Arthroscopic shoulder instability surgery in patients under 25 years of age: the key role of soft tissue with both anterior and posterior axillary hammock tensioning

被引:0
作者
Gervasi, Enrico [1 ]
Fazzari, Federico [2 ]
Spicuzza, Alessandro [3 ]
Gallo, Mauro [4 ]
Surace, Michele [2 ]
Camarda, Lawrence [5 ]
Vigni, Giulio Edoardo [1 ,5 ]
机构
[1] Casa Cura Giovanni XXIII, Shoulder Surg Unit, Monastier Di Treviso, Treviso, Italy
[2] Univ Insubria, Osped Circolo Fdn Macchi, Orthopaed & Traumatol Dept, Varese, Italy
[3] Latisana Hosp, Orthopaed & Traumatol Dept, Latisana, Udine, Italy
[4] Casa Cura Giovanni XXIII, Radiol Dept, Monastier Di Treviso, Treviso, Italy
[5] Univ Palermo, Orthopaed & Traumatol Dept, AOUP Paolo Giaccone, Palermo, Italy
关键词
Shoulder instability; Arthroscopic stabilization; Capsulolabroplasty; Bankart repair; Axillary hammock; Instability; Arthroscopy; GLENOID BONE LOSS; LATARJET PROCEDURE; BANKART REPAIR; GLENOHUMERAL INSTABILITY; COMPUTED-TOMOGRAPHY; MULTIDIRECTIONAL INSTABILITY; CAPSULAR LAXITY; STABILIZATION; DISLOCATION;
D O I
10.1186/s13018-025-05546-0
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background The arthroscopic treatment of shoulder instability is widely debated in the literature and includes very different surgical techniques. Imaging techniques do not allow an accurate assessment of soft tissue quality. The aim of the study is to demonstrate that correct patient selection and a surgical technique involving anterior and posterior capsular ligament repair with axillary retention may be the most crucial factors for successful arthroscopic treatment. Methods Patients with recurrent shoulder instability who underwent arthroscopic stabilization between 2014 and 2015 and aged between 15 and 25 years, were included. The minimum follow-up was 5 years. Specific exclusion criteria were critical bone loss and patients with genetic connective tissue disorders. Demographics, instability characteristics, surgical procedures, recurrences, both dislocations and subluxations, and surgical revisions were evaluated. The surgical procedure, always performed by the same surgeon, involved the use of a minimum of 3 double-suture fixation devices and repair/tensioning of the axillary hammock. Statistical analysis was based on the non-parametric Kendall statistical model and proportions test, with p < 0.05. Results The study population consisted of 44 patients. The first dislocation occurred in 61.4% of cases between the ages of 15 and 19. The number of dislocations prior to surgery was < 3 in 29.5%, between 3 and 9 episodes in 25%, and 10 or more episodes in 45.5%. Defined by patients who had no recurrent dislocations and those whose symptom of instability or subluxation did not require surgical revision, the surgical success rate was 90.9%. During the follow-up period, 4.5% of patients required surgical revision. Patients who required none or one reduction maneuver or had less than three dislocation episodes were statistically correlated with no recurrences after surgery. After the first dislocation, the 88.6% of patients had recurrency. Furthermore, if treated after only one episode, 75% of patients were affected by an isolated capsulolabral injury. Prompt stabilization surgery allows a simpler procedure, due to a reduced bone damage and associated injuries. Conclusions Even in a high-risk age group under 25 years, when the bone defect is subcritical, performing a standardised surgical technique including antero-posterior capsulolabral repair with axillary hammock retensioning demonstrates high success rates. Patients who correlate with the highest chance of success are those who have had less than three dislocation episodes and who have not undergone reduction manoeuvres, confirming the importance of soft tissue quality and thus of early treatment.
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页数:12
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共 45 条
[21]   The Influence of Evidence-Based Surgical Indications and Techniques on Failure Rates After Arthroscopic Shoulder Stabilization in the Contact or Collision Athlete With Anterior Shoulder Instability [J].
