Stolwijk Paul J, Verweij Lukas P E, Kerkhoffs Gino M M J, van Deurzen Derek F P, Priester-Vink Simone, Sierevelt Inger N, van den Bekerom Michel P J
Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands.
Arthroscopy. 2025 Jun;41(6):2090-2102.e9. doi: 10.1016/j.arthro.2024.08.031. Epub 2024 Sep 6.
To compare patient-reported outcome measures (PROMs) at 1-year and 2-year follow-up after treatment for anterior shoulder instability.
Randomized controlled trials and prospective studies that evaluated and reported PROMs after a capsulolabral repair (with or without remplissage), bone augmentation, or nonoperative treatment to treat anterior shoulder instability at both 1-year and 2-year follow-up were included. PROMs were compared between 1-year and 2-year follow-up; forest plots with mean difference were created to compare baseline, 1-year, and 2-year follow-up; and scatterplots were created to visualize clinical improvement over time.
Fourteen studies, comprising 923 patients, with levels of evidence Level I and II were included. Nine PROMs, of which predominantly were the Western Ontario Shoulder Instability Index (WOSI; 11 studies; 79%), were evaluated. Minimal to no statistically significant change in WOSI, Oxford Shoulder Instability Score, American Shoulder and Elbow Surgeons (ASES), Subjective Shoulder Value, Simple Shoulder Test, Disabilities of Arm, Shoulder, and Hand (DASH), Quick DASH, Single Assessment Numeric Evaluation, or visual analog scale was observed between 1-year and 2-year follow-up. Pooling of the WOSI, Oxford Shoulder Instability Score, ASES, and Single Assessment Numeric Evaluation demonstrated improvement from baseline to 1-year follow-up and minimal to no change between 1-year and 2-year follow-up. Scatterplots of the WOSI and ASES demonstrated the most improvement within 6 months and no clear improvement after 1-year follow-up. Recurrence rates increased with time but varied between studies.
In contrast to recurrence rates, which have been shown to increase with time, minimal to no statistically significant change was observed for any of the included PROMs between 1-year and 2-year follow-up. This finding raises the question as to whether it is necessary to evaluate PROMs in long-term follow-up of patients after shoulder stabilization treatment.
Level II, systematic review of Level I and II studies.
比较前肩不稳治疗后1年和2年随访时患者报告的结局指标（PROMs）。
纳入在1年和2年随访时评估并报告了关节盂唇修复术（伴或不伴填充分层修补）、骨增强术或非手术治疗前肩不稳后PROMs的随机对照试验和前瞻性研究。比较1年和2年随访时的PROMs；绘制平均差森林图以比较基线、1年和2年随访情况；绘制散点图以直观展示随时间的临床改善情况。
纳入了14项研究，共923例患者，证据等级为I级和II级。评估了9项PROMs，其中主要是西安大略肩不稳指数（WOSI；11项研究；79%）。在1年和2年随访之间，未观察到WOSI、牛津肩不稳评分、美国肩肘外科医师协会（ASES）评分、主观肩部价值、简单肩部测试、手臂、肩部和手部功能障碍（DASH）、快速DASH、单项评估数值评定或视觉模拟量表有最小至无统计学意义的变化。WOSI、牛津肩不稳评分、ASES评分和单项评估数值评定的汇总结果显示，从基线到1年随访有改善，而在1年和2年随访之间最小至无变化。WOSI和ASES的散点图显示在6个月内改善最明显，1年随访后无明显改善。复发率随时间增加，但各研究之间有所不同。
与已显示随时间增加的复发率相反，在1年和2年随访之间，所纳入的任何PROMs均未观察到最小至无统计学意义的变化。这一发现引发了一个问题，即在肩部稳定治疗后患者的长期随访中是否有必要评估PROMs。
II级，对I级和II级研究的系统评价。
