Abstract：
OBJECTIVE: The purpose of this study was to investigate the outcomes of conservative treatment for recurrent shoulder dislocation without subjective apprehension, despite the presence of a Bankart lesion or glenoid defect.
METHODS: A retrospective analysis was performed for 92 patients with recurrent shoulder dislocation treated with conservative treatment due to negative apprehension between 2009 and 2018. The failure of the conservative treatment was defined as a dislocation or subluxation episode or subjective feeling of instability based on a positive apprehension. The Kaplan-Meier method was used to estimate failure rates over time, and a receiver operating characteristic (ROC) curve was constructed to determine a cut-off value for a glenoid defect. The clinical outcomes were compared between patients who completed conservative treatment without recurrence of instability (Group A) and those who failed and subsequently underwent surgical treatment (Group B) using shoulder functional scores and sports/recreation activity level.
RESULTS: This retrospective study included 61 of 92 eligible patients with recurrent shoulder dislocation. Among the 61 patients, conservative treatment failed in 46 (75.4%) over the 2-year study period. The cut-off value for a glenoid defect was 14.4%. The association between glenoid defect size (≥ 14.4% or as a continuous variable) and survival was statistically significant (p = 0.039 and p < 0.001, respectively). The mean glenoid defect size in Group B increased from 14.6 ± 3.0% to 17.3 ± 3.1% (p < 0.001), and clinical outcomes for Group A were inferior to those for Group B at the 24-month follow-up.
CONCLUSIONS: Conservative treatment for recurrent shoulder dislocation in patients without subjective apprehension showed a high failure rate during the study period, especially if the glenoid defect was ≥ 14.4% in size. Despite clinical improvement in patients who completed conservative treatment without recurrence, functional outcome scores and sport/recreation activity levels were better in the patients who underwent arthroscopic Bankart repair. Therefore, for recurrent anterior shoulder instability, even without subjective apprehension, surgical treatment is warranted over conservative treatment.
METHODS: Level IV.
METHODS: A retrospective analysis was performed for 92 patients with recurrent shoulder dislocation treated with conservative treatment due to negative apprehension between 2009 and 2018. The failure of the conservative treatment was defined as a dislocation or subluxation episode or subjective feeling of instability based on a positive apprehension. The Kaplan-Meier method was used to estimate failure rates over time, and a receiver operating characteristic (ROC) curve was constructed to determine a cut-off value for a glenoid defect. The clinical outcomes were compared between patients who completed conservative treatment without recurrence of instability (Group A) and those who failed and subsequently underwent surgical treatment (Group B) using shoulder functional scores and sports/recreation activity level.
RESULTS: This retrospective study included 61 of 92 eligible patients with recurrent shoulder dislocation. Among the 61 patients, conservative treatment failed in 46 (75.4%) over the 2-year study period. The cut-off value for a glenoid defect was 14.4%. The association between glenoid defect size (≥ 14.4% or as a continuous variable) and survival was statistically significant (p = 0.039 and p < 0.001, respectively). The mean glenoid defect size in Group B increased from 14.6 ± 3.0% to 17.3 ± 3.1% (p < 0.001), and clinical outcomes for Group A were inferior to those for Group B at the 24-month follow-up.
CONCLUSIONS: Conservative treatment for recurrent shoulder dislocation in patients without subjective apprehension showed a high failure rate during the study period, especially if the glenoid defect was ≥ 14.4% in size. Despite clinical improvement in patients who completed conservative treatment without recurrence, functional outcome scores and sport/recreation activity levels were better in the patients who underwent arthroscopic Bankart repair. Therefore, for recurrent anterior shoulder instability, even without subjective apprehension, surgical treatment is warranted over conservative treatment.
METHODS: Level IV.
摘要：
目的：本研究的目的是探讨保守治疗复发性肩关节脱位的效果，而没有主观的顾虑。尽管存在Bankart病变或关节盂缺损。
方法：回顾性分析2009年至2018年92例因阴性忧虑而接受保守治疗的复发性肩关节脱位患者。保守治疗的失败被定义为脱位或半脱位发作或基于积极忧虑的主观不稳定感。Kaplan-Meier方法用于估计一段时间内的故障率，并构建受试者工作特征（ROC）曲线以确定关节盂缺损的临界值。使用肩关节功能评分和运动/娱乐活动水平，比较完成保守治疗但不稳定复发的患者（A组）和失败并随后接受手术治疗的患者（B组）的临床结果。
结果：这项回顾性研究纳入了92例符合标准的复发性肩关节脱位患者中的61例。在61名患者中，在2年的研究期间,46例(75.4%)患者的保守治疗失败.关节盂缺损的临界值为14.4%。关节盂缺损大小（≥14.4％或作为连续变量）与生存率之间的相关性具有统计学意义（分别为p=0.039和p<0.001）。B组的平均关节盂缺损大小从14.6±3.0%增加到17.3±3.1%(p<0.001),在24个月随访时,A组的临床结局劣于B组.
结论：对于没有主观忧虑的复发性肩关节脱位患者，保守治疗在研究期间显示出较高的失败率，尤其是当关节盂缺损的大小≥14.4%时。尽管完成保守治疗而没有复发的患者的临床改善，接受关节镜Bankart修复的患者的功能结局评分和运动/娱乐活动水平较好.因此,复发性肩关节前不稳定，即使没有主观理解，手术治疗优于保守治疗.
方法：四级。
方法：回顾性分析2009年至2018年92例因阴性忧虑而接受保守治疗的复发性肩关节脱位患者。保守治疗的失败被定义为脱位或半脱位发作或基于积极忧虑的主观不稳定感。Kaplan-Meier方法用于估计一段时间内的故障率，并构建受试者工作特征（ROC）曲线以确定关节盂缺损的临界值。使用肩关节功能评分和运动/娱乐活动水平，比较完成保守治疗但不稳定复发的患者（A组）和失败并随后接受手术治疗的患者（B组）的临床结果。
结果：这项回顾性研究纳入了92例符合标准的复发性肩关节脱位患者中的61例。在61名患者中，在2年的研究期间,46例(75.4%)患者的保守治疗失败.关节盂缺损的临界值为14.4%。关节盂缺损大小（≥14.4％或作为连续变量）与生存率之间的相关性具有统计学意义（分别为p=0.039和p<0.001）。B组的平均关节盂缺损大小从14.6±3.0%增加到17.3±3.1%(p<0.001),在24个月随访时,A组的临床结局劣于B组.
结论：对于没有主观忧虑的复发性肩关节脱位患者，保守治疗在研究期间显示出较高的失败率，尤其是当关节盂缺损的大小≥14.4%时。尽管完成保守治疗而没有复发的患者的临床改善，接受关节镜Bankart修复的患者的功能结局评分和运动/娱乐活动水平较好.因此,复发性肩关节前不稳定，即使没有主观理解，手术治疗优于保守治疗.
方法：四级。
