Masud Saad, Momtaz David, Betsch Marcel, Migliorini Filippo, Ghali Abdullah, Popa Alexander, Gouveia Kyle, Leroux Timothy, Degen Ryan, Khan Moin
Wayne State University School of Medicine, Detroit, MI, USA.
Long School of Medicine, San Antonio, TX, USA.
J Shoulder Elbow Surg. 2023 Nov;32(11):e531-e547. doi: 10.1016/j.jse.2023.07.004. Epub 2023 Aug 3.
Anterior shoulder instability is a common clinical problem; however, conflicting evidence exists regarding optimal treatment algorithms. We perform a comparative analysis of stabilization techniques used for recurrent anterior shoulder instability to identify the one associated with the lowest rate of recurrent instability. We additionally explore how glenoid bone loss and osseus lesions affect recurrence rates.
PubMed, MEDLINE, Embase, and Cochrane databases were searched for clinical studies comparing surgical techniques for anterior shoulder instability. Two team members independently assessed all potential studies for eligibility and extracted data. Each included study underwent a risk of bias assessment using the Cochrane risk of bias summary tool. The primary outcome of interest was the rate of recurrent instability, which underwent a Bayesian network meta-analysis. Additional analyses were performed relating to the degree of glenoid bone loss and the presence of osseous lesions.
Of 2699 studies screened, 52 studies with 4209 patients were included. Patients who underwent open Latarjet demonstrated the overall lowest rate of recurrent instability [log odds ratio (L) 1.93], whereas patients who underwent arthroscopic Bankart repair demonstrated the highest (L 2.87). When glenoid bone loss was 10% to 20%, open Latarjet had significantly lower recurrent instability (P = .0016) compared to arthroscopic Bankart repair. When glenoid bone loss increased from 0%-10% to 10%-20%, arthroscopic Bankart repair had a significantly increased rate of recurrence (P = .021). In the presence of an engaging Hill-Sachs lesion, both open Latarjet (P = .01) and arthroscopic Bankart with remplissage (P = .029) had significantly reduced recurrence rates compared to arthroscopic Bankart repair. Finally, regardless of procedure, the presence of a Hill-Sachs or bony Bankart lesion was associated with an increased risk of recurrent instability (r = 0.44, P = .0003, and r = 0.40, P = .006, respectively).
The open Latarjet has the overall lowest recurrent instability and significantly lower compared to arthroscopic Bankart repair in the setting of increasing glenoid bone loss. Bone loss between 0% and 10% results in similar outcomes across all procedures.
肩关节前向不稳是常见的临床问题；然而，关于最佳治疗方案的证据存在冲突。我们对复发性肩关节前向不稳所采用的稳定技术进行比较分析，以确定复发性不稳发生率最低的技术。我们还探讨了肩胛盂骨质流失和骨损伤如何影响复发率。
检索PubMed、MEDLINE、Embase和Cochrane数据库，查找比较肩关节前向不稳手术技术的临床研究。两名团队成员独立评估所有潜在研究的入选资格并提取数据。每项纳入研究使用Cochrane偏倚风险总结工具进行偏倚风险评估。主要关注结局是复发性不稳发生率，对此进行贝叶斯网络荟萃分析。还进行了与肩胛盂骨质流失程度和骨损伤存在情况相关的额外分析。
在筛查的2699项研究中，纳入了52项研究共4209例患者。接受开放性Latarjet手术的患者复发性不稳总体发生率最低[对数优势比（L）1.93]，而接受关节镜下Bankart修复术的患者发生率最高（L 2.87）。当肩胛盂骨质流失为10%至20%时，与关节镜下Bankart修复术相比，开放性Latarjet手术的复发性不稳显著更低（P = 0.0016）。当肩胛盂骨质流失从0% - 10%增加到10% - 20%时，关节镜下Bankart修复术的复发率显著增加（P = 0.021）。存在嵌顿性Hill-Sachs损伤时，与关节镜下Bankart修复术相比，开放性Latarjet手术（P = 0.01）和带 remplissage 的关节镜下Bankart修复术（P = 0.029）的复发率均显著降低。最后，无论采用何种手术，存在Hill-Sachs损伤或骨性Bankart损伤均与复发性不稳风险增加相关（分别为r = 0.44，P = 0.0003，以及r = 0.40，P = 0.006）。
开放性Latarjet手术的复发性不稳总体最低，在肩胛盂骨质流失增加的情况下，与关节镜下Bankart修复术相比显著更低。0%至10%的骨质流失在所有手术中导致的结果相似。
