Schulz William R, Lopez Ramiro J, Marigi Ian M, Crowe Matthew M, Camp Christopher L, Tagliero Adam J, Marigi Erick M
Department of Orthopedic Surgery, Mayo Clinic Florida, Rochester, MN, USA.
Department of Orthopedic Surgery, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA.
Curr Rev Musculoskelet Med. 2025 Mar 31. doi: 10.1007/s12178-025-09962-x.
Management of first-time anterior shoulder instability (ASI) is an extensively studied yet controversial topic. Successful treatment requires incorporation of a wide range of factors including patient demographics, varying presenting pathology, functional demands, and sport specific considerations. The purpose of this review is to provide an up-to-date summary of the current literature and trends regarding management of first time ASI events.
For non-operative treatment of first-time ASI events, shorter times for immobilization and consideration of positioning in external rotation may be more beneficial. Operative intervention may be favored for patients at high risk of recurrence (young, male, collision sports, and/or overhead athlete). Historically, open soft tissue stabilization was a primary treatment option for ASI. More recently, there has been an increased emphasis on arthroscopic Bankart repair (ABR) especially in the United States. The remplissage has become a useful adjunct to ABR to manage cases with Hill-Sachs lesions or sub-critical bone loss. Latarjet (coracoid transfer) remains a well-studied and common option for cases of critical glenoid bone loss. When directly compared both ABR with Remplissage and Latarjet improve outcomes and reduce the risk of recurrence in athletes with first-time ASI. Currently, there is no uniform approach to managing first-time ASI events. Therefore, an individualized approach is required with consideration of the individuals demographic, presence of bone loss, functional demands, and sport specific considerations. In young, male, collision athletes early surgical intervention may be beneficial to prevent recurrence. When faced with minimal (< 13.5%) or subcritical bone loss (13.5% to 20%), ABR with Remplissage may reduce rates of instability compared to ABR alone.
首次前肩不稳（ASI）的管理是一个经过广泛研究但仍存在争议的话题。成功的治疗需要综合考虑多种因素，包括患者人口统计学特征、不同的临床表现病理、功能需求以及特定运动的相关因素。本综述的目的是提供有关首次ASI事件管理的当前文献和趋势的最新总结。
对于首次ASI事件的非手术治疗，缩短固定时间并考虑外旋位可能更有益。对于复发风险高的患者（年轻、男性、从事碰撞性运动和/或上肢运动的运动员），手术干预可能更受青睐。从历史上看，开放软组织稳定术是ASI的主要治疗选择。最近，尤其是在美国，关节镜下Bankart修复术（ABR）受到了更多关注。Remplissage术已成为ABR治疗Hill-Sachs损伤或临界以下骨质流失病例的有用辅助方法。Latarjet（喙突转移）仍然是治疗严重肩胛盂骨质流失病例的一种经过充分研究且常用的选择。直接比较时，ABR联合Remplissage术和Latarjet术都能改善首次ASI运动员的治疗效果并降低复发风险。目前，对于首次ASI事件的管理没有统一的方法。因此，需要采用个体化方法，考虑个体的人口统计学特征、骨质流失情况、功能需求以及特定运动的相关因素。对于年轻、男性、从事碰撞性运动的运动员，早期手术干预可能有助于预防复发。当面临最小（<13.5%）或临界以下骨质流失（13.5%至20%）时，与单纯ABR相比，ABR联合Remplissage术可能会降低不稳定发生率。
