Generoso Talissa Oliveira, La Banca Vitor, Gonzalez Felipe F, Bonadiman João Artur, Pallone Lucas Valerio, Guadagnin Eliane C, Garrigues Grant E, Gustafson Jonathan A, Metsavaht Leonardo, Leporace Gustavo
Instituto Brasil de Tecnologias da Saúde, Rua Visconde de Piraja, 407 suite 905, Rio de Janeiro, RJ 22410-003, Brazil; Midwest Orthopaedics at Rush, 1611 W Harrison St, Chicago, IL 60612 USA.
Instituto Brasil de Tecnologias da Saúde, Rua Visconde de Piraja, 407 suite 905, Rio de Janeiro, RJ 22410-003, Brazil; Disciplina de Ortopedia - Centro Universitário Faculdade de Medicina do ABC (FMABC), Av. Lauro Gomes, 2000, Santo André, SP, Brazil.
J Biomech. 2025 Mar;181:112543. doi: 10.1016/j.jbiomech.2025.112543. Epub 2025 Jan 22.
Anterior Shoulder Instability (ASI) is a common orthopedic condition often resulting in altered shoulder kinematics. Understanding the biomechanics of the unstable shoulder is critical to determine the most appropriate treatment. This study aims to conduct the first systematic review and meta-analysis of three-dimensional (3D) shoulder kinematic studies in ASI patients. A broad search was conducted within PubMed, Scopus, and Cochrane Library following the PRISMA guidelines. All cross-sectional or longitudinal studies with 3D motion analysis describing shoulder kinematics in patients with ASI were included. The quality of each study was assessed using the MINORS criteria. Qualitative and quantitative analyses were performed. Nine studies were included in the qualitative analysis and two in the meta-analysis. The qualitative review detected conflicting evidence for some parameters. The humeral head had a greater anterior translation in unstable shoulders in three of the studies analyzed, while the difference was not significant in one and another found higher variability for global humeral translation for instability patients. Two studies showed decreased rotation range of motion for unstable shoulders while one did not find significant differences. Conflicting results were also found regarding changes in scapulohumeral rhythm and scapular orientation. The meta-analysis indicated a greater scapulohumeral rhythm on the coronal plane for the instability group, suggesting a relatively greater contribution of motion at the glenohumeral joint compared with the scapulothoracic joint for arm abduction, and reduced glenohumeral peak angles for unstable shoulders. Identifying and quantifying kinematic changes associated with ASI are vital for refining treatment interventions.
前肩不稳（ASI）是一种常见的骨科疾病，常导致肩部运动学改变。了解不稳定肩部的生物力学对于确定最合适的治疗方法至关重要。本研究旨在对ASI患者的三维（3D）肩部运动学研究进行首次系统评价和荟萃分析。按照PRISMA指南在PubMed、Scopus和Cochrane图书馆进行了广泛检索。纳入所有采用3D运动分析描述ASI患者肩部运动学的横断面或纵向研究。使用MINORS标准评估每项研究的质量。进行了定性和定量分析。定性分析纳入9项研究，荟萃分析纳入2项研究。定性综述发现一些参数存在相互矛盾的证据。在分析的3项研究中，不稳定肩部的肱骨头向前平移更大，而在1项研究中差异不显著，另一项研究发现不稳定患者的整体肱骨平移变异性更高。2项研究显示不稳定肩部的旋转运动范围减小，而1项研究未发现显著差异。在肩胛肱骨节律和肩胛方向的变化方面也发现了相互矛盾的结果。荟萃分析表明，不稳定组在冠状面上的肩胛肱骨节律更大，这表明在手臂外展时，与肩胛胸壁关节相比，盂肱关节的运动贡献相对更大，且不稳定肩部的盂肱峰值角度减小。识别和量化与ASI相关的运动学变化对于优化治疗干预至关重要。
