Summary
Both DAS+R and B+R procedures demonstrate satisfactory clinical outcomes at a one-year follow-up. The DAS+R group reported less stiffness and a reduced feeling of instability according to the WOSI score compared to the B+R group. However, a greater number of patients in the DAS+R group expressed a fear of falling on their shoulders.
Abstract
【Introduction】
To evaluate the one-year clinical outcomes of two arthroscopic procedures: inlay dynamic anterior stabilization (DAS) with long head of the biceps tendon (LHBT) plus remplissage (DAS+R) versus Bankart repair plus remplissage (B+R) for patients with subcritical glenoid bone loss and on-tract Hill-Sachs lesions.
【Materials and Methods】
A retrospective evaluation of the DAS+R and B+R procedures was performed with a minimum follow-up of one year. Inclusion criteria included patients with recurrent anteroinferior instability, a positive apprehension test at 90 degrees of abduction and external rotation, subcritical glenoid bone loss, and on-tract Hill-Sachs lesion. Exclusion criteria were glenoid bone loss greater than 20%, rupture of the LHBT, pre-existing glenohumeral osteoarthritis, multidirectional or voluntary instability, previous arthroscopic stabilization procedures, and epilepsy. Patient demographics and preoperative Instability Severity Index Score (ISIS) were recorded. Clinical outcomes, including the Simple Shoulder Value (SSV), Rowe score, Western Ontario Shoulder Instability (WOSI) score, and recurrence rates, were reported.
【Results】
Eighteen patients (12 males) treated with DAS+R and 35 patients (19 males) with B+R were enrolled. The average age was 22.5 ± 4.1 in DAS+R and 30.5±16.8 years in B+R (P=0.021) with an average follow-up of 13.3±3.1 years and 36.3±12.5 months (P<.001). Among them, 12 patients (66.7%) in the DAS+R group and 21 patients (60%) in the B+R group were involved in contact and overhead sports (P=0.764). The ISIS score in DAS+R group was 7.3±2.0 and 7.4±2.3 in B+R group (P=0.947). The size of glenoid bone, glenoid defect ratio, and Hill-Sachs lesion in DAS+R and B+R groups were 28.8±11.7mm and 32.5±8.7mm (P=0.362), 14.7±5.2% and 10.2±6.1% (P=0.096), and 12.3±5.0mm and 12.2±3.9mm (P=0.954), respectively. The SSV improved from 42.4±10.2 to 84.7 ± 11.1 (P<.001) at final follow-up in DAS+R group, and from 45.2±11.2 to 84.8±12.1(P<.001) in B+R group (P=976 between groups). The ROWE Stability, Motion, Function, and Total at the final follow-up were 50, 18.3±2.6, 28.3 ± 2.6, and 96.7 ± 5.2 in DAS+R group and 48.3±5.7, 17.4±4.4, 24.3±8.1, and 90.0 ± 12.2 in B+R group (P=0.469, 0.632, 0.239, and 0.2 respectively). The WOSI score was 114.2±64.9 in the DAS+R group and 94.3±124.7 in the B+R group (P=0.707). Among the subscore of the WOSI score, the stiffness, feeling of instability, and fear of falling in DAS+R and B+R groups were 0 vs. 1.9 ± 4.9 (P=0.03), 0 vs. 2.6±6.6 (P=0.027), and 10.8±12.8 vs. 4.0±5.5 (P=0.031). 98.2% of patients improved their functional score beyond the minimal clinically important difference except for one korfball player in the B+R group with recurrent instability 2 years following surgery. No postoperative Popeye deformity, biceps cramping, or other complications were reported.
【Conclusions】
Both DAS+R and B+R procedures demonstrate satisfactory clinical outcomes at a one-year follow-up. The DAS+R group reported less stiffness and a reduced feeling of instability according to the WOSI score compared to the B+R group. However, a greater number of patients in the DAS+R group expressed a fear of falling on their shoulders.