Department of Family Medicine, Mayo Clinic Health System, Eau Claire, WI, USA.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
J Shoulder Elbow Surg. 2022 Feb;31(2):352-358. doi: 10.1016/j.jse.2021.07.016. Epub 2021 Aug 25.
Data on the long-term outcomes of nonoperative treatment of anterior shoulder instability are lacking, particularly for the US population. The purpose was to (1) describe the characteristics of patients with anterior shoulder instability treated nonoperatively, (2) assess the long-term outcomes of nonoperative management in a US population, and (3) identify risk factors for poor outcomes following nonoperative management.
A geographic cohort of >500,000 subjects was used to identify patients treated nonoperatively for anterior shoulder instability. Only patients aged <40 years at the time of initial instability with minimum 10-year follow-up were included. Medical records were reviewed to obtain demographic characteristics, physical examination findings, clinical history data, imaging results, treatment details, and clinical and/or radiographic progression. Recurrent pain, recurrent instability, and the development of symptomatic osteoarthritis (OA) were the primary outcomes evaluated.
The study included 254 patients (73% male) with a median age of 19 years (range, 16-26 years) at the time of initial instability. At median 17-year follow-up, 37.5% experienced recurrent instability, 58.4% had recurrent pain, and 12.2% had symptomatic OA development. Factors associated with recurrent pain at final follow-up were multiple instability events prior to presentation (hazard ratio [HR], 2.43; P < .01) and increased pain at the initial visit (HRs of 0.79 for mild, 1.74 for moderate, and 1.39 for severe; P < .01); patients with multiple instability events prior to presentation also had an increased risk of recurrence (P < .01). Factors increasing the risk of the development of symptomatic OA included increased pain at the initial visit (P = .05), seizure disorder (HR, 27.01; P < .01), and smoking (HR, 5.15; P < .01).
At long-term follow-up of 17 years, a high rate of poor outcomes was observed following nonoperative management of anterior shoulder instability. Overall, 37.5% of patients experienced recurrent shoulder instability, 58.4% had recurrent shoulder pain, and 12.2% had symptomatic OA development. Risk factors associated with adverse clinical outcomes included increased pain at the initial visit, recurrent instability prior to presentation, seizure disorder, and smoking.
缺乏关于非手术治疗肩前不稳定的长期结果的数据，特别是在美国人群中。目的是：(1)描述接受非手术治疗的肩前不稳定患者的特征；(2)评估美国人群中非手术治疗的长期结果；(3)确定非手术治疗后不良结局的危险因素。
利用超过 50 万名患者的地理队列，确定接受非手术治疗的肩前不稳定患者。仅纳入首次不稳定时年龄<40 岁且至少有 10 年随访的患者。回顾病历以获取人口统计学特征、体格检查结果、临床病史数据、影像学结果、治疗细节以及临床和/或影像学进展。评估的主要结局包括复发性疼痛、复发性不稳定和症状性骨关节炎（OA）的发展。
研究纳入了 254 名患者（73%为男性），首次不稳定时的中位年龄为 19 岁（范围 16-26 岁）。在中位 17 年随访时，37.5%的患者发生复发性不稳定，58.4%的患者出现复发性疼痛，12.2%的患者发生症状性 OA。最终随访时出现复发性疼痛的相关因素包括就诊前多次不稳定事件（危险比[HR]，2.43；P<.01）和初始就诊时疼痛增加（轻度 HR 为 0.79，中度 HR 为 1.74，重度 HR 为 1.39；P<.01）；就诊前多次不稳定事件的患者复发风险也增加（P<.01）。增加症状性 OA 发展风险的因素包括初始就诊时疼痛增加（P=.05）、癫痫发作障碍（HR，27.01；P<.01）和吸烟（HR，5.15；P<.01）。
在 17 年的长期随访中，观察到肩前不稳定患者接受非手术治疗后的不良结局发生率较高。总体而言，37.5%的患者发生复发性肩部不稳定，58.4%的患者出现复发性肩部疼痛，12.2%的患者出现症状性 OA。与不良临床结局相关的危险因素包括初始就诊时疼痛增加、就诊前反复不稳定、癫痫发作障碍和吸烟。
