Delgado Cristina, Calvo Elena, Martínez-Catalán Natalia, Valencia Maria, Luengo-Alonso Gonzalo, Calvo Emilio
Department of Orthopaedic Surgery and Traumatology, Shoulder and Elbow Reconstructive Surgery Unit, IIS-Fundación Jiménez Díaz, Madrid, Spain.
Medical Department, Universidad Autónoma de Madrid, Madrid, Spain.
Knee Surg Sports Traumatol Arthrosc. 2025 Mar;33(3):1044-1054. doi: 10.1002/ksa.12391. Epub 2024 Aug 5.
To determine arthroscopic Bankart repair outcomes and recurrence risk factors at a minimum 5-year follow-up.
Retrospective assessment of prospectively collected data, single-cohort study of patients who underwent arthroscopic Bankart repair with a minimum 5-year follow-up. Demographical and preoperative instability features were collected. Primary outcome was recurrent instability set as dislocation or subluxation. Secondary outcomes were revision surgery, postoperative instability degree according to Manta criteria, objective and subjective clinical and functional status, assessed by the Rowe, Western Ontario Shoulder Index (WOSI) and Subjective Shoulder Value (SSV) scores. Return to sport and postoperative sports activity at the final follow-up were also recorded.
One-hundred and seventy-two patients, 82% men, average age at surgery 29.5 ± 9.2 years, were included. At a mean follow-up of 8.3 ± 2.6 years, recurrent instability occurred in 53 of 172 patients (30.8%). Revision surgery was required in 23/53 (43.4%) of shoulder with recurrent instability. Recurrence occurred within the first 2 years postoperative in 49% of the shoulders, whereas 51% of recurrences occurred after this period. Recurrence took place after a traumatic event in 25% and 56%, respectively. Recurrence rates were higher in patients who underwent surgery after two or more dislocations (p = 0.029). Patients younger at the time of first dislocation, younger at surgery and those with a higher preoperative degree of instability also showed significantly higher rates of recurrence (p = 0.04, p = 0.02, p = 0.03). Postoperative ROWE, WOSI and SSV scores were significantly worse in patients with recurrent instability (p < 0.001). Return-to-sports rate was also lower in patients with postoperative recurrence (p < 0.001).
The arthroscopic Bankart repair was associated with a high long-term recurrence rate, and its effectiveness decreased over time. The lowest recurrence rates in arthroscopic Bankart repair were achieved in older patients with only one prior instability episode and a lower instability degree.
Level IV.
确定关节镜下Bankart修复术在至少5年随访期内的疗效及复发危险因素。
对前瞻性收集的数据进行回顾性评估，对接受关节镜下Bankart修复术且随访至少5年的患者进行单队列研究。收集人口统计学和术前不稳定特征。主要结局为复发性不稳定，定义为脱位或半脱位。次要结局为翻修手术、根据Manta标准评估的术后不稳定程度、客观和主观临床及功能状态，通过Rowe评分、西安大略肩指数（WOSI）和主观肩值（SSV）评分进行评估。还记录了最终随访时的运动恢复情况和术后体育活动情况。
纳入172例患者，其中男性占82%，手术时平均年龄为29.5±9.2岁。平均随访8.3±2.6年，172例患者中有53例（30.8%）出现复发性不稳定。53例复发性不稳定的肩关节中有23例（43.4%）需要翻修手术。49%的肩关节在术后2年内复发，而51%的复发发生在此之后。分别有25%和56%的复发发生在创伤事件之后。经历过两次或更多次脱位后接受手术的患者复发率更高（p = 0.029）。首次脱位时年龄较小、手术时年龄较小以及术前不稳定程度较高的患者复发率也显著更高（p = 0.04，p = 0.02，p = 0.03）。复发性不稳定患者的术后ROWE、WOSI和SSV评分显著更差（p < 0.001）。术后复发患者的运动恢复率也较低（p < 0.001）。
关节镜下Bankart修复术长期复发率较高，且其疗效随时间下降。关节镜下Bankart修复术复发率最低的情况出现在仅有一次既往不稳定发作且不稳定程度较低的老年患者中。
四级。
