背景:尽管已经发表了许多关于关节镜Bankart修复(ABR)后恢复运动(RTS)率的研究,关于患者不进行RTS的预后因素的证据有限.这项研究的目的是确定与原发性ABR后RTS失败和RTPS失败相关的预后因素。假设是RTS和RTPS失败的预后因素与诱发复发的因素相似。
方法:进行了一项包括六家荷兰医院的多中心回顾性病例对照研究。在2014年至2019年期间连续接受原发性ABR的患者被邀请参加并接受问卷调查。运动参与是在症状前评估的,术后六个月,在最后的后续行动中。未能参加RTS被定义为不返回任何运动,未能恢复到受伤前的运动水平(RTPS)被定义为没有恢复到相同(或更高)的运动水平。使用逻辑回归确定RTS失败或RTPS失败的预后因素。基于单变量分析选择用于回归分析的协变量。
结果:纳入了三百十八例患者,平均随访时间为4.2年(±1.8年)。在这318名患者中,26例(8.2%)患者没有RTS,100例(31%)患者未发生RTPS。Logistic回归分析显示关节盂骨丢失(GBL)(OR,1.09;CI,1.04-1.15;p=.001)和工作期间路肩的头顶使用(OR,3.77;95%CI,1.45-9.85;p=.007)是RTS失败的预后因素。此外,它表明术前专业运动水平(OR,2.94;95%CI,1.07-8.05;p=.04)和术前体重指数(BMI)(OR,1.11;95%CI,1.01-1.21;p=.04)是RTPS失败的预后。Bankart骨损伤修复术(或,0.35;95%CI,0.15-0.81;p=.02)或前唇骨膜套撕脱(ALPSA)(OR,0.44;95%CI,12020-0.97;p=.04)被确定为促进RTPS的因素。
结论:这项研究确定工作期间使用GBL和头顶上的肩部与RTS失败有关。此外,术前运动水平和术前BMI与RTPS失败相关.相比之下,骨性Bankart病变和ALPSA病变促进了RTPS。需要未来的前瞻性研究来确认这些因素,并确定哪部分影响可归因于手术治疗(失败)或行为改变。
BACKGROUND: Even though many studies have been published regarding return-to-sport (RTS) rates following arthroscopic Bankart repair (ABR), evidence regarding prognostic factors for which patients do not RTS is limited. The aim of this
study was to identify prognostic factors that are associated with failure to RTS and failure to return to preinjury level of sport (RTPS) following primary ABR. The hypothesis was that prognostic factors for failure to RTS and failure to RTPS would be similar to those predisposing recurrence.
METHODS: A multicenter, retrospective case-control
study including 6 Dutch hospitals was performed. Consecutive patients who underwent primary ABR between 2014 and 2019 were invited to participate and received a questionnaire. Sports participation was assessed before symptom onset, at 6 months postoperatively, and at final follow-up. Failure to RTS was defined as no return to any sport, and failure to RTPS was defined as no return to the same level (or a higher level) of sport. Prognostic factors for failure to RTS or failure to RTPS were identified using logistic regression. Covariates for the regression analysis were selected based on univariate analyses.
RESULTS: This
study included 318 patients with a mean follow-up period of 4.2 years (standard deviation, 1.8 years). Of these 318 patients, 26 (8.2%) did not RTS and 100 (31%) did not RTPS. Logistic regression analysis demonstrated that glenoid bone loss (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.04-1.15; P = .001) and overhead use of the shoulder during work (OR, 3.77; 95% CI, 1.45-9.85; P = .007) were prognostic factors for failure to RTS. In addition, it showed that preoperative professional sports level (OR, 2.94; 95% CI, 1.07-8.05; P = .04) and preoperative body mass index (OR, 1.11; 95% CI, 1.01-1.21; P = .04) were prognostic factors for failure to RTPS. Repair of a bony Bankart lesion (OR, 0.35; 95% CI, 0.15-0.81; P = .02) and the presence of an anterior labral periosteal sleeve avulsion (ALPSA) (OR, 0.44; 95% CI, 0.20-0.97; P = .04) were identified as factors that facilitated RTPS.
CONCLUSIONS: This
study identified glenoid bone loss and overhead use of the shoulder during work to be associated with failure to RTS. Moreover, preoperative sports level and preoperative body mass index were found to be associated with failure to RTPS. In contrast, a bony Bankart lesion and an anterior labral periosteal sleeve avulsion (ALPSA) lesion facilitated RTPS. Future prospective studies are needed to confirm these factors and determine which part of the effect can be attributed to (failure of) surgical treatment or changes in behavior.