Leroux, Timothy S. ;
Saltzman, Bryan M. ;
Meyer, Maximilian ;
Frank, Rachel M. ;
Bach, Bernard R. ;
Cole, Brian J. ;
Romeo, Anthony A. ;
Verma, Nikhil N. .
AMERICAN JOURNAL OF SPORTS MEDICINE, 2017, 45 (05) :1218-1225
[22]   Multidirectional Instability of the Shoulder: A Systematic Reviewe [J].
Longo, Umile Giuseppe ;
Rizzello, Giacomo ;
Loppini, Mattia ;
Locher, Joel ;
Buchmann, Stefan ;
Maffulli, Nicola ;
Denaro, Vincenzo .
ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY, 2015, 31 (12) :2431-2443
[23]   Latarjet, Bristow, and Eden-Hybinette Procedures for Anterior Shoulder Dislocation: Systematic Review and Quantitative Synthesis of the Literature [J].
Longo, Umile Giuseppe ;
Loppini, Mattia ;
Rizzello, Giacomo ;
Ciuffreda, Mauro ;
Maffulli, Nicola ;
Denaro, Vincenzo .
ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY, 2014, 30 (09) :1184-1211
[24]   Glenoid and humeral head bone loss in traumatic anterior glenohumeral instability: a systematic review [J].
Longo, Umile Giuseppe ;
Loppini, Mattia ;
Rizzello, Giacomo ;
Romeo, Giovanni ;
Huijsmans, Polydoor Emile ;
Denaro, Vincenzo .
KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, 2014, 22 (02) :392-414
[25]   Risk factors for recurrent instability or revision surgery following arthroscopic Bankart repair [J].
Mahure, S. A. ;
Mollon, B. ;
Capogna, B. M. ;
Zuckerman, J. D. ;
Kwon, Y. W. ;
Rokito, A. S. .
BONE & JOINT JOURNAL, 2018, 100B (03) :324-330
[26]   Low grade of osteoarthritis development after Latarjet procedure with a minimum 5 years of follow-up: a systematic review and pooled analysis [J].
Menon, Alessandra ;
Fossati, Chiara ;
Magnani, Mauro ;
Boveri, Sara ;
Compagnoni, Riccardo ;
Randelli, Pietro Simone .
KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, 2022, 30 (06) :2074-2083
[27]   Immobilization in External Rotation and Abduction Versus Arthroscopic Stabilization After First-Time Anterior Shoulder Dislocation: A Multicenter Randomized Controlled Trial (vol 49, pg 857, 2021) [J].
Minkus, Marvin ;
Koenigshausen, Matthias ;
Pauly, Stephan ;
Maier, Dirk ;
Mauch, Frieder ;
Stein, Thomas ;
Greiner, Stefan ;
Moursy, Mohamed ;
Scheibel, Markus .
AMERICAN JOURNAL OF SPORTS MEDICINE, 2022, 50 (11) :NP45-NP45
[28]   Immobilization in External Rotation and Abduction Versus Arthroscopic Stabilization After First-Time Anterior Shoulder Dislocation: A Multicenter Randomized Controlled Trial [J].
Minkus, Marvin ;
Koenigshausen, Matthias ;
Maier, Dirk ;
Mauch, Frieder ;
Stein, Thomas ;
Greiner, Stefan ;
Moursy, Mohamed ;
Scheibel, Markus .
AMERICAN JOURNAL OF SPORTS MEDICINE, 2021, 49 (04) :857-865
[29]   Long-term results of the Latarjet procedure for anterior instability of the shoulder [J].
Mizuno, Naoko ;
Denard, Patrick J. ;
Raiss, Patric ;
Melis, Barbara ;
Walch, Gilles .
JOURNAL OF SHOULDER AND ELBOW SURGERY, 2014, 23 (11) :1691-1699
[30]   Outcomes of Arthroscopic Posterior Shoulder Stabilization in the Beach-Chair Versus Lateral Decubitus Position: A Systematic Review [J].
Moeller, Ellie A. ;
Houck, Darby A. ;
McCarty, Eric C. ;
Seidl, Adam J. ;
Bravman, Jonathan T. ;
Vidal, Armando F. ;
Frank, Rachel M. .
ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE, 2019, 7 (01)