Loss of external rotation after open Bankart repair: an important prognostic factor for patient satisfaction

被引:17
作者
Rahme, Hans [1 ,2 ]
Vikerfors, Ola [3 ]
Ludvigsson, Lena [3 ]
Elven, Maria [3 ]
Michaelsson, Karl [2 ,4 ]
机构
[1] Elisabeth Hosp, S-75226 Uppsala, Sweden
[2] Univ Uppsala Hosp, Dept Surg Sci, Sect Orthopaed, Uppsala, Sweden
[3] Cent Hosp Vasteras, Dept Orthopaed, Vasteras, Sweden
[4] Univ Uppsala Hosp, Uppsala Clin Res Ctr, Uppsala, Sweden
关键词
Shoulder instability; Bankart repair; Suture anchors; External rotation; ANTERIOR SHOULDER INSTABILITY; FOLLOW-UP; STABILIZATION; DISLOCATION; METAANALYSIS;
D O I
10.1007/s00167-009-0987-6
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
The repair of the capsuloligamentous complex during shoulder stabilisation procedures can be followed by a persistent restricted capacity of external rotation. The prognostic importance of this loss in external rotation for patient satisfaction has not previously been evaluated. We therefore followed 68 consecutive patients operated for recurrent traumatic unidirectional anterior instability of the glenohumeral joint to assess the association between loss of external rotation and patient satisfaction. All patients underwent open Bankart repair. Two independent observers carried out a follow-up (5 years on average) after surgery. At follow-up, recurrent dislocation had developed in four of the 68 patients (6%). The median pre-operative Rowe score was 65 (range 42-87), which can be compared with 92 (range 46-100) at the follow-up. Three patients rated their outcome as poor, 13 as fair, 23 as good and 29 as excellent. There was a five-fold increased risk for a poor or fair outcome among patients with loss of external rotation in 0A degrees of abduction (age- and gender-adjusted odds ratio [OR] 5.3; 95% confidence interval [CI] 1.3-22.0, P = 0.0007). A linear association between the degree of loss in external rotation and patient dissatisfaction was found. The risk of being dissatisfied, independent of recurrent dislocation, occasional pain, positive apprehension test, age and gender, more than doubled (OR 2.6; 95% CI 1.4-4.8, P = 0.002) for every 10A degrees of post-operative loss of external rotation. Loss of external rotation almost explained all of the variation in patient satisfaction with a population attributable risk of 0.85 (95% CI 0.20-0.94). We conclude that open Bankart repair with a modified Rowe procedure is an excellent surgical option regarding stability, but restriction in external rotation reduces the likelihood of a satisfied patient.
引用
收藏
页码:404 / 408
页数:5
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