Jain Neil, McKeeman Jonathan, Higgins Margaret, Johnson Alexander, Smith Tyler, Waterman Brian
Department of Orthopaedic Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, U.S.A.
Department of Orthopedic Surgery, Atrium Health Wake Forest Baptist Orthopaedics and Sports Medicine, Winston-Salem, North Carolina, U.S.A.
Arthrosc Sports Med Rehabil. 2025 Apr 10;7(3):101141. doi: 10.1016/j.asmr.2025.101141. eCollection 2025 Jun.
To assess the clinical outcomes of dynamic anterior stabilization using a long head of the biceps transfer (DAS-LHB) with Bankart repair for management of anterior shoulder instability with subcritical glenoid bone loss.
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a review of the PubMed, Scopus, EMBASE, and Medline databases was performed in March 2025. Studies were limited to those reporting outcomes for patients ≥16 years old with subcritical glenoid bone loss (≤20%) and undergoing primary DAS-LHB with Bankart repair. Articles were assessed for range of motion, patient-reported outcomes, recurrent instability, and reoperation rates. The Methodological Index for Non-Randomized Studies scoring criteria were used for study appraisal. Forest plots were created to visualize mean differences in variables of interest.
Among the 4 studies evaluated, 90 patients with mean ages of 23.4 to 31.9 years were included. Average follow-up and bone loss ranged from 24.0 to 41.8 months and 8.0% to 10.5%, respectively. Rowe scores showed improvements ranging from 54.5 to 74.0 points, with 87.9% to 100% of patients meeting minimal clinically important difference thresholds. Changes in forward flexion and external rotation ranged from 3° to 23° and -2.3° to 8.3°, respectively. Four patients (4.4%) experienced a recurrence of dislocation, of whom 2 underwent successful revision with a Latarjet procedure. Of all patients, 90.1% to 100.0% were able to return to sport at any level, while 60.0% to 78.8% returned to their preinjury level of athletic involvement.
DAS-LHB in conjunction with Bankart repair preserves motion while showing clinically important functional improvements with low rates of recurrent instability or complication in the short-term postoperative period for patients with symptomatic shoulder instability.
Level IV, systematic review of Level III and IV studies.
评估采用肱二头肌长头肌腱转位（DAS-LHB）联合Bankart修复术进行动态前路稳定术治疗合并临界以下肩胛盂骨丢失的肩关节前向不稳的临床疗效。
按照系统评价和Meta分析的首选报告项目指南，于2025年3月对PubMed、Scopus、EMBASE和Medline数据库进行了检索。纳入研究限于报告年龄≥16岁、合并临界以下肩胛盂骨丢失（≤20%）且接受初次DAS-LHB联合Bankart修复术患者的疗效。对文章的运动范围、患者报告的结局、复发性不稳和再次手术率进行评估。采用非随机研究方法学指数评分标准对研究进行评价。绘制森林图以直观显示感兴趣变量的平均差异。
在评估的4项研究中，纳入了90例平均年龄为23.4至31.9岁的患者。平均随访时间和骨丢失率分别为24.0至41.8个月和8.0%至10.5%。Rowe评分改善范围为54.5至74.0分，87.9%至100%的患者达到最小临床重要差异阈值。前屈和外旋的变化分别为3°至23°和-2.3°至8.3°。4例患者（4.4%）出现脱位复发，其中2例通过Latarjet手术成功翻修。所有患者中，90.1%至100.0%能够恢复到任何水平的运动，而60.0%至78.8%恢复到受伤前的运动参与水平。
对于有症状的肩关节不稳患者，DAS-LHB联合Bankart修复术在保留运动功能的同时，在术后短期内显示出具有临床意义的功能改善，复发性不稳或并发症发生率较低。
IV级，III级和IV级研究的系统评价。
