Arner Justin W, Keeling Laura E, Spaeder David, Bradley James P
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Orthop J Sports Med. 2025 Jul 23;13(7):23259671251358374. doi: 10.1177/23259671251358374. eCollection 2025 Jul.
Posterior shoulder instability has recently been linked to a higher and flatter acromion. However, the effect of acromial morphology on surgical outcomes has not been evaluated.
To evaluate differences in acromial morphology between patients undergoing primary and revision arthroscopic stabilization for posterior shoulder instability.
Case-control study; Level of evidence, 3.
A series of patients who underwent either primary or revision arthroscopic stabilization for posterior shoulder instability between 2001 and 2022 were identified. Revision patients were matched to nonrevision patients based on age, sex, and sport. Comparisons of patient characteristics and acromial and glenoid morphology were done between groups using previously described magnetic resonance imaging parameters, including posterior acromial tilt (PAT), anterior acromial coverage (AAC), posterior acromial coverage (PAC), and posterior acromial height (PAH). Glenoid bone loss and glenoid version were also evaluated. Continuous variables were compared between groups using a 2-tailed Student test.
A total of 37 patients who underwent revision posterior shoulder stabilization during the study period were identified and matched to 37 patients who underwent primary posterior shoulder stabilization. The mean ages of the primary and revision patients at the time of initial surgery were 21.5 ± 4.8 years (range, 13-35 years) and 19.6 ± 6.1 years (range, 12-45 years), respectively ( = .95). Men comprised 54% of each group. The mean PAT in the primary and revision groups was 51.6° and 53.7° ( = .32), while the mean PAH was 10 mm and 13.5 mm ( = .04), respectively. The mean AAC in the primary and revision groups was 4.44° and 7.10° ( = .20), while the mean PAC was 72.1° and 63.3°± 8.11° ( = .08), respectively. No difference was found in the glenoid version (6.22° in the primary group vs 8.08° in the revision group; = .06). The mean glenoid bone loss was 0.57% (range, 0%-8.9%) in the primary group and 1.4% (range, 0%-5.8%) in the revision group ( = .02).
A higher acromion was associated with requiring revision of previous arthroscopic posterior capsulolabral repair. PAT and coverage were not significantly different between patients undergoing primary versus revision repair. There was no significant difference in glenoid version between groups. Although the amount was small, glenoid bone loss was statistically higher in the revision group.
近来，肩后部不稳定与肩峰更高且更平有关。然而，肩峰形态对手术效果的影响尚未得到评估。
评估初次和翻修关节镜下稳定术治疗肩后部不稳定患者之间的肩峰形态差异。
病例对照研究；证据等级，3级。
确定了2001年至2022年间接受初次或翻修关节镜下稳定术治疗肩后部不稳定的一系列患者。根据年龄、性别和运动项目将翻修患者与非翻修患者进行匹配。使用先前描述的磁共振成像参数（包括肩峰后倾角（PAT）、肩峰前覆盖度（AAC）、肩峰后覆盖度（PAC）和肩峰后高度（PAH））对两组患者的特征以及肩峰和肩胛盂形态进行比较。还评估了肩胛盂骨丢失和肩胛盂版本。使用双尾Student检验对两组之间的连续变量进行比较。
在研究期间共确定了37例接受翻修肩后部稳定术的患者，并将其与37例接受初次肩后部稳定术的患者进行匹配。初次手术时初次和翻修患者的平均年龄分别为21.5±4.8岁（范围13 - 35岁）和19.6±6.1岁（范围12 - 45岁）（P = 0.95）。每组男性占54%。初次组和翻修组的平均PAT分别为51.6°和53.7°（P = 0.32），而平均PAH分别为10 mm和13.5 mm（P = 0.04）。初次组和翻修组的平均AAC分别为4.44°和7.10°（P = 0.20），而平均PAC分别为72.1°和63.3°±8.11°（P = 0.08）。肩胛盂版本无差异（初次组为6.22°，翻修组为8.08°；P = 0.06）。初次组肩胛盂骨丢失的平均值为0.57%（范围0% - 8.9%），翻修组为1.4%（范围0% - 5.8%）（P = 0.02）。
较高的肩峰与先前关节镜下后侧关节囊盂唇修复术的翻修有关。初次修复与翻修修复患者之间的PAT和覆盖度无显著差异。两组之间肩胛盂版本无显著差异。尽管量很小，但翻修组肩胛盂骨丢失在统计学上更高。
