Lee Jae-Hoo, Shin Sang-Jin
Department of Orthopaedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Republic of Korea.
Department of Orthopaedic Surgery, Ewha Shoulder Disease Center, Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
Orthop J Sports Med. 2023 Mar 3;11(3):23259671231151418. doi: 10.1177/23259671231151418. eCollection 2023 Mar.
All-suture anchors have been used for primary arthroscopic Bankart repair because of their ability to minimize initial bone loss.
To evaluate the clinical efficacy of using all-suture anchors in revision arthroscopic labral repair after failed Bankart repair.
Case series; Level of evidence, 4.
Enrolled in this study were 28 patients who underwent revision arthroscopic labral repair with all-suture anchors after a failed primary arthroscopic Bankart repair. Revision surgery was determined for patients who had a frank redislocation history with subcritical glenoid bone loss (<15%), nonengaged Hill-Sachs lesion, or off-track lesion. Minimum 2-year postoperative outcomes were evaluated using shoulder range of motion (ROM), the Rowe score, the American Shoulder and Elbow Surgeons (ASES) score, apprehension, and the redislocation rate. Postoperative shoulder anteroposterior radiographs were assessed to evaluate arthritic changes in the glenohumeral joint.
The mean patient age was 28.1 ± 6.5 years, and the mean time between primary Bankart repair and revision surgery was 5.4 ± 4.1 years. Compared with the number of suture anchors used in the primary operation, significantly more all-suture anchors were inserted in the revision surgery (3.1 ± 0.5 vs 5.8 ± 1.3, < .001). During the mean follow-up period of 31.8 ± 10.1 months, 3 patients (10.7%) required reoperation because of traumatic redislocation and symptomatic instability. Of patients with symptoms that did not require reoperation, 2 patients (7.1%) had subjective instability with apprehension depending on the arm position. There was no significant change between preoperative and postoperative ROM. However, ASES (preoperative: 61.2 ± 13.3 to postoperative: 81.4 ± 10.4, < .01) and Rowe (preoperative: 48.7 ± 9.3 to postoperative: 81.7 ± 13.2, < .01) scores were significantly improved after revision surgery. Eight patients (28.6%) showed arthritic changes in the glenohumeral joint on final plain anteroposterior radiographs.
Revision arthroscopic labral repair using all-suture anchors demonstrated satisfactory 2-year clinical outcomes in terms of functional improvement. Postoperative stability was obtained in 82% of patients without recurrent shoulder instability after failed arthroscopic Bankart repair.
全缝线锚钉已被用于初次关节镜下Bankart修复，因为它们能够将初始骨丢失降至最低。
评估在初次Bankart修复失败后，使用全缝线锚钉进行翻修关节镜下盂唇修复的临床疗效。
病例系列；证据等级，4级。
本研究纳入了28例患者，这些患者在初次关节镜下Bankart修复失败后，使用全缝线锚钉进行翻修关节镜下盂唇修复。对于有明确复发性脱位病史且存在临界以下肩胛盂骨丢失（<15%）、未嵌顿的Hill-Sachs损伤或轨迹异常损伤的患者，决定进行翻修手术。使用肩关节活动范围（ROM）、Rowe评分、美国肩肘外科医师（ASES）评分、恐惧试验和再脱位率评估至少2年的术后结果。评估术后肩关节前后位X线片，以评估盂肱关节的关节炎变化。
患者平均年龄为28.1±6.5岁，初次Bankart修复与翻修手术之间的平均时间为5.4±4.1年。与初次手术中使用的缝线锚钉数量相比，翻修手术中插入的全缝线锚钉明显更多（3.1±0.5对5.8±1.3，P<.001）。在平均31.8±10.1个月的随访期内，3例患者（10.7%）因创伤性再脱位和症状性不稳定需要再次手术。在症状不需要再次手术的患者中，2例患者（7.1%）根据手臂位置有主观不稳定伴恐惧试验阳性。术前和术后ROM无显著变化。然而，翻修手术后ASES评分（术前：61.2±13.3，术后：81.4±10.4，P<.01）和Rowe评分（术前：48.7±9.3，术后：81.7±13.2，P<.01）显著改善。8例患者（28.6%）在最后的前后位X线平片上显示盂肱关节有关节炎变化。
使用全缝线锚钉进行翻修关节镜下盂唇修复在功能改善方面显示出令人满意的2年临床结果。在初次关节镜下Bankart修复失败后，82%的患者术后获得了稳定性，无复发性肩关节不稳定。
