Kaiser Permanente Southern California, Department of Orthopaedic Surgery, 1011 Baldwin Park Blv, Baldwin Park, CA 91706, USA.
Tohoku Rosai Hospital, 4-3-21 Dainohara, Aoba-ku, Sendai 981-8563, Japan.
J ISAKOS. 2024 Apr;9(2):168-183. doi: 10.1016/j.jisako.2023.10.008. Epub 2023 Oct 29.
Arthroscopic Bankart repair (ABR) has been accepted as a standard procedure for anterior shoulder instability with a minimum or no glenoid bone loss and an on-track Hill-Sachs lesion if present. However, several controversies exist in the surgical treatment of anterior shoulder instability. This article will discuss some of these controversies in, "simple," dislocations (without bone loss) as well as, "complex," (with critical bone loss). Determining which patients will benefit from an arthroscopic procedure depends on multiple factors including age, activity level, adequate determination of bone loss, performed with feasible and reliable imaging techniques. In the absence of concomitant significant bony and soft tissue pathology, ABR alone can provide satisfactory clinical results on a long-term basis. Controversies, including whether to remove cartilage from the edge of the glenoid, knotted versus knotless anchors, and routine rotator interval closure, still exist. In cases with significant bone loss, several bone restoring procedures have been described, such as, the Latarjet procedure, iliac crest bone graft, arthroscopic anatomic glenoid reconstruction with a frozen distal tibial allograft, and fresh distal tibial allograft reconstruction. This article will address these controversies and provide guidance based on available published data.
关节镜下 Bankart 修复术（ABR）已被接受为治疗有或无肩盂骨丢失和存在轨道型 Hill-Sachs 损伤的前肩不稳定的标准程序。然而，在前肩不稳定的手术治疗中存在一些争议。本文将讨论“单纯”（无骨丢失）和“复杂”（有临界骨丢失）脱位中这些争议中的一些。确定哪些患者将受益于关节镜手术取决于多个因素，包括年龄、活动水平、骨丢失的充分确定，以及可行和可靠的影像学技术的应用。在没有伴随明显骨和软组织病变的情况下，单独进行 ABR 可以在长期基础上提供满意的临床结果。仍存在一些争议，包括是否从肩盂边缘切除软骨、结节与无结锚钉、以及常规旋转间隔关闭。对于有明显骨丢失的病例，已经描述了几种骨修复程序，例如 Latarjet 手术、髂嵴骨移植、关节镜下解剖性肩盂重建伴冷冻胫骨远端同种异体移植物、以及新鲜胫骨远端同种异体移植物重建。本文将讨论这些争议，并根据现有发表的数据提供指导。
