Young Bradley L, Corpus Keith T, Scarola Gregory, Trofa David P, Connor Patrick M, Hamid Nady, Piasecki Dana P, Saltzman Bryan M, Fleischli James E
Carolinas Medical Center, Atrium Musculoskeletal Institute, Charlotte, NC, USA.
OrthoCarolina Sports Medicine Center, Charlotte, NC, USA.
J Shoulder Elbow Surg. 2021 Dec;30(12):2720-2728. doi: 10.1016/j.jse.2021.04.030. Epub 2021 May 5.
The purpose of this study was to compare outcomes of patients who underwent posterior labral repair with and without concomitant glenohumeral chondral pathology.
A retrospective review was performed on patients aged ≥18 years who underwent primary posterior labral repair over 5 years. Charts were reviewed to determine the presence and location of high-grade (Outerbridge grade III or IV) pathology. Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), Western Ontario Stability Index (WOSI), visual analog scale (VAS), and Simple Shoulder Test (SST) scores were collected at median 71.5-month follow-up and compared between patients with and without concomitant chondral pathology during the index procedure.
Of 100 patients who underwent primary posterior labral repair, 43% had glenoid and/or humeral-sided high-grade chondral pathology. Patients with chondral pathology were older than those without (P < .001). A higher proportion of patients with chondral pathology underwent concomitant biceps tenodesis (19.3% vs. 37.2%, P = .046). The type of anchor (all-suture or solid body, P = .010) used was different between patients with and without chondral pathology at time of posterior labrum repair. There was no difference in reoperation rates at final follow-up between patients with and without chondral damage at time of index procedure (P = .200). All outcome scores were similar between all comer patients with and without chondral pathology. Isolated glenoid pathology was significantly associated with lower QuickDASH (P = .018), higher SST (P = .013), lower VAS (P = .016), and lower WOSI scores (P = .046) compared to patients with bipolar lesions. After stratifying by age, there was an association between chondral pathology and lower VAS and WOSI scores in patients aged <35 years, and there was an association between chondral pathology and lower SST scores in patients aged ≥35 years.
Based on median QuickDASH, SST, WOSI, and VAS scores, subjective and functional outcomes after primary arthroscopic posterior labral repair were not negatively influenced by the presence of concomitant chondral damage at the time of surgery for patients aged <35 years at minimum 2-year follow-up. Although our primary outcome score, the QuickDASH, was not significantly associated with the presence of chondral damage in patients aged >35 years, SST scores were negatively influenced by concomitant chondral damage in this older cohort, but this may not be adequately powered. It appeared that patients with chondral damage localized to the glenoid tended to have better outcomes scores that those with bipolar damage.
本研究的目的是比较接受后盂唇修复且伴有或不伴有肱盂关节软骨病变患者的治疗结果。
对年龄≥18岁、在5年期间接受初次后盂唇修复的患者进行回顾性研究。查阅病历以确定高级别（Outerbridge III级或IV级）病变的存在和位置。在中位随访71.5个月时收集手臂、肩部和手部快速残疾问卷（QuickDASH）、西安大略稳定性指数（WOSI）、视觉模拟量表（VAS）和简易肩部测试（SST）评分，并比较初次手术时伴有和不伴有软骨病变患者之间的差异。
在100例接受初次后盂唇修复的患者中，43%存在肩胛盂和/或肱骨侧高级别软骨病变。有软骨病变的患者比无软骨病变的患者年龄更大（P <.001）。有软骨病变的患者中接受肱二头肌固定术的比例更高（19.3%对37.2%，P =.046）。后盂唇修复时，有和无软骨病变的患者使用的锚钉类型（全缝线或实体，P =.010）不同。初次手术时有和无软骨损伤的患者在最终随访时的再次手术率无差异（P =.200）。所有结局评分在有和无软骨病变的所有患者组之间相似。与双极病变患者相比，孤立的肩胛盂病变与更低的QuickDASH评分（P =.018）、更高的SST评分（P =.013）、更低的VAS评分（P =.016）和更低的WOSI评分（P =.046）显著相关。按年龄分层后，<35岁患者中软骨病变与更低的VAS和WOSI评分相关，≥35岁患者中软骨病变与更低的SST评分相关。
基于中位QuickDASH、SST、WOSI和VAS评分，对于年龄<35岁的患者，在至少2年的随访中，初次关节镜下后盂唇修复术后的主观和功能结局不受手术时伴有软骨损伤的负面影响。虽然我们的主要结局评分QuickDASH在年龄>35岁的患者中与软骨损伤的存在无显著相关性，但在这个年龄较大的队列中，SST评分受到伴有软骨损伤的负面影响，但可能样本量不足。似乎局限于肩胛盂的软骨损伤患者的结局评分往往比双极损伤患者更好。
