Department of Orthopaedic Surgery, Harvard Medical School/Massachusetts General Hospital, Boston Shoulder Institute, Boston, MA, USA.
School of Medicine, University of Jordan, Amman, Jordan.
J Shoulder Elbow Surg. 2024 Aug;33(8):1836-1846. doi: 10.1016/j.jse.2024.01.045. Epub 2024 Mar 16.
Recurrent anterior shoulder instability remains the most common complication from a prior shoulder dislocation, especially among young and active individuals who engage in athletic activities. This instability can lead to repeated subluxation or dislocations of the humeral head from the glenoid fossa. The purpose of this study is to compare postoperative recurrence rates, instability-related revision and return to sport (RTS) rates between isolated arthroscopic Bankart repair (ABR) and ABR with remplissage (ABR + R) for anterior shoulder instability with subcritical glenoid bone loss (GBL) and a Hill-Sachs lesion (HSL).
PubMed, Embase, and Web of Science were searched on June 2022. Studies sought were those comparing postoperative outcomes of ABR + R versus isolated ABR for subcritical GBL and an HSL. Study quality was evaluated using the revised Cochrane tool. Redislocations, instability-related revisions, and RTS rates were extracted and pooled estimates were calculated using the random-effect model.
Twelve studies were included with a mean follow-up of 48.2 months for isolated ABR and 43.2 months for ABR + R. The meta-analytic comparison demonstrated that ABR + R resulted in statistically significant improvement in Rowe and American Shoulder and Elbow Surgeons scores by 6.5 and 2.2 points, respectively; however, the improvements in patient-reported outcomes were not clinically meaningful. ABR + R resulted in reduced external rotation at the side by 1° which was not clinically meaningful and there was no significant difference in terms of forward elevation. ABR + R resulted in a statistically significant reduction of overall postoperative recurrences (odds ratio [OR]: 9.36), postoperative dislocations (OR: 6.28), instability-related revision (OR: 3.46), and RTS to any level (OR: 2.85).
The addition of remplissage to ABR for recurrent anterior shoulder instability with subcritical GBL and HSL results in significantly lower postoperative instability recurrence, lower instability-related revisions, and higher RTS to any level.
复发性前肩不稳定仍然是前肩脱位最常见的并发症，尤其是在从事运动活动的年轻和活跃人群中。这种不稳定性可导致肱骨头反复从关节盂窝半脱位或脱位。本研究的目的是比较有临界性骨下盂肱关节（glenoid bone loss，GBL）和 Hill-Sachs 损伤（Hill-Sachs lesion，HSL）的复发性前肩不稳定患者，行单纯关节镜下 Bankart 修复术（arthroscopic Bankart repair，ABR）和 Bankart 修复术联合填充术（ABR+R）后的术后复发率、与不稳定相关的翻修率和重返运动（return to sport，RTS）率。
于 2022 年 6 月在 PubMed、Embase 和 Web of Science 上进行检索。研究纳入比较 ABR+R 与单纯 ABR 治疗临界性 GBL 和 HSL 的术后结果的研究。使用修订后的 Cochrane 工具评估研究质量。提取再脱位、与不稳定相关的翻修和 RTS 率，并使用随机效应模型计算合并估计值。
纳入 12 项研究，单纯 ABR 的平均随访时间为 48.2 个月，ABR+R 的平均随访时间为 43.2 个月。Meta 分析比较显示，ABR+R 在 Rowe 和美国肩肘外科医生（American Shoulder and Elbow Surgeons，ASES）评分方面分别显著提高 6.5 分和 2.2 分；然而，患者报告的结局改善并不具有临床意义。ABR+R 导致外旋在侧方减少 1°，这并不具有临床意义，且在前举方面无显著差异。ABR+R 显著降低总体术后复发率（比值比[odds ratio，OR]：9.36）、术后脱位（OR：6.28）、与不稳定相关的翻修（OR：3.46）和任何级别 RTS（OR：2.85）。
在复发性前肩不稳定伴临界性 GBL 和 HSL 的患者中，ABR 联合填充术可显著降低术后不稳定复发率、降低与不稳定相关的翻修率，并提高任何级别 RTS 的比率。
