Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, U.S.A.; Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York, U.S.A.; Plancher Orthopaedics & Sports Medicine, New York, New York, U.S.A.; Orthopaedic Foundation, Stamford, Connecticut, U.S.A..
Orthopaedic Foundation, Stamford, Connecticut, U.S.A.
Arthroscopy. 2024 May;40(5):1420-1430. doi: 10.1016/j.arthro.2023.10.020. Epub 2023 Oct 26.
To compare return to sport, functional outcomes, recurrence of instability, and osteoarthritis (OA) between collision/contact and limited/noncontact athletes following arthroscopic labral reconstruction with a modified inferior capsular shift for anterior shoulder instability.
Athletes underwent an arthroscopic labral reconstruction with a modified inferior capsular shift by the senior author between 1999 and 2018. Inclusion criteria were labral stripping from 12 (just beyond the biceps anchor) to 6 o'clock, less than 20% glenoid bone loss, active sports participation, and no previous surgery. Athletes were divided into collision/contact and limited/noncontact groups. Outcome measures, physical examination, and radiographic evaluation were collected at a minimum 5-year follow-up. Reoperations or any subjective laxity were considered failures. Radiographs were analyzed for OA using the Samilson-Prieto Radiological Classification.
Ninety-two patients underwent arthroscopic labral reconstruction with a modified inferior capsular shift. Sixty-four met the inclusion criteria. Thirty-eight (age = 26.0 ± 8.0 years) participated in at least 1 collision/contact sport, and 26 (age = 38.0 ± 9.0 years) participated in limited/noncontact sports. Two (5%) collision/contact and 3 (12%) limited/noncontact athletes had traumatic reinjury requiring revision surgery. Of the remaining athletes (59/64), minimum 5-year follow-up was obtained on 54 (92%), with a mean follow-up of 12 ± 4 years (range 5-23 years). All athletes returned to their original sport at the same level. There was no significant difference between collision/contact and limited/noncontact athletes in timing of return to sports (5.2 ± 1.9 and 6.0 ± 3.1 months, respectively; P = .389). There were no significant differences between groups on any outcomes scores.
Arthroscopic labral reconstruction with a modified inferior capsular shift addressed anterior instability with return to sport for both collision/contact and limited/noncontact athletes with excellent functional and clinical outcomes, full shoulder range of motion, and a low prevalence of advanced OA at minimum 5-year follow-up. This modified technique resulted in a low failure rate in both limited/noncontact and collision/contact athletes.
Level III, retrospective case control study.
比较关节镜下盂唇重建伴改良下囊转移术治疗前肩不稳中接触性/碰撞性和局限性/非接触性运动员的运动回归、功能结果、再不稳定和骨关节炎（OA）。
1999 年至 2018 年间，由资深作者对前肩不稳患者行关节镜下盂唇重建伴改良下囊转移术。纳入标准为：从 12 点（刚好超出二头肌锚点）到 6 点的盂唇撕裂、小于 20%的肩胛盂骨丢失、积极参与运动、无既往手术史。运动员分为接触性/碰撞性和局限性/非接触性两组。在至少 5 年的随访中收集结果测量、体格检查和影像学评估。再次手术或任何主观松弛被认为是失败。使用 Samilson-Prieto 放射学分类对 X 线片进行 OA 分析。
92 例患者行关节镜下盂唇重建伴改良下囊转移术，64 例符合纳入标准。38 例（年龄=26.0±8.0 岁）参加至少 1 项接触性/碰撞性运动，26 例（年龄=38.0±9.0 岁）参加局限性/非接触性运动。2 例（5%）接触性/碰撞性和 3 例（12%）局限性/非接触性运动员因创伤性再损伤需要行翻修手术。其余 59 名运动员（64 名）中的 54 名（92%）获得至少 5 年的随访，平均随访时间为 12±4 年（5-23 年）。所有运动员均以相同水平重返原运动。接触性/碰撞性和局限性/非接触性运动员的运动回归时间无显著差异（分别为 5.2±1.9 和 6.0±3.1 个月；P=0.389）。两组在任何结果评分上均无显著差异。
关节镜下盂唇重建伴改良下囊转移术治疗前肩不稳，接触性/碰撞性和局限性/非接触性运动员均可重返运动，功能和临床结果良好，全肩关节活动范围正常，在至少 5 年的随访中，晚期 OA 的发生率较低。该改良技术在局限性/非接触性和接触性/碰撞性运动员中均导致较低的失败率。
III 级，回顾性病例对照研究。
