Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
Bone Joint J. 2024 Oct 1;106-B(10):1125-1132. doi: 10.1302/0301-620X.106B10.BJJ-2024-0262.R1.
The prevalence of osteoarthritis (OA) associated with instability of the shoulder ranges between 4% and 60%. Articular cartilage is, however, routinely assessed in these patients using radiographs or scans (2D or 3D), with little opportunity to record early signs of cartilage damage. The aim of this study was to assess the prevalence and localization of chondral lesions and synovial damage in patients undergoing arthroscopic surgery for instablility of the shoulder, in order to classify them and to identify risk factors for the development of glenohumeral OA.
A total of 140 shoulders in 140 patients with a mean age of 28.5 years (15 to 55), who underwent arthroscopic treatment for recurrent glenohumeral instability, were included. The prevalence and distribution of chondral lesions and synovial damage were analyzed and graded into stages according to the division of the humeral head and glenoid into quadrants. The following factors that might affect the prevalence and severity of chondral damage were recorded: sex, dominance, age, age at the time of the first dislocation, number of dislocations, time between the first dislocation and surgery, preoperative sporting activity, Beighton score, type of instability, and joint laxity.
A total of 133 patients (95%) had synovial or chondral lesions. At the time of surgery, shoulders were graded as having mild, moderate, and severe OA in 55 (39.2%), 72 (51.4%), and six (4.2%) patients, respectively. A Hill-Sachs lesion and fibrillation affecting the anteroinferior glenoid cartilage were the most common findings. There was a significant positive correlation between the the severity of the development of glenohumeral OA and the patient's age, their age at the time of the first dislocation, and the number of dislocations (p = 0.004, p = 0.011, and p = 0.031, respectively).
Synovial inflammation and chondral damage associated with instability of the shoulder are more prevalent than previously reported. The classification using quadrants gives surgeons more information about the chondral damage, and could explain the pattern of development of glenohumeral OA after stabilization of the shoulder. As the number of dislocations showed a positive correlation with the development of OA, this might be an argument for early stabilization.
与肩关节不稳定相关的骨关节炎（OA）的患病率在 4%至 60%之间。然而，这些患者的关节软骨通常通过 X 线或扫描（二维或三维）进行评估，几乎没有机会记录软骨损伤的早期迹象。本研究的目的是评估接受肩关节镜不稳定手术的患者的软骨病变和滑膜损伤的发生率和定位，以便对其进行分类，并确定发生肩峰下 OA 的危险因素。
共纳入 140 名患者（140 例肩关节），平均年龄 28.5 岁（15 至 55 岁），均因复发性肩峰下关节不稳定接受关节镜治疗。根据肱骨头和肩胛盂分为象限，分析和分级软骨病变和滑膜损伤的发生率和分布。记录可能影响软骨损伤发生率和严重程度的以下因素：性别、优势侧、年龄、首次脱位年龄、脱位次数、首次脱位与手术时间间隔、术前运动活动、Beighton 评分、不稳定类型和关节松弛度。
共有 133 例（95%）患者存在滑膜或软骨病变。手术时，55 例（39.2%）、72 例（51.4%）和 6 例（4.2%）患者肩关节分别被评为轻度、中度和重度 OA。前下肩胛盂软骨的 Hill-Sachs 损伤和骨赘是最常见的发现。肩峰下 OA 发展的严重程度与患者年龄、首次脱位年龄和脱位次数呈显著正相关（p = 0.004、p = 0.011 和 p = 0.031）。
与肩关节不稳定相关的滑膜炎和软骨损伤比以前报道的更为常见。使用象限的分类为外科医生提供了更多关于软骨损伤的信息，并可以解释肩关节稳定后肩峰下 OA 的发展模式。由于脱位次数与 OA 的发展呈正相关，这可能是早期稳定的一个理由。
