Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Oregon Shoulder Institute, Medford, OR, USA.
J Shoulder Elbow Surg. 2023 Jun;32(6S):S99-S105. doi: 10.1016/j.jse.2023.02.011. Epub 2023 Feb 23.
The purpose of this study was to compare recurrent instability rates between patients with on-track Hill-Sachs lesions who underwent arthroscopic labral repair (ALR) alone and those who underwent ALR with remplissage (ALR-R). Our hypothesis was that ALR-R would decrease the rate of recurrent instability, especially among patients at high risk of recurrent instability after ALR, such as contact athletes with near-track Hill-Sachs lesions.
We performed a multicenter, retrospective analysis of patients aged 14-50 years with on-track Hill-Sachs lesions who underwent ALR-R or ALR without remplissage between January 2014 and December 2019 with minimum 2-year follow-up. The exclusion criteria included prior ipsilateral shoulder surgery, >15% glenoid bone loss (GBL), off-track Hill-Sachs lesion, concomitant shoulder procedure, and connective tissue disorder. Age, sex, follow-up, and contact sports participation were recorded. GBL, Hills-Sachs interval (HSI), glenoid track, and distance to dislocation (DTD) were determined from preoperative magnetic resonance imaging scans. Affected-shoulder range of motion, Western Ontario Shoulder Instability Index scores, Subjective Shoulder Value scores, and recurrent dislocation and/or revision surgery status were also collected. A subgroup analysis was performed on "high-risk" patients (defined as participants in contact sports with DTD <10 mm) from each cohort.
The ALR-R cohort included 56 patients, and the ALR cohort included 127. ALR-R patients had greater GBL (P = .004) and a greater HSI (P < .001). In the ALR-R cohort, only 1 patient (1.8%) had a recurrent dislocation and there were no revision operations. In comparison, in the ALR cohort, 14 patients (11.0%) had recurrent dislocations (P = .040) and 8 (6.3%) underwent revision operations (P = .11). Univariate analysis showed that remplissage protected against recurrent dislocation (P = .040) whereas younger age (P = .004), contact sports participation (P = .001), and increased GBL (P = .048) were associated with recurrent dislocation. Multivariate analysis showed that HSI (P = .001) and contact sports participation (P = .002) predicted recurrent dislocation. Among high-risk patients, only 1 patient (4.2%) in the ALR-R group had a recurrent instability event vs. 6 (66.7%) in the ALR group (P < .001). The high-risk ALR-R subgroup also had significantly better final Western Ontario Shoulder Instability Index (P = .008) and Subjective Shoulder Value (P = .001) scores than the high-risk ALR subgroup.
Anterior shoulder instability patients with on-track Hill-Sachs lesions have lower recurrent dislocation rates after ALR plus remplissage when compared with ALR alone. This is especially true for high-risk patients, such as contact athletes with a DTD <10 mm.
本研究旨在比较有经轨迹 Hill-Sachs 病变的复发性不稳定率，这些患者接受单纯关节镜下盂唇修复术（ALR）和 ALR 联合填充术（ALR-R）的患者。我们的假设是，ALR-R 会降低复发性不稳定的发生率，尤其是在 ALR 后复发性不稳定风险较高的患者中，例如接近经轨迹 Hill-Sachs 病变的接触性运动员。
我们对 2014 年 1 月至 2019 年 12 月期间接受 ALR-R 或无填充 ALR 治疗的年龄在 14-50 岁之间有经轨迹 Hill-Sachs 病变的患者进行了多中心回顾性分析，且随访时间至少为 2 年。排除标准包括同侧肩部手术史、>15%的肩胛盂骨丢失（GBL）、经轨迹外 Hill-Sachs 病变、同期行肩关节手术和结缔组织疾病。记录年龄、性别、随访时间和参与接触性运动情况。从术前磁共振成像扫描中确定 GBL、Hills-Sachs 间隔（HSI）、肩胛盂轨迹和脱位距离（DTD）。还收集了受累肩的活动范围、Western Ontario 肩部不稳定指数评分、主观肩部价值评分、复发性脱位和/或翻修手术情况。对每个队列中的“高危”患者（定义为 DTD<10mm 的接触性运动参与者）进行亚组分析。
ALR-R 队列包括 56 例患者，ALR 队列包括 127 例。ALR-R 患者的 GBL 更大（P=0.004），HSI 更大（P<0.001）。在 ALR-R 队列中，只有 1 例（1.8%）患者发生复发性脱位，且无翻修手术。相比之下，在 ALR 队列中，14 例（11.0%）患者发生复发性脱位（P=0.040），8 例（6.3%）患者行翻修手术（P=0.11）。单因素分析显示，填充术可预防复发性脱位（P=0.040），而年龄较小（P=0.004）、参与接触性运动（P=0.001）和 GBL 增加（P=0.048）与复发性脱位有关。多因素分析显示，HSI（P=0.001）和参与接触性运动（P=0.002）预测复发性脱位。在高危患者中，ALR-R 组仅 1 例（4.2%）患者发生不稳定事件，而 ALR 组有 6 例（66.7%）（P<0.001）。高危 ALR-R 亚组的 Western Ontario 肩部不稳定指数（P=0.008）和主观肩部价值（P=0.001）评分也明显优于高危 ALR 亚组。
与单纯 ALR 相比，有经轨迹 Hill-Sachs 病变的复发性肩前不稳定患者接受 ALR 联合填充术后复发性脱位率较低。对于接触性运动员等高风险患者，如 DTD<10mm 的患者，情况更是如此。
