Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France.
Valdoltra Orthopaedic Hospital, Ankaran, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Arthroscopy. 2022 Jun;38(6):1766-1771. doi: 10.1016/j.arthro.2021.11.043. Epub 2021 Dec 7.
To evaluate the short-term outcomes of the arthroscopic dynamic anterior stabilization (DAS), which is a transfer of the intra-articular portion of the long head biceps through the subscapularis split and fixation on the anterior glenoid, combined with a Bankart repair.
A retrospective evaluation was performed of DAS and a minimum of 2-year follow-up. Inclusion criteria were the presence of anteroinferior instability, a positive apprehension test at 90° of abduction and external rotation, and subcritical glenoid bone loss (less than 20%). Exclusion criteria were severe (≥20%) glenoid bone loss, presence of biceps lesions or rupture (spontaneous or biceps tenotomy), pre-existing glenohumeral osteoarthritis, multidirectional or voluntary instability, previous arthroscopic stabilization procedure, and epilepsy. Outcomes included the Rowe score, range of motion (ROM), and recurrence.
Twenty-three patients were treated with DAS and arthroscopic Bankart repair during the study period. One person was lost to follow-up, leaving 22 patients available at last follow-up. Those 22 patients had an average age of 31.9 ± 12.3 years (range, 18-68) and were evaluated at an average follow-up of 3.2 ± 0.7 years (range, 1.2-4.2). The Rowe score increased from 36.1 ± 16.2 (range, 10-70) preoperatively to 89.8 ± 20.1 (range, 30-100) postoperatively (P < .001) with almost all patients (90.9%) improving their score beyond the minimal clinically important difference of 9.7 points. Postoperatively, ROM was maintained. Three patients (13.6%) analyzed at final follow-up demonstrated recurrence, one was successfully treated conservatively, but two revised with a Latarjet. No postoperative Popeye deformity, biceps cramping, or other complication were reported.
The DAS procedure may be an option for augmentation of a Bankart repair in patients with anterior shoulder instability and subcritical bone loss. ROM is maintained without evidence of postoperative Popeye deformity or biceps cramping.
Level IV, retrospective study.
评估关节镜下动态前稳定（DAS）的短期疗效，该方法将长头腱关节内部分通过肩胛下肌劈开转移，并固定在前肩胛盂上，同时进行 Bankart 修复。
对 DAS 进行回顾性评估，并进行至少 2 年的随访。纳入标准为存在前下不稳定，外展和外旋 90°时出现明显的恐惧试验，以及临界下盂骨丢失（小于 20%）。排除标准为严重（≥20%）盂骨丢失、二头肌病变或撕裂（自发性或二头肌切断术）、先前存在肩关节炎、多向或主动不稳定、先前的关节镜稳定手术和癫痫。结果包括 Rowe 评分、活动范围（ROM）和复发。
在研究期间，23 例患者接受 DAS 和关节镜 Bankart 修复治疗。1 人失访，最后随访时共有 22 例患者。这 22 例患者的平均年龄为 31.9±12.3 岁（范围，18-68 岁），平均随访时间为 3.2±0.7 年（范围，1.2-4.2 年）。Rowe 评分从术前的 36.1±16.2（范围，10-70）增加到术后的 89.8±20.1（范围，30-100）（P<0.001），几乎所有患者（90.9%）的评分都超过了 9.7 分的最小临床重要差异。术后 ROM 保持稳定。在最后一次随访时，3 例（13.6%）患者出现复发，1 例经保守治疗成功，2 例经 Latarjet 修复。无术后 Popeye 畸形、二头肌痉挛或其他并发症发生。
DAS 手术可能是治疗前肩不稳定和临界下盂骨丢失患者的 Bankart 修复的一种选择。ROM 保持稳定，无术后 Popeye 畸形或二头肌痉挛的证据。
IV 级，回顾性研究。
