Laboute Eric, Hoffmann Raoul, Bealu Alexia, Ucay Olivier, Verhaeghe Emmanuel
C.E.R.S., Groupe Ramsay Santé, Capbreton, France.
JSES Int. 2021 May 6;5(4):609-615. doi: 10.1016/j.jseint.2021.04.007. eCollection 2021 Jul.
Surgeons differ in their preferences concerning the best surgical technique for treating shoulder instability in sportspeople. The purpose was to evaluate the risk of recurrence and the likelihood of return to sport for the 2 principal shoulder stabilization techniques used to treat shoulder instability in sportspeople.
We screened sportspeople who had undergone shoulder stabilization for inclusion in this cohort study. For eligibility, patients had to have undergone surgery by one of the 2 techniques: Latarjet or arthroscopic Bankart between 2005 and 2011, and aged from 18 to 35 years. We excluded acromioclavicular dislocation, tendinous lesion, global or posterior instability, bone fracture or severe glenoid bone loss, neurological lesion, other surgical technique, and orthopedic treatment. Patients were contacted by telephone between 2009 and 2012 and asked to participate in follow-up after surgery. The primary endpoint was recurrence, evaluated by determining frequency and time to recurrence (or censoring) with Cox models. The secondary endpoint was the return to sport (training and competition).
Follow-up telephone interviews were conducted with 120 sportspeople (response rate of 61.5%), one of whom was excluded due to the occurrence of a new contralateral dislocation before returning to sport after surgery (Latarjet = 80, Bankart = 39). The risk of recurrence was significantly higher ( < .001) for Bankart ( = 7, 17.9%) than for Latarjet ( = 2, 2.5%) interventions. Being under the age of 20 years was a significant risk factor for recurrence ( = .007). Return to sport was significantly more frequent among sportspeople undergoing Latarjet procedures, for both training ( = .031) and competition ( = .038), and was also significantly more rapid for training ( = .034) with a mean time to return to training of 5.1 months for Latarjet procedures, versus 6.4 months for Bankart procedures.
The Latarjet surgical technique results in fewer recurrences than the Bankart technique, with a higher rate of return to sport (training, competition) and a faster return to training for sportspeople practicing potentially risky sports in competition. Age was also identified as an additional risk factor for recurrence. It is important to take these factors into account when considering the indications for surgery.
外科医生对于治疗运动员肩部不稳定的最佳手术技术偏好各异。目的是评估用于治疗运动员肩部不稳定的两种主要肩部稳定技术的复发风险以及恢复运动的可能性。
我们筛选了接受肩部稳定手术的运动员纳入本队列研究。符合条件的患者必须在2005年至2011年间接受过以下两种技术之一的手术：Latarjet手术或关节镜下Bankart修复术，年龄在18至35岁之间。我们排除了肩锁关节脱位、肌腱损伤、全向或后方不稳定、骨折或严重的肩胛盂骨丢失、神经损伤、其他手术技术以及骨科治疗。在2009年至2012年间通过电话联系患者，要求他们参与术后随访。主要终点是复发，通过Cox模型确定复发频率和复发时间（或截尾时间）来评估。次要终点是恢复运动（训练和比赛）。
对120名运动员进行了随访电话访谈（应答率为61.5%），其中1人因术后恢复运动前对侧出现新的脱位而被排除（Latarjet手术组 = 80人，Bankart修复术组 = 39人）。Bankart修复术组的复发风险（= 7，17.9%）显著高于Latarjet手术组（= 2，2.5%）（< 0.001）。年龄在20岁以下是复发的显著危险因素（= 0.007）。接受Latarjet手术的运动员恢复运动的频率在训练（= 0.031）和比赛（= 0.038）方面均显著更高，并且恢复训练的速度也显著更快（= 0.034），Latarjet手术组恢复训练的平均时间为5.1个月，而Bankart修复术组为6.4个月。
对于从事有潜在风险运动比赛的运动员，Latarjet手术技术比Bankart技术导致的复发更少，恢复运动（训练、比赛）的比例更高，恢复训练的速度更快。年龄也被确定为复发的另一个危险因素。在考虑手术适应症时，考虑这些因素很重要。
