Galvin Joseph W, Yu Henry, Slevin John, Turner Eric K, Eichinger Josef K, Arrington Edward D, Grassbaugh Jason A
Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, Washington.
Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
Arthrosc Sports Med Rehabil. 2021 Aug 13;3(5):e1441-e1447. doi: 10.1016/j.asmr.2021.06.012. eCollection 2021 Oct.
The purposes of this study were to determine the incidence of anterior shoulder pain in young athletes undergoing arthroscopic posterior labral repair for symptomatic unidirectional posterior shoulder instability and in patients with preoperative anterior shoulder pain treated without biceps tenodesis at the time of arthroscopic posterior labral repair who underwent a revision biceps tenodesis procedure at short-term follow up.
A retrospective review was performed at a single institution over a 24-month period. The study included young patients who underwent an arthroscopic posterior labral repair for symptomatic unidirectional posterior shoulder instability. The electronic medical record, magnetic resonance arthrograms, and arthroscopic images were reviewed to exclude patients with posterior labral tears with anterior labral tear or SLAP (superior labrum anterior-to-posterior) tear extension on advanced imaging and arthroscopic examination. Data collected included the presence of preoperative tenderness to palpation of the biceps tendon in the groove, the results of a preoperative Speed test, postoperative Subjective Shoulder Value, the presence of postoperative anterior shoulder pain, and the need for a secondary biceps tenodesis.
We identified 65 patients who underwent arthroscopic labral repair for posterior shoulder instability. From this cohort, 26 patients with symptomatic unidirectional posterior shoulder instability underwent an arthroscopic posterior labral repair. The incidence of preoperative anterior shoulder pain with Zone 2 biceps groove tenderness and a positive Speed test was identified in 20 of 26 patients (76.9%). Of 26 patients, 5 (19%) had concomitant biceps tenodesis. The median postoperative Subjective Shoulder Value was 80 (interquartile range, 60-90) at median follow-up of 2.1 years. Of the 20 patients with preoperative anterior shoulder pain, 8 of 20 (40%) reported persistent anterior pain. One patient (4.7%) underwent a secondary biceps tenodesis.
There is a high incidence of anterior shoulder pain and Zone 2 biceps groove tenderness in patients undergoing isolated arthroscopic posterior labral repair for unidirectional posterior shoulder instability. At short-term follow-up, few patients required a secondary biceps tenodesis procedure; however, 30% of patients had persistent anterior shoulder pain.
Level IV, retrospective diagnostic case series.
本研究的目的是确定因有症状的单向性肩关节后向不稳而接受关节镜下后侧盂唇修复的年轻运动员以及在关节镜下后侧盂唇修复时未行肱二头肌固定术且在短期随访时接受翻修肱二头肌固定术的术前有前肩部疼痛的患者中前肩部疼痛的发生率。
在单一机构进行了为期24个月的回顾性研究。该研究纳入了因有症状的单向性肩关节后向不稳而接受关节镜下后侧盂唇修复的年轻患者。对电子病历、磁共振关节造影和关节镜图像进行了回顾，以排除在高级影像学检查和关节镜检查中存在后侧盂唇撕裂合并前侧盂唇撕裂或SLAP（上盂唇从前到后）撕裂延伸的患者。收集的数据包括术前肱二头肌沟触诊压痛情况、术前Speed试验结果、术后主观肩关节评分、术后前肩部疼痛情况以及二次肱二头肌固定术的必要性。
我们确定了65例因肩关节后向不稳而接受关节镜下盂唇修复的患者。在这个队列中，26例有症状的单向性肩关节后向不稳患者接受了关节镜下后侧盂唇修复。26例患者中有20例（76.9%）术前存在前肩部疼痛，伴有2区肱二头肌沟压痛且Speed试验阳性。26例患者中有5例（19%）同时进行了肱二头肌固定术。在中位随访2.1年时，术后主观肩关节评分的中位数为80（四分位间距，60 - 90）。在20例术前有前肩部疼痛的患者中，20例中有8例（40%）报告存在持续性前肩部疼痛。1例患者（4.7%）接受了二次肱二头肌固定术。
对于因单向性肩关节后向不稳而单纯接受关节镜下后侧盂唇修复的患者，前肩部疼痛和2区肱二头肌沟压痛的发生率较高。在短期随访中，很少有患者需要进行二次肱二头肌固定术；然而，30%的患者存在持续性前肩部疼痛。
IV级，回顾性诊断病例系列。
