能评分相关，尽管在平均6年的随访中，两组在MRI上未发现显著的结构差异。
