Fox Michael A, Drain Nicholas P, Rai Ajinkya, Zheng Aaron, Carlos Noel B, Serrano Riera Rafael, Sabzevari Soheil, Hughes Jonathan D, Popchak Adam, Rodosky Mark W, Lesniak Bryson P, Lin Albert
Pittsburgh Shoulder Institute, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Pittsburgh Shoulder Institute, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Arthroscopy. 2023 Mar;39(3):682-688. doi: 10.1016/j.arthro.2022.10.012. Epub 2022 Dec 7.
The purpose of this study was to compare rates of recurrent dislocation and postsurgical outcomes in patients undergoing arthroscopic Bankart repair for anterior shoulder instability immediately after a first-time traumatic anterior dislocation versus patients who sustained a second dislocation event after initial nonoperative management.
A retrospective chart review was performed of patients undergoing primary arthroscopic stabilization for anterior shoulder instability without concomitant procedures and minimum 2-year clinical follow-up. Primary outcome was documentation of a recurrent shoulder dislocation. Secondary clinical outcomes included range of motion, Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons Shoulder Score (ASES), and Shoulder Activity Scale (SAS).
Seventy-seven patients (mean age 21.3 years ± 7.3 years) met inclusion criteria. Sixty-three shoulders underwent surgical stabilization after a single shoulder dislocation, and 14 underwent surgery after 2 dislocations. Average follow-up was 35.9 months. The rate of recurrent dislocation was significantly higher in the 2-dislocation group compared to single dislocations (42.8% vs 14.2%, P = .03). No significant difference was present in range of motion, VAS, ASES, and SAS scores. The minimal clinically important difference (MCID) was 1.4 for VAS and 1.8 for SAS scores. The MCID was met or exceeded in the primary dislocation group in 31/38 (81.6%) patients for VAS, 23/31 (74.1%) for ASES, and 24/31 for SES (77.4%) scores. For the second dislocation cohort, MCID was met or exceeded in 7/9 (77.8%) for VAS, 4/7 (57.1%) for ASES, and 5/7 for SES (71.4%) scores.
Immediate arthroscopic surgical stabilization after a first-time anterior shoulder dislocation significantly decreases the risk of recurrent dislocation in comparison to those who undergo surgery after 2 dislocation events, with comparable clinical outcome scores. These findings suggest that patients who return to activities after a primary anterior shoulder dislocation and sustain just 1 additional dislocation event are at increased risk of a failing arthroscopic repair.
Retrospective comparative study; Level of evidence, 3.
本研究的目的是比较首次创伤性前脱位后立即接受关节镜下Bankart修复治疗前肩不稳的患者与初次非手术治疗后发生第二次脱位事件的患者的复发性脱位率和术后结果。
对接受初次关节镜下稳定治疗前肩不稳且未进行其他相关手术且临床随访至少2年的患者进行回顾性病历审查。主要结果是记录复发性肩关节脱位情况。次要临床结果包括活动范围、视觉模拟评分（VAS）、美国肩肘外科医师协会肩关节评分（ASES）和肩部活动量表（SAS）。
77例患者（平均年龄21.3岁±7.3岁）符合纳入标准。63例肩部在单次肩关节脱位后接受了手术稳定治疗，14例在2次脱位后接受了手术。平均随访时间为35.9个月。与单次脱位组相比，2次脱位组的复发性脱位率显著更高（42.8%对14.2%，P = 0.03）。活动范围、VAS、ASES和SAS评分方面无显著差异。VAS的最小临床重要差异（MCID）为1.4，SAS评分为1.8。在初次脱位组中，31/38（81.6%）的患者VAS评分、23/31（74.1%）的患者ASES评分以及24/31（77.4%）的患者SES评分达到或超过了MCID。对于第二次脱位队列，7/9（77.8%）的患者VAS评分、4/7（57.1%）的患者ASES评分以及5/7（71.4%）的患者SES评分达到或超过了MCID。
与在2次脱位事件后接受手术的患者相比，首次前肩脱位后立即进行关节镜手术稳定治疗可显著降低复发性脱位的风险，临床结果评分相当。这些发现表明，初次前肩脱位后恢复活动且仅再发生1次脱位事件的患者，关节镜修复失败的风险增加。
回顾性比较研究；证据等级，3级。
