Cusano Antonio, Ment Alexander J, Hao Kevin A, Saleet Jayson, Nian Patrick, Curry Emily, Groot Michael, Novikov David, Abdul-Rassoul Hussein, Parisien Robert L, Owens Brett D, Li Xinning
Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.
Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, U.S.A.
Arthrosc Sports Med Rehabil. 2024 Oct 23;7(2):101032. doi: 10.1016/j.asmr.2024.101032. eCollection 2025 Apr.
To assess clinical outcomes of primary arthroscopic repair for unilateral posterior shoulder instability (PSI) in all patients, to evaluate clinical outcomes in athletes, and to compare clinical outcomes between contact and overhead athletes.
A systematic review was performed using PRISMA Guidelines. Included studies reported on primary arthroscopic treatment of PSI with at least 1 year of follow-up. Studies were excluded if they were not in English, included revisions/open procedures or anterior/multidirectional instability, had fewer than 10 patients or no full text available, or were biomechanical analyses/descriptions of surgical technique. Primary outcomes were rates of return to sport (RTS), return to preinjury level (RTPL), recurrent instability, and revision surgery. Outcomes were evaluated in all patients and all athletes, with further subdivision for and .
Of the 1,504 screened studies, 30 met inclusion criteria (1,649 shoulders). Mean age at surgery was 23.3 years (range: 12.4-65 years), and mean follow-up was 35.5 months (range: 12-140.4 months). There were 1,051 males and 196 females. RTS rates were 91.7% among all patients and 90.9% in all athletes, with no statistical difference between contact and overhead athletes (92.8% vs 88.1%; = .176). RTPL rates were 78.7% among all patients and 75.6% in all athletes, with no statistical difference between contact and overhead athletes (90.8% vs 62.3%; = .072). Recurrent instability rates were 7.0% among all patients and 8.0% in all athletes, with no statistical difference between contact and overhead athletes (7.3% vs 7.4%; = .981). Revision rates were 3.7% among all patients and 3.3% in all athletes, with no statistical difference between contact and overhead athletes (6.8% vs. 0%; = 1).
Primary arthroscopic treatment of PSI is associated with favorable outcomes and high return to sport and work rates. Recurrent instability and pain were the most common reasons for revision.
Level IV, Systematic review and meta-analysis of Level II to IV studies.
评估所有患者原发性关节镜修复治疗单侧后肩关节不稳（PSI）的临床疗效，评估运动员的临床疗效，并比较接触性运动员和过头运动运动员的临床疗效。
按照PRISMA指南进行系统评价。纳入的研究报告了原发性关节镜治疗PSI且随访至少1年的情况。如果研究不是英文的、包括翻修术/开放手术或前侧/多方向不稳、患者少于10例或无全文可用，或者是手术技术的生物力学分析/描述，则将其排除。主要结局指标为恢复运动（RTS）率、恢复到伤前水平（RTPL）率、复发性不稳和翻修手术。对所有患者和所有运动员的结局进行评估，并进一步细分接触性运动员和过头运动运动员的情况。
在1504项筛查研究中，30项符合纳入标准（1649例肩关节）。手术时的平均年龄为23.3岁（范围：12.4 - 65岁），平均随访时间为35.5个月（范围：12 - 140.4个月）。男性1051例，女性196例。所有患者的RTS率为91.7%，所有运动员的RTS率为90.9%，接触性运动员和过头运动运动员之间无统计学差异（92.8%对88.1%；P = 0.176）。所有患者的RTPL率为78.7%，所有运动员的RTPL率为75.6%，接触性运动员和过头运动运动员之间无统计学差异（90.8%对62.3%；P = 0.072）。所有患者的复发性不稳率为7.0%，所有运动员的复发性不稳率为8.0%，接触性运动员和过头运动运动员之间无统计学差异（7.3%对7.4%；P = 0.981）。所有患者的翻修率为3.7%，所有运动员的翻修率为3.3%，接触性运动员和过头运动运动员之间无统计学差异（6.8%对0%；P = 1）。
原发性关节镜治疗PSI疗效良好，恢复运动和工作的比例较高。复发性不稳和疼痛是翻修的最常见原因。
IV级，II至IV级研究的系统评价和荟萃分析。
