Bulleit Clark H, Hurley Eoghan T, Therien Aaron D, Doyle Tom R, Hinton Zoe W, Wu Kevin A, Anakwenze Oke, Klifto Christopher S, Lau Brian C, Dickens Jonathan F
Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA.
Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA.
J Shoulder Elbow Surg. 2025 May;34(5):1305-1312. doi: 10.1016/j.jse.2024.08.054. Epub 2024 Nov 9.
The risk factors associated with recurrent instability following Latarjet procedure remain poorly understood. The purpose of this study was to conduct a systematic review to elucidate risk factors contributing to therapeutic failure after the Latarjet procedure.
A comprehensive literature search was performed using the PubMed/MEDLINE and Embase databases based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies that evaluated risk factors for recurrence of instability following the Latarjet procedure that were published after 2000 were included.
A total of 24 studies, encompassing 3166 patients, were included in the analysis, identifying 13 risk factors. Four studies, comprising 206 patients, evaluated the role of epilepsy as a risk factor for recurrence, with 75% (3) finding a statistically significant increased risk. Meta-analysis demonstrated a recurrence rate of 16.7% (7/42) in epilepsy patients compared with 2.5% (3/119) for those without (P = .003). Previous stabilization surgery was evaluated in 3 studies, with 2 finding increased risk. Meta-analysis revealed a recurrence rate of 17.5% (45/257) for patients with a previous stabilization surgery compared with 5.1% (26/512) for patients undergoing a primary Latarjet procedure. Two studies investigated coracoid width, with 1 finding an increased risk for narrow coracoid measurements. One study found a 4-fold increased risk of recurrence in patients with an engaging Hill-Sachs lesion. However, another study found no difference in the recurrence rate for patients with engaging Hill-Sachs lesions with glenoid bone loss greater than 25%.
The rate of recurrent instability following the Latarjet procedure is inherently low. However, epilepsy and previous stabilization surgery appear to be significant risk factors for recurrence. Other reported risk factors include fixation technique, glenoid bone loss, off-track Hill-Sachs lesions, and bilateral shoulder instability.
与Latarjet手术术后复发性不稳定相关的危险因素仍未得到充分了解。本研究的目的是进行一项系统评价，以阐明导致Latarjet手术治疗失败的危险因素。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南，使用PubMed/MEDLINE和Embase数据库进行全面的文献检索。纳入2000年后发表的评估Latarjet手术后不稳定复发危险因素的研究。
共有24项研究，涵盖3166例患者，纳入分析，确定了13个危险因素。四项研究，共206例患者，评估了癫痫作为复发危险因素的作用，其中75%（3项）发现复发风险有统计学意义的增加。Meta分析显示，癫痫患者的复发率为16.7%（7/42），而无癫痫患者的复发率为2.5%（3/119）（P = 0.003）。3项研究评估了既往稳定手术，其中2项发现风险增加。Meta分析显示，既往有稳定手术的患者复发率为17.5%（45/257），而初次接受Latarjet手术的患者复发率为5.1%（26/512）。两项研究调查了喙突宽度，其中1项发现喙突测量值狭窄的风险增加。一项研究发现，存在嵌顿性Hill-Sachs损伤的患者复发风险增加4倍。然而，另一项研究发现，盂骨丢失大于25%的嵌顿性Hill-Sachs损伤患者的复发率没有差异。
Latarjet手术后复发性不稳定的发生率本身较低。然而，癫痫和既往稳定手术似乎是复发的重要危险因素。其他报告的危险因素包括固定技术、盂骨丢失、非典型Hill-Sachs损伤和双侧肩部不稳定。
