Bitar Ivan Jose, Marangoni Lucas Daniel, Bustos Damian Gabriel, Pezzutti Luciano, Bitar Lucia Belen
Sanatorio Allende, Avenida Hipólito Irigoyen 384, Nueva Córdoba, CP 5000, Córdoba, Argentina.
M85 L2 Causana, Malagueño, Córdoba, Argentina.
Arch Orthop Trauma Surg. 2024 Jul;144(7):3197-3204. doi: 10.1007/s00402-024-05420-4. Epub 2024 Jul 5.
Open Bankart repair plus inferior capsular shift has not yet been tested under the concept of glenoid track as a predictor of failure. The aim of this study was to compare the subjective and objective outcomes in collision athletes with subcritical glenoid bone loss and on-track Hill Sachs lesions versus those with off-track Hill Sachs lesions, all treated with open Bankart repair.
Two study groups were created: 50 patients had on-track Hill Sachs lesions, while 38 had off-track lesions. The subcritical glenoid bone loss was ≤ 10%. A minimum follow-up period of 3 years was established. Preoperative and postoperative evaluation of each group and between them was performed. The Western Ontario Shoulder Instability Index score and the American Shoulder and Elbow Surgeons scale were used to assess subjective outcomes. Recurrence rate, range of motion and return to sport were evaluated as objective outcomes.
Significant differences were reported in the WOSI and ASES scores between preoperative and postoperative values in each group. There were no significant differences between the two groups (p-value = 0.36 and 0.71). Three dislocations (6%) in the on-track group and 3 (7.8%) in the off-track group were recorded, showing no differences between the two groups (p-value = 0.83). There were no differences in ROM between pre- and post-operatively in each group or when comparing the two groups.
We found no differences between the outcomes of the two groups. According to the surgeon's preference, we recommend performing open Bankart repair plus inferior capsular shift as a treatment alternative in collision athletes with SGBL ≤ 10% independently of the type of Hill Sachs lesion.
在关节盂轨迹这一失败预测概念下，开放Bankart修复术联合下关节囊移位术尚未得到验证。本研究的目的是比较开放性Bankart修复术治疗的、关节盂骨量轻度减少且Hill-Sachs损伤位于关节盂轨迹上的碰撞项目运动员与Hill-Sachs损伤位于关节盂轨迹外的运动员的主观和客观结果。
设立两个研究组：50例患者的Hill-Sachs损伤位于关节盂轨迹上，38例患者的损伤位于关节盂轨迹外。关节盂骨量轻度减少≤10%。确定最短随访期为3年。对每组患者术前和术后以及两组之间进行评估。采用西安大略肩不稳定指数评分和美国肩肘外科医师评分评估主观结果。将复发率、活动范围和恢复运动情况作为客观结果进行评估。
每组术前和术后的WOSI和ASES评分均有显著差异。两组之间无显著差异（p值分别为0.36和0.71）。关节盂轨迹上组记录到3例脱位（6%），关节盂轨迹外组记录到3例（7.8%），两组之间无差异（p值 = 0.83）。每组术前和术后的活动范围以及两组之间的活动范围均无差异。
我们发现两组结果无差异。根据外科医生的偏好，我们建议对于关节盂骨量轻度减少≤10%的碰撞项目运动员，无论Hill-Sachs损伤类型如何，均可选择开放性Bankart修复术联合下关节囊移位术作为治疗方案。
