Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands; The Amsterdam Shoulder and Elbow Center of Expertise (ASECE), Amsterdam, the Netherlands.
The Amsterdam Shoulder and Elbow Center of Expertise (ASECE), Amsterdam, the Netherlands; Amsterdam UMC, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Location AMC, Amsterdam, the Netherlands; Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, the Netherlands; Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, the Netherlands.
J Shoulder Elbow Surg. 2023 Jul;32(7):1452-1458. doi: 10.1016/j.jse.2023.01.003. Epub 2023 Feb 2.
Even though many studies have been published regarding return-to-sport (RTS) rates following arthroscopic Bankart repair (ABR), evidence regarding prognostic factors for which patients do not RTS is limited. The aim of this study was to identify prognostic factors that are associated with failure to RTS and failure to return to preinjury level of sport (RTPS) following primary ABR. The hypothesis was that prognostic factors for failure to RTS and failure to RTPS would be similar to those predisposing recurrence.
A multicenter, retrospective case-control study including 6 Dutch hospitals was performed. Consecutive patients who underwent primary ABR between 2014 and 2019 were invited to participate and received a questionnaire. Sports participation was assessed before symptom onset, at 6 months postoperatively, and at final follow-up. Failure to RTS was defined as no return to any sport, and failure to RTPS was defined as no return to the same level (or a higher level) of sport. Prognostic factors for failure to RTS or failure to RTPS were identified using logistic regression. Covariates for the regression analysis were selected based on univariate analyses.
This study included 318 patients with a mean follow-up period of 4.2 years (standard deviation, 1.8 years). Of these 318 patients, 26 (8.2%) did not RTS and 100 (31%) did not RTPS. Logistic regression analysis demonstrated that glenoid bone loss (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.04-1.15; P = .001) and overhead use of the shoulder during work (OR, 3.77; 95% CI, 1.45-9.85; P = .007) were prognostic factors for failure to RTS. In addition, it showed that preoperative professional sports level (OR, 2.94; 95% CI, 1.07-8.05; P = .04) and preoperative body mass index (OR, 1.11; 95% CI, 1.01-1.21; P = .04) were prognostic factors for failure to RTPS. Repair of a bony Bankart lesion (OR, 0.35; 95% CI, 0.15-0.81; P = .02) and the presence of an anterior labral periosteal sleeve avulsion (ALPSA) (OR, 0.44; 95% CI, 0.20-0.97; P = .04) were identified as factors that facilitated RTPS.
This study identified glenoid bone loss and overhead use of the shoulder during work to be associated with failure to RTS. Moreover, preoperative sports level and preoperative body mass index were found to be associated with failure to RTPS. In contrast, a bony Bankart lesion and an anterior labral periosteal sleeve avulsion (ALPSA) lesion facilitated RTPS. Future prospective studies are needed to confirm these factors and determine which part of the effect can be attributed to (failure of) surgical treatment or changes in behavior.
尽管已经有许多关于关节镜下 Bankart 修复（ABR）后重返运动（RTS）率的研究，但关于哪些患者不能 RTS 的预后因素的证据有限。本研究旨在确定与原发性 ABR 后 RTS 失败和无法恢复到术前运动水平（RTPS）相关的预后因素。假设 RTS 失败和 RTPS 失败的预后因素与导致复发的因素相似。
进行了一项多中心、回顾性病例对照研究，包括荷兰的 6 家医院。邀请了 2014 年至 2019 年间接受原发性 ABR 的连续患者参加，并向他们发放了问卷。在症状出现前、术后 6 个月和最终随访时评估运动参与情况。RTS 失败定义为没有任何运动，RTPS 失败定义为没有恢复到相同（或更高）的运动水平。使用逻辑回归确定 RTS 失败或 RTPS 失败的预后因素。回归分析的协变量是根据单变量分析选择的。
本研究纳入了 318 例患者，平均随访时间为 4.2 年（标准差为 1.8 年）。在这 318 例患者中，有 26 例（8.2%）未 RTS，100 例（31%）未 RTPS。逻辑回归分析表明，肩峰骨丢失（比值比[OR]，1.09；95%置信区间[CI]，1.04-1.15；P =.001）和工作时肩部的过顶使用（OR，3.77；95% CI，1.45-9.85；P =.007）是 RTS 失败的预后因素。此外，研究还表明术前职业运动水平（OR，2.94；95% CI，1.07-8.05；P =.04）和术前体重指数（OR，1.11；95% CI，1.01-1.21；P =.04）是 RTPS 失败的预后因素。修复骨 Bankart 病变（OR，0.35；95% CI，0.15-0.81；P =.02）和存在前盂唇骨膜袖撕裂（ALPSA）（OR，0.44；95% CI，0.20-0.97；P =.04）被确定为促进 RTPS 的因素。
本研究发现肩峰骨丢失和工作时肩部的过顶使用与 RTS 失败相关。此外，术前运动水平和术前体重指数与 RTPS 失败相关。相反，骨 Bankart 病变和前盂唇骨膜袖撕裂（ALPSA）病变促进了 RTPS。需要进一步的前瞻性研究来证实这些因素，并确定哪些部分的效果可以归因于（手术治疗的失败）或行为的改变。
