Warner Tyler, Kay Jeffrey, McInnis Shane, Heyworth Benton E
Harvard Medical School, Boston, Massachusetts, USA.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada.
Am J Sports Med. 2025 May;53(6):1494-1504. doi: 10.1177/03635465241267022. Epub 2025 Jan 8.
While risk factors for recurrent instability (RI) after arthroscopic Bankart repair (ABR) for anterior glenohumeral instability (aGHI) have been well established in adult populations, there is much less evidence in pediatric and adolescent patients, despite being the most affected epidemiologic subpopulation.
To identify the clinical, demographic, radiologic, and operative risk factors for RI after ABR for aGHI in pediatric and adolescent patients.
Systematic review; Level of evidence, 4.
This systematic review was performed according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Three databases (PubMed, Embase, and Ovid [MEDLINE]) were searched from data inception to July 5, 2023, using the terms "pediatric,""shoulder instability," and "Bankart repair," allowing data on patients with age up to 19 years. The Methodological Index for Non-randomized Studies tool was used to assess the quality of included studies.
Eleven studies met the criteria, with 767 patients (770 shoulders) with a mean age of 16.4 years (range, 12-19; 18% female). The pooled RI rate was 28%, and the revision aGHI surgery rate was 20%. The following risk factors were identified for RI after ABR, in descending order of frequency of identification, in terms of number of studies: younger age and greater glenoid bone loss, as well as the presence and/or greater size of a Hill-Sachs lesion (HSL) (2 studies each), followed by off-track HSL, >1 dislocation before index surgery, overhead and/or contact sports participation, larger anterior labral tear size, loss of glenoid retroversion, greater number of anchors used, lower postoperative patient-reported outcome scores (PROs), nonunion after bony Bankart repair, and absence of concomitant remplissage (1 study each).
In pediatric and adolescent patients with aGHI, the most common risk factors identified for RI after ABR were younger age, greater glenoid bone loss, and the presence and greater size of an HSL. Other risk factors included >1 dislocation before index surgery, participation in overhead and/or contact sports, larger anterior labral tear size, loss of glenoid retroversion, greater number of anchors used, lower postoperative PROs, nonunion after bony Bankart repair, and absence of concomitant remplissage.
虽然成人前盂肱关节不稳（aGHI）行关节镜下Bankart修复术（ABR）后复发性不稳（RI）的危险因素已得到充分证实，但在儿童和青少年患者中证据要少得多，尽管他们是受影响最严重的流行病学亚人群。
确定儿童和青少年患者aGHI行ABR术后RI的临床、人口统计学、影像学和手术危险因素。
系统评价；证据等级，4级。
本系统评价按照PRISMA指南（系统评价和Meta分析的首选报告项目）进行。从数据起始至2023年7月5日，在三个数据库（PubMed、Embase和Ovid [MEDLINE]）中进行检索，使用“儿科”“肩部不稳”和“Bankart修复”等检索词，纳入年龄最大为19岁患者的数据。采用非随机研究方法学指标工具评估纳入研究的质量。
11项研究符合标准，共767例患者（770个肩部），平均年龄16.4岁（范围12 - 19岁；18%为女性）。汇总的RI发生率为28%，翻修aGHI手术率为20%。确定了ABR术后RI的以下危险因素，按研究中出现频率从高到低排序：年龄较小、肩胛盂骨丢失较多、存在Hill - Sachs损伤（HSL）及HSL较大（各2项研究），其次是偏离轨道的HSL、初次手术前脱位>1次、从事过头和/或接触性运动、前盂唇撕裂较大、肩胛盂后倾丧失、使用的锚钉数量较多、术后患者报告结局评分（PRO）较低、骨性Bankart修复术后不愈合以及未同时进行 remplissage（各1项研究）。
在患有aGHI的儿童和青少年患者中，ABR术后RI最常见的危险因素是年龄较小、肩胛盂骨丢失较多、存在HSL及HSL较大。其他危险因素包括初次手术前脱位>1次、从事过头和/或接触性运动、前盂唇撕裂较大、肩胛盂后倾丧失、使用的锚钉数量较多、术后PRO较低、骨性Bankart修复术后不愈合以及未同时进行 remplissage。
