Avram George Mihai, Neculau Diana-Cosmina, Tomescu Horia, Scarlat Marius, Huri Gazi, Marcheggiani Muccioli Giulio Maria, Obada Bogdan, Popescu Ion-Andrei
Romanian Shoulder Institute, ORTOPEDICUM - Orthopaedic Surgery & Sports Clinic, Bucharest, Romania.
University Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland.
Int Orthop. 2025 Jun 16. doi: 10.1007/s00264-025-06581-6.
Dynamic anterior stabilization (DAS) is a novel soft-tissue procedure for treating anterior shoulder instability in selected cases. The purpose of the present meta-analysis is to provide the up-to-date evidence on DAS's outcomes, safety and characterize study designs to improve future studies and accelerate technical advancements.
A PRISMA guided meta-analysis was performed. Inclusion criteria were human studies, comparative or non-comparative in which DAS was performed as an indication for anterior shoulder instability. Four databases were searched PubMed (via MEDLINE), EMBASE, Web of Science, and Science Direct. ROBINS-I was employed for risk of bias analysis. A random-effects meta-analysis was performed using mean difference (MD) as effect size estimator. Heterogeneity was reported using the I statistic. Dichotomous variables were counted and reported as % out of total sample size for each study.
Five studies met the inclusion criteria. A total of 137 patients were available for analysis with a mean age of 27.8 ± 9 years and 108 patients were males. Mean follow-up duration was 37 ± 11 months. Postoperative ASES score showed an improvement of MD = -15.09 (95% CI: -22.35 to -7.38), p < 0.01, compared to the preoperative period. The ROWE score showed a similar improvement, MD = -58.38 (95% CI: -69.88 to -46.89), p < 0.01. Postoperative range of motion (ROM) was not significantly influenced. Active anterior elevation had a MD = -6.07° (95% CI: -15.04 to 2.91), p = 0.19, active external rotation had a MD = 3.7° (95% CI: -7.71 to 15.11), p = 0.53, and active internal rotation, MD = 0.16° (95% CI: -1.4 to 1.73), p = 0.84. Return to play ranged from 80 to 100% while return to competitive sports, reported by a single study, was 33%. The overall complication rate was 8.6%. The overall risk of bias was "serious" or "critical" for all included studies.
DAS has been shown to improve postoperative PROMs, does not restrict ROM compared to the preoperative period and has an overall complication rate of 8.6%.
动态前路稳定术（DAS）是一种用于治疗特定病例前肩不稳的新型软组织手术。本荟萃分析的目的是提供关于DAS疗效、安全性的最新证据，并对研究设计进行特征分析，以改进未来研究并加速技术进步。
进行了一项遵循PRISMA指南的荟萃分析。纳入标准为针对人类的研究，包括比较性或非比较性研究，其中DAS作为前肩不稳的一种治疗方法。检索了四个数据库：PubMed（通过MEDLINE）、EMBASE、科学网和科学Direct。采用ROBINS - I进行偏倚风险分析。使用平均差（MD）作为效应量估计器进行随机效应荟萃分析。使用I统计量报告异质性。对二分变量进行计数，并报告为每项研究总样本量的百分比。
五项研究符合纳入标准。共有137例患者可供分析，平均年龄为27.8±9岁，其中108例为男性。平均随访时间为37±11个月。与术前相比，术后ASES评分显示平均差MD = -15.09（95%置信区间：-22.35至-7.38），p < 0.01。ROWE评分也有类似改善，MD = -58.38（95%置信区间：-69.88至-46.89），p < 0.01。术后活动范围（ROM）未受到显著影响。主动前屈上举的平均差MD = -6.07°（95%置信区间：-15.04至2.91），p = 0.19；主动外旋的平均差MD = 3.7°（95%置信区间：-7.71至15.11），p = 0.53；主动内旋的平均差MD = 0.16°（95%置信区间：-1.4至1.73），p = 0.84。恢复运动的比例在80%至100%之间，而一项研究报告的恢复竞技运动的比例为33%。总体并发症发生率为8.6%。所有纳入研究的总体偏倚风险为“严重”或“关键”。
已证明DAS可改善术后患者报告的结局测量指标（PROMs），与术前相比不限制ROM，总体并发症发生率为8.6%。
