Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea.
Am J Sports Med. 2023 Dec;51(14):3845-3850. doi: 10.1177/03635465231203152. Epub 2023 Oct 18.
Glenoid concavity compression by rotator cuff muscle contraction is one of the key mechanisms in the stability of the glenohumeral joint.
PURPOSE/HYPOTHESIS: The purpose of this study was to evaluate the effects of glenoid concavity, as represented by the bony shoulder stability ratio (BSSR) and other factors, including glenoid bone defect size, on the surgical failure of arthroscopic stabilization procedures for recurrent anterior shoulder instability. The authors also aimed to determine the critical value of BSSR. It was hypothesized that both glenoid concavity and glenoid bone defect size would be correlated with surgical failure, with glenoid concavity having a stronger correlation.
Case-control study; Level of evidence, 3.
A total of 120 patients who underwent arthroscopic stabilization procedures for recurrent anterior shoulder instability were included. Patients with bony Bankart lesions were excluded to eliminate the postoperative effects of bony fragment restoration on the glenoid concavity. For each patient, variable factors including BSSR, glenoid bone defect size, presence of off-track Hill-Sachs lesions, and age at first dislocation were recorded. Chi-square analysis and Student test were performed to analyze the effect of each variable on surgical failure. Multivariate logistic regression analysis was used to determine the combined effect of >2 variables on surgical failure. The critical value of BSSR was analyzed using a receiver operating characteristic curve.
Nine patients (7.5%) had recurrent instability requiring revision surgery. BSSR (patients with recurrence, 18.6% ± 19.4%; patients without recurrence, 41.8% ± 10.5%; = .01), glenoid bone defect size (17.5% ± 3.6% vs 11.7% ± 7.0%; = .02), age at the time of first dislocation (18.8 ± 3.9 years vs 22.0 ± 6.5 years; = .04), and number of suture anchors used (4.1 ± 0.3 vs 5.8 ± 1.6; < .001) showed significant differences between patients with and without surgical failure. Multivariate logistic regression analysis revealed surgical failure to be correlated with BSSR (odds ratio, 0.849; = .02) and the number of suture anchors used (odds ratio, 0.070; = .03). The critical value of BSSR was 29.3% (area under the curve, 0.84; 95% CI, 0.67-1.00; < .001; sensitivity, 78%; specificity, 93%).
Glenoid concavity is strongly correlated with surgical failure after arthroscopic stabilization procedures for anterior shoulder instability. The value of BSSR reflects shoulder instability caused by glenoid bone morphology more accurately than glenoid bone defect size.
冈下肌收缩时对肩胛盂的挤压是盂肱关节稳定性的关键机制之一。
目的/假设：本研究旨在评估肩胛盂的形态（以骨性肩稳定性比 BSSR 表示）和其他因素（包括盂骨缺损大小）对复发性肩关节前向不稳定行关节镜稳定手术失败的影响。作者还旨在确定 BSSR 的临界值。假设肩胛盂形态和盂骨缺损大小都与手术失败相关，其中肩胛盂形态的相关性更强。
病例对照研究；证据等级，3 级。
共纳入 120 例因复发性肩关节前向不稳定行关节镜稳定手术的患者。排除有骨 Bankart 损伤的患者，以消除骨碎片修复对肩胛盂形态的术后影响。对于每个患者，记录包括 BSSR、盂骨缺损大小、存在外侧移位的 Hill-Sachs 损伤、初次脱位年龄在内的变量因素。采用卡方检验和 Student t 检验分析各变量对手术失败的影响。采用多变量逻辑回归分析确定>2 个变量对手术失败的联合影响。通过受试者工作特征曲线分析 BSSR 的临界值。
9 例（7.5%）患者出现需要翻修手术的复发性不稳定。BSSR（复发组，18.6%±19.4%；未复发组，41.8%±10.5%； =.01）、盂骨缺损大小（17.5%±3.6%比 11.7%±7.0%； =.02）、初次脱位年龄（18.8±3.9 岁比 22.0±6.5 岁； =.04）和缝线锚钉使用数量（4.1±0.3 比 5.8±1.6； <.001）在手术失败患者与无手术失败患者之间存在显著差异。多变量逻辑回归分析显示手术失败与 BSSR（比值比，0.849； =.02）和缝线锚钉使用数量（比值比，0.070； =.03）相关。BSSR 的临界值为 29.3%（曲线下面积，0.84；95%CI，0.67-1.00； <.001；灵敏度，78%；特异性，93%）。
肩胛盂形态与关节镜稳定手术治疗肩关节前向不稳定后的手术失败密切相关。BSSR 值比盂骨缺损大小更能准确反映由肩胛盂骨形态引起的肩关节不稳定。
