Moore Floriane, Labattut Ludovic, Chauvet Thomas, Bordet Alice, Martz Pierre
Department of Orthopaedic Surgery, Dijon University Hospital, Dijon, France.
Department of Orthopaedic Surgery, Dijon University Hospital, Dijon, France.
J Shoulder Elbow Surg. 2025 May;34(5):1225-1235. doi: 10.1016/j.jse.2024.08.029. Epub 2024 Oct 11.
Chronic anterior shoulder instability affects a young and athletic population, with a high demand for functional recovery and return to sport. The arthroscopic Trillat dynamic stabilization technique has shown great results at 2 years in terms of stabilization and functional outcomes on the general population. The hypothesis is that it could do so in at-risk for dislocation athletic population for stabilization and return to sport, with results comparable to the reference techniques.
This is a multicenter retrospective study of Walch-Duplay type 2, 3, and 4 at-risk sports patients treated by arthroscopic Trillat for chronic anterior shoulder instability between January 2012 and January 2021, at a 2-year follow-up. The primary endpoint was the occurrence of dislocation recurrence. Secondary endpoints were subluxation recurrence, functional outcomes, time and level of return to sport, functional scores, bony fusion, and complications.
A total of 74 patients were analyzed, with a mean age of 24.4 years (15-50 years). Sports levels were moderate risk of dislocation Walch-Duplay type 2 for n = 34 (46%), medium-risk Walch-Duplay type 3 for n = 19 (26%), and high-risk Walch-Duplay type 4 for n = 21 (28%). Dislocation recurred in 3 patients (4.1%). All patients (100%) returned to sport, with an average delay of 4.6 months, with 56 (76%) returning to the same previous level. The mean Constant score was 94.5 (79-100), the Rowe score was 94.7 (70-100), the Walch-Duplay score was 90.2 (50-100), and the Shoulder Subjective Value score was 90.5 (65-100). Subgroup analysis of athletes at moderate risk of dislocation recurrence (Walch-Duplay type 2) vs. medium and high risk of dislocation recurrence (Walch-Duplay types 3 and 4) revealed no statistically significant difference. One patient presented with asymptomatic pseudarthrosis.
Arthroscopic Trillat offers highly satisfactory results in the treatment of chronic anterior shoulder instability for athletes regardless of the type of sport practiced and the type of risk according to Walch-Duplay. This simple and quick technique enables a rapid return to sport and at the previous level in the majority of cases. After showing its effectiveness in the general population at 2 years, arthroscopic Trillat offers a reliable alternative to the reference procedures in young athletic patients.
慢性肩关节前向不稳影响年轻的运动员群体，他们对功能恢复和重返运动有很高的需求。关节镜下Trillat动态稳定技术在2年时对普通人群的稳定效果和功能结局方面已显示出良好的结果。假设该技术在有脱位风险的运动员群体中也能实现稳定并帮助其重返运动，且结果与参考技术相当。
这是一项多中心回顾性研究，纳入了2012年1月至2021年1月间接受关节镜下Trillat手术治疗慢性肩关节前向不稳的Walch-Duplay 2型、3型和4型有脱位风险的运动患者，随访2年。主要终点是脱位复发的发生情况。次要终点包括半脱位复发、功能结局、重返运动的时间和水平、功能评分、骨融合及并发症。
共分析了74例患者，平均年龄24.4岁（15 - 50岁）。运动脱位风险水平为：Walch-Duplay 2型（中度脱位风险）34例（46%），Walch-Duplay 3型（中度风险）19例（26%），Walch-Duplay 4型（高度风险）21例（28%）。3例患者（4.1%）出现脱位复发。所有患者（100%）均重返运动，平均延迟时间为4.6个月，56例（76%）恢复到之前的运动水平。Constant评分平均为94.5（79 - 100），Rowe评分为94.7（70 - 100），Walch-Duplay评分为90.2（50 - 100），肩关节主观价值评分为90.5（65 - 100）。对脱位复发中度风险的运动员（Walch-Duplay 2型）与脱位复发中高度风险的运动员（Walch-Duplay 3型和4型）进行亚组分析，结果显示无统计学显著差异。1例患者出现无症状假关节。
关节镜下Trillat技术在治疗运动员慢性肩关节前向不稳方面提供了非常令人满意的结果，无论所从事的运动类型以及根据Walch-Duplay分类的风险类型如何。这种简单快捷的技术能使大多数患者快速重返运动并恢复到之前的水平。在显示其在普通人群中2年的有效性后，关节镜下Trillat技术为年轻运动员患者的参考手术提供了可靠的替代方案。
