Nazzal Ehab M, Herman Zachary J, Engler Ian D, Kaarre Janina, Tisherman Robert T, Gibbs Christopher M, Greiner Justin J, Rai Ajinkya, Hughes Jonathan D, Lesniak Bryson P, Lin Albert
Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Central Maine Healthcare Orthopedics, Central Maine Medical Center, Lewiston, Maine, USA.
Orthop J Sports Med. 2024 Dec 11;12(12):23259671241298014. doi: 10.1177/23259671241298014. eCollection 2024 Dec.
Anterior shoulder instability is a common pathology seen especially in young men and highly active patient populations. Subluxation is a commonly encountered clinical issue, yet little is known about the effects of first-time subluxation compared with dislocation on shoulder stability and clinical outcomes after surgical stabilization.
To compare revision and redislocation rates as well as patient-reported outcomes (PROs) between subluxators and dislocators after a first-time anterior shoulder instability event.
Cohort study; Level of evidence, 3.
Included were patients who underwent operative intervention for a first-time anterior instability event between 2013 and 2020 at a single institution. Exclusion criteria were posterior/multidirectional instability, revision surgery, and recurrent instability. The main outcomes of interest were the rates of redislocation and revision. Demographics and surgical details were retrospectively collected. Instability was categorized as subluxation (no documentation of formal shoulder reduction) or dislocation (documented formal shoulder reduction). Labral tear location and size were determined from preoperative magnetic resonance imaging scans. PROs and return-to-sport, redislocation, and revision rates were collected from prospective survey data.
A total of 256 patients (141 subluxators and 115 dislocators) were available for analysis. There were no significant differences in baseline demographics or preoperative physical examination findings. Rates of bony Bankart lesions were comparable, but Hill-Sachs lesions were more commonly present in dislocators compared with subluxators (88.7% vs 53.9%; < .01). There were no group differences in labral tear size, incidence of concomitant posterior or superior labrum anterior-posterior tears, or number of anchors used. Rates of remplissage were comparable between groups. Prospectively collected survey data of 60 patients (35 subluxators, 25 dislocators) were collected at 6.4 and 7.1 years of follow-up, respectively. Rates of recurrent dislocation (11.8% vs 20.0%) and revision (8.8% vs 16.0%) were comparable between subluxators and dislocators, respectively. All PROs and return-to-sport rates were comparable between groups.
Subluxators and dislocators may present with comparable rates of redislocation and revision surgery even at midterm follow-up. Both cohorts may further present with comparable injury characteristics and PROs. Given the findings, future prospective studies comparing outcomes of first-time instability events are needed.
肩关节前向不稳是一种常见的病理情况，尤其多见于年轻男性和运动活跃的患者群体。半脱位是常见的临床问题，但与脱位相比，首次半脱位对手术稳定后的肩关节稳定性和临床结局的影响知之甚少。
比较首次肩关节前向不稳事件后半脱位患者和脱位患者的翻修率、再脱位率以及患者报告结局（PROs）。
队列研究；证据等级，3级。
纳入2013年至2020年在单一机构因首次前向不稳事件接受手术干预的患者。排除标准为后向/多方向不稳、翻修手术和复发性不稳。主要关注的结局是再脱位率和翻修率。回顾性收集人口统计学资料和手术细节。不稳被分类为半脱位（无正式肩关节复位记录）或脱位（有正式肩关节复位记录）。根据术前磁共振成像扫描确定盂唇撕裂的位置和大小。从前瞻性调查数据中收集PROs、恢复运动情况、再脱位率和翻修率。
共有256例患者（141例半脱位患者和115例脱位患者）可供分析。基线人口统计学资料或术前体格检查结果无显著差异。骨性Bankart损伤的发生率相当，但与半脱位患者相比，Hill-Sachs损伤在脱位患者中更常见（88.7%对53.9%；P<0.01）。盂唇撕裂大小、合并后盂唇或上盂唇前后向撕裂的发生率或使用的锚钉数量在两组间无差异。两组间 remplissage 率相当。分别在随访6.4年和7.1年时收集了60例患者（35例半脱位患者，25例脱位患者）的前瞻性调查数据。半脱位患者和脱位患者的再脱位率（11.8%对20.0%）和翻修率（8.8%对16.0%）相当。两组间所有PROs和恢复运动率相当。
即使在中期随访时，半脱位患者和脱位患者的再脱位率和翻修手术率也可能相当。两组患者可能还具有相当的损伤特征和PROs。鉴于这些发现，未来需要进行前瞻性研究比较首次不稳事件的结局。
