Jewett Callie A, Reardon Patrick, Cox Charles, Bowman Eric, Wright Rick W, Dickens Jonathan, LeClere Lance
Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Division of Sports Medicine, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Orthop J Sports Med. 2023 Jun 8;11(6):23259671231174474. doi: 10.1177/23259671231174474. eCollection 2023 Jun.
Failure rates up to 14% have been reported after arthroscopic posterior capsulolabral repair. It is unknown if revision arthroscopic posterior capsulolabral stabilization has inferior restoration of stability and return to sport when compared with primary repair. Optimal management of failed posterior capsulolabral stabilization is unknown.
To report outcomes of revision posterior capsulolabral repair and factors that contribute to failure and to determine optimal management of failed posterior stabilization procedures.
Systematic review; Level of evidence, 4.
A computerized search of the PubMed, EMBASE, and Web of Science databases and manual screening of selected article reference lists were performed in January 2022. Randomized controlled trial, cohort, case-control, and case series studies reporting clinical outcomes of revision arthroscopic posterior capsulolabral repair were eligible. Patient characteristics, indications for revision, intraoperative findings, surgical techniques, and patient-reported outcomes were recorded. Owing to heterogeneity of reported outcomes, data were summarized and presented without pooled statistics.
Only 3 of the 990 identified studies met inclusion criteria. The included studies encompassed 26 revision arthroscopic posterior capsulolabral repairs, with follow-up ranging from 2.3 to 5.3 years. The failed index procedure was arthroscopic capsulolabral repair with suture anchors (n = 22) or posterior thermal capsulorrhaphy (n = 4). The primary indications for revision were recurrent instability and pain. Six patients experienced recurrent instability after revision. Patient satisfaction ranged from 15% to 25%.
This systematic review of 3 studies demonstrated that the incidence of persistent pain and recurrent instability after revision arthroscopic posterior shoulder stabilization is common, and despite slight improvement in patient-reported outcomes, many patients are dissatisfied with their clinical outcomes. Revision arthroscopic posterior shoulder stabilization appears to have a significant failure rate, and there is need for additional prospective studies to help determine the best intervention for these patients.
关节镜下后关节囊盂唇修复术后的失败率高达14%。与初次修复相比，翻修关节镜下后关节囊盂唇稳定术在稳定性恢复和恢复运动方面是否较差尚不清楚。后关节囊盂唇稳定术失败的最佳处理方法尚不清楚。
报告翻修后关节囊盂唇修复的结果、导致失败的因素，并确定失败的后稳定手术的最佳处理方法。
系统评价；证据等级，4级。
2022年1月对PubMed、EMBASE和科学网数据库进行了计算机检索，并对选定文章的参考文献列表进行了人工筛选。符合条件的是报告翻修关节镜下后关节囊盂唇修复临床结果的随机对照试验、队列研究、病例对照研究和病例系列研究。记录患者特征、翻修指征、术中发现、手术技术和患者报告的结果。由于报告结果的异质性，数据进行了总结并呈现，未进行汇总统计。
990项已识别研究中只有3项符合纳入标准。纳入的研究包括26例翻修关节镜下后关节囊盂唇修复，随访时间为2.3至5.3年。失败的初次手术为使用缝合锚钉的关节镜下关节囊盂唇修复（n = 22）或后热关节囊缝合术（n = 4）。翻修的主要指征是复发性不稳定和疼痛。6例患者翻修后出现复发性不稳定。患者满意度为15%至25%。
这项对3项研究的系统评价表明，翻修关节镜下后肩关节稳定术后持续疼痛和复发性不稳定的发生率很常见，尽管患者报告的结果略有改善，但许多患者对其临床结果不满意。翻修关节镜下后肩关节稳定术似乎有显著的失败率，需要更多的前瞻性研究来帮助确定这些患者的最佳干预措施。
